Hanyar L ta al'ada ita ce hanya ta yau da kullun don maganin fida na karaya. Ko da yake bayyanar yana da kyau sosai, ƙaddamarwa yana da tsawo kuma ana cire nama mai laushi da yawa, wanda a sauƙaƙe yana haifar da rikitarwa irin su jinkirin haɗin gwiwa mai laushi, necrosis, da kamuwa da cuta. Haɗe tare da ƙoƙarce-ƙoƙarcen da al'umma ke yi na ƙayatarwa mai ƙayatarwa, an sami yabo kaɗan sosai. Wannan labarin ya tattara tukwici 8.
Tare da faffadan hanya ta gefe, ɓangaren tsaye na ƙaƙƙarfan yana farawa kaɗan kusa da ƙarshen fibula da gaba zuwa jijiya Achilles. Matsayin yankan ana yin nisa ne kawai zuwa ga ƙujerun fata da jijiyar calcaneal na gefe ke ciyar da shi da kuma sakawa a gindin metatarsal na biyar. An haɗa sassan biyu a diddige don samar da kusurwar dama mai ɗan lanƙwasa. Source: Campbell Orthopedic Surgery.
Praguwar poking mai saurin gaske
A cikin 1920s, Böhler ya bunkasa hanyar m jiyya na masarauta a karkashin tire, kuma na dogon lokaci ragin a ƙarƙashin hanya ya zama babban hanyar karaya.
Ya dace da karaya tare da raguwar gutsuttsuran intraarticular a cikin haɗin gwiwa na subtalar, irin su Sanders nau'in II da wasu raunin harshe na Sanders III.
Ga nau'in Sanders na III da nau'in Sanders na nau'in nau'in nau'in nau'in Sanders mai rauni tare da rugujewar ƙasa mai tsanani, raguwar poking yana da wahala kuma yana da wahala a sami raguwar jikin jikin bangon bangon bango na baya.
Yana da wahala a mayar da faɗin ƙashin ƙugu, kuma ba za a iya gyara nakasar da kyau ba. Sau da yawa yakan bar bangon gefe na ƙashin ƙugu cikin nau'i daban-daban, wanda ke haifar da tasirin ƙananan malleolus na gefe tare da bango na gefen ƙashin ƙugu, ƙaura ko matsawa na peroneus longus tendon, da kuma hana jijiyar peroneal. Ciwon daji, ciwon jijiyoyi na calcaneal, da peroneus longus tendonitis.
Fasahar Westhues/Essex-lopresti. A. Fluoroscopy na gefe ya tabbatar da rushewar guntu mai siffar harshe; B. A kwance jirgin sama CT scan ya nuna Sandess irin IIC karaya. Bangaren gaba na calcaneus a fili an haɗa shi a cikin hotuna biyu. S. Dauke nisa kwatsam.
C. Ba za a iya amfani da ɓarna ta gefe ba saboda tsananin kumburin nama mai laushi da kumburi; D. Lateral fluoroscopy yana nuna saman articular (layi mai digo) da rugujewar tsayi (layi mai ƙarfi).
E da F. An sanya wayoyi jagororin ƙusa maras kyau guda biyu a layi daya zuwa ƙananan ɓangaren juzu'i mai siffar harshe, kuma layin da aka ɗigo shine layin haɗin gwiwa.
G. Juyawa haɗin gwiwa gwiwa, buga fil ɗin jagora, kuma a lokaci guda shuka yana jujjuya tsakiyar ƙafar don rage karaya: H. An daidaita dunƙule na 6.5 mm guda ɗaya zuwa kashin cuboid kuma an sanya wayoyi biyu na Kirschner na 2.0 mm don kula da raguwa saboda raguwar ƙashin baya. Tushen: Mann Kafar Kafa da Tiyata.
Sinus tarsi incision
Ana yin katsewar nisa cm 1 zuwa ƙarshen fibula zuwa gindin metatarsal na huɗu. A cikin 1948, Palmer ya fara ba da rahoton wani ɗan ƙaramin rauni a cikin sinus tarsi.
