I te wā e kōwhiri ana i tētahi mahere maimoatanga mō ngā whati tibial distal, ka taea te whakamahi i te whakapiringa o waho hei whakapiringa rangitahi mō ngā whati me ngā whara kiko ngohengohe kino.
Ngā tohu:
"Whakahaere Pakaru" te whakatika rangitahi i ngā whati kua whara nui ngā kiko ngohengohe, pērā i ngā whati tuwhera, ngā whati kati rānei me te pupuhi nui o ngā kiko ngohengohe.
Te rongoā whakamutunga mō ngā whati kua poke, kua pangia, ngā whati rānei kua whara nui ki ngā kiko ngohengohe.
Examine:
Āhua o te kiko ngohengohe: ①Patunga tuwhera; ②He whara nui o te kiko ngohengohe, he pupuhi o te kiko ngohengohe. Tirohia te āhua o ngā toto io, ā, tuhia marietia.
Whakaahua: Ngā hihi-X anteroposterior me te taha o te tibia, me ngā tohu weronga anteroposterior, taha me te pona o te hononga pona. Mena kei te whakapaehia he whati i roto i te hononga, me mahi he matawai CT o te tibial vault.
Anatomi:·
I tautuhia te "rohe haumaru" ā-tinana mō te whakatakotoranga o te titi whakapiri o waho e ai ki ngā taumata rerekē o te tapahi.
Ko te taha maui o mua o te tibia e whakarato ana i te rohe haumaru āhua pewa 220° ki mua, he wāhi e taea ai te whakatakotoranga o ngā pine whakapiri o waho.
Ko ētahi atu wāhanga o te tibia e whakarato ana i te wāhi whakauru ngira haumaru anteromedial i te awhe 120°~140°.
Stikanga whawhati tata
Tūnga: Ka takoto takoto te tūroro i runga i tētahi tēpu pokanga mārama hihi-X, ā, ka whakatakotoria ētahi atu mea pēnei i te urunga, i te whata rānei ki raro i te peka e pāngia ana hei āwhina i te pupuri i te tūnga. Mā te whakatakoto i te papa ki raro i te hope i te taha kotahi ka hurihia te peka e pāngia ana ki roto, me te kore e nui rawa te hurihanga ki waho.
Awhakatata
I te nuinga o te wā, ka tapahia he iti ki te tibia, te calcaneus, me te metatarsal tuatahi hei whakanoho i ngā pine whakapiri o waho.
He māmā ake te whakatika i ngā whati fibula mai i te rohe kiri raro i te kiri e taea te pā.
Ka taea te whakatika i ngā whati o te tibial vault e pā ana ki te hononga mā te kiri. Mēnā e āhei ana ngā āhuatanga o te kiko ngohengohe, ā, mēnā e tika ana, ka taea te whakamahi i te huarahi anterolateral, medial rānei hei whakatika. Mēnā he mahi whakatika rangitahi noa iho te whakatika o waho, me tawhiti te wāhi whakauru ngira e whakaarohia ana kia whakatakotoria te ngira whakatika o waho i te wāhi whakatika whao whakamutunga hei ārai i te poke o te kiko ngohengohe. Mā te whakatika wawe i te fibula me ngā kongakonga o roto i te hononga ka āwhina i te whakatikanga whakamutunga i muri mai.
Ngā Whakatūpato
Kia tūpato ki te ara titi whakapiri o waho mō te whakapiringa whakamutunga o te papa pokanga, nā te mea ka arahi pea ngā kiko kua pangia ki ngā raruraru i muri i te pokanga. Ko ngā huarahi anterolateral, medial rānei auau me te pupuhi nui o ngā kiko ngohengohe ka arahi pea ki ngā raruraru nui i roto i te whakaora patunga.
Te whakaiti me te whakatika i ngā whati o te fibula:
Ina whakaaetia ngā āhuatanga o te kiko ngohengohe, ka rongoatia tuatahitia ngā whati o te fibula. Ka whakaitihia te whati fibula, ā, ka whakatikahia mā te tapahi taha o te fibula, ko te tikanga he tīwiri whakaroa 3.5mm me te pereti ngongo 3.5mm l/3, he pereti LCDC 3.5mm me ngā tīwiri rānei. Kia whakaitihia te fibula kia rite ki te hanganga tinana, kia mau hoki, ka taea te whakamahi hei paerewa mō te whakahoki mai i te roa o te tibia me te whakatika i te āhua hurihuri o te whati tibial.
Ngā Whakatūpato
Mā te pupuhi nui o ngā kiko ngohengohe, te patunga tuwhera nui rānei, ka ārai pea i te piri tuatahi o te fibula. Kia tūpato kei whakatikahia ngā whati fibular proximal, ā, kia tūpato kei whara te io peroneal superficial proximal.
Ngā whati o te tibia: Te whakaiti me te whakapiri ā-roto
Me whakaiti ngā whati o roto i ngā hononga o te tibial vault i raro i te tirohanga tika mā te huarahi anterolateral, medial rānei o te distal tibia, mā te whakaiti ā-ringa ā-kore rānei i raro i te fluoroscopy.
