Tibial ƒe gbagbã, suprapatellar intramedullary nailing mɔnu .

Intramedullary Tibial Nailing: Access and Alignment, Anterior klo ƒe vevesese .

Amekoko ƒe mɔnu si nye be woatsɔ lãkusi ƒe gbagbãwo aƒo ɖe lãkusi me la le vevie be woatsɔ ade lãkusi si le lãkusia me la me to teƒe si sɔ la me, be woaɖe klo ƒe wɔwɔme siwo le ƒunukpeƒea me la dzi akpɔtɔ, eye be woaɖo afisi wogbugbɔ ɖo ɖe teƒe si sɔ nyuie wu kple ɖa ƒe gege ɖe eme nyuie.

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

Nusi koŋ gbɔ wòtsona be nu manyomanyo si le lãkusi ƒe gbagbã siwo te ɖe eŋu mee nye nɔnɔme madeamedzi si tsoa quadriceps ƒe lãkusi hehe le klo ƒe ƒoƒo me kple mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbeƒu ƒe lãkusi dome le nusi wotsɔ de eme la dede me. Afɔdzideƒea hã xea mɔ na axial nail entry le sagittal plane me (Fig. 1a, b). Eyata mɔnu bubu si bɔ si dzi woato akpɔ nyaa gbɔe nye to medial parapatellar incision, si hea medial vie to lateral nail insertion (Fig. 1C kple 2) me. Ne ɖa la le gegem ɖe ʋuka si le ʋukaa me la me le adzɔge tso gbagbãƒea gbɔ la, akpa si te ɖe eŋu la ƒoa ɖe valgus me (Nɔnɔmetata 2). Mlɔeba la, ŋgɔgbe ƒe akpa si le ŋgɔgbe ƒe teteɖeanyia kpena ɖe valgus la ŋu vie (Nɔnɔmetata 3).

Figure 1 a,b Ne míezã infrapatellar mɔnu si wozãna ɖaa la, patella xea mɔ na axial entry of the nail, si wɔnɛ be anterior apical sagittal alignment kple valgus coronal alignment ƒe nɔnɔme madeamedzi si bɔ. c Parapatellar mɔnu zazã hena ɖa ƒe ƒoƒo ɖe lãkusi me.

Figure 2 tete ɖe teƒe si woge ɖo ŋu to medial parapatellar incision dzi hea medial vie va ɖo lateral nail insertion. Ne ɖa la ge ɖe medullary canal la me didi tso gbagbãƒe (A) gbɔ la, akpa si te ɖe eŋu la ƒoa ɖe valgus (b) me .

Nɔnɔmetata 3 Tenɔnɔ ɖe enu le lãmeka si le ŋgɔgbe ( a ) me la wɔa ectopic ɖoɖo si menya kpɔna dzea sii bɔbɔe o ( B ) .

Afɔti la tsɔtsɔ ƒo ɖe teƒe si keke wu kpena ɖe ame ŋu be woagakpɔ kuxi siwo do ƒome kple klo ƒe ʋuʋu sesẽ le dɔwɔwɔ nɛ me o. Gelbke, Jakma et al. Le ƒe 2010 me eye wòva le amewo lɔ̃m ɖe edzi le ƒe ʋɛ siwo va yi me elabena pinning le afɔkpodzi le abɔ kple afɔ ƒe nɔnɔme si le dzɔdzɔe kloe me na be gbagbã ƒe asitɔtrɔ kple eƒe nɔnɔme tɔtrɔ bɔbɔe. Fluoroscopy va le bɔbɔe be woawɔe le mɔ̃ɖaŋununya me. Woka nya ta be fluoroscopy ɣeyiɣiwo na suprapatellar nailing le kpuie ŋutɔ wu infrapatellar nailing. Tsɔ kpe ɖe eŋu la, dzogoe si dzi wotsɔ ƒo ƒu ɖo (le sagittal plane me) sɔ kple afɔkpodzi ƒe didime ƒe axis le mɔnu sia me wu infrapatellar nail; Esia xea mɔ na mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbeƒu dome, si wɔnɛ be ƒu ƒe gbagbã dzi ɖena kpɔtɔna.

