Tibial intramedullary ongle fixation technique .

Ɲɛgɛnɛsiraw labɛnni bɛ to furakɛli sugandilen ye tibial stem fractures la minnu tɛ sabati ani minnu bɛ bɔ u nɔ na balikuw la. Opereli furakɛli kuntilenna ye ka senkɔni janya, a ɲɔgɔnna ani a jiginni segin a cogo kɔrɔ la ani ka kari kɛnɛya sɔrɔ. Nafa minnu bɛ sɔrɔ kɔnɔbara basigilen na, olu ye opereli bɔnɛ dɔgɔman ye ani joli labɔli bɛnnen ka se ka kari. Ka fara o kan, tibia nailing intramedullary bɛ biomechanical fracture stability bɛnnen di ani a bɛ kɛ doni-ta-minɛn ye min bɛ sira di opereli kɔfɛ mobilizasiyɔn ma joona. Ɲɛtaa minnu kɛra kɔnɔw dilanni ni u dɔgɔyali fɛɛrɛw la, olu ye fɛnɲɛnamafagalanw kɔnɔna na, nɛgɛw labɛnni taamasiɲɛw bonya walasa ka tibia gɛrɛgɛrɛ ni cɛmancɛ saba kari duguma.

Fɔ ka na se bi ma, daga kɔnɔ, ɲɛgɛnɛsiralabanaw ka ɲɛgɛnɛsiralabanaw bɛ kɛ sababu ye ka jolilabanaw furakɛ. Hali ni a bɛ fɔ ko ɲɛgɛnɛsiralabanaw ka fɛnɲɛnamafagalanw ka fɛnɲɛnamafagalanw ka fɛnɲɛnamafagalanw ka teli ka kɛ, a bɛ to ka gɛlɛya sɔrɔ, wa a bɛ se ka gɛlɛya caman sɔrɔ. Opereli fɛɛrɛw bɛ ka taa ɲɛ. Nin barokun in kun ye ka sisan hakilinaw ɲɛfɔ tibial stem fractures intramedullary nail fixation intramedullary kɔnɔ ani ka kɔsa in na ɲɛtaa minnu kɛra foro kɔnɔ, olu lajɛ.

一. Jateminɛ fɔlɔ ni sɛgɛsɛgɛli .

Banabagatɔ minnu ka dɔgɔn, tibial stem fractures ka teli ka sɔrɔ fanga caman joginw fɛ, ani banabagatɔw ka kan ka jateminɛ kɛ ni u bɛ tali kɛ joginda la ka kɛɲɛ ni jogindaw ka ɲɛnamaya sabatili dɛmɛ (ATLS) ka laadilikanw ye. Aw bɛ fari lamini ni farikolo yɔrɔ nugulenw joginw jateminɛ i n’a fɔ kari kurukuruw, fariw sɔgɔsɔgɔli, jeninida, ɲɛgɛnɛsiraw, walima fariw jiginni; Aw bɛ a ɲɛfɔ ni kari da yera, ani ni o kɛra, aw bɛ a furakɛ ni tetanɔsi ni banakisɛfagalanw ye; ani ka hakili ni jolisiraw sɛgɛsɛgɛli kɛ ka ɲɛ ani ka nin kuma fɔlenw sɛbɛn. Aw bɛ kolotugudaw ka bana sɔrɔcogo jateminɛ ani ka kɛnɛyaso sɛgɛsɛgɛliw kɛ nin banabagatɔ ninnu na.

Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko kolotugudaw ka bana min bɛ sɔrɔ tibial tuberosity fractures kɔfɛ, o bɛ se ka se 11,5 % ma. Kɛrɛnkɛrɛnnenya la, banabagatɔ kulu fitininw ka teli ka kolotugudaw sɔrɔ. Osteofascial compartment syndrome ka kan ka da kɛnɛyaso ka sɔrɔw kan, i n’a fɔ dimi jugumanba, farikolo yɔrɔ caman cili, miofascial compartment fununi, ani dimi caya ka bɔ senkɔniw janya la. O la, osteofascial compartment syndrome bɛ to kɛnɛyaso sɛgɛsɛgɛli la ani ka furakɛli sɛgɛsɛgɛli sɛbɛn ka ɲɛ, o nafa ka bon. Degun min bɛ miofascial compartment kɔnɔ, o bɛ se ka suman ni degun furakisɛ ye (Jaa 1) i n’a fɔ sɛgɛsɛgɛli kɛcogo dafalen ka ɲɛsin sɛgɛsɛgɛli kɛrɛnkɛrɛnnen ma.

Jaa 1. Degun sumani bɛ kɛ septum interosseous kɔnɔ ni tansiyɔn pikirijikɛlan ye .

