Ukuphuka kwe-proximal femoral kuvame ukubonakala njengokulimala kwezokwelapha okubangelwa ukulimala okunamandla aphezulu. Ngenxa yezici zomzimba ze-proximal femur, umugqa wokuphuka uvame ukuba seduze nobuso be-articular futhi ungadlulela ejoyintini, okwenza kungabi kuhle ukuqiniswa kwezipikili ngaphakathi kwe-medullary. Ngenxa yalokho, ingxenye enkulu yamacala isathembele ekuqinweni kusetshenziswa uhlelo lwepuleti kanye nezikulufo. Kodwa-ke, izici ze-biomechanical zamapuleti aqinile ngendlela engavamile zibeka ingozi enkulu yezinkinga ezifana nokwehluleka kokuqina kwepuleti eliseceleni, ukuqhekeka kokuqina kwangaphakathi, kanye nokudonswa kwezikulufo. Ukusetshenziswa kosizo lwepuleti eliphakathi ukuze kuqiniswe, yize kusebenza kahle, kuza nezinkinga zokulimala okwandisiwe, isikhathi eside sokuhlinzwa, ingozi enkulu yokutheleleka ngemva kokuhlinzwa, kanye nomthwalo owengeziwe wezezimali weziguli.
Ngenxa yalezi zinto ezicatshangelwayo, ukuze kufezwe ibhalansi efanelekile phakathi kwezingqinamba ze-biomechanical zama-lateral single plates kanye nokulimala kokuhlinzwa okuhlobene nokusetshenziswa kwama-medial kanye nama-lateral double plates, izazi zakwamanye amazwe zisebenzise inqubo ehilela ukulungiswa kwe-lateral plate nge-supplementary percutaneous screw fixation ohlangothini lwe-medial. Le ndlela ibonise imiphumela emihle yezokwelapha.
Ngemva kokuhlinzwa, isiguli sibekwa endaweni yokulala phansi.
Isinyathelo 1: Ukunciphisa ukwaphuka. Faka inaliti ye-Kocher engu-2.0mm ku-tibial tuberosity, ubambe ukuze usethe kabusha ubude besitho, bese usebenzisa i-knee pad ukulungisa ukufuduka kwendiza ye-sagittal.
Isinyathelo 2: Ukubekwa kwepuleti lensimbi eliseceleni. Ngemva kokunciphisa okuyisisekelo ngokudonsela phansi, sondela ngqo ku-distal lateral femur, khetha ipuleti elikhiyayo elifanele ubude ukuze ulondoloze ukunciphisa, bese ufaka izikulufo ezimbili emaphethelweni aseduze nakude okuqhekeka ukuze ulondoloze ukunciphisa kokuqhekeka. Kuleli qophelo, kubalulekile ukuqaphela ukuthi izikulufo ezimbili ezikude kufanele zibekwe eduze ngangokunokwenzeka ukuze kugwenywe ukuthinta ukubekwa kwezikulufo eziphakathi.
Isinyathelo 3: Ukubeka izikulufu zekholomu eziphakathi. Ngemva kokuqinisa ukuqhekeka ngepuleti lensimbi eliseceleni, sebenzisa i-drill eqondiswa yi-screw engu-2.8mm ukuze ungene nge-condyle ephakathi, lapho iphuzu lenaliti likhona endaweni ephakathi noma engemuva ye-distal femoral block, ngokuphambeneyo ngaphandle naphezulu, lingena ethanjeni eliphambene. Ngemva kokunciphisa i-fluoroscopy ngokwanele, sebenzisa i-drill engu-5.0mm ukudala imbobo bese ufaka i-screw yethambo ekhanseliwe engu-7.3mm.
