Inama 5 zo guteranya imisumari ikosorwa yo kuvunika kwa Tibial Distal

Imirongo ibiri yikivugo "gukata no gushiraho imbere, gufunga imisumari yimisumari" byerekana neza imyifatire yabaganga babaga amagufwa kubuvuzi bwavunitse bwa tibia.Kugeza magingo aya, haracyari ikibazo cyo gutekereza niba imigozi ya plaque cyangwa imisumari yimbere ari byiza.Tutitaye kubyo aribyo byiza rwose mumaso yImana, uyumunsi tugiye gukora incamake yinama zo kubaga kubijyanye no gutera imisumari imbere yimitsi ya tibial.

Gutegura mbere ya "spare tire"

Mugihe imyiteguro isanzwe yo gutangira idakenewe, birasabwa kugira ibyuma byabigenewe hamwe namasahani mugihe habaye ibihe bitunguranye (urugero, umurongo wavunitse wihishe ubuza gushyira imiyoboro ifunga, cyangwa ikosa ryabantu ryongera kuvunika kandi bikarinda ubudahangarwa, nibindi. .) ibyo bishobora guturuka kumikoreshereze yimisumari.

Shingiro 4 zo gusubiramo neza

Bitewe na anatomiya ya oblique ya tibial metafhysis ya kure, gukurura byoroshye ntibishobora kuvamo kugabanuka neza.Ingingo zikurikira zizafasha kunoza igipimo cyo gutsinda kwimurwa:

1. fata progaramu ya orthopantomogramu mbere yo gutangira cyangwa gutangira ibikorwa byingingo nzima kugirango ugereranye kandi umenye urugero rwo kugabanya kuvunika kuruhande rwanduye.

2.koresha ikivi cya kabiri cyoroshye kugirango woroshye gushyira imisumari na fluoroscopi

3.koresha retrator kugirango ukomeze ingingo mumwanya n'uburebure

4. Shyira imigozi ya Schanz muri tibia ya kure kandi yegeranye kugirango ifashe kugabanya kuvunika.

7 Ibisobanuro byo Gufasha Kugabanuka no Kwimurwa

1. Shira pin ikuyobora neza muri tibia ya kure ukoresheje igikoresho gifasha cyangwa mbere yo kugunama hejuru yisonga rya pin mbere yo kuyishyira.

2. koresha imbaraga zisubiramo uruhu kugirango ushire imisumari yimbere mumyanya ya spiral na oblique (Ishusho 1)

3. koresha isahani ikomeye hamwe na monocortical fixation (tabula cyangwa compression plaque) mugabanye kumugaragaro kugirango ukomeze kugabanuka kugeza umusumari winjizwamo

4. kugabanya umuyoboro wimisumari winjiza ukoresheje imigozi yo guhagarika kugirango ukosore uburakari hamwe numuyoboro kugirango utezimbere intsinzi yo gushyira imisumari imbere (Ishusho 2)

5. ukurikije ubwoko bwavunitse, hitamo niba wakoresha imigozi yo gukosora hamwe no guhagarika by'agateganyo hamwe na Schnee cyangwa Kirschner.

6. irinde kuvunika gushya mugihe ukoresheje imigozi yo guhagarika abarwayi ba osteoporotic

7. banza ukosore fibula hanyuma tibia mugihe habaye kuvunika kwa fibula kugirango byorohereze tibial reposition

Igishushanyo 1 Gusimbuza Weber clamp repositioning Oblique Reba (Igishushanyo A na B) byerekana ko byoroshye kuvunika kwa tibia kwitaruye kwiha fluoroscopic percutaneous minimally invasive sharp-izuru clamp reposition itera kwangirika gake kwinyama zoroshye.

Igishushanyo cya 2 Gukoresha imigozi yo guhagarika Igishushanyo A cyerekana kuvunika gukabije cyane kwa metafhysis ya tibial intera ikurikirwa no guhindagurika kwimiterere yinyuma, hamwe no guhindagurika kwinyuma nyuma yo gukosorwa kwa fibular nubwo byakosowe nubumuga bwa sagittal inyuma (Ishusho C) (Ishusho). B. kuringaniza (E)
Amanota 6 yo gukosorwa

1. Niba igufwa rya kure ryavunitse rifite amagufwa ahagije, umusumari winjiye urashobora gukosorwa winjizamo imigozi 4 mumpande nyinshi (kugirango uhindure ituze ryamashoka menshi), kugirango ubashe kunoza imiterere.
2. Koresha imisumari yimbere yemerera imigozi yashizwemo kunyuramo hanyuma ugakora imiterere yo gufunga hamwe no guhagarara neza.
3. Koresha imigozi yimbitse, imigozi myinshi, hamwe nindege nyinshi zo gushyira imigozi kugirango ugabanye imigozi hagati yimpera ya kure kandi yegeranye yimvune kugirango ushimangire ingaruka zo gukosora imisumari.
4. Niba umusumari winjiye ushyizwe kure cyane kuburyo icyerekezo cyabanjirije kugoreka kibuza kwaguka kwa tibial kure, noneho hashobora gukoreshwa umurongo ngenderwaho utabanje kugororwa cyangwa kwaguka kure.
5. Gumana umusumari hamwe nisahani yo guhagarika kugeza igihe kuvunika kugabanuka, keretse niba umusumari uhagarika utabuza umusumari winjiza gukwirakwira amagufwa cyangwa isahani imwe yangiza imyenda yoroshye.
6. Niba imisumari yimbere hamwe na screw bidatanga kugabanuka no gukosorwa bihagije, isahani ya percutane cyangwa screw irashobora kongerwamo kugirango byongere ituze ryimisumari.

Kwibutsa

Kurenga 1/3 cyimvune ya tibia ya kure irimo ingingo.By'umwihariko, kuvunika kw'uruti rwa kure rwa tibial, kuvunika kwa tibial spiral, cyangwa kuvunika kwa fibular fibular bigomba gukurikiranwa kugirango bivunike imbere.Niba aribyo, kuvunika imbere-articular bigomba gucungwa ukundi mbere yo gushyira umusumari wimbere.