Impamvu n'uburyo bwo kuvura indwara ya Hoffa vunitse

Kuvunika kwa Hoffa ni ukuvunika kw'umutwe w'inyuma w'inyuma y'inyuma y'inyuma. Byasobanuwe bwa mbere na Friedrich Busch mu 1869, byongera kuvugwa na Albert Hoffa mu 1904, maze byitwa izina rye. Nubwo kuvunika akenshi biba mu muhanda utambitse, kuvunika kwa Hoffa biba mu muhanda w'inyuma kandi ni gake cyane, bityo akenshi ntibikunze kugaragara mu gihe cyo gusuzuma indwara no gusuzuma imirasire.

Ni ryari Hoffa yavunitse?

Kuvunika kwa Hoffa guterwa n’imbaraga zo gukata ivi ku ivi. Imvune zikoresha imbaraga nyinshi zikunze gutera kuvunika hagati y’ivi n’ivunika rya supracondylar ku gice cyo hagati cy’ivi. Uburyo bukunze gukoreshwa cyane burimo impanuka z’ibinyabiziga n’ibinyabiziga no kugwa uvuye hejuru. Lewis n’abandi bavuze ko abarwayi benshi bafite ibikomere bifitanye isano batewe n’imbaraga zo gukubita ivi ku gice cyo hagati cy’ivi mu gihe bari ku ipikipiki ivi rizungurutse kugeza kuri dogere 90.

Ni ibihe bimenyetso by'indwara ya Hoffa vunitse?

Ibimenyetso by'ingenzi by'imvune imwe ya Hoffa ni ukuvunika kw'ivi no gucika amaraso, kubyimba, no gucika intege kw'ivi cyangwa valgus ndetse no kudahagarara neza. Bitandukanye n'imvune za intercondylar na supracondylar, kuvunika kwa Hoffa birashoboka cyane kuboneka mu buryo bw'impanuka mu gihe cyo gupima amashusho. Kubera ko imvune nyinshi za Hoffa ziterwa n'imvune zikoresha imbaraga nyinshi, imvune zivanze ku kibuno, mu kibuno, mu gitsina cy'umugore, mu gituza, mu gituza, mu kibuno, mu mitsi yo mu ivi, no mu mitsi yo mu ivi igomba gukurwaho.

Iyo hakekwa ko Hoffa yavunitse, umuntu yafata X-ray ate kugira ngo yirinde ko isuzuma ritagaragara?

Isuzuma rya radiyo risanzwe rikorwa mbere na nyuma y’ivi, kandi ivi rigaragara mu buryo butari bwo iyo bibaye ngombwa. Iyo imvune idahindutse cyane, akenshi biragoye kuyimenya kuri radiyo. Ku ruhande rw’ivi, hari igihe usanga umurongo w’ivi utandukanye, haba hari cyangwa hatabayeho ubumuga bwa condylar valgus bitewe n’aho ivi riherereye. Bitewe n’imiterere y’ivi, hari aho umurongo w’ivi uhagarara cyangwa intambwe mu murongo w’ivunika igaragara ku ruhande rw’ivi. Ariko, ku ruhande rw’ivi nyaryo, ivi rigaragara nk’aho ritafatanye, mu gihe iyo ivi rigufi kandi rigahinduka, rishobora guhura. Kubwibyo, kureba nabi ivi risanzwe bishobora kuduha igitekerezo kitari cyo, gishobora kugaragazwa n’ishusho ya oblique. Kubwibyo, gusuzuma CT ni ngombwa (Ishusho ya 1). Ishusho ya magnetic resonance (MRI) ishobora gufasha gusuzuma ingingo zoroshye zikikije ivi (nk'imitsi cyangwa menisci) kugira ngo harebwe niba hari ibyangiritse.

Ishusho ya 1 CT yagaragaje ko umurwayi yari afite Letenneur ⅡC ubwoko bwa Hoffa yavunitse mu gice cyo hasi cy'umugongo w'inyuma

Ni ubuhe bwoko bw'imvune za Hoffa?

Amagufwa ya Hoffa agabanyijemo ubwoko bwa B3 n'ubwoko bwa 33.b3.2 mu cyiciro cya AO/OTA hakurikijwe icyiciro cya Muller. Nyuma, Letenneur n'abandi bagabanyijemo amagufwa mu bwoko butatu hashingiwe ku ntera y'umurongo w'amagufwa ya femoral uvuye ku gice cy'inyuma cy'igufwa rya femur.

Ishusho ya 2 Letenneur ishyirwa mu byiciro ry’amagufwa ya Hoffa

Ubwoko bwa I:Umurongo w'aho imvune iherereye kandi uteganye n'agace k'inyuma k'umugongo w'inyuma.

