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Distal Tibial Intramedullary Nail (DTN) eragiddwa ku mbeera ez’enjawulo ez’omugongo, omuli okumenyaamenya enkovu ennyangu, eziriko enkokola, ezisaliddwa, eziwanvuye eziserengese, n’ez’ebitundutundu (naddala eby’omugongo ogw’ewala), awamu n’okumenya kw’ekisambi eky’ewala (distal tibial metaphyseal fractures), non-/mal-unions; era kiyinza okukozesebwa, emirundi mingi n’ebyuma eby’enjawulo, okuddukanya obulema bw’amagumba oba obutakwatagana mu buwanvu bw’ebitundu by’omubiri (nga okuwanvuya oba okufunza).
Okwonooneka okw’amaanyi mu bitundu ebigonvu, omuwendo gw’obulwadde bungi, okuwona okumala ebbanga
Obulabe bw’okulumwa ekinywa ky’okugulu, obutanyweza bulungi, okutera obutakwatagana bulungi
Enkola etali ya kuyingirira nnyo nga erina dizayini y’okuyingiza okudda emabega
Distal tibial fractures kika kya bulijjo eky’okumenya ebitundu by’omubiri ebya wansi. Enzijanjaba ez’ekinnansi nga locking plates ne antegrade intramedullary nails buli emu erina obuzibu bwayo. Ebipande ebisiba biyinza okuleeta yinfekisoni oluvannyuma lw’okulongoosebwa oba okufa kw’ebitundu ebigonvu, ne kiwangaaza okuwona; wadde ng’emisumaali egy’omu maaso tegiyingirira nnyo, giyinza okwonoona ekinywa ky’okugulu, ne gireeta obulumi, era ne gitwala obulabe bw’obutanyweza bulungi oba obutakwatagana bulungi, ne giremesa okudda engulu.
Enkola empya ey’obujjanjabi —Distal Tibial Nail (DTN) —ewa endowooza empya ey’okuddukanya okumenya kw’amagulu ag’ewala n’enkola yaayo ey’enjawulo ey’okudda emabega.
Ekifaananyi 1: Enteekateeka y’okuyingiza DTN emabega
Omulwadde ateekebwa mu mbeera ey’okusitama. Emenyese ezisenguddwa zirina okukendeezebwa mu ngalo; bwe kiba kyetaagisa, kozesa ebyuma ebikendeeza okuyamba nga tonnaba kuyingiza DTN. Singa wabaawo okumenya kw’emiguwa okuwerekerako, okukwatagana obulungi kw’emiguwa kuyinza okuyamba okukendeeza ku binywa by’omugongo.
Ebikulu by’olina okulowoozaako: Enfo ey’okusitama, kozesa ebyuma ebikendeeza (reduction forceps) bwe kiba kyetaagisa. Kulembeza enzirukanya y’okumenya kw’ebinywa (fibular fracture management) okukakasa nti tibial ekendedde bulungi.
Okusalako obuwanvu bwa sentimita 2–3 kukolebwa ku nsonga ya malleolus ey’omu makkati okulaga omusuwa gw’omubiri ogw’okungulu ogwa deltoid. Pini elungamya eyingizibwa ku oba wakati katono ku nsonga ya malleolus, mm 4–5 okuva ku ngulu w’ekitundu ky’omubiri ekiyitibwa articular surface.
Okusala mu buwanvu ku nsonga ya malleolus ey’omu makkati
4–5 mm okuva ku ngulu w’ekiyungo
Sikulufu ezikwatagana mu ngeri ey’okumpi n’ewala
Ekifaananyi 2a: Okuyingiza ppini ezilungamya
Ekifaananyi 2b: Okulaba okw’ebbali
Ekifaananyi 2c: Enkola y’okusiba
Okutambula amangu kw’ekiwanga ky’enkizi n’okukwatagana n’ekigere okutuuka wansi
Okugenda mu maaso okutuuka ku busobozi bw’okusitula obuzito ebitundu 50%
Nga alondoola okutondebwa kwa callus n’obulumi
Emirimu gy’ennyondo z’enkizi gitandika amangu ddala ng’omaze okulongoosebwa
Weewale okusitula obuzito okumala wiiki 4-6
Okukyuka mpolampola okudda ku kusitula obuzito obujjuvu ku wiiki 8–12
Okulondoola buli kiseera mu kukuba ebifaananyi mu kiseera ky’okudda engulu
Okunoonyereza kwakoleddwa ku balwadde 10. We bwatuukira emyezi 3 oluvannyuma lw’okulongoosebwa, emisango 7 gyali giwonye; abalwadde bonna baatuuka ku kuwona mu myezi 6. Omusango gumu buli omu ogw’obulema bwa varus ne recurvatum gwagwawo. Tewali kufiirwa kukendeera, yinfekisoni, ebizibu ebikwatagana n’okuteekebwamu, oba obuvune obw’ekika kya iatrogenic byalabibwa.
