Indlela ejwayelekile ye-Lateral L indlela yindlela ye-Classic indlela yokuhlinzwa ye-calcaneal fractures. Yize ukuvezwa kuphelele, ukuvela kunde kunde futhi izicubu ezithambile zikhunjulwa okuningi, okuholela kalula ezinkingeni ezinjengezinkinga ezithambile ezithambile inyunyana, i-necrosis, kanye nokutheleleka. Kuhlanganiswe nokuphishekela umphakathi kwamanje komphakathi wokuhlaselwa ama-aesthetics ahlaselayo, ukwelashwa okuhlaselayo okuncane kokuhlaselwa kwe-calcaneal fractures kunconyelwe kakhulu. Le ndatshana ihlanganise amathiphu ayi-8.
Ngendlela ebanzi ye-lateral, ingxenye ebheke phezulu ye-incision iqala kancane i-proximal kancane kwisicoco se-fibula kanye ne-anteriors to the achilles tendon. Izinga le-incision lenziwa nje distal distal esikhunjeni esilimele sondliwe yi-lateral calcaneal artery futhi lifaka isisekelo se-metatarsal yesihlanu. Lezi zingxenye ezimbili zixhunyiwe esithendeni ukwakha i-angle ekhethiwe egobile. Umthombo: Ukuhlinzwa kweCampbell Orthopedic.
PUkuncishiswa kwe-rutaneous poking
Ngawo-1920s, i-Böhler yathuthukisa indlela yokwelashwa evusene kakhulu yokuncishiswa kwe-calcaneus ngaphansi kwe-tractions, futhi isikhathi eside ngemuva kwalokho, ukuncishiswa kopoki okuhlangane kwaphezulu kwaba yindlela yokuqothuka yaba yindlela yokuqokwa kwe-calcaneus fractures.
Kufanelekile ukuqhekeka ngokuthuthwa okuncane kwezingcezwana ezingemuva kokuhlanganiswa okuphathelene ne-subtalar, njengohlobo lwamaSanders hlobo II namanye ama-sanders III liilial fractures.
Okwe-SterERS hlobo lwe-sanders nohlobo lwe-sanders uhlobo lwe-IV Fractures ngokuwohloka okukhulu kwe-artalar artalar artalar, ukuncishiswa kopoki kunzima futhi kunzima ukufeza ukuncishiswa kwe-anatomical kwe-calcaneus ye-calcaneus.
Kunzima ukubuyisa ububanzi be-calcaneus, futhi ukulimala akunakulungiswa kahle. Imvamisa ishiya udonga olulandelayo lwe-calcaneus ngamazinga ahlukahlukene, okuholela ekutheni kube nomthelela we-malleolus ephansi enodonga olungaphansi lwe-calcaneus longuus tendon, kanye nokucindezelwa kwe-peroneol tendon, kanye ne-peroneal tendon. Ubuhlungu be-syndrome, nobuhlungu be-calcaneus, kanye ne-poroneus longus.
I-WestHes / Essex-Lopresti inqubo. A. I-Fluoroscopy ye-lateral ikuqinisekisile isiqephu esimiswe ngolimi esimisiwe; B. I-CT enezithelo ze-CT CT SCAN ikhombise uhlobo lwe-sangess uhlobo lwe-IIC fracture. Ingxenye engaphandle ye-calcaneus itholwe kahle kuzo zombili lezi zithombe. S. ukuthwala ibanga kungazelelwe.
C. I-Lateral Incision ayikwazanga ukusetshenziswa ngenxa yokuvuvukala kwezicubu ezithambile nokuqhuma; D. I-Fluoroscopy ye-Lateral ekhombisa indawo ye-articular (umugqa wamachashazi) kanye ne-talar Collapse (umugqa oqinile).
E no-F
G. FLEX I-Knee Joint, PRY UP PIN Guide PIN, futhi ngasikhathi sinye i-Plantar Flex I-Midfoot ukunciphisa i-Fracture: H. Isikulufo se-Cancycy se-Canks safakwa ku-Culoid Bone kanye ne-2,0 mm kirschner izintambo zangezelwa ukuzonda ukuncishiswa ngenxa yokuthola ukuncishiswa ngenxa yokuncipha ngenxa yokuncishiswa kwe-calcaneus anterior. Umthombo: Unyawo lwaMann kanye nokuhlinzwa kwe-ankle.
