ii. Oprehyɛn a Wɔyɛ .
Distal humerus a ɛpaapae no fi adwenemhaw tẽẽ (sɛ nhwɛso no, asehwe) anaasɛ tumi a ɛnteɛ (sɛ nhwɛso no, twitwiw anaa ntini a ɛtwetwe).
iii. Post-op a wɔde siesie wɔn ho .
AO nkyekyem no kyekyɛ humerus a ɛwɔ akyirikyiri no mu ma ɛyɛ ahorow abiɛsa titiriw: A , B , ne C .
iv. Adesua mu aba .
Oprehyɛn ayaresa di AO nnyinasosɛm ahorow akyi: nipadua no mu a ɛso tew, nea ɛyɛ den a wɔde si so, ne sɛnea wɔsan siesie wɔn ho ntɛm.
v. Asɛm ho amanneɛbɔ .
Mprɛte a wɔde to mu no ma nkwaboaa no gyina yiye, titiriw wɔ nnompe dompe mu.
VI. Mpɛnsɛmpɛnsɛmu
Czmeditech de nhwɛso abiɛsa ma: extraarticular (01.1107), lateral (5100-17), ne medial (5100-18) mprɛte.
VII. Awie
Oprehyɛn ayaresa di AO nnyinasosɛm ahorow akyi: nipadua no mu a ɛso tew, nea ɛyɛ den a wɔde si so, ne sɛnea wɔsan siesie wɔn ho ntɛm.
Distal tibial fractures abu so, na atetesɛm mu ayaresa wɔ anohyeto ahorow .
Distal tibial fractures yɛ ade a ɛtaa ba wɔ ase a ɛyɛ mmerɛw. Amanne kwan so ayaresa te sɛ mprɛte a wɔde to mu ne nnadewa a wɔde hyɛ ntini mu no mu biara wɔ wɔn sintɔ ahorow. Mprɛte a wɔde to mu no betumi ama obi anya ɔyare no wɔ oprehyɛn no akyi anaasɛ ntini a ɛyɛ mmerɛw a ɛyɛ mmerɛw, na ama ne ho atɔ no akyɛ; Ɛwom sɛ antegrade nnadewa no ntumi nkɔ nipadua no mu kakraa bi de, nanso ebetumi asɛe kotodwe no nkwaa, ɛde ɛyaw aba, na ɛde asiane a ɛne sɛ ɛbɛhyɛ no yiye anaasɛ ɛnyɛ nea ɛfata, asiw ahotɔ kwan.
Mprɛte a wɔde to mu:
Ntini a ɛyɛ mmerɛw a ɛsɛe ade kɛse, ɔyare mmoawa dodow a ɛkɔ soro, bere tenten a wɔsan nya .
antegrade nnadewa: .
Asiane a ɛwɔ hɔ sɛ wobepira wɔ kotodwe mu, a ɛnyɛ nea ɛfata, a ɛyɛ mmerɛw sɛ ɛbɛbɔ no .
Ano aduru foforo: Distal tibial nail (DTN) .
Aduruyɛ foforo a wɔpaw—distal tibial nail (DTN)—ma wonya adwene foforo a wɔde bedi distal tibial fractures ho dwuma denam ne nsusuwii soronko a ɛwɔ akyi no so.
Retrograde insertion design ma ɔkwan foforo .
Ɔyarefo gyinabea ne ahosiesie a wɔde tew so .
Wɔde ɔyarefo no si baabi a ɔda fam no. Ɛsɛ sɛ wɔde nsa tew mpaapaemu a wɔatu afi wɔn afie mu no so; Sɛ ɛho hia a, fa reduction forceps boa ansa na wode DTN no ahyɛ mu. Sɛ fibular fracture a ɛka ho wɔ hɔ a, fibular alignment a ɛfata betumi aboa tibial reduction. Wobetumi de nnadewa a ɛwɔ intramedullary mu no ayɛ fibular shaft fractures. Sɛnea ɛbɛyɛ a mpaapaemu bɛba ankle no ho no, ɛsɛ sɛ nipadua no so tew ne fibula no a wɔde si hɔ no di tibial reduction anim na amma malalignment ankɔ. Wɔ open fractures a ɛwɔ abɔnten fixation a ɛwɔ hɔ dedaw no mu no, wobetumi de nnadewa no ahyɛ mu bere a wɔhwɛ fixator no so na ama wɔatew so.
