Ukuwa kwe-lateral tibial plateau noma ukuqhekeka kwe-split kuwuhlobo oluvame kakhulu lwe-tibial plateau fracture. Umgomo oyinhloko wokuhlinzwa ukubuyisela ukushelela kwendawo ehlangene nokuqondisa isitho esingezansi. Indawo ehlangene egoqiwe, lapho iphakanyisiwe, ishiya ukukhubazeka kwethambo ngaphansi koqwanga, ngokuvamile okudinga ukubekwa kwethambo le-autogenous iliac, ithambo le-allograft, noma ithambo lokwenziwa. Lokhu kufeza izinhloso ezimbili: okokuqala, ukubuyisela ukusekelwa kwesakhiwo samathambo, futhi okwesibili, ukukhuthaza ukuphulukiswa kwamathambo.
Uma kucatshangelwa ukusika okungeziwe okudingekayo kwethambo le-autogenous iliac, okuholela ekuhlukumezekeni okukhulu kokuhlinzwa, kanye nezingozi ezingaba khona zokwenqatshwa nokutheleleka okuhambisana nethambo le-allograft nethambo lokwenziwa, ezinye izazi ziphakamisa enye indlela ngesikhathi sokunciphisa okuvulekile kwe-lateral tibial plateau kanye nokulungiswa kwangaphakathi (ORIF). Baphakamisa ukuthi kunwetshwe ukusika okufanayo phezulu ngesikhathi senqubo futhi kusetshenziswe ukuxhunyelelwa kwethambo okukhansela kusukela ku-lateral femoral condyle. Imibiko yamacala amaningana ibhale le nqubo.
Ucwaningo lwaluhlanganisa amacala angu-12 anedatha ephelele yokulandela izithombe. Kuzo zonke iziguli, kusetshenziswe indlela evamile ye-tibial anterior lateral. Ngemva kokudalula ithafa le-tibial, ukusika kwanwetshwa phezulu ukuze kuvezwe i-condyle ye-femoral yangemuva. Kwasetshenziswa i-12mm Eckman bone extractor, futhi ngemva kokubhoboza ku-cortex yangaphandle ye-condyle ye-femoral, ithambo elikhansela elisuka ku-condyle eliseceleni lavunwa ngamaphasi amane aphindaphindiwe. Umthamo otholiwe wawusukela ku-20 kuye ku-40cc.
Ngemuva kokunisela okuphindaphindiwe komsele wamathambo, isiponji se-hemostatic singafakwa uma kunesidingo. Ithambo elikhanselwayo elivuniwe lifakwe embotsheni yethambo ngaphansi kwethafa le-lateral tibial, elilandelwa ukulungiswa kwangaphakathi okujwayelekile. Imiphumela ibonisa:
① Ukulungiswa kwangaphakathi kwethafa le-tibial, zonke iziguli zithole ukuphulukiswa kokuphuka.
② Abukho ubuhlungu obuphawulekayo noma izinkinga ezibonwe endaweni lapho ithambo livunwa khona ku-condyle ehlangene.
③ Ukuphulukiswa kwethambo endaweni yokuvuna: Phakathi kweziguli ezingu-12, ezi-3 zabonisa ukuphulukiswa okuphelele kwethambo le-cortical, eziyisi-8 zabonisa ukuphulukiswa okuyingxenye, kanti esi-1 asizange sibonise ukuphulukiswa okusobala kwethambo le-cortical.
④ Ukwakhiwa kwe-bone trabeculae endaweni yokuvuna: Ezimweni ezingu-9, akuzange kube khona ukwakheka kwe-bone trabeculae, futhi ezimweni ezingu-3, ukwakheka kwengxenye ye-bone trabeculae kwabonwa.
⑤ Izinkinga ze-osteoarthritis: Phakathi kweziguli ze-12, i-5 yakha i-arthritis yangemuva kwe-traumatic ye-knee joint. Isiguli esisodwa sashintshwa ngokuhlanganyela ngemva kweminyaka emine.
Ekuphetheni, ukuvuna ithambo elikhansela kusukela ku-ipsilateral lateral femoral condyle kubangela ukuphulukiswa kwethambo elihle le-tibial plateau ngaphandle kokwandisa ingozi yezinkinga ze-postoperative. Le nqubo ingacatshangelwa futhi ibhekiselwe ekusebenzeni komtholampilo.
Isikhathi sokuthumela: Oct-27-2023
