Ukuqina kwangaphakathi nge-bone plate
Ukuhlanganiswa kweqakala ngamapuleti nezikulufo kuyindlela yokuhlinzwa evamile njengamanje. Ukufakwa kwangaphakathi kwepuleti lokukhiya kuye kwasetshenziswa kabanzi ekuhlanganisweni kweqakala. Njengamanje, ukuhlanganiswa kweqakala lepuleti kuhlanganisa kakhulu ipuleti langaphambili kanye nepuleti eliseceleni kweqakala.
Isithombe esingenhla sibonisa amafilimu e-X-ray ngaphambi nangemva kokuhlinzwa kwe-traumatic ankle osteoarthritis ene-anterior locking plate i-internal fixation i-ankle joint fusion
1. Indlela yangaphambilini
Indlela engaphambili ukwenza ukusika okuqondile okuqondile okuphakathi nendawo yeqakala, ukusika ungqimba ngengqimba, bese kungena esikhaleni semisipha; ukusika i-capsule ehlangene, ukuveza i-tibiotalar joint, ukususa i-cartilage kanye nethambo le-subchondral, bese ubeka ipuleti elingaphambili ngaphambili kweqakala.
2. Indlela eseceleni
Indlela eseceleni iwukusika i-osteotomy cishe ngamasentimitha ayi-10 ngaphezu kwesihloko se-fibula bese kususwa isiqu ngokuphelele. Isiqu sethambo esikhanseliwe siyakhishwa ukuze kufakwe ithambo. I-fusion surface osteotomy iyaqedwa futhi igezwe, bese ipuleti libekwa ngaphandle kweqakala.
Inzuzo ukuthi amandla okuqina aphezulu futhi ukuqina kuqinile. Kungasetshenziswa ukulungisa nokwakha kabusha ukukhubazeka okukhulu kwe-varus noma i-valgus kwejoyinti leqakala kanye nezinkinga eziningi zamathambo ngemva kokuhlanza. Ipuleti lokuhlanganisa elenziwe ngendlela yokwakheka komzimba lisiza ukubuyisela ukwakheka okuvamile kwejoyinti leqakala. Indawo.
Ububi ukuthi i-periosteum eningi kanye nezicubu ezithambile endaweni yokuhlinzwa kudingeka zikhunyulwe, futhi ipuleti lensimbi lijiyile, okulula ukucasula imisipha ezungezile. Ipuleti lensimbi elibekwe ngaphambili kulula ukulithinta ngaphansi kwesikhumba, futhi kunengozi ethile.
ukulungiswa kwezipikili ngaphakathi kwe-medullary
Eminyakeni yamuva nje, ukusetshenziswa kwe-retrograde intramedullary nail-type ankle arthrodesis ekwelapheni i-ankle arthritis yesigaba sokugcina kuye kwasetshenziswa kancane kancane emtholampilo.
Njengamanje, indlela yokwenza izinzipho ngaphakathi kwe-medullary isebenzisa kakhulu ukusikwa okuphakathi kwangaphakathi kwe-ankle joint noma ukusikwa okuseceleni kwe-anteroinferior kwe-fibula ukuze kuhlanzwe ubuso be-articular noma kufakwe amathambo. Uzipho ngaphakathi kwe-medullary lufakwa lusuka ku-calcaneus luye ku-tibial medullary cavity, okuwusizo ekulungiseni ukukhubazeka futhi kukhuthaze ukuhlangana kwamathambo.
I-ankle osteoarthritis ihlanganiswe ne-subtalar arthritis. Amafilimu e-X-ray angaphambi kokuhlinzwa angaphambili nangaseceleni abonise umonakalo omkhulu esihlanganyelweni se-tibiotalar kanye ne-subtalar, ukuwohloka kwengxenye ye-talus, kanye nokwakheka kwe-osteophyte ezungeze ilunga (kusukela ku-reference 2)
I-engeli yokufakelwa kwesikulufu sokuhlanganiswa kwezinyawo zangemuva ekhiyiwe i-intramedullary nail iwukuqiniswa kwezindawo eziningi, okungalungisa ijoyinti elithile elizohlanganiswa, kanti ingxenye ekude iyimbobo yokukhiya enentambo, engamelana ngempumelelo nokusika, ukujikeleza, kanye nokudonswa, okunciphisa ingozi yokuhoxiswa kwesikulufu.
I-tibiotalar joint kanye ne-subtalar joint zavezwa futhi zacutshungulwa ngendlela ye-lateral transfibular, kanti ubude bokusikwa emnyango we-plantar intramedullary nail babungu-3 cm.
Uzipho olungaphakathi kwe-medullary lusetshenziswa njengendawo yokuqinisa ephakathi, futhi ukucindezeleka kwalo kuhlakazekile, okungagwema umphumela wokuvikela ukucindezeleka futhi kuhambisana kakhulu nezimiso ze-biomechanics.
Ifilimu ye-X-ray engemuva nangaseceleni inyanga eyodwa ngemuva kokuhlinzwa ibonise ukuthi umugqa wonyawo lwangemuva wawulungile nokuthi uzipho lwangaphakathi lwaluqinile ngokuthembekile
Ukusebenzisa izinzipho ze-retrograde intramedullary ekuhlanganiseni kwamalunga eqakala kunganciphisa ukulimala kwezicubu ezithambile, kunciphise ukuqhekeka kwesikhumba, ukutheleleka nezinye izinkinga, futhi kunganikeza ukulungiswa okwanele okuzinzile ngaphandle kokulungiswa kwangaphandle kweplasta ngemva kokuhlinzwa.
