I-Tibial Fractures, inqubo yezipikili ye-intramelratellar ye-intramedullary

I-intramenduvalting in Nailting Technique yeTibial Fractures: Ngokusebenzisa i-Suprapatellar, indlela yokuhamba ngedolo eliguqulwe ngo-20-30 ° kanye neshubhu elithile lokuvikela ukuvikela izakhiwo ze-intra-articular.

01.I-Tibial intramentary kiling: Ukufinyelela nokuqondanisa, ubuhlungu bedolo elingaphandle

Ukufinyelela kokuhlinzwa kokukhava kwe-Intrauntary of Tibial Fractures kubalulekile ukuze ufake i-intrametuultary ngephuzu lokungena elifanele, ukunciphisa ukulimala kwezakhiwo ze-Intra-articular knee, futhi ukufezekisa ukubuyisela kabusha kwezipikili ze-Intra-articular kanye nokungena kahle kwezipikili.

Izindlela zakudala zeTibial Stem Fractures iyi-infrapatellar ephakathi nendawo noma izindlela ze-parapatellar. Yize lezi zindlela zikhonjiswa ukuqhekeka kwaphakathi nengxenye, i-valgus ye-postoperative, i-anterior, noma izimbotshana zokukhubazeka kwezinye ze-depdesmotic zivame ukwenzeka kuma-fractures amaningi.

Imbangela eyinhloko yeMalalignment in profimal tibial fractures ikhubazeka okubangelwa ukudonsa ama-quadriceps tendon ngesikhathi sokuguquguquka kwe-knee kanye ne-mehendi engqubuzana phakathi kwesipikili se-kibial ngesikhathi sokufakwa kwe-lifent. I-patella futhi ivimbela ukungena kwe-axial kwezipikili endizeni ye-sagittal (Fig. 1a, b). Ngakho-ke, enye indlela evamile yokungena kuleli phuzu ine-incision ye-parapatellar ye-medial, ephumela ekufakweni kwezipikili ezilamula ezingcolile (amakhiwane. 1c no-2). Njengoba izipikili zifaka i-intramerary Canal Distal ekuqhekekeni, ingxenye ye-Proximal igxiliwe kwi-exestosis (Fig. 2). Ekugcineni, ukungezwani kokuphumula kwemisipha ye-anterior Chamber kunikela kancane kwi-ectropion (Fig. 3).

Umdwebo 1 a, B usebenzisa indlela ejwayelekile ye-infrapatellar, i-Patella ivimbela ukungena kwe-axial kwesipikili, okuholela ekulimaleni okujwayelekile kokuqondanisa kwe-anterior apecal sagitmal kanye ne-ectropion coronal anational inhlanganisela yenziwa kusetshenziswa indlela ye-parapatellar.

Umdwebo 2 usondela endaweni yokungena nge-medial parapatellar incision eholela ekulandeni kancane ekufakweni kwezipikili okulandelayo. Njengoba izipikili zifaka i-medullary callal distal ekuqhekekeni (a), ingxenye ye-Proximal ifakwe ku-flare (b)

I-FIG. 3 Ukuphumula kwengxabano yegumbi lemisipha elingaphandle (a) kukhiqiza ilungiselelo elicashile le-ectopic (b)

Ukungena eTibia kusikhundla esinwetshiwe kusiza ukugwema izinkinga ezihambisana ne-flee fnoperative knee flexion.Indlela yachazwa nguGelbke, iJakma et al. Ngo-2010 futhi uzuze ukuthandwa eminyakeni yamuva nje ngoba ukukhala iTibia esimweni esiseduze se-limb elula senza lula ukukhohlisa nokubuyisela emuva. I-FluoRoscopy isibe lula ngokweqiniso. Isikhathi se-fluoroscopy se-suprapatellar siping kubikwa ukuthi sifushane kakhulu kunokuba sikhala nge-infrapatellar. Ngaphezu kwalokho, i-angle yokufaka izipikili (endizeni ye-sagittal) ifana kakhulu ne-eksisi ende ye-tibia ngale ndlela yokungena nge-infrapatellar; Lokhu kuvimbela ukuxabana kwemishini phakathi kwethiphu yesipikili kanye ne-cortex engemuva, ngaleyo ndlela kusiza ukuncishiswa kokuqhekeka.

