Yuav Ua Li Cas Pob Tawb Fusion Surgery

Internal fixation nrog pob txha phaj

Lub pob qij txha fusion nrog daim hlau thiab cov ntsia hlau yog ib qho kev phais feem ntau tam sim no.Xauv phaj sab hauv fixation tau dav siv hauv pob taws fusion.Tam sim no, phaj pob taws fusion feem ntau suav nrog anterior phaj thiab lateral phaj pob taws fusion.

Daim duab saum toj no qhia txog X-ray zaj duab xis ua ntej thiab tom qab kev phais mob rau pob taws pob taws osteoarthritis nrog anterior locking phaj sab hauv fixation pob taws sib koom ua ke

1. Txoj kev ua ntej

Txoj hauv kev anterior yog ua kom muaj qhov anterior longitudinal incision nyob rau hauv lub pob taws qhov chaw, txiav txheej los ntawm txheej, thiab nkag mus rau hauv cov leeg nqaij;txiav cov tshuaj ntsiav sib koom ua ke, nthuav tawm tibiotalar sib koom ua ke, tshem tawm cov pob txha mos thiab cov pob txha subchondral, thiab tso cov phaj anterior rau ntawm pob taws.

2. Txoj kev mus rau sab nraud

Txoj kev mus rau sab nraud yog txiav cov osteotomy txog 10 cm saum toj kawg nkaus ntawm lub fibula thiab tshem tawm cov stump tag.Cov pob txha pob txha tshem tawm yog muab tshem tawm rau pob txha grafting.Lub fusion nto osteotomy tiav thiab ntxuav, thiab lub phaj yog muab tso rau sab nraud ntawm pob qij txha.

Qhov kom zoo dua yog tias lub zog fixation yog siab thiab lub fixation yog ruaj.Nws tuaj yeem siv rau kev kho thiab rov tsim kho qhov mob hnyav lossis valgus deformity ntawm pob taws pob qij txha thiab ntau pob txha tsis xws luag tom qab ntxuav.Lub anatomically tsim fusion phaj pab kho lub cev ib txwm muaj ntawm pob qij txha.Qhov chaw.

Qhov tsis zoo yog tias ntau qhov periosteum thiab cov nqaij mos hauv qhov chaw phais yuav tsum tau muab tshem tawm, thiab cov phaj hlau yog tuab dua, uas yooj yim rau khaus cov leeg nyob ib puag ncig.Lub phaj hlau muab tso rau pem hauv ntej yog yooj yim kov hauv qab ntawm daim tawv nqaij, thiab muaj qee qhov kev pheej hmoo.

intramedullary ntsia thawv fixation

Nyob rau hauv xyoo tas los no, daim ntawv thov ntawm retrograde intramedullary ntsia thawv-type pob taws pob qij txha nyob rau hauv kev kho mob ntawm qhov kawg-stage pob taws pob qij txha tau maj mam siv mus kho mob.

Tam sim no, cov txheej txheem intramedullary nailing feem ntau siv qhov nruab nrab qhov nruab nrab ntawm lub pob qij txha los yog ib qho anteroinferior lateral incision ntawm fibula rau articular deg tu lossis pob txha grafting.Tus ntsia thawv intramedullary yog ntxig los ntawm calcaneus mus rau tibial medullary kab noj hniav, uas yog qhov zoo rau kev kho deformity thiab txhawb cov pob txha fusion.

Pob qij txha osteoarthritis ua ke nrog kev mob caj dab subtalar.Preoperative anteroposterior thiab lateral X-ray films pom kev puas tsuaj loj rau tibiotalar sib koom ua ke thiab subtalar sib koom, ib feem ntawm lub talus, thiab osteophyte tsim nyob ib ncig ntawm qhov sib koom tes (los ntawm kev siv 2)

Lub divergent fusion ntsia hlau implantation lub kaum sab xis ntawm locking hindfoot fusion intramedullary ntsia thawv yog ntau lub dav hlau fixation, uas tuaj yeem kho qhov sib koom ua ke kom fused, thiab qhov kawg ntawm qhov kawg yog threaded xauv qhov, uas tuaj yeem tiv thaiv kev txiav, kev sib hloov, thiab rub tawm. , txo qhov kev pheej hmoo ntawm cov ntsia hlau tshem tawm.

Tibiotalar sib koom thiab subtalar sib koom tau raug nthuav tawm thiab ua tiav los ntawm txoj kev hloov pauv sab nraud, thiab qhov ntev ntawm qhov kev txiav ntawm qhov nkag ntawm tus ntsia thawv plantar intramedullary yog 3 cm.

Cov ntsia hlau intramedullary yog siv los ua lub hauv paus txhim kho, thiab nws txoj kev ntxhov siab yog qhov sib txawv, uas tuaj yeem zam qhov kev ntxhov siab tiv thaiv thiab muaj ntau dua nyob rau hauv txoj kab nrog cov ntsiab lus ntawm biomechanics.

Anteroposterior thiab lateral X-ray zaj duab xis 1 lub hlis tom qab kev ua haujlwm tau pom tias cov kab hauv qab ko taw tau zoo thiab cov ntsia hlau intramedullary tau kho kom ntseeg tau.

Siv retrograde intramedullary rau tes rau pob taws sib koom ua ke tuaj yeem txo cov nqaij mos puas, txo cov tawv nqaij necrosis, kab mob thiab lwm yam teeb meem, thiab tuaj yeem muab kev ruaj khov txaus yam tsis muaj kev pab cuam plaster sab nraud tom qab kev phais.

