Ukuqhekeka kweSiseko seSihlanu seMetatarsal

Unyango olungafanelekanga lwesihlanu lwe-metatarsal fractures lunokukhokelela ekuqhekekeni kwe-nonunion okanye ukulibaziseka komanyano, kwaye iimeko ezinzima zingabangela isifo samathambo, esinempembelelo enkulu kubomi bemihla ngemihla kunye nomsebenzi wabantu.

AngokwendaloSitructore

I-metatarsal yesihlanu yinto ebalulekileyo yekholamu yecala lonyawo, kwaye idlala indima ebalulekileyo ekuthwaleni ubunzima kunye nokuzinza kweenyawo.I-metatarsal yesine neyesihlanu kunye ne-cuboid yenza i-metatarsal cuboid joint.

Kukho i-tendon ezintathu ezifakwe kwisiseko se-metatarsal yesihlanu, i-peroneus brevis tendon ifaka i-tendon ye-dorsolateral ye-tuberosity kwisiseko se-metatarsal yesihlanu;imisipha yesithathu ye-peroneal, engenamandla njenge-tendon ye-peroneus brevis, ifaka kwi-diaphysis distal ukuya kwi-tuberosity yesihlanu ye-metatarsal;i-plantar fascia I-fascicle esecaleni ifaka kwicala le-plantar ye-basal tuberosity ye-metatarsal yesihlanu.

Ukuhlelwa kokwaphuka

Ukuqhekeka kwesiseko se-metatarsal yesihlanu kwahlelwa nguDameron noLawrence,

Ukwaphuka kweZone I kukwaphuka kwe-avulsion ye-metatarsal tuberosity;

I-Zone II ifumaneka ekudibaneni phakathi kwe-diaphysis kunye ne-proximal metaphysis, kubandakanywa amajoyina phakathi kwe-4 kunye ne-5 yamathambo e-metatarsal;

I-Zone III fractures yi-stress fractures ye-proximal metatarsal diaphysis distal ukuya kwi-4th / 5th intermetatarsal joint.

Kwi-1902, uRobert Jones waqala wachaza uhlobo lwe-zone II fracture yesiseko se-metatarsal yesihlanu, ngoko ke i-zone II fracture ikwabizwa ngokuba yi-Jones fracture.

I-avulsion fracture ye-tuberosity ye-metatarsal kwi-zone I yolona hlobo luqhelekileyo lwesihlanu lwesiseko se-metatarsal fracture, i-akhawunti malunga ne-93% yazo zonke iifractures, kwaye ibangelwa ukuguquka kwesityalo kunye nobudlova be-varus.

Iifractures kwi-zone II i-akhawunti malunga ne-4% yazo zonke iifractures kwisiseko se-metatarsal yesihlanu, kwaye ibangelwa ukunyathela kwe-plantar flexion kunye nobundlobongela bokunyusa.Ngenxa yokuba zibekwe kwindawo yamanzi yonikezelo lwegazi kwisiseko se-metatarsal yesihlanu, iifractures kule ndawo ziqhelene nokungahambelani okanye ukulibaziseka ukuphulukisa.

Ukwaphuka kweZone III kumalunga ne-3% yokwaphuka kwesiseko se-metatarsal yesihlanu.

Unyango olulondolozayo

Iimpawu eziphambili zonyango olulondolozayo ziquka ukuchithwa kwe-fracture ngaphantsi kwe-2 mm okanye i-fractures ezinzile.Unyango oluxhaphakileyo lubandakanya ukunyanzeliswa ngamabhandeji eelastiki, izihlangu ezinesoli eqinile, ukungashukumi ngeesanti zesamente, iipadi zokucinezela amakhadibhodi, okanye iibhutsi zokuhamba.

