Njira yodziwika bwino ya L ndiyo njira yachikale yochizira matenda a calcaneal fractures.Ngakhale kuwonetseredwa kumakhala kokwanira, kudulidwa kwake kumakhala kwautali ndipo minofu yofewa imachotsedwa kwambiri, zomwe zimabweretsa mosavuta zovuta monga kuchedwa kwa mgwirizano wa minofu yofewa, necrosis, ndi matenda.Pogwirizana ndi zomwe anthu amasiku ano akufunazo zokongoletsa pang'ono, chithandizo cha maopaleshoni ang'onoang'ono a calcaneal fractures chayamikiridwa kwambiri.Nkhaniyi yaphatikiza malangizo 8.
Pogwiritsa ntchito njira yowonjezereka, mbali yowongoka ya incision imayambira pang'ono mpaka kumapeto kwa fibula ndi kutsogolo kwa tendon Achilles.Mulingo wa ng'anjoyo umapangidwa motalikirana ndi khungu lophwanyika lomwe limadyetsedwa ndi mtsempha wakumbuyo wa calcaneal ndikuyika m'munsi mwa metatarsal yachisanu.Magawo awiriwa amalumikizidwa pachidendene kuti apange ngodya yakumanja yopindika pang'ono.Source: Campbell Orthopedic Surgery.
Pkuchepetsa kuthamanga kwa magazi
M'zaka za m'ma 1920, Böhler adapanga njira yochepetsera yochepetsera calcaneus pansi pa kugwedezeka, ndipo kwa nthawi yaitali pambuyo pake, kuchepetsa kupopera kwa percutaneous pansi pa kukoka kunakhala njira yodziwika bwino yochizira calcaneus fractures.
Ndiwoyenera kuthyoka popanda kusamutsidwa pang'ono kwa zidutswa za intraarticular mu subtalar joint, monga Sanders type II ndi zina za Sanders III zosweka zinenero.
Kwa ma Sanders amtundu wa III ndi ma fractures amtundu wa IV a Sanders okhala ndi kugwa koopsa kwapansi pamadzi, kuchepetsa poking kumakhala kovuta ndipo ndizovuta kukwaniritsa kutsitsa kwapambuyo kwapambuyo kwa calcaneus.
Ndizovuta kubwezeretsa m'lifupi mwa calcaneus, ndipo kupunduka sikungakonzedwe bwino.Nthawi zambiri amachoka pakhoma lakumbuyo la calcaneus mosiyanasiyana, zomwe zimapangitsa kuti malleolus a m'munsi awonongeke ndi khoma la calcaneus, kusamuka kapena kuponderezedwa kwa peroneus longus tendon, ndi kupindika kwa peroneal tendon.Syndrome, kupweteka kwa calcaneal impingement, ndi peroneus longus tendonitis.
Westhues/Essex-lopresti njira.A.Lateral fluoroscopy anatsimikizira kugwa lilime woboola pakati chidutswa;B. Ndege yopingasa CT scan inasonyeza Sandess mtundu wa IIC fracture.Chigawo cham'mbuyo cha calcaneus chikuwonekera bwino muzithunzi zonse ziwiri.S. Kunyamula mtunda mwadzidzidzi.
C. Kucheka kwapakati sikunagwiritsidwe ntchito chifukwa cha kutupa kwambiri kwa minofu yofewa ndi matuza;D. Lateral fluoroscopy kusonyeza articular pamwamba (mzere wa madontho) ndi talar kugwa (mzere wolimba).
E ndi F. Mawaya awiri a misomali opanda misomali anaikidwa mofanana ndi gawo lapansi la chidutswa chooneka ngati lilime, ndipo mzere wa madontho ndi mzere wolumikizana.
G. Flex bondo lolumikizana, tsegulani pini yolondolera, ndipo panthawi imodzimodziyo plantar sinthani pakati pa phazi kuti muchepetse kuthyoka: H. Mphindi imodzi ya 6.5 mm cannulated inakhazikitsidwa ku fupa la cuboid ndipo mawaya awiri a 2.0 mm Kirschner anali omveka. sungani kuchepa chifukwa cha calcaneus anterior comminution.Gwero: Mann Foot and Ankle Surgery.
