Tibial Intramedullary Nail Fixation Technique (cogo min bɛ kɛ ka wuluw jɔcogo kɛ

Nalo fixation intramedullaire tora furakɛli sugandilen ye min bɛ kɛ ni tibial stem karilenw ye minnu tɛ sabati ani minnu bɛ bɔ yɔrɔ wɛrɛ la balikuw la. Opereli furakɛli kun ye ka senkɔni janya, a labɛncogo ani a jiginni segin a cogo kɔrɔ la ani ka kari kɛnɛya sɔrɔ. Nafa minnu bɛ sɔgɔsɔgɔninjɛ la, olu ye opereli ka joginda fitinin ye ani joli min bɛ taa kari la, o maracogo bɛnnen. Ka fara o kan, senkɔniw sɔgɔli senkɔniw kɔnɔ, o bɛ kɛ sababu ye ka biyomekaniki kari sabati cogo bɛnnen na, wa a bɛ kɛ i n’a fɔ doni tila-tila minɛn min bɛ sira di opereli kɔfɛ mobilizasiyɔn ma joona. Ɲɛtaa minnu kɛra wuluwulu dilanni ni a dɔgɔyali fɛɛrɛw la, olu ye wulu sirili taamasiɲɛw caya walasa ka senkɔniw kɛrɛfɛla ni cɛmancɛ sabanan duguma karilenw sen don a la.

Fɔ ka na se bi ma, sɔgɔsɔgɔninjɛ karilenw sirili ɲɛgɛnɛsira kɔnɔ, o kɛra fɛɛrɛ ye min bɛ kɛ ka caya joginda koloci operelikɛlaw fɛ. Hali ni wuluwulu sirili ka di wuluwulu kɔnɔbara la wuluwulu karilenw na minnu bɔra u nɔ na, ​​a bɛ to ka gɛlɛya, wa gɛlɛya caman bɛ se ka sɔrɔ a la. Opereli fɛɛrɛw bɛ ka taa ɲɛ. Nin barokun in kun ye ka hakilina minnu bɛ sen na sisan, olu ɲɛfɔ senkɔni jirisunw karilenw sɔgɔli la ɲɛgɛnɛsira kɔnɔ ani ka ɲɛtaa minnu kɛra kɔsa in na o baara in na, olu lajɛlen.

一 ye. Jateminɛ fɔlɔ ni sɛgɛsɛgɛli

Banabagatɔ fitininw na, a ka ca a la, senkɔniw kari bɛ bɔ joginw de la minnu fanga ka bon, wa banabagatɔw ka kan ka jateminɛ kɛ ni u ni joginda bɛ u ni ɲɔgɔn cɛ ka kɛɲɛ ni Advanced Trauma Life Support (ATLS) ka laadilikanw ye. Aw bɛ fari lamini ni farikolo yɔrɔ nugulama joginw jateminɛ i n’a fɔ kurukuruw karilenw, fari sɔgɔsɔgɔninjɛ, jeninida, fɛnɲɛnamafagalanw, walima fari kɔrɔta; aw bɛ a ɲɛfɔ ni a karilen dabɔra, ni o don, aw bɛ a furakɛ ni tetanɔsi ni banakisɛfagalanw ye; ani ka farikolojidɛsɛ sɛgɛsɛgɛli kɛ ka ɲɛ ani ka nin kuma fɔlenw sɛbɛn. Aw bɛ kolotugudaw sɔrɔcogo jateminɛ ani ka kɛnɛyaso sɛgɛsɛgɛli caman kɛ o banabagatɔ ninnu na.

Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko kolotugudaw ka bana sɔrɔli senkɔniw karilen kɔfɛ, o bɛ se ka kɛ 11,5 % ye. Kɛrɛnkɛrɛnnenya la, banabagatɔ kulu fitininw ka teli ka kolotugudaw sɔrɔ. Kolotugudaw sɛgɛsɛgɛli ka kan ka kɛ ka da kɛnɛyaso ka sɔrɔw kan, i n’a fɔ dimi jugumanba, farikolojidɛsɛ caman cili, ɲɛgɛnɛsira fununi, ani dimi caya ka bɔ senkɔniw janya la min tɛ kɛ. O la, kolotugudaw ka bana bɛ to kɛnɛyaso sɛgɛsɛgɛli ye wa kɛnɛyaso sɛgɛsɛgɛli sɛbɛn ka ɲɛ, o nafa ka bon. Degun min bɛ ɲɛgɛnɛsira kɔnɔ, o bɛ se ka suman ni degun pikirijikɛlan ye (Jaa 1) i n’a fɔ sɛgɛsɛgɛli fɛɛrɛ min bɛ fara sɛgɛsɛgɛli kɛrɛnkɛrɛnnen kan.

Jaa 1. Degun sumani kolotugudaw la ni degun pikirijikɛlan ye

Walasa ka kunnafoniw sɔrɔ minnu bɛ se ka da u kan, ɲɛdawolo kɔnɔ tansiyɔn ka kan ka suman ɲɛgɛnɛsira naani na ani yɔrɔw la minnu tɛ kelen ye ɲɛgɛnɛsira kelen-kelen bɛɛ kɔnɔ. Kɔlɔsili minnu kɛra sɛbɛnw kɔnɔ, olu b’a jira ko ni tansiyɔn danfara ka dɔgɔn milimɛtiri 30 ma (tansiyɔn diyastoliki ka tansiyɔn bɔ farikolo yɔrɔ tansiyɔn na) o bɛ fasa yɔrɔ taamasiɲɛ jira. A ka ca a la, tansiyɔn jiginni bɛ dɔgɔya opereli senfɛ, wa tansiyɔn min bɛ kɛ ka kɔn opereli ɲɛ, o ka kan ka jateminɛ ni tansiyɔn danfaralen jatebɔ bɛ kɛ.

Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko farikolo tansiyɔn kɔlɔsili ye baarakɛminɛn ye min bɛ se ka nafa sɔrɔ ɲɛdawolo yɔrɔ jugumanba sɛgɛsɛgɛli la, ni a sɛgɛsɛgɛli ye 94 % ye ani a kɛrɛnkɛrɛnnenya ye 98 % ye. Nka, ka da a kan, ka da a kan, a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ.

Jaw jateminɛni ka kan ka kɛ ni ortopantomogramme standards ye ani senkɔni joginlenw yecogo kɛrɛfɛ ani gɛnɛgɛnɛ ni senkɔniw kɛrɛfɛla jateminɛw, minnu bɛ jateminɛ ka taa a fɛ ni tomogramu computé (CT) ye. O cogo kelen na, senkɔni CT scan bɛ se ka kɛ walasa ka senkɔni kariyɔrɔw ye minnu bɛ taa fo senkɔni yɔrɔ la ani senkɔni joginw minnu tɛ ɲɔgɔn kɛrɛfɛ

二 ye. Dɔgɔtɔrɔsow ka jaanw

Kɛmɛsarada la, senkɔni cɛmancɛ cɛmancɛ tilancɛ karilenw hakɛ caman fɔra ni senkɔni karilenw ye. Ni baara kɛra ni CT scan kɔrɔlenw ye, senkɔni cɛmancɛ ni duguma tila sabanan karilenw 43 % ni senkɔniw karilenw bɛ taa ɲɔgɔn fɛ, minnu fanba tun ka kan ka kɛ opereli ye. Kari suguya min ka teli ka kɛ, o tun ye senkɔni yɔrɔjan cɛmancɛ tila sabanan duguma kari ye min bɛ tali kɛ senkɔni kɔfɛla kari dɔɔni walima min ma wuli (Jaa 2). K’a sababu kɛ senkɔni karilen min bɛ tali kɛ o la, o jiginni fitinin ye, joginda 45 % dɔrɔn de bɛ se ka ye senkɔni ja gansanw na. O la, senkɔni CT scan kɛcogo kɔrɔlenw ka kan ka sinsin kosɛbɛ ni cɛmancɛ senkɔni duguma karilen bɛ yen (sɛbɛn ɲɛ 3).

Jaa 2.AF kinibolo kiniyanfan cɛmancɛ tila sabanan duguma karili (spiral fracture) (A, B) Senkɔni jateminɛ minnu kɛra ka kɔn opereli ɲɛ, olu b’a jira ko a bɛ cogo la (C). Opereli senfɛ C-arm fluoroscopy bɛ kɔfɛ senkɔni karilen jira min ma wuli ka bɔ yɔrɔ wɛrɛ la (D) Opereli kɔfɛ ja minnu bɛ kɛ opereli jɔli kɔfɛ (EF) olu bɛ senkɔni ni senkɔni karilenw kɛnɛya ka ɲɛ

Jaa 3. AF kinibolo kiniyanfan cɛmancɛ ni duguma tila sabanan karilen (AB) sani opereli ka kɛ; (CD) CT scan minnu kɛra ka kɔn opereli ɲɛ, olu bɛ kɔfɛla karilen jira min ma wuli ka bɔ yɔrɔ wɛrɛ la; (EF) min bɛ senkɔni ni senkɔni karilen kɛnɛyali jira min tɛ kɛ

三 ye. Opereli kɛcogo minnu bɛ kɛ

01. Tibial Needle dondaw

Donda tigitigi sigili jɔyɔrɔ ka bon kosɛbɛ wa kalan caman minnu kɛra sɛbɛnw kɔnɔ, olu ye kunnafoni nafamaw di donyɔrɔ ɲuman sigiyɔrɔ farikolo la, senkɔniw karilenw sɔgɔli senkɔniw kɔnɔ. Nin ɲinini ninnu y’a jira ko pinning point ideal bɛ sɔrɔ tibial plateau ɲɛfɛla la ani cɛmancɛ dɔrɔn na ka se tibial spur lateral ma. Lakanali yɔrɔ min bonya ye milimɛtɛrɛ 22,9 ± milimɛtɛrɛ 8,9 ye, o fana fɔra, min tɛ tiɲɛni kɛ kolotugudaw jɔcogo kɛrɛfɛ. Laada la, daminɛyɔrɔ min bɛ kɛ ka senkɔni jiribolo karilenw siri senkɔni kɔnɔ, o sigira sen kan ni senkɔniw senkɔni fɛɛrɛ ye, ni senkɔni senkɔni tilalen don (transpatellar approach) walima ni senkɔniw jɔli yɔrɔ dɔ bɔli ye (paratendinous approach).

