5 Lub Tswv Yim Rau Kev Kho Cov Ntiv Tes Intramedullary ntawm Distal Tibial Fractures

Ob kab lus ntawm zaj paj huam "txiav thiab teeb tsa sab hauv, kaw teeb tsa intramedullary nailing" qhia txog tus cwj pwm ntawm cov kws phais pob txha rau kev kho mob ntawm distal tibia fractures. Txog niaj hnub no, nws tseem yog ib qho teeb meem ntawm kev xav seb cov ntsia hlau phaj lossis cov ntsia hlau intramedullary zoo dua. Txawm hais tias qhov twg zoo dua tiag tiag hauv Vajtswv lub qhov muag, hnub no peb yuav ua ib qho kev piav qhia txog cov lus qhia phais rau intramedullary nailing ntawm distal tibial fractures.

Cov khoom siv "lub log tsheb seem" ua ntej phais

Txawm hais tias kev npaj ua ntej phais tsis tas yuav tsum muaj, nws raug pom zoo kom muaj cov ntsia hlau thiab cov phaj seem yog tias muaj xwm txheej tsis tau xav txog (piv txwv li, kab tawg zais uas tiv thaiv kev tso cov ntsia hlau xauv, lossis kev ua yuam kev ntawm tib neeg uas ua rau qhov tawg hnyav dua thiab tiv thaiv kev tsis txav mus los, thiab lwm yam) uas yuav tshwm sim los ntawm kev siv cov ntsia hlau intramedullary.

4 lub hauv paus rau kev hloov chaw ua tiav

Vim yog qhov anatomy ntawm distal tibial metaphysis, kev rub yooj yim yuav tsis ua rau kev txo qis zoo. Cov ntsiab lus hauv qab no yuav pab txhim kho qhov kev vam meej ntawm kev hloov chaw:

1. thaij duab orthopantomograms ua ntej phais lossis thaum phais ntawm ceg tawv kom sib piv thiab txiav txim siab qhov kev txo qis ntawm qhov pob txha tawg ntawm sab uas raug mob.

2. siv txoj hauj lwm ntawm lub hauv caug uas khoov ib nrab kom yooj yim rau kev tso cov rau tes thiab kev siv fluoroscopy

3. siv lub cuab yeej rub rov qab los tuav ceg kom ruaj khov thiab ntev

4. Muab cov ntsia hlau Schanz tso rau hauv cov pob txha distal thiab proximal tibia kom pab txo qhov tawg.

7 Cov Lus Qhia Txog Kev Pab Txo thiab Kev Tiv Thaiv Kev Txav Mus Los

1. Muab tus pin qhia kom raug rau hauv tus pob txha caj qaum distal los ntawm kev siv cov khoom pab tsim nyog lossis los ntawm kev khoov lub hau ntawm tus pin qhia ua ntej muab tso rau.

2. siv cov forceps uas muaj cov tawv nqaij nyob rau sab saud los tso cov rau tes hauv cov pob txha tawg uas sib ntswg thiab sib tshuam (Daim Duab 1)

3. siv lub phaj nruj nrog monocortical fixation (tabular lossis compression phaj) hauv kev txo qis kom tswj tau qhov kev txo qis kom txog thaum tus ntsia hlau intramedullary raug ntxig.

4. kev siv cov ntsia hlau los kho qhov nkhaus thiab txoj kab kom ua kom txoj kab ntawm tus ntsia hlau hauv medullary nqaim dua (Daim Duab 2)

5. nyob ntawm seb hom pob txha tawg, txiav txim siab seb puas yuav siv cov ntsia hlau kho thiab kev thaiv ib ntus nrog Schnee lossis Kirschner pins.