Walasa ka kunnafoniw sɔrɔ minnu bɛ se ka da u kan, degunw ka kan ka suman kɔnɔw kɔnɔ minnu bɛ sɔrɔ yɔrɔ naani na ani yɔrɔw la minnu tɛ kelen ye miofascial yɔrɔ kelen-kelen bɛɛ kɔnɔ. Kɔlɔsili minnu kɛra sɛbɛnw kɔnɔ, olu b’a jira ko degun danfara min tɛ milimɛtiri 30 bɔ (diastoliki degun min bɛ fasokanw yɔrɔ tansiyɔn bɔ) o bɛ ɲɛda yɔrɔ dɔ jira. A ka ca a la, diastolic pressure bɛ dɔgɔya opereli senfɛ, wa diastolic pressure ka kan ka jateminɛ ka kɔn opereli ɲɛ ni aw bɛ tansiyɔn danfaralen jateminɛ.

Kɔsa in na, sɛgɛsɛgɛliw y’a jira ko kɔnɔ degun kɔlɔsili ye baarakɛminɛn ye min bɛ se ka kɛ nafa ye ka ɲɛsin fasokanw ka bana jugumanba sɛgɛsɛgɛli ma, ni a ka teli ka kɛ 94 % ye ani kɛrɛnkɛrɛnnenya la 98 %. Nka, ni an y’a jateminɛ ko bana minnu bɛ se ka tiɲɛ, olu bɛ se ka tiɲɛni kɛ, yɔrɔ min bɛ wele ko compartment syndrome, o ka kan ka kɛ ka da kɛnɛyaso ka sɔrɔw kan, ani sigida ni ɲɔgɔn cɛ tansiyɔn sumani ka kan ka kɛ cogo kɛrɛnkɛrɛnnenw na, i n’a fɔ ni banabagatɔ jogin na walima ni kɛnɛyaso kunnafoniw yɔrɔw ma jɛya.

Jalajɛ jateminɛ ka kan ka kɛ ni kolotugudaw ye minnu bɛ se ka kɛ ni kolotugudaw ni senkɔniw ye minnu bɛ a kɛrɛfɛ, olu ka senkɔniw ni u senkɔniw bɛ se ka jateminɛ kɛ u la, olu bɛ jateminɛ ka taa a fɛ ni tomografi (CT) ye. O cogo kelen na, senkɔni CT CT scan bɛ se ka kɛ walasa ka kari siraw ye minnu bɛ taa fo tibial plateau ani a ni a ni senkɔniw joginni tɛ minnu na .

二. Clinique Pitfalls .

Kɔnɔbara cɛmancɛ sabanan ka kari hakɛ caman bɛ sɔrɔ a senkɔniw karilen na. Ni aw bɛ baara kɛ ni CT scans conventionnels ye, 43 % ka kari cɛmancɛ ni dugumanan na, senkɔniw karilenw tun bɛ taa ni u ye, u fanba tun ka kan ka kɛ opereli furakɛli la. Kari suguya min ka teli ka kɛ, o ye senkɔni yɔrɔjan cɛmancɛ sabanan kari ye min bɛ tali kɛ kɔfɛ senkɔni karilen na dɔɔni walima min tɛ bɔ a la (Jaa 2). K’a sababu kɛ senkɔni karilen min bɛ tali kɛ a la, o jiginni ka dɔgɔn, joginni 45 % dɔrɔn de bɛ se ka sɔrɔ senkɔniw lajɛyɔrɔw la. O la, senkɔniw ka CT scan (scan) kɛcogo kɔrɔlenw ka kan ka sinsin kosɛbɛ ni senkɔni cɛmancɛ kari duguma bɛ kɛ (sɛbɛn ɲɛ 3).

Jaa 2.Af spiral fracture of the lower middle third tibia (a, b) Senkɔniw ka radiyografu minnu bɛ sɔrɔ ka kɔn opereli ɲɛ, olu bɛ normal (C) jira. Opereli kɔnɔ C-Arm fluoroscopie bɛ kɔfɛ senkɔni (D) opereli kɔfɛ karili jira min ma bɔ a nɔ na opereli fixation kɔfɛ (EF) bɛ tibial ni senkɔni karilenw kɛnɛyali jira ka ɲɛ .

Jaa 3. AF spiral fracture of the middle and dugumanan sabanan (AB) preoperative radiographes; (CD) CT scans minnu bɛ kɛ ka kɔn opereli ɲɛ, olu bɛ kɔfɛla kari min ma bɔ a nɔ na; (EF) A bɛ senkɔniw ni malleolar kari kɛnɛya jira min tɛ kɛ ni ko ye .

三. Opereli fɛɛrɛw .

01. Tibial pikirijikɛlan dondaw .

Donda yɔrɔ tigitigi sigili jɔyɔrɔ ka bon kosɛbɛ wa kalan caman kɛra sɛbɛnw kɔnɔ, olu ye kunnafoni nafamaw di dondaw yɔrɔ ɲuman sigiyɔrɔ kan farikolo kɔnɔ walasa ka tibiw ka kariw kɛ u yɛrɛ kɔnɔ. Nin ɲinini ninnu y’a jira ko pinɛ yɔrɔ ɲuman bɛ sɔrɔ tibial plateau ɲɛfɛla la ani a bɛ kɛ cɛmancɛ la dɔrɔn ka se lateral tibial spur ma. Lakanali yɔrɔ min bonya ye milimɛtɛrɛ 22,9 ± 8,9 ye, o tɛ tiɲɛni kɛ kolotugudaw la minnu bɛ a kɛrɛfɛ, o fana fɔra. Laada la, daminɛyɔrɔ min bɛ kɛ ka ɲɛgɛnɛsiralabanaw siri ni kɔkiliw ye, o sigira sen kan ni fɛɛrɛ ye min tɛ kɛ ni fɛnɲɛnamafagalanw ye, walima ni a bɛ kɛ ni sɔgɔsɔgɔninjɛ (transpatellar approche) tilali ye walima ni patellar tendon stop yɔrɔ dɔ bɔra a la (a kɛcogo basigilen).