SInus tarsi incision
I-incision yenziwa nge-1 cm distal ku-tip of fibulale kuze kube sezingeni lesine metatarsal. Ngo-1948, i-Palmer kuqala ibika ukuvela okuncane ku-Tarsi ye-sinus.
Ngo-2000, ebmheim et al. usebenzise indlela ye-tarsal sinus ekwelashweni komtholampilo kwe-calcaneal fractures.
o kungadalula ngokugcwele i-subtalar ehlanganisiwe, indawo yezinto ezibonakalayo
o Gwema ngokwanele imithambo yegazi elilandelanayo;
O asikho isidingo sokusika i-calcaneofibular ligament kanye ne-subponeal retinaculum, futhi indawo ehlanganayo ingandiswa ngokunwebeka okufanele ngesikhathi sokusebenza, okunezinzuzo zokuphuma okuncane.
Okubi ukuthi ukuvezwa kusobala ukuthi akwanele, okuhambisana nokuncishiswa kokuqhekeka kanye nokubekwa kokulungiswa kwangaphakathi. Ilungele kuphela uhlobo lwe-sanders i kanye nohlobo lwe-calcaneal fracturel.
OBlique incision encane
Ukuguqulwa kwe-Sinus Tarsi incision, cishe ama-4 cm ubude, kugxile ku-2 cm ngaphansi kwe-malleolus ye-lateral kanye nokufana kwe-artival ebusweni.
Uma ukulungiswa kwe-prepoperative kwanele futhi kuvunyelwe imibandela, kungaba nomphumela omuhle nokulungiswa kokulungiswa kohlobo lwe-sanders hlobo II kanye ne-III-arvicular calcaneal frapecitures; Uma i-subtalar ehlanganisiwe i-fusion iyadingeka ngesikhathi eside, ukuvela okufanayo kungasetshenziswa.
I-PT Perenoal tendon. I-PPF Preterior Acticular Support ye-calcaneus. S Sinus Tarsi. I-ap calcaneal protolion. .
I-Poterior Longtudinal Incision
Kusukela emaphakathini komugqa phakathi kwe-achilles tendon kanye ne-tip of the salleolus laterali, kunwebeka ngqo entabeni eyisithende, ubude obungamasentimitha acishe abe ngu-3.5 cm.
Ukuvela okuncane kwenziwa ngezicubu ezithambile ezikude, ngaphandle kokulimaza izakhiwo ezibalulekile, futhi indawo yangaphandle ye-articular iyavezwa kahle. Ngemuva kokungcebeleka okuqondile nokuncishiswa, kufakwe ibhodi le-anatomical ngaphansi kokuholwa ngumbono we-intraperative, kanye nesikulufo esizwakalayo senziwe futhi salungiswa ngaphansi kwengcindezi.
Le ndlela ingasetshenziselwa uhlobo lwe-sanders I, II, no-III, ikakhulukazi ngokudilizwa okuvela endaweni yangaphandle noma i-turbosity fractures.
I-Herringbone cut
Ukuguqulwa kwe-sinus tarsi incision. Kusuka ku-3 cm ngaphezulu kwesihloko sangemuva laseMalleolus, eceleni komngcele wangemuva kwe-FIBILALA kuya esicongweni se-malleolus lateral, bese kuya kusisekelo semetatarsal yesine. Ivumela ukuncishiswa okuhle nokulungiswa kohlobo lwe-sanders hlobo II kanye ne-III calcaneal fractures, futhi kunganwetshwa uma kunesidingo sokudalula i-transfibula, i-talus, noma ikholomu ye-lateral yonyawo.
I-LM lateral ankle. I-MT Metatarsal Joint. I-SPR supra fibula retinacululum.
AUkuncishiswa okusizwa ngokwenziwe nge-Rrossoscopically
Ngo-1997, uRammelt uhlongoze ukuthi i-subtalar arthroscopy ingasetshenziselwa ukunciphisa indawo eyingqayizivele ye-calcaneus ngaphansi kombono oqondile. Ngo-2002, i-rammAmly yaqala ukuncishiswa kwe-arthroscopically okusizwa nge-arthroscop
I-Subtalar Arthroscopy ikakhulukazi idlala indima yokuqapha kanye ne-auxiliaty. Ingabuka isimo se-subtalar articular surcharver ngaphansi kombono oqondile, futhi sisize ekubhekeni ukuncishiswa nokulungiswa kwangaphakathi. Ukuhlaziywa okuhlangene okuhlanganisiwe kwe-subtalar kanye nokuvuselelwa kwe-osteophyte nakho kungenziwa.
