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Lipekere tse 10 tse holimo tsa Distal Tibial Intramedullary (DTN) Amerika Leboea ka Pherekhong 2025
Lipekere tse 10 tse holimo tsa Distal Tibial Intramedullary (DTN) Amerika Leboea ka Pherekhong 2025
Maikutlo: 0 Mongoli: Nako ea Phatlalatso ea Mohlophisi oa Sebaka: 2025-06-17 Tšimoloho: Sebaka
Thuto ea Tleliniki ea Distal Tibial Intramedullary Nail (DTN).
Tlhahlobo e Feletseng ea Mokhoa oa ho Buoa, Liphetho, le Likopo
E phatlalalitsoe: June 17, 2025
The Distal Tibial Intramedullary Nail (DTN) e bontšoa bakeng sa maemo a sa tšoaneng a tibial, ho akarelletsa le bonolo, spiral, comminuted, long oblique, le segmental shaft fractures (haholo-holo ea distal tibia), hammoho le distal tibial metaphyseal fractures, non-/mal-unions; e ka boela ea sebelisoa, hangata ka lisebelisoa tse khethehileng, bakeng sa ho laola bokooa ba masapo kapa ho se lumellane ha maoto le maoto (joalo ka ho lelefatsa kapa ho khutsufatsa).
Ho notlela Lipoleiti
Tšenyo e kholo ea lisele tse bonolo, tekanyo e phahameng ea tšoaetso, ho hlaphoheloa nako e telele
Antegrade Nails
Kotsi ea kotsi ea lenonyeletso la lengole, ho lokisa ho sa lekaneng, ho atisa ho senyeha
Tharollo ea DTN
Mokhoa o fokolang haholo o nang le moralo oa ho kenya retrograde
1Distal tibial fractures e tloaelehile, 'me phekolo ea setso e na le mefokolo
Distal tibial fractures ke mofuta o tloaelehileng oa ho robeha ha leoto le tlase. Liphekolo tsa setso tse kang lipoleiti tsa ho notlela le lipekere tsa antegrade intramedullary li na le mefokolo ea tsona. Lipoleiti tsa ho notlela li ka baka tšoaetso ea postoperative kapa necrosis ea lisele tse bonolo, ho lelefatsa ho hlaphoheloa; le hoja lipekere tsa antegrade li na le tšenyo e fokolang, li ka 'na tsa senya lenonyeletso la lengole, tsa baka bohloko,' me tsa jara likotsi tsa ho se lokisoe ka ho lekaneng kapa ho se sebetse hantle, ho sitisa ho hlaphoheloa.
2Tharollo e ncha: Nail ea Distal Tibial (DTN)
Khetho e ncha ea phekolo-Distal Tibial Nail (DTN) -e fana ka pono e ncha ea ho laola fractures ea distal tibial ka moralo oa eona o ikhethang oa ho khutlela morao.
Setšoantšo sa 1: Moralo oa ho kenya retrograde oa DTN
II. Mokhoa oa ho Buoa
1Boemo ba mokuli le ho itokisetsa ho fokotsa
Mokuli o behoa setulong sa supine. fractures displaced e lokela ho fokotsoa ka letsoho; ha ho hlokahala, sebelisa matla a phokotso ho thusa pele o kenya DTN. Haeba ho na le fracture e tsamaeang le fibula, ho tsamaisana ho nepahetseng ha fibula ho ka thusa ho fokotsa tibial.
Lintlha tsa bohlokoa: Sebaka sa supine, sebelisa li-forceps ha ho hlokahala. Beha pele tsamaiso ea fracture ea fibula ho netefatsa ho fokotseha ho nepahetseng ha tibial.
2Mokhoa oa ho kenya DTN
Sekhahla sa bolelele ba 2-3 cm se etsoa ntlheng ea malleolus ea medial ho pepesa li-deltoid ligament e kaholimo. Pini e tataisang e kenngoa kapa e bohareng hanyenyane ho ea fihla ntlheng ea malleolus, 4-5 mm ho tloha sebakeng sa articular.
