Te whakapiri ā-roto me te pereti wheua
He tikanga pokanga noa te whakakotahitanga o ngā pona waewae ki ngā pereti me ngā tīwiri i ēnei rā. Kua whānuitia te whakamahi i te whakapiringa o roto o ngā pereti raka i roto i te whakakotahitanga o ngā pona waewae. I tēnei wā, ko te whakakotahitanga o ngā pereti pona waewae ko te whakakotahitanga o ngā pereti o mua me ngā pereti o te taha.
E whakaatu ana te pikitia i runga ake nei i ngā kiriata hihi-X i mua atu, ā, i muri mai i te pokanga mō te osteoarthritis pona waewae whara me te hononga hononga pona waewae o roto me te pereti maukati o mua.
1. Te huarahi o mua
Ko te huarahi o mua ko te tapahi i tētahi tapahi roa o mua ki waenganui i te hononga pona, ka tapahia papatahi i te papatahi, ka tomo mā te wāhi uaua; tapahia te kāpū hononga, whakaatuhia te hononga tibiotalar, tangohia te kiriuhi me te wheua subchondral, kātahi ka whakatakotoria te pereti o mua ki te taha mua o te pona.
2. Huarahi taha
Ko te huarahi taha ko te tapahi i te osteotomy kia 10 cm te teitei ake i te pito o te fibula, ka tangohia katoatia te tumu. Ka tangohia te tumu wheua cancellous hei hono wheua. Ka oti te osteotomy mata honohono, ka horoia, kātahi ka whakatakotoria te pereti ki waho o te hononga pona.
Ko te painga he kaha te whakapiri, ā, he pūmau te whakapiri. Ka taea te whakamahi mō te whakatika me te hanga anō i te hē nui o te hononga pona waewae, o te varus rānei, me te maha o ngā hapa wheua i muri i te horoinga. Ka āwhina te pereti whakakotahitanga hanganga tinana ki te whakahoki mai i te hanganga noa o te hononga pona waewae. Te wāhi.
Ko te ngoikoretanga, he nui ake ngā wāhanga o te periosteum me ngā kiko ngohengohe o te wāhi pokanga me tango, ā, he matotoru ake te pereti maitai, ka ngāwari te whakararuraru i ngā uaua e karapoti ana. He ngāwari te pā o te pereti maitai kei mua i raro i te kiri, ā, he tūponotanga kei reira.
te whakapiri i ngā whao i roto i te medullary
I ngā tau tata nei, kua āta whakamahia te whakamahinga o te retrograde intramedullary nail-type pona arthrodesis hei rongoā i te mate rumatiki pona o te wāhanga whakamutunga.
I tēnei wā, ko te tikanga whao intramedullary e whakamahi ana i te tapahi o mua o te hononga pona, i te tapahi taha anteroinferior rānei o te fibula hei horoi i te mata hononga, hei tāpiri wheua rānei. Ka whakaurua te whao intramedullary mai i te calcaneus ki te kōhao tibial medullary, he mea whai hua ki te whakatika i te ahua rerekē, ā, ka whakatairanga i te hononga wheua.
Te osteoarthritis o te pona waewae me te rumatiki subtalar. I whakaatuhia e ngā kiriata X-ray anteroposterior me lateral i mua i te pokanga he kino nui ki te hononga tibiotalar me te hononga subtalar, te hinganga wāhanga o te talus, me te hanganga osteophyte huri noa i te hononga (mai i te tohutoro 2)
Ko te koki whakauru tīwiri honohono rerekē o te whao honohono o te waewae muri he whakapiringa maha-papa, ka taea te whakatika i te hononga motuhake hei honohono, ā, ko te pito tawhiti he kōhao raka miro, ka taea te ātete pai ki te tapahi, te hurihuri, me te kume, ka whakaiti i te mōrearea o te tangohanga o te tīwiri.
I hurahia te hononga tibiotalar me te hononga subtalar, ā, i tukatukahia mā te huarahi transfibular taha, ā, ko te roa o te tapahi i te tomokanga o te whao plantar intramedullary he 3 cm.
Ka whakamahia te whao intramedullary hei whakapiringa matua, ā, he āhua marara noa iho tōna ahotea, ka taea te karo i te pānga tiaki ahotea, ā, he rite ake ki ngā mātāpono o te koiora-mīhini.
I whakaatuhia e te kiriata X-ray anteroposterior me te taha kotahi marama i muri i te pokanga he pai te raina waewae o muri, ā, i mau pono te whao intramedullary.
Mā te tāpiri i ngā whao retrograde intramedullary ki te hononga pona ka taea te whakaiti i te kino o ngā kiko ngohengohe, te whakaiti i te nekrosis kiri kua motu, te mate me ētahi atu raruraru, ā, ka taea te whakarato i te pumau me te kore e hiahiatia he whakapiripiri ā-waho tāpiri i muri i te pokanga.
