Izindlela zokuhlinza
Ngemuva kokungeniswa, iziguli zelashwa ngokuhlinzwa okuhleliwe kuye ngesimo.Okokuqala, i-fixator yangaphandle yayilungisiwe, futhi uma izimo zezicubu ezithambile zivunyelwe, zathathelwa indawo ukulungiswa kwangaphakathi.
Ababhali bafingqa isipiliyoni sabo futhi bathola ukuthi isihluthulelo sokunciphisa ukuphuka nokugcinwa kokunciphisa ukunciphisa ukuphuka kwe-cortical posterior ye-tibia kuqala, bese ubhekana nokuphulwa kokucindezela kwe-anterior tibial plateau, ukuze kubuyiselwe indiza ye-sagittal evamile. umugqa.
Ababhali batusa ukusetshenziswa kwe-proximal tibial anterolateral kanye ne-posteromedial izindlela zokunciphisa ukuphuka nokulungiswa.
Indlela ye-posterior tibial ingasetshenziselwa ukuveza isakhiwo sangemuva se-tibia futhi senze ukunciphisa kanye nokulungiswa kwepuleti lokusekela i-anteromedial ngesikhathi sokusebenza.
Ukwengeza, ukulungiswa kwesikhashana kwe-posterior tibial plateau fractures kungase kusebenze njenge-fulcrum yokuphakamisa ukuphuka kwangaphambili nokunciphisa ukuhlukana kwe-fracture ngesikhathi sokulungiswa okulandelayo kokuqondisa kwe-sagittal.
Uma ukuncishiswa kokuphuka kwangemuva sekuqediwe, idivayisi yokulungisa yesikhashana kufanele isetshenziselwe ukulungiswa, njengepuleti leshubhu elingu-1/3 noma isikulufu esingu-3.5mm ukusuka ekugcineni kwe-distal yangaphambili kuya ekugcineni kwe-proximal engemuva.
Okulandelayo, buyisela ukuqondanisa kwe-tibial plateau articular surface kanye nendiza ye-sagittal.Ngesikhathi sokusebenza, sebenzisa idivayisi yokunciphisa enethiphu ebanzi ukuze unciphise ingcindezi futhi ugweme ukungezwani kokuphuka.
Ukubuyiselwa kokuthambekela kwe-posterior tibial kwaqalwa nge-anterior flap spacer noma i-osteotome kanyekanye (Fig. 2).Ngaphansi komugqa ohlangene osondelene, izintambo eziningi ze-Kirschner zafakwa ngokufana ukusuka phambili kuya emuva, futhi i-tibial retroversion yabuyiselwa ngokuphakamisa izintambo ze-Kirschner, bese zilungiswa ku-cortex yangemuva.
I-A- Fibular head autograft;I-B- Spinal Cage egcwalisa ukukhubazeka kwamathambo
I-X-ray yangemuva ibonisa ukukhubazeka kwe-sagittal, futhi ifilimu engenalutho engakwesokudla ibonisa ama-forceps okunciphisa ukunciphisa ukuphuka kwe-posterior tibial ngosizo lwesiphazamisi sesikhala seshidi.
Ekugcineni, ipuleti lasetshenziselwa ukunciphisa isiqeshana sokuphuka ukuze kulungiswe i-sagittal retroversion.Ukuphela okuseduze kwe-proximal lateral tibial plate (ukukhiya noma ukungakhiyi) kufanele kuhambisane nendawo ye-articular, futhi ukuphela kwe-distal kufanele kube ngemuva kancane.Ipuleti laligxiliswe ku-proximal fragment ngezikulufu, bese ipuleti kanye ne-proximal fragment yancishiswa futhi yalungiswa ku-tibial shaft ngokulungisa i-distal plate, ukuze kubuyiselwe ukuthambekela okujwayelekile kwe-tibial posterior.
Uma ukuncishiswa kokuphuka sekuqediwe, ukulungiswa kwesikhashana ngezintambo ze-Kirschner kungasetshenziswa.Kwezinye izimo, ukulungiswa kwesikhashana okuzinzile kunzima ukwenza ngaphandle kokuqala ukubuyisela umugqa wamandla nge-graft (i-tricortical iliac graft, i-fibular head graft, njll.)
Isikhathi sokuthumela: May-09-2022