I-Navicular Antnion yenzeka malunga ne-5-15% yazo zonke izinto ezinobungozi kwithambo le-navicular, nge-navicular necrosis yenzeka malunga ne-3%. Izinto ezinomngcipheko kwi-Navicular Antnion ibandakanya ukuphoswa kwesifo, ukubekwa kwe-proximal yomgca wokuqhekeka, ukufuduswa okungaphezulu kwe-1 mm, kunye nokuqhekezwa kukungazinzi kwemoto. Ukuba ishiywe enganyangwa, i-Navicular Osteochondral Insuleloon ihlala inxulunyaniswa nesifo samathambo, esabizwa ngokuba yi-navicular ye-osteochondracralhralthrigis.
I-BONAGRAFY NOKANYE ngaphandle kwe-vasculard flap inokusetyenziselwa ukunyanga i-osteochoracralracracralracracracral Nangona kunjalo, kwizigulana ezine-osteonecrosis yesibonda se-proximal yethambo le-navicular, iziphumo zomgangatho wethambo ngaphandle kwencam ye-vascular ingonelisi, kwaye inqanaba lokuphilisa ithambo lingama-40% kuphela. Ngokwahlukileyo, inqanaba lokuphilisa lezithambo elinamafutha ane-vasculard inokuba phezulu njenge-88% -91%. I-vascular ye-vascular ye-vascular kwisenzo sekliniki ibandakanya i-1,2-i-tics ye-tics ye-ticral the thet, i-vascular runder ye-vascular ye-vascture ye-vascture ye-vastylar ye-vastylar ngencam ye-vascular ye-vascular ye-vascular ye-vascular enesipili se-vascular sengqele. I-MFC yasimahla ye-MFC ibonakalisiwe ukuba isebenze kunyango lwe-navicorparal aremppal ye-metacarpal, kwaye i-MFC VBG isebenzisa isebe elisecaleni le-tempe. Xa kuthelekiswa nezinye iiflethi, i-MFC VBG ibonelela ngenkxaso eyaneleyo yokwakha ukubuyisela ubume obuqhelekileyo bethambo eliqhelekileyo, ngakumbi kwi-Navicular Fracture Kunyango lwe-Navicular Osteochondrasis osteonecrosis eqhubekayo, i-1,2-i-1,2-i-1,2-i-1,2-i-1,2-i-ICICSRA-i-Disra-i-tics ye-disrap inikwe iflethi yokuphilisa i-40% kuphela, ngelixa i-MFC VBG inomgangatho we-100%.
Umzobo 1. Ukuqhekeka kwethambo le-navicular enesiphene "esithe nkqi", i-CT ibonisa ibhloko ye-fricture phakathi kwamathambo angama-9 °.
Ukulungiswa kwenkonzo
Emva kovavanyo lomzimba we-Wrist ochaphazelekayo, kufuneka lwenziwe uvavanyo lokuvavanya inqanaba le-Wrist. I-radiographs ecacileyo iluncedo ukuqinisekisa indawo yokuqhekeka, inqanaba lokufuduswa, kunye nobukho bento yokwandisa okanye i-sclerosis yesiphelo esiphukileyo. Imifanekiso yangaphandle yangaphandle isetyenziselwa ukuvavanya ukuwa kwesandla, ukungazinzi kwe-dorsal ye-Wrist (Didi) usebenzisa umlinganiselo wobude obuhle (ukuphakama / ububanzi) ye-≤1.52 okanye i-radial ° ye-radial enkulu kune-15 °. I-MRI okanye i-CT inokunceda ekufumaneni i-malaficy yethambo le-navicular okanye i-osteonecrosis. I-radiographs ka-Lateral okanye i-biquique sagittal ct yethambo le-Navicular enesithambisi sethambo lase-Navicular "ithethwa njengeyona nto iphambili kwi-Navicular ye-Navicular ye-Navicular ye-Navicular i-Navict kwi-phraction.
