Ukuwa kwethafa le-tibial lateral noma ukuwa okuqhekekile uhlobo oluvame kakhulu lokuphuka kwethafa le-tibial. Umgomo oyinhloko wokuhlinzwa ukubuyisela ukushelela kobuso bejoyinti nokuqondisa umlenze ongezansi. Ubuso bejoyinti eliwile, uma buphakanyisiwe, bushiya isici sethambo ngaphansi kwe-cartilage, okuvame ukudinga ukufakwa kwethambo le-iliac eliyi-autogenous, ithambo le-allograft, noma ithambo lokwenziwa. Lokhu kufeza izinjongo ezimbili: okokuqala, ukubuyisela ukwesekwa kwesakhiwo samathambo, kanti okwesibili, ukukhuthaza ukuphulukiswa kwamathambo.
Uma sibheka ukusikwa okwengeziwe okudingekayo ethanjeni le-iliac eliyi-autogenous, okuholela ekulimaleni okukhulu kokuhlinzwa, kanye nezingozi ezingaba khona zokwenqatshwa kanye nokutheleleka okuhlobene nethambo le-allograft kanye nethambo lokwenziwa, ezinye izazi ziphakamisa indlela ehlukile ngesikhathi sokunciphisa okuvulekile kwe-tibial plateau kanye nokulungiswa kwangaphakathi (i-ORIF). Ziphakamisa ukwelula ukusikwa okufanayo phezulu ngesikhathi senqubo nokusebenzisa i-cancellous bone graft evela ku-lateral femoral condyle. Imibiko eminingana yamacala ibhale phansi le ndlela.
Ucwaningo luhlanganise amacala ayi-12 anedatha ephelele yokuthwebula izithombe. Kuzo zonke iziguli, kusetshenziswe indlela ejwayelekile ye-tibial anterior lateral. Ngemva kokudalula i-tibial plateau, ukusikwa kwelulelwa phezulu ukuze kudalulwe i-lateral femoral condyle. Kwasetshenziswa i-12mm Eckman bone extractor, kwathi ngemva kokubhoboza i-cortex yangaphandle ye-femoral condyle, ithambo le-cancellous elivela ku-lateral condyle lavunwa ngokuphindaphindiwe kane. Umthamo otholiwe wawusukela ku-20 kuya ku-40cc.
Ngemva kokunisela ngokuphindaphindiwe umsele wamathambo, isiponji esingena igazi singafakwa uma kudingeka. Ithambo elivuniwe elikhanseliwe lifakwa esikhumbeni samathambo ngaphansi kwethafa le-lateral tibial, kulandele ukufakwa kwangaphakathi okuvamile. Imiphumela ikhombisa:
① Ukuze kuqiniswe ngaphakathi kwethafa le-tibial, zonke iziguli zithole ukwelashwa kokuphuka.
② Akukho buhlungu obukhulu noma izinkinga ezibonwe endaweni lapho ithambo liqoqwe khona ku-lateral condyle.
③ Ukuphulukiswa kwethambo endaweni yokuvuna: Phakathi kweziguli ezingu-12, ezintathu zibonise ukuphulukiswa okuphelele kwethambo le-cortical, ezingu-8 zibonise ukuphulukiswa okuyingxenye, kanti eyodwa ayibonisanga ukuphulukiswa okusobala kwethambo le-cortical.
④ Ukwakheka kwe-trabeculae yamathambo endaweni yokuvuna: Ezimweni ezingu-9, akukho ukwakheka okubonakalayo kwe-trabeculae yamathambo, kanti ezimweni ezingu-3, kwabonakala ukwakheka okuyingxenye kwe-trabeculae yamathambo.
⑤ Izinkinga ze-osteoarthritis: Phakathi kweziguli ezingu-12, ezi-5 zaba nesifo samathambo esilandela ukushaqeka kwedolo. Isiguli esisodwa sashintshwa ijoyinti eminyakeni emine kamuva.
Ekuphetheni, ukuvuna ithambo elikhanseliwe kusuka ku-ipsilateral lateral femoral condyle kuphumela ekwelapheni okuhle kwethambo le-tibial plateau ngaphandle kokwandisa ingozi yezinkinga zangemva kokuhlinzwa. Le ndlela ingacatshangelwa futhi ibhekiselwe kuyo emitholampilo.
Isikhathi sokuthunyelwe: Okthoba-27-2023
