Kugadziriswa kwemukati neplate yemapfupa
Kubatanidza mabvi nemaplate nemasikuruu inzira yekuvhiya yakajairika pari zvino. Kusunga mukati me plate yekukiya kwave kuchishandiswa zvakanyanya mukubatanidza mabvi. Parizvino, kubatanidza mabvi e plate kunosanganisira anterior plate ne lateral plate fusion ye mabvi.
Mufananidzo uri pamusoro unoratidza mafirimu eX-ray vasati vavhiyiwa uye mushure mekuvhiyiwa kwetraumatic ankle osteoarthritis ine anterior locking plate internal fixation ankle joint fusion
1. Nzira yekutanga
Nzira yekumberi ndeyekuita kucheka kwemberi kwenguva refu kwakatarisana nenzvimbo yejoini regumbo, kucheka jira nejira, uye kupinda munzvimbo yetendon; kucheka kapisiyumu yejoini, kuburitsa pachena joini yetibiotalar, kubvisa cartilage nefupa resubchondral, uye kuisa ndiro yekumberi pamusoro peAnterior yegumbo.
2. Maitiro epadivi
Nzira yekucheka osteotomy iri pamusoro pe10 cm pamusoro pemusoro wefibula wobvisa chigunwe chose. Chigunwe chepfupa chinobviswa kuti chibatanidzwe nemapfupa. Kuvhiyiwa kwe osteotomy pamusoro pechigunwe kwapera uye kwagezwa, uye ndiro yacho inoiswa kunze kwegumbo.
Chakanakira ndechekuti simba rekugadzirisa rakawanda uye kugadzirisa kwacho kwakasimba. Inogona kushandiswa kugadzirisa nekuvakazve kuremara kwakanyanya kwevarus kana valgus yegumbo retsoka uye zvikanganiso zvakawanda zvemapfupa mushure mekuchenesa. Puratifomu yekubatanidza yakagadzirwa nemaune inobatsira kudzoreredza hunhu hwegumbo retsoka. Nzvimbo.
Dambudziko nderekuti periosteum yakawanda nenyama yakapfava munzvimbo yekuvhiyiwa zvinoda kubviswa, uye ndiro yesimbi yakakora, izvo zviri nyore kutsamwisa tsinga dzakatenderedza. Ndiro yesimbi yakaiswa pamberi iri nyore kubata pasi peganda, uye pane njodzi yakati.
kunamira kwenzara mukati memedullary
Mumakore achangopfuura, kushandiswa kwe retrograde intramedullary nail-type ankle arthrodesis mukurapa arthritis yemakumbo kwave kushandiswa zvishoma nezvishoma mukurapa.
Parizvino, nzira yekupinza mapfupa mudumbu inoshandisa jira repakati pegumbo kana jira repamusoro re fibula pakuchenesa pamusoro pegumbo kana kuisa mapfupa mudumbu. Nzara yemukati inopinzwa kubva mu calcaneus kuenda ku tibial medullary cavity, iyo inobatsira kugadzirisa hurema uye inokurudzira kubatana kwemapfupa.
Osteoarthritis yebvi pamwe chete ne subtalar arthritis. Mafirimu eX-ray asati avhiyiwa akaratidza kukuvara kukuru kwejoini retibiotalar ne subtalar, kuputsika kwechikamu chetalus, uye kuumbwa kwemapfupa akakomberedza joini (kubva panhamba 2)
Kona yekuisira sikuruu yakasiyana-siyana yekukiya tsoka yepamberi petsoka. Chipikiri chemukati memedullary chinogadziriswa nenzira dzakasiyana-siyana, chinogona kugadzirisa jointi chaiyo inofanira kusanganiswa, uye mugumo wekure iburi rakakiyiwa rine shinda, rinogona kudzivirira kucheka, kutenderera, uye kudhonzwa, zvichideredza njodzi yekubviswa kwesikuruu.
Chidimbu chetibiotalar nechikamu chesubtalar zvakaburitswa pachena uye zvakagadziriswa kuburikidza nenzira ye lateral transfibular, uye kureba kwekucheka pamusuwo wechipikiri che plantar intramedullary kwaive 3 cm.
Nzara yemukati memedullary inoshandiswa senzvimbo yekubatanidza, uye kushushikana kwayo kwakapararira zvishoma, izvo zvinogona kudzivirira mhedzisiro yekudzivirira kushushikana uye zvinoenderana nemisimboti ye biomechanics.
Firimu reX-ray repashure nepadivi mwedzi mumwe chete mushure mekuvhiyiwa rakaratidza kuti mutsetse wetsoka yekumashure waive wakanaka uye nzara yemukati memedullary yakanga yakasimbiswa zvakanaka.
Kuisa nzara dzemukati memudullary pakubatanidza makumbo kunogona kuderedza kukuvara kwenyama yakapfava, kuderedza kuchekwa kweganda, hutachiona nezvimwe zvinetso, uye kunogona kupa kugadzikana kwakakwana pasina kusimbiswa kwekunze kweplaster mushure mekuvhiyiwa.
Gore rimwe mushure mekuvhiyiwa, mafirimu eX-ray akanaka uye ane huremu hwepadivi akaratidza kubatana kwemapfupa kwejoini retibiotalar nejoini resubtalar, uye kurongeka kwetsoka yekumashure kwaive kwakanaka.
