Ukuqhekeka kweHoffa kukuqhekeka kwe-coronal plane ye-femoral condyle. Kwaqala ukuchazwa nguFriedrich Busch ngo-1869 kwaye kwaxelwa kwakhona nguAlbert Hoffa ngo-1904, kwaye kwathiywa ngaye. Nangona ukuqhekeka kudla ngokuvela kwi-horizontal plane, ukuqhekeka kweHoffa kwenzeka kwi-coronal plane kwaye kunqabile kakhulu, ngoko ke kuhlala kuphosakele ngexesha lokuxilongwa kokuqala kweklinikhi kunye ne-radiological.
Kwenzeka nini ukuba iHoffa iqhekeke?
Ukuqhekeka kweHoffa kubangelwa kukuqhekeka kwamandla kwi-femoral condyle edolweni. Ukulimala okunamandla aphezulu kudla ngokubangela ukuqhekeka kwe-intercondylar kunye ne-supracondylar kwi-distal femur. Ezona ndlela zixhaphakileyo ziquka iingozi zezithuthi kunye neemoto kwaye ziwe ukusuka ekuphakameni. ULewis et al. babonise ukuba uninzi lwezigulane ezineengozi ezinxulumene noko zibangelwe kukuchaphazeleka ngokuthe ngqo kwi-lateral femoral condyle ngelixa bekhwele isithuthuthu kunye nedolo eligobileyo ukuya kwi-90°
Ziziphi iimpawu zeklinikhi zokuqhekeka kweHoffa?
Iimpawu eziphambili zokuqhekeka kweHoffa enye kukuqhekeka kwedolo kunye ne-hemarthrosis, ukudumba, kunye ne-genu varum okanye i-valgus encinci kunye nokungazinzi. Ngokungafaniyo nokuqhekeka kwe-intercondylar kunye ne-supracondylar, ukuqhekeka kweHoffa kunokwenzeka ukuba kufumaneke ngengozi ngexesha lophando lwemifanekiso. Ngenxa yokuba uninzi lokuqhekeka kweHoffa lubangelwa kukwenzakala okunamandla aphezulu, ukwenzakala okudibeneyo kwi-hip, i-pelvis, i-femur, i-patella, i-tibia, i-knee ligaments, kunye nemithambo ye-popliteal kufuneka kungabandakanywa.
Xa kurhanelwa ukuba iHoffa yaphukile, umntu angayifumana njani i-X-ray ukuze angaphoswa yingxaki yokufunyaniswa kwesi sifo?
Ii-radiographs eziqhelekileyo ze-anteroposterior kunye ne-lateral zenziwa rhoqo, kwaye ii-oblique views zedolo zenziwa xa kuyimfuneko. Xa ukwaphuka kungasuswanga kakhulu, kudla ngokuba nzima ukukubona kwi-radiographs. Kwi-lateral view, ngamanye amaxesha kubonakala ukuhlukana okuncinci komgca we-femoral joint, kunye okanye ngaphandle kokukhubazeka kwe-condylar valgus kuxhomekeke kwi-condyle echaphazelekayo. Ngokuxhomekeke kwi-contour ye-femur, ukungazinzi okanye inyathelo kumgca we-fracture kunokubonwa kwi-lateral view. Nangona kunjalo, kwi-lateral view yokwenyani, ii-femoral condyles zibonakala zingahambelani, ngelixa ukuba ii-condyles zifutshane kwaye zisuswa, zinokudibana. Ke ngoko, umbono ongalunganga we-dolo joint eqhelekileyo unokusinika umbono ongeyonyani, onokuboniswa nge-oblique views. Ke ngoko, uvavanyo lwe-CT luyimfuneko (Umfanekiso 1). I-Magnetic resonance imaging (MRI) inokunceda ukuvavanya izicubu ezithambileyo ezijikeleze idolo (ezifana ne-ligaments okanye i-menisci) ukuze kubonwe umonakalo.
Umfanekiso 1 I-CT ibonise ukuba isigulana sasinokwaphuka kweLetenneur ⅡC uhlobo lweHoffa kwi-lateral femoral condyle
Ziziphi iintlobo ze-fractures ze-Hoffa?
Ukuqhekeka kweHoffa kwahlulwe ngohlobo lwe-B3 kunye nohlobo lwe-33.b3.2 kudidi lwe-AO/OTA ngokwendlela kaMuller yokwahlulahlula. Kamva, uLetenneur et al. bahlulahlula ukuqhekeka kwaba ziintlobo ezintathu ngokusekelwe kumgama womgca wokuqhekeka kwe-femoral ukusuka kwi-posterior cortex ye-femur.
Umfanekiso 2 Ukuhlelwa kweLetenneur yee-fractures zeHoffa
Uhlobo lokuQala:Umgca wokuqhekeka ufumaneka kwaye uhambelana ne-cortex engasemva ye-femoral shaft.
Uhlobo II:Umgama ukusuka kumgca wokuqhekeka ukuya kumgca we-cortical ongasemva we-femur wahlulwe ngakumbi waba ziintlobo ezimbini ze-IIa, IIb kunye ne-IIc ngokwebanga ukusuka kumgca wokuqhekeka ukuya kwithambo le-cortical elingasemva. Uhlobo lwe-IIa lukufutshane ne-cortex engasemva ye-femoral shaft, ngelixa i-IIc ikude kakhulu ne-cortex engasemva ye-femoral shaft.
