Nhwɛsoɔ: 0 Ɔkyerɛwfoɔ: Site Editor Bere a wɔde tintimii: 2025-07-07 Mfiase: Beaeɛ
Tibial shaft yɛ mmeae a ɛtaa pae no mu biako, na ɛyɛ 13.7% wɔ nipadua no mu abubu nyinaa mu. Distal tibia no wɔ nipadua mu su ahorow te sɛ mogya a wɔde ma a ɛnyɛ papa ne ntini a ɛyɛ mmerɛw a ɛkata so kakraa bi. Sɛ akisikuru bi ba pɛ a, ntini a ɛyɛ mmerɛw a ɛsɛe ne mogya a ɛwɔ mpɔtam hɔ a ɛnyɛ den no betumi ama akisikuru no ayaresa a ɛyɛ den no ayɛ kɛse. Bio nso, sɛnea ɛbɛyɛ yiye sɛ nhama no bɛpaapae bere koro mu na entumi nnyina pintinn no ma oprehyɛn kwan a ɛfata a wɔbɛpaw no ho hia.
Tibial shaft a ɛwɔ mfinimfini kosi soro no ntwemu yɛ ahinanan, bere a nea ɛto so abiɛsa a ɛwɔ fam no yɛ ahinanan. Mfinimfini ne ase nkyem abiɛsa mu biako no yɛ teateaa koraa na egyina hɔ ma nsakrae a ɛba wɔ ne nsusuwii mu, na ɛma ɛyɛ beae a wɔtaa ma mpaapaemu.
Honam ani nkutoo na ɛkata tibia no anim nkyem abiɛsa mu biako so a ntini nkata so, na ɛma ɛyɛ mmerɛw sɛ ɛpaapae wɔ baabi a nnompe asinasin no tow honam ani no. Wɔ akisikuru a wɔato mu mpo mu no, honam ani ntini ne honam ani ntini a ɛsɛe ka tibial a ɛpaapae dodow no ara ho. Mfinimfini tibia no nni ntini a ɛkata so, na fascial compartments anan na atwa tibia ne fibula ho ahyia. Sɛ wɔde compartment syndrome toto tibial fractures ho a, compartment syndrome no dɔɔso.
AO/OTA Arabic akontabuo nkyekyɛmu no kyerɛ tibial shaft a abubu sɛ 4 (tibia) 2 (shaft). Type A ne mpaapaemu a ɛnyɛ den a ɛwɔ mpaapaemu nhama biako, a ɛno ne ɔkwan a ɛtaa ba no hyia. Type B a ɛpaapae no wɔ asinasin bi a ɛte sɛ wedge a ɛwɔ mfinimfini. Type C a ɛpaapae no fi ahodwiriw a ahoɔden kɛse wom na ɛyɛ comminuted segmental fractures.
Ɔkwan I: Kuru no tenten nnu sɛntimita 1, mpɛn pii no ɛyɛ kuru a wɔato mu a ɛho tew kakra a nnompe no ano pue fa honam ani. Ntini a ɛyɛ mmerɛw a ɛsɛe no sua koraa, na opira biara nni hɔ a ɛbɛbɔ. Mpaapaemu no yɛ mmerɛw, ɛyɛ ntwemu, anaasɛ ɛyɛ tiaa a ɛkɔ fam, na entumi nsɛe.
Ɔkwan II: Kuru no boro sɛntimita 1, na ntini a ɛyɛ mmerɛw sɛe kɛse nanso ɛnyɛ avulsion anaasɛ flap formation. Ntini a ɛyɛ mmerɛw da opira a ɛyɛ mmerɛw kosi nea ɛkɔ fam a ɛbubu, efĩ a ɛkɔ fam, ne abubuw no a ɛyɛ mmerɛw adi.
Type IIIA: Ɛmfa ho sɛ obi apira kɛse wɔ avulsion mu anaasɛ flap formation, anaasɛ ahoɔden kɛse a ɛyɛ hu a kuru no kɛse mfa ho no, ntini a ɛyɛ mmerɛw a ɛkata abubuw no so sɛnea ɛsɛ.
Type IIIB: Ntini a ɛyɛ mmerɛw a ɛsɛe kɛse na ɛyera, a periosteal no yiyi ne dompe a ɛda adi, a efĩ a emu yɛ den ka ho.
Type IIIC: Ɛne ntini mu opira a ɛhwehwɛ sɛ wosiesie no wɔ abusuabɔ.
Ayaresa a ɛnyɛ oprehyɛn a wɔde sa tibial a abubu no bi ne braces, plaster a wɔde si akyi, twetwe, nsa a wɔde tew so, ne akyi fixation frames a wɔde di dwuma. Oprehyɛn a wobetumi apaw no bi ne mprɛte a wɔatoto mu a wɔde hyɛ mu ne nnadewa a wɔde hyɛ medullary mu, ne afoforo.
