Tibial fractures, suprapatellar intramedullary nail technique .

Kɔnɔbara kɔnɔ nailing technique for tibial fractures: ka tɛmɛ suprapatellar, transarticular approach fɛ ni gɛnɛgɛnɛ bɛ wuli 20-30° la ani lakanani tuubu kɛrɛnkɛrɛnnen dɔ walasa ka farikolo kɔnɔna fɛnw lakana.

01.Tibial intramedullary nailing .: Sɔrɔ ni ɲɔgɔndɛmɛ, gɛnɛgɛnɛ ɲɛfɛla dimi .

Opereli sɔrɔli tibial fractures intramedullary nailing intramedullary la, o nafa ka bon walasa ka kɔnɔbara basigilen don a kɔnɔ ka tɛmɛ don yɔrɔ ɲuman fɛ, walasa ka tiɲɛni dɔgɔya gɛnɛgɛnɛ kɔnɔna na, ani ka kariyɔrɔ caman sɔrɔ ani ka nɛgɛ doncogo ɲuman sɔrɔ.

Tibial stem fractures kɔrɔlenw ye infrapatellar walima parapatellar fɛɛrɛw cɛmancɛ ye. Hali ni nin fɛɛrɛ ninnu bɛ jira ka bɔ kariw la minnu bɛ sɔrɔ cɛmancɛ la, opereli kɔfɛ valgus, anterior, walima syndesmotic deformities bɛ to ka kɛ kariw la minnu ka surun kosɛbɛ.

Banakisɛ minnu bɛ sɔrɔ tibial proximale fractures la, olu sababuba ye tiɲɛni ye min bɛ sɔrɔ senkɔniw sɔgɔli fɛ gɛnɛgɛnɛ jiginni waati ni u ka masinw ka ɲɔgɔndɛmɛ na wulu kunbere ni kɔfɛla ɲɛgɛnɛsira kɔfɛla dontuma na. Patella fana bɛ axial donli bali ka kɛ nɛgɛ ye sagittal plane kɔnɔ (Ja 1A, b). O la, fɛɛrɛ wɛrɛ min bɛ kɛ ka don o yɔrɔ la, o ye parapatellar incision medial ye, o bɛ na ni nɛgɛ doncogo cɛmancɛ ye dɔɔnin (Ja 1C ani 2). Ni nɛgɛ bɛ don kɔnɔboli kɔnɔ ka a fara kari, a yɔrɔ min bɛ a kɛrɛfɛ, o bɛ kɔrɔta ka kɛ ɛksostosi ye (Ja 2). A laban na, ɲɛfɛla farikolo yɔrɔw ka lafiɲɛbɔ bɛ kɛ sababu ye ka ɲɛgɛnɛ kɛ dɔɔni (Ja 3).

Jaa 1 a,b ni infrapatellar fɛɛrɛ kɔrɔlen ye, patella bɛ nɛgɛ donli bali, o bɛ na ni apical sagittal alignment ani ectropion coronal alignment.c intramedullary ongle alignment ye min bɛ kɛ ni parapatellar fɛɛrɛ ye.

Jaa 2 Ka gɛrɛ don yɔrɔ la ka tɛmɛ parapatellar tigɛcogo cɛmancɛ fɛ, o bɛ na ni cɛmancɛ ye ka taa n’a ye lateral nail doncogo la. Ni nɛgɛ bɛ don medullaire kanal la ka a kari (a), a yɔrɔ min bɛ a kɛrɛfɛ, o bɛ kɔrɔta ka kɛ flare (b) ye .

Jaa 3 Lafiɲɛbɔ tansiyɔn ɲɛfɛla farikolo yɔrɔ ( a ) bɛ kɛ sababu ye ka ɲɛgɛnɛsiralabanaw labɛn ( b ) .

