Ọkpụkpụ tibial, usoro ntu intramedullary suprapatellar

Usoro ntu intramedullary maka mgbaji tibial: site na suprapatellar, ụzọ transarticular na ikpere na-atụgharị na 20-30 Celsius na tube nchebe kpọmkwem iji chebe ihe owuwu intra-articular.

01.Tibial Intramedullary Nailing: ohere na nhazi, mgbu ikpere ikpere

Ịwa ahụ maka ntu intramedullary nke mgbaji tibial dị mkpa iji tinye ntu intramedullary site na ntinye ziri ezi, iji belata mmebi nke akụkụ ikpere ikpere ụkwụ, na iji nweta nkwụghachi nke ọma na ntinye ntu kwesịrị ekwesị.

Ụzọ kpochapụwo maka mgbaji ụkwụ tibial bụ ụzọ etiti infrapatellar ma ọ bụ parapatellar. Ọ bụ ezie na egosipụtara ụzọ ndị a maka mgbaji n'etiti akụkụ, valgus postoperative, nrụrụ ihu, ma ọ bụ syndesmotic deformities na-emekarị na mgbaji dị nso.

Isi ihe na-ebute adịghị mma na mgbaji tibial dị nso bụ nrụrụ site na ịdọrọ eriri quadriceps n'oge mgbanwe ikpere na esemokwu n'etiti ntu ntu na azụ tibial cortex n'oge ntinye. Patella na-egbochikwa ntinye axial nke ntu n'ime ụgbọ elu sagittal (Fig 1a, b). Ya mere, ụzọ ọzọ a na-ejikarị abanye n'ókè bụ site na nkwụsịtụ nke parapatellar medial, nke na-eme ka ntinye ntu ntu dị ntakịrị na-aga n'ihu (Figs 1c na 2). Ka ntu na-abanye n'ọwa mmiri intramedullary ruo n'ọkpụkpụ ahụ, akụkụ ahụ dị nso na-agbanye n'ime exostosis (Fig 2). N'ikpeazụ, esemokwu izu ike nke uru ahụ dị n'ihu na-enye aka na ectropion (Fig 3).

Ọgụgụ 1 a,b N'iji usoro infrapatellar a na-ahụkarị, patella na-egbochi ntinye axial nke ntu ahụ, na-ebute nrụrụ nkịtị nke nrụrụ aka nke apical sagittal alignment na ectropion coronal alignment.c A na-eme nhazi ntu ntu intramedullary site na iji usoro parapatellar.

Ọgụgụ 2 Ịbịaru nso n'ebe ntinye site na nbibi nke parapatellar medial na-eduga na ntanye etiti ruo n'akụkụ ntinye ntu. Ka ntu na-abanye n'ọwa mmiri medullary ruo n'ọkpụkpụ ahụ (a), akụkụ ahụ dị nso na-atụgharị ka ọ bụrụ ọkụ (b)

Fig. 3 Nkwụsịtụ ike nke akụkụ ahụ akwara ihu (a) na-emepụta nhazi ectopic dị nro (b)

Ịkụnye tibia n'ime ebe gbatịkwuru na-enyere aka izere nsogbu ndị metụtara nnukwu mgbatị ikpere intraoperative. A kọwara usoro ahụ site na Gelbke, Jakma et al. n'afọ 2010 ma nwetala ewu ewu n'afọ ndị na-adịbeghị anya n'ihi na ịkpọtu tibia n'ebe ọ fọrọ nke nta ka ọ kwụ ọtọ na-eme ka ọ dị mfe mgbaji ọkpụkpụ na ngbanwe. Fluoroscopy adịla mfe na teknụzụ dị mfe ịrụ. A kọwo na oge fluoroscopy maka ntu suprapatellar dị mkpụmkpụ karịa maka ntu infrapatellar. Tụkwasị na nke ahụ, akụkụ ntinye ntinye ntu (n'ime ụgbọ elu sagittal) na-ejikọta ya na ogologo ogologo nke tibia na usoro a karịa na infrapatellar nailing; nke a na-egbochi ọgụ igwe n'etiti ọnụ ntu na cortex dị n'azụ, si otú a na-eme ka mbelata mgbaji.

