Tibial Intramedullary Nail Fixing Technique

Gyaran ƙusa na intramedullary ya kasance maganin zaɓi don karyewar tibial maras ƙarfi da ƙauracewa a cikin manya. Makasudin maganin tiyata shine don dawo da tsayi, daidaitawa da juyawa na tibia da kuma cimma nasarar waraka. Amfanin ƙusa intramedullary ƙananan rauni ne na tiyata da kuma kiyayewar da ya dace na samar da jini zuwa karaya. Bugu da kari, ƙusa intramedullary na tibia yana ba da kwanciyar hankali na karaya da ya dace kuma yana aiki azaman na'urar raba kaya wanda ke ba da damar fara motsa jiki da wuri. Ci gaba a cikin ƙirar ƙusa ta intramedullary da fasahohin ragewa sun faɗaɗa alamomi don gyaran ƙusa na intramedullary don haɗawa da tibia kusa da ƙananan karaya ta uku.

Har wala yau, rufaffiyar raguwar ƙusa ta intramedullary gyaran ƙusa na tibial ya zama wata hanya ta gama gari ga likitocin kashin baya. Duk da shaharar gyaran ƙusa na intramedullary don karyewar tibial ƙusa, ya kasance mai ƙalubale kuma yana da matsaloli masu yawa. Hanyoyin tiyata suna ci gaba da haɓakawa. Manufar wannan labarin shine don bayyana ra'ayoyin yanzu a cikin gyaran ƙusa na intramedullary na karayar tibial karaya da kuma taƙaita ci gaban da aka samu a filin kwanan nan.

一. Ƙimar farko da dubawa

A cikin ƙananan marasa lafiya, raunin ƙwayar tibial sau da yawa shine sakamakon raunin kuzari, kuma dole ne a kimanta marasa lafiya don raunin da ya shafi alaƙa bisa ga jagororin Advanced Trauma Life Support (ATLS). Yi la'akari da raunin da ke kewaye da fata da laushin nama irin su karayar blisters, abrasions fata, konewa, ecchymosis, ko hawan fata; bayyana ko karayar a bude take, kuma idan haka ne a yi maganin tetanus da maganin rigakafi; da kuma yin cikakken nazarin neurovascular da rubuta abubuwan da ke sama. Yi la'akari da abin da ya faru na ciwon ciwon osteofascial da kuma yin jerin gwaje-gwaje na asibiti a cikin waɗannan marasa lafiya.

Binciken na baya-bayan nan ya nuna cewa abin da ya faru na ciwon ciwon osteofascial bayan raunin tuberosity na tibial zai iya kai 11.5%. Musamman ma, ƙananan ƙungiyoyin marasa lafiya suna iya haifar da ciwon osteofascial. Ya kamata a yi la'akari da ciwon ciwon osteofascial a cikin binciken asibiti, ciki har da ciwo mai tsanani, sauye-sauye na neurovascular, kumburi na sashin jiki na myofascial, da kuma ƙara yawan ciwo daga ƙafar ƙafar ƙafa. Sabili da haka, ciwon ciwon osteofascial ya kasance mai ganewar asibiti kuma cikakkun takardun jarrabawar asibiti yana da mahimmanci. Za'a iya auna matsi a cikin sashin myofascial ta hanyar allurar matsa lamba (Hoto 1) azaman hanyar jarrabawa na ƙwararrun gwaji.

Hoto 1. Ma'auni na matsa lamba a cikin septum interosseous ta hanyar allurar matsa lamba

Don samun tabbataccen bayanai, ya kamata a auna matsi na intrafascial a cikin rukunan myofascial guda huɗu kuma a wurare daban-daban a cikin kowane ɗaki na myofascial. Nazarin a cikin wallafe-wallafen sun nuna cewa bambancin matsa lamba na kasa da 30 mmHg (matsa lamba na diastolic ya rage matsa lamba na fascial) yana nuna alamar ciwon kwakwalwa. Matsalolin diastolic yawanci yana raguwa yayin tiyata, kuma yakamata a yi la'akari da matsa lamba na diastolic lokacin da ake ƙididdige matsin lamba.

