Ukuqhekeka kwethafa le-tibial kunye nokuqhekeka kwe-ipsilateral tibial shaft kudla ngokubonakala kwizilonda ezinamandla aphezulu, apho ama-54% eengozi ezivulekileyo. Izifundo zangaphambili zifumanise ukuba i-8.4% yokuqhekeka kwethafa le-tibial plateau inxulunyaniswa nokuqhekeka kwe-tibial shaft ngaxeshanye, ngelixa i-3.2% yezigulane eziqhekeke kwi-tibial shaft zineengxaki zokuqhekeka kwethafa le-tibial plateau ngaxeshanye. Kuyacaca ukuba ukudibana kokuqhekeka kwethafa le-tibial plateau kunye ne-shaft akuqhelekanga.
Ngenxa yokuba olu hlobo lokulimala lunamandla aphezulu, kudla ngokubakho umonakalo omkhulu kwizicubu ezithambileyo. Ngokwethiyori, inkqubo yepleyiti kunye neskrubu ineengenelo ekufakweni kwangaphakathi kwezaphuko zeplate, kodwa ukuba izicubu ezithambileyo zasekuhlaleni zinokunyamezela na ukufakelwa kwangaphakathi ngenkqubo yepleyiti kunye neskrubu nayo yinto ebalulekileyo ecingelwayo. Ke ngoko, okwangoku kukho iindlela ezimbini ezisetyenziswa rhoqo zokufakelwa kwangaphakathi kwezaphuko zeplate yetibial kunye nezaphuko ze-tibial shaft:
1. Indlela ye-MIPPO (Minimally Invasive Plate Osteosynthesis) enepleyiti ende;
2. Isikrufu seenzipho ze-intramedullary + iplateau.
Zombini ezi ndlela zichazwe kwiincwadi, kodwa okwangoku akukho sivumelwano sokuba yeyiphi engcono okanye engaphantsi ngokwesantya sokuphiliswa kwamathambo, ixesha lokuphiliswa kwamathambo, ukulungelelaniswa kwamalungu asezantsi, kunye neengxaki. Ukujongana nale meko, iingcali ezivela kwisibhedlele seyunivesithi yaseKorea zenze uphando oluthelekisayo.
Olu phononongo luquke izigulana ezingama-48 ezinezaphuko zethafa le-tibial ezidityaniswe nezaphuko zethafa le-tibial. Phakathi kwazo, amatyala angama-35 anyangwa ngendlela ye-MIPPO, ngokufakwa kwepleyiti yentsimbi ecaleni ukuze ifakelwe, kwaye amatyala ali-13 anyangwa ngezikrufu zethafa ezidityaniswe nendlela ye-infrapatellar yokufakela iinzipho ngaphakathi kwe-medullary.
▲ Ityala 1: Ukufakelwa kwangaphakathi kwepleyiti yentsimbi ye-Lateral MIPPO. Indoda eneminyaka engama-42 ubudala, ebandakanyeke kwingozi yemoto, yaphuka umngxuma we-tibial ovulekileyo (uhlobo lweGustilo II) kunye noqhekeko loxinzelelo lwe-tibial plate oluhambelanayo (uhlobo lweSchatzker IV).
▲ Ityala lesi-2: Isikrufu se-tibial plateau + i-suprapatellar intramedullary nail fixation yangaphakathi. Indoda eneminyaka engama-31 ubudala, ebandakanyeke kwingozi yemoto, yafumana ukwaphuka kwe-tibial shaft evulekileyo (uhlobo lweGustilo IIIa) kunye nokuqhekeka kwe-tibial plateau ecaleni (uhlobo lweSchatzker I). Emva kokususwa kwenxeba kunye nonyango lwe-negative pressure wound (VSD), inxeba lafakelwa eluswini. Izikrufu ezibini ze-6.5mm zasetyenziselwa ukunciphisa nokulungisa i-plateau, zalandelwa kukulungiswa kwezikrufu ze-tibial shaft ngaphakathi kwendlela ye-suprapatellar.
Iziphumo zibonisa ukuba akukho mahluko ubalulekileyo ngokwezibalo phakathi kweendlela ezimbini zotyando ngokubhekiselele kwixesha lokuphiliswa kwamathambo, izinga lokuphiliswa kwamathambo, ukulungelelaniswa kwamalungu asezantsi, kunye neengxaki.
Ngokufana nokudibanisa ukwaphuka kwe-tibial shaft kunye nokuqhekeka kwe-ankle joint okanye ukwaphuka kwe-femoral shaft kunye nokuqhekeka kwe-femoral neck, ukwaphuka kwe-tibial shaft okubangelwa ngamandla aphezulu kunokukhokelela ekulimaleni kwi-joint ekufutshane. Kwimisebenzi yeklinikhi, ukuthintela ukuxilongwa okungalunganga yeyona nto iphambili ekuxilongweni nasekunyangweni. Ukongeza, ekukhetheni iindlela zokulungisa, nangona uphando lwangoku lubonisa ukuba akukho mahluko abalulekileyo, kusekho amanqaku aliqela ekufuneka aqwalaselwe:
1. Kwiimeko zokuqhekeka kwethafa le-tibial apho ukulungiswa okulula kwesikrufu kunzima, kusenokubekwa phambili ukusetyenziswa kwepleyiti ende enokulungiswa kwe-MIPPO ukuzinzisa ngokwaneleyo ithafa le-tibial, ukubuyisela ukuhambelana komphezulu wamalungu kunye nokulungelelaniswa kwamalungu asezantsi.
2. Kwimeko yokuqhekeka okulula kwethafa le-tibial, phantsi kokusikwa okuncinci, ukunciphisa okusebenzayo kunye nokulungiswa kwezikrufu kunokufezekiswa. Kwimeko ezinjalo, kuqala kunokunikwa ukulungiswa kwezikrufu kulandele ukulungiswa kwezipikili ze-suprapatellar intramedullary kwi-tibial shaft.
Ixesha lokuthumela: Matshi-09-2024