Supine gyinabea, fa reduction forceps di dwuma sɛ ɛho hia a .
Fa fibular fracture management di kan na ama woahwɛ ahu sɛ ɛtew tibial so pɛpɛɛpɛ .
Wɔyɛ 2–3 cm longitudinal incision wɔ mfinimfini malleolus no ano de da deltoid ligament a ɛwɔ soro no adi. Wɔde akwankyerɛ pin bi hyɛ malleolus no ano anaasɛ ɛyɛ mfinimfini kakra (Mfonini 2A), 4–5 mm fi articular surface no so. Afã hwɛ kyerɛ insertion via intercondylar groove (Mfonini 2B), a ɛkwati sɛe wɔ akyi tibialis ntini no mu. Tew deltoid ligament a ɛwɔ soro no mu, afei fa reamer ma medullary canal no yɛ kɛse kodu metaphyseal region (Mfonini 2C). Yi cancellous dompe a ɛbɛn proximal medial cortex no na fa nnadewa no hyɛ mu (Fig. 2D). Fa nnadewa a wɔde sɔ hwɛ hyɛ mu de si DTN kɛse so dua (Mfonini 2E). Kwati sɛ wobɛbɔ hama anaasɛ wobɛkyinkyin dodo na asiw iatrogenic medial malleolar fracture ano. Siesie nnadewa no mu dɔ na hwɛ hu sɛ distal screws no nkɔ ankle joint anaa fracture site no mu. Fixation no yɛ nea wɔde nkɔnsɔnkɔnsɔn a ɛka bom yɛ no wɔ bɛn ne akyirikyiri.
Nneɛma a wɔde twa: .
Wɔatwitwa no bere tenten wɔ malleolus tip no so .
Guide pin gyinabea:
4–5 mm fi nkwaa no ani .
Reaming & sɔhwɛ nnadewa:
Ream kosi metaphysis no so, si nnadewa kɛse so dua .
Nnadewa a wɔde hyɛ mu:
Kwati sɛ wobɛbɔ wo ho, yɛ nsakrae wɔ mu na bɔ nkwaa ho ban .
Fixation: .
Nkrukyire a ɛwɔ ntam no bɛn ne akyirikyiri .
DTN a wɔde hyɛ mu no ho nhyehyɛe .
Wɔma ankle nkwaa a ɛkɔ so ntɛm ara ne fam a ɛkɔ fam no ho kwan ma kwan ma wɔyɛ oprehyɛn no akyi
a ɛnyɛ duru so bearing ma adapɛn 4–6
kɔ so kɔ so yɛ nea emu duru yɛ pɛ wɔ adapɛn 8–12 ntam, bere a wɔhwɛ Callus a ɛba ne ɛyaw so .Ankle nkwaa dwumadi fi ase bere a wɔayɛ no oprehyɛn akyi pɛɛ .
Kwati sɛ wobɛsoa wo mu duru adapɛn 4–6 .
Nsakrae nkakrankakra a ɛkɔ mu duru a ɛyɛ pɛ so wɔ adapɛn 8–12 mu .
Ayarefo 10 a wodi wɔn akyi .
Nhwehwɛmu bi dii ayarefo 10 akyi (Table 1). Eduu asram 3 wɔ akyi no, na nsɛm 7 ayɛ yiye; Ayarefo no nyinaa nyaa ayaresa wɔ asram 6 ntam. Asɛm biako a emu biara yɛ varus ne recurvatum dɛmdi ahorow no sii. Wonhuu nea ɛso tew, ɔyare mmoawa, ɔhaw ahorow a ɛfa nneɛma a wɔde hyɛ nipadua mu ho, anaa iatrogenic opira biara (Table 2).
7 nsɛm a wɔyaree wɔ asram 3 ntam; Ne nyinaa a wɔsa no asram 6 .
