Iifractures zeTibial, i-suprapatellar intramedullary nail technique

I-intramedullary nailing technique for tibial fractures: ngokusebenzisa i-suprapatellar, indlela ye-transarticular kunye nedolo eliguquguqukayo kwi-20-30 ° kunye netyhubhu ethile yokukhusela ukukhusela izakhiwo ze-intra-articular.

01.I-Tibial Intramedullary Nailing: ukufikelela kunye nokulungelelanisa, intlungu yangaphambili yamadolo

Ukufikelela kokuhlinzwa kwi-intramedullary nailing of tibial fractures kubalulekile ukwenzela ukuba kufakwe isikhonkwane se-intramedullary ngendawo yokungena echanekileyo, ukunciphisa umonakalo kwizakhiwo zamadolo e-intra-articular, kunye nokufezekisa ukuchithwa kwe-fracture efanelekileyo kunye nokungena ngokufanelekileyo kwe-nail.

Iindlela zakudala zokuqhekeka kwe-tibial stem yi-median infrapatellar okanye i-parapatellar approach. Nangona ezi ndlela zibonakaliswe kwi-middle-partment fractures, i-postoperative valgus, i-anterior, okanye i-syndesmotic deformities iyenzeka rhoqo kwiifractures ezingaphezulu.

Isizathu esiphambili sokungahambi kakuhle kwi-proximal tibial fractures kukukhubazeka okubangelwa ukutsalwa kwe-tendon ye-quadriceps ngexesha lokuguqa kwamadolo kunye nokungqubuzana komatshini phakathi kwe-nail tip kunye ne-posterior tibial cortex ngexesha lokufakwa kokufakelwa. I-patella iphinda ithintele ukungena kwe-axial yesikhonkwane kwindiza ye-sagittal (Umfanekiso 1a, b). Ngoko ke, enye indlela eqhelekileyo yokungena kwinqanaba ngokusebenzisa i-parapatellar ye-medial incision, ekhokelela ekufakweni kwe-nail encinci ukuya kwi-lateral (Imifanekiso ye-1c kunye ne-2). Njengoko isikhonkwane singena kwi-intramedullary canal distal kwi-fracture, inxalenye esondeleyo igxininiswe kwi-exostosis (Umfanekiso 2). Ekugqibeleni, ukunyanzeliswa kokuphumla kwezihlunu zegumbi langaphambili kuncedisa kancane kwi-ectropion (Umfanekiso 3).

Umzobo we-1 a, b Ukusebenzisa indlela ye-infrapatellar eqhelekileyo, i-patella ivimbela ukungena kwe-axial yesikhonkwane, okubangelwa ukukhubazeka okuqhelekileyo kwe-anterior apical apical sagittal alignment kunye ne-ectropion coronal alignment.c Ukulungelelaniswa kwe-intramedullary nail kwenziwa ngokusebenzisa indlela ye-parapatellar.

Umfanekiso wesi-2 Ukusondela kwindawo yokungena ngokusebenzisa i-medial parapatellar incision ikhokelela ekufakweni okuphakathi ukuya kwicala elisecaleni. Njengoko isikhonkwane singena kwi-medullary canal distal ukuya kukwaphuka (a), inxenye esecaleni ikekele kwi-flare (b)

Umzobo we-3 Ukuphumla koxinzelelo kwi-compartment ye-muscle yangaphambili (a) ivelisa ilungiselelo elifihlakeleyo le-ectopic (b)

Ukubethelela i-tibia kwindawo eyandisiweyo kunceda ukuphepha iingxaki ezinxulumene ne-intraoperative knee flexion.Ubuchule buchazwe nguGelbke, Jakma et al. ngo-2010 kwaye iye yafumana ukuthandwa kwiminyaka yakutshanje ngenxa yokuba ukubethelela i-tibia kwindawo ephantse yathe tye yenza lula ukuqhekezwa kwe-fracture kunye nokubekwa ngokutsha. I-Fluoroscopy iye yaba lula ngobuchule ukwenza. Ixesha le-fluoroscopy lokubethelwa kwe-suprapatellar lichazwe njengelifutshane kakhulu kune-infrapatellar nailing. Ukongezelela, i-angle yokufaka i-nail (kwi-plane ye-sagittal) ihambelana ngakumbi ne-longitudinal axis ye-tibia ngale ndlela kunokuba i-infrapatellar nailing; oku kuthintela ukungqubana koomatshini phakathi kwencam yesikhonkwane kunye ne-cortex yangasemva, ngaloo ndlela kuququzelela ukuncitshiswa kokwaphuka.

