Tibial a ɛpaapae, suprapatellar intramedullary nnadewa kwan

Intramedullary nailing kwan a wɔfa so de tibial fractures: denam suprapatellar, transarticular kwan a wɔde kotodwe no abɔ wɔ 20-30° ne ahobammɔ tube pɔtee bi a wɔde bɔ intra-articular nhyehyɛe ahorow no ho ban so.

01.Tibial Intramedullary Nnade a Wɔde Yɛ Adwuma: kwan a wɔfa so kɔ hɔ ne nea ɛne ne ho hyia, kotodwe anim yaw

Oprehyɛn kwan a wɔfa so de nnadewa a wɔde hyɛ tibial fractures no mu no ho hia na ama wɔde nnadewa a ɛwɔ medullary no mu afa baabi a ɛfata a wɔde hyɛn mu, sɛnea ɛbɛyɛ a wɔbɛsɛe kotodwe nhyehyɛe ahorow a ɛwɔ ntini no mu no kakraa bi, na wɔanya akisikuru no a wɔbɛsan de asi baabi a eye na nnadewa no akɔ mu yiye.

Akwan a wɔtaa fa so yɛ tibial stem fractures ne median infrapatellar anaa parapatellar akwan. Ɛwom sɛ wɔakyerɛ akwan yi ama mfinimfini fã a ɛpaapae de, nanso oprehyɛn akyi valgus, anim, anaa syndesmotic deformities taa ba wɔ akisikuru a ɛbɛn kɛse no mu.

Ade titiriw a ɛde malalignment ba wɔ proximal tibial fractures mu ne dɛmdi a ɛba esiane quadriceps tendon a wɔtwe bere a wɔrebɔ kotodwe no ne mfiri a ɛko tia nnadewa no ano ne akyi tibial cortex ntam bere a wɔde implant rehyɛ mu no. Patella no nso siw nnadewa no kwan sɛ ɛbɛkɔ axial wɔ sagittal plane no mu (Mfonini 1a, b). Enti, ɔkwan foforo a wɔtaa fa so hyɛn beae no mu ne sɛ wɔfa mfinimfini parapatellar incision, a ɛde nnadewa a wɔde hyɛ mfinimfini kosi akyi kakra (Mfonini 1c ne 2). Bere a nnadewa no hyɛn intramedullary canal a ɛwɔ akyirikyiri wɔ abubuw no ho no, ɔfã a ɛbɛn no dan kɔ exostosis mu (Mfonini 2). Awiei koraa no, ahomegye mu nhyɛso a ɛwɔ anim dan mu ntini no mu no boa kakra ma ectropion no ba (Mfonini 3).

Mfonini 1 a,b Sɛ yɛde infrapatellar kwan a wɔtaa fa so di dwuma a, patella no siw nnadewa no axial kwan a ɛkɔ mu no ano, na ɛde anterior apical sagittal alignment ne ectropion coronal alignment a ɛtaa yɛ dɛmdi ba.c Wɔde parapatellar kwan no na ɛyɛɛ intramedullary nail alignment.

Mfonini 2 Sɛ wofa mfinimfini parapatellar incision so bɛn baabi a wobɛhyɛn no a, ɛma wɔde nnadewa no hyɛ mfinimfini kosi akyi kakra. Bere a nnadewa no hyɛn medullary canal a ɛwɔ akyirikyiri wɔ baabi a abubu (a) no, wɔdannan fã a ɛbɛn no ma ɛbɛyɛ ogyaframa (b) .

Mfonini 3 Ahomegye mu nhyɛso a ɛwɔ anim ntini dan no mu ( a ) ma ɛyɛ anifere kwan so nhyehyɛe a ɛwɔ awotwaa no akyi ( b ) .

