Tibial Intramedullary Nail Fixation Ɔkwan a Wɔfa so Yɛ

Intramedullary nail fixation da so ara yɛ ayaresa a wɔpaw ma tibial dua a abubu a entumi nnyina na ɛkɔ baabi foforo wɔ mpanyimfo mu. Botae a ɛwɔ oprehyɛn ayaresa mu ne sɛ ɛbɛma asen no tenten, ahyia ne nea ɛkyinkyini bio na ama abubu no asa. Mfaso a ɛwɔ nnadewa a wɔde hyɛ nipadua no mu so ne oprehyɛn mu ahodwiriw kakraa bi ne mogya a ɛkɔ baabi a abubu no a wɔkora so sɛnea ɛfata. Afei nso, intramedullary nailing of the tibia ma biomechanical fracture stability a ɛfata na ɛyɛ adwuma sɛ adesoa-kyɛ afiri a ɛma kwan ma wɔboaboa ano ntɛm wɔ oprehyɛn akyi. Nkɔso a aba wɔ nnadewa a ɛwɔ medullary mu a wɔyɛ ne akwan a wɔfa so tew so mu no atrɛw nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde nnadewa a ɛwɔ medullary mu no si hɔ no mu ma ɛka tibia a ɛbɛn ne mfinimfini fã a ɛto so abiɛsa a ɛwɔ fam no ho.

Ɛde besi nnɛ no, closed reduction intramedullary nail fixation of tibial fractures abɛyɛ adeyɛ a wɔtaa yɛ ma nnompe ho oprehyɛn a wɔyɛ adwenemhaw. Ɛmfa ho sɛ agye din a wɔde intramedullary nail fixation di dwuma ma tibial stem a abubu a wɔatu afi baabi foforo no, ɛda so ara yɛ den na ɛwɔ nsɛnnennen pii a ebetumi de aba. Oprehyɛn akwan kɔ so nya nkɔso. Asɛm yi atirimpɔw ne sɛ ɛbɛkyerɛkyerɛ mprempren nsusuwii ahorow a ɛfa nnadewa a wɔde si tibial stem a abubu ho wɔ intramedullary nail fixation mu na yɛabɔ nkɔso a aba nnansa yi wɔ adwuma no mu no mua.

一 na ɛyɛ. Nhwehwɛmu ne nhwehwɛmu a edi kan

Wɔ ayarefo nkumaa mu no, mpɛn pii no, tibial stem a ɛpaapae fi ahoɔden kɛse a wɔde pirapira wɔn, na ɛsɛ sɛ wɔhwɛ ayarefo no mu hwɛ sɛ ebia wɔanya ahodwiriwde a ɛbata ho sɛnea Advanced Trauma Life Support (ATLS) akwankyerɛ ahorow kyerɛ no. Hwɛ honam ani ne ntini a ɛyɛ mmerɛw a apira te sɛ akisikuru a abubu, honam ani akisikuru, ɔhyew, ecchymosis, anaa honam ani a ɛkɔ soro; ma emu da hɔ sɛ ebia abubuw no abue, na sɛ ɛte saa a, fa tetanus ne nnuru a ekum ɔyare mmoawa sa; na wɔyɛ ntini mu ntini mu nhwehwɛmu a edi mũ na wɔkyerɛw nea yɛaka wɔ atifi hɔ no. Hwɛ sɛnea osteofascial compartment syndrome ba no mu na yɛ ayaresabea nhwehwɛmu ahorow toatoa so wɔ ayarefo yi mu.

Nnansa yi nhwehwɛmu ada no adi sɛ osteofascial compartment syndrome a ɛba wɔ tibial tuberosity fractures akyi no betumi akɔ soro akodu 11.5 %. Titiriw no, ayarefo akuw nkumaa taa nya osteofascial compartment syndrome. Ɛsɛ sɛ wogyina nea wɔahu wɔ ayaresabea so na ɛkyerɛ sɛ obi anya osteofascial compartment syndrome, a ɛyaw a emu yɛ den, ntini mu ntini mu nsakrae, myofascial compartment a ɛho ahonhon, ne ɛyaw a ɛkɔ soro a efi nansoaa a ɛnyɛ adwuma mu ka ho. Enti, osteofascial compartment syndrome da so ara yɛ ayaresabea nhwehwɛmu na ayaresabea nhwehwɛmu no ho nkrataa a edi mũ ho hia. Wobetumi de nhyɛso afiri (Mfonini 1) asusuw nhyɛso a ɛwɔ myofascial compartment no mu sɛ nhwehwɛmu kwan a ɛka sɔhwɛ titiriw no ho.

Mfonini 1. Nhyɛso a ɛwɔ interosseous septum no mu a wɔde nhyɛso needle susuw

Sɛnea ɛbɛyɛ na wɔanya nsɛm a wotumi de ho to so no, ɛsɛ sɛ wɔsusuw nhyɛso a ɛwɔ anom no mu wɔ myofascial afã anan no mu ne mmeae ahorow wɔ myofascial dan biara mu. Nhwehwɛmu ahorow a wɔayɛ wɔ nhoma ahorow mu kyerɛ sɛ nhyɛso mu nsonsonoe a ennu 30 mmHg (diastolic nhyɛso a wɔayi fascial compartment pressure afi mu) kyerɛ sɛ fascial compartment syndrome. Mpɛn pii no, diastolic nhyɛso so tew bere a wɔreyɛ oprehyɛn no, na ɛsɛ sɛ wosusuw diastolic pressure ansa na wɔayɛ oprehyɛn no ho bere a wɔrebu nhyɛso a ɛsono no ho akontaa no.