Iintlungu zedolo zangaphambili ze-postoperative yingxaki efanelekileyo. Iintlungu zangaphambili zamadolo zichazwe kwi-50-70% yezigulane ezineentlungu, kunye ne-30% kuphela yezigulane ezifumana intlungu emva kokususwa kwe-endplate. Ukufikelela kwi-access-related scar formation of the patellar tendon kunye ne-Hoffa's fat pad kuqikelelwa ukuba ngumthombo onokuthi ube ngumthombo weentlungu zamadolo emva kokuhlinzwa. Ukongezelela, indlela ye-suprapatellar igwema ukuchongwa kwendabuko yokuqhawula isebe lesebe le-patellar ye-nerve ye-saphenous, ekhusela ukuguqa kwamadolo angaphambili kunye nemvakalelo edibeneyo (Umfanekiso 4). Ukugqithisa isikhonkwane kwi-tendon ye-quadriceps, ngaloo ndlela ishiya i-tendon ye-patellar ingaguquki, ibonakala inciphisa kakhulu izinga leentlungu zedolo emva kokuhlinzwa.

Umzobo we-4 Ubudlelwane phakathi kwe-nerve ye-saphenous kunye nokufikelela okuhlukeneyo kwi-tibialis obliqua nail

Ngenxa yesiphumo esilungileyo sokuqhekeka okusondeleyo, izibonakaliso ekusebenzeni kweklinikhi ziye zandiswa kuzo zonke iifractures.

Iingxaki ezinokwenzeka ngokubethelwa kwe-intramedullary kwindlela ye-suprapatellar:

- Ingashiya inkunkuma ephinda iphinda ijike kwindawo edibeneyo yedolo. Nangona kunjalo, amava eklinikhi kunye ne-retrograde femoral nailing ayizange ibonise nayiphi na imiphumo emfutshane okanye yexesha elide elibi.

- I-implant ikhutshwa njani emva kokuba i-fracture ipholile? Nangona kunokwenzeka ngokobuchwepheshe ukususa isikhonkwane se-intramedullary ngokusebenzisa indlela ye-suprapatellar, ubuchule bufuna kwaye abaninzi oogqirha bakhetha ukususa isikhonkwane se-intramedullary ngendlela ye-infrapatellar.

02.Ifanele isetyenziswe nini isikhonkwane se-suprapatellar intramedullary?

Iingenelo

- I-semi-extended knee position iququzelela ukuguqulwa kwe-fracture kunye nokunciphisa ngokukhulula amandla emisipha kunye nokugcinwa ngexesha lokufakwa kwezipikili.

-Umngcipheko ophantsi wokungahambi kakuhle kwangemva kokusebenza, ukwaphuka kwecandelo, kunye ne-distal xa kuthelekiswa nobugcisa bemveli.

- Ukubethelela kulula ngobuchule ukwenza

- Ukubethelela kuyenzeka 'njengenkqubo yotyando olunye'.

- Ukunciphisa ixesha le-fluoroscopy

- Akukho monakalo kwi-tendon ye-patellar kunye nesiganeko esincinci se-post-nailing anterior pain pain

-Kulula ukwenza kwinkqubo yamaqela amaninzi, njengepolytrauma.

Iingxaki

- Ingozi yomonakalo kwi-cartilage yamadolo kunye nezinye izakhiwo ze-intra-articular

- Umngcipheko wokunyuka kwamadolo

- Ukususwa kofakelo kunokufuna indlela eyahlukileyo

Iimpawu

- Iifractures ezongezelelweyo ze-tibia ekufutshane (Uhlobo lwe-AO 41A)

- Iifractures ezilula kunye ne-tibial diaphysis (uhlobo lwe-AO 42A-C)

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

-Izahlulo ezongezelelweyo kunye ne-intra-articular distal extension fractures ye-distal tibia (iintlobo ze-AO 43A kunye ne-C1)

- Idolo elidadayo

Contraindications

- I-Gustilo grade 3C i-fractures evulekile ye-tibia ngenxa yokunyuka kwengozi yokusuleleka ngokudibeneyo, nangona ingozi eyongeziweyo yokusuleleka ngokudibeneyo ayizange ichazwe kwiifractures ezivulekileyo.

