I-Tibial fractures, i-suprapatellar intramedullary nail technique

I-Intramedullary nailing technique ye-tibial fractures: ngokusebenzisa i-suprapatellar, indlela ye-transarticular enedolo eliguquguqukayo ku-20-30 ° kanye neshubhu elithile lokuvikela ukuvikela izakhiwo ze-intra-articular.

01.I-Tibial Intramedullary Nailing: ukufinyelela nokuqondanisa, ubuhlungu bamadolo obungaphambili

Ukufinyelela okuhlinzayo kwe-intramedullary nailing of tibial fractures kubalulekile ukuze kufakwe isipikili se-intramedullary endaweni efanele yokungena, ukunciphisa ukulimala kwezakhiwo zamadolo e-intra-articular, kanye nokufeza ukuhlelwa kabusha kwe-fracture efanele kanye nokungena kahle kwezipikili.

Izindlela zakudala zokuqhekeka kwesiqu se-tibial ziyi-median infrapatellar noma i-parapatellar approach. Nakuba lezi zindlela zikhonjiswa ukuphuka kwengxenye emaphakathi, ukukhubazeka kwe-valgus yangemuva kokuhlinzwa, okungaphambili, noma kwe-syndesmotic kuvame ukwenzeka ekuqhekekeni okusondele kakhulu.

Isizathu esiyinhloko sokungahambi kahle kwe-proximal tibial fractures ukukhubazeka okubangelwa ukudonsa i-tendon ye-quadriceps ngesikhathi sokuguqa kwamadolo kanye nokungqubuzana kwemishini phakathi kwephuzu le-nail kanye ne-posterior tibial cortex ngesikhathi sokufakwa kokufakelwa. I-patella iphinde ivimbele ukungena kwe-axial ye-nail endizeni ye-sagittal (Fig. 1a, b). Ngakho-ke, enye indlela evamile yokungena ephuzwini ngokusebenzisa i-medial parapatellar incision, okuholela ekufakweni kancane kwe-nail ye-medial-to-lateral (Figs. 1c no-2). Njengoba i-nail ingena emseleni we-intramedullary distal kuya ekuqhekekeni, ingxenye eseduze igxiliwe ku-exostosis (Fig. 2). Ekugcineni, ukungezwani kokuphumula kwemisipha yekamelo langaphambili kunomthelela kancane ku-ectropion (Fig. 3).

Umfanekiso 1 a,b Ngokusebenzisa indlela evamile ye-infrapatellar, i-patella ivimbela ukungena kwe-axial ye-nail, okuholela ekukhubazekeni okuvamile kwe-anterior apical apical sagittal alignment kanye ne-ectropion coronal alignment.c Ukulungiswa kwe-intramedullary nail kwenziwa kusetshenziswa indlela ye-parapatellar.

Umfanekiso wesi-2 Ukusondela endaweni yokungena ngokusebenzisa i-medial parapatellar incision kuholela ekufakweni kwezinzipho ezimaphakathi kancane kuya ngaseceleni. Njengoba uzipho lungena kumsele we-medullary kuya ekuqhekekeni (a), ingxenye eseduze itshekiswa ibe yi-flare (b)

Umfanekiso we-3 Ukuphumula kwe-tension ye-anterior muscle compartment (a) ikhiqiza ukuhlelwa kwe-ectopic ecashile (b)

Ukubethela i-tibia endaweni enwetshiwe kusiza ukugwema izinkinga ezihlobene nokuguquguquka okukhulu kwamadolo kwangaphakathi.Le nqubo yachazwa nguGelbke, Jakma et al. ngo-2010 futhi ithole ukuthandwa eminyakeni yamuva nje ngoba ukubethela i-tibia endaweni ecishe iqonde kwenza kube lula ukuphulwa kwe-fracture kanye nokubeka kabusha. I-Fluoroscopy isibe lula ngobuchwepheshe ukwenza. Isikhathi se-fluoroscopy sokubethelwa kwe-suprapatellar kubikwe ukuthi sifushane kakhulu kune-infrapatellar nailing. Ngaphezu kwalokho, i-angle yokufaka izinzipho (endizeni ye-sagittal) ihambisana kakhulu ne-axis longitudinal ye-tibia ngale ndlela kunokubethelwa kwe-infrapatellar; lokhu kuvimbela ukungqubuzana kwemishini phakathi kwephuzu le-nail kanye ne-posterior cortex, ngaleyo ndlela kube lula ukunciphisa ukuphuka.

