Indlela evamile ye-lateral L iyindlela ejwayelekile yokwelapha ngokuhlinzwa ama-fracture e-calcaneal. Nakuba ukuvezwa kuphelele, ukusikwa kukude futhi izicubu ezithambile ziyasuswa kakhulu, okuholela kalula ezinkingeni ezifana nokuhlanganiswa kwezicubu ezithambile okubambezelekile, i-necrosis, kanye nokutheleleka. Kanye nokuphishekela komphakathi wamanje ubuhle obungenasivikelo, ukwelashwa ngokuhlinzwa kwama-fracture e-calcaneal okungenasivikelo kuye kwanconywa kakhulu. Lesi sihloko sihlanganise amathiphu ayi-8.
Ngokusebenzisa indlela ebanzi eseceleni, ingxenye eqondile yesitho iqala kancane eduze kwesihloko se-fibula kanye nangaphambili kwe-Achilles tendon. Izinga lesitho lenziwa liqhelelene nesikhumba esilimele esiphakelwa umthambo we-lateral calcaneal bese lifakwa phansi kwe-metatarsal yesihlanu. Izingxenye ezimbili zixhunywe esithendeni ukuze zakhe i-engeli yesokudla egobile kancane. Umthombo: Ukuhlinzwa Kwamathambo eCampbell.
Pukunciphisa ukubhoboza kwesikhumba
Ngawo-1920, uBöhler wasungula indlela yokwelapha engangenisi kakhulu yokunciphisa i-calcaneus ngaphansi kokudonswa, futhi isikhathi eside ngemva kwalokho, ukunciphisa ukudonswa kwe-percutaneous ngaphansi kokudonswa kwaba yindlela eyinhloko yokwelapha ukuqhekeka kwe-calcaneus.
Ifanelekela ukwaphuka okunokususwa okuncane kwezingcezu zangaphakathi kwe-articular esihlanganisini esingaphansi kwe-subtalar, njenge-Sanders type II kanye nezinye izingcezu zolimi lwe-Sanders III.
Kuma-Sanders type III kanye nama-comminuted Sanders type IV fractures anokuwohloka okukhulu kwe-subtalar articular surface, ukunciphisa i-poking kunzima futhi kunzima ukufeza ukunciphisa i-anatomical surface ye-posterior articular ye-calcaneus.
Kunzima ukubuyisela ububanzi be-calcaneus, futhi ukukhubazeka akukwazi ukulungiswa kahle. Ngokuvamile kushiya udonga oluseceleni lwe-calcaneus ngamazinga ahlukahlukene, okuholela ekuthintekeni kwe-malleolus engezansi engezansi nodonga oluseceleni lwe-calcaneus, ukufuduka noma ukucindezelwa kwe-tendon ye-peroneus longus, kanye nokucindezelwa kwe-tendon ye-peroneal. Isifo, ubuhlungu bokucindezelwa kwe-calcaneal, kanye ne-peroneus longus tendonitis.
Indlela ye-Westhues/Essex-lopresti. A. I-fluoroscopy eseceleni iqinisekisile ukuthi ingxenye yolimi ewile yayisiyindilinga; B. I-CT scan evundlile ibonise ukuphuka kwe-Sandess type IIC. Ingxenye engaphambili ye-calcaneus icacile kuzo zombili izithombe. S. Ibanga lokuthwala ngokuzumayo.
C. Ukusikwa kwe-lateral kwakungeke kusetshenziswe ngenxa yokuvuvukala okukhulu kwezicubu ezithambile kanye nokuqhakaza; D. I-lateral fluoroscopy ekhombisa ubuso be-articular (umugqa onamachashazi) kanye nokuwa kwe-talar (umugqa oqinile).
E no-F. Izintambo ezimbili zokuqondisa izinzipho ezingenalutho zabekwa zihambisana nengxenye engezansi yengcezu emise okwelimi, kanti umugqa onamachashazi uwumugqa ohlangene.
G. Gobisa idolo, susa iphini lokuqondisa, bese ngesikhathi esifanayo ugobisa i-midfoot ukuze unciphise ukuphuka: H. Isikulufu esisodwa esingu-6.5 mm esine-cannulated safakwa ethanjeni le-cuboid kwathi izintambo ezimbili ze-Kirschner ezingu-2.0 mm zahlanganiswa ukuze kugcinwe ukuncipha ngenxa yokuguquka kwangaphambi kwe-calcaneus. Umthombo: Ukuhlinzwa Kwezinyawo Neqakala LaseMann.
Sukusikwa kwe-inus tarsi
Ukusikwa kwenziwa nge-1 cm ukusuka esiqongweni se-fibula kuya phansi kwe-metatarsal yesine. Ngo-1948, uPalmer wabika okokuqala ngokusikwa okuncane kwi-sinus tarsi.
