Kuphulika kwa mapiri a Tibial pamodzi ndi fractures ya ipsilateral tibial shaft fractures nthawi zambiri kumawoneka kuvulala kwamphamvu kwambiri, ndi 54% kukhala fractures yotseguka.Kafukufuku wam'mbuyo adapeza kuti 8.4% ya fractures ya tibial plateau imagwirizanitsidwa ndi fractures ya tibial shaft fractures, pamene 3.2% ya odwala a tibial shaft fracture ali ndi concomitant tibial plateau fractures.Zikuwonekeratu kuti kuphatikiza kwa ipsilateral tibial plateau ndi shaft fractures si zachilendo.
Chifukwa cha mphamvu zambiri zovulala zoterezi, nthawi zambiri pamakhala kuwonongeka kwakukulu kwa minofu yofewa.Mwachidziwitso, mbale ndi wononga dongosolo ali ndi ubwino mu fixation mkati kwa fractures kumapiri, koma ngati minofu yofewa m'deralo akhoza kulekerera fixation mkati ndi mbale ndi wononga dongosolo ndi kuganiziranso zachipatala.Choncho, pakali pano pali njira ziwiri zomwe zimagwiritsidwa ntchito pokonzekera mkati mwa tibial plateau fractures kuphatikizapo tibial shaft fractures:
1. Njira ya MIPPO (Minimally Invasive Plate Osteosynthesis) yokhala ndi mbale yayitali;
2. Msomali wa intramedullary + wononga.
Zosankha zonse ziwirizi zikufotokozedwa m'mabuku, koma pakali pano palibe mgwirizano womwe uli wapamwamba kapena wotsika potengera kuchuluka kwa machiritso a fracture, nthawi ya machiritso a fracture, kuyanjanitsa kwa miyendo yapansi, ndi zovuta.Pofuna kuthana ndi zimenezi, akatswiri a pachipatala cha payunivesite ya ku Korea anachita kafukufuku woyerekezera.
Phunziroli linaphatikizapo odwala 48 omwe ali ndi tibial plateau fractures kuphatikizapo tibial shaft fractures.Pakati pawo, milandu ya 35 inathandizidwa ndi njira ya MIPPO, ndikuyika pambali mbale yachitsulo kuti ikonzedwe, ndipo milandu 13 inachitidwa ndi zomangira zamapiri kuphatikizapo njira ya infrapatellar yokonza misomali ya intramedullary.
▲ Mlandu 1: Lateral MIPPO zitsulo mbale mkati fixation.Mnyamata wina wazaka 42, yemwe adachita ngozi ya galimoto, adapatsidwa fracture yotseguka ya tibial shaft (mtundu wa Gustilo II) ndi concomitant medial tibial plateau compression fracture (mtundu wa Schatzker IV).
▲ Mlandu 2: Tibial plateau screw + suprapatellar intramedullary msomali mkati.Mnyamata wina wazaka 31, yemwe adachita ngozi ya galimoto, adapatsidwa fracture yotseguka ya tibial shaft (mtundu wa Gustilo IIIa) ndi concomitant lateral tibial plateau fracture (Schatzker I type).Pambuyo pakuwonongeka kwa chilonda ndi chithandizo choyipa cha bala (VSD), balalo lidalumikizidwa pakhungu.Zomangira ziwiri za 6.5mm zidagwiritsidwa ntchito kuchepetsa ndi kukonza phirilo, ndikutsatiridwa ndi intramedullary misomali ya tibial shaft kudzera njira ya suprapatellar.
Zotsatira zimasonyeza kuti palibe kusiyana kwakukulu pakati pa njira ziwiri zopangira opaleshoni ponena za nthawi ya machiritso a fracture, mlingo wa machiritso a fracture, kugwirizanitsa miyendo yapansi, ndi zovuta.
Mofanana ndi kuphatikizika kwa tibial shaft fractures ndi fractures ya ankle fractures kapena femoral shaft fractures ndi khosi lachikazi la khosi, kuphulika kwamphamvu kwa tibial shaft fractures kungayambitsenso kuvulala kwa mawondo oyandikana nawo.Muzochita zachipatala, kupewa matenda olakwika ndikofunikira kwambiri pakuzindikira komanso kuchiza.Kuphatikiza apo, pakusankha njira zokonzera, ngakhale kafukufuku wapano akuwonetsa kuti palibe kusiyana kwakukulu, pali mfundo zingapo zofunika kuziganizira:
1. Pazochitika za comminuted tibial plateau fractures komwe kuphweka kwa screw fixation kumakhala kovuta, chofunika kwambiri chikhoza kuperekedwa kugwiritsa ntchito mbale yayitali yokhala ndi MIPPO fixation kuti ikhazikitse bwino chigawo cha tibial, kubwezeretsa kugwirizanitsa pamwamba ndi kutsika kwa miyendo.
2. Pazochitika zosavuta za tibial plateau fractures, pansi pa zowonongeka pang'ono, kuchepetsa kogwira mtima ndi kukonza screw kungatheke.Zikatero, kuyenera kuperekedwa patsogolo pakukonza misomali ndikutsatiridwa ndi suprapatellar intramedullary nail fixation ya tibial shaft.
Nthawi yotumiza: Mar-09-2024