2 Mfomso a emu nyɛ den (varus 1, 1 recurvatum) .
Nyarewa biara nni hɔ, nsɛnnennen a ɛde ba a wɔde hyɛ nipadua mu, anaasɛ ɛso tew .
Ɔyarefo a wadi mfe 69 a ɔyɛ ɔbarima .
Mmubui no su:
Transverse tibial fracture + fibular fracture .
Nsɛnnennen: .
Ntini a ɛyɛ mmerɛw a ɛma ɛyɛ mmerɛw sɛe .
Post-op: .
Nneɛma nketenkete 6 pɛ, ayaresa a edi mũ wɔ afe 1 mu .
Mfonini 3 & 4: .
Radiographic ne oprehyɛn akyi a wɔsan nya ho mfonini ahorow .
Nsɛnkyerɛnne a ɛkyerɛ sɛ DTN .
Nhwehwɛmu yi bi ne AO 43-A ne C1 a ɛpaapae; Wosusuw C2 nso ho. DTNs no tenten yɛ mm 7 ne mm 8, a ɛkyerɛ sɛnea wɔde nkɔnsɔnkɔnsɔn a ɛbɛn no bom. Mmubui a ɛwɔ 2–9 cm atifi wɔ articular surface no so no yɛ candidates a ɛfata ma DTN fixation. Wobetumi atrɛw nsɛnkyerɛnne ahorow mu akɔ AO 42 mu.
a ɛfa AO 43-A, C1 ho no, susuw ho sɛ wobɛtrɛw mu akɔ C2 ne 42 .
Nea eye sen biara a efi mu ba ma mpaapaemu a efi nkwaa no ani 2–9 cm .
Biomechanical a ɛyɛ den .
Retrograde nnadewa wɔ axial a ɛkorɔn ne rotational stiffness sɛ wɔde toto medial locking plates ne antegrade nnadewa ho a. Greenfield ne afoforo. Wɔyɛɛ biomechanical sɔhwɛ a ɛkyerɛ sɛ distal screws abien a wɔde di dwuma wɔ DTN no mu no nyaa 60–70% wɔ compressive stiffness no mu ne 90% a ɛyɛ torsional stiffness no sɛ wɔde toto screws abiɛsa ho a. DTN atew fracture fragment movement so wɔ adesoa ase. Wɔ nsɛm 3 a na ɛnsa yare wɔ asram 3 ntam no, nneɛma bi ne ntini a ɛyɛ mmerɛw a ɛsɛe, medullary ntrɛwmu, beae a ɛpaapae, ne nnompe mu yare. Esiane sɛ DTN ahorow no wɔ akɛse abiɛsa pɛ na distal fixation yɛ nkɔnsɔnkɔnsɔn abiɛsa pɛ nti, ebetumi ama annyina a ɛdɔɔso wɔ nsuten a ɛtrɛw anaa nnompe mu dompe mu. Ɛsɛ sɛ wɔde ahwɛyiye di dwuma wɔ nsɛm a ɛtete saa mu ntɛm ara sɛ ɛbɛsoa nneɛma a emu yɛ duru ntɛm.
Ɛkorɔn sen mprɛte a wɔde to mu ne nnadewa a wɔde twam .
Nneɛma a wɔkamfo kyerɛ sɛ wɔmfa nsiesie: 2 Proximal + 3 distal screws .
Mfaso a ɛwɔ DTN so .
Sɛ wɔde toto mprɛte a wɔde to mu ho a, nnadewa a ɛwɔ ntini no mu no mma ntini a ɛyɛ mmerɛw no nsɛe pii, na nea ɛfata titiriw ma ayarefo a wɔn mfe akɔ anim ne wɔn a wɔapirapira wɔn ntini a ɛyɛ mmerɛw a emu yɛ den a efi apirakuru a ahoɔden kɛse wom mu ba no. Wɔ saa nhwehwɛmu yi mu no, wɔde DTN ahorow no hyɛɛ mu denam ntwitwiridii nketenkete asia pɛ so, a na ntini a ɛyɛ mmerɛw ho haw biara nni mu. Adeyɛ no nhwehwɛ sɛ wɔde nkotodwe bɔ, na ɛtew asiane a ɛwɔ hɔ sɛ wɔbɛtew so no so na ɛma ɛfata ma ayarefo a wɔn kotodwe no ntumi nkɔ (sɛ nhwɛso no, nkotodwe ntini anaa TKA akyi).
