Indlela yotyando

Isishwankathelo: Injongo: Ukuphanda izinto ezinxulumeneyo kwisiphumo sokusebenza kokusetyenziswa kokulungiswa kwangaphakathi kwepleyiti yentsimbi ukubuyiselaukwaphuka kwethafa le-tibialIndlela: Izigulana ezingama-34 ezine-tibial plate fracture zatyandwa ngokusebenzisa i-steel plate internal fixation icala elinye okanye amabini, zabuyisela isakhiwo se-anatomical se-tibal plate, zaqiniswa ngokuqinileyo, zaza zathatha umthambo wokusebenza kwangethuba emva kotyando. Isiphumo: Zonke izigulana zalandelwa iinyanga ezi-4-36, umyinge weenyanga ezili-15, ngokwe-Rasmussen score, izigulana ezingama-21 zazikwimeko entle kakhulu, ezi-8 zikwimeko entle, ezi-3 zikwimeko entle kakhulu, ezi-2 zikwimeko embi kakhulu. Umlinganiselo obalaseleyo wawuyi-85.3%. Isiphelo: Fumana amathuba otyando afanelekileyo, sebenzisa iindlela ezichanekileyo kwaye wenze umthambo wokusebenza kwangethuba, usinike iziphumo ezilungileyo zotyando ekunyangeni.i-tibialukwaphuka kwethafa.

1.1 Ulwazi Oluqhelekileyo: Eli qela lalinabaguli abangama-34 kunye namadoda angama-26 kunye nabasetyhini abasi-8. Abaguli babeneminyaka engama-27 ukuya kuma-72 ubudala ngokomyinge weminyaka engama-39.6. Kwakukho amatyala angama-20 okwenzakala kwiingozi zendlela, amatyala ali-11 okwenzakala kokuwa kunye namatyala ama-3 okutyumzwa kakhulu. Zonke iimeko zaziziingozi ezivaliweyo ngaphandle kokwenzakala kwemithambo yegazi. Kwakukho amatyala ama-3 okwenzakala kwi-cruciate ligament, amatyala ama-4 okwenzakala kwi-collateral ligament kunye namatyala ama-4 okwenzakala kwi-meniscus. Ukwaphuka kwahlulwa ngokweSchatzker: amatyala asi-8 ohlobo lwe-I, amatyala ali-12 ohlobo lwe-II, amatyala ama-5 ohlobo lwe-III, amatyala ama-2 ohlobo lwe-IV, amatyala ama-4 ohlobo lwe-V kunye namatyala ama-3 ohlobo lwe-VI. Zonke izigulana zahlolwa nge-X-ray, i-CT scan ye-tibial plateau kunye nokwakhiwa kwakhona kwe-three-dimensional, kwaye ezinye izigulana zahlolwa ngu-MR. Ngaphandle koko, ixesha lotyando laliyi-7~21d emva kokwenzakala, umyinge we-10d. Kubo bonke aba, kwakukho izigulana ezingama-30 ezamkela unyango lokufakelwa amathambo, izigulana ezi-3 ezamkela ukufakelwa i-double plate, kwaye ezinye izigulana zamkela ukufakelwa kwangaphakathi kwelinye icala.

1.2 Indlela yotyando: yenziweumqoloi-anesthesia okanye i-intubation anesthesia, isigulane sasilele phantsi, kwaye sityandwa nge-pneumatic tourniquet. Utyando lusebenzise idolo elingasemva, i-anterior tibial okanye i-lateralidoloukunqunyulwa kwangasemva. I-coronary ligament yanqunyulwa ecaleni kwe-Incision ecaleni komphetho ongezantsi we-meniscus, yaza yaveza umphezulu we-articular we-tibial plateau. Yehlisa ukwaphuka kwe-plateau phantsi kombono othe ngqo. Amanye amathambo aqala alungiswa ngee-Kirschner pins, aze alungiswe ngee-plates ezifanelekileyo (i-golf-plate, ii-L-plates, i-T-plate, okanye adityaniswe ne-medial buttress plate). Iziphene zamathambo zazaliswa yi-allogen bone (kwangoko) kunye ne-allograft bone grafting. Kutyando, ugqirha wotyando waqonda ukunciphisa i-anatomical kunye nokunciphisa i-proximal anatomical, wagcina i-tibial axis eqhelekileyo, ukuqina kwangaphakathi okuqinileyo, i-compact bone graft kunye nenkxaso echanekileyo. Wahlola i-knee ligament kunye ne-meniscus ukuze kufunyanwe isifo ngaphambi kotyando okanye amatyala akrokrelwayo ngaphakathi kotyando, waza wenza inkqubo efanelekileyo yokulungisa.

1.3 Unyango Emva Kotyando: ibhandeji elastiki yemilenze emva kotyando kufuneka ibotshwe kakuhle, kwaye ukunqunyulwa kade kufakwe ityhubhu yokukhupha amanzi, ekufuneka ikhutshwe kwiiyure ezingama-48. I-analgesia eqhelekileyo emva kotyando. Izigulana zenze umthambo wemisipha yemilenze emva kweeyure ezingama-24, kwaye zenze umthambo we-CPM emva kokususa ityhubhu yokukhupha amanzi ukuze zifumane izaphuko ezilula. Zidibanise i-collateral ligament, iimeko zokulimala kwe-posterior cruciate ligament, zishukumise idolo ngamandla nangokungashukumiyo emva kokulungisa iplasta okanye i-brace kangangenyanga enye. Ngokweziphumo zovavanyo lwe-X-ray, ugqirha wotyando wakhokela izigulana ukuba zithathe umthambo wokulayisha ubunzima bemilenze kancinci kancinci, kwaye umthwalo opheleleyo kufuneka wenziwe ubuncinci kwiinyanga ezine kamva.