Mgbu ikpere ikpere mgbe arụchara ọrụ ahụ bụ nsogbu dị mkpa. A na-akọ na mgbu ikpere ikpere na 50-70% nke ndị ọrịa nwere mgbawa, na naanị 30% nke ndị ọrịa na-enwe ihe mgbu mgbe e wepụsịrị njedebe. Achọpụtara na ọnya patellar na abụba Hoffa nwere ike ịkpata mgbu ikpere gachara. Tụkwasị na nke ahụ, ụzọ suprapatellar na-ezere nkwụsị nke ọdịnala nke ịwapụ alaka nke patellar nke akwara saphenous, nke na-ezere nkwụsị ikpere ikpere na mgbagwoju anya (Nyocha 4). Ịgafe ntu ahụ site na akaị quadriceps, si otú a na-ahapụ akwara patellar na-adịghị emebi emebi, na-egosi na ọ na-ebelata oke mgbu ikpere ikpere.

Fig. 4 Mmekọrịta dị n'etiti akwara saphenous na ohere dị iche iche na tibialis obliqua ntu.

N'ihi nsonaazụ dị mma nke mgbaji dị nso, ihe ngosi na-egosi na omume ụlọ ọgwụ agbatịwo n'ọkpụkpụ niile.

Nsogbu nwere ike na intramedullary nailing na usoro suprapatellar:

- Enwere ike ịhapụ irighiri ihe na-emegharị na nkwonkwo ikpere. Otú ọ dị, ahụmahụ ụlọ ọgwụ na ntu femoral retrograde egosila mmetụta ọjọọ ọ bụla dị mkpirikpi ma ọ bụ ogologo oge.

- Kedu otu esi ewepụ ihe nkwụnye ahụ mgbe ọkpụkpụ ahụ gwọchara? Ọ bụ ezie na ọ ga-ekwe omume na teknụzụ iji wepụ ntu intramedullary site na ụzọ suprapatellar, usoro a na-achọsi ike na ọtụtụ ndị dọkịta na-awa na-ahọrọ iwepụ ntu intramedullary site na ụzọ infrapatellar.

02. Kedu mgbe a ga-eji ntu intramedullary suprapatellar mee ihe?

Uru

- Ọkpụkpụ ikpere gbatịpụrụ ọkara na-eme ka mgbaji mgbaji na mbelata site na izu ike ike anụ ahụ na njide n'oge ntinye ntu.

- Obere ihe ize ndụ nke mmebi ahụ nke dị n'akụkụ, akụkụ, na nke dị anya ma e jiri ya tụnyere usoro ọdịnala.

- Ịkụ ntu dị mfe na teknụzụ dị mfe ịrụ

- Enwere ike ịkpọ ntu dị ka usoro dọkịta na-awa otu.

- Mbelata oge fluoroscopy

- Ọ dịghị mmebi na akwara patellar na obere ihe mgbu nke ikpere ikpere na-esote nku

- Ọ dị mfe ịrụ na usoro ọtụtụ otu, dị ka ọ dị na polytrauma.

Ọdịmma

- Ihe ize ndụ nke mmebi nke cartilage ikpere na akụkụ ndị ọzọ nke intra-articular

- Mmụba ihe ize ndụ nke ọrịa ikpere

- Mwepụ nke ihe etinyere nwere ike ịchọ ụzọ dị iche

Ngosipụta

- mgbaji mgbawa nke tibia dị nso (ụdị AO 41A)

- Mgbaji dị mfe nke tibial diaphysis (ụdị AO 42A-C)

- Akụkụ mgbaji tibial diaphysis (ụdị AO 42C)

- Extra-articular na mfe intra-articular distal ndọtị mgbaji nke tibia distal (ụdị AO 43A na C1)

- Na-ese n'elu ikpere

Contraindications

- Gustilo grade 3C na-agbaji agbaji nke tibia n'ihi ụbara ihe ize ndụ nke ọrịa nkwonkwo, ọ bụ ezie na a kọwabeghị ihe ize ndụ nke ọrịa nkwonkwo na mgbawa.

