Indlela eqhelekileyo ye-L ecaleni yindlela eqhelekileyo yonyango lotyando lwezaphuko ze-calcaneal. Nangona ukuvezwa kucocekile, ukusika kukude kwaye izicubu ezithambileyo zihlutywa ngakumbi, nto leyo ekhokelela kwiingxaki ezinje ngokudinwa kokudibana kwezicubu ezithambileyo, i-necrosis, kunye nosulelo. Kunye nokufuna koluntu lwangoku ubuhle obungenazintsholongwane, unyango lotyando lwezaphuko ze-calcaneal olungenazintsholongwane luye lwanconywa kakhulu. Eli nqaku liqokelele iingcebiso ezisi-8.
Ngokusebenzisa indlela ebanzi ecaleni, inxalenye ethe nkqo ye-incision iqala kancinci kufutshane nencam ye-fibula kwaye ingaphambili kwi-Achilles tendon. Inqanaba le-incision lenziwa lide kakhulu kulusu olutyumkileyo olunikwa yi-lateral calcaneal artery kwaye lifakwe kwisiseko se-metatarsal yesihlanu. Ezi ndawo zimbini ziqhagamshelwe esithendeni ukuze zenze i-engile yasekunene egobileyo kancinci. Umthombo: Utyando lwe-Campbell Orthopedic.
Pukunciphisa ukudumba kwesikhumba
Ngeminyaka yoo-1920, uBöhler wavelisa indlela yokunyanga engaphantsi kakhulu yokunciphisa i-calcaneus phantsi kokutsalwa, kwaye ixesha elide emva koko, ukunciphisa ukutsalwa kwe-percutaneous poking phantsi kokutsalwa kwaba yindlela eqhelekileyo yokunyanga ukwaphuka kwe-calcaneus.
Ifanelekile kwiingozi ezingenakushukunyiswa kakhulu ziingceba zangaphakathi kwilungu elingaphantsi kwethambo, ezifana nohlobo lweSanders II kunye nezinye iingozi zolwimi lweSanders III.
Kwi-Sanders type III kunye ne-comminuted Sanders type IV fractures kunye nokuwa okukhulu komphezulu we-subtalar articular, ukunciphisa i-poking kunzima kwaye kunzima ukufikelela ekunciphiseni i-anatomical yomphezulu we-posterior articular we-calcaneus.
Kunzima ukubuyisela ububanzi be-calcaneus, kwaye ukukhubazeka akunakulungiswa kakuhle. Kudla ngokushiya udonga olusecaleni lwe-calcaneus ngamaqondo ahlukeneyo, okubangela impembelelo ye-malleolus esezantsi ecaleni kunye nodonga olusecaleni lwe-calcaneus, ukufuduka okanye ukucinezelwa kwe-tendon ye-peroneus longus, kunye nokuthintelwa kwe-tendon ye-peroneal. Isifo, intlungu yokuthintelwa kwe-calcaneal, kunye ne-peroneus longus tendonitis.
Indlela yeWesthues/Essex-lopresti. A. I-fluoroscopy esecaleni iqinisekisile ukuba isiqwenga solwimi esiwileyo siwile; B. I-CT scan ethe tye ibonise ukwaphuka kohlobo lwe-IIC lweSandess. Inxalenye engaphambili ye-calcaneus icacile ngokucacileyo kwimifanekiso yomibini. S. Umgama wokuthwala ngequbuliso.
C. Ukusikwa kwecala akukwazanga ukusetyenziswa ngenxa yokudumba okukhulu kwezicubu ezithambileyo kunye nokudumba kwamadyungudyungu; D. I-fluoroscopy esecaleni ebonisa umphezulu we-articular (umgca onamachaphaza) kunye nokuwa kwe-talar (umgca oqinileyo).
E kunye no-F. Iingcingo ezimbini zesikhokelo sezikhonkwane ezingenanto zibekwe ngakwicala elisezantsi lesiqwenga esimile njengolwimi, kwaye umgca onamachaphaza ngumgca odibeneyo.
G. Thunga idolo, susa iphini yesikhokhelo, kwaye kwangaxeshanye tyumza i-midfoot ukuze unciphise ukwaphuka: H. I-screw enye ye-cannulated eyi-6.5 mm yayinamathele kwithambo le-cuboid kwaye iingcingo ezimbini ze-Kirschner eziyi-2.0 mm zadityaniswa ukuze kugcinwe ukuncipha ngenxa yokuphazamiseka kwangaphambi kwe-calcaneus. Umthombo: Utyando lweMann Foot and Ankle.