Izinkomba zincane: kuphela uhlobo lwe-sanders ⅱ ngokuqalwa okuncane kwe-articular surface kanye ne-Ao / OTA Type 83-C2 Fractures; Ngenkathi nge-sanders ⅲ, ⅳ no-Ao / OTA hlobo 83-C3 Fractures ngokuwa kwe-articular komhlaba okufana nama-83-C4 no-83-C4 kunzima ukusebenza.
isikhundla somzimba
b. I-arthroscopy yasemuva ye-ankle. c. Ukufinyelela kokuqhekeka kanye nokuhlangana kwe-subtalar.
Izikulufa zeSchantz zabekwa.
e. Setha kabusha futhi kulungiswe okwesikhashana. f. Ngemuva kokusetha kabusha.
g. Lungisa okwesikhashana i-articular sucation bone block. H. Lungisa ngezikulufo.
Mina. I-Postoperative Sagittal CT SCAN. J. Umbono we-postoperative axial.
Ngaphezu kwalokho, isikhala esihlanganyelwe esingezansi siyinselele, futhi ukugcwala noma kubakaki kuyadingeka ukusekela isikhala esihlanganyelwe ukwenza lula ukubekwa kwe-arthroscope; Isikhala sokukhohlisa okungaphakathi kwe-Intra-articular sincane, futhi ukukhohlisa ngokunganaki kungadala kalula ukulimala kwe-cartilage ye-iatrogen; Amasu okuhlinza angenazimele athambekele ekulimaleni kwasendaweni.
PI-Earcutaneous Balloon Angingplasty
Ngo-2009, iBeno yaqala yahlongoza inqubo ye-Balloon Dilatation inqubo yokwelashwa kweziqhekezi ze-calcaneal. OkweSelper Uhlobo II Fractures, iningi lezincwadi libheka umphumela ukuze licace. Kepha ezinye izinhlobo zokuqhekeka zinzima ngokwengeziwe.
Lapho nje i-Bone Conment ingena esikhaleni esihlanganayo esingezansi ngesikhathi sokusebenza, kuzodala ukugqokwa kobuso bendatshana kanye nomkhawulo wokunyakaza okuhlangene, futhi ukwanda kwe-balloon ngeke kube nokulinganisela ukuncishiswa kwe-fracture.
Ukubekwa kwe-Cannula kanye ne-Wire Wire Pikelata ngaphansi kwe-fluoroscopy
Izithombe ngaphambi nangemva kokunyuka kwe-airbag
I-X-ray kanye ne-CT izithombe eminyakeni emibili ngemuva kokuhlinzwa.
Njengamanje, amasampula ocwaningo wobuchwepheshe bakwaBalloon ngokuvamile ancanyana, futhi iningi lama-fractures anemiphumela emihle libangelwa udlame oluphansi lwamandla. Ucwaningo olwengeziwe lusadingeka eCalcaneal Fractures ngokufuduka okunzima kwe-fracture. Kwenziwe isikhashana, futhi ukusebenza kahle kwesikhathi eside nezinkinga namanje akucaci.
CI-alcaneal intramentary nail
Ngo-2010, i-calcaneal intramentary nail yaphuma. Ngo-2012, uM.GoldZak ahlasele ukwelashwa okuncane kakhulu kokuqhekeka kwe-calcaneal nge-intramedullary kilisa. Kufanele kugcizelelwe ukuthi ukuncishiswa akunakutholwa ngokungena emgqeni.
Faka isikhundla se-PIN PIN, FluoRoscopy
Ukuphindisela okuhlanganisiwe kwe-subtalar
Beka uhlaka lokubeka isikhundla, shayela isipikili esijwayelekile, bese usilungisa ngezikulufo ezimbili ezi-5 mm
Umbono ngemuva kokubekwa kwe-intramerary nail.
I-intrametullary Kiling ikhonjiswe ukuthi iphumelele ekwelapheni kohlobo lwe-sanders hlobo II no-III waqhekeka we-calcaneus. Yize abanye odokotela bazama ukuyisebenzisa ku-sanders IV fractures, umsebenzi wokunciphisa ubunzima futhi ukuncishiswa okuhle akunakutholwa.
Umuntu oxhumana naye: Yoyo
Wa / Tel: +8615682071283
Isikhathi Seposi: Meyi-31-2023
