I-Tibial plateau fractures edibeneyo kunye ne-ipsilateral tibial shaft fractures ibonakala ngokuqhelekileyo kukulimala kwamandla aphezulu, kunye ne-54% ibe yi-fractures evulekileyo.Izifundo zangaphambili zifumene ukuba i-8.4% ye-tibial plateau fractures idibaniswa ne-tibial shaft fractures, ngelixa i-3.2% yezigulane ze-tibial shaft fracture zineengqungquthela ze-tibial plateau fractures.Kuyabonakala ukuba ukudibanisa kwe-ipsilateral tibial plateau kunye ne-shaft fractures ayiqhelekanga.
Ngenxa yobukhulu bamandla omonzakalo olunjalo, kuhlala kukho ukonakala okukhulu kwezicubu ezithambileyo.Kwithiyori, i-plate kunye ne-screw system ineenzuzo ekulungiseni kwangaphakathi kwi-plateau fractures, kodwa ukuba i-tissue ethambileyo yendawo inokunyamezela ukulungiswa kwangaphakathi kunye ne-plate kunye ne-screw system nayo iqwalaselo lweklinikhi.Ke ngoko, kukho iindlela ezimbini ezisetyenziswa ngokuqhelekileyo zokulungiswa kwangaphakathi kwe-tibial plateau fractures edityaniswe ne-tibial shaft fractures:
1. I-MIPPO (i-Minimally Invasive Plate Osteosynthesis) ubuchule obunepleyiti ende;
2. I-Intramedullary nail + plateau screw.
Zombini iinketho zichazwe kwiincwadi, kodwa okwangoku akukho mvumelwano malunga nokuba iphezulu okanye iphantsi ngokwenqanaba lokuphulukisa ukuphuka, ixesha lokuphulukisa ukuphuka, ukulungelelaniswa kwemilenze ephantsi, kunye neengxaki.Ukuhlangabezana noku, abaphengululi besibhedlele saseyunivesithi yaseKorea benza uphononongo lothelekiso.
Uphononongo lubandakanya izigulane ze-48 ezine-tibial plateau fractures ezidibeneyo kunye ne-tibial shaft fractures.Phakathi kwabo, iimeko ze-35 zaphathwa ngobuchule be-MIPPO, kunye nokufakwa kwecala leplate yensimbi yokulungiswa, kunye namatyala e-13 aphathwe ngezikrufu zeplateau ezidityaniswe ne-infrapatellar indlela yokulungiswa kwe-intramedullary nail.
▲ Ityala le-1: I-Lateral MIPPO yentsimbi yentsimbi yokulungiswa kwangaphakathi.Indoda eneminyaka eyi-42 ubudala, ebandakanyeka engozini yemoto, inikwe i-tibial shaft fracture evulekile (uhlobo lwe-Gustilo II) kunye ne-concomitant medial tibial plateau compression fracture (uhlobo lwe-Schatzker IV).
▲ Ityala le-2: I-Tibial plateau screw + i-suprapatellar intramedullary nail fixation yangaphakathi.Indoda eneminyaka eyi-31 ubudala, ebandakanyeka engozini yemoto, inikwe i-tibial shaft fracture evulekileyo (uhlobo lwe-Gustilo IIIa) kunye ne-concomitant lateral tibial plateau fracture (Schatzker I type).Emva kokutshatyalaliswa kwenxeba kunye nonyango olubi loxinzelelo lwenxeba (VSD), inxeba lafakelwa ulusu.Izikrufu ezimbini ze-6.5mm zisetyenziselwe ukunciphisa kunye nokulungiswa kwe-plateau, elandelwa yi-intramedullary nail fixation ye-tibial shaft ngendlela ye-suprapatellar.
Iziphumo zibonisa ukuba akukho mahluko obalulekileyo phakathi kweendlela ezimbini zotyando ngokwexesha lokuphulukisa ukuphuka, izinga lokuphulukisa ukuphuka, ukulungelelaniswa kwemilenze ephantsi, kunye neengxaki.
Ngokufana nokudibanisa i-tibial shaft fractures kunye ne-ankle joint fractures okanye i-femoral shaft fractures ene-femoral neck fractures, i-high-energy-induced tibial shaft fractures ingakhokelela kukulimala kwidolo elisondeleyo.Kwinkqubo yeklinikhi, ukuthintela ukuxilongwa kakubi kuyinkxalabo ephambili ekuxilongweni nasekunyangweni.Ukongeza, ekukhetheni iindlela zokulungisa, nangona uphando lwangoku lubonisa ukuba akukho mahluko ubalulekileyo, kusekho amanqaku amaninzi ekufuneka eqwalaselwe:
1. Kwiimeko ze-comminuted tibial plateau fractures apho ukulungiswa kwe-screw elula kungumngeni, ingqwalaselo ephambili inokunikwa ukusetyenziswa kweplate ende kunye nokulungiswa kwe-MIPPO ukuzinzisa ngokwaneleyo i-plateau ye-tibial, ukubuyisela i-joint surface congruence kunye nokulungelelaniswa kwemilenze ephantsi.
2. Kwiimeko ze-tibial plateau fractures ezilula, phantsi kweengqungquthela ezincinci, ukunciphisa okusebenzayo kunye nokulungiswa kwe-screw kunokufezekiswa.Kwiimeko ezinjalo, ingqwalaselo ephambili inokunikezelwa kwi-screw fixation elandelwa yi-suprapatellar intramedullary nail fixation ye-tibial shaft.
Ixesha lokuposa: Mar-09-2024
