Ukuqhekeka kwe-proximal femoral kudla ngokubonakala njengeengozi zeklinikhi ezibangelwa kukwenzakala okunamandla aphezulu. Ngenxa yeempawu zomzimba ze-proximal femur, umgca wokuqhekeka uhlala ukufutshane nomphezulu we-articular kwaye unokungena kwi-joint, okwenza ukuba ingafanelekanga ukufakwa kweenzipho ngaphakathi kwe-medullary. Ngenxa yoko, uninzi lwamatyala lusaxhomekeke ekufakweni kwe-plate kunye ne-screw system. Nangona kunjalo, iimpawu ze-biomechanical zee-plates ezizinzileyo zibeka umngcipheko ophezulu weengxaki ezinje ngokungaphumeleli kokufakwa kwe-lateral plate, ukuqhekeka kwe-internal fixation, kunye nokutsalwa kwe-screw. Ukusetyenziswa koncedo lwe-medial plate kwi-fixation, nangona kusebenza, kuza neengxaki zokwanda kwe-trauma, ixesha elide lotyando, umngcipheko ophezulu wosulelo emva kotyando, kunye nomthwalo wemali owongezelelekileyo kwizigulana.
Ngenxa yezi ngqwalasela, ukuze kufezekiswe ulungelelwaniso olufanelekileyo phakathi kweengxaki ze-biomechanical zeeplates ezisemacaleni kunye nokwenzakala kotyando okunxulunyaniswa nokusetyenziswa kweeplates ezisemacaleni nezisemacaleni, iingcali zamanye amazwe ziye zamkela indlela ebandakanya ukulungiswa kweplate esecaleni kunye nokulungiswa kwesikrufu esongezelelweyo kwicala le-medial. Le ndlela ibonakalise iziphumo ezilungileyo zeklinikhi.
Emva kokufumana i-anesthesia, isigulane sibekwa kwindawo yokulala phantsi.
Inyathelo 1: Ukunciphisa ukwaphuka kwamathambo. Faka inaliti yeKocher eyi-2.0mm kwi-tibial tuberosity, ubambe ukuze ulungise ubude bamalungu, kwaye usebenzise idolo ukulungisa ukufuduka kwe-sagittal plane.
Inyathelo lesi-2: Ukubekwa kwepleyiti yentsimbi esecaleni. Emva kokunciphisa okusisiseko ngokutsalwa, sondela ngqo kwi-distal lateral femur, khetha ipleyiti yokutshixa enobude obufanelekileyo ukugcina ukunciphisa, kwaye ufake izikrufu ezibini kwiziphelo ezikufutshane nezikude zokuqhekeka ukugcina ukunciphisa ukuqhekeka. Kule ngongoma, kubalulekile ukuqaphela ukuba izikrufu ezibini ezikude kufuneka zibekwe kufutshane nangaphambili kangangoko kunokwenzeka ukuze kuthintelwe ukubekwa kwezikrufu ze-medial.
Inyathelo lesi-3: Ukubeka izikrufu zekholamu ephakathi. Emva kokulungisa ukuqhekeka ngepleyiti yentsimbi esecaleni, sebenzisa i-drill ekhokelwa yi-screw eyi-2.8mm ukuze ungene nge-condyle ephakathi, apho inaliti ibekwe kwindawo ephakathi okanye engasemva yebhloko ye-femoral ekude, i-diagonally iphuma isiya phezulu, ingena kwithambo le-cortical elichaseneyo. Emva kokunciphisa i-fluoroscopy ngokwaneleyo, sebenzisa i-drill eyi-5.0mm ukwenza umngxuma kwaye ufake i-screw yethambo ekhanselisiweyo eyi-7.3mm.