Ubuhlungu be-Antererior Knee abasebenza ngenkinga efanele. Ubuhlungu be-beene bede bubikwe ngo-50-70% weziguli ezinama-fractures, nge-30% kuphela yeziguli ezibhekene nokukhululeka kobuhlungu ngemuva kokususwa kwe-explate. Ukwakheka okuhlobene nokufinyelela kwe-Patellar tendon kanye ne-hod pad ka-hofa kulinganiselwa ukuthi kube ngumthombo ongaba khona we-postorative knee pain. Ngaphezu kwalokho, indlela ye-suprapatellar igwema ukuvela kwendabuko kokuhlukaniswa kwegatsha legatsha le-patellar lezinzwa ezihlekisayo, ezigwema ukukhathazeka kwamadolo wangaphandle kanye nokuzwakala okwenziwe ngamadolo (Umdwebo 4). Ukudlula ezipikili nge-quadriceps tendon, ngaleyo ndlela kushiye i-patellar tendon, kubonakala kuncipha kakhulu isilinganiso sobuhlungu bezinkune.

I-Fig. 4 ubudlelwano phakathi kwezinzwa zezinzwa ezihlekisayo kanye nokufinyelela okuhlukile ku-tibialis obliqua nail

Ngenxa yemiphumela emnandi yokuqhekeka kwe-proximal, izinkomba zokuzilolonga emtholampilo ziye zanwetshwa kuwo wonke ama-fractures.

Izinkinga ezingaba khona ngokungena emgqeni esontweni suprapatellar:

- Kwangathi kungashiya imfucumfucu evuthayo ekuhlanganiseni kwedolo. Kodwa-ke, isipiliyoni somtholampilo nge-Retrograde Femoral Killing Ayikhombisi yimiphumela emibi- noma yesikhathi eside.

- Ukufakelwa kususwe kanjani ngemuva kokuphulukisa? Yize ngokwenzeka ngobuchwepheshe ukususa inkatho ye-intramerary ngendlela ye-suprapatellar, inqubo iyadingeka futhi odokotela abahlinzayo abaningi bakhetha ukususa isipikili se-intrameltary ngendlela ye-infrapatellar.

02. Lapho kufanele kusetshenziswe i-suprapatellar intramellary nail?

Izinzuzo

- Isikhundla se-semi-enwetshiwe sisiza ukukhohlisa nokuncishiswa kwemisipha yokuphumula nokugcinwa kabusha ngesikhathi sokufakwa kwezipikili.

- Ingozi ephansi yokuphazamiseka kwe-postoperative of proximal, i-Segtal, kanye ne-distal fractures ngokuqhathaniswa namasu endabuko

- Ukukhonkotha kungcono ngokwezobuchwepheshe ukwenza

- Ukukhala kwenzeke njengenqubo 'eyodwa yodokotela ohlinzayo '.

- Isikhathi se-fluoroscopy

- Akukho monakalo kwi-Patellar Tendon kanye nezehlakalo ezingenazincane ze-Anterior Knee Pain

- Kulula ukwenza ngenqubo yeqembu eliningi, njengePoliyTrauma.

