Abstract: Chinangwa: Kuongorora zvinhu zvakabatana zvekushanda kwekushandisa kwesimbi ndiro yemukati kugadzirisa kugadzirisa iyotibial plateau fracture.Nzira: Varwere ve34 vane tibial plateau fracture vakashandiswa nekushandisa ndiro yesimbi mukati mekugadzirisa rutivi rumwe kana maviri, vakadzorerai tibal plateau anatomical structure, yakasimba kugadzirisa, uye vakatora basa rekutanga basa mushure mekushanda.Mhedzisiro: Varwere vese vakateverwa kwemwedzi 4-36, avhareji yemwedzi gumi nemishanu, maererano nechikamu cheRasmussen, varwere makumi maviri nemumwe vaive vakanaka kwazvo, 8 mune zvakanaka, 3 mukubvumidza, 2 muvarombo.Chiyero chakanakisa chaive 85.3%.Mhedziso: Bata mikana yekuvhiya yakakodzera, shandisa nzira dzakaringana uye tora maekisesaizi ekutanga ekuita, utipe maitiro akanaka ekushanda mukurapa.tibialPlateau fracture.
1.1 Ruzivo Rwose: boka iri raive nevarwere makumi matatu nevana nevarume makumi maviri nevatanhatu nevakadzi vasere.Varwere vaiva nemakore 27 kusvika 72 vane avhareji yemakore 39.6.Paive nenyaya dze20 dzekukuvadzwa kwetsaona dzemotokari, 11 kesi dzekukuvadzwa kwekudonha uye 3 kesi dzekupwanya kukuru.Mhosva dzose dzakavharwa kuputsika pasina kukuvara kwevascular.Paiva nezviitiko zve 3 zvekukuvadzwa kwe cruciate ligament, 4 zviitiko zvekukuvadzwa kwechibvumirano uye 4 zviitiko zvekukuvara kwemeniscus.Kuputsika kwakarongedzerwa maererano neSchatzker: 8 kesi dzeI type, 12 kesi dzeII type, 5 kesi dzeIII type, 2 kesi dzeIV mhando, 4 kesi dzeV mhando uye 3 kesi dzeVI mhando.Vese varwere vakaongororwa neX-ray, CT scan yetibial plateau uye matatu-dimensional reconstruction, uye vamwe varwere vakaongororwa naMR.Kunze kwezvo, nguva yekushanda yaive 7 ~ 21d mushure mekukuvara, avhareji 10d.Pane izvi, paiva nevarwere ve30 vaibvuma kurapwa kwepfupa, varwere ve3 vanobvuma kugadziriswa kweplate mbiri, uye vamwe varwere vanogamuchira unilateral internal fixation.
1.2 Nzira yekuvhiya: inoitwamusanaanesthesia kana intubation anesthesia, murwere akanga ari panzvimbo yepamusoro, uye akashanda pasi pepneumatic tourniquet.Kuvhiya kwakashandisa anterolateral ibvi, anterior tibial kana lateralibvi rakabatanaposterior incision.Coronary ligament yakachekwa pamwe neIncision pamwe nechepazasi pemucheto wemeniscus, uye yakafumura articular pamusoro petibial plateau.Deredza kutsemuka kwebani pasi pekuona kwakananga.Mamwe mapfupa akatanga kugadziriswa neKirschner pini, ndokuzogadziriswa nemahwendefa akakodzera (gorofu-plate, L-plate, T-plate, kana kusanganiswa ne medial buttress plate).Kuremara kwepfupa kwakazadzwa ne allogenic bone (pakutanga) uye allograft bone grafting.Mukuvhiya, chiremba anovhiya akaziva kuderedzwa kweanatomical uye proximal anatomical reduction, yakaramba yakajairwa tibial axis, yakasimba mukati mekugadzirisa, compacted bone graft uye kutsigirwa chaiko.Yakaongorora ibvi ligament uye meniscus ye preoperative diagnostic kana intra-operative inofungirwa nyaya, uye akaita nzira yakakodzera yekugadzirisa.
1.3 Kurapa Kwepashure: iyo postoperative yegumbo elastic bandage inofanira kusungwa zvakanaka, uye kunonoka kuchekwa kwakaiswa ne drainage tube, iyo inofanirwa kuburitswa pa48h.Routine postoperative analgesia.Varwere vakatora maekisesaizi emamhasuru emakumbo mushure me24h, uye vakatora maekisesaizi eCPM mushure mekubvisa chubhu yemvura yekutsemuka.Yakasanganiswa iyo collateral ligament, posterior cruciate ligament maronda ekukuvara, achishingaira uye asinganzwisisi akafambisa ibvi mushure mekugadzirisa plaster kana simbi kwemwedzi mumwe.Zvinoenderana nemhedzisiro yeX-ray kuongororwa, chiremba anovhiya akatungamira varwere kuti vatore zvishoma nezvishoma maekisesaizi ekuremedza mitezo, uye kurodha kwakazara kunofanirwa kuitwa mwedzi mina gare gare.
Nguva yekutumira: Jun-02-2022