Sinus tarsi incision
Kudulako kumapangidwa 1 cm kutali mpaka kunsonga kwa ulusi mpaka kumunsi kwa metatarsal yachinayi.Mu 1948, Palmer poyamba adanena kuti anadulidwa pang'ono mu sinus tarsi.
Mu 2000, Ebmheim et al.adagwiritsa ntchito njira ya tarsal sinus pochiza matenda a calcaneal fractures.
o Itha kuwonetsa bwino gawo la subtalar, posterior articular surface ndi anterolateral fracture block;
o Pewani mokwanira mitsempha ya m'mphepete mwa calcaneal;
o Palibe chifukwa chodula calcaneofibular ligament ndi subperoneal retinaculum, ndipo malo olowa nawo amatha kuwonjezedwa ndi kutembenuzidwa koyenera panthawi ya opaleshoni, yomwe ili ndi ubwino wodula pang'ono komanso kuchepa kwa magazi.
Choyipa ndichakuti kuwonetseredwa mwachiwonekere sikukwanira, komwe kumalepheretsa komanso kumakhudza kuchepetsedwa kwa fracture ndi kuyika kwa kukonza mkati.Ndizoyenera ku Sanders mtundu I ndi mtundu II calcaneal fractures.
Okung'amba pang'ono
Kusintha kwa sinus tarsi incision, pafupifupi 4 masentimita m'litali, pakati pa 2 cm pansi pa lateral malleolus ndi yofanana ndi kumbuyo kwa articular pamwamba.
Ngati kukonzekera kwa preoperative kuli kokwanira ndipo mikhalidwe ikuloleza, imatha kukhalanso ndi kuchepetsedwa kwabwino komanso kukonza kwa Sanders mtundu wa II ndi III wa intra-articular calcaneal fractures;ngati subtalar joint fusion ikufunika pakapita nthawi, kudulidwa komweko kungagwiritsidwe ntchito.
PT Peroneal tendon.PF Posterior articular pamwamba pa calcaneus.Ndi sinus tarsi.AP Calcaneal protrusion..
Posterior longitudinal incision
Kuyambira pakati pa mzere pakati pa tendon ya Achilles ndi nsonga ya lateral malleolus, imayenda molunjika mpaka pachidendene cha talar, ndi kutalika kwa pafupifupi 3.5 cm.
Kung'ambika pang'ono kumapangidwa mu minofu yofewa kwambiri, popanda kuwononga zida zofunika, ndipo kumbuyo kwa articular kumawonekera bwino.Pambuyo pofufuza ndi kuchepetsa, bolodi la anatomical linkayikidwa motsogozedwa ndi intraoperative percutaneous, ndipo percutaneous screw idakhomedwa ndikukhazikika pansi pa kukakamizidwa.
Njirayi ingagwiritsidwe ntchito pa mtundu wa Sanders I, II, ndi III, makamaka pazigawo zapambuyo zapambuyo kapena zophulika za tuberosity.
Herringbone kudula
Kusintha kwa sinus tarsi incision.Kuyambira 3 masentimita pamwamba pa nsonga ya lateral malleolus, m'mphepete chakumbuyo kwa ulusi mpaka kunsonga kwa lateral malleolus, ndiyeno kumunsi kwa metatarsal wachinayi.Zimalola kuchepetsa ndi kukonza bwino kwa Sanders mtundu wa II ndi III calcaneal fractures, ndipo akhoza kuwonjezeredwa ngati kuli kofunikira kuwonetsa transfibula, talus, kapena lateral column of phazi.
LM lateral ankle.Mgwirizano wa MT metatarsal.SPR Supra fibula retinaculum.
Arthroscopically kuthandiza kuchepetsa
Mu 1997, Rammelt adanena kuti subtalar arthroscopy ingagwiritsidwe ntchito kuchepetsa kumbuyo kwa calcaneus pansi pa masomphenya.Mu 2002, Rammelt adayamba kuchita masewera olimbitsa thupi arthroscopically kuthandiza kuchepetsa percutaneous ndi kukonza zomangira za ma fractures amtundu wa Sanders I ndi II.
