Mamalion navicular ibaho hafi 5-15% byibintu byose bikaze byamagufwa ya navicular ane, hamwe na necrosis na necrosis ibaho hafi 3%. Ibintu bishobora guteza akaga gakomeye birimo kubura cyangwa gutinda kwisuzumisha, kuba hafi yumurongo wavuzagurika, kwimurwa kurenza mm, no kuvunika hamwe na karpal ihungabana. Iyo bitavuwe, naviculand osteochondral cannion akenshi ifitanye isano na rubagimpande, uzwi kandi nka ostecHandral osteochondral hamwe no gusenyuka osteoorthritis.
Amagufwa ahinnye cyangwa adafite flap ya kera irashobora gukoreshwa mugufata nabi notulacHandral onninion. Ariko, kubarwayi bafite osteoneCrosis ya pole ya proximal yinkumi ya nabi, ibisubizo byamagufwa nta tsinda ridashimishije, kandi igipimo cyo gukiza amagufwa ni 40% -67% gusa. Ibinyuranye, igipimo cyo gukiza amagufwa hamwe na flaps ya kera irashobora kuba hejuru ya 88% -91%. Amagufwa majoro ya Vascularsuress flaps mumyitozo y'amavuriro irimo amagufwa ya marike, amagufwa ya palmar. birashimishije. Ubuntu MFC VBG yerekanwe kugirango ikore neza kuvura ibyangiritse hamwe na metacarpal gusenyuka, kandi MFC VBG ikoresha ishami rya articular ryamanuka nkishami ryikigo nkuru. Ugereranije nundi flaps, Mfc VBG itanga inkunga ihagije yo kugarura imiterere isanzwe yamagufa ya navicular, cyane cyane mububiko bwa ostecochondrosis hamwe nubumuga bwinyuma (Ishusho 1). Mu kuvura osteochondral osteochondral osteonecrosise hamwe no gusenyuka kwa karose yitera imbere, amagufwa ya marike ya marike ya marike ya marike yavuzwe mu magufwa ya 40% gusa, mu gihe MFC VBG ifite ubukungu bwa 100%.
Igishushanyo 1. Kuvunika amagufwa na "wunamye", CT yerekana kuvunika hagati yamagufwa ya nagwiririra ku nkoni ya 90 °.
Imyiteguro yo gutegura
Nyuma yo gusuzuma umubiri kuboko kwipimisha ingaruka, amasomo agomba gukorwa kugirango hasuzugure urwibutegetsi. Radiyo isanzwe ni ingirakamaro kugirango wemeze aho kuvunika, urwego rwo kwimura, no kubahagurukwa cyangwa sclerose yimpera yavunitse. Amashusho yinyuma yinyuma akoreshwa mugusuzuma kuboko gusenyuka, gukurikiranwa ku kuboko (Disi) ukoresheje uburebure bwanditseho uburebure bwahinduwe (uburebure) bwa ≤1.52 cyangwa umuti wa radiyo urenga 15 °. MRI cyangwa CT irashobora gufasha kwisuzumisha malamu yinkumi cyangwa osteonecrose. Radiokarasi ya Ragigral cyangwa Swagittal CT igufwa rya Navicular hamwe na navicular angle> 45 ° itanga igabanya igufwa rya magufa ya navicular
Ibimenyetso ndetse no kumenyekanisha:
Navicular osteochondral nonion hamwe nubumuga bwinyuma na Disi; MRI yerekana ischesime ya porcrosis yamagufwa ya navicular, hakurya yumuhanda urekura amagufwa arangije amagufwa ya navicuric aracyafite amagufwa ya sclerotic yera; Kunanirwa kwambere kwa Wedge yatsinze cyangwa gukosora imbere bisaba gufata amagufwa nini ya VGB (> 1CM3). Gukurikiza cyangwa kubona ibintu bya Osteoarthritis bya karubile karakaye; Niba amahirwe akomeye yo gusenyuka osteoarthritis yabaye, hanyuma urwenya, navicular osteotomy, quadramilar osteotomy, quadramile osteotomy, ibisanzwe navicular malnion, necrosis ya proximis, ariko hamwe na morphology yamagufwa isanzwe (urugero, kuvunika kwabatagatanya naviculati yakoresheje amaraso make kuri pole ya proxima); Kugabanuka kwa malunion na osteonecrose. (1,2-ISTRA irashobora gukoreshwa nkumusimbura wa Radius Flap).