A cikin 2000, Ebmheim et al. ya yi amfani da tsarin sinus na tarsal a cikin maganin ƙwayar ƙwayar ƙwayar cuta.
o Zai iya fallasa cikakken haɗin gwiwa na subtalar, saman articular na baya da toshe karaya na gaba;
o Guji nisantar tasoshin jini na gefe;
o Babu buƙatar yanke ligament na calcaneofibular da subperoneal retinaculum, kuma za a iya ƙara sararin haɗin gwiwa ta hanyar jujjuyawar da ta dace yayin aikin, wanda yana da fa'ida na ƙananan ƙwayar cuta da ƙarancin zubar jini.
Rashin hasara shi ne cewa bayyanarwa a fili ba ta isa ba, wanda ke iyakancewa kuma yana rinjayar raguwa da kuma sanyawa na ciki. Ya dace da nau'in Sanders I da nau'in nau'in kashi na II na calcaneal.
Oblique ƙananan incision
Gyaran katsewar tarsi na sinus, kusan 4 cm tsayi, wanda ke tsakiya 2 cm ƙasa da malleolus na gefe da layi ɗaya zuwa saman bango na baya.
Idan shirye-shiryen riga-kafi ya isa kuma sharuɗɗan sun ba da izini, kuma yana iya samun raguwa mai kyau da gyare-gyare a kan nau'in Sanders na II da na III na intra-articular calcaneal fractures; idan ana buƙatar haɗin haɗin gwiwa na subtalar a cikin dogon lokaci, ana iya amfani da inci iri ɗaya.
PT Peroneal tendon. PF Na baya articular surface na calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Ƙwaƙwalwar tsayi na baya
Yana farawa daga tsakiyar layin da ke tsakanin jijiyar Achilles da tip na malleolus na gefe, ya shimfiɗa a tsaye zuwa ga haɗin gwiwar diddige, tare da tsawon kusan 3.5 cm.
Ana yin ƙasa kaɗan a cikin nama mai laushi mai nisa, ba tare da lalata mahimman sifofi ba, kuma saman bango na baya yana da kyau fallasa. Bayan ƙwanƙwasawa da raguwa, an shigar da allon jikin mutum a ƙarƙashin jagorancin hangen nesa na ciki, kuma an buga dunƙule mai ɓarna kuma an gyara shi a ƙarƙashin matsin lamba.
Ana iya amfani da wannan hanya don nau'in Sanders na I, II, da III, musamman don ɓarke jiyan bangon baya ko tuberosity fractures.
Herringbone yanke
Gyaran ɓarnar sinus tarsi. Daga 3 cm sama da tip na malleolus na gefe, tare da iyakar baya na fibula zuwa ƙarshen malleolus na gefe, sa'an nan kuma zuwa tushe na metatarsal na hudu. Yana ba da damar raguwa mai kyau da gyara nau'in Sanders nau'in II da III karaya na calcaneal, kuma za'a iya tsawaita idan ya cancanta don fallasa ginshiƙan transfibula, talus, ko gefen kafa.
LM na gefe idon kafa. MT metatarsal haɗin gwiwa. SPR supra fibula retinaculum.
Arage taimakon rthroscopically
A cikin 1997, Ramelt ya ba da shawarar cewa za'a iya amfani da arthroscopy na subtalar don rage saman bangon bango na baya na calcaneus a ƙarƙashin hangen nesa kai tsaye. A shekara ta 2002, Ramelt ya fara aiwatar da rage ƙwanƙwasawa da ƙwanƙwasa ƙwanƙwasa da gyare-gyare ga raunin Sanders I da II.
Subtalar arthroscopy yana taka rawar gani da saka idanu. Yana iya lura da yanayin da ke cikin subtalar articular surface a ƙarƙashin hangen nesa kai tsaye, kuma yana taimakawa wajen lura da raguwa da gyaran ciki. Hakanan za'a iya yin ɓarnawar haɗin gwiwa mai sauƙi da osteophyte.
