Maitiro ekuvhiya

Pfupiso: Chinangwa: Kuongorora zvinhu zvine chekuita nekushanda kwesimbi plate yesimbi kugadzirisa simbikutyoka kwenzvimbo yetibial plateauNzira: Varwere makumi matatu nevana vane mapfupa akatyoka mu tibial plate vakavhiyiwa nesimbi plate inogadzirisa divi rimwe kana maviri, vakagadzirisa chimiro chemuviri we tibal plate, vakagadzirisa zvakasimba, uye vakatora maekisesaizi ekutanga mushure mekuvhiyiwa. Mhedzisiro: Varwere vese vakateverwa kwemwedzi 4-36, avhareji yemwedzi gumi nemishanu, zvichienderana neRasmussen score, varwere makumi maviri nerimwe vaive vakanaka, vasere vakanaka, vatatu vakatenderwa, vaviri vakaipa. Chiyero chakanaka chaive 85.3%. Mhedziso: Bata mikana yakakodzera yekuvhiyiwa, shandisa nzira dzakakodzera uye tora maekisesaizi ekutanga, tipe mhedzisiro yakanaka yekuvhiyiwa mukurapa.tibialkutsemuka kweplateau.

1.1 Ruzivo Rwakazara: boka iri raiva nevarwere 34, varume 26 nevakadzi 8. Varwere ava vaiva nemakore ari pakati pe27 ne72, vane makore anosvika 39.6. Paiva nezviitiko makumi maviri zvekukuvara mutsaona dzemumugwagwa, zviitiko gumi nerimwe zvekukuvara kwekudonha uye zviitiko zvitatu zvekupwanywa zvakanyanya. Zviitiko zvese zvaive zvakatyoka zvisina kukuvara kwetsinga. Paiva nezviitiko zvitatu zvekukuvara kwemutsipa wemutsipa, zviitiko zvina zvekukuvara kwemutsipa wemutsipa uye zviitiko zvina zvekukuvara kwemeniscus. Kutyoka kwakarongwa zvichienderana neSchatzker: zviitiko zvisere zverudzi rweI, zviitiko gumi nezviviri zverudzi rweII, zviitiko zvishanu zverudzi rweIII, zviitiko zviviri zverudzi rweIV, zviitiko zvina zverudzi rweV uye zviitiko zvitatu zverudzi rweVI. Varwere vese vakaongororwa neX-ray, CT scan yetibial plateau uye kugadziriswa kwemativi matatu, uye vamwe varwere vakaongororwa naMR. Kunze kweizvozvo, nguva yekuvhiyiwa yaive mazuva manomwe kusvika makumi maviri nerimwe mushure mekukuvara, avhareji yemazuva gumi. Pavanhu ava, paive nevarwere makumi matatu vaibvuma kurapwa kwekuiswa kwemapfupa, varwere vatatu vaibvuma kugadziriswa kwemaplate maviri, uye vamwe vese vaibvuma kugadziriswa kwemukati kweumwe neumwe.

1.2 Nzira yekuvhiya: yakaitwamusanaanesthesia kana intubation anesthesia, murwere aive akarara pasi, uye akavhiyiwa achishandisa pneumatic tourniquet. Kuvhiyiwa kwacho kwakashandisa anterolateral ibvi, anterior tibial kana lateral ibvi.majoini ebviKuchekwa kwepashure. Mhezi yeropa yakachekwa pamwe chete neKuchekwa kumucheto wezasi wemeniscus, uye yakaburitsa pachena pamusoro penzvimbo yetibial plateau. Kuderedza kutsemuka kweplateau pasi pekuona zvakananga. Mamwe mapfupa akatanga agadziriswa neKirschner pini, uye akazogadziriswa nemaplate akakodzera (gorofu-plate, L-plates, T-plate, kana kusanganiswa neplate yepakati yebuttress). Zvikanganiso zvemapfupa zvakazadzwa nemapfupa anokonzera allogenic (kutanga) uye allograft bone grafting. Mukuvhiyiwa, chiremba wezvekuvhiya akaona kudzikiswa kweanatomical uye kudzikiswa kweproximal anatomical, akachengetedza tibial axis yakajairika, kugadzika kwakasimba kwemukati, compacted bone graft uye rutsigiro rwakarurama. Akaongorora mhezi yebvi nemeniscus kuti aone kana paine nyaya dzaifungidzirwa kuti dzakaitika mukati mekuvhiyiwa, uye akaita maitiro akakodzera ekugadzirisa.

1.3 Kurapa Mushure mekuvhiyiwa: bhandeji re elastic mushure mekuvhiyiwa rinofanira kusungwa zvakanaka, uye kuchekwa kwakanonoka kwakaiswa nechubhu ye drainage, iyo inofanira kusunungurwa maawa makumi mana nemasere. Kurapa kwemarwadzo mushure mekuvhiyiwa nguva dzose. Varwere vakarovedza tsandanyama dzemakumbo mushure memaawa makumi maviri nemana, uye vakarovedza CPM mushure mekubvisa chubhu ye drainage kuti vasaputsike zviri nyore. Vakabatanidza collateral ligament, posterior cruciate ligament kukuvara, vakafambisa ibvi zvinyoro nyoro mushure mekugadzirisa plaster kana brace kwemwedzi mumwe chete. Zvichienderana nemhedzisiro yekuongororwa kweX-ray, chiremba akatungamira varwere kuti vatore zvishoma nezvishoma maekisesaizi e body-loading, uye mutoro wakazara unofanira kuitwa mwedzi mina gare gare.