Semi-extension intramedullary nailing ye jateminɛba sɔrɔ kolotugudaw sɛbɛnw kɔnɔ minnu bɔra kɔsa in na, wa Tornetta ni Collins b’a jira ko u bɛ baara kɛ ni parapatellar medial fɛɛrɛ ye nail kɔnɔna na walasa ka apex kɛ kɔnɔbara basigilen na ka don kɔnɔbara basigilen na. Nailing in the semi-extension position fana ka ɲi. Baara kɛli ni suprapatellar fɛɛrɛ ye tibial intramedullary nailing ani intramedullary nail doncogo la ka tɛmɛ patellofemoral joint fɛ a semi-extended position na.

O kɛcogo bɛ kɛ ni gɛnɛgɛnɛ ye min bɛ wuli degere 15-20 ɲɔgɔn na, wa a janya bɛ se santimɛtɛrɛ 3 ɲɔgɔn ma, o bɛ kɛ bolokɔni kelen fo fila ɲɔgɔn na, a bɛ kɛ bolokɔni bonya ye patella sanfɛ. Quadriceps tendon bɛ tila cogo la min bɛ kɛ ka a janya ani ka a tigɛtigɛ ka kɛ patellofemoral joint ye. Sokɛti blunt bɛ don patellofemoral joint fɛ walasa ka don yɔrɔ dɔ da tibial cortex proximale ni jolisiraw yɔrɔ la (Jaa 4).

Jaa 4. AB ka opereli kɔnɔ ja minnu bɛ (a) senkɔniw senkɔniw tila ani ka trocar don patellofemoral joint fɛ ka taa tibial donyɔrɔ la; (b) dondaw lajɛcogo lateral lateral lateral .

3,2 mm drill bit bɛ kɛ ka daminɛ furakisɛ yɔrɔ dɔn C-arm ɲɛminɛcogo kɔrɔ. Sokɛti min bɛ don a kɔnɔ, o bɛ di walasa ka don ni bɔli yɔrɔw 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 olu la: Sen-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ-yɔrɔ bɛ Se ka dɛmɛ ka kari-yɔrɔ-yɔrɔ-ko-yɔrɔ-ko-yɔrɔ-ko-yɔrɔ-ko Kɛ, kɛrɛnkɛrɛnnenya la kariw la minnu bɛ Kɛ ni tibia-yɔrɔ sabanan ye min bɛ Kɛ ni 'kɛrɛnkɛrɛnnenya ye ani min bɛ Taa ɲɛfɛ. . .

Jaa 5. Ja min bɛ opereli kɔnɔ, o bɛ farikolo yɔrɔ nuguma jogin infrapatellar yɔrɔ la, o ye taamasiɲɛ ye min bɛ kɛ ka ɲɛsin suprapatellar fɛɛrɛ ma yɔrɔ la min janya bɛ se hakɛ tilancɛ ma.

Kɔlɔsiliw y’a jira ko suprapatellar fɛɛrɛ min bɛ kɛ ni tibial intramedullary nailing ye a tilayɔrɔba la, o ye opereli fɛɛrɛ ye min tɛ mɔgɔ tɔɔrɔ ani min bɛ se ka kɛ. Kɛnɛyabaarakɛlaw ka sɛgɛsɛgɛli nataw ka kan ka kɛ walasa ka sɛgɛsɛgɛli kɛ ka taa a fɛ, ka ɲɛsin suprapatellar approach intramedullary nailing ma ani ka jateminɛ kuntaalajanw jateminɛ minnu bɛ tali kɛ nin fɛɛrɛ in na.

02. Segin-ka-bɔ-fɛɛrɛw .

Tibial intramedullary nail dɔrɔn bilali tɛ kɛ sababu ye ka kari dɔgɔya ka ɲɛ; Kari dɔgɔyali ɲuman ka kan ka mara reaming taabolo bɛɛ la ani kɔnɔboli kɔnɔ. Boloci dɔrɔn bɛ se ka kɛ tuma bɛɛ ko a tɛ se ka farikolo karili dɔgɔya a yɛrɛ ma. Nin barokun bɛna ɲɛfɔli kɛ fɛn suguya caman kan minnu datugulen don, minnu tɛ don mɔgɔ la, ani minnu bɛ da mɔgɔw ɲɛ na.

-Sigida la, a bɛ se ka kɛ ko a bɛ se ka segin a cogo kɔrɔ la .