Ngemva konyaka wokuhlinzwa, amafilimu e-X-ray abonisa ukuhlangana kwamathambo kwejoyinti le-tibiotalar kanye nejoyinti elingaphansi kwe-subtalar, futhi ukulingana kwezinyawo zangemuva kwakukuhle.
Isiguli singavuka embhedeni sithwale isisindo kusenesikhathi, okuthuthukisa ukubekezelela kwesiguli kanye nekhwalithi yokuphila. Kodwa-ke, ngenxa yokuthi ijoyinti elingaphansi kwe-subtalar lidinga ukulungiswa ngesikhathi esifanayo, akukhuthazwa ezigulini ezinejoyinti elihle elingaphansi kwe-subtalar. Ukulondolozwa kwejoyinti elingaphansi kwe-subtalar kuyisakhiwo esibalulekile sokubuyisela umsebenzi wejoyinti leqakala ezigulini ezine-fusion yejoyinti leqakala.
ukulungiswa kwangaphakathi kwesikulufu
Ukubopha kwangaphakathi kwesikulufo se-percutaneous kuyindlela evamile yokubopha i-ankle arthrodesis. Inezinzuzo zokuhlinzwa okuncane njengokusikwa okuncane nokulahlekelwa igazi okuncane, futhi inganciphisa ngempumelelo umonakalo wezicubu ezithambile.
Amafilimu e-X-ray angaphambili nangaseceleni e-ankle emile ngaphambi kokuhlinzwa abonise i-osteoarthritis enzima ye-ankle yesokudla enokukhubazeka kwe-varus, futhi i-engeli phakathi kobuso be-tibiotalar articular yalinganiswa ukuthi ingu-19° varus.
Izifundo zikhombisile ukuthi ukubopha okulula ngezikulufo ezi-2 kuya kwezi-4 kungafeza ukubopha okuzinzile nokucindezelwa, futhi ukusebenza kulula kakhulu futhi izindleko zishibhile. Kuyisinqumo sokuqala sezazi eziningi okwamanje. Ngaphezu kwalokho, ukuhlanza amalunga eqakala okungangenisi kakhulu kungenziwa ngaphansi kwe-arthroscopy, futhi izikulufo zingafakwa nge-percutaneously. Ukulimala kokuhlinzwa kuncane futhi umphumela wokwelapha uyanelisa.
Ngaphansi kwe-arthroscopy, indawo enkulu yesici se-cartilage ye-articular ibonakala; ngaphansi kwe-arthroscopy, idivayisi ye-cone microfracture isetshenziselwa ukwelapha ubuso be-articular.
Abanye ababhali bakholelwa ukuthi ukufakwa kwezikulufo ezintathu kunganciphisa izehlakalo zengozi yokungahlanganisi ngemva kokuhlinzwa, futhi ukwanda kwesilinganiso sokuhlanganiswa kungase kuhlobane nokuqina okuqinile kokufakwa kwezikulufo ezintathu.
Ifilimu ye-X-ray elandelayo ngemva kwamasonto ayi-15 ukuhlinzwa ibonise ukuhlangana kwamathambo. Isilinganiso se-AOFAS sasingu-47 amaphuzu ngaphambi kokuhlinzwa kanye namaphuzu angu-74 ngonyaka owodwa ngemva kokuhlinzwa.
Uma kusetshenziswa izikulufo ezintathu ukuze kuqiniswe, indawo yokulinganisa elinganiselwe ukuthi izikulufo ezimbili zokuqala zifakwa ngokulandelana kusukela ezinhlangothini ze-anteromedial kanye ne-anterolateral ze-tibia, ziwele endaweni eqondile ziye emzimbeni we-talar, kanti isikulufo sesithathu sifakwa kusukela ohlangothini olungemuva lwe-tibia kuya ohlangothini oluphakathi lwe-talus.
Indlela yokulungisa yangaphandle
Ama-fixator angaphandle ayeyizinto zokuqala ezazisetshenziswa ku-ankle arthrodesis futhi athuthukile kusukela ngawo-1950 kuya ku-Ilizarov, Hoffman, Hybrid kanye no-Taylor space frame (TSF) yamanje.
Ukulimala okuvulekile kweqakala ngenxa yokutheleleka iminyaka emi-3, i-ankle arthrodesis ezinyangeni ezi-6 ngemuva kokulawulwa kokutheleleka
Kwezinye izimo eziyinkimbinkimbi ze-arthritis yeqakala ezinezifo eziphindaphindayo, ukuhlinzwa okuphindaphindiwe, izimo zesikhumba sendawo kanye nezicubu ezithambile ezingezinhle, ukwakheka kwezibazi, amaphutha ethambo, i-osteoporosis kanye nezilonda zokutheleleka kwendawo, i-Ilizarov ring external fixator isetshenziswa kakhulu ngokwezokwelapha ukuhlanganisa i-ankle joint.
I-fixator yangaphandle efana nendandatho inamathele endizeni ye-coronal kanye nendizeni ye-sagittal, futhi inganikeza umphumela wokuzinza ozinzile. Enkambisweni yokuqala yokuthwala umthwalo, izocindezela ukuphela kokuqhekeka, ikhuthaze ukwakheka kwe-callus, futhi ithuthukise izinga lokuhlanganiswa. Ezigulini ezinokukhubazeka okukhulu, i-fixator yangaphandle ingalungisa kancane kancane ukukhubazeka. Yiqiniso, ukuhlanganiswa kwe-ankle ye-fixator yangaphandle kuzoba nezinkinga ezifana nokuphazamiseka kokugqokwa kweziguli kanye nengozi yokutheleleka kwenaliti.
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Email:liuyaoyao@medtechcah.com
Isikhathi sokuthunyelwe: Julayi-08-2023
