I-Tibial plateau fractures ehlangene ne-ipsilateral tibial shaft fractures ivame ukubonakala ekulimazeni okunamandla amakhulu, kanti i-54% ibe ama-fractures avulekile.Ucwaningo lwangaphambili luye lwathola ukuthi i-8.4% ye-tibial plateau fractures ihlotshaniswa ne-concomitant tibial shaft fractures, kuyilapho i-3.2% yeziguli ze-tibial shaft fracture zine-concomitant tibial plateau fractures.Kusobala ukuthi ukuhlanganiswa kwe-ipsilateral tibial plateau kanye ne-shaft fractures akuyona into engavamile.
Ngenxa yemvelo enamandla yokulimala okunjalo, kuvame ukuba nomonakalo omkhulu wezicubu ezithambile.Ngokombono, i-plate and screw system inezinzuzo ekulungiseni kwangaphakathi kokuphuka kwe-plateau, kodwa ukuthi izicubu ezithambile zendawo zingakwazi yini ukubekezelela ukulungiswa kwangaphakathi ngepuleti nesistimu yezikulufu nakho kuwukucatshangelwa komtholampilo.Ngakho-ke, okwamanje kunezinketho ezimbili ezivame ukusetshenziswa zokulungiswa kwangaphakathi kwe-tibial plateau fractures ehlanganiswe ne-tibial shaft fractures:
1. Indlela ye-MIPPO (I-Minimally Invasive Plate Osteosynthesis) enepuleti elide;
2. I-Intramedullary nail + isikulufu sethafa.
Zombili izinketho zibikwa ezincwadini, kodwa okwamanje akukho ukuvumelana ngokuthi yikuphi okuphakeme noma okuphansi ngokwezinga lokuphulukisa ukuphuka, isikhathi sokuphulukiswa kokuphuka, ukuqondanisa kwemilenze ephansi, kanye nezinkinga.Ukuze kubhekwane nalokhu, izazi zesibhedlela saseyunivesithi yaseKorea zenza ucwaningo lokuqhathanisa.
Ucwaningo lwaluhlanganisa iziguli ze-48 ezine-tibial plateau fractures ezihlangene ne-tibial shaft fractures.Phakathi kwazo, amacala angu-35 aphathwe ngendlela ye-MIPPO, ngokufakwa eceleni kwepuleti lensimbi ukuze kulungiswe, futhi amacala angu-13 aphathwe ngezikulufu ze-plateau ezihlanganiswe nendlela ye-infrapatellar yokulungiswa kwe-intramedullary nail.
▲ Ikesi 1: I-Lateral MIPPO steel plate fixation yangaphakathi.Owesilisa oneminyaka engu-42 ubudala, ohileleke engozini yemoto, unikezwe ukuphuka kwe-shaft ye-tibial evulekile (uhlobo lwe-Gustilo II) kanye nokuphulwa kokucindezela kwe-tibial plateau compression fracture (uhlobo lwe-Schatzker IV).
▲ Icala lesi-2: I-Tibial plateau screw + i-suprapatellar intramedullary nail fixation yangaphakathi.Owesilisa oneminyaka engu-31 ubudala, ohileleke engozini yemoto, wethulwe ukuphuka kwe-shaft ye-tibial evulekile (uhlobo lwe-Gustilo IIIa) kanye nokuphuka kwe-lateral tibial plateau fracture (uhlobo lwe-Schatzker I).Ngemuva kokukhishwa kwesilonda kanye nokwelashwa kwesilonda esibi (VSD), isilonda saxhunyelelwa isikhumba.Izikulufu ezimbili ezingu-6.5mm zasetshenziselwa ukunciphisa nokulungiswa kwethafa, kulandelwa ukulungiswa kwe-intramedullary nail shaft ye-tibial ngendlela ye-suprapatellar.
Imiphumela ibonisa ukuthi awukho umehluko obalulekile ngokwezibalo phakathi kwezindlela ezimbili zokuhlinza ngokwesikhathi sokuphulukiswa kokuphuka, izinga lokuphulukiswa kokuphuka, ukuqondanisa kwemilenze ephansi, kanye nezinkinga.
Ngokufanayo nokuhlanganiswa kwe-tibial shaft fractures nge-ankle joint fractures noma i-femoral shaft fractures ene-femoral neck fractures, i-high-induced tibial shaft fractures ingase iholele ekulimaleni ekuhlanganyeleni kwamadolo aseduze.Emisebenzini yomtholampilo, ukuvimbela ukuxilonga kuyinkinga eyinhloko ekuxilongweni nasekwelapheni.Ukwengeza, ekukhethweni kwezindlela zokulungisa, nakuba ucwaningo lwamanje luphakamisa ukuthi awekho umehluko omkhulu, kusenamaphuzu amaningana okufanele acatshangelwe:
1. Ezimeni zokuqhekeka kwe-tibial plateau ehlanganisiwe lapho ukulungiswa kwesikulufa okulula kuyinselele, okubalulekile kungase kunikezwe ukusetshenziswa kwepuleti elide eline-MIPPO fixation ukuze kunzinziswe ngokwanele i-tibial plateau, ukubuyisela ukuhlangana kwendawo ehlangene kanye nokuqondisa kwemilenze ephansi.
2. Ezimweni zokuqhekeka kwe-tibial plateau elula, ngaphansi kokucutshungulwa okuncane, ukunciphisa okusebenzayo nokulungiswa kwezikulufu kungafinyelelwa.Ezimweni ezinjalo, kungase kunikezwe kuqala ukulungiswa kwesikulufu okulandelwa yi-suprapatellar intramedullary nail fixation ye-tibial shaft.
Isikhathi sokuthumela: Mar-09-2024
