Nānā: 0 Mea kākau: Lunahooponopono Paena Manawa Hoʻopuka: 2025-07-07 Kumu: Paena
ʻO ka tibial shaft kekahi o nā wahi maʻamau no nā haʻihaʻi, helu ʻia no 13.7% o nā haʻihaʻi āpau o ke kino. Loaʻa nā hiʻohiʻona anatomical o ka tibia distal e like me ka maikaʻi ʻole o ka hāʻawi ʻana i ke koko a me ka liʻiliʻi o ka uhi ʻana o ka ʻiʻo palupalu. Ke hiki mai ka ha'i, hiki ke ho'onui i ka pilikia o ka ho'ōla ha'iha'i. Eia kekahi, ʻo ke kūlana kiʻekiʻe o nā haʻihaʻi fibular concurrent a me ka hiki ʻole ke koho i kahi ala ʻoki kūpono.
ʻO ka ʻaoʻao keʻa o ka lāʻau tibial waena a i luna he triangular, a ʻo ka hapakolu lalo he quadrilateral. ʻO ka hui ʻana o ka hapakolu waena a me lalo he haiki a hōʻike i ka hoʻololi ʻana i ke ʻano, e lilo ia i wahi maʻamau no nā haki.
ʻO ka hapakolu mua o ka tibia i uhi wale ʻia e ka ʻili me ka uhi ʻole o ka ʻiʻo, e maʻalahi i ka wehe ʻana i nā haʻihaʻi kahi e hou ai nā ʻāpana iwi i ka ʻili. ʻOiai i loko o nā haʻihaʻi paʻa, ʻo ka hapa nui o nā tibial fractures e hui pū ʻia me ka pōʻino i ka ʻili a me ka ʻiʻo subcutaneous. ʻAʻole hiki i ka mid-tibia ke uhi i ka ʻiʻo, a ʻehā mau ʻāpana fascial e hoʻopuni ana i ka tibia a me ka fibula. ʻOi aku ka kiʻekiʻe o ka maʻi o ka compartment ma nā tibial fracture i hoʻohālikelike ʻia me nā haʻihaʻi ʻē aʻe.
ʻO ka helu helu Arabic AO/OTA e kuhikuhi ana i nā haʻihaʻi lāʻau tibial ma ke ʻano he 4 (tibia) 2 (kuʻi). ʻO ke ʻano A pili i nā haʻihaʻi maʻalahi me kahi laina haʻihaʻi hoʻokahi, ʻo ia ke ʻano maʻamau. Loaʻa i nā haʻihaʻi ʻano B he ʻāpana koʻikoʻi koʻikoʻi. Hoʻokumu ʻia nā haʻihaʻi ʻano C e ka ʻeha ikaika nui a ua hoʻohālikelike ʻia nā ʻāpana ʻāpana.
ʻAno I: ʻO ka lōʻihi o ka ʻeha ma lalo o 1 knm, ʻo ka maʻamau he ʻeha maʻemaʻe maʻemaʻe me ka piko o ka iwi e puka ana ma ka ʻili. He liʻiliʻi ka pōʻino o ka ʻiʻo palupalu, me ka ʻeha ʻole. He maʻalahi ka haʻihaʻi, transverse, a pōkole paha oblique, me ka ʻole o ka comminution.
ʻAno II: ʻOi aku ka ʻeha ma mua o 1 knm, me ka nui o ka pōʻino o ka ʻiʻo palupalu akā ʻaʻohe avulsion a i ʻole ka hoʻokumu ʻana o ka flap. Hōʻike ka ʻiʻo palupalu i ka ʻeha haʻahaʻa a haʻahaʻa, ka hoʻohaumia haʻahaʻa, a me ka haʻahaʻa haʻahaʻa o ka haki.
