Tibial fractures, suprapatellar intramedullary ɖa ƒe mɔnu

Intramedullary nailing technique for tibial fractures: to suprapatellar, transarticular mɔnu si me wobɔbɔ kloa le 20-30° kple ametakpɔnu tɔxɛ aɖe be woatsɔ akpɔ intra-articular structures ta.

01.Tibial Intramedullary Ƒe Ʋuʋudedi: mɔɖeɖe kple ɖoɖowɔwɔ ɖe wo nɔewo ŋu, klo ƒe vevesese le ŋgɔgbe

Amekoko ƒe mɔɖeɖe be woatsɔ aƒo ɖa le abɔta ƒe gbagbãƒewo ŋu le vevie be woate ŋu atsɔ ɖa si le lãkusia me la ato teƒe nyuitɔ si woage ɖo, be woaɖe nusiwo gblẽ le klo ƒe wɔwɔme siwo le ƒunukpeƒewo ŋu dzi akpɔtɔ, eye woakpɔ gbagbãƒea gbugbɔgaɖoanyi nyuitɔ kekeake kple ɖaa ƒe gege ɖe eme nyuie.

Mɔnu xoxo siwo wozãna na tibial stem fractures enye median infrapatellar alo parapatellar mɔnuwo. Togbɔ be woɖe mɔnu siawo fia na akpa si le titina ƒe gbagbã hã la, dɔwɔwɔ vɔ megbe valgus, anterior, alo syndesmotic deformities dzɔna zi geɖe le gbagbã siwo te ɖe wo nɔewo ŋu wu me.

Nu vevitɔ si hea nu masɔmasɔ vɛ le proximal tibial fractures me enye nuwɔametɔ si tsoa akɔta ƒe lãkusi ƒe hehe le klo ƒe ƒoƒo me kple mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbe tibial cortex dome le implant dede me gbɔ. Patella hã xea mɔ na ɖaa ƒe axial gege ɖe sagittal plane me (Fig. 1a, b). Eyata mɔnu bubu si bɔ si dzi woato age ɖe teƒeae nye to titina ƒe parapatellar incision, si wɔnɛ be wotsɔa ɖa dea titina vaseɖe axadzi vie (Fig. 1c kple 2). Ne ɖaa ge ɖe intramedullary canal si le didiƒe ʋĩ tso gbagbãƒea gbɔ la, akpa si te ɖe eŋu la ƒoa xlãe wòzua exostosis (Fig. 2). Mlɔeba la, ŋgɔgbexɔa ƒe lãmekawo ƒe gbɔɖeme ƒe tete kpena ɖe ectropion ŋu vie (Nɔnɔm. 3).

Figure 1 a,b Ne wozã infrapatellar mɔnu si bɔ la, patella xea mɔ na axial gege ɖe ɖaa me, si wɔnɛ be anterior apical sagittal alignment kple ectropion coronal alignment ƒe nɔnɔme madeamedzi si bɔ.c Wowɔ intramedullary nail alignment to parapatellar mɔnu zazã me.

Nɔnɔmetata 2 Ne wogogo afisi woage ɖo to titina ƒe parapatellar incision me la, ena wotsɔa ɖa dea titina vaseɖe axadzi vie. Ne ɖaa ge ɖe medullary canal si le didiƒe ʋĩ tso gbagbãƒea gbɔ (a) la, akpa si te ɖe eŋu la ƒoa xlãe wòzua dzobibi (b) .

Fig. 3 Gbɔɖeme ƒe tete ɖe ŋgɔgbe lãmeka ƒe akpa ( a ) naa ɖoɖo si menya kpɔna dzea sii bɔbɔe o si le vidzidɔa godo ( b ) .

