Iyo yekuzadzika nguva yakatevera nguva ndiyo nzira yekare yekuvhiya kwekuvhiya kweCalcaneal Fractures. Kunyangwe kuratidzwa kwakanyatsoziva, iyo incision yakareba uye iyo tsananguro yakapfava inobviswa zvakanyanya, iyo inotungamira kune zvinonetsa zvakanonoka kubatana, necrosis, uye hutachiona. Yakabatanidzwa neyekutsvaga kweNystems yekutsvaga zvishoma kusanzwisisika aesthetics, zvishoma zvinosangana nekuvhiya kwekuvhiringidza kweCalcaneal Fraces yakarumbidzwa zvakanyanya. Ichi chinyorwa chakanyora matipi masere.
Nenzira yakakura kwazvo, chikamu chetsiva chechinwiwa chinotanga zvishoma proximal kune iyo tip yeiyo fibulisa uye anterior kune Achilles tendon. Iyo nhanho yeiyo incision inoitwa chete isingabvumirwe kune ganda rakapwanyika rakadywa neyekare calcaneal artery uye inoisa pazasi pechishanu metatarsal. Izvo zvikamu zviviri zvakabatana nechitsitsinho kuti ugadzire zvishoma zvakakoshwa sekona. Kunobva: Campbell Orthopedic Kuvhiya.
Percutaneous ping kuderedzwa
Muma1920s, Böhler akagadzira zvishoma zvekurapa kwekurapa kwekudzikisira kweiyo calcaneus iri pasi pedzimba, uye kwenguva yakareba mushure menguva yakareba, percutaneous pokerction pasi pehurongwa hwekurapa kwemarapi wemari.
Izvo zvakakodzera kuti zvidimbu zviitwe nekuregererwa zvisingaite zvezvimedu zvechinyaradzo mune subtarlar mubatanidzwa, senge sanders mhando II uye mamwe ma sanders iii lingual fractures.
Kune Sanders Type III uye SANARFER SUPLAR SUBTULAR SEATONE, zvakaoma kuzadzisa kudzikiswa kweiyo calcaneus.
Zvakaoma kudzoreredza hupamhi hweMalcaneus, uye kuremara hakugone kurangwa. Zvinowanzosiya madziro eCalcaneus akaunganidzwa mumadhigirii akasarudzika, achizoita kuti madziro ezasi eLallool neiyo yeCalcaneus. Syndrome, calcaneal impermentement kurwadziwa, uye peroneus Longus Tendonitis.
WestHues / Essex-Lopresti maitiro. A. Greateral fluoroscopy yakasimbisa iyo yakadonhedzwa rurimi ruvara rwerimi; B. Iyo yakatwasuka ndege CT Scan yakaratidza jecha rondedzero iic kupwanya. Chikamu cheAnterior chemuCalcaneus zvakajeka kuenderana nemifananidzo miviri. S. Kutakura kure kure.
C. Kurebalcy incision haina kukwanisa kushandiswa nekuda kweiyo yakanyanya nyoro nyoro yekuzvimba uye kuputika; D. Starreral Fluoroscopy inoratidza articular pamusoro (dotted mutsara) uye talar collapse (mutsara wakasimba).
E naF. Tevedza vaviri vepombi vekumiraira vakaiswa kuiswa pasi pechikamu chepazasi cherurimi, uye mutsara wedombo ndihwo hwakaenzana.
G. FLEX iyo ibvi yakabatanidzwa, pry Up iyo nguva yekutungamira, uye panguva imwe chete yekudyara iyo yepakati kuti udzikiswe: H. Imwe mm Kirschner vairesi Kwayaka: Mann tsoka uye anovhiya.
SInus tarsi incision
Iyo incision inoitwa 1 cm distal kune iyo tip yeiyo fibula kune iyo pasi pechina metatarsal. Muna 1948, Palmer yakatanga yakataura chidiki chidiki muSinus Tarsi.
