Uburyo busanzwe bwo kuvura imvune zo mu gice cya L ni bwo buryo busanzwe bwo kuvura imvune zo mu gice cya kalcaneal. Nubwo iyo mvune iba ndende, imvune iba ndende kandi ingingo zoroshye zigakurwamo cyane, ibyo bikaba byatera ingorane nko gutinda guhuza ingingo zoroshye, kwangirika no kwandura. Hamwe n'uburyo umuryango w'ubu ukurikirana ubwiza buke, ubuvuzi bwo kuvura imvune zo mu gice cya kalcaneal bwashimiwe cyane. Iyi nkuru yakusanyije inama 8.
Mu buryo bwagutse bwo ku ruhande, igice gihagaze cy'igisebe gitangira hafi gato ku mutwe wa fibula no imbere y'umutsi wa Achilles. Urugero rw'igisebe rukorwa kure gato y'uruhu rwakomeretse rutangwa n'imitsi yo ku ruhande rwa calcaneal hanyuma rugashyirwa ku nsi ya metatarsal ya gatanu. Ibice byombi bifatanye ku gatsinsino kugira ngo bikore inguni y'iburyo igoramye gato. Inkomoko: Campbell Orthopedic Surgery.
Pkugabanya gushyuha kw'uruhu
Mu myaka ya 1920, Böhler yavumbuye uburyo bwo kuvura bugabanya calcium iri munsi y’umuvuduko, kandi nyuma y’igihe kirekire, kugabanya calcium iri munsi y’umuvuduko biba uburyo busanzwe bwo kuvura calcium vunitse.
Ikwiriye ku mvune zifite aho zikura cyane mu ngingo iri munsi y’ingingo, nka Sanders type II na Sanders III lingual breakage.
Ku mvune zo mu bwoko bwa Sanders zo mu bwoko bwa III na Sanders zo mu bwoko bwa IV zavunitse cyane hamwe no kugwa gukomeye kw'ubuso bwa subtalar articular, kugabanya gukubita biragoye kandi biragoye kugabanya imiterere y'ubuso bw'inyuma bwa calcaneus.
Biragoye gusubiza ubugari bwa calcaneus, kandi ubusembwa ntibushobora gukosorwa neza. Akenshi iva ku rukuta rw'inyuma rwa calcaneus mu buryo butandukanye, bigatera ingaruka za malleolus yo hasi ku rukuta rw'inyuma rwa calcaneus, kwimuka cyangwa gukanda kw'umutsi wa peroneus longus, no gukanda kw'umutsi wa peroneal. Indwara, ububabare bwo gukanda kw'umutsi, na peroneus longus tendonitis.
Ubuhanga bwa Westhues/Essex-lopresti. A. Fluoroscopy yo mu ruhande rw'inyuma yemeje igice cy'urulimi cyaguye; B. Isuzuma rya CT ryo mu kirere ritambitse ryagaragaje kuvunika kwa Sandess type IIC. Igice cy'imbere cya calcaneus kiragaragara neza mu mashusho yombi. S. Intera yo gutwara itunguranye.
C. Gukata igice cyo ku ruhande ntibyashoboraga gukoreshwa kubera kubyimba gukomeye kw'ingingo zoroshye no kuzana udusebe; D. Gupima imiterere y'inyuma yerekana ubuso bw'ingingo (umurongo ufite utudomo) n'igabanuka rya talar (umurongo ukomeye).
E na F. Insinga ebyiri z'ubudodo ziyobora inzara zashyizwe hamwe n'igice cyo hasi cy'igice cy'urulimi, kandi umurongo w'utudomo ni umurongo uhuza.
G. Kosora ingingo y'ivi, shyiramo agapira ko kuyobora, hanyuma icyarimwe ushyiremo plantar ushyiremo hagati y'ikirenge kugira ngo ugabanye kuvunika: H. Isosi imwe ifite uburebure bwa mm 6.5 yashyizwe ku igufwa rya cuboid maze insinga ebyiri za Kirschner za mm 2.0 zashyizwemo uburebure kugira ngo zikomeze kugabanuka bitewe no kwangirika kwa calcaneus imbere. Inkomoko: Mann Foot and Ankle Surgery.
Sinus tarsi icibwamo
Icibwa rikorwa kuri cm 1 uvuye ku mutwe wa fibula kugeza ku gice cyo hasi cya metatarsal ya kane. Mu 1948, Palmer yavuze bwa mbere ko hari icika rito muri sinus tarsi.
