Ukuphuka kwe-Hoffa ukuphuka kwendiza ye-coronal ye-condyle yesifazane. Yaqala ukuchazwa nguFriedrich Busch ngo-1869 futhi yabikwa futhi ngu-Albert Hoffa ngo-1904, futhi yaqanjwa ngaye. Nakuba ukuphuka ngokuvamile kwenzeka endizeni evundlile, ukuphuka kwe-Hoffa kwenzeka endizeni ye-coronal futhi kuyivelakancane kakhulu, ngakho-ke kuvame ukuphuthelwa ngesikhathi sokuxilongwa kokuqala komtholampilo kanye ne-radiological.
Kwenzeka nini ukuphuka kwe-Hoffa?
Ukuphuka kwe-Hoffa kubangelwa amandla e-shear ku-condyle yesifazane emadolweni. Ukulimala okuphezulu kwamandla ngokuvamile kubangela ukuphuka kwe-intercondylar kanye ne-supracondylar ye-distal femur. Izindlela ezivame kakhulu zihlanganisa izingozi zezimoto kanye nezimoto kanye nokuwa kusuka ekuphakameni. Lewis et al. waveza ukuthi iziguli eziningi ezinokulimala okuhlobene zidalwe amandla okuthonya aqondile ku-condyle ye-femoral yangemuva ngenkathi zigibela isithuthuthu idolo ligotshwe ku-90 °.
Yiziphi izimpawu zomtholampilo zokuphuka kukaHoffa?
Izimpawu eziyinhloko zokwephuka kwe-Hoffa eyodwa ukuqina kwamadolo kanye ne-hemarthrosis, ukuvuvukala, kanye ne-varum yohlobo oluncane noma i-valgus nokungazinzi. Ngokungafani nokuqhekeka kwe-intercondylar kanye ne-supracondylar, ukuphuka kwe-Hoffa cishe kuzotholakala ngengozi phakathi nezifundo ze-imaging. Ngenxa yokuthi ukuphuka okuningi kwe-Hoffa kubangelwa ukulimala kwamandla aphezulu, ukulimala okuhlangene ku-hip, i-pelvis, i-femur, i-patella, i-tibia, i-knee ligaments, kanye nemikhumbi ye-popliteal kumele ikhishwe.
Uma kusolakala ukuthi i-Hoffa iphukile, umuntu kufanele ayithathe kanjani i-X-ray ukuze agweme ukuphuthelwa ukuxilongwa?
I-radiographs ejwayelekile ye-anteroposterior kanye ne-lateral yenziwa njalo, futhi imibono ye-oblique yamadolo yenziwa uma kunesidingo. Uma ukuphuka kungasuswanga kakhulu, kuvame ukuba nzima ukukubona kuma-radiographs. Ekubukeni kwe-lateral, ukungezwani okuncane komugqa ohlangene we-femoral ngezinye izikhathi kubonakala, noma ngaphandle kokukhubazeka kwe-condylar valgus kuye ngokuthi i-condyle ehilelekile. Kuye nge-contour ye-femur, ukungaqhubeki noma isinyathelo emgqeni wokuphuka kungabonakala ekubukeni kwe-lateral. Kodwa-ke, ekubukeni kweqiniso kwaseceleni, amakhondali esifazane abonakala engagqagqani, kanti uma amakhondiyeli efinyeziwe futhi esuswa, angase adlulelane. Ngakho-ke, umbono ongalungile wokuhlanganiswa kwamadolo ovamile ungasinika umbono wamanga, ongaboniswa ngemibono ye-oblique. Ngakho-ke, ukuhlolwa kwe-CT kuyadingeka (Umfanekiso 1). I-Magnetic resonance imaging (MRI) ingasiza ekuhloleni izicubu ezithambile ezizungeze idolo (njengemigqa noma i-menisci) ngomonakalo.
Umfanekiso we-1 CT ubonise ukuthi isiguli sasinohlobo lwe-Letenneur ⅡC uhlobo lwe-Hoffa lokuphuka kwe-condyle ye-femoral lateral
Yiziphi izinhlobo ze-Hoffa fractures?
Ukuphuka kwe-Hoffa kuhlukaniswe ngohlobo lwe-B3 bese thayipha u-33.b3.2 kusigaba se-AO/OTA ngokuya ngesigaba sika-Muller. Kamuva, uLetenneur et al. ihlukanise ukuphuka kwaba izinhlobo ezintathu ngokusekelwe ebangeni lomugqa wokuphuka kwe-femoral kusukela ku-posterior cortex ye-femur.
Umfanekiso 2 Ukuhlukaniswa kwe-Letenneur kwama-Hoffa fractures
Thayipha I:Umugqa wokuphuka utholakala futhi uhambisana ne-posterior cortex ye-femoral shaft.
Uhlobo II:Ibanga elisuka emgqeni wokuphuka kuya emgqeni we-cortical wangemuva we-femur liphinde lihlukaniswe libe yi-subtypes IIa, IIb ne-IIc ngokwebanga elisuka emgqeni wokuphuka kuya ethambo le-cortical yangemuva. I-Type IIa iseduze kakhulu ne-posterior cortex ye-femoral shaft, kuyilapho i-IIc ikude kakhulu ne-posterior cortex ye-femoral shaft.