Ayarefo a wɔapirapira a wɔn mfe akɔ anim ne wɔn a wɔn mfe akɔ anim a wɔapirapira kɛse, a ɛyɛ nea eye ma ayarefo a wɔn mfe akɔ anim .
Nkotodwe a wɔbɔ no ho hia, a ɛfata ma kotodwe a ɛkɔ fam kakraa bi .
Oprehyɛn ho asiane ne ahwɛyiye ahorow .
Asiane ahorow no bi ne akyi tibialis ntini ne mfinimfini malleolar fracture a wopira. Wobetumi de nhyɛso band wiring, plating, anaa abɔnten so afiri ayɛ medial malleolar fractures.
Ɛsɛ sɛ wɔhwɛ yiye na wɔakwati screw a ɛkɔ fibular notch no mu. Mfiri a ɛwɔ gyinabea no betumi ama DTN no akyi a ɛkyinkyini esiane ne mu duru nti; Siesie skru a ɛto so abien no ma ɛkyerɛ fibula no (Mfonini 4C).Nsɛnnennen a ebetumi aba:
Akyi tibialis opira, medial malleolar fracture .
Ntotoeɛ:
Tension band, plating, anaa akyi fixator .
Screw kwankyerɛ ne gyinabea afiri mu duru hwehwɛ sɛ wɔde adwene si so wɔ oprehyɛn no mu .
Ayaresa mu ntotoho .
Antegrade nnadewa no a ɛnyɛ nkabom ne nea ɛnyɛ biako no yɛ 0–25% ne 8.3–50%, sɛnea ɛte biara; Wɔ mprɛte a wɔde to mu ho no, 0–17% ne 0–17%. Wɔ saa nhwehwɛmu yi mu no, nsɛm no nyinaa nyaa Union, na 20% pɛ na na ɛwɔ dɛmdi >5°, a wɔde toto atetesɛm akwan ho.Nyarewa dodow a ɛwɔ mu: Nyarewa a ɛwɔ soro no yɛ 0–8.3% ma nnadewa a ɛyɛ antegrade ne 0–23% ma mprɛte a wɔde to mu; Nyarewa a emu dɔ yɛ 0–23% ne 0–8.3%, sɛnea ɛte biara. Saa nhwehwɛmu yi bɔɔ amanneɛ sɛ ntini a ɛyɛ mmerɛw no mu nsɛnnennen biara nni hɔ, na ɛboroo nea wɔde si ananmu abien no nyinaa so.Functional scores:
Aofas nkontaahyɛde ma antegrade nnadewa: 86–88 (Type A), 73 (Type C); Mprɛte a wɔde to mu: 84–88 (Type A) .
Saa adesua yi: AOfas nkyɛmu: 92.6.
EQ-5D-5L: mprɛte a wɔde to mu: 0.62–0.76; Saa adesua yi: 0.876 .
safe-Q (ayarefo a wɔn nan ne wɔn nan ase ntini): 67–75; Saa adesua yi: 83–91.7 (Table 3) .
Kabom dodow, dɛmdi dodow, ne ɔyare mmoawa dodow yɛ adwuma sen atetesɛm akwan .
Dwumadi mu nkontaahyɛde (AOfas, EQ-5D-5L, Safe-Q) kyerɛ sɛ nea efi mu ba no yɛ papa .
Sɛ yɛbɛbɔ no mua a, DTN de mfaso horow ma sen mprɛte a wɔde to mu ne nnadewa a wɔde hyɛ ntini no mu no na egyina hɔ ma ano aduru a etu mpɔn a wɔde sa tibial a ɛpaapae wɔ akyirikyiri no.
DTN no wɔ invasiveness a ɛba fam koraa, ɛkɔ soro, na ɛsan ba ntɛmntɛm .
Ɛyɛ ɔkwan a ɛsom bo a wɔfa so si atetesɛm mu ayaresa ananmu na ɛfata sɛ wɔhyɛ ho nkuran .
