I. Enyanjula .
Ekirungo ekiyitibwa distal humerus kirimu empagi ez’omu makkati n’ez’ebbali, nga muno mulimu epicondles ne condyles.
II. Enkola y'okulongoosa .
Distal humerus fractures ziva ku buvune obutereevu (okugeza, okugwa) oba amaanyi agatali butereevu (okugeza, okukyusakyusa oba okusika ebinywa).
iii. Okuddaabiriza oluvannyuma lw’okutandika .
Ensengeka ya AO egabanya okumenyaamenya kwa distal humerus mu bika bisatu ebikulu: A , B , ne C .
iv. Ebivudde mu kunoonyereza .
Obujjanjabi bw’okulongoosa bugoberera emisingi gya AO: okukendeeza ku mubiri, okunyweza okunywevu, n’okuddaabiriza nga bukyali.
V. Alipoota y’omusango .
Ebipande ebikugira biwa obutebenkevu obw’ekika kya biomechanical obw’ekika ekya waggulu naddala mu ggumba ly’amagumba.
vi. Okuteesa
CZMEDITECH ekuwa ebika bisatu: eby’ebweru w’omubiri (01.1107), eby’ebbali (5100-17), n’ebipande eby’omu makkati (5100-18).
VII. Mu bufunzi
Obujjanjabi bw’okulongoosa bugoberera emisingi gya AO: okukendeeza ku mubiri, okunyweza okunywevu, n’okuddaabiriza nga bukyali.
Okumenyeka kw’omugongo ogw’ewala (distal tibial fractures) kwa bulijjo, era obujjanjabi obw’ekinnansi bulina we bukoma .
Distal tibial fractures kye kika ky’okumenya ekitundu eky’okunsi ekya bulijjo. Enzijanjaba z’ekinnansi nga locking plates ne antegrade intramedullary nails buli emu erina ebizibu byayo. Ebipande ebisiba biyinza okuleeta yinfekisoni oluvannyuma lw’okulongoosebwa oba okufa kw’ebitundu ebigonvu, okuwangaala okuwanvuwa; Wadde ng’emisumaali egy’ekika kya antegrade tegiyingiramu nnyo, giyinza okwonoona ekinywa ky’okugulu, okuleeta obulumi, n’okutwala obulabe bw’okunyweza oba okukola malo, okulemesa okuwona.
Ebipande ebisiba:
Okwonoonebwa okw’amaanyi mu bitundu ebigonvu, omuwendo gw’abakwatibwa obulwadde bungi, okuwona okumala ebbanga eddene .
Antegrade Emisumaali:
Obulabe bw’okufuna obuvune mu kiwanga, okunyweza okutali kumala, okutera okukola malalignment .
Ekizibu Ekipya: Omusumaali ogw’ewala ogw’omugongo (DTN) .
Enkola empya ey’obujjanjabi —Distal Tibial Nail (DTN) —egaba endowooza empya ey’okuddukanya okumenya kw’omugongo ogw’ewala n’enteekateeka yaayo ey’enjawulo ey’okudda emabega.
Retrograde insertion design egaba enkola empya .
Okuteeka omulwadde mu kifo n’okukendeeza ku kukendeeza omulwadde .
Omulwadde ateekebwa mu mbeera ya supine. Okumenyaamenya okusenguddwa kulina okukendeezebwa mu ngalo; Bwe kiba kyetaagisa, kozesa ebyuma ebikendeeza ku kukendeeza ku kuyamba nga tonnaba kuyingiza DTN. Singa wabaawo okumenya kw’ekiwujjo ekiwerekerako, okukwatagana okutuufu okw’ekiwuziwuzi kuyinza okuyamba okukendeeza ku tibial. Fibular shaft fractures ziyinza okutebenkeza n’emisumaali egy’omu lubuto. Ku kumenyaamenya okwetoloola enkizi, okukendeeza ku mubiri n’okunyweza fibula kisaana okukulembera okukendeeza ku tibial okwewala malalignment. Mu kumenya okuggule n’okunyweza okw’ebweru okuliwo, omusumaali gusobola okuyingizibwa nga gukuuma ekinyweza okusobola okutuuka ku kukendeeza.
supine position, kozesa reduction forceps bwe kiba kyetaagisa .
Okukulembeza okuddukanya okumenya okumenyaamenya okulaba ng’okendeeza bulungi ku tibial .
Okusalako kwa sentimita 2–3 mu buwanvu kukolebwa ku ntikko y’omuguwa ogw’omu makkati ogw’omu makkati okulaga omuguwa ogw’okungulu ogw’ekikuta. PIN elungamya eyingizibwa mu oba katono wakati ku nsonga ya malleolus (Fig. 2A), mm 4–5 okuva ku ngulu w’ekitundu ky’omubiri. Okulaba okw’ebbali kulaga okuyingizibwa nga kuyita mu kisenge kya intercondylar (Fig. 2B), okwewala okwonooneka kw’ekinywa kya tibialis eky’emabega. Yawula omusuwa gwa deltoid ogw’okungulu, olwo okozese reamer okugaziya omukutu gwa medullary okutuuka mu kitundu kya metaphyseal (Fig. 2C). Ggyawo eggumba erisazaamu okumpi n’ekitundu eky’omu makkati eky’okumpi okuyingiza omusumaali (Fig. 2d). Teeka omusumaali ogugezesebwa okukakasa obunene bwa DTN (Fig. 2E). Weewale okukuba ennyondo oba okunyiga ennyo okuziyiza iatrogenic medial malleolar fracture. Teekateeka obuziba bw’omusumaali okukakasa nti sikulaapu ez’ewala toyingira mu kiyungo ky’enkizi oba ekifo we bamenya. Okunyweza kutuukirizibwa ne sikulaapu ezikwatagana (interlocking screws) proximally ne distally.