Klo ƒe klo ƒe ƒoƒo ɖe teƒe si keke wu kpena ɖe ame ŋu be woaƒo asa na kuxi siwo do ƒome kple klo ƒe ƒoƒo sesẽ le dɔwɔwɔ me.Gelbke, Jakma et al. le ƒe 2010 me eye wòva xɔ ŋkɔ le ƒe ʋɛ siwo va yi me elabena ne woƒo afɔkpodzia le abɔ kple afɔ ƒe nɔnɔme si le dzɔdzɔe kloe me la, enaa asitɔtrɔ le afɔkpodzi ƒe gbagbã ŋu kple eɖoɖo ɖe teƒe bubu nɔa bɔbɔe. Fluoroscopy wɔwɔ va le bɔbɔe le mɔ̃ɖaŋununya gome. Woka nya ta be ɣeyiɣi si woatsɔ awɔ fluoroscopy na suprapatellar nailing la le kpuie ŋutɔ wu infrapatellar nailing . Tsɔ kpe ɖe eŋu la, dzogoe si dzi wotsɔa ɖa dea ɖae (le sagittal plane me) sɔ kple afɔkpodzi ƒe didime ƒe axadzi kple mɔnu sia wu ne wotsɔa ɖa si wotsɔ ƒoa ɖae le infrapatellar me; esia xea mɔ na mɔ̃wo ƒe dzrewɔwɔ le ɖaa ƒe nugbɔ kple megbeƒu dome, si wɔnɛ be eƒe gbagbã dzi ɖena kpɔtɔna.

Klo ƒe vevesese le dɔwɔwɔ vɔ megbe nye kuxi si sɔ. Woka nya ta be klo ƒe veve le ŋgɔgbe le dɔnɔ siwo ƒe klo gbã la ƒe 50-70% ŋu, eye dɔnɔ 30% koe kpɔa vevesese dzi ɖena kpɔtɔna le nuwuƒea ɖeɖe ɖa vɔ megbe. Wobu akɔnta be abi si dzɔna le patellar tendon kple Hoffa ƒe ami ƒe ami si do ƒome kple mɔɖeɖe ɖe eŋu la ate ŋu ahe klo ƒe vevesese vɛ le dɔwɔwɔ vɔ megbe. Tsɔ kpe ɖe eŋu la, suprapatellar mɔnu ƒoa asa na lãɖeɖe si wowɔna tsã be woatso saphenous nerve ƒe patellar alɔdze ƒe alɔdze, si wɔnɛ be klo ƒe ŋgɔgbe ƒe ʋuʋu kple seselelãme si me mekɔ o (Nɔnɔmetata 4). Edze abe ne wotsɔ ɖaa to asike ƒe lãkusi ene me, si wɔnɛ be patellar lãkusia natsi anyi la, ɖea klo ƒe vevesese le dɔwɔwɔ vɔ megbe dzi kpɔtɔna ŋutɔ ene.

Fig. 4 Ƒomedodo si le saphenous nerve kple mɔ vovovo siwo dzi woato ayi tibialis obliqua nail la dome

Le nu nyui si dona tso proximal fractures me ta la, wokeke dzesi siwo le dɔdaƒewo ɖe enu ɖe ​​gbagbãƒewo katã ŋu.

Kuxi siwo ate ŋu ado mo ɖa le intramedullary nailing ŋu le suprapatellar mɔnu me:

- Ate ŋu agblẽ reaming debris ɖe klo ƒe ƒunukpeƒe. Gake dɔdaƒe ƒe nuteƒekpɔkpɔ le akɔta ƒe ƒoƒo ɖe megbe meɖe nu gbegblẽ aɖeke si nɔa anyi ɣeyiɣi kpui alo didi aɖeke fia o.

- Aleke woɖea nusi wotsɔ de ame me la ɖa ne eƒe gbagbãƒea haya vɔ? Togbɔ be le mɔ̃ɖaŋununya gome la, anya wɔ be woaɖe ɖa si le lãkusi me ɖa to mɔnu si le abɔta tame dzi hã la, mɔnu sia bia nu geɖe ŋutɔ eye amekola akpa gãtɔ dina be yewoaɖe ɖa si le lãkusi me ɖa to mɔnu si le lãkusi me dzi.

02.Ɣekaɣie wòle be woazã suprapatellar intramedullary nail?

Viɖe siwo le eŋu

- Klo ƒe nɔnɔme si keke afã kple afã naa gbagbã ƒe asitɔtrɔ kple edziɖeɖe nɔa bɔbɔe to lãmekawo ƒe ŋusẽwo dzi ɖena kpɔtɔna kple wo léle ɖe te le ɖa dede eme me.

- Afɔku si le dɔwɔwɔ vɔ megbe ƒe masɔmasɔ me le proximal, segmental, kple distal fractures me dzi ɖe kpɔtɔ ne wotsɔe sɔ kple mɔnu xoxowo

- Nailing nye mɔ̃ɖaŋununya bɔbɔe be woawɔ

- Nailing ateŋu adzɔ abe 'amekola ɖeka ƒe dɔwɔwɔ'.

