Uburyo busanzwe bwa L ni uburyo bwa kera bwo kubaga kuvura kuvunika kwa calcaneal. Nubwo guhura kwuzuye, gutemagura ni birebire kandi imyenda yoroshye yambuwe byinshi, ibyo bikaba byoroshye biganisha ku ngorane nko gutinda guhuza ingirabuzimafatizo zoroshye, nérosose, no kwandura. Hamwe na societe iriho ubu ikurikirana ubwiza bwubwiza bworoheje, kuvura kubaga byibasiye imiti ivunika ya calcaneal yarashimiwe cyane. Iyi ngingo yakusanyije inama 8.
Hamwe nuburyo bwagutse, igice gihagaritse cyo gutemba gitangira hafi gato yisonga rya fibula ninyuma yimbere ya Achilles. Urwego rwo gutemwa rukozwe gusa kuruhu rwakomeretse rugaburirwa na arteriire ya calcaneal hanyuma ukinjiza munsi ya metatarsal ya gatanu. Ibice byombi bihujwe ku gatsinsino kugirango bigire inguni igororotse gato. Inkomoko: Kubaga amagufwa ya Campbell.
Pkugabanuka gukabije
Mu myaka ya za 1920, Böhler yashyizeho uburyo bwo kuvura bworoheje bwo kugabanya calcaneus ikururwa, kandi mu gihe kirekire nyuma yaho, kugabanuka kwa pokisi byatewe no gukurura byabaye uburyo nyamukuru bwo kuvura imvune za calcane.
Irakwiriye kuvunika hamwe no kwimura gake ibice byimbere mu gice cya subtalar, nka Sanders ubwoko bwa II hamwe na Sanders III yavunitse ururimi.
Kuri Sanders ubwoko bwa III hamwe na Sanders ubwoko bwavunitse bwavunitse hamwe nubutaka bukabije bwa subtalar arctular gusenyuka, kugabanya poke biragoye kandi biragoye kugera kugabanuka kwa anatomicike yinyuma yinyuma ya calcaneus.
Biragoye kugarura ubugari bwa calcane, kandi ubumuga ntibushobora gukosorwa neza. Bikunze gusiga urukuta rwuruhande rwa calcane muburyo butandukanye, bikavamo ingaruka za malleolus yo hepfo hamwe nurukuta rwuruhande rwa calcaneus, kwimura cyangwa kwikanyiza kuri peroneus longus tendon, no kubangamira imitsi ya peroneal. Syndrome, ububabare bwa calcaneal, na peroneus longus tendonitis.
Westhues / Essex-lopresti tekinike. A． Uruhande rwa fluoroscopi rwemeje igice cyururimi rwaguye; B. Indege itambitse CT scan yerekanaga Sandess ubwoko bwa IIC. Igice cyimbere cya calcaneus kigaragara neza mumashusho yombi. S. Gutwara intera itunguranye.
C. Gutemagura kuruhande ntibishobora gukoreshwa kubera kubyimba byoroshye byoroshye kubyimba no kubyimba; D. Fluoroscopi yerekana impande zose (umurongo utudomo) hamwe no gusenyuka kwa talar (umurongo ukomeye).
E na F
G. Hindura ivi, shyira hejuru icyerekezo, kandi icyarimwe icyarimwe gihinduranya ibirenge hagati kugirango kigabanye kuvunika: H. Umuyoboro umwe wa mm 6.5 mm washyizwe kumagufa ya cuboid naho insinga ebyiri za mm 2 za Kirschner zasobanuwe kugirango zigabanye kugabanuka bitewe na calcaneus imbere. Inkomoko: Kubaga ibirenge hamwe no kubaga amaguru.
Sinus tarsi
Gutemagura bikozwe muri cm 1 kugera ku isonga rya fibula kugeza munsi ya metatarsal ya kane. Mu 1948, Palmer yabanje kumenyesha agace gato muri sinus tarsi.
