Usoro nhazi ntu intramedullary Tibial

Ntuzi ntu intramedullary ka bụ ọgwụgwọ nhọrọ maka mgbaji tibial stem na-adịghị akwụsi ike na nke chụpụrụ na ndị okenye. Ebumnuche nke ọgwụgwọ ịwa ahụ bụ iweghachi ogologo, nhazi na ntụgharị nke tibia na iji nweta ọgwụgwọ mgbaji. Uru nke intramedullary nailing bụ obere trauma ịwa ahụ na nchekwa kwesịrị ekwesị nke inye ọbara na mgbaji. Na mgbakwunye, ntu intramedullary nke tibia na-enye nkwụsi ike mgbaji biomechanical kwesịrị ekwesị ma na-arụ ọrụ dị ka ngwaọrụ nkekọrịta ibu na-enye ohere ịchịkọta n'oge mgbe emechara ya. Ọganihu n'ichepụta ntu intramedullary na usoro mbelata agbasawanyela ihe ngosi maka ndozi ntu intramedullary gụnyere tibia proximal na mgbaji n'etiti etiti atọ dị ala.

Ruo taa, mbelata ntu intramedullary mechiri emechi nke mgbaji tibial abụrụla usoro a na-ahụkarị maka ndị dọkịta na-awa ọkpụkpụ ọkpụkpụ. N'agbanyeghị na ewu ewu nke ntu intramedullary maka mgbaji tibial a na-achụpụ, ọ ka na-esi ike ma nwee ọtụtụ nsogbu nwere ike ime. Usoro ịwa ahụ na-aga n'ihu na-etolite. Ebumnuche nke isiokwu a bụ ịkọwapụta echiche ndị dị ugbu a na ntinye ntu intramedullary nke ọkpụkpụ tibial stem fractures na ichikota ọganihu na-adịbeghị anya n'ọhịa.

一. Ntụle mbụ na nyocha

N'ime ndị ọrịa na-eto eto, mgbaji ọkpụkpụ tibial na-abụkarị n'ihi mmerụ ahụ ike dị elu, a ga-enyochakwa ndị ọrịa maka trauma metụtara dịka ntụziaka Advanced Trauma Life Support (ATLS). Nyochaa mmerụ ahụ gbara ya gburugburu na anụ ahụ dị nro dị ka ọnya mgbaji, abrasions akpụkpọ, ọkụ, ecchymosis, ma ọ bụ elu akpụkpọ ahụ; dokwuo anya ma mgbaji ahụ emeghere, ma ọ bụrụ otú ahụ, gwọọ tetanus na ọgwụ nje; ma mee nyocha nke ọma neurovascular ma detuo ihe ndị dị n'elu. Nyochaa ihe omume nke osteofascial compartment syndrome ma mee usoro nyocha ụlọ ọgwụ na ndị ọrịa a.

Nnyocha ndị e mere n'oge na-adịbeghị anya egosiwo na ọrịa nke osteofascial compartment syndrome na-esochi mgbaji tibial tuberosity nwere ike ịdị elu ruo 11.5%. Karịsịa, ìgwè ndị ọrịa na-eto eto na-enwekarị ike ịmalite ọrịa osteofascial compartment syndrome. Nchoputa nke osteofascial compartment syndrome kwesịrị ịdabere na nchọpụta ụlọ ọgwụ, gụnyere oké mgbu, mgbanwe neurovascular, ọzịza nke akụkụ myofascial, na ụbara mgbu site na mgbatị ụkwụ na-agafe agafe. Ya mere, ọrịa osteofascial compartment syndrome ka bụ nchoputa ụlọ ọgwụ na akwụkwọ nke ọma nke nyocha ụlọ ọgwụ dị mkpa. Enwere ike tụọ nrụgide dị n'ime oghere myofascial site na agịga nrụgide (Njirimara 1) dịka usoro nyocha mgbakwunye na ule ọpụrụiche.

Ọnụ ọgụgụ 1. Ntụle nrụgide na interosseous septum site na agịga nrụgide

Iji nweta data a pụrụ ịdabere na ya, a ga-atụle nrụgide intrafascial na akụkụ anọ nke myofascial na n'ebe dị iche iche n'ime akụkụ ọ bụla nke myofascial. Nnyocha ndị dị na akwụkwọ ndị ahụ na-atụ aro na nrụgide nrụgide nke na-erughị 30 mmHg (nrụgide diastolic na-ebelata ihe mgbagwoju anya) na-egosi ọrịa nke akụkụ nke fascial. Nrụgide diastolic na-agbadakarị n'oge ịwa ahụ, yana nrụgide diastolic tupu ịwa ahụ kwesịrị iburu n'uche mgbe ị na-agbakọ nrụgide dị iche.

