Iifractures ze-femoral ezikufutshane ziqhele ukubonwa ngokulimala kweklinikhi okubangelwa yi-high-energy trauma.Ngenxa yeempawu ze-anatomical ze-proximal femur, umgca we-fracture uhlala ulala kufuphi ne-articular surface kwaye unokwandisa kwi-joint, okwenza kube lula ukulungelelanisa izikhonkwane ze-intramedullary.Ngenxa yoko, inxalenye ebalulekileyo yamatyala isaxhomekeke ekulungiseni kusetyenziswa ipleyiti kunye nenkqubo yesikrufu.Nangona kunjalo, iimpawu ze-biomechanical ze-eccentrically fixed plates zibeka umngcipheko ophezulu weengxaki ezifana nokungaphumeleli kokulungiswa kwepleyiti esecaleni, ukuphuka kwangaphakathi kokulungiswa, kunye nokukhupha i-screw-out.Ukusetyenziswa koncedo lweplate ye-medial ukulungiswa, nangona kusebenza, kuza kunye neengxaki zokunyuka kwentlungu, ixesha elide lotyando, umngcipheko ophezulu wokosuleleka emva kokuhlinzwa, kunye nomthwalo wemali ongezelelweyo kwizigulane.
Xa kuthathelwa ingqalelo ezi ngqwalasela, ukuze kuphunyezwe ulungelelwaniso olufanelekileyo phakathi kokusilela kwe-biomechanical kwiipleyiti ezisecaleni ezisecaleni kunye nokwenzakala kotyando okuyanyaniswa nokusetyenziswa kweepleyiti ezimbini zangaphakathi kunye nezasecaleni, abaphengululi bamazwe angaphandle baye bamkela ubuchule obubandakanya ukulungiswa kwepleyiti esecaleni kunye nokulungiswa kwesikrufu esongezelelweyo sepercutaneous. kwicala eliphakathi.Le ndlela ibonise iziphumo ezifanelekileyo zeklinikhi.
Emva kwe-anesthesia, isigulane sibekwe kwindawo yokulala.
Inyathelo 1: Ukuncitshiswa kokwaphuka.Faka inaliti ye-2.0mm ye-Kocher kwi-tuberosity ye-tibial, ukutsala ukuseta kwakhona ubude belungu, kwaye usebenzise i-knee pad ukulungisa ukufuduka kwe-sagittal plane.
Inyathelo lesi-2: Ukubekwa kwepleyiti yentsimbi esecaleni.Emva kokunciphisa okusisiseko nge-traction, sondela ngokuthe ngqo kwi-distal lateral femur, khetha ipleyiti yokutshixa ubude obufanelekileyo ukuze ugcine ukunciphisa, kwaye ufake izikrufu ezimbini kwiindawo ezikufutshane kunye neziphelo ezikude zokuqhekeka ukugcina ukuncitshiswa kwe-fracture.Ngeli xesha, kubalulekile ukuba uqaphele ukuba i-screws ezimbini ze-distal kufuneka zibekwe ngokusondeleyo ngaphambili ngokusemandleni ukuphepha ukuchaphazela ukubekwa kwe-screws medial.
Inyathelo lesi-3: Ukubekwa kwezikrufu zekholamu ephakathi.Emva kokuzinzisa ukuphuka ngepleyiti yensimbi esecaleni, sebenzisa i-2.8mm i-screw-guided drill ukuze ungene kwi-condyle ephakathi, kunye nendawo yenaliti ebekwe embindini okanye ngasemva kwibhloko ye-distal femoral, ngaphandle kwe-diagonally ngaphandle nangaphezulu, ingena kwelinye icala. ithambo lecortical.Emva kokuncitshiswa kwe-fluoroscopy ngendlela eyanelisayo, sebenzisa i-5.0mm drill ukwenza umngxuma kwaye ufake i-7.3mm cancellous bone screw.