Intramedullary nailing fixation yɛ nea nnompe ho oprehyɛn ho animdefo pii ani gye ho esiane oprehyɛn a ɛyɛ mmerɛw, ntwitwiridii nketenkete, apirakuru kakraa bi, ne nnadewa no a woyi fi hɔ a ɛyɛ mmerɛw bere a abubu no asa akyi nti. Ɛma nipadua no mu ntini a emu yɛ den si hɔ, na ɛma oprehyɛn akyi dwumadi mu apɔw-mu-teɛteɛ ntɛm na ɛkwati mpɔtam hɔ ne nhyehyɛe mu nsɛnnennen. Saa mfaso horow yi ne AO nnyinasosɛm ahorow a ɛfa ayaresa ho no hyia.
Anterior oblique cutting wɔ proximal end siw patellar ligament a ɛyɛ abufuw ano.
Advance proximal locking design ma proximal fragment no gyinabea a wɔpɛ no yɛ kɛse.
Distal oblique locking option a ɛbɛma soft tissue asɛe na ama distal fragment no agyina pintinn akɔ soro.
Locking screw a wɔayɛ no abien lead thread ma ɛyɛ mmerɛw sɛ wɔde bɛhyɛ mu.
Locking nhyehyɛe ma ahoɔden fixation, tew oprehyɛn akyi asinasin dislocation.
Multi points of fixation ma angular stability ne mmoa a ɛyɛ den ma tibial palteau.
Afiri no wɔ nsakraeɛ dwumadie a ɛtumi sesa, a ne nsɛsoɔ mu nsakraeɛ a wɔada no adi wɔ mfonini ahodoɔ no mu wɔ pre-compression (loose state) ne post-compression (tightly fitted) tebea nyinaa mu.
Multi fixation kwan a efi proximal ne distal, kyerɛ awiei koraa no proximal ne distal tibial fractures.
Nnadewa titiriw no awiei a ɛwɔ akyirikyiri no yɛ tratraa, na ɛma ɛyɛ mmerɛw sɛ wɔde bɛhyɛ medullary cavity no mu.
Nkuruwankuruwa abien a wɔde tow mu a ɛyɛ ahinanan wɔ proximal awiei no siw ɔfã a abubu no kwan sɛ ɛbɛdannan ne ho.
Anatomical curvature soronko bi hwɛ hu sɛ nnadewa titiriw no besi baabi a eye sen biara wɔ medullary cavity no mu.
Angle locking screws abiɛsa a ɛtwam wɔ akyirikyiri awiei no ma mmoa ne fixation a etu mpɔn.
Ɛfata ma tibial shaft a ɛpaapae dodow no ara (midshaft ne distal/proximal fractures bi), bere a wɔayɛ ahorow afoforo (sɛ nhwɛso no, DTN anaa Expert Nail) ama nipadua mu mmeae pɔtee bi anaasɛ abubu a ɛyɛ den.
Ɔkwan a wɔfa so yɛ ade (parapatellar anaa transpatellar) di ɔkwan a wɔde asi hɔ yiye a adesua kwan a ɛba fam wom akyi, bere a akwan titiriw (sɛ nhwɛso no, suprapatellar) hwehwɛ mfiridwuma ho ntetee foforo.
Sɛ wɔde toto nnadewa titiriw te sɛ Expert Nail anaa DTN ho a, mpɛn pii no, nnadewa a ɛwɔ tibial intramedullary a wɔde di dwuma daa no bo yɛ den, na ɛma ɛfata ma nsɛm a wɔtaa yɛ.
Ɛne amansan nnwinnade hyia (sɛ nhwɛso no, nkɔnsɔnkɔnsɔn a wɔde tow, mfiri a wɔde si wɔn ani so), bere a nnadewa titiriw (sɛ nhwɛso no, Expert Nail a ɛwɔ akwan horow pii a wɔde tow nneɛma) betumi ahwehwɛ nnwinnade a ɛyɛ wɔn de.
| Type | Nsɛnkyerɛnne a Ɛyɛ | Paara Mfaso Titiriw |
|---|---|---|
| Ɔbenfo Nail | Nnompe mu akisikuru a ɛyɛ den, nnompe mu yare | Multi-planar locking, a ɛkorɔn a ɛyɛ den |
| Nnadewa a Ɛwɔ Suprapatellar | Proximal fractures, ayarefo a wɔayɛ kɛse mmoroso | Suprapatellar kwan, ɛtew nkotodwe anim nsɛnnennen so |
| DTN na ɛyɛ | Distal fractures (a ɛbɛn ankle nkwaa) . | Multi-akwankyerɛ distal locking, ko tia tiawa |
| Nnadewa a Wɔde Di Dwuma | Mid-shaft a ɛyɛ mmerɛw a ɛpaapae | Adwumayɛ a ɛnyɛ den, ɛho ka sua |
Drilling Instruments : Nea ɛka ho ne drill bits, reamers, ne nnwinnade afoforo a wɔde di dwuma tẽẽ de tutu nnompe.
