Kutyoka kweHoffa kuputsika kweiyo coronal ndege yefemoral condyle. Yakatanga kutsanangurwa naFriedrich Busch muna 1869 uye yakashumwa zvakare naAlbert Hoffa muna 1904, uye yakatumidzwa zita rake. Nepo kuputsika kunowanzoitika mundege yakatwasuka, Hoffa fractures inoitika mucoronal plane uye isingawanzoitiki, saka ivo vanowanzo potsa panguva yekutanga yekiriniki uye radiological kuongororwa.
Kuputsika kweHoffa kunoitika riini?
Hoffa fractures inokonzerwa neshear force kune femoral condyle pamabvi. Kukuvadzwa kwepamusoro-simba kazhinji kunokonzera intercondylar uye supracondylar fractures ye distal femur. Nzira dzinowanzozivikanwa dzinosanganisira motokari dzemotokari nemotokari dzemotokari uye inodonha kubva pakakwirira. Lewis et al. akataura kuti varwere vazhinji vane kukuvara kwakabatana kwakakonzerwa nechisimba chakananga kune lateral femoral condyle pavanenge vakatasva mudhudhudhu nemabvi akachinjika ku90 °.
Ndezvipi zviratidzo zvekliniki zveHoffa kuputsika?
Zviratidzo zvikuru zvekuputsika kweHoffa imwe chete ibvi effusion uye hemarthrosis, kuzvimba, uye mild genu varum kana valgus uye kusagadzikana. Kusiyana ne intercondylar uye supracondylar fractures, Hoffa fractures inowanzowanikwa nechiitiko panguva yezvidzidzo zvekufungidzira. Nokuti kuparara kwakawanda kweHoffa kunokonzerwa nekukuvadzwa kwemasimba makuru, kukuvara kwakasanganiswa kwehudyu, pelvis, femur, patella, tibia, mabvi emakumbo, uye popliteal midziyo inofanira kubviswa.
Kana Hoffa kutyoka kuchifungidzirwa, munhu anofanira kutora sei maX-rays kuti arege kupotsa kuongororwa?
Standard anteroposterior uye lateral radiographs inoitwa nguva dzose, uye maonero oblique emabvi anoitwa kana zvichidiwa. Kana kuputsika kusinganyanyi kubviswa, zvinowanzonetsa kuzviona pane radiographs. Pamusoro pekuona kwemashure, kukanganisa kuduku kwemutsara wekubatana kwevakadzi dzimwe nguva kunoonekwa, kana kuti pasina condylar valgus deformity zvichienderana nekondiro inobatanidzwa. Zvichienderana ne contour ye femur, discontinuity kana nhanho mumutsara wekuputsika inogona kuonekwa pane lateral maonero. Nekudaro, pane yechokwadi lateral maonero, iyo femoral condyles inoratidzika isiri-yakabatana, nepo kana macondyles akapfupikiswa uye akatamiswa, anogona kupindirana. Nokudaro, maonero asina kururama emabvi akajairika anogona kutipa pfungwa yenhema, iyo inogona kuratidzwa ne oblique maonero. Saka, kuongorora kweCT kunodiwa (Mufananidzo 1). Magnetic resonance imaging (MRI) inogona kubatsira kuongorora zvinyoro zvinyoro zvakapoteredza ibvi (zvakadai semarunda kana menisci) kukuvadza.
Mufananidzo 1 CT wakaratidza kuti murwere aive neLetenneur ⅡC mhando yeHoffa kuputsika kweiyo lateral femoral condyle.
Ndeapi marudzi eHoffa fractures?
Hoffa fractures yakakamurwa kuva mhando B3 uye nyora 33.b3.2 muAO/OTA classification maererano neMuller's classification. Gare gare, Letenneur et al. akakamura kuputsika mumhando nhatu zvichienderana nekureba kwemutsara wekutyoka kwechikadzi kubva kushure kwe cortex yefemur.
Mufananidzo2 Letenneur kupatsanurwa kweHoffa fractures
Type I:Mutsara wekuputsika unowanikwa uye unofananidzwa neshure cortex ye femoral shaft.
Type II:Nharaunda kubva kumutsara wekuputsika kusvika kumutsara wekortical wekupedzisira we femur unowedzera kugoverwa kuva subtypes IIa, IIb uye IIc maererano nechekure kubva kumutsara wekuputsika kusvika kune posterior cortical bone. Type IIa iri padyo neiyo posterior cortex yefemoral shaft, nepo IIc iri kure kure neiyo posterior cortex yefemoral shaft.
