Kusweka kwa fupa la proximal femoral nthawi zambiri kumachitika chifukwa cha kuvulala kwamphamvu kwambiri. Chifukwa cha mawonekedwe a thupi la proximal femur, mzere wosweka nthawi zambiri umakhala pafupi ndi pamwamba pa articular ndipo ukhoza kufalikira mpaka pa malo olumikizirana, zomwe zimapangitsa kuti misomali isakonzeke bwino mkati mwa medullary. Chifukwa chake, milandu yambiri imadalirabe kukhazikika pogwiritsa ntchito plate ndi screw system. Komabe, mawonekedwe a biomechanical a plates okhazikika bwino amabweretsa chiopsezo chachikulu cha zovuta monga kulephera kwa lateral plate, kuphulika kwa internal fixation, ndi kutulutsa screw. Kugwiritsa ntchito thandizo la medial plate pokhazikitsa, ngakhale kuli kothandiza, kumabwera ndi zovuta za kuvulala kowonjezereka, nthawi yayitali ya opaleshoni, chiopsezo chachikulu cha matenda pambuyo pa opaleshoni, komanso mavuto azachuma kwa odwala.
Poganizira izi, kuti pakhale mgwirizano wabwino pakati pa zovuta za biomechanical za lateral single plates ndi kuvulala kwa opaleshoni komwe kumachitika chifukwa chogwiritsa ntchito medial ndi lateral double plates, akatswiri akunja agwiritsa ntchito njira yolumikizira lateral plate ndi percutaneous screw fixation yowonjezera mbali ya medial. Njirayi yawonetsa zotsatira zabwino zachipatala.
Pambuyo pa opaleshoni, wodwalayo amagonekedwa chagada.
Gawo 1: Kuchepetsa kusweka kwa fupa. Ikani singano ya 2.0mm Kocher mu tibial tuberosity, kukoka kuti mukonzenso kutalika kwa mwendo, ndikugwiritsa ntchito bondo kuti mukonze kusamuka kwa sagittal plane.
Gawo 2: Kuyika mbale yachitsulo cham'mbali. Mukachepetsa pang'ono pokoka, yang'anani mwachindunji mbali ya ...
Gawo 3: Kuyika zomangira zapakati. Mukakhazikitsa kusweka ndi mbale yachitsulo cham'mbali, gwiritsani ntchito chobowolera chowongolera cha 2.8mm kuti mulowe kudzera mu condyle yapakati, pomwe nsonga ya singano ili pakati kapena kumbuyo kwa chipika cha distal femoral, mopingasa kupita kunja ndi mmwamba, kulowa m'fupa la cortical lotsutsana. Mukachepetsa bwino fluoroscopy, gwiritsani ntchito chobowolera cha 5.0mm kuti mupange dzenje ndikuyika chomangira cha fupa cha 7.3mm cancellous.
Chithunzi chosonyeza njira yochepetsera ndi kukhazikika kwa kusweka kwa fupa. Mkazi wazaka 74 yemwe ali ndi kusweka kwa fupa la m'chiuno (AO 33C1) asanachite opaleshoni. (A, B) Ma X-ray a fupa la m'chiuno asanachite opaleshoni omwe akuwonetsa kusamuka kwakukulu kwa kusweka kwa fupa la m'chiuno; (C) Pambuyo pochepetsa kusweka kwa fupa, mbale yakunja ya fupa imayikidwa ndi zomangira zomwe zimateteza malekezero onse a proximal ndi a distal; (D) Chithunzi cha Fluoroscopy chomwe chikuwonetsa malo abwino a waya wotsogolera wa medial; (E, F) Ma X-ray a fupa la m'chiuno ndi a anteroposterior pambuyo pa opaleshoni atayika screw ya fupa la m'chiuno.
Pa nthawi yochepetsa, ndikofunikira kuganizira mfundo zotsatirazi:
(1) Gwiritsani ntchito waya wotsogolera wokhala ndi sikuru. Kuyika zomangira zapakati pa mzere kumakhala kwakukulu, ndipo kugwiritsa ntchito waya wotsogolera wopanda sikuru kungayambitse ngodya yayitali pobowola condyle yapakati, zomwe zimapangitsa kuti ikhale yotsetsereka.
(2) Ngati zomangira zomwe zili mu lateral plate zikugwira bwino lateral cortex koma sizikugwira bwino dual cortex fixation, sinthani screw direction kutsogolo, zomwe zimalola zomangira kulowa mbali yakutsogolo ya lateral plate kuti zikwaniritse dual cortex fixation yokwanira.
(3) Kwa odwala matenda a osteoporosis, kuyika chotsukira ndi sikulu yapakati kungalepheretse sikulu kuti isadule fupa.
(4) Zomangira zomwe zili kumapeto kwa mbale zitha kulepheretsa kuyika kwa zomangira zapakati. Ngati zomangira zatsekedwa panthawi yoyika zomangira zapakati, ganizirani kuchotsa kapena kusintha zomangira zakutali za mbale ya mbali, poika patsogolo zomangira zapakati.
Nkhani 2. Wodwala wamkazi, wazaka 76, yemwe ali ndi kusweka kwa mbali ya femoral extra-articular. (A, B) Ma X-ray asanayambe opaleshoni omwe akuwonetsa kusamuka kwakukulu, kusokonekera kwa angular, ndi kusamuka kwa korona; (C, D) Ma X-ray a pambuyo pa opaleshoni m'mawonekedwe a mbali ndi a anteroposterior omwe akuwonetsa kukhazikika ndi mbale yakunja ya mbali yophatikizidwa ndi zomangira zapakati; (E, F) Ma X-ray otsatira pambuyo pa miyezi 7 opaleshoni ikuwonetsa kuchira kwabwino kwa kusweka popanda zizindikiro za kulephera kwa kukhazikika kwa mkati.
Nkhani 3. Wodwala wamkazi, wazaka 70, yemwe wasweka mozungulira chogwirira cha femoral. (A, B) Ma X-ray asanayambe opaleshoni omwe akuwonetsa kusweka kwa periprosthetic kuzungulira chogwirira cha femoral pambuyo pa kuthyoka kwa bondo lonse, ndi kusweka kwa extra-articular ndi kukhazikika kwa prosthetic; (C, D) Ma X-ray a pambuyo pa opaleshoni omwe akuwonetsa kukhazikika ndi mbale yakunja yolumikizana ndi zomangira zapakati kudzera mu njira yowonjezera; (E, F) Ma X-ray otsatira pambuyo pa miyezi 6 pambuyo pa opaleshoni akuwonetsa kuchira kwabwino kwa kusweka, ndi kukhazikika kwamkati m'malo mwake.
Nthawi yotumizira: Januwale-10-2024