- Fluoroscopy ɣeyiɣi dzi ɖeɖe kpɔtɔ

- Nu gbegblẽ aɖeke megblẽ le patellar tendon ŋu o eye klo ƒe ŋgɔgbe veve le ɖaƒoƒo vɔ megbe hã dzi ɖe kpɔtɔ

- Ele bɔbɔe be woawɔe le ƒuƒoƒo geɖe ƒe dɔwɔwɔ me, abe alesi wòle le polytrauma gome ene.

Nusiwo gblẽ le eŋu

- Afɔku si ate ŋu agblẽ nu le klo ƒe ƒunukpeƒewo kple ƒunukpeƒetetedɔ bubuwo ŋu

- Afɔku si le klo ƒe dɔléle me dzi ɖe edzi

- Nusi wotsɔ de eme la ɖeɖe ate ŋu abia mɔnu bubu

Nusiwo ɖee fia

- Extra-articular fractures of the proximal tibia (Ƒomevi AO 41A) .

- Tibial diaphysis ƒe gbagbã bɔbɔe siwo wogbã (ƒomevi AO 42A-C) .

- Segmental tibial diaphysis ƒe gbagbã (ƒomevi AO 42C) .

- Extra-articular kple bɔbɔe intra-articular distal extension fractures of the distal tibia (ƒomevi AO 43A kple C1) .

- Klo si le tsia dzi

Nusiwo tsi tre ɖe eŋu

- Gustilo grade 3C ƒe afɔkpodzi ƒe gbagbã siwo le ʋuʋu ɖi le ƒunukpeƒetetedɔ ƒe afɔku si dzi ɖe edzi ta, togbɔ be womegblɔ ƒunukpeƒetetedɔ ƒe afɔku si dzi ɖe edzi le ƒunukpeƒetetedɔ siwo le ʋuʋu ɖi me o hã

- Lãmetsi falɛfalɛwo ƒe vuvu sesẽ, ɖiƒoƒo alo dɔlékuiwo xɔxɔ le suprapatellar nuto me

- Klo ƒe akpa ɖeka (ipsilateral knee prosthesis (si tsi tre ɖe eŋu le mɔ aɖe nu) .

- Klo ƒe fusion

- Klo ƒe kekeɖenudɔwɔwɔ si gbɔ eme >20°

- Ipsilateral tibial plateau fracture si lɔ ɖa ƒe gege ɖe eme ɖe eme nye nusi tsi tre ɖe eŋu vie

- Nusiwo wotsɔ dea lãme na ame siwo xea mɔ na ɖaa ƒe gege ɖe eme

- Ipsilateral patella fracture (si tsi tre ɖe eŋu le mɔ aɖe nu) .

03. Amekoko ƒe mɔnuwo

1 Ŋutilã ƒe nɔnɔme kple nukpɔsusu

Fig. 5 Dɔnɔa mlɔa anyi ɖe kplɔ̃ si dzi keklẽŋusẽ le si ɖea mɔ be wòate ŋu anɔ afɔ si me mama le la dzi. Wogblẽa abɔ si gbã la ɖi wònɔa xɔxlɔ̃m faa eye wotsɔa agbalẽ xatsaxatsa aɖe dana ɖe klo ƒe ƒunukpeƒe (a) te be kloa nabɔbɔ 10-30° 

(b) . Wotsɔa C-abɔa dana ɖe akpa si tsi tre ɖe eŋu. Woɖiɖia afɔ si ŋu womegblẽ nu le o la ɖe anyi 10-30° tso tsia dzi be woakpɔ egbɔ be woɖe nɔnɔmetata nyuie le axadzinɔnɔme.

