Karyar tibial, dabarar ƙusa suprapatellar intramedullary

Intramedullary tibial nailing: samun dama da daidaitawa, ciwon gwiwa na gaba

Hanyar tiyata don ƙusa intramedullary na ƙusa tibial yana da mahimmanci don shigar da ƙusa ta ciki ta hanyar shigarwa daidai, don rage lalacewa ga tsarin gwiwa na ciki, da kuma cimma nasarar sake gyara ƙusa mai kyau da kuma shigar da ƙusa mai dacewa.

Hanyoyi na yau da kullun don karaya mai tushe na tibial sune tsaka-tsakin infrapatellar ko infrapatellar parapatellar. Kodayake ana nuna waɗannan hanyoyin don karyewar yanki na tsakiya, valgus na baya, na baya, ko haɗaɗɗen nakasu akai-akai suna faruwa a mafi kusancin karaya.

Babban abin da ke haifar da rashin daidaituwa a cikin ɓarna na tibial na kusa shine nakasar da aka haifar ta hanyar ja da ƙwanƙwasa quadriceps a lokacin ƙwanƙwasa gwiwa da rikici na inji tsakanin tip ƙusa da na baya na tibial cortex a lokacin shigar da shi. Har ila yau, patella yana hana shigar da ƙusa axial a cikin jirgin sama na sagittal (Fig. 1a, b). Sabili da haka, wata hanyar da aka saba amfani da ita don samun dama ga ma'anar ita ce ta hanyar tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsaki, wanda ke haifar da ƙananan tsaka-tsaki zuwa shigar da ƙusa na gefe (Figs. 1c da 2). Yayin da ƙusa ya shiga cikin canal distal na intramedullary zuwa karaya, ɓangaren kusa yana karkata zuwa valgus (Hoto 2). A ƙarshe, kwanciyar hankali na tsokoki na baya na baya yana taimakawa dan kadan zuwa valgus (Hoto 3).

Hoto 1 a,b Yin amfani da tsarin infrapatellar na al'ada, patella yana hana shigarwar axial na ƙusa, wanda ya haifar da nakasar gama gari na alignment apical sagittal alignment da valgus coronal alignment. c Yin amfani da tsarin parapatellar don daidaita ƙusa na intramedullary.

Hoto 2 Kusanci wurin shigarwa ta hanyar tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsaki yana kaiwa zuwa tsaka-tsaki kadan zuwa shigar da ƙusa na gefe. Yayin da ƙusa ya shiga cikin magudanar ruwa na medullary zuwa karaya (a), ɓangaren kusa yana karkata zuwa valgus (b)

Hoto 3 Huta tashin hankali a cikin sashin tsoka na gaba (a) yana haifar da tsari na ectopic na dabara (b)

Ƙunƙarar tibia a cikin wani matsayi mai tsawo yana taimakawa wajen kauce wa rikice-rikicen da ke hade da matsananciyar ƙwanƙwasa gwiwa. An bayyana dabarar ta Gelbke, Jakma et al. a cikin 2010 kuma ya zama sananne a cikin 'yan shekarun nan saboda sanya tibia a kusan matsayi na gaba yana sauƙaƙa magudi da sakewa. Fluoroscopy ya zama sauƙi a fasaha don yin. Lokutan fluoroscopy na ƙusa na suprapatellar an ba da rahoton cewa sun fi guntu sosai fiye da ƙusa infrapatellar. Bugu da ƙari, kusurwar saka ƙusa (a cikin jirgin sama na sagittal) ya fi dacewa da tsayin daka na tibia a cikin wannan hanya fiye da ƙusa infrapatellar; wannan yana hana rikice-rikice na inji tsakanin tip ƙusa da cortex na baya, don haka yana sauƙaƙe raguwa.

Ciwon gwiwa na baya bayan tiyata matsala ce mai alaƙa. An ba da rahoton ciwon gwiwa na baya a cikin 50-70% na marasa lafiya masu rauni, tare da 30% kawai na marasa lafiya suna fama da jin zafi bayan cirewar shuka na ciki. An kiyasta cewa samuwar tabo da ke da alaƙa da samun dama ga tendon patellar da Hoffa fat pad shine yuwuwar tushen ciwon gwiwa bayan tiyata. Bugu da ƙari, tsarin suprapatellar yana guje wa ƙaddamar da al'ada na reshe na reshe na patellar na jijiyar saphenous, ta haka ne ya guje wa ƙwanƙwasa gwiwa na gaba da rashin hankali (Hoto 4). Wucewa ƙusa ta hanyar ƙwanƙwasa quadriceps, ta haka barin jijiyar patellar ba ta da kyau, ya bayyana yana rage yawan ciwon gwiwa bayan tiyata.

Sakamakon sakamako mai kyau na raunin da ya faru na kusa, alamun da aka nuna a cikin aikin asibiti an ƙaddamar da su zuwa duk raguwa.

Yaushe ya kamata a yi amfani da ƙusa intramedullary suprapatellar?

Amfani

• Matsayin da aka kara da shi na rabin-tsawo yana inganta gyaran karaya da kuma sakewa ta hanyar shakatawa da ƙarfin tsoka da riƙewa yayin saka ƙusa.

• Ƙananan haɗari na ɓarna bayan aikin tiyata na kusa, ɓarna da ɓarna mai nisa idan aka kwatanta da fasaha na al'ada.

• Aikin ƙusa yana da sauƙin yi a fasaha

• Shigar ƙusa yana yiwuwa a matsayin 'hanyar likitan fiɗa ɗaya'

• Rage lokacin fluoroscopy

• Babu lalacewa ga tendon patellar da ƙananan abin da ya faru na ciwon gwiwa na baya bayan stapling

• Mafi sauƙin yin aiki a cikin tsarin ƙungiyoyi da yawa, kamar a cikin rauni da yawa

  
  

Alamu

• Karaya mai ƙarfi na tibia na kusa (nau'in AO 41A)

• Sauƙaƙan karaya na diaphysis tibial (nau'in AO 42A-C)

• Yanke tibial diaphyseal fracture (nau'in AO 42C)

• Rarrabuwar tibial extra-articular fractures da sassauƙan karaguwar intra-articular distal tsawo karaya (nau'ikan AO 43A da C1)

• Gwiwa mai iyo

• Ossification na patellar tare da ossification na tendon patellar

• gurɓataccen rauni a matakin jijiya na patellar

Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?

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