Kuvunika Tibial, Suprapatellar Intramedinal Tekinike

Intramedillary Umusuka Yumusumari kubicuruzwa bya Tibial: Binyuze mu mayeri, uburyo butarimo ibintu hamwe na pivi yuzuyemo 20-10 ° hamwe n'umuyoboro ukingira wo kurinda inzego za ArTran.

01.Tibial Intramedilary imisumari: kwinjira no guhuza, ububabare bwo mu kibo

Kubaga kubaga intera imisumari ya tibialte ni ngombwa kugirango ushiremo intera umusumari unyuze mu nyubako za intramedi, kandi kugirango ugabanye ibyangiritse kuri intrame-artramet ivitiye ivi, kandi kugirango ugere kumiterere ya Articiation hamwe no kwinjiza kandi neza.

Icyerekezo cya kera cyo kuvunika indwara zo muri tibial ni infrapatellar cyangwa parapatellar yegeranye. Nubwo ubwo buryo bwerekanwe hagati yumugabane wa kabiri, valgus ya nyuma, imbere, cyangwa syndesmotique akenshi bibaho muburyo bwihuse.

Impamvu nyamukuru yo gukwirakwiza muri karacttire yimyandikire ya Proximile ni ubumuga buterwa no gukurura quadrices mugihe cyamakimbirane ya mavi hamwe ninyuma ya tibial cortex. Patella nayo irinda kwinjira mumusumari mu ndege ya SAGITLAL (Igishushanyo 1a, b). Kubwibyo, ubundi buryo busanzwe bwo kwinjira muburyo bunyuze kuri parapatellar yo hagati, bikavamo imitako yo hagati-kuri-kuruhande-yinjira-kuruhande rwimibonano mpuzabitsina (imitini. 1c na 2). Nkuko imisumari yinjira mu kamaro ka intramedullar itandukana no kuvunika, igice cyagenwe kigabanuka muri Exoton (Ishusho 2). Hanyuma, guhagarika imitsi yicyumba cyimbere kigira uruhare ruto kuri ectipion (Ishusho 3).

Igishushanyo 1 A, B ukoresheje uburyo busanzwe bwa verapatellar, patella birinda kwinjira mu musumari, bikaviramo ubudahurika rusange cya Sagitment ya Sagitment na ECTTROPULL ihuza na Serivileal yakozwe hakoreshejwe uburyo bwa ParapateLelLe.

Igishushanyo 2 cyegera aho winjira ukoresheje parapatellar yo hagati biganisha ku bucanwa gato kugirango ushiremo Umusatsi. Nkuko umusumari yinjira muri calullary malullary itandukana (a), igice cyambere kirimo umurongo (b)

Igishushanyo 3 Kuruhuka Impagarara yikigereranyo cyimbere (a) bitanga gahunda yoroshye

Imisumari ya tibia mumwanya waguwe ufasha kugirango wirinde ingorane zijyanye ningo zijyanye no gupfukama bikabije. Ubuhanga bwasobanuwe na Gelbke, Jakma et al. Mu mwaka wa 2010 kandi yungutse akunzwe mu myaka yashize kuko imisumari mumwanya ugororotse ugororotse yoroshya miniculation no gusubiramo. Flueroscopi yaroroshye gukora tekinike gukora. Igihe cya fluoskopy cyo gutanga imisumari ya suprapatellar yavuzwe ko ngufi kuruta kubwisubukeresiteri. Mubyongeyeho, inguni yumunwa (mu ndege ya SAGITLAL) irangiye cyane mu nsanganyamatsiko ndende ya tibia ubwo buryo kuruta hamwe nisusu ryinshi; Ibi birinda amakimbirane yaharanira imisumari hagati yumusumari hamwe ninyuma ya cortex, bityo yoroshya kugabanya.

Ububabare bwa nyuma yinyuma yububabare ni ikibazo kijyanye. Ububabare bwo mu ivi bwavuzwe muri 50-70% byabarwayi bafite kuvunika, hamwe na 30% gusa byabarwayi bafite ububabare bwo kubabara nyuma yo kuvanagurwa. Kwinjira-gutoza bifitanye isano na patella Tendon na Pad ya Hoffa yagereranijwe ko ari isoko ishobora kuba ububabare bwa pose. Byongeye kandi, uburyo bwo gushora urugero bwirinda guhagarika ishami ryishami rya patellar rya saphenor nervice yo mu mitsi ya saphenous, yirinda kunanirwa kumera no gutemba (Ishusho 4). Kunyura umusumari unyuze kuri quadriceps, bityo usige patellar Tendon Standation, bigaragara ko igabanya cyane igipimo cyigipimo cyamavi.