Binciken da aka yi kwanan nan ya nuna cewa saka idanu kan matsa lamba na intrafascial kayan aiki ne mai yuwuwar amfani don gano cututtukan cututtukan ƙwayar cuta, tare da azanci na 94% da takamaiman 98%. Duk da haka, idan aka ba da sakamakon da zai iya haifar da ciwo na sashin jiki, ganewar ƙwayar cuta ya kamata a dogara ne akan binciken asibiti, kuma ya kamata a yi amfani da ma'aunin matsa lamba na tsaka-tsaki a cikin yanayi na musamman, kamar lokacin da majiyyaci ya ji rauni ko lokacin da bayanan asibiti ba su da tabbas.

Ƙimar hoto ya kamata ya haɗa da daidaitattun orthopantomograms da ra'ayoyi na gefe na tibia da suka ji rauni da radiyo na kusa da gwiwa da haɗin gwiwa, waɗanda aka kara kimantawa ta hanyar amfani da ƙididdigar ƙididdiga (CT). Hakazalika, CT scan na idon sawun na iya zama dole don ganin layukan karaya da suka miƙe zuwa tudun tibial da kuma raunin idon sawun da ba su da ƙarfi.

二. Matsalolin asibiti

An ba da rahoton babban kashi na karaya na ƙananan tsakiyar uku na tibia tare da karaya. Yin amfani da CT scans na al'ada, 43 % na karaya na tsakiya da ƙananan kashi uku na tibia sun kasance tare da raunin idon kafa, mafi yawan abin da ke buƙatar maganin tiyata. Mafi yawan nau'in karayar da aka fi sani da shi shine karaya mai karkata zuwa ƙananan tsakiyar uku na tibia mai nisa da ke da alaƙa da ɗan ƙaramin rauni ko mara ƙaura na baya (Hoto 2). Saboda ƙananan ƙaura na raunin ƙafar idon da ke da alaƙa, kawai 45% na raunin da za a iya ganowa akan radiyo na idon sawu. Saboda haka, CT scans na yau da kullum na idon sawun ya kamata a jaddada sosai lokacin da ƙananan tibia na tsakiya ya kasance (Fig. 3).

Hoto 2.AF Karyawar kasan tsakiyar uku na dama (A, B) Radiyon riga-kafi na idon sawun yana nuna al'ada (C). Intraoperative C-arm fluoroscopy yana nuna raunin da ba a kwance ba na idon sawun baya (D) Hotunan rediyo na baya bayan aikin tiyata (EF) yana nuna sassaucin warkarwa na tibial da karyewar idon sawun.

Hoto 3. AF Karya Karya na tsakiya da ƙananan uku na hagu na tibia (AB) radiyo na farko; (CD) CT scans na farko yana nuna karayar malleolar da ba ta gushe ba; (EF) yana nuna waraka mara kyau na tibia da karaya

三. Hanyoyin tiyata

01. Wurin Shigar Allura na Tibial

Ƙaddamar da madaidaicin wurin shiga yana taka muhimmiyar rawa kuma yawancin karatu a cikin wallafe-wallafen sun ba da bayanai masu mahimmanci game da wurin jikin jiki na madaidaicin wurin shigarwa na intramedullary nailing na tibial fractures. Wadannan binciken sun nuna cewa madaidaicin madaidaicin madaidaicin yana samuwa a gefen gaba na tibial plateau kuma kawai tsaka-tsaki zuwa tibial spur na gefe. An kuma bayar da rahoton wani yanki mai aminci mai faɗin 22.9 mm ± 8.9 mm, wanda baya haifar da lahani ga tsarin haɗin gwiwa. A al'ada, an kafa wurin farawa don gyaran ƙusa na intramedullary na ƙusar ƙanƙara ta tibial ta hanyar hanyar infrapatellar, ko dai ta hanyar rarraba ƙwayar ƙwayar cuta (hanyar transpatellar) ko kuma ta hanyar cire wani ɓangare na dakatarwar ƙusa na patellar (daidaitacce).

Semi-tsawo intramedullary ƙusa ya jawo hankali sosai a cikin wallafe-wallafen orthopedic na baya-bayan nan, kuma Tornetta da Collins sun ba da shawarar yin amfani da tsarin tsaka-tsakin tsaka-tsakin tsaka-tsaki don gyaran ciki na ƙusa a cikin matsakaicin matsakaicin matsayi don kauce wa fitowar kololuwar ƙusa na intramedullary a cikin gabatowar tibial cortex don amfani da parapatellary cortex. an kuma ba da shawarar matsakaicin matsakaicin matsayi. Ana ba da shawarar yin amfani da tsarin suprapatellar don ƙusa intramedullary na tibial da kuma shigar da ƙusa na intramedullary ta hanyar haɗin gwiwa na patellofemoral a cikin matsayi mai tsayi.