Si-inus tarsi incision
Ukusika kwenziwa nge-1 cm ukusuka encamini ukuya kwisiseko se-fourth fibula. Ngo-1948, uPalmer waxela okokuqala ukuba kukho ukunqunyulwa okuncinci kwi-sinus tarsi.
Ngowama-2000, u-Ebmheim nabanye basebenzise indlela ye-tarsal sinus kunyango lwezonyango lwezaphuko ze-calcaneal.
o Ingaveza ngokupheleleyo i-subtalar joint, umphezulu we-articular ongasemva kunye ne-anterolateral fracture block;
o Ziphephe ngokwaneleyo imithambo yegazi esecaleni ye-calcaneal;
Akukho mfuneko yokunqumla i-calcaneofibular ligament kunye ne-subperoneal retinaculum, kwaye indawo yamalungu inokwandiswa ngokujika okufanelekileyo ngexesha lotyando, okunezibonelelo zokusikwa okuncinci kunye nokopha kancinci.
Ingxaki kukuba ukuvezwa akwanelanga ngokucacileyo, nto leyo ethintela kwaye ichaphazela ukunciphisa ukwaphuka kunye nokubekwa kokulungiswa kwangaphakathi. Ifanelekile kuphela kwiintlobo zeSanders zokwaphuka kwe-calcaneal type I kunye ne-type II.
Oisikrweqe esincinci se-blique
Utshintsho lwe-sinus tarsi incision, malunga ne-4 cm ubude, ephakathi kwi-2 cm ngaphantsi kwe-lateral malleolus kwaye ihambelana nomphezulu ongasemva we-articular.
Ukuba amalungiselelo angaphambi kotyando anele kwaye iimeko ziyavuma, anokuba nefuthe elihle lokunciphisa nokulungisa ii-fractures ze-calcaneal ze-Sanders zohlobo lwesibini nolwesithathu; ukuba kufuneka i-subtalar joint fusion kwixesha elide, i-incision efanayo ingasetyenziswa.
I-PT Peroneal tendon. Umphezulu we-PF ongasemva we-calcaneus. I-S sinus tarsi. I-AP I-Calcaneal protrusion. .
Ukusikwa kwe-longitudinal yangasemva
Iqala kumbindi womgca ophakathi kwe-Achilles tendon kunye nencam ye-lateral malleolus, yolulela ngokuthe nkqo ukuya kwi-talar heel joint, enobude obumalunga ne-3.5 cm.
Akukho kusikwa kuninzi kwizicubu ezithambileyo, ngaphandle kokonakalisa izakhiwo ezibalulekileyo, kwaye umphezulu ongasemva we-articular ubonakala kakuhle. Emva kokucwiliswa nokuncitshiswa kwe-percutaneous, ibhodi ye-anatomical ifakwe phantsi kwesikhokelo se-pericutaneous perspective, kwaye i-screw ye-percutaneous yacofwa yaza yaqiniswa phantsi koxinzelelo.
Le ndlela ingasetyenziselwa uhlobo lweSanders I, II, kunye no-III, ingakumbi kwi-displaced posterior articular surface okanye i-tuberosity fractures.
Isiqwenga seHerringbone
Ukuguqulwa kwe-sinus tarsi incision. Ukusuka kwi-3 cm ngaphezulu kwencam ye-lateral malleolus, ecaleni komda ongasemva we-fibula ukuya kwincam ye-lateral malleolus, uze uye kwisiseko se-fourth metatarsal. Ivumela ukunciphisa okuhle kunye nokulungiswa kwe-Sanders type II kunye ne-III calcaneal fractures, kwaye inokwandiswa ukuba kuyimfuneko ukuze iveze i-transfibula, i-talus, okanye ikholamu esecaleni yonyawo.
Iqatha elisecaleni le-LM. Ilungu le-MT metatarsal. I-SPR Supra fibula retinaculum.
Aukunciphisa ngoncedo lwe-rthroscopically
Ngo-1997, uRammelt wacebisa ukuba i-subtalar arthroscopy ingasetyenziselwa ukunciphisa umphezulu ongasemva we-calcaneus phantsi kokubona ngqo. Ngo-2002, uRammelt waqala ukwenza i-arthroscopically assisted percutaneous reduction kunye ne-screw fixation kwiintlobo zeSanders type I kunye ne-II fractures.
I-subtalar arthroscopy ikakhulu idlala indima yokubeka esweni kunye neyokuncedisa. Ingajonga imeko yomphezulu we-subtalar articular phantsi kombono othe ngqo, kwaye incede ekuboneni ukunciphisa kunye nokulungiswa kwangaphakathi. Ukuqhaqha okulula kwe-subtalar joint kunye nokususwa kwe-osteophyte nako kunokwenziwa.
