Indlela eqhelekileyo yecala ye-L yindlela yeklasi yonyango lotyando lwe-calcaneal fractures. Nangona i-exposure icokisekile, i-incision inde kwaye izicubu ezithambileyo zihluthwe ngakumbi, ezikhokelela ngokulula kwiingxaki ezifana nokulibaziseka komanyano lwezicubu ezithambileyo, i-necrosis, kunye nosulelo. Xa kudityaniswe nephulo loluntu lwangoku lokukhangela ubuhle obungephi, unyango lotyando olungenako ukuvaleka kwe-calcaneal fractures lunconywe kakhulu. Eli nqaku liqulunqe iingcebiso ezisi-8.
Ngendlela ebanzi esecaleni, inxalenye ethe nkqo ye-incision iqala ngokukhawuleza ukuya kwincam ye-fibula nangaphambili kwi-tendon ye-Achilles. Inqanaba lokusikeka lenziwa kude nje kwisikhumba esigruzukileyo esondliwe ngumthambo osecaleni we-calcaneal kunye nokufakwa kwisiseko se-metatarsal yesihlanu. La malungu mabini adityaniswe kwisithende ukwenza i-engile egobile kancinane. Umthombo: UCampbell Orthopedic Surgery.
Pukunciphisa i-ercutaneous poking
Ngeminyaka yee-1920, u-Böhler wavelisa indlela yonyango ehlasela kancinci yokunciphisa i-calcaneus phantsi kokutsalwa, kwaye ixesha elide emva koko, ukucutha i-percutaneous poking phantsi kwe-traction yaba yeyona ndlela iphambili yonyango lwe-calcaneus fractures.
Ilungele iifractures kunye nokufuduka okuncinci kwamaqhekeza e-intraarticular kwi-subtalar joint, njenge-Sanders uhlobo lwe-II kunye nezinye ii-Sanders III ze-lingual fractures.
Kuhlobo lwe-Sanders lwe-III kunye nohlobo lwe-Sanders oluqhubekileyo lwe-IV kunye nokuqhekeka okukhulu kwe-subtalar articular surface, ukunciphisa i-poking kunzima kwaye kunzima ukufezekisa ukunciphisa kwe-anatomical ye-posterior articular surface ye-calcaneus.
Kunzima ukubuyisela ububanzi be-calcaneus, kwaye ukukhubazeka akukwazi ukulungiswa kakuhle. Ihlala ishiya udonga olusecaleni lwe-calcaneus ngamaqondo ahlukeneyo, okukhokelela kwimpembelelo ye-malleolus ephantsi esecaleni kunye nodonga olusecaleni lwe-calcaneus, ukufuduka okanye ukunyanzeliswa kwe-tendon ye-peroneus longus, kunye nokunyanzeliswa kwe-tendon peroneal. I-Syndrome, intlungu ye-calcaneal impingement, kunye ne-peroneus longus tendonitis.
Westhues/Essex-lopresti ubuchule. A. I-Lateral fluoroscopy iqinisekise iqhekeza elibume ngolwimi; B. Inqwelomoya ethe tyaba yeCT scan ibonise uhlobo lweSandes lwe-IIC fracture. Inxalenye yangaphambili ye-calcaneus icaciswa ngokucacileyo kwimifanekiso yomibini. S. Ukuthwala umgama ngesiquphe.
C. Ukusikwa kweLateral akuzange kusetyenziswe ngenxa yokudumba okunzulu kwezicubu ezithambileyo kunye nokudumba; D. I-Lateral fluoroscopy ebonisa umphezulu we-articular (umgca onamachaphaza) kunye ne-talar collapse (umgca oqinileyo).
U-E kunye no-F. Iingcingo ezimbini zesikhokelo ezivulekileyo zesikhonkwane zibekwe ngokuhambelana nendawo engezantsi yeqhekeza elifana nolwimi, kwaye umgca onamachaphaza ngumgca odibeneyo.
G. I-Flex idolo elihlangeneyo, i-pry up i-pin yesikhokelo, kwaye ngexesha elifanayo i-plantar flex i-midfoot ukunciphisa ukuphuka: H. Enye i-6.5 mm ye-screw cannulated yayigxininiswe kwithambo le-cuboid kunye neengcingo ezimbini ze-2.0 mm ze-Kirschner zichazwe kwi-subspan ukuze kugcinwe ukunciphisa ngenxa ye-calcaneus anterior comminution. Umthombo: Mann Foot kunye ne-Ankle Surgery.