Okubi

- Ingozi yomonakalo yokuqothuka kwe-knee kanye nezinye izakhiwo ze-intra-articular

- Ubungozi obukhulayo bokutheleleka kwamadolo

- Ukususwa kokufakelwa kungadinga indlela ehlukile

Izinkomba

- Ukuqhekeka okwengeziwe-ezindabeni ze-proximal tibia (thayipha ao 41a)

- Ama-fractures alula ahlanganisiwe e-tibial diaphysis (thayipha ao 42a-C)

- Isehlukaniso Tibial Diaphysis Fracture (Thayipha Ao 42C)

- I-Extra-Acticular and Acticular Internal Extension Extension Extension Expressional Fractures of distal tibia (izinhlobo ao 43a ne-C1)

- Idolo elintantayo

Contraindications

- I-Gustilo grade 3c Vula ama-fractures we-tibia ngenxa yengozi ekhulayo yokutheleleka ngokuhlanganyela, yize ingozi eyandayo yokutheleleka ngokuhlanganyela ayibikwanga kuma-fractures avulekile

- Izicubu ezithambile ezithambile, ukungcoliswa noma ukutheleleka esifundeni se-suprapatellar

- I-IPSILATASAL KNGEE PROFTHESIS (ROVERITAIRE CONTIAMPIINCIC

- I-FNEE FUSION

- I-SNEE hyperextension> 20 °

- I-IPsimelial tibial tibial plateau fracture ehilela indawo yokungena kwezipikili yinto ephikisayo

- Izimila ezivimbela iphuzu lokungena kwezipikili

- I-Ipsilateral Patella Fracture (I-Round Contraindication)

03. Izindlela Zokuhlinzwa

① isikhundla somzimba kanye nombono

Fig. 5 Isiguli sisezingeni eliphakeme etafuleni le-radiolucent elivumela isikhundla semilenze ehlukanisayo. I-lingb ephukile ishiywe ilenga ngokukhululeka futhi umqulu ubekwe ngaphansi kokuhlanganiswa kwedolo (a) ukufeza i-10-30 ° ye-knee flexion 

(b). Ingalo ye-C ibekwa ngakolunye uhlangothi. Umlenze ongathinteki wehliswe ngo-10-30 ° kusuka ku-ovelinal ukuqinisekisa ukucabanga okufanele endaweni yamuva.

②Imba iphuzu lokungena elifanele

Umdwebo 6 Le ndlela imakwe ngumgodi we-patella, i-tibial Tuberoluty, ne-anterior tibial cortex. Isikhumba se-2 cm endeitudinal isikhumba senziwa nge-1-1,5 cm proximal esisekelweni esiphakeme se-patella. I-Quadriceps tendon iveziwe futhi i-midline longitudinal incision yenziwa ngendlela ye-tendon fibers. I-Suprapatellar Recess ivulwa futhi iminwe yodokotela ohlinzayo ingena ngokuhlanganiswa kwedolo kusuka ngaphansi kwe-patella ukuze ihlole ukufinyelela kalula. Ukunwetshwa okuncane kwe-limb kungahle kube lula ukufinyelela ku-kneecap. Ukufakwa kwe-langenbeck retractor yokuphakama okuncane kwe-patella kungahle kube ngcono ukufinyelela. Uma isikhala esihlanganyelwe sinzima kakhulu futhi sinzima kakhulu, i-medial noma i-lateral Support band ingahle ibekwe amandla kuyo ukuze i-Semi-idenzele i-Patella ibe ngakolunye uhlangothi.

③Protection of cartilage

Umdwebo 7 Ukuvikelwa kwe-cartilage ye-patelofemore kusuka ekulimaleni okuhlobene nokuhlinzwa kungenye yezinhloso eziphambili zenqubo yokuhlinzwa. Ngakho-ke, kufanele kusetshenziswe imikhono yokuvikela ngesikhathi sensimbi nokufakwa kwezipikili Inaliti ye-trocar iqoqwana nesibambo esivikelayo sokuvikela kanye nokubamba izibambo ezikhuphukayo ezinezimbobo zomoya omncane. I-knob ngaphezulu kwesibambo sokufaka ivimbela ukungafakwanga kwengozi yomhlangano wesibambo

Faka umhlahlandlela bese ulungisa isikhundla

Umdwebo 8A Umhlangano Wezimpatho ufakwa ngaphansi kwe-Patella ngokusebenzisa i-patellofemoralioralioralioralioraliored ehlanganiswe endaweni yokungena oyifunayo eTibia (Umdwebo 9). Ezimweni eziningi, i-patella izohamba kancane i-medily noma kamuva ngesikhathi sokufakwa kwensimbi. I-groove e-Patellofemoemoemoemoemoral Joint ivame ukuqondisa inaliti yeTrocar esimweni esifanele ngokuzenzakalelayo.