Manɛw bɛ se ka kɛ ni dɔgɔyali ye ni dɔgɔyali baarakɛminɛn ye i n’a fɔ F-fracture reducer, o ye F-cogo la, reduction de réduction ye min bɛ se ka wuli ka bɔ ɲɔgɔn na, min bɛ inversion/exversion angles ani medial/lateral translation (Ja 6) latilen.

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

Nka, o minɛn bɛ se ka degunba lase farikolo yɔrɔ nɔgɔlenw ma, wa o fɛn kura in tali waati jan kɔnɔ, o ka kan ka bali. Reduction forceps fana bɛ se ka bila farikolo la, i n’a fɔ a bɛ se ka kɛ cogo min na kariw ni obliques. O baarakɛminɛnw bɛ se ka kɛ teriya cogo la min bɛ kɛ ni fɛn dɔw ye minnu bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn misɛnninw ye (Ja 7).

Jaa 7. Percutanée clamping ka tibial kari a la .

Opereli suguya ni opereli tigɛyɔrɔ ka kan ka sugandi ka da fɛɛrɛ dɔ kan walasa ka tiɲɛni kuntaalajanw dɔgɔya farikolo yɔrɔ nɔgɔlenw na ka bɔ sirilan bilali la (Jaa 8).

Jaa 8. Foroko minnu bɛ kɛ ka u bila u jɔyɔrɔ la walasa ka tibial fracture reset .

Retracteurs fana ye resetting commun resettings dɔ ye min bɛ kɛ ka janya segin senkɔni na. A ka c’a la, u bɛ bila cɛmancɛ la ani ka u yɔrɔ janya yɔrɔ la, kɔnɔboli kɔnɔ, nɛgɛ min bɛ sɔrɔ a kɔnɔ, o ka kan ka bila yɔrɔ min na. Proximal traction pins bɛ se ka bila walasa ka proximal blocking screw position ladege, o bɛ kɛ sababu ye ka kari dɔgɔya nɔgɔya la ni intramedullary nail bɛ sɔrɔ.

Dɔw la, jigincogo minnu datugulen don ani minnu tɛ don mɔgɔ la, olu tɛ se ka kɛ hali bi walasa ka farikolo dɔgɔyali sɔrɔ. O cogo la, fɛnɲɛnamafagalanw dɔgɔyali fɛɛrɛw ka kan ka jateminɛ ni u lamini farikolo yɔrɔ nɔgɔlenw ɲɛnabɔcogo ɲuman ye. Nafa minnu bɛ se ka sɔrɔ da wulilenw dɔgɔyali fɛɛrɛw la, olu dɔw ye opereli bɔnɛ wɛrɛw ye, o bɛ se ka dɔ fara opereli yɔrɔ banakisɛ sɔrɔli kan. Ka fara o kan, joli bɔli ka fara kariyɔrɔ kan, o bɛ se ka dɔ fara opereli kɔfɛ karibaliya kan.

-Fɛɛrɛko seko ni dɔnko siratigɛ la .

Incisional reduction maneuvers tɛ sɔn dɔrɔn opereli dɔgɔyali foroko minnu bɛ bila a cogo bɛnnen na, nka u bɛ kɛ fana ka splint misɛnniw walima fitininw kɛ kariyɔrɔ la walasa ka kari dɔgɔyali sabati kɔnɔbara basigilen na.

Faliw bɛ siri kariyɔrɔw la minnu bɛ gɛrɛ ɲɔgɔn na ani minnu bɛ yɔrɔjanw na ni monocortical screws ye. O sɔgɔsɔgɔninjɛ bɛ mara ka ɲɛ, ka ɲɛgɛnɛsiralabanaw bila sen kan, ka u bila senkɔniw kɔnɔ. Kɔnɔbara kɔnɔna na, o kɔfɛ, a bɛ bɔ walima a bɛ to a nɔ na walasa ka fɛn jɔlen sabatili sabati (Jaa 9). Ni aw ye tasa to a nɔ na, ​​a ka kan ka kɛ ni kɔkili kelen ye min bɛ kɛ ni kɔri fila ye. A ka kan ka jateminɛ ka kɛ ko sugandilenw na, ni tibial stem bɛ opereli da wuli walasa ka kari dɔgɔyali min bɛ sɔn.

Jaa 9. Tibia kari da wulilen ni kɔmisiyɔn ni kolo tiɲɛni jugumanba ye, kɔkili kelen sirili ni kurukuru fitini ye kari dakun karilen na a kɔfɛ ani a bɔli kɔfɛ ni kɔkiliw ye minnu bɛ sɔrɔ kɔnɔbara basigilen kɔnɔ .