Nnyocha e mere n'oge na-adịbeghị anya egosila na nlekota nrụgide intrafascial bụ ngwá ọrụ nwere ike ịba uru maka nchọpụta nke nnukwu ọrịa fascial compartment syndrome, nke nwere mmetụta nke 94 % na kpọmkwem 98 %. Otú ọ dị, n'inyere ihe ndị nwere ike ịkpata nsogbu nke akụkụ ahụ nke akụkụ ahụ, nchoputa nke ọrịa akụkụ ahụ kwesịrị ịdabere na nchọpụta ụlọ ọgwụ, ma ekwesịrị iji nha nrụgide ọnụ ụlọ interosseous mee ihe n'ọnọdụ pụrụ iche, dịka mgbe onye ọrịa merụrụ ahụ ma ọ bụ mgbe isi data ụlọ ọgwụ na-edoghị anya.

Ntụle onyonyo kwesịrị ịgụnye orthopantomogram ọkọlọtọ na echiche dị n'akụkụ nke tibia merụrụ ahụ na redio nke ikpere ikpere na nkwonkwo nkwonkwo ụkwụ, bụ nke a na-enyocha n'ihu site na iji tomography computed (CT). N'otu aka ahụ, nyocha CT nke nkwonkwo ụkwụ nwere ike ịdị mkpa iji were anya nke uche hụ ahịrị mgbaji na-agbatị ruo n'ala ala tibial yana mmerụ ahụ nkwonkwo ụkwụ na-enweghị mgbagha.

二. Ọnyà ụlọ ọgwụ

Ọnụ ọgụgụ dị elu nke mgbaji nke etiti etiti atọ nke tibia nwere mgbaji ụkwụ ka akọpụtala. N'iji nyocha CT nke a na-emekarị, 43 % nke mgbaji nke etiti na nke atọ nke tibia na-ejikọta ya na nkwonkwo ụkwụ, ọtụtụ n'ime ha chọrọ ọgwụgwọ ịwa ahụ. Ụdị mgbaji a na-ahụkarị bụ mgbaji gbajiri agbaji nke ala etiti atọ nke distal tibia jikọtara ya na mgbaji ụkwụ ụkwụ dị ntakịrị ma ọ bụ nke na-abụghị nke a na-ewepụ (Njirimara 2). N'ihi obere mwepu nke mgbaji nkwonkwo ụkwụ jikọtara ya, ọ bụ naanị 45% nke mmerụ ahụ nwere ike ịhụ na redio nke nkwonkwo ụkwụ nkịtị. Ya mere, a na-emesi CT na-enyocha nkwonkwo ụkwụ na-aga n'ihu nke ukwuu mgbe ọkpụkpụ tibia dị n'etiti dị ala dị (Fig 3).

Ọgụgụ 2.AF Spiral fracture nke ala etiti atọ nke tibia aka nri (A, B) Radiographs tupu arụ ọrụ nke nkwonkwo ụkwụ na-egosi nkịtị (C). Fluoroscopy C-arm intraoperative na-egosi mgbaji na-enweghị mgbaji nke nkwonkwo ụkwụ azụ (D) Radiograph postoperative ka emechara ịwa ahụ (EF) na-egosi ọgwụgwọ dị mma nke tibial na mgbaji ụkwụ.

Ọgụgụ 3. AF Spiral fracture nke etiti na ala nke atọ nke redio tibia ekpe (AB) tupu arụ ọrụ; (CD) nyocha CT tupu arụ ọrụ nke ọma na-egosi mgbaji azụ malleolar na-enweghị isi; (EF) na-egosi ọgwụgwọ na-enweghị isi nke tibia na mgbaji malleolar

三. Ụzọ ịwa ahụ

01. Ebe ntinye agịga Tibial

Ịmepụta ebe ntinye ziri ezi na-arụ ọrụ dị oke mkpa na ọtụtụ ọmụmụ ihe na akwụkwọ akụkọ enyela ozi dị mkpa banyere ebe anatomical nke ebe ntinye dị mma maka ntinye aka intramedullary nke ọkpụkpụ tibial. Ọmụmụ ihe ndị a egosila na ebe a na-atụnye nke ọma dị n'akụkụ ihu nke ala ala tibial na dị n'etiti etiti akụkụ tibial spur. A kọkwara mpaghara nchekwa nke nwere obosara nke 22.9 mm ± 8.9 mm, nke na-adịghị emebi ihe owuwu njikọ dị n'akụkụ. Na omenala, mmalite nke ntu intramedullary ntu nke ọkpụkpụ tibial eguzobewo site na usoro infrapatellar, ma ọ bụ site n'ịkewa eriri patellar (transpatellar approach) ma ọ bụ site n'iwepụ akụkụ nke nkwụsị ụkwụ patellar (paratendinous approach).

