Tibial Karatun, Suprapatellalar Kila na Kila

Dokar Na'urar ta shiga cikin tsararru na tibial: ta hanyar Suprapatellar, Haɓaka Transtartellar tare da gwiwar gwiwa a gwiwa a 20-30 ° da kuma takamaiman bututun kariya don kare tsarin intra-articular don kare tsarin kariya.

01.Tibial Intraedully Nighing: samun dama da jeri, ciwon gwiwa

Samun damar shiga tiyata don tsawan iska mai mahimmanci yana da mahimmanci don sanya ƙusa mai shigowa ta hanyar gyara gwiwa, kuma don samun ingantacciyar tsagaita gwiwa da ingantaccen ƙafar ƙirji.

Hanyoyin gargajiya na tasirin karara na tibial shine cunkoson infrapatelllar ko kuma matsakaicin kusanci. Ko da yake ana nuna waɗannan hanyoyin don tsakiyar yanki, balgus na postrus, na gaba, ko kuma nakasassu na yau da kullun suna faruwa a cikin ƙarin karaya.

Babban dalilin Malafignment a cikin kusancin tibial shine nakasar cututtukan ƙwararraki a lokacin juyawa na ƙusa a lokacin sakewa na ƙusa. The Patella kuma yana hana shigowar ƙusa a cikin jirgin sama mai sahun (Fig. 1A, B). Sabili da haka, wata hanyar gama gari ta shigar da batun ita ce ta hanyar fisllarar fi'ima, wacce ke haifar da ɗanɗano ƙusa mai zuwa (Fign. 1C da 2). Kamar yadda ƙusa ya shiga cikin farji Canal nesa har zuwa karaya, ana karkatar da yanki mai ɗorewa a cikin asalin (Fig. 2). A ƙarshe, tashin hankali na ɓangaren ƙwayar cuta na baya yana ba da gudummawa kaɗan ga lalata (Fig. 3).

Hoto 1 A, B ta amfani da tsarin rashin daidaituwa na al'ada, Patella ta hana shigowar ƙusa na ƙusa, wanda ya haifar da daidaituwa na ƙwararraki apical.

Hoto na gabatowa wurin shigarwar ta hanyar ingarma na lambobin da ke kaiwa zuwa danshi mai kyau zuwa mashigar ƙusa. Kamar yadda ƙusa ya shiga cikin medulary canal distal ga karaya (a), ana karkatar da ɗakunan matsayi a cikin harshen wuta (B)

Hoto na 3

Diya da Tibiya a cikin wani mawuyacin hali yana taimakawa wajen guje wa rikitarwa da aka danganta da rauni a gwiwa. A shekara ta 2010 kuma ya sami shahararrun mutane a cikin 'yan shekarun nan saboda nailiyar tibia a cikin wani wuri mai kusan reshe na sauƙaƙe karaya da kuma sake sake. Fluraoroscopy ya zama mafi sauƙin yin amfani da shi. An ruwaito lokacin Supratelcy na kasala mai yawa fiye da tsintsiyar infrapatellar. Bugu da kari, kusurwoyin sagittal (a cikin jirgin sama na sagittal) ya fi layi daya zuwa axis na Tibiya tare da tsakar fitila da ke da tsintsiya; Wannan yana hana rikici tsakanin injin da ke tsakanin ƙila tiel da kuma cortex, ta haka yana gyara raguwar karaya.

Rashin ciwon gwiwa yana da matsala mai dacewa. An ruwaito zafin gwiwa a cikin 50-70% na marasa lafiya da karaya, tare da 30% kawai na marasa lafiya suna fuskantar kwanciyar hankali bayan cire ƙarshen. Hanyoyin samun dama da ke tattare da tayar da tayar da Tallar Patellar da pay na Hoffa ya zama tushen raunin gwiwa. Bugu da kari, dabarun suprapatelar yana guje wa raba gargajiya na sake reshe na jijiyoyin patellar reshe, wanda ke nisanta iyaka da gwiwa da abin da ya faru (Hoto na 4). Yana wucewa ƙusa ta hanyar haɗewar Quadriceps, ta hanyar barin hauhawar patelllar da ba tare da alaƙa da rage yawan ciwon ciki ba.

Fig.

Sakamakon sakamako mai kyau na karar-dabaru, alamu a cikin al'adar asibiti.

