Mafuta am'nyanja a Navinion amapezeka pafupifupi 5-15% yonse ya ma pachimake cham'madzi am'madzi a Navricular, ndi Nest necrosis omwe amachitika pafupifupi 3%. Zowopsa za Navisular kuperewera zimaphatikizapo kuchepa kapena kuchedwa, kulumikizana kofananira kwa mzere wa kuwonongeka kwa 1 mm, ndi kusokonekera ndi kusakhazikika kwa kapangidwe kake. Ngati simunasiyidwe, osakhudzidwa ndi Navicocher Osteochral nthawi zambiri amagwirizanitsidwa ndi matenda ang'onotic, omwe amadziwikanso kuti Naviclar Osteochrion Punyurion ndi kugwa.
Mafupa olumikiza ndi kapena wopanda phokoso lamphamvu amatha kugwiritsidwa ntchito pochiza matenda a Nambochirral osteochral. Komabe, kwa odwala omwe ali ndi osteones of the proxulal fupa la National fupa la mafupa osakwaniritsidwa, ndipo fupa lakuchiritsa ndi 40% yokha -67%. Mosiyana ndi izi, machiritso ochiritsa mafupa okhala ndi ma flap osweka amatha kukhala okwera ngati 88% -91%. Mafupa akulu akuluakulu omwe ali pachipatala amaphatikizapo ma rup 1,2-riclul nthochi, fupa lam'mimba, ndi zotsatira za ma blower topt, zotsatira za mawu ophatikizika ndizokhutiritsa. MFC VBG yawonetsedwa kuti ikhale yothandiza pochiza matenda am'madzi omwe ali ndi metacarpal kugwa, ndipo MFC VBG imagwiritsa ntchito nthambi ya argelar ya otsika ngati Tsamba la Tsamba lotsika kwambiri. Poyerekeza ndi zikwama zina, mfc vbg imapereka chithandizo chokwanira chobwezeretsa mawonekedwe am'madzi a Navricular Osteochondrosis ndi zonyansa (Chithunzi 1). Mankhwalawa a Navhilar Osteochral ostecorcrosis okhala ndi chipongwe cha carpal chigwa, ma ricy 1,2-yicral toul adanenedwa kuti ali ndi mafupa ochiritsa 40% okha, pomwe MFC VBG imangokhala ndi mafupa ochiritsa.
Chithunzi 1. Kuwonongeka kwa fupa la Navricular ndi "Kuwerama"
Kukonzekera
Pambuyo pakuyesedwa kwakuthupi kwa dzanja, maphunziro oyerekeza ayenera kuchitidwa kuti ayesetse dipririst kugwa. Ma radiograph owoneka bwino ndi othandiza kutsimikizira komwe kuwonongeka, kuchuluka kwazosamuka, ndipo kukhalapo kwa relorption kapena sclerosis ya kumapeto kwake. Zithunzi zakumbuyo zimagwiritsidwa ntchito poyesa kugwa kwa dzanja, kukhazikika kwa dzanja (dissi) pogwiritsa ntchito chipilala chosinthika (kutalika / kutalika kwa radial kwa okulirapo 15 °. MRI kapena CT itha kuthandiza kuzindikira mafupa a Navricular fupa kapena osteones. Ma radiograph ofananira kapena oblique sagittal ct ya mafupa a Navricular Sherle> 45
Zisonyezo ndi Contraindications:
Navicher Osteochrion nonunaion yokhala ndi zonyansa ndi didi; Mri akuwonetsa Ischemic necrosis ya mafupa a Navricular fupa la alendo komanso kuwonera kwa madzi osweka a Natural Spay fupa loyera; Kulephera kwa tige yoyambirira kutsatsa kapena kukhazikika kwamkati kumafunikira mafupa akuluakulu a VGB (> 1cm3). Zopeza zothandizira kapena zopatsa chidwi za osteroartisritis a radial plapal; Ngati utoni wovuta kwambiri wa National wokhala ndi Ostearthritis yachitika, kenako kuphatikizira kwamimba, quadlalar ospal osteyal osteal, etc., angafunikire; Matenda am'nyanja a Navinion, proximal necrosis, koma wokhala ndi mafupa a Nayphology (mwachitsanzo, osakhala ndi matumbo a Navicular (omwe alibe) matenda osavomerezeka ndi magazi osayenera ku Proximal pamtengo); Kufupikitsa zakudya zam'madzi za Naviicor popanda osteones. .