Nnansa yi nhwehwɛmu ada no adi sɛ intrafascial pressure monitoring yɛ adwinnade a ebetumi ayɛ nea mfaso wɔ so a wɔde hwehwɛ acute fascial compartment syndrome, a ɛyɛ 94 % na ɛyɛ pɔtee 98 %. Nanso, esiane nea ebetumi asɛe ade kɛse afi compartment syndrome mu nti, ɛsɛ sɛ wogyina nea wɔahu wɔ ayaresabea so na ɛkyerɛ sɛ obi anya compartment syndrome, na ɛsɛ sɛ wɔde ntini ntam nhyɛso susuw di dwuma wɔ tebea horow titiriw mu, te sɛ bere a ɔyarefo no apira anaasɛ bere a ayaresabea mu nsɛm a ɛwɔ hɔ no mu nna hɔ.

Ɛsɛ sɛ mfoniniyɛ mu nhwehwɛmu ka orthopantomograms a wɔtaa de di dwuma ne akyi hwɛbea a wɔde hwɛ asen a apira no ne kotodwe ne anansoro nkwaa a ɛbɛn ho no radiographs, a wɔde kɔmputa so tomography (CT) hwehwɛ mu bio. Saa ara nso na ebia ɛho behia sɛ wɔyɛ nansoaa no CT mfonini na ama wɔatumi ayɛ nsensanee a abubu a ɛtrɛw kɔ tibial plateau ne nansoaa mu apirakuru a ɛnyɛ nea ɛtoatoa so a ɛbata ho no ho mfonini

二 na ɛyɛ. Ayaresa mu afiri ahorow

Wɔabɔ amanneɛ sɛ asen no fã a ɛwɔ fam mfinimfini nkyem abiɛsa mu biako a abubu a nansoaa abubu no ɔha biara mu nkyem kɛse. Sɛ wɔde CT scan a wɔtaa yɛ no dii dwuma a, na asen no mfinimfini ne fã a ɛwɔ fam no mu nkyem abiɛsa mu biako a abubu no mu 43 % ne nansoaa a abubu, a na emu dodow no ara hwehwɛ sɛ wɔyɛ oprehyɛn. Akisikuru a ɛtaa ba ne asen a ɛwɔ akyirikyiri no mfinimfini nkyem abiɛsa mu abiɛsa a ɛwɔ fam a ɛyɛ nkuruwankuruwa a ɛne akyi anan a ɛpaapae kakra anaasɛ entumi nkɔ baabi foforo no wɔ abusuabɔ (Mfonini 2). Esiane sɛ ankle a ɛpaapae a ɛbata ho no tu kɔ baabi foforo ketewaa bi nti, 45 % pɛ na wotumi hu wɔ ankle radiographs a ɛnyɛ den so. Enti, ɛsɛ sɛ wosi CT mfonini a wɔyɛ daa wɔ nansoaa no so dua kɛse bere a mfinimfini asen no ase abubu wɔ hɔ no (Mfonini 3).

Mfonini 2.AF Spiral fracture of the lower middle third of the right tibia (A, B) Radiographs a wɔyɛ ansa na wɔayɛ oprehyɛn wɔ ankle no so no kyerɛ sɛ ɛteɛ (C). Intraoperative C-arm fluoroscopy kyerɛ sɛ akyi nansoaa no abubu a entu (D) Oprehyɛn akyi radiographs wɔ oprehyɛn a wɔde asi hɔ akyi (EF) kyerɛ sɛ tibial ne ankle a abubu no sa yiye

Mfonini 3. AF Spiral fracture a ɛwɔ benkum tibia (AB) no mfinimfini ne fam nkyem abiɛsa mu biako ansa na wɔayɛ oprehyɛn no radiographs; (CD) CT mfonini ahorow a wɔyɛe ansa na wɔreyɛ oprehyɛn a ɛkyerɛ sɛ akyi malleolar abubu a entumi nkɔ baabi foforo; (EF) a ɛkyerɛ sɛ tibia ne malleolar fracture no sa yare a biribiara nsii

三 na ɛyɛ. Akwan a wɔfa so yɛ oprehyɛn

01. Tibial Needle a wɔde hyɛn mu

Beae a wɔde hyɛn mu a ɛyɛ pɛpɛɛpɛ a wɔde besi hɔ no di dwuma titiriw na nhwehwɛmu pii a wɔayɛ wɔ nhoma ahorow mu no de nsɛm a ɛho hia ama wɔ nipadua mu beae a ɛfata a wɔde hyɛn mu a wɔde nnadewa a wɔde hyɛ tibial a abubu no mu wɔ ntini mu no ho. Saa nhwehwɛmu ahorow yi ada no adi sɛ beae a eye a wɔde pinning no wɔ tibial plateau no anim fã na ɛwɔ mfinimfini pɛɛ wɔ lateral tibial spur no mu. Wɔbɔɔ ahobammɔ beae bi a ne tɛtrɛtɛ yɛ mm 22.9 ± 8.9 mm, a ɛnsɛe nkwaa a ɛbɛn hɔ nso ho amanneɛ. Sɛnea wɔtaa yɛ no, wɔde infrapatellar kwan so asi baabi a wobefi ase de nnadewa a wɔde hyɛ tibial stem a abubu no mu asi hɔ, denam patellar tendon a wɔbɛpaapae mu (transpatellar kwan) anaasɛ wɔbɛyi patellar tendon gyinabea no fã bi (paratendinous kwan) so.