- akwa akwa akwa dị nro siri ike, mmetọ ma ọ bụ ọrịa na mpaghara suprapatellar

- Ipsilateral ikpere prosthesis (mmetụta mmekọrịta)

- Njikọ ikpere

- hyperextension ikpere>20°

- Ọkpụkpụ tibial plateau Ipsilateral gụnyere ebe ntinye ntu bụ ihe mgbochi

- Akụnye na-egbochi ebe ntinye ntu

- mgbaji patella nke ipsilateral (mmetụta ọ bụla)

03. Ụzọ ịwa ahụ

① Ọnọdụ ahụ na echiche

Fig. 5 Onye ọrịa na-edina ala na tebụl rediolucent nke na-enye ohere ka ọ gbawaa ụkwụ. A na-ahapụ akụkụ ahụ gbajiri agbaji ka ọ kwụgidere n'efu ma tinye akwụkwọ mpịakọta n'okpuru nkwonkwo ikpere (a) iji nweta 10-30 ° nke ntụgharị ikpere. 

(b). A na-etinye C-ogwe aka n'akụkụ nke ọzọ. A na-agbada ụkwụ na-adịghị emetụta 10-30 ° site na kehoraizin iji hụ na eserese kwesịrị ekwesị na ọnọdụ mpụta.

② Chọta ebe ntinye agịga ziri ezi

Ọnụ ọgụgụ 6 A na-eji usoro a akara site na ogwe nke patella, tuberosity tibial, na ihu tibial cortex. A na-eme mbepụ akpụkpọ ahụ ogologo 2 cm ogologo 1-1.5 cm dị nso na isi elu nke patella. Akwụsị akwara quadriceps na-ekpughere na a na-eme mbepụ ogologo ogologo nke etiti na ntụzịaka nke eriri akwara. A na-emeghe ezumike suprapatellar na mkpịsị aka onye dọkịta na-awa ahụ na-abanye na nkwonkwo ikpere site n'okpuru patella iji chọpụta ịdị mfe ịnweta. Obere ndọtị nke akụkụ ahụ nwere ike ime ka ịnweta ikpere ikpere. Ntinye nke Langenbeck retractor maka ntakịrị elu nke patella nwekwara ike ịkwalite ohere. Ọ bụrụ na oghere nkwonkwo dị warara nke ukwuu na ngwá ọrụ siri ike, a na-etinye eriri nkwado nke etiti ma ọ bụ n'akụkụ ya ka ọ ghara imebi patella n'otu akụkụ.

③ Nchekwa cartilage

Ihe osise 7 Nchebe nke cartilage patellofemoral site na mmerụ ahụ metụtara ịwa ahụ bụ otu n'ime ihe mgbaru ọsọ bụ isi nke usoro ịwa ahụ. Ya mere, a ga-eji uwe mkpuchi nchebe mee ihe n'oge ntinye ihe na ntinye ntu.a Ngwa maka ịnweta transarticular gụnyere ntinye ntinye aka, n'èzí (dị nro) na ime (metal) mkpuchi mkpuchi, eriri trocar, na ntụziaka waya porous. A na-ejikọta agịga trocar na aka nchekwa na ntinye aka.b Ịkwado aka na oghere ikuku ikuku. Mkpịsị aka dị n'elu ntinye aka na-egbochi mgbapụ na mberede nke mgbakọ aka

④ Tinye akwụkwọ ntuziaka ma dozie ọnọdụ ahụ

Ọgụgụ 8a A na-etinye mgbakọ aka n'okpuru patella site na nkwonkwo patellofemoral na-aga ebe a chọrọ na tibia (Njirimara 9). N'ọtụtụ ọnọdụ, patella ga-emegharị ntakịrị na etiti ma ọ bụ n'akụkụ n'oge ntinye ngwá ọrụ. Oghere dị na nkwonkwo patellofemoral na-eduzikarị agịga trocar n'ọnọdụ ziri ezi na-akpaghị aka.

