Hanyar L ta al'ada ita ce hanyar da aka saba amfani da ita wajen magance karaya a cikin ƙashin ƙugu. Duk da cewa an yi amfani da ita sosai, yankewar tana da tsayi kuma an cire ƙashin ƙugu fiye da kima, wanda hakan ke haifar da matsaloli kamar jinkirin haɗin ƙashin ƙugu, necrosis, da kamuwa da cuta. Tare da neman ƙawance mai ƙarancin haɗari da al'umma ke yi, an yaba wa tiyatar tiyata mai ƙarancin haɗari ta ƙashin ƙugu sosai. Wannan labarin ya tattara shawarwari guda 8.
Tare da kusanci mai faɗi a gefe, ɓangaren da aka yanke a tsaye yana farawa kaɗan kusa da ƙarshen fibula da kuma gaban jijiya ta Achilles. Matsayin da aka yanke yana nesa da fatar da ta ji rauni da jijiyar calcaneal ta gefe da aka saka a ƙasan metatarsal na biyar. An haɗa sassan biyu a diddige don samar da ɗan kusurwar dama mai lanƙwasa. Tushe: Campbell Orthopedic Surgery.
Prage bugun ercutaneous
A shekarun 1920, Böhler ya ƙirƙiro hanyar rage ƙashin ƙashi mai ƙarancin tasiri, kuma na dogon lokaci bayan haka, rage ƙashin ƙashi ta hanyar jan ƙafa ya zama babbar hanyar magance karyewar ƙashin ƙashi.
Ya dace da karaya mai ƙarancin motsi na gutsuttsuran da ke cikin haɗin gwiwa na ƙasa, kamar su Sanders type II da wasu karaya na harshe na Sanders III.
Ga Sanders nau'in III da kuma comminuted Sanders nau'in IV karaya tare da mummunan rugujewar saman subtalar articular, rage bugun jini yana da wahala kuma yana da wuya a cimma raguwar yanayin jiki na saman bayan articular na calcaneus.
Yana da wuya a mayar da faɗin calcaneus, kuma ba za a iya gyara nakasar da kyau ba. Sau da yawa yana barin bangon gefe na calcaneus a matakai daban-daban, wanda ke haifar da tasirin ƙananan malleolus na gefe tare da bangon gefe na calcaneus, ko dai ko matsewa ko matsewar jijiyar peroneus longus, da kuma toshewar jijiyar peroneal. Ciwon, ciwon kumburin calcaneal, da kuma ciwon tsokar peroneus longus.
Dabarar Westhues/Essex-lopresti. A. Lateral fluoroscopy ta tabbatar da rushewar gutsuttsuran da ke siffar harshe; B. Wani hoton CT da aka ɗauka a kwance ya nuna karyewar IIC ta Sandess. An nuna ɓangaren gaba na calcaneus a cikin hotunan biyu. S. Tazarar ɗaukar hoto kwatsam.
C. Ba za a iya amfani da yankewa a gefe ba saboda kumburin nama mai laushi da ƙuraje; D. Binciken fluoroscopy na gefe wanda ke nuna saman haɗin gwiwa (layin da aka yi da digo) da rugujewar talar (layin da ya yi ƙarfi).
E da F. An sanya wayoyi biyu masu ƙusa da aka yi wa fenti a layi ɗaya da ƙasan ɓangaren da ke da siffar harshe, kuma layin da aka yi wa fenti shi ne layin haɗin gwiwa.
G. Lanƙwasa haɗin gwiwa, ɗaga fil ɗin jagora, kuma a lokaci guda a lanƙwasa tsakiyar ƙafa don rage karyewar: H. An daura sukurin cannula ɗaya mai tsawon mm 6.5 a kan ƙashin cuboid kuma an yi wa wayoyi biyu na Kirschner mai tsawon mm 2.0 a ƙarƙashin gwiwa don kiyaye raguwa saboda haɗin gaban calcaneus. Tushe: Tiyatar ƙafa da idon sawu ta Mann.
Syankewar tarsi a cikin
An yi wannan yankewa a nesa da santimita 1 daga ƙarshen fibula zuwa tushen metatarsal na huɗu. A shekarar 1948, Palmer ya fara bayar da rahoton ƙaramin yankewa a cikin sinus tarsi.
