Kugadziriswa kwemukati nebhokisi remapfupa
Ankle fusion ine mahwendefa uye screws inzira yakajairika yekuvhiya parizvino.Kuvhara ndiro yemukati kugadzirisa yakashandiswa zvakanyanya muankle fusion.Parizvino, plate ankle fusion inonyanya kusanganisira anterior plate uye lateral plate ankle fusion.
Mufananidzo uri pamusoro unoratidza mafirimu e-X-ray vasati vavhiyiwa uye mushure mekuvhiyiwa kwekushungurudza ankle osteoarthritis ine anterior locking plate yemukati fixation ankle joint fusion.
1. Anterior approach
Nzira yepamberi ndeyokuita anterior longitudinal incision yakatarisa panzvimbo yejojo yemakumbo, cheka jira nehupamhi, uye kupinda pamwe chete netendon space;cheka iyo capsule yakabatana, fumura iyo tibiotalar joint, bvisa cartilage uye subchondral bone, uye isa anterior plate paAnterior yegumbo.
2. Nzira yekufamba nayo
The lateral approach ndeyekucheka osteotomy inenge 10 cm pamusoro pemuromo we fibula uye kubvisa chigutsa zvachose.Kanzura pfupa chigutsa chinotorwa kuti pfupa ribatanidzwe.Iyo fusion surface osteotomy inopedzwa uye yakagezwa, uye ndiro inoiswa kunze kwechitsiko chejoini.
Zvakanakira ndezvokuti simba rekugadzirisa rakakwirira uye kugadzirisa kwakasimba.Inogona kushandiswa pakugadzirisa nekugadzirisa kwevarus yakaoma kana valgus deformity yejoini yemakumbo uye kukanganisa kwemapfupa akawanda mushure mekuchenesa.Iyo anatomical yakagadzirwa fusion plate inobatsira kudzoreredza yakajairika anatomy yeankle joint.Nzvimbo.
Izvo zvisingabatsiri ndezvokuti mamwe periosteum uye zvinyoro zvinyoro munzvimbo yekuvhiya zvinoda kubviswa, uye ndiro yesimbi yakanyanyisa, iyo iri nyore kutsamwisa tambo dzakapoteredza.Iyo ndiro yesimbi yakaiswa pamberi iri nyore kubata pasi peganda, uye pane imwe njodzi.
intramedullary nail fixation
Mumakore achangopfuura, kushandiswa kwe retrograde intramedullary nail-type ankle arthrodesis mukurapa kwemagumo emakumbo emakumbo zvishoma nezvishoma kwave kushandiswa kuchipatara.
Parizvino, intramedullary nailing technique inonyanya kushandisa anterior median incision yeanteroinferior lateral incision of the fibula for articular surface cleaning kana bone grafting.Iyo intramedullary mbambo inoiswa kubva kucalcaneus kusvika kune tibial medullary cavity, iyo inobatsira pakuremara kugadzirisa uye inosimudzira fusion yemapfupa.
Ankle osteoarthritis yakasanganiswa ne subtalar arthritis.Preoperative anteroposterior uye lateral X-ray mafirimu akaratidza kukuvadzwa kwakanyanya kune tibiotalar joint uye subtalar joint, kuparara kwechikamu chetalus, uye osteophyte kuumbwa kwakatenderedza mubatanidzwa (kubva pakutaura 2)
Iyo divergent fusion screw implantation angle yekukiya hindfoot fusion intramedullary mbambo ndeyekugadziriswa kwendege yakawanda, iyo inogona kugadzirisa iyo chaiyo joint kuti ibatanidzwe, uye iyo distal end igomba rakakiyiwa, rinogona kuramba kucheka, kutenderera, uye kudhonza-kunze. , kuderedza njodzi yekubvisa screw.
Iyo tibiotalar joint uye subtalar joint yakafumurwa uye yakagadziriswa kuburikidza ne lateral transfibular nzira, uye kureba kweiyo incision pamusuwo weplantar intramedullary nail yaive 3 cm.
Iyo intramedullary mbambo inoshandiswa sepakati pekugadzirisa, uye kushushikana kwayo kunenge kwakapararira, izvo zvinogona kudzivirira kushushikana kwekudzivirira mhedzisiro uye zvakanyanya kuenderana nemisimboti yebiomechanics.
Anteroposterior uye lateral X-ray firimu 1 mwedzi mushure mekushanda kwakaratidza kuti mutsara wetsoka wekumashure wakanga wakanaka uye intramedullary nail yakagadziriswa yakavimbika.
Kuisa retrograde intramedullary zvipikiri kune ankle joint fusion kunogona kuderedza kukuvara kwenyama yakapfava, kuderedza incision ganda necrosis, utachiona uye mamwe matambudziko, uye inogona kupa yakakwana yakagadzikana kugadzirisa pasina yekubatsira plaster yekunze kugadzirisa mushure mekuvhiyiwa.
