Ko te whati o Hoffa he whati o te papa korona o te hononga femur. I whakaahuahia tuatahitia e Friedrich Busch i te tau 1869, ā, i pūrongohia anō e Albert Hoffa i te tau 1904, ā, i tapaina ki tōna ingoa. Ahakoa he maha ngā wā ka puta ngā whati i te papa whakapae, ka puta ngā whati o Hoffa i te papa korona, ā, he tino onge, nō reira ka ngaro i te wā tuatahi e tātaritanga haumanu me te tātaritanga hihi-X.
Āhea ka puta te whati o te hononga o Hoffa?
Ko ngā whati o Hoffa i puta mai i te kaha kutikuti ki te hononga o te femur i te turi. Ko ngā whara kaha te take o ngā whati i waenga i ngā hononga me ngā whati i runga ake i te femur o te pito tawhiti. Ko ngā tikanga tino noa ko ngā aituā waka me ngā aituā waka me ngā hinganga mai i te teitei. I tohu a Lewis me ētahi atu ko te nuinga o ngā tūroro i whara i puta mai i te kaha pānga tika ki te hononga o te femur taha i a rātou e eke motopaika ana me te turi e piko ana ki te 90°.
He aha ngā tohu haumanu o te whati o Hoffa?
Ko ngā tohu matua o te whati kotahi o te Hoffa ko te rerenga o te turi me te hemarthrosis, te pupuhi, me te genu varum, te valgus rānei, me te kore pumau. Kāore i rite ki ngā whati intercondylar me supracondylar, ko ngā whati Hoffa ka kitea pea i te wā o ngā rangahau whakaahua. Nā te mea ko te nuinga o ngā whati Hoffa ka puta mai i ngā whara kaha, me tango atu ngā whara whakakotahi ki te hope, te pelvis, te femur, te patella, te tibia, ngā hononga turi, me ngā oko toto popliteal.
Mēnā e whakapaetia ana he whati o Hoffa, me pēhea te tango i ngā hihi-X kia kore ai e ngaro te tautuhi i te mate?
He mea noa te mahi i ngā whakaahua X-ray anteroposterior me lateral, ā, ka mahia ngā tirohanga whakarara o te turi ina hiahiatia. Mēnā kāore te whati i tino nekehia, he uaua ki te kite i ngā whakaahua X-ray. I te tirohanga taha, ka kitea he iti noa te rerekētanga o te hononga femur, me te kore rānei he condylar valgus deformity i runga i te condyle e pā ana. I runga i te āhua o te femur, ka kitea he motumotu, he takahanga rānei i roto i te rārangi whati i te tirohanga taha. Heoi, i te tirohanga taha pono, ka puta ngā condyle femur kāore e taupatupatu, engari ki te whakapotohia, ka nekehia ngā condyle, ka taupatupatu pea. Nō reira, mā te tirohanga hē o te hononga turi noa ka puta he whakaaro hē, ka taea te whakaatu mā ngā tirohanga whakarara. Nō reira, me tirotiro te CT (Pikitia 1). Ka taea e te whakaahua aukume (MRI) te āwhina ki te aromatawai i ngā kiko ngohengohe huri noa i te turi (pērā i ngā ligaments, i ngā menisci rānei) mō te kino.
I whakaatuhia e te CT Pikitia 1 he whati Letenneur ⅡC momo Hoffa o te condyle femur taha o te tūroro.
He aha ngā momo whati o Hoffa?
E ai ki te whakarōpūtanga a Muller, ka wehea ngā whati o Hoffa ki te momo B3 me te momo 33.b3.2 i roto i te whakarōpūtanga AO/OTA. Nō muri mai, ka wehea e Letenneur me ētahi atu te whati kia toru ngā momo i runga i te tawhiti o te rārangi whati o te femur mai i te cortex o muri o te femur.
Pikitia 2 Te whakarōpūtanga Letenneur o ngā whati Hoffa
Momo Tuatahi:Kei te tū te rārangi whati, ā, e whakarara ana ki te cortex o muri o te kakau femur.
Momo Tuarua:Ko te tawhiti mai i te rārangi whati ki te rārangi cortical o muri o te femur ka wehea anō ki ngā momo IIa, IIb me IIc e ai ki te tawhiti mai i te rārangi whati ki te wheua cortical o muri. Ko te momo IIa e tata ana ki te cortex o muri o te kakau femur, ko te IIc ia e tawhiti rawa atu ana i te cortex o muri o te kakau femur.
