I-Tibial Intramengractary Nail Technique

Ukulungiswa kwezipikili kwe-intramentundary kungukuphathwa kokukhethwa kokuziqhenyayo okungazinzile futhi okususiwe kwe-tibial stem fractures kubantu abadala. Umgomo wokwelashwa okuhlinzayo ukubuyisela ubude, ukuqondanisa nokujikeleza kwe-tibia futhi kufinyelele ukuphulukiswa kokuphulukisa. Izinzuzo ze-intrametullary Kiling zincane ngokuhlinzwa okuncane okuhlaselayo nokulondolozwa okufanelekile kokuhlinzekwa kwegazi ekuphumeni. Ngaphezu kwalokho, ukukhamba kwamaphakathi kweTibia kunikeza ukuqina okulungile kwe-biomechanical kokuqhekeka kanye nezenzo njengedivayisi yokwabelana ngomthwalo okuvumela ukuhlanganisa kusenesikhathi. Intuthuko ekwakhiweni kwezipikili ze-intramelwanounta futhi amasu okunciphisa ikhulise izinkomba zokulungiswa kwezipikili ezingenamkhawulo ukufaka i-tibia ye-proximal kanye nokuqhekeka okuphakathi kwesithathu.

Kuze kube namuhla, ukuncishiswa okuvaliwe kwe-intrametundary kwezipikili kwezipikili zeTibial Fractures sekuyinqubo evamile yoHulumeni Ohlinzwa Ama-Orthopedic. Naphezu kokuthandwa kokulungiswa kwezipikili okuhlangene kwe-tibial stem cractures, kuhlala kuyinselele futhi kunezinkinga eziningi ezingaba khona. Amasu okuhlinza aqhubeka nokuvela. Inhloso yalo ndatshana ukuchaza imiqondo yamanje ekusetshenzisweni kwezipikili ze-intrametullary of tibial stem fractures kanye nokufingqa intuthuko yakamuva enkundleni.

一. Ukuhlola kokuqala nokuhlolwa

Ezigulini ezincane, ama-tibial stem fractures avame ukubangelwa ukulimala kwamandla aphezulu, futhi iziguli kumele zihlolwe ngenxa yokuhlelwa kwezinhlekelele ngokusho kwezinkombandlela ezithuthukile ze-Trauma Life Support (ATLS). Ahlaziye isikhumba esiseduze nokulimala kwezicubu ezithambile njengama-fracture bloisters, ukushiswa kwesikhumba, ukushiswa, i-ecchchymosis, noma ukuphakama kwesikhumba; Cacisa ukuthi ngabe ukuqhekeka kuvulekile, futhi uma uphatha nge-tetanus nama-antibiotic; futhi wenze ukuhlolwa okuphelele kwe-neurovascular bese ubhala okungenhla. Linganisa ukwenzeka kwe-OsteoFascial Tigrome ye-Osteofascial futhi wenze uchungechunge lwezivivinyo zomtholampilo kulezi ziguli.

Ucwaningo lwakamuva lukhombisile ukuthi izehlakalo ze-OsteoFascial Coardence Syndrome ezilandela iTibial Tubolual Fractures ingaba phezulu njenge-11.5%. Ikakhulu, amaqembu eziguli ezisencane kungenzeka athuthukise i-OsteoFascial Tigregree Syndrome. Ukuxilongwa kwesifo se-OsteoFascial Timerdrome kufanele kususelwe ekutholweni kwemitholampilo, kufaka phakathi izinhlungu ezinzima, izinguquko ze-neurovascular, ukuvuvukala kwendawo ye-myofaascial, futhi kwandise izinhlungu ezivela ekunwetshisweni kwe-toe ye-toe. Ngakho-ke, i-OsteoFacual Timendrome ihlala ixilongwa kwemitholampilo kanye nemibhalo ephelele yokuhlolwa komtholampilo kubalulekile. Ingcindezi ngaphakathi kwehlathi le-myofaascial ingalinganiswa ngenaliti yengcindezi (Umdwebo 1) njengendlela yokuhlola ephelele ekuhlolweni okukhethekile.

