Ukuqhekeka kwe-tibial plateau kuhlanganiswe nokuqhekeka kwe-ipsilateral tibial shaft kuvame ukubonakala ekulimaleni okunamandla aphezulu, kanti ama-54% awokuqhekeka okuvulekile. Izifundo zangaphambilini zithole ukuthi ama-8.4% okuqhekeka kwe-tibial plateau kuhlotshaniswa nokuqhekeka kwe-tibial shaft okuhambisanayo, kuyilapho ama-3.2% eziguli eziqhekekile i-tibial shaft enokuqhekeka kwe-tibial plateau okuhambisanayo. Kusobala ukuthi ukuhlanganiswa kokuqhekeka kwe-ipsilateral tibial plateau kanye ne-shaft akuyona into engavamile.
Ngenxa yemvelo enamandla aphezulu yalezi zingozi, kuvame ukuba nomonakalo omkhulu wezicubu ezithambile. Ngokombono, uhlelo lwepuleti kanye nesikulufu lunezinzuzo ekufakweni kwangaphakathi kwama-plate fracture, kodwa ukuthi izicubu ezithambile zendawo zingabekezelela yini ukufakwa kwangaphakathi ngepuleti kanye nohlelo lwesikulufu nakho kuyinto ebalulekile emtholampilo. Ngakho-ke, okwamanje kunezinketho ezimbili ezivame ukusetshenziswa zokufakwa kwangaphakathi kwama-plate plate fracture kuhlanganiswe nokuqhekeka komgodi we-tibial:
1. Indlela ye-MIPPO (Minimally Invasive Plate Osteosynthesis) enepuleti elide;
2. Isikulufu sezinzipho zangaphakathi + i-plateau.
Zombili izinketho zibikiwe ezincwadini, kodwa okwamanje akukho ukuvumelana ngokuthi yikuphi okungcono noma okuphansi ngokwezinga lokuphulukiswa kokuphuka, isikhathi sokuphulukiswa kokuphuka, ukuhambisana kwezingalo ezingezansi, kanye nezinkinga. Ukuze kuxazululwe lokhu, izazi ezivela esibhedlela saseyunivesithi yaseKorea zenze ucwaningo lokuqhathanisa.
Ucwaningo luhlanganise iziguli ezingu-48 ezinezimpaphe ze-tibial plateau eziqhekekile kanye nezimpaphe ze-tibial shaft. Phakathi kwazo, amacala angu-35 aphathwe ngendlela ye-MIPPO, ngokufakwa kwepuleti lensimbi eceleni ukuze liqiniswe, kanti amacala angu-13 aphathwa ngezikulufo ze-plateau ezihlanganiswe nendlela ye-infrapatellar yokulungisa izinzipho ngaphakathi kwe-medullary.
▲ Icala 1: Ukufakwa kwangaphakathi kwepuleti lensimbi le-MIPPO eliseceleni. Indoda eneminyaka engu-42 ubudala, ebandakanyeke engozini yemoto, yathola ukuphuka komgodi we-tibial ovulekile (uhlobo lwe-Gustilo II) kanye nokuphuka kokucindezela kwe-tibial plate ye-medial (uhlobo lwe-Schatzker IV).
▲ Icala 2: Isikulufu se-tibial plateau + ukufakwa kwangaphakathi kwezipikili ze-suprapatellar intramedullary. Indoda eneminyaka engu-31 ubudala, ebandakanyeke engozini yemoto, yathola ukuphuka kwe-tibial shaft evulekile (uhlobo lwe-Gustilo IIIa) kanye nokuphuka kwe-tibial plateau lateral (uhlobo lwe-Schatzker I). Ngemva kokususwa kwenxeba kanye nokwelashwa kwe-negative pressure wound (VSD), inxeba laxhunyelelwa esikhumbeni. Izikulufu ezimbili ezingu-6.5mm zasetshenziswa ukunciphisa nokulungisa i-plateau, kwalandela ukufakwa kwezipikili ze-intramedullary ze-tibial shaft ngendlela ye-suprapatellar.
Imiphumela ikhombisa ukuthi akukho mehluko obalulekile ngokwezibalo phakathi kwezindlela ezimbili zokuhlinzwa maqondana nesikhathi sokuphulukiswa kokuphuka, izinga lokuphulukiswa kokuphuka, ukuhlelwa kwezitho ezingezansi, kanye nezinkinga.
Njengokuhlanganiswa kokuphuka kwe-tibial shaft okunokuphuka kwe-ankle joint noma ukuphuka kwe-femoral shaft okunokuphuka kwe-femoral neck neck, ukuphuka kwe-tibial shaft okubangelwa amandla aphezulu nakho kungaholela ekulimaleni kwe-joint yedolo eseduze. Emtholampilo, ukuvimbela ukuhlonza okungalungile kuyinto ebaluleke kakhulu ekuxilongweni nasekwelashweni. Ngaphezu kwalokho, ekukhetheni izindlela zokulungisa, yize ucwaningo lwamanje luphakamisa ukuthi akukho mehluko obalulekile, kusenamaphuzu amaningana okufanele acatshangelwe:
1. Ezimweni zokuphuka kwe-tibial plateau lapho ukulungiswa okulula kwesikulufo kuyinselele, kungabekwa phambili ukusetshenziswa kwepuleti elide elinokulungiswa kwe-MIPPO ukuze kuzinziswe ngokwanele i-tibial plateau, kubuyiselwe ukuhambisana kobuso bamalunga kanye nokuqondana kwezingalo ezingezansi.
2. Ezimweni zokuqhekeka okulula kwethafa le-tibial, ngaphansi kokusikwa okungangeni kakhulu, ukunciphisa okuphumelelayo kanye nokulungiswa kwezikulufo kungafinyelelwa. Ezimweni ezinjalo, kuqala kunganikezwa ukulungiswa kwezikulufo okulandelwa ukulungiswa kwezipikili ze-suprapatellar intramedullary ze-tibial shaft.
Isikhathi sokuthunyelwe: Mashi-09-2024
