Ko te huarahi tuku iho o te taha L te huarahi matarohia mō te rongoā pokanga mō ngā whati o te angaanga. Ahakoa he tino ātaahua te whakaaturanga, he roa te tapahi, ā, ka nui ake te tango i te kiko ngohengohe, ka tere ai te puta o ngā raruraru pērā i te whakaroa o te hononga o ngā kiko ngohengohe, te pirau, me te mate. I te taha o te whai a te hapori o nāianei i te āhua ataahua iti rawa te whakaekenga, kua tino whakanuia te rongoā pokanga iti rawa te whakaekenga mō ngā whati o te angaanga. E 8 ngā tohutohu kua kohia e tēnei tuhinga.
Mā te whānui o te taha, ka tīmata te wāhanga poutū o te tapahi i te taha tata ki te pito o te fibula, ā, i mua i te uaua Achilles. Ko te taumata o te tapahi ka mahia i te taha tawhiti noa iho o te kiri maru e whāngaihia ana e te uaua calcaneal taha me ngā whakaurunga ki te turanga o te tuarima o te metatarsal. Ka honoa ngā wāhanga e rua i te rekereke hei hanga i tētahi koki matau paku piko. Puna: Campbell Orthopedic Surgery.
Pte whakaiti i te werohanga kiri
I te tekau tau atu i 1920, i whakawhanakehia e Böhler te tikanga maimoatanga iti rawa te whakaekenga mō te whakaiti i te calcaneus i raro i te kume, ā, mō te wā roa i muri mai, ko te whakaiti i te kume percutaneous i raro i te kume ka noho hei tikanga matua mō te maimoatanga o ngā whati calcaneus.
He pai mō ngā whati he iti ake te nekenga o ngā kongakonga o roto i te hononga i roto i te hononga raro, pērā i te momo Sanders II me ētahi whati arero o Sanders III.
Mō ngā whati Sanders momo III me ngā whati Sanders momo IV kua pakaru me te hinganga nui o te mata hononga subtalar, he uaua te whakaiti i te poking, ā, he uaua hoki ki te whakatutuki i te whakaiti anatomical o te mata hononga o muri o te calcaneus.
He uaua ki te whakahoki mai i te whānui o te calcaneus, ā, kāore e taea te whakatika pai i te āhua o te piko. He maha ngā wā ka wehe atu i te pakitara taha o te calcaneus i ngā taumata rerekē, ka hua ake te pānga o te malleolus taha o raro ki te pakitara taha o te calcaneus, te nekehanga, te pēhi rānei o te uaua peroneus longus, me te pānga o te uaua peroneal. Te mate pukupuku, te mamae pānga o te calcaneus, me te peroneus longus tendonitis.
Tikanga Westhues/Essex-lopresti. A． I whakaūhia e te fluoroscopy taha te pakaru o te kongakonga āhua arero; B. I whakaatuhia e te matawai CT papa whakapae he whati momo Sandess IIC. He mārama te pakaru o te wāhanga o mua o te calcaneus i ngā whakaahua e rua. S. Te tawhiti kawe ohorere.
C. Kāore i taea te whakamahi i te tapahi taha nā te pupuhi nui o ngā kiko ngohengohe me te pupuhi; D. Te whakaahuatanga o te taha e whakaatu ana i te mata hononga (rārangi iraira) me te hinganga o te niho (rārangi totoka).
E me F. E rua ngā waea arataki whao tuwhera i whakatakotoria kia whakarara ki te wāhanga o raro o te kongakonga āhua-arero, ā, ko te rārangi iraira te rārangi hononga.
G. Whakapikohia te hononga turi, hurahia te pine ārahi, ā, i te wā kotahi whakapikohia te waewae waenga ki te whakaiti i te whati: H. Kotahi te tīwiri cannulated 6.5 mm i whakapirihia ki te wheua porowhita, ā, e rua ngā waea Kirschner 2.0 mm i honoa ki raro i te whānui hei pupuri i te whakaitinga nā te calcaneus anterior comminution. Puna: Mann Foot and Ankle Surgery.
