I. Ŋgɔdonya .
Distal humerus la nye titina kple axadzi sɔtiwo, siwo dometɔ aɖewoe nye epicondyles kple condyles.
II. Amekokomɔnu .
Distal humerus fractures tsoa nuveviwɔame tẽ (le kpɔɖeŋu me, anyidzedze) alo ŋusẽ siwo metso tẽ o gbɔ (le kpɔɖeŋu me, twisting alo lãmeka hehe).
III. Post-op gbugbɔgaɖɔɖo .
AO ƒe hatsotso la maa humerus siwo le didiƒe ƒe gbagbãwo ɖe ƒomevi vevi etɔ̃ me: A , B , kple C .
iv. Nusɔsrɔ̃a me tsonu .
Amekoko ƒe atikewɔwɔ zɔna ɖe AO ƒe gɔmeɖosewo dzi: ŋutilã ƒe wɔwɔme dzi ɖeɖe kpɔtɔ, fixation si li ke, kple gbugbɔgaɖɔɖo kaba.
V. Nyatakaka si ku ɖe dɔlélea ŋu .
Ne wotu agbawo la, wowɔa biomechanical ƒe liƒo si de ŋgɔ wu, vevietɔ le ƒumeŋuɖui ƒe ƒu me.
VI. Numedzodzro
CzmediTech na mɔ̃ etɔ̃: extraarticular (01.1107), lateral (5100-17), kple medial (5100-18) plates.
VII. Nyanuwuwuw
Amekoko ƒe atikewɔwɔ zɔna ɖe AO ƒe gɔmeɖosewo dzi: ŋutilã ƒe wɔwɔme dzi ɖeɖe kpɔtɔ, fixation si li ke, kple gbugbɔgaɖɔɖo kaba.
Tibial ƒe gbagbã le didiƒe bɔ, eye seɖoƒe li na atikewɔwɔ siwo wowɔna le kɔnu nu .
Distal tibial fractures nye abɔ kple afɔ ƒe gbagbã ƒomevi si bɔ. Atikewɔwɔ siwo wowɔna tsã abe ʋuƒo siwo wotsɔ xea mɔ na nu kple antegrade intramedullary nails dometɔ ɖesiaɖe ƒe kuxiwo le wo dometɔ ɖesiaɖe ŋu ene. Plate plate ate ŋu ana dɔlékuiwo naxɔ ame le dɔwɔwɔ vɔ megbe alo lãkusi falɛfalɛwo ƒe kuku, si ana wòahaya ɣeyiɣi didi aɖe; Togbɔ be antegrade ɖawo megena ɖe eme boo o hã la, woate ŋu agblẽ nu le klo ƒe ƒunukpeƒea ŋu, ana woase veve, eye woatsɔ afɔku siwo nye be woagaɖɔ ɖo nyuie o alo woƒe lãme nagasɔ nyuie o, si xea mɔ na hayahaya.
Agbalẽ siwo wotsɔ xea mɔe:
Nu vevi aɖe si gblẽ le lãkusi falɛfalɛwo ŋu, dɔlékuiwo ƒe agbɔsɔsɔ si sɔ gbɔ, hayahaya didi .
Antegrade ƒe ɖawo:
Afɔku si le klo ƒe ƒunukpeƒe ƒe abixɔxɔ, fixation si mesɔ gbɔ o, si te ŋu trɔna bɔbɔe me .
Egbɔkpɔnu Yeye: Distal Tibial Nail (DTN) .
Atikewɔwɔ ƒe mɔnu yeye aɖe—si nye distal tibial nail (DTN)—na nukpɔsusu yeye aɖe si dzi woato akpɔ distal tibial fractures gbɔ kple eƒe retrograde design tɔxɛa.
Retrograde Insertion Design naa mɔnu yeye aɖe .
Dɔnɔwo ƒe Nɔnɔme Kple Wo Dzadzraɖo Ðe Wo Dzi Ðeɖe Akpɔtɔ .
Wotsɔa dɔnɔa dana ɖe akɔta ƒe nɔnɔme me. Ele be woate ŋu aɖe gbagbãƒe siwo woɖe ɖa la dzi akpɔtɔ kple asi; Ne ehiã la, zã reduction forceps nàtsɔ akpe ɖe eŋu hafi nàde DTN la eme. Ne ka ƒe gbagbã si kpe ɖe eŋu li la, ka ƒe ɖoɖo nyuie ate ŋu akpe ɖe tibial dzi ɖeɖe kpɔtɔ ŋu. Woate ŋu atsɔ ɖa siwo le lãkusi me aɖo fibular shaft fractures ŋu. Le gbagbãƒe siwo ƒo xlã afɔkpodzi gome la, ele be ŋutilã ƒe wɔwɔme dzi ɖeɖe kpɔtɔ kple fibula ƒe fixation nado ŋgɔ na tibial dzi ɖeɖe kpɔtɔ be woaƒo asa na malignment. Le ʋuʋu siwo le ʋuʋu ɖi kple gotagome fixation si li me la, woate ŋu ade ɖa la eme esime wole fixator la dzi kpɔm be wòaɖo edzi.