Umdwebo obonisa inqubo yokunciphisa nokuqiniswa kokuqhekeka. Owesifazane oneminyaka engu-74 ubudala one-distal femoral intra-articular fracture (AO 33C1). (A, B) Ama-radiograph angaphambi kokuhlinzwa abonisa ukuhamba okuphawulekayo kokuqhekeka kwe-distal femoral; (C) Ngemva kokunciphisa ukuqhekeka, kufakwa ipuleti langaphandle eliseceleni elinezikulufo ezibopha kokubili iziphetho eziseduze nezikude; (D) Isithombe se-Fluoroscopy esibonisa indawo eyanelisayo yentambo yokuqondisa ye-medial; (E, F) Ama-radiograph angemuva kokuhlinzwa kanye ne-anteroposterior ngemva kokufakwa kwesikulufu sekholomu ye-medial.
Ngesikhathi senqubo yokunciphisa, kubalulekile ukucabangela amaphuzu alandelayo:
(1) Sebenzisa ucingo oluqondisayo olunesikulufu. Ukufakwa kwezikulufu zekholomu ephakathi kubanzi kakhulu, futhi ukusebenzisa ucingo oluqondisayo olungenasikulufu kungaholela ekhoneni eliphezulu ngesikhathi sokubhoboza i-condyle ephakathi, okwenza kube lula ukushelela.
(2) Uma izikulufo eziseceleni zibamba ngempumelelo i-cortex eseceleni kodwa zehluleka ukufeza ukuqina kwe-cortex ekabili okusebenzayo, lungisa indlela yesikulufo eya phambili, uvumele izikulufo zingene ohlangothini olungaphambili lwe-plate eseceleni ukuze kufezwe ukuqina kwe-cortex ekabili okwanelisayo.
(3) Ezigulini ezine-osteoporosis, ukufaka umshini wokuwasha one-screw yekholamu ephakathi kungavimbela isikulufu ukuthi singasikeki singene ethanjeni.
(4) Izikulufo ekugcineni kwepuleti zingase zivimbele ukufakwa kwezikulufo zekholomu ephakathi. Uma kutholakala ukuvinjelwa kwezikulufo ngesikhathi sokufakwa kwesikulufo sekholomu ephakathi, cabanga ngokuhoxisa noma ukushintsha izikulufo zekholomu eseceleni, unikeze kuqala ukubekwa kwezikulufo zekholomu ephakathi.
Icala 2. Isiguli sesifazane, esineminyaka engu-76 ubudala, esinokwaphuka kwe-extra-articular ye-distal femoral. (A, B) Ama-X-ray angaphambi kokuhlinzwa abonisa ukufuduka okukhulu, ukukhubazeka kwe-angular, kanye nokufuduka kwe-coronal plane kokuqhekeka; (C, D) Ama-X-ray angemva kokuhlinzwa emibonweni eseceleni kanye neyangaphambili ekhombisa ukuqiniswa ngepuleti yangaphandle eseceleni ehlanganiswe nezikulufo zekholomu eziphakathi; (E, F) Ama-X-ray alandelayo ezinyangeni ezingu-7 ngemuva kokuhlinzwa aveza ukuphulukiswa okuhle kakhulu kokuqhekeka ngaphandle kwezimpawu zokwehluleka kokulungiswa kwangaphakathi.
Icala 3. Isiguli sesifazane, esineminyaka engu-70 ubudala, esinokwaphuka kwe-periprosthetic eduze kwe-femoral implant. (A, B) Ama-X-ray angaphambi kokuhlinzwa abonisa ukwaphuka kwe-periprosthetic eduze kwe-femoral implant ngemuva kwe-arthroplasty yedolo lonke, kanye nokuphuka kwe-extra-articular kanye nokuqina kokufakelwa okuzinzile; (C, D) Ama-X-ray angemva kokuhlinzwa abonisa ukulungiswa nge-external lateral plate ehlanganiswe nezikulufu ze-medial column ngendlela ye-extra-articular; (E, F) Ama-X-ray alandelayo ezinyangeni eziyi-6 ngemuva kokuhlinzwa aveza ukuphulukiswa okuhle kakhulu kokuphuka, kanye nokulungiswa kwangaphakathi endaweni.
Isikhathi sokuthunyelwe: Jan-10-2024
