Tibial fracture, suprapatellar intramedullary nailing technique

Intramedullary tibial nailing: kuwana uye kurongeka, kurwadziwa kwemabvi anterior

Nzira yekuvhiya kune intramedullary nailing yetibial fractures yakakosha kuitira kuti uise intramedullary mbambo kuburikidza nenzvimbo yakarurama yekupinda, kuderedza kukuvadzwa kune intra-articular mabvi maitiro, uye kuwana optimal fracture repositioning uye kukodzera kwembambo yekupinda.

Nzira dzekare dzetibial stem fractures ndeye infrapatellar median kana infrapatellar parapatellar approach. Kunyange zvazvo nzira idzi dzichiratidzwa kwepakati-chikamu fractures, postoperative valgus, anterior, kana kusanganiswa kukanganiswa kunowanzoitika mune zvakanyanya kuputsika.

Chikonzero chikuru chekusagadzikana mu proximal tibial fractures ndiko kuremara kunokonzerwa nekukwevera kwetendon ye quadriceps panguva yekuputika kwemabvi uye kupesana kwemagetsi pakati pechipikiri chembambo uye posterior tibial cortex panguva yekuisa. Iyo patella inodzivirirawo axial nail kupinda mu sagittal ndege (Fig. 1a, b). Nokudaro, imwe nzira yakajairika yekuwana iyo pfungwa ndeyekuburikidza nepakati parapatellar incision, iyo inotungamirira kune zvishoma zvishoma kune lateral chipikiri kuiswa (Figs. 1c uye 2). Sezvo mbambo inopinda mu intramedullary canal distal kusvika pakuputsika, chikamu chepamusoro chinotenderera mu valgus (Mufananidzo 2). Pakupedzisira, kushushikana kwekuzorora kweanterior compartment muscles kunobatsira zvishoma kune valgus (Mufananidzo 3).

Mufananidzo 1 a, b Uchishandisa nzira yakajairika ye infrapatellar, patella inodzivirira kupinda kweaxial yembambo, zvichiita kuti kukanganiswa kwakafanana kweanterior apical sagittal alignment uye valgus coronal alignment. c Kushandisa iyo parapatellar nzira yekumisikidza intramedullary chipikiri.

Mufananidzo 2 Kusvika panopindwa kuburikidza nepakati parapatellar incision inotungamira kune yepakati zvishoma kune lateral chipikiri kuiswa. Sezvo mbambo ichipinda mumedullary canal distal kusvika pakatyoka (a), chikamu chepamusoro chinotsvedza mu valgus (b)

Mufananidzo 3 Kusagadzikana kwekuzorora muchikamu chemukati chemuscle (a) chinobudisa maitiro asina kujeka ectopic (b)

Kupinza tibia mune imwe nzvimbo yakawedzera kunobatsira kudzivirira matambudziko anoenderana neakanyanya intraoperative ibvi kuchinjika. iyo nzira yakatsanangurwa naGelbke, Jakma et al. muna 2010 uye yakawedzera mukurumbira mumakore achangopfuura nekuti kupinza tibia munzvimbo inenge yakatwasuka yemakumbo kunorerutsa kutsemuka kwekutyoka uye kudzorerazve. Fluoroscopy yave nehunyanzvi nyore kuita. Fluoroscopy nguva dze suprapatellar nailing dzakanzi dzakapfupika pane ye infrapatellar nailing. Mukuwedzera, kona yekupinza kwembambo (mu sagittal plane) inonyanya kufanana neyo longitudinal axis ye tibia nenzira iyi kupfuura infrapatellar nail; izvi zvinodzivirira kukakavara kwemagetsi pakati pechipikiri chepikiri uye posterior cortex, nekudaro kufambisa kuderedzwa kwekutyoka.

Postoperative anterior ibvi kurwadziwa idambudziko rakabatana. Anterior ibvi kurwadziwa kwakataurwa mu50-70% yevarwere vakaputsika, vane 30% chete yevarwere vanonzwa kurwadziwa shure kwekubviswa kwemuti wemukati. Inofungidzirwa kuti kuumbwa kwevanga kunobatanidza nekuwana patellar tendon uye Hoffa mafuta pad ndiyo inogona kukonzera kurwadziwa kwemabvi mushure mekushanda. Mukuwedzera, iyo suprapatellar nzira inodzivisa kuvharwa kwechinyakare kwebazi rebazi repatellar resaphenous nerve, nokudaro kudzivisa anterior mabvi numbness uye kunzwa kunonoka (Mufananidzo 4). Kupfuudza mbambo kuburikidza ne quadriceps tendon, nokudaro zvichisiya patellar tendon yakasimba, inoratidzika kuderedza zvakanyanya kuwanda kwemarwadzo emabvi epashure.

Pamusana pemigumisiro yakanaka yeproximal fractures, zviratidzo mumakiriniki ekudzidzira zvakawedzerwa kune zvose zvakaputsika.

Ndeipi iyo suprapatellar intramedullary nail inofanira kushandiswa?

Zvakanakira

• Semi-yakawedzerwa ibvi chinzvimbo inosimudzira kutsemuka uye kudzoreredza nekuzorodza tsandanyama simba uye kuchengetwa panguva yekuiswa kwembambo.

• Ngozi yakaderera ye postoperative dislocation ye proximal, segmental uye distal fractures zvichienzaniswa nemaitiro akajairwa.

• Nailing oparesheni iri nyore kuita

• Kupinzwa kwembambo kunogoneka se 'nzira imwe chete yachiremba'

• Yakaderedzwa fluoroscopy nguva

• Hapana kukuvadzwa kune patellar tendon uye chiitiko chakaderera chemashure-stapling anterior mabvi kurwadziwa

• Zviri nyore kuita mune akawanda-timu maitiro, semukushungurudzika kwakawanda

  
  

Zviratidzo

• Kuwedzera-kutyoka kweiyo proximal tibia (AO 41A mhando)

• Kuputsika kwakapusa kweiyo tibial diaphysis (AO 42A-C mhando)

• Segmental tibial diaphyseal fracture (AO 42C mhando)

• Distal tibial yakawedzera-articular fractures uye nyore intra-articular distal extension fractures (AO 43A uye C1 marudzi)

• Ibvi rinoyangarara

• Patellar ossification ine patellar tendon ossification

• Ronda rakasvibiswa pamwero wepatellar tendon

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