Ngo-2000, u-Ebmheim nabanye basebenzise indlela ye-tarsal sinus ekwelapheni ukuqhekeka kwe-calcaneal.
o Ingaveza ngokugcwele i-subtalar joint, ubuso obungemuva obuhlangene kanye ne-anterolateral fracture block;
o Gwema ngokwanele imithambo yegazi ye-calcaneal eseceleni;
Asikho isidingo sokusika i-calcaneofibular ligament kanye ne-subperoneal retinaculum, futhi isikhala samalunga singandiswa ngokuguquguquka okufanele ngesikhathi sokuhlinzwa, okunezinzuzo zokusikwa okuncane kanye nokopha okuncane.
Ububi ukuthi ukuvezwa akwanele ngokusobala, okukhawulela futhi kuthinte ukuncipha kokuqhekeka kanye nokubekwa kokuqina kwangaphakathi. Kufanelekela kuphela ukwaphuka kwe-calcaneal yohlobo lwe-Sanders kanye nohlobo lwe-II.
Oukusikwa okuncane kwe-blique
Ukuguqulwa kwe-sinus tarsi incision, cishe ubude obungu-4 cm, phakathi nendawo engu-2 cm ngaphansi kwe-lateral malleolus futhi kuhambisane nobuso be-articular obungemuva.
Uma ukulungiselela kwangaphambi kokuhlinzwa kwanele futhi izimo zivuma, kungaba nomthelela omuhle wokunciphisa nokuqinisa ama-fracture e-Sanders type II kanye ne-III intra-articular calcaneal; uma kudingeka ukuhlanganiswa kwamalunga e-subtalar esikhathini eside, ukusikwa okufanayo kungasetshenziswa.
I-PT Peroneal tendon. PF Ubuso obungemuva be-calcaneus. I-S sinus tarsi. AP I-Calcaneal protrusion. .
Ukusikwa kwe-longitudinal ngemuva
Kusukela maphakathi nomugqa ophakathi kwe-Achilles tendon kanye nesihloko se-lateral malleolus, inwebeka iqonde phansi iye esithendeni se-talar, ubude bayo bungaba ngu-3.5 cm.
Kwenziwa ukusikwa okuncane ezicutshini ezithambile ezikude, ngaphandle kokulimaza izakhiwo ezibalulekile, futhi ubuso obungemuva be-articular buvezwa kahle. Ngemva kokuhlikihla nokunciphisa i-percutaneous, kwafakwa ibhodi lokwakheka ngaphansi kwesiqondiso sokubuka kwangaphakathi kokuhlinzwa, kwathi isikulufu se-percutaneous sathintwa futhi saqiniswa ngaphansi kwengcindezi.
Le ndlela ingasetshenziswa kuhlobo lwe-Sanders I, II, kanye no-III, ikakhulukazi ekuqhekekeni kobuso obungemuva obune-articular noma i-tuberosity.
Ukusikwa kwe-Herringbone
Ukuguqulwa kokusikwa kwe-sinus tarsi. Kusukela ku-3 cm ngaphezu kwesihloko se-lateral malleolus, eduze komngcele ongemuva we-fibula kuya esihlokweni se-lateral malleolus, bese kuba phansi kwe-fourth metatarsal. Ivumela ukunciphisa okuhle nokulungiswa kokuqhekeka kwe-calcaneal yohlobo lwe-Sanders II nolwe-III, futhi ingandiswa uma kudingeka ukuze iveze i-transfibula, i-talus, noma ikholomu eseceleni yonyawo.
Iqakala eliseceleni le-LM. I-MT metatarsal joint. I-SPR Supra fibula retinaculum.
Aukunciphisa okusizwa yi-rthroscopically
Ngo-1997, uRammelt waphakamisa ukuthi i-subtalar arthroscopy ingasetshenziswa ukunciphisa ubuso be-posterior articular be-calcaneus ngaphansi kokubona okuqondile. Ngo-2002, uRammelt waqala ukwenza i-arthroscopically assisted percutaneous reduction kanye ne-screw fixation yama-fractures ohlobo lwe-Sanders I nolwe-II.
I-subtalar arthroscopy idlala indima yokuqapha kanye nokusiza. Ingabona isimo sobuso be-subtalar articular ngaphansi kokubona ngqo, futhi isize ekuqapheni ukuncipha kanye nokuqina kwangaphakathi. Ukusikwa okulula kwe-subtalar joint kanye nokususwa kwe-osteophyte nakho kungenziwa.
