I. Isingeniso
I-hudistal humerus iqukethe amakholomu aphakathi nendawo nawesi-lateral, ahlanganisa ama-epicondyles nama-dychy.
II. Inqubo yokuhlinzwa
I-distal humerus fractures ibangelwa usizi oluqondile (isib. Ukuwa) noma amandla angaqondile (isib., Ukusonteka noma ukudonsa kwemisipha).
III. Ukuvuselelwa kwe-post-ap
Ukuhlukaniswa kwe-AO kuhlukanisa distal humerus fractures ezinhlotsheni ezintathu eziphambili: a, b, no c.
IV. Imiphumela Yokufunda
Ukwelashwa okuhlinza okulandela imigomo ye-AO: ukuncishiswa kwe-anatomical, ukulungiswa okuzinzile, kanye nokuvuselelwa kusenesikhathi.
V. Umbiko Wecala
Ukukhiya amapuleti kunikeza ukuqina okuphezulu kwe-bioowokhanical, ikakhulukazi ethanjeni le-osteoporotic.
VI. Ukukhuluma
I-CZMeditech inikezela ngamamodeli amathathu: eyengeziwe (01.1107), ipuleti ye-lateral (5100-17), ne-Medial (5100-18).
VII. Ukugcina
Ukwelashwa okuhlinza okulandela imigomo ye-AO: ukuncishiswa kwe-anatomical, ukulungiswa okuzinzile, kanye nokuvuselelwa kusenesikhathi.
Ukuqhekeka kwe-distal tibial kuvamile, futhi ukwelashwa kwendabuko kunomkhawulo
Ama-distal tibial fractures anguhlobo olujwayelekile lokuqhekeka okuphansi kwemilenze. Ukwelashwa kwendabuko okunjengamapuleti okukhiya kanye ne-antregrade izipikili ezihlabelelayo ngayinye zinezinkinga zazo. Ukukhiya amapuleti kungadala ukutheleleka nge-postoperationational noma i-necrosis ethambile ye-necrosis, ukululama okwengeziwe; Yize izipikili ze-AntGrade zihlasela kancane, zingalimaza i-Knee Joint, zibangele izinhlungu, futhi ziphathe ubungozi bokulungiswa okunganele noma emganzweni, kuvimbela ukululama.
Ukukhiya amapuleti:
Ukulimala okubalulekile kwezicubu ezithambile, izinga lokutheleleka okuphezulu, ukululama isikhathi eside
Izinzipho ze-Antegrade:
Ingozi yokulimala okuhlangene kwedolo, ukulungiswa okunganele, okuthambekele ekumeni
Isixazululo Esisha: I-Distal Tibial Nail (DTN)
Inketho yokwelashwa kwenoveli-distal tibial nail nail (DTN) -Umbono omusha wokuphatha ama-distal tibial fractures nge-design yayo eyingqayizivele ye-repOgrade.
I-Retrograde Insount Design inikeza indlela entsha
Ukubekwa Kweziguli Nokunciphisa Ukulungiswa
Isiguli sibekwe endaweni ephakeme. Ama-fractures asusiwe kufanele abe nzima ngokwengeziwe; Uma kunesidingo, sebenzisa amandla okunciphisa ukusiza ngaphambi kokufaka i-DTN. Uma kunokuphazamiseka okuhambisana nalokhu, ukuqondanisa okufanele kwe-fibular kungasiza ukuncishiswa kwe-tibial. I-Fibular shaft fractures ingaqiniswa ngezipikili zomhlaba. Ukuqhekeka ezungeze i-ankle, ukuncishiswa kwe-anatomical kanye nokulungiswa kwe-fibula kufanele kudlule ukuncishiswa kwe-tibial ukugwema ukuphambama. Ekuvuleleni okuvulekile ngokulungiswa kwangaphandle okukhona, izipikili zingafakwa ngenkathi kugcinwa i-Fishator ukufeza ukuncishiswa.
Isikhundla se-supine, sebenzisa amandla okunciphisa uma kudingeka
Ukubeka phambili ukuphathwa kwe-Fracture Fracture ukuqinisekisa ukwehliswa okunembile kwe-tibial
Ukuvela oku-2-3 cm okude emude kwenziwa engxenyeni ye-medial malleolus ukudalula i-deltoid ligament engaphezulu. I-PIN yomhlahlandlela ifakwe noma i-medial kancane kuya esicongweni se-malleolus (Fig. 2a), 4-5 mm kusuka endaweni yezimangaliso. Ukubuka okulandelayo kukhombisa ukufakwa nge-intercondylar Groove (Fig. 2b), ukugwema ukulimala kwemisipha yangemuva yeTibialis. Hlukanisa i-DelFood Ligament engaphezulu, bese usebenzisa i-REAMER ukuze wandise umsele we-medullary ufinyelela esifundeni saseMetaphyeal (Fig. 2c). Susa ithambo elikhanyisiwe eduze kwe-proxilal medial cortex ukufaka isikhonkwane (Fig. 2D). Faka isipikili sesilingo ukuqinisekisa usayizi we-DTN (Fig. 2e). Gwema ukugoqa noma ukwehla okweqile ukuvikela ukuqhekeka kwe-iatrogenic medial mallerial malleial mallerial mallerial mallear. Lungisa ukujula kwezipikili ukuze uqinisekise ukuthi izikulufa ezihlanekezelwe azifaki isayithi elihlangene le-ankle noma lokuphuka. Ukulungiswa kutholakala ngezikulufo ezihlanganayo kanye ne-distally.
