I-10 ephezulu ye-Distal Tibial Misumari ya ndani ya mfupa (DTN) eMntla Melika ngoJanuwari ka-2025
Iimboniselo: 0 uMbhali: Ixesha lokupapasha loMhleli weSiza: 2025-06-17 Imvelaphi: Isiza
I-Distal Tibial Msumari wa ndani ya mfupa (DTN) i-Clinical Study
Uhlalutyo oluBanzi lweTeknikhi yoTyando, iZiphumo, kunye nezicelo
Ipapashwe: ngoJuni 17, 2025
I-Distal Tibial Msumari wa ndani ya mfupa (i-DTN) iboniswa kwiintlobo ezahlukeneyo zeemeko ze-tibial, ezibandakanya i-simple, i-spiral, i-comminuted, i-oblique ende, kunye ne-segmental shaft fractures (ingakumbi i-distal tibia), kunye ne-distal tibial metaphyseal fractures, non-/mal-unions; inokuphinda isetyenziswe, rhoqo ngezixhobo ezikhethekileyo, ukulawula iziphene zamathambo okanye ukungangqinelani kobude belungu (njengokwandiswa okanye ukufinyeza).
Locking Plates
Umonakalo obalulekileyo wezicubu ezithambileyo, izinga eliphezulu losulelo, ukubuyisela ixesha elide
Izikhonkwane ze-Antegrade
Umngcipheko wokulimala kwamadolo, ukulungiswa okunganelanga, ukulungelelaniswa nokungahambi kakuhle
Isisombululo se-DTN
Indlela ehlaselayo encinci kunye noyilo lofakelo lokubuyisela umva
I. Intshayelelo
1I-distal tibial fractures ixhaphakile, kwaye unyango lwendabuko lunemida
I-distal tibial fractures luhlobo oluqhelekileyo lokuphuka kwemilenze ephantsi. Unyango lwesintu olufana ne- Locking Plates kunye nezikhonkwane ze-antegrade intramedullary nganye inentsilelo yayo. Locking Plates inokubangela usulelo emva kokuhlinzwa okanye i-necrosis yezicubu ezithambileyo, ukwandisa ukuchacha; nangona izikhonkwane ze-antegrade zincinci, zingonakalisa idolo elihlangeneyo, zibangele intlungu, kwaye zithwale imingcipheko yokungalungiswa ngokwaneleyo okanye ukungahambi kakuhle, ukuthintela ukubuyiswa.
2Isisombululo esitsha: I-Distal Tibial Nail (DTN)
Inketho yonyango entsha-i-Distal Tibial Nail (i-DTN)-inika imbono entsha yokulawula i-distal tibial fractures kunye noyilo olukhethekileyo lokubuyisela.
Umzobo 1: uyilo lofakelo lokubuyisela i-DTN
II. Inkqubo yoTyando
1Ukubekwa kwesigulane kunye nokulungiswa kokunciphisa
Isigulane sibekwe kwindawo yokulala. Iifractures ezifudusiweyo kufuneka zincitshiswe ngesandla; ukuba kuyimfuneko, sebenzisa iiforcep zokunciphisa ukuncedisa phambi kokufaka i-DTN. Ukuba kukho i-fibular fracture ehamba kunye, ukulungelelaniswa okufanelekileyo kwe-fibular kunokuncedisa ukunciphisa i-tibial.
Iingcamango eziphambili: Isikhundla esiphezulu, sebenzisa i-forceps yokunciphisa ukuba kuyimfuneko. Ukubeka phambili ulawulo lwe-fibular fracture ukuqinisekisa ukunciphisa okuchanekileyo kwe-tibial.
2Inkqubo yokufaka i-DTN
I-2-3 cm ye-longitudinal incision yenziwa kwincam ye-medial malleolus ukuveza i-superficial deltoid ligament. Ikhoni yesikhokelo ifakwe okanye iphakathi kancinci kwincam ye-malleolus, i-4-5 mm ukusuka kwi-articular surface.
