Inkqubo ye-Supraplatellar yindlela yokuhlinqwa eguqulweyo ye-tibial ye-tibial ye-tibilidlary yesikhonkwane kwisikhundla se-semi. Zininzi izibonelelo, kodwa nezinto ezingalunganga, ekwenzeni isikhonkwane se-tibia ngokuhamba kwe-tibia ngokuhamba kwe-tibia ngendlela ye-halupus. Abanye oogqirha baqhele ukusebenzisa i-SPN ukuba baphathe zonke i-tibial quares ngaphandle kweqhinga le-proximal 1/3 ye-tibia.
Iimpawu zeSPN zezi:
I-1. Ithayile okanye iqhekeza lezinto ze-tibial stem stem. 2;
2. I-quaphys ye-tibial tibial tibial;
3. Ukuqhekeka kwe-hip okanye idolo elinomda okhethekileyo okhethiweyo (umzekelo, i-hip edibeneyo ye-hip okanye i-fusinetionation ye-HIP, i-osteoarthritis yedolo, i-hip (umz.
I-4. I-tibial facking idityaniswe nokulimala kolusu kwi-infrapatellar tendon;
I-5. I-tibilial sucture kwisigulana esine-tibia ende kakhulu (i-proximal yokuphela kwe-tibia ihlala inzima ukuyibona phantsi kwe-fluoroscopy xa i-tioroscopy idlula apho i-fluoroscopy idlula khona).
Inzuzo ye-Tomi-yongeza i-semi ye-tibial ye-Itibial ye-Inrameliquie yendlela yokunyanga i-tibial diaphysis kunye ne-tibial tibial fility ilele kwindawo yokuhlala kunye nokukhululeka kwe-fluoroscopy. Le ndlela ivumela ukuba inkxaso egcweleyo yobude obugcweleyo ye-tibia kunye nokuncitshiswa okulula kwe-sagittal yokuqhekeka ngaphandle kwesidingo sobuchule (amanani 1, 2). Oku kuphelisa isidingo somncedisi oqeqeshiweyo ukunceda kwi-Intramellary Natique.
Umzobo 1: Isikhundla esiqhelekileyo sendlela ye-Intramedullary ye-Intramellary yendlela ye-infrapatellar: idolo likwindawo eguqukayo kwi-fluoroscoftically petpod. Nangona kunjalo, esi sikhundla sinokwandisa ukulungelelaniswa okungalunganga kwebhloko yefuko kwaye kufuna ubuchwepheshe ongezelelweyo wokuncitshiswa konciphiso lwefraction.
Umzobo 2: Ngokwahlukileyo, indawo eyandisiweyo yedolo kwi-Foam ramp iququzelela ulungelelwaniso lwe-Fobreaty kunye nobuqhinga olandelayo.
Iindlela zoqhaqho
Itheyibhile / isigulana isigulana silele kwindawo yase-Supine kwibhedi ye-fluoroscopic. Itreyitha ephantsi ye-Exrimity ingenziwa, kodwa ayimfuneko.Itali ye-vascular ilungele kakuhle indlela ye-tirapatellar yendlela ye-tibilimerlay, kodwa ayimfuneko. Nangona kunjalo, uninzi lweebhedi zokuqhekezwa kweebhedi okanye iibhedi ze-fluoroscopic azicetyiswanga njengoko zingalunganga kwi-SupraPilitellar yendlela ye-tibilimerlary.
I-padding i-iplilateral i-IPSOTEL inceda ukugcina isiphelo esisezantsi kwindawo ejikelezwe ngaphandle. I-ramp ye-file ye-file isetyenziselwa ukuphakamisa umlenze ochaphazelekayo ngentla kwecala le-Posteroalpol Buliseroscopy, kunye nesikhundla se-hip kunye ne-hip kunye ne-GEEMEDLLlary yokukhokela. I-ETLE egqibeleleyo i-engise ixoxiwe, kunye ne-beltran et al. Ukucebisa nge-10 ° I-10 ° Ukucebisa nge-30 ° idolo lokutshintsha kwamadolo. Uninzi lwabaphengululi bayavuma ukuba ii-angle zedolo zedolo ngaphakathi kwezi zibanzi zamkelekile.
