Kev tawg ntawm tibial plateau ua ke nrog kev tawg ntawm tibial shaft ipsilateral feem ntau pom muaj nyob rau hauv kev raug mob siab, nrog rau 54% yog kev tawg qhib. Cov kev tshawb fawb yav dhau los tau pom tias 8.4% ntawm kev tawg ntawm tibial plateau yog txuam nrog kev tawg ntawm tibial shaft, thaum 3.2% ntawm cov neeg mob tawg ntawm tibial shaft muaj kev tawg ntawm tibial plateau. Nws yog qhov tseeb tias kev sib xyaw ua ke ntawm ipsilateral tibial plateau thiab kev tawg ntawm ncej tsis yog qhov tsis tshua muaj.
Vim yog qhov xwm txheej ntawm cov kev raug mob no muaj zog heev, feem ntau muaj kev puas tsuaj rau cov nqaij mos mos. Hauv kev xav, lub phaj thiab lub hau ntswj system muaj qhov zoo hauv kev kho sab hauv rau cov pob txha tawg, tab sis seb cov nqaij mos mos hauv zos puas tuaj yeem zam kev kho sab hauv nrog lub phaj thiab lub hau ntswj system kuj yog qhov kev txiav txim siab hauv kev kho mob. Yog li ntawd, tam sim no muaj ob txoj kev xaiv uas siv ntau rau kev kho sab hauv ntawm cov pob txha tawg ntawm tibial plateau ua ke nrog cov pob txha tawg ntawm tibial:
1. MIPPO (Minimally Invasive Plate Osteosynthesis) txoj kev siv lub phaj ntev;
2. Cov ntsia hlau sab hauv + cov ntsia hlau tiaj tiaj.
Ob txoj kev xaiv no tau tshaj tawm hauv cov ntaub ntawv sau, tab sis tam sim no tsis muaj kev pom zoo tias qhov twg zoo dua lossis qis dua hais txog qhov ceev ntawm kev kho pob txha tawg, lub sijhawm kho pob txha tawg, kev sib dhos ntawm cov ceg qis, thiab cov teeb meem. Txhawm rau daws qhov teeb meem no, cov kws tshawb fawb los ntawm tsev kho mob hauv tsev kawm ntawv qib siab Kauslim tau ua kev tshawb fawb sib piv.
Cov kev tshawb fawb no suav nrog 48 tus neeg mob uas muaj pob txha tawg ntawm tibial plateau ua ke nrog pob txha tawg ntawm tibial shaft. Ntawm lawv, 35 tus neeg mob tau kho nrog cov txheej txheem MIPPO, nrog rau kev ntxig ib daim hlau rau sab nraud rau kev kho, thiab 13 tus neeg mob tau kho nrog cov ntsia hlau plateau ua ke nrog txoj hauv kev infrapatellar rau kev kho cov ntsia hlau intramedullary.
▲ Rooj Plaub 1: Kev kho sab hauv ntawm daim hlau MIPPO sab nraud. Ib tug txiv neej hnub nyoog 42 xyoo, uas raug xwm txheej tsheb sib tsoo, tau muaj qhov tawg ntawm tibial shaft (hom Gustilo II) thiab qhov tawg ntawm medial tibial plateau compression (hom Schatzker IV).
▲ Rooj Plaub 2: Tibial plateau ntsia hlau + suprapatellar intramedullary ntsia hlau sab hauv. Ib tug txiv neej hnub nyoog 31 xyoo, koom nrog hauv kev sib tsoo tsheb, tau tshwm sim nrog qhov tawg qhib tibial ncej (Gustilo IIIa hom) thiab qhov tawg lateral tibial plateau ua ke (Schatzker I hom). Tom qab kev tshem tawm qhov txhab thiab kev kho mob qhov txhab tsis zoo (VSD), qhov txhab tau raug hloov daim tawv nqaij. Ob lub ntsia hlau 6.5 hli tau siv rau kev txo thiab kho qhov plateau, ua raws li kev kho tus ntsia hlau intramedullary ntawm tibial ncej ntawm txoj hauv kev suprapatellar.
Cov txiaj ntsig qhia tau tias tsis muaj qhov sib txawv tseem ceeb ntawm ob txoj kev phais mob hais txog lub sijhawm kho pob txha tawg, qhov nrawm ntawm kev kho pob txha tawg, kev sib dhos ntawm cov ceg qis, thiab cov teeb meem.
Zoo ib yam li kev sib xyaw ua ke ntawm tibial shaft fractures nrog ankle joint fractures lossis femoral shaft fractures nrog femoral caj dab fractures, high-energy-induced tibial shaft fractures kuj tuaj yeem ua rau raug mob hauv lub hauv caug sib ze. Hauv kev kho mob, kev tiv thaiv kev kuaj mob tsis raug yog qhov kev txhawj xeeb tseem ceeb hauv kev kuaj mob thiab kev kho mob. Tsis tas li ntawd, hauv kev xaiv cov txheej txheem fixation, txawm hais tias kev tshawb fawb tam sim no qhia tsis muaj qhov sib txawv tseem ceeb, tseem muaj ntau lub ntsiab lus yuav tsum xav txog:
1. Yog tias muaj pob txha tawg uas raug txiav ua tej daim me me uas yooj yim kho nrog cov ntsia hlau, qhov tseem ceeb tshaj plaws yog siv lub phaj ntev uas muaj MIPPO kho kom ruaj khov lub pob txha tibial, rov qab kho qhov sib npaug ntawm cov pob qij txha thiab ua kom cov ceg qis sib npaug.
2. Yog tias muaj kev tawg ntawm tibial plateau yooj yim, nyob rau hauv kev phais me me, kev txo qis zoo thiab kev kho ntsia hlau tuaj yeem ua tiav. Hauv cov xwm txheej zoo li no, qhov tseem ceeb yuav muab rau kev kho ntsia hlau ua ntej los ntawm kev kho ntsia hlau suprapatellar intramedullary ntawm tibial ncej.
Lub sijhawm tshaj tawm: Lub Peb Hlis-09-2024
