Navicular malunion anoitika munenge 5-15% yemapfupi ese acraji eiyo Navicular pfupa, ne Navicular necrosis inoitika mune angangoita 3%. Zvinhu zvine njodzi zveNavicular malunion zvinosanganisira yakarasikirwa kana kunonoka kuongororwa, proximal kuswededzwa kweiyo fracture mutsara, kutamiswa kwakakura kupfuura 1 mm, uye kupwanyika neCarral kusagadzikana. Kana ikasiyiwa isina kurapwa, Navicular Osteochondral nonunion inowanzobatanidzwa nehurongwa hwekurwara, zvakare dzinozivikanwa seNavicular osteochondral nonunion neLollaping osteoarthritis.
Bone Grainting ne kana pasina chisungo chelap chinogona kushandiswa kurapa navicular osteochondral nonunion. Nekudaro, kune varwere vane osteonecrosis yeproxalarrosis yeiyo Navicular pfupa, mhedzisiro yekurova kwepopi pasina tip isina kugutsikana, uye iyo pfupa rekuporesa rinongova makumi mana muzana -67%. Mukupesana, mwero wekuporesa wekubereka mapfupa ane vascularised flaps inogona kuve yakakwira se88% -91%. Iyo huru Vascularised Bone Flaps muClinical Muitiro anosanganisira 1,2-ICSRA-YAKAITWA BONESI YEMAHARA, NDIMELIC CONGLLARD BONE (MFC VBG), zvinogutsa. Iyo yemahara mfc vbg yakaratidzwa kuti ibudirire mukurapa kweNavicular Fraces ne metacarpal kudonha, uye iyo MFC vbg inoshandisa bazi rebvudzi rebvudzi sebazi guru trophic. Kuenzaniswa nedzimwe flaps, iyo MFC vbg inopa rutsigiro rwakakwana rwechimiro chekudzorera chimiro cheNavicular, kunyanya muNavicular fracture neakakotama musana deformity (Mufananidzo 1). Mukurapa kweNavicular Osteochondral osteonecrosis kudonha, iyo 1,2-icsra-yakaputirwa distal flap yeiyo 40%, nepo mfc vbg ine maronda ekupora kweanopora.
Mufananidzo 1. Kuvhiringidza kweiyo Navicular pfupa ne "Akakotama kumashure" deformity, ct inoratidzira bhajeti riri pakati pemapfupa eNavical nekona inenge 90 °.
Kugadzirira Kwazvo
Mushure mekuongororwa kwepanyama kwechiuno chakakanganisika, kufungidzira zvidzidzo kunofanirwa kuitwa kuti uongorore mwero wekudonha kwechiuno. Plain radiographs inobatsira kusimbisa nzvimbo yekupwanya, iyo degree rekutungamirwa, uye kuvapo kwekuzorora kana sclerosis yekupedzisira yakaputsika. Posterior anterior mifananidzo inoshandiswa kuongorora chiuno chekupedzisira, dortil kusagadzikana kwechiuno (kushandurwa) kusimudzira ruoko (urefu) we ≤1.52 kana radial radial cona yeakakura kupfuura 15 °. MRI kana CT inogona kubatsira kuongorora malalignment yeiyo navicular pfupa kana osteonecrosis. Yakatevera radiographs kana oblique sagittal ct yeiyo Navicular Barle>
Zviratidzo uye zvinokanganisa:
Navicular osteochondral nonunion pamwe nekukotama kudzoserwa kudzoka uye Dishi; Mri anoratidza ischemic necrosis yeiyo Navicular pfupa, Intrapaepaperative kusunungura kweiyo tournet uye kucherechedzwa kwekupwanya yakaputsika kupunyuka kweNavicular pfupa richiri chena sclerotic pfupa. Kukundikana kweiyo yekutanga wedge bafiting kana screw yemukati kugadziriswa kunoda hombe vgb yeBone yeBrofing (>CM3). chaiyo kana intraoperative yakawanikwa yeiyo osteoarthritis yeiyo radial carpal Joint; Kana yakakosha Navicular Hune neLollapsing Osteoarthritis yakaitika, Navicular Deneroty, Navicular Osteotomy, Proximal Carpal Carpal Osteoty, Etlis Fungisai, etc., inogona kudikanwa; Navicular malunion, proximal necrosis, asi neyakajairika navicular pfumo (semuenzaniso, risiri-rakadzingwa neNavicular bracture neine murombo reropa kune proximal pole); kupfupika kweNavicular malunion pasina osteonecrosis. (1,2-icsra inogona kushandiswa sechinhu chinotsiva ye distal radius flap).
