3 Tindlela Letintshwa ta Vuhandzuri to Lunghisa Ku Pfuxetiwa ka Patella

Ku tshoveka ka patellar ku endla 1% wa timhangu hinkwato ta ku vaviseka, naswona nkongomiso wa sweswi lowu ringanyetiweke wa endlelo ra vuhandzuri ro tshungula ku tshoveka ko olova ka transverse patellar hi ku rhurha ka le henhla ka articular i waya wa tension band (TBW), lowu tirhaka tanihi xitirhisiwa xo lwisana na ntshikelelo loko vuandlalo bya patellar (lebyi olovisiweke) byi ri ehansi ka matimba yo gombonyoka.

Hambiswiritano, swiphiqo swa endlelo leri swi katsa ku tsandzeka ka ku khomiwa ka ntambhu endzeni ka tintambhu, ku tluleriwa hi mavabyi ni ku tshoveka ka swilondza. Ku engetela kwalano, ku cheriwa ka tintambhu to leha swinga tika swinene, ngopfu ngopfu loko ku tsemiwa naku lahla makumu ya waya eka patellar tendon na quadriceps tendon.

Hi endlile tithekiniki ta 3 letintshwa to khoma ti transverse patella fractures hiku tirhisa switirhisiwa leswi fanaka na standard TBW.

1. ku tirhisiwa ka figure-of-eight wire tension band endzhaku ko cross-driving ti kerf pins.

2. ti longitudinal Kirschner pins na ti tension bands eka matlhelo hamambirhi ya patella.

3. tiphini ta Kirschner leti tsemakanyeke ni swirhendzevutana swo tsindziyela swa le tlhelo.

Hikokwalaho, xikongomelo xa dyondzo leyi ya biomechanical akuri ku pimanisa 3 wa tindlela tintshwa ta fixation na AO gold standard ya wire tension banding. 

Hypothesis ya hina yosungula akuri leswaku biomechanical integrity ya swivumbeko leswi tirhisaka ti crossed kerf pins aswifanelanga ku onhaka. Xiringanyeto xa hina xa vumbirhi a ku ri leswaku TBW ya le tlhelo yi ta va na mbuyelo lowu fanaka na wa TBW ya ntolovelo.

Maendlelo ya kona

Ku tshoveka ko olova ka transverse patellar ku tsemiwile hi pendulum saw, naswona tithekiniki letintshwa ta 3 ti tlhele ti tirhisiwa hi ku landzelelana eka matsolo yo hambanyisa ku tiyisisa leswaku ya nga akiwa hi ndlela leyi yimelaka endlelo leri hlayisekeke na leri nga tlheriseriwaka leri sekeriweke eka anatomy ya munhu (hilaha swi kombisiweke hakona eka Swifaniso 2 na 3). Hinkwaswo swi fikeleriwile hi ndlela leyi humelelaka. Xitirhisiwa xa biomechanical xitirhisiwile ku kambela vutshembeki bya biomechanical bya tithekiniki ta 3 letintshwa.

Mimbuyelo

Mimbuyelo ya swikambelo hinkwaswo yi kombisiwile eka Swifaniso swa 4 na 5.

Mbuyelo wu kombisile leswaku Xivumbeko lexi nga na ku rhurha lokutsongo swinene ka xivandla xa ku tshoveka hinkwako a ku ri tiphini ta kerf leti tsemakanyeke leti hlanganisiweke na TBW ya le tlhelo (thekiniki ya 3), na ku rhurha ka xivandla xa ku tshoveka ka le xikarhi ka 0.43 mm (range 0.10-0.80 mm) endzhaku ka 100 wa swirhendzevutani, ehansi swinene ka ku rhurha lokukulu ka 2 mm.

TBW ya ntolovelo leyi hlanganisiweke na ti crossed kerf pins (technique 1) akuri yona leyi landzelaka ya kahle swinene, laha kungana mean fracture gap displacement ya 0.61 mm (0.06 kuya eka 2.06 mm).