Ni aw ye tibia sɔgɔ ka taa yɔrɔ la min janya ka bon, o bɛ dɛmɛ ka gɛlɛyaw kunbɛn minnu bɛ sɔrɔ gɛnɛgɛnɛw kɔnɔ minnu bɛ opereli kɔnɔ.O fɛɛrɛ ɲɛfɔra Gelbke fɛ, Jakma et al. San 2010 ani a ye mɔgɔw kanu kosɛbɛ san laban ninnu na bawo ka n senkɔni sɔgɔ a farikolo yɔrɔ tilennen jɔyɔrɔ la, o bɛ kari manipule ni a jɔyɔrɔ kura nɔgɔya. Fluoroscopie kɛra fɛɛrɛ ye min kɛli ka nɔgɔn fɛɛrɛko siratigɛ la. a jirala ko fluoroskopi waati min bɛ kɛ suprapatellar nailing na , o ka surun kosɛbɛ ka tɛmɛ infrapatellar nailing kan . Ka fara o kan, nɛgɛ doncogo yɔrɔ (sanji-yɔrɔ la) bɛ bɛn ni senkɔni janya janya ye ni nin fɛɛrɛ in ye ka tɛmɛ infrapatellar nailing kan; O bɛ kɛ sababu ye ka masinw ka ɲɔgɔn sɔrɔli bali wulu kun ni kɔfɛla la, o bɛ kɛ sababu ye ka kari dɔgɔyali nɔgɔya.

Opereli kɔfɛ gɛnɛgɛnɛ dimi ye gɛlɛya ye min bɛ bɛn o ma. Gɛnɛgɛnɛ ɲɛfɛla dimi fɔra banabagatɔ 50-70% la minnu karilen don, banabagatɔ 30% dɔrɔn de bɛ dimi madali sɔrɔ a laban bɔlen kɔfɛ. A jateminɛna ko sɔgɔsɔgɔninjɛ ni Hoffa ka tulumafɛnw bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛ dimi sɔrɔ opereli kɔfɛ. Ka fara o kan, suprapatellar fɛɛrɛ bɛ a yɛrɛ tanga laadala tigɛ ma min bɛ kɛ ka safensi nɛrɛmugu bolokɔni tigɛ, o min bɛ gɛnɛgɛnɛ ɲɛfɛla kirinni ni a dusukunnata dunbali bali (Jaa 4). Ni aw ye nɛgɛ tɛmɛ senkɔni naani fɛ, o la, a bɛ kɛ ko a bɛ to ka senkɔniw da ka ɲɛ, o bɛ dɔ bɔ kosɛbɛ gɛnɛgɛnɛ dimi hakɛ la opereli kɔfɛ.

Jaa 4 Jɛɲɔgɔnya min bɛ safensi nɛrɛ ni a sɔrɔcogo danfaralenw cɛ Tibialis Obliqua Nail .

K’a sababu kɛ proximale fractures (kɛrɛfɛ karilenw) kɔlɔlɔ ɲuman ye, taamasiɲɛ minnu bɛ kɛnɛyaso baarakɛcogo la, olu bɛ bonya ka se kari bɛɛ ma.

Gɛlɛya minnu bɛ se ka sɔrɔ kɔnɔboli kɔnɔ, olu bɛ sɔrɔ suprapatellar fɛɛrɛ la:

- A bɛ se ka kɛ ka reaming nɔgɔw to gɛnɛgɛnɛ joli la. Nka, kɛnɛyaso ka ko kɛlen ni senkɔniw ye minnu bɛ sɔrɔ kɔfɛ, o ma kɔlɔlɔ kuntaala surun walima waati jan jira.

- A doncogo bɛ bɔ cogo di kari kɛnɛyalen kɔfɛ ? Hali n’a bɛ se ka kɛ fɛɛrɛko siratigɛ la ka kɔnɔnin dɔ bɔ a la ka tɛmɛ suprapatellar fɛɛrɛ fɛ, o fɛɛrɛ in bɛ ɲini wa operelikɛla fanba b’a fɛ ka kɔnɔnin kɔnɔ wulu bɔ a la ni fɛɛrɛ ye min tɛ se ka kɛ.

02.Suprapatellar intramedullary nail ka kan ka kɛ tuma jumɛn?