Ana yin wannan hanya tare da karkatar da gwiwa a kusan digiri 15-20, kuma an yi wani yanki mai tsayi kusan santimita 3 kusan nisan yatsa ɗaya zuwa biyu sama da patella. An raba tendon quadriceps a cikin tsari mai tsayi kuma ana yin ɓarna a fili cikin haɗin gwiwa na patellofemoral. An shigar da soket mara kyau ta hanyar haɗin gwiwa na patellofemoral don ƙirƙirar wurin shiga a mahaɗin daɗaɗɗen tibial cortex na gaba da farfajiyar articular (Hoto 4).

Hoto 4. ab Hotunan intraoperative na (a) tsaga igiyar quadriceps da shigar da trocar ta hanyar haɗin gwiwa na patellofemoral zuwa wurin shigarwar tibial; (b) hangen nesa na intraoperative na wurin shigarwa

Ana amfani da ƙwanƙwasa 3.2 mm don ƙayyade wurin farawa a ƙarƙashin jagorancin C-arm. Ana samar da soket mai ratsa jiki don daidaita wuraren shiga da fita. Sauran hanyoyin tiyata da suka haɗa da reaming da saka ƙusa tibial ana yin su ta soket.

AMFANIN DA AKE YIWA: Matsayin ƙafar ƙafar da ba a kai ba na iya taimakawa wajen sake fasalin karaya, musamman ma a cikin karaya tare da kusan kusan uku na tibia da kusurwa gaba. , Matsayin da aka ƙaddamar da shi zai iya kawar da tashin hankali a kan tsokar quadriceps da kuma taimakawa wajen sake farfadowa da raguwa. , Matsayin matsakaicin matsakaicin matsayi na suprapatellar na iya zama madadin tsarin infrapatellar na gargajiya (Figure 5).

Hoto 5. Hoton ciki na ciki yana nuna raunin nama mai laushi a cikin yankin infrapatellar a matsayin nuni ga tsarin suprapatellar a cikin matsayi mai tsayi.

Nazarin ya nuna cewa tsarin suprapatellar na tibial intramedullary nailing a cikin matsayi mai tsawo shine amintaccen fasaha na tiyata. Ana buƙatar gwaje-gwaje na asibiti na gaba don ƙarin bincika fa'idodi da rashin amfani na tsarin suprapatellar nailing intramedullary da kuma kimanta sakamakon dogon lokaci da ke da alaƙa da wannan fasaha.

02. Sake saitin fasaha

Sanya ƙusa na intramedullary na tibial kadai baya haifar da isasshen raguwa; Dole ne a kiyaye raguwar karyewar da ya dace a duk lokacin aikin reaming da kuma sanya ƙusa cikin tsaka-tsaki. Yin amfani da gogayya da hannu shi kaɗai na iya ba koyaushe cimma raguwar karaya da kanta ba. Wannan labarin zai bayyana iri-iri na rufaffiyar, mafi ƙarancin mamayewa, da buɗaɗɗen ragi.

-Rufe dabarun sake saiti

Za'a iya cimma matakan rage ƙulli tare da kayan aiki na ragewa kamar F-fracture reducer, na'urar rage ragi mai siffar F-dimbin radiyo wanda ke daidaita kusurwoyi na jujjuyawa / ɓarna da kuma fassarar tsaka-tsaki / gefe (Fig. 6).

Hoto 6. F-dimbin raguwar karaya wanda aka ambata a cikin tiyata

Koyaya, na'urar na iya sanya damuwa mai mahimmanci akan kyallen takarda, kuma ya kamata a guji amfani da dogon lokaci na wannan na'urar sake saiti. Hakanan za'a iya sanya ƙwanƙwasawa mai ƙarfi a kai a kai, kamar a cikin yanayin karkatacciya da karaya. Ana iya amfani da waɗannan kayan aikin a cikin hanyar sada zumunci mai laushi ta hanyar ƙananan ƙananan (Figure 7).

Hoto 7. Matsawa a kai tsaye don sake saita karayar tibial

Ya kamata a zaɓi nau'in matsewa da wurin da aka yi wa tiyatar tiyata bisa dabara don rage lalacewa na dogon lokaci ga kyallen takarda mai laushi daga wurin matsawa (Hoto 8).