Semi-extension intramedullary nailing adọtala mmasị dị ukwuu na akwụkwọ orthopedic na nso nso a, na Tornetta na Collins na-atụ aro iji usoro nke parapatellar medial maka imezi ntu n'ime oghere nke ọkara iji zere ịpụta n'elu elu nke ntu intramedullary n'ime ihu tibial cortex na-eru nso na nkebial cortex. a na-atụkwa aro ka ọkara ndọtị ahụ. A na-atụ aro iji usoro suprapatellar maka tibial intramedullary nailing na ntinye nke ntu intramedullary site na nkwonkwo patellofemoral n'ọnọdụ ọkara gbatịpụrụ.

A na-eme usoro ahụ site na ikpere ikpere na ihe dịka ogo 15-20, a na-eme ka mbepụ ogologo oge dị ihe dịka 3 centimita dịka otu mkpịsị aka abụọ n'elu patella. A na-ekewa akwara quadriceps n'ụdị ogologo ogologo ma na-eme nkewa nke ọma na nkwonkwo patellofemoral. A na-etinye oghere na-adịghị mma site na nkwonkwo patellofemoral iji mepụta ebe ntinye na nkwụsị nke proximal anterior tibial cortex na elu articular (Nyocha 4).

Ihe osise 4. ab foto intraoperative nke (a) kewaa akwara quadriceps na ịtinye trocar site na nkwonkwo patellofemoral na ntinye tibial; (b) anya n'akụkụ intraoperative nke ebe ntinye

A na-eji obere mkpọpu 3.2 mm iji chọpụta ebe mmalite agịga n'okpuru nduzi C-arm. A na-enye oghere gbawara agbawa iji mezie ebe ntinye na ụzọ ọpụpụ. A na-eme usoro ịwa ahụ fọdụrụnụ gụnyere reaming na ntinye ntu tibial site na oghere.

URU NDỊ MMADỤ: Ọkpụkpụ ụkwụ gbatịpụrụ ọkara nwere ike inye aka n'ịgbanwe mgbaji, ọkachasị n'ịgbajie nwere ihe dị nso n'ụzọ atọ nke tibia na n'ihu. , Ọkara agbatị nwere ike iwepụ esemokwu na akwara quadriceps ma nyere aka n'ịhazigharị mgbaji. , Ọkara-agbatị ọnọdụ suprapatellar ụzọ nwekwara ike ịbụ ihe ọzọ na omenala infrapatellar obibia (Nyocha 5).

Ọgụgụ 5. Foto intraoperative na-egosi mmerụ ahụ dị nro na mpaghara infrapatellar dị ka ihe ngosi maka ụzọ suprapatellar n'ogo nke ọkara.

Nnyocha e mere egosiwo na ụzọ suprapatellar na-aga na tibial intramedullary nailing na ọkara agbatị bụ usoro ịwa ahụ dị mma ma dị irè. Ọnwụnwa ụlọ ọgwụ n'ọdịnihu dị mkpa iji nyochaa uru na ọghọm dị na ụzọ suprapatellar intramedullary nailing na iji nyochaa nsonaazụ ogologo oge jikọtara ya na usoro a.

02. Tọgharia teknụzụ

Ntinye ntu intramedullary tibial naanị anaghị eme ka mbelata mgbawa zuru oke; Ekwesịrị idowe mbelata mgbaji kwesịrị ekwesị n'oge usoro mweghachi na ntinye ntu intramedullary. Ngwa nke traction akwụkwọ ntuziaka naanị nwere ike ọ gaghị enweta mbelata anatomic nke mgbaji n'onwe ya. Edemede a ga-akọwa ụzọ dị iche iche nke mechiri emechi, nke pere mpe, na mbelata meghere.