Matsaloli masu yiwuwa tare da tsinkaye mai tsoratarwa a cikin tsarinsu na biyu:

- Zai iya barin tarkace a gindin gwiwa. Koyaya, kwarewar asibiti tare da tsawan hutu na retrograde ba su nuna wasu ƙarancin sakamako ba.

- Ta yaya ake cire maganin bayan karaya ya warke? Kodayake yana yiwuwa a zahiri don cire ƙusa na shiga cikin tsarin yanke hukunci, dabarar tana buƙatar cire ƙusa na infrapatellary ta hanyar hanyar da take cikin infrapatellary ƙusa.

02.Wan nan ya kamata a yi amfani da ƙusa na biyu?

Yan fa'idohu

- Semi-Fighted gwiwa Matsayi ya sauƙaƙe mantawa da raguwa ta hanyar jan hankalin sojojin tsoka da riƙewa yayin shigar ƙusa.

- ƙananan haɗarin Malaleperative na Encimal, yanki na, da kuma karkatar da karaya idan aka kwatanta da fasahar gargajiya

- Nailing yana da sauƙin yin amfani da shi

- Nailing mai yiwuwa ne a matsayin wani 'hanyar tiyata guda '.

- rage lokacin liloorcy

- Babu lalacewar jijiyoyin Passellar da ƙarancin abin da ya faru na ƙarshen ƙarshen rauni

- Sauƙaƙa don yin cikin tsarin ƙungiya, kamar yadda tare da Ploltrauma.

Rashin daidaito

- hadarin lalacewa ga gwiwa da sauran tsarin arra-articular

- karuwar hadarin kamuwa da gwiwa

- Cire na shafawa na iya buƙatar wata hanya ta daban

Alamar

- karin karaya-articular na tibia na tibia (nau'in Ao 41A)

- Saduwar comcrates na Tibal Diaphysis (nau'in Ao 42a-C)

- Yasu kashi tibicysis karaya (buga Ao 42c)

- karin-art-articular da sauki na tsayayyen tsorarru na kusa da karuwa na Distal Tibia (nau'in Ao 43a da C1)

- gwiwa da gwiwa

Karatun

- Gustlo karo na 3C bude karar gwiwa na tibia saboda karuwar hadarin kamuwa da cuta, kodayake ba a fitar da hadarin kamuwa da cutar haduwa ba a bude karaya

- Mai tsananin hatsewa mai taushi, gurbatawa ko kamuwa da cuta a cikin yankin suprapatellar

- Ipsayal na gwiwa prosthesis (dangi na musamman)

- gwangwani gwiwa

- Yankana na gwiwa> 20 °

- Filin Tibal na Ipsateau na Ipsateau ya shafi batun shigarwar ƙusa shine dangi mai mahimmanci

- implants gano wurin shigar da namiji

- Ipsilashin Patella rauni (dangi na musamman)

03. Hanyar tiyata

Matsayin jiki da hangen nesa

Hoto 5 Mai haƙuri ya yi daidai da tebur na radiol-ent wanda ya ba da damar tsagewa-kafa. An sa karancin karaya tare da yardar kaina kuma an sanya littafi a karkashin haɗin gwiwa (a) don cimma 10-30 ° na gwiwa subseon 

(b). An sanya hannu a gefe. An saukar da kafaffun kafaffun kafa 10-30 ° daga kwance a kwance don tabbatar da kyakkyawan tunani a cikin mukamin.

②ל da dama shigowa shigowa

Hoto na 6 Wannan alama ta hanyar sharar ta Patella, gwaje-gwaje na Tibiyar, da kuma cututtukan ƙwayar cuta da na tibial. A 2 cm cm mai nisa na fata an yi 1-1.5 cm wakili ga mafificin tushe na Patella. An fallasa Quadriceps da ci gaba a tsakiyar tsakiyar layi a cikin shugabanci na jijiyoyin. Yadaukar da Supratellarin da aka buɗe an bude su kuma yatsun tiyata suka shiga gwiwa a gwiwa daga ƙasa da Patella don tantance sauƙin samun dama. Oxcrearin ƙara yawan haɓaka na iya sauƙaƙe damar shiga gwiwa. Saka wani lakabin lakkara don kadanukaka na kadan tasirin Patella na iya inganta damar. Idan sararin hadin gwiwa yana da kunkuntar da kuma kayan aiki mai wahala, na iya zama mai tallafi na tsakiya ko a kaikaice ana iya inkena a gare shi domin semi-downlockate na patella zuwa gefe daya.

