Tibial fracture, suprapatellar intramedullary nailing kwan .

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

Oprehyɛn kwan a wɔfa so yɛ tibial fractures intramedullary no ho hia na ama wɔatumi de nnadewa a ɛwɔ intramedullary no mu no afa baabi a ɛfata a ɛkɔ mu no mu, na ama asɛe a ɛwɔ nkotodwe no mu a ɛwɔ ntini no mu no so atew, na wɔanya abubuw a wɔde si hɔ a eye sen biara ne nnadewa a wɔde hyɛ mu yiye.

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

Ade titiriw a ɛde malalignment ba proximal tibial fractures mu ne deformity a efi quadriceps tendon a wɔtwe bere a wɔrebɔ nkotodwe ne mfiri ntawntawdi a ɛda nnadewa no ano ne akyi tibial cortex ntam bere a wɔde rehyɛ mu no. Patella no nso siw axial nail entry wɔ sagittal plane no mu (Mfonini 1A, B). Enti, ɔkwan foforo a wɔtaa fa so nya asɛm no ne sɛ wɔde parapatellar incision, a ɛde medial kakra kɔ lateral nail a wɔde hyɛ mu no ba (Mfonini 1c ne 2). Bere a nnadewa no hyɛn intramedullary canal no mu kɔ akyirikyiri kosi abubu no mu no, ɔfã a ɛbɛn no no dannan kɔ valgus mu (Mfonini 2). Awiei koraa no, nhyɛso a ɛwɔ anim dan no mu ntini no mu no boa kakra ma valgus no (Mfonini 3).

Mfonini 1 A,B Sɛ wɔde infrapatellar kwan a wɔtaa fa so no di dwuma a, patella no siw axial entry a ɛwɔ nnadewa no mu no ano, na ɛde anterior apical sagittal alignment ne valgus coronal alignment a ɛtaa ba no ba. c a wɔde parapatellar kwan a wɔfa so yɛ intramedullary nail alignment no di dwuma.

Mfonini 2 Ɛrebɛn kwan a wɔfa so kɔ mu no denam medial parapatellar incision so no ma wɔde side a wɔde hyɛ akyi kakra kɔ akyi. Bere a nnadewa no hyɛn medullary canal no mu kɔ akyirikyiri kosi akisikuru no mu (a) no, ɔfã a ɛbɛn no no dannan kɔ valgus (b) mu .

Mfonini 3 Nhyɛso a ɛma obi home wɔ ntini a ɛwɔ anim no mu ( a ) no ma ectopic nhyehyɛe a ɛyɛ anifere ( B ) .

Tibia a wɔde pintiw no wɔ baabi a ɛtrɛw kɛse no boa ma wɔkwati nsɛnnennen a ɛbata kotodwe a wɔde yɛ oprehyɛn no mu a emu yɛ den ho. Gelbke, Jakma ne ne mfɛfo na wɔkaa ɔkwan a wɔfa so yɛ no ho asɛm. Wɔ afe 2010 mu na abɛyɛ nea nkurɔfo ani gye ho kɛse wɔ nnansa yi mfe mu efisɛ ɛkame ayɛ sɛ tibia no a wɔde bɛhyɛ nipadua no akwaa mu a ɛyɛ tẽẽ no ma fracture manipulation ne repositioning yɛ mmerɛw. Fluoroscopy abɛyɛ nea ɛyɛ mmerɛw wɔ mfiridwuma mu. Wɔabɔ amanneɛ sɛ fluoroscopy bere a wɔde yɛ suprapatellar nailing no yɛ tiaa kɛse sen infrapatellar nnadewa. Bio nso, nnadewa a wɔde hyɛ mu no anim (wɔ sagittal plane no mu) ne tibia no tenten a ɛwɔ saa kwan yi so no hyia kɛse sen infrapatellar nnadewa no; Eyi mma mfiri mu ntawntawdi ba nnadewa no ano ne akyi ntini no ntam, na ɛnam so ma mpaapaemu no so tew.