- Ukukrazula kwezicubu ezithambileyo, ukusuleleka okanye ukusuleleka kwingingqi ye-suprapatellar

-Ipsilateral knee prosthesis (i-contraindication ehambelanayo)

- Ukudibanisa idolo

- I-hyperextension yedolo> 20 °

-I-Ipsilateral tibial plateau fracture ebandakanya indawo yokungena yezikhonkwane yinto echaseneyo.

- Izifakelo ezithintela indawo yokungena ezikhonkwane

-Ipsilateral patella fracture (i-contraindication ehambelanayo)

03. Iindlela zotyando

① Isimo somzimba kunye nembono

Umzobo we-5 Isigulane silele phezu kwetafile ene-radiolucent evumela ukuba indawo yomlenze wokuqhekeka. Ilungu eliphukileyo lishiywe lijinga ngokukhululekileyo kwaye umqulu ubekwe phantsi kwedolo elihlangeneyo (a) ukufikelela kwi-10-30 ° yokuguqa kwedolo. 

(b). I-C-arm ibekwe kwelinye icala. Umlenze ongathintekiyo wehliswa i-10-30 ° ukusuka kwindawo ethe tyaba ukuze kuqinisekiswe umfanekiso ofanelekileyo kwindawo esecaleni.

②Fumana indawo yokungena inaliti efanelekileyo

Umzobo we-6 Le ndlela ibonakaliswe yi-shaft ye-patella, i-tuberosity ye-tibial, kunye ne-anterior tibial cortex. I-2 cm ye-longitudinal skin incision yenziwa i-1-1.5 cm esondele kwisiseko esiphezulu sepatella. I-tendon ye-quadriceps ibonakaliswe kwaye i-midline longitudinal incision yenziwa kwicala le-tendon fibers. I-recess ye-suprapatellar ivuliwe kwaye iminwe yogqirha ingena edolweni ukusuka ngaphantsi kwe-patella ukuvavanya ukukhululeka kokufikelela. Ukwandiswa okuncinci kwelungu kunokuncedisa ukufikelela kwi-kneecap. Ukufakwa kwe-Langenbeck retractor ukwenzela ukuphakama okuncinci kwepatella kunokuphucula ukufikelela. Ukuba indawo edibeneyo incinci kakhulu kwaye i-instrumentation inzima, i-medial okanye i-lateral band yokuxhasa inokuthi ifakwe ngokusondeleyo kuyo ukwenzela ukuba i-semi-dislocate i-patella kwelinye icala.

③Ukukhusela intlala

Umzobo we-7 Ukukhuselwa kwe-patellofemoral cartilage kwingozi enxulumene nokuhlinzwa yenye yeenjongo eziphambili zenkqubo yokuhlinzwa. Ngoko ke, imikhono yokukhusela kufuneka isetyenziswe ngexesha lesixhobo kunye nokufakwa kwezikhonkwane.a Izixhobo zokufikelela kwi-transarticular zibandakanya izibambo zokufaka, ngaphandle (ezithambileyo) kunye nemikhono yangaphakathi (yentsimbi) yokukhusela, izikhonkwane zetrocar, kunye nezikhokelo zocingo ezinobumba.b Izibambo zokufaka zihlanganiswe kunye nomkhono okhuselayo kunye nomkhono wangaphandle (othambileyo) kunye wangaphakathi (wesinyithi) okhuselayo wepini, intambo yokukhusela i-atrocarous, i-wire pin, i-wire pin, i-autocarrous pin. Inaliti yetrocar idityaniswe nomkhono okhuselayo kunye nomqheba wokufaka.b Isibambo sokunyuka kunye nemingxuma esecaleni yokungenisa umoya. Iqhoshana eliphezu kwesibambo sofakelo lithintela ukukhutshwa ngengozi kwendibano yokubamba