Ackprotection na guringuntsi

Hoto na 7 Kare ne na Colellofemoral Cleilage daga rauni mai dangantaka yana daya daga cikin manyan manufofin tiyata. Sabili da haka, dole ne a yi amfani da rigakafin kariya yayin kayan aiki na ƙusa don haɗin gwiwar hannu, da na ciki (ƙarfe) da ke cikin ƙasa, da kuma murfin Trovacous. Buƙatar Trocar tana tattarawa tare da suturar kariya da sakawa ta hanyar sakawa.b Haɓakawa tare da ramuka na iska. Knob a saman abubuwan da shigarwar ya hana rarrabuwar mai ba da izini

Saka jagora da daidaita matsayin

Hoto na 8A da aka saka taron Majalisar Patella ta hanyar haɗin gwiwar Patellofemory zuwa wurin shigar da ake so a kan Tibia (Hoto na 9). A mafi yawan lokuta, patella zai motsa dan kadan a hankali ko a kazara yayin shigar da kayan aiki. A tsintsiya a cikin hadin gwiwar patellofemoror yawanci yana jagorancin allurar Trocar zuwa madaidaicin matsayi ta atomatik.

Hoto 8b matsayi aka tabbatar a cikin sincla ta amfani da filaye kuma ana gyara inda ya cancanta. Ana maye gurbin allurar Trocar ta hanyar jagora, jagora da ke wucewa ta tsakiya na jagora tibial don tabbatar da matsayin daidai.

Hoto na 8C Lokacin da Jagora yana cikin matsayi mai zurfi, ana iya amfani da shi na biyu don yin ɗan kaɗan a cikin ƙaƙƙarfan jagora kuma sanya shi a ɓoye a mafi kyawun tashar. Kayan aikin sa tare da jagora to sai ya zame kan Jagora.

⑤ fadada medulla almarar

Fig. 9a yana buɗe kogon meduly daga wurin shigarwar wuri shine mahimmin mataki a cikin tsarin tiyata. A cikin jirgin sama na keritopososer, wannan shine fannin media na tibial Tibal. A cikin jirgin sama na kaikaice, daidai shigarwa wurin yana wurin canzawa tsakanin farjin articular da kuma cortex.

Hoto 9B daidai matsayin jagora yana da layi tare da tibial axial a cikin jirgin sama na ciki kuma kusa da layi daya zuwa gajiya cortex yadda zai yiwu a cikin tsarin tsinkaye. Mai jagora yana da hankali.

Hoto na 9C a cikin lokuta inda ba za a saka fil ko ƙusa daidai ba, toshewa da ƙusa ko fil yana taimakawa jagoranci ƙusa a cikin madaidaicin matsayi. 

Ana amfani da katangar ƙusoshin a cikin yankin yalwataccen yankin lokacin da Jagora ko ƙusa ba za a iya tsayar da layi ɗaya ba a cikin ɗaya ko biyu jiragen sama ya rage lokacin shigar ƙusa.

Hoto na 10 A wannan matakin, ana bada shawara cewa an kula da Majalisar don neman kulawa ta amfani da waya 3.2 MM. Wannan yana hana Majalisar daga barin Tibiya.

Hoto 11 na 11 da 12 a MM Hand dill ɗin an sanya shi ta hanyar riga kariya ta ciki da ƙasa ta hanyar jagora zuwa kashi. Ana buɗe canal medullary Canal ta hanyar hakowa zuwa zurfin 8-10 cm da kuma aka shigar da Jagorar Ball-ƙare a cikin Tibiya Tibia.

⑥ rage karaya

Hoto na 12a a wannan matakin, muna sake saita karaya.

Hoto na 12b ya danganta da wurin karaya da ilimin halittarsa, kayan aikin rage da ake iya amfani da su don cimma daidaito. A cikin matsakaicin karaya tibial, wani lokacin ko da taimakon ƙarin implants, kafin buɗe canal medullary ta hakowa. Redoming sandar yana ci gaba a nagari kuma saka a cikin tsakiyar Mataimakin Tibiysis. Bayan sake juyawa, tsayin da kuma diamita na ƙusa an ƙaddara. Idan ya cancanta, faɗaɗa canjin tibial zuwa diamita da ake so ta sake yin amfani da increm 0.5 mm. Bude a cikin kayan kwalliyar riga yana ba da damar zubar da tarkace da tarkace daga haɗin gwiwa yayin sake dawowa. Idan za ta yiwu, ana bada shawarar cewa ƙusa tare da mafi ƙarancin diamita na 10 mm. Kulle kulle na 5.0 na ƙusa don wannan nau'in ƙusa ya fi mai tsayayya da gazawa fiye da ƙugiya ta Mm 4.0 da aka yi amfani da ita wajen ƙusofi. Tsawon kusancin tsoho yawanci ana ƙaddara shi ne tare da mai mulki mai ƙarfi.