Nafaw .

- Gɛnɛgɛnɛ jɔyɔrɔ tilancɛ min janyalen don, o bɛ kari manipule ni a dɔgɔyali nɔgɔya ni farikolo fanga lafiyali ye ani ka to a la wuluw dontuma na.

- Farati min bɛ sɔrɔ opereli kɔfɛ, o bɛ dɔgɔya ka bɔ kariw la minnu bɛ kɛ ka surunya, minnu bɛ segin u kan, ani minnu bɛ yɔrɔjan fɛ ni u bɛ tali kɛ laadala fɛɛrɛw la .

- Nailing ka nɔgɔn fɛɛrɛko siratigɛ la .

- Nailing bɛ se ka kɛ i n'a fɔ 'Single Surgeon Procedure'.

- fluoroskopi waati dɔgɔyali .

- Tiɲɛni ma kɛ senkɔniw na ani gɛnɛgɛnɛ ɲɛfɛla dimi ka dɔgɔn .

- A kɛli ka nɔgɔn ekipu caman taabolo la, i n’a fɔ politrauma.

Nafa minnu bɛ sɔrɔ .

- farati bɛ gɛnɛgɛnɛ kolotugudaw la ani fɛn wɛrɛw minnu bɛ kɛ ni fɛnɲɛnamafagalanw ye .

- Gɛnɛgɛnɛw ka bana sɔrɔli farati ka bon .

- Ka fɛn min bɛ don a kɔnɔ , o bɔli bɛ se ka kɛ fɛɛrɛ wɛrɛ ye .

Taamaʃyɛnw .

- Kɔnɔbara kɔkanna kari minnu bɛ kɛ ka ɲɛgɛnɛ kɛ (Type AO 41A) .

- Tibial diaphysis ka kari nɔgɔmanw (Type AO 42A-C) .

- Segmental tibial diaphyse fracture (Type AO 42C) .

- A bɛ kɛ ni fɛnɲɛnamafagalanw ye minnu bɛ wele ko extra-articulaire ani simple distal extension distal tibia (Types AO 43A ani C1) .

- Gɛnɛgɛnɛ min bɛ pan .

A ka kan ka kɛ sababu ye ka .

- Gustilo Grade 3C Open fractures of the Tibia ka da a kan a bɛ se ka kɛ sababu ye ka kolotugudaw ka bana sɔrɔ, hali ni a ma fɔ ko jolilabanaw ka teli ka sɔrɔ ka bɔ kariw la.

- farikolo yɔrɔ nugulamaw ɲɛjibɔ, nɔgɔ walima banakisɛ bɛ sɔrɔ suprapatellar yɔrɔ la .

- Gɛnɛgɛnɛw ka prothèse ipsilateral (intraindication de contraindication) .

- Gɛnɛgɛnɛ fusion .

- Gɛnɛgɛnɛ jiginni >20° .

- Ipsilateral tibial plateau kari min bɛ kɛ ni nɛgɛ don yɔrɔ ye , o ye a kunbɛncogo ye .

- Implants obstructed the nail dondaw .

- Ipsilateral patella kari (a ka jugu ni ɲɔgɔn ye) .

03. Opereli fɛɛrɛw .

1 Farikolo jɔyɔrɔ ni a jateminɛcogo .

Jaa 5 Banabagatɔ bɛ a yɛrɛ da tabali kan min bɛ se ka kɛ ni sen tilancɛ ye. A bolokɔni karilen bɛ to ka jɛngɛ ka jɛngɛ ani ka sɛbɛnfura dɔ bila gɛnɛgɛnɛ joli jukɔrɔ (a) walasa ka gɛnɛgɛnɛ 10-30° sɔrɔ . 

(b). C-arm bɛ bila fan dɔ fɛ. Sen min ma nɔ bila a la, o bɛ jigin 10-30° la ka bɔ jiginni na walasa ka ja ɲuman sɔrɔ kɛrɛfɛyɔrɔ la.