Sɛ wɔde nnadewa bɔ tibia no mu wɔ gyinabea a ɛtrɛw kɛse a, ɛboa ma wɔkwati nsɛnnennen a ɛbata kotodwe a ɛbɔ denneennen wɔ oprehyɛn no mu ho.Gelbke, Jakma ne afoforo na wɔkaa ɔkwan no ho asɛm. wɔ afe 2010 mu na agye din wɔ nnansa yi mfe mu efisɛ sɛ wɔde nnadewa bɔ asen no wɔ baabi a ɛkame ayɛ sɛ ɛyɛ tẽẽ a, ɛma ɛyɛ mmerɛw sɛ wɔbɛdannan abubuw no na wɔasan de asi baabi foforo. Fluoroscopy abɛyɛ nea ɛyɛ mmerɛw wɔ mfiridwuma mu. Wɔabɔ amanneɛ sɛ bere a wɔde yɛ fluoroscopy bere a wɔde bɔ nnadewa a ɛwɔ akyi no yɛ tiaa koraa sen nnadewa a wɔde bɔ nnadewa a ɛwɔ akyi no . Afei nso, nnadewa a wɔde hyɛ mu no anim (wɔ sagittal plane no mu) ne tibia no tenten kwan no hyia kɛse wɔ saa kwan yi so sen infrapatellar nnadewa a wɔde hyɛ mu; eyi mma mfiri a ɛbɔ nnadewa no ano ne akyi ntini no ntam, na ɛnam so ma ɛyɛ mmerɛw sɛ wɔbɛtew akisikuru no so.

Oprehyɛn akyi kotodwe anim yaw yɛ ɔhaw a ɛfata. Wɔabɔ amanneɛ sɛ kotodwe anim yaw wɔ ayarefo a wɔabubu no mu 50-70% mu, na ayarefo 30% pɛ na ɛyaw no ano brɛ ase bere a wɔayi endplate no akyi. Wɔabu akontaa sɛ akuru a ɛba wɔ patellar tendon ne Hoffa srade a wɔde hyɛ mu a ɛfa kwan a wɔfa so nya ho no betumi ama nkotodwe mu yaw wɔ oprehyɛn akyi. Bio nso, suprapatellar kwan no kwati atetesɛm mu ntwitwiridii a ɛne sɛ wobetwa saphenous nerve no patellar nkorabata no nkorabata no, na ɛkwati kotodwe anim a ɛyɛ mmerɛw na ɛyɛ mmerɛw (Mfonini 4). Ɛte sɛ nea nnadewa no a wɔde fa quadriceps ntini no mu, na ɛnam so ma patellar ntini no yɛ nea enni dɛm no ma kotodwe mu yaw a ɛba wɔ oprehyɛn akyi no so tew kɛse.

Mfonini 4 Abusuabɔ a ɛda saphenous nerve ne akwan horow a wɔfa so kɔ tibialis obliqua nnadewa no so ntam

Esiane sɛ nea efi proximal fractures mu ba yiye nti, wɔatrɛw nsɛnkyerɛnne a ɛwɔ ayaresabea adwumayɛ mu no mu akɔ abubuw nyinaa mu.

Ɔhaw ahorow a ebetumi aba wɔ intramedullary nailing ho wɔ suprapatellar kwan no so:

- betumi agyaw reaming debris wɔ kotodwe nkwaa mu. Nanso, ayaresabea osuahu a ɛfa retrograde femoral nailing ho no nkyerɛɛ nkɛntɛnso bɔne biara a ɛba bere tiaa anaa bere tenten mu.

- sedee ebeye na woyi implant no bere a abubuo no asa akyi? Ɛwom sɛ ɛyɛ yiye wɔ mfiridwuma mu sɛ wobeyi nnadewa a ɛwɔ medullary mu denam suprapatellar kwan so de, nanso ɔkwan a wɔfa so yɛ no yɛ nea ɛhwehwɛ pii na oprehyɛnfo dodow no ara pɛ sɛ wɔfa infrapatellar kwan so yi nnadewa a ɛwɔ medullary mu.

02.Bere bɛn na ɛsɛ sɛ wɔde suprapatellar intramedullary nail di dwuma?

Mfaso a ɛwɔ so

- semi-extended knee position ma fracture manipulation ne reduction denam ntini ahoɔden a ɛma ahomegye ne retention bere a wɔde nnadewa rehyɛ mu no so.

- asiane a ɛba fam sɛ oprehyɛn akyi malalignment a ɛwɔ proximal, segmental, ne distal fractures mu no sua sɛ wɔde toto atetesɛm akwan ho a

- nailing ye mfiridwuma mu mmerɛw se wobeye

- Nailing yɛ yie sɛ 'oprehyɛnfoɔ baako adeyɛ'.