Umdwebo 1. Ukulinganiswa kwengcindezi e-Septum enobuthi ngokusebenzisa inaliti yengcindezi

Ukuthola idatha ethembekile, izingcindezi ze-intrafascial kufanele zilinganiswe ezingxenyeni ezine ze-MyOFascial nasezindaweni ezahlukene ngaphakathi kwegumbi ngalinye le-MyOFAScial. Izifundo ezincwadini ziphakamisa ukuthi umehluko wokucindezela ongaphansi kwama-30 mmhg (ukucindezela kwe-diastolic minus fascial cell cell) kukhombisa i-Faiscial Cards Syndrome. Ukucindezela kwe-Diastolic kuvame ukwehla ngesikhathi sokuhlinzwa, futhi ingcindezi ye-diastolic kufanele ibhekwe lapho kubalwa ingcindezi ehlukile.

Ucwaningo lwakamuva lukhombisile ukuthi ukuqapha ingcindezi yengcindezi ye-Intrafascial kuyithuluzi eliwusizo lokuxilongwa kwesifo se-acute faculial acial syndrome, ngokuzwela kuka-94% kanye nokucaciswa kwama-98%. Kodwa-ke, unikezwe imiphumela ebuhlungu kakhulu ye-avattom syndrome, ukuxilongwa kwe-fird syndrome kufanele kususelwe ekutholakaleni kwemitholampilo, futhi izilinganiso zengcindezi yezinombolo eziningi kufanele zisetshenziswe ezimweni ezikhethekile, njengalapho iziguli zilimele noma lapho amaphoyinti wedatha emtholampilo engacacile.

Ukuhlolwa kokucabanga kufanele kufake ama-orthopantocograms ajwayelekile kanye nokubukwa kwe-tibia okulimele kanye nemisebe ye-radiow Ngokufanayo, ukuskena kwe-ankle kungadingeka ukubona ngeso lengqondo imigqa ye-fracture inwebeka ethafeni laseTibial Plateau kanye nokulimala okungahambisani ne-ankle ankle

二. Izingibe Zomtholampilo

Amaphesenti aphezulu okuqhekeka kwengxenye ye-Tibia ephansi yeTibia ebikiwe. Kusetshenziswa ama-CT CT ajwayelekile, ama-43% ama-fractures engxenye yesithathu nelesithathu leTibia ahambisana nokuqhekeka kwe-ankle, iningi lawo adinga ukwelashwa okuhlinzayo. Uhlobo olujwayelekile kakhulu lokuqhekeka kwakuwukuqhekeka okuphakathi kwengxenye yesithathu ephakathi kwe-tibia dibia edilizwa ediliya ehambisana nokuqhekeka kwe-ankle (umdwebo 2). Ngenxa yokufuduka okuncane kokuqhekeka kwe-ankle ehlobene, kuphela ama-45% okulimala angatholwa kuma-radiographs acacile ama-ankle. Ngakho-ke, ukuskena kwe-coustine CT ye-ankle kufanele kugcizelelwe kakhulu lapho ukuqhekeka kwe-tibia ephakathi nendawo ephakathi (umkhiwane 3).

Umdwebo 2.AF Spiral Fracture of the light maphakathi nengxenye ye-tibia efanele (a, b) imisakazo epristialional of ankle show evamile (c). I-Intraoperative C-arm fluoroscopy ikhombisa ukwaqhekeka okuhlanganisiwe kwe-ankle ankle (d) ama-radiographs angemva kokuhlunga (i-EF) khombisa ukuphulukiswa okubushelelezi kwama-tibial kanye ne-ankle fractures

Umdwebo 3. I-AF SWILOR SHORACTURE ye-Middle neyesithathu ephansi ye-Tibia yesobunxele (ab) ama-radioniarative ahlukene; . (Ef) ekhombisa ukuphulukiswa okungafanele kweTibia kanye ne-malleolar fracture

三. Izindlela Zokuhlinzwa

01. I-Tibial Naneliti Photo

Ukusungula iphuzu lokungena elinembile kudlala indima ebalulekile futhi izifundo eziningi ezincwadini zinikeze imininingwane ebalulekile endaweni efanelekile yendawo yokungena ekahle yokungena kwe-TIBIAL KIPTION. Lezi zifundo zikhombisile ukuthi iphuzu elilungile elikhonkotha litholakala emugqeni ongaphandle wethafa leTibial Plateau futhi alamule nje kwi-lateral tibial spur. Indawo Yokuphepha enobubanzi obungu-22,9 mm ± 8.9 mm, okungabangeli ukulimala kwezakhiwo ezihlanganyelwe eziseduze, kwabikwa. Ngokwesiko, indawo yokuqala yokulungiswa kwezipikili okuhlangene kweTibial Stem Fractures isungule indlela ye-inforapatellar, kungaba ngokuhlukanisa i-patellar tendon (ukusondela kwe-transpatellar) noma ngokukhipha ingxenye ye-Patellar Tendon Stop (Indlela Esezingeni Eliphezulu).

