Nkwadebe na ọnọdụ tupu ịwa ahụ dị ka akọwara na mbụ maka nrụzi etiti transarticular mpụga.
Intra-articular mgbawa repositioning na ndozi:
A na-eji mbelata mbepu na ndozi dị oke. Enwere ike ịhụ mgbawa nke elu articular dị ala ozugbo site na obere mbepụ anteromedial na anterolateral na mbepụ mpụta nke capsule nkwonkwo n'okpuru meniscus.
Ntugharị nke akụkụ ahụ emetụtara na iji akwara na-agbazi nnukwu iberibe ọkpụkpụ, na mkpakọ etiti nwere ike ịtọgharịa site na ịpị na ịcha.
Lezienụ anya na iweghachi obosara nke tibial plateau, na mgbe enwere nkwarụ ọkpụkpụ n'okpuru ebe a na-ahụ anya, mee ọkpụkpụ ọkpụkpụ iji kwado elu elu ahụ mgbe ị na-atụgharị iji tọgharịa elu articular.
Lezienụ anya na ịdị elu nke ikpo okwu etiti na n'akụkụ, nke mere na ọ dịghị nzọụkwụ elu articular.
A na-eji ndozi nwa oge nwere mkpọ nrụpụta ma ọ bụ pin Kirschner iji dokwaa nrụpụta.
Ndokwa nke kposara oghere, kposara kwesịrị ịdị n'akụkụ elu nke articular ma dị na ọkpụkpụ subchondral, iji mee ka ike nke nhazi dịkwuo elu. Ekwesịrị ịme fluoroscopy X-ray intraoperative iji lelee skru ma ọ dịghị mgbe ị ga-ebuba skru na nkwonkwo.
Epiphyseal mgbaji agbaji emegharị:
Ntugharị na-eweghachi ogologo na axis axis nke akụkụ ahụ emetụtara.
A na-akpachapụ anya iji mezie mgbanwe ntụgharị nke akụkụ ahụ emetụtara site na ịpịa tuberosity tibial ma tụkwasa ya n'etiti mkpịsị ụkwụ mbụ na nke abụọ.
Ndokwa mgbanaka dị nso
Oke nke mpaghara nchekwa maka idobe waya tibial plateau tensioning wire:
Ọkpụkpụ popliteal, vein popliteal na akwara tibial na-aga n'azụ tibia, na akwara peroneal nkịtị na-aga n'azụ n'isi fibular. Ya mere, ma ntinye na ọpụpụ nke agịga kwesịrị ime n'ihu na ala ala tibial, ya bụ, agịga kwesịrị ịbanye ma wepụ agịga nchara n'ihu na etiti etiti nke tibia na n'ihu ihu ihu nke fibula.
N'akụkụ akụkụ, enwere ike ịtinye agịga ahụ site na ihu ihu nke fibula wee si n'akụkụ anteromedial ma ọ bụ n'akụkụ etiti; ebe ntinye etiti na-adịkarị n'ọnụ ọnụ nke tibial plateau na akụkụ ihu ya, iji zere waya mgbakasị ahụ ka ọ gafere n'anụ ahụ.
A kọwapụtara na akwụkwọ akụkọ na ntinye ntinye nke waya esemokwu kwesịrị ịbụ ma ọ dịkarịa ala 14 mm site na elu articular iji gbochie waya esemokwu ịbanye na capsule nkwonkwo na-ebute ọrịa ogbu na nkwonkwo.
Debe waya esemokwu mbụ:
Enwere ike iji ntụtụ olive, nke a na-agafe na ntụtụ nchekwa dị na mgbanaka mgbanaka, na-ahapụ isi oliv n'èzí nke ntụtụ nchekwa ahụ.
Onye na-enyere aka na-edobe ọnọdụ nke mgbanaka mgbanaka ka ọ bụrụ ihe yiri ya na elu articular.
Gwuo ntụtụ oliv site na anụ ahụ dị nro na site na tibial plateau, na-elezi anya na-achịkwa ntụziaka ya iji hụ na ntinye na ụzọ ọpụpụ dị n'otu ụgbọ elu.
Mgbe ịpụchara akpụkpọ ahụ n'akụkụ akụkụ ahụ na-aga n'ihu na-apụ na agịga ahụ ruo mgbe isi oliv na-akpọtụrụ ntụtụ nchekwa.
