3 Oprehyɛn akwan foforo a wɔfa so di patella mu akisikuru ho dwuma .

Patellar fractures no yɛ 1% wɔ trauma nsɛm nyinaa mu, na mprempren akwankyerɛ a wɔkamfo kyerɛ sɛ wɔnyɛ oprehyɛn mfa nsa patellar a ɛyɛ mmerɛw a ɛwɔ patellar mu a articular surface displacement yɛ no ne tension band wire (TBW), a ɛyɛ adwuma sɛ antitension device bere a patellar (stretched) no ani yɛ den wɔ tumi a ɛbɔ no ase.

Nanso, ɔhaw ahorow a ɛwɔ saa adeyɛ yi mu no bi ne waya mu fixation huammɔdi, ɔyare mmoawa, ne kuru a ɛyɛ mmerɛw. Nea ɛka ho no, nhama a ɛkɔ akyiri a wɔde di dwuma no betumi ayɛ den yiye, titiriw bere a wɔretwitwa na wɔasie nhama no awiei wɔ patellar ntini ne quadriceps ntini no mu no.

Yɛyɛɛ akwan foforo 3 a yɛde besiesie transverse patella fractures a yɛde nneɛma koro no ara a ɛwɔ TBW a ɛwɔ hɔ no di dwuma.

1. Sɛ wode figure-of-eight wire tension band di dwuma bere a wode cross-driving Kerf pins no ahyɛ mu akyi a.

2. Kirschner pin a ɛyɛ tenten ne nhyɛso a ɛwɔ patella no afanu nyinaa.

3. Kirschner pin a wɔatwa ne akyi nhyɛso ahama.

Enti, na saa biomechanical nhwehwɛmu yi atirimpɔw ne sɛ wɔde akwan foforo 3 a wɔfa so fixation no bɛtoto AO Gold gyinapɛn a ɛfa wire tension banding ho no ho. 

Yɛn adwene a edi kan ne sɛ ɛnsɛ sɛ biomechanical integrity a ɛwɔ structures a wɔde crossed Kerf pins di dwuma no sɛe. Yɛn hypothesis a ɛtɔ so mmienu ne sɛ lateral TBW bɛnya nea ɛfiri mu aba a ɛte sɛ TBW a ɛwɔ hɔ daa no.

Akwan a wɔfa so yɛ adwuma .

Wɔde pendulum saw twaa transverse patellar fracture a ɛyɛ mmerɛw no twaa mu, na afei wɔde akwan foforo 3 no dii dwuma nnidiso nnidiso de tetew nkotodwe mu de hwɛ hui sɛ wobetumi ayɛ no wɔ ɔkwan a egyina hɔ ma ɔkwan a ahobammɔ wom na wotumi san yɛ so a egyina nnipa nipadua so (sɛnea wɔada no adi wɔ Mfonini 2 ne 3 mu no). Wotumi yɛɛ ne nyinaa yiye. Wɔde biomechanical afiri dii dwuma de sɔɔ biomechanical integrity a ɛwɔ akwan foforo 3 no mu hwɛe.

Nsunsuansoɔ

Nea efii sɔhwɛ ahorow no nyinaa mu bae no wɔakyerɛ wɔ Mfonini 4 ne 5 mu.

Nea efii mu bae no kyerɛe sɛ nhyehyɛe a ɛwɔ fracture gap a ɛyɛ ketewaa sen biara no mu no yɛ Kerf pin a wɔatwa no crossed ne lateral TBW (Technique 3), a fracture gap a ɛkɔ fam no yɛ 0.43 mM (range 0.10-0.80 mM) wɔ 100 cycles akyi, a ɛba fam koraa wɔ 2 mM a ɛho hia no ase.

TBW a ɛyɛ gyinapɛn a wɔde Kerf pin a wɔatwa ho ahyia (Technique 1) no ne nea edi hɔ a eye sen biara, a ne mu paapae mu nsonsonoe a ɛda ntam no yɛ 0.61 mm (0.06 kosi 2.06 mm).

Adesoa a wɔde dii dwuma no yɛ 69.2 N. AO gyinapɛn no yɛ nea enye koraa, a nea etwa to a ɛyɛ mmerɛw no mu nsonsonoe a ɛda ntam no yɛ mm 1.72 (0.47 kosi 2.24 mm) na adesoa a wɔde dii dwuma no yɛ 79.6 N. AO gyinapɛn no yɛ nea enye koraa, a nea etwa to a ɛyɛ mpaapaemu a etwa to a ɛyɛ 1.72 mm (0.2.47 mm).

