Indlela evamile ye-lateral L iyindlela yakudala yokwelashwa kokuhlinzwa kokuphuka kwe-calcaneal.Nakuba ukuchayeka kuphelele, ukusika kuyinde futhi izicubu ezithambile zihluthulwa kakhulu, okuholela kalula ezinkingeni ezinjengokubambezeleka kwezicubu ezithambile, i-necrosis, nokutheleleka.Ngokuhambisana nokuphishekela komphakathi kwamanje kobuhle obungahlaseleki kancane, ukwelapha okuhlinzayo okungavamisile kokuphuka kwe-calcaneal kuye kwanconywa kakhulu.Lesi sihloko sihlanganise amathiphu angu-8.
Ngendlela ebanzi ebheke eceleni, ingxenye emile yokusikwa iqala ukusondele kancane esihlokweni se-fibula nangaphambili ku-Achilles tendon.Izinga lokusikeka lenziwa libe kude nje esikhunjeni esilimele esiphakelwa umthambo ongemuva we-calcaneal bese ifakwa phansi kwe-metatarsal yesihlanu.Izingxenye ezimbili zixhunywe esithendeni ukuze zakhe i-engeli engakwesokudla egobile kancane.Umthombo: I-Campbell Orthopedic Surgery.
Pukunciphisa i-ercutaneous poking
Ngawo-1920s, u-Böhler wasungula indlela yokwelapha ehlasela kancane yokunciphisa i-calcaneus ngaphansi kokudonsa, futhi isikhathi eside ngemva kwalokho, ukuncishiswa kwe-percutaneous poking ngaphansi kokudonsa kwaba indlela evamile yokwelapha ukuphuka kwe-calcaneus.
Ifanele ukuphuka okunokugudluzwa okuncane kwezingcezu ze-intraarticular kujoyinti ye-subtalar, efana nohlobo lwe-Sanders II kanye nokunye ukuphuka kwezilimi ze-Sanders III.
Ohlotsheni lwe-Sanders III kanye nokuphuka kwe-Sanders yohlobo lwe-IV oluqhubekayo olunokugoqeka okuqinile kwe-articular surface, ukunciphisa i-poking kunzima futhi kunzima ukuzuza ukuncishiswa kwe-anatomical kwendawo engemuva ye-articular ye-calcaneus.
Kunzima ukubuyisela ububanzi be-calcaneus, futhi ukukhubazeka akukwazi ukulungiswa kahle.Ivamise ukushiya udonga oluseceleni lwe-calcaneus ngamazinga ahlukahlukene, okuholela kumthelela we-malleolus engemuva ephansi enodonga oluseceleni lwe-calcaneus, ukufuduka noma ukucindezelwa kwethenda ye-peroneus longus, kanye nokungena kwe-tendon peroneal.I-Syndrome, ubuhlungu be-calcaneal impingement, kanye ne-peroneus longus tendonitis.
Indlela ye-Westhues/Essex-lopresti.A.I-Lateral fluoroscopy yaqinisekisa ucezwana olubumbeke njengolimi;B. I-CT scan yendiza evundlile ibonise ukuphuka kwe-IIC yohlobo lwe-Sadess.Ingxenye yangaphambili ye-calcaneus iboniswa ngokucacile kuzo zombili izithombe.S. Ukuthwala ibanga ngokuzumayo.
C. Ukusika i-lateral akukwazanga ukusetshenziswa ngenxa yokuvuvukala okukhulu kwezicubu ezithambile kanye namabhamuza;D. I-Lateral fluoroscopy ebonisa indawo ye-articular (umugqa onamachashazi) nokugoqa kwe-talar (umugqa oqinile).
U-E no-F. Izintambo ezimbili zomhlahlandlela wezinzipho ezingenalutho zabekwa ngokuhambisana nengxenye engezansi yesiqephu esimise okolimi, futhi umugqa onamachashazi umugqa ohlangene.
G. Flex ilunga ledolo, uphakamise iphinikhodi, futhi ngesikhathi esifanayo i-plantar flex i-midfoot ukunciphisa ukuphuka: H. Isikulufu esisodwa se-cannulated esingu-6.5 mm sasigxilwe ethanjeni le-cuboid kanye nezintambo ezimbili ze-Kirschner ezimbili ezingu-2.0 mm zachazwa ngaphansi kwe-subspan ukuze gcina ukuncipha ngenxa ye-calcaneus anterior comminution.Umthombo: Ukuhlinzwa kweMann Foot kanye ne-Ankle.
