I-Tibial fracture, i-suprapatellar intramedullary nailing technique

I-Intramedullary tibial nailing: ukufinyelela nokuqondanisa, ubuhlungu bamadolo angaphambili

Indlela yokuhlinzwa ye-intramedullary nailing of tibial fractures ibalulekile ukuze kufakwe isipikili se-intramedullary endaweni efanele yokungena, ukunciphisa ukulimala kwezakhiwo zamadolo e-intra-articular, kanye nokufeza ukuhlelwa kabusha kwe-fracture efanele kanye nokungena kahle kwezipikili.

Izindlela zakudala zokuqhekeka kwe-tibial stem yi-infrapatellar median noma infrapatellar parapatellar approach. Nakuba lezi zindlela ziboniswa ukuphuka kwesigaba esimaphakathi, i-valgus yangemuva kokuhlinzwa, ukukhubazeka kwangaphambili, noma okuhlangene kuvame ukwenzeka ekuqhekekeni okusondele kakhulu.

Isizathu esiyinhloko sokungahambi kahle kwe-proximal tibial fractures ukukhubazeka okubangelwa ukudonsa i-tendon ye-quadriceps ngesikhathi sokuguqa kwamadolo kanye nokungqubuzana kwemishini phakathi kwephuzu le-nail kanye ne-posterior tibial cortex ngesikhathi sokufakwa kokufakelwa. I-patella iphinde ivimbele ukungena kwe-axial nail endizeni ye-sagittal (Fig. 1a, b). Ngakho-ke, enye indlela evamile yokufinyelela iphuzu ngokusebenzisa i-medial parapatellar incision, okuholela ekufakweni okuncane kwe-nail lateral (Fig. 1c no-2). Njengoba isikhonkwane singena emseleni we-intramedullary distal kuya ekuqhekekeni, ingxenye eseduze ijika ibe yi-valgus (Umfanekiso 2). Ekugcineni, ukungezwani kokuphumula kwemisipha yegumbi langaphambili kunomthelela omncane ku-valgus (Umfanekiso 3).

Umfanekiso we-1 a,b Ngokusebenzisa indlela evamile ye-infrapatellar, i-patella ivimbela ukungena kwe-axial ye-nail, okuholela ekukhubazekeni okuvamile kokuqondanisa kwe-apical apical sagittal kanye nokuqondisa kwe-valgus coronal. c Ukusebenzisa indlela ye-parapatellar yokuqondisa izinzipho ze-intramedullary.

Umfanekiso 2 Ukusondela endaweni yokungena ngokusebenzisa i-medial parapatellar incision kuholela ekufakweni kwezinzipho ezimaphakathi kancane kuya eceleni. Njengoba uzipho lungena kumsele we-medullary kuya ekwaphukeni (a), ingxenye eseduze itshekela ku-valgus (b)

Umfanekiso we-3 Ukuphumula kwe-tension endaweni ye-muscle yangaphambili (a) ikhiqiza ukuhlelwa kwe-ectopic ecashile (b)

Ukuphina i-tibia endaweni enwetshiwe kusiza ukugwema izinkinga ezihambisana nokuguquguquka kwedolo okunzima kwe-intraoperative. le nqubo yachazwa nguGelbke, Jakma et al. ngo-2010 futhi sekuye kwanda kakhulu eminyakeni yamuva nje ngoba ukuphina i-tibia endaweni ecishe iqonde kwenza kube lula ukuphambana kokuphuka nokubekwa kabusha. I-Fluoroscopy isibe lula ngobuchwepheshe ukwenza. Izikhathi ze-fluoroscopy zokubethelwa kwe-suprapatellar kubikwe ukuthi zifushane kakhulu kunezipikili ze-infrapatellar. Ngaphezu kwalokho, i-angle yokufaka izipikili (endizeni ye-sagittal) ihambisana kakhulu ne-axis longitudinal ye-tibia kule ndlela kune-infrapatellar nail; lokhu kuvimbela ukungqubuzana kwemishini phakathi kwephuzu le-nail kanye ne-posterior cortex, ngaleyo ndlela kube lula ukunciphisa ukuphuka.

Ubuhlungu be-postoperative anterior anterior yinkinga ehlobene. Ubuhlungu bamadolo angaphambili buye babikwa ku-50-70% yeziguli eziphukayo, kuphela i-30% yeziguli ezithola ukukhululeka kobuhlungu ngemva kokususwa kwesitshalo sangaphakathi. Kulinganiselwa ukuthi ukwakheka kwezibazi okuhlotshaniswa nokufinyelela ku-tendon ye-patellar kanye ne-Hoffa fat pad kungumthombo ongase ube nobuhlungu bamadolo ngemva kokuhlinzwa. Ukwengeza, indlela ye-suprapatellar igwema ukusika kwendabuko kwegatsha legatsha le-patellar le-saphenous nerve, ngaleyo ndlela igweme ukuguqa kwamadolo angaphambili kanye nokungabi nalutho kwezinzwa (Umfanekiso 4). Ukudlulisa isipikili ngethenda ye-quadriceps, ngaleyo ndlela kushiya i-patellar tendon iqinile, kubonakala kunciphisa kakhulu izinga lobuhlungu bamadolo ngemva kokuhlinzwa.

Ngenxa yemiphumela emihle ye-proximal fractures, izinkomba ekusebenzeni komtholampilo ziye zanwetshwa kuzo zonke iziqephu.

Kufanele isetshenziswe nini i-suprapatellar intramedullary nail?

Izinzuzo

• Ukuma kwedolo elinwetshiwe kancane kukhuthaza ukuxhaphazwa kokuphuka kanye nokubeka kabusha ngokuphumuza amandla emisipha nokugcinwa ngesikhathi sokufakwa kwezinzipho.

• Ingozi ephansi ye-postoperative dislocation of proximal, segmental and distal fractures uma kuqhathaniswa namasu avamile.

• Ukusebenza kwezipikili kulula ngokobuchwepheshe ukwenza

• Ukufakwa kwezinzipho kungenzeka 'njengenqubo kadokotela ohlinzayo oyedwa'

• Isikhathi se-fluoroscopy esincishisiwe

• Akukho monakalo ku-tendon ye-patellar kanye nesigameko esiphansi sobuhlungu be-post-stapling anterior anterior

• Kulula ukwenza ngenqubo yamaqembu amaningi, njengasekuhlukumezekeni okuningi

  
  

Izinkomba

• Ukuphuka okungaphezulu kwe-articular kwe-proximal tibia (uhlobo lwe-AO 41A)

• Ukuphuka okulula okuhlanganisiwe kwe-tibial diaphysis (uhlobo lwe-AO 42A-C)

• I-segmental tibial diaphyseal fracture (uhlobo lwe-AO 42C)

• Ukuphuka kwe-distal tibial extra-articular kanye nokuqhekeka okulula kwesandiso se-distal kwe-intra-articular (izinhlobo ze-AO 43A ne-C1)

• Idolo elintantayo

• I-Patellar ossification ene-patellar tendon ossification

• Inxeba elingcolile ezingeni le-patellar tendon

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