Sɛ yɛhwɛ nkɔanim a ɛkɔ soro wɔ kyinhyia biara mu a, Kerf a wɔatwa (Techniques 1 ne 3) nhyehyɛe abien no nyinaa kyerɛ sɛ ɛpaapae nketenkete: 0.27 mM ma Kerf nhyehyɛe abien no nyinaa wɔ kyinhyia a etwa to no mu, sɛ wɔde toto 0.41 mm ne 0.60 mm ho ma AO a ɛyɛ gyinapɛn ne kerf nhyehyɛe a ɛwɔ lateral TBW, a ɛte saa ara. Eyi yɛ adanse a ɛkyerɛ sɛ Kerf nhyehyɛe a wɔatwa no ma mpaapaemu no yɛ den kɛse wɔ adesoa ase Eyi yɛ adanse a ɛkyerɛ sɛ mpaapaemu no mu nsonsonoe no yɛ den kɛse wɔ adesoa a wɔde ma a wɔde crossed clinch pin nhyehyɛe no ma no ase.

Mpɛnsɛmpɛnsɛmu

Nea efii mu bae no kyerɛ sɛ sɛ wɔsan de Kirschner pin no si hɔ ma ɛyɛ nhyehyɛe a ɛte sɛ mmeamudua a ɛwɔ akyirikyiri fi ntini a ɛyɛ mmerɛw a atwa ho ahyia no ho, nanso sɛ wɔde sie wɔ plane koro no ara mu (kyerɛ sɛ, mm 5 wɔ patella no anim a ɛyɛ kɔntɔnkrɔn no akyi), ɛnka biomechanical integrity no wɔ ɔkwan a enye so, na mmom ɛka sɛnea emu fracture fixation no gyina pintinn no. Sɛ wɔde toto kerf pin a ɛkɔ akyiri ho a, ɛte sɛ nea cruciform nhyehyɛe no ma fracture block no gyina anim nhyɛso no yiye na ebetumi ama nhyɛso a ɛwɔ articular no ani no ayɛ kɛse.

Saa nsɛm yi foa yɛn adwene a edi kan a ɛne sɛ kyphotic pin a wɔatwa no nyɛ oprehyɛn a enye koraa bere a wɔde toto kyphotic pin a ɛkɔ akyiri ho no so, na nokwarem no, nhyehyɛe abien no nyinaa yɛ adwuma yiye sen kyphotic pin a ɛkɔ akyiri a wɔde kyphotic pin a wɔatwa ho ahyia di dwuma no. Yɛn hypothesis a ɛtɔ so mmienu no da so ara kari pɛ, ɛfiri sɛ ɛda so ara yɛ pefee wɔ saa nhwehwɛmu yi mu sɛ ebia nea ɛfiri lateral TBW mu ba no yɛ nea wɔde toto TBW a ɛyɛ gyinapɛn ho anaa.

Eyi ne biomechanical nhwehwɛmu a edi kan a ɛkyerɛ sɛ ɛkorɔn sen AO ɔkwan no denam oprehyɛn kwan a wɔfa so yɛ TBW no a wɔsan susuw ho ara kwa so. Ɛmmɔ foforo biara nni ho na ebia ɔkwan a wɔfa so yɛ no yɛ ntɛmntɛm efisɛ ɛho nhia sɛ wɔde wɔn ho hyɛ mu kakraa bi. Kyphotic pin a wɔatwa a wɔde di dwuma no ma ntini a ɛyɛ mmerɛw a atwa ho ahyia no sɛe (titiriw quadriceps ne patellar tendons). Bio nso, sɛ nnuruyɛfo a wɔyɛ oprehyɛn no dwen sɛnea ntini a ɛyɛ mmerɛw a wɔakata so no te ne asiane a ɛwɔ hɔ sɛ wɔde dade a ɛwɔ anim no bɛhyɛ mu no ho a ɛbɛhyɛ obi abufuw anaasɛ apue a, ɛsɛ sɛ nhwehwɛmu yi ma wɔn awerɛhyem sɛ TBW a wɔde bɛto patella no afã abien no nyinaa no kwati eyi na ɛma fixation no nyinaa tu mpɔn.

Saa nhwehwɛmu yi kyerɛ sɛ Kerf pin akwan foforo abien a wɔatwa no crossed no korɔn sen sika kɔkɔɔ gyinapɛn a mprempren AO no kyerɛkyerɛ mu wɔ patella a ɛyɛ mmerɛw a ɛyɛ mmerɛw no ayaresa mu no.