Ste tapahi inus tarsi
Ka tapahia te wheua kia 1 henimita te tawhiti atu i te pito o te fibula ki te turanga o te tuawhā o ngā metatarsal. Nō te tau 1948, i kōrero tuatahi a Palmer mō tētahi tapahi iti i te sinus tarsi.
I te tau 2000, i whakamahia e Ebmheim me ētahi atu te huarahi tarsal sinus hei rongoā haumanu mō ngā whati o te calcaneal.
o Ka taea te whakaatu katoa i te hononga raro, te mata hononga o muri me te aukati whati anterolateral;
o Āta karohia ngā uaua toto o te calcaneus taha;
Kāore he take ki te tapahi i te ligament calcaneofibular me te retinaculum subperoneal, ā, ka taea te whakanui ake i te ātea hononga mā te huri tika i te wā o te pokanga, he painga nō te tapahi iti me te iti o te toto.
Ko te ngoikoretanga, he mārama kāore i te rawaka te pānga, ā, ka whakawhāitihia, ka pāngia hoki te whakaiti i te whati me te whakatakotoranga o te whakapiringa ā-roto. He pai anake mō ngā whati anga o te anga o Sanders momo I me te momo II.
Otapahi iti a Blique
He whakarerekētanga o te tapahi o te sinus tarsi, tata ki te 4 cm te roa, kei waenganui i te 2 cm i raro i te malleolus taha, ā, e whakarara ana ki te mata hononga o muri.
Mena he rawaka te whakarite i mua i te pokanga, ā, e āhei ana ngā āhuatanga, ka pai hoki te whakaiti me te whakau i ngā whati o te hononga o roto o te hononga Sanders momo II me te III; mena e hiahiatia ana te honohono hononga subtalar mō te wā roa, ka taea te whakamahi i te tapahi kotahi.
PT Te uaua peroneal. PF Te mata hononga o muri o te calcaneus. S sinus tarsi. AP Te pupū o te calcaneal. .
Tapahi roa o muri
Mai i waenganui o te rārangi i waenganui i te uaua Achilles me te pito o te malleolus taha, ka toro poutū ki raro ki te hononga rekereke o te uaua, ko te roa e 3.5 cm te roa.
He iti ake te tapahi i ngā kiko ngohengohe o tawhiti, me te kore e kino ngā hanganga nui, ā, e kitea pai ana te mata hononga o muri. Whai muri i te werohanga me te whakaiti i te kiri, ka whakauruhia he papa tinana i raro i te arataki a te tirohanga i te wā o te pokanga, ā, ka patohia te tīwiri kiri, ka whakauhia i raro i te pēhanga.
Ka taea te whakamahi i tēnei tikanga mō te momo Sanders I, II, me te III, inā koa mō ngā whati o te mata hononga o muri kua nekehia, ngā whati rānei o te ngongo.
Tapahi hereni
Te whakarerekētanga o te tapahi sinus tarsi. Mai i te 3 cm i runga ake i te pito o te malleolus taha, i te taha o muri o te fibula ki te pito o te malleolus taha, kātahi ki te turanga o te tuawhā o te metatarsal. Ka taea te whakaiti me te pupuri i ngā whati calcaneal momo Sanders II me te III, ā, ka taea te whakaroa mēnā e tika ana kia whakaatuhia te transfibula, te talus, te pou taha rānei o te waewae.
Pona waewae taha LM. Hononga metatarsal MT. SPR Supra fibula retinaculum.
Ate whakaiti i āwhinahia e te arthroscopic
I te tau 1997, i whakaarohia e Rammelt kia whakamahia te arthroscopy subtalar hei whakaiti i te mata hononga o muri o te calcaneus i raro i te tirohanga tika. I te tau 2002, i mahi tuatahi a Rammelt i te whakaiti kiri ā-ringa me te whakapiri tīwiri mō ngā whati momo I me II a Sanders.
Ko te mahi matua a te arthroscopy subtalar he aroturuki me te āwhina. Ka taea e ia te tirotiro i te āhua o te mata hononga subtalar i raro i te tirohanga tika, ā, ka āwhina i te aroturuki i te whakaiti me te whakapiri o roto. Ka taea hoki te mahi i te tapahi hononga subtalar me te tango osteophyte.