④ Faka i-guidewire kwaye ulungise indawo

Umzobo 8a Indibano yokubamba ifakwe phantsi kwepatella ngokusebenzisa i-patellofemoral joint ukuya kwindawo yokungena oyifunayo kwi-tibia (Umfanekiso 9). Kwiimeko ezininzi, i-patella iya kuhamba kancinci phakathi okanye ecaleni ngexesha lokufakwa kwesixhobo. I-groove kwi-patellofemoral joint ngokuqhelekileyo ikhokela inaliti ye-trocar kwindawo echanekileyo ngokuzenzekelayo.

Umzobo 8b Isikhundla saqinisekiswa kuzo zombini iinqwelomoya kusetyenziswa i-fluoroscopy kwaye yalungiswa apho kuyimfuneko. Inaliti ye-trocar ke ithathelwe indawo yi-guide ye-porous, i-guidewire edlula kwi-hole yeziko le-guidewire kunye ne-tip yayo ifakwe kwi-proximal tibial metaphysis ukuqinisekisa indawo echanekileyo.

Umzobo 8c Xa i-guidewire ikwi-suboptimal position, i-guidewire yesibini ingasetyenziselwa ukwenza uhlengahlengiso oluncinci kwindawo engcono ngokusebenzisa i-guide guidewire, ukuya kuthi ga kwi-4.3 mm Njengenye indlela, kunokuba lula ukuqala nge-guidewire kwaye uyibeke ingancediswanga kwindawo efanelekileyo yokungena. Isixhobo sofakelo esinocingo olukhokelayo luthi ke lutyibilike phezu kocingo olukhokelayo.

⑤ Ukwandiswa kwe-medulla oblongata

Umfanekiso we-9a Ukuvula i-medullary cavity ukusuka kwindawo efanelekileyo yokungena linyathelo elibalulekileyo kwinkqubo yotyando. Kwinqwelomoya ye-anteroposterior, le yinkalo ye-medial ye-lateral tibial spur. Kwi-plane lateral, indawo yokungena echanekileyo ifumaneka kwinguqu phakathi kwe-articular surface kunye ne-cortex yangaphambili.

Umzobo we-9b Indawo echanekileyo ye-guidewire ihambelana ne-axis ye-tibial kwindiza ye-anteroposterior kwaye isondele kwi-parallel kwi-cortex yangaphambili njengoko kunokwenzeka kwi-projection lateral. I-guidewire ithanda ukuhamba ngasemva.

Umfanekiso 9c Kwiimeko apho isikhonkwane okanye isikhonkwane singenako ukufakwa ngokuchanekileyo, ukuvala isikhonkwane okanye isikhonkwane kunceda ukukhokelela isikhonkwane kwindawo efanelekileyo. 

Izikhonkwane zokuthintela zisetyenziselwa kummandla obanzi we-metaphyseal xa i-guidewire okanye isikhonkwane singenako ukugxilwa ngokuhambelana ne-longitudinal axis yethambo okanye xa ukuphulwa kwe-fracture kwenye okanye zombini iindiza zihlala ngexesha lokufakwa kwe-nail.

Umzobo we-10 Ngeli nqanaba, kucetyiswa ukuba indibano yokubamba ikhuselwe kwi-condyle ye-femoral usebenzisa i-3.2 mm yocingo lwesikhokelo. Oku kuthintela indibano ekuphumeni kwi-tibia.

Umfanekiso we-11 I-12.0 mm ye-drill bitana ifakwe kwi-sleeve yangaphakathi ekhuselayo kwaye ihla nge-guidewire ukuya kwithambo. Umsele we-medullary uvulwa ngokubhobhoza kubunzulu be-8-10 cm kunye ne-ball-ended guidewire ifakwe kwi-proximal tibia.

⑥ Ukunciphisa ukuphuka

Umzobo 12a Kweli nqanaba, siseta kwakhona ukuphuka.