Semi-extension intramedullary nailing atwetwe adwene kɛse wɔ nnansa yi nnompe ho nhoma ahorow mu, na Tornetta ne Collins hyɛ nyansa sɛ wɔmfa medial parapatellar kwan nni dwuma mfa nhyɛ nnadewa no mu wɔ semi-extension gyinabea no mu na wɔakwati sɛ wɔbɛpue apex a ɛwɔ intramedullary nail no mu akɔ anterior tibial cortex no mu.3 The use of a medial parapatellar approach for wɔkamfo intramedullary nailing nso kyerɛ wɔ semi-extension gyinabea no. Wɔkamfo suprapatellar kwan a wɔfa so de nnadewa a wɔde hyɛ tibial intramedullary mu na wɔde fa patellofemoral nkwaa no mu hyɛ mu wɔ gyinabea a ɛtrɛw fã no kyerɛ.

Wɔde kotodwe no abɔ mu bɛyɛ digrii 15-20 na ɛyɛ adeyɛ no, na wɔtwa no tenten bɛyɛ sɛntimita 3 bɛyɛ nsateaa biako kosi abien wɔ akyi berɛmo no atifi. Wɔpaapae quadriceps tendon no mu wɔ ɔkwan tenten so na wɔyɛ blunt dissection kɔ patellofemoral joint no mu. Wɔde socket a ɛyɛ mmerɛw fa patellofemoral joint no mu de yɛ baabi a wɔbɛhyɛn mu wɔ proximal anterior tibial cortex ne articular surface no nhyiam no so (Mfonini 4).

Mfonini 4. ab Mfonini ahorow a wɔyɛ wɔ oprehyɛn mu a ɛkyerɛ (a) wɔpaapae quadriceps tendon no mu na wɔde trocar no fa patellofemoral joint no mu kɔ tibial entry point no mu; (b) oprehyɛn no akyi hwɛbea a wɔde hyɛn mu no

Wɔde 3.2 mm drill bit di dwuma de kyerɛ baabi a wɔde ade a wɔde fi ase no wɔ C-abasa akwankyerɛ ase. Wɔde socket a ntokuru ahyɛ mu ma de asiesie mmeae a wɔhyɛn mu ne baabi a wofi mu no yiye. Wɔnam socket no so na ɛyɛ oprehyɛn a aka a reaming ne tibial nail insertion ka ho no.

MFASOƆ A ƐBƐTUMI: Nan a ɛtrɛw fã bi no betumi aboa ma wɔasan de akisikuru no asi baabi foforo, titiriw wɔ akisikuru a ɛtaa ba a ɛyɛ asen no nkyem abiɛsa mu biako a ɛbɛn na ɛyɛ anim no mu. , Gyinabea a ɛtrɛw fã no betumi ayi nhyɛso a ɛwɔ quadriceps ntini no so no afi hɔ na aboa ma wɔasan de abubuw no asi baabi foforo. , Semi-extended position suprapatellar kwan no nso betumi ayɛ ɔkwan foforo a wɔfa so yɛ atetesɛm infrapatellar kwan no (Mfonini 5).

Mfonini 5. Mfonini a wɔde yɛ oprehyɛn a ɛkyerɛ ntini a ɛyɛ mmerɛw a opira wɔ infrapatellar mpɔtam hɔ sɛ sɛnkyerɛnne a ɛkyerɛ sɛ wɔbɛfa suprapatellar kwan so wɔ gyinabea a ɛtrɛw fã.

Nhwehwɛmu ahorow ada no adi sɛ suprapatellar kwan a wɔfa so de nnadewa bɔ tibial intramedullary wɔ gyinabea a wɔatrɛw mu fã no yɛ oprehyɛn kwan a ahobammɔ wom na etu mpɔn. Daakye ayaresabea sɔhwɛ ahorow ho hia na wɔakɔ so ahwehwɛ mfaso ne ɔhaw ahorow a ɛwɔ suprapatellar approach intramedullary nailing so na wɔasusuw nea ebefi mu aba bere tenten a ɛbata saa kwan yi ho no ho.

02. Reset mfiridwuma ho nimdeɛ

Sɛ wɔde tibial intramedullary nail nkutoo si hɔ a, ɛmma mpaapaemu no so tew sɛnea ɛsɛ; ɛsɛ sɛ wɔhwɛ ma wɔtew akisikuru no so yiye wɔ reaming nhyehyɛe no nyinaa mu ne nnadewa a wɔde hyɛ medullary no mu. Ebia ɛnyɛ bere nyinaa na nsaano twetwe nkutoo a wɔde bedi dwuma no ankasa betumi atew akisikuru no so wɔ nipadua mu. Saa asɛm yi bɛkyerɛkyerɛ akwan horow a wɔfa so tew so a wɔato mu, a ɛnyɛ nea wɔde hyɛ mu kɛse, na wɔabue mu.

