Njira Yopangira Opaleshoni |Ipsilateral Femoral Condyle Graft Internal Fixation for Chithandizo cha Tibial Plateau Fractures

Kugwa kwamtundu wa tibial Plateau kugwa kapena kugawanika ndi mtundu wofala kwambiri wa fracture ya tibial.Cholinga chachikulu cha opaleshoni ndikubwezeretsa kusalala kwa malo olowa ndikugwirizanitsa gawo lapansi.Malo olowa olowa, akakwera, amasiya chilema cha fupa pansi pa chichereŵechereŵe, chomwe nthawi zambiri chimafuna kuti pakhale fupa la autogenous iliac, allograft bone, kapena fupa lopanga kupanga.Izi zimagwira ntchito ziwiri: choyamba, kubwezeretsanso chithandizo cha mafupa, ndipo chachiwiri, kulimbikitsa machiritso a mafupa.

Poganizira za kudulidwa kowonjezera komwe kumafunikira fupa la autogenous iliac, lomwe limabweretsa kuvulala kwakukulu kwa opaleshoni, komanso kuopsa kwa kukanidwa ndi matenda okhudzana ndi fupa la allograft ndi fupa lopanga, akatswiri ena amalingalira njira ina yochepetsera kutsika kwapakati ndi kukhazikika kwamkati (ORIF). ).Amalimbikitsa kukulitsa njira yomweyi m'mwamba panthawi ya ndondomekoyi ndikugwiritsanso ntchito kulumikiza mafupa kuchokera ku lateral femoral condyle.Malipoti angapo awonetsa njira iyi.

Phunziroli linaphatikizapo milandu ya 12 yokhala ndi deta yotsatizana yotsatizana.Odwala onse, njira yachizolowezi ya tibial anterior lateral inagwiritsidwa ntchito.Pambuyo powonetsa mtunda wa tibial, kudulidwako kunapitilizidwa mmwamba kuti awonetsere lateral femoral condyle.A 12mm Eckman bone extractor anagwiritsidwa ntchito, ndipo atabowola kunja kwa kotekisi ya femoral condyle, fupa lochotsa kuchokera ku lateral condyle linakololedwa m'njira zinayi zobwerezabwereza.Voliyumu yomwe idapezedwa idachokera ku 20 mpaka 40cc.

Pambuyo kuthirira mobwerezabwereza kwa ngalande ya fupa, siponji ya hemostatic ikhoza kuyikidwa ngati kuli kofunikira.Fupa lokolola lokolola limayikidwa mu chilema cha fupa pansi pa lateral tibial plateau, ndikutsatiridwa ndi kukonza mkati mwachizolowezi.Zotsatira zikuwonetsa:

① Kukonzekera kwamkati kwa tibial Plateau, odwala onse adapeza machiritso a fracture.

② Palibe zowawa zazikulu kapena zovuta zomwe zinawonedwa pamalo pomwe fupa linakololedwa kuchokera ku lateral condyle.

③ Kuchiritsa fupa pamalo okolola: Pakati pa odwala 12, 3 adawonetsa kuchiritsa kwathunthu kwa fupa la cortical, 8 adawonetsa kuchiritsa pang'ono, ndipo 1 sanawonetse machiritso owoneka bwino a cortical.

④ Mapangidwe a mafupa a trabeculae pamalo okolola: Muzochitika 9, panalibe kupangika kwa mafupa a trabeculae, ndipo muzochitika za 3, kupangika pang'ono kwa mafupa a trabeculae kunawonedwa.

⑤ Zovuta za Osteoarthritis: Pakati pa odwala 12, 5 adayambitsa nyamakazi yowopsya pambuyo pa bondo.Wodwala wina adalowa m'malo mwake zaka zinayi pambuyo pake.

Pomaliza, kukolola fupa la cancellous kuchokera ku ipsilateral lateral femoral condyle kumabweretsa machiritso abwino a tibial plateau popanda kuonjezera chiopsezo cha zovuta za postoperative.Njirayi ikhoza kuganiziridwa ndikutchulidwa muzochita zachipatala.