Iyo yakajairwa lateral L maitiro ndiyo yakajairika nzira yekuvhiya kurapwa kwecalcaneal fractures. Kunyangwe kuratidzwa kwacho kwakanyatso, kuchekwa kwakareba uye matishu akapfava anobviswa zvakanyanya, izvo zvinotungamira zviri nyore kumatambudziko akadai sekunonoka mubatanidzwa wetishu, necrosis, uye hutachiona. Zvichibatanidzwa nenharaunda yemazuva ano kutsvaga kweaesthetics shoma, zvishoma kuvhiya kurapwa kwecalcaneal fractures kwakarumbidzwa zvikuru. Ichi chinyorwa chakanyora 8 matipi.
Iine yakafara lateral nzira, iyo yakamira chikamu cheiyo incision inotanga zvishoma kusvika kumucheto wefibula uye anterior kune Achilles tendon. Chiyero chekuchekwa chinoitwa kure kune ganda rakapwanyika rinodyiswa ne lateral calcaneal artery uye inoiswa pazasi pechishanu metatarsal. Zvikamu zviviri zvakabatanidzwa pachitsitsinho kuti zvigadzire kona yakakombama zvishoma. Kunobva: Campbell Orthopedic Surgery.
Percutaneous poking kuderedza
Mumakore ekuma1920, Böhler akagadzira nzira yekurapa ishoma yekudzikisa calcaneus pasi pekudhonza, uye kwenguva yakareba mushure mazvo, kuderedzwa kwepercutaneous poking pasi pekudhonza kwakava nzira huru yekurapa kwecalcaneus fractures.
Inokodzera mafractures ane kushomeka kuchinjika kwe intraarticular zvidimbu mu subtalar joint, senge Sanders type II uye mamwe maSanders III lingual fractures.
Kune maSanders rudzi III uye akaunza maSanders emhando IV mafracture ane yakanyanya subtalar articular surface kudonha, kudzikisa poking kwakaoma uye zvakaoma kuwana kuderedzwa kweanatomical kweiyo posterior articular pamusoro pecalcaneus.
Zvakaoma kudzorera hupamhi hwecalcaneus, uye kuremara hakugoni kunyatsogadziriswa. Iyo inowanzosiya madziro emadziro e calcaneus mumadhigirii akasiyana, zvichikonzera kukanganisa kweiyo yakaderera lateral malleolus ine lateral rusvingo rwecalcaneus, kutama kana kudzvinyirira kweperoneus longus tendon, uye kupindira kweperoneal tendon. Syndrome, calcaneal impingement kurwadziwa, uye peroneus longus tendonitis.
Westhues/Essex-lopresti nzira. A. Lateral fluoroscopy yakasimbisa chidimbu chakaita serurimi rwakaputsika; B. A horizontal plane CT scan yakaratidza Sandess type IIC fracture. Iyo anterior chikamu checalcaneus inonyatso kunyorwa mumifananidzo miviri. S. Kutakura chinhambwe kamwe kamwe.
C. Lateral incision yaisagona kushandiswa nekuda kwekuzvimba kwenyama yakapfava zvakanyanya uye mablister; D. Lateral fluoroscopy inoratidza articular surface (dotted line) uye talar collapse (solid line).
E uye F. Waya mbiri dzembambo dzembambo dzakaiswa dzakafanana nechepazasi pechikamu chakaita serurimi, uye mutsara une doti ndiwo mutsara wakabatana.
G. Flex mabvi akabatanidzwa, pry up pini yemutungamiri, uye panguva imwechete plantar flex the midfoot kuderedza kuputsika: H. Imwe 6.5 mm cannulated screw yakagadziriswa kune cuboid bone uye maviri 2.0 mm Kirschner waya dzaive subspan yakataurwa kuchengetedza kuderedzwa nekuda kwecalcaneus anterior comminution. Kunobva: Mann Foot uye Ankle Surgery.
