Kukhazikika kwamkati ndi mbale ya fupa
Kulumikiza akakolo ndi mbale ndi zomangira ndi njira yofala kwambiri yochitira opaleshoni pakadali pano. Kulumikiza mkati mwa plate yotseka kwagwiritsidwa ntchito kwambiri polumikiza akakolo. Pakadali pano, kuphatikiza akakolo a plate kumaphatikizapo kuphatikiza anterior plate ndi lateral plate.
Chithunzi pamwambapa chikuwonetsa mafilimu a X-ray asanayambe komanso atachitidwa opaleshoni ya osteoarthritis ya ankle traumatic yokhala ndi anterior locking plate fixation internal joint fusion
1. Njira yoyambira
Njira yakutsogolo ndi kupanga chotupa cha anterior longitudinal pakati pa malo olumikizirana akakolo, kudula gawo ndi gawo, ndikulowa m'malo mwa tendon; kudula kapisozi yolumikizirana, kuwonetsa cholumikizira cha tibiotalar, kuchotsa cartilage ndi fupa la subchondral, ndikuyika mbale yakutsogolo pa Anterior ya akakolo.
2. Njira yolunjika
Njira yolumikizira mbali ndi kudula osteotomy pafupifupi 10 cm pamwamba pa nsonga ya fibula ndikuchotsa chitsa chonse. Chitsa cha fupa chochotsedwa chimachotsedwa kuti chikalumikizidwe ndi mafupa. Osteotomy yolumikizana pamwamba imamalizidwa ndikutsukidwa, ndipo mbaleyo imayikidwa kunja kwa bondo.
Ubwino wake ndi wakuti mphamvu yokhazikika ndi yokwera ndipo kukhazikikako ndi kolimba. Kungagwiritsidwe ntchito kukonza ndi kukonzanso kuwonongeka kwakukulu kwa varus kapena valgus pa bondo ndi zolakwika zambiri zamafupa mutatsuka. Mbale yolumikizira yopangidwa mwachibadwa imathandiza kubwezeretsa kapangidwe kabwino ka bondo. Malo.
Vuto lake ndilakuti minofu yambiri ya periosteum ndi yofewa pamalo ochitira opaleshoni iyenera kuchotsedwa, ndipo mbale yachitsulo ndi yokhuthala, zomwe zimakhala zosavuta kukwiyitsa minofu yozungulira. Mbale yachitsulo yomwe imayikidwa patsogolo ndi yosavuta kukhudza pansi pa khungu, ndipo pali chiopsezo china.
kukonza misomali mkati mwa medullary
M'zaka zaposachedwapa, kugwiritsa ntchito mankhwala a retrograde intramedullary ankle arthrodesis pochiza matenda a nyamakazi a m'makonde kwakhala kukugwiritsidwa ntchito pang'onopang'ono kuchipatala.
Pakadali pano, njira yopangira misomali ya intramedullary imagwiritsa ntchito kudula kwapakati kwa bondo kapena kudula kwa mbali ya fibula ya anterior inferior poyeretsa pamwamba pa bondo kapena kulumikiza mafupa. Msomali wa intramedullary umalowetsedwa kuchokera ku calcaneus kupita ku tibial medullary cavity, zomwe zimathandiza kukonza kupunduka kwa mafupa ndikulimbikitsa kuphatikizika kwa mafupa.
Matenda a mafupa a akakolo pamodzi ndi nyamakazi ya subtalar. Mafilimu a X-ray asanachite opaleshoni adawonetsa kuwonongeka kwakukulu kwa cholumikizira cha tibiotalar ndi cholumikizira cha subtalar, kugwa pang'ono kwa talus, ndi kupangika kwa mafupa ozungulira cholumikizira (kuchokera patsamba 2)
Ngodya yolumikizirana ya screw yolumikizirana ya msomali wa kumbuyo kwa phazi lakumbuyo ndi yolumikizirana m'njira zambiri, yomwe imatha kukonza cholumikizira chomwe chikufunika kulumikizidwa, ndipo kumapeto kwake ndi dzenje lotsekeka lokhala ndi ulusi, lomwe limatha kukana kudula, kuzungulira, ndi kutulutsa, kuchepetsa chiopsezo cha kuchotsedwa kwa screw.
Cholumikizira cha tibiotalar ndi cholumikizira cha subtalar chinawonekera ndikukonzedwa kudzera mu njira ya lateral transfibular, ndipo kutalika kwa chocheka pakhomo la msomali wa plantar intramedullary kunali 3 cm.
Msomali wa intramedullary umagwiritsidwa ntchito ngati cholumikizira chapakati, ndipo kupsinjika kwake kumakhala kosiyana pang'ono, zomwe zingapewe zotsatira zoteteza kupsinjika ndipo zimagwirizana kwambiri ndi mfundo za biomechanics.
Filimu ya X-ray ya anteroposterior ndi lateral patatha mwezi umodzi kuchokera pamene opaleshoni inasonyeza kuti mzere wa phazi lakumbuyo unali wabwino ndipo msomali wa intramedullary unakhazikika bwino.
Kuyika misomali ya retrograde intramedullary ku bondo lolumikizana kungachepetse kuwonongeka kwa minofu yofewa, kuchepetsa kupangika kwa khungu, matenda ndi zovuta zina, komanso kungapereke kukhazikika kokwanira popanda kupangika kwakunja kwa plaster pambuyo pa opaleshoni.
