Shirye-shiryen riga-kafi da matsayi kamar yadda aka bayyana a baya don gyaran firam na waje na transarticular.
Intra-articular fracture repositioning and fixation:
Ana amfani da raguwa da gyare-gyare mai iyaka. Za'a iya ganin karaya na ƙasan articular na ƙasa kai tsaye ta hanyar ƙananan ɓangarorin anteromedial da aterolateral incisions da gefen gefen capsule na haɗin gwiwa a ƙasan meniscus.
Ƙunƙarar ɓangaren da abin ya shafa da kuma amfani da haɗin gwiwa don daidaita manyan gutsuttsuran kashi, kuma ana iya sake saita matsawa ta hanyar prying da tarawa.
Kula da maido da nisa na tibial plateau, kuma lokacin da akwai lahani na kashi a ƙasan bangon articular, yi aikin daskarewa kashi don tallafawa farfajiyar articular bayan prying don sake saita farfajiyar articular.
Kula da tsayin dandali na tsaka-tsaki da na gefe, don haka babu wani mataki na gaba na articular.
Ana amfani da gyare-gyare na ɗan lokaci tare da matsi na sake saiti ko Kirschner fil don kula da sake saiti.
Sanya screws, screws ya kamata su kasance daidai da farfajiyar articular kuma suna cikin kashin subchondral, don ƙara ƙarfin gyarawa. Ya kamata a yi fluoroscopy X-ray na ciki don bincika sukurori kuma kada a taɓa fitar da sukurori cikin haɗin gwiwa.
Epiphyseal fracture repositioning:
Tashin hankali yana mayar da tsayi da axis na abin da ya shafa.
Ana kulawa don gyara jujjuyawar gaɓar da abin ya shafa ta hanyar lanƙwasa tuberosity na tibial da daidaita shi tsakanin yatsun farko da na biyu.
Wurin Wuri Na Kusa
Kewayon amintattun yankuna na tibial plateau tension wire jeri:
Jijiya popliteal, jijiya popliteal da jijiya tibial suna gudana a baya zuwa tibia, kuma jijiya na peroneal na kowa yana gudana a baya zuwa kan fibular. Don haka, duka shigarwa da fitowar allura ya kamata a yi gaba da tudun tibial, watau, allurar ta shiga ta fita daga allurar karfe ta gaba zuwa tsakiyar kan iyakar tibia da gaba zuwa gaban iyakar fibula.
A gefe na gefe, ana iya shigar da allurar daga gefen gaba na fibula kuma an fitar da shi daga gefen anteromedial ko daga gefen tsakiya; Matsakaicin shigarwa na tsakiya yawanci yana a gefen tsakiyar tsakiyar tibial plateau da gefensa na gaba, don kauce wa waya ta tashin hankali don wucewa ta karin ƙwayar tsoka.
An ba da rahoto a cikin wallafe-wallafen cewa wurin shigarwa na waya mai tayar da hankali ya kamata ya kasance aƙalla 14 mm daga farfajiyar articular don hana igiyar tashin hankali daga shiga cikin capsule na haɗin gwiwa da kuma haifar da cututtukan cututtuka.
Sanya wayar tashin hankali ta farko:
Ana iya amfani da fil ɗin zaitun, wanda aka ratsa ta cikin fil ɗin aminci akan mariƙin zobe, barin kan zaitun a wajen fil ɗin aminci.
Mataimakin yana kula da matsayi na mariƙin zobe don ya kasance daidai da farfajiyar articular.
Hana fil ɗin zaitun ta cikin laushi mai laushi kuma ta cikin tudun tibial, kula da sarrafa alkiblarsa don tabbatar da cewa wuraren shiga da fita suna cikin jirgi ɗaya.
Bayan fitar da fata daga gefen da ya saba wa juna, ci gaba da fita daga allurar har sai kan zaitun ya tuntubi fil ɗin aminci.