1 Aw bɛ pikirijikɛlan doncogo ɲuman sɔrɔ .

Jaa 6 Nin fɛɛrɛ in bɛ taamasiyɛn kɛ ni patelli, tibial tuberosity, ani ɲɛda ɲɛgɛnɛsira ɲɛfɛla ye. Fari janya janya bɛ kɛ santimɛtɛrɛ 2 ye, o bɛ kɛ santimɛtɛrɛ 1-1,5 ye ka surunya patelli basigilen sanfɛla la. Quadriceps tendon bɛ bɔ kɛnɛ kan ani cɛmancɛ janya tigɛ bɛ kɛ senkɔniw sira fɛ. Suprapatellar recess bɛ da wuli ani operelikɛla bolokɔniw bɛ don gɛnɛgɛnɛ joli la ka bɔ patelli jukɔrɔ walasa ka se ka don nɔgɔya jateminɛ. Farikolo yɔrɔ janya dɔɔni bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛ sɔrɔli nɔgɔya. Langenbeck retractor donni walasa ka patella kɔrɔta dɔɔni, o fana bɛ se ka dɔ fara a sɔrɔli kan. Ni joginda yɔrɔ ka dɔgɔ kosɛbɛ ani minɛnw ka gɛlɛn, dɛmɛlan cɛmancɛ walima a kɛrɛfɛla bɛ se ka tigɛ a la walasa ka patella dislocate semi-discore ka taa fan kelen fɛ.

3Baarakɛcogo lakanani .

Jaa 7 Patellofemoral cartilage lakanani ka bɔ joginni na min bɛ sɔrɔ opereli fɛ, o ye opereli kɛcogo kuntilenna jɔnjɔn dɔ ye. O la, bolokɔfɛfɛnw ka kan ka kɛ minɛnw ni nɛgɛw dontuma na.Fɛn minnu bɛ kɛ ka ɲɛgɛnɛsiraw don, olu ye dondaw ye, kɛnɛma (soft) ani kɔnɔna (nɛgɛ) lakanani bolokɔniw, trocar pins, ani porous fil guides.b dondaw bɛ lajɛ ni bolokɔfɛfɛn ye ani kɛnɛma (soft) ani kɔnɔna (metal) ani trocar pineve, ani a pineve, ani a pineve. Trocar pikirijikɛlan bɛ lajɛ ni bolokɔfɛfɛn ye ani a doncogo minɛn.B Mounting handle with lateral ventilation holes. Kɔnɔbara min bɛ don a kɔnɔ, o bɛ a bali ka a minɛ cogo la min bɛ kɛ ni a bɛ kɛ ni a bɛ se ka kɛ a bolo ye .

1 Aw bɛ GuideWire don a kɔnɔ ani ka a jɔyɔrɔ ladilan .

Jaa 8A Boloci bɛ don patelli jukɔrɔ ka tɛmɛ patellofemoral joint fɛ ka taa don yɔrɔ ɲininen na senkɔni kan (Ja 9). A ka c’a la, patella bɛna taa cɛmancɛ la dɔɔnin walima kɛrɛfɛ minɛnw dontuma na. A ka c’a la, groove in the patellofemoral joint bɛ trocar pikirijikɛlan ɲɛminɛ ka taa a jɔyɔrɔ ɲuman na a yɛrɛma.

Jaa 8B jɔyɔrɔ tun sigilen bɛ plan fila bɛɛ la ni fluoroscopie ye ani ka a latilen ni a mago bɛ a la. O kɔfɛ, trocar pikirijikɛlan bɛ bila a nɔ na ni porose guidewire ye, guidewire min bɛ tɛmɛ guidewire cɛmancɛ dingɛ fɛ ani min kun bɛ don tibial metaphysis proximale la walasa ka a jɔyɔrɔ ɲuman sɔrɔ.

