Proximal femoral fractures inowanzoonekwa kukuvara kwekiriniki kunokonzerwa nekukuvara kwepamusoro-simba.Nekuda kwemaitiro eanatomical eiyo proximal femur, mutsara wekutyoka kazhinji unorara padyo nearticular surface uye unogona kuwedzera mujoinhi, zvichiita kuti isanyanya kukodzera kune intramedullary nail fixation.Nekuda kweizvozvo, chikamu chakakosha chekesi chichiri kuvimba nekugadzirisa uchishandisa ndiro uye screw system.Nekudaro, iyo biomechanical maficha eeccentrically fixed mahwendefa anoisa njodzi yakanyanya yezvinetso senge lateral plate fixation kutadza, mukati mekugadzirisa kuputika, uye screw pull-out.Kushandiswa kwepakati peplate rubatsiro rwekugadzirisa, kunyange zvazvo kunobudirira, kunouya nezvipingamupinyi zvekuwedzera kushungurudza, nguva yekuvhiya kwenguva refu, njodzi yakawedzerwa yehutachiona hwepashure, uye kuwedzera mutoro wemari kune varwere.
Tichifunga izvi, kuitira kuti tiwane kuenzanisa pakati pe biomechanical drawbacks ye lateral single plate uye kukuvara kwekuvhiya kunoenderana nekushandiswa kwepakati uye lateral mahwendefa maviri, nyanzvi dzekune dzimwe nyika dzakatora nzira inosanganisira lateral plate fixation nekuwedzera percutaneous screw fixation. kudivi repakati.Iyi nzira yakaratidza mhedzisiro yekiriniki yakanaka.
Mushure meanesthesia, murwere anoiswa panzvimbo yepamusoro.
Danho 1: Kuderedza kuputsika.Isai 2.0mm Kocher tsono mu tibial tuberosity, traction kuti igadzirise kureba kwenhengo, uye shandisa ibvi pad kugadzirisa sagittal plane kusimuka.
Danho 2: Kuiswa kweiyo lateral simbi ndiro.Mushure mekutanga kudzikiswa nekudhonza, yakananga kune distal lateral femur, sarudza yakakodzera kureba yekukiya ndiro kuti uchengetedze kudzikisira, uye isa ma screws maviri kumagumo uye kure kure ekutyoka kuchengetedza kuderedzwa kwekutyoka.Panguva ino, zvakakosha kuziva kuti madhiri maviri e-distal anofanirwa kuiswa pedyo nechemberi sezvinobvira kuti arege kukanganisa kuiswa kwepakati pepakati.
Danho rechitatu: Kuiswa kwemedial column screws.Mushure mekudzikamisa pakatyoka neplate yesimbi yekumashure, shandisa 2.8mm screw-guided drill kuti upinde nepamedial condyle, ine tsono yepakati kana kumashure kwenzvimbo ye distal femoral block, diagonally kunze uye kumusoro, ichipinda zvakapesana. cortical bone.Mushure mekudzikisa zvinogutsa fluoroscopy, shandisa 5.0mm drill kugadzira gomba uye isa 7.3mm cancellous bone screw.
Dhiagiramu inoratidza maitiro ekuderedza kuputsika uye kugadzirisa.Mukadzi ane makore makumi manomwe nemana ane distal femoral intra-articular fracture (AO 33C1).(A, B) Preoperative lateral radiographs inoratidza kutama kukuru kwe distal femoral fracture;(C) Mushure mekuderedzwa kwekutyoka, yekunze lateral ndiro inopinzwa ine screws inochengetedza zvese zviri proximal uye distal magumo;(D) Mufananidzo weFluoroscopy unoratidza nzvimbo inogutsa yewaya inotungamira waya;(E, F) Postoperative lateral uye anteroposterior radiographs mushure mekuiswa kwepakati pembiru screw.
Munguva yekuderedza maitiro, zvakakosha kufunga nezve zvinotevera pfungwa:
(1) Shandisa waya yekutungamirira ine sikuruu.Kuiswa kwepakati pembiru screws kwakakura, uye kushandisa dhairekitori waya isina screw kunogona kutungamira kune yakakwira kona panguva yekuboora kuburikidza nepakati condyle, zvichiita kuti iite nyore kutsvedza.
(2) Kana masiruuru ari muplate repashure akanyatsobata lateral cortex asi achitadza kugonesa gadziriso yehuviri cortex, gadzirisa sikururu kumberi, zvichibvumira masiruu kupinda nechekumberi kweplate re lateral kuti awane zvinogutsa dual cortex fixation.
(3) Kune varwere vane osteoporosis, kuisa washer ine medial column screw kunogona kudzivirira sikuruu kubva pakucheka mubhonzo.
4Kana kuvharirwa sikuruwa kukasangana panguva yekuiswa kwekona yepakati, funga kubvisa kana kuisa patsva masiruuru epadivi peplate, uchipa pamberi pekuiswa kwepakati pembiru screws.
Nyaya 2. Murwere wechikadzi, ane makore 76, ane distal femoral extra-articular fracture.(A, B) Preoperative X-rays inoratidza kutama kwakakosha, kukanganisa kweangular, uye coronal plane displacement yekuputsika;(C, D) Postoperative X-rays mu lateral uye anteroposterior maonero anoratidza kugadzirisa nekunze kweplate yeplate yakasanganiswa ne medial column screws;(E, F) Tevedzera X-rays pamwedzi 7 mushure mekushanda ichiratidzira yakanakisa kuputsika kupora pasina zviratidzo zvekutadza kugadzirisa mukati.
Nyaya 3. Murwere wechikadzi, ane makore 70, ane periprosthetic fracture yakakomberedza femoral implant.(A, B) Preoperative X-rays inoratidzira periprosthetic fracture yakatenderedza femoral implant mushure mekuzara kwemabvi arthroplasty, ine extra-articular fracture uye yakagadzikana prosthetic fixation;(C, D) Postoperative X-rays inoratidzira kugadzirisa nekunze lateral plate yakasanganiswa nemedial column screws kuburikidza ne-extra-articular approach;(E, F) Tevedzera X-rays pamwedzi mitanhatu mushure mekushanda ichiratidzira yakanakisa kuputsika kupora, nekugadziriswa kwemukati munzvimbo.
Nguva yekutumira: Jan-10-2024
