Uburyo bwa suprapatellar nuburyo bwahinduwe bwo kubaga kubirenge bya tibial intramedullary imisumari mugice cya kabiri cyagutse cyamavi.Hariho ibyiza byinshi, ariko kandi nibibi, gukora imisumari yimbere ya tibia ukoresheje uburyo bwa suprapatellar muburyo bwa salux valgus.Bamwe mu babaga bamenyereye gukoresha SPN mu kuvura imvune zose za tibial usibye kuvunika bidasanzwe-articular ya hafi ya 1/3 cya tibia.
Ibimenyetso kuri SPN ni:
1. Kuvunika cyangwa gutandukanya ibice byuruti rwa tibial.2;
2. kuvunika kwa tibial metafhysis ya kure;
3. kuvunika ikibuno cyangwa ivi hamwe no kugabanuka kwabanje kubaho (urugero, ikibuno cyangirika cyangwa guhuza, osteoarthritis yo mu ivi) cyangwa kudashobora guhindukiza ivi cyangwa ikibuno (urugero, gutandukana inyuma yibibuno, kuvunika kuruhande femur);
4. kuvunika tibial hamwe no gukomeretsa uruhu kuri infrapatellar tendon;
5. kuvunika kwa tibial kumurwayi ufite tibia ndende cyane (impera yegeranye ya tibia akenshi biragoye kuyibona munsi ya fluoroscopi mugihe uburebure bwa tibia burenze uburebure bwa trapode ishobora kunyuramo fluoroskopi).
Ibyiza bya kimwe cya kabiri cyagutse cyamavi tibial intramedullary imisumari tekinike yo kuvura diaphysis yo hagati ya tibial no kuvunika kwa tibial intera iri muburyo bworoshye bwo guhinduranya no koroshya fluoroskopi.Ubu buryo butuma habaho ubufasha buhebuje bwuburebure bwuzuye bwa tibia no kugabanya sagittal byoroshye kuvunika bitabaye ngombwa ko umuntu akoreshwa (Ishusho 1, 2).Ibi bivanaho gukenera umufasha watojwe kugirango afashe tekinike yimisumari.
Igishushanyo 1: Umwanya usanzwe muburyo bwa tekinike yimisumari yuburyo bwa infrapatellar: ikivi kiri mumwanya uhindagurika kuri fluoroskopi yinjira muri trapo.Ariko, uyu mwanya urashobora gukaza umurongo mubi wo kuvunika kandi bisaba ubundi buryo bwo kugabanya kugabanya kuvunika.
Igishushanyo 2: Ibinyuranye, umwanya wagutse wivi kumurongo wifuro byorohereza guhuza ibice byavunitse no gukoreshwa nyuma.
Ubuhanga bwo kubaga
Imeza / Umwanya Umurwayi aryamye mu mwanya wa supine ku buriri bwa fluoroscopique.Gukwega gukabije kurashobora gukorwa, ariko ntibikenewe.Imbonerahamwe yimitsi ikwiranye neza na suprapatellar yegereye tibial intramedullary imisumari, ariko ntabwo ari ngombwa.Nyamara, ibyinshi byavunitse byo kuryamaho cyangwa ibitanda bya fluoroscopique ntibisabwa kuko bidakwiriye uburyo bwa suprapatellar uburyo bwa tibial intramedullary.
Kuzuza ikibero cyibice bibiri bifasha kugumya kuruhande rwo hasi mumwanya uzunguruka.Ikirahuri cya sterile gikoreshwa noneho kugirango uzamure ingingo yibasiwe hejuru yuruhande rwuruhande rwa fluoroscopi ya posterolateral, kandi ikibuno cyi ivi hamwe n ivi nabyo bifasha mukuyobora pin no gushyira imisumari imbere.Impande nziza ivi ihindagurika iracyajya impaka, hamwe na Beltran nibindi.byerekana ivi rya 10 ° na Kubiak byerekana 30 ° ivi.Intiti nyinshi zemeza ko inguni zihindagurika zivi muri izi ntera zemewe.
Ariko, Eastman n'abandi.basanze uko inguni ihindagurika yivi yagendaga yiyongera kuva kuri 10 ° ikagera kuri 50 °, ingaruka za talon femorale zinjira mubikoresho byaragabanutse.Kubwibyo, ivi rinini rihindagurika rizafasha muguhitamo neza imisumari yimbere yinjira no gukosora ubumuga bwindege mu ndege ya sagittal.