Nail balili kun ye ka medullary cavity dɔgɔya metaphyseal mara la. Nakɔw datuguli bɛ bila joli-sira-funu-yɔrɔ surun kɔnɔ ani deformité (dɔgɔyali) fan fɛ min bɛ kɛ ka kɔn o ɲɛ, ka sɔrɔ ka nɛgɛ bila sen kan. Misali la, senkɔni sabanan kariyɔrɔ ka karicogo cogoya bɛ dɔn ni valgus ni forward angulation ye. Walasa ka valgus deformité (valgus deformité) latilen, locking screw (datugulan) bɛ se ka bila proximal fracture fragment (o kɔrɔ ye ko deformité (deformité) fan concave (kɛrɛnkɛrɛnnen) fan fɛ) yɔrɔ la min bɛ ɲɛfɛla la. Kɔnɔbara kɔnɔna na, o bɛ ɲɛminɛ ka bɔ cɛmancɛ fan fɛ, o bɛ kɛ sababu ye ka Valgus bali. O cogo kelen na, sɔgɔsɔgɔninjɛ bɛ se ka se sɔrɔ ni a bɛ sirilan dɔ bila a kɛrɛfɛ ka taa a bila a kɔfɛla yɔrɔ la min bɛ wele ko proximal block (o kɔrɔ ye ko deformité fan concave) (Ja 10).

Jaa 10. Tibial karili dɛmɛnan ka kɛɲɛ ni nɛgɛw bilali ye .

-Medullary ka ɲɛtaa .

Kariyɔrɔko segin-ka-bɔ-yɔrɔ-ko dafalen kɔfɛ, medullary reaming (medullary reaming) bɛ sugandi walasa ka kolo labɛn ka kɛ intramedullary nail insertion ye. Bololabaarakɛminɛn min bɛ kɛ ni bolo ye, o bɛ don tibial marrow cavity kɔnɔ ani ka tɛmɛ kariyɔrɔ fɛ, ani reaming drill bɛ tɛmɛ bololanɛgɛ kan min bɛ kɛ ni bolo ye. Bololabaarakɛla ka ɲɛminɛlan jɔyɔrɔ dafalen don C-arm fluoroscopie kɔrɔ ka kɛ senkɔni joli hakɛ la, ani ɲɛminɛlan tun sinsinnen don kosɛbɛ ɲɛfɛla ni kɔfɛla filɛli fila bɛɛ kan (Jaa 11).

Jaa 11. A bɛ ɲɛminɛlan jɔyɔrɔ jira medulari kɔnɔna na C-arm fluoroscopie kan ɲɛda ni kɛrɛfɛyɔrɔw la .

Medulla min bɛ bonya ni fɛn wɛrɛ ye, o koɲɛ kɛra sɔsɔli ye. An dalen b’a la ko Ameriki Woroduguyanfan operelikɛlaw fanba b’a fɛ ka ɲɛgɛnɛsiralabanaw ka fɛnɲɛnamafagalanw kɛ ka ɲɛ ka tɛmɛ u kana bonya. Nka, nailing intramedullary kɔnɔ nailing min bɛ bonya ani min tɛ bonya, o fila bɛɛ bɛ se ka kɛ fɛɛrɛ jɔnjɔnw ye minnu bɛ sɔn, wa jateminɛ ɲumanw bɛ se ka sɔrɔ ni o fɛɛrɛ fila bɛɛ ye.

-Baarakɛcogo min bɛ kɛ ka fɛnw bila .

Kurukuru minnu bɛ ɲɔgɔn siri tibial stem fractures la, olu tali kun ye ka surunyali ni a ka dimi bali, o bɛ kɛ sababu ye ka tibia senkɔniw karimedulari kɔnɔ ka se tibial marikew karili ma min bɛ gɛrɛ ɲɔgɔn na ani ka a kɛ yɔrɔjan ye. Kariw la minnu bɛ metafizini yɔrɔ la, juru minnu bɛ ɲɔgɔn cɛ, olu kɛra nafa ye kosɛbɛ axial alignment marali la.

Proximal interlocking screws saba bɛ sabatili ɲɛnabɔ kosɛbɛ, ani angle-stabilised interlocking vises bɛ se ka sabatili caman di ka tɛmɛ conventionnement vises conventionnels kan, o bɛ se ka kɛ sababu ye ka stabilité kelen in sɔrɔ ka sɔrɔ ka sɔrɔ ni vises interlocking hakɛ fitinin ye. Dɔgɔtɔrɔso kunnafoniw minnu bɛ sɔrɔ fɛnɲɛnamafagalanw hakɛ ni u labɛncogo kan minnu ka kan ka kɛ senkɔni kɔnɔna labɛnni na, olu bɛ to dan na.

A ka ca a la, a ka teli ka kɛ ko a bɛ kɛ ni scope ye min bɛ siri ni scope ye min sirilen bɛ intramedullary nail spike la. Distal interlocking screws bɛ don freehand kɔnɔ fluoroscopic guidance kɔnɔ. Baarakɛcogo min bɛ kɛ ni ɔridinatɛri dɛmɛnan ye min bɛ dɛmɛ ni kuran ye, o bɛ fɔ walasa ka tibial tibial interlocking screws don (Jaa 12). Nin fɛɛrɛ in bɛ sira di fiɲɛw donli ma minnu tɛ se ka don yɔrɔjan na, wa a jirala ko a bɛ se ka kɛ fɛɛrɛ ye min bɛ se ka kɛ ani min bɛ se ka kɛ.