Fig. 8b A kwadoro ọnọdụ na ụgbọ elu abụọ ahụ site na iji fluoroscopy ma dozie ebe ọ dị mkpa. A na-edochizi agịga trocar site na ntụzịaka porous, onye ndu nke na-agafe n'etiti oghere nke guidewire ma tinye ọnụ ya n'ime tibial metaphysis dị nso iji hụ na ọnọdụ ziri ezi.

Ọnụ ọgụgụ 8c Mgbe onye nduzi ahụ nọ n'ọnọdụ dị mma, enwere ike iji ntuziaka nke abụọ mee ntakịrị mgbanwe na ọnọdụ dị mma site na porous guidewire, ruo n'ókè nke 4.3 mm Dị ka ihe ọzọ, ọ nwere ike ịdị mfe ịmalite na ntuziaka ma tinye ya n'enweghị enyemaka na ebe kacha mma ntinye. Ngwa ntinye na ntuziaka na-adaba n'elu ntuziaka.

⑤ Mgbasawanye nke medulla oblongata

Fig 9a Imeghe oghere medullary site na ntinye dị mma bụ nzọụkwụ dị oke egwu na usoro ịwa ahụ. N'ime ụgbọ elu anteroposterior, nke a bụ akụkụ etiti nke tibial mpụta. N'ime ụgbọ elu dị n'akụkụ, ebe ntinye ziri ezi dị na mgbanwe n'etiti elu articular na ihu ihu.

Fig. 9b Ọnọdụ ziri ezi nke onye nduzi nduzi kwekọrọ na axis tibial na anteroposterior ụgbọelu na dị ka ihe dị nso na cortex dị n'ihu dị ka o kwere mee na ntụgharị ihu. The guidewire na-achọkarị ịkwaga n'azụ.

Ọgụgụ 9c N'ọnọdụ ebe enweghị ike itinye ntụtụ ma ọ bụ ntu nke ọma, igbochi ntu ma ọ bụ ntụtụ na-enyere aka iduzi ntu n'ọnọdụ ziri ezi. 

A na-eji ntu mgbochi na mpaghara metaphyseal sara mbara mgbe ndu ma ọ bụ ntu enweghị ike ịgbado n'etiti ya na axis ogologo ọkpụkpụ ma ọ bụ mgbe mgbaji dị n'otu ụgbọ elu ma ọ bụ abụọ dị n'oge ntinye ntu.

Ọnụ ọgụgụ 10 N'oge a, a na-atụ aro ka a na-echekwa mgbakọ aka na condyle femoral site na iji waya nduzi 3.2 mm. Nke a na-egbochi mgbakọ ahụ ịpụ na tibia.

Ọgụgụ 11 A na-edobe olulu oghere 12.0mm site na aka uwe nchebe dị n'ime wee gbadaa site na ntuziaka ntuziaka ruo n'ọkpụkpụ. A na-emeghe ọwa mmiri medullary site na igwu mmiri na omimi nke 8-10 cm ma tinye ntụzịaka bọọlụ na-etinye n'ime tibia dị nso.

⑥ Mbelata mgbaji

Ọgụgụ 12a N'oge a, anyị na-emegharị mgbaji ahụ.