ʻAno IIIA: ʻOiai ka nui o ka ʻeha avulsion a i ʻole ka hoʻokumu ʻana o ka flap, a i ʻole ka ʻeha ikaika nui me ka nānā ʻole i ka nui o ka ʻeha, ua lawa ka uhi ʻana o ka ʻiʻo palupalu ma luna o ka haʻihaʻi.
ʻAno IIIB: ʻO ka pōʻino a me ka nalo ʻana o ka ʻiʻo palupalu nui, me ka wehe ʻana o ka periosteal a me ka iwi i ʻike ʻia, i hui pū ʻia me ka haumia nui.
ʻAno IIIC: Hoʻopili ʻia me ka ʻeha ʻāʻī e pono ai ke hoʻoponopono.
ʻO nā lāʻau lapaʻau ʻole no ka haʻihaʻi ʻana o ka tibial e komo pū me nā braces, plaster external fixation, traction, manual reduction, a me ka hoʻohana ʻana i nā papa hoʻoponopono waho. ʻO nā koho ʻokiʻoki i loko o ka pā paʻa paʻa i loko a me ka nailing intramedullary, a me nā mea ʻē aʻe.
ʻO ka hoʻoponopono nailing Intramedullary e makemake nui ʻia e nā kauka orthopedic trauma ma muli o kāna kaʻina hana maʻalahi, nā ʻoki liʻiliʻi, ka ʻeha liʻiliʻi, a me ka wehe ʻana i ke kui ma hope o ka hoʻōla ʻana i ka haʻihaʻi. Hāʻawi ia i ka hoʻoponopono kūloko ikaika, e ʻae i ka hoʻomaʻamaʻa hana postoperative mua a pale i nā pilikia kūloko a me ka ʻōnaehana. Kūlike kēia mau pono me nā loina AO o ka lāʻau lapaʻau.
ʻO ka ʻoki oblique mua i ka hopena proximal pale i ka huhū i ka ligament patellar.
Hoʻonui ka hoʻolālā paʻa proximal mua i ka paʻa i makemake ʻia no ka ʻāpana proximal.
ʻO ke koho laka oblique distal e pale aku i ka pōʻino o ka ʻiʻo palupalu a hoʻonui i ka paʻa o ka ʻāpana mamao.
Hoʻolālā ʻia ka wili paʻa me ke kaula alakaʻi pālua no ka hoʻokomo maʻalahi.
Hoʻolālā laka no ka hoʻopaʻa ikaika ʻana, hoʻemi i ka dislocation ʻāpana postoperative.
Hāʻawi nā helu he nui o ka hoʻoponopono ʻana i ke kūpaʻa angular a me ke kākoʻo paʻa no ka tibial palteau.
Hōʻike ʻia ka hāmeʻa i kahi hana hoʻoponopono adaptive, me kāna mau hoʻololi morphological i hōʻike ʻia ma nā kiʻi ma lalo o nā kūlana pre-compression (moku'āina wehe) a me ka post-compression (paʻa paʻa).
ʻO ke ʻano hoʻoponopono nui mai ka proximal a me ka distal, e hōʻike i nā haʻihaʻi tibial proximal a me distal.
He hoʻolālā pālahalaha ka hopena o ka nail nui, e hoʻokomo maʻalahi i loko o ka lua medullary.
ʻElua mau ʻoki ʻoki ʻoki ma ka ʻaoʻao kokoke e pale i ka huli ʻana a me ka neʻe ʻana o ka ʻāpana haʻihaʻi.
ʻO kahi curvature anatomical kūikawā e hōʻoia i ka hoʻonohonoho pono ʻana o ka nail nui i loko o ka lua medullary.
ʻEkolu mau ʻoki ʻoki ʻoki ʻoki ʻana ma ka ʻaoʻao mamao e hāʻawi i ke kākoʻo kūpono a me ka hoʻoponopono ʻana.
He kūpono no ka hapa nui o nā haʻihaʻi tibial shaft (midshaft a me kekahi mau haʻihaʻi mamao/proximal), aʻo nā ʻano ʻē aʻe (e laʻa, DTN a i ʻole Expert Nail) i hoʻolālā ʻia no nā ʻāpana anatomical kikoʻī a i ʻole nā haʻihaʻi paʻakikī.
