Misomali Yapamwamba 10 ya Distal Tibial Intramedullary (DTN) ku North America mu Januware 2025
Mawonedwe: 0 Wolemba: Mkonzi Watsamba Nthawi Yosindikiza: 2025-06-17 Poyambira: Tsamba
Distal Tibial Intramedullary Nail (DTN) Clinical Study
Kusanthula Kwakukulu kwa Njira Zopangira Opaleshoni, Zotsatira, ndi Ntchito
The Distal Tibial Intramedullary Nail (DTN) imasonyezedwa kwa mitundu yosiyanasiyana ya tibial, kuphatikizapo zosavuta, zozungulira, zowonongeka, zowonongeka, ndi zowonongeka zamagulu (makamaka za distal tibia), komanso distal tibial metaphyseal fractures, non-/mal-unions; Itha kugwiritsidwanso ntchito, nthawi zambiri ndi zida zapadera, poyang'anira kuwonongeka kwa mafupa kapena kusiyana kwa kutalika kwa miyendo (monga kutalikitsa kapena kufupikitsa).
Zokhoma mbale
Kuwonongeka kwakukulu kwa minofu yofewa, kuchuluka kwa matenda, kuchira kwa nthawi yayitali
Antegrade Misomali
Chiwopsezo cha kuvulala kwa mawondo, kusakhazikika bwino, kumakonda kusokoneza
DTN Solution
Njira yowononga pang'ono yokhala ndi kapangidwe ka retrograde
I. Chiyambi
1 Distal tibial fractures ndizofala, ndipo mankhwala achikhalidwe ali ndi malireDistal tibial fractures ndi mtundu wamba wa kusweka kwa miyendo yapansi. Mankhwala achikhalidwe monga kutsekera mbale ndi antegrade intramedullary misomali iliyonse ili ndi zovuta zake. Kutseka mbale kungayambitse matenda a postoperative kapena necrosis ya minofu yofewa, kuwonjezera kuchira; ngakhale kuti misomali ya antegrade imakhala yochepa kwambiri, imatha kuwononga mawondo a bondo, kupweteketsa mtima, komanso kukhala ndi chiopsezo chosakwanira kukonza kapena kusokoneza, kulepheretsa kuchira.
2 Yankho Latsopano: Distal Tibial Nail (DTN)Njira yatsopano yothandizira-Distal Tibial Nail (DTN) -imapereka malingaliro atsopano owongolera ma distal tibial fractures ndi mapangidwe ake apadera obwerera.
Chithunzi 1: DTN retrograde yoyikanso
II. Njira Yopangira Opaleshoni
1 Kuyika kwa odwala ndi kukonzekera kuchepetsaWodwalayo amaikidwa pamalo apamwamba. Zophwanyika zochotsedwa ziyenera kuchepetsedwa pamanja; ngati kuli kofunikira, gwiritsani ntchito mphamvu zochepetsera kuti muthandizire musanayike DTN. Ngati pali fracture yotsatizana ndi fibular, kuyanjanitsa koyenera kwa fibula kungathandize kuchepetsa tibial.
Mfundo zazikuluzikulu: Malo apamwamba, gwiritsani ntchito mphamvu zochepetsera ngati pakufunika. Yang'anani kasamalidwe ka fibular fracture kuti mutsimikizire kuchepetsedwa kolondola kwa tibial.
2 Njira yopangira DTNKutalika kwa 2-3 masentimita kumapangidwira kumapeto kwa malleolus apakati kuti awonetsere chiuno cha deltoid ligament. Pini yolondolera imayikidwa pakati kapena pakati pang'ono kunsonga kwa malleolus, 4-5 mm kuchokera pamwamba.