Semi-extension intramedullary nailing ye mɔgɔw hakili sama kosɛbɛ kɔsa in na kolotugudaw la sɛbɛnw kɔnɔ, wa Tornetta ni Collins b’a fɔ ko aw ka baara kɛ ni medial parapatellar approach ye walasa ka nail kɔnɔna sirili semi-extension position na walasa ka intramedullary nail kuncɛ bɔli bali ka don anterior tibial cortex kɔnɔ.3 The use of a medial parapatellar approach for sɔgɔsɔgɔninjɛ min bɛ kɛ ɲɛgɛnɛsira kɔnɔ, o fana ka ɲi. Suprapatellar fɛɛrɛ kɛli ka ɲɛsin tibial intramedullary nailing ma ani ka intramedullary nail don senkɔniw fɛ ka tɛmɛ patellofemoral joint fɛ a yɔrɔ la min janyalen don a tilancɛ la.

O kɛcogo bɛ kɛ ni gɛnɛgɛnɛ kɔrɔtalen don degere 15-20 ɲɔgɔn na, ani ka janya tigɛ min bɛ se santimɛtɛrɛ 3 ɲɔgɔn ma, o bɛ kɛ bolokɔni kelen fo fila ɲɔgɔn na bolokɔni sanfɛ. Kɔnɔbara naani bɛ tila ka kɛ janya la ani ka tigɛli kɛ ka don senkɔni kolotuguda la. Sosɛti bɔgɔlen dɔ bɛ don senkɔni kolotuguda fɛ walasa ka donyɔrɔ dɔ dilan senkɔni ɲɛfɛla kɛrɛfɛla ni senkɔni yɔrɔ ɲɛfɛla cɛtigɛyɔrɔ la (Jaa 4).

Jaa 4. ab Opereli senfɛ foto minnu bɛ (a) senkɔni naani sɔgɔsɔgɔninjɛ tila ani ka trocar don senkɔni senkɔni fɛ ka taa senkɔni dondaw la; (b) opereli kɔnɔ dondaw filɛli kɛrɛfɛ

3,2 mm drill bit bɛ kɛ ka daminɛ pikirijikɛlan yɔrɔ dɔn C-arm ɲɛminɛni kɔnɔ. Sosɛti dabɔlen dɔ bɛ dilan walasa ka dondaw ni bɔyɔrɔw labɛn ka ɲɛ. Opereli tɔ minnu bɛ kɛ i n’a fɔ reaming ani tibial nail insertion, olu bɛ kɛ sosɛti fɛ.

NAFA minnu bɛ se ka sɔrɔ: Senw jɔcogo tilancɛ janyalen bɛ se ka dɛmɛ don kariyɔrɔw sigicogo kura la, kɛrɛnkɛrɛnnenya la ni senkɔniw karilenw bɛ kɛ ni senkɔni tila sabanan ye min bɛ kɛ ka surunya ani ka kɛ ɲɛfɛ. , A jɔyɔrɔ tilancɛ janyalen bɛ se ka degun bɔ senkɔni naani farikolo la ani ka dɛmɛ don kariyɔrɔ seginni na. , Semi-extended position suprapatellar fɛɛrɛ fana bɛ se ka kɛ fɛɛrɛ wɛrɛ ye ka tɛmɛn laadala infrapatellar fɛɛrɛ kan (Jaa 5).

Jaa 5. Opereli kɔnɔ foto min bɛ farikolo yɔrɔ nɔgɔlenw jogin jira senkɔniw yɔrɔ la i n’a fɔ taamasiɲɛ min bɛ kɛ ka ɲɛsin ɲɛda sanfɛla taamacogo ma yɔrɔ la min janyalen don a tilancɛ la.

Kɔlɔsiliw y’a jira ko suprapatellar fɛɛrɛ min bɛ kɛ ka tibial intramedullary nailing kɛ a yɔrɔ la min janyalen don a tilancɛ la, o ye opereli fɛɛrɛ ye min tɛ mɔgɔ tɔɔrɔ ani min bɛ se ka kɛ. Kɛnɛyaso sɛgɛsɛgɛli nataw ka kan ka kɛ walasa ka suprapatellar approach intramedullary nailing nafaw ni a dɛsɛw sɛgɛsɛgɛ ka taa a fɛ ani ka kuntaalajan jateminɛ minnu bɛ tali kɛ nin fɛɛrɛ in na.

02. Seginkanni fɛɛrɛbɔ

Ni aw ye nɛgɛ bila senkɔniw kɔnɔ, o dɔrɔn tɛ kɛ sababu ye ka kari dɔgɔya ka ɲɛ; karilenw dɔgɔyali ka kan ka to senna sɔgɔsɔgɔninjɛ kɛcogo bɛɛ la ani wuluw bilali senkɔniw kɔnɔ. Bololabaarakɛcogo dɔrɔn tɛ se ka kɛ sababu ye ka kari dɔgɔya farikolo la tuma bɛɛ a yɛrɛ ma. Nin barokun bɛna ɲɛfɔli kɛ dɔgɔyali manɛwɛrɛ suguya caman kan minnu datugulen don, minnu tɛ fɛn caman kɛ, ani minnu dabɔra.

-Closed reset fɛɛrɛ laadilikanw

Dɔgɔyali manɛwɛrɛ datugulenw bɛ se ka kɛ ni dɔgɔyali baarakɛminɛn ye i n’a fɔ F-fracture reducer, F-shaped radiographically transmissible reduction device min bɛ inversion/exversion angles latilen ka fara medial/lateral translation kan (Ja 6).