-Closed reset mfiridwuma ho afotuo

Wobetumi de adwinnade a wɔde tew so te sɛ F-fracture reducer, afiri a ɛtew so a ɛte sɛ F a wɔde radiographically transmissible a ɛteɛteɛ inversion/exversion angles ne medial/lateral translation nso ayɛ reduction maneuvers a wɔatoto mu (Mfonini 6).

Fig. 6. F-shaped fracture reducer a wɔafa aka wɔ oprehyɛn mu

Nanso, afiri no betumi de adwennwen kɛse aba ntini a ɛyɛ mmerɛw no so, na ɛsɛ sɛ wɔkwati sɛ wɔde saa afiri a wɔde sesa nneɛma yi bedi dwuma bere tenten. Wobetumi de reduction forceps nso afa honam ani, te sɛ nea ɛte wɔ spiral ne oblique fractures ho no. Wobetumi de saa nnwinnade yi adi dwuma wɔ ɔkwan a ɛyɛ mmerɛw so denam ntwitwiridii nketenkete so (Mfonini 7).

Mfonini 7. Percutaneous clamping de san de tibial a abubu no si hɔ

Ɛsɛ sɛ wogyina ɔkwan a wɔbɛfa so atew bere tenten a ɛbɛsɛe ntini a ɛyɛ mmerɛw a efi krampɔn a wɔde besisi hɔ no so paw krampɔn ko ne beae a oprehyɛn no bɛtwa (Mfonini 8).

Mfonini 8. Pointed repositioning forceps de san de tibial a abubu no si hɔ

Retractors nso yɛ nnwinnade a wɔtaa de resetting a wɔde san ma tibia no tenten san ba no mu biako. Wɔtaa de si mfinimfini na ɛwɔ akyirikyiri fi beae a ɛsɛ sɛ wɔde nnadewa a ɛwɔ medullary no mu no si no. Wobetumi de proximal traction pins asi hɔ de asuasua proximal blocking screw gyinabea, na ɛma ɛyɛ mmerɛw sɛ wɔbɛtew abubuw no so bere a intramedullary nnadewa no akɔ mu no.

Wɔ tebea horow bi mu no, akwan a wɔfa so tew so a wɔatoto mu na wɔmfa nhyɛ mu kɛse no da so ara nnɔɔso sɛ wobenya nipadua mu nneɛma a wɔtew so. Wɔ tebea horow a ɛtete saa mu no, ɛsɛ sɛ wosusuw akwan a wɔfa so tew ntini a wɔatwa no so ho de ahwɛyiye di ntini a ɛyɛ mmerɛw a atwa ho ahyia no ho dwuma. Mfomso ahorow a ebetumi aba wɔ akwan a wɔfa so tew nneɛma a wɔabue mu so no bi ne oprehyɛn mu ahodwiriw foforo, a ebetumi ama asiane a ɛwɔ hɔ sɛ wobenya ɔyare mmoawa wɔ baabi a wɔyɛ oprehyɛn no ayɛ kɛse. Afei nso, mogya a ɛkɔ baabi a abubu no foforo a wɔbɛyi afi hɔ no betumi ama asiane a ɛwɔ hɔ sɛ oprehyɛn akyi abubu a ɛnyɛ biako no ayɛ kɛse.

-Mfiridwuma ho nimdeɛ a ɛfa Incision ne Repositioning ho

Ɛnyɛ oprehyɛn a wɔde tew nhama so nko na ɛma kwan ma wɔde nhama nketenkete anaa nketewa gu baabi a abubu no na ama abubu no so atew bere a wɔreyɛ nnadewa a ɛwɔ anom no mu.

Wɔde monocortical screws na ɛkyekyere mprɛte wɔ proximal ne distal fracture asinasin no ho. Wɔkora nhama no so wɔ bere a wɔde reaming na wɔde intramedullary nail no si tibia no nyinaa mu. Bere a wɔde nnadewa a ɛwɔ medullary no mu no sii hɔ akyi no, woyii mprɛte no anaasɛ wogyaw no wɔ nea ɛwɔ hɔ no mu sɛnea ɛbɛyɛ a ɔdan a wɔahyɛ no den no agyina pintinn (Mfonini 9). Ɛdenam mprɛte no a wobegyaw wɔ nea ɛwɔ so no so no, ɛsɛ sɛ wɔde cortical screw biako no sesa cortical screw abien no. Ɛsɛ sɛ wosusuw ho sɛ wɔde bedi dwuma wɔ tebea horow a wɔapaw a ɛho hia sɛ wɔyɛ tibial dua no oprehyɛn a wɔabue ano na ama wɔatumi atew akisikuru no so a wogye tom no mu.