Yakaiswa anatomy
Iyo MFC vbg inopiwa neyekuverengeka madiki madiki madiki midziyo yekukanganisa (zvinoreva kuti 30, 20-50) Iyi midziyo yekurova yaive ichinyanya kugoverwa neyekuburitsa artery Iyo Dga yakatanga kubva kune yepamusoro fory yechikadzi proynal kune iyo medial everylus yemuMolloolus, kana ari chinhambwe chegumi neyekupedzisira. " Iyo Dga inotangira kubva kune yepamusoro femeral artery pa 13.7 cm (10.5 cm (10.5 cm (10.5 cm) proximal kune iyo manzwi ekutarisa Naizvozvo, kana iyo dga kana smga inogamuchirika, kunyangwe iyo yekutanga iri yakakodzera iyo tibiae nekuda kwekureba uye kuyamwisa chombo.
Fig. 2
Mufananidzo 3
Kuvhiya Kuwanikwa
Murwere anoiswa pasi pegreatesia mune chinzvimbo chepamusoro, aine ruoko rwakakanganisika rwakaiswa pane tafura yekuvhiya. Kazhinji, anopa bone flap anotorwa kubva kuIpsialateral medial echikadzi, kuitira kuti murwere afambe nemaruva mushure mekuvhiyiwa. Ibvi rekuzvidzora rinogona kusarudzwa zvakare kana paine nhoroondo yekare trauma kana kuvhiya kune rumwe rutivi rwebvi. Ibvi racho rakachinjika uye hip hwokunze rakatenderedzwa, uye tourniquets dzinoiswa kune ese maviri ekumusoro uye akadzika magumo. Iyo nzira yekuvhiya yaive yekutanga RWSE nzira, Cm proximal kune iyo tripled Carpal Tunaki yeFirti Iyo Tendon Sheath yeRadilisimus Tendon yakaiswa uye iyo Tendon inokweverwa, uye iyo Ladial Plancular Yemusoro weTisuculence yeNagicular Bone kuti ibvumidze kuratidzwa kweiyo Navicular Bone (Mufananidzo 4). Simbisa iyo nharaunda yekusaziva, mhando yehunyanzvi cartilage uye degree reIschaemia yeNavicular pfupa. Mushure mekusunungura turentiquet, tarisa proximal danda reNavicular pfupa rekupaza kubuda ropa kuti uone kana paine ischemic necrosis. Kana iyo Navicular necrosis isina kubatana neyeRadial Carpal kana Intercarpal Arthritis, MFC vgb inogona kushandiswa.
Mufananidzo 4. Navicular Surgical maitiro: (a) Chiitiko chinotanga 8 Cm Profestever Carpicured Carpi Terpi . (C) ziva iyo nzvimbo yeiyo Navicular Osseous kuderedzwa.
A 15-20 cm refu incision inoitwa proximal kune iyo mbopa yemubatanidzwa weiyo mwero weMFCASE FUNDSE (Fig. 5). Iyo Vascular Pealicle inosunungurwa proclelly, kutora hanya kuchengetedza iyo periesteum uye midziyo yehondo yedhiramu pane iyo bony nzvimbo.
Mufananidzo 5. Kuvhiya Kuwanikwa kweMFC: (a) A 15-20 cm kwenguva refu incisional inoitwa padhuze nepashure pepfungwa yechikadzi yemukati kubva pabvi miti yebvi. .
Kugadzirira kweiyo Navicular Bone
Iyo Navicular Dishi Disformity inofanirwa kururamisa uye iyo nzvimbo yeiyo osteochondral bill fraft yakagadzirirwa isati yasimudzwa nekuchinjisa ruoko kuti udzore radial radial radial radial radies A 0.0625-tsoka (ingangoita 1.5-mm) Kirschner Pin inodhakwa kubva kuDorsally kuFace Lunate Inoshamisa Iyo nzvimbo yakatsvaira yakajekeswa neiyo nyoro nyoro uye yakaenderera mberi yakavhurika neplate kupararira. Chidimbu chidiki chekudzoreredza chinoshandiswa kubhururuka pfupa uye simbisa kuti iyo yekuisa iyo yakawedzera kufanana kwechimiro, chinoda kuti iyo Navicular GAP iine garandi rakaputika pane pamba pane pane darsal side. Mushure mekuvhura gap, iko kuremara kunoyerwa mumatatu matatu kuti uone kukura kweiyo pfupa graft, inowanzoitika 10-12 mm pakureba kwemativi ese egraft.