Yawona mu myezi 3
Yawona emyezi 6
Yinfekisoni
| Ebivaamu Ebipimo | Ebivudde mu DTN | Enkola ez’ennono |
|---|---|---|
| Omuwendo gw’omukago (emyezi 3) . | Ebitundu 70% | Ebitundu 40-60% |
| Obutakwatagana bulungi (>5°) . | Ebitundu 20% | Ebitundu 25-40% |
| Omuwendo gw’abakwatibwa obulwadde | 0% . | Ebitundu 5-15% |
| Obukodyo bwa AOFAS | 92.6 | 73-88 |
Ekika ky’okumenya: Okumenya kw’omugongo mu ngeri ewanvuye + okumenya kw’ennyindo (fibular fracture).
Ekizibu: Obuvune mu kunyiga ebitundu ebigonvu
Post-op: Okusalako obutonotono 6 bwokka, okuwona okujjuvu mu mwaka 1
DTN esimbibwa nga eyitira mu kutema okutono nga ekuuma bulungi ebitundu ebigonvu. Fibular fracture etebenkedde n’omusumaali ogw’omu lubuto. Omulwadde yatuuka ku kuwona mu bujjuvu nga tewali buzibu bwonna.
Okukuba ebifaananyi nga tonnalongoosebwa
Amangu Post-op
Okugoberera okw’emyezi 3
Okuwona okw’omwaka 1
Emisumaali egy’okudda emabega girina obugumu obw’ekika kya axial ne rotational obusingako bw’ogeraageranya n’emisumaali egy’okusiba egy’omu makkati n’egya antegrade. Greenfield ne banne. yakola okugezesa okw’obutonde (biomechanical testing) nga kulaga nti okukozesa sikulaapu bbiri ez’ewala mu DTN kyatuuka ku bitundu 60–70% eby’obugumu bw’okunyigiriza n’ebitundu 90% eby’obugumu obw’okukyusakyusa bw’ogeraageranya ne sikulaapu ssatu.
Bw’ogeraageranya n’ebipande ebisiba, emisumaali egy’omu misuwa tegikola kwonooneka nnyo mu bitundu ebigonvu naddala nga gisaanira abalwadde abakadde n’abo abalina obuvune obw’amaanyi mu bitundu ebigonvu olw’obuvune obw’amaanyi amangi. Enkola eno tekyetaagisa kufukamira kugulu, okukendeeza ku bulabe bw’okufiirwa okukendeeza n’okugifuula esaanira abalwadde abalina okutambula okutono okw’okugulu.
Emiwendo gy’obutakwatagana n’obutakwatagana bulungi ku misumaali egy’omu maaso (antegrade nails) giri 0–25% ne 8.3–50%, okusinziira ku; ku bipande ebisiba, 0–17% ne 0–17%. Mu kunoonyereza kuno, emisango gyonna gyatuuka ku kugatta, era 20% bokka be baalina obulema >5°, okugeraageranyizibwa ku nkola ez’ennono.
Mu bufunze, DTN egaba enkizo ku kusiba obupande n’emisumaali egy’omu lubuto egy’omu maaso (antegrade intramedullary nails) era ekiikirira eky’okugonjoola ekirungi eky’okujjanjaba okumenya kw’ekisambi eky’ewala. DTN erimu obutayingira bungi, okutebenkera okw’amaanyi, n’okuwona amangu. Kiba kya muwendo nnyo okusinga obujjanjabi obw’ekinnansi era nga kigwana okutumbulwa.
Omuze:1200-27
Ebikwata ku BikozesebwaOmutindo:1000-0139
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