Ukulungiswa kwangaphakathi ngepleyiti yethambo
Ukudibanisa iqatha ngeepleyiti kunye nezikrufu yindlela eqhelekileyo yotyando okwangoku. Ukubopha kwangaphakathi kwepleyiti yokutshixa kuye kwasetyenziswa kakhulu ekuhlanganiseni iqatha. Okwangoku, ukuhlanganisa iqatha lepleyiti kuquka ikakhulu ipleyiti yangaphambili kunye nepleyiti esecaleni.
Umfanekiso ongasentla ubonisa iifilimu ze-X-ray ngaphambi nasemva kotyando lwe-traumatic ankle osteoarthritis kunye ne-anterior locking plate i-internal fixation i-ankle joint fusion
1. Indlela yangaphambili
Indlela engaphambili kukwenza umqadi ongaphambili ojikeleze iqakala, usike umaleko ngomaleko, uze ungene kwindawo yemisipha; usike i-joint capsule, uveze i-tibiotalar joint, ususe i-cartilage kunye nethambo le-subchondral, uze ubeke ipleyiti engaphambili kwi-Anterior yeqakala.
2. Indlela esecaleni
Indlela esecaleni kukusika i-osteotomy malunga ne-10 cm ngaphezulu kwencam ye-fibula uze ususe i-stump ngokupheleleyo. I-stump yethambo ekhanselisiweyo iyakhutshwa ukuze ifakelwe ithambo. I-fusion surface osteotomy igqityiwe kwaye ihlanjwe, kwaye ipleyiti ibekwe ngaphandle kwe-ankle joint.
Inzuzo kukuba amandla okuqina aphezulu kwaye ukuqina kuqinile. Ingasetyenziselwa ukulungisa nokwakha kwakhona ukukhubazeka okukhulu kwe-varus okanye i-valgus kwilungu leqakala kunye neziphene ezininzi zamathambo emva kokucoca. I-fusion plate eyenzelwe ngokwe-anatomium inceda ukubuyisela i-anatomium eqhelekileyo yelungu leqakala. Indawo.
Ingxaki kukuba kufuneka kususwe i-periosteum kunye nezicubu ezithambileyo kwindawo yotyando, kwaye ipleyiti yentsimbi ityebile, nto leyo elula ukuyicaphukisa imisipha ejikelezileyo. Ipleyiti yentsimbi ebekwe ngaphambili kulula ukuyichukumisa phantsi kolusu, kwaye kukho umngcipheko othile.
ukulungiswa kwezipikili ngaphakathi kwe-medullary
Kwiminyaka yakutshanje, ukusetyenziswa kwe-retrograde intramedullary nail-type ankle arthrodesis kunyango lwe-end-stage ankle arthritis kuye kwasetyenziswa kancinci kancinci eklinikhi.
Okwangoku, indlela yokwenza izipikili ngaphakathi kwe-medullary isebenzisa kakhulu i-anterior median incision ye-ankle joint okanye i-anteroinferior lateral incision ye-fibula ukuze kucocwe umphezulu we-articular okanye kufakwe ithambo. I-intramedullary nail ifakwe kwi-calcaneus ukuya kwi-tibial medullary cavity, eluncedo ekulungiseni ukukhubazeka kwaye ikhuthaza ukuhlanganiswa kwamathambo.
I-ankle osteoarthritis idibene ne-subtalar arthritis. Iifilimu ze-X-ray zangaphambi kotyando kunye nezecala zibonise umonakalo omkhulu kwi-tibiotalar joint kunye ne-subtalar joint, ukuwohloka okuncinci kwe-talus, kunye nokwakheka kwe-osteophyte ejikeleze i-joint (ukusuka kwisalathiso sesi-2)
I-engile yokufakelwa kwesikrufu se-fusion yeenyawo zangasemva etshixayo, isikhonkwane se-intramedullary sinamaqhuqhuva amaninzi, esinokulungisa ijoyinti ethile eza kuhlanganiswa, kwaye isiphelo esikude ngumngxuma wokutshixa onemisonto, onokumelana ngempumelelo nokusikwa, ukujikeleza, kunye nokutsalwa, okunciphisa umngcipheko wokurhoxiswa kwesikrufu.
I-tibiotalar joint kunye ne-subtalar joint zavezwa zaza zacutshungulwa ngendlela ye-lateral transfibular, kwaye ubude bokunqunyulwa emnyango we-plantar intramedullary nail babuyi-3 cm.
I-intramedullary nail isetyenziswa njengendawo yokubambelela phakathi, kwaye uxinzelelo lwayo lusasazeke kakhulu, nto leyo enokuthintela impembelelo yokukhusela uxinzelelo kwaye ihambelana ngakumbi nemigaqo ye-biomechanics.
Ifilimu ye-X-ray esecaleni nesecaleni emva kwenyanga e-1 yotyando ibonise ukuba umgca weenyawo zangasemva ulungile kwaye isikhonkwane se-intramedullary silungisiwe ngokuthembekileyo.
Ukusebenzisa iinzipho ze-intramedullary ezibuyela umva kwi-ankle joint fusion kunokunciphisa umonakalo wezicubu ezithambileyo, kunciphise i-incision skin necrosis, usulelo kunye nezinye iingxaki, kwaye kunokubonelela ngokuqina okwaneleyo ngaphandle kokufakelwa kwe-plaster yangaphandle emva kotyando.