⑦⑦erer Intrawald Nail

Fig. 13 Sauran Sail ta hanyar sake fasalin sanda a ƙarƙashin Fluoroscopy. Lura cewa shigarwar Superpatellar ƙusa ya fi tsayi da ƙusa infrapatellar ƙusa saboda nisan fata zuwa batun shigar na Nail ya kuma ya fi tsayi.

Hoto 13B Lall ɗin da fatan za a lura cewa lanƙwasa (Herzog Claving) a ƙarshen ƙarshen ƙaho na Mata na ciki ba za a iya sakewa ta hannun riga na ƙarfe na ciki ba. Sabili da haka, dole ne a cire hannun riga kariya daga haɗuwa da ƙusa (B; duba sashe 'kurakurai da rikitarwa '). Duba matsayin ƙarshe na ƙusa na tsoho a cikin yanayin halitta da ra'ayoyi. Cire reaming sanda. Idan ƙusa na buƙatar maye gurbinsa, bar sake yin rubutun a cikin wurin kuma saka sabon ƙusa a cikin sanda. Mam 5 mm a kan abin da aka sa ya nuna zurfin shigar da abin da ke cikin tibia (Fig. 14). (Hoto na 14)

⑧ Distal da makullin kulle

Hoto na 14A kai da kuma daidaitattun kulle kulle dogaro akan takamaiman halaye na fashewa. Za'a iya cim ma kulle makullin tare da hannu mai kyau. Distal Locking an kammala kyauta ko ta hanyar amfani da jagorar jirgin ruwan radiopaque. Optionally, ƙarshen hula na iya amfani da shi, wanda ke hana kashi daga haɓaka zuwa ƙarshen kusancin ƙirar ƙusoshin da yake ciki. Musamman, ƙusoshin da aka saka ƙusoshin da aka saka suna da sauƙin cirewa lokacin da ake amfani da iyakokin da suka dace. Tsawon da ake so na ƙarshen hula an auna ta hanyar saka alama a kan rike ko ta hanyar saka waya mai jagora ta hannu.

Hoto na 14B The tif na jagora yana nuna matsayin kusancin ƙusa na intremedullamy ƙusa. Dabbun da ke haɗa hannu da nufin da nufin ƙusa yana buƙatar cire ƙusa don saka ƙarshen hula. A ƙarshen hula ya wuce ta hanyar ganga na sa hannu. Hannun shigar ya kasance a wuri. Wannan yana canza ƙarshen tafiya tare da saman ƙusa na inturedullamy kuma yana hana shi rasa a gwiwa. Sanya jagora ta hanyar ganga ta ƙare wuri zuwa ƙarshen ƙusar ta kuma yana taimaka wajan ƙarshen ƙarshen ƙafar ƙwararraki a ƙarshen ƙusar ta. A ƙarshen hanyar, ya kamata a rinanar maganin gishirin bakararre don wanke duk wani ɓangaren tarkace.

04. Cautions

Gargaɗi don Ayyukan Hiki

- A cikin lokuta na preexisting osteoarthritis, ƙuntatawa matsalar Patelllar na iya hana damar haɗin gwiwa. Inctions na kewayon matsayi na medial ko a kaikaice band daga gefen midal yana sauƙaƙa shigar da Trocar Pin.

- Cutar gwiwa ta iverates ta gwiwa ba ta tsayayye ta tazara ga Supratellar Pinning. Ka lura, duk da haka, cewa bazai yuwu a sami damar shiga farkon farawa daga tsarin Nightal Tibial.

- A cikin karaya tare da tsawaita articular, ana iya saka ƙarin sukurori don rashin daidaituwa na kayan karuwa na articular. An ba da shawarar waɗannan dunƙulen da aka sanya kafin shigar da ƙusa don guje wa gudun hijira na sakandare na ƙwayoyin cuta mai articular.

Makarantuwar Tibia ciyawar

Abubuwan Tibial Tibal sune mafi wahalar karuwa tibial zuwa ƙusa da kuma buƙatar wuraren shigowa da aka bayyana a sama). Ya kamata a rage wadannan karabbi kafin tsayewa don magance duk wani haramtaccen jami'an kuma kara samun nasara. A wasu halaye, daidai sanya reshe na abin da abin ya shafa a cikin matsayi na Semi-m da kuma sanya ƙusa tare da canal da ke cikin ciyayi a cikin nailing.

