Ukukhiya uchungechunge lwepuleti - distal tibial complial ukukhiya ipuleti yamathambo

Ukukhiya uchungechunge lwepuleti - distal tibial complial ukukhiya ipuleti yamathambo

            I-distal tibial pilon fractures ayivamile, i-accounting ye-10% yama-fractures azungeze i-ankle. Izicubu ezithambile e-distal tibia zinokubekezelela kabi ukubekezelela kwezicubu ezithambile ezinganele, ezikhulisa ubunzima bokwelashwa kwe-Fracture. I-Pilon Fractures yaziwa ngokuziphendulisa, ukuthuthwa kobuso bezinzwa, nokulimala kwezicubu ezithambile. Ngenxa yezinguquko ku-Joint ColUity kanye ne-Limb ukuqondanisa, ukuqhekeka okuningi kudinga ukulungiswa kokuhlinzwa. Ukwelashwa okuvimbayo okuchazayo kufanele kuhambisane nezinhlobo ezithile zokuphuka, ukulimala kwezicubu ezithambile, kanye neziguli. Isikhathi esifanele ukwelashwa kokuhlinzwa kuyisihluthulelo sempumelelo.

     

            Izindlela zokulimala

Ukulimala Okuphezulu: Ukuwa kusuka ekuphakameni, ukushushuluza, izingozi zemoto, njll. Low - Ukulimala Kwamandla

Ukuqondiswa kodlame: ukucindezela kwe-axial; Amandla okujikeleza ajikelezayo; Amandla we-varus shear; I-Valgus Shear Force.

I-VarUS Force Femenelced:   ivame kakhulu kubantu abasha, ngokuhlukumezeka okunzima kakhulu nokulimala kwamandla okuphezulu. Umugqa we-Fracture usendizeni yakwaSagittal, futhi i-Fibula imvamisa iqinile.

I-VALGUS Force Force:   Imvelo kakhulu kubantu asebekhulile, ngokuhlukumezeka okuncane kakhulu nokulimala kwamandla. Umugqa we-Fracture usendizeni ye-coronal futhi uvame ukuhlotshaniswa nokuqhekeka kwe-fubular.

Ukulinganisa Ukuhlolwa

            I-AnteroPerteral ejwayelekile ye-anteroporeoriner, i-lateral, futhi isidumbu ukubuka x - imisebe ye-ankle iyathathwa. Ubude obugcwele - Ubude be-X - i-ray of tibia ingakhombisa ukuqondanisa kanye nokuhlanganiswa kwedolo ngenhla. Kwezinye iziguli ezinama-fractures ahlukahlukene, ama-X - Imisebe ye-Traentaratel Lilb ithathiwe ukuhlinzeka ngesethenjwa sokwakhiwa kabusha kwe-fracture futhi ukuthola i-anatomical noma ukuhlukahluka okukhona.

            Indlela yokulimala ingabikezelwa kusuka kuhlobo lwe-Fibular Fracture ku-X - Imisebe futhi ihlukaniswe njengodlame: Ubudlova obucindezelayo (i-valgus deform), i-axiil), i-axial fibula). Uma i-fibula iqinile, imvamisa iyi-intra ende ye-intra - i-articular (uhlobo b) ukulimala. Ukulimala kwe-Axial Ukulayisha akubangeli ukuthutha okuningi kepha kuholele ekutheni inani elikhulu lokulayisha ama-axial e-dibia dibia, ngezingcezwana eziningi ze-arxicwall Ukuqondiswa kokuqhekeka kweqabunga le-Fracture kungabikezelwa kusuka ku-X - RAY kukhombisa uhlobo lokufuduka kwetalerali (imvamisa ukufuduka okungaphandle).

            Okubili - Okubucayi kanye nokwakha kabusha ama-CT kabusha we-CT CT kubalulekile. Banganikeza imininingwane kufaka phakathi izinga lokuphakelwa kwe-fracture, isikhundla nenombolo yezingcezwana zamathambo, kanye nokuqondisa kokufuduka.

Ukuhlela ngohlobo oluthile

Non - Ukwelashwa okuhliswa

            Okungapheli ukwelashwa kwe-distal tibial pilon fractures akuvamile. Izinkomba ziyizinhlobo ezakhiwe kancane ze-Fracture kanye neziguli ezine-comorbidities ezikhulisa ubungozi bokwelashwa kokuhlinzwa. Okungeziwe - Ukuqhekeka kwe-Aricular okunezinguquko ezincane ekuhlazisweni kwe-tibial jikelele nakho kungaphathwa nge-plaster ukungasebenzi kahle ngaphandle kokuhlinzwa. I-splint ekuqaleni isetshenziswa kuze kube yilapho ukuvuvukala kuncipha, bese kusetshenziswa udaka oludonsayo. Izinguquko ezinzima ekuhlolweni kwe-tibial noma kwe-articular ebusweni kungaholela ezinkingeni ngokuqondanisa kwe-limb kanye nokuqina. Ukuqhubeka okuqhubekayo kwe-X - Izivivinyo zeRay ziyadingeka ukuqinisekisa ukuhlangana okuhlanganyelwe kanye nokuqondanisa kwe-limb.

            Khetha i-Intra - Ukuqhekeka kwe-Aticural kungalashwa okungeyona - ngokuhlinzwa. Okwe-Intra - ama-articular fractures anokungaphansi kwe-2 mm kokuthuthwa kwe-fracture kanye ngaphansi kwesinyathelo esingu-3 mm - off, okungekho - ukwelashwa kokuhlinzwa kungabhekwa iziguli ezinezidingo eziphansi ezisebenzayo.

Izinkomba zokuhlinzwa

Isikhathi sokuhlinza

            (1) Ukwelashwa okuphuthumayo: ukuncishiswa kanye nokulungisa ukungcola; Vula ama-fractures; Ukulimala kwemithambo ye-vascular; Syndrome.

            (2) okokuqala - Isiteji (ukubuyiselwa kobude bemilenze kanye nokuqondanisa): I-calcaneal traction; Ukulungiswa kwangaphandle; Ukuncishiswa kanye nokulungiswa kwangaphakathi kwama-fractures e-fibular, ukuncishiswa okuphezulu okulinganiselwe kanye nokulungiswa kwangaphakathi kwangemuva kweTibial Fibial Fractures; Ukuvimbela i-Thrumbus.

            (3) Okwesibili - Isiteji: cishe ezinsukwini eziyi-10 - 14 kamuva, ukuncishiswa okuvulekile kanye nokulungiswa kwangaphakathi kokuqhekeka kweTibial.

            .

Indlela yokuhlinzwa

            (1) Khulisa ukuvezwa komugqa we-Fracture.

            (2) Xazulula konke ukuqhekeka ngezindlela ezimbalwa zokuhlinzwa.

            (3) Gwema izindawo ezinezimo ezithambile zezicubu ezithambile.

            (4) Cabanga ngendlela yokulimala.

            (5) Cabanga ngesikhundla sokubekwa kwepuleti.

•                     Okokuphazamiseka ngokulimala kweVarus, kukhethwe ipuleti ye-medial buttial, futhi kusetshenziswa indlela ye-anteromedial.

•                     Ukuze kukhishwe ama-valgus deform, kukhethwe ipuleti le-buttilly leateral, futhi kusetshenziswa indlela ye-antentalantal.

•                     Ibanga phakathi kwalezi zinto ezimbili kufanele okungenani libe ngo-5 - 7 cm.

Imikhiqizo ye-CZMeditech