Ukuqhekeka kwe-hofa kungukuqhekeka kwendiza ye-coronal ye-somerdyle yabesifazane. Yayichazwa okokuqala nge-Friedrich Bussch ngonyaka we-1869 yaphinde yabikwa ngu-Albert Hoffa ngo-1904, futhi yaqanjwa ngokuthi emva kwakhe. Ngenkathi ama-fractures evame ukwenzeka endizeni evundlile, ama-hofa fractures avela endizeni ye-coronal futhi ayaqabukela, ngakho-ke ajwayele ukuphuthelwa ngesikhathi sokuxilongwa komtholampilo nakwa-radiological.
Kwenzeka nini i-hofsa fracture?
Ama-hofa fractures abangelwa amandla we-shear aya e-toweryle yabesifazane edolweni. Ukulimala kwamandla aphezulu kuvame ukudala i-Intercondylor kanye ne-supracondyloar fractures ye-distal femur. Izindlela ezivame kakhulu zifaka izimoto zemoto nezingozi zemoto futhi ziwe ekuphakameni. Lewis et al. kuvezwe ukuthi iningi leziguli ezinomthelela ohlobene nalo libangelwa amandla anomthelela oqondile kwi-conderformy yowesifazane wamuva ngenkathi egibela isithuthuthu ngedolo elivuthayo ku-90 °
Yikuphi ukubonakaliswa kwemitholampilo kukaHofra fracture?
Izimpawu eziphambili zokuqhekeka okukodwa kwe-hofsa kungukukhuphuka kwamadolo kanye ne-hemarthrosis, ukuvuvukala, kanye ne-gen mon ger varum noma i-valgus nokuqina. Ngokungafani ne-intercondylar kanye ne-supracondylar fractures, ama-hofa fractures kungenzeka atholakale ngengozi ngesikhathi sezifundo zokucabanga. Ngoba ama-hofa fractures amaningi avela ekulimaleni kwamandla aphezulu, ukulimala okuhlanganisiwe ku-hip, pelvis, felvis, patella, tigamenta, nemithambo ye-popliteal kumele kubekwe ngaphandle.
Lapho kusolwa ukuqhekeka kwe-hofsa, umuntu kufanele athathe kanjani ama-x-ray ukugwema ukuyeka ukuxilongwa?
Ama-radiographs ajwayelekile we-anteroposteror kanye nama-radiographs asetshenziswa njalo, futhi ukubukwa okukhohlisayo kwedolo kwenziwa lapho kunesidingo. Lapho ukuqhekeka kungadingiswa kakhulu, kuvame ukuba nzima ukukuthola kuma-radiographs. Ekubukeni kwangemuva, ukuhlukaniswa okuncane komugqa womuntu wesifazane kwesinye isikhathi kubonakala, ngokuqina kwe-valgus noma ngaphandle kokuqina kwe-condylar valgus ngokuya nge-collyle ehilelekile. Ngokuya nge-contour ye-femur, ukunqanyulwa noma isinyathelo emgqeni we-fracture kungabonakala ekubukeni kwangemuva. Kodwa-ke, ekubukeni kwangempela kwangempela, ama-desylieve wowesifazane avela ngokungenhla, kanti uma ama-ndoyle ancishisiwe futhi adilizwe, angahle anciphise. Ngakho-ke, umbono ongalungile we-Knee evamile ngokuhlangana ungasinika umbono ongamanga, ongakhonjiswa ngokubukwa okukhohlisayo. Ngakho-ke, ukuhlolwa kwe-CT kuyadingeka (Umdwebo 1). I-Magnetic Resonance imaging (MRI) ingasiza ukuhlola izicubu ezithambile ezizungeze idolo (njengama-ligaments noma i-menisci) ngomonakalo.
Umdwebo ongu-1 CT wakhombisa ukuthi isiguli saba ne-letenneur ⅱc Try DOFA FRACTURE ye-Hoteral Femoryledle
Yiziphi izinhlobo ze-hofa fractures?
Ama-hofa fractures ahlukaniswe ngohlobo lwe-B3 nohlobo lwe-33.b3.2 ekuhlukanisweni kwe-AO / OTA ngokusho kokuhlukaniswa kukaMuller. Kamuva, uLetenneur et al. Ihlukaniswe ukuqhekeka ezinhlotsheni ezintathu ngokususelwa ebangeni le-Femort Fracture Line kusuka ku-cortex ngemuva kwe-femur.
Ukuhlukaniswa kwe-Lide2 lenneur of hofsa fractures
Thayipha I:Umugqa we-Fracture utholakala futhi uhambisana ne-cortex yangemuva ye-Femord Shaft.
Uhlobo II:Ibanga kusuka kulayini we-fracture kuya kulayini we-fomur wangemuva we-femur uhlukaniswe nge-subtypes IIA, iib kanye ne-IIC ngokuya ngebanga ukusuka ethanjeni eliphakeme le-cortical. Uhlobo lwe-IIA lusondele kakhulu kwi-cortex engemuva kweshwele yangemuva, kanti iic i-IIC ide kakhulu e-cortex yangemva kwesimo sowesifazane.