2Di afisi aŋea age ɖo nyuie

Nɔnɔmetata 6 Mɔnu sia dzena le akɔta ƒe asike, afɔkpodzi ƒe lãkusi, kple afɔkpodzi ƒe ŋgɔgbe lãkusi. Woɖea ŋutigbalẽa ƒe didime sentimeta 2 wòdidi sentimeta 1-1.5 le abɔta ƒe gɔme si le etame la gbɔ. Woɖea lãkusi eneawo ɖe go eye woɖea titina ƒe didime le lãkusia ƒe kaawo ƒe mɔ dzi. Woʋua suprapatellar recess eye amekolaa ƒe asibidɛwo gena ɖe klo ƒe ƒunukpeƒea tso patella te be woakpɔe ɖa be ele bɔbɔe be woage ɖe eme. Afɔkpodzia keke vie ate ŋu ana be woate ŋu aɖo kloa gbɔ bɔbɔe. Langenbeck retractor dede eme be wòakɔ akɔta vie hã ate ŋu ana mɔɖeɖea nanyo ɖe edzi. Ne ƒunukpeƒea ƒe teƒea le kpuie ŋutɔ eye dɔwɔnuwo zazã sesẽ la, woate ŋu atso titina alo axadzi ƒe kpeɖeŋutɔ ƒe ka si te ɖe eŋu be woatsɔ atso ƒunukpeƒea ƒe akpa aɖe ayi axa ɖeka.

3Ametakpɔkpɔ na ƒunukpeƒetetedɔ

Nɔnɔmetata 7 Patellofemoral cartilage takpɔkpɔ tso abi si dona tso amekoko me nye amekokoa ƒe taɖodzinu veviwo dometɔ ɖeka. Eyata ele be woazã ametakpɔnu ƒe abɔta le dɔwɔnu kple ɖa dede me.a Dɔwɔnu siwo woatsɔ age ɖe ƒunukpeƒewo dometɔ aɖewoe nye asiléƒe siwo wotsɔ dea eme, gotagome (falɛfalɛ) kple ememe (ga) ametakpɔnu, trocar pins, kple ka si me ʋuʋudedi le ƒe mɔfianu.b Wotsɔa abɔta si kpɔa ame ta kple gotagome (falɛfalɛ) kple ememe (ga) takpɔnu ƒe abɔta, a trocar pin, kple mɔfianu si me ka si me ʋuʋudedi le. Woƒoa trocar aŋea nu ƒu kple ametakpɔnu ƒe abɔta kple asiléƒe si wotsɔ dea eme.b Mounting handle with lateral ventilation holes. Kpo si le asiléƒe si wotsɔ dea eme la tame xea mɔ na asiléƒea ƒe ƒuƒoƒoa ƒe ʋuʋu le vo me

4 De mɔfiame ka la eme eye nàtrɔ asi le teƒe si wòle ŋu

Nɔnɔmetata 8a Wotsɔ asiléƒea ƒe ƒuƒoƒoa dea afɔkpodzia te to afɔkpodzi ƒe ƒunukpeƒea yia afisi wodi be woage ɖo le afɔkpodzia dzi (Nɔnɔmetata 9). Zi geɖe la, afɔkpodzia aʋuʋu vie le titina alo axadzi le dɔwɔnua dede eme me. Zi geɖe la, do si le patellofemoral joint me la fiaa mɔ trocar needle la yia teƒe nyuitɔ le eɖokui si.

Fig. 8b Wozã fluoroscopy tsɔ ɖo kpe nɔƒea dzi le yameʋu eveawo siaa me eye woɖɔe ɖo le afisi wòhiã le. Emegbe wotsɔa mɔfiaka si me ʋuʋudedi le ɖɔlia trocar aŋea, si nye mɔfiaka si toa mɔfiaka la ƒe titina do me eye wotsɔa eƒe nugbɔ dea proximal tibial metaphysis me be woakpɔ egbɔ be ele teƒe nyuitɔ.

Figure 8c Ne mɔfiaka la le nɔnɔme si mesɔ o me la, woate ŋu azã mɔfiaka evelia atsɔ awɔ asitɔtrɔ suewo le teƒe nyuitɔ to mɔfiaka si me ʋuʋudedi le me, vaseɖe milimeta 4.3 si sɔ gbɔ wu Abe mɔnu bubu ene la, ate ŋu anɔ bɔbɔe be woadze egɔme kple mɔfiaka la eye woatsɔe aɖo teƒe nyuitɔ si woage ɖo kpekpeɖeŋu manɔmee. Emegbe wotsɔa dɔwɔnu si wotsɔ dea nu me si me mɔfiaka la le la ƒua du toa mɔfiaka la dzi.

