Views: 0 Author: Site Editor Tata Ɣeyiɣi: 2025-07-07 Dzɔtsoƒe: Teƒe
Tibial shaft nye teƒe siwo wogbãna le wu dometɔ ɖeka, eye wònyea 13.7% le ŋutilã ƒe gbagbãwo katã me. Ŋutilã ƒe nɔnɔmewo le afɔkpodzi si le didiƒe abe ʋu ƒe fexexe nyuie o kple lãkusi falɛfalɛ sue aɖe ko ene. Ne lãmeka aɖe nya gbã ko la, lãmeka falɛfalɛwo ƒe gbegblẽ kple ʋu ƒe sisi le teƒea ƒe gbegblẽ ate ŋu ana lãmeka falɛfalɛa ƒe dɔyɔyɔ nasesẽ ɖe edzi. Tsɔ kpe ɖe eŋu la, alesi wòate ŋu adzɔe be ka ƒe gbagbã le ɣeyiɣi ɖeka me kple malikenyenye nana amekokomɔnu si sɔ tiatia le vevie ŋutɔ.
Tibial shaft ƒe titina vaseɖe etame ƒe akpa si wotso la nye dzogoe etɔ̃, gake etɔ̃lia si le ete la nye dzogoe ene. Titina kple ete ƒe akpa etɔ̃lia ƒe gododo le kpuie vie eye wòtsi tre ɖi na nɔnɔme ƒe tɔtrɔ, si wɔe be wònye teƒe si bɔ be wogbãna le.
Ŋutilã si me lãmekawo metsyɔ o koe tsyɔa afɔkpodzi ƒe akpa etɔ̃lia si le ŋgɔgbe, si wɔnɛ be wòte ŋu gbãna bɔbɔe le afisi ƒu kakɛawo toa ŋutigbalẽa me le. Le lãkusi siwo wotu gɔ̃ hã me la, ŋutigbalẽa kple ŋutigbalẽ te lãkusiwo ƒe gbegblẽ kpena ɖe afɔkpodzi ƒe gbagbã akpa gãtɔ ŋu. Lãmetsiwo metsyɔa titinatibia la dzi o, eye fascial ƒe akpa ene li siwo ƒo xlã tibia kple fibula. Compartment syndrome ƒe dzɔdzɔ sɔ gbɔ wu le tibial fractures me ne wotsɔe sɔ kple fractures bubuwo.
AO/OTA Arabgbe me xexlẽdzesiwo ƒe hatsotso yɔ tibial shaft ƒe gbagbãwo be 4 (tibia) 2 (shaft). A ƒomevi sɔ kple gbagbã bɔbɔe siwo ŋu gbagbãƒe ƒe fli ɖeka le, si nye ƒomevi si bɔ wu. Kakɛ si le titina si le abe wedge ene le B ƒomevi ƒe gbagbãƒewo ŋu. Ŋusẽ geɖe ƒe nuveviwɔame gbɔe C ƒomevi ƒe gbagbãwo tsona eye wonyea akpa aɖewo ƒe gbagbã siwo wogbãna.
Ƒomevi I: Abi ƒe didime mede sentimeta 1 o, zi geɖe la, enyea abi si me woɖe do le si le dzadzɛ vie eye ƒu ƒe nugbɔ dona to ŋutigbalẽa me. Lãmetsi falɛfalɛwo ƒe nugbegblẽ medea ame dzi boo o, eye abi aɖeke megbãna o. Gbagbãƒea le bɔbɔe, eƒe akpa si le tsia dzi, alo le kpuie si le tsia dzi, eye womegbãe o.
Ƒomevi II: Abi la wu sentimeta 1, eye lãmeka falɛfalɛwo gblẽna le eŋu wòkeke ta wu gake womeɖea abi alo ƒunukpeƒetetedɔ aɖeke o. Lãmetsi falɛfalɛwo ɖea abi si nu mesẽ o va ɖo esi le titina fiana, ɖiƒoƒo si sɔ, kple gbagbãƒea ƒe gbagbã le mɔ si sɔ nu.
Ƒomevi IIIA: Togbɔ be abi gã aɖe xɔ abi le avulsion alo flap formation, alo abi si ŋu ŋusẽ geɖe le metsɔ le abi ƒe lolome me o hã la, lãmeka falɛfalɛ siwo tsyɔa abi la dzi nyuie.
