Ukuqhekeka kwe-Tibial Shaft Kuyingozi kakhulu futhi kuvame ukuhlinzwa
I-tibia iyithambo elikhulu le-shin elisemkhatsini wamadolo ne-ankle. Le ngxenye yomzimba ibizwa ngokuthi-emigulweni yezokwelapha-umlenze, futhi kanye nomlenze nethanga kube nomkhawulo ophansi (umlenze empeleni kuphela ingxenye phakathi kwamadolo nezinyawo, nakuba abantu abaningi bebiza umkhawulo ophansi njengoba 'umlenze').
Kukhona amathambo amabili omlenze, i-tibia kanye ne-fibula.
I-tibia yithambo elikhulu abantu abavame ukubhekisela kulo njengethambo le-shin. Iningi lesisindo somzimba lisekelwa yi-tibia. I-fibula ithambo elincanyana elisendaweni engaphandle komlenze futhi alisekeli isisindo esikhulu somzimba, nakuba sisebenzela imisebenzi ebalulekile ekuhlanganyeleni kwamadolo nangamazinyo futhi kuhlanganiswa kwemisipha nemigqa.
I-Tibial shaft fractures kukhona ukulimala okungenzeka ngemva kokuwa, izingozi zemoto, ukulimala kwezemidlalo, neminye imisebenzi. I-shaft ye-tibia yiyona ingxenye ephakathi yethambo, hhayi ukuphela kwethambo eliphezu kwesigca noma ngaphezulu kwe-ankle. Igama lezokwelapha lomuthi we-tibia yi-diaphysis yethambo. I-shaft ye-tibia yi-tube engenalutho, nakuba inomumo oyingqayizivele ongaphansi kwe-tibia crest ibe yi-ridge evelele ngaphambili kwe-shin. Ama-fractures angase avele phezulu kwesifuba shin (i -tibia fractures ) noma ngaphansi kwe-bone bone ( distal tibia fractures ).
Ngaphakathi kwesizinda esingenalutho sothambo lwesinki yi-canal yomnyofu wamathambo. Ingxenye yangaphandle yethambo ibanzi futhi iqine; lokhu kubizwa ngokuthi i-cortex yethambo futhi inikeza amandla we-tibia. Uma kwenzeka ukuqubuka kwe-tibia , ithambo liphazanyiswa, futhi ukuzinza komlenze kuyonakele. I-Tibia fractures ivame ukulimala kabi, futhi ngokuvamile idinga ukwelashwa okuphuthumayo.
Izimpawu ze-Tibial Shaft Fractures
I-Tibia fractures ngokuvamile ilimala ngokusobala, kodwa ngezinye izikhathi ukuhlukunyezwa okungezona okushiwo phansi, okungabikho kwemiphakathi kungase kube nzima ukubona. Izimpawu ezijwayelekile ze-tibia fracture zifaka:
- Ubuhlungu obukhulu emkhawulweni
- Ukukhubazeka komlenze
- Ukuthambekela ngokuqondile emathanjeni
- Ukungakwazi ukubeka isisindo emlenzeni
Uma kukhona ukukhathazeka mayelana nokwehlukana kwe-shabial shaft, i-x-ray izotholakala ukuze kunqume ukuthi ithambo lonakalisiwe. Ngokuvamile ukuhlolwa kwe-x-ray kukwanele ukwenza ukuxilongwa, noma kunjalo, ezimweni ezinjenge- tibial stress fractures , kungase kube khona umbuzo mayelana nobuhlungu bokulimala, futhi kungenzeka ukuthi i-MRI noma i-scan scan itholakala uma kukhishwa isifo futhi ama-x-ray ajwayelekile.