Ukungenisa ama-Semi-Extension Kingling kudonsele ukunakwa okukhulu ezincwadini zamathambo asanda kwenziwa, kanti uTorntetta noCollins baphakamisa ukusebenzisa indlela ye-parapatellar yangaphakathi yesipikili se-apex ye-apex ye-cortex.3 ukusetshenziswa kwendlela ye-medial parapatellar yokungena nge-intrametullary kuyanconywa futhi. Ukusetshenziswa kwendlela ye-suprapatellar yokukhonkotha kwe-tibial intramentary ukukhanyisa nokufakwa kwe-intrametuundary nail ngokusebenzisa i-patellofemoral Joint endaweni eseluliwe.

Inqubo yenziwa ngedolo eliguqulwe ngama-degree acishe abe ngu-15-20, nokuvela okude kwamasentimitha acishe kube ngu-3 kwenziwa cishe ububanzi obubodwa ababili ngenhla kwe-patella. I-Quadriceps tendon ihlukaniswe ngemfashini ende kanye nokuhlukaniswa okufiphele kwenziwa ekuhlanganiseni kwe-patallofemoral. Isokhethi eliluhlaza lifakwe ngokuhlanganiswa kwe-patellofeemoraliore ukudala indawo yokungena emhlanganweni wokuhlangana kwe-anterimal teterial tibial cortex kanye ne-articular cerce (Umdwebo 4).

Umdwebo 4. Izithombe ezingemuva kwe-AB (a) ezihlukanisa i-quadriceps tendon futhi zifaka i-troclor ngokusebenzisa i-patellofemoral Joint kuya eTibial Entry Point; .

I-3.2 mm drill bit isetshenziselwa ukunquma indawo yokuqalisa inaliti ngaphansi kokuholwa kwe-C-ARM. Isokhethi elihlanganisiwe linikezwa ukugcwala okufakiwe nokuphuma kwamaphoyinti. Izinqubo ezisele ezisele kufaka phakathi ukugcwala kanye nokufakwa kwezipikili kwenziwa ngesokhethi.

Izinzuzo ezingaba khona: Isikhundla se-semi-enwetshiwe singasiza ekuhlolweni kokuqhekeka, ikakhulukazi ekuqhekekeni okunengxenye yesithathu evamile ye-Tibia futhi yangenisa phambili. , Isikhundla esinwetshiwe singasusa ukungezwani emisipha ye-quadriceps kanye nosizo ekuphakamiseni kokuqhekeka. , Indlela yokunwetshwa kwe-semi-inxtended suprapatellar nayo ingaba ngenye indlela yendabuko ye-infrapatellar yendlela (Umdwebo 5).

Umdwebo 5

Ucwaningo selukhombisile ukuthi indlela ye-Suprapatellar eya eTibials Hilialling Eaping endaweni eseluliwe yindlela ephephile futhi esebenzayo. Kudingeka izivivinyo zemitholampilo ezizayo ukuze kuqhutshele ukuphenya ngezinzuzo nokubi kwe-suprapatar kusondelana ngezithambisi zomphakathi kanye nokuhlola imiphumela yesikhathi eside ehambisana nale ndlela.

02. Setha kabusha ubuchwepheshe

Ukubekwa kwesipikili se-tibial intramentary nail kuphela akuholeli ekunciphiseni okwanele kokuqhekeka; Ukuncishiswa kwe-Fracture efanele kufanele kugcinwe kuyo yonke inqubo yokuvuselela nokubekwa kwe-intrameraryuntary. Ukusetshenziswa kwe-tracthanction ebhukwini kuphela kungenzeka kungafinyeleli ukuncishiswa kwe-anatomic kokuqhekeka ngokwako. Le ndatshana izochaza izinhlobo ezahlukene ezivaliwe, ezihlaselayo, futhi ezivulekile zokunciphisa.