Mfonini 9. Open tibia fracture a ɛwɔ comminution a emu yɛ den na bone difect, single cortical fixation a splint ketewaa bi wɔ fracture no awiei a abubu bere a wɔatew so na wɔayi splint no akyi intramedullary nail fixation

Botae a ɛwɔ nnadewa a esiw ano no mu ne sɛ ɛbɛtew medullary cavity a ɛwɔ metaphyseal mpɔtam hɔ no so. Wɔde nnadewa a esiw kwan no gu ntini no asinasin tiawa no mu ne ɔfã a ɛyɛ kurukuruwa no mu ansa na wɔde nnadewa no ahyɛ medullary mu. Sɛ nhwɛso no, sɛnea ɛtaa yɛ dɛm wɔ tibia no nkyem abiɛsa mu abiɛsa a ɛbɛn no mu a ɛpaapae no yɛ nea ɛda adi ne valgus ne anim a ɛkɔ anim. Sɛnea ɛbɛyɛ na wɔasiesie valgus no mu dɛmdi no, wobetumi de skru a wɔde to mu ahyɛ proximal fracture fragment no fã a ɛwɔ akyi (kyerɛ sɛ, deformity no fã a ɛyɛ concave) no mu wɔ anteroposterior kwan so. Wɔkyerɛ nnadewa a ɛwɔ medullary no kwan fi mfinimfini fã no, na ɛnam so siw valgus ano. Saa ara nso na wobetumi adi angulation deformity so denam locking screw a wɔde besi mfinimfini kosi akyi akɔ proximal block no akyi fã (kyerɛ sɛ, deformity no fã a ɛyɛ concave) no so (Mfonini 10).

Mfonini 10. aboa ma wɔasan asiesie tibial fracture denam nnadewa a esiw ano a wɔde besisi hɔ so

- a ɛyɛ medullary ntrɛwmu

Bere a wɔasan asiesie dompe no awie no, wɔpaw medullary reaming de siesie dompe no ma wɔde nnadewa bɛhyɛ medullary mu. Wɔde akwankyerɛ hama a ɛwɔ bɔɔl ano no hyɛ tibial marrow cavity no mu na ɛfa baabi a abubu no, na wɔde reaming drill no fa akwankyerɛ hama a ɛwɔ bɔɔl awiei no so. Wɔsii so dua sɛ akwankyerɛ hama a ɛwɔ bɔɔl no awiei no gyinabea wɔ C-arm fluoroscopy ase sɛ ɛwɔ ankle nkwaa no gyinabea, na na akwankyerɛ hama no wɔ mfinimfini yiye wɔ anteroposterior ne lateral views nyinaa so (Mfonini 11).

Mfonini 11. kyerɛ gyinabea a akwankyerɛ hama no wɔ wɔ medullary cavity no mu wɔ C-arm fluoroscopy so wɔ anim ne akyi gyinabea

Asɛm a ɛfa medulla a wɔatrɛw mu ne nea ɛntrɛw ho no agye akyinnye. Yegye di sɛ nnuruyɛfo dodow no ara a wɔyɛ oprehyɛn wɔ Amerika Atifi fam no pɛ sɛ wɔde nnadewa a wɔatrɛw mu wɔ medullary intramedullary a wɔde bɔ tibia no mu sen sɛ wɔmfa ntrɛw mu. Nanso, wobetumi de nnadewa a wɔde hyɛ ntini mu a wɔatrɛw mu ne nea wɔantrɛw mu nyinaa adi dwuma sɛ akwan a wɔfa so de di dwuma a wogye tom, na wobetumi de akwan abien no nyinaa anya nneɛma pa.

-Locking skru a wɔde si hɔ

Wɔabɔ wɔn tirim sɛ wɔde nkɔnsɔnkɔnsɔn a ɛka bom di dwuma wɔ tibial stem a ɛpaapae mu no sɛ wɔbɛma asiw tibia ne malrotation ano, na wɔatrɛw nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde nnadewa bɛbɔ tibia no mu wɔ medullary mu no mu akɔ tibial stem fractures a ɛbɛn ne akyirikyiri kɛse a ɛfa metaphysis ho. Wɔ mpaapaemu a ɛfa metaphyseal mpɔtam hɔ ho no, nkɔnsɔnkɔnsɔn a ɛka bom bɛyɛɛ nea ɛho hia kɛse wɔ axial alignment a wɔbɛkɔ so akura mu no mu.

Nkuruwankuruwa abiɛsa a ɛka bom a ɛbɛn no maa sɛnea ɛyɛ den no nyaa nkɔso kɛse, na nkɔnsɔnkɔnsɔn a wɔde ka bom a wɔde anim a ɛyɛ den no betumi ama nneɛma atumi agyina pintinn kɛse asen nkɔnsɔnkɔnsɔn a wɔde ka bom a wɔtaa de di dwuma no, a ebetumi ama wɔanya nhyehyɛe mu ahoɔden koro no ara denam nkɔnsɔnkɔnsɔn kakraa bi a wɔde ka bom so. Ayaresabea ho nsɛm a ɛfa nkɔnsɔnkɔnsɔn dodow ne sɛnea wɔahyehyɛ a ɛho hia na wɔde akyekye asen no mu no ho da so ara sua.

Wɔtaa de scope a wɔde abata intramedullary nail spike no ho na ɛyɛ proximal interlocking screws a wɔde si hɔ. Wɔde distal interlocking screws hyɛ freehand ase wɔ fluoroscopic akwankyerɛ ase. Wɔkamfo kyerɛ sɛ wɔmfa akwankyerɛ nhyehyɛe a wɔde kɔmputa boa a wɔde anyinam ahoɔden di dwuma mfa nkɔhyɛ distal tibial interlocking screws mu (Mfonini 12). Saa kwan yi ma kwan ma wɔde nkɔnsɔnkɔnsɔn a ɛka bom a ɛwɔ akyirikyiri no hyɛ mu a mframa bɔne biara nni mu na wɔada no adi sɛ ɛyɛ ɔkwan a wobetumi ayɛ na ɛyɛ pɛpɛɛpɛ.