I te wā e akiakihia ana te tīwiri whakaroa, me whakamau tuatahi te kongakonga whati ki te waea Kirschner.
Mā te whakaiti me te whakatika wawe i ngā whati o roto i te hononga ka taea ngā tikanga iti rawa te whakaekenga me te ngāwari ake i roto i te whakatikanga tuarua. Mā ngā āhuatanga ngoikore o te kiko ngohengohe pēnei i te pupuhi nui, te kino nui rānei o te kiko ngohengohe ka ārai pea i te whakatikanga wawe o ngā kongakonga o roto i te hononga.
Ngā Whati o te Tibial: Te Whakapūmautanga o Waho o te Pona
Ka taea te whakamahi i tētahi taputapu whakatika hononga o waho.
E ai ki ngā whakaritenga o te tikanga whakapiri whakamutunga o te wāhanga tuarua, i whakaurua ngā pine whakapiri o waho e rua, he haurua-miro 5mm te whānui, mā roto i te kiri, mā roto rānei i ngā tapahi iti ki te mata waenga, ki te mata anterolateral rānei o te tibia i te pito proximal o te whati.
Tuatahi, tapahia kia matara noa ki te mata o te wheua, kātahi ka tiakina te kiko huri noa ki tētahi ringaringa tiaki kiko ngohengohe, kātahi ka pokaia, ka patohia, ka panaia te tīwiri mā roto i te ringaringa.
Ka taea te whakanoho i ngā pine whakapiri o waho i te pito tawhiti o te whati ki runga i te kongakonga tibial tawhiti, ki te calcaneus me te metatarsal tuatahi, ki te kaki rānei o te talus.
Me whakanoho ngā pine whakapiri o waho transcalcaneal ki te ngongo o te calcaneal mai i te taha ki te taha hei ārai i te kino o ngā hanganga neurovascular o roto.
Me whakanoho te pine whakapiri o waho o te metatarsal tuatahi ki te mata anteromedial o te turanga o te metatarsal tuatahi.
I ētahi wā ka taea te whakanoho i tētahi pine whakapiri o waho ki mua i te taha mā roto i te tapahi o te sinus tarsal.
Kātahi ka tautuhia anō te tibia distal, ka whakatikatikaina te aho kaha mā te fluoroscopy i te wā o te pokanga, ā, ka huihuia te taputapu whakatika o waho.
I te wā e whakatikatika ana i te pūmau o waho, wetekina te topenga hono, whakamahia te kume roa, ka mahi i te whakaiti ā-ringa mārie i raro i te tirotiro ā-pūoro hei whakatikatika i te tūranga o te kongakonga whati. Kātahi ka pupuri te kaiwhakahaere i te tūranga i te wā e whakakukū ana te kaiawhina i ngā topenga hono.
Mpūwāhi kore
Mena ehara te whakapiringa ā-waho i te maimoatanga tuturu, me waiho te ara ngira whakapiringa ā-waho kia matara atu i te wāhi whakapiringa tuturu i te wā e whakamahere ana i te mahi, kia kore ai e poke te mara mahi ā muri ake nei. Ka taea te whakanui ake i te pumau o te whakapiringa ā-waho mā te whakanui ake i te mokowā o ngā pine whakapiringa i ia wāhi whati, te whakanui ake i te diameter o ngā pine, te whakanui ake i te maha o ngā pine whakapiringa me ngā pou hono, te tāpiri i ngā pūwāhi whakapiringa puta noa i te hononga pona, me te whakanui ake i te papa whakapiringa, te whakamahi rānei i te mowhiti whakapiringa ā-waho. Me whakarite kia tika te whakatikatika mā roto i ngā wāhanga o mua-muri me te taha.
Ngā whati o te tibial: te whakapiringa o waho o te hononga kore-whānui
I ētahi wā, he kōwhiringa te whakamahi i tētahi taputapu whakatika o waho kāore e horapa ana i te hononga. Mena he nui te kongakonga tibial distal hei whakauru i ngā pine whakatika o waho haurua-miro, ka taea te whakamahi i tētahi taputapu whakatika o waho māmā. Mō ngā tūroro he iti ngā kongakonga whati metaphyseal, he pai te taputapu whakatika o waho ranu kei roto ko tētahi pine whakatika o waho haurua-miro proximal me tētahi waea Kirschner angiangi distal hei tikanga maimoatanga rangitahi, hei tikanga maimoatanga whakamutunga rānei. Me tūpato i te wā e whakamahi ana i ngā taputapu whakatika o waho kore-whānui-hononga mō ngā whati kua poke i ngā kiko ngohengohe. Tangohia tēnei kiko kua poke, tangohia te ara ngira, me te whakaū i te peka ki roto i te maka kia ora pai te patunga i mua i te taea te whakaū i te whakaū.
Te Kamupene Hangarau ChenAnHui o Sichuan
Whakapā mai: Yoyo
Waeaatu:+8615682071283
Email: liuyaoyao@medtechcah.com
Wā tuku: Hui-tanguru-10-2023