I-Fig. Isikhundla se-8b saqinisekiswa kuzo zombili izindiza zisebenzisa i-fluoroscopy futhi zilungiswe lapho kunesidingo. Inaliti ye-Trocar bese ithathelwa indawo ngumhlahlandlela we-poroous, umhlahlandlela odlula emgodini wesikhungo somhlahlandlela wesikhombisi futhi ofakwe ithiphu elifakwe ku-proximal tibial metaphys ukuze uqinisekise isikhundla esifanele.

Umdwebo 8c lapho umhlahlandlela womhlahlandlela usesimweni esingemuva, umhlahlandlela wesibili ungasetshenziswa ukwenza ushintsho oluncane endaweni eyisiqondisi esingcono ngomhlahlandlela we-poroous, kuze kube yilapho kungukuthi enye imali engu-4.3 njengenye indawo, kungaba yindawo ehlukile yokungena. Ithuluzi lokufaka elinomhlahlandlela womhlahlandlela bese-ke slid phezu komhlahlandlela.

⑤ Ukunwetshwa kwe-medulla oblongata

Fig. 9A Ukuvula i-medullary cavity kusuka endaweni elungele ukungena kuyisinyathelo esibucayi kwinqubo yokuhlinzwa. Endizeni e-anteroporeterior, lesi yisici sempilo ye-lateral tibial spur. Endizeni elandelayo, iphuzu lokungena elifanele litholakala eguquko phakathi kwe-articular support kanye ne-cortex engaphandle.

I-Fig. 9b Isikhundla esifanele somhlahlandlela sihambisana ne-tibial axis endizeni e-antereposterterior futhi eduze nokuhambisana ne-anterior cortex ngangokunokwenzeka. Umhlahlandlela umhlahlandlela uvame ukuhambisa ngemuva kwalokho.

Umdwebo 9 

Ukuvinjwa kwezipikili kusetshenziswa esifundeni esibanzi se-metaphyeal lapho umhlahlandlela noma izipikili angeke zigxile ku-eksisi ende e-eksisi ende yethambo noma lapho izindiza ze-fracture ku-munye noma zombili izindiza zihlala ngesikhathi sokufakwa kwezipikili.

Umdwebo o-10 kulesi sigaba, kunconywa ukuthi umhlangano wesibandla uvikeleke kwi-someryle yowesifazane usebenzisa ucingo olu-3.2 mm. Lokhu kuvimbela umhlangano ekuphumeleleni iTibia.

Umdwebo 11 The 12.0 mm hollow drill bit ubekwe esikhwameni sangaphakathi sokuvikela futhi phansi ngesikhombisi esiya ethanjeni. I-Medullary Canal ivulwa ngokushayela ekujuleni kuka-8-10 cm kanye nomhlahlandlela opheleliswe yibhola ufakwa eTibimal Tibia.

⑥ Ukuncipha kokuncipha

Umdwebo 12A kulesi sigaba, sisetha kabusha ukwaphuka.