Nangona kunjalo, e-Eastman et al. ifumanise ukuba njengokutshutshiswa kwedolo ngokuthe ngcembe kwandiswa ukusuka kwi-10 ° ukuya kwi-50 °, isiphumo se-Teloral Talon kwi-Petcutaneal Pointition Inzuzo yesixhobo sancitshiswa. Ke ngoko, i-angle enkulu ye-idolo iya kunceda ekukhetheni indawo yokungena kwe-Intramellary ye-Intramellary echanekileyo kunye nokulungisa iingxaki ze-angland kwindiza ye-sagittal.
Fluoroscopy
Umatshini we-C-Arm Arm kufuneka ubekwe kwelinye icala letafile ukusuka kumlenze ochaphazelekayo, kwaye ukuba ugqirha ugqirha umi ecaleni kwedolo elichaphazelekayo, iliso kufuneka libe sentlokweni yomatshini we-C-Arm kwaye asondele. Oku kuvumela ugqirha ogqirha kunye nengcali ye-roodlogist ukuba agcine ngokulula iliso, ngaphandle kwaxa i-divert i-dive ifakwe. Nangona kunganyanzelekanga, ababhali bacebisa ukuba ingalo ye-C ifuduselwe kwicala elinye kunye notyando kwelinye icala xa i-screal ikhutshiwe. Ngenye indlela, umatshini we-C-Arm Marmar kufuneka ubekwe kwicala elichaphazelekayo ngelixa ugqirha owenza ugqirha wenza inkqubo kwicala le-courtrailatel (umzobo 3). Le yeyona ndlela isetyenziswa kakhulu ngababhali kuba ivumela imfuno yotyando ukuba itshintshe kwicala leMedial ukuya kwicala elifunekileyo.
Umzobo 3: Ugqirha umi kwelinye icala le-tibia echaphazelekayo ukuze idlule kwi-screw filw iqhutywa ngokulula. Lo mboniso uphela malunga notyando, entloko yengalo ye-C.
Zonke ii-anterosterior zase-anterpostior kunye ne-Pluoralscopic ze-Fluoroscopic zifunyanwe ngaphandle kokuhambisa umlenze ochaphazelekayo. Oku kuphephe ukufudukela kwindawo yokuqhekeka esele kuseto kwakhona ngaphambi kokuqhekeka kumiselwe ngokupheleleyo. Ukongeza, ubude bemifanekiso epheleleyo ye-tibia inokufunyanwa ngaphandle kokutsala ingalo ye-C-ngendlela echazwe apha ngasentla.
Isikhumba solusu zombini esilinganiselweyo kwaye isimilo esandisiweyo ezifanelekileyo sifanelekile. Indlela ye-percutaneal suprapatellar ye-Inramelitrary Nail isekwe ekusetyenzisweni kwe-3-CM ye-CM yokuqhuba isikhonkwane. Uninzi lweziganeko zo utyando zinde zinde, kodwa zinokuba ziguquka, njengoko kucetyiswa nguGqr Morandi, kunye ne-incavotion eyandisiweyo nguGqr Tornella kunye nezinye ziboniswe ngendlela edibeneyo yePatellar. Umzobo 4 ubonakalisa ulwaphulo-mthetho.
Umzobo 4: Umzekeliso wendlela eyahlukileyo ye-InfoPatellar Transpatellar Limemente; I-2- Parapatellar Limentatellar Ibalo I-3- medical ye-Prapatellar ye-parapatellar ye-liximer I-4- propateli ye-Prapatellar ye-Ilimen I-5- I-Lateral Parapatellar Limentate yeLimela iLimela iLimela. Ukubonakaliswa okunzulu kwendlela ye-parapatellar I-Ligament inokuba yindawo edibeneyo okanye ngaphandle kwebhafu edibeneyo.