Ubuhlungu be-postoperative anterior anterior yinkinga efanele. Ubuhlungu bamadolo angaphambili buye babikwa ku-50-70% yeziguli ezine-fractures, kanye ne-30% kuphela yeziguli ezithola ukukhululeka kobuhlungu ngemva kokususwa kwe-endplate. Ukwakheka kwesibazi esihlobene nokufinyelela sethenda ye-patellar kanye nephedi yamafutha ka-Hoffa kulinganiselwa ukuthi kungaba umthombo ongase ube nobuhlungu bamadolo ngemva kokuhlinzwa. Ukwengeza, indlela ye-suprapatellar igwema ukusika kwendabuko kokuhlukanisa igatsha legatsha le-patellar le-saphenous nerve, eligwema ukuguqa kwamadolo angaphambili kanye nomuzwa ophelile (Umfanekiso 4). Ukudlulisa isipikili ngethenda ye-quadriceps, ngaleyo ndlela kushiya i-patellar tendon iqinile, kubonakala kunciphisa kakhulu izinga lobuhlungu bamadolo ngemva kokuhlinzwa.

Umdwebo 4 Ubudlelwane phakathi kwe-saphenous nerve kanye nokufinyelela okuhlukile ku-tibialis obliqua nail

Ngenxa yomphumela omuhle we-proximal fractures, izinkomba ekusebenzeni komtholampilo ziye zanwetshwa kuzo zonke izinhlobo zokuphuka.

Izinkinga ezingaba khona ngokubethelwa kwe-intramedullary ngendlela ye-suprapatellar:

- Ingase ishiye imfucumfucu evuselelayo endaweni ehlangene yedolo. Kodwa-ke, ulwazi lomtholampilo olune-retrograde femoral nailing aluzange lubonise imiphumela emibi emifushane noma yesikhathi eside.

- I-implant ikhishwa kanjani ngemva kokuphola kokuphuka? Nakuba kungenzeka ngokobuchwepheshe ukususa isipikili esingaphakathi kwe-intramedullary ngokusebenzisa indlela ye-suprapatellar, le nqubo inzima futhi odokotela abaningi abahlinzayo bakhetha ukususa isipikili se-intramedullary ngokusebenzisa indlela ye-infrapatellar.

02.I-suprapatellar intramedullary nail kufanele isetshenziswe nini?

Izinzuzo

- Ukuma kwedolo okunwetshwe kancane kusiza ukuxhaphazwa nokunciphisa ukuphuka ngokuphumuza amandla emisipha nokugcinwa ngesikhathi sokufakwa kwezinzipho.

- Ingozi ephansi yokungalungi kahle kwangemva kokuhlinzwa kokuhlukana okuseduze, kwesegmental, kanye ne-distal uma kuqhathaniswa namasu endabuko

- Ukwenza isipikili kulula ukwenza

- Ukubethelwa isipikili kungenzeka 'njengenqubo kadokotela ohlinzayo oyedwa'.

- Isikhathi se-fluoroscopy esincishisiwe

- Akukho monakalo ku-tendon ye-patellar kanye nezigameko ezincane zobuhlungu bamadolo angaphambili ngemuva kokubethelwa

- Kulula ukwenza ngenqubo yamaqembu amaningi, njenge-polytrauma.