He whāiti ngā tohu: mō te momo Sanders 2 anake me te pakaru ngawari o te mata hononga me ngā whati momo AO/OTA 83-C2; mō Sanders Ⅲ, Ⅳ me te momo AO/OTA 83-C3 ia he uaua ake te whakahaere i ngā whati me te hinga o te mata hononga pēnei i te 83-C4 me te 83-C4.
tūnga tinana
b. Te tirotiro i te pona waewae o muri. c. Te urunga atu ki te whati me te hononga o raro o te hononga.
I whakatakotoria ngā tīwiri Schantz.
e. Tautuhi anō me te whakapūmau rangitahi. f. Whai muri i te tautuhi anō.
g. Whakapiria te poraka wheua o te mata hononga mō tētahi wā. h. Whakapiria ki ngā tīwiri.
i. Matawai CT sagittal i muri i te pokanga. j. Tirohanga axial i muri i te pokanga.
Hei tāpiritanga, he whaiti te wāhi hononga o raro, ā, me whakamahi he toia, he whāriki rānei hei tautoko i te wāhi hononga hei whakahaere i te whakatakotoranga o te arthroscope; he iti te wāhi mō te whakarerekētanga o roto i te hononga, ā, ka taea e te whakarerekētanga mangere te whakararu i te mata o te kiriuhi iatrogenic; ka ngāwari te whara ā-rohe i ngā tikanga pokanga kore pūkenga.
Pte angioplasty poihau kiri
I te tau 2009, i whakaarohia tuatahitia e Bano te tikanga whakawhanui poihau hei rongoā mō ngā whati o te angaanga. Mō ngā whati momo II a Sanders, e whakaaro ana te nuinga o ngā tuhinga he tino pānga. Engari he uaua ake ētahi atu momo whati.
Kia uru te sima wheua ki roto i te mokowā hononga o raro i te hononga i te wā e pokangahia ana, ka pakaru te mata o te hononga, ka whakawhāitihia te nekehanga o te hononga, ā, e kore e taurite te whānui o te poihau hei whakaiti i te whati.
Te whakatakotoranga o te cannula me te waea ārahi i raro i te fluoroscopy
Ngā whakaahua i mua me muri i te pupuhi o te pēke hau
Ngā whakaahua X-ray me te CT i ngā tau e rua i muri i te pokanga.
I tēnei wā, he iti noa iho ngā tauira rangahau o te hangarau poihau, ā, ko te nuinga o ngā whatiwhatinga he pai ngā hua, nā te kaha iti o te pūngao i puta mai. Me whai rangahau anō mō ngā whatiwhatinga angaanga me te nekehanga nui o te whatiwhatinga. He wā poto noa iho tēnei kua mahia, ā, kāore anō kia mārama te whai huatanga me ngā raruraru mō te wā roa.
Cwhao ā-roto-medullary alcaneal
I te tau 2010, i puta mai te whao intramedullary calcaneal. I te tau 2012, i whakamahia e M.Goldzak te maimoatanga iti rawa o ngā whati calcaneal mā te whakamahi i te whao intramedullary. Me whakanui kāore e taea te whakaiti i te whara mā te whao intramedullary.
Whakauruhia te pine aratohu tūnga, te fluoroscopy
Te whakanoho anō i te hononga subtalar
Whakatakotoria te anga tūnga, pēhia te whao intramedullary, ka whakapirihia ki ngā tīwiri cannulated e rua 5 mm te whānui.
Tirohanga i muri i te whakatakotoranga o ngā whao intramedullary.
Kua kitea te angitu o te whakamahi i te nailing intramedullary hei rongoā mō ngā whati Sanders momo II me te III o te calcaneus. Ahakoa i ngana ētahi tākuta ki te whakamahi ki ngā whati Sanders IV, he uaua te mahi whakaiti, ā, kāore i taea te whakatutuki i te whakaiti tino pai.
Tangata Whakapā: Yoyo
WA/TEL:+8615682071283
Wā tuku: Mei-31-2023