Hoto 8. Mayar da aka nuna don sake saita karayar tibial

Retractors suma suna ɗaya daga cikin kayan aikin sake saiti na gama gari da ake amfani da su don dawo da tsayin tibia. Yawancin lokaci ana sanya su a tsaka-tsaki kuma nesa da wurin da ake buƙatar sanya ƙusa na intramedullary. Za'a iya sanya filaye masu kusanci don kwaikwayi matsayi na toshewa kusa, wanda ke ba da damar rage karaya da sauƙi da zarar ƙusa na intramedullary ya shiga.

A wasu lokuta, rufaffiyar da ƙananan dabarun rage ɓarna har yanzu ba su isa ba don samun raguwar jiki. A irin waɗannan lokuta, ya kamata a yi la'akari da dabarun rage ɓarna tare da kulawa da hankali na kayan laushi masu kewaye. Matsalolin da za a iya samu na fasahohin rage buɗaɗɗiya sun haɗa da ƙarin rauni na tiyata, wanda zai iya ƙara haɗarin kamuwa da wurin tiyata. Bugu da ƙari, ƙarin cirewar jini zuwa wurin da aka karye na iya ƙara haɗarin raunin raunin da ya faru bayan tiyata.

-Kwarewar Fasaha don Ciki da Sake Sakawa

Hanyoyin rage ƙwanƙwasa ba wai kawai rage ƙarfin tiyata da aka sanya a cikin matsayi mai kyau ba, har ma da aikace-aikacen ƙananan ko ƙananan splints a wurin karaya don kula da raguwar karaya yayin hanyoyin ƙusa intramedullary.

Ana tsare faranti zuwa gaɓoɓin ɓarna na kusa da nesa ta hanyar amfani da sukurori guda ɗaya. Ana kiyaye tsatsa a duk lokacin aikin reaming da sanya ƙusa na intramedullary a cikin tibia. Bayan sanya ƙusa na intramedullary, an cire farantin ko kuma a bar shi a wuri don inganta kwanciyar hankali na ƙayyadaddun tsari (Figure 9). Ta barin farantin a wuri, ya kamata a musanya dunƙule cortical guda ɗaya tare da dunƙule cortical biyu. Ya kamata a yi la'akari da shi don amfani a cikin zaɓaɓɓun lokuta inda tushen tibial yana buƙatar buɗaɗɗen tiyata don cimma raguwa mai karɓuwa.

Hoto 9. Buɗe tibia fracture tare da comminution mai tsanani da lahani na kashi, gyare-gyaren cortical guda ɗaya tare da ƙananan ƙwayar cuta a ƙarshen ƙarshen raguwa bayan raguwa da cirewa bayan gyaran ƙusa na intramedullary.

Manufar toshe ƙusa shine kunkuntar rami mai zurfi a cikin yankin metaphyseal. Ana sanya kusoshi masu toshewa a cikin guntun guntun guntun gaɓoɓin kuma a gefen maɗaukakin nakasar kafin a sanya ƙusa ta cikin medullary. Misali, nakasar da aka saba samu na karaya na kusa da ukun tibia yana da alaƙa da valgus da angulation na gaba. Don gyara nakasar valgus, za a iya sanya dunƙule dunƙule a cikin ɓangaren gefe na guntuwar da ke kusa (watau gefen nakasar da ke kusa da nakasar) a gaban gaba. An shirya ƙusa na intramedullary daga gefen tsakiya, don haka yana hana valgus. Hakazalika, za'a iya shawo kan nakasar angulation ta hanyar sanya madaidaicin dunƙule makullin zuwa gefe zuwa gefen baya na toshe kusa (watau gefen nakasa) (Hoto na 10).

Hoto 10. Taimakon sake saita karayar tibial ta hanyar sanya kusoshi masu toshewa

-Medullary fadada

Bayan an gama gyaran karaya, ana zaɓar reaming medullary don shirya ƙashin don shigar da ƙusa ta intramedullary. Ana shigar da wayan jagorar da aka gama ball a cikin rami na tibial marrow da kuma ta wurin karyewar, kuma an ratsa ramin ramuka a kan jagorar da ta ƙare. An tabbatar da matsayi na jagorar ƙwallon ƙwallon ƙafa a ƙarƙashin C-arm fluoroscopy don kasancewa a matakin haɗin gwiwa na idon kafa, kuma jagorar jagorar ta kasance mai kyau a kan duka anteroposterior da na gefe (Figure 11).

