Ukuqhekeka kweHoffa kukuphuka kwendiza ye-coronal ye-condyle ye-femoral. Yaqala ukuchazwa nguFriedrich Busch ngo-1869 kwaye yaphinda yaxelwa ngu-Albert Hoffa ngo-1904, kwaye yathiywa ngaye. Ngelixa iifractures zihlala zisenzeka kwinqwelomoya ethe tyaba, ukuphuka kweHoffa kwenzeka kwinqwelomoya ye-coronal kwaye kunqabile kakhulu, ngoko bahlala bephoswa ngexesha lokuxilongwa kokuqala kweklinikhi kunye ne-radiological.
Kwenzeka nini ukwaphuka kweHoffa?
I-Hoffa fractures ibangelwa yi-shear force kwi-condyle ye-femal emadolweni. Ukulimala okuphezulu kwamandla kaninzi kubangela ukuphuka kwe-intercondylar kunye ne-supracondylar ye-distal femur. Ezona ndlela zixhaphakileyo ziquka iingozi zemoto kunye neemoto kunye nokuwa ukusuka kumphakamo. Lewis et al. ibonise ukuba uninzi lwezigulane ezinokulimala okuhambelanayo zibangelwa amandla empembelelo ngokuthe ngqo kwi-condyle ye-femoral esecaleni ngelixa ekhwele isithuthuthu ngedolo eliguquguqukayo ukuya kwi-90 °.
Ziziphi iimpawu zeklinikhi zokuphulwa kweHoffa?
Iimpawu eziphambili ze-Hoffa fracture enye i-knee effusion kunye ne-hemarthrosis, ukuvuvukala, kunye ne-mild genu varum okanye i-valgus kunye nokungazinzi. Ngokungafaniyo ne-intercondylar kunye ne-supracondylar fractures, i-Hoffa fractures inokuthi ifunyanwe ngengozi ngexesha lezifundo zokucinga. Ngenxa yokuba ininzi ye-Hoffa fractures ibangelwa ukulimala kwamandla aphezulu, ukulimala okudibeneyo kwi-hip, i-pelvis, i-femur, i-patella, i-tibia, i-knee ligaments, kunye neenqanawa ze-popliteal kufuneka zingabandakanywa.
Xa kurhanelwa ukuba u-Hoffa wophuka, ubani ufanele azithathe njani iiX-reyi ukuze aphephe ukuphoswa sisifo?
I-standard anteroposterior and lateral radiographs yenziwa ngokuqhelekileyo, kwaye iimbono ze-oblique zamadolo zenziwa xa kuyimfuneko. Xa i-fracture ingafuduki kakhulu, kudla ngokuba nzima ukuyibona kwiiradiographs. Kwimbono yecala, ukungafani okuncinci komgca we-femoral joint ngamanye amaxesha kubonakala, kunye okanye ngaphandle kwe-condylar valgus deformity kuxhomekeke kwi-condyle echaphazelekayo. Ngokuxhomekeke kwi-contour ye-femur, ukuyeka okanye ukunyathela kumgca wokuphuka kunokubonwa kwimbono yecala. Nangona kunjalo, kumbono wecala lokwenyani, ii-condyles ze-femoral zibonakala zingadibaniyo, kanti ukuba ii-condyles zifinyeziwe kwaye zisuswe, zinokuthi zidlulele. Ngoko ke, imbono engalunganga yedolo eliqhelekileyo lingasinika ingcamango yobuxoki, enokuthi iboniswe ngemibono e-oblique. Ngoko ke, uvavanyo lwe-CT luyimfuneko (Umfanekiso 1). I-imaging resonance imaging (MRI) inokunceda ukuvavanya izicubu ezithambileyo ezijikeleze idolo (ezifana nemigqa okanye i-menisci) yomonakalo.
Umzobo we-1 CT ubonise ukuba isigulane sine-Letenneur ⅡC uhlobo lwe-Hoffa fracture ye-lateral femoral condyle
Zeziphi iintlobo ze-Hoffa fractures?
I-Hoffa fractures ihlulwe ngohlobo lwe-B3 kunye nohlobo lwe-33.b3.2 kwi-AO / OTA yokuhlelwa ngokuhlelwa kwe-Muller. Kamva, uLetenneur et al. ukwahlula ukuphuka kwiintlobo ezintathu ezisekelwe kumgama womgca we-femoral fracture ukusuka kwi-cortex yangasemva ye-femur.
Umzobo2 ulwahlulo lweLetenneur yeefractures zeHoffa
Chwetheza I:Umgca wokuqhekeka ufumaneka kwaye uhambelana ne-cortex yangasemva ye-femoral shaft.
Uhlobo II:Umgama ukusuka kumgca wokuphuka ukuya kumgca we-cortical yangasemva we-femur uphinda uhlukaniswe kwii-subtypes IIa, IIb kunye ne-IIc ngokomgama ukusuka kumgca wokuphuka ukuya kwithambo le-cortical yangasemva. Uhlobo lwe-IIa lusondele kakhulu kwi-cortex yangasemva ye-femoral shaft, ngelixa i-IIc ikude kakhulu kwi-cortex yangasemva ye-femoral shaft.
