Tibial a ɛpaapae, suprapatellar intramedullary nnadewa kwan

Intramedullary tibial nailing: kwan a wɔfa so kɔ hɔ ne nea ɛne ne ho hyia, kotodwe anim yaw

Oprehyɛn kwan a wɔfa so de nnadewa bɔ tibial fractures no mu no ho hia na ama wɔde nnadewa a ɛwɔ medullary no mu afa baabi a ɛfata a wɔde hyɛn mu, sɛnea ɛbɛyɛ a wɔbɛsɛe kotodwe no nhyehyɛe ahorow a ɛwɔ ntini no mu no kakraa bi, na wɔanya akisikuru no a wɔbɛsan de asi baabi a eye na nnadewa no akɔ mu yiye.

Akwan a wɔtaa fa so yɛ tibial stem fractures ne infrapatellar median anaa infrapatellar parapatellar kwan. Ɛwom sɛ wɔakyerɛ akwan yi ama mfinimfini fã a ɛpaapae de, nanso oprehyɛn akyi valgus, anim, anaa dɛmdi a wɔaka abom taa ba wɔ akisikuru a ɛbɛn kɛse no mu.

Ade titiriw a ɛde malalignment ba wɔ proximal tibial fractures mu ne dɛmdi a ɛba esiane quadriceps tendon a wɔtwe bere a wɔrebɔ kotodwe no ne mfiri a ɛko tia nnadewa no ano ne akyi tibial cortex ntam bere a wɔde implant rehyɛ mu no. Patella no nso siw axial nnadewa a ɛkɔ sagittal plane no mu ano (Mfonini 1a, b). Enti, ɔkwan foforo a wɔtaa fa so kɔ beae no ne sɛ wɔfa mfinimfini parapatellar incision, a ɛma wɔde nnadewa a wɔde hyɛ mfinimfini kosi akyi kakra (Mfonini 1c ne 2). Bere a nnadewa no hyɛn intramedullary canal a ɛwɔ akyirikyiri wɔ baabi a abubu no, ɔfã a ɛbɛn no dan kɔ valgus (Mfonini 2). Awiei koraa no, ahomegye mu nhyɛso a ɛwɔ anim fã ntini no mu no boa kakra ma valgus no ba (Mfonini 3).

Mfonini 1 a,b Sɛ yɛde infrapatellar kwan a wɔtaa fa so di dwuma a, patella no siw nnadewa no axial kwan a ɛkɔ mu no ano, na ɛde anterior apical sagittal alignment ne valgus coronal alignment a ɛtaa yɛ dɛmdi ba. c Parapatellar kwan a wɔfa so de di dwuma de yɛ intramedullary nnadewa a ɛne ne ho hyia.

Mfonini 2 Sɛ wofa mfinimfini parapatellar incision so bɛn baabi a wobɛhyɛn no a, ɛma nnadewa a wɔde hyɛ mfinimfini kosi akyi kakra. Bere a nnadewa no hyɛn medullary canal a ɛwɔ akyirikyiri wɔ baabi a abubu (a) no, ɔfã a ɛbɛn no dan kɔ valgus (b) .

Mfonini 3 Ahomegye mu nhyɛso a ɛwɔ anim ntini no mu ( a ) ma ɛyɛ anifere kwan so nhyehyɛe a ɛwɔ awotwaa no akyi ( b ) .

Sɛ wɔde tibia no hyɛ baabi a ɛtrɛw kɛse a, ɛboa ma wɔkwati nsɛnnennen a ɛbata kotodwe a ɛbɔ denneennen wɔ oprehyɛn no mu ho. ɔkwan a wɔfa so yɛ no, Gelbke, Jakma ne afoforo na wɔkyerɛkyerɛɛ mu. wɔ afe 2010 mu na agye din kɛse wɔ nnansa yi mfe mu efisɛ sɛ wɔde tibia no pin wɔ baabi a ɛkame ayɛ sɛ ɛyɛ tẽẽ a, ɛma ɛyɛ mmerɛw sɛ wɔbɛdannan abubuw no na wɔasan de asi baabi foforo. Fluoroscopy abɛyɛ nea ɛyɛ mmerɛw wɔ mfiridwuma mu. Wɔabɔ amanneɛ sɛ bere a wɔde fluoroscopy yɛ ma suprapatellar nnadewa no yɛ tiaa koraa sen infrapatellar nnadewa. Afei nso, nnadewa a wɔde hyɛ mu no anim (wɔ sagittal plane no mu) ne tibia no tenten a ɛwɔ ɔkwan yi so no hyia kɛse sen nnadewa a ɛwɔ ase no mu; eyi siw mfiridwuma mu ntawntawdi a ɛda nnadewa no ano ne akyi ntini no ntam ano, na ɛnam so ma ɛyɛ mmerɛw sɛ wɔbɛtew akisikuru no so.

