ʻIke pinepine ʻia nā haki Tibial plateau i hui pū ʻia me nā haki ipsilateral tibial shaft i nā ʻeha ikehu kiʻekiʻe, me 54% he mau haki hāmama. Ua ʻike ʻia nā noiʻi mua he 8.4% o nā haki tibial plateau e pili ana me nā haki tibial shaft concomitant, ʻoiai 3.2% o nā maʻi haki tibial shaft i loaʻa nā haki tibial plateau concomitant. Ua maopopo he mea maʻamau ʻole ka hui pū ʻana o nā haki ipsilateral tibial plateau a me nā haki shaft.
Ma muli o ke ʻano ikaika o ia mau ʻeha, pinepine ka hōʻino nui ʻana o nā ʻiʻo palupalu. Ma ke kumumanaʻo, he mau pono ko ka ʻōnaehana pā a me ka wili i ka hoʻopaʻa ʻana i loko no nā haki plateau, akā inā hiki i nā ʻiʻo palupalu kūloko ke ʻae i ka hoʻopaʻa ʻana i loko me kahi ʻōnaehana pā a me ka wili he mea noʻonoʻo lapaʻau nō hoʻi. No laila, aia i kēia manawa ʻelua mau koho i hoʻohana pinepine ʻia no ka hoʻopaʻa ʻana i loko o nā haki tibial plateau i hui pū ʻia me nā haki tibial shaft:
1. ʻO ke ʻano hana MIPPO (Minimally Invasive Plate Osteosynthesis) me kahi pā lōʻihi;
2. Kui intramedullary + wili plateau.
Ua hōʻike ʻia nā koho ʻelua ma nā palapala, akā ʻaʻohe manaʻo like i kēia manawa no ka mea ʻoi aku ka maikaʻi a i ʻole ka haʻahaʻa ma ke ʻano o ka wikiwiki o ka ho'ōla ʻana i ka haki, ka manawa ho'ōla o ka haki, ke kūlike o nā lālā haʻahaʻa, a me nā pilikia. No ka hoʻoponopono ʻana i kēia, ua hana nā haumāna mai kahi haukapila kulanui Korea i kahi noiʻi hoʻohālikelike.
Ua komo pū ka noiʻi me 48 mau maʻi me nā haki tibial plateau i hui pū ʻia me nā haki tibial shaft. I waena o lākou, ua mālama ʻia he 35 mau hihia me ke ʻano MIPPO, me ka hoʻokomo ʻana i kahi papa kila no ka hoʻopaʻa ʻana, a ua mālama ʻia he 13 mau hihia me nā wili plateau i hui pū ʻia me kahi ala infrapatellar no ka hoʻopaʻa ʻana i ke kui intramedullary.
▲ Hihia 1: Hoʻopaʻa kūloko ʻana o ka papa kila MIPPO ʻaoʻao. He kāne 42 makahiki, i komo i kahi ulia kaʻa, ua hōʻike ʻia me kahi haki tibial shaft hāmama (ʻano Gustilo II) a me kahi haki compression medial tibial plateau concomitant (ʻano Schatzker IV).
▲ Hihia 2: ʻO ka wili Tibial plateau + ka hoʻopaʻa ʻana o ke kui intramedullary suprapatellar. He kāne 31 makahiki, i komo i kahi ulia kaʻa, ua hōʻike ʻia me kahi haki tibial shaft hāmama (ʻano Gustilo IIIa) a me kahi haki tibial lateral tibial plateau concomitant (ʻano Schatzker I). Ma hope o ka debridement ʻeha a me ka lāʻau lapaʻau ʻeha kaomi maikaʻi ʻole (VSD), ua hoʻopili ʻia ka ʻili o ka ʻeha. Ua hoʻohana ʻia ʻelua mau wili 6.5mm no ka hōʻemi a me ka hoʻopaʻa ʻana o ka plateau, a ukali ʻia e ka hoʻopaʻa ʻana o ke kui intramedullary o ke koʻokoʻo tibial ma o kahi ala suprapatellar.
Hōʻike nā hopena ʻaʻohe ʻokoʻa koʻikoʻi ma waena o nā ʻano hana ʻokiʻoki ʻelua e pili ana i ka manawa ho'ōla haki, ka wikiwiki o ka ho'ōla ʻana o ka haki, ke kūlike o nā lālā haʻahaʻa, a me nā pilikia.
E like me ka hui pū ʻana o nā haki tibial shaft me nā haki hui kuʻekuʻe wāwae a i ʻole nā haki femoral shaft me nā haki ʻāʻī femoral, hiki i nā haki tibial shaft i hoʻoulu ʻia e ka ikehu kiʻekiʻe ke alakaʻi i nā ʻeha ma ka hui kuli e pili ana. I ka hana lapaʻau, ʻo ka pale ʻana i ka misdiagnosis kahi mea nui e hopohopo ai i ka ʻike ʻana a me ka mālama ʻana. Eia kekahi, i ke koho ʻana i nā ʻano hoʻopaʻa, ʻoiai ʻaʻole hōʻike ka noiʻi o kēia manawa i nā ʻokoʻa koʻikoʻi, aia nō kekahi mau mea e noʻonoʻo ai:
1. I nā hihia o nā haki tibial plateau comminuted kahi e paʻakikī ai ka hoʻopaʻa ʻana i nā wili maʻalahi, hiki ke hāʻawi ʻia ka mea nui i ka hoʻohana ʻana i kahi pā lōʻihi me ka hoʻopaʻa ʻana o MIPPO e hoʻopaʻa pono i ka tibial plateau, e hoʻihoʻi ana i ka congruence o ka ʻili hui a me ke kaulike ʻana o nā lālā haʻahaʻa.
2. I nā hihia o nā haki tibial plateau maʻalahi, ma lalo o nā ʻoki liʻiliʻi invasive, hiki ke hoʻokō ʻia ka hōʻemi kūpono a me ka hoʻopaʻa ʻana i nā wili. I ia mau hihia, hiki ke hāʻawi ʻia ka mea nui i ka hoʻopaʻa ʻana i nā wili a ukali ʻia e ka hoʻopaʻa ʻana o ke kui suprapatellar intramedullary o ke koʻokoʻo tibial.
Ka manawa hoʻouna: Malaki-09-2024