Amathiphu wecebo lokusetha kabusha kabusha

Ukuncishiswa kokuncishiswa okuvaliwe kungenziwa ngethuluzi lokunciphisa okufana nokunciphisa i-F-fracture, idivaysi eyenziwe nge-radiography enobumba obunqunyiwe elungile elungisa ama-engezi / ukuhunyushwa okuphakathi nendawo (Umdwebo we-Lateral (Fig. 6).

I-Fig. 6

Kodwa-ke, idivaysi ingabeka ingcindezi enkulu ezithweni ezithambile, ukusetshenziswa isikhathi eside kwale divayisi yokusetha kabusha kufanele kugwenywe. Amandla we-Reduction Perceps angabekwa futhi ngenhlawulo, njengasesimweni sokuqhekeka okuthe xaxa. Lawa mathuluzi angasetshenziswa ngendlela enobuthi ethambile ngokufakwa okuncane (Umdwebo 7).

Umdwebo 7

Uhlobo lwe-clamp kanye nokubekelwa indawo yokuhlinzwa kufanele kukhethwe ngokususelwa kwisu lokunciphisa ukulimala kwesikhathi eside kwezicubu ezithambile ezifakwayo (Umdwebo 8).

I-Fig. 8

Abatholile bangenye yamathuluzi ajwayelekile wokusetha kabusha asetshenziselwa ukubuyisela ubude eTibia. Zivame ukubekwa ngokungenakulwa futhi kude nendawo lapho kudinga khona izipikili zomculo. Izikhonkwane ze-Proximal Traction zingabekwa ukulingisa isikhundla se-proximal blocking screw screw isikhundla, esivumela ukwehliswa okulula kokuqhekeka lapho isikhombisi se-intramedullary sikhona.

Kwezinye izimo, amasu wokunciphisa elivaliwe futhi ahlaselayo asanele ukuthola ukuncishiswa kwe-anatomic. Ezimweni ezinjalo, amasu wokunciphisa umzimba Ububi obungaba khona bezinhlelo zokuncipha ezivulekile bufaka phakathi ukuhlukunyezwa okuthe xaxa okuhlinzayo, okungakhulisa ubungozi bokutheleleka kwesiza okuhlinzayo. Ngaphezu kwalokho, ukukhishwa okwengeziwe kokuhlinzekwa kwegazi kwisiza se-fracture kungakhulisa ubungozi bokuqhekeka kwe-postoperative fracture.

Amakhono okubonisana wokuvuselela nokubuyisela kabusha

Ama-Maneuvers Real Reavers awavumeli hhayi kuphela amabutho okunciphisa okubekwe endaweni efanele, kepha futhi ukusetshenziswa kwezindawo ezincane noma ezincane noma ama-splints amancane endaweni yokuqhekeka ukuze ulondoloze ukuncishiswa kwezinkomba zamaphakathi.

Amapuleti avikelekile ezingxenyeni ze-proximal and distal fracture esebenzisa izikulufo ze-monocortical. I-splint igcinwe kuyo yonke inqubo yokuvuselela nokubekwa kwesipikili se-intramedullary eTibia. Ngemuva kokubekwa kwezipikili ezihlangene, ipuleti lisusiwe noma lishiywe endaweni ukuze lithuthukise ukuqina kwesakhiwo esinqunyelwe (Umdwebo 9). Ngokushiya ipuleti endaweni, isikulufa esisodwa se-cortical kufanele siguqulwe ngesikulufa esiphindwe kabili. Kufanele kubhekwe ukuthi kusetshenziswe kumacala akhethiwe lapho isiqubulo se-tibial sidinga ukuhlinzwa okuvulekile ukuze kufinyelelwe ukuncishiswa okwamukelekayo.

Umdwebo 9

Inhloso yesipikili esivinjiwe ukunciphisa i-medullary cavity esifundeni se-metaphyeal. Ukuvinjwa kwezipikili kubekwa ngaphakathi kwesiqephu esifushane se-articular futhi ohlangothini lwe-concave of the deformer Isibonelo, ukulimala okujwayelekile kokuqhekeka kwengxenye yesithathu ye-tibia kubonakaliswa yi-VALGUS nangokuya phambili. Ukulungisa ukuqubuka kwe-VALGUS, isikulufa sokukhiya singafakwa engxenyeni ye-lateral yesiqephu se-proximal fracture (okungukuthi, uhlangothi lwe-concave lokwehla) esiqondisweni se-anteroposter. I-intramerary nail iqondiswa ohlangothini lwe-medial, ngaleyo ndlela luvimbele i-VALGUS. Ngokufanayo, ukungasebenzi kahle komoya kunganqotshwa ngokubeka i-Sclew Screw Medial ukuze icishe ibe yingxenye yangemuva ye-Posterior Block (ie, uhlangothi lwe-concave lihlangothini lokukhubazeka) (Umdwebo 10).