Chaka chimodzi pambuyo pa opaleshoni, mafilimu a X-ray abwino komanso olemera omwe amawonetsa kuphatikizika kwa mafupa a cholumikizira cha tibiotalar ndi cholumikizira cha subtalar, ndipo kulinganiza kwa phazi lakumbuyo kunali bwino.
Wodwalayo amatha kudzuka pabedi ndi kunyamula kulemera msanga, zomwe zimapangitsa kuti wodwalayo azitha kupirira komanso kukhala ndi moyo wabwino. Komabe, chifukwa chakuti cholumikizira cha subtalar chiyenera kukonzedwa nthawi yomweyo, sichikulimbikitsidwa kwa odwala omwe ali ndi cholumikizira chabwino cha subtalar. Kusunga cholumikizira cha subtalar ndi njira yofunika kwambiri yolipirira ntchito ya cholumikizira cha bondo mwa odwala omwe ali ndi cholumikizira cha bondo.
kukonza mkati mwa screw
Kukonza mkati mwa screw ndi njira yodziwika bwino yokonza arthrodesis ya bondo. Ili ndi ubwino wa opaleshoni yochepa kwambiri monga kudula pang'ono komanso kutaya magazi pang'ono, ndipo imatha kuchepetsa kuwonongeka kwa minofu yofewa.
Mafilimu a X-ray a anteroposterior ndi lateral a bondo loyima opaleshoni isanayambe anasonyeza osteoarthritis yoopsa ya bondo lamanja yokhala ndi varus deformity, ndipo ngodya pakati pa tibiotalar articular surface inayesedwa kuti ndi 19° varus.
Kafukufuku wasonyeza kuti kulumikiza kosavuta ndi zomangira ziwiri kapena zinayi kungapangitse kuti zikhale zolimba komanso zomangika bwino, ndipo ntchitoyi ndi yosavuta ndipo mtengo wake ndi wotsika mtengo. Ndi chisankho choyamba cha akatswiri ambiri pakadali pano. Kuphatikiza apo, kuyeretsa pang'ono kwa akakolo kungachitike pogwiritsa ntchito arthroscopy, ndipo zomangira zitha kuyikidwa pakhungu. Kuvulala kwa opaleshoni ndi kochepa ndipo zotsatira zake zimakhala zokhutiritsa.
Pogwiritsa ntchito arthroscopy, malo ambiri okhala ndi vuto la cartilage ya articular amaoneka; pogwiritsa ntchito arthroscopy, chipangizo cha pointed cone microfracture chimagwiritsidwa ntchito pochiza pamwamba pa articular.
Olemba ena amakhulupirira kuti kukhazikika kwa screw 3 kungachepetse chiopsezo cha kusalumikizana pambuyo pa opaleshoni, ndipo kuwonjezeka kwa kuchuluka kwa fusion kungakhale kogwirizana ndi kukhazikika kwamphamvu kwa kukhazikika kwa screw 3.
Filimu yotsatira ya X-ray patatha milungu 15 opaleshoni itachitika inasonyeza kusakanikirana kwa mafupa. Chiwerengero cha AOFAS chinali mapointi 47 opaleshoni isanachitike ndipo mapointi 74 chaka chimodzi opaleshoni itatha.
Ngati zomangira zitatu zimagwiritsidwa ntchito pomangirira, malo oyerekeza omangira ndi akuti zomangira ziwiri zoyambirira zimayikidwa motsatana kuchokera mbali za anteromedial ndi anterolateral za tibia, kudutsa pamwamba pa articular kupita ku thupi la talar, ndipo zomangira zachitatu zimayikidwa kuchokera kumbuyo kwa tibia kupita kumbali yapakati ya talus.
Njira yokonzera kunja
Zipangizo zomangira zakunja zinali zipangizo zoyambirira zomwe zimagwiritsidwa ntchito pochiza ankle arthrodesis ndipo zasintha kuyambira m'ma 1950 mpaka pano za Ilizarov, Hoffman, Hybrid ndi Taylor space frame (TSF).
Kuvulala kwa bondo ndi matenda kwa zaka zitatu, arthrodesis ya bondo miyezi 6 mutachotsa matenda
Pa milandu yovuta ya nyamakazi ya akakolo yokhala ndi matenda obwerezabwereza, opaleshoni yobwerezabwereza, matenda a khungu ndi minofu yofewa ya m'deralo, mapangidwe a zipsera, zolakwika m'mafupa, osteoporosis ndi zilonda za matenda am'deralo, Ilizarov ring external fixator imagwiritsidwa ntchito kwambiri pochiza kuphatikiza cholumikizira cha akakolo.
Chogwirizira chakunja chooneka ngati mphete chimakhazikika pa korona ndi sagittal plane, ndipo chingapereke mphamvu yokhazikika yokhazikika. Poyamba kunyamula katundu, chimakakamiza kumapeto kwa fracture, chimalimbikitsa mapangidwe a callus, ndikuwonjezera kuchuluka kwa fusion. Kwa odwala omwe ali ndi vuto lalikulu, chogwirizira chakunja chimatha kukonza pang'onopang'ono deformity. Zachidziwikire, external fixator ankle fusion idzakhala ndi mavuto monga zovuta kwa odwala kuvala komanso chiopsezo cha matenda a singano.
Lumikizanani nafe:
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Email:liuyaoyao@medtechcah.com
Nthawi yotumizira: Julayi-08-2023
