Ukuphuka kwe-Hoffa kuwukuphuka kwe-coronal plane ye-femoral condyle. Kwaqala ukuchazwa nguFriedrich Busch ngo-1869 futhi kwabikwa futhi ngu-Albert Hoffa ngo-1904, futhi kwaqanjwa ngaye. Nakuba ukuphuka kuvame ukwenzeka endaweni evundlile, ukuphuka kwe-Hoffa kwenzeka endaweni ye-coronal futhi akuvamile kakhulu, ngakho-ke kuvame ukuphuthelwa ngesikhathi sokuxilongwa kokuqala kwezokwelapha kanye ne-radiological.
Kwenzeka nini ukuphuka kwe-Hoffa?
Ukuphuka kwe-Hoffa kubangelwa amandla okucheba i-femoral condyle edolweni. Ukulimala okunamandla aphezulu kuvame ukubangela ukuphuka kwe-intercondylar kanye ne-supracondylar kwe-distal femur. Izindlela ezivame kakhulu zifaka phakathi izingozi zezimoto nezezimoto kanye nokuwa kusuka ekuphakameni. ULewis et al. baveze ukuthi iningi leziguli ezinezimo ezihambisanayo zibangelwa amandla okushaywa ngqo kwi-lateral femoral condyle ngenkathi zigibela isithuthuthu idolo ligobile ku-90°
Yiziphi izimpawu zomtholampilo zokuphuka kwe-Hoffa?
Izimpawu eziyinhloko zokuphuka kwe-Hoffa okukodwa ukuqhekeka kwedolo kanye ne-hemarthrosis, ukuvuvukala, kanye ne-genu varum noma i-valgus encane kanye nokungazinzi. Ngokungafani nokuqhekeka kwe-intercondylar kanye ne-supracondylar, ukuqhekeka kwe-Hoffa cishe kutholakala ngengozi ngesikhathi sokuhlolwa kwezithombe. Ngenxa yokuthi ukuqhekeka okuningi kwe-Hoffa kuvela ekulimaleni okunamandla aphezulu, ukulimala okuhlangene kwe-hip, i-pelvis, i-femur, i-patella, i-tibia, i-knee ligaments, kanye nemithambo ye-popliteal kumele kukhishwe.
Uma kusolwa ukuthi uHoffa uphukile, umuntu kufanele athathe kanjani ama-X-ray ukuze agweme ukuphuthelwa ukuxilongwa?
Ama-radiograph ajwayelekile e-anteroposterior kanye ne-lateral aqhutshwa njalo, kanti ukubuka okuqondile kwedolo kwenziwa uma kudingeka. Uma ukuphuka kungasuswanga kakhulu, kuvame ukuba nzima ukukubona kuma-radiograph. Ekubukeni okuqondile, ukungezwani okuncane komugqa we-femoral joint ngezinye izikhathi kubonakala, ngokuwohloka kwe-condylar valgus noma ngaphandle kwayo kuye ngokuthi i-condyle ihilelekile. Kuye ngokuthi i-contour ye-femur injani, ukungaqhubeki noma isinyathelo emgqeni wokuphuka kungabonakala ekubukeni okuqondile. Kodwa-ke, ekubukeni okuqondile kwangempela, ama-femoral condyle abonakala engahambisani, kanti uma ama-condyle efinyeziwe futhi esuswa, angase ahlangane. Ngakho-ke, umbono ongalungile we-joint evamile yedolo ungasinika umbono ongamanga, ongaboniswa ngemibono eqondile. Ngakho-ke, ukuhlolwa kwe-CT kuyadingeka (Isithombe 1). I-magnetic resonance imaging (MRI) ingasiza ekuhloleni izicubu ezithambile ezizungeze idolo (njenge-ligaments noma i-menisci) ukuze kutholakale umonakalo.
Isibalo 1 se-CT sibonise ukuthi isiguli sasinohlobo lwe-Letenneur ⅡC oluphukile lwe-lateral femoral condyle.
Yiziphi izinhlobo zokuphuka kwe-Hoffa?
Ukuqhekeka kwe-Hoffa kuhlukaniswe ngohlobo lwe-B3 kanye nohlobo lwe-33.b3.2 esigabeni se-AO/OTA ngokwesigaba sikaMuller. Kamuva, uLetenneur nabanye bahlukanisa ukuqhekeka kube izinhlobo ezintathu ngokusekelwe ebangeni lomugqa wokuqhekeka kwe-femoral kusuka ku-cortex engemuva ye-femur.
Umfanekiso 2 Ukuhlukaniswa kwe-Letenneur kokuqhekeka kwe-Hoffa
Uhlobo I:Umugqa wokuqhekeka utholakala futhi uhambisana ne-cortex engemuva ye-femoral shaft.
Uhlobo II:Ibanga elisuka emgqeni wokuqhekeka liye emgqeni we-cortical wangemuva we-femur lihlukaniswe kabanzi libe izinhlobo ezimbili: IIa, IIb kanye ne-IIc ngokwebanga elisuka emgqeni wokuqhekeka liye ethanjeni le-cortical langemuva. Uhlobo lwe-IIa luseduze kakhulu ne-cortex yangemuva ye-femoral shaft, kanti i-IIc ikude kakhulu ne-cortex yangemuva ye-femoral shaft.