Kotahi tau i muri i te pokanga, i whakaatuhia e ngā kiriata hihi-X pai me te taha e mau ana i te taumaha te hononga wheua o te hononga tibiotalar me te hononga subtalar, ā, he pai te tūnga o te waewae o muri.
Ka taea e te tūroro te ara ake i te moenga me te pikau i te taumaha i te wā wawe, ka pai ake te manawanui me te kounga o te oranga o te tūroro. Heoi, nā te mea me whakatika te hononga subtalar i te wā kotahi, kāore i te tūtohutia mō ngā tūroro he pai te hononga subtalar. Ko te tiaki i te hononga subtalar he hanganga nui hei utu i te mahi a te hononga pona i roto i ngā tūroro e hono ana te hononga pona.
whakapiri ā-roto o te tīwiri
Ko te whakapiripiri ā-roto o te tīwiri kiri he tikanga whakapiripiri noa i roto i te arthrodesis pona waewae. He painga ōna o te pokanga iti rawa te whakaekenga pērā i te tapahi iti me te iti o te toto e ngaro ana, ā, ka taea te whakaiti i te kino ki ngā kiko ngohengohe.
I whakaatuhia e ngā kiriata X-ray anteroposterior me lateral o te hononga pona tū i mua i te pokanga te osteoarthritis kino o te pona matau me te varus deformity, ā, i inehia te koki i waenga i te mata hononga tibiotalar ki te 19° varus.
Kua whakaatuhia e ngā rangahau mā te whakapiri ngāwari me ngā tīwiri whakaroa e 2 ki te 4 ka taea te whakatutuki i te whakapiri pumau me te pēhanga, ā, he māmā noa te mahi, he iti hoki te utu. Koinei te whiringa tuatahi a te nuinga o ngā tohunga i tēnei wā. Hei tāpiri, ka taea te horoi i te hononga pona iti rawa te whakaekenga i raro i te arthroscopy, ā, ka taea te whakauru i ngā tīwiri mā te kiri. He iti te whara o te pokanga, ā, he pai te hua whakaora.
I raro i te arthroscopy, ka kitea he wāhi nui o te koha o te kiriuhi hononga; i raro i te arthroscopy, ka whakamahia te taputapu whati iti o te kōne koi hei rongoā i te mata o te hononga.
E whakapono ana ētahi kaituhi ka taea e te whakapiripiri tīwiri-3 te whakaiti i te tūponotanga o te kore-hononga i muri i te pokanga, ā, ko te pikinga o te tere honohono e pā ana ki te pumau kaha ake o te whakapiripiri tīwiri-3.
I whakaatuhia i roto i tētahi kiriata hihi-X i muri i ngā wiki 15 i muri i te pokanga te hononga o ngā wheua. Ko te kaute AOFAS he 47 ngā tohu i mua i te pokanga, ā, 74 ngā tohu i te tau kotahi i muri i te pokanga.
Mena e toru ngā tīwiri e whakamahia ana mō te whakapiri, ko te tūranga whakapiri tata ko te whakauru i ngā tīwiri tuatahi e rua mai i ngā taha anteromedial me anterolateral o te tibia, ka whiti i roto i te mata hononga ki te tinana talar, ā, ko te tīwiri tuatoru ka whakaurua mai i te taha o muri o te tibia ki te taha medial o te talus.
Tikanga whakapiri o waho
Ko ngā taputapu whakatika o waho ngā taputapu tuatahi i whakamahia mō te whara o te pona waewae, ā, kua whanake mai i te tekau tau atu i 1950 ki nāianei ko te Ilizarov, Hoffman, Hybrid me Taylor space frame (TSF).
Whara tuwhera o te pona waewae me te mate mō ngā tau e 3, te hononga o te pona waewae 6 marama i muri i te whakahaere i te mate
Mō ētahi mate rumatiki pona waewae uaua me ngā mate urutā maha, ngā pokanga maha, ngā āhuatanga kiri me ngā kiko ngohengohe o te rohe, te hanganga o ngā koha, ngā hapa wheua, te osteoporosis me ngā whara mate o te rohe, ka whakamahia te Ilizarov ring external fixator ki te taha haumanu hei whakakotahi i te hononga pona waewae.
Ko te taputapu whakapiri o waho āhua porowhita e mau ana ki te papa korona me te papa sagittal, ā, ka taea te whakarato i te pānga whakapiri pumau ake. I te tukanga kawenga tōmua, ka pēhia te pito whati, ka whakatairanga i te hanganga o te callus, ka whakapai ake i te tere honohono. Mō ngā tūroro he tino hē te āhua, ka taea e te taputapu whakapiri o waho te whakatika mārire i te hē. Ko te tikanga, ka pāngia ngā tūroro e te raruraru o te hononga pona o te taputapu whakapiri o waho, pērā i te kore e pai te mau me te mōrearea o te mate ngira.
Whakapā mai:
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Email:liuyaoyao@medtechcah.com
Wā tuku: Hōngongoi-08-2023
