Nā kumu a me ka mālama ʻana i ka haki ʻo Hoffa

ʻO ka haki ʻo Hoffa kahi haki o ka mokulele coronal o ka condyle femoral. Ua wehewehe mua ʻia e Friedrich Busch i ka makahiki 1869 a ua hōʻike hou ʻia e Albert Hoffa i ka makahiki 1904, a ua kapa ʻia ma muli ona. ʻOiai ʻo ka maʻamau o nā haki e kū mai ana ma ka mokulele ākea, ʻo nā haki Hoffa e kū mai ana ma ka mokulele coronal a he mea kakaikahi loa ia, no laila ʻaʻole pinepine lākou e ʻike ʻia i ka wā o ka hōʻoia mua ʻana o ke kauka a me ka radiological.

I ka manawa hea e hana ʻia ai kahi haki Hoffa?

Hoʻokumu ʻia nā haki Hoffa e ka ikaika shear i ka femoral condyle ma ke kuli. ʻO nā ʻeha ikehu kiʻekiʻe e hoʻoulu pinepine i nā haki intercondylar a me supracondylar o ka femur distal. ʻO nā ʻano hana maʻamau e komo pū me nā ulia kaʻa a me nā kaʻa kaʻa a me ka hāʻule ʻana mai ke kiʻekiʻe. Ua kuhikuhi ʻo Lewis et al. ʻo ka hapa nui o nā maʻi me nā ʻeha pili i hoʻokumu ʻia e ka ikaika pili pololei i ka lateral femoral condyle i ka wā e holo ana i kahi mokokaikala me ke kuli i pelu ʻia i 90°.

He aha nā hōʻailona lapaʻau o ka haki Hoffa?

ʻO nā hōʻailona nui o kahi haki Hoffa hoʻokahi ka effusion kuli a me ka hemarthrosis, ka pehu ʻana, a me ka genu varum a i ʻole valgus a me ka paʻa ʻole. ʻAʻole e like me nā haki intercondylar a me supracondylar, ʻoi aku ka nui o ka ʻike ʻia ʻana o nā haki Hoffa ma ke ʻano ulia i ka wā o nā haʻawina kiʻi. No ka mea, ʻo ka hapa nui o nā haki Hoffa e hopena mai nā ʻeha ikehu kiʻekiʻe, pono e kāpae ʻia nā ʻeha i hui pū ʻia i ka ʻūhā, pelvis, femur, patella, tibia, ligaments kuli, a me nā kīʻaha popliteal.

Ke manaʻo ʻia kahi haki Hoffa, pehea e lawe ai i nā X-ray i mea e pale aku ai i ka nalo ʻana o ka hōʻailona?

Hana mau ʻia nā radiographs anteroposterior a me lateral maʻamau, a hana ʻia nā hiʻohiʻona oblique o ke kuli i ka wā e pono ai. Ke ʻole i neʻe nui ʻia ka haki, he mea paʻakikī pinepine ke ʻike iā ia ma nā radiographs. Ma ka hiʻohiʻona lateral, ʻike ʻia kekahi manawa kahi discordance iki o ka laina hui femoral, me ka ʻole a i ʻole ka condylar valgus deformity ma muli o ka condyle i pili. Ma muli o ke ʻano o ka femur, hiki ke ʻike ʻia kahi discontinuity a i ʻole kahi ʻanuʻu i ka laina haki ma ka hiʻohiʻona lateral. Eia nō naʻe, ma kahi hiʻohiʻona lateral maoli, ʻike ʻia nā condyles femoral ʻaʻole e overlapping, ʻoiai inā pōkole a neʻe ʻia nā condyles, hiki iā lākou ke overlapping. No laila, ʻo ka hiʻohiʻona hewa o ka hui kuli maʻamau hiki ke hāʻawi iā mākou i kahi manaʻo wahaheʻe, hiki ke hōʻike ʻia e nā hiʻohiʻona oblique. No laila, pono ka hoʻokolokolo CT (Kiʻi 1). Hiki i ke kiʻi resonance magnetic (MRI) ke kōkua i ka loiloi ʻana i nā ʻiʻo palupalu a puni ke kuli (e like me nā ligaments a i ʻole menisci) no ka hōʻino.

Ua hōʻike ʻia ma ka Kiʻi 1 CT ua loaʻa i ka mea maʻi kahi haki Letenneur ⅡC ʻano Hoffa o ka condyle femoral lateral.

He aha nā ʻano o nā haki Hoffa?

Ua māhele ʻia nā haki Hoffa i ke ʻano B3 a me ke ʻano 33.b3.2 ma ka hoʻokaʻawale ʻana o AO/OTA e like me ka hoʻokaʻawale ʻana o Muller. Ma hope mai, ua māhele ʻo Letenneur et al. i ka haki i ʻekolu ʻano e pili ana i ka mamao o ka laina haki femoral mai ka posterior cortex o ka femur.

Kiʻi 2 Ka hoʻokaʻawale ʻana o Letenneur o nā haki Hoffa

ʻAno I:Aia ka laina haki a kūlike me ka posterior cortex o ke koʻokoʻo femoral.

ʻAno II:Ua māhele hou ʻia ka mamao mai ka laina haki a i ka laina cortical hope o ka femur i nā ʻano IIa, IIb a me IIc e like me ka mamao mai ka laina haki a i ka iwi cortical hope. ʻO ke ʻano IIa ka mea kokoke loa i ka cortex hope o ke koʻokoʻo femoral, ʻoiai ʻo IIc ka mea mamao loa mai ka cortex hope o ke koʻokoʻo femoral.