Ishusho

Bitewe nibisubizo byiza byo kuvunika kwiyongera, ibimenyetso mubikorwa byubuvuzi byageze ku kuvunika byose.

Ibibazo bishobora kuba intera imisumari muburyo bwo gutanga Poprapatellar:

- Birashobora kuva kumyanda yongeye gushimangira mu ivi. Ariko, uburambe bwa kuvura hamwe na retrograde imisumari yubugome ntabwo yerekanye ingaruka mbi- cyangwa ndende ndende.

- Guterwa ni gute kuvunika nyuma yo kuvunika? Nubwo ari tekiniki bishoboka kugirango ukureho umusumari winkuta unyuze muburyo bwo gukwirakwiza, tekinike irasaba kandi abaganga benshi bahitamo gukuraho imisumari ya Intramedillar binyuze muburyo bwa instrapatellar.

02.Iyo appepatellar inttttttttttttramediat isukari?

Ibyiza

.

- Ibyago byo hasi byo gukwirakwiza kwa porsoralation ya proximine ya proximal, igice, no kurenga ugereranije nuburyo gakondo

- imisumari byoroshye kuri tekinike gukora

- Imisumari irashoboka nkikintu cyo kubaga '.

- kugabanya igihe cya fluoscopy

- Nta byangiritse kuri Patellar Tendon no Guteka Gutanga Amavuko Yumusasu

- byoroshye gukora muburyo bwitsinda ryinshi, kimwe na polytrauma.

Ibibi

- ibyago byo kwangirika kuri mavit cartilage nizindi nzego za Artra-Articular

- Kongera ibyago byo kwandura ivi

- Gukuraho Seclant birashobora gusaba ubundi buryo

Ibimenyetso

- kuvunika-urushya rwa tibia proxima (ubwoko Ao 41a)

- Kuvuka byoroshye bya dibiris ya tibial (ubwoko Ao 42A-c)

- kuvunika dibial dibial dimeryos (ubwoko Ao 42c)

- bidasanzwe-bidasanzwe kandi byoroshye intera yo kwagura ikirungo cya ticrance ya tibia (ubwoko Ao 43ya na C1)

- ivi rireremba

Kumenyekanisha

- Sustilo amanota ya 3C yafunguye tibia kubera ibyago byo kongera ibyago byo kwandura hamwe, nubwo ibyago byo kongera ibyago byo kurwara hamwe

- tissue yoroshye yoroheje, kwanduza cyangwa kwandura mukarere ka suprapatellar

- Prothète ivi (ugereranije na sogokuruza)

- ivi

- Icyatsi hyperexTension> 20 °

- Kuvura ibibaya bya ipilate birimo ibikoresho byinjira mu misumari ni isano ifitanye isano

- Gushimira kubangamira imisumari yinjira

- Kuvunika patella ya iPELA (BYANANIRO)

03. Uburyo bwo kubaga

Umwanya wumubiri nicyerekezo

Igishushanyo 5 Umurwayi aryamye kumeza ya Radiyo yemerera umwanya wamaguru. Igihome cyacitse gisigaye kimanitse mu bwisanzure kandi umuzingo gishyirwa munsi yivi (a) kugirango ugere ku 10-30 ° cya pivi 

(b). C-ukuboko gushyirwa kuruhande. Ukuguru kutagira ingaruka kumanurwa 10-30 ° kuva muri horizontal kugirango urebe neza ko ibitekerezo bikwiye mumwanya wuruhande.

②find iburyo bwinjira

Igishushanyo cya 6 Ubu buryo burangwa nigiti cya patella, tuberotike, na tibial tibial cortex. Uruhu rwa CM rurerure rwa CM rurerure rukora 1-1.5 cm proximal kuruhande rukuru rwa patella. Amayeri ya Quadrices yashyizwe ahagaragara kandi ashyizwe hagati ya progaramu ya miremitoudination ikorwa muburyo bwa fibre fibre. Ikiruhuko cya Saprapatellar cyafunguwe kandi intoki zo kubaga zinjiye mu ivi kuva munsi ya pateli kugirango isuzume uburyo bworoshye bwo kugera. Kwagura bike byigihuru birashobora koroshya kugera ivi. Kwinjiza retractor ya langenbeck kugirango habeho gato patella irashobora kandi kuzamura. Niba umwanya uhuriweho ni muto kandi igikoresho kiragoye, itsinda ryubatswe cyangwa kuruhande rishobora guterwa na proximil kuriyo kugirango berekeza igice cya Pateli kuruhande rumwe.

