Ubuchwephesha boTyando | I-Ipsilateral Femoral Condyle Graft Ukulungiswa kwangaphakathi kuNyango lweTibial Plateau Fractures

Ukuwa kweplateau ye-Lateral ye-tibial okanye ukuqhekeka koqhekeko lolona hlobo luqhelekileyo lwe-tibial plateau fracture. Injongo ephambili yotyando kukubuyisela ukugudiswa kwendawo edibeneyo kunye nokulungelelanisa umlenze ongezantsi. Umphezulu odilikayo wejoyinti, xa uphakanyisiwe, ushiya isiphene sethambo ngaphantsi kwe-cartilage, ehlala ifuna ukubekwa kwe-autogenous iliac bone, i-allograft bone, okanye ithambo lokufakelwa. Oku kusebenzela iinjongo ezimbini: okokuqala, ukubuyisela inkxaso yesakhiwo se-bony, kwaye okwesibini, ukukhuthaza ukuphulukiswa kwamathambo.

Ukuqwalasela ukutyunjwa okongeziweyo okufunekayo kwithambo le-autogenous iliac, elikhokelela kumonzakalo omkhulu wotyando, kunye neengozi ezinokubakho zokugatywa kunye nosulelo oluhambelana nethambo le-allograft kunye nethambo lokufakelwa, abanye abaphengululi bacebisa enye indlela ngexesha lokunciphisa i-plateau ye-lateral ye-tibial evulekile kunye nokulungiswa kwangaphakathi (ORIF). Bacebisa ukuba kwandiswe i-incision efanayo phezulu ngexesha lenkqubo kunye nokusebenzisa i-cancellous bone graft ukusuka kwi-lateral femoral condyle. Iingxelo ezininzi zeemeko ziye zabhala obu buchule.

Uphononongo lubandakanya iimeko ze-12 kunye neenkcukacha ezipheleleyo zokulandela umfanekiso. Kuzo zonke izigulane, indlela yesiqhelo ye-tibial anterior lateral isetyenziswe. Emva kokubonakalisa i-plateau ye-tibial, ukuchongwa kwandiswa ukuya phezulu ukuze kuveze i-condyle ye-femal lateral. I-12mm ye-Eckman bone extractor yaqeshwa, kwaye emva kokugrumba kwi-cortex yangaphandle ye-condyle ye-femoral, ithambo elirhoxisayo ukusuka kwi-condyle esecaleni lavunwa ngeendlela ezine eziphindaphindiweyo. Umthamo ofunyenweyo usuka kwi-20 ukuya kwi-40cc.

Emva kokunkcenkceshela ngokuphindaphindiweyo komsele wethambo, isiponji se-hemostatic sinokufakwa ukuba kuyimfuneko. Ithambo elirhoxisiweyo elivuniweyo lifakwe kwisiphene samathambo phantsi kwe-lateral tibial plateau, elandelwa yinkqubo yokulungiswa kwangaphakathi. Iziphumo zibonisa:

① Ukulungiswa kwangaphakathi kwethafa le-tibial, zonke izigulana zifumene ukuphiliswa kwe-fracture.

② Akukho ntlungu ephawulekayo okanye iingxaki ezibonwe kwindawo apho ithambo livunwe kwi-condyle esecaleni.

③ Ukuphiliswa kwethambo kwindawo yokuvuna: Phakathi kwezigulana ezili-12, i-3 ibonise ukuphiliswa ngokupheleleyo kwe-cortical bone, i-8 yabonisa ukuphiliswa ngokungaphelelanga, kwaye i-1 ibonise ukuphiliswa kwe-cortical bone.

④ Ukuqulunqwa kwe-bone trabeculae kwindawo yokuvuna: Kwiimeko ezili-9, kwakungekho kwakheka kwamathambo e-trabeculae, kwaye kwiimeko ezi-3, ukubunjwa kwenxalenye ye-bone trabeculae kwabonwa.

⑤ Iingxaki ze-osteoarthritis: Phakathi kwezigulane ze-12, i-5 yavelisa i-arthritis emva kokuphazamiseka kwedolo. Esinye isigulana senziwe indawo edibeneyo kwiminyaka emine kamva.

Ukuququmbela, ukuvuna ithambo elikhansela kwi-ipsilateral lateral femoral condyle kubangela ukuphulukiswa kwethambo le-tibial plateau ngaphandle kokunyusa umngcipheko weengxaki ze-postoperative. Obu buchule bunokuqwalaselwa kwaye bubhekiselwe ekusebenzeni kweklinikhi.