5 Medulla oblongata ƒe kekeɖenudɔwɔwɔ

Fig. 9a Ʋuʋu le medullary cavity tso teƒe nyuitɔ si woage ɖo nye afɔɖeɖe vevi aɖe le amekokoa me. Le ŋgɔgbe kple megbe yameʋu me la, esiae nye titina ƒe akpa si le axadzi tibial spur la me. Le axadzi yameʋua me la, teƒe si sɔ si woage ɖo la le tɔtrɔ si le ƒunukpeƒe ƒe akpa si le ƒunukpeƒe kple ŋgɔgbe lãkusi dome.

Fig. 9b Mɔfiameka ƒe nɔƒe nyuitɔ sɔ kple tibial axis le anteroposterior plane me eye wòte ɖe parallel kple anterior cortex alesi wòanya wɔ le axadzi projection me. Mɔfiameka la dina be yeaʋuʋu ɖe megbe.

Figure 9c Le nɔnɔme siwo me womate ŋu ade pin alo ɖa nyuie o me la, ne woxe mɔ na ɖa alo pin la kpena ɖe ame ŋu wòfiaa mɔ ɖaa yia teƒe nyuitɔ. 

Wozãa ɖa siwo xea mɔ na ame le metaphyseal nuto si keke wu me ne womate ŋu atsɔ mɔfiaka alo ɖaa aɖo titina wòasɔ kple ƒua ƒe didime ƒe axadzi o alo ne ƒu ƒe gbagbã ƒe masɔmasɔ le yameʋu ɖeka alo evea siaa me gakpɔtɔ le ɖaa dede eme.

Nɔnɔmetata 10 Le afɔɖeɖe sia me la, wokafui be woatsɔ mɔfiaka si ƒe didime nye milimeta 3.2 abla asiléƒea ƒe ƒuƒoƒoa ɖe afɔkpodzi ƒe lãkusia ŋu. Esia wɔnɛ be ƒuƒoƒoa medoa go le afɔkpodzia me o.

Nɔnɔmetata 11 Wotsɔa do si ƒe didime nye milimeta 12.0 la dana to ametakpɔnu si le eme la me eye wotsɔa mɔfianu la yia anyime va ɖoa ƒua gbɔ. Woʋua medullary canal la to tomekuku me wògoglo sentimeta 8-10 eye wotsɔa mɔfiaka si ƒe nuwuwu nye bɔl dea afɔkpodzi si te ɖe eŋu me.

6 Gbagbãƒewo dzi ɖeɖe kpɔtɔ

Figure 12a Le afɔɖeɖe sia me la, míegbugbɔ ɖoa ​​gbagbãƒea.

Figure 12b Le afisi gbagbãƒea le kple eƒe nɔnɔme nu la, woate ŋu azã dɔwɔnu vovovo siwo ɖea nu dzi kpɔtɔna abe percutaneous clips, retractors, fragment plates suewo, kple blocking screws ene be woaɖo wo nɔewo ɖe ɖoɖo nu nyuie. Le proximal tibial fracture dzi ɖeɖe kpɔtɔ me, ɣeaɖewoɣi to kpekpeɖeŋu si wotsɔ dea nu bubuwo me gɔ̃ hã me, hafi woaʋu medullary canal to drilling me. Wodoa reaming rod la ɖe ŋgɔ le didiƒe eye wotsɔnɛ dea distal tibial metaphysis ƒe titina. Ne wogbugbɔ ɖo ɖaa vɔ la, wokpɔa ɖaa ƒe didime kple eƒe didime. Ne ehiã la, na tibial canal la nalo ɖe edzi va ɖo eƒe didime si nèdi to reaming le 0.5 mm ƒe dzidziɖedzi me. Ʋuʋu si le abɔta ƒe asiléƒe si kpɔa ame ta me la wɔnɛ be woate ŋu akɔ gbeɖuɖɔ siwo le ƒunukpeƒea me ahano wo le ƒunukpeƒea ƒe ʋuʋu me. Ne anya wɔ la, wokafui be woazã ɖa si ƒe didime nye milimeta 10 ya teti. 5.0 mm Locking Bolt na ɖa sia ƒomevi te ŋu nɔa te ɖe kpododonu nu wu 4.0 mm Locking Bolt si wozãna na ɖa nyuiwo. Zi geɖe la, wotsɔa fluoroscopic ruler dea dzesi ɖa siwo le lãkusi me ƒe didime.