Kwitegura karitsiye

Igicapo 7 Kurinda karitsiye ya patelloferal kuva gukomeretsa ubwitonzi nimwe mu ntego nyamukuru zuburozi. Kubwibyo, abarinzi bakingira bagomba gukoreshwa mugihe cyibikoresho hamwe na musumari.a ibikoresho byo guhagarika ibintu birimo. Urushinge rwa Trokar rwateranijwe hamwe no gukinisha no kwinjizamo ibikoresho.b kwimuka hamwe nu mwobo wa vari. Ipfundo hejuru yibikorwa byinjiza birinda gutukana kw'inteko ikora

Shyiramo kuyobora no guhindura umwanya

Igishushanyo 8a Inteko yintoki yinjijwe munsi ya pateli binyuze mu mpimbano zifatanije na patelloferal yerekeza kuri tibique yinjira kumurongo (Ishusho 9). Mubihe byinshi, patella izagenda hagati cyangwa kuruhande mugihe cyo gushiramo. Igikoko muburyo bwa patelloferal mubisanzwe biyobora urushinge rwa trokar kumurimo ukwiye mu buryo bwikora.

Igishushanyo cya 8b cyagenwe mu ndege zombi ukoresheje flueroscopi kandi gakosowe aho bibaye ngombwa. Urushinge rwa Trokar noneho rusimburwa na Puxrous Reuntewire, umurongo wayobora unyuze mu mwobo wa Centre winjijwemo kandi inteko yinjijwe muri metaphysis proximis kugirango habeho umwanya ukwiye.

Igishushanyo 8c mugihe umuyobozi wayobora ari mumwanya wa Suboppimal, umurongo wa kabiri urashobora gukoreshwa muguhindura bike muburyo bwiza, kugeza kuri mm ya 4.3. Igikoresho cyo kwinjiza hamwe na The Enterwire noneho iranyerera hejuru yayobora.

Kwagura Medilla Oblongata

Igishushanyo 9a gufungura umwobo wa gisullary uhereye kumurongo mwiza nintambwe ikomeye mubikorwa byo kubaga. Mu ndege ya anteroposition, iyi niyo ngingo yo hagati ya tibial. Mu ndege yikiruhuko, aho byinjira neza biherereye kuri inziba hagati yubuso bwa articular na cortex iri imbere.

Igishushanyo cya 9b Umwanya ukwiye wa The Enterwill uhuza no mu nsanganyamatsiko mu ndege ya Anteroposterion kandi hafi ya Cortex ishoboka muri projection ya Arterior ishoboka muri projection ya Arterior. Umuyobozi ukunda kwimuka inyuma.

Igishushanyo 9c Mugihe PIN cyangwa imisumari idashobora kwinjizwa neza, guhagarika umusumari cyangwa pin bifasha kuyobora umusumari mumwanya ukwiye. 

Guhagarika imisumari bikoreshwa mukarere kagutse mugihe cyayobora cyangwa imisumari idashobora kwibanda kumurongo muremure wamagufwa cyangwa mugihe ikuraho indege imwe cyangwa yombi iguma mugihe cyinjiza.

Igishushanyo 10 kuri iki cyiciro, birasabwa ko inteko yintoki igakingirwa femoral ikoresheje insinga 3.2. Ibi birinda inteko gusohoka muri Tibia.

Igicapo 11. Umuyoboro wa Medullary urakinguwe no gucukura hamwe na cm 8-10 numupira wamaguru winjijwe muri tibia proximal.

Kugabanuka

Igishushanyo 12A kuri iki cyiciro, tugarura kuvunika.

Igishushanyo cya 12B Ukurikije uko uvunika hamwe na morphologiya zayo, ibikoresho bitandukanye byo kugabanuka, clips zitandukanye, umucuruzi, amasahani mato arashobora gukoreshwa kugirango agere ku guhuza neza. Kugabanya imiti mibi yoroheje, rimwe na rimwe ndetse no kubufasha bwinyongera, mbere yo gufungura imiyoboro ya gisabune yo gucukura. Inkoni yo gusubiramo iratera imbere kandi yinjijwe hagati muri metaphysis ya kure. Nyuma yo kwiyongera, uburebure na diameter yumusumari bigenwa. Nibiba ngombwa, wagura umuyoboro mubi wa diameter wifuzwa wiyongera muri 0.5 mm yiyongera. Gufungura mu ntoki zo kurinda bituma bituma kugirango bikure no gusuzugura imyanda uhereye ku ngingo mugihe cyo gusubira inyuma. Niba bishoboka, birasabwa ko umusumari hamwe na diameter ntarengwa ya mm 10 ikoreshwa. 5.0 mm ifunze kuri ubu bwoko bwimisumari irwanya kunanirwa kurenza uko 4.0 mm ifunga bolt yakoreshejwe mumisumari. Uburebure bwimisumari yinganda mubisanzwe bigenwa numutegetsi wa flueroscopique.