Murwere anogona kumuka pamubhedha otakura huremu nekukurumidza, izvo zvinoita kuti murwere akwanise kushivirira uye hupenyu hwake. Zvisinei, nekuti subtalar joint inoda kugadziriswa panguva imwe chete, hazvikurudzirwi kuvarwere vane subtalar joint yakanaka. Kuchengetedzwa kwesubtalar joint inzira yakakosha yekuripa mashandiro egumbo retsoka kuvarwere vane ankle joint fusion.
kugadzirisa mukati me screw
Kugadzirisa mukati meganda ne screw inzira inowanzo shandiswa pakurapa arthrodesis yemakumbo. Ine mabhenefiti ekuvhiya kusinganyanyi kukuvadza muviri zvakaita sekuchekwa kudiki uye kurasikirwa neropa rakawanda, uye inogona kuderedza kukuvara kwenyama dzakapfava.
Mafirimu eX-ray eparutivi petsoka neparutivi petsoka asati avhiyiwa akaratidza osteoarthritis yakanyanya yegumbo rekurudyi ine varus deformity, uye kona iri pakati petibiotalar articular surface yakayerwa kuva 19° varus.
Ongororo dzakaratidza kuti kugadzirisa zviri nyore uchishandisa masikuruu maviri kusvika mana e lag kunogona kuita kuti kugadzirisa kugadzikane uye kudzvanywa kugadzikane, uye kushanda kwacho kuri nyore uye mutengo wacho wakachipa. Ndiyo sarudzo yekutanga yenyanzvi dzakawanda pari zvino. Pamusoro pezvo, kuchenesa majoini etsoka kusingapindi zvakanyanya kunogona kuitwa uchishandisa arthroscopy, uye masikuruu anogona kuiswa nepaganda. Kukuvara kwekuvhiyiwa kudiki uye mhedzisiro yekurapa inogutsa.
Pasi pe arthroscopy, nzvimbo yakakura ine dambudziko remaronda emusana inoonekwa; pasi pe arthroscopy, mudziyo we pointed cone microfracture unoshandiswa kurapa pamusoro pe articular.
Vamwe vanyori vanotenda kuti kugadziriswa kwe 3 screw kunogona kuderedza kuwanda kwengozi yekusabatanidzwa mushure mekuvhiyiwa, uye kuwedzera kwehuwandu hwekubatanidzwa kwe 3 screw kunogona kunge kwakabatana nekugadzikana kwakasimba kwe 3 screw fixation.
Firimu reX-ray rakatevera mushure memavhiki gumi nemashanu ekuvhiyiwa rakaratidza kubatana kwemapfupa. Chibodzwa cheAOFAS chaive mapoinzi makumi mana nemanomwe vasati vavhiyiwa uye mapoinzi makumi manomwe nemana mugore rimwe chete mushure mekuvhiyiwa.
Kana zvikuro zvitatu zvichishandiswa pakusunga, nzvimbo yekusunga ndeyekuti zvikuro zviviri zvekutanga zvinopinzwa zvichitevedzana kubva kumativi e-anteromedial ne-anterolateral e-tibia, zvichiyambuka neparutivi rwe-articular kuenda kumuviri we-talar, uye chikuro chechitatu chinopinzwa kubva kurutivi rwekumashure rwe-tibia kuenda kurutivi rwepakati rwe-talus.
Nzira yekugadzirisa kunze
Zvishandiso zvekunze ndizvo zvakatanga kushandiswa pakurapa arthrodesis yemakumbo uye zvakashanduka kubva kuma1950 kusvika pari zvino, Ilizarov, Hoffman, Hybrid naTaylor space frame (TSF).
Kukuvara kwegumbo kwakavhurika nekuda kwehutachiona kwemakore matatu, arthrodesis yegumbo mwedzi mitanhatu mushure mekudzora hutachiona
Kune dzimwe nyaya dzakaoma dzearthritis dzegumbo dzine hutachiona hunodzokororwa, kuvhiyiwa kunodzokororwa, mamiriro asina kunaka eganda remunharaunda uye nyama dzakapfava, kuumbwa kwemavanga, kukuvara kwemapfupa, osteoporosis uye kukuvara kwehutachiona hwemunharaunda, Ilizarov ring external fixator inoshandiswa zvakanyanya mukurapa kubatanidza gumbo.
Chinogadzirisa chekunze chakaita sedenderedzwa chakasungirirwa pakona yeropa nepakona yesagittal, uye chinogona kupa simba rekugadzirisa rakagadzikana. Pakutanga kwekutakura mutoro, chinodzvanya magumo ekutyoka, kukurudzira kuumbwa kweganda, uye kuvandudza mwero wekusanganiswa. Kune varwere vane hurema hwakakomba, chinogadzirisa chekunze chinogona kugadzirisa hurema hwacho zvishoma nezvishoma. Ehe, kusangana kwetsoka dzechinogadzirisa chekunze kuchave nematambudziko akadai sekusagadzikana kwevarwere kupfeka uye njodzi yehutachiona hwetsono.
Bata nesu:
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Email:liuyaoyao@medtechcah.com
Nguva yekutumira: Chikunguru-08-2023
