Gyaran ciki tare da farantin kashi
Haɗin idon ƙafa tare da faranti da sukurori hanya ce ta fiɗa ta kowa a halin yanzu.An yi amfani da gyare-gyaren ciki na kulle farantin a cikin haɗin gwiwa.A halin yanzu, farantin idon ƙafar ƙafa ya ƙunshi farantin gaba da haɗin gwiwa na gefe.
Hoton da ke sama yana nuna fina-finai na X-ray kafin da kuma bayan tiyata don ciwon ƙwanƙwasa ƙafar ƙafar osteoarthritis tare da makullin gaban farantin ciki na gyaran kafa na haɗin gwiwa.
1. Gaban gaba
Hanya ta gaba ita ce yin ɓangarorin tsayin daka na gaba wanda ke tsakiya akan sararin haɗin gwiwa na idon sawu, yanke Layer ta Layer, da shiga tare da sararin jijiyoyi;yanke capsule na haɗin gwiwa, fallasa haɗin gwiwa na tibiotalar, cire guringuntsi da ƙashi na subchondral, kuma sanya farantin gaba a gaban idon idon.
2. Hanya ta gefe
Hanya ta gefe ita ce yanke osteotomy kamar 10 cm sama da titin fibula kuma cire kututturen gaba daya.Ana fitar da kututturen kashin da aka soke don gyaran kashi.Fusion surface osteotomy an kammala da kuma wanke, da kuma farantin da aka sanya a waje da idon kafa hadin gwiwa.
Amfanin shi ne cewa ƙarfin gyaran gyare-gyare yana da girma kuma gyare-gyare yana da ƙarfi.Ana iya amfani da shi don gyare-gyare da sake ginawa mai tsanani ko nakasar valgus na haɗin gwiwa da kuma lahani da yawa bayan tsaftacewa.Farantin da aka ƙera ta hanyar jiki yana taimakawa dawo da yanayin haɗin gwiwa na idon sawu na yau da kullun.Wuri.
Rashin hasara shi ne cewa ƙarin periosteum da nama mai laushi a cikin yankin tiyata suna buƙatar cirewa, kuma farantin karfe ya fi girma, wanda ke da sauƙi don fusatar da jijiyoyin da ke kewaye.Farantin karfe da aka sanya a gaba yana da sauƙin taɓawa a ƙarƙashin fata, kuma akwai wani haɗari.
intramedullary ƙusa gyarawa
A cikin 'yan shekarun nan, aikace-aikacen retrograde intramedullary ƙusa-nail arthrodesis a cikin jiyya na karshen mataki amosanin gabbai an yi amfani da hankali a asibiti.
A halin yanzu, dabarar ƙusa ta intramedullary galibi tana amfani da tsaka-tsakin tsaka-tsaki na gaba na haɗin gwiwa na idon ƙafar ƙafa ko ɓangarorin ɓangarorin gaba na fibula don tsabtace saman bango ko grafting kashi.Ana shigar da ƙusa na intramedullary daga calcaneus zuwa rami na tibial medullary cavity, wanda ke da amfani ga gyaran nakasa kuma yana inganta haɗin kashi.
Ankle osteoarthritis hade da subtalar arthritis.Hotunan fina-finai na anteroposterior da na gefe na baya sun nuna mummunar lalacewa ga haɗin gwiwa na tibiotalar da haɗin gwiwa na subtalar, rushewar ɓangaren talus, da kuma samuwar osteophyte a kusa da haɗin gwiwa (daga tunani 2).
Maɓalli daban-daban na ƙusa na ƙusa ƙafar ƙafar ƙafar ƙafar ƙafar ƙafar ƙusa shine gyaran gyare-gyaren jirgin sama da yawa, wanda zai iya gyara ƙayyadaddun haɗin gwiwa da za a haɗa shi, kuma ƙarshen nesa shine rami mai zare, wanda zai iya tsayayya da yankewa, juyawa, da cirewa sosai. , rage haɗarin janyewar dunƙule .
An fallasa haɗin gwiwa na tibiotalar da haɗin gwiwa na subtalar kuma an sarrafa su ta hanyar hanyar transfibular ta gefe, kuma tsayin daka a ƙofar ƙusa intramedullary na shuka ya kasance 3 cm.
Ana amfani da ƙusa na intramedullary azaman gyare-gyare na tsakiya, kuma damuwa yana da ƙananan tarwatsawa, wanda zai iya kauce wa tasirin kariya na danniya kuma ya fi dacewa da ka'idodin biomechanics.
Fim ɗin X-ray na anteroposterior da na gefe wata 1 bayan aiki ya nuna cewa layin ƙafar na baya yana da kyau kuma an gyara ƙusa na intramedullary da aminci.
Aiwatar da kusoshi na intramedullary na retrograde zuwa haɗin haɗin gwiwa na idon sawu zai iya rage lalacewar nama mai laushi, rage ƙwayar fata necrosis, kamuwa da cuta da sauran rikice-rikice, kuma zai iya samar da isasshen kwanciyar hankali ba tare da gyare-gyaren filasta na waje ba bayan tiyata.