ʻAno III:Haʻihaʻi kūlou.

Pehea e hoʻonohonoho ai i kahi papahana hana ma hope o ka hōʻoia ʻana?

1. Koho ʻana i ka hoʻopaʻa kūloko Manaʻo nui ʻia ʻo ka hōʻemi hāmama a me ka hoʻopaʻa kūloko ke kūlana gula. No nā haki Hoffa, ua kaupalena ʻia ke koho ʻana o nā implants hoʻopaʻa kūpono. He kūpono nā wili hollow compression hapa wili no ka hoʻopaʻa ʻana. ʻO nā koho implant e komo pū me 3.5mm, 4mm, 4.5mm a me 6.5mm hapa wili hollow compression a me nā wili Herbert. Inā pono, hiki ke hoʻohana ʻia nā papa anti-slip kūpono ma aneʻi. Ua ʻike ʻo Jarit ma o nā haʻawina biomechanical cadaver he ʻoi aku ka paʻa o nā wili lag posteroanterior ma mua o nā wili lag anterior-posterior. Eia nō naʻe, ʻaʻole maopopo loa ke kuleana alakaʻi o kēia ʻike i ka hana lapaʻau.

2. ʻEnehana ʻokiʻoki Ke ʻike ʻia kahi haki Hoffa e hele pū me kahi haki intercondylar a me supracondylar, pono e hāʻawi ʻia ka nānā kūpono, no ka mea, ua hoʻoholo ʻia ka hoʻolālā ʻokiʻoki a me ke koho ʻana o ka hoʻopaʻa ʻana i loko ma muli o ke kūlana i luna. Inā ua māhele ʻia ka condyle ʻaoʻao, ua like ke ʻano o ka ʻokiʻoki me ko ka haki Hoffa. Eia nō naʻe, he mea naʻaupō ke hoʻohana ʻana i kahi wili condylar dynamic, a pono e hoʻohana ʻia kahi papa anatomical, papa kākoʻo condylar a i ʻole ka papa LISS no ka hoʻopaʻa ʻana. He paʻakikī ke hoʻoponopono i ka condyle medial ma o ka ʻoki ʻaoʻao. I kēia hihia, pono kahi ʻoki anteromedial hou e hōʻemi a hoʻoponopono i ka haki Hoffa. I kēlā me kēia hihia, ua hoʻopaʻa ʻia nā ʻāpana iwi condylar nui a pau me nā wili lag ma hope o ka hōʻemi anatomical o ka condyle.

1. ʻAno hana ʻoki kino Aia ka mea maʻi ma ke kūlana moe ma luna o kahi moena fluoroscopic me kahi tourniquet. Hoʻohana ʻia kahi bolster e mālama i ke kihi flexion kuli ma kahi o 90°. No nā haki medial Hoffa maʻalahi, makemake ka mea kākau e hoʻohana i kahi ʻoki waena me kahi ala parapatellar medial. No nā haki Hoffa ʻaoʻao, hoʻohana ʻia kahi ʻoki ʻaoʻao. Manaʻo kekahi mau kauka he koho kūpono hoʻi kahi ala parapatellar ʻaoʻao. Ke hōʻike ʻia nā wēlau haki, hana ʻia ka ʻimi maʻamau, a laila hoʻomaʻemaʻe ʻia nā wēlau haki me kahi curette. Ma lalo o ka ʻike pololei, hana ʻia ka hōʻemi me ka hoʻohana ʻana i kahi forceps hōʻemi kiko. Inā pono, hoʻohana ʻia ke ʻano "joystick" o nā uea Kirschner no ka hōʻemi ʻana, a laila hoʻohana ʻia nā uea Kirschner no ka hōʻemi a me ka hoʻopaʻa ʻana e pale aku i ka neʻe ʻana o ka haki, akā ʻaʻole hiki i nā uea Kirschner ke pale i ke kau ʻana o nā wili ʻē aʻe (Kiʻi 3). E hoʻohana i ʻelua mau wili ma ka liʻiliʻi e hoʻokō i ka hoʻopaʻa paʻa a me ka hoʻopili interfragmentary. E wili kū pololei i ka haki a mamao aku mai ka hui patellofemoral. E pale i ka wili ʻana i loko o ke ana hui hope, ʻoi aku ka maikaʻi me ka fluoroscopy C-arm. Hoʻokomo ʻia nā wili me a me nā mea holoi ʻole e like me ka mea e pono ai. Pono e hoʻokuʻu ʻia nā wili i lalo a lawa ka lōʻihi e hoʻopaʻa ai i ke cartilage subarticular. I loko o ke ʻoki ʻana, e nānā ʻia ke kuli no nā ʻeha e hele pū ana, ke kūpaʻa, a me ka laulā o ka neʻe ʻana, a hana ʻia kahi hoʻoinu wai piha ma mua o ka pani ʻana o ka ʻeha.

Kiʻi 3 Ka hōʻemi manawa pōkole a me ka hoʻopaʻa ʻana i nā haki Hoffa bicondylar me nā kaula Kirschner i ka wā o ke ʻoki ʻana, me ka hoʻohana ʻana i nā kaula Kirschner e wehe i nā ʻāpana iwi.