Okusalako:
Longitudinal okusala ku medial malleolus tip .
Okuteeka ppini mu ndagiriro:
mm 4–5 okuva ku ngulu w’ekiyungo .
Omusumaali gwa Reaming & Trial:
Ream okutuuka ku metaphysis, kakasa obunene bw'omusumaali .
Okuyingiza omusumaali:
Weewale okukuba ennyondo, okutereeza obuziba okukuuma ekinywa .
Okunyweza:
Sikulufu ezikwatagana (interlocking screws) okumpi n’ewala .
Enkola y'okuyingiza DTN .
Okutambula kw’ekiwanga okw’amangu n’okukwatagana kw’ekigere okuva ku wansi kukkirizibwa oluvannyuma lw’okulongoosebwa
okutali kwa buzito okumala wiiki 4–6
okugenda mu maaso okutuuka ku buzito obujjuvu wakati wa wiiki 8–12, ate nga balondoola okutondebwa kw’ekifuba n’obulumi .Ankle joint activity etandika amangu ddala nga bamaze okulongoosebwa .
Weewale okugejja okumala wiiki 4–6 .
Okukyusa mpolampola okudda mu kuzitowa okujjuvu ku wiiki 8–12 .
Okugoberera abalwadde 10 .
Okunoonyereza kwaddiridde abalwadde 10 (Table 1). We zaaweredde emyezi 3 oluvannyuma lw’okukola, emisango 7 gyali giwonye; Abalwadde bonna baafuna okuwona mu myezi 6. Omusango gumu buli omu ku Varus ne recurvatum deformities gwagwawo. Tewali kufiirwa kukendeeza, yinfekisoni, ebizibu ebikwatagana n’okuteekebwamu, oba obuvune obw’ekika kya iatrogenic bwalabiddwa (Table 2).
Emisango 7 gyawonye mu myezi 3; Byonna biwonye emyezi 6 .
2 Obulema obutono (1 Varus, 1 recurvatum) .
Tewali Yinfekisoni, Ebizibu Ebiteekebwa mu Kuteekebwamu, oba Okufiirwa Okukendeeza .
Omulwadde omusajja ow'emyaka 69 .
Ekika ky’okumenya:
Okumenyeka kw’omugongo okuyita mu bbanga + okumenyaamenya .
Okuzibuwalirwa:
Soft tissue crush obuvune .
Oluvannyuma lw'okutandika:
6 zokka 6 ezisaliddwako, okuwona okujjuvu mu mwaka 1 .
Ebifaananyi 3 & 4:
Ebifaananyi eby'okudda engulu eby'oku ssimu n'oluvannyuma lw'okulongoosebwa .
Ebiraga DTN .
Okunoonyereza kuno kwalimu okumenya kwa AO 43-A ne C1; C2 nayo yalowoozebwako. DTNs zibeerawo mu buwanvu bwa mm 7 ne mm 8, ezisalawo okuteekebwa kwa sikulaapu ezikwatagana ez’okumpi. Emenyeka ezisangibwa sentimita 2–9 waggulu w’ekitundu ky’omubiri (articular surface) ze zisinga okuvuganya ku kunyweza DTN. Ebiraga bisobola okugaziyizibwa okutuuka ku AO 42 okumenya.
Ekwata ku AO 43-A, C1, lowooza ku kugaziya okutuuka ku C2 ne 42 .
Ebisinga obulungi ebivaamu okumenya sentimita 2–9 okuva ku ngulu w’ekiwanga .
Okutebenkera kw’ebiramu .
Emisumaali egy’okudda emabega girina obugumu obw’oku ntikko obw’ekyekulungirivu n’okuzimbulukuka bw’ogeraageranya n’obupande obusiba wakati n’emisumaali egy’omu maaso (antegrade). Greenfield et al. Yakola okugezesa kwa biomechanical okulaga nti okukozesa sikulaapu bbiri ez’ewala mu DTN yatuuka ku 60–70% ku kunyigirizibwa okunyigiriza n’obugumu bwa 90% bw’ogeraageranya ne sikulaapu ssatu. DTN yakendeeza ku kutambula kw’ekitundu ky’okumenya wansi w’omugugu. Mu mbeera 3 ezitawona mu myezi 3, ensonga zaalimu okwonooneka kw’ebitundu ebigonvu, okugaziwa kw’omubiri, ekifo we bamenya, n’okulwala amagumba. Okuva DTNs bwe ziyingira mu sayizi ssatu zokka era okunyweza okw’ewala kukoma ku sikulaapu ssatu, ziyinza okuwa okutebenkera okutamala mu mifulejje emigazi oba eggumba ly’amagumba. Okugejja nga bukyali kulina okutuukirira n’obwegendereza mu mbeera ng’ezo.