Mu 2000, Ebmheim n'abandi bakoresheje uburyo bwa tarsal sinus mu kuvura imvune za calcaneal.
o Ishobora kugaragaza neza ingingo iri munsi y'ingingo, ubuso bw'inyuma bw'ingingo n'agace k'imbere k'ingingo;
o Irinde bihagije imiyoboro y'amaraso yo mu ruhande rwa calcaneal;
o Nta mpamvu yo gukata ligament ya calcaneofibular na retinaculum ya subperoneal, kandi umwanya w'ingingo ushobora kwiyongera no guhinduranya neza mu gihe cyo kubagwa, ibyo bikaba bifite ibyiza byo gukata gato no kuva amaraso make.
Ingorane ni uko imiterere yayo idahagije, ibyo bikaba bigabanya kandi bigira ingaruka ku kugabanuka kw'amagufwa no gushyira imbere mu mwanya wayo. Ikwiriye gusa amagufwa ya calcaneal yo mu bwoko bwa Sanders bwa mbere n'ubwa kabiri.
Ogukata gato k'urubura
Impinduka mu gice cya sinus tarsi, gifite uburebure bwa cm 4, giherereye hagati ya cm 2 munsi ya malleolus yo ku ruhande kandi gifatanye n'ubuso bw'inyuma bw'ingingo.
Iyo imyiteguro yo kubagwa ihagije kandi ibintu bikaba bibyemereye, ishobora no kugira ingaruka nziza zo kugabanya no gufunga ku mvune za Sanders zo mu bwoko bwa II na III intra-articular calcaneal fractures; niba hakenewe fusion y’ingingo zo mu gice cya subtalar mu gihe kirekire, incision imwe ishobora gukoreshwa.
PT Peroneal tendon. PF Posterior articular surface ya calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Icamo ry'inyuma ry'ubugari
Guhera hagati mu murongo uri hagati y'umutsima wa Achilles n'isonga rya malleolus yo ku ruhande, biramanuka bihagaze kugeza ku gatsinsino ka talar, bifite uburebure bwa cm 3.5.
Gukata igice gito cy'umubiri mu gice cyoroshye cyane, bitabangamiye imiterere y'ingenzi, kandi ubuso bw'inyuma bw'ingingo bugaragara neza. Nyuma yo gukata igice cy'umubiri no kugigabanya, hashyizweho ikibaho cy'umubiri hifashishijwe uburyo bwo kureba imbere mu kubaga, maze vis yo mu gice cy'umubiri irakomwaho kandi irakomezwa munsi y'igitutu.
Ubu buryo bushobora gukoreshwa ku bwoko bwa Sanders bwa I, II, na III, cyane cyane ku mvune zo inyuma cyangwa ku bice by'umubiri.
Gukata igufwa rya Herringbone
Guhindura icibwa rya sinus tarsi. Kuva kuri cm 3 hejuru y'isonga rya malleolus yo ku ruhande, ku mupaka w'inyuma wa fibula kugeza ku isonga rya malleolus yo ku ruhande, hanyuma ukagera ku gice cyo hasi cya metatarsal ya kane. Bituma habaho kugabanya no gufunga neza kwa mvune za Sanders zo mu bwoko bwa II na III, kandi bishobora kongerwa niba bibaye ngombwa kugira ngo transfibula, talus, cyangwa inkingi yo ku ruhande rw'ikirenge igaragare.
Akaguru ka LM ku ruhande. Urugingo rwa MT metatarsal. SPR Supra fibula retinaculum.
Akugabanya hakoreshejwe ikoranabuhanga rya rthroscopically
Mu 1997, Rammelt yatanze igitekerezo cy'uko subtalar arthroscopy ishobora gukoreshwa mu kugabanya ubuso bw'inyuma bw'agace k'inyuma k ...
Isuzuma rya subtalar arthroscopy rigira uruhare runini mu gukurikirana no gufasha. Rishobora kureba imiterere y'ubuso bw'ingingo buto munsi y'amaso, kandi rigafasha mu gukurikirana uburyo ingingo zigabanuka n'uburyo zifata imbere. Guca ingingo no gukata amagufwa byoroshye nabyo bishobora gukorwa.
