Ukuphuka Kwesisekelo Se-Fifth Metatarsal

Ukwelashwa okungalungile kokuqhekeka kwesisekelo se-metatarsal kungaholela ekuqhekekeni okungezona inyuniyo noma ekubambezelekeni kwenyunyana, futhi izimo ezinzima zingase zidale isifo samathambo, esinomthelela omkhulu empilweni yansuku zonke yabantu nasemsebenzini.

Ai-natomicalSi-tructure

I-metatarsal yesihlanu iyingxenye ebalulekile yekholomu ehlangothini yonyawo, futhi idlala indima ebalulekile ekuthwaleni isisindo nasekuzinzeni konyawo.I-metatarsal yesine neyesihlanu kanye ne-cuboid yakha ilunga le-cuboid le-metatarsal.

Kunezintambo ezintathu ezixhunywe esisekelweni se-metatarsal yesihlanu, i-peroneus brevis tendon ifaka ohlangothini lwe-dorsolateral lwe-tuberosity phansi kwe-metatarsal yesihlanu;imisipha yesithathu ye-peroneal, engaqinile njenge-tendon ye-peroneus brevis, ifaka ku-diaphysis distal kuya ku-tuberosity yesihlanu ye-metatarsal;i-plantar fascia I-fascicle yangemuva ifaka ohlangothini lwesitshalo lwe-basal tuberosity ye-metatarsal yesihlanu.

Ukuhlukaniswa kwe-fracture

Ukuqhekeka kwesisekelo se-metatarsal yesihlanu kwahlukaniswa nguDameron noLawrence,

Ukuphuka kwe-Zone I kuwukuphuka kwe-avulsion ye-metatarsal tuberosity;

I-Zone II itholakala ekuxhumaneni phakathi kwe-diaphysis kanye ne-proximal metaphysis, kuhlanganise namalunga phakathi kwamathambo e-4th kanye ne-5th metatarsal;

Ukuphuka kwe-Zone III kuwukuphuka kwengcindezi ye-proximal metatarsal diaphysis distal kuya ku-4th/5th intermetatarsal joint.

Ngo-1902, uRobert Jones waqala ukuchaza uhlobo lwe-zone II yokuphuka kwesisekelo se-metatarsal yesihlanu, ngakho-ke ukuphuka kwe-zone II kubizwa nangokuthi i-Jones fracture.

Ukuphuka kwe-avulsion ye-metatarsal tuberosity ku-zone I wuhlobo oluvame kakhulu lokuphuka kwesisekelo se-metatarsal, okubalela cishe u-93% wakho konke ukuphuka, futhi kubangelwa ukugoba kwe-plantar kanye nodlame lwe-varus.

Ukuqhekeka ku-zone II kubala cishe u-4% wakho konke ukuphuka phansi kwe-metatarsal yesihlanu, futhi kubangelwa ukuguquguquka kwe-plantar yezinyawo kanye nodlame lokudonsa.Ngenxa yokuthi atholakala endaweni echithekile yamanzi lapho igazi litholakala khona ngaphansi kwe-metatarsal yesihlanu, ukuphuka kule ndawo kujwayele ukuvela okungezona i-nonunion noma ukuphuka okubambezelekile kuyaphola.

Ukuphuka kwe-Zone III kubala cishe u-3% wokuphuka kwesisekelo se-metatarsal yesihlanu.

Ukwelashwa okulandelanayo

Izinkomba eziyinhloko zokwelashwa okulondolozayo zihlanganisa ukususwa kokuphuka okungaphansi kuka-2 mm noma ukuphuka okuzinzile.Izindlela zokwelapha ezivamile zihlanganisa ukuqiniswa ngamabhandeshi anwebekayo, izicathulo ezinesodi eliqinile, ukufakwa kukakhonkolo ngokhonkolo, amaphedi okucindezela amakhadibhodi, noma amabhuzu ahambayo.

