Ndụmọdụ 5 maka ndozi ntu intramedullary nke mgbaji Tibial distal

Ahịrị abụọ nke uri ahụ “bee na tọọ nrụzi nke ime, mechiri emechi nku intramedullary” na-egosipụta nke ọma omume ndị dọkịta na-awa ọkpụkpụ na-ahụ maka ọgwụgwọ mgbaji tibia distal.Ruo taa, ọ ka bụ echiche ma skru plate ma ọ bụ mbọ intramedullary ka mma.N'agbanyeghị nke kacha mma n'anya Chineke, taa, anyị ga-eme nkọwa gbasara ndụmọdụ ịwa ahụ maka ntu intramedullary nke mgbaji tibial dị anya.

Tụkwaa “taya mapụtara” tupu ịwa ahụ

Ọ bụ ezie na nkwadebe tupu ịwa ahụ oge niile adịghị mkpa, a na-atụ aro ka ịnwe skru na efere mapụtara ma ọ bụrụ na ọ dị ihe a na-atụghị anya ya (dịka ọmụmaatụ, ahịrị mgbaji zoro ezo nke na-egbochi ntinye nke skru mkpọchi, ma ọ bụ njehie mmadụ nke na-eme ka mgbaji ahụ dịkwuo njọ ma na-egbochi imegharị ahụ, wdg). .) nke nwere ike ibilite site na iji ntu intramedullary.

Ihe ntọala 4 maka ngbanwe nke ọma

N'ihi anatomi nke oblique nke metaphysis tibial distal, traction dị mfe nwere ike ọ gaghị ebute mbelata nke ọma mgbe niile.Isi ihe ndị a ga-enyere aka melite ọnụego ọganiihu nke ntinyegharị:

1. were tupu ịwa ahụ ma ọ bụ intraoperative orthopantomogram nke akụkụ ahụ dị mma iji tụnyere ma chọpụta oke mbelata mgbaji n'akụkụ akụkụ ahụ metụtara.

2.jiri obere ikpere ikpere mee ka ọ dị mfe itinye ntu na fluoroscopy

3.jiri retractor na-ejigide aka na ebe na ogologo

4.Place Schanz kposara na distal na proximal tibia iji nyere aka na mbelata mgbaji.

Nkọwa 7 nke mbelata enyemaka na enweghị ike

1. Tinye ntụtụ ntuziaka ahụ nke ọma n'ime tibia distal site na iji ngwaọrụ enyemaka kwesịrị ekwesị ma ọ bụ site na-ehutu n'ọnụ ntụ ntụ ntụ tupu etinye ya.

2. jiri ike na-ewelite ntugharị akpụkpọ ahụ tinye ntu intramedullary n'ọkpụkpụ gbajiri agbaji na gbajiri agbaji (Njirimara 1)

3. jiri efere siri ike na monocortical fixation (tabular ma ọ bụ efere mkpakọ) na mbelata oghe iji nọgide na-ebelata ruo mgbe etinyere ntu intramedullary.

4. ibelata ọwa ntu intramedullary site na iji kposara ngọngọ iji dozie angulation na ọwa iji meziwanye ọganihu nke ntinye ntu intramedullary (Figure 2)

5. dabere n'ụdị mgbawa, kpebie ma ị ga-eji screws fixation na nkwụsịtụ nkwụsị oge na Schnee ma ọ bụ Kirschner pin.

6. gbochie mgbaji ọhụrụ mgbe ị na-eji skru na-egbochi ndị ọrịa osteoporotic

7. dozie fibula nke mbụ wee mechaa tibia n'ihe gbasara mgbaji fibula jikọtara ọnụ iji kwado nhazigharị tibial.

Ọgụgụ 1 Percutaneous Weber clamp repositioning Oblique views (Figures A na B) na-atụ aro mgbaji tibia distal dị mfe nke na-etinye onwe ya na fluoroscopic percutaneous obere mwekota mwekota nke na-eme ka obere ihe mebie anụ ahụ dị nro.

Fig. 2 Ojiji nke kposara skru Fig. A na-egosi nbibi nke ukwuu nke distal tibial metaphysis nke na-esote nrụrụ angulation nke azụ, na nrụrụ nrụrụ mpụta mgbe emezigharị fibular n'agbanyeghị mgbazi nke sagittal posterior angulation deformity (Fig. C) (Fig. B), na otu ngọngọ ịghasa etinyere n'azụ na otu n'akụkụ na njedebe dị anya nke mgbawa (Figs. B na C), na medullary dilatation mgbe ọ na-etinye ntụnye nduzi iji dozie nrụrụ coronal (Fig. D), ebe ị na-ejigide sagittal. nha nha (E)
Isi ihe 6 maka ndozi intramedullary

1. Ọ bụrụ na ọkpụkpụ dịpụrụ adịpụ nke ọkpụkpụ ahụ zuru oke, enwere ike idozi ntu intramedullary site na ịtinye skru 4 n'ọtụtụ akụkụ (iji meziwanye nkwụsi ike nke ọtụtụ axes), ka ọ dịkwuo mma nhazi nhazi.
2. Jiri mbọ intramedullary nke na-ekwe ka skru etinyere gafere wee mepụta usoro mkpọchi nwere nkwụsi ike akụkụ.
3. Jiri skru siri ike, ọtụtụ skru, na ọtụtụ ụgbọ elu nke ịdebe screw iji kesaa skru n'etiti ebe dị anya na nso nso nke mgbaji ahụ iji wusie mmetụta nhazi nke ntu intramedullary siri ike.
4. Ọ bụrụ na a na-etinye ntu intramedullary nke ukwuu nke mere na ntuziaka a na-ehulata na-egbochi mgbasawanye tibial dị anya, mgbe ahụ, enwere ike iji ntuziaka na-abụghị nke a na-ehulata ma ọ bụ nke na-adịghị gbasaa.
5. Jido ntu mgbochi na efere ruo mgbe mgbaji ahụ belatara, ọ gwụla ma ntu mgbochi ahụ na-egbochi ntu intramedullary ịgbasa ọkpụkpụ ma ọ bụ efere unicortical na-emebi anụ ahụ dị nro.
6. Ọ bụrụ na ntu intramedullary na kposara adịghị enye mbelata na nhazi nke ọma, enwere ike ịgbakwunye efere ma ọ bụ nkedo percutaneous iji mee ka nkwụsi ike nke mbọ intramedullary dịkwuo elu.

Ihe ncheta

Ihe karịrị 1/3 nke mgbaji tibia dị anya gụnyere nkwonkwo.Karịsịa, a ga-enyocha mgbaji nke ogologo tibial stem, spiral tibial fractures, ma ọ bụ ihe mgbaji na-ejikọta ya maka mgbawa n'ime oghere.Ọ bụrụ otu a, ọ dị mkpa ka a chịkwaa mgbaji n'intra-articular iche tupu etinye ntu intramedullary.