- a wɔatew fluoroscopy bere so

- a enni patellar tendon no mu na ennye nnadewa akyi nkotodwe anim yaw

- a ɛyɛ mmerɛw sɛ wɔbɛyɛ wɔ akuw pii nhyehyɛe mu, sɛnea ɛte wɔ polytrauma ho no.

Mfomso ahorow a ɛwom

- Asiane a ebetumi asɛe kotodwe mu ntini ne ntini afoforo a ɛwɔ ntini no mu

- a ewo asiane a ewo nkotodwe mu yare no ho

- a wobeyi afiri a wode bɛhyɛ mu no betumi ahwehwɛ sɛ wɔfa ɔkwan foforo so

Nsɛnkyerɛnne a ɛkyerɛ

- a ebubu ntini a ewo akyi (Type AO 41A) .

- a ɛyɛ mmerɛw a wɔabubu a ɛyɛ tibial diaphysis (type AO 42A-C) .

- a ɛyɛ segmental tibial diaphysis a ɛpaapae (type AO 42C) .

- extra-articular ne simple intra-articular distal extension fractures a ɛwɔ akyirikyiri tibia (ahorow AO 43A ne C1) .

- a esensen kotodwe

Nneɛma a wɔde siw ano

- Gustilo grade 3C open fractures of the tibia esiane asiane a ɛkɔ soro sɛ nkwaa mu yareɛ bɛba nti, ɛwom sɛ wɔmmɔ asiane a ɛkɔ soro a ɛwɔ nkwaa mu yareɛ ho amanneɛ wɔ open fractures mu

- a ɛyɛ mmerɛw a ɛtetew, efĩ anaa ɔyare mmoawa a ɛwɔ suprapatellar mpɔtam hɔ

- kotodwe a wɔde yɛ nipadua no afã horow (a ɛne ne ho bɔ abira) .

- nkotodwe fusion

- kotodwe mu ntrɛwmu a ɛboro so >20°

- Ipsilateral tibial plateau fracture a ɛfa nnadewa a ɛkɔ mu no ho no yɛ ade a ɛne no bɔ abira kakra

- a wode bɛhyɛ mu a esiw nnadewa no kwan a ɛkɔ mu no kwan

- Ipsilateral patella fracture (a ɛyɛ nea ɛne no bɔ abira) .

03. Akwan a wɔfa so yɛ oprehyɛn

1 Nipadua gyinabea ne sɛnea wohu nneɛma

Mfonini 5 Ɔyarefo no da fam wɔ pon a radiolucent a ɛma kwan ma wotumi gyina ne nan a apaapae so so. Wogyaw ɔhonam akwaa a abubu no sɛn hɔ kwa na wɔde nhoma mmobɔwee bi gu kotodwe nkwaa (a) ase na ama wɔatumi abɔ nkotodwe no 10-30° 

(b) no. Wɔde C-abasa no si ɔfã a ɛne no bɔ abira no so. Wɔma nan a ennyaa nkɛntɛnso no sian 10-30° fi soro na ama wɔahwɛ ahu sɛ mfonini a ɛfata wɔ akyi gyinabea.

2Hwehwɛ baabi a ɛfata a wɔde ade hyɛn mu

Mfonini 6 Saa kwan yi yɛ nea wɔde patella no dua, tibial tuberosity, ne anterior tibial cortex na ɛhyɛ no agyirae. Wɔyɛ honam ani ntwitwiridii a ne tenten yɛ sɛntimita 2 wɔ sɛntimita 1-1.5 a ɛbɛn patella no nnyinaso a ɛwɔ soro no. Wɔda quadriceps ntini no adi na wɔyɛ mfinimfini kwan tenten a wɔatwa wɔ ntini no nhama no kwan so. Wobue suprapatellar recess no na oduruyɛfo a ɔyɛ oprehyɛn no nsateaa fi kotodwe nkwaa no mu fi patella no ase kɔhwɛ sɛnea ɛyɛ mmerɛw sɛ wobɛkɔ hɔ. Ebia ɔhonam akwaa no a wɔbɛtrɛw mu kakra no bɛma ayɛ mmerɛw sɛ wobetumi akɔ kotodwe no so. Langenbeck retractor a wɔde bɛhyɛ mu ma ama patella no akɔ soro kakra nso betumi ama kwan a wɔfa so kɔ hɔ no ayɛ kɛse. Sɛ nkwaa no mu baabi yɛ teateaa yiye na nnwinnade a wɔde bedi dwuma no yɛ den a, wobetumi atwitwa mfinimfini anaa akyi a ɛboa no wɔ baabi a ɛbɛn no sɛnea ɛbɛyɛ a wɔbɛpaapae patella no fã bi akɔ ɔfã biako.

