Nzira yakajairika yekurapa mapfupa eganda remusoro (L) ndiyo nzira yekare yekurapa mapfupa eganda remusoro. Kunyangwe kuchekwa kwacho kuri kwakazara, kukuvara kwacho kwakareba uye nyama yakapfava inobviswa zvakanyanya, izvo zvinotungamira kune matambudziko akadai sekunonoka kubatana kwenyama yakapfava, necrosis, uye hutachiona. Pamwe chete nekutsvaga kwenzanga yazvino kwerunako rusina kupindira zvakanyanya, kurapwa kwekuvhiya kwemapfupa eganda remusoro kwarumbidzwa zvikuru. Chinyorwa chino chakaunganidza mazano masere.
Nekusvika padivi rakafara, chikamu chakamira chekucheka chinotanga zvishoma pedyo nemucheto wefibula uye pamberi peAchilles tendon. Chikamu chekucheka chinoitwa kure neganda rakakuvara rinopihwa netsinga ye lateral calcaneal uye chinoiswa pasi pe fifth metatarsal. Zvikamu zviviri izvi zvakabatana pachitsitsinho kuti zvigadzire kona yekurudyi yakakombama zvishoma. Chitubu: Campbell Orthopedic Surgery.
Pkuderedza kukwenya kweganda
Mumakore ekuma1920, Böhler akagadzira nzira yekurapa isinganyanyi kukuvadza calcaneus iri pasi pesimba remafupa, uye kwenguva yakareba mushure meizvozvo, kuderedza kupwanya kweganda nepaganda kwakava nzira huru yekurapa kupwanyika kwecalcaneus.
Yakakodzera kupwanyika kusina kusimuka kwezvidimbu zvemukati mejoini mujoini re subtalar, zvakaita seSanders type II uye mamwe makwande emutauro weSanders III.
Kune Sanders type III uye Sanders type IV dzakatyoka dzine kudonha kwakanyanya kwe subtalar articular surface, kuderedzwa kwekubaya kwakaoma uye zvakaoma kuderedza anatomic surface ye posterior articular ye calcaneus.
Zvakaoma kudzoreredza upamhi hwe calcaneus, uye deformity yacho haigone kugadziriswa zvakanaka. Inowanzo buda pamadziro e lateral e calcaneus nenzira dzakasiyana, zvichikonzera kukanganiswa kwe lower lateral malleolus ne lateral wall ye calcaneus, kusuduruka kana kudzvanywa kwe peroneus longus tendon, uye kubatwa kwe peroneal tendon. Syndrome, calcaneal impingement pain, uye peroneus longus tendonitis.
Maitiro eWesthues/Essex-lopresti. A. Lateral fluoroscopy yakasimbisa chidimbu chakaita serurimi chakaputsika; B. Kuongororwa kweCT kwakatambanuka kwakaratidza kutyoka kwerudzi rweSandess IIC. Chikamu chepamberi checalcaneus chakanyatsoonekwa mumifananidzo yese. S. Kufamba daro kamwe kamwe.
C. Kuchekwa kwemativi kwaisagona kushandiswa nekuda kwekuzvimba kwakanyanya kwenyama yakapfava uye maronda; D. Kuchekwa kwemativi kunoratidza pamusoro pemabvi (mutsetse une madotsi) uye kudonha kwetalar (mutsetse wakasimba).
E na F. Waya mbiri dzezvipikiri dzakaiswa dzakatenderedza chikamu chezasi chechidimbu chakaita serurimi, uye mutsetse une madotsi ndiwo mutsetse wekubatana.
G. Fukidza pfumo, bvisa pini yekutungamira, uye panguva imwe chete plantar fukisa midfoot kuti uderedze kutyoka: H. Skuruu imwe ine 6.5 mm yakasungirirwa pabhonzo re cuboid uye waya mbiri dzeKirschner dze 2.0 mm dzakaiswa subspan kuti dzirambe dzakaderera nekuda kwe calcaneus anterior comminution. Chitubu: Mann Foot and Ankle Surgery.
Sinus tarsi cheka
Kuchekwa kwacho kunochekwa 1 cm kubva pamucheto we fibula kusvika pasi pe metatarsal yechina. Muna 1948, Palmer akatanga kutaura nezvekuchekwa kudiki mu sinus tarsi.
