Njira ya suprapathellar ndi njira yosinthira opaleshoni ya tibial intramullalry msomali wa bondo la bondo. Pali maubwino ambiri, komanso zovuta, zoti achite msomali zamkati za tibia kudzera pagawo la suprapethellar mu Halsux Vegus. Madokotala ena amazoloweredwa kugwiritsa ntchito span kuti azitha kuchitira ma tibial othamanga okha kupatula mitundu yowonjezera ya proximal 1/3 ya tibia.
Zizindikiro za SPN ndi:
1. Okhazikika kapena ojambula a TIBM. 2;
2. Makonda a Tibraal Tibraysyssis;
3. Kuwonongeka kwa m'chiuno kapena bondo ndi malire omwe ali ndi chisanachitike (mwachitsanzo, cholumikizira cha m'chiuno kapena chofufumitsa, chiuno (mwachitsanzo, kusataya kwa hipsieral femur);
4. TIBAL Frant yophatikizidwa ndi kuvulala kwa khungu ku tendon ya infrapatellar;
5.
Ubwino wa bondo la bondo la intradellallary intramululary njira yochizira pakati pa tibial diaphys ndi ma Tibial Tibrape mu kuphweka kokhazikika pokonzanso komanso kumasuka kwa fluoroscopy. Njira imeneyi imalola kuthandizidwa ndi kutalika kwathunthu kwa kuchepa kwa tibia komanso kusamva kosavuta kwa kuwonongeka popanda kusowa kwa kupukusa (mafiko 1, 2). Izi zimathetsa kufunika kwa wothandizira wophunzitsidwa bwino kuti athandizire ndi njira ya misomali yachikazi.
Chithunzi 1: Malo omwe ali pachiwopsezo cha intradellallary ya njira ya infrapathellar: bondo ili mu mawonekedwe osinthika pa fluorsoscial itatud yokhazikika. Komabe, izi zitha kukulitsa kusinthika kosagwirizana ndi chotchinga cha kuwonongeka ndipo pamafunika njira zochepetsera zochepetsera.
Chithunzi 2: Mosiyana ndi izi, malo owombera bondo okwera pachitsamba amathandizira kusinthika kotchire komanso kupumira kotsatira.
Njira Zopaleshoni
Gome / Maudindo wodwalayo agona mu supine malo pa bedi la fluoroscopic. Tsoka lotsika limatha kuchitidwa, koma sichofunikira.ngalume yaukadaulo imayenereratu ya taprapethellar kuyandikira timphal intradellal, koma sikofunikira. Komabe, kuwongolera mabedi kapena mabedi a fluoroscopic sikulimbikitsidwa chifukwa sioyenera kulowera kwa subial intramial intravellary msomali.
Kuyendetsa ntchafu ya ipsilateral kumathandizira kuti kutsikira kumalire kunja kwa malo akunja. Chotsamwa chosabala chimagwiritsidwa ntchito kukweza dzanja lomwe lakhudzidwa pamwambapa la ma flutrocrat fluoroscopy, komanso mawonekedwe a m'chiuno ndi bondo Kutalika kwa bondo mobwerezabwereza kumatsutsanabe, ndi BEltran et al. Kufotokozera 10 ° bondo lamoto ndi Kubiak akuwonetsa 30 ° bondo. Ophunzira ambiri amavomereza kuti kusinthana kwa bondo mkati mwa magawowa ndikovomerezeka.
Komabe, chakum'mawa et al. adapeza kuti ngati bondo Chifukwa chake, bondo lalikulu limathandizanso kusankha malo olondola a intradellal a intravedullary ndikuwongolera zotumphukira zamphamvu mu ndege ya sagittal.
Fluoroscopy
Makina a C-ART ayenera kuyikidwa mbali ina ya patebulopo kuchokera ku miyendo yomwe yakhudzidwayo, ndipo ngati dokotalayo ayimirira pambali ya bondo lazida, kuwunika kuyenera kukhala pamutu wa makina a C-ARMS ndikuyandikira. Izi zimapangitsa kuti dokotala wa opaleshoni ndi ma radiologine ayang'ane mosavuta wolowerera, kupatula pomwe msomali wolumikizirana wolusa uyenera kuyikidwa. Ngakhale osavomerezeka, olembawo amalimbikitsa kuti C-mkono usunthire mbali yomweyo ndipo dokotalayo adapita mbali ina pomwe chikwangwani cholumikizira cha Medial chikayendetsedwa. Kapenanso, makina a C-ARM kuti aikidwe mbali yomwe yakhudzidwayo pomwe dokotalayo akuchita njirayi kumbali ya contallal (Chithunzi 3). Umu ndi momwe olemba amagwiritsidwira ntchito kwambiri ndi olemba chifukwa amapewa kufunika kwa dokotala wa opaleshoni kuti asasunthire kuchokera kumbali yam'manja mpaka poyendetsa msomali wotseka.