Atụmatụ nrụpụta nrụpụta emechiri emechi

Enwere ike ime usoro mbelata mechiri emechi site na iji ngwa mbelata dị ka F-fracture reducer, ngwaọrụ mbelata nke nwere ike ime ka redio nke F nke na-emezi akụkụ ntụgharị / ntụgharị yana ntụgharị medial / mpụta (Fig 6).

Fig. 6. F-ụdị mgbaji reducer zoro aka na ịwa ahụ

Otú ọ dị, ngwaọrụ ahụ nwere ike itinye nrụgide dị ukwuu na anụ ahụ dị nro, ma ekwesịrị izere iji ngwaọrụ nrụpụta a ogologo oge. Enwere ike idowe ike mbelata n'oge ọ bụla, dịka ọ dị n'ihe gbasara mgbaji gbajiri agbaji na gbajiri agbaji. Enwere ike itinye ngwaọrụ ndị a n'ụdị enyi na enyi dị nro site na obere mbepụ (Nyocha 7).

Onyonyo 7. Mkpọgide na-adị n'otu oge iji tọgharịa mgbaji tibial

A ga-ahọrọ ụdị njigide na ebe ebe mgbawa ịwa ahụ dabere na atụmatụ iji belata mmebi ogologo oge nke anụ ahụ dị nro site na ntinye mwepu (Nyocha 8).

Fig. 8. Ntugharị ihe atụ atụnyere iji tọgharịa mgbaji tibial

Ndị na-emegharị ihe bụkwa otu n'ime ngwa nrụpụta a na-ejikarị weghachi ogologo na tibia. A na-etinyekarị ha n'etiti etiti ma pụọ ​​​​na ebe a chọrọ itinye ntu intramedullary. Enwere ike idowe ntụtụ traction dị nso ka o yie ọnọdụ mgbochi mgbochi nso, nke na-enye ohere maka mbelata mgbaji ahụ ngwa ngwa ozugbo ntu intramedullary batara.

N'ọnọdụ ụfọdụ, usoro mbelata nke mechiri emechi na nke pere mpe ka ezughi oke iji nweta mbelata anatomic. N'ọnọdụ ndị dị otú ahụ, a ga-atụle usoro mbelata mbepụ site na iji nlezianya na-elekọta anụ ahụ dị nro gbara ya gburugburu. Ọdịmma dị iche iche nke usoro mbelata oghere mepere emepe gụnyere trauma ịwa ahụ ọzọ, nke nwere ike ịbawanye ohere nke ibute ebe ịwa ahụ. Tụkwasị na nke ahụ, ịwepụ ọzọ nke ọbara na-enye aka na saịtị mgbawa nwere ike ime ka ohere nke mgbagwoju anya ghara ịdị n'otu.

- Nka nka maka mwepu na ntughari

Ntugharị mbelata mbepụ mbepụ na-enye ohere ọ bụghị naanị ike mbelata ịwa ahụ etinyebere n'ọnọdụ kwesịrị ekwesị, kamakwa itinye obere splint ma ọ bụ nke pere mpe na saịtị mgbaji iji nọgide na-ebelata mgbaji n'oge usoro ntu intramedullary.

A na-echekwa efere n'akụkụ mgbaji dị nso na nke dị anya site na iji skru monocortical. A na-edobe splint ahụ n'oge usoro nhazigharị na ntinye nke ntu intramedullary na tibia. Mgbe etinyere ntu intramedullary, a na-ewepụ ma ọ bụ hapụ efere ahụ iji mee ka nkwụsi ike nke nhazi edozi (Fig 9). Site n'ịhapụ efere ahụ n'ebe ahụ, otu ihe nkedo cortical kwesịrị ịgbanwe ya na nkedo cortical okpukpu abụọ. Ekwesịrị ịtụle ya maka iji ya mee ihe n'ọnọdụ ahọpụtara ebe akụkụ tibial chọrọ ịwa ahụ mepere emepe iji nweta mbelata mgbaji anabatara.

Ọnụọgụ 9. Mepee mgbaji tibia na nbibi siri ike na nkwarụ ọkpụkpụ, otu nrụzi cortical na obere splint na njedebe gbajiri agbaji mgbe mbelata na mwepụ nke splint mgbe ntinye ntu intramedullary.

