Ho robeha ha botšehali ho haufi hangata ho bonoa likotsi tsa bongaka tse bakoang ke ts'oaetso e matla ea matla.Ka lebaka la litšoaneleho tsa anatomical tsa proximal femur, mohala oa ho robeha o atisa ho ba haufi le sebaka sa articular mme o ka fetela ka har'a lenonyeletso, e leng se etsang hore e se ke ea tšoaneleha bakeng sa ho lokisa lipekere tsa intramedullary.Ka lebaka leo, karolo e kholo ea linyeoe e ntse e itšetlehile ka ho lokisa ho sebelisa poleiti le tsamaiso ea screw.Leha ho le joalo, likarolo tsa biomechanical tsa lipoleiti tse tsitsitseng li baka kotsi e kholo ea mathata a kang lateral plate fixation, ho phunyeha ha ka hare, le ho hula ka screwout.Tšebeliso ea thuso ea lipoleiti tsa medial bakeng sa ho lokisa, le hoja e sebetsa hantle, e tla le litšitiso tsa ho eketseha ha ts'oaetso, nako e telele ea ho buuoa, kotsi e eketsehileng ea tšoaetso ea ka mor'a ts'ebetso, le moroalo o eketsehileng oa lichelete bakeng sa bakuli.
Ha ho nahanoa ka lintlha tsena, e le ho finyella ho leka-lekana pakeng tsa litšitiso tsa biomechanical tsa lateral single plates le ts'oaetso ea ho buuoa e amanang le tšebeliso ea lipoleiti tse peli tse bohareng le tse ka morao, litsebi tsa linaha tse ling li amohetse mokhoa o kenyelletsang lateral plate fixation le supplementary percutaneous screw fixation. ka lehlakoreng la bohareng.Mokhoa ona o bontšitse liphello tse ntle tsa kliniki.
Ka mor'a anesthesia, mokuli o behoa sebakeng sa supine.
Mohato oa 1: Ho fokotsa ho robeha.Kenya nale ea 2.0mm ea Kocher ka har'a tibial tuberosity, ho hula ho tsosolosa bolelele ba leoto, 'me u sebelise lesela la lengole ho lokisa phallo ea sefofane sa sagittal.
Mohato oa 2: Ho beha poleiti ea tšepe e ka morao.Ka mor'a ho fokotseha ha motheo ka ho hula, atamela ka ho toba distal lateral femur, khetha poleiti e lekaneng ea ho notlela bolelele ho boloka phokotso, 'me u kenye li-screw tse peli lipheletsong tsa proximal le distal tsa fracture ho boloka ho fokotseha ha fracture.Nakong ena, ke habohlokoa ho hlokomela hore li-screws tse peli tsa distal li lokela ho behoa haufi le ka pele kamoo ho ka khonehang ho qoba ho ama ho behoa ha li-screws tsa medial.
Mohato oa 3: Ho beha li-screw tsa medial column.Ka mor'a ho tsitsisa ho robeha ka poleiti ea lateral ea tšepe, sebelisa sekoahelo se tataisoang ke 2.8mm ho kena ka har'a condyle e bohareng, e nang le ntlha ea nale e bohareng kapa e ka morao ea boloko ea distal femoral, ka ntle le holimo, e phunyeletsa ka lehlakoreng le leng. lesapo la cortical.Ka mor'a phokotso e khotsofatsang ea fluoroscopy, sebelisa mochine oa 5.0mm ho etsa lesoba le ho kenya 7.3mm cancellous bone screw.
Setšoantšo se bontšang mokhoa oa ho fokotsa le ho lokisa fracture.Mosali ea lilemo li 74 ea nang le distal femoral intra-articular fracture (AO 33C1).(A, B) Li-radiographs tsa morao-rao tsa pele ho ts'ebetso tse bontšang ho falla ho hoholo ha fracture ea distal femoral;(C) Ka mor'a ho fokotsa ho robeha, poleiti e ka ntle ea lateral e kenngoa ka li-screws tse sireletsang mahlakore a mabeli le a distal;(D) Setšoantšo sa Fluoroscopy se bontšang boemo bo khotsofatsang ba terata ea tataiso ea medial;(E, F) Li-radiographs tsa postoperative lateral le anteroposterior ka mor'a hore ho kenngoe sekoahelo sa mokokotlo oa bohareng.
Nakong ea ho fokotsa, ho bohlokoa ho ela hloko lintlha tse latelang:
(1) Sebelisa terata e tataisang e nang le screw.Ho kenngoa ha li-screws tsa litšiea tse bohareng ho batla ho pharaletse, 'me ho sebelisa terata ea tataiso ntle le screw ho ka lebisa lehlakoreng le phahameng nakong ea ho phunya ka har'a condyle e bohareng, e leng ho etsang hore e sekamele ho thellang.
(2) Haeba likurufu tsa poleiti e ka morao li tšoara lateral cortex empa li hloleha ho fumana cortex e habeli e sebetsang hantle, lokisa sekoti se eang pele, se lumellang likurufu ho phunyeletsa lehlakore le ka pele la poleiti ea lateral ho fumana tšebetso e khotsofatsang ea cortex e habeli.
(3) Bakeng sa bakuli ba nang le lefu la ho fokola ha masapo, ho kenya washer e nang le sekoti sa medial column ho ka thibela screw ho seha lesapo.
(4) Likokoana-hloko tse qetellong ea poleiti li ka sitisa ho kenngoa ha lisekere tse bohareng.Haeba ho e-na le tšitiso ea sekurufu nakong ea ho kenya sekurufu sa bohareng ba kholomo, nahana ka ho ntša kapa ho beha li-screw tsa distal plate tsa lateral plate, u etelletse pele ho behoa ha lisekurufu tse bohareng.
Nyeoe ea 2. Mokuli oa mosali, ea lilemo li 76, ea nang le distal femoral extra-articular fracture.(A, B) Li-X-ray tsa pele ho ts'ebetso tse bontšang ho falla ho hoholo, ho senyeha ha angular, le ho falla ha sefofane sa coronal sa ho robeha;(C, D) Li-X-rays tsa Postoperative ka lipono tsa lateral le tsa anteroposterior tse bontšang ho lokisoa ka letlapa le ka ntle la lateral le kopantsoeng le li-screws tsa medial column;(E, F) Li-X-ray tsa morao-rao ka mor'a likhoeli tse 7 li senola pholiso e babatsehang ea ho robeha ntle le matšoao a ho hlōleha ho lokisa ka hare.
Nyeoe ea 3. Mokuli oa mosali, ea lilemo li 70, ea nang le fracture ea periprosthetic ho pota-potile ho kenngoa ha botšehali.(A, B) Li-X-rays tsa pele ho ts'ebetso tse bontšang ho robeha ha periprosthetic ho pota-potile ho kenngoa ha botšehali ka mor'a hore lengole le be le arthroplasty, le ho robeha ho eketsehileng le mokhoa o tsitsitseng oa maiketsetso;(C, D) Li-X-rays tsa Postoperative tse bontšang ho lokisoa ka poleiti e ka ntle ea lateral e kopantsoeng le li-screws tsa li-medial column ka mokhoa o eketsehileng;(E, F) Li-X-ray tse latelang ka mor'a likhoeli tsa 6 li senola pholiso e babatsehang ea fracture, ka ho lokisa ka hare.
Nako ea poso: Jan-10-2024
