Ivunika rya Hoffa ni ukuvunika kwindege ya coronale ya femorale condyle. Byasobanuwe bwa mbere na Friedrich Busch mu 1869 kandi byongeye kuvugwa na Albert Hoffa mu 1904, maze bamwitirirwa. Mugihe kuvunika bikunze kugaragara mu ndege itambitse, kuvunika kwa Hoffa bibera mu ndege ya coronale kandi ni gake cyane, bityo bikunze kubura mugihe cyo kwisuzumisha kwa mbere kwa kliniki na radiologiya.
Ni ryari kuvunika kwa Hoffa?
Ivunika rya Hoffa riterwa nimbaraga zo gukata kuri femorale condyle kumavi. Gukomeretsa imbaraga nyinshi akenshi bitera intercondylar na supracondylar kuvunika kwumugore wa kure. Uburyo bukunze kugaragara harimo ibinyabiziga bifite moteri nimpanuka zibinyabiziga bigwa hejuru. Lewis n'abandi. yerekanye ko abarwayi benshi bafite ibikomere bifitanye isano n’ingaruka zatewe n’ingingo ya femorale ya femorale mugihe batwaye ipikipiki ivi ryerekeje kuri 90 °.
Ni ubuhe buryo bugaragara bwo kuvunika kwa Hoffa?
Ibimenyetso nyamukuru byerekana kuvunika kwa Hoffa ni ugusohora ivi na hemarthrosis, kubyimba, hamwe na varum yoroheje cyangwa vargus cyangwa ihungabana. Bitandukanye no kuvunika kwa intercondylar na supracondylar, kuvunika kwa Hoffa birashoboka cyane ko byavumburwa mugihe cyo kwiga amashusho. Kubera ko kuvunika kwa Hoffa kwinshi guturuka ku gukomeretsa ingufu nyinshi, gukomeretsa hamwe ku kibuno, pelvis, femur, patella, tibia, ligaments ivi, hamwe nubwato bwa popliteal bigomba kuvaho.
Iyo hakekwa kuvunika Hoffa, nigute umuntu yafata X-ray kugirango yirinde kubura isuzuma?
Imirasire isanzwe ya anteroposterior hamwe na radiyo ikurikira irakorwa muburyo busanzwe, kandi ibitekerezo bitagaragara byivi bikorwa mugihe bibaye ngombwa. Iyo kuvunika kutimuwe ku buryo bugaragara, akenshi biragoye kubimenya kuri radiyo. Kuruhande rwinyuma, itandukaniro rito ryumurongo wigitsina gore rimwe na rimwe rigaragara, hamwe cyangwa udafite ubumuga bwa condylar bitewe na condyle irimo. Ukurikije ibice byigitsina gore, guhagarara cyangwa intambwe kumurongo wavunitse birashobora kugaragara kuruhande. Ariko, kuruhande rwukuri, kuruhande rwigitsina gore rusa nkudahuzagurika, mugihe mugihe udusimba tugufi kandi twimuwe, birashobora guhuzagurika. Kubwibyo, kureba nabi ingingo zisanzwe zivi zirashobora kuduha ibitekerezo bitari byo, bishobora kwerekanwa nibitekerezo bidasobanutse. Kubwibyo, CT ikizamini kirakenewe (Ishusho 1). Magnetic resonance imaging (MRI) irashobora gufasha gusuzuma ibice byoroshye bikikije ivi (nka ligaments cyangwa menisci) kugirango byangiritse.
Igishushanyo 1 CT cyerekanye ko umurwayi afite Letenneur ⅡC yo mu bwoko bwa Hoffa yavunitse ya condyle ya femorale
Ni ubuhe bwoko bw'imvune za Hoffa?
Ivunika rya Hoffa rigabanijwe mubwoko B3 hanyuma wandike 33.b3.2 mubyiciro bya AO / OTA ukurikije ibyiciro bya Muller. Nyuma, Letenneur n'abandi. yagabanije kuvunika mubwoko butatu ukurikije intera yumurongo wavunitse wigitsina gore kuva cortex yinyuma yigitereko.
Igishushanyo2 Letenneur itondekanya kuvunika Hoffa
Ubwoko I:Umurongo wavunitse uherereye kandi ugereranije na cortex yinyuma yumutwe wigitsina gore.
Ubwoko bwa II:Intera kuva kumurongo wavunitse kugeza kumurongo winyuma wa cortical yinyuma yigitsina gore igabanijwemo ubwoko bwa IIa, IIb na IIc ukurikije intera kuva kumurongo wavunitse kugeza kumagufwa yinyuma. Ubwoko bwa IIa bwegereye cortex yinyuma yumutwe wigitsina gore, mugihe IIc iri kure cyane yinyuma yinyuma yumutwe wigitsina gore.
