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

ʻO ka haʻihaʻi ʻo Hoffa he haʻihaʻi 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 ʻo ia ma hope ona. ʻOiai e loaʻa pinepine ana nā haʻihaʻi i ka mokulele ākea, loaʻa nā haʻihaʻi Hoffa i ka mokulele coronal a he mea kakaʻikahi loa, no laila e nalo pinepine ʻia i ka wā o ka maʻi maʻi a me ka radiological.

I ka manawa hea e loaʻa ai kahi haki Hoffa?

ʻO nā haʻihaʻi ʻo Hoffa ma muli o ka ikaika shear i ka condyle femoral ma ka kuli. ʻO nāʻeha ikaika kiʻekiʻe ke kumu pinepine i ka intercondylar a me ka supracondylar fractures o ka femur distal. ʻO nā mea hana maʻamau e pili ana i nā kaʻa kaʻa a me nā ulia kaʻa kaʻa a hāʻule mai ke kiʻekiʻe. Lewis et al. Ua kuhikuhi ʻia ʻo ka hapa nui o nā maʻi me nā ʻeha pili i hana ʻia e ka hopena pololei i ka condyle femoral lateral i ka wā e holo ana i kahi kaʻa kaʻa me ke kuli i 90 °.

He aha nā hōʻailona hōʻailona o ka haki ʻana o Hoffa?

ʻO nā hōʻailona nui o ka haki Hoffa hoʻokahi, ʻo ia ka hoʻoheheʻe ʻana o ke kuli a me ka hemarthrosis, ka pehu, a me ka genu varum a i ʻole valgus a me ka instability. ʻAʻole like me nā haʻihaʻi intercondylar a me supracondylar, ʻike ʻia nā haʻihaʻi ʻo Hoffa i ka wā o nā haʻawina kiʻi. Ma muli o ka hapa nui o ka ʻeha o Hoffa i nā hōʻeha ikaika, ʻo nā ʻeha i hui pū ʻia i ka ʻūhā, pelvis, femur, patella, tibia, nā kuli kuli, a me nā moku popliteal pono e haʻalele.

Ke kānalua ʻia ka haki ʻana o ka Hoffa, pehea lā e lawe ai i nā kukui X e pale aku ai i ka nalo ʻana o ka maʻi?

Hoʻohana mau ʻia nā radiographs anteroposterior a me lateral, a hana ʻia nā hiʻohiʻona oblique o ke kuli inā pono. Ke hoʻoneʻe ʻole ʻia ka haʻihaʻi, paʻakikī pinepine ka ʻike ʻana ma nā radiographs. Ma ka ʻaoʻao ʻaoʻao, ʻike ʻia kahi ʻokoʻa iki o ka laina hui femoral, me ka condylar valgus deformity a i ʻole ma muli o ka condyle i pili. Ma muli o ke ʻano o ka femur, hiki ke ʻike ʻia kahi hoʻopau a i ʻole ka pae i ka laina haʻihaʻi ma ka ʻaoʻao ʻaoʻao. Eia nō naʻe, ma ka ʻike ʻaoʻao maoli, ʻike ʻia nā condyles femoral ʻaʻole i uhi ʻia, akā inā pōkole a hoʻoneʻe ʻia nā condyles, hiki ke uhi. No laila, hiki i ka ʻike hewa ʻole o ka hui kuli maʻamau ke hāʻawi iā mākou i kahi manaʻo hoʻopunipuni, hiki ke hōʻike ʻia e nā hiʻohiʻona oblique. No laila, pono ka hoʻokolokolo CT (Figure 1). Hiki i ke kiʻi hoʻonaʻauao magnetic (MRI) ke kōkua i ka loiloi ʻana i nā ʻiʻo palupalu a puni ke kuli (e like me nā ligaments a me nā menisci) no ka pōʻino.

Ua hōʻike ka kiʻi 1 CT i ka mea maʻi he Letenneur ⅡC type Hoffa fracture o ka condyle femoral lateral.

He aha nā ʻano o ka ʻeha o Hoffa?

Hoʻokaʻawale ʻia nā haʻihaʻi Hoffa i ke ʻano B3 a me ke ʻano 33.b3.2 i ka hoʻohālikelike AO/OTA e like me ka hoʻohālikelike ʻana o Muller. Ma hope mai, ʻo Letenneur et al. hoʻokaʻawale i ka haʻihaʻi i ʻekolu mau ʻano e pili ana i ka mamao o ka laina haʻihaʻi o ka femoral mai ka cortex hope o ka femur.

Kiʻi 2 Hoʻohui ʻia ʻo Letenneur o nā haki Hoffa

ʻAno I:Aia ka laina haʻihaʻi a pili pū me ka cortex hope o ke kumu femoral.

ʻAno II:ʻO ka mamao mai ka laina haʻihaʻi a hiki i ka laina hope o ka femur ua māhele houʻia i nā subtypes IIa, IIb a me IIc e like me ka mamao mai ka laina haʻihaʻi a hiki i ka iwi cortical hope. ʻO ke ʻano IIa kahi kokoke loa i ka cortex hope o ke kumu femoral, ʻoiai ʻo IIc kahi mamao loa mai ka cortex hope o ke kumu femoral.