Sinus tarsi incision
Ukusikwa kwenziwa nge-1 cm ubude ukuya kwincam yefibula ukuya kwisiseko semetatarsal yesine. Ngomnyaka we-1948, uPalmer waqala wabika i-incision encinci kwi-sinus tarsi.
Ngo-2000, u-Ebmheim et al. wasebenzisa indlela ye-tarsal sinus kunyango lweklinikhi yokuqhekeka kwe-calcaneal.
o Inokuveza ngokupheleleyo i-subtalar joint, i-posterior articular surface kunye ne-anterolateral fracture block;
o Yiphephe ngokufanelekileyo imithambo yegazi esecaleni kwecalcaneal;
o Akukho mfuneko yokusika i-calcaneofibular ligament kunye ne-subperoneal retinaculum, kwaye indawo edibeneyo inokunyuswa ngokuguquguquka okufanelekileyo ngexesha lokusebenza, elineenzuzo ze-incision encinci kunye nokopha okuncinci.
Ukungalungi kukuba ukubonakaliswa ngokucacileyo akwanelanga, okukhawulela kwaye kuchaphazela ukunciphisa ukuphuka kunye nokubekwa kokulungiswa kwangaphakathi. Ilungele kuphela uhlobo lweSanders I kunye nohlobo lwe-II calcaneal fractures.
Oi-blique encinci
Ukuguqulwa kwe-sinus tarsi incision, malunga ne-4 cm ubude, igxininise i-2 cm ngaphantsi kwe-malleolus esecaleni kunye nokuhambelana nomphezulu we-articular yangasemva.
Ukuba ukulungiswa kwangaphambi kokusebenza kwanele kwaye iimeko zivuma, kunokuba nokunciphisa okulungileyo kunye nokulungiswa kwempembelelo kwi-Sanders uhlobo lwe-II kunye ne-III intra-articular calcaneal fractures; ukuba i-subtalar joint fusion iyadingeka kwixesha elide, i-incision efanayo ingasetyenziswa.
I-PT Peroneal tendon. PF Umphezulu ongemva we-calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Ukusika ngasemva kwilongitudinal
Ukuqala ukusuka kumbindi womgca phakathi kwe-tendon ye-Achilles kunye nencam ye-malleolus esecaleni, isuka ngokuthe nkqo ukuya kwi-talar isithende esihlangeneyo, kunye nobude obumalunga ne-3.5 cm.
Ukusika okuncinci kwenziwa kwizicubu ezithambileyo ezikude, ngaphandle kokonakalisa izakhiwo ezibalulekileyo, kwaye i-posterior articular surface ibonakaliswe kakuhle. Emva kwe-percutaneous prying kunye nokunciphisa, ibhodi ye-anatomical yafakwa phantsi kwesikhokelo sombono we-intraoperative, kwaye i-screw percutaneous yaxutywa kwaye yalungiswa phantsi koxinzelelo.
Le ndlela ingasetyenziselwa uhlobo lwe-Sanders I, II, kunye ne-III, ngokukodwa kwi-posterior articular surface okanye i-tuberosity fractures.
Herringbone cut
Ukuguqulwa kwe-sinus tarsi incision. Ukusuka kwi-3 cm ngaphezu kwencam ye-malleolus esecaleni, ecaleni komda ongasemva we-fibula ukuya kwincam ye-malleolus esecaleni, emva koko ukuya kwisiseko se-metatarsal yesine. Ivumela ukunciphisa okulungileyo kunye nokulungiswa kwe-Sanders yohlobo lwe-II kunye ne-III i-calcaneal fractures, kwaye inokwandiswa xa kuyimfuneko ukuveza i-transfibula, i-talus, okanye ikholomu yecala lonyawo.
LM iqatha elisecaleni. I-MT metatarsal joint. SPR Supra fibula retinaculum.
Aukunciphisa uncedo lwe-rthroscopically
Kwi-1997, uRammelt ucebise ukuba i-arthroscopy ye-subtalar ingasetyenziselwa ukunciphisa i-posterior articular surface ye-calcaneus phantsi kombono othe ngqo. Kwi-2002, uRammelt waqala ukwenza i-arthroscopically incedise ukunciphisa i-percutaneous kunye ne-screw fixation ye-Sanders uhlobo lwe-I kunye ne-II fractures.
I-subtalar arthroscopy idlala indima enkulu yokubeka iliso kunye nokuncedisa. Iyakwazi ukujonga imeko ye-subtalar articular surface phantsi kombono othe ngqo, kwaye incedise ekubekeni iliso ekunciphiseni kunye nokulungiswa kwangaphakathi. I-subtalar joint dissection kunye ne-osteophyte resection nayo inokwenziwa.