Jaa 6. F-shaped fracture reducer min kofɔlen don opereli la

Nka, o minɛn bɛ se ka degunba lase farikolo yɔrɔ nɔgɔlenw ma, wa a ka kan ka aw yɛrɛ tanga nin segin-ka-bɔ-minɛn in kɛli ma waati jan kɔnɔ. Reduction forceps fana bɛ se ka bila farikolo la, i n’a fɔ a bɛ kɛ cogo min na ni spiral ni oblique fractures ye. Nin baarakɛminɛn ninnu bɛ se ka kɛ cogo la min bɛ kɛ ni farikolo yɔrɔ nɔgɔlenw ye, ni tigɛtigɛ misɛnniw ye (Jaa 7).

Jaa 7. Farikolo sirili walasa ka senkɔni karilen segin a cogo kɔrɔ la

Kɔrɔsili suguya ni opereli tigɛyɔrɔ ka kan ka sugandi ka da fɛɛrɛ kan min bɛ se ka tiɲɛni kuntaalajan dɔgɔya farikolo yɔrɔ nɔgɔlenw na ka bɔ sirili bilali la (Jaa 8).

Jaa 8. Forobaciyɛnw bilayɔrɔ kura jiralenw walasa ka senkɔni karilen segin a cogo kɔrɔ la

Retracteurs fana ye reset baarakɛminɛnw dɔ ye minnu bɛ kɛ ka janya segin senkɔni ma. A ka ca a la u bɛ bila cɛmancɛ la ani ka yɔrɔ jan yɔrɔ la, nɛgɛso kɔnɔna na, a ka kan ka bila yɔrɔ min na. Proximal traction pins bɛ se ka bila walasa ka proximal blocking screw position ladege, o bɛ a to kari ka dɔgɔya nɔgɔya la ni intramedullary nail donna.

Tuma dɔw la, dɔgɔyali fɛɛrɛ datugulenw ni minnu tɛ fɛn caman kɛ, olu tɛ se ka kɛ hali bi walasa ka farikolojidɛsɛ sɔrɔ. O cogo la, tigɛcogo dɔgɔyali fɛɛrɛw ka kan ka jateminɛ ni lamini farikolo yɔrɔ nɔgɔlenw ladonni ye ka ɲɛ. Nafa minnu bɛ se ka sɔrɔ da wulilenw dɔgɔyali fɛɛrɛw la, olu ye opereli joginda wɛrɛw ye, o bɛ se ka dɔ fara opereli yɔrɔ banakisɛ sɔrɔli kan. Ka fara o kan, joli bɔli ka fara a kan ka taa kariyɔrɔ la, o bɛ se ka dɔ fara opereli kɔfɛ karibaliya kan.

-Fɛɛrɛko seko ni dɔnko tigɛcogo ni a bilali yɔrɔ kura la

Tigɛcogo dɔgɔyali manɛw tɛ sira di opereli dɔgɔyali pinceps dɔrɔn ma minnu bilalen don yɔrɔ bɛnnen na, nka a bɛ sira di fana ka sɔgɔsɔgɔninjɛ misɛnniw walima fɛn fitininw kɛ kariyɔrɔ la walasa ka kari dɔgɔyali sabati senkɔni kɔnɔ sɔgɔsɔgɔninjɛ kɛtuma na.

Aw bɛ platiw siri kari yɔrɔ kɛrɛfɛ ani yɔrɔjan karilenw na ni juruw ye minnu bɛ wele ko monocortical screws. Sɔgɔsɔgɔninjɛ bɛ to senkɔni kɔnɔna na, a sɔgɔli ni a bilali senkɔni bɛɛ la. Kɔnɔbara kɔnɔ nɛgɛ bilalen kɔfɛ, a bɛ plati bɔ walima ka a to a nɔ na walasa ka a jɔlen sabatili sabati (Jaa 9). Ni aw ye plati to a nɔ na, ​​kɔri kelen ka kan ka ɲɔgɔn falen ni kɔri fila kuru ye. A ka kan ka jateminɛ ka kɛ bana sugandilenw na, ni senkɔni jirisun bɛ opereli dafalen kɛ walasa ka kari dɔgɔyali sɔrɔ min bɛ sɔn.

Jaa 9. Senkɔni da wulilen kari ni a sɔgɔli jugumanba ye ani kolotuguda, kɔkolo kelen sirili ni sɔgɔsɔgɔninjɛ fitini ye karilen laban karilen na, sɔgɔsɔgɔninjɛ dɔgɔyali ni a bɔli kɔfɛ, nɛgɛ sirilen kɔfɛ ɲɛgɛnɛsira kɔnɔ

Nɛgɛ min bɛ balili kɛ, o kun ye ka ɲɛgɛnɛsiralabanaw dɔgɔya metafisiyali yɔrɔ la. Nɛgɛ minnu bɛ balili kɛ, olu bɛ bila bolokɔni kurukurunin kɔnɔ ani sɔgɔsɔgɔninjɛ fan min bɛ sɔgɔsɔgɔ ka sɔrɔ ka wulu bila senkɔniw kɔnɔ. Misali la, senkɔni yɔrɔ sabanan karilen ka bɔgɔbɔgɔli cogoya bɛ sɔrɔ valgus ni ɲɛfɛla kɛrɛfɛ. Walasa ka valgus deformité latilen, da tugulan dɔ bɛ se ka bila proximal fracture fragment kɛrɛfɛyɔrɔ la (o kɔrɔ ye ko deformité fan concave) ɲɛfɛla kɔfɛ. Nɔgɔ min bɛ ɲɛgɛnɛsira kɔnɔ, o bɛ bilasira ka bɔ cɛmancɛ fan fɛ, o bɛ kɛ sababu ye ka valgus bali. O cogo kelen na, angulation deformité bɛ se ka se sɔrɔ ni locking screw bilali ye cɛmancɛ la ka taa kɛrɛfɛ ka taa proximal block kɔfɛyɔrɔ la (o kɔrɔ ye ko deformité fan concave) (Jaa 10).

