Ukulungiswa kwangaphakathi nge-bone plate
Ukuhlanganiswa kweqakala namapuleti nezikulufu kuyinqubo yokuhlinzwa evamile uma kuqhathaniswa okwamanje.Ukulungiswa kwangaphakathi kwepuleti lokukhiya sekusetshenziswe kabanzi ekuhlanganiseni kweqakala.Njengamanje, ukuhlanganiswa kwe-plate ankle ikakhulukazi kufaka ipuleti langaphambili kanye ne-lateral plate i-ankle fusion.
Isithombe esingenhla sibonisa amafilimu e-X-ray ngaphambi nangemva kokuhlinzwa kwe-ankle osteoarthritis ehlukumezayo enepuleti lokukhiya elingaphakathi lokuhlanganisa i-ankle joint fusion.
1. Indlela yangaphambili
Indlela yangaphambili ukwenza i-anterior longitudinal incision egxile endaweni ehlangene ye-ankle, ukusika ungqimba ngongqimba, bese ungena eduze kwesikhala se-tendon;usike i-capsule ehlangene, uveze i-tibiotalar joint, susa i-cartilage ne-subchondral bone, bese ubeka ipuleti elingaphambili ku-Anterior ye-ankle.
2. Indlela ebheke eceleni
Indlela ebheke eceleni iwukusika i-osteotomy cishe ngo-10 cm ngaphezu kwesihloko se-fibula bese ususa isiphunzi ngokuphelele.Isiphunzi sethambo esikhansela sikhishelwa ukuxhunyelelwa amathambo.I-fusion surface osteotomy iyaqedwa futhi igezwe, bese ipuleti libekwa ngaphandle kwelunga leqakala.
Inzuzo ukuthi amandla okulungisa aphakeme futhi ukulungiswa kuqinile.Ingasetshenziselwa ukulungiswa nokwakhiwa kabusha kwe-varus enzima noma i-valgus deformity ye-ankle joint kanye nokukhubazeka okuningi kwamathambo ngemva kokuhlanza.Ipuleti le-fusion eliklanywe ngokuzenzakalelayo lisiza ukubuyisela i-anatomy evamile yelunga leqakala.Indawo.
Okubi ukuthi i-periosteum eyengeziwe kanye nezicubu ezithambile endaweni yokuhlinzwa zidinga ukukhunyulwa, futhi i-steel plate ishubile, okulula ukucasula imisipha ezungezile.Ipuleti lensimbi elibekwe ngaphambili kulula ukuthinta ngaphansi kwesikhumba, futhi kunengozi ethile.
ukulungiswa kwe-intramedullary nail
Eminyakeni yamuva nje, ukusetshenziswa kwe-retrograde intramedullary nail-type ankle arthrodesis ekwelapheni i-ankle arthritis yesigaba sokugcina kuye kwasetshenziswa kancane kancane emtholampilo.
Njengamanje, indlela yokufaka izipikili ye-intramedullary ikakhulukazi isebenzisa i-anterior median incision yelunga leqakala noma i-anteroinferior lateral incision ye-fibula yokuhlanza i-articular surface noma ukuxhunyelelwa kwethambo.I-intramedullary nail ifakwe kusukela ku-calcaneus kuya emgodini we-tibial medullary, okuzuzisa ukulungiswa kokukhubazeka futhi ikhuthaze ukuhlanganiswa kwamathambo.
I-ankle osteoarthritis ihlanganiswe ne-subtalar arthritis.Amafilimu angaphambi kokusebenza kwe-anteroposterior kanye ne-lateral X-ray abonise umonakalo omkhulu ekuhlanganyeleni kwe-tibiotalar kanye ne-subtalar joint, ukuwa kwengxenye ye-talus, nokwakheka kwe-osteophyte eduze kwelunga (kusuka kunkomba 2)
I-divergent fusion screw implantation angle yokukhiya i-hindfoot fusion intramedullary nail iyi-multi-plane fixation, engalungisa ilunga elithile ukuze lihlanganiswe, futhi i-distal end iyimbobo yokukhiya enentambo, engamelana ngempumelelo nokusikwa, ukuzungezisa, nokudonsa ngaphandle. , ukunciphisa ingozi yokuhoxiswa kwesikulufa .
Ijoyinti le-tibiotalar kanye nokuhlanganisa kwe-subtalar kwavezwa futhi kwacutshungulwa ngendlela ye-lateral transfibular, futhi ubude bokusika emnyango we-plantar intramedullary nail babungu-3 cm.
I-intramedullary nail isetshenziswa njengendlela yokulungiswa okuphakathi, futhi ukucindezeleka kwayo kuhlakazekile, okungagwema umphumela wokuvikela ukucindezeleka futhi kuhambisana kakhulu nezimiso ze-biomechanics.
Ifilimu ye-X-ray ye-Anteroposterior kanye ne-lateral ye-X-ray inyanga engu-1 ngemva kokusebenza ibonise ukuthi umugqa wezinyawo zangemuva wawulungile futhi i-intramedullary nail yayilungiswe ngokuthembekile.
Ukufaka i-retrograde intramedullary nail ekuhlanganiseni kwamalunga eqakala kunganciphisa ukulimala kwezicubu ezithambile, kunciphise i-necrosis yesikhumba esisikiwe, ukutheleleka kanye nezinye izinkinga, futhi kunganikeza ukulungiswa okwanele okuzinzile ngaphandle kokulungisa ukhonkolo oyisizayo ngemva kokuhlinzwa.