Ibimenyetso ni bito: gusa kuri Sanders type Ⅱ ifite agace gato k'ubuso bw'ingingo n'udusimba twa AO/OTA 83-C2; mu gihe kuri Sanders Ⅲ, Ⅳ na AO/OTA 83-C3 udusimba dufite agace k'ubuso bw'ingingo nka 83-C4 na 83-C4 bigoye gukoresha.
uko umubiri uhagaze
b. Gupima akaguru inyuma. c. Kugera aho imvune n'ingingo iri munsi y'akaguru biherereye.
Hashyizweho vis za Schantz.
e. Gusubizaho no gukosora by'agateganyo. f. Nyuma yo gusubizaho.
g. Kosora by'agateganyo igice cy'igufwa cy'umugongo. h. Kosora ukoresheje vis.
i. Isuzuma rya CT nyuma yo kubagwa. j. Isuzuma rya axial nyuma yo kubagwa.
Byongeye kandi, umwanya wo hagati y’ingingo ni muto, kandi hakenewe uburyo bwo gukurura cyangwa gushyiramo uduce duto kugira ngo ingingo zifatanye kugira ngo byorohereze gushyirwaho arthroscope; umwanya wo gukurura hagati y’ingingo ni muto, kandi gukurura umuntu mu buryo butari bwo bishobora kwangiza ubuso bw’ingingo buterwa n’iy’itrojeni; uburyo bwo kubaga budakoresheje ubuhanga bushobora gutera imvune zo mu gace.
Pangioplasty y'ibaluni yo mu bwoko bwa ercutaneous
Mu 2009, Bano yatanze bwa mbere uburyo bwo kwagura imipira mu kuvura imvune za calcaneal. Ku mvune za Sanders zo mu bwoko bwa II, inyandiko nyinshi zifata ingaruka nk'izizwi. Ariko ubundi bwoko bw'imvune buragoye cyane.
Iyo sima y'amagufwa imaze kwinjira mu mwanya w'ingingo mu gihe cyo kubagwa, bizatuma ubuso bw'ingingo bushira ndetse n'ingingo zigabanye kugenda, kandi kwaguka kw'ibara ry'umupira ntibizaringanizwa kugira ngo bigabanye kuvunika.
Gushyira cannula n'insinga y'ubuyobozi munsi ya fluoroscopy
Amashusho mbere na nyuma y'izamuka ry'ingufu z'umwuka
Amashusho ya X-ray na CT nyuma y'imyaka ibiri akozwe.
Kuri ubu, ingero z'ubushakashatsi ku ikoranabuhanga rya baluni muri rusange ni nto, kandi inyinshi mu mvune zifite umusaruro mwiza ziterwa n'ingufu nke. Haracyakenewe ubundi bushakashatsi ku mvune za calcaneal zifite imvune ikomeye. Byakozwe igihe gito, kandi ingaruka n'ingaruka byagize mu gihe kirekire ntibirasobanuka neza.
Cururabo rw'imbere mu kanwa
Mu 2010, inzara zo mu bwoko bwa calcaneal intramedullary zarasohotse. Mu 2012, M.Goldzak yavuwe mu buryo bugabanya ubukana bw'izuba hakoreshejwe inzara zo mu bwoko bwa intramedullary. Byakagombye gushimangirwa ko kugabanuka bitagerwaho hakoreshejwe inzara zo mu bwoko bwa intramedullary.
Shyiramo agapira k'ubuyobozi bwo gushyiramo aho umuntu ari, fluoroscopy
Gushyira mu mwanya igice cy'umubiri giherereye ku gice cy'umubiri
Shyiraho icyuma gishyiraho imiterere, shyiramo umusumari wo mu nda, hanyuma uwushyireho ukoresheje vis ebyiri za mm 5 zifite icyuma gifunganye
Uburyo bwo kureba inyuma yo gushyira inzara mu nda.
Gutera imisumari mu nda byagaragaye ko ari byiza mu kuvura imvune ya Sanders yo mu bwoko bwa II na III ya calcaneus. Nubwo bamwe mu baganga bagerageje kuyikoresha ku mvune ya Sanders yo mu bwoko bwa IV, kubaga byari bigoye kandi uburyo bwiza bwo kuyigabanya ntibyashobotse.
Umuntu wo kuvugana na we: Yoyo
WA / TEL: +8615682071283
Igihe cyo kohereza: Gicurasi-31-2023
