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Distal Tibial Intramedullary Nails (DTN) 10 ɲumanw Ameriki Woroduguyanfan na san 2025 Zanwuyekalo la
Distal Tibial Intramedullary Nails (DTN) 10 minnu bɛ Ameriki Woroduguyanfan na san 2025 zanwuyekalo la
Views: 0 Author: Site Editor Bɔli waati: 2025-06-17 Bɔyɔrɔ: Yɔrɔ
Distal Tibial Intramedullary Nail (DTN) ka kɛnɛyako sɛgɛsɛgɛli
Opereli kɛcogo, a kɔlɔlɔw ani a kɛcogo sɛgɛsɛgɛli bɛɛjɛfanga
A bɔra: Zuwɛnkalo tile 17, san 2025
Distal Tibial Intramedullary Nail (DTN) bɛ jira senkɔni cogoya suguya caman na, i n’a fɔ senkɔniw karicogo nɔgɔman, spiral, comminuted, long oblique, ani segmental shaft fractures (kɛrɛnkɛrɛnnenya la distal tibia), ani distal tibial metaphyseal fractures, non-/mal-unions a bɛ se ka kɛ fana, a ka ca a la ni minɛn kɛrɛnkɛrɛnnenw ye, walasa ka kolotugudaw walima bolokɔniw janya danfara (i n’a fɔ a janya walima a surunyali).
Locking Plates (Flati minnu bɛ da tugu).
Tiɲɛniba bɛ kɛ farikolo yɔrɔ nɔgɔlenw na, banakisɛ sɔrɔli hakɛ ka ca, a kɛnɛyali ka jan
Antegrade (Nɛgɛw) minnu bɛ wele ko Antegrade
Farati bɛ gɛnɛgɛnɛ jogin na, a sirilen tɛ ka ɲɛ, a ka teli ka kɛ a ma bɛn
DTN Furakɛli
Fɛɛrɛ min tɛ fɛn caman kɛ ni a doncogo ye min bɛ kɛ kɔfɛ
1Distal tibial fractures ka teli ka kɛ, wa dan bɛ laadala furakɛli la
Distal tibial fractures ye senkɔniw duguma kari suguya ye min ka teli ka kɛ. Laadala furakɛli i n’a fɔ dakunw datugulanw ani ɲɛgɛnɛsira kɔnɔna na, u kelen-kelen bɛɛ n’u ka dɛsɛw bɛ u la. Farikolo datugulen bɛ se ka kɛ sababu ye ka banakisɛw bila opereli kɔfɛ walima ka farikolo yɔrɔ nɔgɔlenw sɔgɔsɔgɔ, ka kɛnɛyali janya; hali ni nɛgɛ minnu bɛ ɲɛfɛla la, olu tɛ fɛn caman kɛ, u bɛ se ka gɛnɛgɛnɛ kolo tiɲɛ, ka dimi bila mɔgɔ la, ani ka faratiw lase a ma, n’o ye ka a siri ka ɲɛ walima ka a siri cogo jugu la, o bɛ se ka kɛnɛya bali.
2Fura kura: Nail tibial distal (DTN) .
Furakɛli fɛɛrɛ kura dɔ—Distal Tibial Nail (DTN)—o bɛ hakilina kura di distal tibial karilenw ɲɛnabɔli ma n’a ka kɔfɛcogo kɛrɛnkɛrɛnnen ye.
Jaa 1 : DTN kɔfɛla doncogo
II. Opereli kɛcogo
1Banabagatɔ jɔyɔrɔfacogo ni a dɔgɔyali labɛnni
Banabagatɔ bɛ bila a da la. Kari minnu bɔra u nɔ na, olu ka kan ka dɔgɔya ni bolo ye; ni a mago bɛ a la, aw bɛ reduction forceps kɛ ka dɛmɛ don sani aw ka DTN don a kɔnɔ. Ni fiyɛli karilen bɛ a kɔfɛ, fiɲɛ bilali ɲɔgɔn na cogo bɛnnen na, o bɛ se ka senkɔniw dɔgɔyali dɛmɛ.