Muna 2000, ebmheim et al. akashandisa tarsal sinus nzira mukurapwa kwekiriniki yeCalcaneal Fractures.
o inogona kufumura zvizere subtarlar yakabatana, posterior articular pamusoro uye anteerolateral fracture block;
o dzivirira zvakaringana dzivirira restaral calcaneal ropa;
O Hapanofanirwa Kuda Kucheka Malcanefibular Ligmente uye Subperoneal Retinaculum, uye nzvimbo yakabatanidzwa inogona kuwedzerwa nekutsamwa kwakakodzera panguva yekuvhiya, iyo ine zvakanakira kusakwana uye kushoma kubuda ropa.
Iko kushushikana ndechekuti kuratidzwa kuri pachena hakuna kukwana, iyo miganhu uye inokanganisa kuderedzwa kwekudzikisira uye kuiswa kwekugadziriswa kwemukati. Izvo zvakangofanira kungokodzera sanders mhando ini uye Type Ii Calcaneal Fractures.
OBLEQUE DZVIMBO
Kugadziridzwa kweSinus Tarsi incision, anenge mana cm pakureba, yakagadzirirwa 2 cm pazasi iyo yakazotevera mallleolus uye yakaenzana neyepashure pepamusoro.
Kana iyo yekugadzirira yekugadzirira yakaringana uye mamiriro ezvinhu anobvumirana, inogona zvakare kuve nekudzikiswa kwakanaka uye kugadzirisa kweSander Type II uye III Intra-Artular Callures; Kana subtarlar yakabatanidzwa inobatanidzwa mukureba kwenguva yakareba, iyo yakafanana incision inogona kushandiswa.
Pt Peroneal Tendon. PF posterior articular pamusoro peiyo calcaneus. S sinus tarsi. Ap Calcaneal Protsion. .
Posterior Longitudinal Incision
Kutanga kubva pakati peiyo mutsara pakati peiyo Achilles Tendon uye musvinu weiyo Malleolus, inotambanudza yakasimba pasi kune Talar Heel, nehurefu hwe3,5 cm.
Spection isinganzwisisike inoitwa mumatombo akapfava, pasina kukuvadza zvinhu zvakakosha, uye chinzvimbo chepashure chezvinyorwa chakafumurwa kwazvo. Mushure mekunge percutaneous prying uye kuderedza, bhodhi remasvinu rakaiswa pasi pekutungamirirwa kwesingafambi maonero, uye banga renyama rakabatwa uye rakagadziriswa pasi pekumanikidzwa.
Iyi nzira inogona kushandiswa kune sanders mhando I, II, uye III, kunyanya yekudzingwa posterlular pamusoro kana tubutsity fractures.
Herringbone akacheka
Kugadziridzwa kweSinus Tarsi Incision. Kubva pamamita matatu pamusoro pegomba reiyo raterallus mallleolus, pamwe nemukuru wepamberi weiyo fibula kune iyo tip yeiyo mitalolus yakazotevera, uyezve pachigadziko chechina metatarsal. Inotendera kuderedzwa kwakanaka uye kugadziriswa kweSander Tyment II uye III CALCANEAL FRACRATES, uye inogona kuwedzerwa kana zvichikosha kufumura kufumura taltfibula, Talus, kana Literal Column yetsoka.
Lm Lalteral Ankle. Mt metatarsal Joint. Spring supra fibula retinaculum.
ARthroscopically yakabatsira kuderedzwa
Muna 1997, Rammelt akakurudzira kuti subtarlar arthroscopy inogona kushandiswa kuderedza iyo posterlular pamusoro peiyo calcaneus zvakananga chiratidzo. Muna 2002, Rammelt akatanga kuita arthroscopically akabatsira percutaneous kuderedzwa uye screw kugadzirisa kweSanders Type I uye II Fractures.
Subtarlar arthroscopy inonyanya kuita basa rekutarisa uye rebetsero. Inogona kutarisa mamiriro eiyo subtarlar yeidhi pasi pechiratidzo chakananga, uye kubatsira mukuongorora kuderedzwa uye kugadziriswa kwemukati. Splar Subtarlar Joint dissection uye osteophyte resection inogonawo kuitwa.