Ubwoko bwa kabiri:Intera iri hagati y'umurongo wavunitse n'umurongo w'inyuma w'inyuma y ...

Ubwoko bwa gatatu:Kuvunika kw'inyuma.

Ni gute wategura gahunda yo kubaga nyuma yo gusuzuma indwara?

1. Guhitamo uburyo bwo gufunga imbere Muri rusange abantu bizera ko uburyo bwo kugabanya no gufunga imbere ari byo bipimo ngenderwaho. Ku mvune za Hoffa, guhitamo uburyo bwo gufunga bukwiye ni bike cyane. Udupira two gufunga dufite utudomo duto twometseho ni two tworoshye mu gufunga. Amahitamo yo gushyiramo arimo utudomo duto two gufunga dufite utudomo duto twa 3.5mm, 4mm, 4.5mm na 6.5mm hamwe n'utudomo twa Herbert. Iyo bibaye ngombwa, hari n'udupira dukwiriye two kwirinda kunyerera dushobora gukoreshwa hano. Jarit yavumbuye binyuze mu bushakashatsi bwa biomechanical ko utudomo two gufunga inyuma y'imbere duhamye kuruta utudomo two gufunga imbere n'inyuma. Ariko, uruhare rw'iki kimenyetso mu mikorere y'ubuvuzi ntirurasobanuka neza.

2. Ikoranabuhanga ryo kubaga Iyo imvune ya Hoffa igaragaye ko iherekejwe n'ivunika rya intercondylar na supracondylar, igomba kwitabwaho bihagije, kuko gahunda yo kubaga n'amahitamo yo gufunga imbere bigenwa hashingiwe ku kibazo cyavuzwe haruguru. Niba condyle yo ku ruhande igabanyijemo ibice, imiterere yo kubaga isa n'iya Hoffa. Ariko, si byiza gukoresha screw ya dynamic condylar, kandi plate ya anatomike, plate yo gushyigikira condylar cyangwa plate ya LISS bigomba gukoreshwa mu gufunga. Condyle yo hagati iragoye gukosora binyuze mu gukata lateral. Muri iki gihe, hakenewe indi screw ya anteromedial kugira ngo igabanye kandi ikosore imvune ya Hoffa. Uko byagenda kose, ibice byose by'ingenzi by'amagufwa ya condylar bishyirwaho screws za lag nyuma yo kugabanya imiterere ya condyle.

1. Uburyo bwo kubaga Umurwayi aba aryamye ku buriri bwa fluoroscopic hamwe na tourniquet. Ingufu ikoreshwa kugira ngo inguni yo guhindukira mu ivi igumeho nka 90°. Ku mvune zoroshye za Hoffa zo hagati, umwanditsi ahitamo gukoresha incision median hamwe na medial parapatellar approach. Ku mvune za Hoffa zo ku ruhande, hakoreshwa incision lateral. Abaganga bamwe bavuga ko uburyo bwo gusohora incision lateral nabwo ari amahitamo meza. Iyo impera z'imvune zimaze kugaragara, hakorwa ubushakashatsi buhoraho, hanyuma impera z'imvune zigasukurwa na curette. Mu gihe cyo kureba neza, kugabanya bikorwa hakoreshejwe forceps zo kugabanya ingingo. Iyo bibaye ngombwa, uburyo bwa "joystick" bwa Kirschner bukoreshwa mu kugabanya, hanyuma insinga za Kirschner zigakoreshwa mu kugabanya no gushyiraho kugira ngo hirindwe ko imvune zigenda, ariko insinga za Kirschner ntizishobora kubangamira ishyirwa ry'izindi screws (Ishusho ya 3). Koresha nibura screws ebyiri kugira ngo ubone incision ihamye no gukanda hagati y'ivi. Kangura uruhande rugororotse rw'ivune kandi kure y'urugingo rwa patellofemoral. Irinde gutobora mu mwobo w'inyuma w'ingingo, byaba byiza ukoresheje fluoroscopy ya C-arm. Udupira dushyirwa hamwe n'udupira two kumesa cyangwa tudafite uko bikenewe. Udupira tugomba kurohama kandi tukaba dufite uburebure buhagije kugira ngo dukosore agati kari munsi y'ingingo. Mu gihe cyo kubagwa, ivi risuzumwa kugira ngo harebwe imvune zihurirana, ko rihagaze neza, kandi ko rishobora kugenda neza, hanyuma hagakorwa kuhira cyane mbere yuko igikomere gifunga.

Ishusho ya 3 Kugabanya by'agateganyo no gufungana kw'ivunika rya Hoffa rya bicondylar hakoreshejwe insinga za Kirschner mu gihe cyo kubaga, hakoreshejwe insinga za Kirschner kugira ngo bakuremo ibice by'amagufwa.