Chithunzi 3: Dokotalayo amayimirira mbali ina ya Tibia kuti chipinda cholumikizira cha Medial chitha kuthamangitsidwa mosavuta. Chiwonetserocho chimapezeka moyang'anizana ndi dokotala, pamutu pa mkono.
Onse a anteroproteoteo donacoo doncooscopic malingaliro amapezeka osasuntha miyendo yomwe yakhudzidwayo. Izi zimapewa kusamutsidwa kwa malo osokoneza bongo omwe amakonzedwanso asanakonzedwe kwathunthu. Kuphatikiza apo, zithunzi za kutalika kwathunthu kwa tibia zimatha kupezeka popanda kukakamira cr mkono ndi njira yomwe tafotokozera pamwambapa.
Khungu likuwoneka bwino komanso lotalikirana moyenera ndizoyenera. Njira ya Percupatel Poprapathellar ya msomali wa intradellal ya intradellal amatengera kugwiritsa ntchito 3-cm sturvior kuyendetsa msomali. Ambiri mwa opaleshoni iyi ndi nthawi yayitali, koma amathanso kukhala otchinga, monga momwe amalimbikitsira Dr. Moranetta ndi ena omwe amagwiritsidwa ntchito ndi njira yophatikizira kapena yofananira. Chithunzi 4 chikuwonetsa zovuta zosiyanasiyana.
Chithunzi 4: Chithunzi cha ziwonetsero zosiyanasiyana za opaleshoni.1- Suprapathellar Treppellar Misempha; 2- Pa paraphellar Miseme; 3- Malire ochepa okhazikika a Parapatellar Mitundu; 4- Kutali kwa nthawi yayitali kwa Parapatellar kusintha; 5- Kuwonetsedwa mwakuya kwa njira yoyambira ku Parapatellar kungakhale kudzera mu gawo limodzi kapena kunja kwa Jorsa.
Kuwonekera Kwambiri
Njira ya Percpepelaous suprapethelar imachitika chifukwa cholekanitsa utoto wa Quadrice mpaka kusiyana kwa zida monga gawo la zida monga misomali intervedullary. Njira yofunika kwambiri ya parapatel, yomwe imadutsa pafupi ndi minofu ya quadriceps, itha kuwonetsedwanso ndi luso la tibial intramululary. Chovala cham'madzi cham'madzi cham'madzi cham'madzi chimadutsa mosamala kudzera pa tentlofom, njira yomwe imatsogolera malo olowera kwambiri a tibial intramial intramullal miyala yam'madzi. Trocar akangoyikidwa bwino, ziyenera kukhala zotetezedwa m'malo kuti zisawonongeke pa cartilage ya bondo.
Njira yayikulu yolowera imatha kugwiritsidwa ntchito molumikizana ndi khungu la hyperextlantral pakhungu, kapena njira imodzi kapena njira yofananira. Ngakhale madokotala ena osachita opaleshoni sasunga Bursa Hintractractriment, Kubiak et al. Khulupirirani kuti Bursa iyenera kusungidwa mosamalitsa komanso zowonjezera zomwe zikuyenera kuwonekera bwino. Mwachizolowezi, izi zimapereka chitetezo chabwino kwambiri cha bondo ndipo chimalepheretsa kuwonongeka ngati matenda a bondo.
Njira yomwe tafotokozazi imaphatikiziranso mikata ya hemi, yomwe imachepetsa kukakamiza kwa kulumikizana kwamphamvu. Zikakhala zovuta kuchita kuyeserera kwa Patelofelal kolowera ndi gawo laling'ono komanso chipangizo chokwanira kwambiri, olembawo amalimbikitsa kuti patella ikhale yolumikizidwa ndi yogawanika. Kutanthauzira kwa pakati pa pakati, kumbali inayo, kupewa kuwonongeka kwa zingwe zothandizira, koma zimakhala zovuta kuchita bwino kwambiri.
