Nzira dzokuvhiya
Mushure mekubvumidzwa, varwere vairapwa nekuvhiyiwa kwakarongeka zvichienderana nemamiriro ezvinhu.Kutanga, iyo yekunze yakagadziriswa yakagadziriswa, uye kana mamiriro ezvinyoro zvinyoro akabvumira, yakatsiviwa nekugadzirisa mukati.
Vanyori vakapfupisa ruzivo rwavo uye vakaona kuti kiyi yekuderedza kuputsika uye kuderedza kugadziridza ndeyekudzikisa iyo posterior cortical fracture yetibia kutanga, uyezve kubata nekumanikidza kuputsika kweanterior tibial plateau, kuitira kudzorera yakajairika sagittal ndege. line.
Vanyori vanokurudzira kushandiswa kweproximal tibial anterolateral uye posteromedial nzira dzekuderedza kuputsika uye kugadzirisa.
Iyo posterior tibial nzira inogona kushandiswa kufumura chimiro chemashure chetibia uye kuita kuderedza uye anteromedial support plate fixation panguva yekushanda.
Mukuwedzera, kugadziriswa kwekanguva kwemashure ekuputsika kweplateau fractures kunogona kushanda se fulcrum kusimudza anterior fracture uye kuderedza kuparara kwekuparara panguva yekugadziriswa kunotevera kwesagittal alignment.
Kamwe kuderedzwa kwemashure ekuputsika kwapera, chigadziro chekugadzirisa kwechinguva chinofanirwa kushandiswa kugadzirisa, senge 1/3 tubular plate kana 3.5mm screw kubva kune anterior distal end kusvika kune posterior proximal end.
Zvadaro, dzorera kurongeka kwetibial plateau articular surface uye sagittal ndege.Panguva yekuvhiya, shandisa chishandiso chekudzikisa chine muromo wakafara kuderedza kudzvanywa uye kudzivirira kuwedzera kwekutyoka kunoitwa.
Kudzorerwa kwe posterior tibial inclination kwakatangwa neanterior flap spacer kana osteotome panguva imwe chete (Fig. 2).Pazasi peiyo proximal mutsara wakabatana, waya dzakawanda dzeKirschner dzakaiswa mukufanana kubva mberi kuenda kumashure, uye iyo tibial retroversion yakadzoreredzwa nekusimudza waya dzeKirschner, ndokuzogadziriswa pamashure cortex.
A- Fibular musoro autograft;B- Spinal Cage inozadza chirema chebhonzo
Iyo lateral X-ray inoratidza sagittal deformity, uye iyo chaiyo yakajeka firimu inoratidza kuderedza forceps kuderedza posterior tibial fracture nerubatsiro rweshizha nzvimbo distractor.
Pakupedzisira, ndiro yakashandiswa kuderedza chidimbu chekuputsika kugadzirisa sagittal retroversion.Kupera kwepamusoro kweproximal lateral tibial plate (kuvhara kana kusavhara) kunofanira kufanana nechepamusoro pepamusoro, uye kuguma kwekupedzisira kunofanira kunge kuri shure zvishoma.Iyo ndiro yakagadziriswa kune chidimbu chepamusoro nemakumbo, uye ipapo ndiro uye chidimbu chepamusoro zvakaderedzwa uye zvakagadziriswa patibial shaft nekugadzirisa ndiro ye distal, kuitira kuti idzorere yakajairika tibial posterior inclination.
Kana kuderedzwa kwekutyoka kwapera, kugadzirisa kwechinguva neKirschner waya kunogona kushandiswa.Mune zvimwe zviitiko, kugadzirisa kwechinguva kwakagadzikana kwakaoma kuita pasina kutanga kudzoreredza mutsara wesimba negraft (tricortical iliac graft, fibular head graft, nezvimwewo)
Nguva yekutumira: Chivabvu-09-2022