Izalathiso kunye nokuchasa:
I-navicular osteochoracralracral ye-nosteochondracracracral ye-nosteochondracracral ye-Navicular ye-Osteochondracracral ye-Nosteochondracral ye-Nosteochondracracral nge-Froformation ibuyiselwe kwaye i-Disi; I-MRI ibonisa i-iCrosis yethambo le-navicular, i-intraopeetives ye-Inraopeet kunye nokujonga kokuqhekezwa kwethambo le-navicular ithambo elimhlophe lisesihloni esimhlophe. Ukusilela kwe-Wedge ye-Wedge yethambo okanye i-screw ukulungiswa kwangaphakathi kufuna i-vb ye-vb ye-vb ye-vb (> 1cm3). Iziphumo zokuphumelela okanye ukuntywila kwe-osteoarthritis yomdibaniso we-raidpal; Ukuba i-quunion ye-navicular ebiyela i-osteoarthritis yenzekile, emva koko i-Wrist Derenur, i-Navictur Osteotomy, i-quadrangmal fusion, i-proximal carpal osteotomy, iyonke iyonke, njl. Njl. I-Navicor I-Commarion, i-proximal necrosis, kodwa ine-morphology eqhelekileyo (umz. Ukunqunyulwa ngaphandle kwe-navicular ngaphandle kwe-osteonecrosis. .
Ifake i-anatomy
I-MFC VBG inikezelwa linani leenqanawa ezincinci ze-trophoblastic (zithetha 30, 20-50), elona gazi lininzi lingaphezulu le-Postlel Elstoral (i-6.4), ilandelwe ngu-4.9). These trophoblastic vessels were mainly supplied by the descending geniculate artery (DGA) and/or the superior medial geniculate artery (SMGA), which is a branch of the superficial femoral artery that also gives rise to articular, musculocutaneous, and/or saphenous nerve branches. I-DGE ivela kwi-ortery ye-ortery ye-ordery kwi-convinal edines, okanye kumgama we-13,7 cm), kunye nokuzinza kwesebe bekungama-89% kwiimodeli ze-canaveric (umfanekiso 3). I-DGA ivela kwi-ortery ye-femoral ye-orbficial kwi-13.7 cm-17 cm) i-proximal ye-malleous yefismour okanye i-proximal ebonisa uzinzo lwesebe elinama-100% malunga ne-0.78 mm. Ke ngoko, nokuba i-DGA okanye i-SMGA yamkelekile, nangona yayikukulungele ngakumbi i-tibiae ngenxa yobude nobubanzi benqanawa.
Umzobo 2. Ukuhanjiswa kwe-quadcrant ye-MFC Trophoblast ecaleni komgca othe tyaba phakathi kwe-semitendinus kunye ne-ligament ye-Medial A, umgca we-trouse enkulu ye-patella c, umgca we-menatesior d.
Umzobo 3. I-MFC Vascular Anatomy: (a) amasebe angaqhelekanga kunye ne-MFC Trophoblastic Anatom Anetom, (b) umgama wemvelaphi ye-vascular kumgca odibeneyo
Ukufikelela utyando
Isigulana sibekwe phantsi kwe-anesthesia jikelele kwisikhundla esiphakamileyo, kunye nomlenze ochaphazelekayo ubekwe kwitafile yoqhaqho ngesandla. Ngokubanzi, i-Bone ye-Bone yeBone ithathwe kwi-conmoral ye-Ipsmoral ye-Ipsmoral, ukuze isigulana sishukume kunye notyando emva kotyando. Idolo eliphikisayo linokukhethwa ukuba kukho imbali yoxinzelelo lwasemva okanye utyando kwicala elinye ledolo. Idon iguqukile kwaye i-hip ijikeleze ngaphandle, kwaye iingcingo zisetyenziswa kuzo zombini iindawo ezingaphezulu nangaphantsi. Inkqubo yoNyango yayiyindlela eyandisiweyo ye-russe, eqaqanjelwa yi-8 cm proximal kwi-carpimal ye-radial farpis therp therp therp therpy therp thernes, igqitha kwinqanaba le-trounter enkulu. I-shendon ye-tendotimas i-thersismus ye-teadismus ikhutshiwe kwaye i-tendon itsaliwe, kwaye ithambo lase-Navicular liveliswe yi-tissural ye-radiclel kunye ne-radhel ye-navicularal ye-Navicularal yethambo (umzobo 4). Qinisekisa indawo ye-Union, umgangatho we-artilage ye-artiatur kunye nenqanaba leSchaemia yethambo le-navicular. Emva kokukhulula i-Travithaet, jonga isibonda se-proximal yethambo le-naviculal le-factring ukopha ukufumanisa ukuba ikhona i-ischemic Nectrosis necrosis. Ukuba i-navicular necrosis ayinxulunyaniswa ne-rabial carpal okanye i-intertimis ye-intertimis, i-MFC vbb ingasetyenziswa.