Jaa 12.Ab locking screws via c-arm perspective; CD locking screws via electromagnetic ordinateur-assisted locking .

Proximique ani distal interlocking vises (sɛrɛw minnu bɛ ɲɔgɔn minɛ ka ɲɛ) olu bilali ye opereli ye min tɛ mɔgɔ tɔɔrɔ ani a sirilanw ka kan ka don a kɔnɔ cogo tigitigi la min bɛ kɛ ni farikolo yɔrɔ ye min bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn ye min tɛ se ka kɛ.

Farikoloɲɛnajɛ sɛgɛsɛgɛliw y’a jira ko farati bɛ to ka kɛ peroneal nerve palsy la ni a bɛ proximal medial to lateral oblique interlocking screws. Walasa ka o farati dɔgɔya, operelikɛlaw ka kan ka jateminɛ kɛ walasa ka kurukuruw sɔgɔ C-arm ka bilasirali kɔnɔ, ni C-arm ka fluoroscopic angle ye min bɛ tilennen to drill bitiki plan na. Drill donna distal tibia cortex kɔnɔ, a bɛ se ka gɛlɛya ka a dɔn ni a bɛ se ka kɛ ni a ka kuma ye, wa a kunkolo fibular gɛrɛgɛrɛ bɛ se ka se ka tactile impression datugu ani ka operasɔn kɛ ka hakilina di ka kɛ 'in the Bone' ye k'a sɔrɔ tiɲɛ na, fibular head donna. Vis janya ka kan ka dɔn dɔrɔn ni drill gradué ye, nka a ka kan ka dɔn fana ni juguya jateminɛnanw ye minnu bɛnnen don. Drill walima screw janya sumani o sumani min ka bon ni milimɛtɛrɛ 60 ye, o ka kan ka sikɛli kɛ kɔfɛla bɔli la, o bɛ se ka kɛ sababu ye ka peroneal nerve combat kɛ joginni farati la.

Distal anterior ani posterior interlocking screws bɛ bila ni jateminɛ ye ɲɛda ɲɛfɛla lamini na, n’o ye tibialis anterior tendon, ani extensor digitorum longus ye. Hali ni a ka ca a la, a ka ca a la, operelikɛlaw ka kan ka faratiw dɔn minnu bɛ sɔrɔ farikolo yɔrɔ nɔgɔlenw na. Tibial stem fractures fanba la, proximal ani distal interlocking vis fila bɛ sabatili ɲuman di. Tibial proximal and distal tibial fractures bɛ se ka nafa sɔrɔ ni buruburu wɛrɛw bilali ye planw danfaralenw na walasa ka dɔ fara o jɔcogo sabatili kan (Jaa 13).

Jaa 13. Tibia kari caman, minnu bɛ furakɛ ni kɔnɔboli ye ni nɛgɛ fila ye minnu bɛ ɲɔgɔn cɛ ani minnu bɛ ɲɔgɔn siri, ni o kɔfɛ, X-ray bɛ a jira ko kari kɛnɛyara.

-Fibular Fixation .

Contemporary intramedullary nail designs with distal interlocking screws ye taamasiyɛnw bonya ka ɲɛsin senkɔniw nayuli ma minnu bɛ sɔrɔ kɔnɔbara la walasa ka kari minnu bɛ sɔrɔ proximique ani distal la, olu bɛ sɔrɔ metafise yɔrɔ la.

Distal interlocking screw configurations (bololanɛgɛw labɛncogo) danfaralenw kɛra kalan in na (kurun 2 minnu bɛ bɔ cɛmancɛ la ka taa kɛrɛfɛ ni 2 ye minnu bilalen bɛ ɲɔgɔn na ani minnu bɛɛ lajɛlen ye 3 ye minnu bɛ ɲɔgɔn cɛ ni ɲɔgɔn cɛ ni 1 distal interlocking vis ye). Banabagatɔ minnu ye fibula fibular fixation ani tibial intramedullary nail fixation kɛ, reset bɔnɛnen hakɛ tun ka dɔgɔn kosɛbɛ. Banabagatɔ minnu bɛ ni sɔgɔsɔgɔninjɛ ye, olu bɛɛ lajɛlen 13 % tɛ fiɲɛ bila u la, olu ye reset bɔnɛni kɛ opereli kɔfɛ, ni i ye o suma ni 4 % ye minnu bɛ ni tibial nail fixation ye ni fibular fixation tɛ.

Kɔrɔbɔli wɛrɛ la min bɛ tibial intramedullary nail fixation ni fibular fixation ni tibial intramedullary ongle fixation ni fibulaire fibular fibular fibular fixation ni tibial nailing faralen ɲɔgɔn kan, o bɛ se ka kɛ sababu ye ka ɲɛtaa jira rotation ni inversion/version alignment la.