Mufananidzo 6. Kugadziriswa kweiyo yakakotama yekudzora yeNavicular, ine fluoroscopic yekubhururuka kwechiuno kudzoreredza yakajairika radial-lunar alignment. A 0.0625-tsoka (ingangoita 1.5-mm) Kirschner pini yeNavicular Pfuma yekugadzirisa metacarl
Osteoty
Nzvimbo yeVasculisedised yeiyo Medial fembol centyle inosarudzwa senzvimbo yePfupa Exction, uye nharaunda yePfupa Exction yakanyorwa zvakakwana. Ngwarira kuti urege kukuvadza iyo medial collateral ligrament. Iyo periosteum yakaiswa, uye rectangular bone yakakora saizi yeiyo flap inocheka neyekudzokorora 7). Chenjera chinofanira kutorwa kuti chisapatsanure periosteum, pfupa rekoramu, uye rinogona kushaikwa pfupa rekuputika. Iyo yakadzika magumo ekupedzisira anofanira kusunungurwa kuti urege kuyerera kweropa kuburikidza nepfupi, uye vascular pedicle inofanira kusunungurwa padhuze neinenge matanhatu cm kuti ibvumidze kutevera kusuwa kwemasvomhu. Kana zvichidikanwa, chidiki chidiki chefupi pfupa rinogona kuenderera mberi mukati mekondiri rechikadzi. Iyo yechikadzi cyraylar yakaremara inozadzwa neine pfupa graft kutsiva, uye incision inodururwa uye yakavharwa dura nedanda.
Mufananidzo 7. MFC Bone Flap Kubviswa. . .
Flap kusimbisa uye kugadziriswa
Iyo pfupa racho rakacheneswa kune rakakodzera chimiro, kutora hanya kuti urege kumanikidza iyo Vascular pedicle kana strip the periostum. Iyo flap yakanyoroveswa zvinyoro-nyoro munzvimbo yeiyo Navicular pfupa kuremara, kudzivisa kufunga, uye kugadziriswa nehombodo yeNavicular screws. Kuchengetwa kwakatorwa kuti uve nechokwadi chekuti mugungwa wePalmar weiyo yakamiswa pfupa block yaive svutugadzike yemahombekombe yechikepe kana kuti yaive kushungurudzika zvishoma kuti udzivise. Fluoroscopy yakaitwa kuti isimbise Navicular Bone morphology, mutsara wesimba uye screw chinzvimbo. AnastomoSE The Vascular Flap artery kune radial artery magumo kudivi uye iyo venous tip kune iyo radial artery shamwari yekupera (Mufananidzo 8). Iyo yakabatana capsule yakagadziriswa, asi nzvimbo dzevascular inodzivirirwa.
Mufananidzo 8. Pfupa Flap Kupinza, kugadziriswa, uye kusimuka anastomosis. Iyo pfupa rakanyorova rakanyorova munzvimbo yeiyo Navicular pfupa kuremara uye yakagadziriswa nehombodo navicular screws kana kirschner mapini. Chenjera chinotorwa kuti metacarpal margin yeiyo yakamiswa pfupa block inobhururuka neiyo metacarpal margin yechikepe cheNavicular pfupa kana kushungurudzika kushungurudzika kuti udzivise. Anastomosis yemasendimendi elap artery kune radial artery akaitwa magumo kusvika kumagumo, uye tip yeiyo yerudzi kune radial artery shamwari yakaitwa kupera.
Kudzoserwa Kudzoserwa
Oral Aspirin 325 MG pazuva (kwemwedzi 1), postopenger ur uremu-kutakura kwemakumbo akakanganisika anotenderwa, brok brak inogona kuderedza kusagadzikana kwemurwere, zvichienderana nekugona kwemurwere kuti ufambe panguva yakafanira. Tsigiro yekudzokorora yeimwe crutch imwe inogona kuderedza kurwadziwa, asi kutsigirwa kwenguva refu kwemapendero hazvidikanwa. Mitezo yakabviswa 2 vhiki mushure mekuvhiyiwa uye mauenster kana ruoko rurefu kuenda kugunwe rakakandwa rakachengetwa munzvimbo yemavhiki matatu. Mushure meizvozvo, ruoko rwepfupi kuenda kugunwe rakashandiswa kusvika pakupwanya kupwanya. X-ray inotorwa pana 3-6 vhiki inopindirana, uye kupararira kupora kunosimbiswa neCT. Pashure pazvo, mabasa anoshanda uye anowedzera uye ekuwedzera anofanirwa kutangwa zvishoma nezvishoma, uye kukura uye kuwanda kwekurovedza muviri kunofanira kuwanda zvishoma nezvishoma.
Zvinetso Zvakakura
Zvinonetsa zvikuru zvebvi zvakabatana zvinosanganisira kupfugama kurwadziwa kana kukuvara. Kurwadziwa kwebvi kunonyanya kuitika mukati memavhiki matanhatu mushure mekuvhiyiwa, uye hapana kurasikirwa kwekunzwa kana kurwadza neuromsa nekuda kwekukuvara kweSaphenous nerve kwakawanikwa. Iyo mainini yemawoko manyoro yaisanganisira Refractor's Bone nontaon, kurwadziwa, kusanzwisisika, kushaya simba, kupfupika mapfupa
Yemahara medial echikadzi condylarlised bone bafiting yehuputi dzisingasviki neProximal Pole necrosis uye Carrosis
Kutumira Nguva: May-28-2024
