Kuvhiya Technique | Ipsilateral Femoral Condyle Graft Yemukati Kugadziriswa Kwekurapa kweTibial Plateau Fractures

Lateral tibial plateau kudonha kana kupatsanurwa kudonha ndiyo inonyanya kuzivikanwa mhando yetibial plateau fracture. Chinangwa chikuru chekuvhiya ndechekudzorera kutsvedzerera kwejoint surface uye kuenzanisa nhengo yezasi. Iyo yakadhirika yejoint surface, kana yasimudzwa, inosiya chirema chebhonzo pasi pecartilage, kazhinji ichida kuiswa kweautogenous iliac bone, allograft bone, kana artificial bone. Izvi zvinoshandisa zvinangwa zviviri: chekutanga, kudzoreredza tsigiro yemabhonzo, uye chechipiri, kukurudzira kuporeswa kwemapfupa.

Tichifunga nezvekuwedzera kuchekwa kunodiwa kune autogenous iliac bone, iyo inotungamirira kukukuvara kukuru kwekuvhiya, uye njodzi dzinogona kuitika dzekurambwa uye hutachiona hunobatanidza neallograft bone uye pfupa rekugadzira, dzimwe nyanzvi dzinokurudzira imwe nzira panguva ye lateral tibial plateau yakazaruka kuderedza uye kugadzirisa mukati (ORIF). Vanopa zano rekuwedzera iyo imwechete incision kumusoro panguva yekuitwa uye kushandisa cancellous bone graft kubva kune lateral femoral condyle. Mhosva dzakawanda dzakanyora nzira iyi.

Chidzidzo chacho chaisanganisira zviitiko zve12 zvine data yakazara yekutevera yekufungidzira. Mune varwere vose, imwe nzira yetibial anterior lateral yakashandiswa. Mushure mekufumura iyo tibial plateau, iyo incision yakawedzera kumusoro kuti ibudise pachena lateral femoral condyle. A 12mm Eckman bone extractor yakashandiswa, uye mushure mekuboora nekunze kwecortex yefemoral condyle, cancellous bone kubva kune lateral condyle yakakohwa mumakumbo mana akadzokororwa. Vhoriyamu yakawanikwa kubva pa20 kusvika ku40cc.

Mushure mekudzokorora kudiridza kwebhonzo canal, hemostatic sponge inogona kuiswa kana zvichidiwa. Iyo yakakohwa cancellous bone inosimwa mukati mefupa rakaremara pasi pe lateral tibial plateau, inoteverwa neyakajairwa mukati mekugadzirisa. Zvabuda zvinoratidza:

① Kugadziriswa kwemukati kwetibial plateau, varwere vese vakawana kuporeswa kwekupwanyika.

② Hapana marwadzo makuru kana matambudziko akaonekwa panzvimbo iyo pfupa rakakohwewa kubva kune lateral condyle.

③ Kuporeswa kwebhonzo panzvimbo yegoho: Pakati pevarwere gumi nevaviri, 3 vakaratidza kuporeswa kwakakwana kwe cortical bone, 8 yakaratidza kupora zvishoma, uye 1 yakaratidza pasina pachena cortical bone kuporesa.

④ Kuumbwa kwefupa trabeculae panzvimbo yekukohwa: Muzviitiko zve9, pakanga pasina kuoneka kuumbwa kwefupa trabeculae, uye mumatambudziko matatu, kuumbwa kwechikamu chefupa trabeculae kwakaonekwa.

⑤ Zvinetso zve osteoarthritis: Pakati pevarwere ve12, 5 yakagadzira post-traumatic arthritis yemabvi akabatanidzwa. Mumwe murwere akachinjwa majoini makore mana gare gare.

Mukupedzisa, kukohwa cancellous bone kubva kune ipsilateral lateral femoral condyle inoguma mune yakanaka tibial plateau bone kuporesa pasina kuwedzera njodzi ye postoperative complications. Iyi nzira inogona kutariswa uye kutaurwa mune yekiriniki maitiro.