Unyaka owodwa ngemva kokuhlinzwa, amafilimu e-X-ray anesisindo esihle kanye ne-lateral abonisa ukuhlanganiswa kwethambo le-tibiotalar joint and subtalar joint, futhi ukulungiswa kwezinyawo zangemuva kwakukuhle.
Isiguli singavuka embhedeni futhi sisheshe sikhule, okuthuthukisa ukubekezelela isiguli kanye nezinga lempilo.Kodwa-ke, ngenxa yokuthi i-subtalar joint idinga ukulungiswa ngesikhathi esifanayo, ayinconywa ezigulini ezinokuhlanganiswa okuhle kwe-subtalar.Ukulondolozwa kokuhlanganiswa kwe-subtalar kuyisakhiwo esibalulekile sokunxephezela umsebenzi we-ankle joint ezigulini ezinokuhlanganiswa kwe-ankle joint.
isikulufu ukulungiswa kwangaphakathi
I-Percutaneous screw fixation yangaphakathi iyindlela evamile yokulungisa ku-ankle arthrodesis.Inezinzuzo zokuhlinza okungavamisile okuncane njengokusika okuncane kanye nokulahlekelwa igazi elincane, futhi kunganciphisa ngempumelelo umonakalo ezicutshini ezithambile.
Amafilimu e-X-ray e-Anteroposterior kanye ne-lateral ehlangene leqakala elimile ngaphambi kokuhlinzwa abonise i-osteoarthritis enzima yeqakala elingakwesokudla elinokukhubazeka kwe-varus, futhi i-engeli phakathi kwendawo ye-tibiotalar articular yakalwa yaba yi-19° varus.
Ucwaningo luye lwabonisa ukuthi ukulungiswa okulula ngezikulufu ze-lag ezi-2 kuya kwezi-4 kungafinyelela ukulungiswa okuzinzile nokucindezelwa, futhi ukusebenza kulula futhi izindleko zishibhile.Iwukhetho lokuqala lwezazi eziningi njengamanje.Ngaphezu kwalokho, ukuhlanzwa okuhlangene kwe-ankle okungavamisile kancane kungenziwa ngaphansi kwe-arthroscopy, futhi izikulufu zingafakwa nge-percutaneously.Ukuhlukumezeka kokuhlinzwa kuncane futhi umphumela wokwelapha uyagculisa.
Ngaphansi kwe-arthroscopy, indawo enkulu ye-articular cartilage defect ibonakala;ngaphansi kwe-arthroscopy, idivayisi ye-cone microfracture ekhonjiwe isetshenziselwa ukwelapha indawo ye-articular
Abanye ababhali bakholelwa ukuthi ukulungiswa kwezikulufu ezi-3 kunganciphisa ingozi yokungaxubani kwangemva kokuhlinzwa, futhi ukwenyuka kwezinga lokuhlanganisa kungase kuhlotshaniswe nokuzinza okunamandla kokulungiswa kwezikulufu ezi-3.
Ifilimu ye-X-ray yokulandelela emasontweni angu-15 ngemva kokuhlinzwa yabonisa ukuhlangana kwamathambo.Isikolo se-AOFAS sasingamaphoyinti angu-47 ngaphambi kokusebenza kanye namaphoyinti angu-74 unyaka o-1 ngemva kokusebenza.
Uma izikulufu ezintathu zisetshenziselwa ukulungiswa, indawo elinganiselwe yokulungisa iwukuthi izikulufu ezimbili zokuqala zifakwa ngokulandelana zisuka ezinhlangothini ze-anteromedial kanye ne-anterolateral ye-tibia, zidlule endaweni eyi-articular ziye emzimbeni we-talar, bese isikulufu sesithathu sishuthekwa ngemuva. ohlangothini lwe-tibia kuya ohlangothini oluphakathi lwe-talus.
Indlela yokulungisa yangaphandle
Izilungisi zangaphandle kwakuyizisetshenziswa zakuqala ezazisetshenziswa ku-ankle arthrodesis futhi zavela kusukela ngeminyaka yawo-1950s zaya kuhlaka lwamanje lwe-Ilizarov, Hoffman, Hybrid kanye noTaylor (TSF).
Ukulimala okuvulekile kwe-ankle ngokutheleleka iminyaka engu-3, i-ankle arthrodesis izinyanga ezingu-6 ngemuva kokulawula ukutheleleka
Kwezinye izimo eziyinkimbinkimbi ze-ankle arthritis ezinezifo eziphindaphindiwe, ukuhlinzwa okuphindaphindiwe, isikhumba esibuthakathaka sendawo nezimo zezicubu ezithambile, ukwakheka kwezibazi, ukukhubazeka kwamathambo, i-osteoporosis kanye nezilonda zokutheleleka kwendawo, i-Ilizarov fixator yangaphandle yendandatho isetshenziswa kakhulu emtholampilo ukuhlanganisa ilunga leqakala .
I-fixator yangaphandle emise okwendandatho igxilile endizeni ye-coronal kanye nendiza ye-sagittal, futhi inganikeza umphumela wokulungisa ozinzile.Enqubweni yokuqala yokuthwala umthwalo, izocindezela ukuphela kokuphuka, ikhuthaze ukwakheka kwe-callus, futhi ithuthukise izinga lokuhlanganisa.Ezigulini ezinokukhubazeka okukhulu, i-fixator yangaphandle ingalungisa kancane kancane ukukhubazeka.Yiqiniso, i-external fixator i-ankle fusion izoba nezinkinga ezifana nokuphazamiseka kweziguli ukugqoka kanye nengozi yokutheleleka ngenaliti.
Othintana naye:
Whatsapp: +86 15682071283
Email:liuyaoyao@medtechcah.com
Isikhathi sokuthumela: Jul-08-2023