3Ahobammɔ a wɔbɔ wɔ ntini a ɛwɔ ntini mu ho

Mfonini 7 Patellofemoral cartilage a wɔbɛbɔ ho ban afi opira a oprehyɛn de ba ho no yɛ oprehyɛn no botae atitiriw no mu biako. Enti, ɛsɛ sɛ wɔde nsateaa a ɛbɔ ho ban di dwuma bere a wɔde adwinnade ne nnadewa rehyɛ mu.a Nnwinnade a wɔde fa ntini mu no bi ne nsa a wɔde hyɛ mu, nsa a wɔde hyɛ mu, abɔnten (a ɛyɛ mmerɛw) ne mu (dade) a wɔde bɔ ho ban, trocar pin, ne nhama a ɛwɔ abon mu akwankyerɛfo.b Wɔde nsa a ɛbɔ ho ban ne nsateaa a ɛbɔ ho ban ne abɔnten (a ɛyɛ mmerɛw) ne mu (dade) a ɛbɔ ho ban, a trocar pin, ne a ɛyɛ porous wayam akwankyerɛfo. Wɔde ahobammɔ nsateaa ne nsa a wɔde hyɛ mu no na ɛboaboa trocar needle no ano.b Mounting handle with lateral ventilation holes. Knob a ɛwɔ nsa a wɔde hyɛ mu no atifi no mma nsa no nhyiam no ntumi nkɔ mu wɔ akwanhyia mu

4 Fa akwankyerɛ hama no hyɛ mu na siesie gyinabea no

Mfonini 8a Wɔde nsa nhyiamu no hyɛ patella no ase fa patellofemoral joint no mu kɔ baabi a wɔpɛ sɛ wɔhyɛn tibia no so (Mfonini 9). Mpɛn pii no, patella no bɛkɔ mfinimfini anaa akyi kakra bere a wɔde adwinnade no rehyɛ mu no. Mpɛn pii no, groove a ɛwɔ patellofemoral joint no mu no kyerɛ trocar needle no kwan kɔ baabi a ɛfata no ara kwa.

Mfonini 8b Wɔde fluoroscopy sii gyinabea so dua wɔ wimhyɛn abien no nyinaa mu na wɔteɛteɛɛ mu wɔ baabi a ɛho hia. Afei wɔde akwankyerɛ hama a ɛwɔ abon mu si trocar ade no ananmu, akwankyerɛ hama a ɛfa akwankyerɛ hama no mfinimfini tokuru mu na wɔde ne ano hyɛ proximal tibial metaphysis no mu de hwɛ hu sɛ ɛwɔ baabi a ɛfata.

Mfonini 8c Sɛ akwankyerɛ hama no wɔ beaeɛ a ɛnyɛ papa a, wɔbɛtumi de akwankyerɛ hama a ɛtɔ so mmienu adi dwuma de ayɛ nsakraeɛ kakra wɔ beaeɛ pa afa akwankyerɛ hama a ɛwɔ abon no mu, akɔsi 4.3 mm a ɛboro soɔ Sɛdeɛ ɛyɛ ɔkwan foforɔ no, ebia ɛbɛyɛ mmerɛ sɛ wɔde akwankyerɛ hama no bɛhyɛ aseɛ na wɔde asi baabi a ɛyɛ papa a wɔbɛhyɛn mu a obiara mmoa biara. Afei wɔde adwinnade a wɔde hyɛ mu a ɛwɔ akwankyerɛ hama no so no fa akwankyerɛ hama no so.

