3 Nzira Itsva dzekuvhiya dzeKugadzirisa Patella Fractures

Patellar fractures account ye 1% yezviitiko zvese zvekushungurudzika, uye nhungamiro yemazuva ano inokurudzirwa kuvhiyiwa kwekurapa kweiyo nyore transverse patellar fractures ine articular surface displacement ndiyo tension band wire (TBW), iyo inoshanda senge antitension mudziyo apo patellar (yakatambanudzwa) pamusoro inoiswa pasi pekukotama masimba.

Nekudaro, matambudziko eiyo maitiro anosanganisira waya yemukati kugadzirisa kutadza, kutapukirwa, uye ronda dehiscence. Mukuwedzera, kushandiswa kwetambo dzelongitudinal kunogona kuva kwakaoma zvikuru, kunyanya pakucheka uye kuviga kuguma kwetambo mu patellar tendon uye quadriceps tendon.

Isu takagadzira 3 nzira nyowani dzekugadzirisa dzakachinjika patella fractures tichishandisa zvinhu zvakafanana seyakajairwa TBW.

1. kushandiswa kwechimiro-ye-eight waya tension bhendi mushure mekuyambuka-kutyaira mapini kerf.

2. longitudinal Kirschner pini uye tension mabhendi pamativi ese e patella.

3. akayambuka mapini eKirschner uye lateral tension tambo.

Naizvozvo, chinangwa chechidzidzo ichi chebiomechanical chaive chekuenzanisa nzira nhatu dzekugadzirisa neAO goridhe mwero wewaya tension banding. 

Yedu yekutanga fungidziro yaive yekuti iyo biomechanical kuvimbika kwezvivakwa zvinoshandisa yakayambuka kerf pini haifanire kuderera. Yedu yechipiri hypothesis yaive yekuti lateral TBW yaizove nemhedzisiro yakafanana kune yakajairwa TBW.

Nzira

The simple transverse patellar fracture yakaderedzwa nependulum saw, uye 3 nzira itsva dzakabva dzashandiswa sequentially kuti dziparadzanise mabvi kuti dzive nechokwadi chokuti dzinogona kuvakwa nenzira yaimiririra nzira yakachengeteka uye inobereka maererano nehupenyu hwevanhu (sezvinoratidzwa muMifananidzo 2 uye 3). Zvose zvakabudirira. A biomechanical mudziyo wakashandiswa kuyedza iyo biomechanical kuvimbika kweatatu maitiro matsva.

Results

Mibairo yebvunzo dzese inoratidzwa muFigure 4 ne5.

Mhedzisiro yacho yakaratidza kuti Iyo gadziriso ine diki diki yakazara gap gap displacement yaive yakayambuka kerf pini yakasanganiswa ne lateral TBW (tekiniki 3), ine chirevo chekutsemuka gap displacement ye 0.43 mm (range 0.10-0.80 mm) mushure me100 kutenderera, pazasi pekukosha kwe2 mm.

Iyo yakajairwa TBW yakasanganiswa neyakayambuka kerf pini (tekiniki 1) ndiyo yaitevera yakanakisa, ine chirevo chekutsemuka gap kusimuka kwe0.61 mm (0.06 kusvika 2.06 mm).

Mutengo wakashandiswa waiva 69.2 N. Muyero weAO waiva wakaipisisa, une chirevo chekupedzisira chekuputsika gap displacement ye 1.72 mm (0.47 kusvika 2.24 mm) uye chiyero chekushandiswa kwe79.6 N. Muyero weAO waiva wakaipisisa, une chirevo chekupedzisira chekuputsika gap displacement ye 1.72 mm (0.42 mm).

Panyaya yekuwedzera kwekutamisa kutenderera, ese akayambuka kerf (matekinoroji 1 uye 3) zvimiro zvinoratidza madiki ekutamisa: 0.27 mm kune ese akayambuka kerf zvimiro mukutenderera kwekupedzisira, zvichienzaniswa ne0.41 mm uye 0.60 mm yeyakajairwa AO uye iyo longitudinal kerf chimiro chine lateral TBW, zvichiteerana. ichi chiratidzo chekuti yakayambuka kerf chimiro inopa kuomarara kwakakura kune kuputsika kuri pasi pemutoro Ichi chiratidzo chekuomarara kukuru kwegomba rekutsemuka pasi pemutoro wakapihwa neyakayambuka Clinch pin chimiro.

Kukurukurirana

Mhedzisiro yacho inoratidza kuti kudzorerazve pini yeKirschner muchimiro chakaita semuchinjiko kure neakapoteredzwa matishu akapfava, asi kuichengeta mundege imwechete (kureva, 5 mm kuseri kweanterior convex pamusoro pepatella), haikanganisi kukanganisa biomechanical kutendeseka, asi panzvimbo pezvo inokanganisa kugadzikana kwemukati wekutyoka kugadzirisa. Kuenzaniswa nelongitudinal kerf pini, iyo cruciform chimiro inoratidzika kunge ichidzikamisa zvirinani chivharo chekutyoka kurwisa anterior tension uye inogona kuwedzera kudzvanya kushushikana pane articular surface.

Iyi data inotsigira pfungwa yedu yekutanga yekuti yakayambuka kyphotic pini haisi yakaipisisa nzira yekuvhiya kana ichienzaniswa neiyo longitudinal kyphotic pini, uye kutaura zvazviri, zvese zvimiro zvinoita zviri nani kupfuura longitudinal kyphotic pini vachishandisa yakayambuka kyphotic pini. Yedu yechipiri hypothesis inoramba yakadzikama, sezvo zvichiramba zvisina kujeka kubva muchidzidzo ichi kana mhedzisiro ye lateral TBW inofananidzwa neyakajairwa TBW.

Iyi ndiyo yekutanga biomechanical kudzidza kuratidza hukuru pamusoro peiyo nzira yeAO nekungoongororazve nzira yekuvhiya kuTBW. Iko hakuna mari yekuwedzera uye maitiro anogona kukurumidza nekuti kuratidzwa kushoma kunodiwa. Kushandiswa kwekuyambuka kyphotic pini kunoderedza kukuvadzwa kune yakatenderedza zvinyoro zvinyoro (kunyanya iyo quadriceps uye patellar tendons). Mukuwedzera, kana vanachiremba vane hanya nezvehutano hwezviputi zvakanyorova zvakavharwa uye njodzi yekutsamwa kana kuputika kweanterior metal internal fixation, chidzidzo ichi chinofanira kuvavimbisa kuti kuisa TBW kune rumwe rutivi rwepatella inodzivisa izvi uye inovandudza kugadzirisa zvachose.

Ichi chidzidzo chinoratidza kuti maviri matsva akayambuka kerf pin matekiniki ari pamusoro peiyo goridhe chiyero chiri kutsanangurwa neAO mukurapa kuri nyore transverse patella fractures.