Gushyira mu bikorwa Anatomy
MFC VBG itangwa numubare muto wibikoresho bito bya TromEbaLome (bivuze 30, 20-50), hamwe n'amaraso menshi akurikiranya imiyoboro yo hagati (bisobanura 6.4), bisobanura 4.9) (Ishusho ya 2) (Ishusho 2). Ibi bikoresho byo mu tugo bya trophoblastique byatanzwe ahanini no kumanuka binyuranye (DGA) na / cyangwa igipimo cyo hejuru cyo hagati yubusambanyi (smga), ni ishami ryububiko bwibinyabuzima kandi ritanga amashami ya muziko. DGA yaturutse ku muhanzi wibinyabuzima bitagaragara bya Malleolus ya Malleolus ya Milleolus, cyangwa intera ya CM ya 13,5-17.5), kandi ituze ryibiti ni 89% (Ishusho ya 3). DGA ikomoka mu miyoboro y'ibinyabuzima ikaze mu 13,5 (10.5 cm) proximal kuri MalLeolus ya Malleolus cyangwa PROIMIL ihanitse ishami rishingiye ku gitsina 100%. Kubwibyo, kuba dga cyangwa smga byemewe, nubwo ibyambere bikwiranye na tibiae kubera uburebure na diameter yicyombo.
Igishushanyo cya 2. Gukwirakwiza quadrant enye zo gukwirakwiza TFC Trophoblast kumurongo utambitse hagati ya SemitendinoSus hamwe na licantal B, umurongo wa cole nini ya patella c, umurongo wubukwe bwa meniscus d.
Igishushanyo cya 3. MFC Vascular Anatomy: (a) Amashami adasanzwe na MFC Trophoblastic Vasculasti ya Anatomiya, (b) intera yinkomoko ya vascular kumurongo uhuriweho
Kubaga
Umurwayi ashyizwe muri Anesthesia rusange mumwanya wo gutangaza, hamwe nigitambaro cyibasiwe cyashyizwe kumaboko yo kubaga intoki. Mubisanzwe, amagufwa yabaterankunga yakuwe mumiyoboro yo hagati ya ipilatel cical, kugirango umurwayi ashobore kugendana namaboko nyuma yo kubaga. Ivi ryavuguruye rishobora kandi gutorwa niba hari amateka yihungabana cyangwa kubaga kuruhande rumwe rwivi. Ivi ryahindutse kandi ikibuno kizunguruka hanze, kandi amarushanwa akoreshwa kuri yombi hejuru no hepfo. Uburyo bwo kubaga bwari bumwe bwagutse, hamwe no gutegurira 8 CM Proximal Umuyoboro wa karpal wa transnel wa karpi radial carpi radion, hanyuma ukayizirika ku murongo wa radiyo carpi. Umucyo wa Tendon Longtissimus urwaye kandi Tendon yashushanyije ulnally, kandi amagufwa ya navicuka agaragaramo amagufwa ya radiyo, hamwe no gutandukanya amagufwa ya peripheri kugirango yemere amagufwa ya peripher Emeza agace kanduye, ireme rya karitsiye nurugero rwa Icaemiya ryigufwa rya Navicular. Nyuma yo kurekura irushanwa, witegereze inkingi yingenzi yinkumi yoroheje kugirango utobore amaraso kugirango umenye niba hariho ischemis necrosic. Niba necrosis ya nabi idafitanye isano na karusi ya radiyo cyangwa intera ya arthrite, MFC VGB irashobora gukoreshwa.
Igishushanyo cya 4. Uburyo bwo kubaga Navicular: . (C) Menya agace ka oseous desetinuity.
Guhagarika CM 15-20 bikozwe kumurongo uhuza amavi inyuma yimitsi yo hagati, kandi imitsi isubizwa mu maraso ya articular ya draga na smca, ubusanzwe ifata ishami rinini rya dga na vein iherekeza. PEDICT ya VESCular yarekuwe cyane, yitondera kurengera periosteum nibikoresho byo mu tubyiruka ku buso bwa bony.
Igishushanyo cya 5. Kugabatsa muri MFC: (a) imirongo miremire ya CM 15-20 ikozwe neza mumitsi yimbere mumitsi yo hagati kuva kumurongo uhuza. (B) imitsi yakuweho imbere kugirango yerekane amaraso ya MFC ..
Gutegura igufwa rya Navicular
Ubumuga bwa nabi bugomba gukosorwa hamwe nubutaka bwa osteochondral yateguye mbere yo gukubitwa impinduko munsi yinyuma isanzwe ya radiyo (Ishusho 6). A. Umwanya wavunitse wahanaguweho tissue yoroshye kandi zikaba zifunguye hamwe nisahani. Agace gato kwongeye gukoreshwa muguhindura amagufwa no kwemeza ko flap idahwitse isa ninzitizi zikiranuka zirenze umugozi, bisaba ko icyuho kinini gikemurwa kuruhande rwa palmar kuruta kuruhande rwa doldal. Nyuma yo gufungura icyuho, inenge ipimwa mubipimo bitatu kugirango umenye urugero rwamagufwa, ubusanzwe nimm 10-12 muburebure kumpande zose za Graft.
Igishushanyo cya 6. Gukosora Ububiko bwumugongo wa nabi, hamwe na fluoscopique yo guhindagurika kwintoki zo kugarura radial-ukwezi. A.