Shekara daya bayan aiki, fina-finai na X-ray masu inganci da na gefe sun nuna haɗin kasusuwa na haɗin gwiwa na tibiotalar da haɗin gwiwa na subtalar, kuma daidaitawar ƙafar ta baya yana da kyau.
Mai haƙuri zai iya tashi daga gado kuma ya ɗauki nauyi da wuri, wanda ke inganta haƙuri da ingancin rayuwa.Duk da haka, saboda haɗin gwiwa na subtalar yana buƙatar gyarawa a lokaci guda, ba a ba da shawarar ga marasa lafiya tare da haɗin gwiwa mai kyau ba.Ajiye haɗin gwiwa na subtalar wani muhimmin tsari ne don rama aikin haɗin gwiwa a cikin marasa lafiya tare da haɗin gwiwar idon kafa.
dunƙule ciki gyarawa
Percutaneous dunƙule na ciki gyarawa hanya ce ta gama gari a cikin arthrodesis na idon sawu.Yana da fa'idodin aikin tiyata kaɗan na ɓarna kamar ƙaramin ɓarna da ƙarancin asarar jini, kuma yana iya rage lalacewar kyallen takarda yadda ya kamata.
Fina-finan X-ray na gaba da na gefe na haɗin gwiwar idon sawu a tsaye kafin a fara aiki sun nuna mummunan ciwon osteoarthritis na ƙafar dama tare da nakasar ɓarna, kuma an auna kusurwar da ke tsakanin saman tibiotalar articular 19 ° varus.
Nazarin ya nuna cewa gyare-gyare mai sauƙi tare da 2 zuwa 4 lag screws zai iya cimma daidaito da kuma matsawa, kuma aikin yana da sauƙi kuma farashin yana da arha.Shi ne zabi na farko na mafi yawan malamai a halin yanzu.Bugu da ƙari, ana iya yin tsabtace haɗin gwiwar ƙafar ƙafar ƙanƙara a ƙarƙashin arthroscopy, kuma ana iya shigar da sukurori a cikin lokaci.Rashin raunin tiyata karami ne kuma tasirin warkewa yana da gamsarwa.
A karkashin arthroscopy, ana ganin babban yanki na lahani na guringuntsi;A karkashin arthroscopy, ana amfani da na'urar microfracture na mazugi mai nunawa don magance farfajiyar articular
Wasu mawallafa sun yi imanin cewa gyare-gyaren gyare-gyare na 3 na iya rage yawan haɗarin rashin haɗin gwiwa na baya-bayan nan, kuma haɓakar haɓakar haɓakawa na iya zama dangantaka da kwanciyar hankali na 3 screw fix.
Hoton X-ray mai biyo baya makonni 15 bayan aikin ya nuna haɗin kashi.Makin AOFAS shine maki 47 kafin aiki da maki 74 bayan shekara 1 da aiki.
Idan an yi amfani da sukurori guda uku don gyarawa, matsakaicin matsayi na daidaitawa shine cewa ana shigar da sukurori biyu na farko bi da bi daga ɓangarorin anteromedial da aterolateral na tibia, suna haye ta fuskar bangon bango zuwa jikin talar, kuma an saka dunƙule na uku daga baya. gefen tibia zuwa tsakiyar tsakiyar talus.
Hanyar gyarawa na waje
Masu gyara na waje sune farkon na'urorin da aka yi amfani da su a cikin arthrodesis na idon kafa kuma sun samo asali daga shekarun 1950 zuwa yanzu Ilizarov, Hoffman, Hybrid da Taylor Space frame (TSF).
Rauni bude idon ƙafa tare da kamuwa da cuta don shekaru 3, arthrodesis na idon sawun watanni 6 bayan sarrafa kamuwa da cuta
Ga wasu rikice-rikicen cututtukan cututtukan ƙwayar cuta tare da maimaita cututtuka, maimaita ayyukan, mummunan fata na gida da yanayin nama mai laushi, samuwar tabo, lahani na kashi, osteoporosis da cututtukan cututtuka na gida, ana amfani da madaidaicin zobe na Ilizarov fiye da asibiti don haɗa haɗin gwiwa.
Ana gyarawa na waje mai siffar zobe a kan jirgin sama na coronal da jirgin sama na sagittal, kuma yana iya samar da ingantaccen sakamako mai daidaitawa.A farkon aiwatar da ɗaukar kaya, zai matsar da ƙarshen karaya, haɓaka samuwar kira, da haɓaka ƙimar haɗin gwiwa.Ga marasa lafiya da nakasa mai tsanani, mai gyara na waje zai iya gyara nakasar a hankali.Tabbas, haɗin gwiwar idon kafa na waje zai sami matsaloli kamar rashin jin daɗi ga marasa lafiya don sawa da haɗarin kamuwa da ƙwayar allura.
Tuntuɓar:
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Email:liuyaoyao@medtechcah.com
Lokacin aikawa: Jul-08-2023
