Mugihe uhisemo gahunda yo kuvura kuvunika kwa tibial kure, gukosora hanze birashobora gukoreshwa nkigikorwa cyigihe gito cyo kuvunika hamwe nibikomere byoroheje byumubiri.
Ibyerekana:
"Kugenzura ibyangiritse" gukosora by'agateganyo kuvunika hamwe no gukomeretsa ingirabuzimafatizo zoroheje, nk'imvune zifunguye cyangwa kuvunika gufunze hamwe no kubyimba byoroshye.
Ubuvuzi busobanutse bwo kuvunika kwanduye, kwanduye, cyangwa kuvunika hamwe no gukomeretsa bikabije.
Examine:
Imiterere yumubiri woroshye: ①Gufungura igikomere;②Gukomeretsa cyane tissue tissue, kubyimba byoroshye.Reba neza imitsi yimitsi kandi wandike witonze.
Kwerekana: Anteroposterior na X-imirasire ya tibia, hamwe na anteroposterior, impande zombi hamwe na acupoint ya ruguru.Niba hakekwa kuvunika imbere-articular, hagomba gukorwa CT scan ya tibial vault.
Anatomy:·
Anatomiki "zone yumutekano" yo gushira hanze pin yashyizwe hanze yasobanuwe ukurikije urwego rutandukanye rwambukiranya.
Metafizisike yegeranye ya tibia itanga 220 ° imbere yumutekano wimbere ya arc aho hashobora gushyirwaho pin yo gukosora hanze.
Ibindi bice bya tibia bitanga ahantu hashyizwemo urushinge rutekanye ruri hagati ya 120 ° ~ 140 °.
Stekinike ya urgical
Umwanya: Umurwayi aryamye hejuru kumeza ya X-ray ikora neza, kandi nibindi bintu nko kwisiga cyangwa isanduku bishyirwa munsi yingingo zanduye kugirango bifashe gukomeza umwanya.Gushyira padi munsi yibibuno byuruhande bizunguruka ingingo zanduye imbere nta kuzenguruka gukabije.
Approach
Mu bihe byinshi, uduce duto dukorerwa muri tibia, calcane, na metatarsal ya mbere kugirango dushyireho ibyuma byo gukosora hanze. ··
Ivunika rya Fibula ryoroshe gukosorwa kuva kumupaka wuruhande rwumupaka.
Ivunika rya tibial vault irimo ingingo irashobora gukosorwa muburyo butandukanye.Niba ibintu byoroshye byoroshye byemewe, kandi nibiba ngombwa, uburyo busanzwe butandukanye cyangwa bwo hagati burashobora gukoreshwa mugukosora.Niba gukosora hanze bikoreshwa gusa nkigipimo cyo gukosora byigihe gito, aho urushinge rwinjira aho hateganijwe gushyirwaho urushinge rwo hanze rugomba kuba kure yumwanya wanyuma wo gutunganya imisumari kugirango wirinde kwanduza imyenda yoroshye.Gukosora hakiri kare fibula nibice byimbere-byoroheje byoroha gukosorwa neza.
Kwirinda
Witondere hanze yo gukosora pin kugirango ikurikirane neza neza umurima wo kubaga, kuko ingirangingo zanduye byanze bikunze bizatera ibibazo nyuma yo kubagwa.Uburyo busanzwe bwa anterolateral cyangwa medial hamwe no kubyimba ingirabuzimafatizo byoroshye bishobora no gutera ingorane zikomeye mugukiza ibikomere.
Kugabanya no gukosora kuvunika kwa fibula:
Igihe cyose ibintu byoroshye byoroheje byemewe, kuvunika kwa fibula kubanza kuvurwa.Ivunika rya fibular ryaragabanutse kandi rigakosorwa ukoresheje uruzitiro rwa fibular, mubisanzwe hamwe na 3.5mm ya lag ya lag na 3,5mm l / 3 ya plaque, cyangwa plaque 3,5mm LCDC.Fibula imaze kugabanuka muburyo budasanzwe kandi igakosorwa, irashobora gukoreshwa nkigipimo cyo kugarura uburebure bwa tibia no gukosora ubumuga bwizunguruka bwavunitse.
Kwirinda
Ibibyimba byoroshye byoroshye kubyimba cyangwa igikomere gikinguye gishobora nanone kubuza gukosorwa kwambere kwa fibula.Witondere kudakosora imvune ya fibular yegeranye kandi witondere gukomeretsa imitsi yimbere ya peroneal.
Ibice bya Tibial: Kugabanuka no Gukosora Imbere
Ivunika ryimbere-arctular ya tibial vault rigomba kugabanuka mubyerekezo bitaziguye binyuze muburyo butandukanye cyangwa hagati ya tibia ya kure, cyangwa binyuze mumaboko ataziguye munsi ya fluoroscopi.
