Distal Tibial Nail: Gbɔdzɔe aɖe le Distal Tibial Fractures ƒe Atikewɔwɔ me

Distal tibial fractures bɔ, eye seɖoƒe li na atikewɔwɔ deŋgɔwo

Distal tibial fractures nye abɔ kple afɔ ƒe gbagbã ƒomevi aɖe si bɔ. Dɔdamɔnu siwo wozãna tsã abe gavi siwo wotsɔ blaa nu kple ɖa siwo wotsɔna ƒoa ɖae siwo le lãkusi me siwo le ŋgɔgbe ene dometɔ ɖesiaɖe ƒe kuxiwo le wo ŋu. Plɛti siwo wotu ate ŋu ana dɔlékuiwo naxɔ ame le dɔwɔwɔ vɔ megbe alo lãmeka falɛfalɛwo naku, si ana hayahaya nadidi; togbɔ be antegrade nails mewɔa nu boo aɖeke o hã la, woate ŋu agblẽ nu le klo ƒe ƒunukpeƒe ŋu, ana wòase veve, eye afɔku siwo nye be womate ŋu abla wo nyuie o alo womawɔe nyuie o, si axe mɔ na eƒe hayahaya.

Egbɔkpɔnu yeye: Distal Tibial Nail (DTN) .

Atikewɔwɔ ƒe mɔnu yeye aɖe—Distal Tibial Nail (DTN)—na nukpɔsusu yeye aɖe le distal tibial gbagbãwo gbɔ kpɔkpɔ ŋu kple eƒe megbedede ƒe nɔnɔme tɔxɛ aɖe.

Dɔnɔ ƒe nɔƒe ɖoɖo kple dzadzraɖo ɖe edzi ɖeɖe kpɔtɔ

Wotsɔa dɔnɔa dana ɖe anyinɔƒe. Ele be woatsɔ asi aɖe gbagbãƒe siwo woɖe ɖa la dzi akpɔtɔ; ne ehiã la, zã reduction forceps nàtsɔ akpe ɖe ŋuwò hafi nàde DTN la eme. Ne fibular fracture kpe ɖe eŋu la, fibular ƒe ɖoɖowɔwɔ nyuie ate ŋu akpe ɖe tibial dzi ɖeɖe kpɔtɔ ŋu. Woate ŋu atsɔ ɖa siwo le lãkusi me ana fibular shaft ƒe gbagbãwo nali ke. Le afɔkpodzi ƒe gbagbã siwo ƒo xlã afɔkpodzi gome la, ele be ŋutilã ƒe wɔwɔme dzi ɖeɖe kpɔtɔ kple fibula ƒe etɔtrɔ nado ŋgɔ na tibial ƒe ɖeɖeɖa be woaƒo asa na eƒe masɔmasɔ. Le gbagbãƒe siwo le ʋuʋu ɖi siwo me gotagome nuléle si li xoxo le me la, woate ŋu ade ɖaa eme esime wole nusi wotsɔ léa ɖae la me ɖem be woaɖe edzi akpɔtɔ.

Woɖea didime sentimeta 2–3 le titina malleolus ƒe nugbɔ be woaɖe deltoid ligament si le etame la afia. Wotsɔa mɔfianu dea malleolus ƒe nugbɔ alo le titina vie (Fig. 2a), si didi tso ƒunukpeƒea gbɔ milimeta 4–5. Axadzikpɔkpɔ ɖee fia be wotsɔe de eme to intercondylar groove (Fig. 2b), si ƒoa asa na nusiwo gblẽ le megbe tibialis lãmeka ŋu. Ma deltoid ligament si le etame la ɖe vovo, emegbe nàzã reamer atsɔ adzi medullary canal la ɖe edzi vaseɖe metaphyseal nuto me (Fig. 2c). Ðe cancellous bone si te ɖe proximal medial cortex ŋu ɖa be nàtsɔ ɖaa ade eme (Fig. 2d). De dodokpɔ ƒe ɖa aɖe eme be nàɖo kpe DTN ƒe lolome dzi (Fig. 2e). Ƒo asa na haƒoƒo alo eƒe ʋuʋu fũ akpa be nàxe mɔ ɖe iatrogenic medial malleolar fracture nu. Trɔ asi le ɖa ƒe goglome ŋu be nàkpɔ egbɔ be gavi siwo le didiƒe nagage ɖe afɔkpodzi ƒe ƒunukpeƒe alo afisi wògbã le o. Wotsɔa gavi siwo blana ɖe wo nɔewo ŋu le teƒe si te ɖe wo nɔewo ŋu kple esiwo le didiƒe la léa nu ɖe ​​te.