Muna 2000, Ebmheim nevamwe vake vakashandisa nzira ye tarsal sinus mukurapa kwe calcaneal fractures.
o Inogona kuburitsa pachena zvizere subtalar joint, posterior articular surface uye anterolateral fracture block;
o Dzivisa zvakakwana mitsipa yeropa iri mu lateral calcaneal;
Hapana chikonzero chekucheka calcaneofibular ligament ne subperoneal retinaculum, uye nzvimbo yejoini inogona kuwedzerwa nekupindurwa kwakakodzera panguva yekuvhiyiwa, izvo zvine zvakanakira zvekucheka kudiki uye kubuda ropa kushoma.
Dambudziko nderekuti kuratidzwa kwacho hakuna kukwana, izvo zvinoderedza uye zvinokanganisa kudzikiswa kwekutsemuka uye kuiswa kwekugadzika kwemukati. Inokodzera chete kutsemuka kwecalcaneal kwerudzi rweSanders rudzi rweI nerudzi rweII.
Okucheka kudiki kweblique
Kugadziriswa kwechikamu che sinus tarsi, chakareba masendimita mana, chakaiswa pakati pe 2 cm pasi pe lateral malleolus uye chakafanana ne posterior articular surface.
Kana kugadzirira kwepamberi pekuvhiyiwa kwakakwana uye mamiriro ezvinhu achibvumira, zvinogonawo kuva nemhedzisiro yakanaka yekuderedza uye kugadzirisa mapfupa eSanders type II neIII intra-articular calcaneal fractures; kana subtalar joints fusion ichidikanwa kwenguva refu, kucheka kumwe chete kunogona kushandiswa.
PT Peroneal tendon. PF Posterior articular surface ye calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Kuchekwa kwepashure kwenguva refu
Kutanga kubva pakati pemutsetse uri pakati peAchilles tendon nemucheto we lateral malleolus, inotambanuka yakatwasuka ichidzika kusvika pajoini rechitsitsinho retalar, ine urefu hweinenge 3.5 cm.
Kuchekwa kushoma kunoitwa munyama yakapfava iri kure, pasina kukuvadza zvivako zvakakosha, uye pamusoro pemusana weparutivi petsoka unoonekwa zvakanaka. Mushure mekuchekwa nekucheka nekubvisa ganda, bhodhi remuviri rakaiswa pasi pekutungamirirwa kwemaonero emukati mekuvhiyiwa, uye sikuruu yemusana yakabatidzwa ndokugadziriswa pasi pekumanikidzwa.
Nzira iyi inogona kushandiswa pamhando yeSanders I, II, uye III, kunyanya pakuputsika kweposterior articular surface kana tuberosity.
Kuchekwa kweHerringbone
Kugadziriswa kwe sinus tarsi incision. Kubva pa 3 cm pamusoro pemucheto we lateral malleolus, pamwe nemuganhu wekumashure we fibula kusvika kumucheto we lateral malleolus, uye wobva wasvika pasi pe fourth metatarsal. Izvi zvinobvumira kudzikiswa kwakanaka uye kugadziriswa kwemavanga e calcaneal emhando yeSanders II ne III, uye zvinogona kuwedzerwa kana zvichidikanwa kuti zviratidze transfibula, talus, kana lateral column yetsoka.
Chigunwe cheLM chakatarisana negumbo. MT metatarsal joint. SPR Supra fibula retinaculum.
Akuderedza rheumatoid throscopically
Muna 1997, Rammelt akataura kuti subtalar arthroscopy inogona kushandiswa kuderedza posterior articular surface ye calcaneus kana munhu achiona zvakananga. Muna 2002, Rammelt akatanga kuita arthroscopically assisted percutaneous reduction uye screw fixation yeSanders type I and II breakdowns.
Kuvhiyiwa kwemapfupa emusana (subtalar arthroscopy) kunonyanya kuita basa rekutarisa nekubatsira. Kunogona kuona mamiriro enzvimbo yemapfupa emusana (subtalar articular surface) pasi pekuona zvakananga, uye kubatsira pakutarisa kuderedzwa uye kugadzika kwemukati. Kuvhiyiwa kwemajoini emusana (subtalar joint dissection) uye kubviswa kwemaosteophyte zvinogonawo kuitwa.