Mfonini 12.AB Locking screws denam C-abasa adwene so; CD Locking screws denam electromagnetic kɔmputa a ɛboa locking so

Proxim ne distal interlocking screws a wɔde besi hɔ no yɛ oprehyɛn a ahobammɔ wom na ɛsɛ sɛ wɔde interlocking screws no hyɛ mu wɔ ɔkwan a ɛyɛ pɛpɛɛpɛ na ɛyɛ mmerɛw so.

Anatomic nhwehwɛmu ada no adi sɛ asiane da so ara wɔ hɔ sɛ obi benya peroneal nerve palsy bere a wɔde proximal medial to lateral oblique interlocking screws si hɔ no. Nea ɛbɛyɛ na asiane yi so atew no, ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn susuw ho sɛ wobetutu nkɔnsɔnkɔnsɔn no wɔ C-abasa akwankyerɛ ase, na C-abasa no fluoroscopic angle no gyina drill bit no plane no so. Ebia ɛbɛyɛ den sɛ wobehu drill a ɛkɔ distal tibia no cortex mu denam tactile feedback so, na fibular ti no a ɛbɛn no betumi akata tactile adwene no so na ama oprehyɛnfo no anya adwene sɛ ɔwɔ 'wɔ dompe no mu' bere a nokwarem no, wɔahyɛ fibular ti no mu. Ɛnyɛ sɛ wɔde graduated drill nko na ɛkyerɛ screw tenten na mmom ɛsɛ sɛ wɔde depth gauge susuw a ɛfata nso kyerɛ. Ɛsɛ sɛ drill anaa screw tenten biara a wɔsusuw a ɛboro mm 60 no ma adwenem naayɛ ba sɛ posterolateral protrusion, a ebetumi de peroneal nerve a ɛtaa ba no akɔ asiane mu sɛ ebepira.

Wɔde nkɔnsɔnkɔnsɔn a ɛka bom a ɛwɔ akyirikyiri no si hɔ a wɔde wɔn adwene si ahobammɔ a ɛwɔ anim ntini a ɛwɔ akyi, tibialis anim ntini, ne extensor digitorum longus no so. Ɛwom sɛ mpɛn pii no, skru a wɔde fa honam ani no yɛ nea asiane biara nni ho de, nanso ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn no hu asiane ahorow a ɛwɔ ntini a ɛyɛ mmerɛw a atwa ho ahyia no mu. Wɔ tibial dua a ɛpaapae dodow no ara fam no, nkɔnsɔnkɔnsɔn abien a ɛbɛn ne abien a ɛwɔ akyirikyiri a ɛka bom ma ɛyɛ den sɛnea ɛsɛ. Proximal ne distal tibial fractures betumi anya mfaso afi screws foforo a ɛka bom a wɔde besisi wimhyɛn ahorow mu na ama saa nhyehyɛe yi agyina pintinn akɔ soro (Mfonini 13).

Mfonini 13. Tibia a abubu mpɛn pii, a wɔde intramedullary nailing a wɔde distal ne proximal interlocking screws abien ayɛ ho adwuma, a x-ray a edi hɔ no kyerɛ sɛ abubu no sa.

-Fibular a Wɔde Siesie Nneɛma

Nnɛyi nnadewa a ɛwɔ ntini mu a wɔde nkɔnsɔnkɔnsɔn a ɛka bom wɔ akyirikyiri no atrɛw nsɛnkyerɛnne a ɛkyerɛ sɛ wɔde nnadewa a wɔde hyɛ asen no mu no mu ma ɛka akisikuru a ɛbɛn ne akyirikyiri a ɛfa metaphyseal mpɔtam hɔ ho.

Wɔde distal interlocking screw nhyehyɛe ahorow dii dwuma wɔ nhwehwɛmu no mu (2 screws fi mfinimfini kosi lateral kyerɛ screws 2 a wɔde asisi hɔ tẽẽ wɔ wɔn ho wɔn ho ne ne nyinaa mu 3 distal interlocking screws versus 1 pɛ distal interlocking screw). Wɔ ayarefo a wɔyɛɛ wɔn fibular fixation ne tibial intramedullary nail fixation mu no, na reset a wɔhwere no dodow sua koraa. Ayarefo a wɔde intramedullary nail fixation a wɔamfa fibular fixation anhyɛ mu no nyinaa mu 13 % daa oprehyɛn akyi hweree reset adi, sɛ wɔde toto ayarefo 4 % a wɔde tibial nail fixation a wɔamfa fibular fixation anhyɛ mu no ho a.

Wɔ sɔhwɛ foforo a ɛde sɛnea tibial intramedullary nail fixation yɛ adwuma yiye totoo fibular fixation ne tibial intramedullary nail fixation ho ne fibular fixation a enni hɔ mu no, ayarefo a wɔde fibular fixation a wɔde tibial nailing ka ho saa wɔn yare no daa nkɔso adi wɔ rotational ne inversion/eversion alignment mu.