Chocheka:
Kudula kwautali pamtunda wapakati wa malleolus
Kuyika pini yowongolera:
4-5 mm kuchokera olowa pamwamba
Kukonza:
Zomangira zolumikizirana proximally ndi distal
Chithunzi 2a: Kuyika pini yotsogolera
Chithunzi 2b: Mawonedwe apambuyo
Chithunzi 2c: Njira yobwezeretsanso
III. Post-op Rehabilitation
0-6
Masabata Opanda kulemera
Kuyenda mwachangu kwa akakolo komanso kukhudza phazi mpaka pansi
6-8
Masabata Kulemera pang'ono
Kupitilira mpaka 50% kunyamula zolemera
8-12
Masabata Olemera Kwambiri
Poyang'anitsitsa mapangidwe a callus ndi ululu
Rehabilitation Protocol
Ntchito ya mafupa a m'chiuno imayamba mwamsanga pambuyo pa opaleshoni
Pewani kulemera kwa masabata 4-6
Kusintha kwapang'onopang'ono mpaka kulemera kwathunthu pa masabata 8-12
Kuwunika pafupipafupi kwa radiographic panthawi yochira
IV. Zotsatira za Phunziro
1 Zotsatira Zachipatala za Odwala 10Kafukufuku adatsata odwala 10. Pakatha miyezi itatu, milandu 7 idachira; odwala onse anachiritsidwa mkati mwa miyezi 6. Mlandu umodzi uliwonse wa varus ndi recurvatum deformities zinachitika. Palibe kutayika kwa kuchepa, matenda, zovuta zokhudzana ndi implant, kapena kuvulala kwa iatrogenic zomwe zidawonedwa.
70%
Anachiritsidwa mkati mwa miyezi itatu
100%
Anachiritsidwa ndi miyezi 6
Zotsatira Yesani Zotsatira za DTN Njira Zachikhalidwe
Union Rate (miyezi 3)
70%
40-60%
Kusayenda bwino (>5°)
20%
25-40%
Mlingo wa matenda
0%
5-15%
Zotsatira za AOFAS
92.6
73-88
V. Lipoti la Nkhani
Wodwala wazaka 69 zakubadwa
Mtundu wa Fracture: Kuphulika kwa tibial + kuphulika kwa fibular
Vuto: Kuvulala kwa minofu yofewa
Post-op: Madontho ang'onoang'ono 6 okha, machiritso athunthu mkati mwa chaka chimodzi
Chidule cha Chithandizo
DTN yobzalidwa kudzera m'madulidwe ochepa okhala ndi chitetezo chabwino kwambiri cha minofu yofewa. Fibular fracture imakhazikika ndi msomali wa intramedullary. Wodwalayo adachira kwathunthu popanda zovuta.
Pre-op Imaging
Posachedwapa Post-op
Kutsatira kwa miyezi 3
1-chaka machiritso
VI. Zokambirana
1 Kukhazikika kwa BiomechanicalMisomali yobwereranso imakhala ndi kuuma kwa axial komanso kozungulira poyerekeza ndi mbale zokhoma zamkati ndi misomali ya antegrade. Greenfield et al. adayesa biomechanical kusonyeza kuti kugwiritsa ntchito zomangira ziwiri za distal mu DTN kunakwaniritsa 60-70% ya kuuma kolimba ndi 90% ya kuuma kwa torsion poyerekeza ndi zomangira zitatu.
2 Ubwino wa DTNPoyerekeza ndi mbale zokhoma, misomali ya intramedullary imapangitsa kuti minofu yofewa ikhale yochepa kwambiri, makamaka yoyenera kwa odwala okalamba komanso omwe ali ndi kuvulala kwakukulu kwa minofu yofewa chifukwa cha kuvulala kwamphamvu kwambiri. Njirayi sikutanthauza kugwedeza kwa mawondo, kuchepetsa chiopsezo cha kuchepetsa kuchepa ndikupangitsa kuti ikhale yoyenera kwa odwala omwe ali ndi mawondo ochepa.
3 Kuyerekeza KwachipatalaMisomali yosagwirizana ndi misomali ya antegrade ndi 0-25% ndi 8.3-50%, motsatira; kwa mbale zokhoma, 0-17% ndi 0-17%. Mu phunziro ili, milandu yonse inakwaniritsa mgwirizano, ndipo 20% yokha inali ndi chilema> 5 °, poyerekeza ndi njira zachikhalidwe.
VII. MapetoMwachidule, DTN imapereka ubwino pazitsulo zokhoma ndi antegrade intramedullary misomali ndipo imayimira njira yothetsera matenda a distal tibial fractures. DTN imakhala ndi zowononga zochepa, kukhazikika kwakukulu, komanso kuchira msanga. Ndilofunika njira zina zochiritsira zachikhalidwe komanso zoyenera kukwezedwa.
Mtengo wa magawo DTN
Nail ya Distal Tibial Intramedullary Nail (DTN)
Distal Tibial Intramedullary Nail (DTN) Instrument Set
Distal Tibial Intramedullary Nail (DTN) Instrument Box