Jaa 8c Ni GuideWire bɛ yɔrɔ la min ka ɲi, ɲɛminɛlan filanan bɛ se ka kɛ ka ladilanni dɔɔni kɛ yɔrɔ ɲuman na ka tɛmɛ porose guidewire fɛ, fo ka se milimɛtɛrɛ 4,3 ma i n’a fɔ a nɔfɛta, a bɛ se ka nɔgɔya ka daminɛ ni guidewire ye ani ka a bila dɛmɛ tɛ don min na dondaw la. O kɔfɛ, a doncogo minɛn min bɛ ni GuideWire ye, o bɛ sɔgɔ GuideWire kan.

1 ƝƐFƆLI MIN BƐ KƐ MEDULA OBONGATA .

Jaa 9a Medullary cavity ka bɔ dondaw la minnu ka ɲi kosɛbɛ, o ye senkɔrɔ ye opereli kɛcogo la. Anteroposterior plane kɔnɔ, nin ye fɛnɲɛnamafagalan cɛmancɛ fan ye. Kɛrɛfɛ-plan na, don yɔrɔ bɛnnen bɛ sɔrɔ jiginni na joli-sira-funu-yɔrɔ ni ɲɛfɛla-yɔrɔ cɛ.

Jaa 9b Guidewire jɔyɔrɔ ɲuman bɛ bɛn tibial axis ma ɲɛfɛla la ani a surunyalen don a ɲɛfɛla la ni a bɛ se ka kɛ a kɛrɛfɛla la. Guidewire bɛ teli ka lamaga kɔfɛ.

Jaa 9C Ni pinɛ walima nɛgɛ tɛ se ka don a la ka ɲɛ, ka nɛgɛ walima pini datugu, o bɛ dɛmɛ ka nɛgɛ ɲɛminɛ ka don a jɔyɔrɔ ɲuman na. 

Nakɔw datuguli bɛ kɛ metafizi yɔrɔ la min ka bon kosɛbɛ ni ɲɛminɛlan walima nɛgɛ tɛ se ka kɛ cɛmancɛ ye ka bɛn kolo janya janya ma walima ni karicogo bɛnbaliya bɛ to sen na walima a fila bɛɛ la, o bɛ to sennasanbara dontuma na.

Jaa 10 Nin waati in na, a ka ɲi ka bolokɔniw lajɛ ka u siri senkɔniw na ni 3,2 mm ɲɛminɛlan nɛgɛ ye. O b’a To a bɛ Se ka Kɛ ko a ka kan ka Bɔ a la ka Bɔ senkɔni na.

Jaa 11 12.0 mm hollow drill bit bɛ bila kɔnɔna lakanani bolokɔni fɛ ka jigin ka tɛmɛ GuideWire fɛ ka taa kolo la. Medullary kanal bɛ da wuli ni drilling ye fo ka se santimɛtɛrɛ 8-10 ma ani ka bolola-minɛn dɔ don a kɔnɔ min bɛ don a kɔnɔ.

6 ka kari dɔgɔyali .

Jaa 12A Nin waati in na, an bɛ kari segin.

Jaa 12B Ka da a kariyɔrɔ n’a cogoya kan, dɔgɔyali baarakɛminɛn suguya caman i n’a fɔ klip minnu bɛ kɛ ni fɛnɲɛnamafagalanw ye, retracteurs, plate misɛnniw, ani blocking vises bɛ se ka kɛ walasa ka ɲɔgɔndɛmɛ ɲuman sɔrɔ. Tibial tibial kari dɔgɔyali la, tuma dɔw la hali ni dɛmɛ bɛ kɛ ka fɛn wɛrɛw don a la, sani aw ka medullary kanal da wuli ni drilling ye. Reaming rod bɛ taa ɲɛ ka taa a fɛ ani a bɛ don tibial metaphyse distal cɛmancɛ la. Segin-ka-bɔnye kɔfɛ, nɛgɛ janya ni a cɛmancɛ bɛ dɔn. Ni a mago bɛ a la, aw bɛ tibial kanal bonya fo ka se a cɛmancɛ ɲininen ma ni a bɛ segin ka kɛ milimɛtɛrɛ 0,5 ye. Da min bɛ kɛ bolokɔni lakanani bolo la, o bɛ kɛ sababu ye ka nɔgɔw bɔ joli la ani ka u sama ka bɔ joli la reaming waati la. Ni a bɛ se ka kɛ, a ka ɲi ka kɛ ni nɛgɛ ye min janya ka dɔgɔn milimɛtɛrɛ 10 ye. Nin nɛgɛ suguya in ka 5,0 mm da tugulen bɛ se ka dɛsɛ kunbɛn ka tɛmɛ 4,0 mm da tugulan kan min bɛ kɛ ka nɛgɛ finmanw kɛ. A ka ca a la, a ka ca a la, a bɛ kɛ ni fɛnɲɛnamafagalanw janya ye ni fluoroscopic ruler ye.

