Njira Yopangira Opaleshoni | Ipsilateral Femoral Condyle Graft Internal Fixation pochiza Kusweka kwa Tibial Plateau

Kugwa kwa tibial plateau kapena kugawanika kwa tibial plateau ndi mtundu wofala kwambiri wa kusweka kwa tibial plateau. Cholinga chachikulu cha opaleshoni ndikubwezeretsa kusalala kwa malo olumikizirana mafupa ndikulumikiza mwendo wapansi. Malo olumikizirana mafupa akagwa, akakwezedwa, amasiya vuto la fupa pansi pa cartilage, nthawi zambiri amafunika kuyika fupa la autogenous iliac, fupa la allograft, kapena fupa lopangira. Izi zimagwira ntchito ziwiri: choyamba, kubwezeretsa chithandizo cha mafupa, ndipo chachiwiri, kulimbikitsa kuchira kwa mafupa.

Poganizira za kudula kwina kofunikira pa fupa la iliac lokha, komwe kumabweretsa kuvulala kwakukulu kwa opaleshoni, komanso zoopsa zomwe zingachitike chifukwa cha kukanidwa ndi matenda okhudzana ndi fupa la allograft ndi fupa lochita kupanga, akatswiri ena amapereka njira ina panthawi yochepetsera ndi kukhazikika kwa mkati mwa tibial (ORIF). Amalangiza kukulitsa kudula komweko mmwamba panthawi ya opaleshoni ndikugwiritsa ntchito cancellous bone graft kuchokera ku lateral femoral condyle. Malipoti angapo a milandu alemba njira iyi.

Kafukufukuyu adaphatikizapo milandu 12 yokhala ndi deta yonse yowunikira. Mwa odwala onse, njira yokhazikika yolumikizira tibial anterior lateral idagwiritsidwa ntchito. Pambuyo powonetsa tibial plateau, kudulako kunakulitsidwa mmwamba kuti kuwonetse lateral femoral condyle. Chotulutsira mafupa cha 12mm Eckman chinagwiritsidwa ntchito, ndipo pambuyo pobowola cortex yakunja ya femoral condyle, fupa la cancellous kuchokera ku lateral condyle linasonkhanitsidwa mobwerezabwereza kanayi. Kuchuluka komwe kunapezeka kunali kuyambira 20 mpaka 40cc.

Pambuyo pothirira mobwerezabwereza ngalande ya mafupa, siponji yochotsa magazi imatha kuyikidwa ngati pakufunika kutero. Fupa lochotsa magazi limayikidwa m'chilema cha fupa pansi pa phiri la tibial, kenako ndikukhazikika mkati mwa thupi nthawi zonse. Zotsatira zake zikusonyeza kuti:

① Kuti fupa la tibial likhazikike mkati, odwala onse anachira.

② Palibe ululu waukulu kapena zovuta zomwe zinapezeka pamalo pomwe fupa linachotsedwa mu condyle ya lateral.

③ Kuchira kwa fupa pamalo okolola: Mwa odwala 12, atatu adachira kwathunthu fupa la cortical, 8 adachira pang'ono, ndipo m'modzi sanachiritsidwe bwino fupa la cortical.

④ Kupangidwa kwa mafupa a trabeculae pamalo okolola: Mu milandu 9, palibe kupangika kwa mafupa a trabeculae, ndipo mu milandu itatu, kupangika pang'ono kwa mafupa a trabeculae kunawonedwa.

⑤ Mavuto a mafupa a m'mafupa: Pakati pa odwala 12, 5 adadwala nyamakazi ya bondo pambuyo pa zoopsa. Wodwala m'modzi adasinthidwa mafupa patatha zaka zinayi.

Pomaliza, kuchotsa fupa la khansa kuchokera ku ipsilateral lateral femoral condyle kumapangitsa kuti mafupa a tibial plateau achire bwino popanda kuwonjezera chiopsezo cha mavuto pambuyo pa opaleshoni. Njira imeneyi ikhoza kuganiziridwa ndikugwiritsidwa ntchito kuchipatala.