I-Navicular Malounion yenzeka cishe ngo-5-16% wawo wonke ama-fractures ashuvu wethambo le-Navicular, nge-navicular necrosis yenzeka cishe ku-3%. Izici zobungozi ze-Navicular Malounion zifaka ukuxilongwa okulahlekile noma okubambezelekile, ukusondela kwe-Proximal komugqa we-fracture, ukuhanjiswa okukhulu kuno-1 mm, kanye nokuqhekeka ngokungethezeka kwe-carpal. Uma kushiywe kungalashwa, i-osteochondral ye-navicular ostenohondral ivame ukuhlotshaniswa nesifo esibuhlungu, esaziwa nangokuthi i-Navicular Osteochondral Uninunion ene-Osteoarthritisthring.
Ithambo lixhunyethina noma ngaphandle kwe-vaspealing flap lingasetshenziswa ukwelapha i-osteochondral ye-navicular younenion. Kodwa-ke, ezigulini ezine-osteonecrosis yesigxobo se-proxilal yethambo le-Navicular, imiphumela yokuxhunyelelwa kwamathambo ngaphandle kwesiqeshana se-vascular ayinelisi, futhi izinga lokupholisa amathambo lingama-40% -67%. Ngokuphambene nalokho, izinga lokuphulukisa le-Bone Grafts elinama-flaps ama-vaspealing lingaba phezulu njenge-88% -91%. I-Mark Vasseraling Bone Flaps ekusebenzeni kwemitholampilo ifaka phakathi i-radium ye-carmical ifaka phakathi i-1,2-ICSRA-TETTRA-TETSRA-TETTET + VASCAL BONET EFFAT, FECIAL DRADE FLAP, njll. I-MFC VBG yamahhala ikhonjiswe ukuthi isebenza ngempumelelo ekwelapheni ukuphazamiseka kwama-Navicar ngokuwa kwe-metacarpal, futhi i-MFC VBG isebenzisa igatsha le-artemical yehlayo ye-knee artery njengegatsha eliyinhloko le-trophic. Uma kuqhathaniswa nezinye izithonjana, i-MFC VGG ihlinzeka ngosizo olwanele oluhlelekile ukubuyisela ukwakheka okujwayelekile kwethambo le-Navicular amathambo, ikakhulukazi e-Navicular fracture osteochondrosis nge-Bothed Back Deform (Umdwebo 1). Ekwelapheni kwe-Navicular Osteochondral OsteoneCrosis ngokuwa kwe-carpal oqhubekayo, kuthiwa i-radius radius discra
Umdwebo 1. Ukuqhekeka kwethambo le-Navicular nge- "Bothed Back" Deformation, i-CT ikhombisa ibhlokhi yokuqhekeka phakathi kwamathambo amavukela acishe abe ngu-90 °.
Ukulungiselela abamelene
Ngemuva kokuhlolwa ngokomzimba kwesihlakala esithintekile, izifundo zokucabanga kufanele zenziwe ukuze zihlole izinga lokuwa kwesihlakala. I-radiographs ethambile iyasiza ukuqinisekisa indawo yokuqhekeka, izinga lokufuduka, kanye nokuba khona kokuhlelwa kabusha kwenqubekelaphambili noma i-sclerosis yesiphetho esiphukile. Izithombe zangemuva zangemuva zisetshenziselwa ukuhlola ukuwa kwe-Wrist, ukungazinzi kwe-dorsal of the Wrist (Disi) kusetshenziswa isilinganiso sokuphakama kwe-Wrist (Height / ububanzi) se- ≤1.52 noma i-angle ye-radial ye-radial ye-15 °. I-MRI noma i-CT ingasiza ekuhloleni ukuphazamiseka kwethambo le-Navicular noma i-OsteoneCosis. I-radital ye-laateral noma i-sagittal ye-sagittal yethambo le-lival ene-angle ye-licular
Izinkomba kanye nokuphikisana:
I-Navicular Osteochondral Uninunion nge-Bothed Back Deform kanye ne-Disi; I-MRI ikhombisa i-ischemic necrosis yethambo le-Navicular, ukukhulula okungahambi kahle komqhudelwano kanye nokubukwa kokuphela okuqhekekile kwethambo le-Navicular amathambo amhlophe; Ukwehluleka kwethambo le-wedge bone elixhumeka noma ukulungiswa kwe-screw yangaphakathi kudinga ukuxhunyelelwa kwethambo le-VGB elikhulu (> 1cm3). Ukutholwa okusebenzayo noma okusebenzayo kwe-osteoarthritis ye-radial carpal Joint; Uma i-malevince ebalulekile ye-navicular ne-osteoarthritis yenzeke, khona-ke ukulondolozwa kwe-Wrist, khona-ke i-Wrist Penteate, i-Navicular Osteotomy, i-Quadranger Fusion, i-Proximal Carpal Osteotomy, i-Proximal Carpal Osteotomy, i-Proppal Fusion, njll., Kungadingeka; I-Navicular Malonion, i-Necrosion ye-Navilal Necrosis, kepha nge-monerphology ejwayelekile ye-Navicular Bone (isib ukufushanisa kwe-navicular malonion ngaphandle kwe-osteonecrosis. .