Umdwebo we-12b ngokuya ngendawo yokuqhekeka kanye ne-morphology yayo, amathuluzi ahlukahlukene wokunciphisa okufana neziqeshana ze-Percutaneouneouneuneounezeze Ekunciphisweni kwe-proxial tibial fracture, kwesinye isikhathi ngisho nosizo lwezimila ezingeziwe, ngaphambi kokuvula umsele we-medullary ngokushayela. Induku evuthayo ithuthuke kakhulu futhi ifakwe enkabeni ye-distal tibial metaphysis. Ngemuva kokubuyisela emuva, ubude nobubanzi bezipikili bunqunywa. Uma kunesidingo, yandise umsele we-tibial kububanzi obuyisifiso ngokuvuselela ukukhuphuka ngo-0.5 mm. Ukuvulwa kwesibambo esivikelayo kuvumela ukugcwala kanye nokuvumela imfucumfucu kusuka ekuhlanganiseni ngesikhathi sokuvutha. Uma kungenzeka, kunconywa ukuthi kube nezipikili ezinobubanzi obuncane be-10 mm. I-BOLT ekhiyiwe ka-5.0 mm yalolu hlobo lwezipikili imelana nokuhluleka ukwedlula ukwehluleka ukwedlula i-4.0 mm Lock Bolt esetshenziselwa izinzipho ezinhle. Ubude bezipikili ezihlanganayo buvame ukunqunywa ngombusi we-fluorooscopic.

⑦INSENTET I-Intrauntary Nail

I-Fig. 13a ukufakwa kwezipikili ngenduku evuthayo ngaphansi kwe-fluoroscopy. Qaphela ukuthi isibambo sokufaka se-suprapatellar nail isikhathi eside kunalokho ngenxa yezipikili ze-infrapatellar ngoba ibanga kusuka ekunciphiseni isikhumba endaweni yokungena kwezipikili i-tibial nail Ukungena kubude.

Umdwebo 13b Sicela uqaphele ukuthi i-Bend (i-herzog ijika) ekugcineni kwe-proximal yesipikili se-intrametullary ayinakufakwa ngensimbi yangaphakathi yokuvikela insimbi. Ngakho-ke, umkhono wokuzivikela wangaphakathi kufanele asuswe emhlanganweni wesibambo ngaphambi kokufakwa kwezipikili (b; Bheka amaphutha eSigaba ', izingozi nezinkinga '). Hlola isikhundla sokugcina se-intrametuundary nail ekubukeni okungemuva kokungemuva kokungemuva nangemuva. Susa induku yokuvuselela. Uma izipikili zidinga ukushintshwa, shiya induku evuthayo endaweni bese ufaka isipikili esisha ku-rod. Ukumakwa okungu-5 mm esiphathini sokufaka kukhombisa ukujula kokufakwa kokufakelwa e-Proximal Tibia (Fig. 14). (Umdwebo 14)

⑧ Ukuvalwa kwe-distal kanye ne-profimal

Ukulungiswa kwe-Figure 14a proximal kanye nokuvalwa kokukhiya kuncike ezicini ezithile zokuphuka. Ukuvalwa kweProximal kungenziwa ngengalo ehlose. Ukukhiya okude kwe-distal kufezekile noma ngokusebenzisa i-radiopaque Drill Guide. Ngokuzithandela, ingase isetshenziswe i-cap yokuphela, evimbela ithambo ukuba likhule lingene ekupheleni kwezipikili ze-intramedullary futhi isize ukususwa kamuva kokufakelwa. Ikakhulu, izipikili ezifakwe ngokweqile zilula ukususa lapho kusetshenziswa ama-Cans ubude obufanele. Ubude obufiswayo bokuphela kwe-cap buka ngokufaka umaki kusibambo noma ngokufaka ucingo lomhlahlandlela ngengalo ehlose.