Iningi le-tibia lahleka lingelashwa njengokuphuthuma okuphuthumayo noma ngokuqiniswa okulandelwa ukulibaziseka ukwelashwa okuqondile. Kodwa-ke, kunezimo lapho ukuphela kwe-tibia kudinga khona ukwelashwa okuphuthumayo. Esinye salezi zizathu ukuvuvukala okuvulekile lapho amathambo we-tibia afinyelele esikhumbeni. Ngenxa yokuthi kungenzeka ukutheleleka lapho ithambo lingena esikhumbeni, lezi zinkinga ngokuvamile ziphathwa njengeziphuthumayo zokuhlinzwa .
Ukwelashwa kwe-Tibial Shaft Fractures
Ukuphuka kwe-shabial shaft kungaphathwa ngezindlela eziningana kuye ngokuthi uhlobo lokuphulwa nokulungiswa kwethambo.
Ngokwesiko, iningi le-tibia fractures lalashwa nge-cast application noma ama-braces. Kodwa-ke, maduze nje, lo mkhuba ushintshele ukwelashwa okunamandla okukhulu ngokusimama okuhlinzekwa kwe-bone ephukile. Ukuhlinzekwa kwesizathu kuba yinto evamile ukuthi izimpande nezinqubo zokuhlinzeka ziye zathuthukisa ukwenza ingozi yokuhlinzeka kakhulu futhi izinzuzo zokuphulukiswa okungaphezu kokubikezela kokulimala.
Imithi ejwayelekile kakhulu ye-tibia shaft ephukile ihlanganisa:
- Ukukhipha
I-cast ilungele ama-fracture e-tibial e-shaft engasebenzi kahle futhi ahambelana kahle. Iziguli zidinga ukuba zibe esitokisini esihamba ngenhla emadolweni nangaphansi kwesigqoko (umlenze omude owedlule). Inzuzo yokukhipha ukuthi lezi ziphuka zivame ukuphulukisa kahle nokugxila kugwema izingozi ezingase zibe khona zokuhlinzwa ezifana nokutheleleka. Iziguli ezinama-casts kumele zihlolwe ngokucophelela ukuqinisekisa ukuphulukiswa okwanele kwe-tibia nokuqinisekisa ukuthi amathambo agcina ukulungiswa kwawo. Ama-x-rays avame ukuqhutshwa ukuze kuqinisekiswe ukuthi ukuphulukiswa kuyaqhubeka njengoba kulindeleke.
- I-Intrameduallary (IM) i-Rodding
I-intrameduallary rodding yinkqubo yokubeka induku yomdanso phansi phakathi kwe-tibia ukugcina ukufana kwethambo. I-rodbial rodding yinkqubo yokuhlinzwa ehlala cishe ihora nehafu futhi ivame ukwenza ngaphansi kwe-anesthesia ejwayelekile. Iziguli ziyoba nomshini phezu kwehlangothini lamadolo, kanye nokucubungula okuncane ngaphansi kwamadolo nangaphezulu kwesikhumba. Ngaphezu kwalokho, amanye amafracture angadinga ukuxubana eduze kwe-fracture ukuze kulungiswe amathambo. Izinduku ze-IM zivikelekile ngaphakathi kwethambo ngokufaka izikuluzi zombili ezingenhla nangaphansi kwe-fracture. Izikhonkwane zensimbi kanye nenduku zingasuswa uma zidala izinkinga, kodwa zingashiyelwa endaweni yokuphila. I-rodbi ye-tibial inikeza ukulungiswa okuhle kwamathambo. Ingozi ejwayelekile kunazo zonke yokuhlinza ibuhlungu emadolweni, futhi okuphathelene nokucindezeleka kunesifo. Ukungena kwenduku kungadinga ukukhipha induku ukuze uphulukise ukutheleleka. - Ama-Plates kanye nezikulufa
Amapulangwe kanye nezikuluzi zivame ukusetshenziselwa kakhulu, kepha ziwusizo ezinhlotsheni ezithile zokuqhekeka, ikakhulukazi lezo eziseduze namadolo noma ama-ankle amajoyini (bona ulwazi oluthile lwe-plateau ne-tibial fractures). Odokotela abaningi abahlinzayo bakhetha i-IM rod ye-tibial shaft fractures ngaphandle kokuthi ukuphulwa kuseduze kakhulu nokujoyina ukuvumela ukufakwa kwe-IM rod. Kule fractures eduze kwendawo ehlangene, ipuleti nezikuluzi zingahle kube yindlela enhle yokulungisa. - Fixator yangaphandle
I-fixator yangaphandle ingase ibe usizo nakwezinye izinhlobo ezithile zokuphulwa. Izilungisi zangaphandle zivame ukusetshenziselwa ukuhlukumeza okukhulu, ikakhulukazi ukuvuvukala okuvulekile okuphazamiseka okuhambisana nokulimala komzimba. Kulezi zimo, ukufakwa kwezinduku ze-IM noma amapuleti angeke kwenzeke ngenxa yokulimala kwezicubu. Uma kukhona ukulimala okuphawulekayo kwesikhumba, i-fixator yangaphandle inganikeza ukukhubazeka okuhle kakhulu ngenkathi ivumela ukuqapha nokwelashwa kwezicubu ezincane eziseduze.