Ukubi

- Ingozi yokulimala ku-cartilage yamadolo nezinye izakhiwo ze-intra-articular

- Ukwanda kwengozi yokutheleleka kwedolo

- Ukususwa kokufakelwa kungase kudinge indlela ehlukile

Izinkomba

- Ukuphuka kwe-articular eyengeziwe ye-proximal tibia (Uhlobo AO 41A)

- Ukuqhekeka okulula okwenziwa yi-tibial diaphysis (uhlobo AO 42A-C)

- Ukuphuka kwe-segmental tibial diaphysis (uhlobo AO 42C)

- Ukuqhekeka kwe-distal extra-articular elula futhi elula ye-distal tibia (izinhlobo ze-AO 43A ne-C1)

- Idolo elintantayo

Contraindications

- I-Gustilo grade 3C evulekile ukuphuka kwe-tibia ngenxa yokwanda kwengozi yokutheleleka ngokuhlanganyela, nakuba ingozi eyengeziwe yokutheleleka ngokuhlanganyela ayizange ibikwe ekuqhekekeni okuvulekile.

- Ukudabuka okukhulu kwezicubu ezithambile, ukungcola noma ukutheleleka endaweni ye-suprapatellar

- I-Ipsilateral knee prosthesis (i-contraindication ehlobene)

- Ukuhlangana kwamadolo

- I-hyperextension yamadolo>20°

- Ukuphuka kwe-Ipsilateral tibial Plateau okubandakanya indawo yokungena yezipikili kuyi-contraindication ehlobene

- Izimila ezivimbela indawo yokungena yezinzipho

- I-Ipsilateral patella fracture (i-contraindication ehlobene)

03. Izindlela zokuhlinza

① Ukuma komzimba kanye nokubuka kwakho

Umfanekiso 5 Isiguli silala sibheke etafuleni elikhanyayo elivumela ukuma komlenze ohlukene. Umlenze ophukile ushiywe ulenga ngokukhululekile futhi umqulu ubekwa ngaphansi kwejoyinti lamadolo (a) ukuze ufinyelele ku-10-30 ° wokuguquguquka kwedolo. 

(b). I-C-arm ibekwe ngakolunye uhlangothi. Umlenze ongathinteki wehliswa ngo-10-30 ° ukusuka ovundlile ukuze kuqinisekiswe ukuthwebula isithombe esifanele endaweni engemuva.

②Thola indawo yokungena yenaliti elungile

Umfanekiso we-6 Le ndlela iphawulwa yi-shaft ye-patella, i-tibial tuberosity, ne-anterior tibial cortex. Ukusika kwesikhumba okungu-2 cm ubude kwenziwa ngo-1-1.5 cm eduze nesisekelo esiphezulu se-patella. Ithenda ye-quadriceps iyavezwa futhi i-midline longitudinal incision yenziwa ngendlela yezintambo ze-tendon. I-recess ye-suprapatellar iyavulwa futhi iminwe kadokotela ohlinzayo ingena endaweni ehlangene yamadolo kusukela ngezansi kwe-patella ukuze kuhlolwe kalula ukufinyelela. Ukunwetshwa kancane komlenze kungase kusize ukufinyelela ku-kneecap. Ukufakwa kwe-retractor ye-Langenbeck yokuphakama kancane kwe-patella kungase futhi kuthuthukise ukufinyelela. Uma isikhala esihlanganyelwe sincane kakhulu futhi i-instrumentation inzima, ibhendi yokusekela emaphakathi noma ehlangothini ingase ifakwe eduze kwayo ukuze ihlukanise kancane i-patella ohlangothini olulodwa.

③Ukuvikelwa koqwanga

Umfanekiso we-7 Ukuvikelwa kwe-patellofemoral cartilage ekulimazeni okuhlobene nokuhlinzwa kungenye yezinhloso eziyinhloko zenqubo yokuhlinzwa. Ngakho-ke, imikhono evikelayo kufanele isetshenziswe ngesikhathi sokufakwa kwensimbi kanye nezinzipho.a Amathuluzi okufinyelela okuguquguqukayo ahlanganisa izibambo zokufaka, imikhono evikelayo yangaphandle (ethambile) nengaphakathi (yensimbi), amaphini e-trocar, neziqondiso zocingo ezinembobo.b Izibambo zokufaka zihlanganiswa ngomkhono ovikelayo kanye nomkhono wangaphandle (othambile) nowangaphakathi (wensimbi) ovikelayo, iphinikhodi elivikelayo lensimbi. Inaliti ye-trocar ihlanganiswe nomkhono ovikelayo nesibambo sokufaka.b Isibambo esikhwezwayo esinezimbobo zokungenisa umoya ezisemaceleni. I-knob engaphezulu kwesibambo sokufaka ivimbela ukuphuma ngengozi kokuhlanganiswa kwesibambo