Supine position, zã reduction forceps ne ehiã .
Tsɔ fibular fracture management ɖo nɔƒe gbãtɔ be nàkpɔ egbɔ be woɖe tibia dzi kpɔtɔ pɛpɛpɛ .
Woɖea 2–3 cm didi ƒe ʋuʋudedi le medial malleolus ƒe nugbɔ be wòaɖe deltoid ligament si le gota la ɖe go. Wotsɔa mɔfianu ƒe pin dea malleolus la ƒe nugbɔ alo titina vie (Fig. 2A), si nye 4–5 mm tso articular ƒe akpa dzi. Lateral view ɖee fia be wodoe to intercondylar groove (Fig. 2B) dzi, si wɔnɛ be womegblẽa nu le megbe tibialis lãmekaa ŋu o. Ma deltoid ligament si le gota la ɖa, emegbe nàzã reamer atsɔ adzi medullary canal ɖe edzi vaseɖe metaphyseal nuto me (Fig. 2C). Ðe ƒu si tea fli ɖe eme la ɖa le teƒe si te ɖe titina ƒe lãkusi ŋu be nàtsɔ lãgbalẽa ade eme (Fig. 2D). De dodokpɔ ƒe ɖa aɖe eme be nàtsɔ aɖo kpe DTN ƒe lolome dzi (Fig. 2E). Ƒo asa na hammering alo excessive twiting be woaxe mɔ ɖe iatrogenic medial malleolar fracture nu. Trɔ asi le ɖa ƒe goglome ŋu be nàkpɔ egbɔ be gavi siwo le didiƒe la nagage ɖe afɔkpodzi ƒe ƒunukpeƒe alo teƒe si wogbã o. Wowɔa fixation kple interlocking screws le proximally kple distally.
Nusiwo wotsɔ ƒoa nui:
Wotso ɣeyiɣi didi aɖe le titina malleolus ƒe nugbɔ .
Mɔfiame Pin ƒe ɖoƒe:
4–5 mm tso ƒunukpeƒea ƒe anyigba gbɔ .
Reaming & Trial Nail:
Ream up to the metaphysis, ɖo kpe ɖa ƒe lolome dzi .
Nail ƒe tsɔtsɔ de eme:
Ƒo asa na hammering, trɔ asi le goglome ŋu be nàkpɔ ƒunukpeƒea ta .
Fixation:
Screws siwo le wo nɔewo ŋu le wo nɔewo ŋu kple wo nɔewo ŋu .
DTN ƒe nudede eme ƒe ɖoɖo .
Woɖe mɔ ɖe afɔkpodzi ƒe ƒuƒoƒo ƒe ʋuʋu enumake kple afɔ-ɖe-afɔti ƒe kadodo ŋu le dɔwɔwɔ vɔ megbe si me
kpekpeme mele o hena kwasiɖa 4–6 ƒe
ŋgɔyiyi va ɖo kpekpeme dzi yiyi bliboe le kwasiɖa 8–12 dome, esime wole ŋku lém ɖe callus ƒe wɔwɔme kple vevesese ŋu .Afɔkpodzi ƒe ƒunukpeƒe ƒe dɔwɔwɔ dzea egɔme le amekoko vɔ megbe teti .
Ƒo asa na kpekpeme tsɔtsɔ na kwasiɖa 4–6 .
Trɔtrɔ vivivi yi kpekpeme dzi ɖeɖe blibo gbɔ le kwasiɖa 8–12 me .
Dɔnɔ 10 ƒe kplɔkplɔ ɖo .
Numekuku aɖe kplɔ dɔnɔ 10 ɖo (Tabla 1). Kaka ɣleti 3 naɖo le OP megbe la, nya 7 ye da gbe le eŋu; Dɔnɔawo katã kpɔ dɔyɔyɔ le ɣleti 6 me. Varus kple recurvatum ƒe nɔnɔme madeamedziwo ƒe akpa ɖesiaɖe dzɔ. Womekpɔ dziɖeɖi, dɔlékuiwo xɔxɔ, kuxi siwo do ƒome kple wo nɔewo, alo abi siwo woxɔ le iatrogenic ŋu o (Tabla 2).
nya 7 siwo woda gbe le le ɣleti 3 me; Wo katã woda gbe le wo ŋu le ɣleti 6 me .