Anagwiritsa ntchito anatomy
MfC VBG imaperekedwa ndi ziwiya zingapo za Troosseous yaying'ono (zikutanthauza 30, 20-50), chifukwa cha magazi kwambiri ochulukirapo mpaka pano otsika kwambiri (amatanthauza 6.9) (mkuyu) (1). Zombo zokhotakhotazi zidaperekedwa kwambiri ndi kutsika kwa armeryte (DGA) ndi / kapena zojambulajambula zapamwamba kwambiri. DGA idachokera ku gawo lalikulu lamiyendo lachisoni mpaka pakatikati pa malleolus. DGA imachokera ku masitepe apakati pa 13.7 cm (10 masentimita (10 masentimita) ophatikizira ku Mallexil Pactive kapena poyerekeza ndi ma cadavelan akuwonetsa 100% Mm. Chifukwa chake, ngakhale DGA kapena SMGA ndizovomerezeka, ngakhale zakale ndizoyenera ku Tibrae chifukwa cha kutalika ndi mainchesi.
Mkuyu. 2. Kugawana ndi magawo anayi a MFC Thipost mzere pakati pa semitendososus pang'ono
Chithunzi 3.
Kupezeka kwa Opaleshoni
Wodwalayo amakhala pansi pa mankhwala opaleshoni yapamwamba, yomwe zidakhudzidwazo zomwe zidayikidwa pagome la dzanja. Nthawi zambiri, fupa la Wopereka limatengedwa kuchokera ku bandler medical medyle, kuti wodwalayo aziyenda ndi mikwingwirima atachitidwa opaleshoni. Bondo lotsutsana litha kusankhidwa ngati pali mbiri ya zoopsa zam'mbuyomu kapena opaleshoni yomwe ili mbali yomweyo ya bondo. Bondo limasinthidwa ndipo m'chiuno chimazunguliridwa kunja, ndipo mapepala oyendera amagwiritsidwa ntchito kumalekezero apamwamba komanso otsika. Njira yochitira opaleshoni inali njira yowonjezereka, yokhazikika kuyambira 8 masentimita kuthengo ya radial carbor car courn, kenako ndikumaliza mulingo wa Trocharm wamkulu. Tendolon ya utoto wa Itotomisus tendon yakhazikika ndipo tendon imakokedwa ndi minyewa yakuthwa, ndikulekanitsidwa mosamala ndi fupa la Navicular (Chithunzi 4). Tsimikizani malo omwe muli osagwirizana, mtundu wa cartilage ndi digiri ya Ishchar yamafupa. Mukamasula ulendowu, onetsetsani kuti proximal pole ya Navricular Full fortion kutuluka kuti mudziwe ngati pali ma ischemic necrosis. Ngati Navrosis necrosis sakugwirizana ndi nyama ya radpal kapena intercarpal, MFC VGB ikhoza kugwiritsidwa ntchito.
Chithunzi 4. Njira ya Navricular Opalamula: . (C) Dziwani malo a Nayseous osazindikira.
Kuwonongeka kwa masentimita 15 mpaka 20 kumapangidwa ndi mzere wolumikizirana ndi minofu yam'madzi, ndipo minofu ya MFG imaperekedwa ndi nthambi za MFG ndi zogwirizana ndi mitsempha yolumikizira. Vascular Pedicle amasulidwa molunjika, kusamalira kuteteza periosteum ndi zombo za Trogoblastic pamiyala.
Chithunzi 5. Kupeza kwa Open: .
Kukonzekera kwa fupa la Navrilar fupa
Kulema kwa Nazi kuyenera kuwongolera ndipo kudera la Osteochliya la Osteochring asanakonzedwe ndikusinthana mkono ndi fluoroscopy kuti abwezeretse makona a radial (Chithunzi 6). A 0.0625-phazi (pafupifupi 1.5-mm) pini yoyendetsedwa ndi ma picsnal kupita ku metacarpal kuti mukonzekere zolumikizira, ndipo zovuta zamanyazi zimawoneka ngati dzanja lake likuwongoledwa. Malo osokoneza bongo adayeretsedwa ndi minofu yofewa komanso yotsegulidwa ndi yofananira. Kubwezeretsa kochepa kumagwiritsidwa ntchito kuthyola fupa ndikuwonetsetsa kuti kuwoneka bwino kumafanana ndi mbiri yambiri kuposa mphero ya Navkur. Mukatha kutsegula gap, chilema chimawerengedwa m'magawo atatu kuti mudziwe kuchuluka kwa mafupa, omwe nthawi zambiri amakhala 10-12 mm kutalika mbali zonse za kulumikiza.
Chithunzi 6. Kuwongolera kwa kuwerama kwa ma Natiriclar kwa Navriclar, wokhala ndi fluoroscopic flumix ya dzanja kuti abwezeretse mawonekedwe a radial-mwezir. A 0.0625-phazi (pafupifupi 1.5-mm) pini yoyendetsedwa ndi chipongwe kupita ku metacarpal kuti mukonzerepo fupa la Navrial ndikubwezeretsanso kusiyana kwake komwe kudzayenera kuphatikizidwa.
