ʻO ka haʻihaʻi ʻana o ka tibial, suprapatellar intramedullary nailing technique

Intramedullary tibial nailing: komo a me ka alignment, ʻeha o ke kuli mua

He mea koʻikoʻi ka hoʻokō ʻana i ka nailing intramedullary o nā tibial fractures i mea e hoʻokomo ai i ka nail intramedullary ma o ka helu komo pololei, e hōʻemi i ka pōʻino i nā kūkulu kuli intra-articular, a e hoʻokō i ka hoʻonohonoho hou ʻana i ka haʻihaʻi a me ke komo ʻana o nā kui.

ʻO nā ala maʻamau no nā haʻihaʻi kumu tibial ʻo ia ka infrapatellar median a i ʻole infrapatellar parapatellar approach. ʻOiai ua hōʻike ʻia kēia mau ala no nā haʻihaʻi waena, ʻo ka valgus postoperative, mua, a i ʻole nā ​​deformities i hui pū ʻia e hana pinepine ʻia i nā haʻihaʻi kokoke.

ʻO ke kumu nui o ka malalignment i nā ʻāpana tibial proximal he deformity i ka huki ʻana o ka tendon quadriceps i ka wā o ke kuli a me ka hakakā mechanical ma waena o ka piko kui a me ka cortex tibial hope i ka wā o ka hoʻokomo ʻana. Kāohi pū ka patella i ke komo ʻana o ke kui axial i ka mokulele sagittal (Fig. 1a, b). No laila, ʻo kekahi ala maʻamau o ke komo ʻana i ke kiko ma o ka ʻoki ʻana o ka parapatellar medial, e alakaʻi ana i kahi hoʻokomo liʻiliʻi i waena o ka nail lateral (Fig. 1c a me 2). I ke komo ʻana o ke kui i loko o ka canal intramedullary ma kahi mamao loa i ka haʻihaʻi, hili ka ʻāpana proximal i loko o ka valgus (Figure 2). ʻO ka hope, hāʻawi iki ka hoʻomaha hoʻomaha o nā ʻiʻo o ke keʻena mua i ka valgus (Figure 3).

Kiʻi 1 a, b Me ka hoʻohana ʻana i ka infrapatellar maʻamau, pale ka patella i ke komo axial o ke kui, ka hopena i ka deformity maʻamau o ka alignment apical sagittal anterior a me ka alignment coronal valgus. c Ke hoʻohana nei i ke ala parapatellar no ka hoʻoponopono kui intramedullary.

Kiʻi 2 ʻO ka hoʻokokoke ʻana i ka helu komo ma o kahi ʻoki parapatellar medial e alakaʻi i kahi hoʻokomo nail liʻiliʻi i waena. I ke komo ʻana o ke kui i loko o ke awāwa medullary ma kahi mamao loa i ka haʻi (a), hili ka ʻāpana kokoke i loko o ka valgus (b)

Kiʻi 3 ʻO ka hoʻomaha haʻahaʻa i loko o ke keʻena ʻiʻo mua (a) e hana i kahi hoʻonohonoho ectopic maʻalahi (b)

ʻO ka paʻi ʻana i ka tibia i kahi kūlana lōʻihi e kōkua i ka pale ʻana i nā pilikia e pili ana i ka hoʻololi ʻana o ke kuli intraoperative koʻikoʻi. ua wehewehe ʻia ka ʻenehana e Gelbke, Jakma et al. i ka makahiki 2010 a ua lilo i mea kaulana loa i nā makahiki i hala iho nei no ka mea, ʻo ka pine ʻana i ka tibia i kahi kūlana pololei pololei e hoʻomaʻamaʻa i ka hoʻoponopono ʻana a me ka hoʻonohonoho hou ʻana. Ua maʻalahi ka hana ʻana o ka fluoroscopy. Ua hōʻike ʻia nā manawa fluoroscopy no ka nailing suprapatellar he pōkole loa ma mua o ka nailing infrapatellar. Eia kekahi, ʻoi aku ka like o ke kihi o ka hoʻokomo nail (ma ka sagittal plane) i ka axis longitudinal o ka tibia i kēia ala ma mua o ka nail infrapatellar; pale kēia i ka hakakā mechanical ma waena o ka piko o ke kui a me ka cortex hope, a laila e ho'ēmi i ka haʻihaʻi.

ʻO ka ʻeha hope o ke kuli anterior kahi pilikia pili. Ua hōʻike ʻia ka ʻeha o ke kuli mua ma 50-70% o nā maʻi haʻihaʻi, me 30% wale nō o nā maʻi e ʻike nei i ka hōʻeha ʻeha ma hope o ka wehe ʻana i ka mea kanu kūloko. Ua manaʻo ʻia ʻo ka hoʻokumu ʻana i ka ʻili e pili ana i ke komo ʻana i ka tendon patellar a me ka pā momona ʻo Hoffa kahi kumu kūpono o ka ʻeha o ke kuli postoperative. Eia kekahi, pale ka suprapatellar i ka ʻoki kuʻuna o ka lālā o ka lālā patellar o ke aʻalolo saphenous, no laila e pale aku ai i ka numbness kuli mua a me ka dullness sensory (Figure 4). ʻO ka hele ʻana i ke kui ma ka tendon quadriceps, a laila e haʻalele i ka tendon patellar i paʻa, ʻike ʻia e hōʻemi nui i ka nui o ka ʻeha o ke kuli postoperative.

Ma muli o nā hopena maikaʻi o nā haʻihaʻi kokoke, ua hoʻonui ʻia nā hōʻailona i ka hana lapaʻau i nā haʻihaʻi āpau.

I ka manawa hea e hoʻohana ʻia ai kahi nail intramedullary suprapatellar?

Pono

• ʻO ke kūlana kuli semi-extended e hoʻoikaika i ka manipulation fracture a me ka hoʻonohonoho hou ʻana ma o ka hoʻomaha ʻana i ka ikaika o ka ʻiʻo a me ka paʻa ʻana i ka wā hoʻokomo nail.

• ʻO ka haʻahaʻa haʻahaʻa o ka dislocation postoperative o ka proximal, segmental a me distal fracture i hoʻohālikelike ʻia me nā ʻenehana maʻamau

• He mea maʻalahi ka hana nailing

• Hiki ke hoʻokomo ʻia i ka nail ma ke ʻano he 'kaʻina hana hoʻokaʻawale hoʻokahi'

• Hoʻemi ʻia ka manawa fluoroscopy

• ʻAʻohe pōʻino i ka tendon patellar a me ka ʻeha haʻahaʻa o ka ʻeha o ke kuli mua ma hope o ka hoʻopaʻa ʻana

• ʻOi aku ka maʻalahi o ka hana ʻana i kahi kaʻina hana hui nui, e like me ka trauma lehulehu

  
  

Nā hōʻailona

• ʻO ka haʻihaʻi ʻokoʻa o ka tibia proximal (ʻano AO 41A)

• ʻO ka haʻihaʻi maʻalahi o ka diaphysis tibial (ʻano AO 42A-C)

• ʻO ka haʻihaʻi ʻana o ka tibial diaphyseal (ʻano AO 42C)

• ʻO nā haʻihaʻi ʻokoʻa ʻokoʻa o ka tibial a me nā haʻi hoʻonui maʻalahi intra-articular (AO 43A a me C1 ʻano)

• kuli lana

• Patellar ossification me ka patellar tendon ossification

• ʻEha haumia i ka pae o ka tendon patellar

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