Superior to locking plates ne antegrade nails .
Enkola esengekeddwa ey’okunyweza: 2 Proximal + 3 distal screws .
Ebirungi ebiri mu DTN .
Okugerageranya ku locking plates, intramedullary nails zireeta less soft tissue damage, naddala esaanira abalwadde abakadde n’abo abalina obuvune obw’amaanyi mu bitundu ebigonvu olw’okulumwa amaanyi amangi. Mu kunoonyereza kuno, DTNs zayingizibwa okuyita mu butundutundu obutono mukaaga bwokka, nga tewali buzibu bwa bitundu bigonvu. Enkola eno tekyetaagisa kunyiga kugulu, okukendeeza ku bulabe bw’okufiirwa okukendeeza n’okugifuula ennungi eri abalwadde abalina entambula y’okugulu okutono (okugeza, okugulu oba oluvannyuma lwa TKA).
Abalwadde b’abakadde n’abalina amaanyi amangi abalung’amye mu ngeri etali ya maanyi .
No knee flexion yeetaagibwa, esaanira okutambula okugulu okutono .
Obulabe bw’okulongoosa n’okwegendereza .
Obulabe mulimu obuvune ku binywa by’omugongo eby’emabega n’okumenya malleolar medial malleolar. Medial malleolar fractures ziyinza okujjanjabibwa ne tension band wiring, plating, oba external fixation.
Okwegendereza kulina okukolebwa okwewala okuyingiza sikulaapu mu kisenge ekiyitibwa fibular notch. Ekyuma ekiteeka ekifo kiyinza okuleeta okukyusakyusa okw’emabega kwa DTN olw’obuzito bwakyo; Teekateeka sikulaapu eyookubiri okusonga ku fibula (Fig. 4c).Ebizibu ebiyinza okubaawo:
Obuvune bwa tibialis obw’emabega, okumenya kw’omusuwa ogw’omu makkati ogwa malleolar .
Akaiiko k'abakulu:
tension band, plating, oba fixator ow’ebweru .
Screw direction n'okuteeka ekyuma obuzito kyetaagisa intraoperative okufaayo .
Okugeraageranya mu bujjanjabi .
Emiwendo egitakwatagana n’emisumaali egy’ekika kya antegrade giri 0–25% ne 8.3–50%; Ku bipande ebisiba, 0–17% ne 0–17%. Mu kunoonyereza kuno, emisango gyonna gyatuuka ku kwegatta, era 20% bokka be baalina obulema >5°, nga bageraageranyizibwa ku nkola z’ennono.Emiwendo gy’okukwatibwa: okukwatibwa kungulu kuli 0–8.3% ku misumaali egy’ekika kya antegrade ne 0–23% ku pulati ezisiba; Obulwadde bwa deep infection buli 0–23% ne 0–8.3%, okusinziira ku. Okunoonyereza kuno kwalaga nti tewali bizibu bya bitundu bigonvu, nga bisinga byombi ebirala.
AFAS obubonero ku antegrade emisumaali: 86–88 (ekika A), 73 (ekika C); Ebipande ebisiba: 84–88 (ekika kya A) .
Okunoonyereza kuno: Average ya AFAS: 92.6.
EQ-5D-5L: Ebipande ebisiba: 0.62–0.76; Okunoonyereza kuno: 0.876
Safe-Q (abalwadde b’ebigere n’enkizi): 67–75; Okunoonyereza kuno: 83–91.7 (Ekipande 3)
Omuwendo gw’abakozi, omuwendo gw’abalema, n’omuwendo gw’abakwatibwa obulwadde bisinga enkola z’ekinnansi .
Obubonero bw’emirimu (Aofas, EQ-5D-5L, Safe-Q) Laga ebirungi ebivuddemu
Mu bufunze, DTN egaba enkizo ku locking plates ne antegrade intramedullary nails era ekiikirira solution ennungamu ey’okujjanjaba distal tibial fractures.
DTN erimu okuyingirira okutono, okutebenkera okw’amaanyi, n’okudda engulu amangu .
Ye nkola ey’omuwendo okusinga obujjanjabi obw’ekinnansi era esaanira okutumbula .
Yamakawa Y, Uehara T, Shigemoto K, n’abalala. Ebisookerwako eby’okutebenkeza okumenya kw’omugongo ogw’ewala ennyo n’omusumaali ogw’ewala ogw’omugongo: okunoonyereza okusuubirwa, okw’omuddiring’anwa mu bifo bingi[J]. Obuvune, 2024: 111634.
创伤骨科智能科技 智汇骨. (2024年12月31日). 胫骨远端髓内钉突破胫骨远端骨折的治疗 [微信公众号文章]. 创伤骨科智能科技 智汇骨. https.weixin.qq.com/s/9uqqvj0eae4bkzg2u4nq8q (yatuusibwako: 2025年06月07日)