Sinus tarsi incision
Iyo incision inoitwa 1 cm kureba kusvika kumuromo wefibula kusvika pazasi pechina metatarsal. Muna 1948, Palmer akatanga kurondedzera chidimbu chiduku mu sinus tarsi.
Muna 2000, Ebmheim et al. akashandisa nzira yetarsal sinus mukurapa kwekiriniki yecalcaneal fractures.
o Inogona kuburitsa zvizere subtalar joint, posterior articular surface uye anterolateral fracture block;
o Kudzivirira zvakakwana lateral calcaneal tsinga dzeropa;
o Hapana chikonzero chekucheka calcaneofibular ligament uye subperoneal retinaculum, uye nzvimbo yekubatana inogona kuwedzerwa nekupindurwa kwakakodzera panguva yekushanda, iyo ine zvakanakira diki incision uye kushoma kubuda ropa.
Izvo zvisingabatsiri ndezvokuti kuratidzwa kunenge kusina kukwana, izvo zvinogumira uye zvinokanganisa kuderedzwa kwekuputsika uye kuiswa kwekugadzirisa mukati. Inokodzera chete Sanders mhando I uye nyora II calcaneal fractures.
Oblique diki incision
Kugadziriswa kwe sinus tarsi incision, inenge masendimita mana pakureba, yakadzika 2 cm pasi pe lateral malleolus uye inopindirana kune posterior articular surface.
Kana iyo preoperative gadziriro yakakwana uye mamiriro ezvinhu anobvumira, inogonawo kuva nekuderedza kwakanaka uye kugadzirisa maitiro paSanders type II uye III intra-articular calcaneal fractures; kana subtalar joint fusion ichidikanwa munguva refu, iyo incision yakafanana inogona kushandiswa.
PT Peroneal tendon. PF Posterior articular pamusoro pe calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Posterior longitudinal incision
Kutanga kubva pakati pemutsara pakati peAchilles tendon uye muromo we lateral malleolus, inotambanukira yakadzika kusvika kune talar chitsitsinho chakabatana, nehurefu hunosvika 3.5 cm.
Kuderera kushoma kunoitwa munyama yakapfava, pasina kukuvadza zvakakosha zvimiro, uye iyo posterior articular surface inonyatso kuratidzwa. Mushure mekupenya uye kuderedzwa kwepercutaneous, bhodhi reanatomical rakaiswa pasi pekutungamirwa kwekuona kwemukati, uye iyo percutaneous screw yakabatwa uye yakagadziriswa pasi pekumanikidzwa.
Iyi nzira inogona kushandiswa kuSanders mhando I, II, uye III, kunyanya kune yakadzingwa posterior articular pamusoro kana tuberosity fractures.
Herringbone yakachekwa
Kugadziriswa kwe sinus tarsi incision. Kubva pamasendimita matatu pamusoro pemuromo we lateral malleolus, pamwe neshure kwemuganhu we fibula kusvika kumucheto we lateral malleolus, uyezve kusvika kunheyo yechina metatarsal. Inobvumira kuderedzwa kwakanaka uye kugadzirisa kweSanders mhando II uye III calcaneal fractures, uye inogona kuwedzerwa kana zvichidiwa kuti ibudise pachena transfibula, talus, kana lateral column yetsoka.
LM lateral chidzitiro. MT metatarsal joint. SPR Supra fibula retinaculum.
Arthroscopically inobatsira kuderedza
Muna 1997, Rammelt akaronga kuti subtalar arthroscopy inogona kushandiswa kuderedza posterior articular surface ye calcaneus pasi pechiratidzo chakananga. Muna 2002, Rammelt akatanga kuita arthroscopically achibatsira kuderedza percutaneous uye screw fixation yeSanders mhando I uye II kuputsika.
Subtalar arthroscopy inonyanya kuita basa rekutarisa uye rekubatsira. Inogona kutarisa mamiriro eiyo subtalar articular surface pasi pechiratidzo chakananga, uye kubatsira mukutarisa kuderedzwa uye kugadziriswa kwemukati. Nyore subtalar joint dissection uye osteophyte resection inogonawo kuitwa.