④ Faka i-guidewire bese ulungisa indawo

Umfanekiso we-8a Umhlangano wesibambo ufakwa ngaphansi kwe-patella ngokusebenzisa i-patellofemoral joint kuya endaweni yokungena oyifunayo ku-tibia (Umfanekiso 9). Ezimweni eziningi, i-patella izonyakaza kancane ngokumaphakathi noma eceleni ngesikhathi sokufakwa kwensimbi. I-groove ekuhlanganyeleni kwe-patellofemoral ngokuvamile iqondisa inaliti ye-trocar endaweni efanele ngokuzenzakalelayo.

Umdwebo 8b Indawo yaqinisekiswa kuzo zombili izindiza kusetshenziswa i-fluoroscopy futhi yalungiswa lapho kunesidingo. Inaliti ye-trocar ibe isithathelwa indawo yi-guidewire enezimbotshana, i-guidewire edlula emgodini ophakathi nendawo ye-guidewire futhi ithiphu layo lifakwe ku-proximal tibial metaphysis ukuze kuqinisekiswe indawo efanele.

Umfanekiso 8c Uma i-guidewire isendaweni engaphansi, i-guidewire yesibili ingasetshenziswa ukwenza ukulungiswa okuncane endaweni engcono ngokusebenzisa i-guide wire wire, kuze kufike ku-4.3 mm Njengenye indlela, kungase kube lula ukuqala nge-guidewire futhi uyibeke ngaphandle kosizo endaweni efanelekile yokungena. Ithuluzi lokufaka eline-guidewire libe selisheleleka phezu kwe-guidewire.

⑤ Ukunwetshwa kwe-medulla oblongata

Umfanekiso 9a Ukuvula umgodi we-medullary usuka endaweni efanele yokungena kuyisinyathelo esibalulekile enqubweni yokuhlinzwa. Endizeni ye-anteroposterior, lesi yisici esimaphakathi se-lateral tibial spur. Endizeni ye-lateral, indawo yokungena efanele itholakala ekuguqukeni phakathi kwe-articular surface kanye ne-cortex yangaphambili.

Umfanekiso we-9b Indawo efanele ye-guidewire ihambisana ne-axis ye-tibial endizeni ye-anteroposterior futhi iseduze nokuhambisana ne-cortex yangaphambili ngangokunokwenzeka ekubukeni kwe-lateral. I-guidewire ivamise ukuhamba ngemuva.

Umfanekiso 9c Ezimeni lapho uphini noma uzipho lungafakwa kahle, ukuvimba isipikili kusiza ukuqondisa isipikili endaweni efanele. 

Izipikili zokuvimbela zisetshenziswa endaweni ebanzi ye-metaphyseal lapho i-guidewire noma i-nail ingakwazi ukugxila ngokuhambisana ne-axis longitudinal yethambo noma lapho ukuphulwa kokuphulwa kwendiza eyodwa noma zombili kuhlala ngesikhathi sokufakwa kwezipikili.

Umfanekiso 10 Kulesi sigaba, kunconywa ukuthi ukuhlanganiswa kwesibambo kuvikelwe ku-condyle yesifazane kusetshenziswa intambo yomhlahlandlela engu-3.2 mm. Lokhu kuvimbela umhlangano ekuphumeni kwe-tibia.

Umfanekiso 11 I-drill bit eyi-12.0 mm ifakwa kumkhono ovikelayo wangaphakathi futhi yehle ngocingo oluqondisayo luye ethanjeni. I-medullary canal ivulwa ngokubhoboza kuze kufike ku-8-10 cm ukujula futhi i-guide-ended guidewire ifakwe ku-tibia eseduze.

⑥ Ukunciphisa ukuphuka

Umfanekiso 12a Kulesi sigaba, sisetha kabusha ukuphuka.