Hoto 11. yana nuna matsayin jagorar jagora a cikin rami na medullary akan C-arm fluoroscopy a cikin matsayi na gaba da na gefe.

Batun faɗaɗa tare da medulla da ba a faɗaɗa ba ya haifar da cece-kuce. Mun yi imanin cewa yawancin likitocin fiɗa a Arewacin Amirka sun fi son faɗaɗa ƙusa ta intramedullary na tibia zuwa ga rashin faɗaɗawa. Duk da haka, ana iya amfani da ƙusa na intramedullary da aka fadada da kuma ba a fadada ba a matsayin daidaitattun hanyoyin fasaha, kuma ana iya samun sakamako mai kyau tare da hanyoyi biyu.

-Kulle sanya dunƙulewa

Yin amfani da kusoshi masu tsaka-tsaki a cikin karaya mai tushe na tibial an yi niyya ne don hana ragewa da rashin daidaituwa, ƙara alamun ƙusa na intramedullary na tibia zuwa mafi kusanci da nesa na tibial kara karaya wanda ya shafi metaphysis. A cikin karyewar da ke tattare da yankin metaphyseal, ƙusoshin haɗin gwiwa sun zama mafi mahimmanci don kiyaye daidaitawar axial.

Matsakaicin kusanci guda uku sun inganta kwanciyar hankali sosai, kuma madaidaicin kusurwa na kusurwa na iya samar da kwanciyar hankali fiye da skru na yau da kullun, wanda zai iya ba da damar kwanciyar hankali iri ɗaya da aka samu tare da ƙaramin adadin screws masu haɗawa. Bayanai na asibiti akan lamba da daidaita sukurori masu haɗaka da ake buƙata don gyaran ciki na tibia sun kasance da iyaka.

Wurin sanya kusoshi masu kulle-kulle yawanci ana yin su ta amfani da iyakar da ke haɗe zuwa kakin ƙusa na intramedullary. Ana shigar da sukulan da ke tsaka-tsakin nesa a hannun hannu kyauta ƙarƙashin jagorar fluoroscopic. Ana ba da shawarar yin amfani da tsarin jagora mai taimakon kwamfuta na lantarki don shigar da skru masu haɗa tibial mai nisa (Hoto 12). Wannan dabarar tana ba da izinin shigar da sukukulan da suka haɗa nesa ba tare da radiation ba kuma an nuna ta zama hanya mai yuwuwa kuma madaidaiciyar hanya.

Hoto 12.AB Kulle sukurori ta hanyar hangen nesa na C-arm; Kulle CD ta hanyar kulle-kulle ta taimakon lantarki

Sanya kusoshi masu kusanci da nesa hanya ce ta fida lafiya kuma dole ne a saka skru masu tsaka-tsaki cikin daidaici da taushin nama.

Nazarin ilimin halittar jiki ya nuna cewa har yanzu akwai haɗarin gurɓataccen jijiyar peroneal yayin sanya tsaka-tsaki na kusa zuwa ɓangarorin kulle-kulle na gefe. Don rage girman wannan haɗari, likitocin tiyata suyi la'akari da hakowa don sukurori a ƙarƙashin jagorancin C-arm, tare da kusurwar fluoroscopic na C-arm daidai da jirgin na rawar soja. Shigar hakowa cikin bawo na tibia mai nisa na iya zama da wahala a gane ta hanyar amsawa, kuma kusancin kan fibular na iya rikitar da ra'ayin tactile kuma ya baiwa likitan fida ra'ayin kasancewa 'a cikin kashi' lokacin da a haƙiƙa an shigar da kan fibular. Ya kamata a ƙayyade tsayin dunƙule ba kawai ta hanyar rawar soja ba amma har ma da ma'aunin ma'aunin zurfin da ya dace. Duk wani ma'auni ko tsayin dunƙule wanda ya fi 60 mm ya kamata ya ɗaga zato na fitowar bayan fage, wanda zai iya sanya jijiya ta peroneal na kowa cikin haɗarin rauni.