Rudzi III:Oblique fracture.
Nzira yekugadzira chirongwa chekuvhiya mushure mekuongororwa?
1. Kugadziriswa kwemukati kusarudzwa Zvinowanzotenda kuti kuzarura kuderedza uye kugadziriswa kwemukati ndiyo chiyero chegoridhe. Kune Hoffa fractures, kusarudzwa kweakakodzera kugadzirisa implants ishoma. Partially threaded hollow compression screws akanakira kugadzirisa. Sarudzo dzekudyara dzinosanganisira 3.5mm, 4mm, 4.5mm uye 6.5mm dzine tambo dzakaiswa gollow masikuru uye Herbert screws. Kana zvichidikanwa, mahwendefa e-anti-slip akakodzera anogona kushandiswa pano. Jarit yakawanikwa kuburikidza necadaver biomechanical zvidzidzo zvekuti posteroanterior lag screws yakagadzikana kupfuura anterior-posterior lag screws. Zvisinei, basa rinotungamirira rekutsvaga uku mukushanda kwekliniki harisati ranyatsojeka.
2. Tekinoroji yekuvhiya Kana kuputika kweHoffa kunowanikwa kuperekedzwa neiyo intercondylar uye supracondylar fracture, inofanirwa kutariswa zvakakwana, nekuti chirongwa chekuvhiya uye kusarudzwa kwekugadziriswa kwemukati kunotsanangurwa zvichienderana nemamiriro ari pamusoro apa. Kana iyo lateral condyle yakapatsanurwa coronally, kuvhiyiwa kuratidzwa kwakafanana neiyo yekuputsika kweHoffa. Nekudaro, hazvina kuchenjera kushandisa dynamic condylar screw, uye anatomical plate, condylar support plate kana LISS plate inofanirwa kushandiswa kugadzirisa panzvimbo. Iyo medial condyle yakaoma kugadzirisa kuburikidza ne lateral incision. Muchiitiko ichi, imwe anteromedial incision inotarisirwa kuderedza uye kugadzirisa iyo Hoffa kuputsika. Chero zvazvingaitika, ese makuru econdylar bone fragments anogadziriswa ne lag screws mushure mekuderedzwa kweanatomical yecondyle.
- Nzira yekuvhiya Murwere ari panzvimbo yepamusoro pamubhedha wefluoroscopic ane tourniquet. Bolster inoshandiswa kuchengetedza ibvi rekuchinjika angle yeanenge 90 °. Kune akareruka epakati Hoffa mafractures, munyori anofarira kushandisa yepakati incision ine medial parapatellar nzira. Kune lateral Hoffa fractures, lateral incision inoshandiswa. Vamwe vanachiremba vanoratidza kuti nzira ye lateral parapatellar isarudzo inonzwisisika. Kana imwe nguva magumo ekuputsika akafumurwa, kuongorora kunoitwa nguva dzose, uye ipapo magumo ekuputsika anocheneswa ne curette. Pasi pechiratidzo chakananga, kuderedzwa kunoitwa uchishandisa point reduction forceps. Kana zvichidikanwa, nzira ye "joystick" yeKirschner wires inoshandiswa kuderedza, uye ipapo tambo dzeKirschner dzinoshandiswa kuderedza uye kugadzirisa kudzivirira kuparara kwekuparara, asi Kirschner waya haigoni kutadzisa kuiswa kweimwe screws (Mufananidzo 3). Shandisa angangoita maviri screws kuti uwane yakagadzikana fixation uye interfragmentary compression. Drill perpendicular kusvika pakutyoka uye kure ne patellofemoral joint. Dzivisa kuchera mukati memashure majoini mhango, zviri nani neC-arm fluoroscopy. Screws inoiswa kana isina washers sezvinodiwa. Iyo screws inofanira kunyura uye yehurefu hwakakwana kugadzirisa subarticular cartilage. Intraoperatively, mabvi anoongororwa nokuda kwekukuvara kwakafanana, kugadzikana, uye mararamiro ekufamba, uye kunyatsodiridza kunoitwa kusati kwavhara maronda.
Mufananidzo 3 Kuderedzwa Kwenguva pfupi uye kugadziriswa kwebicondylar Hoffa kuputsika neKirschner waya panguva yekuvhiyiwa, uchishandisa Kirschner waya kuti ubvise mapfupa emapfupa.
Nguva yekutumira: Mar-12-2025