Uhlobo lwesithathu:Ukuphuka kwe-oblique.
Indlela yokwakha uhlelo lokuhlinzwa ngemva kokuxilongwa?
1. Ukukhetha ukuqina kwangaphakathi Ngokuvamile kukholelwa ukuthi ukunciphisa okuvulekile kanye nokuqina kwangaphakathi kuyindinganiso yegolide. Ngokuqhekeka kwe-Hoffa, ukukhethwa kwezifakelo zokuqinisa ezifanele kulinganiselwe kakhulu. Izikulufo zokucindezela ezingenalutho ezinentambo ethile zilungele ukuqina. Izinketho zokufakelwa zifaka izikulufo zokucindezela ezingenalutho ezinentambo ethile ezingu-3.5mm, 4mm, 4.5mm kanye no-6.5mm kanye nezikulufo ze-Herbert. Uma kudingeka, amapuleti afanele okulwa nokushelela angasetshenziswa lapha. I-Jarit ithole ngezifundo ze-biomechanical zesidumbu ukuthi izikulufo ze-posteroanterior lag zizinzile kakhulu kunezikulufo ze-anterior-posterior lag. Kodwa-ke, indima eqondisayo yalokhu okutholakele ekusebenzeni kwezokwelapha ayikacaci.
2. Ubuchwepheshe bokuhlinzwa Uma ukuphuka kwe-Hoffa kutholakala ukuthi kuhambisana nokuphuka kwe-intercondylar kanye ne-supracondylar, kufanele kunikezwe ukunakwa okwanele, ngoba uhlelo lokuhlinzwa kanye nokukhetha kokulungiswa kwangaphakathi kunqunywa ngokusekelwe esimweni esingenhla. Uma i-lateral condyle ihlukaniswe nge-coronally, ukuvezwa kokuhlinzwa kufana nokwephuka kwe-Hoffa. Kodwa-ke, akuhlakaniphile ukusebenzisa isikulufu se-dynamic condylar, futhi kufanele kusetshenziswe ipuleti le-anatomical, ipuleti lokusekela le-condylar noma ipuleti le-LISS ukuze kulungiswe esikhundleni salokho. I-medial condyle kunzima ukuyilungisa ngokusebenzisa ukuqhekeka kwe-lateral. Kulesi simo, kudingeka ukuqhekeka okwengeziwe kwe-anteromedial ukuze kuncishiswe futhi kulungiswe ukuqhekeka kwe-Hoffa. Kunoma ikuphi, zonke izingcezu ezinkulu zamathambo e-condylar ziqiniswa ngezikulufo zokulaxaza ngemuva kokunciphisa i-anatomical ye-condyle.
- Indlela yokuhlinzwa Isiguli silele embhedeni we-fluoroscopic one-tourniquet. I-bolster isetshenziswa ukugcina i-engeli yokugoba kwedolo elingaba ngu-90°. Kuma-fractures alula e-medial Hoffa, umbhali ukhetha ukusebenzisa i-incision ephakathi nendawo ene-medial parapatellar approach. Kuma-fractures e-lateral Hoffa, kusetshenziswa i-side incision. Abanye odokotela basikisela ukuthi indlela ye-lateral parapatellar nayo iyisinqumo esinengqondo. Uma iziphetho zokuphuka seziveziwe, kwenziwa ukuhlola okuvamile, bese iziphetho zokuphuka zihlanzwa nge-curette. Ngaphansi kokubona okuqondile, ukunciphisa kwenziwa kusetshenziswa i-point reduction forceps. Uma kudingeka, inqubo "ye-joystick" yezintambo zikaKirschner isetshenziselwa ukunciphisa, bese izintambo zikaKirschner zisetshenziselwa ukunciphisa nokuqinisa ukuvimbela ukufuduka kokuphuka, kodwa izintambo zikaKirschner azikwazi ukuvimbela ukufakwa kwezinye izikulufo (Isithombe 3). Sebenzisa okungenani izikulufo ezimbili ukuze ufinyelele i-fixation eqinile kanye nokucindezela okuphakathi kwezingxenye. Drill uqonde ngqo ekuqhekekeni futhi kude ne-patellofemoral joint. Gwema ukubhoboza emgodini wangemuva wejoyinti, okungcono nge-C-arm fluoroscopy. Izikulufo zifakwa ngama-washer noma ngaphandle kwawo uma kudingeka. Izikulufo kufanele zicwiliswe kabili futhi zibe nobude obanele ukulungisa i-cartilage engaphansi kwe-articular. Ngesikhathi sokuhlinzwa, idolo liyahlolwa ukuthi alinazo yini ukulimala okuhambisanayo, ukuqina, kanye nobubanzi bokunyakaza, futhi kuniselwe kahle ngaphambi kokuvalwa kwenxeba.
Umfanekiso 3 Ukunciphisa okwesikhashana kanye nokulungiswa kokuqhekeka kwe-bicondylar Hoffa ngezintambo zikaKirschner ngesikhathi sokuhlinzwa, kusetshenziswa izintambo zikaKirschner ukukhipha izingcezu zamathambo
Isikhathi sokuthunyelwe: Mashi-12-2025