Mu 2000, Ebmheim n'abandi. yakoresheje uburyo bwa tarsal sinus mubuvuzi bwo kuvura ivunika rya calcaneal.
o Irashobora kwerekana byimazeyo subtalar ihuriweho, inyuma yinyuma yinyuma hamwe nigice cyo kuvunika;
o Irinde bihagije imiyoboro y'amaraso ya calcaneal;
o Ntibikenewe ko uca calcaneofibular ligament na retinaculum ya subperoneal, kandi umwanya uhuriweho urashobora kwiyongera muguhindura neza mugihe cyo kubaga, bifite ibyiza byo gutemwa bito no kuva amaraso make.
Ikibi ni uko kugaragara bigaragara ko bidahagije, bigabanya kandi bikagira ingaruka ku kugabanya kuvunika no gushyira imbere imbere. Birakwiriye gusa kuri Sanders ubwoko bwa I nubwoko bwa kabiri bwa calcaneal.
Oblique incike
Guhindura ibice bya sinus tarsi, hafi cm 4 z'uburebure, hagati ya cm 2 munsi ya malleolus kuruhande kandi bigereranywa nubuso bwinyuma.
Niba imyiteguro ibanziriza gutangira ihagije kandi ibintu birabemerera, birashobora kandi kugira ingaruka nziza zo kugabanya no gukosora kuri Sanders ubwoko bwa II na III bwavunitse bwa calcaneal calcaneal; niba subtalar ihuriweho hamwe isabwa mugihe kirekire, incike imwe irashobora gukoreshwa.
PT. PF Inyuma ya arctular yubuso bwa calcane. S sinus tarsi. AP Kubara. .
Inyuma ndende
Uhereye hagati yumurongo uri hagati yigitereko cya Achilles nisonga rya malleolus yegeranye, irambura ihagaritse kugeza kumutwe wa talar, hamwe nuburebure bwa cm 3,5.
Gucibwamo gake bikozwe mubice byoroheje byoroshye, bitangiza ibyingenzi, kandi hejuru yinyuma yinyuma hagaragara neza. Nyuma yo gutondagura no kugabanuka, hashyizweho ikibaho cya anatomique kiyobowe nigitekerezo cyo gukorana, hanyuma umugozi wa percutane wakubiswe hanyuma ugashyirwaho igitutu.
Ubu buryo burashobora gukoreshwa kubwoko bwa Sanders bwa I, II, na III, cyane cyane kubutaka bwimuwe inyuma bwimitsi cyangwa kuvunika igituntu.
Herringbone
Guhindura sinus tarsi. Kuva kuri cm 3 hejuru yisonga rya malleolus kuruhande, kumupaka winyuma wa fibula kugera kumutwe wa malleolus, hanyuma ukagera kumutwe wa metatarsal ya kane. Yemerera kugabanya no gukosora neza Sanders yo mu bwoko bwa II na III ivunika rya calcaneal, kandi irashobora kwagurwa nibiba ngombwa kugirango yerekane transfibula, talus, cyangwa inkingi yikirenge.
LM akaguru. MT metatarsal ihuriweho. SPR Supra fibula retinaculum.
Arthroscopically yafashijwe kugabanya
Mu 1997, Rammelt yasabye ko arthroscopie ya subtalar ishobora gukoreshwa kugirango igabanye inyuma yinyuma ya calcaneus mu iyerekwa ritaziguye. Mu 2002, Rammelt yabanje gukora arthroscopically yafashijwe kugabanya percutaneous no gukosora screw kubice bya Sanders byo mu bwoko bwa I na II.
Subtalar arthroscopy igira uruhare runini mugukurikirana no gufasha. Irashobora kwitegereza imiterere yubutaka bwa subtalar munsi yuburyo butaziguye, kandi igafasha mugukurikirana kugabanuka no gukosorwa imbere. Byoroheje subtalar ihuriweho hamwe na osteophyte resection nayo irashobora gukorwa.
