Izinzipho eziyi-10 eziphezulu ze-Distal Tibial Intramedullary (DTN) eNyakatho Melika ngoJanuwari 2025
Ukubuka: 0 Umbhali: Isikhathi Sokushicilela Isihleli Sesayithi: 2025-06-17 Umsuka: Isayithi
I-Distal Tibial Intramedullary Nail (DTN) Ucwaningo Lomtholampilo
Ukuhlaziywa Okubanzi Kwesu Lokuhlinza, Imiphumela, kanye Nezicelo
Kushicilelwe: Juni 17, 2025
I-Distal Tibial Intramedullary Nail (i-DTN) iboniswa ngezimo ezihlukahlukene ze-tibial, kuhlanganise nokulula, okuvunguzayo, okuhlanganisiwe, okuguquguqukayo okude, kanye ne-segmental shaft fractures (ikakhulukazi ye-distal tibia), kanye ne-distal tibial metaphyseal fractures, non-/mal-unions; ingase futhi isetshenziswe, ngokuvamile ngemishini ekhethekile, yokulawula ukukhubazeka kwamathambo noma ukungafani kobude bezitho (njengokwandiswa noma ukufinyeza).
Amapuleti okukhiya
Ukulimala kwezicubu ezithambile eziphawulekayo, izinga eliphezulu lokutheleleka, ukululama isikhathi eside
I-Antegrade Nails
Ingozi yokulimala kwamadolo, ukulungiswa okunganele, okuvame ukungahambi kahle
Isixazululo se-DTN
Indlela ehlasela kancane enomklamo wokufaka we-retrograde
I. Isingeniso
1Ukuhlukana 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.
2Isixazululo 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.
Umfanekiso 1: Idizayini yokufaka kabusha i-DTN
II. Inqubo Yokuhlinza
1Ukuma 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.
Ukucatshangelwa Okubalulekile: Isikhundla se-Supine, sebenzisa ama-forceps okunciphisa uma kudingeka. Beka phambili ukuphathwa kwe-fibular fracture ukuqinisekisa ukunciphisa okunembile kwe-tibial.
2Inqubo yokufaka i-DTN
Ukusika ubude be-2-3 cm kwenziwa ekugcineni kwe-malleolus ephakathi ukuze kuvezwe umsipha we-deltoid ongaphezulu. Iphinikhodi yomhlahlandlela ifakwa noma imaphakathi kancane esihlokweni se-malleolus, 4-5 mm ukusuka endaweni eyi-articular.
Imbobo:
Ukusika kwe-longitudinal kuthiphu ye-malleolus ephakathi
Ukuma kwephinikhodi yomhlahlandlela:
4-5 mm ukusuka endaweni ehlangene
Ukulungisa:
Izikulufu ezihlanganisayo eziseduze nakude
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Umdwebo 2a: Ukufakwa kwephinikhodi yomhlahlandlela
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Umdwebo 2b: Ukubuka kwe-lateral
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Umdwebo 2c: Inqubo yokubuyisela kabusha
III. Ukuvuselelwa kwe-post-op
0-6
Amasonto Non-weight Bearing
Ukuhamba kwamalunga eqakala ngokushesha kanye nokuthintana nonyawo kuya phansi
6-8
Amaviki Ukuthwala Isisindo Esithile
Intuthuko ifinyelele ku-50% womthamo wokuthwala isisindo
8-12
Amaviki Agcwele Isisindo
Ngenkathi uqapha ukwakheka kwe-callus nobuhlungu
I-Rehabilitation Protocol
Umsebenzi we-ankle uqala ngokushesha ngemva kokuhlinzwa
Gwema ukuthwala isisindo amaviki angu-4-6
Ukushintsha kancane kancane ekuthwaleni isisindo esigcwele emavikini angu-8-12
Ukuqapha okujwayelekile kwe-radiographic phakathi nesigaba sokutakula
IV. Imiphumela Yokufunda
1Imiphumela Yomtholampilo Yeziguli Eziyi-10
Ucwaningo lulandele iziguli eziyi-10. 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.
70%
Kwelapheka phakathi nezinyanga ezi-3
100%
Kwelaphe ngezinyanga eziyisi-6
| Umphumela Kala |
Imiphumela ye-DTN |
Izindlela Zendabuko |
| Izinga leNyunyana (izinyanga ezi-3) |
70% |
40-60% |
| I-Malignment (>5°) |
20% |
25-40% |
| Izinga Lokutheleleka |
0% |
5-15% |
| Isikolo se-AOFAS |
92.6 |
73-88 |
V. Umbiko Wecala
Isiguli esineminyaka engu-69 ubudala
Uhlobo lokuphuka: Ukuphuka kwe-tibial okuphambene + ukuphuka kwe-fibular
Inkinga: Ukulimala kwezicubu ezithambile
I-post-op: Imicu emincane emi-6 kuphela, ukuphulukiswa okuphelele kungakapheli unyaka ongu-1
Isifinyezo Sokwelashwa
I-DTN ifakwe ngokusikwa okuncane ngokulondolozwa kwezicubu ezithambile. Ukuphuka kwe-fibular kuzinzile nge-intramedullary nail. Isiguli sizuze ukululama okuphelele ngaphandle kwezinkinga.
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I-Pre-op Imaging
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I-post-op esheshayo
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Izinyanga ezi-3 zokulandela
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Unyaka ongu-1 Wokuphila
VI. Ingxoxo
1Ukuzinza 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.
2Izinzuzo 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. Inqubo ayidingi ukuguquguquka kwamadolo, ukunciphisa ingozi yokulahlekelwa ukunciphisa futhi iyenze ifanele iziguli ezinokunyakaza okulinganiselwe kwamadolo.
3Ukuqhathanisa 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 azuze ukuhlangana, futhi amaphesenti angu-20 kuphela ayenokukhubazeka> 5 °, uma kuqhathaniswa nezindlela zendabuko.
VII. Isiphetho
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.
I-DTN Product Line
I-Distal Tibial Intramedullary Nail (DTN)
I-Distal Tibial Intramedullary Nail (DTN) Isethi Yethuluzi
I-Distal Tibial Intramedullary Nail (DTN) Instrument Box