Wụnye slide mwekota waya n'akụkụ ihe na-emegide ya wee bufee ntụtụ oliv site na mmịfe nkedo waya.
Lezienụ anya ka ọ dị larịị tibial dị n'etiti etiti mgbanaka mgbe niile n'oge ọrụ.
Site na ntuziaka ahụ, a na-edobe waya esemokwu nke abụọ n'otu n'otu, sitekwa n'akụkụ nke ọzọ nke slide mwekota waya.
Ebe atọ erughị ala waya, kwesịrị na a mma nso dị ka o kwere na gara aga set nke erughị ala waya cross n'ime kasị n'akuku, na-emekarị abụọ tent nke ígwè waya nwere ike ịbụ akụkụ nke 50 ° ~ 70 Celsius.
A na-etinye ya na waya erughị ala: Mwepu nke ọma na tightener, gafere n'ọnụ ọnụ waya erughị ala site na tightener, mpikota onu aka, tinye preload nke opekata mpe 1200N na waya erughị ala, wee tinye mkpọchi L-handle.
N'itinye otu usoro nhazi nke mpụga n'ofe ikpere dị ka akọwara na mbụ, tinye ma ọ dịkarịa ala abụọ Schanz skru na tibia distal, tinye otu onye na-ahụ maka mpụga nke nwere otu ogwe aka, ma jikọọ ya na onye na-ahụ maka mpụga gburugburu, wee kwenye na metaphysis na tibial stem. nọ n'usoro igwe nkịtị na nhazigharị ntụgharị tupu ha emechaa nhazi.
Ọ bụrụ na achọrọ nkwụsi ike ọzọ, enwere ike itinye eriri mgbanaka ahụ na ogwe aka ndozi nke mpụga na mkpanaka njikọ.
Na-emechi mbepụ ahụ
A na-emechi mbepụ ịwa ahụ site na oyi akwa.
A na-echekwa traktị agịga ahụ na mkpuchi gauze mmanya.
Nlekọta mgbe arụchara ọrụ gasịrị
Ọrịa fascial na mmerụ ahụ akwara
N'ime 48h mgbe mmerụ ahụ gasịrị, ekwesịrị ịkpachara anya iji hụ ma chọpụta ọnụnọ nke ọrịa nke akụkụ fascial.
Jiri nlezianya lelee irighiri akwara vaskụla nke akụkụ ahụ metụtara. Ọbara na-adịghị mma ma ọ bụ mfu akwara na-aga n'ihu ga-edozirịrị nke ọma dịka ọnọdụ mberede.
Nrụzigharị arụ ọrụ
Enwere ike ịmalite mmega ahụ na-arụ ọrụ n'ụbọchị mbụ nke ịwa ahụ gasịrị ma ọ bụrụ na enweghị mmerụ ahụ ma ọ bụ nsogbu ndị ọzọ na saịtị. Dịka ọmụmaatụ, nkwekọrịta isometric nke quadriceps na mmegharị nke ikpere na-arụ ọrụ nke nkwonkwo ụkwụ.
Ebumnuche nke n'oge na-arụsi ọrụ ike na nke na-agafe agafe bụ iji nweta oke mmegharị nke nkwonkwo ikpere maka oge dị mkpirikpi dị ka o kwere mee mgbe ịwachara ahụ, ya bụ, iji nweta ihe zuru oke nke nkwonkwo ikpere dị ka o kwere mee na 4 ~ Izu 6. N'ozuzu, ịwa ahụ ahụ nwere ike imezu nzube nke nkwụsi ike nke ikpere, na-enye ohere n'oge
ọrụ. Ọ bụrụ na mmega ahụ na-arụ ọrụ na-egbu oge n'ihi na-echere ọzịza ka ọ daa, nke a agaghị enyere gị aka mgbake ọrụ.
Ibu ibu: A naghị akwado ibu ibu n'oge, ma ọ dịkarịa ala izu 10 ruo 12 ma ọ bụ mgbe e mesịrị maka ọkpụkpụ intra-articular a haziri.
Ngwọta ọnya: Leba anya na ọgwụgwọ ọnya ahụ n'ime izu 2 mgbe ịwachara ahụ. Ọ bụrụ na ọrịa ọnya ma ọ bụ ọgwụgwọ na-egbu oge emee, a ga-arụ ọrụ ịwa ahụ ozugbo enwere ike.
Oge nzipu: Ọgọst-16-2024
