5 Talooyin loogu talagalay hagaajinta ciddiyaha intramedullary ee jabka tibial ee fog

Labada sadar ee maansada "gooy oo dejiyaa hagaajin gudaha ah, ciddiyeeynta intramedullary set oo xiran" waxay si habboon u muujinayaan dabeecadda dhakhaatiirta qalliinka lafaha ee ku wajahan daaweynta jabka tibia ee fog.Ilaa maantadan la joogo, weli waa arrin ra'yi ah haddii boolal saxan ah ama cidiyaha intramedullary ay ka fiican yihiin.Iyadoo aan loo eegin mid ka mid ah kuwa ugu wanaagsan indhaha Ilaah, maanta waxaynu samayn doonaa dulmar guud talooyinka qalliinka ee ciddida intramedullary ee jabka tibial fog.

Qalliinka ka hor ee "taayirka firaaqada" dhigay

Iyadoo diyaargarowga caadiga ah ee qalliinka ka hor aan loo baahnayn, waxaa lagu talinayaa in la helo xirmo firaaqo ah oo ah boolal iyo taargooyin haddii ay jiraan xaalado aan la fileynin (tusaale, khad jaban oo qarsoon oo ka hortagaya meeleynta boolal qufulka, ama qaladka bini'aadamka ee sii xumeynaya jabka oo ka hortagaya dhaqdhaqaaqa, iwm. .) taas oo laga yaabo inay ka dhalato isticmaalka ciddida intramedullary.

4ta saldhig ee dib u dhigista guusha leh

Sababo la xiriira anatomy oblique ee metaphysis tibial fog, jiidista fudud ayaa laga yaabaa inaysan had iyo jeer keenin hoos u dhac guul leh.Qodobada soo socda ayaa kaa caawin doona hagaajinta heerka guusha ee meelaynta:

1. qaado orthopantomograms ka hor qaliinka ama qalliinka gudaha ee addinka caafimaadka qaba si loo barbar dhigo oo loo go'aamiyo heerka dhimista jabka dhinaca ay saamaysay.

2.Isticmaal booska jilibka ee badh-jilicsan si aad u fududayso meelaynta ciddiyaha iyo fluoroscopy

3. Isticmaal dib-u-dejiye si aad u ilaaliso addinka meesheeda iyo dhererka

4. Dhig boolal Schanz ee tibia fog iyo u dhow si ay u caawiyaan dhimista jabka.

7 Faahfaahinta Dhimista Caawinta iyo Dhaqdhaqaaq La'aanta

1. Si sax ah u dhig biinka hagaha dhanka tibia fog adiga oo isticmaalaya qalab ku haboon ama adoo hore u foorarsanaya caarada biinka hagaha ka hor meelaynta.

2. isticmaal xooga dib u soo kicinta ee maqaarku ka samaysan yahay si aad u geliso cidiyaha intermedullary ee laf dhabarta iyo laf dhabarta (Jaantuska 1)

3. Isticmaal saxan adag oo leh hagaajinta monocortical (tabular ama saxan cadaadis) hoos u furan si loo ilaaliyo dhimista ilaa cidiyaha intramedullary la geliyo

4. cidhiidhinta kanaalka ciddiyaha intramedullary iyada oo la adeegsanayo boolal xannibaad ah si loo saxo angulation iyo kanaalka si loo hagaajiyo guusha meelaynta ciddiyaha intramedullary (Jaantus 2)

5. iyadoo ku xiran nooca jabka, go'aanso inaad isticmaasho biinanka Schnee ama Kirschner.

6. ka hortag jabka cusub marka la isticmaalayo boolal xannibaya bukaanada lafo-jileecu

7. hagaajin fibula marka hore ka dibna tibia kiiska jabka fibula la isku daray si loo fududeeyo dib u habeynta tibial

Jaantuska 1 Isku xidhka Weber-ku-duubka ee dib-u-dejinta dib-u-habaynta aragtiyaha qarsoon (Jaantusyada A iyo B) waxay soo jeedinayaan dillaac yar oo fog oo tibia ah kaas oo naftiisa u leh fluoroscopic percutaneous ugu yar ee soo galitaanka sanka-fiiqan ee dib-u-dhigista kaas oo waxyeello yar u geysta unugyada jilicsan

Jaantus. 2 Isticmaalka boolal-xidhka Sawirka A wuxuu muujinayaa jabka aadka loo jarjaray ee metaphysis tibial-ka fog oo ay ku xigto qallafsanaanta xagasha dambe, oo leh qallafsanaan hadhaaga ka dib hagaajinta fibular inkastoo la hagaajinayo cilladda xagasha dambe ee sagittal (Jaantus C) (Sawir. B), oo leh hal fur oo xannibaya oo la dhigay gadaal iyo mid dambe oo ku yaal dhammaadka fog ee jabka (Berdihii. B iyo C), iyo ballaarinta medullary ka dib marka la dhejiyo biinanka hagaha si loo sii saxo qallooca wadnaha (Jaantus. D), iyadoo la ilaalinayo sagittal dheellitirka (E)
6 dhibcood oo loogu talagalay hagaajinta intramedullary

1. Haddii lafaha fog ee jabku uu yahay mid ku filan lafo, ciddida intramedullary ayaa lagu hagaajin karaa iyada oo la geliyo 4 boolal oo dhinacyo badan ah (si loo hagaajiyo xasilloonida faashash badan), si loo hagaajiyo qallafsanaanta qaabdhismeedka.
2. Isticmaal cidiyaha intramedullary taasoo u oggolaanaysa furayaasha la geliyey inay dhex maraan oo sameeyaan qaab-dhismeed quful leh oo xasilloon oo xagal ah.
3. Isticmaal boolal qaro weyn, boolal badan, iyo diyaarado badan oo meelaynta fur si aad ugu qaybiso boolal inta u dhaxaysa darafyada fog iyo kuwa u dhow ee jabka si loo xoojiyo saamaynta hagaajinta ciddida intramedullary.
4. Haddii ciddiyaha intramedullary la dhigo meel aad u fog si hagaha hore loo leexiyay uu ka hortagayo fidinta tibial-ka fog, ka dibna hage-hore aan hore u qaloocin ama balaadhin la'aan fog ayaa la isticmaali karaa.
5. Hayso ciddida xannibaysa iyo saxanka ilaa jabku ka yaraado, ilaa ay ciddida xannibaysaa ka hor istaagto in ciddida intramedullary ay faafiso lafta ama saxanka unicortical-ku uu dhaawaco unugyada jilicsan.
6. Haddii ciddiyaha intramedullary iyo boolal aysan bixinin dhimis ku filan iyo hagaajin, saxan ama fur-fure ayaa lagu dari karaa si loo kordhiyo xasilloonida ciddiyaha intramedullary.

Xusuusin

In ka badan 1/3 ee jabka tibia fogaana waxay ku lug leeyihiin wadajirka.Gaar ahaan, jabka jirridda tibial fog, jabka tibial spiraal, ama jabka laf-dhabarta ee laxiriira waa in lagu baaro jabka gudaha articular.Hadday sidaas tahay, jabka gudaha-godku wuxuu u baahan yahay in si gaar ah loo maareeyo ka hor inta aan la dhigin ciddiyaha intramedullary.