Ko ngā rārangi e rua o te rotarota "cut and set internal fixation, closed set intramedullary nailing" e whakaata tika ana i te waiaro o ngā taote pokanga wheua ki te rongoā i ngā whati tibia distal. Tae noa ki tēnei rā, he mea tonu te whakatau mēnā he pai ake ngā tīwiri pereti, ngā whao intramedullary rānei. Ahakoa ko tēhea te mea tino pai ki te aroaro o te Atua, i tēnei rā ka arotakehia e tātou ngā tohutohu pokanga mō te whao intramedullary o ngā whati tibial distal.
Huinga "taia tāpui" i mua i te pokanga
Ahakoa kāore e hiahiatia ngā whakaritenga o mua i te pokanga, he mea pai kia whai tīwiri me ngā pereti tāpiri mēnā ka puta he āhuatanga ohorere (hei tauira, he rārangi whati huna e ārai ana i te whakatakotoranga o ngā tīwiri raka, he hapa tangata rānei e whakanui ana i te whati, e ārai ana hoki i te aukati i te nekeneke, me ētahi atu) ka puta mai i te whakamahinga o te whao intramedullary.
Ngā turanga e whā mō te nekehanga angitu
Nā te āhua whakarara o te metaphysis tibial distal, kāore pea i te angitu te whakahekenga mā te kume noa. Mā ēnei āhuatanga e whai ake nei ka pai ake te angitu o te nekehanga:
1. tangohia he orthopantomogram i mua i te pokanga, i te wā rānei e pokanga ana o te peka hauora hei whakatairite me te whakatau i te whānuitanga o te whakaiti whati i te taha e pāngia ana.
2. Whakamahia he tūnga turi piko-haurua hei whakahaere i te whakatakotoranga o ngā whao me te tirotiro i te kanohi
3. Whakamahia he retractor hei pupuri i te peka ki tōna tūranga me tōna roa
4. Whakanohoia ngā tīwiri Schanz ki te tibia distal me proximal hei āwhina i te whakaiti i te whati.
7 Ngā Taipitopito mō te Āwhina Whakaiti me te Whakakorenga
1. Whakanohoia te pine ārahi ki roto i te tibia distal mā te whakamahi i tētahi taputapu āwhina tika, mā te piko rānei i te pito o te pine ārahi i mua i te whakatakotoranga.
2. whakamahia he kuku whakahou kiri hei whakanoho i ngā whao intramedullary ki roto i ngā whati porowhita me ngā whati whakarara (Pikitia 1)
3. whakamahia he pereti mārō me te whakapiringa monocortical (pereti ripanga, pereti kōpeketanga rānei) i roto i te whakaiti tuwhera hei pupuri i te whakaiti tae noa ki te whakaurunga o te whao intramedullary
4. te whakawhāiti i te awa whao o roto i te medullary mā te whakamahi i ngā tīwiri poraka hei whakatika i te koki me te awa hei whakapai ake i te angitu o te whakatakotoranga whao o roto i te medullary (Pikitia 2)
5. i runga i te momo whati, whakatauhia mēnā ka whakamahia ngā tīwiri whakapiri me te whakapiri aukati rangitahi me ngā pine Schnee, Kirschner rānei.
6. ārai i ngā whati hou ina whakamahia ngā tīwiri ārai i roto i ngā tūroro osteoporosis
7. whakapirihia te fibula i te tuatahi, kātahi te tibia mēnā he whati fibula ngātahi hei whakahaere i te nekehanga o te tibial
Pikitia 1 Te whakanoho anō i te rawhi Weber ā-kiri Ko ngā tirohanga whakarara (Pikitia A me B) e whakaatu ana i tētahi whati tibia distal ngāwari noa iho e tika ana mō te whakanoho anō i te rawhi ihu koi ā-kiri ā-kiri iti rawa te whakaekenga fluoroscopic e kore e nui te kino ki te kiko ngohengohe.
Pikitia 2 Te Whakamahinga o ngā tīwiri aukati E whakaatu ana te Pikitia A i te whati tino pakaru o te metaphysis tibial distal, ā, whai muri ko te kopa angulation o muri, me te kopa hurihanga toenga i muri i te whakau fibular ahakoa te whakatikatika o te kopa angulation o muri sagittal (Pikitia C) (Pikitia B), me te tīwiri aukati kotahi i whakanohoia ki muri, me tetahi ki taha ki te pito distal o te whati (Pikitia B me C), me te whānui o te medullary i muri i te whakatakotoranga o ngā pine aratohu hei whakatika ake i te kopa coronal (Pikitia D), me te pupuri tonu i te taurite sagittal (E)
6 ngā tohu mō te whakapiringa intramedullary
- Mena he nui te wheua o te wheua pito o te whati, ka taea te whakau i te whao intramedullary mā te whakauru i ngā tīwiri e 4 ki ngā koki maha (hei whakapai ake i te pumau o ngā toki maha), kia pai ake ai te pakari o te hanganga.
- Whakamahia ngā whao intramedullary kia taea ai e ngā tīwiri kua whakaurua te haere mā roto, kia hanga ai he hanganga raka me te pumau koki.
- Whakamahia ngā tīwiri matotoru, ngā tīwiri maha, me ngā papa maha o te whakatakotoranga o ngā tīwiri hei tohatoha i ngā tīwiri i waenga i ngā pito tawhiti me ngā pito tata o te whati hei whakapakari i te pānga whakapiri o te whao intramedullary.
- Mena he tawhiti rawa te whakatakotoranga o te whao intramedullary kia kore ai e taea e te waea arataki kua piko-mua te whakawhānui i te tibial distal, ka taea te whakamahi i te waea arataki kāore i piko-mua, te waea arataki kāore rānei i te whakawhānui.
- Puritia te whao me te pereti ārai kia whakaitihia rā anō te whati, ki te kore te whao ārai e ārai i te whao intramedullary kei horapa te wheua, ki te kore rānei e kino te kiko ngohengohe i te pereti unicortical.
- Mena kāore e ranea te whakaiti me te whakau o ngā whao me ngā tīwiri o roto i te uaua, ka tāpirihia pea he pereti kiri, he tīwiri rānei hei whakapiki i te pumau o ngā whao o roto i te uaua.
Ngā Whakamaumahara
Neke atu i te 1/3 o ngā whati o te tibia distal e pā ana ki te hononga. Ina koa, me tirotirohia ngā whati o te kakau tibial distal, ngā whati tibial spiral, ngā whati fibular spiral rānei e pā ana ki te hononga, mō ngā whati hononga-roto. Mena koinā, me whakahaere motuhake te whati hononga-roto i mua i te whakatakotoranga o te whao intramedullary.
Wā tuku: Oketopa-31-2023