Izalathiso zincinci: kuphela kwiSanders type Ⅱ enokutshintsha okuncinci komphezulu we-articular kunye ne-AO/OTA type 83-C2 fractures; ngelixa kwiSanders Ⅲ, Ⅳ kunye ne-AO/OTA type 83-C3 Fractures ene-articular surface collapse efana ne-83-C4 kunye ne-83-C4 kunzima ukuyisebenzisa.
indawo yomzimba
b. I-arthroscopy yeqakala elingasemva. c. Ukufikelela kwindawo ephukileyo nelidibeneyo elingaphantsi kwethambo.
Kwafakwa izikrufu zeSchantz.
e. Ukuseta ngokutsha kunye nokulungiswa okwethutyana. f. Emva kokuseta kwakhona.
g. Lungisa ibhloko yethambo yomphezulu odibeneyo okwethutyana. h. Lungisa ngezikrufu.
i. Iskeni ye-CT yesagittal emva kotyando. j. Imbono ye-axial emva kotyando.
Ukongeza, indawo edibeneyo engaphantsi kwe-subtalar incinci, kwaye kufuneka ukutsala okanye izibiyeli ukuxhasa indawo edibeneyo ukuze kube lula ukubeka i-arthroscope; indawo yokuphathwa kwe-intra-articular incinci, kwaye ukuphathwa ngokungakhathali kunokubangela umonakalo kumphezulu we-cartilage ye-iatrogenic; iindlela zotyando ezingenabuchule zinokubangela ukwenzakala kwasekuhlaleni.
Pi-angioplasty yebhaluni ekhuhlane
Ngowama-2009, uBano waqala ngokucebisa indlela yokwandisa iibhaluni kunyango lwezaphuko ze-calcaneal. Kwiizaphuko ze-Sanders type II, uninzi lweencwadi lubona isiphumo siqinisekileyo. Kodwa ezinye iintlobo zazaphuko zinzima ngakumbi.
Xa isamente yethambo ingena kwindawo edibeneyo engaphantsi kwexesha ngexesha lokusebenza, iya kubangela ukuguguleka komphezulu we-articular kunye nokuthintelwa kokuhamba kwamalungu, kwaye ukwandiswa kwebhaluni akuyi kulungelelaniswa ekunciphiseni ukwaphuka.
Ukubekwa kwe-cannula kunye nentambo yesikhokelo phantsi kwe-fluoroscopy
Imifanekiso ngaphambi nasemva kokunyuka kwe-airbag
Imifanekiso ye-X-ray kunye ne-CT kwiminyaka emibini emva kotyando.
Okwangoku, iisampulu zophando lwetekhnoloji yebhaluni zihlala zincinci, kwaye uninzi lwezaphuko ezineziphumo ezilungileyo zibangelwa bubundlobongela obusebenzisa amandla aphantsi. Kusafuneka uphando olongezelelekileyo lwazaphuko lwe-calcaneal olunokushenxa okukhulu kwazaphuko. Lwenziwe ixesha elifutshane, kwaye ukusebenza kakuhle kwexesha elide kunye neengxaki azikacaci.
Cuzipho lwe-alcaneal intramedullary
Ngowama-2010, kwaphuma uzipho lwe-calcaneal intramedullary. Ngowama-2012, i-M.Goldzak yanyanga kancinci ukuqhekeka kwe-calcaneal nge-intramedullary nailling. Kufuneka kugxininiswe ukuba ukunciphisa akunakufezekiswa nge-intramedullary nailling.
Faka iphini yesikhokelo sokubeka, i-fluoroscopy
Ukutshintsha indawo edibeneyo ye-subtalar
Beka isakhelo sokubeka indawo, qhuba isikhonkwane se-intramedullary, uze usilungise ngezikrufu ezibini ezineengqayi ze-5 mm
Imbono emva kokubekwa kwezipikili ngaphakathi kwe-medullary.
Ukubethelwa kwezipikili ngaphakathi kwe-intramedullary kuye kwabonakala kuphumelele ekunyangeni ukwaphuka kwe-calcaneus yohlobo lwe-Sanders II kunye nolwe-III. Nangona abanye oogqirha bazama ukukusebenzisa kwiikwaphuka ze-Sanders IV, utyando lokunciphisa belunzima kwaye ukuncitshiswa okufanelekileyo bekungenakufumaneka.
Umntu woQhagamshelwano: Yoyo
WA/TEL:+8615682071283
Ixesha lokuthumela: Meyi-31-2023