Izinzuzo zokwelashwa okuvamile zihlanganisa izindleko eziphansi, akukho ukuhlukumezeka, nokwamukelwa kalula yiziguli;ukungalungi kuhlanganisa izehlakalo eziphezulu zokuphuka okungezona iyuniyoni noma ukubambezeleka kwezinkinga zenyunyana, nokuqina kwamalunga okulula.

UkuhlinzaTukwelashwa

Izinkomba zokwelashwa kokuhlinzwa kwe-fifth metatarsal base fractures zifaka:

1. Ukuhlukaniswa kwe-fracture okungaphezu kuka-2 mm;

1. Ukubandakanywa okungaphezulu kwama-30% we-articular surface ye-cuboid distal ukuya ku-metatarsal yesihlanu;

1. Ukuphuka okuphindaphindiwe;

1. Ukuphuka kwenyunyana ebambezelekile noma ukungenzi lutho ngemva kokwelashwa okungahlinzeki;

1. Iziguli ezisencane ezisebenzayo noma abasubathi bezemidlalo.

Njengamanje, izindlela ezivame ukusetshenziswa zokuhlinza zokuphuka kwesisekelo se-metatarsal yesihlanu zifaka ibhande le-Kirschner wire tension fixation yangaphakathi, ukulungiswa kwe-anchor suture ngentambo, ukulungisa kwangaphakathi ngesikulufu, kanye nokulungiswa kwangaphakathi kwepuleti lehhuku.

1. Ukulungiswa kwebhendi ye-Kirschner wire tension

Ukulungiswa kwebhendi ye-Kirschner wire tension kuyindlela yokuhlinza evamile.Izinzuzo zale ndlela yokwelapha zihlanganisa ukufinyelela okulula kwezinto zokulungisa zangaphakathi, izindleko eziphansi, nomphumela omuhle wokucindezela.Okubi kuhlanganisa ukucasuka kwesikhumba kanye nengozi yokuxegiswa kwentambo ye-Kirschner.

2. Ukulungiswa kwe-Suture ngamahange anentambo

Ukulungiswa kwe-anchor suture ngentambo kulungele iziguli ezine-avulsion fractures phansi kwe-metatarsal yesihlanu noma ngezingcezu ezincane zokuphuka.Izinzuzo zihlanganisa ukusika okuncane, ukusebenza okulula, futhi asikho isidingo sokususwa kwesibili.Ukungalungi kuhlanganisa ingozi yokwehla kwe-anchor ezigulini ezine-osteoporosis..

3. Ukulungiswa kwezinzipho ezingenalutho

Isikulufu esingenalutho siyindlela yokwelapha esebenzayo eyaziwa emhlabeni wonke yokuphuka kwesisekelo se-metatarsal yesihlanu, futhi izinzuzo zayo zihlanganisa ukulungiswa okuqinile nokuzinza okuhle.

Ngokomtholampilo, ngenxa yokuphuka okuncane phansi kwe-metatarsal yesihlanu, uma izikulufa ezimbili zisetshenziselwa ukulungiswa, kunengozi yokuhlukana.Uma isikulufu esisodwa sisetshenziselwa ukulungiswa, amandla okuvimbela ukuzungeza aba buthakathaka, futhi ukususwa kabusha kungenzeka.

4. Ipuleti le-hook lilungisiwe

Ukulungiswa kwepuleti le-hook kunezinhlobonhlobo zezinkomba, ikakhulukazi ezigulini ezinokuphuka kwe-avulsion noma i-osteoporotic fractures.Isakhiwo sayo sokuklama sifana nesisekelo sethambo lesihlanu le-metatarsal, futhi amandla okucindezela okulungisa aphakeme kakhulu.Ukungalungi kokulungiswa kwamapuleti kufaka izindleko eziphezulu kanye nokuhlukumezeka okukhulu.

Summary

Lapho ukwelapha ama-fractures phansi kwe-metatarsal yesihlanu, kuyadingeka ukukhetha ngokucophelela ngokuvumelana nesimo esithile somuntu ngamunye, isipiliyoni somuntu siqu sikadokotela kanye nezinga lobuchwepheshe, futhi ucabange ngokugcwele izifiso zomuntu siqu zesiguli.