Osteotomy
Agace ka Vasculardised gakoko kanini kashyizwemo kato byatoranijwe nkigice cyo gukuramo amagufwa, kandi agace ko gukuramo amagufwa karangaga bihagije. Witondere kutakomeretsa imvugo yo hagati. PersiTeum yateguwe, kandi amagufwa y'urukiramende rw'urukiramende rukwiye rwaciwe no gusubira mu magufa yaciwe kuri 45 ° agabanya ubusugire bw'umuriro (Ishusho 7). 7). Bikwiye gufatwa kudatandukanya periosteum, amagufwa ya cortical, hamwe nububiko busenya bwa flap. Amarushanwa yo hepfo yo hepfo agomba kurekurwa kugirango akurikirane amaraso binyuze muri flap, na pedicle ya vascular igomba kubohorwa cyane byibuze cm 6 yemerera anastomose 6 yemerera ibishushanyo 6. Nibiba ngombwa, amagufwa make yo gutaka arashobora gukomeza mumyenda ya femoral. Ingero zuzuye zuzuye zuzuyemo umusimbura w'amagufwa, kandi gutemagura no gufunga urusaku.
Igishushanyo cya 7. MFC Amagufwa yo gukuraho. . (B) Amagufwa ya kabiri yaciwe kuruhande rumwe kuri 45 ° kugirango abe ubusugire bwa flap.
IHURIRO RY'INKINGI
Amagufa flap yatunganijwe nuburyo bukwiye, witondera kudahagarika podicle ya vascular cyangwa yambure periosteum. Flap yatewe byimazeyo ahantu h'uburinzi bwamagufwa ya Navicular, yirinda guhagarara, kandi igashyirwaho imigozi ya navicular. Hafashwe icyemezo cyo kwemeza ko umuvuduko w'amagufwa watewe no guhumeka hamwe n'intoki z'imisozi mirema cyangwa ko byarihebye gato kugirango birinde kudahinduka. Flueroscop yakozwe kugirango yemeze morphologiya ya Navicular, umurongo wingufu numwanya wa screw. Anastomose imiyoboro ya flap ya flap kumurongo wa radial irangirira kuruhande nubuhubu bwamavugo kumugenzi wa radiyo yumugenzi wa radiyo mu mutwe wa Radion EmIn iherezo (Ishusho ya 8). Capule ihuriweho irasanwa, ariko pedicle ya vascular yirindwa.
Igishushanyo cya 8. Amagufwa ya Amagufwa, gukosora, na anastomose ya anascular. Amagufwa flap aterwa yitonze mukarere kamagufwa yamagufwa ya marne kandi igashyirwaho imiyoboro ya navicular cyangwa imitwe ya kirsclene. Ubuvuzi bufatwa ko amanota ya metacarpal yo guhagarika amagufwa yatewe no guhumeka hamwe na metakarpal marning igufwa rinini cyangwa yihebye kugirango wirinde kudahinduka. Anastomoses yububiko bwa flap kumiseri ya radial yakozwe iherezo kugirango irangire, hamwe nu muyaga wa mugenzi wawe wumuhanga mu mazi ya radiyo yakozwe kugirango arangire.
Gusubiza mu buzima busanzwe
OAL ASPIRIIN 325 MG kumunsi (ukwezi 1), gufata ibiro byamazu biremewe, feriki ivi irashobora kugabanya ikibazo cyumurwayi, bitewe nubushobozi bwumurwayi bwo kwimuka mugihe gikwiye. Gushyigikira kunyuranya na crutch imwe birashobora kugabanya ububabare, ariko inkunga ndende yinkoni ntabwo ari ngombwa. Ubudodo bwakuweho ibyumweru 2 nyuma yo kubagwa na Muenster cyangwa ikiganza kirekire ku gikumwe cyagumye mu byumweru 3. Nyuma yibyo, ukuboko kugufi igikumwe gikoreshwa kugeza igihe cyo gucibwa. X-Imirasire ifatwa mubyumweru 3-6 inzangano, no gukiza byemejwe na CT. Nyuma, hagomba gutangira ibikorwa byo kwagura buhoro buhoro, kandi ubukana ninshuro yimyitozo bigomba kwiyongera buhoro buhoro.
Ingorane zikomeye
Ingorane nyamukuru zifatika zirimo ububabare bwo mu ivi cyangwa igikomere. Ububabare bwo mu mavi cyane mugihe cyibyumweru 6 nyuma yo kubagwa, kandi nta gihombo cyo kumva cyangwa kubabaza Neuroma Kubera gukomereka kwa saphenous. Ingorane nyamukuru zirimo amagufwa yo gutunganya, kubabara, gukomera, intege nke, intege nke zamagufa ya radiyo cyangwa amagufwa yububiko bwa peterolitopal nacyo.
Ubuntu Kugereranya femoral Fransy Vascularsurs Gutsimbarara kuri scaphoid
Igihe cya nyuma: Gicurasi-28-2024