Jaa 10. senkɔni karilen seginni dɛmɛni ni nɛgɛw bilali ye minnu bɛ bali

-Medullary (ɲɛnamini) ka bonya

Karilen sigiyɔrɔ seginni dafalen kɔfɛ, medullary reaming bɛ sugandi walasa ka kolo labɛn ka kɛ ɲɛgɛnw doncogo ye ɲɛgɛnɛsira kɔnɔ. Bololabaarakɛla ka ɲɛminɛlan bɛ don senkɔniw kɔnɔ ani ka tɛmɛ a kariyɔrɔ fɛ, ka sɔrɔ ka reaming drill tɛmɛ bololanɛgɛ dakun kan. Bolo-dakun ɲɛminɛlan jɔyɔrɔ sɛgɛsɛgɛra C-arm fluoroscopy fɛ ko a bɛ senkɔni joli hakɛ la, wa ɲɛminɛlan tun bɛ cɛmancɛ la kosɛbɛ ɲɛfɛla ni kɔfɛla fila bɛɛ la (Jaa 11).

Jaa 11. bɛ ɲɛminɛlan jɔyɔrɔ jira ɲɛgɛnɛsira la C-arm fluoroscopy kan ɲɛda ni kɔfɛla jɔyɔrɔw la

Medulla expanded ni non expanded ko in kɛra sɔsɔli ye. An dalen b’a la ko Ameriki Woroduguyanfan operelikɛla fanba ka fisa ni senkɔni sɔgɔli ye min bɛ kɛ ni ɲɛdawolo la, ka tɛmɛ senkɔniw sɔgɔli kan min ma bonya. Nka, sɔgɔsɔgɔninjɛ min bonyalen don ani min ma bonya, o fila bɛɛ bɛ se ka kɛ fɛɛrɛ jɔnjɔnw ye minnu bɛ sɔn, wa, nɔ ɲumanw bɛ se ka sɔrɔ ni o fɛɛrɛ fila bɛɛ ye.

-Locking screw bilali

Kuru minnu bɛ ɲɔgɔn siri senkɔni jiribolo karilenw na, o kun ye ka senkɔni surunyali ni a jiginni jugu bali, ka senkɔni sɔgɔli taamasiɲɛw janya senkɔniw kɔnɔ ka se senkɔni jirisun karilenw ma minnu ka surun ani minnu bɛ yɔrɔ jan, o min bɛ kɛ ni metafizi ye. Kariw la minnu bɛ kɛ ni metafisiyali yɔrɔ ye, juruw minnu bɛ ɲɔgɔn siri ɲɔgɔn na, olu nafa ka bon kosɛbɛ aksidanw ka ɲɔgɔndɛmɛ sabatili la.

Viru saba minnu bɛ ɲɔgɔn siri kɛrɛfɛ, olu ye sabatili ɲɛ kosɛbɛ, wa sirili juru minnu bɛ sabati kɛrɛfɛ, olu bɛ se ka sabatiliba di ka tɛmɛ sirili juru kɔrɔw kan, o bɛ se ka kɛ sababu ye ka jɔli sabatili kelen sɔrɔ ni ɲɔgɔndan juru hakɛ fitinin ye. Dɔgɔtɔrɔso kunnafoniw minnu bɛ tali kɛ juruw sirili hakɛ ni u cogoya la minnu ka kan ka kɛ senkɔni kɔnɔna sirili la, olu dan ye hali bi.

A ka ca a la, sɔgɔsɔgɔninjɛ minnu bɛ ɲɔgɔn siri ɲɔgɔn na, olu bilali bɛ kɛ ni skɔpi ye min sirilen don wuluwulu kɔnɔna na. Distal interlocking screws bɛ don u yɛrɛ ma ni fluoroscopie bilasirali ye. Ɔridinatɛri dɛmɛnan ka ɲɛminɛlan min bɛ kɛ ni kuran ye, o ka ɲi walasa ka senkɔni yɔrɔjanw don ɲɔgɔn na (Jaa 12). O fɛɛrɛ in bɛ sira Di distal interlocking screws (kurunw) doncogo ma ni fiɲɛ tɛ u la, wa a jirala ko a ye fɛɛrɛ ye min bɛ se ka kɛ ani min bɛ tiɲɛ.

Jaa 12.AB Kurukuruw datugucogo C-arm perspective fɛ; CD Locking screws ka kɛ ni kuran ye ɔridinatɛri dɛmɛni fɛ

Kuru minnu bɛ ɲɔgɔn siri kɛrɛfɛ ani minnu bɛ yɔrɔ jan, olu bilali ye opereli kɛcogo ye min tɛ mɔgɔ tɔɔrɔ ani kuru minnu bɛ ɲɔgɔn siri, olu ka kan ka don cogo tigitigi la ani cogo la min bɛ se ka kɛ farikolo yɔrɔ nɔgɔlenw ye.