Ukuvezwa okunzulu
Inkqubo ye-percutaneal supraplatellar yenziwa ngokuyintloko ye-tedriceps i-vedriceps de umsantsa angayifumana indawo yokuhamba kwezixhobo ezifana nezikhonkwane ezifana nezikhonkwane. Indlela ye-Parapatellar Ligamente, edlula ecaleni kwe-quadriceps yemisipha, inokuboniswa kwi-tibial gailikhs ye-tiplemeulique. Inaliti ye-rocar ye-rocar kunye ne-cannula idluliselwa ngononophelo kwi-patelloferal edibeneyo, inkqubo ekhokelela kwindawo yokungena engaphezulu kwe-tibial ye-tifial ye-trocar ngeTrocar. Nje ukuba iTrocar ikwindawo efanelekileyo, kufuneka ikhuselwe kwindawo yokuphepha ukonakala kwi-bartilage yedolo.
Indlela enkulu ye-Transligamentous inokusetyenziswa ngokudibeneyo kunye ne-hyperextran ye-parapatellar yesikhumba, nokuba yindlela yeMedial okanye ye-ofisi. Nangona ezinye oogqirha abaphumeleleyo zingayigcini ngokungenantlonelo, kbiak et al. Kholwa ukuba i-fursa kufuneka igcinwe igcinwe kwaye izakhiwo ezongezelelweyo ze-articular kufuneka zivezwe ngokufanelekileyo. Ithiyori, oku kubonelela ngokhuseleko oluhle kakhulu lwedolo kunye nokuthintela umonakalo onjengosulelo lwamadolo.
Inkqubo echazwe apha ngasentla ibandakanya ukungafunwa kwe-patella, enciphisa uxinzelelo lonxibelelwano kwindawo ethile ye-articular ukuya kuthi ga kwinqanaba elithile. Xa kunzima ukwenza uvavanyo oludibeneyo lwe-patelloferal kunye ne-cavity encinci kunye nesixhobo esondisiweyo sedolo, ababhali bacebisa ukuba i-patella ingafudukanga ngokwahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlulahlula. I-Median Translations eguqukayo, kwelinye icala, ithintela umonakalo kwi-ligations exhasayo, kodwa kunzima ukwenza ukulungiswa kwedolo.
Indawo yokungena ye-SPN yenaliti iyafana neyendlela ye-infrapatellar. I-ANTER kunye ne-Lateral Fluoroscopy ngexesha lokufakwa kwenaliti iqinisekisa ukuba inqaku lokufakwa kwenaliti lichanekile. Ugqirha utyando kufuneka aqinisekise ukuba inaliti yesikhokelo ayiqhutywa kakhulu kwiposti engasemva kwi-proximal tibia. Ukuba iqhutywa ngokunzulu kakhulu, kufuneka iphinde iphinde iphinde ifumane isikhonkwane esiphantsi kwe-poronal ye-poronal ye-poronal fluoroscopy. Ukongeza, e-Eastman et al. Kholwa ukuba ukuqhuba iPIN ye-PIN kwi-AIDS ebiyelwe i-DEE ye-GREX ye-DEE kwi-fessing yokwahlulahlula-bila kwindawo ye-hyperexndenteded.
Izixhobo zokunciphisa
Izixhobo ezenziwayo zokuncitshiswa zibandakanya i-POSTERP encitshisiweyo yobungakanani bobukhulu obahlukeneyo, izixhobo zokuthatha izinto zangaphandle, izixhobo zokulungisa zangaphandle, kunye neelungisa zangaphakathi zokulungiswa kweplate yeqhekeza elincinci. I-Blocks zinokusetyenziselwa le nkqubo yokuncitshiswa ngasentla. Izandi zokuncitshiswa zisetyenziselwa ukulungisa i-angution ye-sagittal kwaye inqabile.
