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Distal Tibial Intramedullary Nails (DTN) 10 a ɛsen biara wɔ Amerika Atifi fam ma January 2025
Distal Tibial Intramedullary Nails (DTN) 10 a ɛsen biara wɔ Amerika Atifi fam ma January 2025
Nhwɛsoɔ: 0 Ɔkyerɛwfoɔ: Site Editor Bere a wɔde tintimii: 2025-06-17 Mfiase: Beaeɛ
Distal Tibial Intramedullary Nail (DTN) Ayaresabea Nhwehwɛmu
Oprehyɛn Ho Ɔkwan, Nea Efi Mu Ba, ne Nea Wɔde Di Dwuma Ho Nhwehwɛmu a Ɛkɔ Akyiri
Wɔtintim no: June 17, 2025
Wɔakyerɛ Distal Tibial Intramedullary Nail (DTN) no ama tibial tebea ahorow, a nea ɛka ho ne simple, spiral, comminuted, long oblique, ne segmental shaft shaft fractures (titiriw no distal tibia), ne distal tibial metaphyseal fractures, non-/mal-unions wobetumi de adi dwuma nso, mpɛn pii no wɔde mfiri titiriw bi adi dwuma, de adi nnompe mu dɛmdi anaa akwaa tenten a ɛnyɛ pɛ (te sɛ nea ɛtrɛw anaasɛ ɛyɛ tiaa) ho dwuma.
Mprɛte a Wɔde Toto Mu
Ntini a ɛyɛ mmerɛw a ɛsɛe kɛse, ɔyare mmoawa dodow a ɛkɔ soro, ahoɔden a ɛtra hɔ kyɛ
Antegrade Nnadewa a Wɔde Yɛ Adwuma
Asiane a ɛwɔ hɔ sɛ kotodwe nkwaa bepira, sɛ wɔmfa nsi hɔ yiye, ɛtaa ma ɛnyɛ pɛpɛɛpɛ
DTN Ano Aduru
Minimally invasive kwan a ɛwɔ retrograde insertion nhyehyɛe
1Distal 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.
2Ano 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.
Mfonini 1: DTN akyigyina a wɔde hyɛ mu ho nhyehyɛe
II. Ɔkwan a Wɔfa so Yɛ Oprehyɛn
1Ɔyarefo 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.
Nneɛma Titiriw a Ɛsɛ sɛ Wosusuw Ho: Sɛ woda fam a, sɛ ɛho hia a, fa reduction forceps di dwuma. Fa fibular fracture management di kan na ama woahwɛ ahu sɛ tibial no so tew pɛpɛɛpɛ.
2DTN a wɔde hyɛ mu ho nhyehyɛe
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 anaasɛ ɛwɔ mfinimfini kakra, 4–5 mm fi articular no ani.
Ntwitwiridii:
Wɔatwa no tenten wɔ malleolus a ɛwɔ mfinimfini no ano
Akwankyerɛ pin gyinabea:
4–5 mm fi nkwaa no ani
Nneɛma a wɔde si hɔ:
Nkuruwankuruwa a ɛka bom wɔ proximally ne distally
Mfonini 2a: Akwankyerɛ pin a wɔde hyɛ mu
Mfonini 2b: Akyi hwɛbea
Mfonini 2c: Reaming nhyehyɛe
III. Post-op Rehabilitation a Wɔde Yɛ Adwuma
0-6 na ɛwɔ hɔ
Adapɛn a Ɛnyɛ Mu duru Bearing
Ankle nkwaa a ɛkɔ baabiara ntɛm ara ne nan a ɛne fam di nkitaho
6-8 na ɛwɔ hɔ
Adapɛn Afã bi mu duru-soa
Nkɔso a ɛkɔ 50% tumi a wɔde soa mu duru
8-12 na ɛwɔ hɔ
Adapɛn a Edi Mu Mu duru-soa
Bere a wɔrehwɛ callus a ɛba ne ɛyaw no so no
Nsiesiei ho Nhyehyɛe
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
Radiographic monitoring daa wɔ bere a obi ho tɔ no
IV. Adesua no mu Nea Efi Mu Ba
1Ayaresa mu Nneɛma a Efi Ayarefo 10 Mu
Nhwehwɛmu bi dii ayarefo 10 akyi. 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.
70% na ɛwɔ hɔ.
Wɔsaa no yare wɔ asram 3 ntam
100% na ɛwɔ hɔ.
Wɔsaa no yare asram 6
0% .
Nyarewa a wɔde nyarewa ba
Nea efi mu ba no susudua
DTN Nea efi mu ba
Amanne kwan so
Union Rate (asram 3) .
70% na ɛwɔ hɔ.
40-60% na ɛwɔ hɔ.
Nneɛma a ɛnyɛ pɛpɛɛpɛ (>5°) .
20% na ɛwɔ hɔ.
25-40% na ɛwɔ hɔ.
Ɔyare mmoawa dodow
0% .
5-15% na ɛwɔ hɔ.
AOFAS Nkonimdi
92.6
73-88 na ɛwɔ hɔ
V. Asɛm no ho Amanneɛbɔ
Ɔyarefo barima a wadi mfe 69
Abubuo su: Transverse tibial fracture + fibular a ɛpaapae
Ɔhaw: Ntini a ɛyɛ mmerɛw a ɛpaapae
Post-op: Ntwitwiridii nketenkete 6 pɛ, ayaresa a edi mũ wɔ afe 1 ntam
Ayaresa Ho Nsɛm a Wɔaboaboa Ano
DTN a wɔde denam ntwitwiridii kakraa bi so a wɔde ntini a ɛyɛ mmerɛw a wɔkora so yiye so. Fibular fracture a wɔde nnadewa a ɛwɔ medullary mu na ɛyɛ den. Ɔyarefo no nyaa ahoɔden a edi mũ a na ɔhaw biara amma.
Mfonini a Wɔyɛ ansa na wɔayɛ adwuma
Ntɛm ara Post-op
Asram 3 akyi a Wɔde Di Dwuma
Afe 1 Ayaresa
VI. Mpɛnsɛmpɛnsɛmu
1Biomechanical 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.
2Mfaso 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. 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.
3Ayaresa 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.
VII. Awie
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.
DTN Nneɛma a Wɔde Yɛ Adwuma
Nnadewa a Ɛwɔ Akyirikyiri Tibial Intramedullary Nail (DTN) .
Osuahu ahorow a wɔayɛ ama ankorankoro a wotumi di so koraa.
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