I-incision:
I-Longitudinal enqunywe empini ye-malleolus ye-medial
Umhlahlandlela Pin Positing:
4-5 mm kusuka endaweni ehlanganyelwe
I-REAMING NE-CEAL NIIP:
Ikhuphuke kuze kufinyelele ku-metaphysis, qinisekisa usayizi wezipikili
Ukufakwa kwezipikili:
Gwema ukuhlanganisa, lungisa ukujula ukuvikela ngokuhlangana
Ukulungiswa:
Ukuvumelanisa izikulufo ze-proxinally futhi kude
Inqubo yokufaka i-DTN
Ukuhamba okuhlangene okuhlangene ngokushesha kanye nokuxhumana kwezinyawo eziphansi kuvunyelwe
ukuthwala okungelona isisindo kumaviki angama-4-6
kuyaqhubeka nokuhambisana okugcwele kwesisindo phakathi kwamaviki 8-12, ngenkathi kubhekiswa ukwakheka nobuhlungu be-callus kanye nobuhlunguUmsebenzi wokuhlangana we-ankle uqala ngokushesha ngemuva kokuhlinzwa
Gwema ukuthwala isisindo amasonto ama-4-6
Ukuguqulwa kancane kancane ekutheleni isisindo esigcwele emavikini angama-8-12
Ukulandela iziguli eziyi-10
Ucwaningo lulandele iziguli eziyi-10 (Ithebula 1). Ngezinyanga ezi-3 ngemuva kwe-OP-OP, amacala ayi-7 asephulukise; Zonke iziguli zithola ukwelashwa kungakapheli izinyanga eziyi-6. Elinye icala ngalinye le-VarUS kanye ne-recrvatum deform lenzekile. Akukho ukulahleka kokuncishiswa, ukutheleleka, izinkinga ezihlobene nokufakelwa, noma ukulimala kwe-IATrogenic kwaqashelwa (Ithebula 2).
Amacala ayi-7 aphulukiswe kungakapheli izinyanga ezintathu; konke kuphulukiswe izinyanga eziyisithupha
2 Ukuwohloka Okumnene (1 Varus, 1 Recurvatum)
Akukho ukutheleleka, izinkinga ezifakayo, noma ukulahleka kokunciphisa
Isiguli sowesilisa esineminyaka engu-69
Uhlobo lwe-Fracture:
I-Transverse Tibial Fracture + Fracture Fibular
Ukubhekana:
Ukulimala kwezicubu ezithambile
I-Post-OP:
Ukulimala okuncane okungu-6 kuphela, ukuphulukiswa okuphelele kungakapheli unyaka owodwa
Amanani 3 & 4:
Izithombe zokubuyisa ze-radiographic and postoperative
Izinkomba ze-DTN
Lolu cwaningo luhlanganisa i-Ao 43-A kanye ne-C1 fractures; I-C2 nayo ibicatshangelwe. I-DTNS iyatholakala ngobude obuyi-7 mm no-8 mm, okunquma ukubekwa kwezikulufo ezihlanganayo zeProximal. Ama-fractures atholakala 2-9 cm ngaphezulu kwe-arturicar ebusweni afanele ama-ukhetho elungiselelwe ukulungiswa kwe-DTN. Izinkomba zinganwetshwa ku-Ao 42 Fractures.
Kusebenza ku-Ao 43-A, C1, cabanga ukwanda ku-C2 no-42
Imiphumela emihle kakhulu yama-fractures 2-9 cm ukusuka endaweni ehlanganisiwe
Ukuqina kwe-biomechanical
Izipikili ze-Retrograde zinokuqina okuphezulu kwe-axial nokujikeleza okuqhathaniswa namapuleti okukhiya izimpilo kanye nezinzipho ze-anslade. Greenfield et al. Kwenziwe ukuhlolwa kwe-biomechanical okubonisa ukuthi ukusebenzisa izikulufo ezimbili ezihlanekezelwe ku-DTN kufinyelelwe ama-60-70% wokuqina okuqinile kanye nama-90% wokuqina okuqinile ngokuqhathaniswa nezikulufo ezintathu. I-DTN incishiwe ye-Fracture Fragments Movement ngaphansi komthwalo. Ezimweni ezi-3 ezingazange ziphilise kungakapheli izinyanga ezintathu, izici zazihlanganisa ukulimala kwezicubu ezithambile, ukunwetshwa kwama-medullary, indawo yokuphuka, kanye ne-osteoporosis. Njengoba ama-DTNS eza ngosayizi amathathu kuphela kanye nokulungiswa kwe-distal akhawulelwe ezikulumweni ezintathu, anganikeza ukuqina okunganele emiseleni ebanzi noma ethanjeni le-osteoporotic. Ukuthwala isisindo kusenesikhathi kufanele kusondwe ngokuqapha ezimweni ezinjalo.