Zvinoratidza zvakaratuka: Chete kune sanders mhando Nepo jecha ⅲ, ⅳ uye ao / ota type 83-c3 fracures neyekunyepedzera nzvimbo inodonha senge 83-c4 uye 83-c4 yakaoma zvakanyanya kushanda.
chinzvimbo chemuviri
b. Posterior ankle arthroscopy. c. Kupinda kune kupunzika uye subtarlar yakabatanidzwa.
SChantz screws yakaiswa.
e. Reset uye yenguva pfupi yekugadzirisa. f. Mushure mekugadzirisa zvakare.
g. Kwechinguva chigadziriso iyo yekunyepedzera pamusoro pefumo. h. Gadzirisa ne screws.
Ini. Postoperative Sagittal Ct Scan. j. Postopengerative exial maonero.
Uye zvakare, iyo subtar yekubatanidza nzvimbo yakatetepa, uye traction kana mabhureki anodiwa kuti atsigire nzvimbo yekubatana kuti ifambise kuiswa kweArthroscope; Iyo nzvimbo yeIntra-yehunyanzvi hwekunyengera idiki, uye kusava nehanya kunogona kukonzera iatrogenic cartilage pamusoro pekukuvara kwepasi; maitiro asina kuvhiya ekuvhiya anowanzo kuve kukuvara kwemunharaunda kuronga.
Percutaneous balloon angopplasty
Muna 2009, Bano akatanga funga nezve nzira dzekurapa dzekurapa kwe calleal fractures. Kune Sanders Type II Fractures, mabhuku mazhinji anofunga zvinoitwa kuti ave chokwadi. Asi mamwe marudzi ezvipundu akanyanya kuoma.
Kamwe bhenekera simende inopinda mukati meiyo subtarlar yakabatanidzwa panguva yekuvhiya, ichaita kuti kupfekedzwa kwekunyepedzera uye kusunganidzwa kwekunzwa, uye kuwedzera kwebhanhire hakuzove kwakaenzana nekudzikiswa kwekunyepedzera.
Kuiswa kweCannula uye Kutungamira Wire pasi peFluoroscopy
Mifananidzo isati yatanga uye mushure mekutevera ndege
X-Ray uye CT mifananidzo makore maviri mushure mekuvhiyiwa.
Parizvino, ma samples ekutsvagisa eBalloon tekinoroji kazhinji idiki, uye mazhinji emakaravira ane mibairo yakanaka anokonzerwa nemhirizhonga yakaderera-simba. Kuwedzera kutsvagira kuchiri kudiwa kune calcaneal fractures neakanyanya kupwanya kutama. Yakaitwa kwenguva pfupi yenguva, uye kushanda kwenguva refu uye matambudziko achiri kuwoneka.
Calcaneal intramedullary mbambo
Muna 2010, mikoni yemalcarelalabutularary yakabuda. Muna 2012, m.Goldzak zvishoma zvinosanganisa kurapwa kweCalcaneal Fractures neIntramedullary Mbiri. Izvo zvinofanirwa kusimbiswa kuti kuderedzwa hakugone kuwanikwa nemukati intramuterllary.
Isa chinzvimbo chekufambisa pini, fluoroscopy
Kudzokorora iyo subtarlar yakabatana
Isa chimiro chekumira, dhizaini yemukati intramedudullary, uye uigadzirise ne2 mm cannulated screws
Kufunga mushure memukati memukati membiremera.
Misumbu intramodollary yakaratidzwa kuti ibudirire pakurapa kweanders Type II uye III Fractures yeMalcaneus. Kunyangwe vamwe varapi vakaedza kuishandisa kuSanders IV Fractures, iyo yekuderedza kushanda kwayo yaive yakaoma uye kuderedzwa kwakanaka kwaisakwanisa kuwanikwa.
Munhu Akasangana: Yoyo
WA / Tel: +8615682071283
Kutumira Nguva: May-31-2023