Osteyomy
Malo osokoneza bongo am'madzi am'madzi amasankhidwa kukhala gawo la fupa, ndipo m'deralo m'zigawo zafuwa ndizokwanira. Samalani kuti musavulaze mitundu ya megiya. Persosteum imaphatikizidwa, ndipo fupa lamadzi liwiro la kukula koyenera la Flap limadulidwa, ndi fupa lachiwiri lodulidwa mbali imodzi kuti iwonetsetse kuti kukhulupirika kwa mbewa (mkuyu. 7). Chisamaliro chiyenera kutengedwa kuti chisalekanitse periyasteum, fupa lapakati, komanso fupa la chivundikiro cha mbendera. Ulendo wapansi pamunsi uyenera kumasulidwa kuti uzichita magaziwo kudzera mu chingwe, ndipo ntchentche adamasulidwa bwino kwa 6 cm kuti alolere ma jastomosis pambuyo pake. Ngati ndi kotheka, fupa laling'ono locheperako limatha kupitilira mkati mwa banya. Chilema chokazika cha ku Stomarallar chimadzaza ndi mafupa kuluma mkota
Chithunzi 7. MFC PHER Flap Kuchotsa. . (B) chidutswa chachiwiri cha fupa chimadulidwa mbali imodzi mpaka 45 ° kuti zitsimikizire kuti kukhulupirika.
Kuwonongeka kwa Flap ndi kukonza
Blap Flap imakonzedwa ku mawonekedwe oyenera, osasamalidwa kuti musandutse vascular pedicle kapena muvuni periosteum. Flap ili pansi modekha m'dera la chilema cha Navinsol fupa lankhondo la Navinsol, kupewa, komanso kukhazikika ndi zomata zam'madzi. Chisamalidwe chidatengedwa kuti chitsimikizire kuti pali Palmar Margin ya Plack Yapakatikati inali yopukutira ndi madera a Palmar a fupa la Navricular pang'ono kuti mupewe kuipitsa. Fluoroscopy adachitidwa kuti atsimikizire mafupa a Naviculogy, mzere wa mphamvu ndi mawonekedwe. Aastomise vascular flap mpaka kumapeto kwa maluso a radery kumatha ndi gawo la venous mer-radial mesery conseon kumapeto (Chithunzi 8). Kapisoziyo imakonzedwa, koma ntchome ya vascolar pedicle imapeweka.
Chithunzi 8. Mafupa a mafupa, kukonza, ndi ma anastaromasis. Blap Flap ili pansi pang'onopang'ono m'dera la Navricular fupa la Naviicular ndi okhazikika ndi zomangira zam'madzi kapena zikhomo za Kirschner. Chisamaliro chimatengedwa kuti malire a metacarpal a block a fupa lamoto akupsa ndi malire a metacarpal mafupa a Naticular fupa kapena kupsinjika pang'ono kuti musafotokozere. Anastomosis ya vascular flap urtery kupita ku ulusi wa radial adatha kutha, ndipo nsonga ya mtsempha yamiyendo yamiyendo yomwe idatha.
Kukonzanso
325 mg patsiku (kwa mwezi umodzi), postoperative kulemera miyendo yomwe yakhudzidwayo imaloledwa, kutengera ndi kuthekera kwa wodwalayo kusuntha pa nthawi yoyenera. Chithandizo cha contrallateral cha crutch imodzi chimatha kuchepetsa ululu, koma kuthandizidwa ndi ndodo kwa nthawi yayitali sikofunikira. Ma stitches adachotsedwa milungu iwiri atachitidwa opaleshoni ndi mungu kapena mkono wautali kuti chala chisanachitike chisanachitike m'malo mwa masabata atatu. Pambuyo pake, mkono wamfupi kuti chala chadzuwa chizigwiritsidwa ntchito mpaka machira akhungu. Ma X-ray amatengedwa pa sabata 3-6 sabata, ndipo machiritso akhungu amatsimikiziridwa ndi CT. Pambuyo pake, zinthu zopitilira patsogolo komanso zochitika zowonjezera ziyenera kuyamba pang'onopang'ono, ndipo kuchuluka kwa zolimbitsa thupi ziyeneranso kuchuluka pang'onopang'ono.
Mavuto Akulu
Zovuta zazikulu za bondo polumikizana zimaphatikizira kupweteka kwa bondo kapena kuvulala mitsempha. Kupweteka kwa bondo makamaka mkati mwa milungu isanu ndi umodzi pambuyo pa opaleshoni, ndipo palibe kutayika kapena kupweteketsa matenda opweteka chifukwa cha kuvulala kwa mitsempha ya sappaus kunapezeka. Mavuto akulu akulu amaphatikizaponso mafupa amtundu, kupweteka, kufooka, kufooka, mafupa am'madzi am'madzi, ndipo chiopsezo cha mitsempha ya perisotopic chalembedwanso.
Makina a Medial Ogwiritsa Ntchito Boyl Vasculated Mafupa a Mafupa a Scaphriid Ogwira Ntchito ndi Proxulal Pole Alsoscular Necrosis ndi Carpal Kugwa
Post Nthawi: Meyi-28-2024
