Distal Tibial Nail: Nkɔso a Ɛbae wɔ Distal Tibial Fractures a Wɔsa Mu

Distal tibial fractures abu so, na atetesɛm mu ayaresa ahorow no nni anohyeto ahorow

Distal tibial fractures yɛ akwaa a ɛwɔ fam a ɛtaa mu paapae. Ayaresa a wɔde di dwuma wɔ amanne kwan so te sɛ mprɛte a wɔde to mu ne nnadewa a wɔde hyɛ ntini a ɛwɔ akyi no mu biara wɔ nea enye. Mprɛte a wɔto mu no betumi ama obi anya oprehyɛn akyi ɔyare mmoawa anaasɛ ntini a ɛyɛ mmerɛw no awuwu, na ama ne ho atɔ no akyɛ; ɛwom sɛ nnadewa a ɛwɔ anim no ntumi nkɔ nipadua no mu kɛse de, nanso ebetumi asɛe kotodwe nkwaa no, ama ayɛ yaw, na ɛde asiane ahorow a ɛne sɛ wɔrentumi nsiw no yiye anaasɛ ɛnkɔ pɛpɛɛpɛ, na asiw ne ho atɔ no kwan.

Ano aduru foforo: Distal Tibial Nail (DTN) .

Ayaresa foforo bi—Distal Tibial Nail (DTN)—ma wonya adwene foforo a wɔde bedi distal tibial a ɛpaapae ho dwuma denam ne nhyehyɛe soronko a wɔde kɔ akyi no so.

Ɔyarefo gyinabea ne ahosiesie a wɔtew so

Wɔde ɔyarefo no si baabi a ɔda fam. Ɛsɛ sɛ wɔde nsa tew akisikuru a wɔatu afi baabi foforo no so; sɛ ɛho hia a, fa reduction forceps di dwuma de boa ansa na wode DTN no ahyɛ mu. Sɛ fibular fracture a ɛka ho wɔ hɔ a, fibular a ɛne ne ho hyia yiye no betumi aboa ma tibial no so atew. Ebia wɔde nnadewa a ɛwɔ medullary mu bɛma fibular shaft a abubu no agyina. Wɔ akisikuru a atwa anansoaa ho ahyia ho no, ɛsɛ sɛ nipadua no mu a wɔtew so ne fibula no a wɔde si hɔ no di tibial a wɔtew no anim na wɔakwati sɛ ɛnkɔ pɛpɛɛpɛ. Wɔ mpaapaemu a abue a abɔnten so ade a wɔde hyɛ mu dedaw mu no, wobetumi de nnadewa no ahyɛ mu bere a wɔhwɛ fixator no so na ama wɔatew so.

Wɔtwa 2–3 cm tenten wɔ medial malleolus no ano de da deltoid ligament a ɛwɔ soro no adi. Wɔde akwankyerɛ pin bi hyɛ malleolus no ano anaa mfinimfini kakra (Mfonini 2a), 4–5 mm fi articular no ani. Sɛ wohwɛ akyi a, ɛkyerɛ sɛ wɔde wɔn ho hyɛ mu denam intercondylar groove no so (Mfonini 2b), na wɔkwati sɛ wɔbɛsɛe akyi tibialis ntini no. Tetew deltoid ligament a ɛwɔ soro no mu, afei fa reamer yɛ medullary canal no kɛse kosi metaphyseal mpɔtam hɔ (Mfonini 2c). Yi cancellous bone a ɛbɛn proximal medial cortex no na fa nnadewa no hyɛ mu (Mfonini 2d). Fa nnadewa a wɔde sɔ hwɛ hyɛ mu de si DTN kɛse so dua (Mfonini 2e). Kwati sɛ wobɛbɔ hama anaasɛ wobɛkyinkyim no dodo na amma iatrogenic medial malleolar fracture no ansɛe. Siesie nnadewa no mu dɔ na ama woahwɛ ahu sɛ nkɔnsɔnkɔnsɔn a ɛwɔ akyirikyiri no renkɔ ankle nkwaa anaa baabi a abubu no mu. Wɔde nkɔnsɔnkɔnsɔn a ɛka bom wɔ proximally ne distally na ɛyɛ fixation.

Wɔma kwan ma ankle nkwaa no nkɔ baabiara ntɛm ara na ɛne nan ne fam di nkitaho wɔ oprehyɛn akyi
Non-weight soaring for 4–6 weeks
Nkɔso kɔ soa mu duru a edi mũ wɔ adapɛn 8–12 ntam, bere a wɔhwɛ callus a ɛba ne ɛyaw so no

Ankle nkwaa dwumadi fi ase ntɛm ara wɔ oprehyɛn akyi

Kwati sɛ wobɛsoa mu duru adapɛn 4–6

Nsakrae nkakrankakra kɔ mu duru a wɔsoa koraa mu wɔ adapɛn 8–12 mu

Ayarefo 10 a wodii wɔn akyi

Nhwehwɛmu bi dii ayarefo 10 akyi (Table 1). Eduu asram 3 wɔ oprehyɛn akyi no, na nsɛm 7 asa; ayarefo no nyinaa nyaa ayaresa wɔ asram 6 ntam. Asɛm biako a emu biara yɛ varus ne recurvatum deformities sii. Wɔanhu sɛnea ɛtew so, ɔyare mmoawa, nsɛnnennen a ɛfa nipadua no a wɔde hyɛ nipadua mu ho, anaasɛ iatrogenic opira biara a wɔhwere (Table 2).