Umdwebo 10

Ukunwebeka -Medullary

Ngemuva kokuqeda ukuphindisela kwe-fracture, i-medullary realing ikhethiwe ukulungiselela ithambo ngokufakwa kwe-intrametundary nail. Umhlahlandlela opheleliswe yibhola ufakwa emgodini weTibial Marrow futhi ngokusebenzisa isayithi lokuphuka, futhi ukudonsa kabusha kudluliswa ngaphezulu komhlahlandlela opheleliswe yibhola. Isikhundla sesiqondisi esiphekwe yibhola saqinisekiswa ngaphansi kwe-C-ARM Fluoroscopy ukuba sezingeni lokuhlanganiswa kwe-ankle, futhi umhlahlandlela womhlahlandlela wawugxile kahle kuzo zombili ukubukwa kwe-anteroposteronder kanye ne-lateral (Umdwebo 11).

Umdwebo 11. Ibonisa isikhundla somhlahlandlela emgodini we-medullary cavity ku-C-arm fluoroscopy ezikhundleni ezingemuva ezingemuva

Udaba lwe-medulla olunwetshiwe olunwetshiwe lube nengxabano. Sikholwa ukuthi odokotela abahlinzayo abaseNyakatho Melika bakhetha ukuvela kwe-medullary emfihlimpi ye-tibia ukuze anwetshwe. Kodwa-ke, zombili izikhala zezinwele ezinwetshiwe nezinganwetshiwe zingasetshenziswa njengamasu ajwayelekile ajwayelekile, futhi imiphumela emihle ingatholwa ngazo zombili izindlela.

-Ukubekwa kwesikulufa

Ukusetshenziswa kwezikulufo ezihlangene ekuhlolweni kweziqu ze-tibial stem kuhloselwe ukuvikela ukuncipha kanye nokusabalalisa, ukunweba izinkomba zokukhokhiswa kwe-toxia ku-toximal to proxilal Ekuphutheni okubandakanya isifunda se-metaphyeeal, izikulufa ezihlangene zaba zibaluleke kakhulu ekugcineni ukuhambisana kwe-axial.

Izikulufo ezintathu zokuvumelanisa ezihlanganisiwe zithuthukise kakhulu ukuqina, kanye nezikulufo ezihlanganayo ze-angle-ezizinzile zinganikeza ukuzinza okukhulu kunezikulufo ezijwayelekile ezixhumeka, ezingavumela ukuqina okufanayo okuzotholwa ngenombolo encane yezikulufo ezihlanganisiwe. Idatha yezemitholampilo ngenombolo nokucushwa kwezikulufo ezixhumene kakhulu ezidingekayo ukuze kulungiswe kwangaphakathi kwe-tibia kuhlale kukhawulelwe.

Ukubekwa kwezikulufo ezihlanganisiwe zeProximal kuvame ukwenziwa kusetshenziswa isikali esinamathiselwe kwi-intrametuuntart Nail Spike Spike. Izikulufo ze-distal interlocking zifakiwe freehand ngaphansi kwemihlahlandlela ye-fluorooscopic. Kunconyelwa ukusetshenziswa kohlelo lokuqondisa olwalusingelwe nge-electromagnetic Le ndlela ivumela ukufakwa kwemisebe-free kwezikulufo ezihlukanisayo

Umdwebo we-12.ab ukukhiya izikulufo nge-C-ARM mbono; Izikulufo ezivalekile ze-CD nge-electromagnetic computer-isize ukukhiya

Ukubekwa kwezikulufo ezi-proximal kanye ne-distal interlocking inqubo ephephile yokuhlinzwa kanye nezikulufo ezixhumene kakhulu kufanele zifakwe ngendlela enomusa futhi ethambile yezicubu ezithambile.