Ib xyoos tom qab kev ua haujlwm, qhov zoo thiab qhov hnyav-kev coj tus kheej X-ray films pom cov pob txha fusion ntawm tibiotalar sib koom ua ke thiab subtalar sib koom ua ke, thiab cov ko taw rov qab yog qhov zoo.

Tus neeg mob tuaj yeem tawm ntawm txaj thiab dais qhov hnyav thaum ntxov, uas txhim kho tus neeg mob lub siab ntev thiab lub neej zoo.Txawm li cas los xij, vim tias qhov sib koom ua ke subtalar yuav tsum tau kho tib lub sijhawm, nws tsis pom zoo rau cov neeg mob uas muaj qhov sib koom ua ke zoo subtalar.Kev khaws cia ntawm qhov sib koom ua ke subtalar yog ib qho tseem ceeb rau kev them nyiaj rau kev ua haujlwm ntawm pob taws pob qij txha hauv cov neeg mob pob qij txha fusion.

ntsia hlau internal fixation

Percutaneous ntsia hlau sab hauv fixation yog ib qho kev kho zoo hauv pob taws pob taws.Nws muaj qhov zoo ntawm kev phais me me xws li kev phais me me thiab txo qis ntshav, thiab tuaj yeem txo qhov kev puas tsuaj rau cov ntaub so ntswg.

anteroposterior thiab lateral X-ray films ntawm lub pob taws pob taws ua ntej kev ua haujlwm tau pom tias mob pob qij txha ntawm txoj cai pob taws nrog varus deformity, thiab lub kaum sab xis ntawm tibiotalar articular nto yog ntsuas los ntawm 19 ° varus.

Cov kev tshawb fawb tau pom tias kev txhim kho yooj yim nrog 2 mus rau 4 lag ntsia hlau tuaj yeem ua tiav ruaj khov kho thiab compression, thiab kev ua haujlwm yog qhov yooj yim thiab tus nqi kuj pheej yig.Nws yog thawj qhov kev xaiv ntawm cov kws tshawb fawb feem ntau tam sim no.Tsis tas li ntawd, kev sib tsoo pob taws me me tuaj yeem ua tau raws li arthroscopy, thiab cov ntsia hlau tuaj yeem muab tso rau hauv percutaneously.Kev phais mob me me thiab cov nyhuv curative yog txaus siab.

Nyob rau hauv arthroscopy, ib cheeb tsam loj ntawm articular pob txha mos raug pom;Nyob rau hauv arthroscopy, lub pointed cone microfracture ntaus ntawv yog siv los kho cov articular nto

Qee cov kws sau ntawv ntseeg tias 3 ntsia hlau fixation tuaj yeem txo qhov tshwm sim ntawm kev pheej hmoo ntawm kev tsis sib haum xeeb tom qab, thiab qhov nce hauv fusion yuav cuam tshuam nrog kev ruaj ntseg ntawm 3 ntsia hlau fixation.

Kev soj ntsuam X-ray zaj duab xis 15 lub lis piam tom qab kev ua haujlwm tau pom cov pob txha fusion.AOFAS cov qhab nia yog 47 cov ntsiab lus ua ntej ua haujlwm thiab 74 cov ntsiab lus 1 xyoo tom qab ua haujlwm.

Yog tias peb cov ntsia hlau siv rau kev txhim kho, qhov kwv yees qhov chaw kho yog tias thawj ob lub ntsia hlau tau muab tso rau ntawm lub anteromedial thiab anterolateral sab ntawm tibia, hla los ntawm cov pob qij txha mus rau lub cev talar, thiab cov ntsia hlau thib peb tau muab tso rau hauv qab. sab ntawm tibia mus rau sab nruab nrab ntawm lub talus.

Sab nrauv fixation txoj kev

Sab nrauv fixators yog cov khoom siv ntxov tshaj plaws siv hauv pob taws pob taws thiab tau hloov zuj zus los ntawm xyoo 1950 mus rau tam sim no Ilizarov, Hoffman, Hybrid thiab Taylor qhov chaw ncej (TSF).

Pob taws qhib kev raug mob nrog kev kis mob rau 3 xyoos, pob qij txha arthrodesis 6 lub hlis tom qab tswj kev kis kab mob

Rau qee qhov teeb meem pob qij txha nrog kev kis kab mob, rov ua haujlwm dua, cov tawv nqaij tsis zoo hauv zos thiab cov nqaij mos mos, tsim caws pliav, pob txha tsis xws luag, pob txha pob txha thiab cov kab mob hauv cheeb tsam, Ilizarov nplhaib sab nraud fixator yog siv ntau hauv kev kho mob rau fuse pob qij txha.

Lub nplhaib-zoo li tus sab nrauv fixator yog tsau rau ntawm lub dav hlau coronal thiab sagittal dav hlau, thiab tuaj yeem muab cov nyhuv fixation ruaj khov.Nyob rau hauv cov txheej txheem thaum ntxov load-bearing, nws yuav pressurize lub puas kawg, txhawb lub tsim ntawm callus, thiab txhim kho tus nqi fusion.Rau cov neeg mob uas muaj deformity loj heev, tus fixator sab nraud tuaj yeem kho qhov deformity.Tau kawg, sab nraud fixator pob taws fusion yuav muaj teeb meem xws li tsis yooj yim rau cov neeg mob hnav thiab muaj feem yuav kis kab mob.

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