Tibial ƒe gbagbã, suprapatellar intramedullary nailing mɔnu

Intramedullary tibial nailing: mɔɖeɖe kple eƒe ɖoɖowɔwɔ, klo ƒe vevesese le ŋgɔgbe

Amekoko ƒe mɔnu si wozãna tsɔ ƒoa ɖa le abɔta ƒe gbagbãƒewo ŋu le vevie be woate ŋu atsɔ ɖa si le lãkusia me la ato teƒe si sɔ, be woaɖe nusiwo gblẽ le klo ƒe wɔwɔme siwo le ƒunukpeƒewo ŋu dzi akpɔtɔ, eye woakpɔ gbagbãƒea ƒe teƒe nyuitɔ kekeake kple ɖaa ƒe gege ɖe eme nyuie.

Mɔnu siwo wozãna tsã na tibial stem fractures enye infrapatellar median alo infrapatellar parapatellar mɔnu. Togbɔ be woɖe mɔnu siawo fia na titina ƒe akpa ƒe gbagbã hã la, dɔwɔwɔ vɔ megbe valgus, ŋgɔgbe, alo ƒokpli ƒe nɔnɔme madeamedziwo dzɔna zi geɖe le gbagbã siwo te ɖe wo nɔewo ŋu wu me.

Nu vevitɔ si hea nu masɔmasɔ vɛ le proximal tibial fractures me enye nuwɔametɔ si tsoa akɔta ƒe lãkusi ƒe hehe le klo ƒe ƒoƒo me kple mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbe tibial cortex dome le implant dede me gbɔ. Patella hã xea mɔ na axial nail ƒe gege ɖe sagittal plane me (Fig. 1a, b). Eyata mɔnu bubu si bɔ si dzi woato aɖo teƒeae nye to titina ƒe parapatellar incision, si wɔnɛ be wotsɔa ɖa dea titina vaseɖe axadzi vie (Fig. 1c kple 2). Ne ɖaa ge ɖe intramedullary canal si le didiƒe ʋĩ tso gbagbãƒea gbɔ la, akpa si te ɖe eŋu la trɔna zua valgus (Nɔnɔmetata 2). Mlɔeba la, ŋgɔgbekpa ƒe lãmekawo ƒe gbɔɖeme ƒe tete kpena ɖe valgus ŋu vie (Nɔnɔmetata 3).

Figure 1 a,b Ne wozã infrapatellar mɔnu si bɔ la, patella xea mɔ na ɖaa ƒe axial gege ɖe eme, si wɔnɛ be anterior apical sagittal alignment kple valgus coronal alignment ƒe nɔnɔme madeamedzi si bɔ. c Parapatellar mɔnu zazã hena intramedullary nail alignment.

Nɔnɔmetata 2 Ne wogogo afisi woage ɖo to titina ƒe parapatellar incision me la, ehea ɖa si wotsɔ dea titina vaseɖe axadzi vie vɛ. Ne ɖaa ge ɖe medullary canal si le didiƒe ʋĩ tso gbagbãƒea gbɔ (a) la, akpa si te ɖe eŋu la trɔna zua valgus (b) .

Nɔnɔmetata 3 Gbɔɖeme ƒe tete le ŋgɔgbe lãmeka ƒe akpa ( a ) naa ɖoɖo si menya kpɔna dzea sii bɔbɔe o si le vidzidɔa godo ( b ) .

Ne wotsɔ afɔkpodzia bla ɖe teƒe si keke wu la, ekpena ɖe ame ŋu be woaƒo asa na kuxi siwo do ƒome kple klo ƒe ƒoƒo sesẽ le dɔwɔwɔ me. aɖaŋua ŋue Gelbke, Jakma kple exɔlɔ̃wo ƒo nu tsoe. le ƒe 2010 me eye wòva xɔ ŋkɔ geɖe wu le ƒe ʋɛ siwo va yi me elabena ne wotsɔ afɔkpodzia ƒo ɖe abɔta ƒe nɔnɔme si le dzɔdzɔe kloe me la, enaa asitɔtrɔ le afɔkpodzi ƒe gbagbã ŋu kple eɖoɖo ɖe teƒe bubu nɔa bɔbɔe. Fluoroscopy wɔwɔ va le bɔbɔe le mɔ̃ɖaŋununya gome. Woka nya ta be ɣeyiɣi siwo woatsɔ akpɔ fluoroscopy na suprapatellar nailing la le kpuie ŋutɔ wu infrapatellar nailing. Tsɔ kpe ɖe eŋu la, dzogoe si dzi wotsɔ ɖaa de (le sagittal plane me) sɔ kple afɔkpodzi ƒe didime ƒe axadzi le mɔnu sia me wu le infrapatellar nail me; esia xea mɔ na mɔ̃ɖaŋunuwo ƒe dzrewɔwɔ le ɖaa ƒe nugbɔ kple megbeƒu ƒe lãkusi dome, si wɔnɛ be ɖa ƒe gbagbã dzi ɖeɖe kpɔtɔ nɔa bɔbɔe.

