Kutsemuka kwetibial plateau pamwe chete nekutsemuka kwetibial shaft kunowanzoonekwa mukukuvara kunokonzerwa nesimba guru, uye 54% iri kutsemuka kwakavhurika. Ongororo dzakapfuura dzakawana kuti 8.4% yekutsemuka kwetibial plateau kunobatanidzwa nekutsemuka kwetibial shaft pamwe chete, nepo 3.2% yevarwere vane kutsemuka kwetibial shaft vane kutsemuka kwetibial plateau pamwe chete. Zviri pachena kuti kusanganiswa kwekutsemuka kwetibial plateau neshaft hakusi kunowanzoitika.
Nekuda kwekukuvara kwakadaro kunowedzera simba, kazhinji pane kukuvara kwakanyanya kwenyama yakapfava. Mukufunga, sisitimu yeplate nescrew ine zvakanakira pakugadzika kwemukati kweplate fracture, asi kana soft tissue yemunharaunda ichigona kutsungirira kugadzika kwemukati neplate nescrew system zvakare inyaya yekiriniki. Saka, parizvino pane nzira mbiri dzinowanzoshandiswa dzekugadzika kwemukati kwetibial plate fracture fracture pamwe chete nekuputsika kwetibial shaft:
1. Nzira yeMIPPO (Minimally Invasive Plate Osteosynthesis) ine plate refu;
2. Chipikiri chemudumbu + sikuruu yeplateau.
Sarudzo dzese dziri mbiri dzakanyorwa mumabhuku, asi parizvino hapana kubvumirana pamusoro pekuti ndeipi iri nani kana kuti yakaderera maererano nekupora kwekukuvara, nguva yekupora kwekukuvara, kumira kwemakumbo epasi, uye matambudziko. Kuti vagadzirise izvi, nyanzvi dzepachipatara cheyunivhesiti yeKorea dzakaita ongororo yekuenzanisa.
Chidzidzo ichi chaisanganisira varwere makumi mana nevasere vane kutyoka kwetibial plateau pamwe chete nekutyoka kwetibial shaft. Pakati pavo, varwere makumi matatu nevashanu vakarapwa nenzira yeMIPPO, nekuiswa kweplate yesimbi parutivi kuti iome, uye varwere gumi nevatatu vakarapwa ne plate screws pamwe chete ne infrapatellar approach yekugadzirisa nzara mukati memedullary.
▲ Nyaya 1: Kuiswa kwesimbi mukati meplate yeMIPPO. Murume ane makore 42 ekuberekwa, akabatwa netsaona yemotokari, akatyoka shaft yetibial yakavhurika (rudzi rweGustilo II) uye akatyoka plate yetibial yakavhurika pamwe chete (rudzi rweSchatzker IV).
▲ Nyaya 2: Sikuruu yeTibial plateau + suprapatellar intramedullary nail fixation. Murume ane makore 31 ekuberekwa, akapinda mutsaona yemotokari, akabatwa nekutyoka kwetibial shaft (rudzi rweGustilo IIIa) uye kutyoka kwetibial plateau (rudzi rweSchatzker I). Mushure mekubviswa kweronda uye negative pressure wound therapy (VSD), ronda racho rakaiswa paganda. Sikuruu mbiri dze6.5mm dzakashandiswa kuderedza nekusimbisa plateau, zvichiteverwa ne intramedullary nail fixation yetibial shaft kuburikidza ne suprapatellar approach.
Zvakabuda zvinoratidza kuti hapana musiyano wakakosha pakati penzira mbiri dzekuvhiya maererano nenguva yekupora kwekutyoka, mwero wekupora kwekutyoka, kurongeka kwemakumbo netsoka, uye matambudziko.
Kufanana nekusanganiswa kwekutyoka kwetsinga dzetibial nekutyoka kwetsinga dzemakumbo kana kutyoka kwetsinga dzefemoral nekutyoka kwemutsipa wefemoral, kutyoka kwetsinga dzetibial kunokonzerwa nesimba guru kunogonawo kukonzera kukuvara mutsinga yebvi iri pedyo. Mukurapa, kudzivirira kuongororwa zvisizvo ndiyo nyaya huru mukuongororwa nekurapwa. Pamusoro pezvo, mukusarudza nzira dzekugadzirisa, kunyangwe tsvakiridzo yazvino ichiratidza kuti hapana mutsauko wakakosha, kuchine zvinhu zvakati wandei zvekufunga nezvazvo:
1. Kana paine kukuvara kwetibial plate uko kugadzirisa sikuruu kuri nyore, chinhu chekutanga chingaitwa kushandisa plate refu ine MIPPO fixation kuti tibial plate igare zvakanaka, kudzoreredza kubatana kwenzvimbo uye kurongeka kwemakumbo nemakumbo.
2. Kana paine kutsemuka kuri nyore kwetibial plateau, kana paine mavanga mashoma, kuderedza zvinobudirira uye kugadzirisa sikuruu kunogona kuitwa. Muzviitiko zvakadaro, chinhu chekutanga chingapihwa kugadzirisa sikuruu kuchiteverwa nekugadzirisa suprapatellar intramedullary nail yetibial shaft.
Nguva yekutumira: Kurume-09-2024