Ebumnuche nke ntu na-egbochi bụ imechi oghere medullary na mpaghara metaphyseal. A na-etinye mbọ mgbochi n'ime mpekere articular dị mkpụmkpụ yana n'akụkụ concave nke nrụrụ tupu etinye ntu intramedullary. Dịka ọmụmaatụ, ụdị nrụrụ nke mgbaji nke akụkụ atọ dị nso nke tibia bụ nke e ji valgus na ntugharị ihu. Iji dozie nrụrụ valgus, enwere ike itinye ihe mkpuchi mkpọchi n'ime akụkụ mpụta nke mgbaji ahụ dị nso (ya bụ, akụkụ concave nke nrụrụ ahụ) n'akụkụ anteroposterior. A na-eduzi ntu intramedullary site na etiti etiti, si otú a na-egbochi valgus. N'otu aka ahụ, enwere ike imeri nrụrụ angulation site n'itinye skru medial n'akụkụ akụkụ azụ nke ngọngọ dị nso (ya bụ, akụkụ concave nke nrụrụ ahụ) (Fig 10).

Ọgụgụ 10. enyere aka ntọgharị mgbaji tibial site n'itinye ntu mgbochi

-Medullary mgbasawanye

Mgbe emechara ntugharị mgbaji ahụ, a na-ahọrọ reaming medullary iji kwado ọkpụkpụ maka ntinye ntu intramedullary. A na-etinye ntụzịaka ahụ na-agwụ bọọlụ n'ime oghere ụmị tibial na site na ebe mgbawa ahụ, a na-agafekwa mgbịrịgba ahụ n'elu ntụzịaka ahụ. A kwadoro ọnọdụ nke ntụziaka ntụzịaka bọọlụ n'okpuru C-arm fluoroscopy ka ọ dị n'ogo nke nkwonkwo nkwonkwo ụkwụ, na ntuziaka na-adabere nke ọma na ma echiche anteroposterior na n'akụkụ (Nyocha 11).

Ọgụgụ 11. na-egosi ọnọdụ nke guidewire na oghere medullary na C-arm fluoroscopy na ọnọdụ ihu na n'akụkụ.

Okwu gbasara ịgbasawanye na medulla na-agbasaghị enweela arụmụka. Anyị kwenyere na ọtụtụ ndị dọkịta na-awa na North America na-ahọrọ ịgbatị ntu intramedullary medullary nke tibia ka ọ ghara ịgbasa. Otú ọ dị, ma gbasaa ma na-agbasaghị intramedullary nailing nwere ike iji dị ka usoro ọkọlọtọ a na-anabata, na enwere ike nweta nsonaazụ dị mma site na ụzọ abụọ ahụ.

-Mkpọchi ịghasa ntinye

Ojiji nke skru na-ejikọta ọnụ na tibial stem fractures bụ iji gbochie mkpirisi na mmebi ahụ, na-agbatị ihe ngosi maka ntu intramedullary nke tibia ka ọ dịkwuo nso na distal tibial stem fractures metụtara metaphysis. N'ọkpụkpụ nke metụtara mpaghara metaphyseal, skru na-ejikọta ọnụ ghọrọ ihe dị mkpa n'ịkwado nhazi axial.

Ihe nkedo atọ dị nso na-eme ka nkwụsi ike dịkwuo mma, na screws skru na-eme ka ọ kwụsie ike n'akụkụ nwere ike inye nkwụsi ike dị ukwuu karịa ihe nkedo na-ejikọta ya, nke nwere ike ikwe ka otu nkwụsi ike nke nhazi ahụ nweta ya na ọnụ ọgụgụ dị nta nke skru na-ejikọta. Data ụlọ ọgwụ na ọnụọgụ na nhazi nke skru na-ejikọta ọnụ achọrọ maka imezi nke tibia ka dị oke.

A na-arụkarị ebe a na-etinye skru nke dị nso site na iji oghere etinyere na ntu ntu intramedullary. A na-etinye skru nke dị anya n'aka efu n'okpuru nduzi fluoroscopic. A na-atụ aro iji usoro ntụzịaka kọmpụta na-enyere aka maka ịtinye skru nke tibial dị anya (Foto 12). Usoro a na-enye ohere ịtinye skru dị anya na-enweghị radieshon wee gosi na ọ bụ usoro nwere ike ime na nke ziri ezi.

Ọgụgụ 12.AB Ịkpọchi skru site na echiche C-arm; Mkpọchi CD site na mkpọchi enyere aka kọmpụta elektrọn

Ndokwa nke skru nke dị nso na nke dị anya bụ usoro ịwa ahụ dị mma na a ga-etinyekwa skru ndị ahụ n'ụzọ ziri ezi ma dị nro n'ụzọ enyi na enyi.