Ƒomevi IIIB: Lãmetsi falɛfalɛwo ƒe gbegblẽ kple woƒe bu geɖe, kple ƒu si le ƒunukpeƒewo ƒe ʋuʋu kple ƒu si woɖe ɖe go, si kpe ɖe ɖiƒoƒo sesẽ ŋu.
IIIC Ƒomevi: Edo ƒome kple ʋukawo ƒe abi si hiã be woadzrae ɖo.
Atikewɔwɔ siwo menye amekoko o na afɔkpodzi ƒe gbagbãwo dometɔ aɖewoe nye akɔtaɖonu, aŋɔsisi le gota gome, hehe, asiɖeɖe le eŋu, kple gotagome xɔtunu zazã. Amekoko ƒe tiatia aɖewoe nye be woatsɔ aŋea abla ɖe ʋuka si me wotu nu ɖo le ememe eye woatsɔ ati aƒoe ɖe lãkusi me, kple bubuawo.
Intramedullary nailing fixation nye nusi lɔ̃a ƒumeŋutinunyala geɖe siwo wɔa nuvevi ame le eƒe amekoko bɔbɔe, lãɖeɖe suesuesuewo, nuveviwɔame suetɔ kekeake, kple ɖaa ɖeɖe ɖa bɔbɔe le ƒu gbagbã ƒe dɔyɔyɔ vɔ megbe ta. Enaa ememe ƒe nuléle sesẽ, si wɔnɛ be woɖea mɔ na dɔwɔwɔ ƒe kamedede kaba le dɔwɔwɔ vɔ megbe eye wòƒoa asa na nutoa me kple ɖoɖowɔɖi ƒe kuxiwo. Viɖe siawo sɔ kple atikewɔwɔ ƒe gɔmeɖose siwo nye AO.
Anterior oblique cutting in proximal end xea mɔ na dzikudodo le patellar ligament ŋu.
Do ŋgɔ na proximal locking design dzia liƒo si wodi na proximal fragment la ɖe edzi.
Distal oblique locking option be woaxe mɔ ɖe lãmeka falɛfalɛwo ƒe gbegblẽ nu eye woadzi distal fragment ƒe liƒo ɖe edzi.
Locking screw si wowɔ kple lead ka eve be woatsɔ ade eme bɔbɔe.
Locking design for stronger fixation, ɖe dɔwɔwɔ vɔ megbe kakɛwo ƒe ʋuʋu dzi kpɔtɔ.
Multi points of fixation naa dzogoe ƒe liƒo kple li ke kpekpeɖeŋu na tibial palteau.
Mɔ̃a ɖea asitɔtrɔ ƒe dɔwɔwɔ si trɔna ɖe nɔnɔmewo ŋu fiana, eye eƒe nɔnɔme ƒe tɔtrɔ siwo woɖe fia le nɔnɔmetataawo me le nɔnɔme siwo me wodo ŋgɔ na nutete (nɔnɔme si me mekɔ o) kple esiwo le nutete megbe (si sɔ nyuie) siaa me.
Multi fixation mɔnu tso proximal kple distal, fia proximal kple distal tibial fractures mlɔeba.
Aɖaŋu si le ɖa gã la ƒe nuwuwu si le didiƒe ʋĩi la le gbadzaa, si wɔnɛ be woate ŋu atsɔe ade lãkusia me bɔbɔe.
Dzogoe me gavi eve siwo wotsɔ blaa nu le eƒe nuwuwu si te ɖe eŋu la xea mɔ na akpa si gbã la ƒe tɔtrɔ kple eƒe ʋuʋu.
Ŋutilã ƒe wɔwɔme tɔxɛ aɖe nana be ɖa vevitɔa le teƒe nyuitɔ kekeake le lãkusia me.
Dzogoe ƒe gavi etɔ̃ siwo do go le eƒe nuwuwu si le didiƒe la naa kpekpeɖeŋu nyuie eye wòléa nu ɖe te.
Esɔ na tibial shaft ƒe gbagbã akpa gãtɔ (midshaft kple distal/proximal fractures aɖewo), gake wowɔ ƒomevi bubuwo (le kpɔɖeŋu me, DTN alo Expert Nail) na ŋutilã ƒe akpa aɖewo koŋ alo fractures sesẽwo.