Zviratidzo zvacho zvakamanikana: chete kune Sanders type Ⅱ ine kuputsika kudiki kwe articular surface uye AO/OTA type 83-C2 fractures; nepo kune Sanders Ⅲ, Ⅳ uye AO/OTA type 83-C3 fractures ine articular surface collapse yakaita se83-C4 uye 83-C4 yakaoma kushandisa.
nzvimbo yemuviri
b. Kuongororwa kwetsoka netsoka. c. Kusvika panzvimbo pakatyoka nepajoini riri pasi petsoka.
Zvikushi zveSchantz zvakaiswa.
e. Kugadzirisazve uye kugadzirisa kwechinguvana. f. Mushure mekugadzirisazve.
g. Gadzirisa bhonzo repamusoro pechinguvana. h. Gadzirisa ne screws.
i. Kuongororwa kweCT mushure mekuvhiyiwa. j. Kuongororwa kweaxial mushure mekuvhiyiwa.
Pamusoro pezvo, nzvimbo yekubatana iri pasi pemajoini yakamanikana, uye kudhonza kana mabhureki zvinodiwa kutsigira nzvimbo yekubatana kuti zvive nyore kuisa arthroscope; nzvimbo yekubatanidza intra-articular idiki, uye kugadzirisa zvisina hanya kunogona kukonzera kukuvara kweiatrogenic cartilage pamusoro; nzira dzekuvhiya dzisina hunyanzvi dzinogona kukonzera kukuvara kwenzvimbo.
Pangioplasty yebharumu reganda
Muna 2009, Bano akatanga kupa zano rekuti nzira yekuwedzera mabharumu ekurapa kutyoka kwecalcaneal. Kune Sanders type II breakdowns, mabhuku mazhinji anoona kuti mhedzisiro yacho ndeyechokwadi. Asi mamwe marudzi ekutyoka akaoma.
Kana simende yemapfupa yapinda munzvimbo iri pasi pejoini panguva yekuvhiyiwa, inokonzera kupera kwenzvimbo yejoini uye kukanganiswa kwekufamba kwemajoini, uye kuwedzera kwebharumu hakuzove kwakaenzana nekuderedza kutyoka.
Kuiswa kwe cannula newaya yekutungamira pasi pe fluoroscopy
Mifananidzo ye airbag isati yatanga uye yapera
Mifananidzo yeX-ray neCT makore maviri mushure mekuvhiyiwa.
Parizvino, mienzaniso yekutsvagisa yetekinoroji yemabharuni inowanzova midiki, uye mizhinji yekutyoka ine mhedzisiro yakanaka inokonzerwa nechisimba chisina simba rakawanda. Kutsvagisa kwakawanda kuchiri kudiwa kune kutyoka kwecalcaneal kune kutyoka kwakanyanya. Kwakaitwa kwenguva pfupi, uye kushanda kwenguva refu uye matambudziko hazvisati zvajeka.
Cnzara yemukati memudullary
Muna 2010, nzara yemukati memedullary yakabuda. Muna 2012, M.Goldzak yakarapwa zvishoma nezvishoma pakutyoka kwetsandanyama yemukati memedullary. Zvinofanira kusimbiswa kuti kudzikira hakugone kuwanikwa nekurovera tsandanyama yemukati memedullary.
Isa pini yekutungamira nzvimbo, fluoroscopy
Kuisazve nzvimbo ye subtalar joint
Isa furemu yekumira, rovera chipikiri chemukati memedullary, wochigadzirisa ne screws mbiri dze 5 mm dzakaiswa mu cannulary
Maonero mushure mekuiswa kwenzara mukati memedullary.
Kurovera mapfupa mukati medumbu kwakaratidzwa kuti kunobudirira mukurapa kutyoka kweganda reSanders rerudzi rwechipiri nerwechitatu. Kunyangwe vamwe vanachiremba vakaedza kuishandisa pakukuvara kweganda reSanders IV, kuvhiyiwa kwekuderedza kwacho kwaive kwakaoma uye kudzikisa kwakakodzera kwaisagona kuwanikwa.
Munhu wekutaura naye: Yoyo
WA/TEL:+8615682071283
Nguva yekutumira: Chivabvu-31-2023