Oprehyɛn akyi kotodwe mu yaw yɛ ɔhaw a ɛfa ho. Wɔabɔ amanneɛ sɛ wɔn kotodwe a ɛwɔ anim no mu yɛ wɔn yaw wɔ ayarefo a wɔabubu no mu 50-70% mu, na ayarefo no mu 30% pɛ na wɔte ɛyaw ano bere a wɔayi afifide a ɛwɔ wɔn mu no afi hɔ akyi. Wobu akontaa sɛ akuru a ɛba a ɛne patellar tendon ne hoffa fat pad a wobenya no wɔ abusuabɔ no yɛ nea ebetumi ama obi akotow wɔ oprehyɛn akyi. Nea ɛka ho no, suprapatellar kwan no kwati atetesɛm mu ntwitwiridii a ɛwɔ saphenous nerve no patellar nkorabata no mu, na ɛnam so kwati nkotodwe a ɛwɔ anim ne nkate mu a ɛyɛ kusuu (Mfonini 4). Ɛte sɛ nea nnadewa no a wɔde fa quadriceps tendon no mu, na ɛnam so ma patellar tendon no yɛ nea ɛnyɛ hwee no ma koma mu yaw a ɛba wɔ oprehyɛn akyi no so tew kɛse.

Esiane sɛ nneɛma pa a efi mu ba no mu paapae nti, wɔatrɛw nsɛnkyerɛnne a ɛwɔ ayaresabea adwumayɛ mu no mu akɔ akisikuru no nyinaa mu.

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

Mfaso a ɛwɔ so .

• Kotodwe gyinabea a ɛtrɛw fã bi no hyɛ mpaapaemu a wɔde di dwuma ne nea wɔde si baabi foforo ho nkuran denam ntini ahoɔden a ɛma ɛyɛ den ne nea ɛma ɛkɔ so tra hɔ bere a wɔde nnadewa hyɛ mu no so .

• Asiane a ɛba fam a ɛwɔ oprehyɛn akyi a ɛbɛpaapae wɔ proximal, segmental ne distal fractures mu no sɛ wɔde toto akwan a wɔtaa fa so .

• Nailing operation yɛ mfiridwuma mu mmerɛw sɛ wɔbɛyɛ .

• Nail a wɔde hyɛ mu no yɛ nea wobetumi ayɛ sɛ 'Oprehyɛn biako ho nhyehyɛe'.

• fluoroscopy bere a ɛso atew .

• Patellar tendon no nsɛe biara na ɛba fam a ɛba fam wɔ akyi kotodwe mu yaw .

• Ɛyɛ mmerɛw sɛ wɔbɛyɛ adwuma wɔ akuw pii mu, sɛnea ɛte wɔ adwenemhaw pii mu no .

  
  

Nneɛma a ɛkyerɛ .

• Tibia a ɛbɛn (AO 41A no su) no mu ntini a ɛwɔ akyi no mu a ɛyɛ mmerɛw .

• Tibial diaphysis no mu a ɛyɛ mmerɛw sɛ ɛbɛpaapae (AO 42A-C type) .

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

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

• kotodwe a ɛrehuruw .

• Patellar Ossification a ɛwɔ patellar tendon ossification .

• Akuru a efĩ wom wɔ patellar tendon no so .

Sɛnea wobɛtɔ nnompe mu nneɛma a wɔde hyɛ nipadua mu ne nnompe mu nnwinnade a wɔde yɛ aduan, .

Ma Czmeditech , yɛwɔ aduru a wɔde yɛ nnompe mu oprehyɛn a edi mũ yiye ne nnwinnade a ɛne no hyia, nneɛma a ɛka ho ne . akyi berɛmo a wɔde hyɛ nipadua mu ., nnadewa a wɔde hyɛ nipadua no mu ., Trauma mprɛte ., Mprɛte a wɔde to mu ., atiridiinini-maxillofacial ., Nneɛma a wɔde yɛ nipadua no ., Nnwinnade a ɛma ahoɔden ., abɔnten so fixators ., Arthroscopy ., Mmoa ho ayaresa ne wɔn adwinnade a ɛboa.

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

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