Ndzhwalo wa xikarhi lowu tirhisiweke a wu ri 69.2 N. Mpimo wa AO a wu bihe ngopfu, laha ku nga na ku rhurha ka xivandla xo hetelela xa ku tshoveka ka 1.72 mm (0.47 ku ya eka 2.24 mm) na ndzhwalo wa le xikarhi lowu tirhisiweke wa 79.6 N. Mpimo wa AO a wu ri wo biha swinene, na ku rhurha ka xivandla xo hetelela xa ku tshoveka ka 1.72 mm (0.47 ku ya eka 2.24 mm).

Hi mayelana na ku rhurha loku engetelekaka hi xirhendzevutani, swivumbeko swa kerf leyi tsemakanyeke (tithekiniki ta 1 na 3) hivumbirhi bya swona swikombisa ku rhurha lokuntsongo: 0.27 mm eka swivumbeko swa kerf leswi tsemakanyeke hi vumbirhi bya swona eka xirhendzevutani xohetelela, loko ku pimanyisiwa na 0.41 mm na 0.60 mm eka standard AO na xivumbeko xa longitudinal kerf lexingana lateral TBW, hiku landzelelana. leswi i vumbhoni bya leswaku xivumbeko xa kerf lexi tsemakanyeke xi nyika ku tiya lokukulu eka ku tshoveka ehansi ka ndzhwalo Leswi i vumbhoni bya ku tiya lokukulu ka xivandla xa ku tshoveka ehansi ka ndzhwalo lexi nyikiwaka hi xivumbeko xa pin ya Clinch leyi tsemakanyeke.

Nkanerisano

Mbuyelo wukomba leswaku ku kongomisiwa nakambe ka pini ya Kirschner eka xivumbeko xa xivumbeko xa xihambano ekule na ti tissue to olova leti rhendzeleke, kambe ku yi hlayisa eka plane yin’we (i.e., 5 mm endzhaku ka anterior convex surface ya patella), aswi khumbi hindlela yo biha vutshembeki bya biomechanical, kambe swi khumba hindlela leyinene kutshamiseka ka ku khomiwa ka fracture yale ndzeni. Loko ku pimanyisiwa na ti longitudinal kerf pins, xivumbeko xa cruciform xivonaka xitiyisisa ku antswa fracture block eka anterior tension naswona xinga engetela compressive stress eka articular surface.

Data leyi yi seketela xiringanyeto xa hina xo sungula xa leswaku tiphini ta kyphotic leti tsemakanyeke a hi endlelo ro biha swinene ra vuhandzuri loko ku pimanisiwa na tiphini ta kyphotic ta longitudinal, naswona entiyisweni, swivumbeko leswi haswimbirhi swi tirha ku antswa ku tlula tiphini ta kyphotic to leha hi ku tirhisa tiphini ta kyphotic leti tsemakanyeke. Xiringanyeto xa hina xa vumbirhi xi tshama xi ringaniseriwile, tanihileswi swi nga si tshamaka swi ri erivaleni eka ndzavisiso lowu loko mbuyelo wa TBW ya le tlhelo wu ringanisiwa na TBW ya ntolovelo.

Leyi i dyondzo yo sungula ya biomechanical ku kombisa ku tlakuka eka thekiniki ya AO hi ku kambisisa ntsena endlelo ra vuhandzuri eka TBW. Akuna ntsengo wo engetelela naswona endlelo ringa hatlisa hikuva ku laveka ku hlangana kutsongo. Ku tirhisiwa ka ti crossed kyphotic pins swihunguta ku onhaka eka ti soft tissues leti rhendzeleke (ngopfu ngopfu ti quadriceps na patellar tendons). Ku engetela kwalano, loko madokodela ya vuhandzuri ya vilerisiwa hi khwalithi ya ti soft tissues leti funengetiweke xikan’we na khombo ra ku hlundzuka kumbe ku huma ka anterior metal internal fixation, ndzavisiso lowu wufanele kuva tiyisekisa leswaku ku veka TBW eka matlhelo hamambirhi ya patella swi papalata leswi naswona swi antswisa ku khomiwa hiku angarhela.

Dyondzo leyi yi kombisa leswaku tithekiniki timbirhi letintshwa ta crossed kerf pin ti tlakukile eka gold standard leyi hlamuseriwaka sweswi hi AO eka vutshunguri bya simple transverse patella fractures.