Umzobo obonisa inkqubo yokunciphisa nokulungisa ukwaphuka. Ibhinqa elineminyaka engama-74 ubudala elinokwaphuka kwe-distal femoral intra-articular (AO 33C1). (A, B) Ii-radiographs zangaphambi kotyando ezibonisa ukuhamba okubonakalayo kokuqhekeka kwe-distal femoral; (C) Emva kokunciphisa ukwaphuka, ipleyiti yangaphandle esemacaleni ifakwa ngezikrufu eziqinisekisa zombini iziphelo ezikufutshane nezikude; (D) Umfanekiso we-Fluoroscopy obonisa indawo eyanelisayo yentambo yesikhokelo se-medial; (E, F) Ii-radiographs zasemva kotyando kunye ne-anteroposterior emva kokufakwa kwesikrufu sekholamu ye-medial.
Ngexesha lenkqubo yokunciphisa, kubalulekile ukuqwalasela la manqaku alandelayo:
(1) Sebenzisa ucingo olukhokelayo olunesikrufu. Ukufakwa kwezikrufu zekholamu ephakathi kubanzi kakhulu, kwaye ukusebenzisa ucingo olukhokelayo olungenasikrufu kunokukhokelela kwi-engile ephezulu ngexesha lokubhoboza i-condyle ephakathi, okwenza kube lula ukutyibilika.
(2) Ukuba izikrufu ezikwipleyiti esecaleni ziyayibamba ngokufanelekileyo i-cortex esecaleni kodwa aziphumeleli ukufezekisa ukubekwa kwe-cortex ephindwe kabini, lungisa indlela yeskrufu phambili, uvumele izikrufu ukuba zingene kwicala elingaphambili lepleyiti esecaleni ukuze zifezekise ukubekwa kwe-cortex ephindwe kabini okwanelisayo.
(3) Kwizigulane ezine-osteoporosis, ukufaka i-washer ene-medial column screw kunokuthintela i-screw ukuba ingasikeki emathanjeni.
(4) Izikrufu ezikwisiphelo esikude sepleyiti zinokuthintela ukufakwa kwezikrufu zekholamu ephakathi. Ukuba kukho ukuvaleka kwezikrufu ngexesha lokufakwa kwezikrufu zekholamu ephakathi, cinga ngokurhoxisa okanye ngokubeka kwakhona izikrufu ezikude zepleyiti esecaleni, unike indawo ephambili yokubekwa kwezikrufu zekholamu ephakathi.
Ityala lesi-2. Isigulana esibhinqileyo, esineminyaka engama-76 ubudala, esinokwaphuka kwe-extra-articular ye-distal femoral. (A, B) Ii-X-rays zangaphambi kotyando ezibonisa ukufuduka okukhulu, ukukhubazeka kwe-angular, kunye nokufuduka kwe-coronal plane yokwaphuka; (C, D) Ii-X-rays zasemva kotyando kwimibono esecaleni nangaphambili ebonisa ukuqiniswa ngepleyiti yangaphandle esecaleni edityaniswe nezikrufu zekholamu ephakathi; (E, F) Ii-X-rays ezilandelelanayo kwiinyanga ezi-7 emva kotyando zityhila ukuphiliswa kakuhle kokwaphuka ngaphandle kweempawu zokusilela kokulungiswa kwangaphakathi.
Ityala 3. Isigulana esibhinqileyo, esineminyaka engama-70 ubudala, esinokwaphuka kwe-periprosthetic circumference kwi-femoral implant. (A, B) Ii-X-rays zangaphambi kotyando ezibonisa ukwaphuka kwe-periprosthetic circumference kwi-femoral implant emva kwe-total knee arthroplasty, kunye nokuqhekeka kwe-extra-articular kunye ne-stable prosthetic fixation; (C, D) Ii-X-rays zasemva kotyando ezibonisa ukulungiswa nge-external lateral plate edityaniswe nezikrufu ze-medial column ngendlela ye-extra-articular; (E, F) Ii-X-rays ezilandelayo kwiinyanga ezi-6 emva kotyando zityhila ukuphiliswa kwe-fractures okugqwesileyo, kunye nokulungiswa kwangaphakathi endaweni.
Ixesha lokuposa: Jan-10-2024