Izinkomba zincane: kuphela ngohlobo lwe-Sanders Ⅱ olunokuqhekeka okuncane kobuso obuhlangene kanye nokuqhekeka kohlobo lwe-AO/OTA 83-C2; kuyilapho ngohlobo lwe-Sanders Ⅲ, Ⅳ kanye nohlobo lwe-AO/OTA 83-C3 Ukuqhekeka okune-articular surface collapse efana ne-83-C4 kanye ne-83-C4 kunzima kakhulu ukukusebenzisa.
isikhundla somzimba
b. I-arthroscopy yeqakala elingemuva. c. Ukufinyelela endaweni ephukile kanye nejoyinti elingaphansi kwe-subtalar.
Kwafakwa izikulufo ze-Schantz.
e. Ukusetha kabusha kanye nokulungiswa kwesikhashana. f. Ngemva kokusetha kabusha.
g. Lungisa okwesikhashana ibhloko lethambo elingaphezulu kwe-articular. h. Lungisa ngezikulufo.
i. Ukuskena kwe-CT ngemuva kokuhlinzwa kwe-sagittal. j. Umbono we-axial ngemuva kokuhlinzwa.
Ngaphezu kwalokho, isikhala samalunga esingaphansi kwe-subtalar sincane, futhi kudingeka ukubamba noma amabhuleki ukusekela isikhala samalunga ukuze kube lula ukubekwa kwe-arthroscope; isikhala sokuphathwa kwangaphakathi kwe-articular sincane, futhi ukuphathwa ngokunganaki kungabangela kalula umonakalo womphezulu we-cartilage we-iatrogenic; amasu okuhlinza angaqeqeshiwe athambekele ekulimaleni kwendawo.
Pi-angioplasty yebhaluni e-ercutaneous
Ngo-2009, uBano waqala ukuhlongoza indlela yokukhulisa amabhaluni yokwelapha ukwaphuka kwe-calcaneal. Kuma-fracture ohlobo lwesibili lukaSanders, izincwadi eziningi zibheka umphumela njengocacile. Kodwa ezinye izinhlobo zokuphuka zinzima kakhulu.
Uma i-bone cement ingena esikhaleni se-subtalar joint ngesikhathi sokuhlinzwa, izobangela ukuguguleka kobuso be-articular kanye nokulinganiselwa kokunyakaza kwamalunga, futhi ukwandiswa kwebhaluni ngeke kulinganiswe ukuze kuncishiswe ukuphuka.
Ukufakwa kwe-cannula kanye nentambo yokuqondisa ngaphansi kwe-fluoroscopy
Izithombe ngaphambi nangemva kokunyuka kwe-airbag
Izithombe ze-X-ray kanye ne-CT eminyakeni emibili ngemuva kokuhlinzwa.
Njengamanje, amasampula ocwaningo lobuchwepheshe bamabhaluni ngokuvamile mancane, futhi iningi lama-fractures anemiphumela emihle abangelwa ubudlova obusebenzisa amandla amancane. Ucwaningo olwengeziwe lusadingeka kuma-fracture e-calcaneal anokuhlukana okukhulu kwama-fracture. Sekuqhutshwe isikhathi esifushane, futhi ukusebenza kahle kwesikhathi eside kanye nezinkinga akukacaci.
Cuzipho lwe-alcaneal intramedullary
Ngo-2010, kwaphuma uzipho lwe-calcaneal intramedullary. Ngo-2012, i-M.Goldzak yathola ukwelashwa okuncane kokwaphuka kwe-calcaneal ngokuziqinisa ngezipikili ze-intramedullary. Kufanele kugcizelelwe ukuthi ukunciphisa akukwazi ukufezwa ngokuziqinisa ngezipikili ze-intramedullary.
Faka iphini yomhlahlandlela wokubeka indawo, i-fluoroscopy
Ukubeka kabusha i-subtalar joint
Beka uhlaka lokubeka indawo, shayela isipikili sangaphakathi kwe-medullary, bese usilungisa ngezikulufo ezimbili ezinamathini angu-5 mm
Umbono ngemva kokubekwa kwezinzipho ngaphakathi kwe-medullary.
Ukubethelwa kwezipikili ngaphakathi kwe-medullary kuye kwabonakala kuphumelele ekwelapheni ukwaphuka kwe-calcaneus yohlobo lwesibili nolwesithathu lwe-Sanders. Nakuba abanye odokotela bazama ukukusebenzisa ekuqhekekeni kwe-Sanders IV, ukuhlinzwa kokunciphisa kwakunzima futhi ukunciphisa okufanele kwakungatholakali.
Umuntu Oxhumana Naye: Yoyo
WA/TEL:+8615682071283
Isikhathi sokuthunyelwe: Meyi-31-2023