An bɛ a fɔ ko fibular fibular fibular fibular bɛ se ka tibial fracture reduction sɔrɔ ani ka distal distal third tibia fractures to sensing intramedullary ongle fixation. Nka, joginda gɛlɛyaw gɛlɛya ka bɔ fɛn wɛrɛw la minnu bɛ kɛ farikolo yɔrɔ la, o bɛ to. O la, an b’a ɲini aw fɛ aw ka aw janto fibular fibular fibular fibular fibular fibular (fibular fibular fibular) baara la.

03. jaabiw .

Tibial stem fractures ka fɛnɲɛnamafagalanw kɔnɔ, o bɛ se ka nɔ ɲuman bɔ. Ɲɛgɛnɛsiraw furakɛli hakɛ minnu bɛ sɔrɔ kɔnɔbara basigilen kɔnɔ, olu fɔra sɛgɛsɛgɛliw la minnu tɛ kelen ye. Ni bi doncogo ni opereli kɛcogo bɛnnenw kɛra, a jirala ko kɛnɛya hakɛ bɛna tɛmɛ 90 % kan. Tibial stem fractures kɛnɛyali hakɛ min ma se ka kɛnɛya kɔnɔbara basigilen kɔfɛ, o ɲɛnabɔra kosɛbɛ kɔnɔna fiɲɛbɔli kɔfɛ ni kɔnɔbara basigilen filanan ye min bonyalen don.

Kɔnɔnafili jateminɛ san kelen opereli kɔfɛ, o y’a jira ko fo ka se banabagatɔ 44 % ma minnu tora ka baara kɛ ka ɲɛ, olu ka baarakɛcogo dantigɛli bɛ to ka se ka baara kɛ ni u ye, ani fo ka se 47 % ma, olu tora ka baara kɛ ni u ye san kelen opereli kɔfɛ. Nin ɲinini in b’a jira ko banabagatɔ minnu furakɛra ni senkɔniw ye minnu bɛ sɔrɔ kɔnɔbara la, olu bɛ taa a fɛ ka baarakɛcogo dan caman sɔrɔ waati jan kɔnɔ. Operelikɛlaw ka kan ka nin ko ninnu dɔn ani ka banabagatɔw laadi ka kɛɲɛ ni o ye!

四. Gɛlɛya minnu bɛ sɔrɔ opereli kɔfɛ .

01. Dimi min bɛ kɛ ka kɔn pateli ɲɛ .

Dimi min bɛ kɛ ɲɛfɛla la, o ye gɛlɛya ye min ka teli ka sɔrɔ ɲɛgɛnɛsira kɔnɔ, tibial stem fractures kɔnɔ. Kɔlɔsiliw y’a jira ko banabagatɔ 47 % ɲɔgɔn bɛ se ka dimi sɔrɔ kɔnɔbara basigilen kɔfɛ, o bana in sababu tɛ faamuya ka ɲɛ. Fɛn minnu bɛ se ka nɔ bila mɔgɔ la, olu ye bɔnɛ ni furakɛli joginni ye ɲɛda kɔnɔ fɛnw na, joginni min bɛ kɛ safensi nɛrɛmugu infrapatellari la, cɛya farikolo fanga dɔgɔyali min bɛ kɛ filanan ye ni dimi bɛ se ka kɛ farikolo la, tuluma pad min bɛ na ni kirinni ye, a ɲɛda cogoya bɛ se ka kɛ, o bɛ bɔ kɔnɔbara basigilen na, a bɛ kɛ sababu ye ka joli bɔn ka bɔ a la. Kɔnɔbara laban min bɛ sɔrɔ a kɛrɛfɛ.

Ni aw bɛ dimi jugumanba sababuya sɛgɛsɛgɛ kɔnɔbara basigilen kɔfɛ, ɲɛgɛnɛsiralabanaw taamasiɲɛw bɛ tali kɛ parapatellar fɛɛrɛ la. Senkɔniw taamasiɲɛ bɛ se ka kɛ ni gɛnɛgɛnɛ dimi ye opereli kɔfɛ. Nka, kɛnɛyaso kunnafoniw minnu bɛ kɛ ka mɔgɔw bila ka miiri, olu ma danfaraba jira transpatellar senkɔniw taabolow ni parapatellar fɛɛrɛ cɛ.

Kɔnɔnatumuw bɔli ɲɛnatɔmɔcogo ɲuman na walasa ka dimi ɲɛnabɔ ka kɔn patellari ɲɛ, tibial intramedullary nailing kɔfɛ, o tɛ dɔn. An b’a ɲini ko tibial kɔnɔ nail ka bɔ a kɔnɔ, o ka jateminɛ ni a sababu bɛ se ka dɔn masinw fɛ, i n’a fɔ wuluwulu bɔli walima ni a bɛ se ka kɛ fɛn ye min bɛ se ka don a la. Nka, tibial intramedullary nail bɔli nafa bɛ banabagatɔ minnu na, olu bɛ to ɲininkali la.

