Te whakarite i mua i te pokanga me te tūranga e ai ki te whakaahuatanga o mua mō te whakapiri i te anga o waho transarticular.
Te whakanoho anō me te whakatika i ngā whati o roto i te hononga：
Ka whakamahia te whakaiti me te whakapiripiri iti. Ka taea te tiro tika i te whati o te mata hononga o raro mā roto i ngā tapahi iti anteromedial me anterolateral me te tapahi taha o te capsule hononga i raro i te meniscus.
Ka taea te tautuhi anō i te kukume o te peka e pāngia ana me te whakamahi i ngā hononga hei whakatikatika i ngā maramara wheua nui, me te pēhanga waenga mā te unu me te hutihuti.
Kia aro ki te whakahoki mai i te whānui o te papa tibial, ā, ki te kitea he koha wheua i raro i te mata hononga, me hono wheua hei tautoko i te mata hononga i muri i te werohanga hei tautuhi anō i te mata hononga.
Kia tupato ki te teitei o ngā papa waenga me ngā papa taha, kia kore ai he takahanga mata hononga.
Ka whakamahia te whakapiri rangitahi mā te whakamahi i te rawhi tautuhi anō, i te pine Kirschner rānei hei pupuri i te tautuhi anō.
Me whakanoho ngā tīwiri tuwhera, me whakarara ngā tīwiri ki te mata hononga, ā, me whakanoho ki roto i te wheua subchondral, kia kaha ake ai te whakapiri. Me mahi te fluoroscopy hihi-X i te wā o te pokanga hei tirotiro i ngā tīwiri, ā, kaua rawa e pana ngā tīwiri ki roto i te hononga.
Te nekehanga o te whati epiphyseal：
Ka whakahokia mai e te kukume te roa me te tuaka ā-pūkaha o te peka e pāngia ana.
Ka āta whakatikahia te nekehanga hurihuri o te peka e pāngia ana mā te pā atu ki te ngongo tibial me te whakanoho i waenganui i te māikuku tuatahi me te māikuku tuarua.
Te Whakatakotoranga o te Mowhiti Tata
Te whānuitanga o ngā rohe haumaru mō te whakatakotoranga waea kume o te tibial plateau：
Kei muri i te tibia te uaua popliteal, te uaua popliteal me te io tibial, ā, kei muri i te pane fibular te io peroneal noa. Nō reira, me mahi te whakaurunga me te putanga o te ngira ki mua i te tibial plateau, arā, me tomo te ngira, me puta hoki i te ngira maitai ki mua i te rohe waenga o te tibia me mua hoki i te rohe o mua o te fibula.
I te taha taha, ka taea te wero i te ngira mai i te taha o mua o te fibula ka tukuna atu i te taha anteromedial, i te taha medial rānei; ko te pūwāhi whakauru medial kei te taha medial o te tibial plateau me tōna taha o mua, kia kore ai e puta te waea kume i roto i ngā kiko uaua.
Kua pūrongohia i roto i ngā tuhinga ko te wāhi whakauru o te waea kume me noho kia 14 mm te iti rawa mai i te mata o te hononga kia kore ai e uru te waea kume ki roto i te kapu o te hononga, ā, kia kore ai e pangia e te mate rumatiki.
Whakatakotoria te waea tārewa tuatahi:
Ka taea te whakamahi i tētahi pine oriwa, ka tukuna mā roto i te pine haumaru kei runga i te pupuri mowhiti, ka waiho te pane oriwa ki waho o te pine haumaru.
Ka pupuri te kaiawhina i te tūranga o te kaipupuri mowhiti kia rite ki te mata hononga.
Werohia te pine oriwa mā roto i te kiko ngohengohe me te tibial plateau, me te āta whakahaere i tōna ahunga kia rite ai te wāhi tomo me te wāhi puta.
I muri i te putanga mai i te kiri mai i te taha ke, me haere tonu te putanga mai i te ngira kia pa ra ano te pane oriwa ki te pine haumaru.