Ɔyarefo barima a wadi mfe 69

Nsɛnkyerɛnne a ɛkyerɛ sɛ DTN

Nea ɛka nhwehwɛmu yi ho ne AO ​​43-A ne C1 a ɛpaapae; Wosusuw C2 nso ho. DTN ahorow wɔ hɔ a ne tenten yɛ mm 7 ne mm 8, na ɛno na ɛkyerɛ baabi a wɔde nkɔnsɔnkɔnsɔn a ɛka bom a ɛbɛn no besisi. Mpaapaemu a ɛwɔ 2–9 cm wɔ articular surface no so no yɛ nea eye ma DTN fixation. Wobetumi atrɛw nsɛnkyerɛnne no mu akɔ AO 42 a ɛpaapae mu.

Biomechanical Stability a Ɛyɛ Fɛ

Retrograde nnadewa wɔ axial ne rotational stiffness a ɛkorɔn sen biara sɛ wɔde toto medial locking plates ne antegrade nnadewa ho a. Greenfield ne afoforo. yɛɛ biomechanical sɔhwɛ a ɛkyerɛ sɛ wɔde distal screws abien a ɛwɔ DTN no mu dii dwuma no nyaa 60–70% wɔ compressive stiffness ne 90% torsional stiffness sɛ wɔde toto screws abiɛsa ho a. DTN maa mpaapaemu asinasin a ɛkɔ baabiara wɔ adesoa ase no yɛɛ ketewaa. Wɔ nsɛm 3 a ansa wɔ asram 3 mu no, nneɛma bi ne ntini a ɛyɛ mmerɛw a asɛe, ntini a ɛtrɛw, beae a abubu, ne nnompe mu yare. Esiane sɛ DTN ahorow no kɛse yɛ abiɛsa pɛ na distal fixation no yɛ nkɔnsɔnkɔnsɔn abiɛsa nkutoo nti, ebia ɛmma entumi nnyina sɛnea ɛsɛ wɔ nsuten a ɛtrɛw anaa nnompe a ayɛ mmerɛw mu. Ɛsɛ sɛ wɔde ahwɛyiye kɔ mu duru a wɔsoa ntɛm no nkyɛn wɔ nsɛm a ɛtete saa mu.

Mfaso a ɛwɔ DTN so

Sɛ wɔde toto mprɛte a wɔto mu ho a, nnadewa a ɛwɔ ntini mu no nsɛe ntini a ɛyɛ mmerɛw kɛse, na ɛfata titiriw ma ayarefo a wɔn mfe akɔ anim ne wɔn a ntini a ɛyɛ mmerɛw apirapira kɛse esiane ahodwiriw a ahoɔden kɛse wom nti. Wɔ nhwehwɛmu yi mu no, wɔde DTN ahorow faa ntwitwiridii nketenkete asia pɛ mu, a na ntini a ɛyɛ mmerɛw no mu nsɛnnennen biara amma. Adeyɛ no nhwehwɛ sɛ wɔbɔ kotodwe, na ɛtew asiane a ɛwɔ hɔ sɛ wɔbɛtew so no so na ama ɛfata ayarefo a wɔn kotodwe ntumi nkɔ baabiara (sɛ nhwɛso no, kotodwe mu ntini mu yare anaa TKA akyi).

Asiane a Ɛwɔ Oprehyɛn Mu ne Ahwɛyiye a Wɔyɛ

Asiane ahorow no bi ne opira a ɛba akyi tibialis ntini ne medial malleolar fracture. Wobetumi de tension band wiring, plating, anaa abɔnten fixation ayɛ medial malleolar fractures ho dwuma.
Ɛsɛ sɛ wɔhwɛ yiye na skru ankɔ fibular notch no mu. Afiri a wɔde kyerɛ baabi a ɛwɔ no betumi ama DTN no akɔ akyi esiane ne mu duru nti; siesie skru a ɛtɔ so mmienu no ma ɛnkyerɛ fibula no (Mfonini 4c).

Ayaresa mu Ntotoho

Nnadewa a ɛnyɛ nkabom ne nea ɛnyɛ pɛpɛɛpɛ a ɛwɔ antegrade nnadewa mu 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 nkabom, na 20% pɛ na na wɔwɔ dɛmdi >5°, a wɔde toto atetesɛm akwan ho.Ɔyare mmoawa dodow: ɔyare mmoawa a ɛwɔ soro no yɛ 0–8.3% ma nnadewa a ɛwɔ anim ne 0–23% ma mprɛte a wɔde to mu; ɔyare mmoawa 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 akwan abien no nyinaa so.Functional scores:

Sɛ yɛbɛbɔ no mua a, DTN de mfaso horow ma sen mprɛte a wɔde to mu ne nnadewa a ɛwɔ akyi a ɛwɔ akyi no na egyina hɔ ma ano aduru a etu mpɔn a wɔde sa distal tibial fractures.

DTN kyerɛ sɛ ɛnyɛ nea ɛkɔ nipadua no mu kakraa bi, ɛgyina pintinn kɛse, na ɛsan nya ahoɔden ntɛmntɛm

Ɛyɛ aduru a ɛsom bo a wɔde si aduruyɛ a wɔde di dwuma wɔ amanne kwan so ananmu na ɛfata sɛ wɔhyɛ ho nkuran