Oprehyɛn akyi kotodwe anim yaw yɛ ɔhaw a ɛne no wɔ abusuabɔ. Wɔabɔ amanneɛ sɛ kotodwe anim yaw wɔ ayarefo a wɔabubu no mu 50-70% mu, na ayarefo 30% pɛ na ɛyaw ano brɛ ase bere a wɔayi afifide a ɛwɔ mu no afi hɔ akyi. Wobu akontaa sɛ akuru a ɛba a ɛbata patellar tendon ne Hoffa srade a wɔde hyɛ mu no ho no yɛ ade a ebetumi ama nkotodwe mu yaw wɔ oprehyɛn akyi. Bio nso, suprapatellar kwan no kwati atetesɛm mu twitwa saphenous nerve no patellar nkorabata no nkorabata no, na ɛnam so kwati anim kotodwe a ɛyɛ mmerɛw ne nkate mu mmerɛwyɛ (Mfonini 4). Ɛte sɛ nea nnadewa no a wɔde fa quadriceps ntini no mu, na ɛnam so ma patellar ntini no yɛ nea enni dɛm no ma kotodwe mu yaw a ɛba wɔ oprehyɛn akyi no so tew kɛse.

Esiane nneɛma pa a efi proximal fractures mu ba nti, wɔatrɛw nsɛnkyerɛnne a ɛwɔ ayaresabea adwumayɛ mu no mu akɔ abubuw nyinaa mu.

Bere bɛn na ɛsɛ sɛ wɔde suprapatellar intramedullary nail di dwuma?

Mfaso a ɛwɔ so

• Kotodwe gyinabea a ɛtrɛw fã bi boa ma wɔyɛ nsakrae wɔ akisikuru no mu na wɔsan de si baabi foforo denam ntini ahoɔden ne nea ɛkora so a ɛma ɛyɛ mmerɛw bere a wɔde nnadewa rehyɛ mu no so

• Asiane a ɛwɔ oprehyɛn akyi a ɛbɛpaapae wɔ proximal, segmental ne distal fractures mu no sua bere a wɔde toto akwan a wɔtaa fa so no ho no

• Wɔ mfiridwuma mu no, ɛnyɛ den sɛ wɔbɛyɛ nnadewa oprehyɛn

• Nnadewa a wɔde bɛhyɛ mu no yɛ nea wobetumi ayɛ sɛ 'oduruyɛfo biako a wɔyɛ oprehyɛn'.

• Fluoroscopy bere a wɔde yɛ adwuma no so tew

• Patellar tendon no nsɛee na kotodwe anim yaw a ɛba wɔ stapling akyi no so tew

• Ɛnyɛ den sɛ wɔbɛyɛ wɔ akuw pii adeyɛ mu, te sɛ nea ɛte wɔ ahodwiriw pii mu no

  
  

Nsɛnkyerɛnne a ɛkyerɛ

• Extra-articular a ɛpaapae wɔ proximal tibia (AO 41A type) .

• Tibial diaphysis (AO 42A-C type) a ɛpaapae a ɛyɛ mmerɛw .

• Segmental tibial diaphyseal a ɛpaapae (AO 42C su) .

• Distal tibial extra-articular a ɛpaapae ne intra-articular distal extension fractures a ɛnyɛ den (AO 43A ne C1 ahorow) .

• Kotodwe a ɛsensɛn nsu so

• Patellar nnompe a ɛyɛ mmerɛw ne patellar ntini a ɛyɛ nnompe

• Kuru a efĩ wom wɔ patellar tendon no gyinabea

Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!

Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.

Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.

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