Yɛde ba awiei sɛ adjunctive fibular fixation ma na ɛma tibial fracture so tew wɔ distal tibia fractures nkyem abiɛsa mu biako a wɔyɛ intramedullary nail fixation mu. Nanso, ɔhaw a ɛfa kuru mu nsɛnnennen a efi ntwitwiridii afoforo mu wɔ baabi a ntini a ayɛ basaa no da so ara wɔ hɔ. Enti yɛkamfo kyerɛ sɛ yɛnyɛ ahwɛyiye wɔ fibular fixation a wɔboa a wɔde bedi dwuma no mu.

03. Nea efii mu bae

Intramedullary nailing fixation a wɔde si tibial stem fractures so no betumi ama aba pa. Wɔabɔ amanneɛ sɛ sɛnea wɔde nnadewa a wɔde hyɛ asen no mu no sa yare wɔ nhwehwɛmu ahorow mu. Sɛ wɔde nnɛyi nneɛma a wɔde hyɛ nipadua mu ne oprehyɛn akwan a ɛfata di dwuma a, wɔhwɛ kwan sɛ ayaresa dodow bɛboro 90 %. Wɔmaa tibial dua a abubu a entumi nsa bere a wɔde nnadewa a ɛwɔ medullary mu a wɔde ahyɛ mu akyi no ayaresa dodow nyaa nkɔso kɛse bere a wɔde nnadewa a ɛto so abien a wɔatrɛw mu a wɔde ahyɛ mu akyi no.

Nea efii mu bae ho nhwehwɛmu wɔ afe biako wɔ oprehyɛn no akyi kyerɛe sɛ ayarefo a ɛkɔ soro kodu 44 % kɔɔ so nyaa dwumadi mu anohyeto ahorow wɔ wɔn anom a wɔapirapira no mu, na ɛkɔɔ so 47 % kɔɔ so bɔɔ dɛmdi a ɛfa adwuma ho amanneɛ wɔ afe biako wɔ oprehyɛn no akyi. Nhwehwɛmu no kyerɛ sɛ ayarefo a wɔde nnadewa a wɔde hyɛ wɔn tibia no mu sa wɔn yare no kɔ so nya dwumadi mu anohyeto kɛse wɔ bere tenten mu. Ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn hu nsɛm yi na wotu ayarefo fo sɛnea ɛfata!

四 na ɛyɛ. Oprehyɛn akyi nsɛnnennen

01. Ɛyaw a ɛba ansa na anom

Anterior patellofemoral pain yɛ ɔhaw a ɛtaa ba bere a wɔde nnadewa a wɔde hyɛ tibial stem a abubu no mu ahyɛ mu akyi. Nhwehwɛmu ahorow ada no adi sɛ bɛyɛ ayarefo 47 % wɔ nnadewa a wɔde hyɛ wɔn ntini mu akyi no betumi anya prepatellar ɛyaw, a wɔnte nea ɛde ba no ase yiye. Nneɛma a ebetumi anya nkɛntɛnso no betumi ayɛ ahodwiriw ne aduruyɛ mu opira a ɛba ntini mu ntini ahorow so, opira a ɛba saphenous nerve no infrapatellar branch no so, asen ntini a ɛyɛ mmerɛw a ɛto so abien wɔ ntini mu ntini a ɛma ɛyaw ho no siw ano, srade a ɛwɔ nipadua no mu a ɛyɛ fibrosis a ɛde impingement ba, reactive patellar tendonitis, bending strain a efi intramedullary mu nnadewa a wɔde bɔ tibia no fã a ɛbɛn no so, ne nnadewa no awiei a ɛbɛn no a ɛpuepue.

Bere a wɔresua nea ɛde prepatellar ɛyaw ba wɔ intramedullary nailing akyi ho ade no, wɔde transpatellar tendon kwan no totoo parapatellar kwan no ho. Ebia transpatellar tendon kwan no ne kotodwe mu yaw a ɛkɔ soro wɔ oprehyɛn akyi no wɔ abusuabɔ. Nanso, ayaresabea ho nsɛm a wɔanhyɛ da a wɔhwɛ kwan no ankyerɛ nsonsonoe titiriw biara wɔ transpatellar tendon kwan ne parapatellar kwan no ntam.

Ɛnyɛ nea wontumi nhu sɛnea nneɛma a wɔde hyɛ nipadua no mu a wɔpaw yi fi hɔ de di prepatellar ɛyaw ho dwuma wɔ tibial intramedullary nailing akyi. Yɛhyɛ nyansa sɛ wonsusuw ho sɛ wobeyi intramedullary tibial nail no afi hɔ sɛ wobetumi ahu mfiri bi a ɛde ba, te sɛ nnadewa a ɛpuepue anaasɛ skru a ɛka bom a ɛpuepue a. Nanso, mfaso a ɛwɔ tibial intramedullary nail removal so wɔ ayarefo a wɔwɔ sɛnkyerɛnne ahorow mu no da so ara yɛ nea asɛm wɔ ho.

Ɛdefa oprehyɛn akyi ɛyaw a ɛba wɔ akyi no ho no, wɔantumi ankyerɛ nea ɛde ɛyaw no bae no pefee wɔ ayaresabea nhwehwɛmu a edi kan a wɔyɛe wɔ nnadewa a wɔde hyɛ tibial nnadewa no mu wɔ akyi berɛmo no so wɔ gyinabea a ɛtrɛw fã no mu. Enti, ɛho hia sɛ wɔyɛ ayaresabea nhwehwɛmu akɛse a wɔde bere tenten di akyi de si nkɛntɛnso a nnadewa a wɔde hyɛ nipadua no mu wɔ suprapatellar kwan no so nya wɔ oprehyɛn akyi prepatellar ɛyaw so no so dua.