7De ɖa si le lãkusi me

Fig. 13a Nail dede to reaming rod la me le fluoroscopy te. De dzesii be asiléƒe si wotsɔ dea ɖa si le abɔta la didi wu esi wotsɔ dea ɖa si le abɔta elabena didime si tso ŋutigbalẽa ƒe lãɖeɖe gbɔ va ɖo afisi ɖa si le afɔkpodzia ge ɖo hã didi wu.

Nɔnɔmetata 13b Taflatse de dzesii be womate ŋu atsɔ akɔtaɖonu (Herzog curve) si le intramedullary nail ƒe nuwuwu si te ɖe eŋu la ade eme to ga si le eme takpɔnu ƒe abɔta o. Eyata ele be woaɖe ememe ametakpɔnu ƒe abɔta ɖa le asiléƒea ƒe ƒuƒoƒoa me hafi woatsɔ ɖaa ade eme (b; kpɔ akpa si nye 'Vodadawo, Afɔkuwo Kple Kuxiwo'). Kpɔ afisi ɖa si le lãkusia me le mamlɛtɔ le ŋgɔgbe-megbe kple axadzi nukpɔkpɔwo me. Ðe reaming-ti la ɖa. Ne ehiã be woaɖɔli ɖaa la, gblẽ reaming-ti la ɖe teƒea eye nàtsɔ ɖa yeyea ade atikplɔa me. Dzesi siwo ƒe didime nye milimeta 5 le asiléƒe si wotsɔ dea nu me la fia alesi wotsɔ nusi wotsɔ de eme la de tome le afɔkpodzi si te ɖe eŋu me (Fig. 14). (Nɔnɔmetata 14)

8 Distal kple proximal ƒe ʋuʋu

Figure 14a Proximal kple distal locking configurations nɔ te ɖe gbagbã ƒe nɔnɔme tɔxɛwo dzi. Woate ŋu atsɔ alɔ si woɖo taɖodzinu na awɔ ʋuƒo si te ɖe wo nɔewo ŋu. Wowɔa didiƒe ʋĩ ƒe ʋuʋu kple asi alo to radiopaque drill guide zazã me. Ne wodi la, woate ŋu azã nuwuƒe ƒe nutrenu, si xea mɔ na ƒu be wòagatsi ayi ɖa si le lãkusia me ƒe nuwuwu si te ɖe eŋu o eye wònaa wònɔa bɔbɔe be woaɖe nusi wotsɔ de eme la ɖa emegbe. Vevietɔ la, ɖa siwo wotsɔ de eme wògbɔ eme la ɖeɖe le bɔbɔe wu ne wozã nuwuƒe ƒe nutrenu siwo ƒe didime sɔ. Wodzidzea nuwuƒea ƒe didime si wodi to dzesi aɖe dede asiléƒea alo mɔfianu ka aɖe dede to alɔ si woɖo taɖodzinu na me.

Nutata 14b Mɔfiame ka ƒe nugbɔ fia afisi ɖaa le si te ɖe eŋu. Ele be woaɖe gavi si doa ka kple alɔ si woɖo taɖodzinu na la ɖa be woatsɔ nuwuƒea ade eme. Nuwuƒea toa asiléƒe si wotsɔ dea nu me ƒe ʋuƒoa me. Asiléƒe si wotsɔ dea eme la gakpɔtɔ le teƒea. Esia nana nuwuƒea sɔna kple ɖa si le lãkusia me ƒe tame eye wòxea mɔ na be mebu ɖe kloa me o. Mɔfianu ka la to ʋuƒoa ƒe nuwuƒe ƒe nugbɔ dede ɖaa ƒe nuwuwu si te ɖe eŋu hã kpena ɖe ame ŋu wòfiaa mɔ nuwuƒea yia eƒe nɔƒe nyuitɔ le ɖa si le lãkusia me ƒe nuwuwu si te ɖe eŋu. Le dɔa ƒe nuwuwu la, ele be aklɔ dzetsi si me dɔlékui mele o be wòaklɔ gbeɖuɖɔ ƒe akpa ɖesiaɖe si susɔ la ɖa.