Uhlobo lwesithathu:Ukuqhekeka kwe-oblique.
Indlela yokwenza isicwangciso sotyando emva kokuxilongwa?
1. Ukukhetha ukufakelwa kwangaphakathi Ngokuqhelekileyo kukholelwa ukuba ukunciphisa okuvulekileyo kunye nokufakelwa kwangaphakathi ngumgangatho ogqwesileyo. Kwizaphuko zeHoffa, ukhetho lwezifakelo zokufakelwa ezifanelekileyo lulinganiselwe kakhulu. Izikrufu zoxinzelelo olungenanto ezinemisonto ethile zilungele ukufakelwa. Iindlela zokufakelwa ziquka izikrufu zoxinzelelo olungenanto ezinemisonto ethile eziyi-3.5mm, 4mm, 4.5mm kunye ne-6.5mm kunye nezikrufu zeHerbert. Xa kuyimfuneko, iipleyiti ezifanelekileyo zokungatyibiliki nazo zingasetyenziswa apha. UJarit ufumanise ngezifundo ze-biomechanical zesidumbu ukuba izikrufu zoxinzelelo lwangasemva kwentloko zizinzile ngakumbi kunezikrufu zoxinzelelo lwangaphambili-ngasemva kwentloko. Nangona kunjalo, indima ekhokelayo yolu fumaniso ekusebenzeni kweklinikhi ayikacaci.
2. Itekhnoloji yotyando Xa kufunyaniswa ukuba ukwaphuka kweHoffa kuhamba nokuqhekeka kwe-intercondylar kunye ne-supracondylar, kufuneka kunikwe ingqwalasela eyaneleyo, kuba isicwangciso sotyando kunye nokukhetha ukulungiswa kwangaphakathi kumiselwa ngokusekelwe kwimeko engentla. Ukuba i-lateral condyle yahlulwe ngokwe-coronally, ukuvezwa kotyando kufana noko kwaphuka kweHoffa. Nangona kunjalo, akuyonto ilungileyo ukusebenzisa isikrufu se-dynamic condylar, kwaye kufuneka kusetyenziswe ipleyiti ye-anatomical, ipleyiti yenkxaso ye-condylar okanye ipleyiti ye-LISS ukuze kulungiswe endaweni yoko. I-medial condyle kunzima ukuyilungisa ngokusebenzisa i-lateral incision. Kule meko, kufuneka i-anteromedial incision eyongezelelweyo ukunciphisa nokulungisa ukwaphuka kweHoffa. Nokuba kunjalo, zonke iziqwenga zethambo ezinkulu ze-condylar zilungiswa ngezikrufu zokulaxaza emva kokunciphisa i-anatomical ye-condyle.
- Indlela yotyando Isigulana silele phantsi ebhedini ye-fluoroscopic ene-tourniquet. I-bolster isetyenziselwa ukugcina i-engile yokujika kwedolo malunga ne-90°. Kwii-fractures ze-medial ezilula ze-Hoffa, umbhali ukhetha ukusebenzisa i-median incision ene-medial parapatellar approach. Kwii-fractures ze-lateral Hoffa, kusetyenziswa i-lateral incision. Abanye oogqirha bacebisa ukuba indlela ye-lateral parapatellar nayo iyindlela efanelekileyo. Nje ukuba iziphelo ze-fracture zivele, kwenziwa uphando oluqhelekileyo, kwaye emva koko iziphelo ze-fracture zicocwe nge-curette. Phantsi kombono othe ngqo, ukunciphisa kwenziwa kusetyenziswa i-point reduction forceps. Ukuba kuyimfuneko, indlela "ye-joystick" yee-Kirschner wires isetyenziselwa ukunciphisa, kwaye emva koko ii-Kirschner wires zisetyenziselwa ukunciphisa kunye nokulungisa ukuthintela ukufuduka kwee-fracture, kodwa ii-Kirschner wires azinakuthintela ukufakwa kwezinye ii-screws (Umfanekiso 3). Sebenzisa ubuncinane ii-screws ezimbini ukuze ufezekise ukulungiswa okuzinzileyo kunye noxinzelelo oluphakathi kwe-fragmentary. Drill i-perpendicular kwi-fracture kwaye ikude ne-patellofemoral joint. Kuphephe ukugqobhoza umngxuma ongasemva kwamalungu, kungcono usebenzise i-C-arm fluoroscopy. Izikrufu zifakwa kunye okanye zingafakwanga ziwashers njengoko kufuneka. Izikrufu mazifakwe ecaleni kwaye zibe nobude obaneleyo bokulungisa i-cartilage engaphantsi kwe-articular. Ngaphambi kotyando, idolo lihlolwa ukuba alinakwenzakala ngaxeshanye, uzinzo, kunye nomgama wokuhamba, kwaye kunkcenkceshelwe kakuhle ngaphambi kokuba inxeba livaleke.
Umfanekiso 3 Ukunciphisa okwethutyana kunye nokulungiswa kwezaphuko ze-bicondylar Hoffa ngeentambo zeKirschner ngexesha lotyando, kusetyenziswa iintambo zeKirschner ukususa amathambo
Ixesha leposi: Matshi-12-2025