Klo ƒe vevesese le dɔwɔwɔ vɔ megbe nye kuxi si do ƒome kplii. Woka nya ta be klo ƒe veve le ŋgɔgbe le dɔnɔ siwo ƒe lãme gbã ƒe 50-70% me, eye dɔnɔ 30% koe kpɔa vevesese dzi ɖena kpɔtɔna le numiemie si le eme la ɖeɖeɖa megbe. Wobu akɔnta be abi ƒe dzɔdzɔ si do ƒome kple gege ɖe patellar tendon kple Hoffa fat pad me nye nusi ate ŋu ahe klo ƒe vevesese vɛ le dɔwɔwɔ vɔ megbe. Tsɔ kpe ɖe eŋu la, suprapatellar mɔnu ƒoa asa na saphenous nerve ƒe patellar alɔdze ƒe alɔdze si woɖena le kɔnu nu, si wɔnɛ be klo ƒe ŋgɔgbe ƒe ʋuʋu kple seselelãme ƒe kuviawɔwɔ (Nɔnɔmetata 4). Edze abe ne wotsɔ ɖaa to asike ƒe lãkusi ene me, si wɔnɛ be patellar lãkusia natsi anyi la, ɖea klo ƒe vevesese le dɔwɔwɔ vɔ megbe dzi kpɔtɔna ŋutɔ ene.

Le nu nyui siwo dona tso proximal fractures me ta la, wokeke dzesi siwo le dɔdaƒewo ɖe enu ɖe ​​gbagbãƒewo katã ŋu.

Ɣekaɣie wòle be woazã suprapatellar intramedullary nail?

Viɖe siwo le eŋu

• Klo ƒe nɔnɔme si keke afã kple afã doa gbagbã ƒe asitɔtrɔ kple egbugbɔɖoɖo ɖe ŋgɔ to lãmeka ƒe ŋusẽ kple eƒe léle ɖe te dzi ɖeɖe kpɔtɔ le ɖa dede eme me

• Afɔku si le dɔwɔwɔ vɔ megbe ƒe ʋuʋu le proximal, segmental kple distal fractures me le ʋɛ wu ne wotsɔe sɔ kple mɔnu siwo wozãna ɖaa

• Le mɔ̃ɖaŋununya gome la, atitsotso ƒe dɔwɔwɔ le bɔbɔe wu

• Nail dede nye nusi woateŋu awɔ abe 'amekola ɖeka ƒe dɔwɔwɔ' ene.

• Fluoroscopy ƒe ɣeyiɣi dzi ɖe kpɔtɔ

• Nu gblẽ le patellar tendon ŋu o eye klo ƒe ŋgɔgbe vevesese le stapling megbe ƒe dzɔdzɔ dzi ɖe kpɔtɔ

• Ele bɔbɔe be woawɔe le ƒuƒoƒo geɖe ƒe dɔwɔwɔ me, abe alesi wòle le nuveviwɔame geɖe me ene

  
  

Nusiwo ɖee fia

• Extra-articular fracture of the proximal tibia (AO 41A ƒomevi) .

• Tibial diaphysis ƒe gbagbã bɔbɔe si wogbã (AO 42A-C ƒomevi) .

• Segmental tibial diaphyseal ƒe gbagbã (AO 42C ƒomevi) .

• Distal tibial extra-articular fractures kple intra-articular distal extension fractures bɔbɔe (AO 43A kple C1 ƒomeviwo) .

• Klo si le tsia dzi

• Patellar ossification kple patellar tendon ƒe ƒu ƒe ʋuʋu

• Abi si me dɔlékui le le patellar tendon ƒe dzidzeme

Ale Si Nàƒle Ƒumeŋuɖuiwo Kple Ƒumeŋuɖui Dɔwɔnuwo?

Elabena CZMEDITECH , míekpɔa adzɔnuwo ƒe hatsotso si de blibo ŋutɔ si me ƒumeŋuɖui ƒe amekoko ƒe nusiwo wotsɔ dea ame me kple dɔwɔnu siwo sɔ kplii, nusiwo dometɔ aɖewoe nye akɔta ƒe akpa siwo wotsɔ dea ame me, ɖa siwo le lãkusi me, trauma plate, ʋuƒo si wotsɔ xea mɔ na nu, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, gotagome fixators, ƒunukpeƒetetedɔ (arthroscopy)., lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe kpeɖeŋutɔ dɔwɔnuwo.

Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi anɔ atike yeyewo wɔm eye míakeke adzɔnuwo ƒe hatsotsowo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho geɖe wu le xexeame katã ƒe ƒumeŋuɖui kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.

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