Abstract: Inhloso: Ukuphenya izici ezihlobene zomphumela wokusebenza wokusebenzisa ipuleti lensimbi ukulungiswa kwangaphakathi ukubuyiselai-tibial plateau fracture. Indlela: Iziguli ze-34 ezine-tibial plateau fracture zaziqhutshwa ngokusebenzisa ipuleti lensimbi ukulungiswa kwangaphakathi ohlangothini olulodwa noma ezimbili, kubuyiselwe i-tibal plateau isakhiwo se-anatomical, ukulungiswa ngokuqinile, futhi kwathatha umsebenzi wokuqala wokuzivocavoca ngemva kokuhlinzwa. Umphumela: Zonke iziguli zalandelelwa izinyanga ezi-4-36, ngokwesilinganiso sezinyanga eziyi-15, ngokwesilinganiso sikaRasmussen, iziguli ezingama-21 zazihamba phambili, eziyi-8 zizinhle, ezi-3 zivunyiwe, ezi-2 kwabampofu. Isilinganiso esihle kakhulu sasingu-85.3%. Isiphetho: Bamba amathuba okusebenza afanelekile, sebenzisa izindlela ezifanele futhi wenze izivivinyo zokusebenza zangaphambili, usinike imiphumela emihle yokusebenza ekwelaphenii-tibiali-plateau fracture.
1.1 Ulwazi Olujwayelekile: leli qembu lineziguli ezingama-34 nabesilisa abangama-26 nabesifazane abayisi-8. Iziguli bezineminyaka engama-27 kuye kwengama-72 kanti isilinganiso seminyaka yobudala engama-39.6. Kunamacala angu-20 okulimala ezingozini zomgwaqo, angu-11 okulimala okuwa kanye nangu-3 okuchotshozwa kanzima. Wonke amacala avaliwe ama-fractures ngaphandle kokulimala kwemithambo. Kwakukhona amacala angu-3 okulimala kwe-cruciate ligament, amacala angu-4 okulimala kwe-collateral ligament kanye namacala angu-4 okulimala kwe-meniscus. Ama-fractures ahlukaniswa ngokuhambisana ne-Schatzker: amacala angu-8 ohlobo lwe-I, amacala angu-12 ohlobo lwe-II, amacala angu-5 ohlobo lwe-III, amacala angu-2 ohlobo lwe-IV, amacala angu-4 ohlobo lwe-V kanye namacala angu-3 ohlobo lwe-VI. Zonke iziguli zahlolwa nge-X-ray, i-CT scan ye-tibial plateau kanye nokwakhiwa kabusha kwezingxenye ezintathu, kanti ezinye iziguli zahlolwa ngu-MR. Ngaphandle kwalokho, isikhathi sokusebenza sasiyi-7~21d ngemva kokulimala, isilinganiso esingu-10d. Kulokhu, bekuneziguli ezingama-30 ezamukela ukwelashwa kokuxhunyelelwa amathambo, iziguli ezi-3 ezamukela ukulungiswa kwepuleti eliphindwe kabili, kanti ezinye iziguli ezamukela ukulungiswa kwangaphakathi okuhlangene.
1.2 Indlela Yokuhlinza: kwenziwaumgogodlai-anesthesia noma i-intubation anesthesia, isiguli sasisesimweni sokulala, futhi siqhutshwa ngaphansi kwe-tourniquet ye-pneumatic. Ukuhlinzwa kusetshenziswa idolo elingemuva, i-anterior tibial noma i-lateralidolo elihlangeneukusika ngemuva. Umsipha we-Coronary waqanjwa eduze kwe-Incision emaphethelweni aphansi we-meniscus, futhi wadalula i-articular surface ye-tibial plateau. Yehlisa ukuphuka kwethafa ngaphansi kombono oqondile. Amanye amathambo aqale alungiswa ngezikhonkwane ze-Kirschner, abese elungiswa ngamapuleti afanelekile (i-golf-plate, L-plates, T-plate, noma ehlanganiswe ne-medial buttress plate). Ukukhubazeka kwamathambo kwakugcwele ithambo le-allogen (ekuqaleni) kanye ne-allograft bone grafting. Ekuhlinzweni, udokotela ohlinzayo wabona ukuncishiswa kwe-anatomical kanye nokuncishiswa kwe-anatomical proximal, igcinwe i-axis ye-tibial evamile, ukulungiswa kwangaphakathi okuqinile, ukuxhunyelelwa kwamathambo okuhlangene nokusekelwa okunembile. Uphenyisise umsipha wedolo kanye ne-meniscus ukuze uthole ukuxilongwa ngaphambi kokuhlinzwa noma amacala asolwayo angaphakathi kokuhlinzwa, futhi wenza inqubo efanele yokulungisa.
1.3 Ukwelashwa Kwangemva Kokuhlinzwa: Ibhandeshi elinwebekayo langemva kokuhlinzwa kufanele liboshwe ngendlela efanele, futhi ukusika sekwephuzile kufakwe ngeshubhu lokudonsa amanzi, okufanele likhishwe ngo-48h. I-analgesia yangemva kokuhlinzwa. Iziguli zenze izivivinyo zezicubu zomzimba ngemva kwamahora angu-24, futhi zathatha izivivinyo ze-CPM ngemva kokukhipha ishubhu lokudonsa amanzi ngenxa yokuphuka okulula. Kuhlanganiswe umsipha wesibambiso, amacala okulimala kwe-posterior cruciate ligament, ngokuzikhandla nangokunyakazisa idolo ngemva kokulungisa ukhonkolo noma i-brace inyanga eyodwa. Ngokwemiphumela yokuhlolwa kwe-X-ray, udokotela ohlinzayo waqondisa iziguli ukuba zithathe kancane kancane izivivinyo zokulayisha isisindo sezitho, futhi ukulayishwa kwesisindo esigcwele kufanele kwenziwe okungenani ezinyangeni ezine kamuva.
Isikhathi sokuthumela: Jun-02-2022