3Aw bɛ se ka don a kɔnɔ .

Jaa 13A Nail doncogo ka tɛmɛ reaming bere fɛ fluoroscopie jukɔrɔ. Aw bɛ a kɔlɔsi ko suprapatellar nail doncogo janya ka tɛmɛ infrapatellar nail kan barisa yɔrɔjan min bɛ bɔ fari tigɛcogo la ka taa tibial nail donyɔrɔ la, o fana ka jan.

Jaa 13b Aw ye aw janto a la ko kuru (curve herzog) min bɛ sɔrɔ kɔnɔbara basigilen dakun kɛrɛfɛla la, o tɛ se ka don kɔnɔna nɛgɛ lakanani bolokɔni fɛ. O la, kɔnɔna lakanani bolokɔni ka kan ka bɔ bolokɔniw lajɛyɔrɔ la ka sɔrɔ ka nɛgɛ don (b; a’ ye sigida 'filiw, faratiw ni gɛlɛyaw lajɛ' lajɛ). Aw bɛ kɔnɔbara basigilen jɔyɔrɔ laban lajɛ ɲɛfɛla ni kɛrɛfɛla lajɛw la. Aw bɛ reaming bere bɔ. Ni wulu ka kan ka wuli, aw bɛ a bila a nɔ na ka a bila a nɔ na ka nɛgɛ kura don bere kɔnɔ. 5 mm taamasiɲɛw doncogo bolokɔni kan, o bɛ a jira ko fɛn min bɛ don a kɔnɔ, o bɛ kɛ ka a don a kɔnɔna na (Ja 14). (Jaa 14)

1 Distal ani proximal locking .

Jaa 14a da tugucogo surunw ni yɔrɔjanw bɛ bɔ karicogo kɛrɛnkɛrɛnnenw na. Proximal locking bɛ se ka kɛ ni laɲini bolo ye. Distal locking bɛ kɛ freehand walima baara kɛli fɛ ni radiopaque drill guide ye. Ni a bɛ se ka kɛ, dakun laban bɛ se ka kɛ, o bɛ kolo bali ka bonya ka don kɔnɔbara basigilen laban na ani ka a doncogo nɔgɔya kɔfɛ. Kɛrɛnkɛrɛnnenya la, nɛgɛ minnu bɛ don u la ka tɛmɛ, olu bɔli ka nɔgɔn ni dakunw janya bɛnnenw bɛ kɛ. A laban dakun janya ɲininen bɛ suman ni taamasiɲɛ dɔ donli ye a bolokɔni kan walima ni ɲɛminɛlan sirilan donli ye laɲini bolo fɛ.

Jaa 14b Guidewire kuncɛ bɛ kɔnɔbara basigilen jɔyɔrɔ jira. Vis min bɛ laɲini bolo siri nɛgɛ la, o ka kan ka bɔ walasa ka a laban dawolo don. A laban dakun bɛ tɛmɛ dondaw la min bɛ don a kɔnɔ. A doncogo bololanɛgɛ bɛ to a nɔ na. O bɛ laban dakun ni kɔnɔbara basigilen sanfɛla labɛn ani ka a bali ka tunun gɛnɛgɛnɛ na. Ni aw bɛ bilasiralikɛlan don barajuru dakun dakun na, o bɛ dɛmɛ fana ka laban ka a jɔyɔrɔ bɛnnen don a la, a bɛ kɛ ka ɲɛkisɛ kɔnɔna na. O kɛcogo laban na, saline sterile (sterile saline) ka kan ka ko walasa ka nɔgɔ tolenw bɛɛ ko.