Umzobo we-12b Ngokuxhomekeke kwindawo yokuphuka kunye ne-morphology yayo, izixhobo ezahlukeneyo zokunciphisa ezifana neziqeshana ze-percutaneous, i-retractors, iipleyiti ezincinci zeqhekeza, kunye nezikrini zokuthintela zingasetyenziselwa ukufezekisa ukulungelelaniswa okufanelekileyo. Kwi-proximal tibial fracture ukunciphisa, ngamanye amaxesha nangoncedo lwezifakelo ezongezelelweyo, ngaphambi kokuvula i-medullary canal ngokubhoboza. Intonga yokubuyisela iqhubela phambili kude kwaye ifakwe kumbindi we-distal tibial metaphysis. Emva kokumiswa kwakhona, ubude kunye nobubanzi besikhonkwane bunqunywe. Ukuba kuyimfuneko, yandisa umsele we-tibial ukuya kububanzi obufunwayo ngokubuyisela kwakhona kwi-0.5 mm increments. Ukuvula kwisibambo somkhono okhuselayo kuvumela ukugungxulwa kunye nokufunxa i-debris kwi-joint ngexesha lokuphinda. Ukuba kunokwenzeka, kucetyiswa ukuba kusetyenziswe isikhonkwane esinobukhulu obuncinci be-10 mm. I-5.0 mm yokutshixa iBolt yolu hlobo lwesikhonkwane ixhathisa ngakumbi ukungaphumeleli kune-4.0 mm yokutshixa iBolt esetyenziselwa izikhonkwane ezicolekileyo. Ubude bezikhonkwane ze-intramedullary budla ngokugqitywa ngerula ye-fluoroscopic.

⑦ Faka isikhonkwane se-intramedullary

Umzobo 13a Ukufakwa kwezikhonkwane kwintonga yokubuyisela ngokutsha phantsi kwefluoroscopy. Qaphela ukuba isibambo sofakelo lwesikhonkwane se-suprapatellar side kunesikhonkwane se-infrapatellar kuba umgama osuka kwi-skin incision ukuya kwindawo yokungena ye-tibial nayo ide.

Umzobo we-13b Nceda uqaphele ukuba i-bend (i-Herzog curve) ekupheleni kwesigxina se-intramedullary nail ayikwazi ukufakwa kwi-sleeve yensimbi yokukhusela yangaphakathi. Ngoko ke, umkhono wokukhusela wangaphakathi kufuneka ususwe kwindibano yokubamba ngaphambi kokufaka isikhonkwane (b; bona icandelo 'Iimpazamo, Iingozi kunye neeNgxaki'. Khangela indawo yokugqibela yesikhonkwane se-intramedullary kwi-anterior-posterior and lateral views. Susa intonga yokubuyisela kwakhona. Ukuba isikhonkwane sidinga ukutshintshwa, shiya intonga yokubuyisela endaweni kwaye ufake isikhonkwane esitsha kwintonga. Iimpawu ze-5 mm kwisibambo sokufaka zibonisa ubunzulu bokufakwa kokufakelwa kwi-tibia esondeleyo (Umfanekiso 14). (Umfanekiso 14)

⑧ Ukuvala i-distal kunye ne-proximal locking

Umzobo we-14a Ulungelelwaniso lokutshixa olusondeleyo kunye ne-distal luxhomekeke kwiimpawu ezithile zokuphuka. Ukutshixa okukufutshane kunokufezekiswa ngengalo ejolise kuyo. Ukutshixa i-Distal kufezekiswa ngokukhululekileyo okanye ngokusetyenziswa kwesikhokelo se-radiopaque drill. Ngokuzikhethela, i-cap end cap inokusetyenziswa, ekhusela ithambo ekukhuleni ukuya ekupheleni kwe-intramedullary nail kwaye iququzelele ukususwa kamva kokufakelwa. Ngokukodwa, izikhonkwane ezifakwe ngokugqithiseleyo zilula ukususa xa ii-caps zobude obufanelekileyo zisetyenziswa. Ubude obunqwenelekayo be-cap yokuphela bulinganiswa ngokufaka uphawu kwi-handle okanye ngokufaka ucingo lwesikhokelo ngengalo ejolise kuyo.