An sanya sukurori na gaba da na baya na tsaka-tsaki tare da kulawa ga kariyar kullin neurovascular na gaba, tibialis na baya, da extensor digitorum longus. Ko da yake sanya dunƙule wuƙaƙƙiya yawanci amintacce ne, likitocin fiɗa suna buƙatar sanin haɗarin da ke kewaye da sifofi masu laushi. Ga mafi yawan karaya karawar tibial, kusoshi biyu na kusa da na nesa biyu suna ba da isasshen kwanciyar hankali. Ƙwararrun tibial na kusa da nisa na iya amfana daga sanyawa na ƙarin skru masu haɗaka a cikin jiragen sama daban-daban don ƙara kwanciyar hankali na wannan tsarin (Hoto 13).

Hoto 13. Ƙwararru da yawa na tibia, wanda aka bi da shi tare da ƙusa na intramedullary tare da kusoshi biyu masu nisa da uku na kusa da juna, tare da radiyon x-ray na gaba suna ba da shawara ga waraka.

- Gyaran Fibular

Zane-zanen ƙusa na intramedullary na zamani tare da kusoshi masu tsaka-tsaki mai nisa sun faɗaɗa alamun ƙusa intramedullary na tibia don haɗawa kusa da karaya mai nisa da suka haɗa da yankin metaphyseal.

An yi amfani da jeri na tsaka-tsaki daban-daban a cikin binciken (2 sukurori daga tsaka-tsaki zuwa gefe tare da screws 2 da aka sanya daidai da juna da jimlar 3 distal interlocking screws a kan kawai 1 distal interlocking dunƙule). A cikin marasa lafiya waɗanda aka yi gyaran gyare-gyaren fibular da gyaran ƙusa na intramedullary na tibial, ƙimar sake saitin da aka rasa ya ragu sosai. Jimlar 13% na marasa lafiya tare da gyaran ƙusa na intramedullary ba tare da gyare-gyaren fibular ba sun nuna asarar sake saiti bayan aiki, idan aka kwatanta da 4 % na marasa lafiya tare da gyaran ƙusa na tibial ba tare da gyaran fibular ba.

A cikin wani gwaji da aka kwatanta da ingancin ƙusa na intramedullary na tibial tare da gyaran gyare-gyaren gyare-gyare da gyaran gyare-gyaren gyare-gyare na tibial ba tare da gyaran gyare-gyaren fibular ba, marasa lafiya da aka bi da su tare da gyaran gyare-gyare a hade tare da ƙusa na tibial sun nuna ci gaba a cikin jujjuyawar juyawa da juyi / juzu'i.

Mun kammala cewa gyaran gyare-gyaren fibular na haɗin gwiwa ya cimma kuma yana kula da raguwar karayar tibial a cikin kashi ɗaya bisa uku na tibia da ke fuskantar gyaran ƙusa na intramedullary. Duk da haka, matsalar rikice-rikicen rauni daga ƙarin ɓarna a yankin nama mai rauni ya rage. Don haka muna ba da shawarar yin taka tsantsan cikin amfani da gyare-gyaren fibular da aka taimaka.

03. Sakamako

Gyaran ƙusa na intramedullary na karaya mai tushe na tibial na iya haifar da sakamako mai kyau. An ba da rahoton adadin waraka na kusoshi na intramedullary na tibia a cikin bincike daban-daban. Tare da yin amfani da na'urorin zamani na zamani da dabarun tiyata masu dacewa, ana sa ran adadin waraka zai wuce 90 %. Adadin waraka na karaya mai tushe na tibial wanda ya kasa warkewa bayan gyaran ƙusa na intramedullary an inganta sosai bayan gyaran ciki tare da faɗaɗa ƙusa na biyu na intramedullary.

Sakamakon sakamako a shekara guda bayan tiyata ya nuna cewa har zuwa 44 % na marasa lafiya sun ci gaba da samun gazawar aiki a cikin ƙananan raunin da suka ji rauni, kuma har zuwa 47 % sun ci gaba da bayar da rahoton rashin lafiyar aiki a shekara guda bayan tiyata. Binciken ya nuna cewa marasa lafiya da aka yi wa ƙusa na intramedullary na tibia suna ci gaba da samun gazawar aiki a cikin dogon lokaci. Likitoci ya kamata su san waɗannan batutuwa kuma su ba marasa lafiya shawara daidai!