Umfanekiso we-12b Ngokuya ngendawo yokuphuka kanye ne-morphology yayo, amathuluzi ahlukahlukene okunciphisa afana neziqeshana ze-percutaneous, ama-retractors, amapuleti amancane ama-fragment, nezikulufa zokuvinjwa zingasetshenziswa ukuze kuzuzwe ukuqondanisa okufanele. Ekuncishisweni kwe-tibial fracture eseduze, ngezinye izikhathi ngisho nangosizo lwezimila ezengeziwe, ngaphambi kokuvula umsele we-medullary ngokubhoboza. Induku yokuvuselela ithuthukisiwe kude futhi ifakwe phakathi nendawo ye-distal tibial metaphysis. Ngemva kokubeka kabusha, ubude nobubanzi be-nail kunqunywa. Uma kunesidingo, khulisa umsele we-tibial kububanzi obufunayo ngokuvuselela ngo-0.5 mm increments. Ukuvuleka kwesibambo somkhono ovikelayo kuvumela ukukhukhuleka nokumunca imfucumfucu ehlangene ngesikhathi sokubuyisela kabusha. Uma kungenzeka, kunconywa ukuthi kusetshenziswe isipikili esinobubanzi obuncane obuyi-10 mm. I-Locking Bolt engu-5.0 mm yalolu hlobo lwezinzipho imelana kakhulu nokwehluleka kuneBolt Yokukhiya engu-4.0 mm esetshenziselwa izinzipho ezinhle. Ubude bezinzipho ze-intramedullary ngokuvamile bunqunywa ngerula le-fluoroscopic.

⑦ Faka i-intramedullary nail

Umfanekiso 13a Ukufakwa kwezipikili ngenduku yokuvuselela kabusha ngaphansi kwe-fluoroscopy. Qaphela ukuthi isibambo sokufaka se-suprapatellar nail side kunaleso se-infrapatellar nail ngoba ibanga ukusuka ekusikeni kwesikhumba kuya endaweni yokungena ye-tibial nail futhi lide.

Umfanekiso 13b Sicela uqaphele ukuthi ukugoba (ijika le-Herzog) ekugcineni kwesipikili se-intramedullary alikwazi ukufakwa ngomkhono ovikelayo wensimbi wangaphakathi. Ngakho-ke, umkhono ovikelayo wangaphakathi kufanele ukhishwe ekuhlanganisweni kwesibambo ngaphambi kokufakwa kwesipikili (b; bheka isigaba 'Amaphutha, Izingozi Nezinkinga'). Hlola ukuma kokugcina kwesipikili se-intramedullary ekubukweni kwangaphambili-ngemuva nangemuva. Susa induku yokuphinda. Uma isipikili sidinga ukushintshwa, shiya induku yokuvuselela endaweni bese ufaka isipikili esisha endukwini. Izimpawu ze-5 mm esibanjeni sokufaka zibonisa ukujula kokufakwa kwe-implant ku-tibia eseduze (Fig. 14). (Umfanekiso 14)

⑧ Ukukhiya kwe-Distal kanye ne-proximal

Umfanekiso 14a Ukulungiselelwa kokukhiya okuseduze nokukude kuncike ezicini ezithile zokuphuka. Ukukhiya okuseduze kungafezwa ngengalo ehlosiwe. Ukukhiya i-Distal kwenziwa mahhala noma ngokusebenzisa umhlahlandlela wokubhoboza i-radiopaque. Ngokuzithandela, i-end cap ingasetshenziswa, evimbela ithambo ekukhuleni ekugcineni kwe-intramedullary nail futhi kusize ukukhishwa kamuva kokufakelwa. Ikakhulukazi, izipikili ezifakwe kakhulu zilula ukususa uma izigqoko zokugcina zobude obufanele zisetshenziswa. Ubude obufunwayo bekepisi lokugcina likalwa ngokufaka uphawu esibanjeni noma ngokufaka ucingo oluqondisayo engalweni ehlosiwe.