ʻO ke ala maʻamau (parapatellar a i ʻole transpatellar) e hahai ana i kahi kaʻina hana i hoʻokumu ʻia me kahi kaʻina aʻo haʻahaʻa, akā ʻo nā ala kūikawā (e laʻa, suprapatellar) e koi i ka hoʻomaʻamaʻa ʻenehana hou.
Hoʻohālikelike ʻia i nā kui kūikawā e like me ka Expert Nail a i ʻole DTN, ʻoi aku ka maʻamau o nā kui tibial intramedullary maʻamau, e kūpono ana ia no nā hihia maʻamau.
Hiki ke kūpono me nā mea kani o ke ao holoʻokoʻa (e laʻa, nā wili paʻa, nā mea hoʻopaʻa ʻia), aʻo nā kui kūikawā (e laʻa, Expert Nail me nā ʻōnaehana laka multi-directional) makemake paha i nā mea hana pono.
| E ʻano i nā | maikaʻi loa | hōʻailona |
|---|---|---|
| Nail Nail | ʻO nā haʻihaʻi kumu paʻakikī, osteoporosis | ʻO ka laka multi-planar, kūpaʻa kiʻekiʻe |
| Nail Suprapatellar | ʻO nā haʻihaʻi kokoke, nā maʻi obese | ʻO ke ala Suprapatellar, ho'ēmi i nā pilikia o ke kuli mua |
| DTN | Nā haʻihaʻi maʻamau (kokoke i ka hui kuʻekuʻe wāwae) | ʻO ka laka distal multi-directional, pale i ka pōkole |
| Nail maʻamau | ʻO nā haʻihaʻi maʻalahi waena | ʻO ka hana maʻalahi, ke kumu kūʻai |
Nā Mea Hana wili : Aia nā ʻāpana drill, reamers, a me nā mea hana ʻē aʻe i hoʻohana pololei ʻia no ka ʻeli iwi.
Nā Mea Hana : Nā mea hana no ka hoʻonohonoho ʻana a me ke alakaʻi ʻana i ka wili ʻana a i ʻole ka hoʻokomo ʻana i ka implant, e like me nā uea alakaʻi, nā lima lima alakaʻi, a me nā mea hoʻolālā.
Nā mea hana hoʻopaʻa : Nā mea hana i hoʻohana ʻia no ka hoʻopili ʻana, laka, a hoʻoponopono ʻana i nā implants, e like me nā hui honua, nā wrenches, nā wili, a me nā hama.
Measuring Tools : Nā mea hana no ke ana ʻana i ka hohonu, hoʻonohonoho ʻana, a i ʻole ke kōkua ʻana i ke ʻoki ʻana, e like me nā ana hohonu, nā kīʻaha hoʻēmi, a me nā awl iwi (AWL).
Nānā Kiʻi: X-ray/CT mua e hōʻoia i ke ʻano haʻihaʻi, ke anawaena canal medullary a me ka lōʻihi, me ke ana ʻana o ka tibia contralateral ma ke ʻano he kuhikuhi.
Ke kūlana: Ke kū i luna me ke kuli o ke kuli 90°-120° a me ka hoʻonui iki ʻana o ka ʻūhā (e hoʻemi i ka ʻāʻī ʻana o ka tendon patellar). Hiki ke kākoʻo i ka popliteal fossa no ka huki ʻana i ke kiʻi radiolucent triangular.
Sterile Draping: ʻO ka sterilization o nā lālā maʻamau a me ka draping, e hōʻoia ana i ka neʻe ʻana o ka lima C.
Hoʻopaʻa lima: Hoʻohana ka mea kōkua i ka traction longitudinal i ka wā e hoʻopaʻa ai ke kauka lapaʻau i ka tibial crest a me ka anteromedial surface e hoʻoponopono i ka alignment (lōʻihi, rotation, angulation).
