Kuchiza molakwika kwa mafupa a fifth metatarsal base fractures kungayambitse kusweka kwa mafupa osalumikizana kapena kuchedwa kwa mgwirizano, ndipo milandu yoopsa ingayambitse nyamakazi, yomwe imakhudza kwambiri moyo watsiku ndi tsiku wa anthu komanso ntchito zawo.
AzachilengedweStructure
Chigawo chachisanu cha metatarsal ndi gawo lofunika kwambiri la mzati wa mbali ya phazi, ndipo chimagwira ntchito yofunika kwambiri pakunyamula zolemera ndi kukhazikika kwa phazi. Chigawo chachinayi ndi chachisanu cha metatarsal ndi cuboid zimapanga cholumikizira cha metatarsal cuboid.
Pali minyewa itatu yolumikizidwa pansi pa metatarsal yachisanu, ma tendon a peroneus brevis omwe ali mbali ya dorsolateral ya tuberosity pansi pa metatarsal yachisanu; minofu yachitatu ya peroneal, yomwe si yamphamvu ngati peroneus brevis tendon, imayikidwa pa diaphysis kutali ndi metatarsal tuberosity yachisanu; plantar fascia Ma lateral fascicle inserts ali mbali ya plantar ya basal tuberosity ya metatarsal yachisanu.
Kugawa kwa kusweka kwa mafupa
Kusweka kwa maziko a metatarsal yachisanu kunagawidwa m'magulu awiri ndi Dameron ndi Lawrence,
Kusweka kwa Zone I ndi kusweka kwa metatarsal tuberosity;
Gawo II lili pamalo olumikizirana pakati pa diaphysis ndi proximal metaphysis, kuphatikizapo zolumikizira pakati pa mafupa a 4 ndi 5 a metatarsal;
Kusweka kwa Zone III ndi kusweka kwa stress kwa proximal metatarsal diaphysis kutali ndi 4th/5th intermetatarsal joint.
Mu 1902, Robert Jones anayamba kufotokoza mtundu wa kusweka kwa gawo lachiwiri la maziko a metatarsal yachisanu, kotero kusweka kwa gawo lachiwiri kumatchedwanso kusweka kwa Jones.
Kusweka kwa metatarsal tuberosity mu zone I ndi mtundu wofala kwambiri wa kusweka kwa maziko a metatarsal kachisanu, komwe kumapanga pafupifupi 93% ya kusweka konse, ndipo kumachitika chifukwa cha kupindika kwa plantar ndi varus violence.
Kusweka kwa mafupa m'chigawo chachiwiri kumapanga pafupifupi 4% ya kusweka konse pansi pa metatarsal yachisanu, ndipo kumachitika chifukwa cha kupindika kwa phazi ndi chiwawa chowonjezera. Chifukwa chakuti amapezeka m'dera lomwe magazi amaperekedwa pansi pa metatarsal yachisanu, kusweka kwa mafupa pamalo awa kumakhala kosavuta kuti kusagwirizana kapena kusweka kwa mafupa kuchedwe kuchira.
Kusweka kwa Zone III kumapanga pafupifupi 3% ya kusweka kwachisanu kwa maziko a metatarsal.
Chithandizo chachisamaliro
Zizindikiro zazikulu za chithandizo chokhazikika ndi monga kusuntha kwa kusweka kwa fupa kosakwana 2 mm kapena kusweka kokhazikika. Chithandizo chofala kwambiri ndi monga kuletsa kuyenda ndi mabandeji otambasuka, nsapato zolimba, kuletsa kuyenda ndi pulasitala, mapepala opondereza makatoni, kapena nsapato zoyendera.
Ubwino wa chithandizo chosamalira bwino mafupa ndi monga mtengo wotsika, kuvulala kosatha, komanso kulandiridwa mosavuta ndi odwala; kuipa kwake ndi monga kusweka kwakukulu kwa mafupa osalumikizana kapena mavuto ochedwa kugwirizana, komanso kuuma kwa mafupa mosavuta.
OpaleshoniTkukonzanso
Zizindikiro za opaleshoni yachisanu cha kusweka kwa maziko a metatarsal ndi izi:
- Kusuntha kwa fracture yoposa 2 mm;
- Kuphatikizidwa kwa > 30% ya pamwamba pa articular ya cuboid distal mpaka metatarsal yachisanu;
- Kusweka kwa minofu;
- Kusweka kwa mafupa kuchedwa kapena kusagwirizana kwa mafupa pambuyo pa chithandizo chosachitidwa opaleshoni;
- Odwala achinyamata omwe ali ndi zochita zambiri kapena othamanga masewera.
Pakadali pano, njira zochizira matenda zomwe zimagwiritsidwa ntchito kwambiri pochiza kusweka kwa maziko a fifth metatarsal ndi monga Kirschner wire tension band internal fixation, anchor suture fixation ndi ulusi, screw internal fixation, ndi hook plate internal fixation.
1. Kukhazikitsa kwa waya wa Kirschner
Kukhazikitsa chingwe cholumikizira waya wa Kirschner ndi njira yachikhalidwe yochitira opaleshoni. Ubwino wa njira imeneyi ndi monga kupeza mosavuta zipangizo zolumikizira mkati, mtengo wotsika, komanso kukanikiza bwino. Zoyipa zake ndi monga kuyabwa pakhungu komanso chiopsezo cha kumasuka kwa waya wa Kirschner.
2. Kukhazikitsa maukonde pogwiritsa ntchito zomangira zolumikizidwa
Kukonza suture ya nangula pogwiritsa ntchito ulusi ndikoyenera kwa odwala omwe ali ndi fracture ya avulsion pansi pa fifth metatarsal kapena omwe ali ndi zidutswa zazing'ono zosweka. Ubwino wake ndi monga kudula pang'ono, opaleshoni yosavuta, komanso kuchotsedwa kwachiwiri. Zoyipa zake ndi monga chiopsezo cha prolapse ya nangula kwa odwala omwe ali ndi osteoporosis.
3. Kukhazikika kwa misomali m'malo obowoka
Skurufu yokhala ndi dzenje ndi njira yodziwika padziko lonse yochizira kusweka kwa maziko a fifth metatarsal, ndipo ubwino wake ndi monga kukhazikika kolimba komanso kukhazikika bwino.
Mwachipatala, pa ma fracture ang'onoang'ono pansi pa metatarsal yachisanu, ngati ma screw awiri agwiritsidwa ntchito pomangirira, pali chiopsezo cha refracture. Pamene screw imodzi ikugwiritsidwa ntchito pomangira, mphamvu yotsutsana ndi kuzungulira imachepa, ndipo malo ake amatha kubwezeretsedwanso.
4. Mbale yolumikizidwa yokhazikika
Kukhazikika kwa mbale ya hook kuli ndi zizindikiro zambiri, makamaka kwa odwala omwe ali ndi kusweka kwa avulsion kapena kusweka kwa mafupa. Kapangidwe kake kamagwirizana ndi maziko a fupa lachisanu la metatarsal, ndipo mphamvu yokakamiza yokhazikika ndi yayikulu. Zoyipa za kukhazikitsa mbale ndi monga mtengo wokwera komanso kuvulala kwakukulu.
Snkhani
Pochiza kusweka kwa mafupa pansi pa fupa lachisanu la metatarsal, ndikofunikira kusankha mosamala malinga ndi momwe munthu aliyense alili, zomwe dokotala wakumana nazo komanso luso lake, ndikuganizira mokwanira zomwe wodwalayo akufuna.
Nthawi yotumizira: Juni-21-2023