2 ƒe nɔnɔme madeamedzi siwo mesẽ o (1 varus, 1 recurvatum) .
Dɔlékuiwo, ame ƒe ŋutilã ƒe akpa si wodona ɖe ame me ƒe kuxiwo, alo nusiwo bu le wo me dzi ɖeɖe kpɔtɔ aɖeke meli o .
Ŋutsu Dɔnɔ Si xɔ ƒe 69 .
Fracture ƒomevi:
Transverse tibial fracture + fibular fracture .
Kuxi si le eŋu:
Nuveviwɔame si le lãkusi falɛfalɛwo me .
Post-Op:
Nu sue 6 koe woɖe, dɔyɔyɔ blibo le ƒe 1 me .
Nɔnɔmetata 3 & 4:
Nɔnɔmetata siwo woɖe le radiographic kple le dɔwɔwɔ vɔ megbe ƒe nɔnɔmetatawo .
Nusiwo fia DTN .
Numekuku sia ƒe akpa aɖewoe nye AO 43-A kple C1 ƒe gbagbã; Wobu C2 hã ŋu. DTNwo ƒe didime nye milimeta 7 kple milimeta 8, eye woawoe dea dzesi alesi woatsɔ gavi siwo te ɖe wo nɔewo ŋu siwo te ɖe wo nɔewo ŋu la ade eme. Fractures siwo le 2–9 cm le articular surface dzi nye ame siwo sɔ nyuie na DTN fixation. Woate ŋu akeke dzesiwo ɖe enu wòaɖo AO 42 ƒe gbagbãƒewo.
Woate ŋu azãe na AO 43-A, C1, bu eŋu be yeakeke ɖe enu ayi C2 kple 42 .
Nu nyuitɔ kekeake siwo ado tso eme na gbagbãƒe 2–9 cm tso ƒunukpeƒea ƒe anyime .
Biomechanical ƒe liƒo .
Retrograde nails ƒe axial kple rotational stiffness si de ŋgɔ wu ne wotsɔe sɔ kple medial locking plates kple antegrade nails. Greenfield kple exɔlɔ̃wo. Wowɔ biomechanical dodokpɔ si ɖee fia be to distal screws zazã le DTN me ɖo 60–70% ƒe compressive stiffness kple 90% le torsional stiffness me ne wotsɔe sɔ kple screw etɔ̃. DTN ɖe Fracture Fragment ƒe ʋuʋu dzi kpɔtɔ le agba te. Le nɔnɔme 3 siwo mehaya le ɣleti 3 me o me la, nusiwo dometɔ aɖewoe nye lãkusi falɛfalɛwo ƒe gbegblẽ, medullary kekeɖenudɔwɔwɔ, ƒu ƒe gbagbã, kple ƒumeŋuɖui. Esi wònye be DTNwo ƒe lolome etɔ̃ koe le eme eye nusiwo wotsɔna ƒoa nu ɖe nu ŋu le didiƒe koe nyea gavi etɔ̃ ta la, woate ŋu ana liƒo si mesɔ o nagali le tɔdzisasrã gbadzawo alo ƒumeŋuɖui ƒe ƒu me o. Ele be woaɖɔ ŋu ɖo le nɔnɔme mawo tɔgbe me.
De ŋgɔ wu ʋuƒo siwo wotsɔna ƒoa nu kple antegrade ɖawo .
Aɖaŋuɖoɖo si wokafu be woatsɔ aɖo fixation: 2 proximal + 3 distal screws .
Viɖe siwo le DTN ŋu .
Ne wotsɔe sɔ kple agba siwo wotsɔna ƒoa nui la, lãkusi siwo le lãkusia me megblẽa nu le lãkusi falɛfalɛwo ŋu boo o, vevietɔ wosɔ na dɔnɔ tsitsiwo kple amesiwo xɔ abi vevie le lãkusi falɛfalɛwo ta tso nuveviwɔame si me ŋusẽ geɖe le me. Le numekuku sia me la, wotsɔ DTNwo de eme to nu sue ade ko me, eye lãkusi falɛfalɛwo ƒe kuxi aɖeke menɔ wo ŋu o. Dɔdamɔnua mehiã klo ƒe ʋuʋu o, si ɖea afɔku si le edzi ɖeɖe kpɔtɔ ƒe bublu me dzi kpɔtɔna eye wònana wòsɔna na dɔnɔ siwo ƒe klo ƒe ʋuʋu seɖoƒe li na (le kpɔɖeŋu me, klo ƒe ƒunukpeƒetetedɔ alo le TKA megbe).
