Fracture ntawm Lub hauv paus ntawm Lub Tsib Hlis Metatarsal

Kev kho mob tsis raug ntawm cov pob txha metatarsal thib tsib tuaj yeem ua rau cov pob txha tsis sib xws lossis ncua kev sib koom ua ke, thiab cov mob hnyav tuaj yeem ua rau mob caj dab, uas muaj kev cuam tshuam loj rau tib neeg lub neej txhua hnub thiab kev ua haujlwm.

AnatomicalSlub tseve

Qhov thib tsib metatarsal yog ib qho tseem ceeb ntawm cov kab ke sab nraud ntawm ko taw, thiab ua lub luag haujlwm tseem ceeb hauv qhov hnyav-kev coj tus kheej thiab ruaj khov ntawm ko taw.Qhov thib plaub thiab thib tsib metatarsals thiab lub cuboid tsim cov metatarsal cuboid sib koom ua ke.

Muaj peb leeg txuas mus rau lub hauv paus ntawm lub thib tsib metatarsal, lub peroneus brevis tendon ntxig rau ntawm dorsolateral sab ntawm tuberosity ntawm lub hauv paus ntawm lub thib tsib metatarsal;qhov thib peb peroneal leeg, uas tsis muaj zog li peroneus brevis leeg, ntxig rau ntawm diaphysis distal mus rau thib tsib metatarsal tuberosity;lub plantar fascia Lub lateral fascicle inserts rau ntawm plantar sab ntawm lub basal tuberosity ntawm lub thib tsib metatarsal.

Kev faib ua pob txha

Cov pob txha ntawm lub hauv paus ntawm lub thib tsib metatarsal raug cais los ntawm Dameron thiab Lawrence,

Zone I fractures yog avulsion fractures ntawm metatarsal tuberosity;

Zone II yog nyob rau ntawm kev sib txuas ntawm diaphysis thiab proximal metaphysis, nrog rau cov pob qij txha ntawm 4 thiab 5th metatarsal pob txha;

Zone III fractures yog kev ntxhov siab tawg ntawm qhov sib thooj metatarsal diaphysis distal mus rau 4th / 5th intermetatarsal sib koom.

Xyoo 1902, Robert Jones thawj zaug piav txog hom kev tawg tsam II ntawm lub hauv paus ntawm lub thib tsib metatarsal, yog li ntawd cheeb tsam II tawg kuj hu ua Jones pob txha.

Qhov avulsion pob txha ntawm lub metatarsal tuberosity nyob rau hauv cheeb tsam kuv yog hom feem ntau ntawm tsib metatarsal puag pob txha, suav txog li 93% ntawm tag nrho cov pob txha, thiab yog tshwm sim los ntawm plantar flexion thiab varus kev nruj kev tsiv.

Cov pob txha hauv cheeb tsam II suav txog li 4% ntawm tag nrho cov pob txha tawg ntawm lub hauv paus ntawm lub thib tsib metatarsal, thiab yog tshwm sim los ntawm ko taw plantar flexion thiab adduction kev nruj kev tsiv.Vim hais tias lawv nyob rau hauv cov dej ntws ntawm cov ntshav ntawm lub hauv paus ntawm lub thib tsib metatarsal, fractures ntawm qhov chaw no yog nquag mus rau nonunion los yog ncua fractures kho.

Zone III fractures suav txog kwv yees li 3% ntawm cov pob txha metatarsal thib tsib.

Conservative kev kho mob

Cov lus qhia tseem ceeb rau kev saib xyuas kev kho mob muaj xws li pob txha tawg tsawg dua 2 hli lossis cov pob txha ruaj khov.Cov kev kho mob feem ntau muaj xws li immobilization nrog elastic bandages, khau tawv tawv, immobilization nrog plaster casts, cardboard compression pads, los yog taug kev khau boots.