02.Oprehyɛn akyi alignment a enye

Nnompe mu ntini mu yare a ɛba wɔ ahodwiriw akyi no da so ara yɛ ɔhaw titiriw bere a wɔde nnadewa a wɔde hyɛ tibial dua a abubu no akyi. Biomechanical nhwehwɛmu ahorow ada no adi sɛ tibial malalignment betumi ama nsakrae kɛse aba wɔ nhyɛso a ɛba wɔ anan ne nkotodwe nkwaa a ɛbɛn hɔ no mu.

Ayaresa mu nhwehwɛmu ahorow a wɔde hwehwɛ nea efi bere tenten mu ba wɔ ayaresabea ne mfoniniyɛ mu wɔ tibial stem a abubu akyi no de nsɛm a ɛbɔ abira ama wɔ nea efi tibial malalignment mu ba no ho, na wonnyaa nsɛm a emu da hɔ biara de besi nnɛ.

Amanneɛbɔ ahorow a ɛkyerɛ sɛ oprehyɛn akyi a ɛnyɛ pɛpɛɛpɛ bere a wɔde nnadewa abɔ asen no mu akyi no da so ara sua, na wɔbɔ amanneɛ kakraa bi. Oprehyɛn akyi a ɛkyinkyin yiye da so ara yɛ ɔhaw a abu so wɔ tibial intramedullary nailing mu, na oprehyɛn mu nhwehwɛmu a wɔyɛ wɔ tibial rotation ho no da so ara yɛ den. Ɛde besi nnɛ no, wɔmfaa ayaresabea nhwehwɛmu anaa mfoninitwa kwan biara nsi hɔ sɛ sika kɔkɔɔ gyinapɛn a wɔde kyerɛ sɛnea asen no di akɔneaba wɔ oprehyɛn mu.CT nhwehwɛmu mu nhwehwɛmu ada no adi sɛ dodow a ɛkyinkyin yiye bere a wɔde nnadewa abɔ asen no mu akyi no betumi ayɛ kɛse akodu 19 % kosi 41 %. Titiriw no, ɛte sɛ nea abɔnten so kyinhyia a ɛyɛ mmerɛw no abu so sen emu a ɛkyinkyini no mu dɛmdi. Wɔbɔɔ amanneɛ sɛ ayaresabea nhwehwɛmu a wɔyɛe de hwɛɛ oprehyɛn akyi nsakrae a ɛnteɛ no nyɛ nokware na ɛkyerɛe sɛ ɛne CT nhwehwɛmu no nni abusuabɔ kɛse.

Yegye di sɛ malalignment da so ara yɛ ɔhaw a ɛtra hɔ kyɛ wɔ tibial stem a ɛpaapae a wɔde intramedullary nailing of the tibia sa no mu. Ɛmfa ho sɛ nsɛm a ɛbɔ abira a ɛfa abusuabɔ a ɛda nea ɛnkɔ so pɛpɛɛpɛ ne nea efi ayaresabea ne mfoniniyɛ mu ba ntam no, yɛhyɛ nyansa sɛ ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn bɔ mmɔden sɛ wobenya nipadua a abubu no ahyia na ama wɔatumi adi saa nsakrae yi so na wɔanya nea eye sen biara.

五 na ɛyɛ. Awie

Static locking expanded medullary intramedullary nailing da so ara yɛ ayaresa a wɔtaa de di dwuma ma tibial stem a abubu a wɔatu afi baabi foforo. Beae a ɛfata a wɔde hyɛn mu no da so ara yɛ oprehyɛn no fã titiriw. Wobu suprapatellar kwan a ɛwɔ gyinabea a wɔatrɛw mu fã no sɛ ɛyɛ ɔkwan a ahobammɔ wom na etu mpɔn, na ɛsɛ sɛ daakye nhwehwɛmu ahorow kɔ so hwehwɛ asiane ne mfaso a ɛwɔ saa ɔkwan yi so no mu. Ɛsɛ sɛ oduruyɛfo a ɔhwɛ oprehyɛn so no hu nnɛyi akwan a wɔfa so san de si baabi foforo. Sɛ wontumi mfa ɔkwan a wɔato mu so ntumi nnya nipadua mu akisikuru a ɛne ne ho hyia a, ɛsɛ sɛ wosusuw akwan a wɔfa so tew ntwitwiridii so ho. Wobetumi anya ayaresa pa a ɛboro 90 % denam intramedullary nailing a wɔatrɛw mu ne nea ɛntrɛw mu nyinaa so. Ɛmfa ho sɛ ayarefo sa yare yiye no, wɔda so ara wɔ dwumadi mu anohyeto ahorow a ɛtra hɔ kyɛ. Titiriw no, ɛyaw a ɛba prepatellar anim no da so ara yɛ anwiinwii a abu so wɔ tibial intramedullary nailing akyi. Nea ɛka ho no, malrotation bere a wɔde tibial fixation a ɛwɔ mu akyi no da so ara yɛ ɔhaw a abu so.

Nsɛm a wɔde gyinaa so

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