Mfundo za SPN siyilowelo yolowera ndizofanana ndi za njira ya infrapatellar. Kunja ndi ma fluoroscopy pa singano ikuluikulu kumatsimikizira kuti malo osowa singano ndi olondola. Dokotalayo akuyenera kuwonetsetsa kuti singano yowongolera siyikuyendetsedwa kutali kwambiri mu proximal tibia. Ngati ikuyendetsedwa mofulumira, iyenera kuyikidwanso mothandizidwa ndi msomali wobowoleza pansi pa coronal corooroscopy. Kuphatikiza apo, chakum'mawa et al. Khulupirirani kuti kubowola pini yolowera kutchulidwa kosinthika kwa bondo la Edzi mu rectopture reportires.
Zida Zotsitsa
Zida Zothandiza pakuchepetsa ndizomwe zimachepetsa mphamvu ya kukula kwamitundu yosiyanasiyana, zida zamagetsi zakunja, zida zakuda zakunja, ndi zokongoletsera zamkati zowoneka bwino ndi mbale imodzi yokha. Kutsetserera misomali kumatha kugwiritsidwanso ntchito pazomwe tafotokozazi. Hambi yochepetsa imagwiritsidwa ntchito kukonza zolakwika za sagital komanso zosokoneza.
Zoikapo
Opanga ambiri opanga ma Orthopdic amkati apanga zida zogwiritsira ntchito mankhwala kuti azitsogolera kuyika kwa tinramial intravellary misomali. Zimaphatikizanso mkono wotalikirapo, chipangizo chowongolera chipika chowongolera, komanso chowonjezera cha hadullary. Ndikofunikira kuti ma trocar atseke ndi a Blunt a Trunt atetezedwe otetezera a intravedullary. Dokotalayo akuyeneranso kuyanjana ndi cannula kotero kuti kuvulaza molumikizana ndi matelofoltural kapena mapangidwe a periartular chifukwa choyandikira kwambiri pa chipangizo choyendetsa sichimachitika.
Kutseka zomangira
Dokotalayo akuyenera kuwonetsetsa kuti kuchuluka kokhotakhota kumayikidwa kuti zizichepetsa. Kukonzekera kwa zidutswa zazing'ono (proximal kapena kusokonekera) kumakwaniritsidwa ndi zomangira zitatu kapena zingapo zotsekera pakati pa zidutswa zoyandikana, kapena ndi ma scress okhazikika okha. Njira ya TIBRAPERLARD Kufikira Trial intramial intramil, yofanana ndi njira yofananira ndi njira yoyeserera njira yoyendetsa. Zojambula zotsekemera zimayendetsedwa molondola mu fluoroscopy.
Kutseka kwa mabala
Kuyamwa ndi malo oyenera nthawi yanthawi ya dilatation kumachotsa mafupa aulere. Mabala onse ayenera kuthiriridwa bwino, makamaka opaleshoni. Teseji ya quadriceps kapena malowa wosanjikiza ndipo suluzi pamalopo pamtambo amatsekedwa, kutsatiridwa ndikutsekedwa kwa ma dermis ndi khungu.
Kuchotsa msomali wa intradellallary
Kaya tibial intramillallary mitambo yoyendetsedwa kudzera mu suprapethellar njira yomwe ingachotsedwe mwa opaleshoni yosiyanasiyana imakhala yotsutsana. Njira yofala kwambiri ndi njira yofikira Suprapetellar njira ya intravedillary. Njirayi imawulula msomali pobowola kudzera mu suprapetellar intravellary mutu pogwiritsa ntchito ma 5.5 mm roblow. Chida chochotsa msomali chimayendetsedwa kudzera mu njira, koma kuyenda uku kungakhale kovuta. Njira zam'madzi ndi infrapather ndi njira zina zochotsa misomali ya intravelallary.
Kuopsa kwa opaleshoni ya njira ya suprapathellar kupita ku ma trial a intramul a intradellallar ndi kuvulaza azachipatala ndi cartilage ku Patullant, kuvulaza kwamankhwala, matenda a intra-articular, ndi zinyalala za intra-articular. Komabe, pali kusowa kolingana kofananira kwa matenda. Odwala ndi chondromaalacia azikhala okonda kuyika ma cartilage omwe amavulala. Kuwonongeka Kwachipatala kwa Patallar ndi zodzikongoletsera zamitundu yamanjenje ndizofunika kwambiri kwa opaleshoni pogwiritsa ntchito njirayi, makamaka njira yoyeserera.
Mpaka pano, palibe umboni wa zipatala pazabwino ndi zovuta za sebial tibial intradellary njira.
Post Nthawi: Oct-23-2023
