Ukulungiswa kwangaphakathi ngeplate yethambo
I-ankle fusion kunye neepleyiti kunye nezikrufu yinkqubo yotyando eqhelekileyo ngoku. I-plate yokutshixa ukulungiswa kwangaphakathi isetyenziswe ngokubanzi kwi-ankle fusion. Okwangoku, iplate ye-ankle fusion ibandakanya ipleyiti yangaphambili kunye ne-lateral plate ye-ankle fusion.
Lo mfanekiso ungasentla ubonisa iifilimu ze-X-reyi ngaphambi nasemva kotyando lwe-ankle osteoarthritis ene-anterior locking plate yangaphakathi yokuhlanganisa i-ankle joint fusion.
1. Indlela yangaphambili
Indlela yangaphambili kukwenza i-anterior longitudinal incision egxile kwi-ankle joint space, i-cut layer by layer, kwaye ungene kunye nesithuba se-tendon; usike i-capsule edibeneyo, uveze i-tibiotalar joint, susa i-cartilage kunye ne-subchondral bone, kwaye ubeke i-plate yangaphambili kwi-Anterior ye-ankle.
2. Indlela esecaleni
Indlela esecaleni kukusika i-osteotomy malunga ne-10 cm ngaphezu kwencam yefibula kwaye ususe isiphunzi ngokupheleleyo. Isiphunzi sethambo esirhoxisiweyo sikhutshwa ukuze kufakwe amathambo. I-fusion surface osteotomy igqityiwe kwaye ihlanjwe, kwaye ipleyiti ibekwe ngaphandle kwe-ankle joint.
Inzuzo kukuba amandla okulungisa aphakamileyo kwaye ukulungiswa kuqinile. Ingasetyenziselwa ukulungiswa nokwakhiwa kwakhona kwe-varus enzima okanye i-valgus deformity ye-ankle joint kunye neziphene ezininzi zamathambo emva kokucoca. Ipleyiti yokudibanisa eyenzelwe i-anatomically inceda ukubuyisela i-anatomy eqhelekileyo ye-ankle joint. Indawo.
Ukungalungi kukuba i-periosteum engaphezulu kunye nezicubu ezithambileyo kwindawo yokuhlinzwa kufuneka zihluthwe, kwaye i-steel plate inzima, ekulula ukucaphukisa i-tendon ejikelezileyo. Isitya sentsimbi esibekwe ngaphambili kulula ukusichukumisa phantsi kwesikhumba, kwaye kukho umngcipheko othile.
ukulungiswa kwe-intramedullary nail
Kwiminyaka yakutshanje, ukusetyenziswa kwe-retrograde intramedullary nail-type ankle arthrodesis kunyango lwe-arthrodesis ye-ankle yokugqibela kuye kwasetyenziswa ngokuthe ngcembe kwiklinikhi.
Okwangoku, ubuchule be-intramedullary nailing technique busebenzisa kakhulu i-anterior median incision ye-ankle joint okanye i-anteroinferior lateral incision ye-fibula yokucoca umphezulu we-articular okanye ukudibanisa amathambo. Isikhonkwane se-intramedullary sifakwe kwi-calcaneus ukuya kwi-tibial medullary cavity, enenzuzo ukulungiswa kokukhubazeka kunye nokukhuthaza ukudibanisa kwamathambo.
I-Ankle osteoarthritis idibene ne-subtalar arthritis. Iifilimu zangaphambili ze-anteroposterior kunye ne-lateral ze-X-ray zibonise umonakalo omkhulu kwi-joint ye-tibiotalar kunye ne-subtalar joint, ukuwa kwengxenye ye-talus, kunye nokwakheka kwe-osteophyte ejikeleze umgudu (ukusuka kwireferensi ye-2)
I-divergent fusion implantation angle yokutshixa i-hindfoot fusion intramedullary nail yi-multi-plane fixation, enokulungisa ijoyini ethile ukuze idityaniswe, kwaye isiphelo esikude singumngxuma wokutshixa, onokuxhathisa ngokufanelekileyo ukusika, ukujikeleza, kunye nokutsalwa ngaphandle, ukunciphisa umngcipheko wokurhoxiswa kwe-screw.
Ukudibanisa kwe-tibiotalar kunye ne-subtalar joint yavezwa kwaye yacutshungulwa ngendlela ye-lateral transfibular approach, kwaye ubude be-incision ekungeneni kwe-plantar intramedullary nail yayiyi-3 cm.
Isikhonkwane se-intramedullary sisetyenziselwa ukulungiswa okuphakathi, kwaye uxinzelelo lwayo luhlakazekile, olunokuphepha umphumo wokukhusela uxinzelelo kwaye luhambelana ngakumbi nemigaqo ye-biomechanics.
Ifilimu ye-Anteroposterior kunye ne-lateral ye-X-ray inyanga ye-1 emva kokusebenza ibonise ukuba umgca weenyawo ongasemva wawulungile kwaye isikhonkwane se-intramedullary sasigxininisekile ngokuthembekileyo.
Ukusebenzisa izikhonkwane ze-intramedullary ze-retrograde kwi-ankle joint fusion kunokunciphisa umonakalo wezicubu ezithambileyo, ukunciphisa i-necrosis yesikhumba, ukusuleleka kunye nezinye iingxaki, kwaye kunokubonelela ukulungiswa okuzinzileyo okwaneleyo ngaphandle kokulungiswa kwe-plaster encedisayo emva kokuhlinzwa.