Kusetshenziswe i-anatomy
I-MFC VBG ihlinzekwa yinqwaba yemikhumbi emincane yeTrophoblastic (kusho abe-30, 20-50), ngokuhlinzekwa kwegazi okugcwele kakhulu okuphansi kwe-Medial Femorleyleyle (kusho u-6.4). Le mikhumbi ye-trophoblastic yayihlinzekwa ikakhulukazi yi-artery ye-genicape ye-genicape (DGA) kanye / noma i-artery yofuba ephakeme (i-SMGA), okuyigatsha lomthambo wesifazane ongekho emthethweni ovusa amagatsha ezinzwa ezingezinhle, futhi noma / noma ezinyangeni. I-DGA yaqhamuka eProximaly Fetery Artery Peximal ekuveleni kwe-Medial Malleolus, noma kude ne-13.7 cm proximal kuya endaweni eyi-13.5-17.5 cm), kanye nokuqina kwegatsha kwakungama-89% kwi-cadaveric specimens (Umdwebo 3). I-DGA ivela kumthambo wesifazane ongemva kwe-artery ngo-13.7 cm (10.5 cm-17.5 cm) Ngakho-ke, noma i-DGA noma i-SMGA yamukelekile, yize okwedlule kufaneleka kakhulu iTibiae ngenxa yobude nobubanzi bomkhumbi.
I-Fig. 2
Umdwebo 3. I-MFC Vascular Anatomy: (a) amagatsha angajwayelekile kanye ne-MFC Trophoblastic Vascular Anatomy, (b) ibanga le-vasculall kusuka kulayini ohlanganyelwe
Okukuhlinzwa
Isiguli sibekwe ngaphansi kwe-anesthesia ejwayelekile esimweni esiphakeme, esinezinyawo ezithintekile ezibekwe etafuleni lokuhlinzwa ngesandla. Ngokuvamile, i-Donor Bone Flap ithathwe kwi-IsiSateral Medial Femoryleyle Medial Deferelyle, ukuze isiguli sihambisane nezinduku ngemuva kokuhlinzwa. I-SPERE PRORALATaly nayo ingakhethwa uma kunomlando wokuhlukumezeka kwangaphambilini noma ukuhlinzwa ohlangothini olufanayo lwedolo. I-knee iguqulwe futhi i-hip iyindiswa ngaphandle, futhi ama-tourniquets asetshenziswa kuwo womabili amaphepheni aphezulu nangaphansi. Indlela yokuhlinza kwakuyindlela yokuqothula ye-russe, ngokuqhafaza okuqala nge-8 cm proximal emhubheni we-carpal oguqukayo futhi unwebise kude emhubheni we-carpal radial radial carpi radialis tendon, bese ugonga emhubheni we-carpal oguqukayo ubheke esisekelweni sesithupha. I-tendon sheath ye-radial longissimus tendon incane futhi i-tendon idonswa i-ulnarly, futhi ithambo le-navicular livezwa ngokuhlukaniswa okubukhali kanye nama-ligaments athambile we-ligate kanye ne-radial ligaments ama-ligaments athambile amathambo ethambo le-navicular bone (Umdwebo 4). Qinisekisa indawo ye-nonunion, ikhwalithi ye-cartilage ye-articular kanye degree of ischaemia yethambo le-Navicular. Ngemuva kokukhulula i-Tourniquet, qaphela isigxobo seProximal sethambo le-Navicular ukuze sikhiphe ukopha ukuthola ukuthi ngabe kukhona yini i-ischemic necrosis. Uma i-necrosis ye-navicular ingenakuhlotshaniswa ne-radial carpal noma isifo samathambo, i-MFC VGB ingahle isetshenziswe.