⑦ mert Intramedilllary Umusumari

Igishushanyo cya 13Imikorere yimisumari binyuze mu nkoni yo gusubiramo munsi ya flueroscopy. Menya ko kwinjiza ibicuruzwa byimisumari ni ndende kuruta ibyo kuri infrapatellar imisumari kuko intera yo gucika intege mubyinjira mumibanire nayo.

Igicapo 13b Nyamuneka menya ko inzoga (Herzog yo mu myuga) irangira ikomeye ya Intramedilary umusumari udashobora kwinjizwa mu maboko y'imbere. Kubwibyo, ikirango cyimbere kigomba gukurwa mubiterane mbere yo kwinjiza umusumari (B; reba igice 'Amakosa, akaga n'ibibazo '). Reba umwanya wanyuma wintangiriro yumusumari mumbere-inyuma kandi kuruhande. Kuraho inkoni yo gusubiramo. Niba umusumari akeneye gusimburwa, kuva ku nkoni yo gusubirwamo mu mwanya no gushyiramo imisumari nshya mu nkoni. 5 mm irarangagura ikigo cyinjiza yerekana ubujyakuzimu bwo gushiramo intera muri tibia proxima (Ishusho 14). (Ishusho ya 14)

Gufunga cyane kandi byateganijwe

Igishushanyo 14 Kubogasha gufunga no kurengera biterwa nibiranga ibintu byihariye. Gufunga kwangirika birashobora kugerwaho hamwe nintoki. Gufunga kure birangizwa kubuntu cyangwa gukoresha igitabo cyimikorere ya radiopaque. Bidakwiye, umupaka wanyuma urashobora gukoreshwa, kibuza amagufwa gukura mumutwe wanyuma wimisumari yinjira no kuborohereza nyuma yo gukuraho imisumari. By'umwihariko, imisumari irenze urugero iroroshye gukuraho iyo ingofero yanyuma yuburebure bukoreshwa. Uburebure bwifuzwa bwa COST yapimwe no kwinjiza ikimenyetso ku ntoki cyangwa mugushiramo insinga binyuze mumaboko agamije.

Igishushanyo 14b Agace ka The Ealicalwire yerekana umwanya wa Proximal ya Intramedillary Umusuko. Umukoresha uhuza ukuboko intego kumusumari akeneye gukurwaho kugirango winjize ingofero yanyuma. Imperuka ya nyuma irarengana muri barrie yo kwinjiza. Kwinjiza ikiganza kigumaho. Ibi bihuza umupira wanyuma hamwe hejuru yintangiriro yumusumari kandi ukayibuza gutakaza mumavi. Kwinjizamo umurongo wa interineti unyuze inyuma yimpera yinyuma yimisumari kandi ifasha kuyobora imperuka yabyo kuruhande rwimisumari ya Intramedinals. Iyo nzira irangiye, igisubizo cya saline kidasanzwe kigomba kwozwa kugirango woza imyanda yose isigaye.

04. Icyifuzo

Ingamba zo kubaga

- Mugihe cya OsteoRistring Osteoarthritis, icyerekezo cya patellar cyabujijwe gishobora gukumira kwinjira. Guhagarika igice cya Proximal cyitsinda ryumutwe hagati cyangwa kuruhande kuva kuruhande rwo hagati cyorohereza kwinjiza trokar PIN.

- Prothèse ivi ivi ntabwo ari uguhuza neza kuri suprapatellar. Reba, ariko, ko bidashoboka kubona intangiriro isanzwe yimiterere minini yo mumirire mibi.

- Kuvunika hamwe no kwagura ibihangano, imigozi yinyongera irashobora kwinjizwamo kugirango ihagarike ibice byo kuvunika ibihangano. Birasabwa ko iyi migozi ishyirwa mbere yo kwinjiza imisumari kugirango wirinde kwimura kwa kabiri.

Ibitekerezo bya Froximal Tibia

Kuvunika kwa tibial tibial nibibazo bitoroshye mumisumari kandi bisaba ingingo zinjira neza (nkuko byasobanuwe haruguru). Izi mvura zigomba kugabanuka mbere yo gutera imisumari kugirango zirwanya imbaraga zose zifatika kandi zigatsindira. Rimwe na rimwe, uhita ushyira mu bikorwa ingingo zakozwe mu gice cya kabiri kandi ukabona umusumari usobanutse kandi ushyira umusumari wo kwizirika mu nsimba ya conal muri cononal na Sagittal bizavamo imisumari ikwiye.

