3 Oprehyɛn Akwan Foforo a Wɔfa so Di Patella a Mpaapae Ho Dwuma

Patellar fractures yɛ 1% wɔ adwenemhaw nyinaa mu, na mprempren akwankyerɛ a ɛkamfo oprehyɛn kwan a wɔfa so sa transverse patellar fractures a ɛnyɛ den a articular surface displacement ne tension band wire (TBW), a ɛyɛ adwuma sɛ antitension device bere a wɔde patellar (stretched) surface no hyɛ tumi a ɛkotow ase.

Nanso, nsɛnnennen a ɛwɔ saa adeyɛ yi mu ne waya a wɔde hyɛ mu a entumi nyɛ adwuma yiye, ɔyare mmoawa, ne kuru a ɛpaapae. Nea ɛka ho no, nhama a ɛtrɛw a wɔde bedi dwuma no betumi ayɛ den yiye, titiriw bere a wɔretwitwa nhama no awiei na wɔasie wɔ patellar tendon ne quadriceps tendon no mu no.

Yɛyɛɛ akwan foforo 3 a yɛde besiesie transverse patella fractures denam nneɛma koro no ara a yɛde yɛ standard TBW no so.

1. wɔde waya tension band a ɛyɛ figure-of-eight di dwuma bere a wɔde cross-driving kerf pins no awie no.

2. Kirschner pin a ɛyɛ tenten ne tension bands a ɛwɔ patella no afã abien no nyinaa.

3. atwa Kirschner pin ne afã a ɛtwetwe nhama.

Enti, na biomechanical nhwehwɛmu yi botae ne sɛ ɛde fixation akwan foforo 3 bɛtoto AO sika kɔkɔɔ gyinapɛn a ɛfa wire tension banding 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 adwene a ɛto so abien ne sɛ lateral TBW benya nea efi mu ba a ɛte sɛ TBW a wɔtaa de di dwuma no.

Akwan a wɔfa so yɛ

Wɔde pendulum saw twaa transverse patellar fracture a ɛnyɛ den no, 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 a egyina nnipa nipadua so (sɛnea wɔada no adi wɔ Mfonini 2 ne 3 mu no). Wotumi yɛɛ ne nyinaa yiye. Wɔde biomechanical device dii dwuma de sɔɔ biomechanical integrity a ɛwɔ akwan foforo 3 no mu hwɛe.

Nsunsuansoɔ

Wɔakyerɛ nea efii sɔhwɛ ahorow no nyinaa mu bae wɔ Mfonini 4 ne 5 mu.

Nea efii mu bae no kyerɛe sɛ Nsiesiei a ɛwɔ mpaapaemu kwan a ɛdannan nyinaa ketewaa bi ne crossed kerf pins a wɔaka abom ne lateral TBW (ɔkwan 3), a ɛwɔ mpaapaemu gap a ɛkɔ soro 0.43 mm (range 0.10-0.80 mm) wɔ 100 cycles akyi, a ɛba fam koraa sen displacement a ɛho hia a ɛyɛ 2 mm.

TBW a wɔahyɛ da ayɛ a wɔde abɔ mu ne crossed kerf pins (ɔkwan 1) no ne nea edi hɔ a eye sen biara, a ɛwɔ fracture gap displacement a ɛyɛ 0.61 mm (0.06 kosi 2.06 mm).

Adesoa a wɔde dii dwuma no yɛ 69.2 N. AO gyinapɛn no na ɛyɛ bɔne sen biara, na abubuw a etwa to no mu nsonsonoe yɛ mm 1.72 (0.47 kosi 2.24 mm) na adesoa a wɔde dii dwuma no yɛ 79.6 N. AO gyinapɛn no na enye koraa, na mpaapaemu kwan a etwa to a ɛkɔ baabi foforo yɛ mm 1.72 (0.47 kosi 2.24 mm).