Uhlobo III:Ukuphuka kwe-Oblique.
Indlela yokwenza uhlelo lokuhlinza ngemva kokuxilongwa?
1. Ukukhethwa kokulungiswa kwangaphakathi Kukholelwa ukuthi ukunciphisa okuvulekile nokulungiswa kwangaphakathi kuyindinganiso yegolide. Ngokuphuka kwe-Hoffa, ukukhethwa kwezimila ezifanele zokulungisa kunqunyelwe. Izikulufu zokuminyanisa ezingenalutho ezinentambo encane zilungele ukulungiswa. Izinketho zokufakelwa zihlanganisa 3.5mm, 4mm, 4.5mm kanye 6.5mm izikulufo zokuminyanisa ezingenalutho ezinentambo kancane kanye nezikulufu zika-Herbert. Uma kunesidingo, amapuleti afanelekile aphikisana nokushelela angasetshenziswa lapha. UJarit uthole ngezifundo ze-cadaver biomechanical ukuthi izikulufu ze-posteroanterior lag zizinzile kunezikulufu ze-anterior-posterior lag. Kodwa-ke, indima eyisiqondiso yalokhu okutholakele ekusebenzeni komtholampilo ayikacaci.
2. Ubuchwepheshe bokuhlinza Uma ukuphuka kwe-Hoffa kutholakala ukuthi kuhambisana ne-intercondylar ne-supracondylar fracture, kufanele kunikezwe ukunakwa okwanele, ngoba uhlelo lokuhlinza kanye nokukhethwa kokulungiswa kwangaphakathi kunqunywa ngokusekelwe esimweni esingenhla. Uma i-condyle yangemuva ihlukaniswa nge-coronally, ukuchayeka ngokuhlinzwa kufana nokuphuka kwe-Hoffa. Kodwa-ke, akuhlakaniphile ukusebenzisa isikulufu se-condylar esiguqukayo, futhi ipuleti le-anatomical, ipuleti lokusekela le-condylar noma ipuleti le-LISS kufanele kusetshenziselwe ukulungisa esikhundleni salokho. I-condyle ephakathi kunzima ukuyilungisa ngokusebenzisa i-lateral incision. Kulokhu, i-anteromedial eyengeziwe eyengeziwe iyadingeka ukuze kuncishiswe futhi kulungiswe ukuphuka kwe-Hoffa. Kunoma yikuphi, zonke izingcezu ezinkulu zamathambo e-condylar zilungiswa nge-lag screws ngemva kokunciphisa i-anatomical ye-condyle.
- Indlela yokuhlinza Isiguli sihlezi phezu kombhede we-fluoroscopic one-tourniquet. I-bolster isetshenziselwa ukugcina i-engeli yokugoba kwamadolo cishe engu-90°. Ukuze uthole ukuphuka kwe-Hoffa okuphakathi, umbhali ukhetha ukusebenzisa i-median incision nge-medial parapatellar approach. Ngokuphuka kwe-lateral Hoffa, i-lateral incision isetshenziswa. Abanye odokotela basikisela ukuthi indlela ye-parapatellar ye-lateral nayo iyisinqumo esinengqondo. Uma iziphetho zokuphuka seziveziwe, ukuhlola okuvamile kwenziwa, bese iziphetho zokuphuka zihlanzwa nge-curette. Ngaphansi kombono oqondile, ukunciphisa kwenziwa ngokusebenzisa i-forceps yokunciphisa iphuzu. Uma kunesidingo, inqubo ye-"joystick" yezintambo ze-Kirschner isetshenziselwa ukunciphisa, bese izintambo ze-Kirschner zisetshenziselwa ukunciphisa nokulungiswa ukuze kuvinjelwe ukukhishwa kwe-fracture, kodwa izintambo ze-Kirschner azikwazi ukuvimbela ukufakwa kwezinye izikulufu (Umfanekiso 3). Sebenzisa okungenani izikulufu ezimbili ukuze ufinyelele ukulungiswa okuzinzile kanye nokuminyanisa kwe-interfragmentary. Gcoba i-perpendicular to the fracture futhi kude nejoyinti le-patellofemoral. Gwema ukubhoboza emgodini ohlangene ongemuva, okungcono nge-C-arm fluoroscopy. Izikulufu zifakwa ngamawasha noma ngaphandle kwawo njengoba kudingeka. Izikulufu kufanele zishiswe futhi zibe nobude obanele ukulungisa i-subarticular cartilage. I-intraoperative, idolo lihlolwa ngokulimala okuhambisanayo, ukuzinza, nobubanzi bokunyakaza, futhi ukuchelela okuphelele kwenziwa ngaphambi kokuvalwa kwesilonda.
Umfanekiso 3 Ukuncishiswa Kwesikhashana kanye nokulungiswa kokuphuka kwe-bicondylar Hoffa ngezintambo ze-Kirschner ngesikhathi sokuhlinzwa, kusetshenziswa izintambo ze-Kirschner ukuze kukhishwe izingcezu zamathambo.
Isikhathi sokuthumela: Mar-12-2025
