Tikanga Pokanga | Te Whakamau ā-roto o te Tākai Condyle Femoral Ipsilateral mō te Maimoatanga o ngā Whati Tibial Plateau

Ko te lateral tibial plateau collapse, te split collapse rānei, te momo whati tibial plateau e tino kitea ana. Ko te whāinga matua o te pokanga he whakahoki mai i te maeneene o te mata o te hononga me te whakarite i te peka o raro. Ina teitei ake te mata o te hononga kua hinga, ka waiho he koha wheua i raro i te kiriuhi, ā, he maha ngā wā ka hiahiatia he wheua iliac autogenous, he wheua allograft, he wheua horihori rānei. E rua ngā kaupapa o tēnei: ​​tuatahi, hei whakahoki mai i te tautoko hanganga wheua, tuarua, hei whakatairanga i te whakaora wheua.

I te whakaaro ki te tapahi tāpiri e hiahiatia ana mō te wheua iliac autogenous, ka nui ake te whara o te pokanga, me ngā mōrearea pea o te whakakorenga me te mate e pā ana ki te wheua allograft me te wheua horihori, ka whakaarohia e ētahi tohunga he huarahi kē atu i te wā o te lateral tibial plateau open reduction me te internal fixation (ORIF). Ka tūtohu rātou kia whakaroahia te tapahi kotahi ki runga i te wā o te tikanga me te whakamahi i te cancellous bone graft mai i te lateral femoral condyle. He maha ngā pūrongo take kua tuhia tēnei tikanga.

I whakaurua ki te rangahau ngā kēhi 12 me ngā raraunga whakaahua whai muri katoa. Mō ngā tūroro katoa, i whakamahia he huarahi tātaritanga ā-taha o mua o te tibial. I muri i te whakaatu i te papa tibial, ka toro atu te tapahi ki runga kia kitea ai te condyle femur taha. I whakamahia he taputapu tango wheua Eckman 12mm, ā, i muri i te keri i roto i te cortex o waho o te condyle femur, ka hauhakehia te wheua cancellous mai i te condyle taha i roto i ngā haerenga e whā. Ko te rōrahi i riro mai i waenga i te 20 ki te 40cc.

Whai muri i te whakamakuku anō i te awa wheua, ka taea te whakauru i te hautai hemostatic mēnā e tika ana. Ka whakatōkia te wheua cancellous kua hauhaketia ki roto i te koha wheua i raro i te papa tibial lateral, ā, muri iho ka whakapūmau ā-roto. E whakaatu ana ngā hua:

① Mō te whakapiri ā-roto o te tibial plateau, i ora katoa ngā tūroro i te whati.

② Kāore i kitea he mamae nui, he raruraru rānei i te wāhi i tangohia mai ai te wheua mai i te condyle taha.

③ Te whakaora o te wheua i te wāhi i kohia ai: I roto i ngā tūroro 12, e 3 i whakaatu i te whakaora katoa o te wheua cortical, e 8 i whakaatu i te whakaora hapa, ā, kotahi i whakaatu kāore i te kitea te whakaora o te wheua cortical.

④ Te hanganga o ngā trabeculae wheua i te wāhi hauhake: I roto i ngā take e 9, kāore i kitea he hanganga o ngā trabeculae wheua, ā, i roto i ngā take e 3, i kitea te hanganga wāhanga o ngā trabeculae wheua.

⑤ Ngā raruraru o te osteoarthritis: I roto i ngā tūroro 12, e 5 i pāngia e te rumatiki o te hononga turi i muri i te whara. Kotahi te tūroro i whakakapia te hononga i muri i ngā tau e whā.

Hei whakamutunga, ko te hauhake i te wheua cancellous mai i te condyle femoral lateral ipsilateral ka hua ake he whakaora pai o te wheua tibial plateau me te kore e whakanui ake i te mōrearea o ngā raruraru postoperative. Ka taea te whakaaro me te whakamahi i tēnei tikanga i roto i te mahi haumanu.