Umzobo we-14b Incam ye-guidewire ibonisa indawo esondeleyo yesikhonkwane se-intramedullary. I-screw edibanisa ingalo ejoliswe kuyo kwisikhonkwane kufuneka ikhutshwe ukuze kufakwe i-cap cap. I-cap end idlula kwi-barrel yesibambo sokufaka. Isibambo sofakelo sihlala sikhona. Oku kulungelelanisa i-cap end kunye ne-top of intramedullary nail kwaye ikhusela ukuba ingalahleki emadolweni. Ukufaka i-guidewire kwi-barrel end cap kwi-proximal end of nail iphinda incede ukukhokela i-cap end kwindawo yayo efanelekileyo kwi-proximal end ye-intramedullary nail. Ekupheleni kwenkqubo, isisombululo se-saline esiyinyumba kufuneka sihlanjululwe ukuhlamba nayiphi na i-debris particles eseleyo.

04. Izilumkiso

Imiqathango yoLwando

- Kwiimeko ze-osteoarthritis esele ikhona, i-patellar motion ethintelweyo inokuthintela ukufikelela ngokubambisana. I-incision yecandelo elisondeleyo le-medial okanye i-lateral band inkxaso ukusuka kwicala eliphakathi liququzelela ukufakwa kwepini ye-trocar.

- I-prosthesis yamadolo e-ipsilateral ayichasananga ngokungqongqo kwi-pinning ye-suprapatellar. Qaphela, nangona kunjalo, ukuba akunakwenzeka ukufikelela kwindawo eqhelekileyo yokuqalisa i-proximal tibial nailing procedure.

- Kwiifractures kunye nokwandiswa kwe-articular, izikrufu ezongezelelweyo zingangeniswa ukuze zenze i-articular fracture component. Kucetyiswa ukuba ezi zikhonkwane zibekwe phambi kokufakwa kwezikhonkwane ukuphepha ukufuduswa kwesibini kwe-articular fracture.

Ukuqwalaselwa kwe-Proximal Tibia Fracture

I-proximal tibial fractures yiyona nto inzima kakhulu i-tibial fractures kwi-nail kwaye ifuna iindawo zokungena ezichanekileyo (njengoko kuchazwe ngasentla). Ezi fractures kufuneka zincitshiswe ngaphambi kokubethelwa ukuze zichasane nayo nayiphi na imikhosi ephazamisayo kunye nokwandisa impumelelo. Kwezinye iimeko, ukubeka ngokuchanekileyo umlenze ochaphazelekayo kwindawo eyandisiweyo kunye nokufumana indawo yokungena echanekileyo kunye nokubeka isikhonkwane nge-medullary canal kwi-coronal kunye ne-sagittal axes kuya kubangela ukulungelelaniswa okufanelekileyo kwe-tibia emva kokubethelwa.

Nangona kunjalo, kwiimeko ezininzi, enye indlela yokunciphisa iyafuneka ukuze kufumaneke kwaye kugcinwe ukulungiswa okwanelisayo kwezi ziqhekeza. Ukuba umgca wokuphuka ulula kwaye u-angled, i-reset reset clamps elula okanye i-coaptation clamps, ebekwe nge-percutaneously, ingasetyenziselwa ukufumana nokugcina ukusetha kwakhona ngexesha lokubethelwa. Ukuba i-clamp ayanelanga okanye inqwelomoya yokuphuka ayiziboleki kwi-clamping, i-pollen okanye izikrufu zokuvala zinganceda ukuthintela ukufuduka kunye nokungahambi kakuhle (Umfanekiso we-15). Ezi zikrufu zibekwe ngasemva kwindawo efunwayo yesikhonkwane kwimbonakalo yecala kunye necala kwindawo efunwayo yesikhonkwane kwimbonakalo yangaphambili-ngasemva. Ukubekwa ngokufanelekileyo kwezi zikrufu ukuze kuhlaziywe kakuhle kunokuba ngumngeni.

Umzobo 15 Izikrufu zokutshixa ezibekwe kumphandle wendlela yezikhonkwane ezifunwayo ngaphambili nangasemva iimbono (a) nangasemva kwendlela enqwenelekayo yezikhonkwane kwimboniselo yecala (b) echasene nemikhosi yoguqulo.