Shigar da zamewar igiyar igiyar waya a gefen da ya saba wa juna kuma ku wuce fil ɗin zaitun ta cikin faifan matsewar waya.
Kula da kiyaye tudun tibial a tsakiyar firam ɗin zobe a kowane lokaci yayin aikin.
Ta hanyar jagorar, ana sanya wariyar tashin hankali ta biyu a layi daya, kuma ta gefen kishiyar matsewar igiyar igiyar waya.
Sanya na uku tashin hankali waya, ya kamata a cikin wani hadari kewayon kamar yadda zai yiwu tare da baya sa na tashin hankali waya giciye cikin mafi girma kwana, yawanci biyu sets na karfe waya iya zama wani kwana na 50 ° ~ 70 °.
Preload da aka yi amfani da wayar tashin hankali: Cikakken tashin hankali mai ɗaukar nauyi, wuce tip na wayar tashin hankali ta cikin matsi, damfara abin hannu, sanya preload na aƙalla 1200N zuwa wayar tashin hankali, sannan a yi amfani da makullin L-handle.
Yin amfani da irin wannan hanyar gyaran waje na waje a fadin gwiwa kamar yadda aka bayyana a baya, sanya akalla biyu Schanz screws a cikin tibia mai nisa, haɗa mai gyaran waje mai hannu guda ɗaya, kuma haɗa shi zuwa mai daidaitawa na waje, kuma sake tabbatar da cewa metaphysis da tibial stem. suna cikin axis na injina na yau da kullun da daidaitawar juyi kafin kammala gyarawa.
Idan ana buƙatar ƙarin kwanciyar hankali, za a iya haɗa firam ɗin zobe zuwa hannun gyarawa na waje tare da sanda mai haɗawa.
Rufe shinge
Ƙwararren tiyata yana rufe Layer ta Layer.
Ana kiyaye filin allura tare da kunsa gauze barasa.
Gudanar da aikin bayan tiyata
Fascial ciwo da kuma jijiya rauni
A cikin 48h bayan raunin da ya faru, ya kamata a kula da hankali don kiyayewa da kuma ƙayyade kasancewar ciwon ƙwayar cuta na fascial.
A hankali kula da jijiyoyi na jijiyoyi na sashin da abin ya shafa. Rashin wadataccen jini ko asarar jijiya mai ci gaba dole ne a sarrafa shi yadda ya kamata azaman yanayin gaggawa.
Gyaran aiki
Za a iya fara motsa jiki na aiki a ranar farko ta bayan tiyata idan babu wasu raunuka ko cututtuka. Misali, ƙanƙancewar isometric na quadriceps da motsi mara ƙarfi na gwiwa da motsi mai aiki na idon sawu.
Manufar farkon aiki da ayyukan m shine don samun matsakaicin iyakar motsi na haɗin gwiwa na gwiwa don ɗan gajeren lokaci kamar yadda zai yiwu bayan tiyata, watau, don samun cikakkiyar motsi na haɗin gwiwa na gwiwa kamar yadda zai yiwu a cikin 4 ~ sati 6. Gabaɗaya, aikin tiyata yana iya cimma manufar gyare-gyaren kwanciyar hankali na gwiwa, yana ba da damar da wuri
aiki. Idan aikin motsa jiki ya jinkirta saboda jiran kumburi ya ragu, wannan ba zai dace da farfadowa na aiki ba.
Nauyin nauyi: Ba a ba da shawarar ɗaukar nauyi na farko ba, amma aƙalla makonni 10 zuwa 12 ko kuma daga baya don ƙera ɓarna a cikin articular.
Warkar da rauni: Ku kula da raunin raunin a cikin makonni 2 bayan tiyata. Idan ciwon rauni ko jinkirin warkarwa ya faru, ya kamata a yi aikin tiyata da wuri-wuri.
Lokacin aikawa: Agusta-16-2024