Opereli kɔfɛ dimi ko la, dimi sababu ma se ka jira ka jɛya kɛnɛyaso sɛgɛsɛgɛli fɔlɔ la, min bɛ wele ko intramedullary nail fixation of the tibial nail on the patelle in the semi-extended position. O la, kɛnɛyaso ka sɛgɛsɛgɛlibaw minnu bɛ kɛ ni tuguni kuntaalajan ye, olu ka kan ka kɛ walasa ka kɔnɔbara basigilenw jɔli nɔ min bɛ sɔrɔ suprapatellar fɛɛrɛ la opereli kɔfɛ dimi kan.

02.Opereli kɔfɛ ɲɔgɔndan faantan .

Osteoarthrite kɔfɛ, o bɛ to gɛlɛyaba ye tibial stem fractures furakɛli kɔfɛ ni intramedullary nailing ye. Biomekanikini sɛgɛsɛgɛliw y’a jira ko tibiyali malali bɛ se ka kɛ sababu ye ka fɛn caman Changements significatifs dans les pressions contacts sur les ankle adjacent ani gɛnɛgɛnɛw.

Dɔgɔtɔrɔso ka sɛgɛsɛgɛliw minnu bɛ kɛnɛyaso ni ja lajɛ kuntaalajanw jateminɛ tibial STEM kari kɔfɛ, olu ye kunnafoniw di minnu bɛ ɲɔgɔn sɔsɔ, minnu bɛ tali kɛ tibial malalogment kɔtigɛcogo la, ni dantigɛli jɛlen ma kɛ fo ka na se bi ma.

Opereli kɔfɛ banaw tali kunnafoniw bɛ to ka dan sigi sen kan senkɔniw na, ni bana damadɔ fɔra. Opereli kɔfɛ malosi bɛ to gɛlɛya ye min bɛ sɔrɔ tibiyali kɔnɔ kɔnɔbara basigilen na, wa tibiyali jiginni jateminɛ opereli kɔnɔ, o bɛ to ka gɛlɛya. Fɔ ka na se bi ma, kɛnɛyaso sɛgɛsɛgɛli walima ja lajɛcogo si ma sigi sen kan i n’a fɔ sanu hakɛ min bɛ kɛ ka tibiyali jiginni jateminɛ opereli kɔnɔ.CT sɛgɛsɛgɛli jateminɛ y’a jira ko malotɛri hakɛ bɛ se ka kɛ kɔnɔbara basigilen kɔfɛ, o bɛ se ka se 19 % ma ka se 41 % ma. Kɛrɛnkɛrɛnnenya la, a bɛ i n’a fɔ kɛnɛma jiginni tiɲɛniw ka ca ni kɔnɔna jiginni tiɲɛniw ye. Dɔgɔtɔrɔso sɛgɛsɛgɛli min kɛra walasa ka opereli kɔfɛ dimi jateminɛ, o fɔra ko a tɛ tiɲɛ ye, wa a ni CT jateminɛ bɛ tali kɛ ɲɔgɔn na kosɛbɛ.

An dalen b’a la ko malali bɛ to gɛlɛya ye min bɛ mɛn sen na tibial stem fractures la minnu furakɛra ni kɔnɔbara basigilen ye senkɔni na. Hali ni kunnafoniw bɛ ɲɔgɔn sɔsɔ ka ɲɛsin jɛɲɔgɔnya ma min bɛ tali kɛ malali ni kɛnɛyaso ni ja lajɛw la, an b’a jira ko operelikɛlaw ka kan k’u cɛsiri walasa ka farikolo yɔrɔ karilenw ka ɲɔgɔndɛmɛ sɔrɔ walasa ka nin fɛn caman ɲɔgɔnna kɔlɔsi ani ka ɲɛtaa ɲuman sɔrɔ.

五. Kuncɛli

Static locking expanded medullary intramedullary nailing bɛ to furakɛli sariyalen ye tibial stem fractures labɔlenw na. Donda ɲuman bɛ to opereli kɛcogo yɔrɔba la. Suprapatellar fɛɛrɛ min bɛ kɛ jɔyɔrɔ tilancɛ la, 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 n’a nafaw jateminɛ ka taa a fɛ. Opereli min bɛ kɛ, o ka kan ka dɔn bi waati caman sigicogo kura fɛɛrɛw la. Ni farikolo yɔrɔw karicogo ɲɔgɔn tɛ se ka sɔrɔ fɛɛrɛ dagalen fɛ, o la, a ka kan ka jateminɛ kɛ ni tigɛcogo dagalen ye. Kɛnɛya hakɛ ɲuman min ka ca ni 90 % ye, o bɛ se ka sɔrɔ ni kɔnɔbara basigilen ye min bɛ bonya ani min tɛ bonya. Hali ni kɛnɛya hakɛ ka ɲi, banabagatɔw ka baarakɛcogo bɛ to sen na waati jan kɔnɔ. Kɛrɛnkɛrɛnnenya la, dimi min bɛ kɛ ka kɔn patellari ɲɛ, o bɛ to ka kɛ ŋunanko ye min bɛ kɛ ka caya tibial intramedullary nailing kɔfɛ. Ka fara o kan, malosiya bɛ to ka kɛ kɔnɔbara basigilen kɔfɛ, o bɛ to gɛlɛya ye min bɛ sɔrɔ tuma bɛɛ.

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