四. Matsalolin bayan tiyata

01. Pre-patellar ciwon

Ciwon patellofemoral na gaba shine rikitarwa na yau da kullun bayan gyaran ƙusa na intramedullary na karaya mai tushe na tibial. Nazarin ya nuna cewa kusan 47 % na marasa lafiya bayan ƙusa intramedullary na iya haifar da ciwon prepatellar, wanda ba a fahimta sosai game da ilimin etiology. Abubuwan da za su iya haifar da tasiri na iya haɗawa da rauni da rauni na likita zuwa tsarin intra-articular, rauni ga reshe na infrapatellar na jijiya saphenous, rauni na tsokoki na cinya na biyu zuwa kashe raɗaɗin raɗaɗi na neuromuscular da ke da alaƙa, fibrosis na kushin mai da ke haifar da haɓakawa, mai kunnawa patellar tendonitis, lankwasa ƙwanƙwasa a cikin ƙwayar tsoka daga natrame. tibia, da kuma fitowar ƙarshen ƙusa.

A lokacin da ake nazarin ilimin ilimin ilimin cututtuka na ciwon prepatellar bayan ƙusa intramedullary, an kwatanta tsarin tendon transpatellar tare da tsarin parapatellar. Hanyar jijiya mai jujjuyawa na iya haɗawa da babban abin da ya faru na ciwon gwiwa bayan tiyata. Duk da haka, bayanan da aka bazu na asibiti ba su nuna wani bambanci mai mahimmanci tsakanin tsarin tendon transpatellar da tsarin parapatellar ba.

Ingancin zaɓin cire gyare-gyaren ciki don magance ciwon prepatellar bayan tibial intramedullary nailing ba shi da tabbas. Muna ba da shawarar cire ƙusa na intramedullary tibial idan za'a iya gano ilimin ilimin kimiyyar injiniya, kamar ƙusa ƙusa ko ɓoye mai shiga tsakani. Koyaya, fa'idar cire ƙusa ta intramedullary tibial a cikin marasa lafiya da alamun alamun ya kasance abin tambaya.

Game da ciwon prepatellar na baya-bayan nan, dalilin ciwon ba zai iya nunawa a fili a cikin binciken farko na asibiti na gyaran ƙusa na intramedullary na ƙusa na tibial a kan patella a cikin matsayi mai tsawo. Sabili da haka, manyan karatun asibiti tare da bin diddigin dogon lokaci wajibi ne don tabbatar da tasirin ƙusa intramedullary ƙusa a cikin tsarin suprapatellar akan ciwon prepatellar bayan tiyata.

02.Rashin daidaitawa bayan tiyata

Post-traumatic osteoarthritis ya kasance matsala mai mahimmanci bayan maganin karayar ƙwayar tibial tare da ƙusa intramedullary. Nazarin nazarin halittu ya nuna cewa rashin daidaituwa na tibial na iya haifar da canje-canje masu mahimmanci a cikin matsa lamba a kusa da idon kafa da gwiwa.

Nazarin asibiti da ke kimanta sakamako na tsawon lokaci na asibiti da kuma hotuna bayan fashewar ƙwayar tibial sun ba da bayanai masu cin karo da juna akan abubuwan da suka faru na rashin lafiya na tibial, ba tare da wani takamaiman bayani ba har zuwa yau.

Rahotanni na rashin daidaituwa bayan tiyata bayan ƙusa a cikin intramedullary na tibia ya kasance mai iyaka, tare da ƙananan adadin lokuta. Rashin lafiya bayan tiyata ya kasance matsala gama gari a cikin kusoshi na intramedullary na tibial, kuma kimantawar jujjuyawar tibial ya kasance mai wahala. Har zuwa yau, ba a kafa wani gwajin asibiti ko hanyar hoto a matsayin ma'aunin zinare don tantance juzu'i na ciki na tibial ba.Kimanin gwajin CT ya nuna cewa ƙimar rashin daidaituwa bayan ƙusa ta intramedullary na tibia na iya kaiwa 19% zuwa 41%. Musamman ma, nakasar jujjuyawar waje ta bayyana ta zama ruwan dare fiye da nakasar juyawa ta ciki. Binciken asibiti don tantance rashin lafiyar bayan tiyata an ba da rahoton cewa ba daidai ba ne kuma ya nuna ƙarancin alaƙa tare da kimantawar CT.

