I-Distal Tibial Nail: Ukuphumelela Ekwelapheni I-Distal Tibial Fractures

Ukuhlukana kwe-distal tibial kuvamile, futhi ukwelashwa kwendabuko kunemikhawulo

I-Distal tibial fractures iwuhlobo oluvamile lokuphuka kwemilenze ephansi. Ukwelashwa kwendabuko okufana namapuleti okukhiya kanye nezinzipho ze-antegrade intramedullary ngayinye inezinkinga zayo. Amapuleti okukhiya angabangela izifo zangemva kokuhlinzwa noma i-necrosis yezicubu ezithambile, andise ukululama; nakuba izipikili ze-antegrade zihlasela kancane, zingase zilimaze idolo elihlangene, zibangele ubuhlungu, futhi zithwale izingozi zokungalungiseki okwanele noma ukungahambi kahle, okuvimbela ukululama.

Isixazululo esisha: I-Distal Tibial Nail (DTN)

Inketho yokwelapha inoveli—I-Distal Tibial Nail (DTN)—inikeza umbono omusha wokulawula ukuphuka kwe-distal tibial ngomklamo wayo oyingqayizivele wokubuyisela emuva.

Ukuma kwesiguli kanye nokulungiswa kokunciphisa

Isiguli sibekwe endaweni yokulala. Ukuphuka okususiwe kufanele kuncishiswe ngesandla; uma kunesidingo, sebenzisa amandla okunciphisa ukuze usize ngaphambi kokufaka i-DTN. Uma kukhona ukuphuka kwe-fibular okuhambisanayo, ukuqondanisa kahle kwe-fibular kungasiza ukunciphisa i-tibial. Ukuphuka kwe-fibular shaft kungase kuqiniswe ngezinzipho ze-intramedullary. Ngokuphuka kwe-ankle, ukunciphisa kwe-anatomical kanye nokulungiswa kwe-fibula kufanele kwandulele ukuncishiswa kwe-tibial ukugwema ukungahambi kahle. Ezingxenyeni ezivulekile ezinokulungiswa kwangaphandle okukhona, i-nail ingafakwa ngenkathi igcina i-fixator ukuze kuzuzwe ukunciphisa.

Ukusika ubude be-2-3 cm kwenziwa ekugcineni kwe-malleolus ephakathi ukuze kuvezwe umsipha we-deltoid ongaphezulu. Iphinikhodi yomhlahlandlela ifakwe noma imaphakathi kancane ekugcineni kwe-malleolus (Fig. 2a), 4-5 mm ukusuka endaweni ye-articular. Ukubuka kwe-Lateral kubonisa ukufakwa nge-intercondylar groove (Fig. 2b), ukugwema ukulimala kumisipha ye-posterior tibialis. Hlukanisa umsipha we-deltoid ongaphezulu, bese usebenzisa i-reamer ukuze ukhulise i-medullary canal kuze kufike endaweni ye-metaphyseal (Fig. 2c). Susa ithambo elikhansela eduze kwe-proximal medial cortex ukuze ufake isipikili (Fig. 2d). Faka isipikili sokuhlola ukuze uqinisekise usayizi we-DTN (Fig. 2e). Gwema ukushaya ngesando noma ukusonteka ngokweqile ukuze uvimbele ukuphuka kwe-iatrogenic medial malleolar. Lungisa ukujula kwezinzipho ukuze uqiniseke ukuthi izikulufu ezikude azifaki ilunga leqakala noma indawo yokuphuka. Ukulungiswa kufinyelelwa ngezikulufu ezixhumene eduze ne-distally.

Ukuhamba ngokuhlanganyela kwe-ankle ngokushesha kanye nokuthintana nonyawo kuya phansi kuvunyelwe ngemuva kokuhlinzwa
Ukungathwali kwesisindo samaviki angu-4-6
Ukuqhubekela phambili ekuthwaleni isisindo esigcwele phakathi kwamaviki 8-12, kuyilapho kuqapha ukwakheka kwe-callus nobuhlungu.

Umsebenzi we-ankle uqala ngokushesha ngemva kokuhlinzwa

Gwema ukuthwala isisindo amaviki angu-4-6

Ukushintsha kancane kancane ekuthwaleni isisindo esigcwele emavikini angu-8-12

Ukulandelelwa kweziguli eziyi-10

Ucwaningo lulandele iziguli eziyi-10 (Ithebula 1). Ezinyangeni ezi-3 ngemuva kokuhlinzwa, amacala ayi-7 ayesepholile; zonke iziguli zithole ukuphulukiswa phakathi nezinyanga eziyisi-6. Icala elilodwa le-varus kanye nokukhubazeka kwe-recurvatum kwenzeka. Akukho ukulahlekelwa kokunciphisa, ukutheleleka, izinkinga ezihlobene nokufakelwa, noma ukulimala kwe-iatrogenic kwabonwa (Ithebula 2).

