3 tindlela letintshwa ta vuhandzuri ku lulamisa ku tshoveka ka patella .

Ti patellar fractures ti endla 1% wa timhangu hinkwato ta trauma, naswona nkongomiso wa sweswi lowu ringanyetiweke hi endlelo ra vuhandzuri eka vutshunguri bya ku tshoveka ko olova ka patellar loku nga na articular surface displacement i tension band wire (TBW), leyi tirhaka tani hi xitirhisiwa xo lwisana na antitension loko patellar (stretched) surface yi langutana na matimba yo gombonyoka.

Hambiswiritano, swiphiqo swa endlelo leri swi katsa ku tsandzeka ka ku khoma ka le ndzeni ka tintambhu, ku tluleriwa hi vuvabyi, na ku onhaka ka swilondza. Ku engetela kwalano, ku tirhisiwa ka ti longitudinal wires swinga va na ntlhontlho swinene, ngopfu ngopfu loko ku tsemiwa naku lahliwa ka makumu ya waya eka patellar tendon na quadriceps tendon.

Hi endlile 3 wa tithekiniki letintshwa to fixation ta transverse patella fractures hi ku tirhisa switirhisiwa leswi fanaka na standard TBW.

1. Ku tirhisiwa ka bandhi ra tension ra wire ra figure-of-eight endzhaku ko cross-driving ti kerf pins.

2. Ti pin ta Kirschner ta longitudinal na ti tension bands eka matlhelo hamambirhi ya patella.

3. yi tsemakanye tiphini ta Kirschner ni swirhendzevutana swa ku tsana ka le tlhelo.

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

Xiringanyeto xa hina xo sungula a ku ri leswaku vutshembeki bya biomechanical bya swivumbeko hi ku tirhisa tiphini ta kerf leti tsemakanyeke a byi fanelanga ku hohloka. Xiringanyeto xa hina xa vumbirhi a ku ri leswaku TBW ya le tlhelo yi ta va na mbuyelo lowu fanaka na TBW ya ntolovelo.

Maendlelo .

Ku tshoveka ko olova ka transverse patellar ku tsemiwile hi pendulum saw, naswona tithekiniki ta 3 letintshwa ti tlhele ti tirhisiwa hi ku landzelelana ku hambanyisa matsolo ku tiyisisa leswaku ya nga akiwa hi ndlela leyi yimelaka endlelo leri hlayisekeke no tlhela ri endliwa leri simekiweke eka anatomy ya munhu (hilaha swi kombisiweke hakona eka Swifaniso swa 2 na 3). Hinkwaswo swi fikeleleriwe hi ndlela leyi humelelaka. Xitirhisiwa xa biomechanical xitirhisiwile ku kambela vutshembeki bya biomechanical bya tithekiniki ta 3 letintshwa.

Mimbuyelo

Vuyelo bya swikambelo hinkwaswo byi kombisiwile eka Swifaniso swa 4 na 5.

Mimbuyelo yi kombisile leswaku xivumbeko lexi nga na ku rhurha lokuntsongo ka xivandla xa ku tshoveka ka ku tshoveka lokutsongo swinene a ku ri tiphini ta Kerf leti tsemakanyaka leti hlanganisiweke na TBW ya le tlhelo (Technique 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, kahle ehansi ka ku rhurha lokukulu ka 2 mm.

TBW ya standard leyi hlanganisiweke na ti crossed kerf pins (Technique 1) akuri yona leyi landzelaka, na mean fracture gap displacement ya 0.61 mm (0.06 kuya eka 2.06 mm).

Ndzhwalo wa le xikarhi lowu tirhisiweke a wu ri 69.2 N. Mpimo wa AO a wu bihe ngopfu, hi ku rhurha ka xiphemu xo hetelela xa ku tshoveka ka 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 bihe ngopfu, hi ku rhurha ka xivandla xo hetelela xa le xikarhi xa 1.72 mm (0.47 ku ya eka 2.24 mm).

Hi mayelana na ku rhurhisiwa ka ku engeteleka hi xirhendzevutani, swivumbeko swa kerf leswi tsemakanyaka (Techniques 1 na 3) hinkwaswo swi kombisa ku rhurha lokuntsongo: 0.27 mm eka swivumbeko swa kerf leswi tsemakanyeke eka xirhendzevutani xo hetelela, loko ku pimanisiwa na 0.41 mm na 0.60 mm eka xivumbeko xa AO na xivumbeko xa le tlhelo xa le tlhelo lexi nga na TBW ya le tlhelo, hi ku landzelelana. Lebyi i vumbhoni bya leswaku xivumbeko xa kerf lexi tsemakanyaka xinyika ku tiya lokukulu eka ku tshoveka ehansi ka ndzhwalo Leswi i vumbhoni bya ku tiya lokukulu ka xivandla xa ku tshoveka ehansi ka ndzhwalo lowu nyikiwaka hi xivumbeko xa tiphini ta clinch leti tsemakanyaka.

Nkanerisano

Mimbuyelo yi ringanyeta leswaku ku kongomisa nakambe pini ya Kirschner eka xivumbeko xa xivumbeko xa xihambano ekule na tinyama to olova leti rhendzeleke, kambe ku yi hlayisa eka xiphemu xin’we (i.e., 5 mm endzhaku ka anterior convex surface ya patella), a swi khumbi hi ndlela yo biha vutshembeki bya biomechanical, kambe swi khumba hi ndlela leyinene ku tshamiseka ka ku lulamisiwa ka ku tsana ka le ndzeni. Loko ku pimanyisiwa na ti longitudinal kerf pins, xivumbeko xa cruciform xivonaka xitiyisisa ku antswa fracture block eka anterior tension naswona swinga engetela ntshikelelo wa compressive eka articular surface.

Data leyi yi seketela xiringanyeto xa hina xo sungula xa leswaku tiphini ta kyphotic leti tsemakanyaka a hi endlelo ro biha swinene ra vuhandzuri loko ri pimanisiwa na tiphini ta kyphotic ta longitudinal, naswona entiyisweni, swivumbeko leswi haswimbirhi swi tirha ku antswa ku tlula tiphini ta kyphotic ta longitudinal hi ku tirhisa tiphini ta kyphotic leti tsemakanyaka. Xiringanyeto xa hina xa vumbirhi xi tshama xi ringaniseriwile, tanihileswi xi nga si tshamaka xi va 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 nakambe ntsena endlelo ra vuhandzuri eka TBW. Akuna ntsengo wo engetela 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 ti patellar tendons). Ku engetela kwalaho, loko madokodela ya vuhandzuri ma vilerisiwa hi khwalithi ya tinyama to olova leti funengetiweke na khombo ra ku hlundzuka kumbe ku humelela ka ku khomiwa ka le ndzeni ka nsimbi ya le mahlweni, ndzavisiso lowu wu fanele ku va tiyisisa leswaku ku veka TBW eka matlhelo hinkwawo ya patella swi papalata leswi naswona swi antswisa ku lulamisiwa hi ku angarhela.

Dyondzo leyi yi kombisa leswaku tithekiniki timbirhi letintshwa ta kerf pin leti tsemakanyeke ti tlakukile eka mpimanyeto wa nsuku lowu sweswi wu hlamuseriweke hi AO eka vutshunguri bya ku tshoveka ko olova ka transverse patella.