Izindlela Ezintsha Zokuhlinza Ezingu-3 Zokubhekana Nezifo Ezivela Ku-Patella

I-Patellar fractures yenza i-1% yazo zonke izimo zokuhlukumezeka, futhi umhlahlandlela wamanje onconyiwe inqubo yokuhlinzwa yokwelapha ukuphuka okulula kwe-patellar transverse nge-articular surface displacement yi-tension band wire (TBW), esebenza njengedivaysi ye-antitension lapho indawo ye-patellar (eyeluliwe) ingaphansi kwamandla okugoba.

Kodwa-ke, izinkinga zale nqubo zihlanganisa ukuhluleka kokulungiswa kwangaphakathi kwentambo, ukutheleleka, nokuncipha kwesilonda. Ngaphezu kwalokho, ukusetshenziswa kwezintambo ze-longitudinal kungaba inselele kakhulu, ikakhulukazi uma unqamula futhi ungcwaba ukuphela kocingo ku-patellar tendon kanye ne-quadriceps tendon.

Sakhe izindlela ezintsha ezi-3 zokulungisa ukuphuka kwe-patella ephambanayo sisebenzisa izinto ezifanayo njenge-TBW evamile.

1. ukusetshenziswa kwebhendi ye-wire tension yesibalo sesishiyagalombili ngemva kokushayela izikhonkwane ze-kerf.

2. izikhonkwane ze-longitudinal Kirschner namabhande okungezwani ezinhlangothini zombili ze-patella.

3. bawela izikhonkwane ze-Kirschner kanye nezintambo zokudonsa ezingemuva.

Ngakho-ke, inhloso yalolu cwaningo lwe-biomechanical kwakuwukuqhathanisa izindlela ezi-3 zokulungisa ezintsha nezinga legolide le-AO le-wire tension banding. 

I-hypothesis yethu yokuqala yayiwukuthi ubuqotho be-biomechanical bezakhiwo ezisebenzisa izikhonkwane ze-kerf eziphambanayo akufanele ziwohloke. I-hypothesis yethu yesibili yayiwukuthi i-TBW yangemuva izoba nemiphumela efanayo ne-TBW evamile.

Izindlela

Ukuphuka okulula kwe-patellar okuguquguqukayo kwancishiswa ngesaha le-pendulum, futhi amasu amasha angu-3 abese esetshenziswa ngokulandelana ukuze ahlukanise amadolo ukuze kuqinisekiswe ukuthi angakhiwa ngendlela emele inqubo ephephile nekwazi ukukhiqizwa kabusha ngokusekelwe ku-anatomy yomuntu (njengoba kuboniswe kuMfanekiso 2 no-3). Konke kuzuzwe ngempumelelo. Kwasetshenziswa idivayisi ye-biomechanical ukuhlola ubuqotho be-biomechanical kumasu amasha ama-3.

Imiphumela

Imiphumela yazo zonke izivivinyo iboniswa kuMfanekiso 4 no-5.

Imiphumela yabonisa ukuthi Ukucushwa okunegebe elincane eliphelele lokuphuka kwegebe kwaba izikhonkwane ze-kerf eziphambanisiwe ezihlanganiswe ne-lateral TBW (ubuchwepheshe 3), nokugudluzwa kwegebe elimaphakathi elingu-0.43 mm (ububanzi obungu-0.10-0.80 mm) ngemva kwemijikelezo engu-100, ngaphansi kakhulu kokugudluzwa okubalulekile okungu-2 mm.

I-TBW evamile ehlanganiswe nezikhonkwane ze-kerf eziphambanayo (isu loku-1) ibe yiyona ehamba phambili, enokususwa kwegebe elimaphakathi elingu-0.61 mm (0.06 kuya ku-2.06 mm).