Anatomie sɛgɛsɛgɛliw y’a jira ko farati bɛ hali bi peroneal nerve palsy la ni aw bɛ proximal medial to lateral oblique interlocking screws bila. Walasa ka o farati dɔgɔya, operelikɛlaw ka kan ka jateminɛ kɛ ka sɔgɔli kɛ juruw kama C-arm ɲɛminɛni kɔnɔ, ni C-bolo ka fluoroscopique kɛrɛ ye min bɛ tilennen ni drill bit plan ye. Drill donni senkɔni yɔrɔjan kɔnɔ, o bɛ se ka gɛlɛya ka a dɔn ni magali kɔsegin ye, wa fibular kunkolo gɛrɛgɛrɛ bɛ se ka tactile impression datugu ani ka operelikɛla bila a ka miiri ko a bɛ 'kolo kɔnɔ' k'a sɔrɔ tiɲɛ na fibular kun donna. Kuru janya man kan ka dɔn ni drill gradué dɔrɔn ye, nka a man kan ka dɔn fana ni depth gauge sumanikɛlan bɛnnenw ye. Drill walima screw janya sumanikɛcogo o sumanikɛlan min ka ca ni milimɛtɛrɛ 60 ye, o ka kan ka siga bila kɔfɛla bɔli la, o bɛ se ka peroneal nerve commun bila farati la ka jogin.

Kɔnɔbara ɲɛfɛla ni kɔfɛla sirilanw bɛ bila ka u janto ɲɛfɛla ɲɛgɛnɛsiralabanaw, tibialis anterior tendon ani extensor digitorum longus lakanani na. Hali ni a ka ca a la, kuru bilali farikolo la, o tɛ kojugu ye, operelikɛlaw ka kan ka faratiw dɔn farikolo yɔrɔ nɔgɔlenw lamini na. Tibial stem kari fanba la, proximal (kɛrɛfɛ-kurun) fila ni distal interlocking screw fila bɛ sabatili ɲuman di. Tibial proximal ni distal fractures bɛ se ka nafa sɔrɔ ni u bilala ɲɔgɔn na ni fɛnɲɛnamafagalan wɛrɛw bilali ye plan wɛrɛw la walasa ka dɔ fara o jɔli sabatili kan (Jaa 13).

Jaa 13. Senkɔni karilen caman, minnu furakɛra ni sɔgɔsɔgɔninjɛ ye ni sɔgɔsɔgɔninjɛ ye ni juru fila ye minnu bɛ ɲɔgɔn siri yɔrɔjan na ani minnu bɛ kɛ kɛrɛfɛ, ni rezow ye minnu bɛ tugu ɲɔgɔn kɔ, olu b’a jira ko karilen kɛnɛyara.

-Fibular Fixation (Fibular Fixation) ye

Bi bi in na, wuluwuluw dilanni minnu bɛ kɛ ni juruw ye minnu bɛ ɲɔgɔn siri yɔrɔjan, olu ye senkɔni sɔgɔli taamasiɲɛw bonya walasa ka senkɔniw sɔgɔsɔgɔninjɛ kɛrɛfɛ ani yɔrɔjan karilenw sen don a la minnu bɛ kɛ ni metafizi yɔrɔ ye.

Distal interlocking screw configurations danfaralenw kɛra kalan in na (kuru 2 minnu bɛ bɔ cɛmancɛ la ka taa kɛrɛfɛ ka kɛɲɛ ni 2 ye minnu bilalen bɛ ɲɔgɔn na ka kɛɲɛ ni ɲɔgɔn ye ani distal interlocking screw 3 bɛɛ lajɛlen ni distal interlocking screw 1 dɔrɔn ye). Banabagatɔ minnu ye fibular fixation ni tibial intramedullary nail fixation kɛ, olu la, reset bɔnɛnen hakɛ tun ka dɔgɔn kosɛbɛ. Banabagatɔ 13 % minnu ka wulu sirilen don senkɔni kɔnɔ ni u ma fiyɛli siri, olu bɛɛ lajɛlen ye bɔnɛ jira opereli kɔfɛ ka segin u cogo kɔrɔ la, ni i ye o suma ni banabagatɔ 4 % ye minnu ka wulu sirilen don ni wuluwulu sirili tɛ.

Kɔrɔbɔli wɛrɛ la, min ye senkɔniw sirili nafa suma ni senkɔniw sirili ni senkɔniw sirili ni senkɔniw sirili ye ni fiɲɛ sirili tɛ, banabagatɔ minnu furakɛra ni fiɲɛ sirili ye ka fara senkɔniw sɔgɔli kan, olu ye ɲɛtaa jira ka ɲɛsin jiginni ni inversion/eversion alignment ma.

An bɛ a kuncɛ ko fibular fixation adjunctive bɛ se ka senkɔni kari dɔgɔyali sɔrɔ ani k’a mara senkɔni karilen tila sabanan yɔrɔjanw na minnu bɛ kɛ ni wuluwulu sirili ye senkɔni kɔnɔ. Nka, joginda gɛlɛyaw gɛlɛya min bɛ sɔrɔ tigɛ wɛrɛw fɛ farikolo yɔrɔ joginnen yɔrɔ la, o bɛ to yen. O la, an b’a fɔ ko aw ka kan ka aw janto fiɲɛ bilali dɛmɛnan na.