Ibimenyetso biragufi: gusa kubwoko bwa Sanders Ⅱ hamwe no kugabanura byoroheje hejuru ya arctular na AO / OTA ivunika 83-C2; mugihe kuri Sanders Ⅲ, Ⅳ na AO / OTA ubwoko bwa 83-C3 Kumeneka hamwe no gusenyuka hejuru ya articular nka 83-C4 na 83-C4 biragoye gukora.
umwanya wumubiri
b. Inyuma yinyuma ya arthroscopy. c. Kugera kumeneka hamwe na subtalar hamwe.
Imashini za Schantz zashyizwe.
e. Gusubiramo no gukosora by'agateganyo. f. Nyuma yo gusubiramo.
g. Gukosora by'agateganyo amagufwa yo hejuru. h. Gukosora hamwe.
i. Nyuma yo gukorerwa sagittal CT scan. j. Icyerekezo cya nyuma yibikorwa.
Mubyongeyeho, umwanya wa subtalar uhuriweho ni muto, kandi gukurura cyangwa gutobora birakenewe kugirango dushyigikire umwanya uhuriweho kugirango byoroherezwe gushyira arthroscope; umwanya wa manipulation intra-articular ni nto, kandi manipulation ititondewe irashobora gutera byoroshye kwangirika kwa karitsiye ya iatrogène; tekinike yo kubaga idafite ubuhanga ikunze gukomeretsa byaho.
Percutaneous ballon angioplasty
Muri 2009, Bano yabanje gusaba tekinike yo kwagura imipira yo kuvura imvune za calcaneal. Kuri Sanders ubwoko bwa kabiri bwavunitse, ibyinshi mubitabo bifata ingaruka zisobanutse. Ariko ubundi bwoko bwimvune buragoye.
Isima ya sima imaze kwinjira mumwanya uhuriweho na subtalar mugihe cyo kubaga, bizatera kwambara hejuru ya arctular no kugabanya umuvuduko uhuriweho, kandi kwaguka kwa ballon ntikuringaniza kugabanya kuvunika.
Gushyira urumogi no kuyobora insinga munsi ya fluoroscopi
Amashusho mbere na nyuma yifaranga ryindege
X-ray na CT amashusho nyuma yimyaka ibiri nyuma yo kubagwa.
Kugeza ubu, ubushakashatsi bwubushakashatsi bwikoranabuhanga rya ballon muri rusange ni buto, kandi ibyinshi byavunitse bifite ibisubizo byiza biterwa n urugomo ruke. Ubushakashatsi buracyakenewe kubuvunika bwa calcaneal hamwe no kuvunika gukabije. Byakozwe mugihe gito, kandi ingaruka zigihe kirekire nibibazo biracyagaragara.
Calcaneal intramedullary umusumari
Muri 2010, imisumari ya calcaneal intramedullary yasohotse. Muri 2012, M.Goldzak kuvura byibuze kuvunika kwa calcaneal hamwe no gutera imisumari. Twakagombye gushimangira ko kugabanuka bidashobora kugerwaho hamwe no gutera imisumari.
Shyiramo umwanya uyobora pin, fluoroscopy
Gusimbuza subtalar hamwe
Shira ikibanza gihagaze, utware umusumari winjiye, hanyuma ubikosore hamwe na mm 5 5 mm
Ibitekerezo nyuma yo gushyira imisumari imbere.
Imisumari yimbere yerekanwe ko yatsindiye kuvura Sanders yo mu bwoko bwa II na III bwa calcaneus. Nubwo abaganga bamwe bagerageje kubishyira mubice bya Sanders IV, igikorwa cyo kugabanya cyari kigoye kandi kugabanuka kwiza ntigushobora kuboneka.
Menyesha Umuntu: Yoyo
WA / TEL: +8615682071283
Igihe cyo kohereza: Gicurasi-31-2023