Targeting Devices : Nnwinnade a wɔde si baabi na ɛkyerɛ kwan wɔ baabi a wɔde drilling anaa implant besi, te sɛ akwankyerɛ nhama, akwankyerɛ nsateaa, ne mfiri a wɔde si wɔn ani so.
Fixation Instruments : Nnwinnade a wɔde ka nneɛma a wɔde hyɛ nipadua mu, te sɛ amansan nkwaa, safe, nkɔnsɔnkɔnsɔn, ne hama bom, to mu, anaa wɔsesa.
Nnwinnade a Wɔde Sua : Nnwinnade a wɔde susuw bun, baabi a ɛwɔ, anaa wɔboa wɔ oprehyɛn mu, te sɛ nea wɔde susuw bun mu, reduction forceps, ne bone awls (AWL).
Mfoniniyɛ Nhwehwɛmu: Preoperative X-ray/CT de si abubuw su, medullary canal diameter ne ne tenten so dua, a wɔsusuw contralateral tibia sɛ nhwɛso.
Positioning: Supine gyinabea a kotodwe flexion 90°-120° na hip adduction kakra (de tew patellar tendon tension). Ebia radiolucent frame a ɛyɛ ahinanan a ɛboa popliteal fossa no ma ɛtwetwe.
Sterile Draping: Standard limb sterilization ne draping, hwɛ hu sɛ C-basa no tumi nantew.
Manual Traction: Assistant de longitudinal traction di dwuma bere a oprehyɛn ho ɔbenfo de ne nsa ka tibial crest ne anteromedial surface de sesa sɛnea ɛne ne ho hyia (tenten, rotation, angulation).
Nnwinnade a Wɔde Boa:
Joystick Technique: Schanz screws a wɔde hyɛ proximal/distal asinasin mu ma lever no so tew.
Percutaneous Clamping: Ntwitwiridii a wɔde tew so a ɛyɛ nsɛntitiriw ma oblique/spiral fractures.
Distractor: Distractor kɛseɛ a wɔde si coronally (proximal Schanz screw parallel to tibial plateau, distal pin wɔ talus anaa distal tibia) na ama ne tenten akɔ so ayɛ.
Nneɛma a Ɛho Hia:
Beae a wɔhyɛn mu 1cm distal to anterior tibial plateau edge, a ɛne medullary axis hyia.
Fluoroscopic confirmation: AP hwɛ ne tibial crest hyia, akyi hwɛ ne tibial axis di nsɛ.
Nnwinnade a Wɔde Bue Mu:
Cannulated drill wɔ guidewire (a ahobammɔ nsateaa) anaasɛ curved solid awl.
Nsa reamers (6-8mm) ma abubu dedaw a canal occlusion.
Guidewire Placement: Ball-tipped guidewire bent 10-15mm wɔ tip ma fracture kwan. Fluoroscopic confirmation wɔ distal physeal scar (ankle mfinimfini).
Reaming Protocol:
Reamers a ɛyɛ mmerɛw a efi ase wɔ 8mm, ɛkɔ soro 0.5mm kosi sɛ cortical 'chatter' (mpɛn pii no 1-1.5mm > nnadewa ntwemu).
Hyɛ no nsow: Sɛ wɔtwe nneɛma fi mu bere ne bere mu a, eyi nneɛma a asɛe no fi hɔ; kwati sɛ ɔhyew a ɛma obi awu.
Bere Tenten a Wɔkyerɛ:
Nsusuwii a wɔyɛ wɔ oprehyɛn mu: Ɔkwan a wɔfa so de akwankyerɛ hama kata so anaasɛ fluoroscopic ruler (beae a wɔde hyɛn ankle joint mu).
Hwɛ hu sɛ nnadewa no ano du nipadua mu akuru a enni proximal protrusion.
Ɔkwan a Wɔfa so De Nneɛma Gu Mu:
Nsa-kɔ anim wɔ akwankyerɛ hama so; sesa reduction sɛ resistance ba a.
Kɔ so tew so bere a worefa mu ama distal fractures.
Ntoatoaso Akwankyerɛ
Mpaapaemu a ne tenten gyina hɔ pintinn: Proximal locking first (skru biako ma kwan ma dynamization).
Length-unstable/comminuted fractures: Distal locking di kan di akyi 'backslap' de mia.
Proximal Locking a Ɛbɛn
≥2 nkɔnsɔnkɔnsɔn via aiming device (multidirectional ma proximal abubu).