Ucwaningo lwe-anatomic luye lwabonisa ukuthi kusekhona ingozi yokuba ne-peroneal nerve palsy lapho ubeka i-proxilal medial ukuze i-ander oblique interlocking screws. Ukunciphisa le ngozi, odokotela abahlinzayo kufanele bacabangele ukumba izikulufo ezingaphansi kwe-C-arm ukuholwa, nge-fluoroscopic angle ye-C-arle ye-C-arge perpendicular endizeni ye-drill bit. Ukungena ku-cortex ye-tibia ye-distal kungenzeka kube nzima ukukubona nge-tactile impendulo, futhi ukusondela kwekhanda le-fibular kungahle kufihlwe umbono onamandla futhi unikeze ohlinzayo 'lapho ebhekene nekhanda le-fibular selingenile. Ubude be-Screw kufanele bunqunywe hhayi kuphela nge-drill ethweswe iziqu kodwa nangezilinganiso ezifanele zokujula. Noma yikuphi ukushayela noma isilinganiso sobude obude kakhulu kune-60 mm kufanele bavuse ukusola kokuphuma kwe-posteratal, okungabeka i-peponeal nerve ejwayelekile engozini yokulimala.

I-distal anterior ne-poseterior extlocking screws ibekwe ukunakwa kokuvikelwa kwenqwaba ye-anterolateral ye-neurovascular, i-tibialis anterior tendon, kanye nesipiliyoni se-extensor. Yize ukubekwa kwesikulufa esihlanzekile kuvame ukuphepha, odokotela abahlinzayo kudingeka bazi ngobungozi bezinhlaka zezicubu ezithambile. Ukuze uthole ubunzima obuningi be-tibial stem, ama-proximal amabili kanye nezikulufo ezimbili zokuxhumanisa ezihlanekezelayo zinikeza ukuqina okwanele. Ama-proximal kanye ne-distal tibial fractures angazuza ekubekeni izikulufo ezengeziwe zokuxhumana ezithombeni ezahlukahlukene ukwandisa ukuqina kwalesi sakhiwo (Umdwebo 13).

Umdwebo 13. Ama-Fractures amaningi eTibia, aphathwe ngokungena emgqeni ngezikulufo ezimbili ezivukile kanye nezikulufo ezintathu zokuxhumanisa izikulufa, ngemisebe elandelayo ye-X-Rays ephakamisa ukuphulukiswa kokuphulukisa.

Ukulungiswa -Fibar

Imiklamo yezipikili evamile ye-Intrandoctionary enezikulungwane ezihlanganisiwe ze-distal interlocking iye yandise izinkomba zokungena emgqeni we-tibia ukufaka indawo ye-proximal and distal fractures ebandakanya isifunda se-metaphyeeal.

Kusetshenziswe ukucushwa kwe-distal interlocking yesikulufa ocwaningweni (izikulufa ezi-2 ukusuka ezindlini zokuqhathanisa nokuqhathanisa nezikulufo ezi-2 ezibekwe nge-perpendicular komunye nomunye kanye nenani le-3 distal interlocking screwff) Ezigulini ezilungiswe ngomugqa we-fibular kanye ne-tibials intramentary nezipikili zokulungiswa, izinga lokusetha okulahlekile laliphansi kakhulu. Ingqikithi yeziguli eziyi-13% ezinokulungiswa kwezipikili ezingenamkhawulo ngaphandle kokulungiswa kwezipikili ezibonisa ukulahleka kokusetha kabusha, uma kuqhathaniswa ne-4% yeziguli ezinokulungiswa kwezipikili ngaphandle kokulungiswa kwezipikili.

Kwesinye isilingo ngokuqhathanisa ukusebenza kwe-tibials intramentary nezipikili ezilungiselelwe ukulungiswa kokulungiswa kwezipikili ze-fibular kanye nokulungiswa kwezipikili ze-tiburary

Siphetha ngokuthi ukulungiswa kwe-fubular emunctive kufezekisa futhi kugcina ukuncishiswa kwe-tibial kokuphuthumayo kwe-distal eyodwa-yesithathu kwe-tibia fractures kuhlaselwa ngokwanele kwezipikili. Kodwa-ke, inkinga yezinkinga ezilimele ekubonakaleni okwengeziwe endaweni yezicubu ezihlukumezekile. Ngakho-ke sincoma ukuqaphela ekusebenziseni ukulungiswa kosizo okusizwayo.