Fluoroscopy
Imashini ya C-arm igomba gushyirwa kuruhande rwameza uhereye kumubiri wanduye, kandi niba umuganga abaga ahagaze kuruhande rwivi ryanduye, monite igomba kuba kumutwe wimashini ya C-arm hanyuma ikegereza hafi. .Ibi bituma umuganga ubaga na radiologue yitegereza byoroshye monitor, usibye mugihe hagomba gushyirwamo umusumari wa kure.Nubwo atari itegeko, abanditsi barasaba ko C-ukuboko kwimurirwa kuruhande rumwe no kubaga ku rundi ruhande mugihe hagomba gutwarwa umugozi wo hagati.Ubundi, imashini ya C-arm igomba gushyirwa kuruhande rwanduye mugihe umuganga ubaga akora inzira kuruhande (Ishusho 3).Ubu ni bwo buryo bukoreshwa cyane n'abanditsi kuko birinda gukenera kubaga kuva mu gice cyo hagati akajya ku mpande iyo atwaye imisumari ya kure.
Igishushanyo cya 3: Umuganga ubaga ahagarara ku rundi ruhande rwa tibia yanduye kugira ngo imiyoboro yo hagati ishobora gutwarwa byoroshye.Iyerekana iherereye ahateganye no kubaga, ku mutwe wa C-ukuboko.
Ibitekerezo byose bya anteroposterior na medial-lateral fluoroscopic biboneka bitabonetse kwimura ingingo yibasiwe.Ibi birinda kwimura urubuga rwavunitse rwasubiwemo mbere yuko kuvunika gukosorwa burundu.Mubyongeyeho, amashusho yuburebure bwuzuye bwa tibia arashobora kuboneka atagoramye C-ukuboko kuburyo bwasobanuwe haruguru.
Gukata uruhu Byombi bigarukira kandi byagutse neza birakwiye.Uburyo bwa suprapatellar percutaneous uburyo bwo gutera imisumari ishingiye kumikoreshereze ya cm 3 kugirango utware umusumari.Ibyinshi muri ibyo bice byo kubaga ni birebire, ariko birashobora no guhinduka, nkuko byasabwe na Dr. Morandi, kandi ubugari bwagutse bwakoreshejwe na Dr. Tornetta hamwe n’abandi bugaragarira mu barwayi bafite insimburangingo ya patellar, bafite ahanini parapatellar. inzira.Igishushanyo cya 4 cyerekana ibice bitandukanye.
Igishushanyo 4: Ishusho yuburyo butandukanye bwo kubaga uburyo bwo kubaga.1- Uburyo bwa Suprapatellar transpatellar ligament;2- Uburyo bwa Parapatellar ligament;3- Uburyo bugarukira hagati ya parapatellar ligament uburyo;4- Hagati yigihe kirekire cyo gutemagura parapatellar ligament uburyo;5- Inzira ya parapatellar ligament.Kugaragara kwimbitse yuburyo bwa parapatellar ligament birashobora kuba binyuze mubice cyangwa hanze ya bursa.
Kumurika cyane
Uburyo bwa suprapatellar percutaneous bukorwa cyane cyane mugutandukanya igihe kirekire gutandukanya quadriceps tendon kugeza igihe icyuho gishobora kwakira inzira yibikoresho nkimisumari yimbere.Inzira ya parapatellar ligament, inyura kuruhande rwimitsi ya quadriceps, irashobora kandi kwerekanwa kubuhanga bwa tibial intramedullary tekinike.Urushinge rudasanzwe rwa trocar na cannula byanyujijwe bitonze binyuze mumutwe wa patellofemorale, inzira iyobora cyane cyane imbere yimbere-isumba iyinjirira imbere yimisumari ya tibial intramedullary ikoresheje trocar femorale.Iyo trocar imaze guhagarara neza, igomba kuba ifite umutekano kugirango yirinde kwangirika kwa karitsiye yivi.
Uburyo bunini bwo gutemagura bushobora gukoreshwa bufatanije na hyperextension parapatellar uruhu, hamwe nuburyo bwo hagati cyangwa kuruhande.Nubwo bamwe mubaganga batabitse bursa muburyo budasanzwe, Kubiak nibindi.bizere ko bursa igomba kubikwa neza kandi inyubako zidasanzwe zigomba kugaragara bihagije.Mubyukuri, ibi bitanga uburinzi buhebuje bwikivi kandi bikarinda kwangirika nko kwandura ivi.
Uburyo bwasobanuwe haruguru burimo na hemi-dislocation ya patella, igabanya umuvuduko wo guhura hejuru yimiterere ya arctular kurwego runaka.Iyo bigoye gukora isuzumabumenyi rya patellofemorale hamwe nuduce duto duto hamwe nigikoresho kinini cyo kwagura ivi, abanditsi basaba ko patella ishobora kwimurwa igice kimwe no gutandukana kwimitsi.Ku rundi ruhande, ibice byo hagati ya median transvers, birinda kwangirika kwingingo zishyigikira, ariko biragoye gusana neza imvune yo mu ivi.
