IiNdlela eziNtsha zoTyando ezi-3 zokulungisa iPatella Fractures

I-Patellar fractures i-akhawunti ye-1% yazo zonke iimeko ze-trauma, kwaye isikhokelo sangoku sinconywa inkqubo yotyando yonyango lwe-patellar fractures elula kunye ne-articular surface displacement yi-tension band wire (TBW), esebenza njengesixhobo esichasene ne-antitension xa i-patellar (eyoluliweyo) iphantsi kwegunya lokugoba.

Nangona kunjalo, iingxaki zale nkqubo ziquka ukungaphumeleli kokulungiswa kocingo lwangaphakathi, ukusuleleka, kunye nokunciphisa inxeba. Ukongezelela, ukusetyenziswa kweengcingo ze-longitudinal kunokuba ngumngeni kakhulu, ngakumbi xa ucofa kwaye ungcwaba ukuphela kocingo kwi-tendon ye-patellar kunye ne-quadriceps tendon.

Siye sayila iindlela ezi-3 ezintsha zokulungisa iifractures zepatella ezinqamlezileyo sisebenzisa izinto ezifanayo ne-TBW eqhelekileyo.

1. ukusetyenziswa kwebhendi yocingo yocingo enomfanekiso-yesibhozo emva kokuqhuba izikhonkwane zekerf.

2. Izikhonkwane ze-longitudinal Kirschner kunye neebhendi zoxinzelelo kumacala omabini epatella.

3. izikhonkwane zeKirschner ezinqamlezileyo kunye neentambo zoxinzelelo ezisecaleni.

Ngoko ke, injongo yolu phononongo lwe-biomechanical yayikukuthelekisa iindlela ezi-3 zokulungisa ezintsha kunye nomgangatho wegolide we-AO we-wire tension banding. 

I-hypothesis yethu yokuqala yayikukuba ingqibelelo ye-biomechanical yezakhiwo ezisebenzisa izikhonkwane ze-kerf ezinqamlekileyo akufanele ziwohloke. I-hypothesis yethu yesibini yayiyeyokuba i-TBW esecaleni iya kuba neziphumo ezifanayo kwi-TBW eqhelekileyo.

Iindlela

I-patellar fracture elula enqamlezileyo yachithwa nge-pendulum saw, kwaye iindlela ezintsha ze-3 zaye zasetyenziswa ngokulandelelana ukuhlukanisa amadolo ukuze kuqinisekiswe ukuba zinokwakhiwa ngendlela emele inkqubo ekhuselekileyo neyimveliso esekelwe kwi-anatomy yomntu (njengoko kuboniswe kwiMifanekiso 2 kunye ne-3). Zonke ziphunyezwe ngempumelelo. Isixhobo se-biomechanical sasetyenziselwa ukuvavanya ingqibelelo ye-biomechanical yeendlela ezi-3 ezintsha.

Iziphumo

Iziphumo zazo zonke iimvavanyo ziboniswe kwiMifanekiso 4 kunye ne-5.

Iziphumo zibonise ukuba ukucwangciswa kunye neyona nto incinci i-gap ye-fracture displacement yayiyizikhonkwane ze-kerf ezinqamlekileyo ezidibeneyo kunye ne-TBW esecaleni (i-technique 3), kunye ne-displacement gap ye-0.43 mm (uluhlu lwe-0.10-0.80 mm) emva kwemijikelezo ye-100, ngaphantsi kwe-2 mm.

Umgangatho we-TBW odityaniswe nezikhonkwane ze-kerf ezinqamlezileyo (ubuchule boku-1) yayiyeyona ilandelayo ingcono, kunye ne-gap ephakathi kwe-0.61 mm (0.06 ukuya kwi-2.06 mm).

Umlinganiselo osetyenzisiweyo womthwalo wawuyi-69.2 N. Umgangatho we-AO wawungowona umbi kakhulu, kunye ne-displacement yokugqibela ye-fracture gap ye-1.72 mm (0.47 ukuya kwi-2.24 mm) kunye nomthwalo osetyenzisiweyo we-79.6 N. Umgangatho we-AO wawungowona umbi kakhulu, kunye ne-displacement ye-break fracture displacement ye-1.74 mm ukuya kwi-2.24 mm (0.24 mm).