A shekara ta 2000, Ebmheim da abokan aikinsa sun yi amfani da hanyar sinus na tarsal wajen magance karyewar kashin baya.
o Zai iya fallasa haɗin gwiwa na ƙasa, saman haɗin gwiwa na baya da kuma toshewar karyewar anterolateral gaba ɗaya;
o A guji hanyoyin jini na lateral calcaneal yadda ya kamata;
o Babu buƙatar yanke jijiyar calcaneofibular da kuma retina na subperoneal, kuma ana iya ƙara sararin haɗin gwiwa ta hanyar juyewa yadda ya kamata yayin aikin tiyata, wanda ke da fa'idodin ƙaramin yankewa da ƙarancin zubar jini.
Rashin kyawunsa shine cewa fallasar ba ta isa ba, wanda ke iyakance kuma yana shafar raguwar karyewar da kuma sanya wurin gyara na ciki. Ya dace ne kawai ga karyewar kalcaneal na Sanders nau'in I da nau'in II.
Oƙaramin yankewa mai launin shuɗi
Gyaran yankewar sinus tarsi, tsawonsa ya kai kimanin santimita 4, a tsakiya santimita 2 a ƙasa da malleolus na gefe kuma a layi ɗaya da saman haɗin gwiwa na baya.
Idan shirye-shiryen kafin tiyata ya isa kuma yanayi ya ba da dama, yana iya samun kyakkyawan sakamako na raguwa da gyarawa akan karyewar ƙashin ƙashi na Sanders nau'i na II da III a cikin jijiyoyin jini; idan ana buƙatar haɗa haɗin gwiwa na ƙasa a cikin dogon lokaci, ana iya amfani da wannan yanke.
PT jijiyar Peroneal. PF saman bayan ƙashin ƙugu. S sinus tarsi. AP fitowar ƙashin ƙugu.
Yanka bayan gefe mai tsayi
Farawa daga tsakiyar layin da ke tsakanin jijiyar Achilles da ƙarshen malleolus na gefe, yana miƙewa tsaye zuwa ga haɗin diddige talar, tare da tsawon kusan santimita 3.5.
Ana yin ɗan yankewa kaɗan a cikin nama mai laushi, ba tare da lalata muhimman gine-gine ba, kuma saman haɗin gwiwa na baya yana bayyana sosai. Bayan an cire shi da kuma rage shi, an saka allon jiki a ƙarƙashin jagorancin hangen nesa na lokacin tiyata, kuma an taɓa sukurori na fata kuma an gyara shi ƙarƙashin matsi.
Ana iya amfani da wannan hanyar ga Sanders nau'in I, II, da III, musamman ga karyewar sassan baya na haɗin gwiwa ko kuma ƙasusuwan da suka lalace.
Yanka ƙashi na herringbone
Gyaran yankewar sinus tarsi. Daga 3 cm sama da ƙarshen malleolus na gefe, tare da iyakar baya na fibula zuwa ƙarshen malleolus na gefe, sannan zuwa ƙasan metatarsal na huɗu. Yana ba da damar ragewa da daidaita karyewar ƙashin ƙashi na Sanders nau'in II da III, kuma ana iya faɗaɗa shi idan ya cancanta don fallasa transfibula, talus, ko ginshiƙin gefe na ƙafa.
LM idon sawu na gefe. Haɗin MT na metatarsal. SPR Supra fibula retinaculum.
ARagewar da aka taimaka ta hanyar rthroscopically
A shekarar 1997, Rammelt ya gabatar da shawarar cewa za a iya amfani da na'urar duban ƙashin ƙugu ta subtalar don rage saman ƙashin ƙugu na baya a ƙarƙashin gani kai tsaye. A shekarar 2002, Rammelt ya fara yin aikin rage rauni da gyara sukurori ta hanyar arthroscopically don karyewar Sanders nau'in I da II.
Aikin tiyatar subtalar arthroscopy galibi yana taka rawa wajen sa ido da taimako. Yana iya lura da yanayin saman subtalar articular a ƙarƙashin gani kai tsaye, kuma yana taimakawa wajen sa ido kan raguwa da gyarawa na ciki. Haka kuma ana iya yin sassauƙan yanke haɗin gwiwa na subtalar da cire osteophyte.
