3 Txoj Kev Kho Mob Tshiab los hais txog Patella Fractures

Patellar fractures suav txog 1% ntawm tag nrho cov kev raug mob, thiab cov lus qhia tam sim no tau pom zoo cov txheej txheem phais mob rau kev kho cov pob txha yooj yim transverse patellar fractures nrog articular deg tsiv tawm yog qhov nro band hlau (TBW), uas ua raws li cov khoom siv tiv thaiv thaum lub patellar (stretched) nto yog raug khoov quab yuam.

Txawm li cas los xij, qhov teeb meem ntawm cov txheej txheem no suav nrog cov xaim sab hauv kho tsis ua haujlwm, kis kab mob, thiab qhov txhab dehiscence. Tsis tas li ntawd, daim ntawv thov ntawm cov xov hlau ntev tuaj yeem nyuaj heev, tshwj xeeb tshaj yog thaum clipping thiab faus qhov kawg ntawm cov hlau nyob rau hauv lub patellar tendon thiab quadriceps tendon.

Peb tsim 3 cov tswv yim tshiab rau kev kho cov pob txha patella transverse siv tib cov ntaub ntawv raws li tus qauv TBW.

1. daim ntawv thov ntawm daim duab-ntawm-yim hlau nro band tom qab hla-tsav lub kerf pins.

2. longitudinal Kirschner pins thiab nro bands ntawm ob sab ntawm patella.

3. hla Kirschner pins thiab lateral nro straps.

Yog li ntawd, lub hom phiaj ntawm txoj kev tshawb fawb biomechanical no yog los sib piv 3 txoj kev kho tshiab nrog AO tus qauv kub ntawm cov hlau nro banding. 

Peb thawj qhov kev xav yog tias biomechanical kev ncaj ncees ntawm cov qauv siv hla kerf pins yuav tsum tsis txhob deteriorate. Peb qhov kev xav thib ob yog tias TBW sab nraud yuav muaj txiaj ntsig zoo ib yam li tus qauv TBW.

Cov txheej txheem

Qhov yooj yim transverse patellar pob txha tawg tau raug txiav nrog lub pendulum pom, thiab 3 cov tswv yim tshiab tau siv ua ntu zus los cais lub hauv caug kom ntseeg tau tias lawv tuaj yeem tsim tau raws li cov txheej txheem kev nyab xeeb thiab rov tsim dua tshiab raws li tib neeg lub cev (raws li qhia hauv daim duab 2 thiab 3). Txhua tus tau ua tiav tiav. Cov cuab yeej biomechanical tau siv los ntsuas qhov kev ncaj ncees ntawm biomechanical ntawm 3 cov tswv yim tshiab.

Cov txiaj ntsig

Cov txiaj ntsig ntawm txhua qhov kev xeem tau pom nyob rau hauv daim duab 4 thiab 5.

Cov txiaj ntsig tau pom tias qhov kev teeb tsa nrog qhov tsawg tshaj plaws tag nrho cov pob txha tawg qhov sib txawv yog qhov hla hla kerf pins ua ke nrog lateral TBW (Technique 3), nrog rau qhov nruab nrab tawg qhov sib txawv ntawm 0.43 mm (ntau 0.10-0.80 mm) tom qab 100 cycles, zoo hauv qab qhov kev hloov pauv tseem ceeb ntawm 2 mm.

Tus qauv TBW ua ke nrog crossed kerf pins (Technique 1) yog qhov zoo tshaj plaws tom ntej, nrog qhov sib txawv ntawm qhov sib txawv ntawm 0.61 hli (0.06 txog 2.06 hli).

Qhov nruab nrab siv load yog 69.2 N. Tus qauv AO yog qhov phem tshaj plaws, nrog qhov nruab nrab ntawm qhov tawg tawg qhov sib txawv ntawm 1.72 hli (0.47 txog 2.24 hli) thiab qhov nruab nrab siv load ntawm 79.6 N. Tus qauv AO yog qhov phem tshaj, nrog rau qhov kawg ntawm qhov tawg tawg qhov sib txawv ntawm 1.72 mm (0.72 mm).

Nyob rau hauv cov nqe lus ntawm incremental displacements ib lub voj voog, ob qho tib si hla kerf (tsim 1 thiab 3) cov qauv qhia me me txav: 0.27 hli rau ob qho tib si hla kerf qauv nyob rau hauv lub voj voog kawg, piv rau 0.41 hli thiab 0.60 hli rau tus qauv AO thiab cov qauv longitudinal kerf nrog rau sab TBW, feem. Qhov no yog pov thawj hais tias tus ntoo khaub lig kerf qauv muab ntau zog rau lub pob txha tawg nyob rau hauv load Qhov no yog pov thawj ntawm qhov nyuaj dua ntawm qhov tawg qhov sib txawv nyob rau hauv load muab los ntawm crossed Clinch tus pin qauv.

Kev sib tham

Cov txiaj ntsig tau qhia tias kev hloov kho Kirschner tus pin rau hauv tus qauv ntoo khaub lig ntawm cov ntaub so ntswg ib puag ncig, tab sis ua kom nws nyob hauv tib lub dav hlau (xws li, 5 hli tom qab lub ntsej muag ntawm lub ntsej muag ntawm patella), tsis cuam tshuam rau biomechanical kev ncaj ncees, tab sis qhov zoo cuam tshuam rau kev ruaj ntseg ntawm sab hauv pob txha fixation. Piv nrog rau longitudinal kerf pins, cov qauv cruciform zoo li zoo stabilize lub pob txha pob txha tiv thaiv anterior nro thiab yuav ua rau kom cov compressive kev nyuaj siab ntawm articular nto.

Cov ntaub ntawv no txhawb nqa peb thawj qhov kev xav tias hla kyphotic pins tsis yog qhov kev phais mob hnyav dua piv rau longitudinal kyphotic pins, thiab qhov tseeb, ob qho tib si qauv ua tau zoo dua li longitudinal kyphotic pins siv crossed kyphotic pins. Peb qhov kev xav thib ob tseem muaj qhov sib npaug, vim nws tseem tsis tau paub meej los ntawm qhov kev tshawb fawb no seb cov txiaj ntsig ntawm TBW sab nraud puas sib piv rau tus qauv TBW.

Qhov no yog thawj qhov kev tshawb fawb biomechanical los qhia qhov zoo tshaj ntawm AO cov txheej txheem los ntawm tsuas yog rov ntsuam xyuas txoj kev phais rau TBW. Tsis muaj nqi ntxiv thiab cov txheej txheem yuav nrawm dua vim tias qhov yuav tsum tau muaj tsawg dua. Kev siv cov hlais kyphotic pins txo kev puas tsuaj rau cov ntaub so ntswg ib puag ncig (feem ntau yog quadriceps thiab patellar tendons). Tsis tas li ntawd, yog tias cov kws phais mob txhawj xeeb txog qhov zoo ntawm cov ntaub so ntswg npog zoo thiab muaj kev pheej hmoo ntawm kev khaus lossis protrusion ntawm cov hlau sab hauv kho kom zoo, qhov kev tshawb fawb no yuav tsum tau rov hais dua lawv tias tso TBW ntawm ob sab ntawm patella zam qhov no thiab txhim kho tag nrho.

Txoj kev tshawb no qhia tau hais tias ob txoj kev tshiab hla kerf pin cov tswv yim zoo dua rau cov qauv kub tam sim no tau piav qhia los ntawm AO hauv kev kho cov pob txha yooj yim transverse patella.