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. Flex idolo elihlangeneyo, uphakamise isikhonkwane sesikhokelo, kwaye kwangaxeshanye iplantar flex in the midfoot ukunciphisa ukuphuka: H. Esinye i-6.5 mm cannulated screw sasigxininiswe kwithambo le-cuboid kunye neengcingo ezimbini ze-2.0 mm Kirschner zaye zachazwa. gcina ukunciphisa ngenxa ye-calcaneus yangaphambili.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 kwiminyaka 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