5 Medulla oblongata no ntrɛwmu

Mfonini 9a Medullary cavity a wobebue afi baabi a eye a wobetumi akɔ mu no yɛ anammɔn titiriw wɔ oprehyɛn no mu. Wɔ anteroposterior plane no mu no, eyi ne mfinimfini fã a ɛwɔ lateral tibial spur no mu. Wɔ akyi wimhyɛn no mu no, baabi a ɛfata a wɔfa so hyɛn mu no wɔ nsakrae a ɛda articular surface ne anterior cortex ntam no.

Mfonini 9b Gyinabea a ɛfata a akwankyerɛ hama no wɔ no ne tibial axis a ɛwɔ anteroposterior plane no mu no hyia na ɛbɛn anim cortex no sɛnea ɛbɛyɛ yiye biara wɔ lateral projection no mu. Akwankyerɛ hama no taa kɔ akyi.

Mfonini 9c Wɔ nsɛm a wontumi mfa pin anaa nnadewa nhyɛ mu yiye mu no, nnadewa anaa pin no a wosiw no boa ma wɔkyerɛ nnadewa no kwan kɔ gyinabea a ɛfata. 

Wɔde nnadewa a esiw kwan di dwuma wɔ metaphyseal mpɔtam a ɛtrɛw no mu bere a wontumi mfa akwankyerɛ hama anaa nnadewa no nsi mfinimfini nkɔ dompe no tenten kwan no so anaasɛ bere a mpaapaemu a ɛnhyia wɔ wimhyɛn biako anaa abien no nyinaa mu no da so ara wɔ hɔ bere a wɔde nnadewa no rehyɛ mu no.

Mfonini 10 Wɔ saa bere yi mu no, wɔkamfo kyerɛ sɛ wɔmfa 3.2 mm akwankyerɛ waya kyekyere nsa nhyiam no wɔ asen no mu. Eyi mma nhyiam no ntumi mfi tibia no mu.

Mfonini 11 Wɔde 12.0 mm tokuru drill bit no fa mu ahobammɔ nsateaa no mu na ɛkɔ fam fa akwankyerɛ hama no mu kɔ dompe no mu. Wɔnam drilling a ɛkɔ fam 8-10 cm so na ebue medullary canal no na wɔde guidewire a ɛyɛ ball-ended hyɛ proximal tibia no mu.

6 Abubuw a wɔtew so

Mfonini 12a Saa bere yi mu no, yɛsan de abubuw no si hɔ.

Mfonini 12b Ɛgyina beaeɛ a abubuo no wɔ ne ne nsɛsoɔ so no, wɔbɛtumi de nnwinnadeɛ ahodoɔ a ɛtew so te sɛ percutaneous clips, retractors, fragment plates nketewa, ne blocking screws adi dwuma na ama ayɛ pɛpɛɛpɛ. Wɔ proximal tibial fracture reduction mu no, ɛtɔ mmere bi mpo a wɔde nneɛma foforo a wɔde hyɛ nipadua mu boa, ansa na wɔabue medullary canal no denam drilling so. Wɔde reaming poma no kɔ anim wɔ akyirikyiri na wɔde hyɛ distal tibial metaphysis no mfinimfini. Sɛ wɔsan de nnadewa no si baabi foforo wie a, wɔkyerɛ nnadewa no tenten ne ne kɛse. Sɛ ɛho hia a, ma tibial canal no nyɛ kɛse ma ɛnyɛ ne kɛse a wopɛ denam reaming a wode 0.5 mm nkɔanim so. Bue a ɛwɔ nsateaa a ɛbɔ ho ban no mu no ma wotumi hohoro nneɛma a asɛe a efi nkwaa no mu na wɔtwe bere a wɔreyɛ reaming no. Sɛ ɛbɛyɛ yiye a, wɔkamfo kyerɛ sɛ wɔmfa nnadewa a anyɛ yiye koraa no ne kɛse yɛ mm 10 nni dwuma. 5.0 mm Locking Bolt a wɔde yɛ nnadewa yi no tumi gyina huammɔdi ano sen 4.0 mm Locking Bolt a wɔde yɛ nnadewa a ɛyɛ fɛ no. Wɔtaa de fluoroscopic ruler kyerɛ nnadewa a ɛwɔ medullary mu no tenten.