03. Imiphumela

Ukulungiswa kwe-intramentundary ukukhanyisa kokuqhekeka kweTibial Stem Cractures kungaveza imiphumela emihle. Amanani okuphulukisa okuvela emgqeni weTibia abikwe ezifundweni ezihlukile. Ngokusebenzisa izimila zesimanjemanje namasu afanelekile okuhlinza, amanani okuphulukisa kulindeleke ukuthi adlule ku-90%. Izinga lokuphulukisa lokuqhekeka kwe-tibial stem ehlulekile ukululama ngemuva kokulungiswa kwezipikili zomculo kwathuthukiswa kakhulu ngemuva kokulungiswa kwangaphakathi ngesipikili sesibili esandisiwe nesipikili esandisiwe sesibili ngesipikili esinwetshiwe sesibili ngesipikili esinwetshiwe sesibili ngesipikili esinwetshiwe sesibili ngesipikili esinwetshiwe se-intrametuultary nak

Ukuhlolwa komphumela ngonyaka owodwa ngemuva kokuhlinzwa kwakhombisa ukuthi ama-44% eziguli aqhubeka nokuba nemikhawulo esebenzayo emaphethelweni aphansi alimale, futhi afike ku-47% aqhubeke nokubika ukukhubazeka okuhlobene nomsebenzi ngonyaka owodwa ngemuva kokuhlinzwa. Lolu cwaningo luveza ukuthi iziguli ziphathwe ngokufakwa emgqeni we-tibia ziyaqhubeka nokulinganiselwa okubalulekile esikhathini eside. Odokotela abahlinzayo kufanele bazi ngalezi zinkinga futhi bacebisa iziguli ngokufanele!

四. Izinkinga ezingemthetho

01. Ubuhlungu be-Pre-Patellar

Ubuhlungu be-patellofeemoralior buyinkinga evamile ngemuva kokulungiswa kwezipikili ezihlasimulisayo zeTibial Stem Cractures. Ucwaningo luye lwabonisa ukuthi cishe ama-47% eziguli ngemuva kokukhahlela kwe-intrameldary zingaqhakambisa izinhlungu ze-Prepatellar, i-Etilogy yayo engaqondakali ngokuphelele. Izici ezinamandla ezithonya zingafaka ukulimala kabi kanye nokulimala kwezokwelapha ezinhlakeni ze-Intra-articular, ubuthakathaka begatsha lezinzwa ezihlekisayo, ama-fibrosis we-talellar pad eholela ekunciphiseni, esebenzayo ye-patellar tandonitis, eboshwe nge-tendonitis ebhekene nengxenye ye-intellimary yengxenye ye I-Tibia, nokukhishwa kwesiphetho seProximal yesipikili.

Lapho ufunda i-Epiology yobuhlungu be-Predatellar ngemuva kokukhanyisa kwe-intramelvary, indlela yeTranspatellar Tendon yaqhathaniswa nendlela yeparapatellar. Indlela yeTranspatellar Tendon ingahlotshaniswa nezehlakalo eziphakeme zobuhlungu bezinhlansi ezisebenzayo. Kodwa-ke, idatha ye-Clinical engahleliwe engahleliwe ayikhombisanga noma yimuphi umehluko obalulekile phakathi kwendlela yeTranspatellar tendon kanye nendlela ye-parapatellar.

Ukusebenza kahle kokususwa okukhethiwe kokulungiswa kwangaphakathi ukubhekana nobuhlungu be-Prepatellar ngemuva kokutholwa kwezikhala zomculo ezingenangqondo akuqinisekile. Sincoma ukuthi ukususwa kwe-libial ye-tibial ye-intrameldary kubhekwe uma kutholakale indlela ye-mehendi, njenge-protorrion yezipikili noma isikulufa esibonakalayo sokuvumelanisa. Kodwa-ke, inzuzo yokususwa kwezipikili kwe-tibial ezihlangene ezinezimpawu ezilula kuhlala kungabazekayo.

Mayelana nobuhlungu be-PrepOperative Prepatellar, imbangela yobuhlungu ayikwazanga ukukhonjiswa ngokucacile ekufundweni kokuqala komtholampilo kokulungiswa kwezipikili okuhlangene kwe-tibial isipikili se-tibial nail. Ngakho-ke, izifundo ezinkulu zemitholampilo ezilandelwa isikhathi eside ziyadingeka ukuqinisekisa umphumela wokulungiswa kwezipikili kwe-intrametullary kwindlela ye-suprapatar kubuhlungu be-prepportative Preppellar.