Kokua i na mea hana:
ʻO ka ʻenehana Joystick: Hoʻokomo ʻia nā wili Schanz i nā ʻāpana proximal/distal no ka hōʻemi ʻana i ka lever.
Hoʻopaʻa ʻia i ka ʻili: ʻO nā kīʻaha hoʻohaʻahaʻa kikoʻī no nā haʻi oblique/spiral.
Mea hoʻoheheʻe: Hoʻokomo ʻia ka mea hoʻopuʻi nui i ke coronally (ʻo Schanz screw proximal e like me ka pāpū tibial, pin distal ma talus a i ʻole tibia distal) e mālama i ka lōʻihi.
Nā kaha ʻāina:
ʻO ka helu komo 1cm ka lōʻihi i ka ʻaoʻao pāpū tibial mua, i hoʻolike ʻia me ke koʻi medullary.
Hōʻoia Fluoroscopic: Kūlike ka nānā ʻana i ka AP me ka piko tibial, ka nānā ʻaoʻao e like me ke koʻi tibial.
Nā mea kani wehe:
ʻO ka drill cannulated ma luna o ke kaula alakaʻi (me ka lima pale) a i ʻole ka awl solid curved.
ʻO nā reamers lima (6-8mm) no nā haki kahiko me ka hoʻopaʻa ʻana i ke kahawai.
Hoʻokomo ʻia ʻo Guidewire: ʻO ke kaula alakaʻi i hoʻopaʻa ʻia i ka pōpē i piʻo 10-15mm ma ka piko no ka haʻi ʻana. ʻO ka hōʻoia ʻana o ka fluoroscopic ma ka ʻili physeal distal (waena wāwae).
Kūlana Reaming:
Hoʻomaka nā reamers maʻalahi ma 8mm, e hoʻonui ana i ka 0.5mm a hiki i ka cortical 'chatter' (maʻamau 1-1.5mm > anawaena kui).
Hoʻomaopopo: Hoʻomaʻemaʻe ka wehe ʻana i nā ʻōpala; pale i ka necrosis wela.
Hoʻoholo lōʻihi:
Ana Intraoperative: Guidewire overlap method or fluoroscopic ruler (kahi komo i ka hui kuʻekuʻe wāwae).
E hōʻoia i ka hōʻea ʻana o ka piko o ka kui i ka ʻili kino me ka ʻole o ka puka kokoke.
ʻenehana hoʻokomo:
Holomua lima ma luna o ke kaula alakaʻi; hoʻololi i ka hoʻemi ʻana inā loaʻa ke kūʻē.
E mālama i ka hoʻemi ʻana i ka wā e hele ai no nā haʻihaʻi mamao.
Hoʻolālā Kaʻina
ʻO nā haʻihaʻi lōʻihi-paʻa: Laka mua ma kahi kokoke (hiki i ka wili hoʻokahi ke hoʻolaʻa).
ʻO nā haʻihaʻi lōʻihi-hiki ʻole/hoʻopiʻi: ʻO ka laka ʻana ma mua a ukali ʻia e ka 'backslap' e kaomi.
Laka Laka
≥2 wili ma o ka mea hoʻoholo (multidirectional for proximal fractures).
Paʻa Paʻa
ʻO ka ʻenehana Fluoroscopic: ʻO ke kukui waena e kū pololei ana i nā puka wili ('poʻai hemolele'), ka wili ʻokoʻa.
≥2 wili no nā haʻihaʻi mamao (hiki ke hoʻohui i nā kuhikuhi AP/oblique).
Kāpena Hoʻopau: Hoʻokomo ʻia ke koho (pale i ka ulu ʻana o nā iwi), e hōʻoia i ka ʻole o ka hoʻokuʻi ʻana.
Pani ʻana i ka ʻEha: Hoʻoponopono ʻia nā ʻāʻī patellar i hoʻopaʻa ʻia me nā humu o lalo o ka ʻili.