Ngokumalunga nokufuduswa okunyukayo kumjikelo ngamnye, zombini i-kerf enqamlezileyo (i-teknoloji ye-1 kunye ne-3) ibonisa ukufuduka okuncinci: i-0.27 mm kuzo zombini izakhiwo ze-kerf ezinqamlezileyo kumjikelo wokugqibela, xa kuthelekiswa ne-0.41 mm kunye ne-0.60 mm ye-AO eqhelekileyo kunye nesakhiwo se-kerf yobude kunye ne-TBW esecaleni, ngokulandelelana. obu bubungqina bokuba isakhiwo se-kerf esinqamlekileyo sinikeza ukuqina okukhulu kwi-fracture phantsi komthwalo Obu bubungqina bobunzima obukhulu be-gap ye-fracture phantsi komthwalo onikwe yi-crossed Clinch pin structure.

Ingxoxo

Iziphumo zibonisa ukuba ukuhlengahlengiswa kwepini ye-Kirschner kwisakhiwo esinqamlezileyo kude nezicubu ezithambileyo ezijikelezayo, kodwa ukuyigcina kwindiza efanayo (oko kukuthi, i-5 mm emva kwe-convex yangaphambili ye-patella), ayichaphazeli kakubi ukunyaniseka kwe-biomechanical, kodwa kunoko kuchaphazela ngokufanelekileyo ukuzinza kwe-fracture fixation yangaphakathi. Xa kuthelekiswa nezikhonkwane ze-kerf ze-longitudinal, isakhiwo se-cruciform sibonakala sizinzisa ngcono ibhloko ye-fracture ngokuchasene noxinzelelo lwangaphambili kwaye inokunyusa uxinzelelo oluxinzelelekileyo kwi-articular surface.

Ezi datha zixhasa i-hypothesis yethu yokuqala yokuwela i-kyphotic pins ayiyona inkqubo yotyando embi kakhulu xa kuthelekiswa nezikhonkwane ze-kyphotic ze-longitudinal, kwaye ngokwenene, zombini izakhiwo zenza ngcono kunezikhonkwane ze-kyphotic ezinqamlekileyo zisebenzisa izikhonkwane ze-kyphotic ezinqamlekileyo. I-hypothesis yethu yesibini ihlala ilungelelene, njengoko ihlala ingacacanga kolu phononongo ukuba ingaba iziphumo ze-TBW ezisecaleni zithelekiseka ne-TBW eqhelekileyo.

Olu luphononongo lokuqala lwe-biomechanical ukubonisa ukongama kunobuchule be-AO ngokuphonononga ngokulula indlela yotyando kwi-TBW. Akukho ndleko eyongezelelweyo kwaye inkqubo ingakhawuleza kuba utyhileko oluncinci luyafuneka. Ukusetyenziswa kwezikhonkwane ze-kyphotic ezinqamlekileyo kunciphisa umonakalo kwizicubu ezithambileyo ezijikelezayo (ikakhulukazi i-quadriceps kunye ne-patellar tendons). Ukongezelela, ukuba oogqirha banenkxalabo malunga nomgangatho wezicubu ezithambileyo ezigqunyiweyo kunye nomngcipheko wokucaphuka okanye ukukhutshwa kwentsimbi yangaphakathi yokulungiswa kwangaphakathi, olu pho nonongo kufuneka lubaqinisekise ukuba ukubeka i-TBW ngapha nangapha kwepatella igwema oku kwaye iphucula ukulungiswa okupheleleyo.

Olu phononongo lubonisa ukuba iindlela ezimbini ezintsha zokuwela i-kerf pin zingaphezulu komgangatho wegolide ochazwa ngoku yi-AO kunyango lweefracture ezinqamlezileyo zepatella.