Sincision tarsi
Ukusika kwenziwa ubude obungu-1 cm ukuya esihlokweni se-fibula kuya esisekelweni se-metatarsal yesine.Ngo-1948, uPalmer waqala ukubika ukusika okuncane ku-sinus tarsi.
Ngo-2000, u-Ebmheim et al.wasebenzisa indlela ye-tarsal sinus ekwelapheni imitholampilo ye-calcaneal fractures.
o Ingadalula ngokugcwele i-subtalar joint, i-posterior articular surface kanye ne-anterolateral fracture block;
o Gwema ngokwanele imithambo yegazi ye-calcaneal;
o Asikho isidingo sokusika i-calcaneofibular ligament kanye ne-subperoneal retinaculum, futhi isikhala esihlangene singandiswa ngokuguquguquka okufanele ngesikhathi sokusebenza, okunezinzuzo zokusika okuncane nokopha okuncane.
Okubi ukuthi ukuchayeka ngokusobala akwanele, okukhawulela futhi kuthinte ukuncishiswa kokuphuka kanye nokubekwa kokulungiswa kwangaphakathi.Ilungele kuphela uhlobo lwe-Sanders I bese uthayipha II ama-calcaneal fractures.
Oi-blique encane
Ukuguqulwa kwe-sinus tarsi incision, cishe u-4 cm ubude, kugxile ku-2 cm ngaphansi kwe-malleolus ehlangothini futhi kuhambisane nendawo engemuva ye-articular.
Uma ukulungiswa kwangaphambi kokuhlinzwa kwanele futhi izimo zivuma, kungase futhi kube nomthelela omuhle wokunciphisa kanye nokulungiswa ku-Sanders uhlobo lwe-II kanye no-III lwe-intra-articular calcaneal fractures;uma i-subtalar joint fusion idingeka esikhathini eside, ukusika okufanayo kungasetshenziswa.
I-PT Peroneal tendon.PF Posterior articular surface of the calcaneus.S sinus tarsi.I-AP Calcaneal protrusion..
I-posterior longitudinal incision
Kusukela maphakathi nendawo yomugqa ophakathi kwethenda ye-Achilles kanye nechopho le-malleolus engemuva, inwebeka iqonde phansi iye ejoyintini lesithende se-talar, ubude obungaba ngu-3.5 cm.
Ukusika okuncane kwezicubu ezithambile ezikude, ngaphandle kokulimaza izakhiwo ezibalulekile, futhi i-posterior articular surface ivezwe kahle.Ngemuva kokucubungula nokunciphisa i-percutaneous, ibhodi le-anatomical lafakwa ngaphansi kokuqondisa kombono we-intraoperative, futhi isikulufu se-percutaneous sacindezelwa futhi salungiswa ngaphansi kwengcindezi.
Le ndlela ingasetshenziselwa uhlobo lwe-Sanders I, II, no-III, ikakhulukazi endaweni ye-articular yangemuva esusiwe noma ukuphuka kwe-tuberosity.
I-Herringbone inqunywe
Ukuguqulwa kwe-sinus tarsi incision.Kusukela ku-3 cm ngaphezu kwechopho le-malleolus engemuva, eduze komngcele ongemuva we-fibula kuya ekugcineni kwe-malleolus ehlangothini, bese kuya phansi kwe-metatarsal yesine.Ivumela ukuncishiswa okuhle nokulungiswa kohlobo lwe-Sanders II kanye no-III lwe-calcaneal fractures, futhi inganwetshwa uma kunesidingo ukuze kuvezwe i-transfibula, i-talus, noma ikholomu ehlangene yonyawo.
I-LM lateral iqakala.Ukuhlanganiswa kwe-MT metatarsal.I-SPR Supra fibula retinaculum.
Aukunciphisa okusizwa nge-rthroscopically
Ku-1997, u-Rammelt uhlongoze ukuthi i-subtalar arthroscopy ingasetshenziswa ukunciphisa i-posterior articular surface ye-calcaneus ngaphansi kombono oqondile.Ngo-2002, u-Rammelt waqala ukwenza i-arthroscopically ukusiza ukunciphisa i-percutaneous kanye nokulungisa izikulufu zokuphuka kohlobo lwe-Sanders I no-II.
I-subtalar arthroscopy idlala ikakhulukazi indima yokuqapha kanye neyokusiza.Ingakwazi ukubona isimo se-subtalar articular surface ngaphansi kombono oqondile, futhi isize ekuqapheni ukunciphisa nokulungiswa kwangaphakathi.I-dissection elula ye-subtalar joint dissection kanye ne-osteophyte resection nayo ingenziwa.