Isilinganiso somthwalo osetshenzisiwe sasingu-69.2 N. Izinga le-AO lalibi kakhulu, linesilinganiso sokugcina igebe lokuphuka elingu-1.72 mm (0.47 kuya ku-2.24 mm) kanye nomthwalo osetshenziswayo omaphakathi ongu-79.6 N. Izinga le-AO lalibi kakhulu, elinokukhishwa kwegebe lokugcina lokuphuka elingu-1.74 mm (0.42 mm).

Mayelana nokugudluzwa okukhuphukayo ngomjikelezo ngamunye, zombili izinhlaka ze-kerf eziphambanayo (amaqhinga 1 kanye no-3) zibonisa ukugudluzwa okuncane: 0.27 mm kuzo zombili izakhiwo ze-kerf eziphambanayo emjikelezweni wokugcina, uma kuqhathaniswa no-0.41 mm no-0.60 mm we-AO evamile kanye nesakhiwo sekherf longitudinal esine-TBW ehlangene, ngokulandelana. lokhu kuwubufakazi bokuthi isakhiwo se-kerf esiphambanayo sinikeza ukuqina okukhulu ekuqhekekeni ngaphansi komthwalo Lokhu kuwubufakazi bokuqina okukhulu kwegebe lokuphuka ngaphansi komthwalo onikezwe isakhiwo se-Clinch pin esiphambanayo.

Ingxoxo

Imiphumela iphakamisa ukuthi ukulungisa kabusha iphinikhodi ye-Kirschner ibe isakhiwo esimise okwesiphambano kude nezicubu ezithambile ezizungezile, kodwa ukuyigcina endizeni efanayo (okungukuthi, i-5 mm ngemuva kwe-anterior convex surface ye-patella), akuthinti kabi ubuqotho be-biomechanical, kodwa kunalokho kuthinta kahle ukuzinza kokulungiswa kwe-fracture yangaphakathi. Uma kuqhathaniswa nezikhonkwane ze-kerf ze-longitudinal, isakhiwo se-cruciform sibonakala sizinzisa kangcono ibhulokhi yokuphuka ngokumelene nokushuba kwangaphambili futhi kungase kwandise ukucindezeleka okucindezelayo endaweni ye-articular.

Le datha isekela i-hypothesis yethu yokuqala yokuthi izikhonkwane ze-kyphotic eziwela akuyona inqubo yokuhlinzwa embi kakhulu uma kuqhathaniswa nezikhonkwane ze-kyphotic ze-longitudinal, futhi empeleni, zombili izakhiwo zenza kangcono kunezikhonkwane ze-kyphotic ze-longitudinal zisebenzisa izikhonkwane ze-kyphotic eziwela. I-hypothesis yethu yesibili ihlala ibhalansile, njengoba kungakacaci kulolu cwaningo ukuthi imiphumela ye-TBW yangemuva iyaqhathaniswa yini ne-TBW evamile.

Lolu wucwaningo lokuqala lwe-biomechanical ukukhombisa ukuphakama ngaphezu kwendlela ye-AO ngokumane ibuyekeze kabusha indlela yokuhlinzwa ye-TBW. Azikho izindleko ezengeziwe futhi inqubo ingase isheshe ngoba kudingeka ukuchayeka kancane. Ukusetshenziswa kwezikhonkwane ze-kyphotic eziwela kunciphisa ukulimala kwezicubu ezithambile ezizungezile (ikakhulukazi i-quadriceps ne-patellar tendon). Ukwengeza, uma odokotela abahlinzayo bekhathazekile ngekhwalithi yezicubu ezithambile ezimboziwe kanye nengozi yokucasuka noma ukuphuma kwensimbi yangaphakathi yokulungiswa kwangaphakathi, lolu cwaningo kufanele lubaqinisekise ukuthi ukubeka i-TBW kunoma yiluphi uhlangothi lwe-patella kugwema lokhu futhi kuthuthukisa ukulungiswa okuphelele.

Lolu cwaningo lubonisa ukuthi izindlela ezimbili ezintsha zephinikhodi ye-kerf ziphakeme kunezinga legolide elichazwa yi-AO ekwelapheni ukuphuka kwe-patella okuphambanayo okulula.