Ukusika:
I-longitudinal cut in the medial malleolus tip
Isikhonkwane sokubekwa kwesikhokhelo:
4-5 mm ukusuka kwindawo edibeneyo
Ukulungiswa:
I-Inter Izikrufu zokutshixa ngokusondeleyo kunye ne-distally
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Umzobo 2a: Ufakelo lwesikhonkwane sesikhokelo
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Umzobo 2b: Imbono esecaleni
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Umzobo 2c: Inkqubo yokubuyisela kwakhona
III. Ukubuyisela kwimo yesiqhelo emva kokuphuma
0-6
Iiveki Ukuthwala ubunzima
Ukuhamba ngokudibeneyo kwe-ankle kunye nokuqhagamshelana nonyawo ukuya kumgangatho
6-8
Iiveki Ukuthwala ubunzima
Inkqubela phambili ukuya kwi-50% yomthamo wokuthwala ubunzima
8-12
Iiveki Ubunzima obugcweleyo
Ngelixa esweni ukubunjwa kweefowuni kunye neentlungu
Umgaqo wokubuyisela kwisimo sangaphambili
Umsebenzi odibeneyo we-Ankle uqala ngokukhawuleza emva kokuhlinzwa
Kuphephe ukuthwala ubunzima kwiiveki ezi-4-6
Ukutshintshela ngokuthe ngcembe kwisisindo esipheleleyo kwiiveki ezi-8-12
Ukujongwa rhoqo kweradiographic ngexesha lesigaba sokubuyisela
IV. Iziphumo zoFundo
1Iziphumo zeklinikhi zezigulane ezili-10
Uphononongo lulandele izigulane ezili-10. Ngeenyanga ezi-3 emva kokuphuma, iimeko ezisi-7 sele ziphilisiwe; zonke izigulane zifumene ukuphiliswa kwiinyanga ezi-6. Imeko enye yevarus kunye ne-recurvatum deformities yenzeka. Akukho kulahleka kokunciphisa, ukusuleleka, iingxaki ezinxulumene nokufakelwa, okanye ukulimala kwe-iatrogenic kwabonwa.
70%
Uphiliswe kwiinyanga ezi-3
100%
Uphiliswe ngeenyanga ezi-6
| Umlinganiselo weSiphumo |
Iziphumo zeDTN |
Iindlela zesiNtu |
| Umyinge weManyano (iinyanga ezi-3) |
70% |
40-60% |
| Ukungahambi kakuhle (>5°) |
20% |
25-40% |
| Inqanaba losulelo |
0% |
5-15% |
| Amanqaku e-AOFAS |
92.6 |
73-88 |
V. Ingxelo yeCase
Umguli oneminyaka engama-69 ubudala
Uhlobo lokuqhekeka: I-Transverse tibial fracture + i-fibular fracture
Ingxaki: Ukwenzakala kwezicubu ezithambileyo
I-Post-op: I-6 kuphela i-incision encinci, ukuphilisa okupheleleyo ngaphakathi kwe-1 unyaka
IsiShwankathelo soNyango
I-DTN ifakwe ngokusikeka okuncinci ngogcino lwethishu ethambileyo. I-Fibular fracture izinzile nge-intramedullary nail. Isigulana siphumelele ukuchacha ngokupheleleyo kwaye akukho zingxaki.
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Ukufanekisa kwangaphambili
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Kwangoko Post-op
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Ulandelelwano lweenyanga ezi-3
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Unyaka we-1 wokuphila
VI. Ingxoxo
1Uzinzo lweBiomechanical
Izikhonkwane ze-retrograde zine-axial ephezulu kunye nokuqina okujikelezayo xa kuthelekiswa ne-medial Locking Plates kunye nezikhonkwane ze-antegrade. Greenfield et al. kwenziwe uvavanyo lwe-biomechanical olubonisa ukuba ukusebenzisa izikrufu ezibini ze-distal kwi-DTN kuzuze i-60-70% yokuqina koxinzelelo kunye ne-90% yokuqina kwe-torsional xa kuthelekiswa nezikrufu ezithathu.
2Izinto ezilungileyo ze-DTN
Xa kuthelekiswa ne- Locking Plates , izikhonkwane ze-intramedullary zenza umonakalo ongaphantsi kwezicubu ezithambileyo, ezilungele kakhulu izigulane ezisebekhulile kunye nezo zinokulimala kakhulu kwezicubu ezithambileyo ezivela kwi-high-energy trauma. Inkqubo ayifuni ukuguqa ngamadolo, ukunciphisa umngcipheko wokunciphisa ilahleko kunye nokwenza ukuba ifaneleke izigulane ezinedolo elilinganiselweyo.
3Uthelekiso lweklinikhi
Amazinga angabonakaliyo kunye nokungahambi kakuhle kwezikhonkwane ze-antegrade yi-0-25% kunye ne-8.3-50%, ngokulandelanayo; ye Locking Plates , 0–17% kunye ne-0–17%. Kolu phononongo, zonke iimeko ezifunyenwe umanyano, kwaye kuphela i-20% yayinokukhubazeka> 5 °, xa kuthelekiswa neendlela zendabuko.
VII. Ukuqukumbela
Isishwankathelo, i-DTN inikezela ngeenzuzo ngaphezu kwe- Locking Plates kunye ne-antegrade intramedullary izikhonkwane kwaye imele isisombululo esisebenzayo sokunyanga i-distal tibial fractures. I-DTN ibonakalisa ukungahlaseli okuncinci, ukuzinza okuphezulu, kunye nokuchacha ngokukhawuleza. Yenye indlela enexabiso kunyango lwesintu kwaye ifanele ukukhuthazwa.
DTN Product Line
I-Distal Tibial Msumari wa ndani ya mfupa (DTN)
I-Distal Tibial Msumari wa ndani ya mfupa (DTN) Instrument Set
I-Distal Tibial Msumari wa ndani ya mfupa (DTN) Ibhokisi yeSixhobo