Iphakeme kunamapuleti okukhiya kanye nezipikili ze-andergrade
Isu elinconyelwe ukulungiswa: 2 proximal + 3 izikulufo ezi-distal
Izinzuzo ze-DTN
Uma kuqhathaniswa namapuleti okukhiya, izinzipho ezihlekisayo zidala ukulimala kwezicubu ezithambile, ikakhulukazi ezilungele iziguli ezikhulile nalezo ezilimala kanzima kwezicubu ezithambile ezivela kubuhlungu obunamandla. Kulolu cwaningo, ama-DTNs afakwe ekulweni okuncane okuyisithupha kuphela, azikho izinkinga ezithambile zezicubu. Inqubo ayidingi ukuguquguquka kwamadolo, ukunciphisa ingozi yokunciphisa ukunciphisa futhi okwenza ilungele iziguli ezinomkhawulo we-know inqume (isib.
Ukuhlasela okuncane, okulungele iziguli ezindala nezezimali eziphakeme ze-Trauma
Akukho ukuguquguquka kwamadolo okudingekayo, okulungele ukuhamba okulinganiselwe kwamadolo
Izingozi Zokuhlinza Neziqinisekiso
Izingozi zifaka ukulimala emsipha wangemuva we-tibialis kanye nokuqhekeka kwe-mallelial malleolar. Ama-medial malleolar fractures angalashwa nge-tension band wiring, amaplanethi, noma ukulungiswa kwangaphandle.
Ukunakekelwa kumele kuthathwe ukugwema ukungenela ukungena kwi-notch ye-fibular. Idivaysi yokuma ingadala ukujikeleza okungemuva kwe-DTN ngenxa yesisindo sayo; Lungisa isikulufa sesibili ukukhomba i-Fibula (Fig. 4c).Izinkinga ezingaba khona:
Ukulimala kwe-Tibialis
Ukuphatha:
I-Tension Band, i-Plating, noma i-Finator yangaphandle
Ukuqondisa kwesikulufa kanye nesisindo sedivayisi edinga ukunakwa kwe-intraperative
Ukuqhathanisa Clinical
Amanani e-nonnion kanye nemagagali ye-AntGrade Nails angu-0-25% no-8.3-50%, ngokulandelana; Okokukhiya amapuleti, 0-17% no-0-17%. Kulolu cwaningo, wonke amacala afinyelela inyunyana, futhi u-20% kuphela owawunobuqili> 5 °, aqhathanise nezindlela zendabuko.Izithako ezingezinhle: Ukutheleleka ngokweqile kungu-0-8.3% wezindawo zokuvala izinzipho ezi-0 Ukutheleleka okujulile kungu-0-23% no-0-8.3%, ngokulandelana. Lolu cwaningo lungabiki ukuthi azikho izinkinga ezithambile zezicubu, ezidlula zonke izindlela zokusebenzisa ezinye izindlela.
Izikolo ze-Aofas ze-Antgrade Nails: 86-88 (Thayipha a), 73 (Thayipha c); Ukukhiya amapuleti: 84-88 (thayipha a)
Lolu cwaningo: Isilinganiso se-AOFAS: 92.6
I-EQ-5D-5L: Amapuleti okukhiya: 0.62-0.76; Lolu cwaningo: 0.876
Iziguli eziphephile-Q (Foot kanye ne-Ankle): 67-75; Lolu cwaningo: 83-91.7 (Ithebula 3)
Izinga le-Union, izinga lokukhubazeka, kanye nezinga lokutheleleka kwezinga lokutheleleka
Izikolo ezisebenzayo (AOFAS, EQ-5D-5L-5L, Ephephile-Q) zibonisa imiphumela emihle kakhulu
Ngamafuphi, i-DTN inikeza izinzuzo ngaphezulu kwamapuleti okukhiya kanye nama-andrade we-intrametullary izipikili futhi imele isisombululo esisebenzayo sokwelapha i-distal tibial fractures.
I-DTN ifaka ukuhanjiswa okuncane, ukuqina okuphezulu, kanye nokululama okusheshayo
Kuyindlela ebalulekile yokwelashwa kwendabuko futhi kufanelekile ukukhuthaza
I-Yamakawa y, Uehara T, Shigemoto K, et al. Imiphumela yokuqala yokuzinza kwe-distal distal tibia fractures nge-distal tibial nail: Isifundo esingaba khona, esisezingeni eliphakeme. Ukulimala, 2024: 111634.
创伤骨科智能科技 智汇骨. (2024 年 1211 年). 胫骨远端髓内钉突破胫骨远端骨折的治疗 [微信公众号文章]. 创伤骨科智能科技 智汇骨. https://mp.weixin.qq.com/9uqqvvj0/s/9uqqzzzg2k20nq8q (Ifinyeziwe: 2025 年 06月 07日)