Koyaya, a mafi yawan lokuta, ana buƙatar wasu rage ragewar rage don samun kuma kula da sake buɗe abubuwan da ke da gamsarwa na waɗannan karar. Idan layin karaya mai sauki ne kuma mai sauƙin sake saita clamps ko coptomation claps, sanya shi da sauri, ana iya amfani dashi don sake saiti yayin Nine. Idan matsa ba ta dace ba ko jirgin sama mai rauni ba ya bada ranta wa tsinkaye, pollen ko toshe sloks na iya taimakawa wajen hana fitarwa da mugun 15). Ana sanya waɗannan dunƙulen da aka sa su gaba zuwa matsayin ƙusa da ake so a kan lattion gani da kuma a ɓoye zuwa matsayin ƙusa da ake so akan ra'ayi na baya akan ra'ayi-ƙarshe. Matsayi yadda ya dace na waɗannan dunƙulen don sake saiti mai kyau na iya zama kalubale.

HIG

Wani ingantaccen dabara mai inganci shine ficewa na ɗan lokaci na karaya a cikin wani matsayi na Anatomic (Fig. 16). Yawancin lokaci karamin farantin totular da biyu ko uku na corticing square za su riƙe karar karaya yayin shiri na tushen canal da kuma fadin canal shiri da ƙusa. Farantin zai sarrafa duka gudun hijira. Ya kamata a bar farantin muddin babu tsayayyen rata don hana asarar da yawanci yakan faru ne bayan cirewar farantin. Wannan farantin tare da dunƙulen cortical guda ɗaya ba m kuma ba zai shafi yanayin dangi na ƙusa ba. Za'a iya amfani da dabarun sake saita don buɗe ido da kuma rufewa.

Hoto na 16 karamin farantin kulle tare da dunƙule guda ɗaya za a iya samu kuma a kiyaye shi a cikin sake buɗe ido. A mafi yawan lokuta, ya kamata a bar farantin a wuri bayan tai. wani fari na bergus nagari na wani karaya Tibal. B karamin farantin karaya tare da dunƙule na karar guda daya ana sanya shi akai-akai don samun da kuma kula da jujjuyawar. c A farantin ba a cire bayan zartarwa ba saboda yana samar da ƙarin kwanciyar hankali

Babu shakka, haɗarin da rikicewa

- Crourracturewar ƙaƙƙarfan ƙoshin kariya na iya haifar da lalacewar guringuntsi da tsarin gwiwa mai artrau-articular (Hoto na 17). Dole ne a sake sanya hannun riga mai kyau.

- 'Yan kadan karkatarwa daga hannun riga kariya na iya haifar da reamer hakar kai. FluraorScopy yana taimakawa wajen gano matsalar. Sake daidaitawa na riga kariya zai magance matsalar (Fig. 18)

- Kulle ƙulle-up: wanda ya shafa na iya zama ya makale a cikin hannun rigar ƙarfe a ƙarshen lanƙwasa (Herzog Curve). Don shigarwar ƙusa na ƙarshe, buƙatar cire bututun ƙarfe kawai, ya bar kawai hannun riga na suturar filastik mai laushi. Lokacin da ƙusa ya makale, yana buƙatar cire gaba ɗaya gaba kuma kuma an sake shigar da shi gaba ɗaya bayan cire murfin ƙarfe ta hanyar filastik filastik kawai.

Figabi na 17 Kare Sleeve Colddrawal ba tare da lura da liyafa ba na iya haifar da rauni a gwiwa

Hoto na 18 Wani yanki ne mai ban dariya ko haɗari na karewar kariya na iya tsoma baki tare da cirewar Reamer, kamar yadda reamer shugaban na iya matsar. b wani bincike mai zurfi tare da gyaran jeri yana ba da damar cire kan shugaban maimaitawa. C The Reamer kai za a iya cire idan mai sake sake sake ba a wurin. D Rearer kai za a iya cire idan mai sake sake sake ba a wurin ba.

Nassoshi

Hessmann mh, BUHL M, Finkemeier c, Khouy A, Blaiful M. Supipatellar Naushe raguwar karaya na Tibiya. Oper orthop trumatol. 2020 Oct; 32 (5): 440-454.