Ọmụmụ ihe gbasara anatomic egosila na a ka nwere ihe ize ndụ nke nrụrụ akwara peroneal mgbe ị na-etinye skru dị nso na mpụta na-emechi anya. Iji belata ihe ize ndụ a, ndị dọkịta na-awa ahụ kwesịrị ịtụle ịkụ ala maka skru n'okpuru nduzi C-arm, na akụkụ fluoroscopic nke C-arm perpendicular na ụgbọ elu nke olulu ahụ. Ịbanye n'ime cortex nke tibia distal nwere ike isi ike ịghọta site na nzaghachi nhụsianya, na ịdị nso nke isi fibular nwere ike ikpuchi mmetụta uche ahụ ma nye dọkịta na-awa ahụ echiche nke ịbụ 'n'ime ọkpụkpụ' mgbe n'ezie isi fibular abanyela. Ekwesịrị ikpebi ogologo ịghasa ọ bụghị naanị site na akuku ume gụsịrị akwụkwọ kamakwa site na nha omimi kwesịrị ekwesị. Ntụgharị ọ bụla ma ọ bụ mkpọsa ogologo karịa 60 mm kwesịrị iwelite enyo maka protrusion posterolateral, nke nwere ike itinye akwara peroneal nkịtị n'ihe ize ndụ nke mmerụ ahụ.

A na-edobe skru nke dị anya na nke azụ na nlebara anya na nchekwa nke ngwugwu neurovascular anterolateral, akwara ihu tibialis, na extensor digitorum longus. Ọ bụ ezie na ntinye nkuku percutaneous na-adịkarị mma, ndị dọkịta na-awa ahụ kwesịrị ịma ihe egwu dị n'akụkụ akụkụ anụ ahụ dị nro gbara ya gburugburu. Maka ọtụtụ mgbaji azuokokoosisi tibial, skru abụọ dị nso na nke abụọ dị anya na-enye nkwụsi ike zuru oke. Ọkpụkpụ tibial dị nso na nke dị anya nwere ike irite uru site na ntinye nke skru ndị ọzọ na-ejikọta ọnụ na ụgbọ elu dị iche iche iji mee ka nkwụsi ike nke ihe owuwu a dịkwuo elu (Nyocha 13).

Ọgụgụ 13. Ọtụtụ mgbaji nke tibia, na-emeso ya na intramedullary nailing na abụọ distal na atọ proximal interlocking skru, na x-ray na-esote na-atụ aro ọgwụgwọ mgbaji.

-Fibular ndozi

Ntu ntu intramedullary nke dị ugbu a nwere skru na-ejikọta ọnụ agbasawanyela ihe ngosi maka ntu intramedullary nke tibia iji tinye mgbaji dị nso na nke dị anya metụtara mpaghara metaphyseal.

A na-eji nhazi ihe nkedo dị iche iche dị iche iche na-eme ihe n'ọmụmụ ihe (2 screws from medial to lateral veins 2 screws do perpendicular na ibe ha na ngụkọta nke 3 distal interlocking screws versus only 1 disstal interlocking screw). N'ime ndị ọrịa nwere nhazi fibular na nhazi ntu intramedullary tibial, ọnụego nrụpụta furu efu dị obere. Ngụkọta 13% nke ndị ọrịa nwere ntu ntu intramedullary na-enweghị ndozi fibular gosipụtara mfu nke nrụpụta mgbe arụchara ọrụ gasịrị, ma e jiri ya tụnyere 4% nke ndị ọrịa nwere ntu tibial na-enweghị ndozi fibular.

N'ime ule ọzọ na-atụnyere ịdị irè nke ntu nke intramedullary tibial na-edozi ihe na-eme ka ọkpụkpụ na-eme ka ọkpụkpụ na-eme ka ọkpụkpụ na-eme ka ọ bụrụ nke na-adịghị edozi ahụ, ndị ọrịa na-eme ka ọkpụkpụ na-edozi ahụ na-ejikọta ya na ntanye tibial gosipụtara ọganihu na ntụgharị ntụgharị na ntụgharị / ntụgharị.

Anyị kwubiri na mgbakwunye fibular na-arụkọ ọrụ na-enweta ma na-edobe mbelata mgbaji tibia na mgbaji tibia dị otu ụzọ n'ụzọ atọ na-eme ndozi ntu intramedullary. Otú ọ dị, nsogbu nke nsogbu ọnya site na nkwụsịtụ ndị ọzọ na mpaghara anụ ahụ mebiri emebi na-anọgide. Ya mere, anyị na-akwado ịkpachara anya n'iji nhazi fibular enyere aka.

