Tibial nail distal: A ye fɛn dɔ tiɲɛ tibial distal fractures furakɛli la .

Tibial distal fractures (tibiyali yɔrɔjanw) ka ca, wa laadala furakɛli bɛ dan .

Tibial dibial fractures ye farikolo yɔrɔ dɔw kari suguya ye min ka teli ka sɔrɔ. Laadalata furakɛli i n’a fɔ dakunw datugucogo ani antegrade intramedullary nails kelen-kelen bɛɛ bɛ ni u ka dɛsɛ ye. Datugulanw bɛ se ka bana bila opereli kɔfɛ walima farikolo yɔrɔ nugulamaw la, ka kɛnɛya ka taa a fɛ; Hali ni antegrade wuluw bɛ don a la dɔɔni dɔɔni, u bɛ se ka gɛnɛgɛnɛ tiɲɛ, ka dimi bila mɔgɔ la, ani ka faratiw lase mɔgɔ ma minnu bɛ se ka u siri walima ka u siri, ka u kɛnɛya.

Fura kura: distal tibial nail (DTN) .

Furakɛli suguya kura dɔ—distal tibial nail (DTN)—o bɛ hakilina kura di tibial distal fractures ɲɛnabɔli ma n’a ka retrograde dicogo kɛrɛnkɛrɛnnen ye.

Banabagatɔ jɔyɔrɔ ni a dɔgɔyali labɛnni .

Banabagatɔ bɛ bila a da la. Yɛlɛma minnu bɛ bɔ u nɔ na, olu ka kan ka dɔgɔya ni bolo ye; Ni a mago bɛ a la, aw bɛ jiginɛw kɛ ka dɛmɛ don sani aw ka DTN don a kɔnɔ. Ni fibular fracture (fibulari kari) bɛ yen, fibular alignment (fibulari) ɲuman bɛ se ka tibial (banakisɛ) dɔgɔya. Fibular shaft fractures bɛ se ka sabati ni kɔnɔbara kɔnɔ wuluw ye. Ni aw bɛ kariw lamini senkɔniw lamini na, fibula farikolo dɔgɔyali ni a jɔli ka kan ka kɛ ka kɔn senkɔniw dɔgɔyali ɲɛ walasa ka aw tanga bana ma. Kari dafalenw na minnu bɛ ni kɛnɛma fiɲɛ ye, nɛgɛ bɛ se ka don a kɔnɔ ka sɔrɔ ka fiɲɛ bila a la walasa ka dɔ bɔ a la.

2–3 cm longitudinal incision bɛ kɛ Malleolus cɛmancɛ kun na walasa ka deltoid ligament sanfɛla jira. Guide pin dɔ bɛ don a la walima a bɛ kɛ a cɛmancɛ la dɔɔni ka se malleulus (ja 2a) kun ma walima a cɛmancɛ la, milimɛtɛrɛ 4–5 ka bɔ joli-sira-funu-yɔrɔ la. Lateral view bɛ doncogo jira ni intercondylar groove ye (Ja 2b), ka i yɛrɛ tanga tiɲɛni ma kɔfɛla tibialis farikolo la. Aw bɛ sanfɛla deltoid ligament fara ɲɔgɔn kan, o kɔ aw bɛ reamer kɛ ka medullaire kanal bonya fo ka se metaphyseal yɔrɔ ma (Ja 2C). Aw bɛ kolo cancellous bɔ ka surunya proximal medial cortex la walasa ka nɛgɛ don (sɛbɛn ɲɛ 2D). Aw bɛ sɛgɛsɛgɛli kɛ ka ɲɛ walasa ka DTN hakɛ dafa (sɛbɛn ɲɛ 2E). Aw bɛ aw yɛrɛ tanga marifa ma walima ka kirinni kojugu walasa ka malleolar medial medial fracture bali. Aw bɛ wuluwulu juguman ladilan walasa ka a dɔn ko kurukuruw bɛ don senkɔniw joli la walima ka u kari yɔrɔ la. Fixation bɛ sɔrɔ ni interlocking vises proximally ani distally.

Senkɔniw lamagacogo teliya la ani sen ni duguma ɲɔgɔn sɔrɔli bɛ sɔn opereli kɔfɛ
girinya tɛ se ka kɛ dɔgɔkun 4–6 kɔnɔ
ka taa a fɛ ka se girinya dafalen ma dɔgɔkun 8–12 cɛ, ka sɔrɔ ka callus formation ni dimi kɔlɔsi

Senkɔniw kolotuguda baara bɛ daminɛ opereli kɔfɛ o yɔrɔnin bɛɛ .

Aw bɛ aw yɛrɛ tanga girinya ma dɔgɔkun 4–6 .

Yɛlɛma dɔɔnin dɔɔnin ka taa girinya dafalen na dɔgɔkun 8–12 kɔnɔ .

Banabagatɔ 10 ka tuguni kɛli .

Kalan dɔ kɛra banabagatɔ 10 kan (Taabolo 1). Kalo 3 op kɔfɛ, bana 7 tun kɛnɛyara; Banabagatɔ bɛɛ ye kɛnɛya sɔrɔ kalo 6 kɔnɔ. Ko kelen varus ni recurvatum deformités kelen-kelen bɛɛ kɛra. Dɔgɔyali, banakisɛ sɔrɔli, gɛlɛya minnu bɛ sɔrɔ fɛnw doncogo la, walima joginni minnu bɛ sɔrɔ farikolo la, olu ma ye (Taabolo 2).

Cɛ banabagatɔ min si bɛ san 69 la .

DTN taamasiyɛnw .