Dɔnɔ siwo mewɔa nu boo aɖeke o, siwo sɔ nyuie na dɔnɔ tsitsiwo kple esiwo ŋu ŋusẽ le ŋutɔ siwo ŋu nuvevi wɔ .
klo ƒe ʋuʋu aɖeke mehiã o, si sɔ na klo ƒe ʋuʋu si seɖoƒe li na .
Amekoko ƒe afɔkuwo kple afɔɖeɖewo .
Afɔkuawo dometɔ aɖewoe nye abi si woxɔna le megbe tibialis lãmeka kple medial malleolar fracture ŋu. Woate ŋu atsɔ tension band wiring, plating, alo external fixation awɔ nu ɖe medial malleolar fractures ŋu.
Ele be woakpɔ nyuie be woagage ɖe fibular notch la me o. Mɔ̃ si wotsɔna ɖoa teƒe aɖe ate ŋu ana DTN ƒe megbe natrɔ le eƒe kpekpeme ta; Trɔ asi le gavi evelia ŋu be nàfia asi fibula la (Fig. 4C).Kuxi siwo ate ŋu ado tso eme:
Megbe tibialis ƒe abixɔxɔ, titina malleolar fracture .
Dzikpɔkpɔ:
Tension band, plating, alo gotagome fixator .
Screw mɔfiame kple teƒeɖoɖo mɔ̃ ƒe kpekpeme bia be woalé ŋku ɖe eŋu le dɔwɔwɔ me .
Dɔdaƒe ƒe tsɔtsɔ sɔ kple wo nɔewo .
Nonign kple malignment rates na antegrade nails nye 0–25% kple 8.3–50%, le wo nɔewo yome; Le ʋuƒo siwo wotsɔ xea mɔe gome la, 0–17% kple 0–17%. Le numekuku sia me la, nɔnɔmeawo katã ɖo union gbɔ, eye 20% koe ƒe nɔnɔme gblẽ >5°, si sɔ kple mɔnu xoxowo.Dɔléle ƒe agbɔsɔsɔme: Dɔlékui siwo le gota nye 0–8.3% na antegrade ɖawo kple 0–23% na plating plates; Dɔlékui goglowo nye 0–23% kple 0–8.3%, le wo nɔewo yome. Numekuku sia ka nya ta be lãmeka falɛfalɛwo me kuxi aɖeke mele o, si wɔ dɔ wu mɔnu eveawo siaa.Dɔwɔwɔ ƒe dzesiwo:
AOFAS ƒe xexlẽdzesiwo na antegrade ɖawo: 86–88 (ƒomevi A), 73 (ƒomevi C); Agbalẽ siwo wotsɔ xea mɔe: 84–88 (Ƒomevi A) .
Numekuku sia: AOFAS ƒe mamã dedie: 92.6.
EQ-5D-5L: Agbalẽ siwo wotsɔ xea mɔe: 0.62–0.76; Numekuku sia: 0.876
SAFE-Q (afɔ kple afɔkpodzi dɔnɔwo): 67–75; Numekuku sia: 83–91.7 (Tabla 3)
Union ƒe agbɔsɔsɔ, eƒe nɔnɔme madeamedziwo, kple dɔlékuiwo ƒe agbɔsɔsɔ wɔa dɔ wu mɔnu siwo wozãna tsã .
Dɔwɔwɔ ƒe dzesiwo (Aofas, EQ-5D-5L, Safe-Q) ɖe emetsonu nyuiwo fia
Kpuie ko la, DTN naa viɖewo wu ʋuƒo siwo wotsɔna ƒoa nu kple antegrade intramedullary nails eye wòtsi tre ɖi na egbɔkpɔnu nyui aɖe si woatsɔ ada distal tibial fractures.
DTN ƒe amedzidzedze sue aɖe koe le DTN ŋu, eƒe liƒo kɔkɔ, eye wòhayana kabakaba .
Enye mɔnu vevi aɖe si woate ŋu azã ɖe atikewɔwɔ siwo wozãna tsã teƒe eye edze be woadoe ɖe ŋgɔ .
Yamakawa Y, Uehara T, Shigemoto K, kple ame bubuwo. Nusiwo do tso eme ƒe ŋgɔgbedede si le didiƒe ʋĩ ƒe liƒolili kple akɔta ƒe ɖa si le didiƒe: numekuku si wowɔ le teƒe geɖe, si nye teƒe geɖe ƒe numekuku[J]. Nuveviwɔame, 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 [微信公众号文章]. 创伤骨科智能科技 智汇骨. 10. Nu kae nye 10. Nu kae nye 192, si nye 2025年06月07日