Umzobo 4. Inkqubo ye-Navicular utyarmarical: (a) I-proximal iqalisa i-8 cm proximal ye-carpal ye-radial firsor i-raping therpul teram kwi-therpul tennel. . (C) Chonga indawo ye-Navicular Oltium)
I-ATM e-15 ukuya kwe-20 yenziwa i-proximal kumgca odibeneyo wamadolo ecaleni komda we-Posterial Work, kwaye umsipha wegazi ugcinwe kakhulu ukuba asebenzise isebe le-MFC kunye nethambo elilinganayo le-DGA kunye nethambo elihambelanayo. I-vascular pedicle ikhululwe ngendlela eyiyo, ethathela ingqalelo ukukhusela i-periosteum kunye neenqanawa ze-trophobistic kwicandelo le-bony.
Umzobo 5. Ukufikelela kwi-subical ukuya kwi-MFC: (a) I-I-15 ukuya kwi-20 cm yenziwa ngendlela engathethekiyo yomda we-posteral wemisipha ye-medial edolophini. .
Ukulungiswa kwethambo le-navicular
Isiphene se-Navicular Dismiform kufuneka silungiswe kwaye indawo ye-osteochondral Bone ilungiselelwe ngaphambi kokufakwa kwi-veoroscopy ye-fluoroscopy ye-radial ye-radial rabial (umfanekiso 6). A 0.0625-foot (approximately 1.5-mm) Kirschner pin is drilled percutaneously from dorsal to metacarpal to fixate the radial lunate joint, and the navicular malunion gap is exposed when the wrist is straightened. Indawo yokuqhekeka icocwe kwi-tishu ezithambileyo kwaye iqhubekile ivuliwe kunye nosasazo lweplate. I-Sawtiction Recipitocal Reciting isetyenziselwa ukuthoba ithambo kwaye kuqinisekiswe ukuba iflefa yeflanethi ifana nesakhiwo esixanda kunomsantsa, ofuna ukuba i-Navicular Gap ithwaxwe kwicala elingaphezulu kwe-parmal ecaleni kwecala le-parmar kunakwicala lasecaleni kunakwicala lasecaleni. Emva kokuvula umsantsa, isiphene silinganiswe ngemilinganiselo emithathu yokufumanisa ubungakanani bethambo, elihlala liyi-10-12 mm ubude kuwo onke amacala e-graft.
Umzobo we-6 I-0.0625 yeenyawo (malunga ne-1.5-MM) iPIN ye-kirschner ikhutshiwe kwi-dorbacarpaal gesion yokulungisa i-rameral ye-radicy kwaye ibonisa ubungakanani be-rap eqingqiweyo ekufuneka ihlawulwe.
Osteotomy
Indawo ye-vascular ye-vascular ye-Onyango ye-Medial inyulwe njengendawo yokukhutshelwa kwethambo, kwaye indawo yethambo iphawulwe ngokufanelekileyo. Lumka ungayenzakalisa i-ligament ye-Medical Countration. I-periosteum iyakhutshwa, kwaye ithambo le-fack yoxande yobungakanani obufanelekileyo lweflepu elinqwenelekayo linqunywe nge-45 ° kwi-Blob ye-Blob Stock nge-45 kwicala elinye lokuqinisekisa ukuthembeka kweflethi (umzobo 7). 7). Unonophelo kufuneka luthathelwe ukuba ungahluleli i-periosteum, ithambo lethambo, kunye nethambo leflethi. I-Turnitotity esezantsi ye-Gremicioting kufuneka ikhutshwe ukuze iqaphele igazi lihamba ngeflethi, kwaye i-vascular pedicle kufuneka ikhululwe kwi-6 cm ukuvumela i-vastomosis elandelayo. Ukuba kukho imfuneko, isixa esincinci sethambo elinzima sinokuqhubeka ngaphakathi kwe-conmolution. Isiphene se-themoral se-themoral se-themoral sigcwele into yokubambela ithambo, kwaye i-vemos ikhutshiwe kwaye ivaliwe ungqimba.