Mɔnu si wozãna ɖaa (parapatellar alo transpatellar) zɔna ɖe ɖoɖo si woɖo anyi nyuie dzi kple nusɔsrɔ̃ ƒe fli si bɔbɔ ɖe anyi wu, gake mɔnu tɔxɛwo (le kpɔɖeŋu me, suprapatellar) ya bia mɔ̃ɖaŋununya ƒe hehe bubuwo.
Ne wotsɔe sɔ kple ɖa tɔxɛwo abe Expert Nail alo DTN ene la, zi geɖe la, tibial intramedullary nails siwo wozãna ɖaa la ƒe asi bɔbɔ wu, si wɔnɛ be wosɔ na dɔléle siwo wowɔna edziedzi.
Ewɔa dɔ kple xexeame katã ƒe dɔwɔnuwo (le kpɔɖeŋu me, gavi siwo wotsɔ xea mɔe, mɔ̃ siwo wotsɔ ɖoa taɖodzinui), gake ɖa tɔxɛwo (le kpɔɖeŋu me, ɖaƒoƒo Eŋutinunyala si si ʋuƒo ƒe ɖoɖo siwo yia mɔ vovovowo dzi le) ate ŋu abia dɔwɔnu siwo nye wo tɔ.
| Type | Best Indications | Viɖe Veviwo |
|---|---|---|
| Eŋutinunyala Nail | Ƒumeŋuɖui ƒe gbagbã sesẽwo, ƒumeŋuɖui | Multi-planar ʋuʋu, liƒo kɔkɔ |
| Suprapatellar ƒe ɖaƒoƒo | Proximal fractures, dɔnɔ siwo lolo akpa | Suprapatellar mɔnu, ɖea klo ƒe ŋgɔgbe kuxiwo dzi kpɔtɔna |
| DTN | Distal fractures (si te ɖe afɔkpodzi ƒe ƒunukpeƒe ŋu) . | Multi-mɔfiame didiƒe ʋuʋu, tsi tre ɖe kpuie |
| Standard Nail | Mid-shaft ƒe gbagbã bɔbɔewo | Dɔwɔwɔ bɔbɔe, si mexɔa ga geɖe o |
Dɔwɔnu Siwo Wotsɔ Kua Ƒui : Domenuwo, reamers, kple dɔwɔnu bubu siwo wozãna tẽ tsɔ kua ƒuwoe hã le eme.
Targeting Devices : Dɔwɔnu siwo wotsɔ ɖoa teƒe si wotu tomekuku alo nusiwo wotsɔ dea lãme na ame ƒe teƒe kple mɔfiame, abe mɔfianu kawo, mɔfianu ƒe abɔta, kple mɔ̃ siwo wotsɔna ɖoa taɖodzinui ene.
Fixation Instruments : Dɔwɔnu siwo wozãna tsɔ doa ka, xea mɔ, alo trɔa asi le nusiwo wotsɔ dea lãme na ame ŋu, abe xexeame katã ƒe ƒunukpeƒewo, safuiwo, gaviwo, kple akplɔwo ene.
Dɔwɔnu Siwo Dzia Nu : Dɔwɔnu siwo wotsɔ dzidzea goglome, teƒe si wòle, alo kpena ɖe amekoko ŋu, abe goglomedzidzenu, ƒumeŋuɖui siwo dzi ɖena kpɔtɔna, kple ƒu ƒe ʋuƒo (AWL) ene.
Nɔnɔmetatawo Me Dzodzro: X-ray/CT do ŋgɔ na dɔwɔwɔ na ame be woatsɔ aɖo kpe gbagbã ƒomevi, medullary canal ƒe didime kple didime dzi, eye woadzidze akɔta ƒe akpa si tsi tre ɖe eŋu abe nusi woatsɔ akpɔe ene.
Ðoƒe: Afɔdzidede kple klo ƒe ƒoƒo 90°-120° kple akɔta ƒe ʋuʋu vie (be wòaɖe patellar tendon ƒe tete dzi akpɔtɔ). Dzogoe etɔ̃ me radiolucent frame ate ŋu alé popliteal fossa la ɖe te be wòahe.
Sterile Draping: Afɔ kple afɔ ƒe vidzidzi kple draping si wozãna ɖaa, si naa C-alɔ ƒe ʋuʋu.
Asi Hehe: Kpeɖeŋutɔ zãa hehe didi esime amekola le asi lém ɖe tibial crest kple anteromedial surface ŋu be yeatrɔ asi le woƒe ɖoɖo nu (didime, tɔtrɔ, dzogoe).
