Kutyoka kweBase reFifth Metatarsal

Kurapa kusina kunaka kwefifth metatarsal base fractures kunogona kukonzera kusabatana kwemapfupa kana kunonoka kubatana kwemapfupa, uye zviitiko zvakakomba zvinogona kukonzera arthritis, iyo ine kukanganisa kukuru pahupenyu hwevanhu hwezuva nezuva nebasa.

AzvechisikigoSchivakwae

Metatarsal yechishanu chinhu chakakosha pachikamu chetsoka, uye chinoita basa rakakosha mukutakura huremu uye kugadzikana kwetsoka. Metatarsal yechina neyechishanu uye cuboid zvinoumba metatarsal cuboid joint.

Kune tsinga nhatu dzakanamirwa pahwaro hwechishanu chemetatarsal, tsinga dzeperoneus brevis dziri padivi redorsolateral re tuberosity pahwaro hwechishanu chemetatarsal; tsandanyama yechitatu yeperoneal, isina kusimba setsinga dzeperoneus brevis, dziri pa diaphysis distal kusvika kufifth metatarsal tuberosity; plantar fascia. tsinga dzelateral fascicle dziri padivi replantar re basal tuberosity refifth metatarsal.

Kupatsanurwa kwemakumbo

Kutyoka kwehwaro hwechishanu chemetatarsal kwakarongwa naDameron naLawrence,

Kutyoka kweZone I kutyoka kwemetatarsal tuberosity;

Nzvimbo yechipiri iri pakati pe diaphysis ne proximal metaphysis, kusanganisira majoini ari pakati pemapfupa e4th ne5th metatarsal;

Kutyoka kweZone III kutyoka kwekumanikidzwa kweproximal metatarsal diaphysis iri kure nejoini re4th/5th intermetatarsal.

Muna 1902, Robert Jones akatanga kutsanangura rudzi rwekutyoka kwenzvimbo yechipiri yechigadziko che metatarsal yechishanu, saka kutyoka kwenzvimbo yechipiri kunonziwo Jones fracture.

Kutyoka kwemetatarsal tuberosity mu zone I ndiyo mhando inonyanya kuwanikwa yekutyoka kwemetatarsal base yechishanu, inokwana 93% yekutyoka kwese, uye inokonzerwa nekukwenya kweplantar uye varus violence.

Kutyoka munzvimbo yechipiri kunoumba inenge 4% yemapfupa ese ari pasi pechikamu chechishanu chemetatarsal, uye kunokonzerwa nekukwenya kwetsoka uye kukuvara kwetsinga. Nekuti ari munzvimbo ine ropa riri pasi pechikamu chechishanu chemetatarsal, kutyoka panzvimbo iyi kunowanzoita kuti mapfupa asabatana kana kuti kunonoka kupora.

Kutyoka kweZone III kunokonzera anenge 3% yezvikamu zvishanu zve metatarsal base fractures.

Kurapa kwekuchengetedza

Zviratidzo zvikuru zvekurapa kwekuchengetedza mapfupa zvinosanganisira kuputsika kwemapfupa kuri pasi pe2 mm kana kuputsika kwakasimba. Kurapa kwakajairika kunosanganisira kumisa kufamba nemabhandiji anochinjika, shangu dzakasimba, kumisa kufamba neplaster casts, mapedhi ekumanikidza makadhibhodhi, kana bhutsu dzekufamba.

Zvakanakira kurapwa kwekuchengetedza mapfupa zvinosanganisira kudhura kwakaderera, kusava nekukuvara, uye kugamuchirwa zviri nyore nevarwere; zvazvakaipira zvinosanganisira kuwanda kwematambudziko ekutyoka kwemapfupa kana kunonoka kwekubatana kwemapfupa, uye kuomarara kwemajoini kuri nyore.

KuvhiyaTkugadziriswa

Zviratidzo zvekuvhiyiwa kwechirwere chechishanu che metatarsal base fractures zvinosanganisira:

1. Kufamba kwekuputika kwepfupa kupfuura 2 mm;

1. Kubatanidzwa kwe > 30% yenzvimbo iri pakati pe cuboid distal kusvika kune yechishanu metatarsal;

1. Kutyoka kweganda;

1. Kutyoka kunononoka kubatana kana kusabatana mushure mekurapwa pasina kuvhiyiwa;

1. Varwere vechidiki vari kushanda nesimba kana vatambi vemitambo.

Parizvino, nzira dzekuvhiya dzinoshandiswa zvakanyanya pakutyoka kwehwaro hwefifth metatarsal dzinosanganisira Kirschner wire tension band internal fixation, anchor suture fixation ne thread, screw internal fixation, uye hook plate internal fixation.

1. Kugadzika kwebhandi rekumanikidza waya reKirschner

Kugadzirisa tambo yeKirschner wire tension band inzira yekuvhiya inowanzoitwa nevanhu. Zvakanakira nzira iyi yekurapa zvinosanganisira kuwana zviri nyore zvinhu zvekugadzirisa tambo yemukati, mutengo wakaderera, uye kudzvanywa kwakanaka. Zvakaipa zvinosanganisira kutsamwa kweganda uye njodzi yekuti tambo yeKirschner irege kusunuka.

2. Kugadzirisa suture netambo dzinosungirirwa

Kugadziriswa kwesimbi ye anchor ne thread kwakakodzera varwere vane mapfupa akatyoka pasi pe fifth metatarsal kana kuti vane zvidimbu zvidiki zvakatyoka. Zvakanakira zvinosanganisira kucheka kudiki, kuvhiyiwa kuri nyore, uye hapana chikonzero chekubviswa kwechipiri. Zvakaipa zvinosanganisira njodzi yekudonha kwe anchor muvarwere vane osteoporosis.

3. Kugadzika nzara dzisina chinhu

Skuruu ine hollow imishonga inozivikanwa pasi rose inoshanda yekurapa kutyoka kwehwaro hwefifth metatarsal, uye zvakanakira zvayo zvinosanganisira kugadzika kwakasimba uye kugadzikana kwakanaka.

Panyaya dzekurapa, kana paine zvidimbu zvidiki zviri pasi pechikamu chechishanu che metatarsal, kana zvikushi zviviri zvikashandiswa pakusunga, pane njodzi yekuramba kutenderera. Kana chikushi chimwe chete chikashandiswa pakusunga, simba rekudzivirira kutenderera rinodzikira, uye zvinogona kudzoserwa panzvimbo yacho.

4. Hook plate yakagadziriswa

Kugadzika kwehook plate kune zviratidzo zvakasiyana-siyana, kunyanya kune varwere vane avulsion fractures kana osteoporotic fractures. Magadzirirwo ayo akafanana nehwaro hwefifth metatarsal bone, uye simba rekumanikidza kwefixation rakakwira. Zvakaipa zvekugadzirisa plate zvinosanganisira kudhura kwakanyanya uye kukuvara kukuru.

Sruzivo

Pakurapa kutyoka kwemapfupa ari pasi pechikamu chechishanu chemetatarsal, zvakakosha kusarudza nokungwarira zvichienderana nemamiriro ezvinhu emunhu wega wega, ruzivo rwechiremba uye hunyanzvi hwake, uye kunyatsofunga nezvezvinodiwa nemurwere.