Jateminɛba minnu ka kan ka kɛ: I da la, aw bɛ pinces réductions kɛ ni aw mago bɛ a la. Aw bɛ fibulu karilenw furakɛli bila jɔyɔrɔ fɔlɔ la walasa ka senkɔniw dɔgɔyali tigitigi sɔrɔ.
2DTN doncogo taabolo
Tigɛ min janya ye santimɛtɛrɛ 2–3 ye, o bɛ kɛ cɛmancɛla ɲɛgɛnɛsira kuncɛ la walasa ka deltoid ligament sanfɛla jira. Ɲɛjirali-pini dɔ bɛ don a cɛmancɛ la dɔɔni ka se a kuncɛ ma, milimɛtɛrɛ 4–5 ka bɔ joli-sira-funu-yɔrɔ la.
Tigɛcogo:
Tigɛ janyalen bɛ kɛ malleolus cɛmancɛ la
Guide pin positioning: 1. Bamako, Mali.
4–5 mm ka bɔ kolotugudaw la
Fixation (Fixation) ye:
Kuru minnu bɛ ɲɔgɔn siri ɲɔgɔn na kɛrɛfɛ ani yɔrɔ jan
Jaa 2a: Guide pin doncogo
Jaa 2b: Kɛrɛfɛla lajɛ
Jaa 2c : Reaming taabolo
III. Opereli kɔfɛ Rehabilitation (Opereli kɔfɛ Rehabilitation).
0-6
Dɔgɔkunw Non-weight Bearing
Senkɔni kolotugudaw lamagacogo teliya la ani sen ni duguma magali
6-8 lajɛ
Dɔgɔkunw Kɛrɛnkɛrɛnnenya la, girinya-taama
Ɲɛtaa ka se 50% girinya ta seko ma
8-12 la
Dɔgɔkunw Kisɛ-taama dafalen
Ka a to ka callus (kalu) sɔrɔli ni dimi kɔlɔsi
Protokol de réhabilitation (labɛn min bɛ kɛ ka mɔgɔw labɛn).
Senkɔni kolotugudaw baara bɛ daminɛ o yɔrɔnin bɛɛ opereli kɔfɛ
Aw bɛ aw yɛrɛ tanga girinya tali ma dɔgɔkun 4–6 kɔnɔ
A bɛ wuli dɔɔni dɔɔni ka taa girinya dafalen na dɔgɔkun 8–12 kɔnɔ
Kɔlɔsili kɛli tuma bɛɛ ni rezow ye kɛnɛya waati la
IV. Kalan jaabiw
1Banabagatɔ 10 ka kɛnɛyaso sɔrɔcogo
Sɛgɛsɛgɛli dɔ kɛra banabagatɔ 10 nɔfɛ. Kalo 3 opereli kɔfɛ, bana 7 kɛnɛyara; banabagatɔ bɛɛ ye kɛnɛya sɔrɔ kalo 6 kɔnɔ. Varus ni recurvatum deformities kelen-kelen bɛɛ kɛra. Dɔgɔyali, banakisɛ, gɛlɛya minnu bɛ sɔrɔ fɛn donta la, walima jogin minnu bɛ sɔrɔ iatrɔzɛni fɛ, olu bɔnɛni si ma ye.
70% ye .
A kɛnɛyara kalo 3 kɔnɔ
100% ye .
A kɛnɛyara ni kalo 6 ye
0% ye .
Banakisɛw
Kɔnɔnafili sumanikɛlan
DTN jaabiw
Laadalata fɛɛrɛw
Union Rate (kalo 3) .
70% ye .
40-60% ye .
Baarakɛbaliya (>5°) .
20% ye .
25-40% ye .
Banakisɛ sɔrɔli hakɛ
0% ye .
5-15% ye .
