Kukonzekera kwamkati ndi fupa la mafupa
Kuphatikizika kwa ankle ndi mbale ndi zomangira ndi njira yodziwika bwino yopangira maopaleshoni pano. Locking mbale mkati fixation wakhala chimagwiritsidwa ntchito maphatikizidwe akakolo. Pakadali pano, kuphatikizika kwa ankle ankle kumaphatikizanso mbale zam'mbuyo ndi lateral plate ankle fusion.
Chithunzi pamwambapa chikuwonetsa mafilimu a X-ray asanayambe kapena atatha opaleshoni ya osteoarthritis ya ankle osteoarthritis yokhala ndi mbale yotsekera yamkati yophatikizira mafupa olumikizana.
1. Njira yakutsogolo
Njira yam'mbuyo ndiyo kupanga kutsogolo kwakutali kotalikirana pakati pa malo olumikizana ndi bondo, kudula wosanjikiza ndi wosanjikiza, ndikulowa m'malo a tendon; kudula kapisozi olowa, kuulula tibiotalar olowa, chotsani chichereŵechereŵe ndi subchondral fupa, ndi kuika m'mwamba mbale pa M'mbuyo pa bondo.
2. Njira yotsatirira
Njira yotsatirira ndiyo kudula mafupa osteotomy pafupifupi 10 cm pamwamba pa nsonga ya fibula ndikuchotsa chitsa chonsecho. Chitsa cha fupacho chimachotsedwa kuti akamezedwe. The fusion surface osteotomy imatsirizidwa ndikutsukidwa, ndipo mbaleyo imayikidwa kunja kwa mgwirizano wa m'chiuno.
Ubwino wake ndikuti mphamvu yokhazikika ndiyokwera kwambiri ndipo kukhazikika kumakhala kolimba. Itha kugwiritsidwa ntchito kukonzanso ndi kukonzanso kwa varus kwambiri kapena valgus deformity ya olowa olowa ndi mafupa ambiri zofooka pambuyo kuyeretsa. Chophatikizika chopangidwa ndi anatomiki chimathandizira kubwezeretsa mawonekedwe abwinobwino a m'chiuno. Malo.
Choyipa ndichakuti minofu yambiri ya periosteum ndi yofewa m'malo opangira opaleshoni iyenera kuchotsedwa, ndipo mbale yachitsulo imakhala yolimba, yomwe imakhala yosavuta kukwiyitsa ma tendon ozungulira. Chitsulo chachitsulo chomwe chimayikidwa kutsogolo n'chosavuta kukhudza pansi pa khungu, ndipo pali chiopsezo china.
kukonza msomali wa intramedullary
M'zaka zaposachedwa, kugwiritsa ntchito retrograde intramedullary msomali wamtundu wa ankle arthrodesis pochiza matenda a nyamakazi yapakatikati pang'onopang'ono kwagwiritsidwa ntchito kuchipatala.
Pakali pano, njira yokhomerera intramedullary imagwiritsa ntchito misomali yapakatikati pa mfundo ya bondo kapena nsonga ya anteroinferior lateral ya ulusi poyeretsa pamwamba kapena kulumikiza mafupa. Msomali wa intramedullary umalowetsedwa kuchokera ku calcaneus kupita ku tibial medullary cavity, zomwe zimakhala zopindulitsa kuwongolera zolakwika ndikulimbikitsa kuphatikizika kwa mafupa.
Ankle osteoarthritis kuphatikizapo subtalar nyamakazi. Mafilimu a preoperative anteroposterior ndi lateral X-ray adawonetsa kuwonongeka kwakukulu kwa mgwirizano wa tibiotalar ndi subtalar joint, kugwa pang'ono kwa talus, ndi mapangidwe a osteophyte kuzungulira mgwirizano (kuchokera ku 2)
The divergent maphatikizidwe wononga wononga implantation ngodya ya locking hindfoot maphatikizidwe intramedullary msomali ndi Mipikisano ndege fixation, amene angathe kukonza olowa enieni kuti anasakaniza, ndi distal mapeto ndi ulusi loko dzenje, amene mogwira kukana kudula, kasinthasintha, ndi kukokera-kunja, kuchepetsa chiopsezo chochotsa wononga .
Kuphatikizika kwa tibiotalar ndi subtalar joint kudawululidwa ndikukonzedwa kudzera munjira ya lateral transfibular, ndipo kutalika kwa chodulira pakhomo la msomali wa plantar intramedullary kunali 3 cm.
Msomali wa intramedullary umagwiritsidwa ntchito ngati kukhazikika kwapakati, ndipo kupsinjika kwake kumabalalika pang'ono, komwe kumatha kupewetsa kutsekereza kupsinjika komanso kumagwirizana kwambiri ndi mfundo za biomechanics.
Filimu ya Anteroposterior ndi lateral X-ray 1 mwezi pambuyo pa opaleshoni inasonyeza kuti mzere wa phazi lakumbuyo unali wabwino ndipo msomali wa intramedullary unakhazikitsidwa modalirika.
Kugwiritsa ntchito misomali ya retrograde intramedullary misomali kuphatikizika kwa minofu yofewa kumatha kuchepetsa kuwonongeka kwa minofu yofewa, kuchepetsa necrosis yapakhungu, matenda ndi zovuta zina, ndipo kungapereke kukhazikika kokwanira kokhazikika popanda pulasitala wothandiza wakunja pambuyo pa opaleshoni.