Umfanekiso 14b Ithiphu ye-guidewire ibonisa indawo eseduze yesipikili se-intramedullary. Isikulufu esixhuma ingalo ephokophele kuzipho sidinga ukukhishwa ukuze kufakwe isivalo sokugcina. I-end cap idlula emgqonyeni wesibambo sokufaka. Isibambo sokufaka sihlala sisendaweni. Lokhu kuqondanisa ikepisi lokugcina nengaphezulu le-intramedullary nail futhi livimbele ukuthi lingalahleki edolweni. Ukufaka i-guidewire ngokusebenzisa i-cap end yomphongolo ekugcineni kwe-nail kuphinde kusize ukuqondisa isiphetho sesiphetho endaweni yaso efanele ekugcineni kwesipikili se-intramedullary. Ekupheleni kwenqubo, isisombululo se-saline oyinyumba kufanele sigezwe ukuze kugezwe noma yiziphi izinhlayiya zemfucumfucu ezisele.

04. Izixwayiso

Izinyathelo Zokuqaphela Ngokuhlinza

- Ezimeni ze-osteoarthritis esivele ikhona, ukunyakaza kwe-patellar okukhawulelwe kungase kuvimbele ukufinyelela okuhlangene. Ukusika kwengxenye eseduze yebhendi yokusekela emaphakathi noma ehlangothini ukusuka ohlangothini oluphakathi kusiza ukufakwa kwephinikhodi ye-trocar.

- I-prosthesis yamadolo e-ipsilateral ayiyona into eqinile ephikisana ne-suprapatellar pinning. Nokho, qaphela ukuthi kungase kungenzeki ukufinyelela endaweni evamile yokuqala yenqubo yokubethela ye-tibial eseduze.

- Ezingxenyeni eziphukile ezinokwengezwa kwe-articular, izikulufu ezengeziwe zingase zifakwe ukuze kuvinjwe ingxenye ye-articular fracture. Kunconywa ukuthi lezi zikulufi zibekwe ngaphambi kokufakwa kwezinzipho ukuze kugwenywe ukugudluka kwesibili kokuphuka kwe-articular.

Ukucatshangelwa kwe-Proximal Tibia Fracture

I-proximal fractures ye-tibial yi-tibial fractures enzima kunazo zonke ukuze i-nail futhi idinga amaphuzu okungena aqondile (njengoba kuchazwe ngenhla). Lokhu kuphuka kufanele kuncishiswe ngaphambi kokubethelwa ukuze kulwisane nanoma yimaphi amandla okonakala futhi kwandiswe impumelelo. Kwezinye izimo, ukubeka kahle umlenze othintekile endaweni enwetshiwe kancane futhi uthole indawo yokungena enembile futhi ubeke isipikili nge-medullary canal kuma-coronal kanye ne-sagittal axs kuzoholela ekuqondaneni okufanele kwe-tibia ngemva kokubethelwa.

Kodwa-ke, ezimweni eziningi, ukuqondisa okuthile kokunciphisa kuyadingeka ukuze kutholwe futhi kugcinwe ukubekwa kabusha okwanelisayo kwalokhu kuphuka. Uma umugqa wokuphuka ulula futhi une-engeli, izinsimbi zokusetha kabusha ezikhonjiwe ezilula noma izinsimbi zokuhlanganisa, ezibekwe nge-percutaneously, zingasetshenziswa ukuthola nokugcina ukusetha kabusha ngesikhathi sokubethelwa. Uma i-clamp inganele noma indiza ephukile ingazibophezeli ekubambeni, impova noma izikulufu zokuvimba zingasiza ukuvimbela ukugudluzwa kanye nokungahambi kahle (Umfanekiso 15). Lezi zikulufi zibekwe ngemuva endaweni efiswayo yezinzipho ekubukeni okuseceleni kanye naseceleni endaweni efiswayo yezinzipho ekubukeni kwangaphambili-ngemuva. Ukubekwa kahle kwalezi zikulufu ukuze zisethwe kabusha kahle kungaba inselele.

