5 Lub Tswv Yim rau Intramedullary Nail Fixation ntawm Distal Tibial Fractures

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

Preoperative "spare log" teeb

Thaum cov kev npaj ua ntej niaj hnub tsis tsim nyog, nws raug pom zoo kom muaj cov khoom seem ntawm cov ntsia hlau thiab cov phaj nyob rau hauv cov xwm txheej tsis tau pom dua (piv txwv li, cov kab tawg zais zais uas tiv thaiv kev tso ntawm cov ntsia hlau xauv, lossis tib neeg yuam kev uas ua rau cov pob txha tawg thiab tiv thaiv immobilization, thiab lwm yam. .) uas tej zaum yuav tshwm sim los ntawm kev siv intramedullary nailing.

Lub 4 lub hauv paus rau kev ua tiav repositioning

Vim lub cev oblique ntawm lub distal tibial metaphysis, qhov yooj yim traction tej zaum yuav tsis tas yuav ua rau kev txo qis.Cov ntsiab lus hauv qab no yuav pab txhim kho qhov ua tau zoo ntawm kev rov ua haujlwm:

1. noj preoperative los yog intraoperative orthopantomograms ntawm lub cev nqaij daim tawv noj qab haus huv los sib piv thiab txiav txim seb qhov luaj li cas ntawm fracture txo nyob rau hauv cov mob.

2.siv lub hauv caug ib nrab flexed txoj hauj lwm kom yooj yim rau kev tso cov ntsia hlau thiab fluoroscopy

3.siv lub retractor los tswj cov ceg ntawm qhov chaw thiab ntev

4.Place Schanz screws nyob rau hauv lub distal thiab proximal tibia los pab nyob rau hauv fracture txo.

7 Cov ntsiab lus ntawm kev pab txo qis thiab kev tsis muaj zog

1. Muab tus pin qhia kom raug rau hauv qhov distal tibia los ntawm kev siv cov cuab yeej pab tsim nyog lossis los ntawm kev khoov ntawm tus ntiv tes taw qhia ua ntej muab tso rau.

2. siv cov tawv nqaij-tipped resurfacing forceps los tso cov ntsia hlau intramedullary hauv cov pob txha thiab oblique pob txha (Daim duab 1)

3. siv lub phaj nruj nrog monocortical fixation (tabular lossis compression phaj) nyob rau hauv qhib txo kom txo qis kom txog thaum tus ntsia thawv intramedullary muab tso.

4. nqaim ntawm intramedullary ntsia thawv channel siv thaiv cov ntsia hlau los kho angulation thiab channel los txhim kho txoj kev vam meej ntawm intramedullary ntsia thawv tso (Daim duab 2)

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

6. tiv thaiv cov pob txha tshiab thaum siv cov ntsia hlau thaiv hauv cov neeg mob osteoporotic

7. fixate lub fibula ua ntej thiab tom qab ntawd lub tibia nyob rau hauv cov ntaub ntawv ntawm ib tug ua ke fibula puas los pab txhawb tibial repositioning

Daim duab 1 Percutaneous Weber clamp repositioning Oblique views (Figures A thiab B) qhia ib qho yooj yim distal tibia tawg uas qiv nws tus kheej rau fluoroscopic percutaneous minimally invasive sharp-nosed clamp repositioning uas ua rau me ntsis kev puas tsuaj rau cov nqaij mos.

Fig. 2 Kev siv thaiv cov ntsia hlau Fig. A qhia tau hais tias muaj kev cuam tshuam loj heev ntawm cov pob txha ntawm tibial metaphysis tom qab los ntawm kev rov qab angulation deformity, nrog residual inversion deformity tom qab fibular fixation txawm kho ntawm sagittal posterior angulation deformity (Daim duab C) (Fig. B), nrog rau ib qho thaiv cov ntsia hlau muab tso rau tom qab thiab ib sab ntawm qhov kawg ntawm qhov tawg (Daim duab B thiab C), thiab medullary dilatation tom qab muab cov lus qhia pins los kho cov coronal deformity (Daim duab D), thaum tswj sagittal Kev sib npaug (E)
6 ntsiab lus rau intramedullary fixation

1. Yog hais tias cov pob txha distal ntawm cov pob txha puas txaus, cov ntsia hlau intramedullary tuaj yeem kho tau los ntawm kev ntxig 4 screws hauv ntau lub kaum sab xis (kom txhim kho qhov ruaj khov ntawm ntau lub axes), txhawm rau txhim kho cov txheej txheem rigidity.
2. Siv cov ntsia hlau intramedullary uas tso cai rau cov ntsia hlau ntxig kom dhau mus thiab tsim cov qauv xauv nrog lub kaum sab xis.
3. Siv cov ntsia hlau tuab, ntau cov ntsia hlau, thiab ntau lub dav hlau ntawm cov ntsia hlau tso rau faib cov ntsia hlau nruab nrab ntawm qhov nruab nrab thiab qhov sib thooj ntawm qhov tawg kom ntxiv dag zog rau cov nyhuv kho ntawm cov ntsia hlau intramedullary.
4. Yog hais tias tus ntsia thawv intramedullary tau muab tso rau deb dhau los kom lub pre-bent guidewire tiv thaiv kev nthuav dav ntawm tibial, ces siv cov ntaub ntawv uas tsis yog-pre-bent guidewire lossis distal non-expansion.
5. Khaws cov ntsia hlau thaiv thiab phaj kom txog thaum lub pob txha raug txo, tshwj tsis yog cov ntsia hlau thaiv thaiv cov ntsia hlau intramedullary los ntawm kev sib kis ntawm cov pob txha lossis cov phaj unicortical puas rau cov nqaij mos.
6. Yog tias cov ntsia hlau intramedullary thiab cov ntsia hlau tsis muab kev txo qis thiab kho kom zoo, lub phaj percutaneous lossis ntsia hlau yuav raug ntxiv los ua kom muaj kev ruaj ntseg ntawm cov rau tes intramedullary.

Nco ntsoov

Ntau tshaj 1/3 ntawm cov pob txha pob txha ntawm tibia cuam tshuam nrog kev sib koom tes.Tshwj xeeb, cov pob txha ntawm cov pob txha pob txha, cov pob txha pob txha pob txha, los yog cov pob txha txha caj qaum yuav tsum raug tshawb xyuas rau cov pob txha pob txha.Yog tias muaj, cov pob txha pob txha yuav tsum tau tswj hwm nyias ua ntej tso rau ntawm tus ntsia thawv intramedullary.