04. Nuxlɔ̃amewo

Kpɔ nyuie le Amekoko ƒe Dɔwɔwɔwo Ŋu

- Le ƒunukpeƒetetedɔ si nɔ anyi do ŋgɔ me la, ƒunukpeƒetetedɔ si ŋu seɖoƒe le ate ŋu axe mɔ na ƒunukpeƒewo ƒe gege ɖe ƒunukpeƒewo. Ne wotso titina alo axadzi ƒe akpa si te ɖe eŋu tso titina ƒe akpa dzi la, enaa trocar pin la dede bɔbɔe.

- Klo ƒe akpa si wowɔ le ipsilateral klo ƒe akpa aɖe menye nusi tsi tre ɖe suprapatellar pinning ŋu vevie o. Gake de dzesii be ɖewohĩ manya wɔ be woaɖo afisi wodzea proximal tibial nailing ƒe dɔwɔwɔ gɔme le zi geɖe o.

- Le ƒunukpeƒetetedɔ siwo me ƒunukpeƒetetedɔ keke ɖo me la, woate ŋu ade gavi bubuwo eme be woatsɔ ana ƒunukpeƒetetedɔa ƒe akpaa nagaʋuʋu o. Wokafui be woatsɔ gavi siawo ade eme hafi woatsɔ ɖaa ade eme be woaƒo asa na ƒunukpeƒe ƒe gbagbãƒea ƒe ʋuʋu zi evelia.

Nusiwo Ŋu Woabu le Proximal Tibia Fracture ŋu

Proximal tibial fractures nye tibial fractures siwo sesẽ wu be woatsɔ aƒo ɖa eye ebia be woage ɖe eme pɛpɛpɛ (abe alesi míegblɔe le etame ene). Ele be woaɖe gbagbãƒe siawo dzi akpɔtɔ hafi aƒo ati ɖe wo ŋu be woatsɔ atsi ŋusẽ ɖesiaɖe si gblẽa nu le ame ŋu nu eye woakpɔ dzidzedze geɖe wu. Le go aɖewo me la, ne wotsɔ abɔ si ŋu dɔlélea le la ɖo teƒe si keke afã kple afã nyuie eye woakpɔ afisi tututu woage ɖo eye woatsɔ ɖaa aɖo ɖa kple medullary canal le coronal kple sagittal axes me ana tibia nasɔ nyuie le ɖaƒoƒo vɔ megbe.

Gake zi geɖe la, ehiã be woawɔ afɔɖeɖe aɖewo atsɔ aɖe wo dzi akpɔtɔ be woakpɔ gbagbãƒe siawo ƒe teƒe bubu si dze ame ŋu ahalé wo me ɖe asi. Ne fli si gbagbã la le bɔbɔe eye wòle dzogoe dzi la, woate ŋu azã nutrenu bɔbɔe siwo wotsɔ ɖoa ​​nu ŋu alo coaptation clamps, siwo woda ɖe ŋutigbalẽ me, atsɔ axɔ gbugbɔgaɖoanyi le atitsotso me eye woalé eme ɖe asi. Ne clamp la mesɔ gbɔ o alo fracture plane mesɔ na clamping o la, pollen alo blocking screws ateŋu akpeɖeŋu be woaxe mɔ ɖe ʋuʋu kple nɔnɔme gbegblẽ nu (Nɔnɔmetata 15). Wotsɔa gavi siawo dana ɖe megbe na ɖa ƒe nɔnɔme si wodi le axadzikpɔkpɔ me eye wotsɔa axadzi na ɖa ƒe nɔnɔme si wodi le ŋgɔgbe-megbe kpɔkpɔ me. Gavi siawo ɖoɖo nyuie be woagbugbɔ aɖo wo teƒe nyuie ate ŋu asesẽ.

Fig. 15 Kplu siwo wotsɔ xea mɔ si wodi la ƒe gota le ŋgɔgbe kple megbekpɔkpɔ me (a) kple megbe na ɖamɔ si wodi le axadzikpɔkpɔ me (b) siwo tsi tre ɖe nusiwo trɔna ƒe ŋusẽwo ŋu