Klo ƒe vevesese si le ŋgɔgbe le dɔwɔwɔ vɔ megbe nye kuxi si do ƒome kplii. Woka nya ta be klo ƒe klo ƒe vevesese le dɔnɔ 50-70% ƒe 50-70% me, eye dɔnɔ 30% koe le vevesese dzi ɖem kpɔtɔ le numiemie si le eme la ɖeɖe ɖa vɔ megbe. Wobu akɔnta be abi ƒe wɔwɔme si do ƒome kple patellar tendon kple hoffa fat pad ƒe gege ɖe emee nye nusi ate ŋu ana klo ƒe vevesese nado tso eme le dɔwɔwɔ nɛ vɔ megbe. Tsɔ kpe ɖe eŋu la, suprapatellar ƒe mɔnu la ƒoa asa na saphenous nerve ƒe patellar alɔdzea ƒe alɔdze si nye kɔnu la ɖeɖe, to esia me woƒoa asa na klo ƒe ʋuʋu kple seselelãme ƒe kuɖiɖi (Nɔnɔmetata 4). Edze abe ne woto ɖa ŋu to lãkusia ƒe lãkusia me, si wɔnɛ be patellar ƒe lãkusia megagblẽna o la, eɖea klo ƒe vevesese le dɔwɔwɔ nɛ vɔ megbe dzi kpɔtɔna ŋutɔ ene.

Le nu nyui siwo do tso ƒu siwo te ɖe wo nɔewo ŋu me ta la, wokeke dzesi siwo le atikewɔnyawo me la ɖe enu va ɖo gbagbãƒewo katã.

Ɣekaɣie wòle be woazã atike si nye suprapatellar intramedullary nail?

Viɖewo .

• Klo ƒe nɔnɔme si keke afã kple afã doa gbagbã ƒe asitɔtrɔ kple eƒe nɔnɔme tɔtrɔ ɖe ŋgɔ to lãmeka ƒe ŋusẽ si naa ame ƒe dzi dzea eme kple eƒe léle ɖe asi me le ɖadede me .

• Afɔku si le dɔwɔwɔ vɔ megbe ƒe ʋuʋu le proximal, segmental kple distal fractures me dzi ɖe kpɔtɔ ne wotsɔe sɔ kple mɔnu siwo wozãna ɖaa .

• Nailing dɔwɔwɔ le bɔbɔe le mɔ̃ɖaŋununya gome .

• Nail insertion nye nusi woate ŋu awɔ abe 'amekola ɖeka ƒe ɖoɖo' ene.

• fluoroscopy ƒe ɣeyiɣi dzi ɖe kpɔtɔ .

• Nu aɖeke megblẽ le patellar tendon la ŋu o eye klo ƒe klo ƒe vevesese megbe ƒe dzɔdzɔ le sue wu .

• Dɔwɔwɔ le ƒuƒoƒo geɖe ƒe dɔwɔwɔ me le bɔbɔe wu, abe alesi wòle le nuveviwɔame geɖe me ene .

  
  

Nusiwo fia .

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

• Tibiaphal diaphysis (AO 42A-C ƒomevi) ƒe gbagbã bɔbɔe si wotsɔ ƒo ƒui

• Segmental tibial diaphyseal fracture (AO 42C ƒomevi) .

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

• Klo si le tsia dzi .

• Patellar ossification kple patellar tendon ossification .

• Abi si me dɔlékuiwo le le patellar tendon ƒe kɔkɔme .

Ale Si Nàƒle Ƒumeŋutinunya Kple Ƒumeŋuɖuiwo ƒe Dɔwɔnuwo)

na . czmediTech , míekpɔa atike ƒomevi aɖe si de blibo ŋutɔ le ƒumeŋutinunya ƒe dɔwɔwɔ na ame ƒe ŋutilã kple dɔwɔnu siwo sɔ kplii me, atikeawo dometɔ aɖewoe nye . Akɔta ƒe nusiwo wotsɔ dea akɔtae ., Intramedullary ƒe ɖawo ., nuveviwɔame ƒe agbalẽvi ., Locking Plate ., Tagbɔ-maxillofacial ., Ametia ƒe akpa aɖe ., Ŋusẽ Dɔwɔnuwo ., External fixators ., Arthroscopy ., Lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe dɔwɔnu siwo kpena ɖe wo ŋu.

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

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