Ukufakelwa
Abavelisi abaninzi beefayile zangaphakathi ze-orthopedic baphuhlise iinkqubo zokusebenzisa izixhobo zokukhokela ukubekwa ngokusemgangathweni kwezikhonkwane ze-tibial. Ibandakanya ingalo eyongeziweyo, isixhobo sePine sePiction ubude, kunye ne-medullary yandise. Kubaluleke kakhulu ukuba i-trocar kunye ne-bisnt ye-rocar pins ikhusela i-Intramellary Nations. Ugqirha utyando kufuneka aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aphinde aqiniseke isikhundla se-cannula ukuze sibe nengozi kwi-patelloferal edibeneyo okanye izakhiwo ze-perricular ngenxa yokusondela kufutshane nesixhobo sokuqhuba senzeki.
Ukutshixa izikrelem
Ugqirha utyando kufuneka aqinisekise ukuba inani elaneleyo lesikali sokutshixa sifakwe ukugcina unciphiso olunelisayo. Ukulungiswa kwamaqhekeza amancinci aqhekezayo Indlela ye-Supraplatellar kwi-tibial ye-Indementurary Napiki yendlela ifana nendlela ye-infrapatellar malunga nendlela yokuqhuba isikroba. Ukutshixa izikrelemnqa ziqhutywa ngokuchanekileyo phantsi kwe-fluoroscopy.
Ukuvalwa kwenxeba
Ukunyanzelwa nge-curing yedwa ngexesha lokuncipha kususa iziqwenga zamathambo zasimahla zethambo. Onke amanxeba adinga ukunkcenkceshelwa ngokucokisekileyo, ngakumbi indawo yedolo. I-quadriceps tendon okanye ungqameko lwe-quadrices okanye ungqameko lwe-quadrices okanye i-ligament ye-ligament kunye nomnyhadala kwindawo yendawo yokuqhekeza emva koko ivaliwe, ilandelwa ngokuvalwa kwe-demis kunye nolusu.
Ukususwa kwesikhonkwane se-intramellary
Nokuba i-tibility yesipikili iqhutywa ngendlela ye-Suprapatellar inokukhutshwa ngendlela eyahlukileyo yoqhaqho ihlala iphikisane. Eyona ndlela ixhaphakileyo yindlela ye-suntrapatellar yendlela yokususwa kwe-Inramellary National. Obu buchule buveza isikhonkwane ngokuqhuba ngesipili se-sueramellar sail sipile usebenzisa i-5.5 mm ye-DM. Isixhobo sokukhupha isikhonkwane emva koko siqhutywa kwijelo, kodwa le misinuve inokuba nzima. I-parapatellar kunye ne-infrapatellar yeendlela zendlela ezizinye zokususa izikhonkwane ze-intramellary.
Ingozi umngcipheko we-readtical yendlela ye-curipatellar kwi-tibial formique yendlela ye-patella kunye ne-catella yendlela ye-patella kunye ne-carmoral bartilage, ukulimala kwezemizimba, ukulimala kwezonyango, kunye ne-Intra-Forericur. Nangona kunjalo, kukho ukunqongophala kweengxelo zetyala elihambelana nezonyango. Izigulana ezine-chondromalacia ziya kuthatha inxaxheba ngakumbi kunyango lwe-cartilage. Umonakalo wonyango kwi-patellar kunye nezakhiwo zommandla we-articular olona xhala luphambili ngoogqirha besebenzisa le ndlela yongxami, ngakumbi indlela yedwa.
Ukuza kuthi ga ngoku, akukho bungqina bezibalo kwizibonelelo kunye nezinto eziluncedo kwi-semi-yongezwa kwe-tibial tibial tipial tramelique.
IXESHA LOKUQALA: I-Oct-23 ukuya kwi-2023