Mɔnu bubu si wɔa dɔ ŋutɔe nye be woatsɔ atɔ te gbagbãƒea hena ɣeyiɣi aɖe le ŋutilã ƒe nɔnɔme me (Nɔnɔm. 16). Zi geɖe la, kakɛ sue aɖe si le abe ʋuƒo ene si me wotsɔa gavi eve alo etɔ̃ siwo xea mɔ na lãkusi ɖeka le la alé gbagbãƒea ɖe te le ke ƒe mɔ dzadzraɖo kple ɖa dede eme me. Plɛti la akpɔ ʋuʋu eveawo siaa dzi. Ele be woagblẽ agbalẽvi la ɖe teƒea zi alesi dometsotso aɖeke meli si woɖo ɖi o be woatsɔ axe mɔ ɖe edziɖeɖekpɔtɔ ƒe bu si dzɔna zi geɖe le agbalẽa ɖeɖe vɔ megbe nu. Plɛti sia si me cortical screw ɖeka le la mesẽna o eye makpɔ ŋusẽ ɖe ɖaa ƒe liƒo si sɔ dzi o. Woate ŋu azã reset plate mɔnu la na gbagbãƒe siwo woʋu kple esiwo wotu siaa.

Nɔnɔmetata 16 Woate ŋu akpɔ ʋuƒo sue aɖe si me wotsɔa ʋuka ƒe ʋuƒo ɖeka le eye woalée ɖe te le ŋutilã ƒe nɔnɔme yeye me. Zi geɖe la, ele be woagblẽ agbaa ɖe teƒea ne woƒoe vɔ. a Valgus ƒe gbagbã le gɔmedzedzea me le proximal tibial fracture me. b Wotsɔa gbagbãƒe sue aɖe si me cortical screw ɖeka le la dana ɖe titina be woakpɔ gbagbãƒea ƒe tɔtrɔ le teƒe bubu le atitsotso me eye wòalé eme ɖe asi. c Womeɖea agbalẽa ɖa le atitsotso vɔ megbe o elabena enaa wòli ke ɖe edzi

Masɔmasɔ, Afɔkuwo Kple Kuxiwo

- Ametakpɔnu ƒe Abɔta ƒe ʋuʋu le dɔwɔwɔ me ate ŋu agblẽ nu le ƒunukpeƒe kple klo ƒe wɔwɔme siwo le ƒunukpeƒewo ŋu (Nɔnɔmetata 17). Ele be woagbugbɔ ametakpɔnu ƒe abɔta ade eme bliboe.

- Ametakpɔnu ƒe Abɔta ƒe ʋuʋu vie ate ŋu ana reamer ƒe ta ɖeɖe nasẽ ɖe edzi. Fluoroscopy kpena ɖe ame ŋu wòdea dzesi kuxia. Ne wogbugbɔ trɔ asi le ametakpɔnu ƒe abɔta ŋu la, akpɔ kuxia gbɔ (Fig. 18) .

- Nail Lock-Up: Nusi wotsɔ de eme ate ŋu atɔ ɖe ga ƒe abɔta le proximal bend (Herzog curve). Be woatsɔ ɖa mamlɛtɔ ade eme la, ele be woaɖe ga si wotsɔ blae la ɖa, eye gotagome plastik-abɔta falɛfalɛa koe susɔ. Ne ɖaa tsi la, ehiã be woagaɖee ɖa keŋkeŋ eye woagade nusi wotsɔ de eme la eme ne woɖe ga si wotsɔ ƒoa ɖaa to aŋetu la ɖeɖeko me vɔ.

Figure 17 Ametakpɔnu ƒe abɔta ɖeɖe ɖa fluoroscopic ŋkuléle ɖe eŋu manɔmee ate ŋu ana klo naxɔ abi

Figure 18 a Ametakpɔnu ƒe ʋuƒoa ƒe ʋuʋu alo eƒe ʋuʋu le vo me ate ŋu ado kplamatse reamer ɖeɖeɖa, elabena reamer ƒe ta ate ŋu atɔ. b Fluoroscopic inspection kple alignment correction ɖea mɔ be woaɖe reamer ƒe ta ɖa. c Woate ŋu aɖe reamer ƒe ta la ɖa ne reamer ƒe ta mele teƒea o. d Woateŋu aɖe reamer ƒe ta ɖa ne reamer ƒe ta mele teƒea o.

Nusiwo ŋu woke ɖo

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Atitsoga si wotsɔ ƒoa afɔkpodzi ƒe gbagbãƒewo le etame. Oper Orthop ƒe Nuveviwɔame. 2020 Oct;32 (5): 440-454 ƒe ɣleti gbãtɔ.