03. Jateminɛw

Ni aw ye senkɔni jiribolo karilenw siri ni sɔgɔsɔgɔninjɛ ye, o bɛ se ka nɔ ɲuman bɔ. Senkɔni sɔgɔsɔgɔninjɛ kɛnɛyali hakɛ fɔra sɛgɛsɛgɛli suguya wɛrɛw la. Ni bi fɛnw donna mɔgɔ kɔnɔ ani opereli fɛɛrɛ bɛnnenw, a jirala ko kɛnɛya hakɛ bɛ tɛmɛ 90 % kan. Senkɔni jirisun karilenw kɛnɛyali hakɛ min ma se ka kɛnɛya ɲɛgɛnɛsira kɔnɔ wulu sirilen kɔfɛ, o ɲɛnabɔra kosɛbɛ kɔnɔna jɔli kɔfɛ ni ɲɛgɛnɛsira kɔnɔ wulu filanan ye min bonyalen don.

Kɔnɔnafiliw jateminɛni san kelen opereli kɔfɛ, o y’a jira ko fo ka se banabagatɔ 44 % ma, u tora ka baarakɛcogo dɔgɔya u duguma yɔrɔ joginlen na, ani fo ka se 47 % ma, u tora ka baarakɛbaliya fɔ san kelen opereli kɔfɛ. Nin ɲinini in y’a jira ko banabagatɔ minnu furakɛra ni senkɔniw sɔgɔli ye senkɔniw kɔnɔ, olu bɛ to ka baarakɛcogo danba sɔrɔ waati jan kɔnɔ. Operelikɛlaw ka kan ka o ko ninnu dɔn ani ka banabagatɔw laadi ka kɛɲɛ ni o ye!

四 ye. Gɛlɛya minnu bɛ sɔrɔ opereli kɔfɛ

01. Dimi min bɛ kɛ ka kɔn ɲɛda ɲɛ

Dimi ɲɛfɛla senkɔniw ye gɛlɛya ye min ka teli ka sɔrɔ senkɔni jiribolo karilenw na ni u sirilen don ɲɛgɛnɛsira kɔnɔ. Kɔlɔsiliw y’a jira ko banabagatɔ 47 % ɲɔgɔn bɛ se ka dimi sɔrɔ ɲɛgɛnɛsira la, dimi min sababu ma faamuya ka ɲɛ. Fɛn minnu bɛ se ka nɔ bila o la, olu ye joginni ye min bɛ se ka kɛ joli-sira-funu-yɔrɔw la, joginni minnu bɛ sɔrɔ joli-sira-funu-kɔnɔ-fɛnw na, joginni minnu bɛ sɔrɔ saphenous nerve infrapatellar bolo la, cɛya farikolo fanga dɔgɔyali min bɛ kɛ filanan ye ka a sababu kɛ dimi bɛ sɔrɔ farikolojidɛsɛ la, tulumafɛnw fibrose min bɛ na ni impingement ye, patellar tendonitis réactive, bending strain from intramedullary sɔgɔsɔgɔninjɛ kɛli senkɔni kɛrɛfɛyɔrɔ kan, ani sɔgɔsɔgɔninjɛ dakun kɛrɛfɛla bɔli.

Ni u tun bɛ dimi min bɛ sɔrɔ ɲɛda ɲɛfɛ, o sababu sɛgɛsɛgɛ ɲɛgɛnɛsira kɔnɔ sɔgɔsɔgɔninjɛ kɔfɛ, ɲɛgɛnɛsira kɔkanna fɛɛrɛ ni parapatellar fɛɛrɛ sumalen don. Transpatellar tendon fɛɛrɛ bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛ dimi caya opereli kɔfɛ. Nka, kɛnɛyaso kunnafoniw minnu kɛra ni mɔgɔw ye, olu ma danfaraba jira transpatellar tendon fɛɛrɛ ni parapatellar fɛɛrɛ cɛ.

Kɔnɔnafilili bɔli sugandilen na walasa ka dimi ɲɛnabɔ senkɔni ɲɛfɛla sɔgɔsɔgɔninjɛ kɔfɛ, o nafa tɛ dɔn. An b’a ɲini aw fɛ aw ka jateminɛ kɛ senkɔni kɔnɔbara la ni a sababu dɔ bɛ se ka dɔn ni masin ye, i n’a fɔ wulu bɔli walima sɔgɔsɔgɔninjɛ min bɛ bɔ kɛnɛma. Nka, nafa min bɛ sɔrɔ senkɔniw na, o nafa ka bon banabagatɔw la minnu taamasiɲɛw bɛ u la, o bɛ to ka ɲininkali kɛ.

Ka ɲɛsin dimi ma min bɛ kɛ opereli kɔfɛ, dimi sababu ma se ka jira ka jɛya kɛnɛyaso ka sɛgɛsɛgɛli fɔlɔ la, min kɛra ka ɲɛgɛnɛsiraw siri senkɔni na ɲɛdawolo la, a jɔyɔrɔ tilancɛ janyalen na. O la, kɛnɛyaso ka sɛgɛsɛgɛlibaw ni tuguni kuntaalajanw ka kan ka kɛ walasa ka wuluwulu sirili nɔ min bɛ ɲɛda ɲɛfɛla fɛɛrɛ la, o nɔ min bɛ se ka kɛ opereli ɲɛfɛ dimi na, o ka kan ka kɛ.

