Kuputsika kwechikamu chetibial plateau kana kuputsika kwakapatsanurwa ndiyo mhando inonyanya kuzivikanwa yekuputsika kwechikamu chetibial plateau. Chinangwa chikuru chekuvhiya ndechekudzorera kutsetseka kwenzvimbo yejoini uye kurongeka kwechikamu chezasi. Nzvimbo yejoini yakaputsika, kana yakakwira, inosiya chikanganiso chepfupa pasi pekatsi, kazhinji ichida kuiswa kwebhoni re autogenous iliac, bhoni re allograft, kana bhoni rekugadzira. Izvi zvine zvinangwa zviviri: chekutanga, kudzoreredza rutsigiro rwemafupa, uye chechipiri, kukurudzira kupora kwemapfupa.
Tichifunga nezvekuchekwa kwekuwedzera kunodiwa pamapfupa eiac akazvimirira, izvo zvinotungamira mukukuvadzwa kukuru kwekuvhiyiwa, uye njodzi dzinogona kuitika dzekurambwa uye kutapukirwa nemapfupa eallograft nemapfupa ekugadzira, vamwe vaongorori vanokurudzira imwe nzira panguva yekuderedza mapfupa etibial plateau open reduction uye internal fixation (ORIF). Vanokurudzira kuwedzera kucheka kumwe chete kumusoro panguva yekurapa uye kushandisa cancellous bone graft kubva ku lateral femoral condyle. Mishumo yakati wandei yakaratidza nzira iyi.
Chidzidzo ichi chakabatanidza vanhu gumi nevaviri vane ruzivo rwakakwana rwekutevera mifananidzo. Muvarwere vese, nzira yakajairika yekubatanidza tibial anterior lateral approach yakashandiswa. Mushure mekuburitsa tibial plateau, kucheka kwacho kwakatambanudzwa kumusoro kuti kubudise lateral femoral condyle. Muchina wekubvisa mapfupa weEckman we12mm wakashandiswa, uye mushure mekuboora nekunze kwecortex ye femoral condyle, mapfupa ecancellous kubva ku lateral condyle akatorwa kane kaviri. Huwandu hwakawanikwa hwaibva pa20 kusvika 40cc.
Mushure mekudiridza mapfupa kakawanda, chipanje chehemostatic chinogona kuiswa kana zvichidikanwa. Pfupa rakachekwa rinoiswa muchikamu chemapfupa chiri pasi pe lateral tibial plateau, zvichiteverwa nekugadzika kwemukati memapfupa nguva dzose. Mhedzisiro yacho inoratidza:
① Kuti nzvimbo yetibial igare zvakanaka, varwere vese vakapora pakutyoka kwetsinga.
② Hapana kurwadziwa kwakanyanya kana matambudziko akaonekwa panzvimbo yakatorwa mapfupa kubva mudumbu remusana.
③ Kuporeswa kwepfupa panzvimbo yekukohwa: Pakati pevarwere gumi nevaviri, vatatu vakaporeswa zvakakwana kwepfupa remukati memuviri, vasere vakaporeswa zvishoma, uye mumwe chete haana kuporeswa pachena kwepfupa remukati memuviri.
④ Kuumbwa kwemapfupa etrabeculae panzvimbo yekukohwa: Muzviitiko zvipfumbamwe, hapana kuumbwa kwakajeka kwemapfupa etrabeculae, uye muzviitiko zvitatu, kuumbwa kwemapfupa etrabeculae kwakaonekwa.
⑤ Matambudziko e osteoarthritis: Pakati pevarwere gumi nevaviri, vashanu vakarwara nearthritis yebvi mushure mekukuvara. Mumwe murwere akatsiviwa nejoini makore mana gare gare.
Mukupedzisa, kuunganidza pfupa re cancellous kubva mu ipsilateral lateral femoral condyle kunoita kuti pfupa re tibial plateau riporeswe zvakanaka pasina kuwedzera njodzi yematambudziko mushure mekuvhiyiwa. Nzira iyi inogona kufungwa nezvayo uye kutaurwa nezvayo mukurapa.
Nguva yekutumira: Gumiguru-27-2023
