Tibial plateau fractures yakasanganiswa ne ipsilateral tibial shaft fractures inowanzoonekwa mukukuvara kwepamusoro-simba, uye 54% iri kuvhurika fractures.Ongororo dzakapfuura dzakawana kuti 8.4% yetibial plateau fractures inosanganiswa neinopindirana tibial shaft fractures, nepo 3.2% yetibial shaft fracture varwere vane concomitant tibial plateau fractures.Zviri pachena kuti kusanganiswa kwepsilateral tibial plateau uye shaft fractures hazviwanzoitiki.
Nekuda kwehukuru-simba hunhu hwekukuvadzwa kwakadaro, pane kazhinji kacho kukuvara kwenyama yakapfava.Muchidzidzo, ndiro uye screw system ine zvakanakira mukati mekugadzirisa kwemukati kweplateau fractures, asi kana nzvimbo yakapfava yemuno inogona kushivirira kugadzirisa kwemukati nendiro uye screw system zvakare inofungidzirwa kiriniki.Naizvozvo, pane pari zvino maviri anowanzo shandiswa sarudzo dzekugadziriswa kwemukati kwetibial plateau fractures yakasanganiswa netibial shaft fractures:
1. MIPPO (Minimally Invasive Plate Osteosynthesis) maitiro ane ndiro refu;
2. Intramedullary chipikiri + plateau screw.
Zvose zviri zviviri zvingasarudzwa zvinoshumwa mumabhuku, asi parizvino hapana kubvumirana kuti ndezvipi zviri pamusoro kana kuti zvakaderera maererano nekutyoka kupora, nguva yekutyoka, kurongeka kwemakumbo, uye matambudziko.Kuti zvigadzirise izvi, nyanzvi dzepachipatara cheyunivhesiti yeKorea dzakaita ongororo yekuenzanisa.
Chidzidzo chacho chaisanganisira varwere ve48 vane tibial plateau fractures pamwe chete netibial shaft fractures.Pakati pavo, makumi matatu neshanu akabatwa nehunyanzvi hweMIPPO, nekuiswa kwekupedzisira kwesimbi ndiro yekugadzirisa, uye 13 kesi dzakabatwa neplateau screws dzakasanganiswa ne infrapatellar nzira ye intramedullary chipikiri kugadzirisa.
▲ Nyaya 1: Lateral MIPPO simbi ndiro yemukati kugadzirisa.Murume ane makore 42 okuberekwa, akabatanidzwa mutsaona yemotokari, akazarurirwa tibial shaft fracture (Gustilo II type) uye concomitant medial tibial plateau compression fracture (Schatzker IV type).
▲ Nyaya yechipiri: Tibial plateau screw + suprapatellar intramedullary nail internal fixation.Murume ane makore 31 okuberekwa, akabatanidzwa mutsaona yemotokari, akazarurirwa tibial shaft fracture (Gustilo IIIa type) uye concomitant lateral tibial plateau fracture (Schatzker I type).Mushure mekuparadzwa kweronda uye negative pressure ronda therapy (VSD), ronda racho rakabatanidzwa paganda.Maviri 6.5mm screws akashandiswa kuderedza uye kugadzirisa kwenzvimbo, ichiteverwa ne intramedullary nail fixation ye tibial shaft kuburikidza ne suprapatellar approach.
Mhedzisiro yacho inoratidza kuti hapana mutsauko wakakosha pakati pematanho maviri ekuvhiya maererano nekutyoka nguva yekuporesa, kuputika kwekuporesa mwero, kurongeka kwemakumbo, uye matambudziko.
Zvakafanana nekubatanidzwa kwetibial shaft fractures nemakumbo emakumbo emakumbo kana femoral shaft fractures ine femoral neck fractures, high-energy-induced tibial shaft fractures inogonawo kutungamirira kukuvadzwa mumabvi ari pedyo.Muchiito chekiriniki, kudzivirira kutadza kuongororwa ndicho chinhu chinonyanya kukosha mukuongororwa uye kurapwa.Pamusoro pezvo, mukusarudza nzira dzekugadzirisa, kunyangwe kutsvagisa kwazvino kunoratidza kusakosha kwakasiyana, kuchine akati wandei mapoinzi ekufunga nezvazvo:
1. Muzviitiko zve comminuted tibial plateau fractures apo nyore screw fixation inonetsa, kukoshesa kunogona kupiwa kushandiswa kweplate refu neMIPPO fixation kuti igadzikane zvakakwana tibial plateau, kudzorera kubatana kwepamusoro kuwirirana uye kutsika kwemakumbo ezasi.
2. Muzviitiko zviri nyore tibial plateau fractures, pasi pezvinyorwa zvishoma zvishoma, kuderedza kunobudirira uye kugadzirisa screw kunogona kuwanikwa.Mumamiriro ezvinhu akadaro, kukoshesa kunogona kupiwa screw fixation inoteverwa ne suprapatellar intramedullary nail fixation ye tibial shaft.
Nguva yekutumira: Kurume-09-2024