Ọnụọgụ 12b Dabere na ebe mgbaji ahụ na ọdịdị ya, a pụrụ iji ngwá ọrụ dị iche iche nke mbelata dị ka clips percutaneous, retractors, obere mpempe akwụkwọ, na skru na-egbochi iji nweta nhazi kwesịrị ekwesị. Na mbelata mgbaji tibial dị nso, mgbe ụfọdụ ọbụna site n'enyemaka nke mgbakwunye mgbakwunye, tupu imepe oghere medullary site na igwu mmiri. A na-ebuli mkpanaka na-emegharị ahụ anya ma tinye ya n'etiti etiti tibial metaphysis dị anya. Mgbe emegharịrị, a na-ekpebi ogologo na dayameta nke ntu ahụ. Ọ bụrụ na ọ dị mkpa, gbasaa ọwa mmiri tibial ka ọ bụrụ dayameta achọrọ site n'ịkwalite na 0.5 mm gbakwunyere. Ihe mmeghe dị na aka mkpuchi mkpuchi na-enye ohere maka ịsacha na nsị nke irighiri ihe sitere na nkwonkwo n'oge ịgha mkpụrụ. Ọ bụrụ na ọ ga-ekwe omume, a na-atụ aro ka a na-eji ntu nwere dayameta kacha nta nke 10 mm. Ihe mkpuchi mkpuchi 5.0 mm maka ụdị ntu a na-eguzogide ọdịda karịa 4.0 mm Locking Bolt eji maka mbọ mbọ kacha mma. Ogologo mbọ intramedullary na-ekpebikarị site na onye na-achị fluoroscopic.

⑦Fanye ntu intramedullary

Fig. 13a Ntinye ntu site na mkpanaka reaming n'okpuru fluoroscopy. Rịba ama na ntinye ntinye maka ntu suprapatellar dị ogologo karịa nke ahụ maka ntu infrapatellar n'ihi na anya site na mbepụ akpụkpọ ahụ ruo na ntinye ntu tibial dịkwa ogologo.

Ọgụgụ 13b Biko mara na ehulata (Herzog curve) na njedebe dị nso nke ntu intramedullary enweghị ike itinye ya site na mkpuchi mkpuchi igwe dị n'ime. Ya mere, a ga-ewepụrịrị mkpuchi mkpuchi nke ime na mgbakọ aka tupu etinye ya ntu (b; lee ngalaba ' Njehie, Ihe egwu na Nsogbu'). Lelee ọnọdụ ikpeazụ nke ntu intramedullary na ihu ihu-azụ na n'akụkụ. Wepu mkpanaka reaming. Ọ bụrụ na ọ dị mkpa ka edochie ntu ahụ, hapụ mkpanaka reaming ebe ma tinye ntu ọhụrụ n'ime mkpanaka ahụ. Ihe nrịbama 5 mm na ntinye ntinye na-egosi omimi nke ntinye nke ihe ntinye na tibia nso (Fig 14). (Foto nke 14)

⑧ Mkpọchi dị anya na nso nso

Ọgụgụ 14a Nhazi mkpọchi dị nso na nke dị anya na-adabere na njirimara mgbaji dị iche iche. Enwere ike imechi mkpọchi dị nso na ogwe aka ebumnuche. A na-emecha mkpọchi nke anya site na aka ma ọ bụ site na iji ntuziaka mkpọpu rediopaque. Nhọrọ, enwere ike iji okpu ngwụcha, nke na-egbochi ọkpụkpụ ka ọ ghara itolite na njedebe dị nso nke ntu intramedullary ma mee ka e mesịa wepụ ihe ntinye ahụ. Karịsịa, ntu ndị a na-etinye n'elu na-adị mfe iwepụ mgbe ejiri njedebe njedebe nke ogologo kwesịrị ekwesị. A na-atụ ogologo okpu njedebe achọrọ site na ịtinye akara na aka ma ọ bụ site na ịtinye waya nduzi site na ogwe aka ebumnuche.