Rimwe gore mushure mekushanda, mafirimu akanaka uye anotevera uremu hwe X-ray akaratidza bony fusion yetibiotalar joint uye subtalar joint, uye kurongeka kwetsoka kumashure kwaive kwakanaka.
Murwere anogona kubva pamubhedha uye kutakura uremu nekukurumidza, izvo zvinovandudza kushivirira kwemurwere uye hupenyu hwehupenyu.Zvisinei, nokuti iyo subtalar joint inoda kugadziriswa panguva imwe chete, haina kukurudzirwa kune varwere vane yakanaka subtalar joint.Kuchengetedzwa kwechikamu che subtalar chimiro chakakosha chekubhadhara basa rekubatana kwechidzitiro kune varwere vane ankle joint fusion.
screw yemukati kugadzirisa
Percutaneous screw internal fixation inzira yakajairika yekugadzirisa mu ankle arthrodesis.Iine mabhenefiti ekuvhiyiwa kusinganyanyi kupindira senge kuchekwa kudiki uye kushomeka kweropa, uye inogona kunyatso kudzikisa kukuvadzwa kwezvinyoro zvinyoro.
Anteroposterior uye lateral X-ray mafirimu echidzitiro chakamira chejoini chisati chavhiyiwa chakaratidza osteoarthritis yakaoma yegumbo rekurudyi ine varus deformity, uye kona iri pakati petibiotalar articular surface yakayerwa kuva 19 ° varus.
Zvidzidzo zvakaratidza kuti gadziriso yakapusa ine 2 kusvika 4 lag screws inogona kuwana yakagadzikana gadziriso uye compression, uye mashandiro acho ari nyore uye mutengo wakachipa.Ndiyo sarudzo yekutanga yevadzidzi vazhinji parizvino.Pamusoro pezvo, kucheneswa kwechidzitiro kusinganyanyi kupindira kunogona kuitwa pasi pe arthroscopy, uye screws inogona kuiswa percutaneously.Kukuvadzwa kwekuvhiya kudiki uye kurapa kunogutsa.
Pasi pe arthroscopy, nzvimbo yakakura ye articular cartilage defect inoonekwa;pasi pe arthroscopy, iyo yakanongedza cone microfracture mudziyo inoshandiswa kurapa articular pamusoro
Vamwe vanyori vanotenda kuti 3 screw fixation inogona kuderedza chiitiko che postoperative non-fusion ngozi, uye kuwedzera kwehuwandu hwekusanganiswa kunogona kunge kwakabatana nekusimba kwakasimba kwe3 screw fixation.
Firimu yekutevera X-ray mavhiki gumi nemashanu mushure mekuvhiyiwa kwakaratidza kusanganiswa kwebhonzo.Nhamba yeAOFAS yaiva 47 points isati yashanda uye 74 points 1 gore mushure mekushanda.
Kana ma screws matatu akashandiswa kugadzirisa, fungidziro yekumisikidza nzvimbo ndeyekuti maviri ekutanga screws anoiswa zvakateerana kubva kune anteromedial uye anterolateral mativi etibia, achiyambuka nepakati pechiso kuenda kumuviri wetalar, uye screw yechitatu inoiswa kubva kumashure. rutivi rwetibia kusvika kudivi repakati retalus.
External fixation nzira
Zvigadziriso zvekunze zvaive zvigadziriso zvekutanga zvakashandiswa muankle arthrodesis uye zvakashanduka kubva kuma1950 kusvika kune yazvino Ilizarov, Hoffman, Hybrid uye Taylor space frame (TSF).
Ankle yakavhurika kukuvara nehutachiona kwemakore matatu, ankle arthrodesis 6 mwedzi mushure mekudzivirira hutachiona
Kune dzimwe dzakaomesesa ankle arthritis kesi dzine hutachiona hunodzokororwa, kudzokorora kuvhiyiwa, kushata kweganda renzvimbo uye mamiriro akapfava enyama, kuumbwa kwevanga, kuremara kwemapfupa, osteoporosis uye maronda ekutapukira emunharaunda, Ilizarov ring yekunze inogadzirisa inoshandiswa zvakanyanya kukiriniki kusanganisa majoini egumbo.
Iyo mhete-yakaita yekunze fixator inogadziriswa pane coronal ndege uye sagittal ndege, uye inogona kupa yakanyanya kugadzikana kugadzirisa.Mukutanga-kutakura mutoro, inomanikidza kupera kwekutsemuka, kukurudzira kuumbwa kwe callus, uye kugadzirisa fusion rate.Kune varwere vane hurema hwakanyanya, mugadziri wekunze anogona kugadzirisa zvishoma nezvishoma kukanganisa.Ehe, ekunze fixator ankle fusion ichave nezvinetso senge kusagadzikana kwevarwere kupfeka uye njodzi yekutapukirwa netsono.
Contact:
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Email:liuyaoyao@medtechcah.com
Nguva yekutumira: Jul-08-2023