Umdwebo 4. Indlela yokugqwayiza ye-Navicular . (C) Khomba indawo ye-Navicular Ossed Redintinuty.
I-15-20 cm ende incation yenziwa i-proximal kulayini ohlangene we-knee eceleni komngcele wangemuva we-medial feolial, kanti umsipha utholwa ngaphandle kwamagatsha egazi e-MFC, i-SMGA, imvamisa ethatha igatsha elihlanganisiwe le-DGA kanye nethambo elihambisanayo le-DGA. I-Vascular Pediole idedelwa ngenhlawulo, inakekela ukuvikela i-periosteum kanye nemikhumbi yezobutho le-trophoblastic ePony Pover.
Umdwebo 5 (B) Imisipha itholwa ngaphandle kokudalula ukunikezwa kwegazi le-MFC ..
Ukulungiselela ithambo le-Navicular
Ukukhubazeka kwe-Navicular Disi kumele kulungiswe futhi indawo yokuxhumeka kwethambo le-osteochondral okulungiselelwe ngaphambi kokufakwa ngokuguquguquka ngokuguqula i-angle ye-fluorooscopy ukubuyisela i-angle ye-radial evamile ye-radial (Umdwebo 6). I-0.0625-Foot (cishe i-1.5-mm) i-Kirschner Pin iyamiswa nge-dorsal to dorsal to metacarpal ukuze ilungiswe i-radial lunate ageyimu, futhi igebe le-navicular malunion liyadalulwa lapho isihlakala siqondile lapho isihlakala siqondile lapho isihlakala siqondile lapho isihlakala siqondile. Isikhala sokuphuka sasisulwa izicubu ezithambile futhi ziphinde zagcwala zivulekile ngeplatererer yepuleti. I-SAWE ebuyisi encane isetshenziselwa ukuthambisa ithambo futhi liqinisekise ukuthi i-lifent flap ifana nesakhiwo esingunxande kune-wedge, okudinga ukuthi igebe le-lixar liphathwe nge-palsar lide. Ngemuva kokuvula igebe, lesi sici silinganiswa ngobukhulu obuthathu ukuthola ubukhulu bokuxhunyelelwa kwethambo, okuvame ukuba ngu-10-12 mm ubude kuzo zonke izinhlangothi zezinhlangothi zonke.
Umdwebo 6 I-0.0625-Foot (cishe i-1.5-mm) i-PIN ye-KIRSchner idonswa nge-dorsal to metacarpal ukuze i-metacarpal ihlele i-radial Lunate Joint, iveze igebe elibhekisisani, elilingana negebe elibikezelwa.
Osteotomy
Indawo eyakhiwe ngemithambo ye-medial femord collord ikhethiwe njengendawo yokukhishwa kwamathambo, futhi indawo yokukhishwa kwamathambo imakwe kahle. Qikelela ukuthi ungalimazi i-Medial Collateral Ligament. I-Periosteum iyavunywa, futhi ichopho lamathambo elingunxantathu losayizi ofanelekile we-flap olifunayo lisikwa nge-saw repeting, nge-bone block yesibili egayiwe ngo-45 ° eceleni kolunye uhlangothi ukuqinisekisa ubuqotho beflap (Fig. 7). 7). Ukunakekelwa kufanele kuthathwe ukungahlukanisi i-periosteum, ithambo le-cortical, nethambo elikhanyiselwe le-flap. I-Low Extremity Tourniquet kufanele ikhishwe ukuze ibheke ukugeleza kwegazi ngeflapha, futhi i-vascular pedicle kufanele ikhululwe ngobuhlakani okungenani ama-6 cm ukuvumela i-anastomosis eyalandela ye-vascular. Uma kunesidingo, inani elincane lethambo lekhansula lingaqhutshelwa ngaphakathi kwe-Deferedle Femoryle. Isisulu sowesifazane se-condylar sigcwele indawo ebambekayo yethambo, futhi ukuvela kukhishwe futhi kuvaliwe ungqimba ngesendlalelo.