02.Opereli kɔfɛ ɲɔgɔndan jugu

Koloci kɔfɛ, o bɛ to gɛlɛyaba ye senkɔni jiribolo karilenw furakɛli kɔfɛ ni sɔgɔsɔgɔninjɛ ye. Biomekanikini sɛgɛsɛgɛliw y’a jira ko senkɔniw ka ɲɔgɔndɛmɛbaliya bɛ se ka kɛ sababu ye ka fɛn caman Changements significatifs dans les contacts depressions dans les plusieurs sentiers ni gɛnɛgɛnɛ kolotugudaw la.

Dɔgɔtɔrɔso ka sɛgɛsɛgɛliw minnu bɛ kɛnɛyaso ni ja lajɛ kuntaalajan sɔrɔlenw jateminɛ senkɔni jiribolo karilen kɔfɛ, olu ye kunnafoniw di minnu bɛ ɲɔgɔn sɔsɔ senkɔniw ka ɲɔgɔndɛmɛ kɔlɔlɔw kan, fo ka na se bi ma.

Opereli kɔfɛ, senkɔniw sɔgɔsɔgɔninjɛ kɔfɛ, senkɔniw sɔgɔsɔgɔninjɛ kɔfɛ, olu hakɛ danmadɔ bɛ to, ni bana damadɔw fɔra. Opereli kɔfɛ, jiginni jugu bɛ to gɛlɛya ye min ka teli ka kɛ senkɔniw sɔgɔli la, wa opereli senfɛ senkɔniw jiginni jateminɛni bɛ to ka gɛlɛya. Fɔ ka na se bi ma, kɛnɛyaso sɛgɛsɛgɛli walima ja lajɛ fɛɛrɛ si ma sigi sen kan i n’a fɔ sanu hakɛ min bɛ se ka kɛ ka senkɔniw jiginni dɔn opereli kɔnɔ.CT sɛgɛsɛgɛli jateminɛ y’a jira ko senkɔniw jiginni juguya hakɛ bɛ se ka kɛ senkɔniw sɔgɔli kɔfɛ senkɔniw kɔnɔ, o bɛ se ka caya fo ka se 19 % fo 41 % ma. Kɛrɛnkɛrɛnnenya la, a bɛ iko kɛnɛma jiginni dɛsɛw ka ca ka tɛmɛ kɔnɔna jiginni dɛsɛw kan. Dɔgɔtɔrɔso sɛgɛsɛgɛli min kɛra walasa ka opereli kɔfɛ jiginni jugu jateminɛ, o fɔra ko o tɛ tiɲɛ ye, wa a y’a jira ko jɛɲɔgɔnya ka dɔgɔn ni CT jateminɛ ye.

An dalen b’a la ko ɲɔgɔndanbaliya bɛ to gɛlɛya kuntaalajan ye senkɔni jiribolo karilenw na minnu furakɛra ni senkɔniw sɔgɔli ye senkɔniw kɔnɔ. Hali ni kunnafoniw bɛ ɲɔgɔn sɔsɔ ka ɲɛsin jɛɲɔgɔnya ma min bɛ bɛnbaliya ni kɛnɛyaso ni ja lajɛ kɔlɔlɔw cɛ, an b’a fɔ ko operelikɛlaw ka kan k’u cɛsiri ka kariw labɛncogo farikolo la walasa ka nin fɛn caman ɲɔgɔnna in kunbɛn ani ka jateminɛ ɲumanw sɔrɔ.

五 ye. Kuncɛli

Static locking expanded medullary intramedullary nailing tora furakɛli sariyalen ye senkɔni jirisun karilenw na minnu bɔra u nɔ na. Donda yɔrɔ ɲuman bɛ to opereli kɛcogo yɔrɔ koloma ye. Suprapatellar fɛɛrɛ min bɛ kɛ cogo min na, o bɛ jate fɛɛrɛ ye min tɛ mɔgɔ tɔɔrɔ ani min bɛ se ka kɛ, wa kalan nataw ka kan ka nin wale in faratiw ni a nafaw jateminɛ ka taa a fɛ. Operelikɛla min bɛ taa a fɛ, o ka kan ka bi yɔrɔw labɛncogo dɔn. Ni farikolo karilenw sinsinni tɛ se ka kɛ ni fɛɛrɛ dagalen ye, tigɛcogo dɔgɔyali fɛɛrɛw ka kan ka jateminɛ. Kɛnɛya hakɛ ɲuman minnu ka ca ni 90 % ye, olu bɛ se ka sɔrɔ ni sɔgɔsɔgɔninjɛ ye min janyalen don ani min ma bonya. Hali ni kɛnɛya hakɛ ka ɲi, banabagatɔw ka baarakɛcogo dan tɛ u la hali bi. Kɛrɛnkɛrɛnnenya la, dimi min bɛ kɛ ɲɛda ɲɛfɛ, o bɛ to ka kɛ ɲininkali ye min bɛ kɛ tuma caman na senkɔniw sɔgɔsɔgɔninjɛ kɔfɛ. Ka fara o kan, jiginni juguya senkɔniw kɔnɔna sirilen kɔfɛ, o bɛ to gɛlɛya ye min bɛ sɔrɔ tuma caman.

Sɛbɛn minnu bɛ tali kɛ o la

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