Dɔwɔnu Siwo Kpena Ðe Ame Ŋu:
Joystick Mɔnu: Schanz-gavi siwo wotsɔ dea proximal/distal fragments me hena lever dzi ɖeɖe kpɔtɔ.
Percutaneous Clamping: Pointed reduction forceps na oblique/spiral gbagbãwo.
Distractor: Distractor gã aɖe si woda ɖe coronally (proximal Schanz screw parallel to tibial plateau, distal pin in talus alo distal tibia) be wòalé didime ɖe te.
Dzesi siwo ɖe dzesi:
Teƒe si woge ɖo 1cm didi tso ŋgɔgbe tibial plateau ƒe nugbɔ, si sɔ kple medullary axis.
Fluoroscopic kpeɖodzi: AP ƒe nukpɔkpɔ sɔ kple tibial crest, axadzikpɔkpɔ sɔ kple tibial axis.
Dɔwɔnu Siwo Wotsɔ Ʋua Nui:
Cannulated drill le guidewire (si me ametakpɔnu ƒe abɔta le) alo curved solid awl.
Asi reamers (6-8mm) na xoxo gbagbãwo kple canal occlusion.
Mɔfiameka ƒe Ðoɖo: Mɔfianu si ƒe nugbɔ le bɔl si wobɔbɔ 10-15mm le eƒe nugbɔ hena gbagbã ƒe mɔzɔzɔ. Fluoroscopic kpeɖodzi le distal physeal scar (afɔkpodzi titina).
Reaming ƒe Ðoɖowɔɖi:
Reamers siwo te ŋu trɔna bɔbɔe dzea egɔme tso 8mm, dzina ɖe edzi 0.5mm vaseɖe cortical 'chatter' (zi geɖe la, 1-1.5mm > nail diameter).
De dzesii: Ne woɖe nu le eme ɣeaɖewoɣi la, eɖea gbeɖuɖɔwo ɖa; ƒo asa na dzoxɔxɔ ƒe ame kuku.
Didime ƒe Nyametsotso:
Dzidzedze le dɔwɔwɔ me: Mɔfiameka si wotsɔ ƒoa ƒui ƒe mɔnu alo fluoroscopic ruler (teƒe si woge ɖo yi afɔkpodzi ƒe ƒunukpeƒe).
Kpɔ egbɔ be ɖa ƒe nugbɔ ɖo physeal scar gbɔ proximal protrusion manɔmee.
Mɔnu si Wotsɔ Dea Nu Me:
Asi-ŋgɔyiyi ɖe mɔfianu dzi; trɔ asi le edziɖeɖekpɔtɔ ŋu ne tsitretsitsi dzɔ.
Lé edzi ɖe te le mɔzɔzɔ me na distal fractures.
Tsitretsitsi ƒe Mɔnu
Gbagbãƒe siwo li ke le didime nu: Woƒe ʋuʋu te ɖe wo nɔewo ŋu gbã (screw ɖeka ɖea mɔ na dynamization).
Length-unstable/comminuted fractures: Distal locking gbã eye 'backslap' kplɔe ɖo be woatsɔ aƒoe.
Locking si Te Ðe Eŋu
≥2 screws to aiming device (mɔ geɖe dzi na proximal fractures).
Adzɔge ʋĩi ƒe Ʋuʋu
Fluoroscopic mɔnu: Titina keklẽ si le tsitre ɖe do siwo wotsɔ gavi wɔe ŋu ('ƒo xlãe deblibo'), tomekuku to ŋutigbalẽ me.
≥2 screws na distal fractures (ate ŋu aƒo AP/oblique orientations nu ƒu).
End Cap: Ne èdi be yeade eme (exea mɔ na ƒu ƒe tsitsi ɖe eme), kpɔ egbɔ be ƒunukpeƒe aɖeke medo go o.
Abi ƒe Nutsotso: Wodzraa patellar tendon ɖo ɖe ƒuƒoƒo me kple lãkusi te siwo me mekɔ o.
Gbugbɔgaɖɔɖo Kaba:
Abɔ kple afɔ ƒe kɔkɔme; ŋkuléle ɖe compartment syndrome ŋu le 24hrs me.