Iimpawu zincinci: kuphela kwi-Sanders yohlobo Ⅱ kunye nokuhamba kancinci kwe-articular surface kunye ne-AO/OTA uhlobo lwe-83-C2 fractures; ngelixa uSanders Ⅲ, Ⅳ kunye nohlobo lwe-AO/OTA 83-C3 Ukuqhekeka kunye nokuwa komphezulu we-articular njenge-83-C4 kunye ne-83-C4 kunzima kakhulu ukusebenza.
indawo yomzimba
b. I-arthroscopy ye-ankle yangasemva. c. Ukufikelela kwi-fracture kunye ne-subtalar joint.
Izikrufu zeSchantz zafakwa.
e. Ukusetha kwakhona kunye nokulungiswa kwexeshana. f. Emva kokusetha kwakhona.
g. Lungisa okwethutyana ibhloko yethambo le-articular surface. h. Lungisa ngezikrufu.
i. I-postoperative sagittal CT scan. j. Umbono we-axial wasemva kokusebenza.
Ukongezelela, indawo edibeneyo ye-subtalar incinci, kwaye i-traction okanye i-brackets iyadingeka ukuxhasa indawo edibeneyo ukuze kube lula ukubekwa kwe-arthroscope; indawo yokuguqulwa kwe-intra-articular incinci, kwaye ukuguqulwa ngokungakhathali kunokubangela umonakalo we-iatrogenic cartilage surface; iindlela zotyando ezingenazakhono zithandeka kwintlangano yokulimala kwendawo.
Pibhaluni ye-ercutaneous angioplasty
Ngo-2009, u-Bano waqala ukwenza isindululo sobuchule bokwandiswa kwebhaluni kunyango lwezaphulelo zecalcaneal. Kuhlobo lweSanders II fractures, uninzi loncwadi lujonga isiphumo siqinisekile. Kodwa ezinye iintlobo zokuqhekeka zinzima ngakumbi.
Emva kokuba i-samente yethambo ingena kwindawo edibeneyo ye-subtalar ngexesha lokusebenza, iya kubangela ukugqoka kwendawo ye-articular kunye nokunciphisa ukunyakaza okuhlangeneyo, kunye nokwandiswa kwebhaluni akuyi kulungelelaniswa ekunciphiseni ukuphuka.
Ukubekwa kwe-cannula kunye nocingo lwesikhokelo phantsi kwe-fluoroscopy
Imifanekiso phambi nasemva kokunyuka kwamaxabiso e-airbag
X-ray kunye CT imifanekiso iminyaka emibini emva kotyando.
Okwangoku, iisampulu zophando lweteknoloji yebhaluni zincinci, kwaye uninzi lweefractures ezineziphumo ezilungileyo zibangelwa bubundlobongela obuphantsi kwamandla. Uphando olongezelelweyo lusafuneka kwi-calcaneal fractures kunye ne-fracture embi kakhulu. Kuye kwenziwa ixesha elifutshane, kwaye ukusebenza kwexesha elide kunye neengxaki azikacaci.
Cisikhonkwane se-alcaneal intramedullary
Ngo-2010, i-calcaneal intramedullary nail yaphuma. Ngo-2012, i-M.Goldzak i-invasive encinci yonyango lwe-calcaneal fractures kunye ne-intramedullary nailing. Kufuneka kugxininiswe ukuba ukunciphisa akukwazi ukufezekiswa nge-intramedullary nailing.
Faka iphini lokubeka isikhokelo, i-fluoroscopy
Ukubeka ngokutsha i-subtalar joint
Beka isakhelo sokumisa, uqhube isikhonkwane se-intramedullary, kwaye usilungise ngezikrufu ezibini ze-5 mm ezinkonkxiweyo.
Umbono emva kokubekwa kwe-intramedullary nail.
I-Intramedullary nailing ibonakaliswe ukuba iphumelele kunyango lwe-Sanders uhlobo lwe-II kunye ne-III fractures ye-calcaneus. Nangona abanye oogqirha bazama ukuyifaka kwi-Sanders IV fractures, umsebenzi wokunciphisa wawunzima kwaye ukunciphisa okufanelekileyo kwakungafumaneki.
Umntu woQhagamshelwano: Yoyo
WA/TEL:+8615682071283
Ixesha lokuposa: May-31-2023
