ʻIke pinepine ʻia nā haʻihaʻi ʻo Tibial plateau i hui pū ʻia me ka ipsilateral tibial shaft i nā hōʻeha ikaika, me ka 54% he mau haki hāmama. Ua ʻike ʻia nā haʻawina mua e pili ana ka 8.4% o nā haʻihaʻi pāpaʻu tibial me nā haʻihaʻi o ka tibial shaft concomitant, aʻo 3.2% o nā maʻi maʻi tibial shaft fractures concomitant tibial plateau fractures. Ua ʻike ʻia ʻo ka hui pū ʻana o ka ipsilateral tibial plateau a me nā haʻihaʻi shaft he mea maʻamau.
Ma muli o ke ʻano kiʻekiʻe o ka ikehu o ia mau ʻeha, loaʻa pinepine ka pōʻino o ka ʻiʻo palupalu. Ma ke kumumanaʻo, ʻoi aku ka maikaʻi o ka pā a me ka ʻōnaehana wili i ka hoʻoponopono kūloko no nā haʻihaʻi plateau, akā inā hiki i ka ʻiʻo palupalu kūloko ke ʻae i ka hoʻoponopono kūloko me ka pā a me ka ʻōnaehana screw he mea noʻonoʻo pū kekahi. No laila, aia i kēia manawa ʻelua mau koho maʻamau no ka hoʻopaʻa ʻana i loko o nā haʻihaʻi pāpū tibial i hui pū ʻia me nā haʻihaʻi tibial shaft:
1. ʻO MIPPO (Minimally Invasive Plate Osteosynthesis) ʻenehana me kahi pā lōʻihi;
2. Intramedullary nail + plateau screw.
Ua hōʻike ʻia nā koho ʻelua ma ka palapala, akā ʻaʻohe manaʻo i kēia manawa i ʻoi aku ka maikaʻi a i ʻole ka haʻahaʻa ma ke ʻano o ka hoʻōla ʻana o ka haʻihaʻi, ka manawa hoʻōla haʻihaʻi, ka hoʻoponopono ʻana i nā lālā haʻahaʻa, a me nā pilikia. No ka hoʻoponopono ʻana i kēia, ua hana nā loea mai kahi haukapila o Korea i kahi haʻawina hoʻohālikelike.
ʻO ke aʻo ʻana he 48 mau mea maʻi me nā haʻihaʻi pāpū tibial i hui pū ʻia me nā haʻihaʻi tibial shaft. Ma waena o lākou, 35 mau hihia i mālama ʻia me ka ʻenehana MIPPO, me ka hoʻokomo ʻana i ka ʻaoʻao o kahi pā kila no ka hoʻopaʻa ʻana, a ʻo 13 mau hihia i mālama ʻia me nā wili pālolo i hui pū ʻia me kahi ala infrapatellar no ka hoʻopaʻa ʻana i nā kui intramedullary.
▲ Kahi 1: Lateral MIPPO pā kila i hoʻopaʻa ʻia i loko. He kāne 42 makahiki, i komo i loko o kahi ulia kaʻa, i hōʻike ʻia me kahi haʻihaʻi o ka tibial shaft (ʻano Gustilo II) a me kahi ʻāpana medial tibial plateau compression fracture (Schatzker IV type).
▲ Kekahi 2: Tibial plateau screw + suprapatellar intramedullary nail hoʻoponopono kūloko. ʻO kahi kāne 31 makahiki, i komo i loko o kahi ulia kaʻa, hōʻike ʻia me kahi haʻihaʻi o ka tibial shaft (ʻano Gustilo IIIa) a me kahi haʻihaʻi lateral tibial plateau concomitant (Schatzker I type). Ma hope o ka hoʻomaʻemaʻe ʻana i ka ʻeha a me ka hoʻomaʻamaʻa hōʻeha ʻeha ʻeha (VSD), ua hoʻopaʻa ʻia ka ʻili. Ua hoʻohana ʻia ʻelua 6.5mm screws no ka hoʻohaʻahaʻa ʻana a me ka hoʻoponopono ʻana i ka pāpū, a ukali ʻia e ka hoʻopaʻa ʻana i nā kui intramedullary o ke kumu tibial ma o kahi ala suprapatellar.
Hōʻike nā hualoaʻa ʻaʻohe ʻokoʻa koʻikoʻi ma waena o nā ala ʻokiʻoki ʻelua e pili ana i ka manawa hoʻōla haʻihaʻi, ka nui o ka hoʻōla ʻana o ka haʻihaʻi, ka hoʻoponopono ʻana i nā lālā haʻahaʻa, a me nā pilikia.
E like me ka hui pū ʻana o ka ʻāʻī o ka tibial me nā wāwae kuʻekuʻe wāwae a i ʻole ka ʻāʻī ʻana o ka ʻāʻī me ka ʻāʻī o ka ʻāʻī, hiki ke alakaʻi i nā hōʻeha i ka ʻāʻī o ke kuli e pili ana i ka ikaika. Ma ka hoʻomaʻamaʻa hoʻomaʻamaʻa, ʻo ka pale ʻana i ka misdiagnosis ka mea nui i ka maʻi a me ka mālama ʻana. Eia kekahi, i ke koho ʻana i nā ʻano hoʻoponopono, ʻoiai ʻaʻole i hōʻike ʻia ka noiʻi o kēia manawa ʻaʻohe ʻokoʻa koʻikoʻi, aia kekahi mau mea e noʻonoʻo ai:
1. Ma na hihia o ka comminuted tibial plateau haʻihaʻi kahi e maʻalahi ka hoʻopaʻa ʻana i ka wiliwili, hiki ke hāʻawi mua i ka hoʻohana ʻana i kahi pā lōʻihi me ka MIPPO fixation e hoʻopaʻa pono i ka tibial plateau, e hoʻihoʻi i ka hui like ʻana o ka ʻili a me ka alignment lālā haʻahaʻa.
2. Ma na hihia o ka tibial plateau haʻihaʻi, ma lalo o ka liʻiliʻi invasive incisions, pono hoemi a me ka screw fixation hiki ke hoʻokō. I kēlā mau hihia, hiki ke hāʻawi ʻia ka mea nui i ka hoʻopaʻa ʻana i ka wili a ukali ʻia e ka suprapatellar intramedullary nail fixation o ka tibial shaft.
Ka manawa hoʻouna: Mar-09-2024