Iinzuzo zonyango olulondolozayo ziquka iindleko eziphantsi, akukho ntlungu, kunye nokwamkelwa lula zizigulane;izinto ezingeloncedo zibandakanya izehlo eziphezulu zokuqhekeka kwe-nonnunion okanye ukulibaziseka kweengxaki zomanyano, kunye nokuqina kwamalungu ngokulula.

UtyandoTunyango

Iimpawu zonyango lotyando lwesihlanu se-metatarsal fractures ziquka:

1. Ukuchithwa kwe-fracture ngaphezu kwe-2 mm;

1. Ukubandakanywa kwe-30% ye-articular surface ye-cuboid distal ukuya kwi-metatarsal yesihlanu;

1. Ukuqhekeka okungapheliyo;

1. I-fracture ilibazisekile imanyano okanye i-non-nonunion emva konyango olungenalo utyando;

1. Izigulane eziselula ezisebenzayo okanye iimbaleki zezemidlalo.

Okwangoku, iindlela zotyando ezisetyenziswa ngokuqhelekileyo zokwaphuka kwesiseko se-metatarsal yesihlanu ziquka i-Kirschner wire tension band ukulungiswa kwangaphakathi, ukulungiswa kwe-anchor suture ngentambo, ukulungiswa kwangaphakathi kwe-screw, kunye ne-hook plate yokulungiswa kwangaphakathi.

1. I-Kirschner wire tension band fixation

I-Kirschner wire tension band fixation yinkqubo yotyando ngokwesithethe.Iingenelo zale ndlela yonyango zibandakanya ukufikelela lula kwizinto zokulungiswa kwangaphakathi, iindleko eziphantsi, kunye nefuthe elihle lokucinezela.Ukungalungi kubandakanya ukucaphuka kwesikhumba kunye nomngcipheko wokukhulula ucingo lweKirschner.

2. Ukulungiswa kwe-Suture kunye neehange ezinemisonto

Ukulungiswa kwe-Anchor suture kunye nentambo ifanelekile kwizigulane ezine-avulsion fractures kwisiseko se-metatarsal yesihlanu okanye ngamaqhekeza amancinci.Iingenelo ziquka ukusika okuncinci, ukusebenza okulula, kwaye akukho mfuneko yokususwa kwesibini.Ukungalungi kubandakanya umngcipheko we-anchor prolapse kwizigulane ezine-osteoporosis..

3. Ukulungiswa kwezikhonkwane ezingenanto

I-Hollow screw lunyango olusebenzayo olwamkelwa kumazwe ngamazwe lokuqhekeka kwesiseko se-metatarsal yesihlanu, kwaye iingenelo zalo ziquka ukulungiswa okuqinileyo kunye nokuzinza okulungileyo.

Ngokweklinikhi, kwiifractures ezincinci kwisiseko se-metatarsal yesihlanu, ukuba i-screws ezimbini zisetyenziselwa ukulungiswa, kukho umngcipheko wokuqhawula.Xa esinye isikrufu sisetyenziselwa ukulungiswa, amandla okulwa nokujikeleza ayancipha, kwaye ukutshintshwa kwakhona kunokwenzeka.

4. Ihook plate ilungisiwe

Ukulungiswa kweplate ye-Hook kunoluhlu olubanzi lwezibonakaliso, ngakumbi kwizigulane ezine-avulsion fractures okanye i-osteoporotic fractures.Isakhiwo sayo soyilo sihambelana nesiseko sethambo lesihlanu le-metatarsal, kwaye amandla okunciphisa ukulungelelanisa aphakamileyo.Ukungalungi kokulungiswa kwepleyiti kubandakanya iindleko eziphezulu kunye nokwenzakala okukhulu.

Summary

Xa unyango lwezaphulelo kwisiseko se-metatarsal yesihlanu, kuyimfuneko ukuba ukhethe ngokucophelela ngokwemeko ethile yomntu ngamnye, amava omntu kagqirha kunye nenqanaba lobugcisa, kwaye uqwalasele ngokupheleleyo iminqweno yobuqu yesigulane.