6. tiv thaiv cov pob txha tawg tshiab thaum siv cov ntsia hlau thaiv rau cov neeg mob pob txha tawg

7. kho qhov fibula ua ntej thiab tom qab ntawd tibia hauv cov ntaub ntawv ntawm kev sib koom ua ke ntawm fibula tawg kom pab txhawb tibial repositioning

Daim Duab 1 Percutaneous Weber clamp repositioning Oblique views (Daim Duab A thiab B) qhia txog qhov tawg ntawm distal tibia yooj yim uas ua rau nws tus kheej muaj fluoroscopic percutaneous minimally invasive sharp-nosed clamp repositioning uas ua rau me ntsis puas tsuaj rau cov nqaij mos.

Daim Duab 2 Siv cov ntsia hlau thaiv Daim Duab A qhia txog qhov tawg ntawm lub pob txha distal tibial metaphysis uas raug sib xyaw ua ke heev ua raws li qhov posterior angulation deformity, nrog rau qhov seem inversion deformity tom qab fibular fixation txawm tias kho qhov sagittal posterior angulation deformity (Daim Duab C) (Daim Duab B), nrog rau ib lub ntsia hlau thaiv tso rau sab tom qab thiab ib lub laterally rau ntawm qhov kawg ntawm qhov tawg (Daim Duab B thiab C), thiab medullary dilatation tom qab muab cov guide pins los kho qhov coronal deformity ntxiv (Daim Duab D), thaum tswj hwm sagittal equilibrium (E)
6 cov ntsiab lus rau kev kho intramedullary

1. Yog tias pob txha distal ntawm qhov tawg yog pob txha txaus, tus ntsia hlau intramedullary tuaj yeem kho tau los ntawm kev ntxig 4 lub ntsia hlau rau hauv ntau lub kaum sab xis (txhawm rau txhim kho kev ruaj khov ntawm ntau lub axis), yog li txhawm rau txhim kho qhov ruaj khov ntawm cov qauv.
2. Siv cov ntsia hlau intramedullary uas cia cov ntsia hlau uas ntxig rau hauv kom hla dhau thiab tsim ib qho qauv xauv uas muaj lub kaum sab xis ruaj khov.
3. Siv cov ntsia hlau tuab, ntau lub ntsia hlau, thiab ntau lub dav hlau ntawm qhov chaw ntsia hlau los faib cov ntsia hlau ntawm qhov kawg thiab qhov kawg ntawm qhov tawg kom txhawb nqa qhov cuam tshuam ntawm cov ntsia hlau intramedullary.
4. Yog tias tus ntsia hlau intramedullary raug tso deb dhau kom cov hlau qhia ua ntej-bent tiv thaiv kev nthuav dav ntawm tibial distal, ces siv tau cov hlau qhia tsis-pre-bent lossis distal non-expansion.
5. Khaws tus ntsia hlau thiab phaj uas thaiv kom txog thaum qhov tawg raug txo qis, tshwj tsis yog tias tus ntsia hlau uas thaiv tiv thaiv tus ntsia hlau intramedullary kom tsis txhob nthuav cov pob txha lossis daim phaj unicortical ua rau cov nqaij mos puas.
6. Yog tias cov ntsia hlau thiab cov ntsia hlau hauv cov pob txha caj qaum tsis muab kev txo qis thiab kev kho kom txaus, yuav muaj ib daim phaj percutaneous lossis cov ntsia hlau ntxiv rau kom ua rau cov ntsia hlau hauv cov pob txha caj qaum ruaj khov.

Cov Lus Ceeb Toom

Ntau tshaj 1/3 ntawm cov pob txha tawg ntawm lub pob qij txha distal tibia yog vim muaj pob qij txha tawg. Tshwj xeeb, yuav tsum tshawb xyuas cov pob txha tawg ntawm lub distal tibial stem, cov pob txha tawg ntawm lub pob qij txha spiral tibial, lossis cov pob txha tawg ntawm lub pob qij txha spiral fibular kom paub txog cov pob txha tawg hauv pob qij txha. Yog tias muaj, yuav tsum tau kho qhov pob txha tawg hauv pob qij txha ua ntej muab tus ntsia hlau intramedullary tso rau hauv pob qij txha.