Izinkomba zincane: kuphela ohlotsheni lwe-Sanders Ⅱ olunokuhambisana okuncane kwe-articular surface kanye nokuphuka kwe-AO/OTA kohlobo 83-C2;kuyilapho okwaSanders Ⅲ, Ⅳ kanye nohlobo lwe-AO/OTA 83-C3 Ukuphuka okunokugoqeka kwe-articular okufana no-83-C4 kanye no-83-C4 kunzima kakhulu ukusebenza.
isikhundla somzimba
b.I-arthroscopy yangemuva ye-ankle.c.Ukufinyelela kokuphuka kanye nelunga elingaphansi.
Izikulufu ze-Schantz zafakwa.
e.Setha kabusha nokulungiswa kwesikhashana.f.Ngemva kokusetha kabusha.
g.Lungisa okwesikhashana i-articular surface bone block.h.Lungisa ngezikulufo.
i.I-postoperative sagittal CT scan.j.Umbono we-axial we-postoperative.
Ukwengeza, isikhala esihlangene esingaphansi sincane, futhi i-traction noma amabakaki ayadingeka ukuze asekele indawo ehlangene ukuze kube lula ukubekwa kwe-arthroscope;isikhala sokukhwabanisa kwe-intra-articular sincane, futhi ukuxhaphaza ngokunganaki kungabangela kalula umonakalo we-iatrogenic cartilage surface;amasu okuhlinza abangenamakhono athambekele ekuhleleni ukulimala kwendawo.
Pi-ercutaneous balloon angioplasty
Ngo-2009, u-Bano waqala ukuphakamisa indlela yokwelula ibhaluni yokwelapha ukuphuka kwe-calcaneal.Ngokwaphuka kohlobo lwe-Sanders II, iningi lezincwadi libheka umphumela njengokuqinisekile.Kodwa ezinye izinhlobo zokuphuka zinzima kakhulu.
Uma usimende wethambo ungena endaweni ehlangene ye-subtalar ngesikhathi sokusebenza, kuzobangela ukuguga kwe-articular surface kanye nomkhawulo wokunyakaza okuhlangene, futhi ukunwetshwa kwebhaluni ngeke kulinganiswe ekunciphiseni ukuphuka.
Ukubekwa kwe-cannula nocingo oluqondisayo ngaphansi kwe-fluoroscopy
Izithombe ngaphambi nangemuva kwe-inflation ye-airbag
Izithombe ze-X-ray ne-CT eminyakeni emibili ngemva kokuhlinzwa.
Njengamanje, amasampula ocwaningo obuchwepheshe bebhaluni ngokuvamile mancane, futhi ukuphuka okuningi okunemiphumela emihle kubangelwa udlame olungenawo amandla amancane.Ucwaningo olwengeziwe lusadingeka mayelana nokuqhekeka kwe-calcaneal nokugudluka okukhulu kokuphuka.Kuye kwenziwa isikhathi esifushane, futhi ukusebenza kahle kwesikhathi eside kanye nezinkinga akukacaci.
Ci-alcaneal intramedullary nail
Ngo-2010, i-calcaneal intramedullary nail yaphuma.Ngo-2012, i-M.Goldzak yokwelashwa okuncane kakhulu kokuphuka kwe-calcaneal ngezipikili ze-intramedullary.Kufanele kugcizelelwe ukuthi ukunciphisa akukwazi ukufezwa nge-intramedullary nailing.
Faka iphinikhodi yokubeka indawo, i-fluoroscopy
Ukubeka kabusha i-subtalar joint
Beka ifreyimu yokumisa, shayelela isipikili se-intramedullary, bese usilungisa ngezikulufu ezimbili ezingama-5 mm.
Umbono ngemva kokubekwa kwe-intramedullary nail.
Ukubethelwa kwe-Intramedullary kukhonjiswe ukuthi kuphumelele ekwelapheni ukuphuka kohlobo lwe-Sanders II kanye no-III lwe-calcaneus.Nakuba abanye odokotela bezama ukuyifaka ekwaphukeni kwe-Sanders IV, ukuhlinzwa kokunciphisa kwakunzima futhi ukunciphisa okuhle akutholakalanga.
Umuntu Othintwayo: Yoyo
WA/TEL:+8615682071283
Isikhathi sokuthumela: May-31-2023