Kunyaka omnye emva kotyando, iifilimu ze-X-ray ezithwala ubunzima nezamacala zibonisa ukudibana kwamathambo kwe-tibiotalar joint kunye ne-subtalar joint, kwaye ukulungelelaniswa kweenyawo zangasemva bekukuhle.
Isigulana sinokuvuka ebhedini size sithwale ubunzima kwangethuba, nto leyo ephucula ukunyamezela kwesigulana kunye nomgangatho wobomi. Nangona kunjalo, ngenxa yokuba i-subtalar joint kufuneka ilungiswe ngaxeshanye, ayikhuthazwa kwizigulana ezine-subtalar joint elungileyo. Ukugcinwa kwe-subtalar joint lulwakhiwo olubalulekileyo lokuhlawula umsebenzi we-ankle joint kwizigulana ezine-ankle joint fusion.
ukulungiswa kwangaphakathi kwesikrufu
Ukufakelwa kwangaphakathi kwe-Percutaneous screw yindlela eqhelekileyo yokufakelwa kwi-ankle arthrodesis. Inezibonelelo zotyando olungenabungozi kangako njengokusikwa okuncinci kunye nokulahleka kwegazi okuncinci, kwaye inokunciphisa ngempumelelo umonakalo kwizicubu ezithambileyo.
Iifilimu ze-X-ray ezingasemva nangasemva zelungu leqakala elimileyo ngaphambi kotyando zibonise i-osteoarthritis enzima yeqakala lasekunene kunye nokukhubazeka kwe-varus, kwaye i-engile phakathi komphezulu we-tibiotalar articular ilinganiswe njenge-19° varus.
Izifundo zibonise ukuba ukufakelwa okulula ngee-screws ezi-2 ukuya kwezi-4 ezilagiweyo kunokufezekisa ukufakelwa okuzinzileyo kunye nokucinezelwa, kwaye ukusebenza kulula kwaye ixabiso liphantsi kakhulu. Lukhetho lokuqala lwabafundi abaninzi okwangoku. Ukongeza, ukucoca amalungu eqakala okuncinci kunokwenziwa phantsi kwe-arthroscopy, kwaye ii-screws zinokufakwa nge-percutaneously. Ukulimala kotyando kuncinci kwaye isiphumo sokunyanga siyanelisa.
Phantsi kwe-arthroscopy, indawo enkulu ye-articular cartilage iyabonakala; phantsi kwe-arthroscopy, isixhobo se-cone microfracture sisetyenziselwa ukunyanga umphezulu we-articular.
Abanye ababhali bakholelwa ukuba ukulungiswa kwezikrufu ezintathu kunokunciphisa umngcipheko wokungadibani emva kotyando, kwaye ukunyuka kwesantya sokuhlanganiswa kunokunxulunyaniswa nokuzinza okuqinileyo kokulungiswa kwezikrufu ezintathu.
Ifilimu ye-X-ray elandelayo emva kweeveki ezili-15 emva kotyando yabonisa ukudibana kwamathambo. Amanqaku e-AOFAS ayengama-47 amanqaku ngaphambi kotyando kunye nama-74 amanqaku kunyaka omnye emva kotyando.
Ukuba kusetyenziswa izikrufu ezintathu zokubopha, indawo yokulinganisa kukuba izikrufu zokuqala ezimbini zifakwe ngokulandelelana ukusuka kumacala angaphambili nangasemva kwe-tibia, ziwela kumphezulu we-articular ukuya kumzimba we-talar, kwaye isikrufu sesithathu sifakwe ukusuka kwicala elingasemva le-tibia ukuya kwicala eliphakathi le-talus.
Indlela yokulungisa yangaphandle
Izixhobo zokulungisa iiseli zangaphandle yayizizixhobo zokuqala ezisetyenziswa kwi-ankle arthrodesis kwaye ziye zavela ukususela ngeminyaka yoo-1950 ukuya kwi-Ilizarov, Hoffman, Hybrid kunye neTaylor space frame (TSF) yangoku.
Ukulimala kweqakala okuvulekileyo ngenxa yosulelo iminyaka emi-3, i-ankle arthrodesis kwiinyanga ezi-6 emva kokulawulwa kosulelo
Kwezinye iimeko ezinzima ze-arthritis ye-ankle ezineentsholongwane eziphindaphindayo, utyando oluphindaphindayo, ulusu olubi lwasekuhlaleni kunye nezicubu ezithambileyo, ukwakheka kwamanxeba, iziphene zamathambo, i-osteoporosis kunye nezilonda zentsholongwane zasekuhlaleni, i-Ilizarov ring external fixator isetyenziswa kakhulu ngokwezonyango ukudibanisa i-ankle joint.
I-fixator yangaphandle enemilo yesangqa inamathele kwi-coronal plane nakwi-sagittal plane, kwaye inokubonelela ngesiphumo sokuqina esizinzileyo. Kwinkqubo yokuqala yokuthwala umthwalo, iya kucinezela isiphelo sokuqhekeka, ikhuthaze ukwakheka kwe-callus, kwaye iphucule izinga lokudibana. Kwizigulana ezinokukhubazeka okukhulu, i-fixator yangaphandle ingalungisa kancinci kancinci ukukhubazeka. Kakade ke, ukuhlanganiswa kwe-ankle ye-fixator yangaphandle kuya kuba neengxaki ezifana nokuphazamiseka kokunxiba kwezigulana kunye nomngcipheko wosulelo lwendlela yenaliti.
Qhagamshelana:
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Email:liuyaoyao@medtechcah.com
Ixesha lokuthumela: Julayi-08-2023