Olunye ubuchule obusebenzayo kukulungiswa kwesikhashana kokuqhekeka kwindawo ye-anatomic (Umfanekiso we-16). Ngokuqhelekileyo iqhekeza elincinci lepleyiti ye-tubula enezikrufu ezimbini okanye ezintathu zekhortical enye yokutshixa iya kubamba ukwaphuka okuncitshisiweyo ngexesha lokulungiswa komsele weengcambu kunye nokufakwa kwezikhonkwane. Ipleyiti iya kulawula zombini ukufuduswa. I-plate kufuneka ishiywe kwindawo nje ukuba akukho sithuba esisisigxina sokuthintela ukulahleka kokunciphisa okuqhelekileyo okwenzeka emva kokususwa kweplate. Le pleyiti ene-screw ye-cortical enye ayiqinanga kwaye ayiyi kuchaphazela ukuzinza kwesikhonkwane. Ubuchule bokusetha kwakhona ipleyiti bunokusetyenziswa kuzo zombini iifractures ezivulekileyo nezivaliweyo.

Umzobo we-16 Ipleyiti encinci yokutshixa ene-screw ye-cortical enye inokufumaneka kwaye igcinwe kwindawo yokubeka i-anatomic. Kwiimeko ezininzi, ipleyiti kufuneka ishiywe kwindawo emva kokubethelwa. Ukukhubazeka kwe-valgus yokuqala yokwaphuka kwe-tibial ekufutshane. b Ipleyiti encinci yokuphuka ene-screw ye-cortical enye ibekwe phakathi ukufumana kunye nokugcina i-fracture repositioning ngexesha lokubethelwa. c Ipleyiti ayikhutshwa emva kokubethelwa ngenxa yokuba inika uzinzo olongezelelweyo

Ukungahambi kakuhle, iiNgozi kunye neengxaki

- Ukufuduswa kwe-Intraoperative ye-Sleeve eKhuselayo kunokubangela umonakalo kwi-cartilage kunye ne-intra-articular knee structures (Umfanekiso 17). Umkhono okhuselayo kufuneka ubuyiselwe ngokupheleleyo.

-Ukuthambeka kancinci komkhono oKhuselayo kunokwandisa ukutsalwa kwentloko ye-reamer. I-Fluoroscopy inceda ukuchonga ingxaki. Ukulungiswa kwakhona komkhono wokukhusela kuya kusombulula ingxaki (Umfanekiso we-18)

- Isitshixo seZikhonkwane: Ufakelo lusenokuncamathela kumkhono wesinyithi kwindawo egobileyo (igophe leHerzog). Ukufakwa kwesikhonkwane sokugqibela, ityhubhu yentsimbi kufuneka isuswe, kushiyeke kuphela umkhono weplastiki othambileyo ongaphandle. Xa isikhonkwane sibambekile, kufuneka sisuswe ngokupheleleyo kwakhona kwaye ukufakelwa kwakhona kufakwe emva kokususa i-cannula yensimbi nge-cannula yeplastiki kuphela.

Umfanekiso we-17 Ukurhoxiswa komkhono okhuselayo ngaphandle koqwalaselo lwefluoroscopic kunokukhokelela kukwenzakala edolweni

Umzobo 18 Ukuthambeka okanye ukuthambeka ngempazamo kwegophe elikhuselayo kunokuphazamisana nokususwa kwesixhobo esibuyisela umva, njengoko intloko yokubuyisela inokuthi jam. b Ukuhlolwa kwe-fluoroscopic kunye nokulungiswa kokulungelelaniswa kuvumela ukususwa kwentloko ye-reamer. c Intloko yokubuyisela kwakhona inokususwa ukuba intloko yokubuyisela ayikho endaweni. d Intloko yokubuyisela kwakhona inokususwa ukuba intloko yokubuyisela ayikho endaweni.

Iimbekiselo

UHessmann MH, uBuhl M, uFinkemeier C, uKhoury A, Mosheiff R, uBlauth M. Suprapatellar ukubethelwa kweefractures ze-tibia. Oper Orthop Traumatol. 2020 Okt;32(5):440-454.