03. Nsonaazụ

Ndozi ntu intramedullary nke mgbaji tibial stem nwere ike rụpụta nsonaazụ dị mma. A kọwo ọnụego ọgwụgwọ nke ntu intramedullary nke tibia n'ọmụmụ ihe dị iche iche. Site n'iji ntinye nke oge a na usoro ịwa ahụ kwesịrị ekwesị, a na-atụ anya na ọnụ ọgụgụ ọgwụgwọ ga-agafe 90 %. Ọnụọgụ ọgwụgwọ nke mgbaji ụkwụ tibial nke na-adaghị agwọta mgbe edozichara ntu intramedullary dị mma nke ukwuu ka emechara n'ime ya na ntu intramedullary gbasaa nke abụọ.

Ntụle nsonaazụ n'otu afọ mgbe a wachara ya ahụ gosipụtara na ihe ruru 44% nke ndị ọrịa na-aga n'ihu na-enwe oke arụ ọrụ na nsọtụ ala merụrụ ahụ, ihe ruru 47% gara n'ihu na-ekwupụta nkwarụ metụtara ọrụ n'otu afọ mgbe a wachara ya ahụ. Ọmụmụ ihe ahụ na-egosi na ndị ọrịa a na-emeso ya na ntu intramedullary nke tibia na-aga n'ihu na-enwe oke ọrụ dị ukwuu n'ime ogologo oge. Ndị dọkịta na-awa ahụ kwesịrị ịma banyere okwu ndị a ma nye ndị ọrịa ndụmọdụ ndụmọdụ!

四. Nsogbu mgbe ịwachara ahụ gasịrị

01. Pre-patellar mgbu

Mgbu patellofemoral nke ihu bụ ihe mgbagwoju anya mgbe emechara ntu intramedullary nke tibial stem fractures. Nnyocha e mere egosiwo na ihe dịka 47% nke ndị ọrịa mgbe a na-etinye aka na intramedullary nwere ike ịmalite mgbu prepatellar, nke a na-aghọtachaghị ihe gbasara etiology. Ihe ndị nwere ike ịkpata mmetụta nwere ike ịgụnye mmerụ ahụ na ahụike na akụkụ intra-articular, mmerụ ahụ na ngalaba infrapatellar nke akwara saphenous, adịghị ike nke akwara apata ụkwụ nke abụọ na-ebelata ihe mgbu na-emetụta neuromuscular reflexes, fibrosis nke pad pad nke na-eduga na nkwụsịtụ, mgbatị patellar na-emeghachi omume, na-agbagọ n'ahụ ahụ nke na-eme ka ọ ghara ịdị na-eme ka ahụ ghara ịdị na-eme ka ọ ghara ịdị na-eme ka ahụ ghara ịdị na-aga n'ihu site na nhụsianya na-adịghị mma. tibia, na mputa nke nso nso nke ntu.

Mgbe ị na-amụ ihe gbasara etiology nke ihe mgbu nke prepatellar mgbe a na-etinye ntu intramedullary, a na-atụnyere ụzọ ntụgharị nke transpatellar na ụzọ parapatellar. Enwere ike jikọta ụzọ akwara transpatellar na mmụba dị elu nke mgbu ikpere mgbe ọ gasịrị. Otú ọ dị, data ụlọ ọgwụ a na-atụ anya na-egosighị ọdịiche ọ bụla dị n'etiti ụzọ akwara transpatellar na ụzọ parapatellar.

Ịdị irè nke nhọpụta nhọrọ nke nhazi ime ime iji dozie mgbu prepatellar mgbe tibial intramedullary nailing bụ ihe a na-ejighị n'aka. Anyị na-akwado na a ga-atụle mwepụ nke ntu tibial intramedullary ma ọ bụrụ na enwere ike ịchọpụta etiology n'ibu, dị ka ntu ntu ma ọ bụ ihe mkpuchi na-apụta. Agbanyeghị, uru nke iwepụ ntu intramedullary tibial na ndị ọrịa nwere mgbaàmà ka na-enyo enyo.

Banyere ihe mgbu prepatellar nke na-eme n'ihu, ihe kpatara mgbu ahụ enweghị ike igosi n'ụzọ doro anya na nchọpụta mbụ nke ụlọ ọgwụ nke intramedullary nail fixation nke ntu tibial na patella na ọkara agbatị. Ya mere, nnukwu ọmụmụ ihe gbasara ụlọ ọgwụ na nsonye ogologo oge dị mkpa iji kwado mmetụta nke ntinye ntu intramedullary na usoro suprapatellar na mgbu prepatellar postoperative.