Uhlobo III:Ukuqhekeka kwe-Oblique.
Indlela yokwenza isicwangciso sotyando emva kokuxilongwa?
1. Ukukhethwa kokulungiswa kwangaphakathi Kukholelwa ngokubanzi ukuba ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi ngumgangatho wegolide. Kwizahlulo zeHoffa, ukhetho lokufakelwa kokulungiswa okufanelekileyo lulinganiselwe. Izikrufu zocinezelo eziholwa ngokuyinxenye zilungele ukulungiswa. Iinketho zokufakelwa zibandakanya i-3.5mm, 4mm, 4.5mm kunye ne-6.5mm ezinemisonto enomsonto wokucinezela izikrufu kunye nezikrufu zikaHerbert. Xa kuyimfuneko, iipleyiti ezichasene ne-slip ezifanelekileyo nazo zingasetyenziswa apha. IJarit ifunyenwe ngezifundo ze-cadaver biomechanical ukuba izikrufu ze-posteroanterior lag zizinze ngakumbi kunezikrufu zangaphambili-ngasemva kwe-lag. Nangona kunjalo, indima ekhokelayo yolu phando ekusebenzeni kweklinikhi ayikacaci.
2. Iteknoloji yokuhlinzwa Xa i-Hoffa fracture ifunyenwe ihamba kunye ne-intercondylar kunye ne-supracondylar fracture, kufuneka inikwe ingqwalasela eyaneleyo, kuba isicwangciso sotyando kunye nokukhethwa kokulungiswa kwangaphakathi kunqunywe ngokusekelwe kwimeko engentla. Ukuba i-condyle esecaleni ihlukaniswe nge-coronally, ukuvezwa kotyando kufana ne-Hoffa fracture. Nangona kunjalo, akunangqiqo ukusebenzisa i-condylar screw, kunye ne-anatomical plate, i-condylar support plate okanye i-LISS plate kufuneka isetyenziswe ukulungiswa endaweni yoko. I-condyle ephakathi kunzima ukuyilungisa nge-lateral incision. Kule meko, i-anteromedial incision eyongezelelweyo iyadingeka ukunciphisa kunye nokulungisa i-Hoffa fracture. Kwimeko nayiphi na into, zonke iinqununu ezinkulu zamathambo e-condylar zilungiswe kunye ne-lag screws emva kokunciphisa i-anatomical ye-condyle.
- Indlela yotyando Isigulana sikwindawo yokulala phezu kwebhedi ene-fluoroscopic ene-tourniquet. I-bolster isetyenziselwa ukugcina i-angle ye-knee flexion malunga ne-90 °. Ukuqhekeka kwe-Hoffa ye-medial elula, umbhali ukhetha ukusebenzisa i-median incision kunye ne-medial parapatellar approach. Ukuqhekeka kweHoffa ecaleni, i-lateral incision isetyenzisiweyo. Abanye oogqirha bacebisa ukuba indlela ye-parapatellar esecaleni nayo ilukhetho olufanelekileyo. Emva kokuba iziphelo zokuphuka zibonakaliswe, ukuhlolwa kwesiqhelo kuyenziwa, kwaye iziphelo zokuphuka zicocwa nge-curette. Ngaphantsi kombono othe ngqo, ukunciphisa kwenziwa ngokusebenzisa i-forceps yokunciphisa iphuzu. Ukuba kuyimfuneko, ubuchule be-"joystick" beentambo ze-Kirschner zisetyenziselwa ukunciphisa, kwaye ke iingcingo ze-Kirschner zisetyenziselwa ukunciphisa kunye nokulungiswa kokuthintela ukuchithwa kwe-fracture, kodwa iingcingo ze-Kirschner azikwazi ukuthintela ukufakelwa kwezinye i-screws (Umfanekiso 3). Sebenzisa ubuncinane izikrufu ezibini ukuze ufezekise ukulungiswa okuzinzileyo kunye nokunyanzeliswa kwe-interfragmentary. I-Drill perpendicular to fracture kwaye kude ne-patellofemoral joint. Kuphephe ukugrumba kwindawo ehlangeneyo yangasemva, ngokukhethekileyo nge-C-arm fluoroscopy. Izikrufu zibekwe kunye okanye ngaphandle kweewasha njengoko kufuneka. Izikrufu kufuneka zichane kwaye zibe nobude obaneleyo ukulungisa i-cartilage ye-subarticular. I-intraoperatively, idolo lihlolwe ngokulimala okuhambelanayo, ukuzinza, kunye noluhlu lokunyakaza, kunye nokunkcenkceshela ngokucokisekileyo kwenziwa ngaphambi kokuvalwa kwesilonda.
Umzobo 3 Ukunciphisa okwethutyana kunye nokulungiswa kwe-bicondylar Hoffa fractures kunye neengcingo zaseKirschner ngexesha lotyando, usebenzisa i-Kirschner ingcingo ukuze uhlolisise amathambo amathambo.
Ixesha lokuposa: Mar-12-2025
