Nasiha 5 don Gyaran Ƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Tibial

Layukan waƙar guda biyu “yanke da saita gyaran ciki, rufaffiyar ƙusa ta intramedullary” daidai gwargwado suna nuna halayen likitocin kashin baya wajen maganin karyewar tibia mai nisa.Har wa yau, har yanzu batun ra'ayi ne ko ƙusoshin faranti ko kusoshi na intramedullary sun fi kyau.Ko da wanene ya fi kyau a wurin Allah, a yau za mu yi bayani ne kan shawarwarin tiyata don ƙusa cikin ƙusa mai nisa na tibial fractures.

Saitin “tayan gyara taya” kafin aiki

Duk da yake shirye-shiryen riga-kafi na yau da kullun ba lallai ba ne, ana ba da shawarar samun saiti na sukurori da faranti a cikin yanayin da ba a zata ba (misali, layin karyewar ɓoyayyi wanda ke hana sanya skru na kullewa, ko kuskuren ɗan adam wanda ke ƙara karaya kuma yana hana motsi, da sauransu. .) wanda zai iya tasowa daga yin amfani da kusoshi na intramedullary.

Tushen guda 4 don nasarar sakewa

Saboda jijiyar jikin mutum mai nisa na tibial metaphysis, raguwa mai sauƙi na iya ba koyaushe haifar da raguwa mai nasara ba.Abubuwan da ke biyowa za su taimaka wajen inganta yawan nasarar sake matsayi:

1. ɗauki preoperatives ko intraoperative orthopantomograms na lafiyayyan gaɓoɓin jiki don kwatantawa da sanin girman raguwar karaya a gefen da abin ya shafa.

2.amfani da wani wuri mai sassauƙa na gwiwa don sauƙaƙa sanya ƙusa da fluoroscopy

3.yi amfani da retractor don kula da gaɓa a wuri da tsayi

4.Place Schanz sukurori a cikin nisa da tibia na kusa don taimakawa rage raguwa.

7 Cikakkun bayanai na Rage Taimako da Cire Motsi

1. Sanya fil ɗin jagora daidai cikin tibia mai nisa ta amfani da na'urar taimako da ta dace ko ta lankwasawa da titin fil ɗin jagora kafin a sakawa.

2. Yi amfani da ƙarfi mai sake tayar da fata don sanya kusoshi na intramedullary a karkace da karaya (Hoto na 1)

3. Yi amfani da faranti mai tsauri tare da daidaitawar monocortical (tabular ko farantin matsawa) a buɗe ragi don kula da raguwa har sai an saka ƙusa na intramedullary.

4. kunkuntar tashar ƙusa ta intramedullary ta amfani da toshe sukurori don gyara angulation da tashar don inganta nasarar ƙusa na intramedullary (Figure 2)

5. dangane da nau'in karaya, yanke shawarar ko za a yi amfani da sukurori da gyaran gyare-gyare na wucin gadi tare da Schnee ko Kirschner fil.

6. hana sabon karaya lokacin amfani da toshe sukurori a cikin marasa lafiya osteoporotic

7. Gyara fibula da farko sannan kuma tibia a cikin yanayin hadadden karayar fibula don sauƙaƙa sake fasalin tibial.

Hoto 1 Percutaneous Weber clamp repositioning Oblique views (Figures A da B) suna ba da shawarar karaya mai sauƙi mai sauƙi wanda ya ba da kansa ga ƙwayar ƙwayar cuta ta fluoroscopic ɗan ƙaramin matsi mai kaifi-hanchi mai matsewa wanda ke haifar da ɗan lahani ga taushin nama.

Hoto 2 Amfani da toshe screws Hoto A yana nuna raguwar raguwa mai zurfi na distal tibial metaphysis wanda ya biyo bayan nakasar angulation na baya, tare da ragowar inversion nakasar bayan gyare-gyaren fibular duk da gyaran gyare-gyaren sagittal na baya (Fig. C) (Fig. B), tare da dunƙule guda ɗaya da aka sanya a baya kuma ɗaya a kai tsaye a kan ƙarshen ɓarke ​​​​(Figs. B da C), da kuma dilatation medullary bayan sanya fil ɗin jagora don ƙara gyara nakasar coronal (Fig. D), yayin da yake kiyaye sagittal. daidaito (E)
maki 6 don gyaran intramedullary

1. Idan nisa kashi na karaya isasshe kashi, da intramedullary ƙusa za a iya gyarawa ta hanyar saka 4 sukurori a mahara kusurwoyi (don inganta kwanciyar hankali na mahara gatari), don inganta tsarin rigidity.
2. Yi amfani da kusoshi na intramedullary waɗanda ke ba da damar ƙusoshin da aka saka su wuce ta kuma samar da tsarin kullewa tare da kwanciyar hankali na kusurwa.
3. Yi amfani da sukurori mai kauri, sukurori da yawa, da jirage masu yawa na sanya dunƙulewa don rarraba sukurori tsakanin ɓangarorin nesa da kusa da ƙarshen karaya don ƙarfafa tasirin ƙusa na intramedullary.
4. Idan ƙusa na intramedullary an sanya shi da nisa ta yadda jagorar da aka riga aka lanƙwasa ta hana haɓakar tibial mai nisa, to ana iya amfani da madaidaicin jagorar da ba a riga an lanƙwasa ba ko nisa.
5. Rike ƙusa mai toshewa da farantin har sai raunin ya ragu, sai dai idan ƙusa mai toshewa ya hana ƙusa na intramedullary yada kashi ko farantin unicortical yana lalata laushin nama.
6. Idan kusoshi na intramedullary da sukurori ba su samar da isasshen raguwa da gyarawa ba, ana iya ƙara faranti ko dunƙule don ƙara kwanciyar hankali na kusoshi na intramedullary.

Tunatarwa

Fiye da 1/3 na raunin tibia mai nisa sun haɗa da haɗin gwiwa.Musamman ma, ya kamata a binciko karyewar tushen tibial mai nisa, karkacewar tibial fractures, ko karkacewar fibular da ke da alaƙa don ɓarkewar ciki.Idan haka ne, ana buƙatar sarrafa karyewar cikin articular daban kafin sanya ƙusa na intramedullary.