Woɖe mɔ na afɔkpodzi ƒe ƒunukpeƒe ƒe ʋuʋu enumake kple afɔ kple anyigba ƒe kadodo le dɔwɔwɔ vɔ megbe
Kpekpeme matsɔmatsɔ kwasiɖa 4–6
Yi ŋgɔ va ɖo kpekpeme tsɔtsɔ bliboe le kwasiɖa 8–12 dome, esime wole ŋku lém ɖe callus ƒe wɔwɔme kple vevesese ŋu

Afɔkpodzi ƒe ƒunukpeƒewo ƒe dɔwɔwɔ dzea egɔme le amekoko vɔ megbe teti

Ƒo asa na kpekpeme tsɔtsɔ kwasiɖa 4–6

Trɔtrɔ vivivi yi kpekpeme tsɔtsɔ bliboe gbɔ le kwasiɖa 8–12 me

Dɔnɔ 10 ƒe kplɔkplɔ ɖo

Numekuku aɖe kplɔ dɔnɔ 10 ɖo (Tabla 1). Kaka ɣleti 3 naɖo le dɔwɔwɔ nɛ vɔ megbe la, dɔléle 7 haya; dɔnɔawo katã kpɔ dɔyɔyɔ le ɣleti 6 me. Varus kple recurvatum ƒe nɔnɔme madeamedziwo dometɔ ɖesiaɖe dzɔ. Womekpɔ nusiwo dzi ɖe kpɔtɔ, dɔlékuiwo xɔxɔ, kuxi siwo do ƒome kple nusiwo wotsɔ dea lãme na ame, alo abi siwo tso iatrogenic me o (Tabla 2).

Ŋutsu dɔnɔ si xɔ ƒe 69

Dzesiwo na DTN

Numekuku sia lɔ AO 43-A kple C1 ƒe gbagbãwo ɖe eme; Wobu C2 hã ŋu. DTN-wo li le didime si nye milimeta 7 kple milimeta 8, siwo fiaa afisi woaɖo gavi siwo tsia tre ɖe wo nɔewo ŋu le wo nɔewo gbɔ. Gbagbãƒe siwo le sentimeta 2–9 le ƒunukpeƒea tame nye esiwo sɔ nyuie na DTN ƒe tsɔtsɔ. Woate ŋu akeke dzesiwo ɖe enu wòaɖo AO 42 ƒe gbagbãƒewo gbɔ.

Biomechanical ƒe Liƒo

Retrograde nails ƒe axial kple rotational stiffness nyo wu ne wotsɔe sɔ kple medial locking plates kple antegrade nails. Greenfield kple exɔlɔ̃wo. wɔ biomechanical dodokpɔ si ɖee fia be distal screws eve zazã le DTN me ɖo 60–70% le compressive stiffness kple 90% le torsional stiffness ne wotsɔe sɔ kple screw etɔ̃. DTN ɖe gbagbã kakɛ ƒe ʋuʋu le agba te dzi kpɔtɔ. Le dɔléle 3 siwo mehaya le ɣleti 3 me o me la, nusiwo gbɔ wòtso dometɔ aɖewoe nye lãmeka falɛfalɛwo ƒe gbegblẽ, ƒumeŋuɖui ƒe keke, afisi wògbã, kple ƒu ƒe gbagbã. Esi wònye be DTN-wo ƒe lolome nye etɔ̃ ko eye distal fixation nyea gavi etɔ̃ ko ta la, woate ŋu ana woali ke nyuie le tɔdzisasrã gbadzawo alo ƒu si me ƒu le me o. Ele be woate ɖe kpekpeme tsɔtsɔ kaba ŋu kple ŋuɖɔɖɔɖo le nɔnɔme mawo tɔgbe me.