Chaka chimodzi pambuyo pa opaleshoni, mafilimu abwino ndi ozungulira olemera a X-ray amasonyeza kuphatikizika kwa bony kwa mgwirizano wa tibiotalar ndi subtalar joint, ndipo kuyanjanitsa kwa phazi lakumbuyo kunali kwabwino.
Wodwala amatha kudzuka pabedi ndi kulemera msanga, zomwe zimakulitsa kulolerana kwa wodwalayo komanso moyo wabwino. Komabe, chifukwa mgwirizano wa subtalar uyenera kukhazikitsidwa panthawi imodzimodziyo, sikuvomerezeka kwa odwala omwe ali ndi mgwirizano wabwino wa subtalar. Kusungidwa kwa mgwirizano wa subtalar ndi njira yofunikira yolipirira ntchito ya mgwirizano wamagulu kwa odwala omwe ali ndi mgwirizano wamagulu.
wononga mkati fixation
Percutaneous screw internal fixation ndi njira yowonjezera yowonjezera mu ankle arthrodesis. Ili ndi ubwino wa opaleshoni yochepetsetsa pang'ono monga kudula pang'ono ndi kutaya magazi ochepa, ndipo imatha kuchepetsa kuwonongeka kwa minofu yofewa.
Mafilimu a X-ray a anteroposterior ndi lateral a cholowa cham'bowo asanayambe kuchitidwa opaleshoni anawonetsa nyamakazi yoopsa ya bondo lamanja ndi varus deformity, ndipo mbali pakati pa tibiotalar articular surface inayesedwa kukhala 19 ° varus.
Kafukufuku wasonyeza kuti kukonza kosavuta ndi 2 mpaka 4 lag screws kumatha kukwaniritsa kukhazikika kokhazikika ndi kuponderezana, ndipo ntchitoyo ndi yosavuta komanso mtengo wake ndi wotsika mtengo. Ndilo kusankha koyamba kwa akatswiri ambiri pakali pano. Kuphatikiza apo, kuyeretsa pang'onopang'ono kwa akakolo kumatha kuchitidwa pansi pa arthroscopy, ndipo zomangira zimatha kuyikidwa molunjika. Kuvulala kwa opaleshoni kumakhala kochepa ndipo zotsatira zochiritsira ndizokhutiritsa.
Pansi pa arthroscopy, dera lalikulu la articular cartilage defect likuwoneka; pansi pa arthroscopy, chipangizo chotchedwa cone microfracture chimagwiritsidwa ntchito pochiza articular pamwamba
Olemba ena amakhulupirira kuti 3 screw fixation ikhoza kuchepetsa chiwopsezo cha postoperative non-fusion, ndipo kuchuluka kwa maphatikizidwe kumatha kukhala kogwirizana ndi kukhazikika kwamphamvu kwa 3 screw fixation.
Kanema wotsatira wa X-ray patatha milungu 15 opaleshoniyo adawonetsa kuphatikizika kwa mafupa. Chiwerengero cha AOFAS chinali 47 mfundo isanayambe kugwira ntchito ndi 74 mfundo 1 chaka pambuyo pa ntchito.
Ngati zomangira zitatu zimagwiritsidwa ntchito pokonza, pafupifupi zomangira ziwiri zoyambira zimayikidwa motsatana kuchokera kumbali ya anteromedial ndi anterolateral ya tibia, kudutsa pamtunda kupita ku thupi la talar, ndipo zomangira zachitatu zimayikidwa kuchokera kuseri kwa tibia kupita ku mbali yapakati ya talus.
Njira yothetsera kunja
Zokonzera zakunja zinali zida zakale kwambiri zomwe zidagwiritsidwa ntchito mu ankle arthrodesis ndipo zidasintha kuchokera ku 1950s mpaka pano Ilizarov, Hoffman, Hybrid ndi Taylor space frame (TSF).
Bondo lotseguka kuvulala ndi matenda kwa zaka 3, bondo arthrodesis 6 miyezi kulamulira matenda
Kwa matenda ena ovuta a nyamakazi omwe ali ndi matenda obwerezabwereza, kuchita maopaleshoni mobwerezabwereza, khungu losauka komanso minofu yofewa, kupangika kwa zipsera, kuwonongeka kwa mafupa, kufooka kwa mafupa ndi zotupa zam'deralo, mphete ya Ilizarov yakunja imagwiritsidwa ntchito kwambiri kuphatikizira mfundo za akakolo.
Chokonzera chakunja chokhala ngati mphete chimakhazikika pa ndege ya coronal ndi ndege ya sagittal, ndipo imatha kupereka kukhazikika kokhazikika. Kumayambiriro kwa kunyamula katundu, kumakakamiza kutha kwa fracture, kulimbikitsa mapangidwe a callus, ndikuwongolera kuchuluka kwa maphatikizidwe. Kwa odwala omwe ali ndi chilema chachikulu, chowongolera chakunja chimatha kukonza pang'onopang'ono chilemacho. Zoonadi, kuphatikizika kwachitsulo chakunja kudzakhala ndi mavuto monga kusokonezeka kwa odwala kuvala komanso chiopsezo cha matenda a singano.
Contact:
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Email:liuyaoyao@medtechcah.com
Nthawi yotumiza: Jul-08-2023