04. Aw ye aw janto .

Fɛɛrɛ minnu bɛ tigɛ opereli baara kama .

- Ni koloci min tun bɛ yen ka kɔrɔ, patellar motion dantɛmɛnen bɛ se ka jolisira sɔrɔli bali. Ni aw ye dɛmɛlan cɛmancɛ walima kɛrɛfɛla yɔrɔ gɛrɛgɛrɛ yɔrɔ tigɛ ka bɔ cɛmancɛ fan fɛ, o bɛ trocar pin donli nɔgɔya.

- Gɛnɛgɛnɛ min bɛ kɛ ipsilateral (ipsilateral) la, o tɛ suprapatellar pinning (suprapatellar pinning) kɔlɔlɔ gɛlɛn ye. Nka, a kɔlɔsi ko a bɛ se ka kɛ ko a tɛ se ka don tibial nailing proximate proximite daminɛyɔrɔ la min bɛ kɛ tuma bɛɛ.

- Kariw la minnu bɛ ni joli-sira-funu ye, juru wɛrɛw bɛ se ka don walasa ka joli-sira-funu-yɔrɔ-yɔrɔ lamaga. A ka ɲi nin kuru ninnu ka bila ka sɔrɔ ka nɛgɛ don a la walasa ka joli-sira-funu-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-la-banaw ka Kɛ.

Tibia proximale karili jateminɛw .

Tibiw kari minnu bɛ kɛ ka ɲɛ, olu ye tibial karili ye min ka gɛlɛn ka tɛmɛ jiribuluw kan, wa u bɛ don yɔrɔ tigitigiw de wajibiya (i n’a fɔ a ɲɛfɔlen don cogo min na sanfɛ). O kariw ka kan ka dɔgɔya ka sɔrɔ ka u sɔgɔ walasa ka fanga caman tiɲɛ ani ka ɲɛtaa caman sɔrɔ. Dɔw la, ni aw ye bolokɔni min bɛ bana in na, ni aw bɛ a bila yɔrɔ la min janyalen don ani ka donyɔrɔ tigitigi sɔrɔ ani ka nɛgɛ bila ni medulari kanal ye koronawirisi ni sagittal axes la, o bɛna kɛ sababu ye ka senkɔniw sinsinni kɛ ka ɲɛ senkɔni kɔfɛ.

Nka, a ka c’a la, dɔ bɔli manɛwɛrɛ dɔw ka kan ka kɛ walasa ka o kariw sigicogo kura sɔrɔ ani k’u mara. Ni kariyɔrɔ sira ka nɔgɔn ani a bɛ kɛ kɛrɛ fɛ, a bɛ se ka kɛ fɛn nɔgɔmanw ye minnu bɛ se ka kɛ ka fɛnw bila u la walima ka u siri ɲɔgɔn na, olu bɛ se ka kɛ ka segin u cogo kɔrɔ la ani ka u mara. Ni sirilan ma dafa walima ni a karilen don, ni a ma juru don a la, ni a bɛ kɛ ka fɛnw mugumugu walima ni a bɛ se ka kɛ sababu ye ka fɛnw bali ka bɔ u nɔ na ani ka u bali (Jaa 15). O kurukuruw bɛ bila kɔfɛla la ka taa nɛgɛ jɔyɔrɔ ɲininen na kɛrɛfɛla lajɛ la ani kɛrɛfɛ ka taa nɛgɛ jɔyɔrɔ ɲininen na ɲɛfɛla-kɔfɛ-yɔrɔ la. O kurukuruw bilali ka ɲɛ walasa ka u lasegin u cogo kɔrɔ la, o bɛ se ka kɛ gɛlɛya ye.