Nin ɲinini in kɛra AO 43-A ani C1 kariw ye; C2 fana jateminɛna. DTNw bɛ sɔrɔ milimɛtɛrɛ 7 ni milimɛtɛrɛ 8 janya la, minnu bɛ proximal interlocking vises (kɛrɛfɛ-minɛnw) bilali jateminɛ. Kari minnu bɛ sɔrɔ santimɛtɛrɛ 2–9 sanfɛ joli sira fɛ, olu ye mɔgɔ ɲumanw ye DTN fixation na. Taamaʃyɛnw bɛ se ka bonya ka se AO 42 kariw ma.

Biomekaniki sabatili .

Kɔnɔbara kɔfɛta bɛ kɛ ni aksidan ni jiginni gɛlɛya ye ni i ye a suma ni cɛmancɛ dasirilanw ye ani nɛgɛ minnu bɛ kɛ ka ɲɛ. Greenfield et al. Biomechanical testing (Biomekaniko sɛgɛsɛgɛli) kɛra min b’a jira ko ni baara kɛra ni distal vis fila ye DTN kɔnɔ, o ye 60–70% sɔrɔ compression stiffness (janya gɛlɛya) la ani 90% la torsional stiffness (banakisɛ gɛlɛyali) la ni i ye a suma ni screw saba ye. DTN ye fracture fragment mouvement dɔgɔya doni kɔrɔ. 3 la minnu ma kɛnɛya kalo 3 kɔnɔ, fɛn minnu ye farikolo yɔrɔ nugulamaw tiɲɛni ye, medullary expansion, kari yɔrɔ, ani koloci. Ikomi DTNw bɛ na ni hakɛ saba dɔrɔn ye ani ni fiɲɛ bilali yɔrɔjan na, o bɛ dan juru saba ma, u bɛ se ka sabatili dafalen di kanal caman na walima kolo kolo kolo la. A ka kan ka gɛrɛ farikolo girinya la joona ni hakilisigi ye o ko suguw la.

Nafa minnu bɛ DTN la .

Ni aw ye a suma ni da tugulanw ye, kɔnɔbara basigilenw bɛ kɛ sababu ye ka farikolo yɔrɔ dɔw tiɲɛ, kɛrɛnkɛrɛnnenya la minnu bɛnnen don banabagatɔ kɔrɔbaw ma ani mɔgɔ minnu jogincogo ka jugu, ni fanga caman bɛ u la. Nin ɲinini in na, DTNw donna tigɛtigɛ misɛnnin wɔɔrɔ dɔrɔn fɛ, gɛlɛya si ma sɔrɔ farikolo yɔrɔ nugulamaw la. O kɛcogo tɛ gɛnɛgɛnɛ jiginni wajibiya, o bɛ dɔ bɔ a dɔgɔyali farati la ani ka a kɛ a bɛnnen don banabagatɔw ma minnu ka gɛnɛgɛnɛ lamagacogo ka dɔgɔn (misali la, gɛnɛgɛnɛ joli walima TKA kɔfɛ).

Opereli faratiw ni fɛɛrɛw tigɛcogo .

Farati minnu bɛ a la, olu dɔw ye kɔkolo kɔkanna farikolo ni a cɛmancɛ malleolar fracture ye. Malleolar fractures medial bɛ se ka furakɛ ni tension band wiring, plating, walima external fixation ye.
Aw ka kan ka aw janto a la walasa a kana don fiyɛli la fibular notch kɔnɔ. A jɔyɔrɔfalen-minɛn bɛ se ka kɛ sababu ye ka DTN jiginni kɔfɛ ka a sababu kɛ a girinya ye; Aw bɛ kuru filanan ladilan walasa ka a ɲɛsin fibula ma (sɛbɛn ɲɛ 4C).

Kɛnɛyaso ka ɲɔgɔndan .

Antegrade nails non union ani malaligment hakɛ ye 0–25% ani 8,3–50% ye, o cogo kelen na; ka ɲɛsin dakunw ma, 0–17% ani 0–17%. Nin kalan in kɔnɔ, bana bɛɛ sɔrɔla, ani 20% dɔrɔn de tun bɛ ni tiɲɛni ye >5° la, min bɛ se ka suma ni laadala fɛɛrɛw ye.banakisɛ hakɛ: Sanfɛla banakisɛ ye 0–8,3% ye nɛgɛw la minnu bɛ kɛ ka ɲɛ ani 0–23% ye dakunw datugucogo ye Banakisɛ jugumanba ye 0–23% ani 0–8,3% ye. Nin ɲinini in y’a jira ko gɛlɛya si ma sɔrɔ farikolo yɔrɔ nugulamaw la, ka tɛmɛ a nɔfɛta fila bɛɛ kan.Functional scores:

Kuma surun na, DTN bɛ nafaw di ka tɛmɛ dakunw kan minnu bɛ datugu ani ka antegrade intramedullary nails ani a bɛ fura ɲuman jira tibial distal fractures furakɛli la.

DTN bɛ binkanni fitinin jira, a sabatili ka bon, ani a kɛnɛyali teliya la .

O ye fɛɛrɛ nafama ye ka tɛmɛ laadala furakɛliw kan ani a nafa ka bon .

Yamakawa Y, Uehara T, Shigemoto K, ani a ɲɔgɔnnaw. Tibia kari minnu bɛ bɔ yɔrɔjan yɔrɔjan, olu sabatili jateminɛ fɔlɔw ni tibial nail yɔrɔjan ye: a prospective, multicentre case series study[J]. Jogin, 2024: 111634.
创伤骨科智能科技 智汇骨. (2024年12月31日). 胫骨远端髓内钉突破胫骨远端骨折的治疗 [微信公众文章]. 创伤骨科智能科技 智汇骨. 1999, 2025月07日)