Umdwebo 14b Ithiphu yesiqondisi somhlahlandlela ikhombisa isikhundla seProximal se-intrametullary nail. Isikulufo esixhumanisa ingalo yokuhlosela kwizipikili zidinga ukususwa ukuze zifake i-cap yokuphela. Ukuphela kwe-cap kudlula emgqonyeni wesibambo sokufaka. Isibambo sokufaka sihlala sisendaweni. Lokhu kuqondanisa nokuphela kwe-cap ngenhla kwesipikili se-intramedullary futhi kusivimbele ekulahlekelweni edolweni. Ukufaka umhlahlandlela ngomkhondo nge-Barrel End Cap endaweni yokuphela kwe-PROPIMAL yesipikili futhi kuyasiza ukuqondisa i-cap yokuphela endaweni yayo efanelekile endaweni ephelele yesipikili esifanelekile. Ekupheleni kwenqubo, isixazululo se-saline ayizihibe kufanele sihlanjululwe ukuze sihlanze noma yimiphi izinhlayiya ezisele zemfucumfucu.

04. Izeluleko

Izindlela zokuqapha zokusebenza kokuhlinzwa

- Ezimweni ze-Preexisting Osteoarthritis, ukunyakaza okuvinjelwe kwe-Patellar kungavimba ukufinyelela okuhlangene. Ukuvela kwengxenye yeProximal ye-Medial noma i-Lateral Support Band kusuka ohlangothini lwe-Medial kusiza ukufakwa kwe-PIN yeTrocar.

- I-IPSILATILTAL KINEE PROFTTESS akuyona into ebonakalayo eqinile ku-suprapatellar pinning. Qaphela, noma kunjalo, ukuthi kungenzeka kungenzeki ukufinyelela indawo evamile yokuqalisa yenqubo yokukholiswa ye-proximal tibial.

- Ku-Fractures nge-Acticular Extension, izikulufo ezingezekile zingafakwa ukuze zisebenze ingxenye ye-articular fracture. Kunconywa ukuthi lezi zikulufo zibekwe ngaphambi kokufakwa kwezipikili ukugwema ukuthuthwa kwamabili kokuqhekeka kwe-abricular.

I-Proximal Tibia Fracture Ukucatshangelwa

Ama-proximal tibial fractures yiyona enzima kunazo tibial fractures ezipikili ezipikili futhi zidinga amaphuzu okufaka aqondile (njengoba kuchaziwe ngenhla). Lokhu kuqhekeka kufanele kwehliswe ngaphambi kokungena ekulweni nanoma yimaphi amandla okulima futhi wandise impumelelo. Kwezinye izimo, ukubeka kahle umlenze othintekile endaweni esezingeni eliphakeme futhi uthole indawo eqondile yokungena nokubeka isipikili nge-medullary canal emasondweni ama-coronary kanye nama-sagittal kuzoholela ekuqondeni kahle kwe-tibia ngemuva kokukhala.

Kodwa-ke, ezimweni eziningi, okunye ukuncipha kwe-Maneuver kuyadingeka ukuthola nokugcina ukuphindisela okugculisayo kwalokhu kuqhekeka. Uma umugqa we-fracture ulula futhi u-angled, ama-clamp athambile athungatha ukusetha kabusha noma ama-clamps ama-compation, abekwe ngempumelelo, angasetshenziselwa ukuthola ukusetha kabusha ngesikhathi sokungena. Uma i-clamp ingenele noma indiza ye-fracture ayizibomeli ekubambeni, impova noma ukuvimba izikulufo kungasiza ukuvimbela ukufuduka kanye nokwelula (umfanekiso 15). Lezi zikulungi zibekwe ngemuva kwesikhundla sezipikili ezifiselekayo ekubukeni kwangemuva kokubukwa kwangemuva kokubuka kwezipikili ezifiselekayo ekubukeni kwe-anterior-poserior ukubukwa. Ukubekwa okufanele kwalezi zikulungisa zokusetha kabusha okuhle kungaba inselele.