Ukubuyisela Ukulandela Ukulimala
Ukuphulukisa isikhathi esilandelayo ngokuhlukana kwe-shabial shaft kungase kuxhomeke kakhulu kuhlobo lokuphuka, ubunzima bokulimala kanye nendlela yokwelapha ekhethiwe. Ngokuvamile, ama-fracture e-tibial shaft azothatha okungenani izinyanga ezingu-3 ukuphulukiswa, futhi akuyona into engavamile ukuba izinhlanzi zithathe izinyanga ezingu-4 kuya ku-6 ukuze ziphinde zithole. Ukuzwa lokhu kungase kuphazamise, kodwa khumbula ukuthi kuye ngokuthi isimo sakho esiyingqayizivele ungakwazi ukwenza okusheshayo ngokushesha.
Inani lesisindo esingasetshenziswa emkhawulweni nalo liguquguquke kakhulu. Kwezinye izimo ezinamalahle azinzile aphethwe endaweni enezimboni zensimbi, kungenzeka ukuvunyelwa kwesisindo ngokushesha. Kwezinye izimo lapho kunokukhathazeka okuningi mayelana nokuvumelanisa ukuhlukana noma ukuzinza, isisindo singavinjelwa kuze kuphele ukuphulukiswa.
Ukukhathazeka okunye nge-tibia fractures kubizwa ngokuthi yi- nonunion , isimo lapho amathambo ehluleka ukuphulukisa ngokuphelele. Amanyunyana awavamile kubantu bonke-ajwayelekile kakhulu ngemva kokulimala kakhudlwana nokuvuvukala okuvulekile, noma kubantu abanezimo zezokwelapha ezingase zenze ukuphulukiswa kwamathambo. Esinye sezimbangela ezivame kakhulu zokungaboni ngaso sonke isikhathi kungukusebenzisa ugwayi , lapho ukusetshenziswa kwe-nicotine kuholela ekuphutheni ukuphulukiswa kwe-bone fracture, ngakho-ke kubalulekile ukugwema ukubhema nezinye izinhlobo zokudla ugwayi. Ingxoxo nodokotela wakho ingcono ukunquma ukuthi yiyiphi indlela engcono kakhulu yokwenza ngayo kulesi simo.
> Imithombo:
> Tejwani N, Polonet D, uWolinsky PR. "Ukuphikisana okugxilwe kwe-intramedullary ye-probia et distal tibia fractures" J Am Acad Orthop Surg. 2014 Oct; 22 (10): 665-73.
> Bedi A, LeTT, Karunakar MA. "Ukwelashwa okuhlinzekwa kwe-nonarticular distal tibia fractures" J Am Acad Orthop Surg. 2006 Jul; 14 (7): 406-16.
> Bono CM, et al. "Izinyathelo Zokungavumelani Zomphakathi Okungavunyelwe Ukwelashwa: Izinketho Zokwelashwa Nokumiswa Kwezinqumo" J Am Acad Orthop Surg May / June 2001; 9: 176-186.