Hoʻoponopono mua:
Kiʻekiʻe lālā; nānā no ka compartment syndrome i loko o 24 mau hola.
E hoʻomaka i ka hoʻoikaika ʻana i ka hui pū ʻana (pamu kuʻekuʻe wāwae, hoʻololi kuli) ma POD 1-2.
Kūkākūkā Kaumaha:
Kaumaha hapa no nā pule 6 (hoʻololi ʻia no ke kūpaʻa), e holomua ana a piha ke ʻike ʻia ka callus.
Ka Hoʻomau: Ka loiloi hōʻailona / radioological ma 2, 6, a me 12 pule.
Ke poʻo: Raynham, Massachusetts, USA
Nā huahana hae:
Expert Tibial Nail (ETN) - Hoʻolālā ʻia no ka paʻa ʻana i nā ʻāpana tibial paʻakikī.
T2 Tibial Nail - Hāʻawi i ka hoʻoponopono a me ka hoʻopiʻi i hoʻonui ʻia.
Nā ikaika nui: R&D ikaika, hoʻolaha honua, a me ka hoʻohui pū me nā hopena trauma.
Ke poʻo: Kalamazoo, Michigan, USA
Nā huahana hae:
T2 Tibial Nail - Pūnaehana modular no nā haʻihaʻi lāʻau tibial.
Gamma3 Tibial Nail - Hoʻohui i nā kui intramedullary me nā koho laka.
ʻO nā ikaika nui: nā robotics kiʻekiʻe (Mako), nā hopena invasive liʻiliʻi, a me ka portfolio trauma ikaika.
Ke poʻo: Lādana, UK
Nā huahana hae:
TRIGEN Tibial Nail - Hoʻolālā ʻia no ka maʻalahi o ka hoʻokomo ʻana a me ka paʻa.
IM Tibial Nail - Hoʻoponopono Intramedullary no nā haʻihaʻi tibial.
Nā Mana Nui: E nānā i ka lāʻau lapaʻau haʻuki a me ka trauma, nā mea hou.
Ke poʻo: Changzhou, Kina
Nā huahana hae:
Distal Tibial Intramedullary Nail (DTN) - Hoʻopili ʻia no nā haʻihaʻi ākea.
ʻO ka Nail Intramedullary Expert Tibia - Hoʻolālā kiʻekiʻe o ka titanium alloy.
Suprapatellar Approach Tibial Intramedullary Nail - Hoʻokomo liʻiliʻi loa.
Tibial Intramedullary Nail - Nā koho hoʻoponopono nui.
Nā ikaika nui: nā hoʻonā kumu kūʻai, hoʻonui i ka noho honua.
Ke poʻo: Warsaw, Indiana, USA
Nā huahana hae:
ZNN Tibial Nail - Hoʻolālā Anatomic no ka hoʻomaikaʻi maikaʻi ʻana.
Pūnaehana Nail Kūlohelohe - Mimics mechanics iwi maoli.
ʻO nā ikaika nui: ikaika i ka hana hou ʻana, ka hoʻohui ʻana i ka biologics, a me nā hoʻonā pilikino.
Ke poʻo: Lewisville, Texas, USA
Nā huahana hae:
LON Tibial Nail (Lateral Orthopedic Nail) - Hoʻolālā ʻia no ke ala komo ʻaoʻao.
Nā Mana Koʻikoʻi: Kūikawā i ka hoʻoulu ʻana i ka iwi, ka hoʻoponopono ʻana i ka deformity lālā.
Hāʻawi ʻo CZMEDITECH i nā hoʻonā nailing tibial piha no nā haʻihaʻi proximal, distal, a paʻakikī, me nā hoʻolālā hou (e laʻa, multi-directional locking, suprapatellar approach) e hoʻohālikelike ʻia me nā hōʻailona alakaʻi honua i ka biomechanics a me nā hopena lapaʻau.