1Distal 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.
2Egbɔkpɔnu 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.
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.
Nu Vevi Siwo Ŋu Nàbu: Ne èle akɔta, zã reduction forceps ne ehiã. Tsɔ fibular fracture dzikpɔkpɔ ɖo nɔƒe gbãtɔ be nàkpɔ egbɔ be woɖe tibial dzi kpɔtɔ pɛpɛpɛ.
2DTN dede eme ƒe ɖoɖo
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, si didi tso ƒunukpeƒea gbɔ milimeta 4–5.
Lãɖeɖe:
Wotsoe wòdidi le titina malleolus ƒe nugbɔ
Mɔfiame pin ƒe ɖoɖo:
4–5 mm tso ƒunukpeƒea ƒe anyime
Nusiwo woatsɔ aɖɔe ɖo:
Screws siwo ƒoa ƒu ɖe wo nɔewo ŋu le proximally kple distally
Dɔwɔwɔ vɔ megbe: Woɖe lã sue 6 pɛ ko, wohaya keŋkeŋ le ƒe 1 me
Atikewɔwɔ Ŋuti Nyatakaka Kpuie
DTN si wodo to lãɖeɖe suetɔ kekeake me kple lãmeka falɛfalɛwo takpɔkpɔ nyuie ŋutɔ. Fibular fracture li ke kple intramedullary nail. Dɔnɔa haya bliboe evɔ kuxi aɖeke menɔ eŋu o.
Nɔnɔmetatawo ɖeɖe do ŋgɔ na dɔwɔwɔ
Enumake Post-op
Ɣleti 3 ƒe Dzɔdzɔmenuwo Dzikpɔkpɔ
Ƒe 1 ƒe Dɔyɔyɔ
VI. Numedzodzro
1Biomechanical 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.
2Viɖe 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. 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 ƒe klo meʋãna tututu o.
3Dɔdaƒewo ƒe Nusɔsɔe
Nonunion kple malalignment ƒe agbɔsɔsɔme na antegrade nails nye 0–25% kple 8.3–50%, le wo nɔewo yome; na agbalẽ 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.
VII. Nyanuwuwuw
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.
DTN ƒe Adzɔnuwo ƒe Dɔwɔƒe
Distal Tibial Intramedullary Nail (DTN) ƒe lãkusi si le ŋgɔgbe (DTN) .
Nuteƒekpɔkpɔ siwo wowɔ na ame ŋutɔ le ŋusẽ blibo me.
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