Ọgụgụ 14b N'ọnụ nke guidewire na-egosi na nso nso nke intramedullary ntu. Ekwesịrị iwepụ ihe nkedo na-ejikọta ogwe aka ebumnuche na ntu iji fanye okpu njedebe. Okpu njedebe na-agafe na gbọmgbọm nke ntinye aka. Aka ntinye na-anọgide na ebe. Nke a na-ejikọta okpu njedebe na n'elu ntu intramedullary ma gbochie ya ịla n'iyi na ikpere. Ịtinye ntuziaka wire site na okpu njedebe gbọmgbọm n'ime njedebe dị nso nke ntu ahụ na-enyekwa aka na-eduzi okpu njedebe n'ọnọdụ ya kwesịrị ekwesị na njedebe dị nso nke ntu intramedullary. N'ọgwụgwụ nke usoro a, a ga-asachapụ ihe ngwọta saline na-adịghị ọcha iji sachapụ ihe ọ bụla mebiri emebi.

04. ịdọ aka ná ntị

Akpachara anya maka ịwa ahụ

- N'ihe gbasara ọrịa ogbu na nkwonkwo na-adịbu adị, mmegharị patellar amachibidoro nwere ike igbochi ịnweta nkwonkwo. Mbibi nke akụkụ dị nso nke eriri nkwado etiti ma ọ bụ mpụta site n'akụkụ etiti na-eme ka ntinye nke pin trocar dị mfe.

- Prosthesis ikpere ipsilateral abụghị ihe mgbochi siri ike maka pinning suprapatellar. Mara, Otú ọ dị, na ọ gaghị ekwe omume ịnweta ebe mmalite nke usoro ntu tibial dị nso.

- N'ọkpụkpụ nke nwere mgbatị articular, enwere ike ịtinye screws ndị ọzọ iji mee ka akụkụ mgbaji ahụ kwụsị. A na-atụ aro ka etinye skru ndị a tupu ntinye ntu iji zere ngbanwe nke abụọ nke mgbaji ọkpụkpụ.

Atụmatụ mgbaji Tibia nso

Mgbaji tibial dị nso bụ mgbaji tibial kacha sie ike iji ntu ma chọọ ebe ntinye kpọmkwem (dị ka akọwara n'elu). Ekwesịrị ibelata mgbaji mgbaji a tupu ịkụ ntu iji gbochie ike ọ bụla na-emebi emebi wee bulie ihe ịga nke ọma. N'ọnọdụ ụfọdụ, idobe akụkụ ahụ emetụtara n'ụzọ ziri ezi n'ọnọdụ dị obere agbatị na ịnweta ebe ntinye ziri ezi na itinye ntu ahụ na ọwa mmiri medullary na coronal na axes sagittal ga-eme ka nhazi nke tibia dị mma mgbe a na-akụtu ya.

Agbanyeghị, n'ọtụtụ ọnọdụ, achọrọ mbelata ụfọdụ iji nweta ma jikwaa ngbanwe nke nhụsianya ndị a na-eju afọ. Ọ bụrụ na ahịrị mgbaji ahụ dị mfe ma nwee akụkụ, enwere ike iji ntugharị nrụpụta ma ọ bụ mkpuchi mkpuchi, nke etinyere n'otu oge, iji nweta ma jikwaa nrụpụta n'oge ntu. Ọ bụrụ na njide ahụ ezughị oke ma ọ bụ ụgbọ elu gbajiri agbaji anaghị agbazinye onwe ya na njigide, pollen ma ọ bụ igbochi skru nwere ike inye aka gbochie nchụpụ na ọnọdụ ọjọọ (Nyocha 15). A na-etinye skru ndị a n'azụ n'ọnọdụ ntu a na-achọsi ike na anya n'akụkụ na n'akụkụ ebe a na-achọ ntu na ihu ihu-azụ. Ndokwa nke ọma nke skru ndị a maka nrụpụta dị mma nwere ike bụrụ ihe ịma aka.