Qhov zoo ntawm kev saib xyuas kev kho mob suav nrog tus nqi qis, tsis muaj kev raug mob, thiab kev lees txais yooj yim los ntawm cov neeg mob;qhov tsis zoo muaj xws li qhov tshwm sim siab ntawm pob txha tsis sib xws lossis ncua kev sib koom ua ke, thiab yooj yim sib koom ua ke.

Kev phaisTkev kho mob

Cov lus qhia rau kev kho mob phais ntawm tsib metatarsal puag pob txha muaj xws li:

1. Kev tawg tawg ntawm ntau tshaj 2 hli;

1. Kev koom tes ntawm> 30% ntawm articular nto ntawm lub cuboid distal mus rau lub thib tsib metatarsal;

1. comminuted puas;

1. Fracture ncua union lossis nonunion tom qab kev kho mob uas tsis yog phais;

1. Active cov neeg mob hluas los yog cov neeg ncaws pob ncaws pob.

Tam sim no, feem ntau siv txoj kev phais mob rau pob txha ntawm lub hauv paus ntawm lub thib tsib metatarsal suav nrog Kirschner hlau nro band sab hauv fixation, thauj tog rau nkoj suture fixation nrog xov, ntsia hlau sab hauv fixation, thiab nuv phaj sab hauv fixation.

1. Kirschner hlau nro band fixation

Kirschner hlau nro band fixation yog ib txoj kev phais ib txwm.Qhov zoo ntawm txoj kev kho mob no suav nrog kev nkag tau yooj yim rau cov khoom siv kho kom zoo, tus nqi qis, thiab cov nyhuv compression zoo.Qhov tsis zoo muaj xws li tawv nqaij khaus thiab kev pheej hmoo ntawm Kirschner hlau loosening.

2. Suture fixation nrog threaded anchors

Thauj tog rau nkoj suture fixation nrog xov yog haum rau cov neeg mob uas muaj avulsion fractures nyob rau hauv lub hauv paus ntawm lub thib tsib metatarsal los yog nrog me me fractures.Qhov zoo muaj xws li kev txiav me me, kev ua haujlwm yooj yim, thiab tsis xav tau kev tshem tawm thib ob.Qhov tsis zoo suav nrog kev pheej hmoo ntawm cov pob txha prolapse hauv cov neeg mob osteoporosis..

3. Hollow ntsia thawv fixation

Hollow ntsia hlau yog ib qho kev pom zoo thoob ntiaj teb kev kho mob rau pob txha ntawm lub hauv paus ntawm lub thib tsib metatarsal, thiab nws cov txiaj ntsig suav nrog kev ruaj khov thiab kev ruaj ntseg zoo.

Clinically, rau me me pob txha nyob rau hauv lub hauv paus ntawm lub thib tsib metatarsal, yog hais tias ob tug screws yog siv rau fixation, muaj kev pheej hmoo ntawm refracture.Thaum ib tug ntsia hlau yog siv rau fixation, lub anti-rotation quab yuam yog tsis muaj zog, thiab redisplacement yog ua tau.

4. Hook phaj tsau

Hook phaj fixation muaj ntau yam qhia, tshwj xeeb tshaj yog rau cov neeg mob uas muaj avulsion puas los yog osteoporotic fractures.Nws cov qauv tsim sib tw rau lub hauv paus ntawm cov pob txha metatarsal thib tsib, thiab lub zog fixation compression yog qhov siab.Qhov tsis zoo ntawm cov phaj fixation suav nrog tus nqi siab thiab kev raug mob loj heev.

Sua ummary

Thaum kho cov pob txha ntawm lub hauv paus ntawm lub thib tsib metatarsal, nws yog ib qho tsim nyog yuav tau xaiv ua tib zoo raws li txhua tus neeg qhov xwm txheej tshwj xeeb, tus kws kho mob tus kheej kev paub thiab qib kev txawj ntse, thiab xav txog tus neeg mob qhov kev xav tau ntawm tus kheej.