Kunyaka omnye emva kokusebenza, iifilimu ze-X-ray ezinobunzima kunye necala elisecaleni libonisa ukuhlanganiswa kwebhony ye-tibiotalar joint kunye ne-subtalar joint, kwaye ukulungelelaniswa kweenyawo zangasemva kwakukuhle.
Isigulana sinokuphuma ebhedini kwaye sithwale ubunzima kwangoko, nto leyo ephucula ukunyamezelana nomgangatho wobomi besigulana. Nangona kunjalo, ngenxa yokuba i-subtalar joint idinga ukulungiswa ngexesha elifanayo, ayikhuthazwa kwizigulane ezine-subtalar joint joint. Ukugcinwa kwe-subtalar joint isakhiwo esibalulekileyo sokuhlawulela umsebenzi we-ankle joint kwizigulane ezine-ankle joint fusion.
Screw ukulungiswa kwangaphakathi
Ukulungiswa kwangaphakathi kwe-Percutaneous screw yindlela eqhelekileyo yokulungiswa kwe-ankle arthrodesis. Ineengenelo zotyando olungephi olufana nokutsala kancinci kunye nokulahleka kwegazi okuncinci, kwaye kunokunciphisa ngokufanelekileyo umonakalo kwiithishu ezithambileyo.
Iifilimu ze-X-ray ze-Anteroposterior kunye ne-lateral ye-ankle edibeneyo yokuma phambi kokuhlinzwa ibonise i-osteoarthritis enzima ye-ankle yasekunene kunye ne-varus deformity, kwaye i-angle phakathi kwe-tibiotalar articular surface yalinganiswa ukuba yi-19 ° varus.
Uphononongo lubonise ukuba ukulungiswa okulula kunye ne-2 ukuya kwi-4 lag screws kunokufikelela ukulungiswa okuzinzileyo kunye nokunyanzeliswa, kwaye ukusebenza kulula kwaye iindleko zincinci. Lukhetho lokuqala lwabaphengululi abaninzi ngoku. Ukongezelela, ukucocwa kwe-ankle edibeneyo encinci kunokwenziwa phantsi kwe-arthroscopy, kwaye izikrufu zingafakwa nge-percutaneously. Ukwenzakala kotyando kuncinci kwaye isiphumo sokunyanga siyanelisa.
Ngaphantsi kwe-arthroscopy, indawo enkulu ye-articular cartilage defect ibonakala; phantsi kwe-arthroscopy, isixhobo se-cone cone microfracture sisetyenziselwa ukunyanga i-articular surface
Abanye ababhali bakholelwa ukuba i-3 screw fixation inokunciphisa umngcipheko we-postoperative non-fusion, kwaye ukunyuka kwezinga lokudibanisa kunokuhambelana nokuzinza okunamandla kwe-3 screw fixation.
Ifilimu elandelwayo ye-X-reyi kwiiveki ezili-15 emva kotyando ibonise ukudityaniswa kwamathambo. Inqaku le-AOFAS laliyi-47 amaphuzu ngaphambi kokusebenza kunye ne-74 amanqaku 1 unyaka emva kokusebenza.
Ukuba izikrufu ezithathu zisetyenziselwa ukulungiswa, indawo eqikelelweyo yokulungiswa kukuba izikrufu ezibini zokuqala zifakwe ngokulandelelana ukusuka kwicala le-anteromedial kunye ne-anterolateral ye-tibia, ukuwela umphezulu we-articular ukuya kumzimba we-talar, kwaye isikrufu sesithathu sifakwe ukusuka kwicala elingasemva le-tibia ukuya kwicala eliphakathi le-talus.
Indlela yokulungisa yangaphandle
Izilungisi zangaphandle yayizezona zixhobo zakuqala ezazisetyenziswa kwi-ankle arthrodesis kwaye ziye zavela kwi-1950s ukuya kuthi ga ngoku Ilizarov, Hoffman, Hybrid kunye neTaylor space frame (TSF).
Ukulimala kwe-Ankle evulekileyo ngokusuleleka kwi-3 iminyaka, i-ankle arthrodesis kwiinyanga ezi-6 emva kokulawula usulelo
Kwezinye iimeko ezintsonkothileyo ze-ankle arthritis ezinosulelo oluphindaphindiweyo, ukuhlinzwa okuphindaphindiweyo, ulusu lwasekhaya olubuthathaka kunye neemeko ezithambileyo zezicubu, ukwakheka kwesiva, iziphene zamathambo, i-osteoporosis kunye nezilonda zosulelo lwasekhaya, i-Ilizarov ring fixator yangaphandle isetyenziswa ngakumbi eklinikhi ukuhlanganisa i-ankle joint.
I-fixator yangaphandle eyenziwe ngendandatho igxininiswe kwi-coronal plane kunye ne-sagittal plane, kwaye inokubonelela ngesiphumo sokulungiswa okuzinzile. Kwinkqubo yokuqala yokuthwala umthwalo, iya kucinezela ukuphela kokuphuka, ukukhuthaza ukubunjwa kwefowuni, kunye nokuphucula izinga lokudibanisa. Kwizigulane ezinokukhubazeka okukhulu, i-fixator yangaphandle inokulungisa ngokuthe ngcembe ukukhubazeka. Ngokuqinisekileyo, i-fixator ye-ankle fusion yangaphandle iya kuba neengxaki ezifana nokuphazamiseka kwezigulana ukunxiba kunye nomngcipheko wosulelo lwenaliti.
Qhagamshelana:
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Email:liuyaoyao@medtechcah.com
Ixesha lokuposa: Jul-08-2023