Subtalar arthroscopy makamaka imagwira ntchito yowunikira komanso yothandizira.Ikhoza kuyang'ana mkhalidwe wa subtalar articular pamwamba pansi pa masomphenya achindunji, ndikuthandizira kuyang'anira kuchepetsa ndi kukonza mkati.Kuphatikizika kosavuta kwa subtalar joint dissection ndi osteophyte resection zithanso kuchitidwa.
Zizindikiro ndi zopapatiza: kokha kwa Sanders mtundu Ⅱ ndi wofatsa comminution wa articular pamwamba ndi AO/OTA mtundu 83-C2 fractures;pomwe kwa Sanders Ⅲ, Ⅳ ndi mtundu wa AO/OTA 83-C3 Zophwanyika zokhala ndi kugwa kwapamtunda monga 83-C4 ndi 83-C4 zimakhala zovuta kugwira ntchito.
malo a thupi
b.Arthroscopy ya ankle yapambuyo.c.Kufikira fracture ndi subtalar joint.
Zomangira za Schantz zidayikidwa.
e.Bwezerani ndi kukonza kwakanthawi.f.Mukayambiranso.
g.Konzani kwakanthawi fupa la articular pamwamba.h.Konzani ndi zomangira.
ndi.Postoperative sagittal CT scan.j.Maonedwe a axial a postoperative.
Kuonjezera apo, malo ophatikizana a subtalar ndi opapatiza, ndipo kukoka kapena mabatani amafunika kuthandizira malo olowa kuti athandize kuyika kwa arthroscope;danga la intra-articular manipulation ndi laling'ono, ndipo kuwongolera mosasamala kungayambitse kuwonongeka kwa iatrogenic cartilage pamwamba;osadziwa opaleshoni njira sachedwa kuvulala m'deralo bungwe.
Percutaneous balloon angioplasty
Mu 2009, a Bano adayamba kupanga njira yochepetsera chibaluni pochiza matenda a calcaneal fractures.Kwa Sanders Type II fractures, mabuku ambiri amawona zotsatira zake kukhala zotsimikizika.Koma mitundu ina ya fractures ndi yovuta kwambiri.
Pamene simenti ya fupa imalowa mu malo ophatikizana a subtalar panthawi ya opareshoni, izi zidzapangitsa kuvala kwa articular pamwamba ndi kuchepetsa kusuntha kwa mgwirizano, ndipo kukula kwa baluni sikudzakhala koyenera kuti kuchepetsa kuphulika.
Kuyika kwa cannula ndi waya wowongolera pansi pa fluoroscopy
Zithunzi zisanachitike komanso pambuyo pa kukwera kwa mitengo ya airbag
Zithunzi za X-ray ndi CT zaka ziwiri pambuyo pa opaleshoni.
Pakalipano, zitsanzo za kafukufuku waukadaulo wa baluni nthawi zambiri zimakhala zazing'ono, ndipo zosweka zambiri zomwe zimakhala ndi zotsatira zabwino zimayambitsidwa ndi chiwawa chochepa mphamvu.Kufufuza kwina kukufunikabe pa calcaneal fractures yokhala ndi fracture kwambiri.Zakhala zikuchitika kwakanthawi kochepa, ndipo mphamvu yayitali komanso zovuta zake sizikudziwikabe.
Calcaneal intramedullary msomali
Mu 2010, msomali wa calcaneal intramedullary unatuluka.Mu 2012, M.Goldzak amathandizira pang'onopang'ono kuphulika kwa calcaneal ndi misomali ya intramedullary.Tiyenera kutsindika kuti kuchepetsa sikungatheke ndi misomali ya intramedullary.
Ikani pini yowongolera, fluoroscopy
Kuyikanso gawo la subtalar
Ikani chimango choyikira, yendetsani msomali wa intramedullary, ndikuikonza ndi zomangira ziwiri za 5 mm.
Malingaliro pambuyo pa kuyika kwa msomali wa intramedullary.
Kukhomerera kwa intramedullary kwawonetsedwa kuti ndikwabwino pochiza Sanders mtundu II ndi III fractures wa calcaneus.Ngakhale kuti madokotala ena anayesa kuigwiritsa ntchito ku Sanders IV fractures, ntchito yochepetsera inali yovuta ndipo kuchepetsa koyenera sikunapezeke.
Munthu Wothandizira: Yoyo
WA/TEL:+8615682071283
Nthawi yotumiza: May-31-2023