Isiguli esineminyaka engu-69 ubudala

Izinkomba ze-DTN

Lolu cwaningo lwaluhlanganisa i-AO 43-A kanye ne-C1 fractures; I-C2 nayo yacatshangelwa. Ama-DTN atholakala ngobude obungu-7 mm kanye no-8 mm, obunquma ukubekwa kwezikulufu ezisondelene. Izingcezu ezitholakala ngo-2–9 cm ngaphezu kwendawo eyi-articular zingamakhandidethi afanelekile okulungiswa kwe-DTN. Izinkomba zinganwetshwa ku-AO 42 amafracture.

Ukuzinza kwe-Biomechanical

Izinzipho ezibuyisela emuva zinokuqina okuphakeme kwe-axial nokuzungezayo uma kuqhathaniswa namapuleti okukhiya aphakathi nendawo nezinzipho ze-antegrade. Greenfield et al. yenze ukuhlola kwe-biomechanical okubonisa ukuthi ukusebenzisa izikulufu ezimbili ezikude ku-DTN kuzuze u-60–70% wokuqina okucindezelwayo kanye no-90% wokuqina kwe-torsion uma kuqhathaniswa nezikulufu ezintathu. I-DTN inciphise ukunyakaza kwezingcezu zokuphuka ngaphansi komthwalo. Ezimweni ezingu-3 ezingazange ziphole phakathi nezinyanga ezingu-3, ​​izici zihlanganisa ukulimala kwezicubu ezithambile, ukunwetshwa kwe-medullary, indawo yokuphuka, kanye ne-osteoporosis. Njengoba ama-DTN eza ngosayizi abathathu kuphela futhi ukulungiswa kwe-distal kukhawulelwe kuzikulufu ezintathu, angase anikeze ukuzinza okunganele emiseleni ebanzi noma ithambo le-osteoporotic. Ukuthwala isisindo kusenesikhathi kufanele kusondele ngokuqapha ezimweni ezinjalo.

Izinzuzo ze-DTN

Uma kuqhathaniswa namapuleti okukhiya, izinzipho ze-intramedullary zenza umonakalo omncane wezicubu ezithambile, ikakhulukazi ezilungele iziguli esezikhulile kanye nalezo ezinokulimala okunzima kwezicubu ezithambile ngenxa yokulimala okukhulu kwamandla. Kulolu cwaningo, ama-DTN afakwe ngezisiwo ezincane eziyisithupha kuphela, ngaphandle kwezinkinga zezicubu ezithambile. Inqubo ayidingi ukugoba kwamadolo, ukunciphisa ingozi yokunciphisa ukulahlekelwa futhi iyenze ifanele iziguli ezinokunyakaza okulinganiselwe kwamadolo (isb, isifo samathambo noma i-post-TKA).

Izingozi Zokuhlinzwa kanye Nezinyathelo Zokuqapha

Izingozi zihlanganisa ukulimala kwe-posterior tibialis muscle kanye ne-medial malleolar fracture. Ukuphuka kwe-malleolar emaphakathi kungase kuphathwe nge-tension band wiring, i-plating, noma ukulungiswa kwangaphandle.
Kufanele kuqashelwe ukugwema ukungena ngezikulufu endaweni ye-fibular notch. Idivayisi yokumisa ingase ibangele ukuzungezisa kwangemuva kwe-DTN ngenxa yesisindo sayo; lungisa isikulufu sesibili ukuze sibheke ku-fibula (Fig. 4c).

Ukuqhathanisa Komtholampilo

Amazinga angewona ama-nonunion kanye nokungalungi kahle kwezinzipho ze-antegrade angu-0–25% kanye no-8.3–50%, ngokulandelana; amapuleti okukhiya, 0–17% no-0–17%. Kulolu cwaningo, wonke amacala azuzwe ekuhlanganiseni, futhi amaphesenti angu-20 kuphela ayenokukhubazeka> 5 °, uma kuqhathaniswa nezindlela zendabuko.Amazinga okutheleleka: ukutheleleka okungaphezulu ngu-0-8.3% wezipikili ze-antegrade kanye ne-0-23% yamapuleti okukhiya; ukutheleleka okujulile kungu-0-23% no-0-8.3%, ngokulandelana. Lolu cwaningo lubike ukuthi azikho izinkinga zezicubu ezithambile, zisebenza kahle kakhulu kunezinye izindlela zombili.Amaphuzu asebenzayo:

Kafushane, i-DTN inikeza izinzuzo ngaphezu kwamapuleti okukhiya kanye ne-antegrade izinzipho ze-intramedullary futhi imele isisombululo esiphumelelayo sokwelapha ukuphuka kwe-distal tibial.

I-DTN ifaka ukuhlasela okuncane, ukuzinza okuphezulu, nokululama ngokushesha

Kuyindlela ehlukile yokwelapha yendabuko futhi ekufanele ukukhuthazwa