Uhlobo lwe-III:Ukuqhekeka okuyi-oblique.
Ukwenza kanjani uhlelo lokuhlinza ngemuva kokuxilongwa?
1. Ukukhethwa kwangaphakathi kwangaphakathi kuvame ukukholelwa ukuthi ukuncishiswa okuvulekile nokulungiswa kwangaphakathi kuyindinganiso yegolide. Ukuze uthole ama-hofa fractures, ukukhethwa kwezimila ezifanelekile ezilinganiselwe kukhawulelwe impela. Izikulufo ezihlanganiswe ngokwengxenye ze-Holew Comprys zilungele ukulungiswa. Izinketho zokufakwa zifaka i-3.5mm, 4mm, 4.5mm kanye nezikulungwane eziyi-6.5mm ngokwengxenye ezihlanganisiwe ze-Hole Compression Scress kanye nezikulufo ezingama-herbert. Lapho kunesidingo, kufanelekile, amapuleti afanelekayo alwa nama-anti-slip nawo angasetshenziswa lapha. IJarit itholwe ngezifundo ze-cadaver biomechanical izikulufu ze-posteroanterterior lag zizinza ngokwedlula izikulufo ze-anterior-poserior lag. Kodwa-ke, indima eqondisayo yalokhu okutholakele ekusebenzeni komtholampilo akukacaci.
2. Ubuchwepheshe bokuhlinza lapho kutholakala i-hofa fracture kuhambisana ne-intercondylar kanye ne-supracondylar fracture, kufanele inikezwe ukunakwa ngokwanele, ngoba uhlelo lokuhlinzwa nokukhethwa kokulungiswa kwangaphakathi kunqunywe ngesimo esingenhla. Uma i-whearyle ye-lateral ihlukaniswa ngokuphelele, ukuvezwa kokuhlinzwa kuyafana nalokho kwe-hoffa fracture. Kodwa-ke, akukhona ukuhlakanipha ukusebenzisa isikulufa se-condylar enamandla, nepuleti ye-anatomical, ipuleti lokusekela le-condylar noma ipuleti ye-liss kufanele isetshenziselwe ukulungiswa esikhundleni salokho. I-Medial Collecyle kunzima ukuyilungisa ngokuvela kwamuva. Kulokhu, ukuvela okwengeziwe kwe-anteremidial kuyadingeka ukunciphisa nokulungisa ukuqhekeka kwe-hofa. Kunoma ikuphi, zonke izingcezwana ezinkulu ze-condylar zihlelwe ngezikulufo ze-lag ngemuva kokuncishiswa kwe-anatomical kwe-condom.
- Indlela yokuhlinzwa Isiguli sisendaweni ephakeme embhedeni we-fluoroscopic onomhleli we-tourniquet. I-bolster isetshenziselwa ukugcina i-knee flexion angle e-90 °. Ukuze uthole ukuqhekeka okulula kwe-hofma, umbhali ukhetha ukusebenzisa incision median enendlela ye-parapatellar ye-medial. Ukuze kusetshenziswe i-hofsa fractures, kusetshenziswa inciselwame lateral. Abanye odokotela baphakamisa ukuthi indlela ye-parapatellar elanda futhi iyisinqumo esifanele. Lapho nje ukwaphuka kuphelile kudalulwa, kuhlolwe inqubo ejwayelekile, bese kuthi ama-fracture ends ahlanzwa nge-curte. Ngaphansi kombono oqondile, ukwehliswa kwenziwa kusetshenziswa ama-point redruction forceps. Uma kunesidingo, inqubo ye- "Joyststick" ye-KIRSchner Wires isetshenziselwa ukuncishiswa, bese kuthi izintambo ze-kirschner zisetshenziselwa ukunciphisa ukuncishiswa, kepha izintambo ze-kirschner azikwazi ukuvimbela ukufuduka kwezinye izikulufu (Umdwebo 3). Sebenzisa okungenani izikulufo ezimbili ukuze uzuze ukulungiswa okuzinzile nokucindezelwa okungachazwanga. Ukushayela ngokuhlukile ekuqhekekeni futhi kude ne-patellofemoral Joint. Gwema ukumba ungene endaweni ehlanganyelwe ehlanganayo, mhlawumbe nge-C-arm fluoroscopy. Izikulufa zibekwe noma ngaphandle kokugeza njengoba kudingeka. Izikulufo kufanele zibe yi-couressink futhi ubude obunele ukulungisa i-cartilage ye-subticular. I-Intraoperatively, idolo lihlolwe ukulimala okuhlangene, ukuqina, kanye nobubanzi bokunyakaza, kanye nokunisela ngokuphelele kwenziwa ngaphambi kokuvalwa kokulimala.
Umdwebo wokuncishiswa okwesithathu nokulungiswa kokulungiswa kwesikhashana kwe-bicondylar hofa fractures nge-kirschner izintambo ngesikhathi sokuhlinzwa, kusetshenziswa izintambo zeKistschner zokuthola izingcezwana zamathambo
Isikhathi sePosi: Mar-12-2025