02. Ndozi n'ihu na-adịghị mma

Post-traumatic osteoarthritis na-anọgide na-enwe nnukwu nsogbu mgbe ọgwụgwọ nke tibial stem fractures na intramedullary nailing. Ọmụmụ ihe ọmụmụ biomechanical egosila na mmebi nke tibial nwere ike ime ka mgbanwe dị ukwuu na nrụgide kọntaktị na nkwonkwo ụkwụ na ikpere ikpere.

Ọmụmụ ihe ọmụmụ ụlọ ọgwụ na-enyocha ogologo oge nlekọta ahụike na ihe onyonyo mgbe ọkpụkpụ tibial na-agbaji na-enye data ndị na-emegiderịta onwe ha na nsonazụ nke tibial malalignment, na-enweghị nkwubi okwu doro anya ruo taa.

Akụkọ banyere arụrụ arụ mgbe arụchara ọrụ ahụ gasịrị mgbe a kpọchara ntu intramedullary nke tibia ka dị oke, yana ọnụ ọgụgụ dị nta nke a kọrọ. Ọkpụkpụ arụ ọrụ mgbe emechara ka na-abụ nsogbu a na-ahụkarị na ntu intramedullary tibial, na nyocha ime ime nke ntụgharị tibial ka na-ama aka. Ka ọ dị ugbu a, ọ nweghị nyocha ụlọ ọgwụ ma ọ bụ usoro onyonyo eguzobela dị ka ọkọlọtọ ọla edo maka ikpebi intraoperative nke ntụgharị tibial.Nnyocha nyocha CT egosila na ọnụ ọgụgụ nke nrụrụ aka mgbe ntu ntu intramedullary nke tibia nwere ike ịdị elu dị ka 19% ruo 41%. Karịsịa, nrụrụ ntụgharị ntụgharị dị n'èzí yiri ka ọ na-adịkarị karịa nrụrụ ntụgharị nke ime. Nnyocha ụlọọgwụ iji chọpụta mmebi nke arụrụ arụ na-aga n'ihu na-akọ na ezighi ezi ma gosipụta mmekọrịta dị ala na nyocha CT.

Anyị kwenyere na mmebi ahụ na-anọgide na-enwe nsogbu ogologo oge na mgbaji tibial stem a na-emeso ya na ntu intramedullary nke tibia. N'agbanyeghị data ndị na-emegiderịta onwe ha banyere mmekọrịta dị n'etiti mmebi ahụ na ụlọ ọgwụ na nsonaazụ onyonyo, anyị na-atụ aro na ndị dọkịta na-awa ahụ kwesịrị ịgbalịsi ike iji nweta nhazi nke anatomic nke mgbaji iji chịkwaa mgbanwe a ma nweta nsonaazụ kacha mma.

五. Mmechi

Mkpọchi kwụsiri ike gbasawanye medullary intramedullary ntu ka bụ ọgwụgwọ ọkọlọtọ maka mgbaji tibial steepụ. Ebe ntinye ziri ezi na-anọgide na-abụ akụkụ dị egwu nke usoro ịwa ahụ. A na-ewere usoro suprapatellar n'ogo ọkara agbatị dị ka usoro dị mma ma dị irè, na ọmụmụ ihe n'ọdịnihu ga-enyochakwu ihe ize ndụ na uru nke usoro a. Dọkịta na-awa ahụ na-abịa kwesịrị ịma usoro nhazigharị nke oge a. Ọ bụrụ na enweghị ike nweta nzizi mgbaji ọkpụkpụ anatomic site na ụzọ mechiri emechi, ekwesịrị ịtụle usoro mbelata mbepu. Enwere ike nweta ọnụọgụ ọgwụgwọ dị mma karịa 90% site na ntu intramedullary gbasawanye na nke na-agbasaghị. N'agbanyeghị ọnụ ọgụgụ ọgwụgwọ dị mma, ndị ọrịa ka nwere oke ọrụ ogologo oge. Karịsịa, ihe mgbu prepatellar na-anọgide na-enwe mkpesa mgbe tibial intramedullary nailing gasịrị. Na mgbakwunye, nrụrụ aka mgbe emechara tibial n'ime ime ka bụ nsogbu a na-ahụkarị.

Ntụaka

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