Zviratidzo zvakatetepa: chete kune maSanders emhando Ⅱ ane zvinyoro comminution ye articular surface uye AO/OTA mhando 83-C2 fractures; nepo maSanders Ⅲ, Ⅳ uye AO/OTA mhando 83-C3 Maputsi ane articular pamusoro kudonha akadai 83-C4 uye 83-C4 zvakanyanya kuoma kushanda.
chinzvimbo chemuviri
b. Posterior ankle arthroscopy. c. Kusvika kune iyo yakaputsika uye subtalar joint.
Schantz screws yakaiswa.
e. Reset uye kugadzirisa kwenguva pfupi. f. Mushure mekugadzirisa zvakare.
g. Kwenguva gadzirisa articular surface bone block. h. Gadzirisa ne screws.
i. Postoperative sagittal CT scan. j. Postoperative axial maonero.
Mukuwedzera, iyo subtalar yakabatana nzvimbo yakamanikana, uye traction kana mabhureki anodiwa kutsigira nzvimbo yakabatana kufambisa kuiswa kwearthroscope; nzvimbo ye intra-articular manipulation idiki, uye kusangwarira kushandura kunogona kukonzera nyore iatrogenic cartilage pamusoro kukuvara; unyanzvi hwekuvhiya husina hunyanzvi hunoenderana nekuronga kwekukuvara kwenzvimbo.
Percutaneous balloon angioplasty
Muna 2009, Bano akatanga kupa zano nzira yekudzikisa bharumu yekurapa calcaneal fractures. Kune maSanders Type II mafractures, mazhinji ezvinyorwa anoona mhedzisiro yacho kuve yechokwadi. Asi mamwe marudzi ekutsemuka akanyanya kuoma.
Kamwe simende yebhonzo inopinda munzvimbo yejoint subtalar panguva yekushanda, inokonzera kupfeka kwearticular surface uye kuderedzwa kwekubatana kwekubatana, uye kuwedzera kwebharumu hakuzove kwakaenzana pakuderedza kuputsika.
Kuiswa kwecannula uye kutungamira waya pasi pefluoroscopy
Mifananidzo isati yasvika uye mushure meairbag inflation
X-ray uye CT mifananidzo makore maviri mushure mekuvhiyiwa.
Parizvino, sampuli dzekutsvakurudza dzebharuni tekinoroji kazhinji idiki, uye mazhinji eakaputsika ane mhedzisiro yakanaka anokonzerwa nekushomeka kwesimba rechisimba. Imwe tsvakiridzo ichiri kudikanwa kune calcaneal fractures ine yakanyanya fracture displacement. Yakave ichiitwa kwenguva pfupi, uye kushanda kwenguva refu uye zvinetso hazvisati zvanyatsojeka.
Calcaneal intramedullary nail
Muna 2010, iyo calcaneal intramedullary nail yakabuda. Muna 2012, M.Goldzak inorapwa zvishoma nezvishoma yecalcaneal fractures ine intramedullary nailing. Inofanira kusimbiswa kuti kuderedza hakugone kuwanikwa ne intramedullary nailing.
Isa chinzvimbo chekutungamira pini, fluoroscopy
Repositioning the subtalar joint
Isa iyo yekumisikidza furemu, rovera iyo intramedullary mbambo, uye gadzirisa ne maviri 5 mm cannulated screws.
Maonero mushure mekuiswa kwe intramedullary nail.
Intramedullary nailing yakaratidza kubudirira mukurapa kweSanders mhando II uye III kuputsika kwecalcaneus. Kunyange zvazvo vamwe vanachiremba vakaedza kuishandisa kuSanders IV kuputsika, kuvhiyiwa kwekuderedza kwakanga kwakaoma uye kuderedza kwakakodzera hakuna kuwanikwa.
Munhu Wokuona: Yoyo
WA/TEL:+8615682071283
Nguva yekutumira: May-31-2023