Umzobo 7. I-MFC yethambo ithambo. . (B) isiqwenga sesibini sethambo sinqunyulwa ecaleni kwe-45 ° Ukuqinisekisa ukuthembeka kweflethi.
Ukufakwa kweflethi kunye nokulungiswa
I-bone flap iconjululwe kwimo efanelekileyo, ithathela ingqalelo ukungayicinezeli i-vascular okanye i-perioteum. Iflepu ifakwe ngokufana nendawo yethambo le-navicular yethambo, ukuthintela i-percussion, kwaye ilungiswe ngezikrelemnqa ezinqabileyo. Inkathalo yathatyathwa ukuqinisekisa ukuba umda we-plmar we-bone efakwe kwi-bone efakwe kwi-barmar yethambo le-navicular okanye elalixinezelekile kakhulu ukuba liphephe ukubekwa. I-Fluoroscopy yenziwa ukuqinisekisa i-Navicular Bone Morphology, umgca wemigangatho kunye nendawo yokukroba. I-Anastomomose i-vascular floiry kwi-radicial freery iphele icala kunye ne-venous ichibi ukuya kwi-radlery ye-radlery ye-radlery vein ephelisile ukuphela (umzobo 8). I-capsule edibeneyo ilungiswa, kodwa i-vascular pedicle ithintelwe.
Umzobo 8. I-Bone Flap yokubeka, ukulungiswa, kunye ne-vascular i-anastomosis. I-bone flap ifakwe kwindawo yethambo le-navicular yethambo kwaye ilungiswe ngesikrelemnqa se-navicular screen okanye izikhonkwane zeKirschner. Inkathalo ithathwa ukuba umda we-metacarpal we-bone efakwe kwibhloko efakwe kwi-comphacarpal yomda wethambo le-navicular okanye uxinezelekile ukuphepha ukungabonakali. I-Anastomosis ye-vascular flap ye-vascular flapp kwi-radial scired ukuphela, kwaye i-venking ingcebiso kwi-radial vein yenziwa sisiphelo.
Ukubuyiselwa kwimeko yesiqhelo
I-Aral Aspirin 325 MG ngosuku (kwinyanga e-1), i-Pobstoperapeation I-In Engled yelungu elichaphazelekayo livunyelwe, ukugqobhoza kwamadolo kunokunciphisa isigulana, kuxhomekeka kubuchule bomguli wokuhamba ngexesha elifanelekileyo. Inkxaso ye-paspoilalting ye-crutch enye inokunciphisa iintlungu, kodwa inkxaso yexesha elide yeetyuwa azimfuneko. Iinyikima zasuswa kwiiveki ezi-2 emva kotyando kunye ne-omenster okanye ingalo ye-humen to hume igcinwe kwindawo kwiiveki ezi-3. Emva koko, ingalo emfutshane yokutsiba isetyenziswa de iphilise. I-X-rays ithathwa kwi-3-6 yeVeki yeVeki, kunye nokuphiliswa komtshato kuqinisekisiwe yi-CT. Emva koko, izinto eziguquguqukayo nezingenayo ziya kuqaliswa ngokuthe chu ngokuthe chu, kwaye ubunzulu kunye nokusebenza rhoqo kuya kwandiswa ngokuthe chu.
Iingxaki ezinkulu
Iingxaki eziphambili ze-idolo zibandakanya iintlungu zedolo okanye ukwenzakala kwe-nerve. Iintlungu zedolo ikakhulu zenzeka kwiiveki ezi-6 emva kotyando, kwaye akukho lwancinane ngemvakalelo okanye i-neuroma enentlungu ngenxa ye-saphentuus nerve yentlungu yafunyanwa. Eyona nto iphambili kwi-Wrist Wrist iquka ithambo le-Nounlogion, iintlungu, ukuqina okukhuni, ubuthathaka, amathambo anokuqhubeka ne-osteoarthritis ye-radial shaterotopic nako kunikwa ingxelo.
I-Free Pomoral ye-Oneal Demoral i-vemily yethambo le-Scapilaid ye-Scapimad ye-Proximal Pole i-necrosis kunye ne-carpal iwa
IXESHA LOKUQALA: INDLELA YOKUGQIBELA - 28-2024