Ubwoko bwa III:Kuvunika.
Nigute ushobora gutegura gahunda yo kubaga nyuma yo gusuzuma?
1. Guhitamo gukosora imbere Muri rusange Byemezwa ko kugabanya gufungura no gukosora imbere ari zahabu. Kuvunika kwa Hoffa, guhitamo ibyashizweho bikwiye gukosorwa ni bike. Igice kimwe cyogoshywemo Hollow compression screw nibyiza gukosorwa. Amahitamo yatewe arimo 3.5mm, 4mm, 4.5mm na 6.5mm igice cyometseho igice cyogusenyera hamwe na Herbert. Iyo bibaye ngombwa, ibyapa birwanya anti-kunyerera nabyo birashobora gukoreshwa hano. Jarit yasanze binyuze mubushakashatsi bwibinyabuzima bwa cadaver bwerekana ko imigozi yinyuma ya posteroanterior ihagaze neza kuruta imigeri yimbere yinyuma. Icyakora, uruhare ruyoboye ubu bushakashatsi mu mikorere y’amavuriro ntirurasobanuka.
2. Ubuhanga bwo kubaga Iyo kuvunika kwa Hoffa gusanze guherekejwe no kuvunika kwa intercondylar na supracondylar, bigomba kwitabwaho bihagije, kuko gahunda yo kubaga no guhitamo gukosora imbere bigenwa hashingiwe ku bihe byavuzwe haruguru. Niba condyle yinyuma igabanijwemo ibice, kubaga kubaga bisa nibyavunitse Hoffa. Ariko, ntabwo bihuje n'ubwenge gukoresha imashini ya condylar ifite imbaraga, kandi isahani ya anatomique, isahani yo gushyigikira cyangwa isahani ya LISS igomba gukoreshwa mugukosora aho. Umuyoboro wo hagati uragoye gukosora unyuze kuruhande. Muri iki gihe, hasabwa ubundi buryo bwo kugabanya anteromedial kugabanya no gukosora kuvunika kwa Hoffa. Ibyo ari byo byose, ibice byose by'amagufwa ya condylar bikosorwa hamwe n'amashanyarazi nyuma yo kugabanuka kwa anatomike.
- Uburyo bwo kubaga Umurwayi ari mumwanya mwiza kuburiri bwa fluoroscopique hamwe na tourniquet. Bolster ikoreshwa mugukomeza ivi rya flexion ingana na 90 °. Kubice byoroheje byavunitse Hoffa, umwanditsi ahitamo gukoresha intambwe yo hagati hamwe na parapatellar medial. Kuvunika kuruhande rwa Hoffa, gukata kuruhande birakoreshwa. Abaganga bamwe bavuga ko inzira ya parapatellar nayo ari amahitamo yumvikana. Iyo impera zavunitse zimaze kugaragara, ubushakashatsi busanzwe burakorwa, hanyuma impera zavunitse zisukurwa hamwe na curette. Mubyerekezo bitaziguye, kugabanya bikorwa hakoreshejwe imbaraga zo kugabanya ingingo. Bibaye ngombwa, tekinike ya "joystick" y'insinga za Kirschner ikoreshwa mukugabanya, hanyuma insinga za Kirschner zikoreshwa mukugabanya no gukosora kugirango birinde kwimuka, ariko insinga za Kirschner ntizishobora kubangamira iyindi miyoboro (Ishusho 3). Koresha byibuze imigozi ibiri kugirango ugere kumurongo uhamye no kwikuramo intera. Kora perpendicular kumeneka kandi kure yumutwe wa patellofemoral. Irinde gucukura mumyanya yinyuma yinyuma, nibyiza hamwe na C-arm fluoroscopy. Imiyoboro ishyirwa hamwe cyangwa idakaraba nkuko bikenewe. Imiyoboro igomba kuba ibara kandi ifite uburebure buhagije kugirango ikosore karitsiye. Muburyo budasanzwe, ivi risuzumwa ibikomere byahujwe, gutekana, hamwe no kugenda, kandi hakorwa kuhira neza mbere yo gufunga ibikomere.
Igicapo 3 Kugabanya by'agateganyo no gukosora kuvunika kwa bicondylar Hoffa hamwe ninsinga za Kirschner mugihe cyo kubagwa, ukoresheje insinga za Kirschner kugirango urye ibice byamagufwa
Igihe cyo kohereza: Werurwe-12-2025