02.Pooor POSTOperative ukuqondaniswa

I-Post-Traaumatic Osteoarthritis ihlala iyinkinga ebalulekile ngemuva kokwelashwa kokuqhekeka kwe-tibial stem ukuphahlakala nge-intramedullary kiling. Izifundo ze-biomechanical zikhombisile ukuthi ukuphathwa kabi kwe-tibial kungahle kuholele ekushintsheni okubalulekile kwezingcindezi zokuxhumana ezihlangene zama-ankle kanye namadolo.

Izifundo zemitholampilo zihlola imiphumela yesikhathi eside emtholampilo kanye nemicabango ngemuva kokuqhekeka kwesiqu se-tibial kuhlinzeke ngemininingwane engqubuzanayo kwi-sequelae ye-tibial magalignment, ngaphandle kweziphetho ezicacile kuze kube manje.

Imibiko yokumangala kabi ngemuva kokuvalwa kwe-tibia kuhlala kukhawulelwe, kusho inani elincane lamacala abikiwe. Ukulimala kabi kwe-postoperative kuhlala kuyinkinga evamile eTibials Weillivary Eaping, kanye nokuhlolwa kwe-Intrapeaperative kokujikeleza kweTibial kuhlala kuyinselele. Kuze kube manje, akukho ukuhlolwa kwemitholampilo noma indlela yokucabanga esungulwe njengezinga legolide lokunqunywa kwegolide lokuzimisela kweTibial Retation.Ct kukhombisile ukuthi ukufakwa kwezingcingo kwe-tibia kungahle kube ngo-19% kuya ku-41%. Ikakhulu, ukuqunjelwa kokujikeleza kwangaphandle kubonakala kuvame kakhulu ukwedlula ukungasebenzi kahle kwangaphakathi. Ukuhlolwa kwemitholampilo ukuhlola ukungasebenzi kahle kwe-postotative kubi kubikwa ukuthi kungalungile futhi kukhombise ukuxhumeka okuphansi ngokuhlola i-CT.

Sikholwa ukuthi inyamazane ihlala iyinkinga yesikhathi eside ku-tibial stem fractures ephathwe ngokukhokhiswa kwe-tibia. Ngaphandle kwemininingwane engqubuzanayo maqondana nobudlelwano phakathi kwemiphumela emibi nemitholampilo kanye nemiphumela yokucabanga, siphakamisa ukuthi odokotela abahlinzayo kufanele balwele ukufezekisa ukuvumelanisa kwe-anatomic kwama-fractures ukuze balawule lokhu kuhlukahluka futhi bathole imiphumela efanele.

五. Ukugcina

Ukukhiya kwe-static okunwetshiwe kwe-medullary ukukhatha okuhlangene kwe-intruvary kuhlala ukwelashwa okujwayelekile kokuqhekeka okususelwa ekufuyweni kweTibial Stem. Iphuzu lokungena elifanele lihlala liyingxenye ebucayi yenqubo yokuhlinzwa. Indlela yeSuprapatellar esikhungweni esinwetshiwe ithathwa njengenqubo ephephile nesebenzayo, kanye nezifundo zesikhathi esizayo kudingeka ukuthi zithuthukise ubungozi nezinzuzo zale nqubo. Udokotela ohlinzayo kufanele ajwayele amasu wokuphakamisa amaphuzu wanamuhla. Uma ukuvumelanisa kwe-anatomic fracture akunakutholwa ngendlela evaliwe, kufanele kubhekwe amasu wokunciphisa umzimba. Amanani wokuphulukisa amahle angaphezu kwama-90% angatholakala ngayo yomibili eyandisiwe nenganwetshiwe Naphezu kwamanani amahle okupholisa, iziguli zisenemikhawulo yokusebenza yesikhathi eside. Ikakhulu, ubuhlungu be-Prepatellar buhlala buyisikhalazo esivamile ngemuva kokukhala kwe-tibials entambama. Ngaphezu kwalokho, ama-malrotation ngemuva kokulungiswa kweTibial yangaphakathi kuhlala kuyinkinga evamile.

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