ʻAno III:Oblique fracture.

Pehea e hoʻolālā ai i ka hoʻolālā ʻokiʻoki ma hope o ka ʻike?

1. Ke koho hoʻoponopono kūloko Ua manaʻo ʻia ʻo ka hoʻohaʻahaʻa hāmama a me ka hoʻoponopono kūloko ke kūlana gula. No nā haʻihaʻi o Hoffa, ua kaupalena ʻia ke koho ʻana i nā implants fixation kūpono. He kūpono no ka hoʻopaʻa ʻana i nā wili hollow compression ʻāpana. ʻO nā koho i hoʻokomo ʻia he 3.5mm, 4mm, 4.5mm a me 6.5mm i hoʻopaʻa ʻia i kahi ʻāpana hollow compression screws a me Herbert screws. I ka wā e pono ai, hiki ke hoʻohana ʻia nā papa anti-slip kūpono ma ʻaneʻi. Ua ʻike ʻia ʻo Jarit ma o nā noiʻi biomechanical cadaver e ʻoi aku ka paʻa o nā wīwī lag posteroanterior ma mua o nā screws lag anterior-posterior. Eia naʻe, ʻaʻole maopopo ka hana alakaʻi o kēia ʻike i ka hana lapaʻau.

2. ʻO kaʻenehanaʻenehana Keʻikeʻia kahi'āpana Hoffa e hui pū me ka'āpana intercondylar a me ka supracondylar, pono e hāʻawi nuiʻia ka nānāʻana, no ka mea, ua hoʻoholoʻia ka papahana hoʻolālā a me ke kohoʻana o ka hoʻoponopono i loko ma muli o ke kūlana i luna. Inā ʻoki ʻia ka condyle ʻaoʻao, ua like ka ʻike ʻana i ka ʻokiʻoki ʻana me ka haki ʻana o Hoffa. Eia nō naʻe, pono ʻole ka hoʻohana ʻana i ka wili condylar dynamic, a me kahi pā anatomical, condylar support plate a i ʻole LISS plate e hoʻohana ʻia no ka hoʻoponopono ʻana. He paʻakikī ke hoʻoponopono ʻana i ka condyle medial ma o ka ʻoki ʻaoʻao. I kēia hihia, koi ʻia kahi ʻoki anteromedial hou e hōʻemi a hoʻoponopono i ka haki ʻana o Hoffa. ʻO kēlā me kēia hihia, ua hoʻopaʻa ʻia nā ʻāpana iwi condylar nui me nā lag screws ma hope o ka hōʻemi anatomical o ka condyle.

1. ʻO ke kaʻina hana ʻO ka mea maʻi ma ke kūlana supine ma luna o kahi moena fluoroscopic me kahi tourniquet. Hoʻohana ʻia kahi bolster no ka mālama ʻana i ke kihi flexion kuli ma kahi o 90°. No nā haʻihaʻi medial Hoffa maʻalahi, makemake ka mea kākau e hoʻohana i kahi ʻoki waena me kahi ala parapatellar medial. No nā haʻihaʻi ʻaoʻao o Hoffa, hoʻohana ʻia kahi ʻoki ʻaoʻao. Manaʻo kekahi mau kauka he koho kūpono hoʻi ke ala parapatellar lateral. Ke ʻike ʻia nā ʻaoʻao o ka haʻi, hana ʻia ka ʻimi maʻamau, a laila hoʻomaʻemaʻe ʻia nā hope haʻi me kahi curette. Ma lalo o ka ʻike maka, hana ʻia ka hoʻohaʻahaʻa ʻana 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 hoʻoponopono ʻana i mea e pale ai i ka haʻihaʻi ʻana, akā ʻaʻole hiki i nā uea Kirschner ke kāohi i ka hoʻokomo ʻana o nā ʻūlū ʻē aʻe (Figure 3). E hoʻohana i ʻelua wili liʻiliʻi e hoʻokō i ka hoʻopaʻa paʻa a me ka hoʻoemi interfragmentary. E wili pololei i ka haʻi a ma waho o ka hui patellofemoral. Hōʻalo i ka wili ʻana i loko o ka lua hui hope, ʻoi aku ka maikaʻi me ka fluoroscopy lima lima. Hoʻokomo ʻia nā ʻūlū me nā mea holoi a ʻaʻohe mea e pono ai. Pono e hoʻopaʻa ʻia nā wili a lawa ka lōʻihi e hoʻoponopono ai i ka cartilage subarticular. Intraoperatively, nānā ʻia ke kuli no nā ʻeha concomitant, kūpaʻa, a me ke ʻano o ka neʻe ʻana, a hana ʻia kahi irrigation maikaʻi ma mua o ka pani ʻana i ka ʻeha.

Kiʻi 3 Hoʻohaʻahaʻa manawa a hoʻopaʻa ʻia nā haʻihaʻi ʻo Hoffa bicondylar me nā uea Kirschner i ka wā o ka ʻoki ʻana, me ka hoʻohana ʻana i nā uwea Kirschner e ʻohi i nā ʻāpana iwi.