Litlhahiso tse 5 tsa ho Lokisoa ha Nail ea Intramedullary ea Distal Tibial Fractures

Mela e 'meli ea thothokiso ea "khaola le ho beha ho lokisa ka hare, ho koaloa ho behiloeng intramedullary nailing" ka nepo e bonahatsa boikutlo ba lingaka tsa masapo mabapi le phekolo ea distal tibia fractures.Ho fihlela kajeno, e ntse e le taba ea maikutlo hore na li-screws tsa poleiti kapa lipekere tsa intramedullary li molemo.Ho sa tsotelehe hore na ke efe e hlileng e leng betere mahlong a Molimo, kajeno re tlil'o etsa kakaretso ea malebela a ho buoa bakeng sa lipekere tsa intramedullary tsa distal tibial fractures.

Pele ho opereishene "taere" ea "spare".

Le hoja litokisetso tse tloaelehileng tsa pele ho opereishene li sa hlokehe, ho kgothaletswa ho ba le sete sa "screw" le lipoleiti haeba maemo a sa lebelloa (mohlala, mohala o patiloeng oa ho robeha o thibelang ho beoa ha li-screws, kapa phoso ea motho e mpefatsang ho robeha le ho thibela ho senyeha, joalo-joalo. .) tse ka hlahang ka lebaka la tshebediso ya ho kokota ka intramedullary.

Metheo e 4 ea ho beha maemo bocha ka katleho

Ka lebaka la sebopeho sa oblique sa distal tibial metaphysis, ho hula habonolo ho ka 'na ha se ke ha fella ka ho fokotsa katleho kamehla.Lintlha tse latelang li tla thusa ho ntlafatsa sekhahla sa katleho ea ho repositioning:

1. nka li-orthopantomograms tsa pele ho ts'ebetso kapa li-intraoperative tsa setho se phetseng hantle ho bapisa le ho fumana hore na ho fokotseha ha fracture ho kae lehlakoreng le amehileng.

2.sebelisa boemo ba lengole le nang le halofo ho thusa ho behoa ha lipekere le fluoroscopy

3.sebelisa retractor ho boloka leoto le le sebakeng le bolelele

4.Beha li-screw tsa Schanz sebakeng sa distal le proximal tibia ho thusa ho fokotsa ho robeha.

7 Lintlha tsa Phokotso e Thusang le ho Ikemela

1. Beha pinana ea tataiso ka mokhoa o nepahetseng ka har'a tibia ea distal ka ho sebelisa sesebelisoa se loketseng sa ho thusa kapa ka ho khumama ntlha ea pinana ea tataiso pele u beha.

2. sebelisa li-forceps tse tsosolosang letlalo ho kenya lipekere tsa intramedullary ka fractures ea spiral le oblique (Setšoantšo sa 1)

3. sebelisa poleiti e thata e nang le monocortical fixation (tabular kapa compression plate) ka phokotso e bulehileng ho boloka phokotso ho fihlela sepekere sa intramedullary se kenngoa.

4. ho fokotsa mocha oa lipekere oa intramedullary ka ho sebelisa li-block screws ho lokisa ho ferekana le mocha ho ntlafatsa katleho ea ho beha lipekere tsa intramedullary (Setšoantšo sa 2)

5. ho itšetlehile ka mofuta oa ho robeha, etsa qeto ea hore na u sebelise li-screws tsa ho lokisa le ho thibela nakoana ka li-pin tsa Schnee kapa Kirschner.

6. thibela fractures e ncha ha u sebelisa li-screws tse thibelang ho bakuli ba osteoporotic

7. lokisa fibula pele 'me joale tibia tabeng ea ho robeha ha fibula e kopantsoeng ho thusa ho khutlisetsa tibial

Setšoantšo sa 1 Percutaneous Weber clamp repositioning maikutlo a Oblique (Lipalo A le B) li fana ka maikutlo a hore ho na le fracture e bonolo ea distal tibia e itšetlehileng ka fluoroscopic percutaneous minimally invasive sharp-nosed clamp repositioning e bakang tšenyo e nyenyane liseleng tse bonolo.

Setšoantšo sa 2 Tšebeliso ea li-screws tse thibelang Setšoantšo sa A se bontša ho robeha ho hoholo ha distal tibial metaphysis e lateloa ke ho senyeha ha morao ka morao, ho na le ho senyeha ha masala ka mor'a ho lokisa li-fibula ho sa tsotellehe ho lokisoa ha sagittal posterior angulation deformity (Fig. C) (Fig. B), e nang le sekoti se le seng se thibelang se behiloe ka morao 'me se seng ka lehlakoreng le leng la distal qetellong ea fracture (Figs. B le C), le medullary dilatation ka mor'a ho beha lithapo tsa tataiso ho tsoela pele ho lokisa bokooa ba coronal (Fig. D), ha u ntse u boloka sagittal. tekatekano (E)
Lintlha tse 6 tsa ho lokisa intramedullary

1. Haeba lesapo la distal la fracture le lekana ka ho lekaneng, sepekere sa intramedullary se ka lokisoa ka ho kenya li-screws tse 4 ka li-angles tse ngata (ho ntlafatsa botsitso ba li-axes tse ngata), e le ho ntlafatsa ho tiea ha moralo.
2. Sebelisa lipekere tsa intramedullary tse lumellang li-screws tse kentsoeng hore li fete le ho etsa mohaho oa ho notlela o nang le botsitso ba angular.
3. Sebelisa likurufu tse teteaneng, likurufu tse ngata, le lipolane tse ngata tsa ho beha likurufu ho aba li-screw pakeng tsa distal le lipheletsong tse haufi tsa leqhetsoana ho matlafatsa tšebetso ea ho lokisa ea manala a intramedullary.
4. Haeba sepekere sa intramedullary se behiloe hole haholo e le hore tataiso ea pele e kobehileng e thibela ho atolosoa ha distal tibial, joale ho ka sebelisoa tataiso e sa tsitsang kapa e sa atoloseng ea distal.
5. Boloka lenala le letlapa le thibelang ho fihlela ho robeha ho fokotsehile, ntle le haeba lenala le thibelang le thibela lenala la intramedullary ho hasana lesapo kapa poleiti ea unicortical e senya lesela le bonolo.
6. Haeba lipekere le li-screw tsa intramedullary li sa fane ka ho fokotsa le ho lokisa ka ho lekaneng, ho ka kenyelletsoa poleiti ea percutaneous kapa screw ho eketsa botsitso ba lipekere tsa intramedullary.

Likhopotso

Ho feta 1/3 ea distal tibia fractures e kenyelletsa lenonyeletso.Haholo-holo, fractures ea distal tibial stem, spiral tibial fractures, kapa fractures e amanang le spiral fibular e lokela ho batlisisoa bakeng sa fractures ea intra-articular.Haeba ho joalo, ho robeha ha intra-articular ho hloka ho laoloa ka thoko pele ho beoa sepekere sa intramedullary.