Wɔ nkɔanim a ɛkɔ soro wɔ kyinhyia biara mu no, kerf a wɔatwa (kwan 1 ne 3) nhyehyɛɛ mmienu no nyinaa kyerɛ nsunsuansoɔ nketewa: 0.27 mm ma kerf nhyehyɛɛ mmienu a wɔatwa no nyinaa wɔ kyinhyia a ɛtwa toɔ no mu, sɛ wɔde toto 0.41 mm ne 0.60 mm ma standard AO ne longitudinal kerf structure a ɛwɔ lateral TBW, sɛdeɛ ɛteɛ biara. eyi yɛ adanse a ɛkyerɛ sɛ kerf nhyehyɛe a wɔatwa no ma ɛyɛ den kɛse ma mpaapaemu a ɛwɔ adesoa ase Eyi yɛ adanse a ɛkyerɛ sɛ mpaapaemu kwan a ɛwɔ adesoa ase no yɛ den kɛse a Clinch pin nhyehyɛe a wɔatwa no de ama no.

Mpɛnsɛmpɛnsɛmu

Nea afi mu aba no kyerɛ sɛ Kirschner pin no a wɔsan de kɔ baabi a ɛte sɛ mmeamudua a ɛwɔ akyirikyiri fi ntini a ɛyɛ mmerɛw a atwa ho ahyia no ho, nanso sɛ wɔma ɛkɔ so tra wimhyɛn koro no ara mu (kyerɛ sɛ, mm 5 wɔ patella no anim a ɛyɛ kurukuruwa no akyi), nnya biomechanical integrity no so nkɛntɛnso bɔne, na mmom ɛka sɛnea emu abubuw a wɔde si hɔ no gyina pintinn no so nkɛntɛnso pa. Sɛ wɔde toto longitudinal kerf pins ho a, ɛte sɛ nea cruciform structure no ma fracture block no gyina yiye wɔ anterior tension ho na ebetumi ama compressive stress 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 sɛ wɔde toto kyphotic pin a ɛkɔ akyiri ho a, na nokwarem no, nhyehyɛe abien no nyinaa yɛ adwuma yiye sen kyphotic pin a ɛtrɛw a wɔde kyphotic pin a wɔatwa so di dwuma no. Yɛn adwene a ɛtɔ so mmienu no da so ara kari pɛ, ɛfiri sɛ ɛda so ara yɛ nea ɛnyɛ nea ɛda adi pefee wɔ 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 kwan no denam oprehyɛn kwan a wɔfa so yɛ TBW a wɔsan susuw ho ara kwa no so. Wɔmmɔ ka foforo biara na ebia ɔkwan a wɔfa so yɛ no bɛyɛ ntɛmntɛm efisɛ ɛho nhia sɛ wɔde wɔn ho hyɛ mu kakraa bi. Kyphotic pin a wɔatwa ho ahyia a wɔde di dwuma no brɛ ntini a ɛyɛ mmerɛw a atwa ho ahyia (titiriw quadriceps ne patellar tendons) a ɛsɛe no ase. Afei nso, sɛ nnuruyɛfo a wɔyɛ oprehyɛn no dwen sɛnea ntini a ɛyɛ mmerɛw a wɔakata so no ye ne asiane a ɛwɔ hɔ sɛ ɛbɛhyɛ dade a ɛwɔ anim no mu abufuw anaasɛ ɛbɛpue a, ɛsɛ sɛ nhwehwɛmu yi ma wɔn awerɛhyem sɛ sɛ wɔde TBW no si akyi berɛmo no afã abien no nyinaa a, ɛkwati eyi na ɛma ntini a wɔde si hɔ no nyinaa tu mpɔn.

Saa nhwehwɛmu yi kyerɛ sɛ crossed kerf pin akwan foforo abien korɔn sen sika kɔkɔɔ gyinapɛn a mprempren AO ka ho asɛm wɔ transverse patella fractures a ɛnyɛ den no ayaresa mu.