Momo III:Whati piko.
Me pēhea te whakarite i tētahi mahere pokanga i muri i te tātaritanga?
1. Te whiriwhiri i te whakapiri ā-roto E whakaponohia whānuitia ana ko te whakaiti tuwhera me te whakapiri ā-roto te paerewa koura. Mō ngā whati Hoffa, he iti noa te whiriwhiri i ngā whakaurunga whakapiri e tika ana. He pai ngā tīwiri kōpeketanga tuwhera miro-wāhanga mō te whakapiri. Ko ngā kōwhiringa whakaurunga ko ngā tīwiri kōpeketanga tuwhera miro-wāhanga 3.5mm, 4mm, 4.5mm me te 6.5mm me ngā tīwiri Herbert. Mena e tika ana, ka taea hoki te whakamahi i ngā pereti ārai-paheke e tika ana i konei. I kitea e Jarit mā roto i ngā rangahau koiora-mīhini tūpāpaku he pumau ake ngā tīwiri whakaroa posteroanterior i ngā tīwiri whakaroa anterior-posterior. Heoi, kāore anō kia mārama te tūranga ārahi o tēnei kitenga i roto i te mahi haumanu.
2. Hangarau Pokanga Ina kitea he whati i waenganui i ngā hononga me ngā hononga i runga ake i te hononga o te hononga, me aro nui atu, nā te mea ka whakatauhia te mahere pokanga me te whiriwhiri i te whakapiri ā-roto i runga i te āhuatanga o runga ake nei. Mena ka wehea te hononga taha ki te karauna, ka rite te whakaaturanga pokanga ki te whati Hoffa. Heoi, kāore i te whakaaro nui te whakamahi i te tīwiri hononga hihiri, ā, me whakamahi he pereti anatomical, he pereti tautoko hononga, he pereti LISS rānei hei whakapiri. He uaua te whakatika i te hononga waenga mā te tapahi taha. I tēnei take, me tāpiri he tapahi anteromedial hei whakaiti me te whakatika i te whati Hoffa. Ahakoa pēhea, ka whakapirihia ngā kongakonga wheua nui katoa ki ngā tīwiri whakaroa i muri i te whakaiti anatomical o te hononga.
- Tikanga pokanga Kei te takoto takoto te tūroro i runga i te moenga fluoroscopic me te tourniquet. Ka whakamahia he bolster hei pupuri i te koki piko o te turi ki te 90°. Mō ngā whati Hoffa waenga ngāwari, he pai ake ki te kaituhi te whakamahi i te tapahi waenga me te huarahi parapatellar medial. Mō ngā whati Hoffa taha, ka whakamahia he tapahi taha. E kī ana ētahi tākuta he kōwhiringa tika hoki te huarahi parapatellar taha. Kia kitea ngā pito whati, ka mahia te tirotiro auau, kātahi ka horoia ngā pito whati ki te curette. I raro i te tirohanga tika, ka mahia te whakaiti mā te whakamahi i te forceps whakaiti ira. Mena e tika ana, ka whakamahia te tikanga "joystick" o ngā waea Kirschner mō te whakaiti, kātahi ka whakamahia ngā waea Kirschner mō te whakaiti me te whakapiri hei ārai i te nekehanga whati, engari kāore e taea e ngā waea Kirschner te aukati i te whakaurunga o ētahi atu tīwiri (Pikitia 3). Whakamahia kia rua ngā tīwiri kia tutuki ai te whakapiri pumau me te pēhitanga i waenga i ngā wāhanga. Keria poutū ki te whati, kia matara atu i te hononga patellofemoral. Kaua e keria ki roto i te kōhao hononga o muri, he pai ake mā te fluoroscopy C-ringa. Ka whakanohoia ngā tīwiri me ngā whāriki, kāore rānei, ina hiahiatia. Me totohu ngā tīwiri ki raro, kia roa hoki hei whakau i te kiriuhi o raro o te hononga. I te wā o te pokanga, ka tirotirohia te turi mō ngā whara e pā ana, te pumau, me te whānuitanga o te nekehanga, ā, ka mahia he whakamakuku pai i mua i te katinga o te patunga.
Pikitia 3 Te whakaiti rangitahi me te whakau i ngā whati o te Hoffa bicondylar me ngā waea Kirschner i te wā pokanga, mā te whakamahi i ngā waea Kirschner hei unu i ngā kongakonga wheua.
Wā tuku: Maehe-12-2025