I-Fig. 15 Izikulufo ezikhiyiwe ezibekwe ngaphandle kwendlela oyifunayo yezipikili ekubukeni kwangaphambi nangemuva (a) nangemuva kwendlela yesipikili efiselekayo ekubukeni okuhlangenwe nakho (b) okuphathelene nemikhosi yokushintshana

Enye inqubo esebenza kahle kakhulu ngokulungiswa kwesikhashana kokuqhekeka endaweni ye-anatomic (Fig. 16). Imvamisa ipuleti elincane le-tubular elinezikulufo ezikhiyiwe ezimbili noma ezintathu ze-cortical ezikhiyayo zizobamba ukuqhekeka okuncishisiwe ngesikhathi sokulungiselela umsele wezimpande nokufakwa kwezipikili. Ipuleti lizolawula ukufuduka. Ipuleti kufanele lishiywe endaweni inqobo nje uma kungekho igebe elinqunyelwe ukuvikela ukulahleka kokuncishiswa okuvame ukwenzeka ngemuva kokususwa kwepuleti. Leli puleti elinesikulufo esisodwa se-cortical aliqinile futhi ngeke liphazamise ukuqina kwesipikili. Indlela yokusetha kabusha i-Plate ingasetshenziselwa ukuqhekeka okuvulekile nokuvaliwe.

Umdwebo 16 Ipuleti elincane lokukhiya elinesikulufa esisodwa se-cortical lingatholakala futhi ligcinwe ekuphindisweni kwe-anatomic. Ezimweni eziningi, ipuleti kufanele lishiywe endaweni ngemuva kokukhala. ukulimala kwe-valgus kokuqala kwe-proximal tibial fracture. b Ipuleti elincane lokuqhekeka elinesikulufa esisodwa se-cortical libekwe ngokungenantambo ukuze lithole futhi lilondoloze ukubuyiselwa kokuqhekeka ngesikhathi sokukhala. C Ipuleti alisuswa ngemuva kokukhala ngoba linikeza ukuqina okwengeziwe

Ukuhlambalaza, izingozi nezinkinga

- Ukuthunyelwa kwe-intrapeaperative kwesikhonkwane esivikela kungahle kudale ukulimala kwe-cartilage kanye nezakhiwo ze-intra-articular knee (Umdwebo 17). Umkhono wokuvikela kufanele anikezwe kabusha ngokuphelele.

- Ukulinganisa okuncane komkhono wokuvikela kungandisa ukukhishwa kwekhanda le-REamer. I-FluoRoscopy isiza ukukhomba inkinga. Ukulungiswa kabusha kwekhono elivikelayo kuzoxazulula inkinga (Umdwebo 18)

- I-Nail Lock-Up: Ukufakelwa kungahle kuthathwe esikhwameni sensimbi endaweni ye-proximal bend (ijika le-herzog). Ukufakwa kwezipikili kokugcina, ishubhu lensimbi lidinga ukususwa, kushiye kuphela umkhono wepulasitiki othambile wangaphandle. Lapho izipikili zinamathela, zidinga ukususwa ngokuphelele futhi futhi zifakwe kabusha ngemuva kokususa i-cannula yensimbi ngokusebenzisa i-cannula yepulasitiki kuphela.

Umdwebo 17 Ukuvikelwa Kwesikhwama Sokuvimbela Ngaphandle Kwama-Fluoroscopic ukubonwa kungaholela ekulimaleni kwamadolo

Umdwebo 18 Ukuqunjelwa kokuthambisa noma ngengozi kokuvikela okuvikelayo kungaphazamisa ukususwa kwe-ceamer, njengoba ikhanda le-reamer lingajaja. b Ukuhlolwa kwe-fluoroscopic okulungiselelwe ukulungiswa kokuqondanisa kuvumela ukususwa kwekhanda le-reamer. C Ikhanda le-REamer lingasuswa uma ikhanda le-reamer lingekho. D Ikhanda le-REamer lingasuswa uma ikhanda le-reamer lingekho.

Ukunqubekela phambili

Hessmann MH, Buhl M, Finkemeier C, Khoudy A, Mosheiff r, Blauth M. suprapatellar ekhabethelwe ukufakwa kwamahlane kweTibia. I-orthop traumatol. 2020 Oct; 32 (5): 440-454.