Mun yi imanin cewa rashin daidaituwa ya kasance matsala na dogon lokaci a cikin karaya mai tushe na tibial da aka yi da kusoshi na intramedullary na tibia. Duk da rikice-rikicen bayanai game da alaƙar da ke tsakanin rashin daidaituwa da na asibiti da kuma sakamakon hoto, muna ba da shawarar cewa likitocin tiyata su yi ƙoƙari don cimma daidaituwar ƙwayar jiki na raguwa don sarrafa wannan canji kuma su sami sakamako mafi kyau.

五. Kammalawa

A tsaye kulle kulle medullary intramedullary ƙusa ya kasance daidaitaccen jiyya don karyewar tibial. Madaidaicin wurin shigarwa ya kasance muhimmin sashi na aikin tiyata. Hanya na suprapatellar a cikin matsayi mai tsawo ana la'akari da hanya mai aminci da tasiri, kuma nazarin nan gaba yana buƙatar ƙarin kimanta haɗari da fa'idodin wannan hanya. Likitan fiɗa ya kamata ya san dabarun sake sanyawa na zamani. Idan ba za a iya samun daidaitawar raunin jiki ta hanyar rufaffiyar hanya ba, ya kamata a yi la'akari da dabarun rage ɓarna. Za'a iya samun ingantacciyar ƙimar warkaswa sama da 90% tare da faɗuwa da ƙusa na intramedullary ba tare da faɗaɗa ba. Duk da kyawawan matakan warkarwa, marasa lafiya har yanzu suna da gazawar aiki na dogon lokaci. Musamman, ciwon prepatellar ya kasance ƙarami na kowa bayan tibial intramedullary nailing. Bugu da ƙari, rashin daidaituwa bayan gyaran tibial na ciki ya kasance matsala gama gari.

Nassoshi

1.Nazari don Ƙimar Ƙarfafa Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru. Bhandari M, Guyatt G, Tornetta P, III, Schemitsch EH, Swiontkowski M, et al. Gwajin da ba a sani ba na reamed da ƙusa intramedullary ba tare da gyara ba na karyewar igiya na tibial. J Kashi Joint Surg Am. 2008;90:2567–2578. doi: 10.2106/JBJS.G.01694.

2.McQueen MM, Duckworth AD, Aitken SA, Sharma R, Kotun-Brown CM. Masu tsinkaya na ciwon sashe bayan karayar tibial. J Orthop Trauma. 2015. [Epub gaba da bugawa].

3.Park S, Ahn J, Gee AO, Kuntz AF, Esterhai JL. Ciwon daki a cikin karaya na tibial. J Orthop Trauma. 2009;23:514–518. doi: 10.1097/BOT.0b013e3181a2815a.

4.McQueen MM, Kotun-Brown CM. Kula da daki a cikin karyewar tibial. Ƙofar matsa lamba don ragewa. J Bone Joint Surg (Br) 1996;78:99–104.

5.McQueen MM, Duckworth AD, Aitken SA, Kotun-Brown CM. Ƙididdigar hankali da ƙayyadaddun yanayin sa ido na matsa lamba na ɗaki don ciwo mai tsanani. J Kashi Joint Surg Am. 2013;95:673–677. doi: 10.2106/JBJS.K.01731.

6.Whitesides TE, Jr, Haney TC, Morimoto K, Harada H. Nama matsa lamba ma'auni a matsayin ƙaddara ga bukatar fasciotomy. Clin Orthop. 1975; 113:43–51. doi: 10.1097/00003086-197511000-00007.

7.Kakar S, Firoozabadi R, McKean J., Tornetta P. J Orthop Trauma. 2007; 21:99–103. doi: 10.1097/BOT.0b013e318032c4f4.

8.Purnell GJ, Gilashin ER, Altman DT, Sciulli RL, Muffly MT, Altman GT. Sakamako na ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun rugujewar tibial na uku don tantance karayar malleolar maras ƙarfi. J Trauma. 2011; 71:163–168. doi: 10.1097/TA.0b013e3181edb88f.

9.Buehler KC, Green J, Woll TS, Duwelius PJ. Dabarar ƙusa intramedullary na karayar tibia na uku kusa. J Orthop Trauma. 1997; 11:218–223. doi: 10.1097/00005131-199704000-00014.

10.McConnell T, Tornetta P, III, Tilzey J, Casey D. Tibial portal jeri: daidaitaccen radiyo na yankin lafiya na anatomic. J Orthop Trauma. 20

01; 15: 207-209. doi: 10.1097/00005131-200103000-00010 .da sauransu......