Fig 15 Mkpọchi kposara etinyere n'èzí nke ụzọ ntu a na-achọ n'ihu na n'azụ echiche (a) na n'azụ ụzọ ntu a chọrọ n'akụkụ anya (b) na-emegide ndị agha deformation.

Usoro ọzọ dị irè bụ nkwụsị nwa oge nke mgbaji na ọnọdụ anatomic (Fig 16). Ọtụtụ mgbe, obere efere tubular nke nwere skru abụọ ma ọ bụ atọ otu cortical mkpọchi ga-ejide mgbaji ahụ belata n'oge nkwadebe mgbọrọgwụ na ntinye ntu. Efere ahụ ga-ejikwa nchụpụ abụọ ahụ. Ekwesịrị ịhapụ efere ahụ ma ọ bụrụhaala na enweghị oghere a kapịrị ọnụ iji gbochie mbelata mbelata nke na-emekarị mgbe e wepụsịrị efere. Efere a nwere otu skru cortical adịghị esi ike na ọ gaghị emetụta nkwụsi ike nke ntu ahụ. Enwere ike iji usoro ntọgharị efere maka ma mgbaji mepere emepe ma mechiri emechi.

Ọgụgụ 16 Enwere ike nweta ma dokwaa obere efere mkpọchi nwere otu skru cortical na nhazigharị anatomic. N'ọtụtụ ọnọdụ, a ga-ahapụ efere ahụ mgbe a na-agbanye ntu. Nrụrụ valgus mbụ nke mgbaji tibial dị nso. b A na-edobe obere efere mgbaji nwere otu skru cortical n'etiti etiti iji nweta ma nọgide na-atụgharị mgbaji n'oge ntu. c A naghị ewepụ efere ahụ mgbe ọ na-agbanye ntu n'ihi na ọ na-enye nkwụsi ike ọzọ

Mmejọ, ihe egwu na mgbagwoju anya

- Ntugharị intraoperative nke mkpuchi mkpuchi nwere ike ime ka mmebi nke cartilage na akụkụ ikpere ikpere (Nyocha 17). A ghaghị itinyeghachi aka uwe nchebe nke ọma.

- Ntugharị ntakịrị nke mkpuchi mkpuchi nwere ike ime ka mmịpụta isi reamer ka njọ. Fluoroscopy na-enyere aka ịchọpụta nsogbu ahụ. Ndozigharị nke mkpuchi mkpuchi ga-edozi nsogbu ahụ (Fig 18)

- Mkpọchi ntu: Ihe etinyere nwere ike ịrapagidesi ike na ogwe aka igwe n'ebe dị nso (Herzog curve). Maka ntinye ntu ikpeazụ, ọ dị mkpa ka ewepụ tube metal ahụ, na-ahapụ naanị uwe plastik dị nro dị n'èzí. Mgbe ntu ahụ rapaara, ọ dị mkpa ka ewepụ ya kpamkpam ma tinyeghachi ihe ntinye ahụ mgbe ọ wepụsịrị cannula metal site na cannula plastik naanị.

Ọgụgụ 17 Mwepụ mkpuchi mkpuchi na-enweghị nlele fluoroscopic nwere ike ibute mmerụ ikpere

Ọgụgụ 18 a Tilting ma ọ bụ na mberede tilti nke mkpuchi mkpuchi nwere ike igbochi mwepụ reamer, n'ihi na isi reamer nwere ike ịgbachi. b Nyocha fluoroscopic na nhazi nhazi na-enye ohere iwepụ isi reamer. c Enwere ike wepu isi reamer ma ọ bụrụ na isi reamer adịghị ebe. d Enwere ike iwepu isi reamer ma ọ bụrụ na isi reamer adịghị ebe.

Ntụaka

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar ntu nke mgbaji nke tibia. Ọkpụkpụ Orthop Traumatol. Ọktoba 2020; 32 (5): 440-454 .