Mugihe utwaye umugozi wa lag, igice cyacitse kigomba gukosorwa mbere na wire ya Kirschner.
Kugabanuka hakiri kare no gukosora imvune yimbere-arctular ituma tekinike yibasirwa byoroheje kandi bigahinduka mugihe cyakabiri cyakosowe.Ibintu bitameze neza byoroshye-tissue nkibimenyetso byabyimbye cyangwa ibyangiritse byoroshye-tissue birashobora gukumira hakiri kare ibice byimbere.
Ivunika rya Tibial: Transarticular External Fixation
Kwambukiranya-guhuza ibintu hanze birashobora gukoreshwa.
Ukurikije ibisabwa byuburyo bwa kabiri bwo gukosora neza, ibyuma bibiri 5mm byigice kimwe cya kabiri cyumutwe winyuma washyizwemo muburyo butandukanye cyangwa binyuze mubice bito ku gice cyo hagati cyangwa hagati ya tibia kumpera yanyuma yo kuvunika.
Banza ucike intege hejuru yamagufwa, hanyuma urinde ingirangingo zikikije urutoki rworoshye rwo kurinda ingirangingo, hanyuma utobore, kanda, hanyuma utware umugozi unyuze mumaboko.
Amabati yo gukosora hanze kumpera ya kure yamenetse arashobora gushirwa kumurongo wa tibial intera, calcaneus na metatarsal yambere, cyangwa ijosi rya talus.
Transcalcaneal yo hanze ikosora igomba gushyirwa mubitereko bya calcaneal kuva hagati kugeza kuruhande kugirango birinde kwangirika kwimitsi yo mumitsi.
Hanze yo gukosora pin ya metatarsal yambere igomba gushyirwa hejuru ya anteromedial yubuso bwa metatarsal yambere.
Rimwe na rimwe, pin yo hanze irashobora gushirwa muburyo butandukanye binyuze muri tarsal sinus.
Hanyuma, tibia ya kure yarasubiwemo hanyuma umurongo wingufu uhindurwa binyuze muri fluoroscopi intraoperative, hanyuma uwakosoye hanze araterana.
Mugihe uhindura ibyuma bikosora hanze, fungura clip ihuza, ukore tronction longitudinal, kandi ugabanye intoki zoroheje munsi ya fluoroscopi kugirango uhindure umwanya wigice cyacitse.Ukoresha noneho agumana umwanya mugihe umufasha akomeza clips zihuza.
Mingingo
Niba gukosora hanze atari uburyo bunoze bwo kuvura, inzira y'urushinge rwo gukosora igomba kubikwa kure yikibanza cyagenwe mugihe cyo gutegura ibikorwa, kugirango bidahumanya umurima uzaza.Ihagarikwa ryimiterere yo hanze irashobora kwiyongera mugukomeza intera yimashini ikosora kuri buri kibanza cyacitse, kongera diameter ya pin, kongera umubare wibikoresho byo gukosora no guhuza imirongo, ukongeramo ingingo zo gukosora hejuru yibirenge, no kongera gukosora indege cyangwa gukoresha impeta ikosora hanze.Guhuza bihagije bikwiye gukemurwa hifashishijwe ibice byimbere-byinyuma.
Ivunika rya Tibial: non-span-articular fixation yo hanze
Rimwe na rimwe, ni amahitamo yo gukosora hanze idakwiranye.Niba igice cya tibial intera ari kinini bihagije kugirango kibashe igice-cy-umugozi wo hanze cyo gukosora, byoroshye gukosora hanze birashobora gukoreshwa.Ku barwayi bafite uduce duto duto twa metafhyseal, ibyuma bivangavanze byo hanze bigizwe na kimwe cya kabiri cyegeranye-cyoherejwe na pin hamwe na wire ya Kirschner nziza ni ingirakamaro nkubuhanga bwo kuvura by'agateganyo cyangwa busobanutse.Ugomba kwitonda mugihe ukoresheje non-span-articular fixator yo hanze kugirango ivunike hamwe nuduce tworoshye twanduye.Kurandura iyi tissue yanduye, kuvanaho inzira yinshinge, hamwe na immobilisation yumutwe mugice kimwe kugeza igihe gukira ibikomere byiza bisanzwe bikenewe mbere yuko hakorwa immobilisation yuzuye.
Sichuan ChenAnHui Technology Co., Ltd.
Twandikire: Yoyo
WhatsApp: +8615682071283
Email: liuyaoyao@medtechcah.com
Igihe cyo kohereza: Gashyantare-10-2023