Alamomin sun yi ƙanƙanta: ga nau'in Sanders Ⅱ kawai tare da ɗan haɗin saman haɗin gwiwa da karyewar AO/OTA 83-C2; yayin da ga Sanders Ⅲ, Ⅳ da AO/OTA 83-C3 Karyewar da ke da rugujewar saman haɗin gwiwa kamar 83-C4 da 83-C4 sun fi wahalar aiki.
matsayin jiki
b. Binciken tiyatar idon ƙafa na baya. c. Samun damar shiga gaɓɓan ƙashi da kuma gaɓɓan ƙasa.
An sanya sukurori na Schantz.
e. Sake saitawa da gyara na ɗan lokaci. f. Bayan sake saitawa.
g. Gyara toshewar ƙashin haɗin gwiwa na ɗan lokaci. h. Gyara da sukurori.
i. Duban CT na sagittal bayan tiyata. j. Ra'ayin axial bayan tiyata.
Bugu da ƙari, sararin haɗin gwiwa na subtalar yana da kunkuntar, kuma ana buƙatar jan hankali ko maƙallan hannu don tallafawa sararin haɗin gwiwa don sauƙaƙe sanya arthroscope; sararin da za a yi amfani da shi don sarrafa intra-articular ƙarami ne, kuma sarrafa rashin kulawa na iya haifar da lalacewar saman cartilage na iatrogenic cikin sauƙi; dabarun tiyata marasa ƙwarewa suna da sauƙin kamuwa da raunin gida.
Pangioplasty na balan-balan na ercutaneous
A shekarar 2009, Bano ya fara gabatar da dabarar fadada balan-balan don magance karayar kashin baya. Ga karayar Sanders nau'in II, yawancin wallafe-wallafen suna ɗaukar tasirin a matsayin tabbatacce. Amma sauran nau'ikan karayar sun fi wahala.
Da zarar simintin ƙashi ya shiga cikin sararin haɗin gwiwa na ƙasa yayin aikin, zai haifar da lalacewa a saman haɗin gwiwa da kuma iyakance motsi na haɗin gwiwa, kuma faɗaɗa balan-balan ba zai daidaita ba don rage karyewar.
Sanya igiyar cannula da waya mai jagora a ƙarƙashin fluoroscopy
Hotuna kafin da kuma bayan hauhawar farashin jakar iska
Hoton X-ray da CT shekaru biyu bayan tiyata.
A halin yanzu, samfuran binciken fasahar balan-balan gabaɗaya ƙanana ne, kuma yawancin karyewar da ke da kyakkyawan sakamako ana haifar da su ne ta hanyar tashin hankali mai ƙarancin kuzari. Har yanzu ana buƙatar ƙarin bincike don karyewar calcaneal tare da mummunan canjin karyewar. An gudanar da shi na ɗan gajeren lokaci, kuma ingancinsa na dogon lokaci da rikitarwa har yanzu ba a fayyace su ba.
Cƙusa na alcaneal intramedullary
A shekarar 2010, an gano ƙusa ta calcaneal intramedullary. A shekarar 2012, M.Goldzak ya yi maganin karaya ta calcaneal ta hanyar amfani da ƙusa ta intramedullary. Ya kamata a jaddada cewa ba za a iya cimma raguwar ƙusa ta hanyar amfani da ƙusa ta intramedullary ba.
Saka fil ɗin jagora na sanya wuri, fluoroscopy
Sake sanya haɗin gwiwa na subtalar
Sanya firam ɗin matsayi, a tura ƙusa ta intramedullary, sannan a gyara shi da sukurori biyu masu manne 5 mm
Ra'ayi bayan sanya ƙusa a cikin medullary.
An nuna cewa aikin farfasa ƙashin ƙashi na ciki (intramedullary farce) yana da nasara wajen magance karyewar ƙashin ƙashi na nau'in Sanders na II da III. Duk da cewa wasu likitoci sun yi ƙoƙarin shafa shi a kan karyewar ƙashin ƙashi na Sanders na IV, aikin rage raunin ya yi wahala kuma ba a sami nasarar rage shi da kyau ba.
Mutumin da ake tuntuɓa: Yoyo
WA/TEL:+8615682071283
Lokacin Saƙo: Mayu-31-2023
