Kuvunika kwa Tibial, suprapatellar intramedullary tekinike yo gutera imisumari

Intambedullary tibial imisumari: kugera no guhuza, kubabara ivi imbere

Uburyo bwo kubaga uburyo bwo gutera imisumari yimitsi ya tibial ni ngombwa kugirango winjize umusumari winjiye unyuze aho winjirira neza, kugirango ugabanye ibyangiritse ku mavi yimbere yimbere, kandi bigere no kuvunika neza no kwinjiza imisumari.

Uburyo bwa kera bwo kuvunika tibial stem ni infrapatellar median cyangwa infrapatellar parapatellar. Nubwo ubu buryo bwerekanwe kumeneka yo hagati, valgus nyuma yibikorwa, imbere, cyangwa ubumuga bwahujwe bikunze kugaragara mubice byinshi byegeranye.

Impamvu nyamukuru itera malaignment mu kuvunika kwa tibial hafi ni ubumuga buterwa no gukurura tendon ya quadriceps mugihe cyo guhindagurika kw'ivi hamwe namakimbirane yubukanishi hagati yimisumari na cortex yinyuma mugihe cyo kuyinjiza. Patella irinda kandi imisumari ya axial kwinjira mu ndege ya sagittal (Ishusho 1a, b). Kubwibyo, ubundi buryo busanzwe bwo kugera kuri iyo ngingo ni ukunyura hagati ya parapatellar yo hagati, biganisha ku gipimo gito cyo kwinjiza imisumari (Ishusho 1c na 2). Mugihe umusumari winjiye mu muyoboro winjiye kure cyane yo kuvunika, igice cyegeranye kijya muri valgus (Ishusho 2). Hanyuma, impagarara zo kuruhuka imitsi yimbere igira uruhare runini kuri valgus (Ishusho 3).

Igishushanyo 1 a, b Ukoresheje uburyo busanzwe bwa infrapatellar, patella irinda kwinjiza imisumari yumusumari, bikavamo ubumuga busanzwe bwo guhuza imbere ya apical sagittal ihuza na valgus coronal ihuza. c Gukoresha uburyo bwa parapatellar kugirango uhuze imisumari.

Igishushanyo cya 2 Kwegera aho winjirira unyuze hagati ya parapatellar iganisha kumurongo muto ugana imisumari kuruhande. Mugihe umusumari winjiye mumuyoboro wa medullary uri kure kuvunika (a), igice cyegeranye kijya muri valgus (b)

Igishushanyo cya 3 Kuruhura impagarara imbere yimitsi yinyuma (a) itanga gahunda ya ectopique yoroheje (b)

Gutera tibia mumwanya muremure bifasha kwirinda ingorane zijyanye no guhindagurika kw'ivi rikomeye. tekinike yasobanuwe na Gelbke, Jakma n'abandi. muri 2010 kandi yarushijeho kumenyekana mumyaka yashize kuko gukubita tibia mumwanya ugororotse hafi yingingo byoroshe kuvunika no guhinduranya. Fluoroscopy yoroshye mubuhanga gukora. Ibihe bya Fluoroscopy kumisumari ya suprapatellar byavuzwe ko ari bigufi cyane ugereranije na infrapatellar. Byongeye kandi, inguni yo kwinjiza imisumari (mu ndege ya sagittal) irasa cyane na axe ndende ya tibia muri ubu buryo kuruta mu musumari wa infrapatellar; ibi birinda amakimbirane hagati yimisumari na cortex yinyuma, bityo bikagabanya kuvunika.

Kubagwa nyuma yo kubaga ivi imbere ni ikibazo gifitanye isano. Ububabare bw'ivi bw'imbere bwagaragaye kuri 50-70% by'abarwayi bavunitse, aho 30% by'abarwayi bonyine bafite ububabare nyuma yo gukuraho igihingwa cy'imbere. Bigereranijwe ko inkovu zifitanye isano no kugera kuri patellar tendon hamwe na Hoffa ibinure bishobora kuba intandaro yo kubabara ivi nyuma yo kubagwa. Byongeye kandi, uburyo bwa suprapatellar bwirinda gutemwa gakondo kwishami ryishami rya patellar ryumutima wa saphenous, bityo ukirinda kunanirwa ivi ryimbere no kutumva neza (Ishusho 4). Kunyuza umusumari unyuze muri quadriceps, bityo ugasiga imitsi ya patellar idahwitse, bigaragara ko bigabanya cyane umuvuduko wububabare bwamavi nyuma yo kubagwa.

Bitewe nibisubizo byiza byavunitse byegeranye, ibimenyetso mubikorwa byubuvuzi byageze no kumeneka yose.

Ni ryari hagomba gukoreshwa umusumari wa suprapatellar intramedullary?

Ibyiza

• Umwanya urambuye wamavi utera kuvunika no guhinduranya muguhindura imbaraga imitsi no kugumana mugihe cyo kwinjiza imisumari

• Ibyago bike byo kwimurwa nyuma yibikorwa byavunitse byegeranye, igice kimwe na kure ugereranije nubuhanga busanzwe

• Gukora imisumari biroroshye gukora

• Kwinjiza imisumari birashoboka nka 'uburyo bumwe bwo kubaga '

• Kugabanya igihe cya fluoroscopi

• Nta kwangirika kw'imitsi ya patellar hamwe no kugabanuka kwa nyuma yo kubabara ivi ryimbere

• Byoroshye gukora muburyo bwitsinda ryinshi, nko mubihahamuka byinshi

  
  

Ibyerekana

• Kuvunika birenze urugero bya tibia yegeranye (ubwoko bwa AO 41A)

• Kuvunika byoroheje bya diaphysis ya tibial (ubwoko bwa AO 42A-C)

• Igice cya tibial diaphyseal kuvunika (ubwoko bwa AO 42C)

• Tibial tibial extra-articular ivunika hamwe byoroheje byimbere-articular ivunika ryagutse (ubwoko bwa AO 43A na C1)

• Amavi areremba

• Patellar ossification hamwe na patellar tendon ossification

• Igikomere cyanduye kurwego rwa patellar tendon

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