7Fa nnadewa a ɛwɔ medullary mu hyɛ mu

Mfonini 13a Nnadewa a wɔde hyɛ mu fa reaming poma no mu wɔ fluoroscopy ase. Hyɛ no nsow sɛ nsa a wɔde hyɛ mu ma suprapatellar nnadewa no ware sen nea wɔde hyɛ infrapatellar nnadewa no mu efisɛ kwan a ɛda honam ani ntwitwiridii no so kosi baabi a tibial nnadewa no hyɛn mu no nso ware.

Mfonini 13b Yɛsrɛ sɛ hyɛ no nsow sɛ wontumi mfa dade ahobammɔ nsateaa a ɛwɔ mu no mu nkɔhyɛ bend (Herzog curve) a ɛwɔ intramedullary nail no awiei a ɛbɛn no mu. Enti, ɛsɛ sɛ woyi emu ahobammɔ nsateaa no fi nsa nhyiamu no mu ansa na wɔde nnadewa no ahyɛ mu (b; hwɛ ɔfa 'Mfomsoɔ, Asiane ne Nsɛnnennen'). Hwɛ gyinabea a etwa to a intramedullary nail no wɔ wɔ anim-akyi ne akyi hwɛbea no mu. Yi reaming poma no fi hɔ. Sɛ ɛho hia sɛ wɔsesa nnadewa no a, gyaw reaming poma no wɔ nea ɛwɔ hɔ no mu na fa nnadewa foforo no hyɛ abaa no mu. 5 mm agyiraehyɛde a ɛwɔ nsa a wɔde hyɛ mu no kyerɛ sɛnea wɔde ahyɛ mu no mu dɔ wɔ proximal tibia no mu (Mfonini 14). (Mfonini 14) .

8 Distal ne proximal a wɔde to mu

Mfonini 14a Proximal ne distal locking nhyehyeɛ gyina mpaapaemu su pɔtee so. Wobetumi de abasa a wɔde si wɔn ani so ayɛ proximal locking. Wɔyɛ distal locking no freehand anaasɛ denam radiopaque drill guide a wɔde di dwuma so. Sɛ wopɛ a, wobetumi de end cap adi dwuma, na ɛmma dompe nnyin nkɔ nnadewa a ɛwɔ medullary no awiei a ɛbɛn no na ɛma ɛyɛ mmerɛw sɛ wobeyi nea wɔde ahyɛ mu no akyiri yi. Titiriw no, ɛnyɛ den sɛ wobeyi nnadewa a wɔde ahyɛ mu boro so bere a wɔde awiei nkataso a ne tenten fata di dwuma no. Wɔnam agyiraehyɛde bi a wɔde bɛhyɛ nsa no so anaasɛ akwankyerɛ hama a wɔde fa abasa a wɔde si wɔn ani so no mu so na esusuw awiei kyɛw no tenten a wɔpɛ.

Mfonini 14b Akwankyerɛ hama no ano kyerɛ beae a ɛbɛn nnadewa a ɛwɔ medullary no mu. Ɛsɛ sɛ woyi skru a ɛka abasa a wɔde si wɔn ani so no bata nnadewa no ho no na ama wɔde awiei ano no ahyɛ mu. Awiei kyɛw no fa toa a ɛwɔ nsa a wɔde hyɛ mu no mu. Nsa a wɔde hyɛ mu no kɔ so tra hɔ. Eyi ma awiei kyɛw no ne nnadewa a ɛwɔ medullary no atifi no hyia na ɛmma ɛnyera wɔ kotodwe no mu. Sɛ wode akwankyerɛ hama no fa toa no awiei kyɛw no mu hyɛ nnadewa no awiei a ɛbɛn no mu a, ɛboa nso ma wɔkyerɛ awiei kyɛw no kwan kɔ ne gyinabea a ɛfata wɔ nnadewa a ɛwɔ medullary no awiei a ɛbɛn no mu. Wɔ adeyɛ no awiei no, ɛsɛ sɛ wɔhohoro nkyene a ɛnyɛ ɔyare mmoawa mu na ama wɔahohoro nneɛma a asɛe biara a aka no afi hɔ.