Umzobo obonisa inkqubo yokunciphisa i-fracture kunye nokulungiswa.Ibhinqa elineminyaka engama-74 ubudala kunye ne-distal femoral intra-articular fracture (AO 33C1).(A, B) Iiradiographs zangaphambili zangaphambili ezibonisa ukufuduka okuphawulekayo kwe-distal femoral fracture;(C) Emva kokunciphisa i-fracture, i-plate yangaphandle yangaphandle ifakwe kunye nezikhonkwane ezikhusela zombini iziphelo ezihamba phambili kunye ne-distal;(D) Umfanekiso we-Fluoroscopy obonisa indawo eyanelisayo yocingo lwesikhokelo se-medial;(E, F) I-postoperative lateral kunye ne-anteroposterior radiographs emva kokufakwa kwe-screw yekholamu ye-medial.
Ngexesha lenkqubo yokunciphisa, kubalulekile ukuqwalasela la manqaku alandelayo:
(1) Sebenzisa ucingo lwesikhokelo ngesikrufu.Ukufakwa kwezikrufu zekholamu ephakathi kuninzi kakhulu, kwaye ukusebenzisa ucingo lwesikhokelo ngaphandle kwesikrufu kunokukhokelela kwi-angle ephezulu ngexesha lokubhoboza kwi-condyle ephakathi, okwenza kube lula ukutyibilika.
(2) Ukuba izikrufu ezikwipleyiti esecaleni zibamba ngokufanelekileyo icortex esecaleni kodwa zisilele ekufezekiseni icortex embaxa-mbili esebenzayo, lungelelanisa isikrufu kwicala eliya phambili, uvumele izikrufu ukuba zingene kwicala langaphambili lepleyiti esecaleni ukufikelela okwanelisayo kwicortex embaxa-mbili.
(3) Kwizigulane ezine-osteoporosis, ukufaka iwasha nge-screw yekholamu yangaphakathi kunokuthintela isikrufu ekusikeni kwithambo.
(4) Izikrufu ekupheleni kwepleyiti zinokuthintela ukufakwa kwezikrufu zekholamu ephakathi.Ukuba uthintelo lwesijija luhlangatyezwa ngexesha lokufakwa kwesikrufu sekholamu yangaphakathi, cinga ukurhoxisa okanye ukubeka kwindawo ngokutsha izikrufu zedistal zepleyiti esecaleni, unike kuqala ekubekweni kwezikrufu zekholamu yangaphakathi.
Ityala le-2. Isigulana esisetyhini, iminyaka eyi-76 ubudala, kunye ne-distal femoral extra-articular fracture.(A, B) I-X-rays yangaphambi kokusebenza ebonisa ukufuduka okuphawulekayo, ukukhubazeka kwe-angular, kunye nokufuduka kwendiza ye-coronal ye-fracture;(C, D) I-X-rays ye-postoperative kwimibono yecala kunye ne-anteroposterior ebonisa ukulungiswa kunye neplate yangaphandle yangaphandle edibeneyo kunye ne-screws yekholomu ephakathi;(E, F) Ukulandelela ii-X-rays kwiinyanga ze-7 emva kokuhlinzwa ngokubonisa ukuphulukiswa kwe-fracture egqwesileyo ngaphandle kweempawu zokungaphumeleli kokulungiswa kwangaphakathi.
Ityala le-3. Isigulane sowesifazane, iminyaka eyi-70 ubudala, kunye ne-periprosthetic fracture ejikeleze i-femoral implant.(A, B) I-X-rays yangaphambi kokuhlinzwa ebonisa ukuphuka kwe-periprosthetic malunga nokufakelwa kwe-femoral emva kwe-arthroplasty epheleleyo yamadolo, kunye ne-fracture engaphezulu kwe-articular kunye nokulungiswa okuzinzileyo kweprosthetic;(C, D) I-X-rays ye-postoperative ebonisa ukulungiswa kunye neplate yangaphandle yangaphandle edibeneyo kunye ne-screws yekholomu ye-medial ngokusebenzisa indlela eyongezelelweyo;(E, F) Ukulandelela i-X-rays kwiinyanga ze-6 emva kokubonisa ukuphulukiswa kwe-fracture ebalaseleyo, kunye nokulungiswa kwangaphakathi endaweni.
Ixesha lokuposa: Jan-10-2024