Ariko, mubihe byinshi, igabanuka ryinshi rirasabwa kubona no gukomeza guhagarika ibirangaza. Niba umurongo uvunika ukuro kandi ukarangiwe, byoroshye gusubiramo clamp cyangwa clamps yo guhona, yashyizwe kuri buri muntu, arashobora gukoreshwa kugirango abone kandi akomeze gusubiramo mugihe cyubwato. Niba clamp idahagije cyangwa indege itavunika ntabwo itanga imigozi, amababi cyangwa guhagarika imigozi irashobora gufasha kwirinda kwimurwa na malposition (Ishusho 15). Iyi miyoboro ishyirwa inyuma yimyanda yifuzwa kumutwe kuruhande no kuruhande rwimisumari yifuzwa kumurongo wimbere-inyuma. Gushyiraho izo migozi yo gusubiramo neza birashobora kugorana.

Igishushanyo 15 cyo gufunga cyashyizwe hanze yinzira yifuro yifuzwa imbere ninyuma (a) hamwe ninyuma yinzira yifuro yifuzwa muruhande

Ubundi tekinike nziza cyane ni ugukosora by'agateganyo kuvunika mumwanya wa anatomic (Ishusho 16). Mubisanzwe agace gato k'isahani tutular hamwe nimigozi ibiri cyangwa itatu yo gufunga izakomeza kugabanuka mugihe cyo gutegura umuzi nigikorwa cyumunda. Isahani izagenzura kwimurwa byombi. Isahani igomba gusigara mu mwanya igihe cyose nta cyuho cyagenwe cyo gukumira gutakaza kugabanya ubusanzwe nyuma yo gukuraho plate. Isahani ifite imigozi imwe ituruka ntabwo ikomera kandi ntizagira ingaruka kumiterere ugereranije numusumari. Ubutumire bwa plaque burashobora gukoreshwa kubicuruzwa bifunguye kandi bifunze.

Igishushanyo 16 Icyapa gito cyo gufunga hamwe na screwike imwe yubukonje irashobora kuboneka no kubungabungwa mubitabo bya anatomic. Mubihe byinshi, isahani igomba gusigara aho imisumari imaze gutera imisumari. ubumuga bwa mbere bwimico yo kuvunika imiterere mibi. b isahani ntoya hamwe na screw imwe yubukonje ishyirwa mubunini kugirango ubone kandi ukomeze kuvuka mugihe cyo gutera imisumari. c isahani ntabwo ikurwaho nyuma yo gutera imisumari kuko itanga imbaraga zinyongera

Ku nabi, Akaga n'ibibazo

- Kwimura ibintu byo mu buryo bwo gukingira birashobora kuviramo ibyangiritse kuri karitsiye na intra-artra-articular ivite (ishusho ya 17). Kuboko gukingira bigomba kugarurwa byimazeyo.

- Ingero nkeya zo gukingira zirashobora kuzamura reamer yo gukuramo umutwe. Fluorscopy ifasha kumenya ikibazo. Ongera uhindure amaboko yo kurinda azakemura ikibazo (Ishusho 18)

- Umusumari uhagaze: Gutera bishobora guhindurwa mucyuma kuri bross ya proximal (Herzog Umurongo wa Herzog). Kubikorwa byanyuma, umuyoboro wicyuma gikeneye kuvaho, hasigara gusa amaboko yo hanze. Iyo umusumari yagumye, agomba kongera gukurwa burundu kandi imbaraga zongeye kuvugururwa nyuma yo gukuraho clatty cannula ikoresheje umuyoboro wa plastike gusa.

Igicapo 17 Kurindagura ibirambo bitarimo fluoscopique birashobora gutera igikomere

Igishushanyo 18 Gukandagira cyangwa impanuka yo gukinisha birashobora kubangamira gukuraho reamer, nkuko umutwe wa reamer ushobora gusubirwamo. B Ubugenzuzi bwa Fluoscopique hamwe no gukosora guhuza kwemerera kuvana umutwe wa reamer. C Umutware wa reamer arashobora gukurwaho niba umutwe wa reamer udahari. d Umutware wa reamer urashobora gukurwaho niba umutwe wa reamer udahari.

INGINGO

Hessmann Mh, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar imisumari ya Tibia. Oper orthop ihahamu. 2020 oct; 32 (5): 440-454.