Sekoa:
Sekhao sa longitudinal ntlheng ea medial malleolus
Sebaka sa phini ea tataiso:
4-5 limilimithara ho tloha sebakeng se kopane
Tokiso:
Li-screws tse hokahaneng proximally le disally
Setšoantšo sa 2a: Ho kenya phini ea tataiso
Setšoantšo sa 2b: Pono ea ka morao
Setšoantšo sa 2c: Mokhoa oa ho tsosolosa
III. Ho tsosolosa ka mor'a-op
0-6
Libeke tse se nang boima ba 'mele
Ho sisinyeha ha maqaqailaneng hang-hang le ho kopana ha leoto ho ea fatše
6-8
Libeke Ho jara Boima bo sa Feleng
Tsoelopele ho isa ho 50% matla a ho jara boima
8-12
Libeke tse Tletseng Boima ba 'mele
Ha o ntse o shebile sebopeho sa callus le bohloko
Protocol ea Tsosoloso
Mosebetsi oa manonyeletso a maqaqailana o qala hang ka mor'a ho buuoa
Qoba ho jara boima ba 'mele bakeng sa libeke tse 4-6
Butle-butle phetoho ea boima bo feletseng ka libeke tse 8-12
Tlhokomelo ea kamehla ea radiographic nakong ea mohato oa ho hlaphoheloa
IV. Liphetho tsa Thuto
1Liphello tsa Clinical tsa Bakuli ba 10
Phuputso e ile ea latela bakuli ba 10. Ka mor'a likhoeli tse 3, linyeoe tse 7 li ne li folile; bakuli bohle ba fihletse pholiso nakong ea likhoeli tse 6. Ketsahalo e 'ngoe ea varus le recurvatum deformity e etsahetse. Ha ho tahlehelo ea phokotso, tšoaetso, mathata a amanang le ho kenngoa, kapa likotsi tsa iatrogenic tse ileng tsa bonoa.
70%
E folile nakong ea likhoeli tse 3
100%
E folile ka likhoeli tse 6
0%
Tšoaetso
Sephetho Lekanya
Liphetho tsa DTN
Mekhoa ea Setso
Sekhahla sa Union (likhoeli tse 3)
70%
40-60%
Ho se lekane (>5°)
20%
25-40%
Sekhahla sa Tšoaetso
0%
5-15%
Lintlha tsa AOFAS
92.6
73-88
V. Tlaleho ea Nyeoe
Mokuli e motona ea lilemo li 69
Mofuta oa fracture: Transverse tibial fracture + fibular fracture
Bothata: Ho lematsoa ha lisele tse bonolo
Post-op: Ke likheo tse nyane tse 6 feela, pholiso e felletseng nakong ea selemo se le seng
Kakaretso ea Kalafo
DTN e kentsoeng ka likheo tse nyane tse nang le paballo e ntle haholo ea lisele tse bonolo. Ho robeha ha fibula ho tsitsitse ka sepekere sa intramedullary. Mokuli o fihletse ho hlaphoheloa ka botlalo ntle le mathata.
Imaging ea pele
Hang-hang Post-op
Tsoelo-pele ea likhoeli tse 3
1-year Healing
VI. Puisano
1Botsitso ba Biomechanical
Lipekere tse khutlisetsang morao li na le boima bo phahameng ba axial le rotational ha bo bapisoa le lipoleiti tsa ho notlela tse bohareng le lipekere tsa antegrade. Greenfield le ba bang. e ile ea etsa tlhahlobo ea biomechanical e bontšang hore ho sebelisa li-screw tse peli tsa distal ho DTN ho fihletse 60-70% ea ho satalla ha khatello le 90% ea ho satalla ha torsional ha ho bapisoa le li-screw tse tharo.
2Melemo ea DTN
Ha ho bapisoa le lipoleiti tsa ho notlela, lipekere tsa intramedullary li baka tšenyo e fokolang ea lisele tse bonolo, haholo-holo tse loketseng bakuli ba tsofetseng le ba nang le likotsi tse tebileng tsa lisele tse bonolo tse bakoang ke ts'oaetso e matla ea matla. Mokhoa ona ha o hloke ho otlolla lengole, ho fokotsa kotsi ea ho fokotsa tahlehelo le ho etsa hore e be e loketseng bakuli ba nang le ho sisinyeha ha lengole.
3Papiso ea Clinical
Litefiso tsa ho se kopane le ho se lumellane ha lipekere tsa antegrade ke 0-25% le 8.3-50%, ka ho latellana; bakeng sa lipoleiti tsa ho notlela, 0–17% le 0–17%. Phuputsong ena, linyeoe tsohle li fihletse bonngoe, 'me ke 20% feela e nang le bokooa> 5 °, e bapisoang le mekhoa ea setso.
VII. Qetello
Ka kakaretso, DTN e fana ka melemo ho feta lipoleiti tsa ho notlela le lipekere tsa antegrade intramedullary 'me e emela tharollo e sebetsang bakeng sa ho phekola distal tibial fractures. DTN e na le ts'oaetso e fokolang, botsitso bo phahameng, le ho hlaphoheloa ka potlako. Ke mokhoa o mong oa bohlokoa ho liphekolo tsa setso mme o lokela ho khothaletsoa.
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