Alamun sun kasance kunkuntar: kawai don nau'in Sanders Ⅱ tare da ƙaddamarwa mai sauƙi na farfajiyar articular da nau'in AO / OTA nau'in 83-C2; yayin da Sanders Ⅲ, Ⅳ da AO/OTA nau'in 83-C3 Karyas tare da rugujewar farfajiya kamar 83-C4 da 83-C4 sun fi wahalar aiki.
matsayin jiki
b. Na baya idon idon arthroscopy. c. Samun dama ga karaya da haɗin gwiwa na subtalar.
An sanya screws na Schantz.
e. Sake saiti da gyarawa na ɗan lokaci. f. Bayan sake saiti.
g. Na ɗan lokaci gyara shingen ƙashi na bango na articular. h. Gyara tare da sukurori.
i. Sagittal CT scan bayan tiyata. j. hangen nesa axial bayan aiki.
Bugu da ƙari, sararin haɗin gwiwa na subtalar yana da kunkuntar, kuma ana buƙatar ƙugiya ko shinge don tallafawa sararin haɗin gwiwa don sauƙaƙe sanyawa na arthroscope; sararin samaniya don magudi na intra-articular yana da ƙananan, kuma magudi na rashin kulawa zai iya haifar da lalacewar guringuntsi na iatrogenic sauƙi; Hanyoyin tiyata marasa ƙwarewa suna da wuyar tsara raunin gida.
Pballoon angioplasty ercutaneous
A shekara ta 2009, Bano ya fara ba da shawarar fasahar dilatation na balloon don maganin karaya. Ga Sanders type II fractures, yawancin wallafe-wallafen suna ɗaukar tasirin tabbatacce. Amma sauran nau'ikan karaya sun fi wahala.
Da zarar simintin kashi ya shiga cikin sararin haɗin gwiwa na subtalar yayin aikin, zai haifar da lalacewa na articular surface da iyakancewar motsin haɗin gwiwa, kuma balloon ba zai daidaita ba don raguwa.
Sanya cannula da waya jagora a ƙarƙashin fluoroscopy
Hotuna kafin da bayan hauhawar farashin jakar iska
Hoton X-ray da CT shekaru biyu bayan tiyata.
A halin yanzu, samfuran bincike na fasahar balloon gabaɗaya kaɗan ne, kuma yawancin karaya da sakamako mai kyau suna haifar da tashin hankali mara ƙarfi. Har yanzu ana buƙatar ƙarin bincike don karyewar ƙwayar ƙwayar cuta tare da ƙaura mai tsanani. An gudanar da shi na ɗan gajeren lokaci, kuma tasiri na dogon lokaci da rikitarwa har yanzu ba a bayyana ba.
Cƙusa intramedullary alcaneal
A cikin 2010, ƙusa intramedullary calcaneal ya fito. A cikin 2012, M.Goldzak mafi ƙarancin maganin ɓarkewar ƙwayar ƙwayar cuta tare da kusoshi na intramedullary. Ya kamata a jaddada cewa ba za a iya samun raguwa ba tare da ƙusa intramedullary.
Saka fil jagorar matsayi, fluoroscopy
Sake sanya haɗin gwiwa na subtalar
Sanya firam ɗin matsayi, fitar da ƙusa na intramedullary, kuma gyara shi tare da sukurori 5 mm guda biyu.
Hangen bayan intramedullary ƙusa jeri.
An nuna ƙusa a cikin medullary don samun nasara wajen magance karayar Sanders nau'in II da III na calcaneus. Ko da yake wasu likitoci sun yi ƙoƙari su yi amfani da shi ga Sanders IV fractures, aikin ragewa yana da wuya kuma ba a iya samun raguwa mai kyau ba.
Abokin tuntuɓa: Yoyo
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Lokacin aikawa: Mayu-31-2023