04. Kɔkɔbɔ ahorow

Ahwɛyiye a Wɔbɛyɛ wɔ Oprehyɛn Ho Oprehyɛn Ho

- a ewo nnompe mu yare a woadi kan anya mu no, patellar motion a woabara no betumi asiw nkwaa no kwan. Sɛ wotwa mfinimfini anaa akyi mmoa kuw no fã a ɛbɛn no fi mfinimfini fã no a, ɛma ɛyɛ mmerɛw sɛ wɔde trocar pin no bɛhyɛ mu.

- ipsilateral knee prosthesis nyɛ ade a ɛtia suprapatellar pinning a ɛyɛ katee. Nanso hyɛ no nsow sɛ ebia ɛrentumi nyɛ yiye sɛ wobenya baabi a wɔtaa fi ase wɔ proximal tibial nailing procedure no mu.

- wo mpaapaemu a articular extension wom mu no, wobetumi de screws foforo ahyɛ mu de asi articular fracture component no ano. Wɔkamfo kyerɛ sɛ wɔmfa saa nkɔnsɔnkɔnsɔn yi nsi hɔ ansa na wɔde nnadewa no ahyɛ mu na amma ntini a abubu no ankɔ baabi foforo.

Proximal Tibia Fracture Ho Nneɛma a Wosusuw Ho

Proximal tibial fractures yɛ tibial fractures a ɛyɛ den sen biara sɛ wɔde nnadewa bɛbɔ na ɛhwehwɛ sɛ wɔhyɛn mu pɛpɛɛpɛ (sɛnea yɛaka ho asɛm wɔ atifi hɔ no). Ɛsɛ sɛ wɔtew saa mpaapaemu yi so ansa na wɔabɔ nnadewa na ama wɔatumi ako atia tumi biara a ɛma nneɛma sɛe no na wɔadi nkonim kɛse. Wɔ tebea horow bi mu no, sɛ wɔde ɔhonam akwaa a ɛka no no si baabi a ɛtrɛw fã yiye na wonya baabi pɔtee a wɔbɛhyɛn mu na wɔde nnadewa no ne medullary canal no ahyɛ coronal ne sagittal axes no mu a, ɛbɛma tibia no ahyia yiye bere a wɔabɔ nnadewa awie no.

Nanso, mpɛn pii no, ɛho hia sɛ wɔyɛ ɔkwan bi a wɔfa so tew so na ama wɔanya saa akisikuru yi a wɔbɛsan de asi baabi foforo wɔ ɔkwan a ɛma abotɔyam so na wɔakɔ so akura mu. Sɛ fracture line no yɛ mmerɛw na ɛyɛ ahinanan a, wobetumi de pointed resetting clamps a ɛnyɛ den anaa coaptation clamps, a wɔde gu honam ani no adi dwuma de anya reset na wɔakura mu bere a wɔrebɔ nnadewa no. Sɛ clamp no ntumi anaasɛ fracture plane no ntumi mfa ne ho nhyɛ clamping mu a, pollen anaa blocking screws betumi aboa ma wɔasiw displacement ne malposition ano (Mfonini 15). Wɔde saa nkɔnsɔnkɔnsɔn yi si nnadewa gyinabea a wɔpɛ wɔ akyi hwɛbea no akyi na wɔde si nnadewa gyinabea a wɔpɛ wɔ anim-akyi hwɛbea no akyi. Saa nkɔnsɔnkɔnsɔn yi a wɔde besisi hɔ yiye na ama wɔasan ayɛ no yiye no betumi ayɛ den.

