Nasihu 5 Don Gyaran Farce Na Cikin Gashin Kansa Na Distance Tibial

Layuka biyu na waƙar "yanke da saita fixation na ciki, rufe saitin intramedullary ƙusa" sun nuna halin likitocin ƙashi game da maganin karyewar tibia ta distal. Har zuwa yau, har yanzu ana tattaunawa kan ko sukurori na faranti ko ƙusa na intramedullary sun fi kyau. Ko da kuwa wanne ya fi kyau a idanun Allah, a yau za mu yi taƙaitaccen bayani game da shawarwarin tiyata don gyaran farce na intramedullary na karyewar tibial ta distal.

Saitin "tayar ajiya" kafin tiyata

Duk da cewa shirye-shiryen da ake yi kafin tiyata ba lallai ba ne, ana ba da shawarar a sami wasu sukurori da faranti idan akwai wani yanayi da ba a zata ba (misali, layin karyewar da ke hana sanya sukurori masu kullewa, ko kuskuren ɗan adam wanda ke ƙara ta'azzara karyewar kuma yana hana motsi, da sauransu) wanda zai iya tasowa sakamakon amfani da ƙusa a cikin intramedullary.

Tushe 4 don samun nasarar sake saita wuri

Saboda yanayin da ke kewaye da tibial metaphysis, sauƙin jan hankali ba koyaushe yana haifar da raguwa mai nasara ba. Abubuwan da ke tafe za su taimaka wajen inganta nasarar sake saitawa:

1. a ɗauki hotunan orthopantomograms na gaɓɓai masu lafiya kafin a yi tiyata ko kuma a lokacin tiyata don kwatantawa da kuma tantance girman raguwar karyewar da ke gefen da abin ya shafa.

2. yi amfani da wurin da aka sanya gwiwa a hankali don sauƙaƙe sanya ƙusa da kuma duba fluoroscopy

3. yi amfani da na'urar cirewa don kiyaye gaɓɓan a wurin da tsawonsu yake

4. Sanya sukurori na Schanz a cikin tibia na nesa da na kusa don taimakawa wajen rage karyewar ƙashi.

Cikakkun bayanai 7 game da Taimakawa Ragewa da Rage Motsi

1. Sanya fil ɗin jagora daidai a cikin tibia ta nesa ta amfani da na'urar taimako mai dacewa ko ta hanyar lanƙwasa ƙarshen fil ɗin jagora kafin sanya shi.

2. yi amfani da forceps mai gyara fata don sanya kusoshin intramedullary a cikin karyewar karkace da karkace (Hoto na 1)

3. Yi amfani da faranti mai tauri tare da gyarawa ta monocortical (tabular ko matse farantin) a cikin rage buɗewa don kiyaye raguwa har sai an saka ƙusa a cikin medullary

4. rage tasirin ƙusa ta hanyar amfani da sukurori don gyara kusurwa da hanyar sadarwa don inganta nasarar sanya ƙusa ta hanyar sadarwa ...

5. Dangane da nau'in karyewar, yanke shawara ko za a yi amfani da sukurori masu gyara da kuma gyara toshewa na ɗan lokaci ta amfani da fil ɗin Schnee ko Kirschner.

6. hana sabbin karaya yayin amfani da sukurori masu toshewa ga masu fama da cutar osteoporosis

7. A fara gyara fibula sannan a gyara tibia idan an haɗa fibula don sauƙaƙa sake saita tibia.

Hoto na 1 Sake saita maƙallin Percutaneous Weber Ra'ayoyi masu kama da juna (Hotuna A da B) suna nuna karyewar tibia mai sauƙi wacce ke ba da damar sake saita maƙallin percutaneous mai kaifi wanda ba shi da lahani sosai ga nama mai laushi.

Hoto na 2 Amfani da sukurori masu toshewa Hoto na A yana nuna karyewar metaphysis na tibial na nesa wanda ya biyo baya da nakasar kusurwa ta baya, tare da nakasar juyawar da ta rage bayan fibular fibular duk da gyara nakasar kusurwa ta baya (Hoto na C) (Hoto na B), tare da sukurori ɗaya mai toshewa da aka sanya a baya da kuma ɗaya a gefe a ƙarshen karyewar (Hoto na B da C), da kuma faɗaɗa medullary bayan sanya fil ɗin jagora don ƙara gyara nakasar kumburin zuciya (Hoto na D), yayin da ake kula da daidaiton kusurwa (E)
Maki 6 don gyarawa ta intramedullary

1. Idan ƙashin bayan karyewar ya isa ƙashi, ana iya gyara ƙusa ta intramedullary ta hanyar saka sukurori guda 4 a kusurwoyi da yawa (don inganta daidaiton gatari da yawa), don inganta taurin tsarin.
2. Yi amfani da kusoshin intramedullary waɗanda ke ba da damar sukurori da aka saka su ratsa ta ciki kuma su samar da tsarin kullewa mai kwanciyar hankali.
3. Yi amfani da sukurori masu kauri, sukurori da yawa, da kuma wurare da yawa na sanya sukurori don rarraba sukurori tsakanin ƙarshen nesa da kusa na karyewar don ƙarfafa tasirin gyara ƙusa a cikin medullary.
4. Idan an sanya ƙusa a cikin medullary da nisa sosai ta yadda wayar jagora da aka lanƙwasa ta hana faɗaɗa tibial na nesa, to za a iya amfani da wayar jagora da ba ta lanƙwasa ba ko kuma wayar mara faɗaɗawa ta nesa.
5. A riƙe ƙusa da farantin da ke toshewa har sai an rage karyewar, sai dai idan ƙusa da ke toshewa ta hana ƙusa ta intramedullary yaɗuwa ƙashi ko kuma farantin unicortical ya lalata nama mai laushi.
6. Idan kusoshin intramedullary da sukurori ba su samar da isasshen raguwa da gyarawa ba, za a iya ƙara faranti ko sukurori a kan fata don ƙara daidaiton kusoshin intramedullary.

Masu tunatarwa

Fiye da kashi 1/3 na karyewar tibia ta distal sun shafi haɗin gwiwa. Musamman ma, ya kamata a binciki karyewar tushen tibia na distal, karyewar tibia ta spiral, ko karyewar fibular mai kama da juna don gano karyewar da ke cikin articular. Idan haka ne, ana buƙatar a kula da karyewar da ke cikin articular daban kafin a sanya ƙusa a cikin medullary.