Dze ƒunukpeƒetetedɔ si le dɔ wɔm gɔme (afɔkpodzi ƒe pɔmpiwo, klo ƒe ƒoƒo) le POD 1-2 dzi.
Kpekpeme Dzitsɔtsɔ ƒe Ðoɖowɔɖi:
Kpekpeme ƒe akpa aɖe tsɔtsɔ kwasiɖa 6 (wotrɔ asi le eŋu le liƒo ɖesiaɖe nu), yi ŋgɔ va ɖo bliboe ne callus do.
Dɔwɔwɔ ɖe edzi: Dɔdaƒe/yakeliŋutinunya ƒe dodokpɔ le kwasiɖa 2, 6, kple 12 me.
Dɔwɔƒegã: Raynham, Massachusetts, U.S.A
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
Expert Tibial Nail (ETN) – Wotrɔ asi le eŋu be wòali ke le tibial ƒe gbagbã sesẽwo me.
T2 Tibial Nail – Enaa fixation kple compression si nyo wu.
Ŋusẽ Veviwo: Numekuku kple ŋgɔyiyi sesẽ, xexeame katã ƒe mama, kple ɖekawɔwɔ kple nuveviwɔame gbɔ kpɔnu.
Dɔwɔƒegã: Kalamazoo, Michigan, U.S.A
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
T2 Tibial Nail – Modular ɖoɖo na tibial shaft ƒe gbagbã.
Gamma3 Tibial Nail – Eƒoa intramedullary nailing kple locking tiatia nu ƒu.
Ŋusẽ Veviwo: Robot deŋgɔwo (Mako), egbɔkpɔnu siwo mewɔa nu boo aɖeke o, kple nuveviwɔame ƒe agbalẽ sesẽ.
Dɔwɔƒegã: London, Eŋlisiawo
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
TRIGEN Tibial Nail – Wotrɔ asi le eŋu be woatsɔe ade eme bɔbɔe eye wòali ke.
IM Tibial Nail – Intramedullary fixation na tibial ƒe gbagbã.
Ŋusẽ Veviwo: Lé fɔ ɖe kamedefefewo ƒe atikewɔwɔ kple nuveviwɔame, nu yeyewo ŋu.
Dɔwɔƒegã: Changzhou, China
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
Distal Tibial Intramedullary Nail (DTN) – Wotrɔ asi le eŋu nyuie wu na didiƒe ƒe gbagbã.
Eŋutinunyala Tibia Intramedullary Nail – Ŋusẽ gã titanium akɔbli ƒe nɔnɔme.
Suprapatellar Mɔnu Tibial Intramedullary Nail – Nusiwo wotsɔ dea eme si mewɔa nu boo aɖeke o.
Tibial Intramedullary Nail – Tiatia siwo woate ŋu azã le mɔ vovovowo nu.
Ŋusẽ Veviwo: egbɔkpɔnu siwo me ga menɔa anyi o, xexeame katã ƒe anyinɔnɔ keke ɖe enu.
Dɔwɔƒegã: Warsaw, Indiana, U.S.A
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
ZNN Tibial Nail – Anatomic ƒe nɔnɔme hena eƒe dzedzeme nyuie wu.
Dzɔdzɔme Nail System – Srɔa dzɔdzɔme ƒu ƒe mɔ̃ɖaŋununya.
Ŋusẽ Veviwo: Esẽ le ƒunukpeƒewo gbugbɔgatu, biologics ƒe ƒoƒo ɖekae, kple egbɔkpɔnu siwo wowɔ na ame ŋutɔ me.
Dɔwɔƒegã: Lewisville, Texas, U.S.A
Adzɔnu Siwo Wozãna Le Nu Gbagbewo:
LON Tibial Nail (Lateral Orthopedic Nail) – Wotrɔ asi le eŋu na axadzi gegeɖe mɔnu.
Ŋusẽ Veviwo: Etɔxɛe le ƒu ƒe tsitsi ƒe ʋuʋu, abɔ kple afɔ ƒe nɔnɔme madeamedzi ɖɔɖɔɖo me.
CZMEDITECH naa tibial nailing solutions blibo na proximal, distal, kple complex fractures, kple aɖaŋu yeyewo (le kpɔɖeŋu me, multi-directional locking, suprapatellar approach) si sɔ kple xexeame katã ƒe adzɔnu xɔŋkɔwo le biomechanics kple dɔdamɔnu me tsonu me.
Nusiwo Wowɔ