Mfonini 15 Locking screws a wɔde ato nnadewa kwan a wɔpɛ no akyi wɔ anim ne akyi hwɛbea (a) ne nnadewa kwan a wɔpɛ no akyi wɔ nkyɛn hwɛbea (b) a ɛko tia deformation tumi ahorow no

Ɔkwan foforo a etu mpɔn yiye ne sɛ wɔde bere tiaa bi si abubuw no so wɔ nipadua mu tebea bi mu (Mfonini 16). Mpɛn pii no, asinasin ketewaa bi a ɛte sɛ ntini a ɛwɔ nkɔnsɔnkɔnsɔn biako anaa abiɛsa a wɔde tow cortical mu no bɛma abubu no so atew bere a wɔresiesie ntini kwan na wɔde nnadewa ahyɛ mu no. Mprɛte no bedi nneɛma abien no nyinaa a ɛbɛtu akɔ baabi foforo no so. Ɛsɛ sɛ wogyaw mprɛte no wɔ nea ɛwɔ hɔ bere tenten a ɔkwan biara nni hɔ a ɛyɛ pintinn na amma wɔanhwere tew a ɛtaa ba bere a wɔayi mprɛte no akyi no ano. Saa mprɛte a ɛwɔ cortical screw biako no nyɛ den na ɛrenka sɛnea nnadewa no gyina pintinn kakra no. Wobetumi de reset plate kwan no adi dwuma ama abubuw a wɔabue ne nea wɔato mu nyinaa.

Mfonini 16 Wobetumi anya mprɛte ketewa bi a wɔde to mu a ɛwɔ cortical screw biako na wɔakura mu wɔ anatomic reposition. Mpɛn pii no, ɛsɛ sɛ wogyaw mprɛte no wɔ nea ɛwɔ hɔ bere a wɔabɔ nnadewa awie no. a Mfiase no valgus deformity a ɛba wɔ proximal tibial fracture mu. b Wɔde mpaapaemu mprɛte ketewa bi a ɛwɔ cortical screw biako si mfinimfini sɛnea ɛbɛyɛ a wobenya na wɔakura abubuw no gyinabea foforo bere a wɔrebɔ nnadewa no. c Wonnyi mprɛte no bere a wɔabɔ no nnade akyi efisɛ ɛma ɛyɛ den kɛse

Misalignment, Asiane ne Nsɛnnennen a Ɛba

- Intraoperative displacement of the Protective Sleeve betumi ama cartilage ne intra-articular kotodwe nhyehyɛe no asɛe (Mfonini 17). Ɛsɛ sɛ wɔsan de nsateaa a ɛbɔ ho ban no hyɛ mu koraa.

- a wode Protective Sleeve no danee kakra no betumi ama reamer ti a woyi no mu aye den. Fluoroscopy boa ma wohu ɔhaw no. Sɛ wɔsan siesie ahobammɔ nsateaa no a, ɛbɛma wɔadi ɔhaw no ho dwuma (Mfonini 18) .

- Nail Lock-Up: Ebia nea wɔde ahyɛ mu no akɔhyɛ dade nsateaa no mu wɔ proximal bend (Herzog curve). Sɛ wɔde nnadewa a etwa to bɛhyɛ mu a, ɛsɛ sɛ woyi dade afiri no, na ɛka akyi plastic nsateaa a ɛyɛ mmerɛw no nkutoo. Sɛ nnadewa no abata a, ɛsɛ sɛ woyi fi hɔ koraa bio na wɔsan de nea wɔde ahyɛ mu no hyɛ mu bere a wɔayi dade kankyee no afa plastic kankyee no nkutoo mu awie no.

Mfonini 17 Nsa a ɛbɔ ho ban a wɔtwe fi hɔ a wɔmfa fluoroscopic nhwɛ no betumi ama obi apira ne kotodwe

Mfonini 18 a Sɛ wɔdannan anaasɛ wɔdannan wɔ akwanhyia mu wɔ ahobammɔ afiri no mu a, ebetumi asiw reamer no a woyi fi hɔ no kwan, efisɛ reamer ti no betumi ayɛ jam. b Fluoroscopic nhwehwɛmu a wɔde alignment correction ka ho ma wotumi yi reamer ti no fi hɔ. c Wobetumi ayi reamer ti no sɛ reamer ti no nni nea ɛwɔ hɔ a. d Wobetumi ayi reamer ti no sɛ reamer ti no nni nea ɛwɔ hɔ a.

Nsɛm a wɔde gyinaa so

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Nnadewa a wɔde bɔ asen a abubu no wɔ atifi fam. Oper Orthop Traumatol a wɔde di dwuma wɔ ɔkwan a ɛyɛ hu so. 2020 Ɔpɛpɔn;32 (5): 440-454.