Umdwebo 7. I-MFC Bone Flap Demoval. . (B) Ucezu lwesibili lwethambo lusikwa eceleni kolunye uhlangothi ngo-45 ° ukuqinisekisa ubuqotho beflap.
Flap ukufakwa nokulungiswa
I-Bone Flap inciswe umumo ofanele, unakekele ukuthi ungacindezeli i-vascular pedicle noma ukhumule i-periosteum. I-Flap ifakwe kahle endaweni yesiphephelo sethambo le-Navicular, igwema ukuqina, futhi ihlelwe ngezikulufo ezingenazifiso zakwaVali. Ukunakekelwa kwathathwa ukuqinisekisa ukuthi i-Palmar Margin yeBlock Efaziwe ye-Block yagcwala nge-Palmar Margin yethambo le-Navicular noma ukuthi lalicindezelekile kancane ukugwema ukuhlukunyezwa. I-FluoRoscopy yenziwe ukuqinisekisa amathambo amathambo amathambo, umugqa wamandla kanye nesikhundla. I-Anastomose i-vascular flop artery emgqeni we-radial artery ekugcineni kanye nethiphu ye-venous ku-radial artery umlingani weveni ekugcineni (Umdwebo 8). I-capsule ehlanganisiwe iyalungiswa, kepha i-vascular pedicle ivinjelwe.
Umdwebo 8 I-Bone Flap ifakwe kahle endaweni ye-Navicular bone isici futhi ilungiswe ngezikulufo ze-valicarvicular noma izikhonkwane ze-kirschner. Ukunakekelwa kuthathwa ukuthi umngcele we-metacarpal we-tatured bone block ugcwele umugqa we-metacarpal wethambo le-ravicular noma elicindezeleke ngobumnene ukugwema ukungcola. I-Anastomosis ye-vascular flap artery emgodleni we-radial artery yenziwe ukuphela, futhi i-vein tip emthonjeni wemithambo yomngane we-radial artery yenziwa ekugcineni.
Ukuvuselelwa Kwe-Propeative
I-Oral Aspirin 325 mg ngosuku (ngenyanga engu-1), ukuthwala isisindo se-postoperative) kuvunyelwe umlenze othintekile, ukubopha amadolo kunganciphisa ukungaphatheki kahle kwesiguli, kuya ngekhono lesiguli lokuhamba ngesikhathi esifanele. Ukuxhaswa ngokwemikhulu kwe-crutch eyodwa kunganciphisa izinhlungu, kepha ukwesekwa isikhathi eside kwemishini kungadingekile. Imithungo yasuswa amasonto ama-2 ngemuva kokuhlinzwa kanye nomnyusheli noma ingalo ende kuye kwesithupha. Emva kwalokho, ingalo emfushane eya ku-thumtha esetshenzisiwe kuze kube yilapho ukwaphuka kokwelapha. Ama-X-ray athathwa ngezikhathi ezithile zeviki le-3-6, futhi ukuphulukiswa kokuqhekeka kuqinisekiswa yi-CT. Ngemuva kwalokho, ukuguquguquka okusebenzayo nokungemuva kwemisebenzi yokwandiswa kufanele kuqale kancane kancane, futhi ubukhulu bokuzivocavoca umzimba kufanele bandiswe kancane kancane.
Izinkinga ezinkulu
Izinkinga eziphambili ze-Knee Joint zihlanganisa izinhlungu zedolo noma ukulimala kwezinzwa. Ubuhlungu bedene lwenzeka ikakhulukazi emavikini ayi-6 ngemuva kokuhlinzwa, futhi akukho ukulahleka kwemizwa noma ne-neuroma ebuhlungu ngenxa yokulimala kwezinzwa zezinzwa. Izinkinga eziphambili zesandla zihlanganisa i-defractional bone nodoun, izinhlungu, ubuthakathaka, ubuthakathaka, ubuthakathaka, amathamborithitititititititititititititititititis we-radial noma amathambo e-interoosteal heterotopic nawo kubikwe.
I-Medial Femolfyle Clexyle Swelfilaring Bone ixhumeka ngokuxhunyelelwa kwe-Scaphoid Nonunion ngeProximal Pole Necrosis kanye nokuwa kwe-carpal
Isikhathi Seposi: Meyi-28-2024