Urushinge rwa SPN rwinjira ni kimwe nuburyo bwa infrapatellar.Fluoroskopi yimbere ninyuma mugihe cyo gushiramo inshinge byemeza ko aho inshinge zinjirira ari ukuri.Umuganga abaga agomba kwemeza ko urushinge ruyobora rutayoborwa cyane inyuma muri tibia yegeranye.Niba itwarwa cyane inyuma yinyuma, igomba guhindurwa hifashishijwe umusumari uhagarika munsi ya fluoroscopi yinyuma.Mubyongeyeho, Eastman n'abandi.bizere ko gucukura pin yinjira muburyo buvugwa bwivi bwikivi bifasha mukuvunika gukurikiraho gusubira mumwanya wa hyperextended.
Ibikoresho byo kugabanya
Ibikoresho bifatika byo kugabanya harimo kugabanya ingingo zingero zingana, kuzamura igitsina gore, ibikoresho byo gutunganya hanze, hamwe nogukosora imbere kugirango bikosore uduce duto twavunitse hamwe nisahani imwe.Guhagarika imisumari birashobora kandi gukoreshwa muburyo bwo kugabanya twavuze haruguru.Kugabanya inyundo zikoreshwa mugukosora uburakari bwa sagittal no guhinduranya kwimuka.
Abimurwa
Abenshi mubakora orthopedic imbere yimbere batezimbere uburyo bwo gukoresha ibikoresho kugirango bayobore uburyo busanzwe bwo gushyira imisumari ya tibial intramedullary.Harimo ukuboko kwagutse kumwanya, igikoresho cyo gupima uburebure bwa pin, hamwe no kwagura imiti.Ni ngombwa cyane ko trocar na blunt trocar pin zirinda imisumari yimbere neza.Umuganga abaga agomba kwemeza aho urumogi ruhagaze kugirango imvune yibice bya patellofemorale cyangwa ibice bya periarticular bitewe no kuba hafi yikintu cyo gutwara.
Gufunga imigozi
Umuganga abaga agomba kwemeza ko hashyizweho umubare uhagije wo gufunga kugirango ugabanye kugabanuka gushimishije.Gukosora uduce duto twavunitse (hafi cyangwa kure) bikorwa hamwe ninshuro 3 cyangwa zirenga zifunga hagati yimvune zegeranye, cyangwa hamwe nu mfuruka zifatika zonyine.Uburyo bwa suprapatellar kuri tekinike ya tibial intramedullary tekinike isa nuburyo bwa infrapatellar muburyo bwa tekinike yo gutwara screw.Gufunga imigozi birayoborwa neza na fluoroscopi.
Gufunga ibikomere
Kunywa hamwe nigitereko cyimbere gikwiye mugihe cyagutse gikuraho ibice byamagufwa yubusa.Ibikomere byose bigomba kuvomererwa neza, cyane cyane kubaga ivi.Quadriceps tendon cyangwa ligament layer hamwe na suture ahabereye guturika noneho bigafungwa, bigakurikirwa no gufunga dermis nuruhu.
Gukuraho umusumari winjiye
Niba imisumari ya tibial intramedullary ikoreshwa muburyo bwa suprapatellar irashobora gukurwaho muburyo butandukanye bwo kubaga bikomeje kutavugwaho rumwe.Uburyo bukunze kugaragara ni inzira ya suprapatellar ya transarticular yo gukuramo imisumari.Ubu buhanga bugaragaza umusumari mu gucukura binyuze mu muyoboro wa suprapatellar intramedullary ukoresheje umusumari wa mm 5.5.Igikoresho cyo gukuraho imisumari noneho kinyuzwa kumuyoboro, ariko iyi myitozo irashobora kugorana.Inzira ya parapatellar na infrapatellar nubundi buryo bwo gukuraho imisumari yimbere.
Ingaruka Ingaruka zo kubaga uburyo bwa suprapatellar kuri tekinike ya tibial intramedullary tekinike ni ibikomere byubuvuzi kuri patella na femorale talus cartilage, gukomeretsa kwa muganga ku zindi nyubako zo mu nda, kwandura hamwe, hamwe n’imyanda yo mu nda.Ariko, harabura raporo zijyanye na clinique zijyanye.Abarwayi bafite chondromalacia bazakunda gukomeretsa indwara ya karitsiye.Kwangirika kwubuvuzi kuri patellar na femoral articular surface ni impungenge zikomeye kubaganga babaga bakoresheje ubu buryo bwo kubaga, cyane cyane inzira ya transarticular.
Kugeza magingo aya, nta bimenyetso bifatika by’amavuriro byerekana ibyiza n'ibibi bya tekinike yo kwagura igice cya tibial intramedullary tekinike.
Igihe cyo kohereza: Ukwakira-23-2023