Viɖe siwo le DTN ŋu

Ne wotsɔe sɔ kple agbalẽvi siwo wotu la, ɖa siwo le lãkusi me megblẽa nu le lãkusi falɛfalɛwo ŋu boo o, vevietɔ na dɔnɔ tsitsiwo kple amesiwo xɔ abi vevie le lãkusi falɛfalɛwo ŋu le nuveviwɔame si ŋu ŋusẽ geɖe le ta. Le numekuku sia me la, wotsɔ DTN-wo de eme to lãɖeɖe sue ade ko me, eye lãmeka falɛfalɛwo ƒe kuxi aɖeke menɔ eŋu o. Dɔdamɔnua mehiã be woabɔbɔ klo o, si ɖea afɔku si le be woaɖe klo dzi akpɔtɔ ƒe bublu dzi kpɔtɔna eye wònana wòsɔna na dɔnɔ siwo klo ƒe ʋuʋu seɖoƒe li na (le kpɔɖeŋu me, klo ƒe ƒunukpeƒetetedɔ alo TKA megbe).

Amekoko ƒe Afɔkuwo Kple Afɔɖeɖewo

Afɔkuawo dometɔ aɖewoe nye abixɔxɔ le megbeƒu ƒe lãmeka ŋu kple titina ƒe lãkusi ƒe gbagbã. Woate ŋu atsɔ tension band wiring, plating, alo gotagome fixation awɔ atike na medial malleolar fractures.
Ele be woakpɔ nyuie be gavi nagage ɖe fibular notch la me o. Mɔ̃ si wotsɔ dea dzesi teƒea ate ŋu ana DTN la natrɔ ɖe megbe le eƒe kpekpeme ta; trɔ asi le gavi evelia ŋu be wòafia asi fibula la gbɔ (Fig. 4c).

Dɔdaƒewo ƒe Nusɔsɔe

Nonunion kple malalignment ƒe agbɔsɔsɔme na antegrade nails nye 0–25% kple 8.3–50%, le wo nɔewo yome; na agbalẽvi siwo wotsɔ xea mɔ na wo la, 0–17% kple 0–17%. Le numekuku sia me la, dɔléleawo katã ɖo ɖekawɔwɔ gbɔ, eye 20% koe ƒe nɔnɔme madeamedzi >5°, si sɔ kple mɔnu xoxowo.Dɔlékui ƒe agbɔsɔsɔ: dɔlékui si le gotae nye 0–8.3% na antegrade nails kple 0–23% na locking plates; dɔlékui goglowo nye 0–23% kple 0–8.3%, le wo nɔewo yome. Numekuku sia megblɔ be lãmeka falɛfalɛwo ƒe kuxi aɖeke medzɔ o, eye wòwɔ dɔ wu mɔnu eveawo siaa.Dɔwɔwɔ ƒe dzesiwo:

Kpuie ko la, DTN naa viɖewo wu ʋuƒo siwo wotsɔ blaa nu kple antegrade intramedullary nails eye wòtsi tre ɖi na egbɔkpɔnu nyui aɖe si woatsɔ ada distal tibial fractures.

DTN ƒe dzesiwo megena ɖe ame dzi boo o, eƒe li ke ŋutɔ, eye wòhayana kabakaba

Enye atike xɔasi aɖe si woate ŋu azã ɖe atikewɔmɔnu siwo wozãna tsã teƒe eye edze be woadoe ɖe ŋgɔ