Tāutahia te kiriata rawhi waea ki te taha whakamuri, ka tukuna te pine oriwa mā roto i te kiriata rawhi waea.
Kia tūpato kia noho tonu te papa tibial ki waenganui o te anga mowhiti i ngā wā katoa e whakahaerehia ana te mahi.
Mā te aratohu, ka whakatakotoria he waea kume tuarua kia whakarara, mā te taha kē atu hoki o te kiriata rawhi waea.
Whakanohoia te waea kume tuatoru, me noho ki te awhe haumaru kia tae ki te tawhiti rawa atu me te waea kume o mua e whiti ana ki te koki nui rawa atu, ko te tikanga ka taea e ngā waea maitai e rua te koki o te 50° ~ 70°.
Te utaina mua ki te waea kume: Kume katoatia te whakakī, tukuna te pito o te waea kume mā roto i te whakakī, pēhia te kakau, whakamahia he utaina mua o te 1200N neke atu rānei ki te waea kume, kātahi ka whakamahia te raka kakau-L.
Mā te whakamahi i te tikanga whakapiri o waho puta noa i te turi i whakaahuatia i mua, whakatakotoria kia rua ngā tīwiri Schanz ki roto i te tibia distal, tāpirihia te whakapiri o waho ringa kotahi, ka hono atu ki te whakapiri o waho porowhita, ka whakaū anō kei te tuaka ā-ringa me te tūnga hurihuri noa te metaphysis me te kakau tibial i mua i te whakaoti i te whakapiri.
Mena e hiahiatia ana he pumau ake, ka taea te tāpiri i te anga mowhiti ki te ringa whakapiri o waho mā te whakamahi i te tokotoko hono.
Te kati i te tapahi
Ka katia te tapahi pokanga papatahi i te papatahi.
Ka tiakina te ara ngira ki ngā takai kākahu waipiro.
Te whakahaere i muri i te pokanga
Te mate pāwera me te whara o te io
I roto i te 48 hāora i muri i te whara, me āta tirotiro me te whakatau mēnā kei te kitea te mate wāhanga fascial.
Me āta tirotiro i ngā io toto o te peka e pāngia ana. Me whakahaere tika te ngoikore o te rere o te toto, te ngaro haere rānei o te pūnaha io i roto i te wā ohorere.
Whakaora mahi
Ka taea te tīmata i ngā mahi whakakori tinana i te rā tuatahi i muri i te pokanga mēnā kāore he whara i te wāhi, he mate tāpiri rānei. Hei tauira, ko te whakahekenga isometric o ngā quadriceps me te nekehanga kore mahi o te turi me te nekehanga kaha o te pona waewae.
Ko te kaupapa o ngā mahi tōmua hohe me ngā mahi kore hohe he whakatutuki i te whānuitanga nekehanga mōrahi o te hononga turi mō te wā poto rawa atu i muri i te pokanga, arā, kia tutuki ai te whānuitanga nekehanga katoa o te hononga turi i roto i ngā wiki 4-6. I te nuinga o te wā, ka taea e te pokanga te whakatutuki i te kaupapa o te hanga anō i te pumau o te turi, kia taea ai te tere o te
mahi. Mena ka whakaroahia ngā mahi whakakori tinana nā te tatari kia memeha te pupuhi, e kore tēnei e whai hua mō te whakaoranga mahi.
Te amo taumaha: Kāore i te tūtohutia te amo taumaha i te wā tōmua, engari i te iti rawa 10 ki te 12 wiki, i muri mai rānei mō ngā whati hononga kua hangaia.
Te whakaora patunga: Me āta tirotiro i te whakaora o te patunga i roto i ngā wiki e rua i muri i te pokanga. Mena ka pangia te patunga, ka roa rānei te whakaora, me mahi wawe tonu te pokanga.
Wā tuku: 16 o Ākuhata-2024
