Kuphulika kwachikazi kwapafupi kumawonedwa kawirikawiri kuvulala kwachipatala chifukwa cha kuvulala kwakukulu kwa mphamvu.Chifukwa cha mawonekedwe a anatomical a proximal femur, mzere wosweka nthawi zambiri umakhala pafupi ndi articular pamwamba ndipo ukhoza kupitilira mu mgwirizano, ndikupangitsa kuti ikhale yosayenerera kukhazikika kwa intramedullary.Chifukwa chake, gawo lalikulu lamilandu likudalirabe kukonza pogwiritsa ntchito mbale ndi screw system.Komabe, mawonekedwe a biomechanical a eccentrically fixed plates amabweretsa chiwopsezo chachikulu cha zovuta monga kulephera kwa mbale ya lateral, kuphulika kwa mkati, ndi kukoka zomangira.Kugwiritsiridwa ntchito kwa mbale yamkati yothandizira kukonza, ngakhale kuti n'kothandiza, kumabwera ndi zovuta za kuvulala kowonjezereka, nthawi yayitali ya opaleshoni, chiopsezo chowonjezereka cha matenda a pambuyo pa opaleshoni, ndi kuwonjezereka kwachuma kwa odwala.
Poganizira izi, kuti tikwaniritse bwino pakati pa zovuta za biomechanical za lateral mbale imodzi ndi kuvulala kwa opaleshoni komwe kumayenderana ndi kugwiritsa ntchito mbale ziwiri zapakati ndi zam'mbali, akatswiri akunja atengera njira yophatikizira mbale za lateral ndi fixation percutaneous screw fixation. ku mbali yapakati.Njira imeneyi yasonyeza zotsatira zabwino zachipatala.
Pambuyo pa opaleshoni, wodwalayo amaikidwa pamalo ogona.
Khwerero 1: Kuchepetsa fracture.Ikani singano ya 2.0mm Kocher mu tibial tuberosity, kukoka kuti mukhazikitsenso kutalika kwa nthambi, ndikugwiritsa ntchito bondo kuti mukonze kusamuka kwa ndege ya sagittal.
Khwerero 2: Kuyika kwa lateral zitsulo mbale.Pambuyo pochepetsako pokoka, yandikirani mbali ya distal lateral femur, sankhani mbale yoyenera yotsekera kutalika kuti muchepetseko, ndikuyika zomangira ziwiri kumapeto kwa fracture kuti muchepetse kuchepa.Panthawiyi, ndikofunika kuzindikira kuti zomangira ziwiri za distal ziyenera kuikidwa pafupi ndi kutsogolo momwe zingathere kuti zisakhudze kuyika kwazitsulo zamkati.
Khwerero 3: Kuyika zomangira zamkati.Mukakhazikitsa chophwanyikacho ndi mbale yachitsulo ya lateral, gwiritsani ntchito chobowolera chowongolera cha 2.8mm kuti mulowe kudzera pa condyle yapakati, ndi singano yomwe ili pakati kapena kumbuyo kwa chipika cha distal femoral block, diagonally kunja ndi mmwamba, kulowa mosiyana. fupa la cortical.Mukatsitsa mogwira mtima, gwiritsani ntchito kubowola kwa 5.0mm kuti mupange dzenje ndikuyika 7.3mm cancellous bone screw.
Chithunzi chosonyeza njira yochepetsera fracture ndi kukonza.Mkazi wazaka 74 yemwe ali ndi distal femoral intra-articular fracture (AO 33C1).(A, B) Preoperative lateral radiographs kusonyeza kusamuka kwakukulu kwa distal femoral fracture;(C) Pambuyo pochepetsa kuthyoka, mbale yakunja yakunja imayikidwa ndi zomangira zomwe zimateteza ma proximal ndi distal;(D) Chithunzi cha fluoroscopy chosonyeza malo okhutiritsa a waya wotsogolera wapakati;(E, F) Postoperative lateral ndi anteroposterior radiographs pambuyo pa kuyika kwa medial column screw.
Panthawi yochepetsera, ndikofunikira kuganizira mfundo zotsatirazi:
(1) Gwiritsani ntchito waya wolondolera wokhala ndi screw.Kuyika kwa zomangira zamkati ndizokulirapo, ndipo kugwiritsa ntchito waya wowongolera popanda wononga kumatha kupangitsa kuti pakhale ngodya yayikulu pakubowola kupyola pa medial condyle, ndikupangitsa kuti ikhale yosavuta kutsetsereka.
(2) Ngati zomangira za m'mbali mwa mbale zigwira bwino mbali ya mbali ya mbali koma zikulephera kukhazikika bwino, sinthani zomangira zomangira kutsogolo, kulola zomangirazo kuti zilowe m'mbali ya kutsogolo kwa mbale yakumbuyo kuti ikwaniritse bwino kotekisi yapawiri.
(3) Kwa odwala matenda osteoporosis, kulowetsa washer ndi zomangira zamkati kungalepheretse wononga kuti zisadulire fupa.
(4) Zopangira kumapeto kwa mbale zitha kulepheretsa kuyika kwa zomangira zamkati.Ngati wononga wononga wononga mkati mwa zomangira zapakati, lingalirani zochotsa kapena kuyikanso zomangira zakutali za mbale yakumbuyo, ndikuyika patsogolo kuyika kwa zomangira zapakati.
Mlandu 2. Wodwala wamkazi, zaka 76, ndi distal femoral extra-articular fracture.(A, B) Ma X-ray a Preoperative akuwonetsa kusamuka kwakukulu, kupunduka kwa angular, ndi kusuntha kwa ndege ya coronal ya fracture;(C, D) Ma X-ray a Postoperative mu lateral ndi anteroposterior mawonedwe akuwonetsa kukhazikika ndi mbale yakunja yakunja yophatikizidwa ndi zomangira zamkati;(E, F) Kutsatira X-ray pa miyezi ya 7 pambuyo pochita opaleshoni kuwonetsa machiritso abwino kwambiri a fracture popanda zizindikiro za kulephera kwa mkati.
Mlandu 3. Wodwala wamkazi, zaka 70, ndi periprosthetic fracture kuzungulira chikazi implant.(A, B) Ma X-ray asanayambe kuchitidwa opaleshoni akuwonetsa kupasuka kwa periprosthetic mozungulira chiberekero cha chikazi pambuyo pa arthroplasty yonse ya bondo, ndi kupasuka kwapadera ndi kukhazikika kokhazikika kwa prosthetic;(C, D) Ma X-ray a Postoperative akuwonetsa kukhazikika ndi mbale yakunja yakumbuyo yophatikizidwa ndi zomangira zamkati kudzera munjira yowonjezera;(E, F) Kutsatira X-ray pa miyezi ya 6 pambuyo pochita opaleshoni kuwonetsa machiritso abwino kwambiri a fracture, ndi kukonzanso mkati.
Nthawi yotumiza: Jan-10-2024