Jaa 15 Datugulan sirilenw bɛ bila nɛgɛ sira ɲininen kɛnɛma na ɲɛfɛ ni kɔfɛla lajɛw la (a) ani nɛgɛ sira ɲininen kɔfɛ kɛrɛfɛla lajɛ (b) min bɛ fɛn caman tigɛli fanga kɛlɛ .

Fɛɛrɛ wɛrɛ min bɛ se ka kɛ kosɛbɛ, o ye ka kari sirili waati dɔɔni farikolo la (sɛbɛn ɲɛ 16). A ka c’a la, tubalan fitini dɔ bɛ kɛ ni tubu ye min bɛ kɛ ni fɛn fila walima saba ye, o bɛna a minɛ ka a ka kari min bɛ dɔgɔya jirisunw labɛnni na ani ka wuluw don a kɔnɔ. Plate bɛna o jiginni fila bɛɛ kunbɛn. Falan ka kan ka to a nɔ na fo ni yɔrɔ jɔlen tɛ yen walasa ka dɔgɔyali bali min ka teli ka kɛ plati bɔli kɔfɛ. Nin plati in ni a ɲɛkisɛ kelen tɛ gɛlɛya, wa a tɛna nɔ bila wulu sabatili la. Reset plate technique bɛ se ka kɛ ka kari da wulilenw ni da datugulen fila bɛɛ la.

Jaa 16 Datugulan fitinin dɔ bɛ se ka sɔrɔ ani ka a mara farikolo yɔrɔ dɔ la. A ka ca a la, a ka kan ka to a nɔ na, ​​a ka kan ka to a nɔ na. Valgus deformité fɔlɔ dɔ bɛ sɔrɔ tibial proximal fracture la. b Karilan fitinin dɔ bɛ bila ni jiribolo kelen ye, o bɛ bila cɛmancɛ la walasa ka kariyɔrɔ segincogo sɔrɔ ani ka a mara nailing waati la. c Plate tɛ bɔ a sɔgɔli kɔfɛ bawo a bɛ sabatili wɛrɛ di .

Labɛnbaliya, faratiw ani gɛlɛyaw .

- Opereli kɔnɔna na, a bɛ se ka kɛ sababu ye ka farikolo tangalan ni a kolotugudaw tiɲɛ (Jaa 17). Lakanali bolokɔni ka kan ka don a la ka ɲɛ.

- Lakanali bolokɔni kɔrɔtalen dɔɔni bɛ se ka reamer kunkolo bɔli juguya. Fluoroscopie bɛ dɛmɛ ka gɛlɛya in dɔn. Segin-ka-bɔ-labɛncogo kura bɛna gɛlɛya in ɲɛnabɔ (Ja 18) .

- Nail lock-up : A doncogo bɛ se ka siri nɛgɛ bolokɔni na ka a siri a kurulen na (Herzog curve). Walasa ka nɛgɛ don laban na, nɛgɛbere ka kan ka bɔ, ka kɛnɛma plastiki nɔgɔlen dɔrɔn to. Ni nɛgɛ bɛ siri, a ka kan ka bɔ pewu tuguni ani ka don a kɔnɔ ka a don nɛgɛ kanɛli bɔlen kɔfɛ plastiki kanɛli dɔrɔn fɛ.

Jaa 17 Bolo lakanani ni a kɔlɔsili ye min bɛ kɛ ni fluoroscopic ye, o bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛ jogin .

Jaa 18 Latangalikɛlan jiginni walima a jiginni kasaara bɛ se ka kɛ sababu ye ka reamɛri bɔli bali, bawo reamer kunkolo bɛ se ka ja. B A sɛgɛsɛgɛli ni a bɛ se ka kɛ ko a bɛ se ka kɛ ka reamer kunkolo bɔ. c Reamer kunkolo bɛ se ka bɔ ni reamer kunkolo tɛ a nɔ na. d Reamer kunkolo bɛ se ka bɔ ni reamer kunkolo tɛ a nɔ na.

References .

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar Nailing of the Tibia. Oper orthop traumatol. 2020 Ɔkutɔburukalo;32(5):440-454.