Distal Locking a Wɔde Toto Nneɛma Mu
Fluoroscopic kwan: Central beam perpendicular to screw ntokuru ('perfect circle'), percutaneous drilling.
≥2 screws ma distal fractures (ebia ɛka AP / oblique orientations bom).
End Cap: Optional insertion (siw nnompe ingrowth), hwɛ hu sɛ nkwaa biara mfi adi.
Kuru a Wɔto mu: Wɔde nhama a wɔde kyekyere honam ani ntini a ɛyɛ mmerɛw siesie patellar tendon a ɛyɛ ntoatoaso.
Nsiesiei a Wɔyɛ no Mfiase:
Akwaa akwaa a ɛkɔ soro; hwɛ sɛ compartment syndrome wɔ 24hrs mu.
Fi ase yɛ nkwaa a ɛyɛ nnam (ankle pumps, knee flexion) wɔ POD 1-2 so.
Nneɛma a Wɔde Soa Mu duru Ho Nhyehyɛe:
Afã bi a wɔde soa mu duru adapɛn 6 (wɔayɛ nsakrae wɔ sɛnea ɛgyina pintinn biara mu), ɛkɔ so yɛ ma bere a callus pue no.
Akyi: Ayaresa/radiological nhwehwɛmu wɔ adapɛn 2, 6, ne 12 mu.
Asafo ti: Raynham, Massachusetts, U.S.A
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
Expert Tibial Nail (ETN) – Wɔayɛ no sɛnea ɛbɛyɛ a ɛbɛgyina pintinn wɔ tibial a ɛyɛ den mu.
T2 Tibial Nail – Ɛma fixation ne compression a ɛkɔ anim.
Ahoɔden Titiriw: Nhwehwɛmu ne nkɔso a emu yɛ den, wiase nyinaa nkyekyɛmu, ne nkabom a ɛne adwenemhaw ano aduru.
Asafo ti: Kalamazoo, Michigan, U.S.A
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
T2 Tibial Nail – Modular nhyehyɛe a wɔde yɛ tibial shaft a ɛpaapae.
Gamma3 Tibial Nail – Ɛka intramedullary nnadewa ne locking options bom.
Ahoɔden Titiriw: Robɔt a ɛkɔ akyiri (Mako), ano aduru a ɛnyɛ den pii, ne adwenemhaw ho sikakorabea a emu yɛ den.
Asafo ti: London, UK
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
TRIGEN Tibial Nail – Wɔayɛ no sɛnea ɛbɛyɛ a ɛnyɛ den sɛ wɔde bɛhyɛ mu na ayɛ den.
IM Tibial Nail – Intramedullary fixation a ɛma tibial a abubu.
Ahoɔden Titiriw: Fa w’adwene si agumadi mu nnuruyɛ ne adwenemhaw, nneɛma foforo so.
Asafo ti: Changzhou, China
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
Distal Tibial Intramedullary Nail (DTN) – Wɔayɛ no yiye ama akyirikyiri akisikuru.
Onimdefo Tibia Intramedullary Nail – Titanium aduru a ahoɔden kɛse yɛ.
Suprapatellar Approach Tibial Intramedullary Nail – Nneɛma a wɔde hyɛ mu a ɛnyɛ den pii.
Tibial Intramedullary Nail – Nneɛma a wɔde si hɔ a wobetumi de ayɛ nneɛma pii.
Ahoɔden Titiriw: ano aduru a ɛho ka sua, wiase nyinaa a wɔbɛtrɛw mu.
Asafo ti: Warsaw, Indiana, U.S.A
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
ZNN Tibial Nail – Anatomic nhyehyɛe a ɛma ɛfata yiye.
Natural Nail System – Ɛsuasua abɔdeɛ mu nnompe mfiridwuma.
Ahoɔden Titiriw: Ɔyɛ den wɔ nkwaa a wɔsan yɛ, biologics a wɔde ka bom, ne ano aduru a wɔde ma obiara mu.
Asafo ti: Lewisville, Texas, U.S.A
Nneɛma a Wɔde Yɛ Nneɛma a Ɛyɛ Fɛ:
LON Tibial Nail (Lateral Orthopedic Nail) – Wɔayɛ ama ɔkwan a wɔfa so hyɛn akyi.
Ahoɔden Titiriw: Wɔayɛ no titiriw wɔ nnompe nyin nkanyan, akwaa a ɛyɛ dɛmdi nteɛso mu.
CZMEDITECH de tibial nailing ano aduru a ɛkɔ akyiri ma proximal, distal, ne complex fractures, a ɛwɔ nhyehyɛe foforo (sɛ nhwɛso no, multi-directional locking, suprapatellar approach) a wɔde toto wiase nyinaa brands a edi kan wɔ biomechanics ne ayaresabea mu aba ho.
Nneɛma a wɔyɛ