Umdwebo 15 Izikulufu zokukhiya ezibekwe ngaphandle kwendlela yezipikili efiselekayo ngaphambi nokubukwa kwangemuva (a) nangemuva kwendlela yezipikili efiselekayo ekubukeni oseceleni (b) ezimelene namandla okuguquka.

Enye indlela ephumelela kakhulu ukulungiswa kwesikhashana kokuphuka endaweni ye-anatomic (Fig. 16). Ngokuvamile ipuleti elincane le-tubular elinezikulufu ezimbili noma ezintathu ezilodwa zekhohlo eyodwa zizobamba ukuphuka okuncishisiwe ngesikhathi sokulungiswa komsele wezimpande kanye nokufakwa kwezinzipho. Ipuleti lizolawula kokubili ukususwa. Ipuleti kufanele lishiywe lisendaweni inqobo nje uma lingekho igebe elingaguquki lokuvimbela ukulahlekelwa kokunciphisa okuvame ukwenzeka ngemva kokususwa kwepuleti. Leli puleti eline-screw ye-cortical eyodwa aliqinile futhi ngeke lithinte ukuqina okuhlobene kwesipikili. Indlela yokusetha kabusha ipuleti ingasetshenziselwa kokubili ukuphuka okuvulekile nokuvaliwe.

Umfanekiso 16 Ipuleti elincane lokukhiya elinesikulufu sekhorasi eyodwa lingatholakala futhi ligcinwe lisesimweni se-anatomic. Ezimweni eziningi, ipuleti kufanele lishiywe endaweni ngemva kokubethelwa. ukukhubazeka kwe-valgus kokuqala kokuphuka kwe-tibial eseduze. b Ipuleti elincane lokuphuka elinesikulufu sekhorotiki eyodwa libekwa phakathi ukuze kutholwe futhi kugcinwe ukubekwa kabusha kokuphuka ngesikhathi sokubethelwa. c Ipuleti alikhishwa ngemva kokubethelwa ngoba linikeza ukuzinza okwengeziwe

Ukungaqondi kahle, Izingozi kanye Nezinkinga

- Ukuxoshwa kwe-Intraoperative ye-Protective Sleeve kungase kubangele ukulimala kwe-cartilage kanye nezakhiwo zamadolo ze-intra-articular (Umfanekiso we-17). Umkhono ovikelayo kufanele ufakwe kabusha ngokugcwele.

- Ukutshekisa kancane komkhono Wokuvikela kungabhebhethekisa ukukhishwa kwekhanda le-reamer. I-Fluoroscopy isiza ukukhomba inkinga. Ukulungiswa kabusha komkhono ovikelayo kuzoxazulula inkinga (Fig. 18)

- Ukukhiya Izinzipho: Ukufakelwa kungase kubhajwe kumkhono wensimbi ejikeni eliseduze (ijika le-Herzog). Ukuze kufakwe izinzipho zokugcina, ishubhu lensimbi lidinga ukususwa, kusale kuphela umkhono wepulasitiki othambile ongaphandle. Uma isipikili sibhajwe, sidinga ukuphinde sikhishwe ngokuphelele futhi isigxivizo sifakwe kabusha ngemva kokukhipha i-cannula yensimbi nge-cannula yepulasitiki kuphela.

Umfanekiso 17 Ukuhoxiswa kwemikhono evikelayo ngaphandle kokubhekwa kwe-fluoroscopic kungase kuholele ekulimaleni kwedolo

Umfanekiso 18 Ukutshekisa noma ukutshekiswa ngephutha kwekesi yokuvikela kungase kuphazamise ukususwa kwe-reamer, njengoba ikhanda le-reamer lingase ligxumeke. b Ukuhlolwa kwe-fluoroscopic nokulungiswa kokuqondisa kuvumela ukususwa kwekhanda le-reamer. c Ikhanda le-reamer lingasuswa uma ikhanda lokubuyisela lingekho endaweni. d Ikhanda lokubuyisela kabusha lingasuswa uma ikhanda eliphindayo lingekho endaweni.

Izithenjwa

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar ukubethelwa kokuphuka kwe-tibia. I-Oper Orthop Traumatol. Okthoba 2020; 32(5):440-454.