AOFAS ka jatebɔ
92.6
73-88 la
V. Ko kɛlenw ka kunnafoni
Cɛ banabagatɔ min si bɛ san 69 na
Kari suguya : Tibial transversal kari + fibular fracture
Gɛlɛya: Joginni min bɛ kɛ farikolo yɔrɔ nɔgɔlenw na
Opereli kɔfɛ : Tigɛ misɛnnin 6 dɔrɔn, a bɛ kɛnɛya pewu san 1 kɔnɔ
Furakɛli kuncɛlen
DTN bɛ don a kɔnɔ ni tigɛcogo fitininw ye ni farikolo yɔrɔ nɔgɔlenw maracogo ɲuman ye. Fibular fracture sabatilen ni intramedullary nail ye. Banabagatɔ ye kɛnɛya dafalen sɔrɔ ni gɛlɛya si ma sɔrɔ a la.
Ja minnu bɛ kɛ ka kɔn opereli ɲɛ
O yɔrɔnin bɛɛ Post-op
Kalo 3 ka tugu-tugu ɲɔgɔn kɔ
San 1 Kɛnɛya
VI. Jɛkafɔ
1Biomecanique ka sabatili
Nɛgɛ minnu bɛ kɔfɛ, olu ka gɛlɛya ka fisa ni u ye aksidan ni u jiginni na ni i ye u suma ni cɛmancɛ datugulanw ye ani wulu minnu bɛ ɲɛfɛ. Greenfield ni a ɲɔgɔnnaw. ye biyomekaniki sɛgɛsɛgɛli kɛ min y’a jira ko ni baara kɛra ni distal vis fila ye DTN kɔnɔ, o bɛ se ka 60–70% sɔrɔ degun gɛlɛya la ani 90% torsional stiffness la ni i y’a suma ni kuru saba ye.
2Nafa minnu bɛ DTN la
Ni aw ye a suma ni tabali datugulenw ye, wulu minnu bɛ kɛ wuluwulu kɔnɔ, olu tɛ farikolo yɔrɔ nɔgɔlenw tiɲɛni dɔgɔya, kɛrɛnkɛrɛnnenya la banabagatɔ kɔrɔbaw ni farikolo yɔrɔ nɔgɔlenw jogin jugumanba bɛ minnu na, ka a sababu kɛ joginda ye min fanga ka bon. O kɛcogo tɛ gɛnɛgɛnɛ kuruli wajibiya, o bɛ dɔ bɔ dɔgɔyali bɔnɛ na ani ka a kɛ a bɛnnen don banabagatɔw ma minnu gɛnɛgɛnɛ lamagacogo dan ye.
3Dɔgɔtɔrɔsow ka ɲɔgɔn sangali
Antegrade nails nonunion ani malalignment hakɛ ye 0–25% ani 8,3–50% ye; ka ɲɛsin platiw datugucogo ma, 0–17% ani 0–17%. Nin kalan in kɔnɔ, bana bɛɛ ye jɛɲɔgɔnya sɔrɔ, wa 20% dɔrɔn de ye deformité >5° sɔrɔ, o bɛ se ka suma ni laadala fɛɛrɛw ye.
VII. Kuncɛli
Kuma surun na, DTN bɛ nafa di ka tɛmɛ dakunw datugulanw ni ɲɛgɛnɛsira kɔnɔ wuluw kan minnu bɛ ɲɛfɛ ani a bɛ fura ɲuman jira senkɔni yɔrɔjan karilenw furakɛli la. DTN bɛ a jira ko a tɛ se ka don a la kosɛbɛ, a sabatili ka bon, ani a bɛ kɛnɛya joona. O ye fura nafama ye min bɛ se ka kɛ laadala furakɛli nɔnabila ye, wa a nafa ka bon ka laseli kɛ.
Ko kɛlenw minnu kɛra mɔgɔ yɛrɛ ta ye, olu bɛ se ka kunbɛn kosɛbɛ.
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