Txoj kev phais mob sab nraud L yog txoj kev phais mob qub rau kev kho mob pob txha tawg calcaneal. Txawm hais tias qhov kev phais mob yog qhov ua tiav, qhov kev phais mob ntev thiab cov nqaij mos mos raug tshem tawm ntau dua, uas yooj yim ua rau muaj teeb meem xws li kev sib koom ua ke ntawm cov nqaij mos mos qeeb, necrosis, thiab kev kis kab mob. Ua ke nrog lub zej zog tam sim no nrhiav kev kho kom zoo nkauj tsawg kawg nkaus, kev kho mob phais mob tsawg kawg nkaus ntawm pob txha tawg calcaneal tau txais kev qhuas heev. Tsab xov xwm no tau sau 8 lub tswv yim.
Nrog rau txoj kev dav dav ntawm sab nraud, qhov ntsug ntawm qhov txiav pib me ntsis proximal rau qhov kawg ntawm fibula thiab pem hauv ntej rau Achilles tendon. Qib ntawm qhov txiav yog ua rau distal rau daim tawv nqaij raug mob los ntawm cov leeg calcaneal sab nraud thiab ntxig rau ntawm lub hauv paus ntawm tsib metatarsal. Ob qhov txuas nrog ntawm lub pob taws los tsim lub kaum sab xis me ntsis nkhaus. Qhov chaw: Campbell Orthopedic Surgery.
Pkev txo qis ntawm qhov mob ercutaneous
Xyoo 1920, Böhler tau tsim txoj kev kho mob minimally invasive ntawm kev txo cov calcaneus hauv qab traction, thiab rau lub sijhawm ntev tom qab ntawd, percutaneous poking reduction hauv qab traction tau dhau los ua txoj hauv kev tseem ceeb rau kev kho cov pob txha tawg calcaneus.
Nws yog qhov tsim nyog rau cov pob txha tawg nrog tsawg dua qhov kev hloov pauv ntawm cov khoom hauv intraarticular hauv subtalar pob qij txha, xws li Sanders hom II thiab qee qhov Sanders III lingual fractures.
Rau Sanders hom III thiab Sanders hom IV pob txha tawg nrog rau qhov tawg ntawm cov pob txha hauv qab pob txha loj heev, kev txo qhov mob yog qhov nyuaj thiab nws nyuaj rau ua tiav qhov kev txo qis ntawm qhov chaw ntawm cov pob txha hauv qab pob txha ntawm calcaneus.
Nws nyuaj rau kho qhov dav ntawm calcaneus, thiab qhov deformity tsis tuaj yeem kho tau zoo. Nws feem ntau tawm ntawm phab ntsa sab ntawm calcaneus hauv ntau qib, ua rau muaj kev cuam tshuam ntawm cov malleolus sab qis nrog phab ntsa sab ntawm calcaneus, kev hloov pauv lossis kev nias ntawm cov leeg peroneus longus, thiab kev cuam tshuam ntawm cov leeg peroneal. Syndrome, calcaneal impingement mob, thiab peroneus longus tendonitis.
Westhues/Essex-lopresti txoj kev siv. A. Kev siv fluoroscopy sab nraud tau lees paub qhov tawg uas zoo li tus nplaig; B. Ib daim duab CT scan kab rov tav qhia tau tias muaj qhov tawg Sandess hom IIC. Qhov pem hauv ntej ntawm lub pob txha calcaneus tau sib xyaw ua ke hauv ob daim duab. S. Kev nqa deb sai sai.
C. Siv tsis tau qhov phais sab nraud vim cov nqaij mos mos o thiab ua pob liab liab heev; D. Kev siv tshuaj fluoroscopy sab nraud qhia txog qhov chaw ntawm cov pob qij txha (kab dotted) thiab cov pob txha talar tawg (kab khov).
E thiab F. Ob txoj hlua ntsia hlau hollow tau muab tso rau sib luag rau qhov qis dua ntawm daim nplaig zoo li tus nplaig, thiab kab dotted yog kab sib koom ua ke.
G. Ua kom lub pob qij txha ntawm lub hauv caug khoov, rub lub koob qhia, thiab tib lub sijhawm ua kom lub hauv caug khoov nruab nrab ntawm ko taw kom txo qhov tawg: H. Ib lub ntsia hlau 6.5 hli cannulated tau raug kho rau ntawm pob txha cuboid thiab ob lub xov hlau Kirschner 2.0 hli tau raug sib txuas hauv qab kom tswj tau qhov kev txo qis vim yog calcaneus anterior comminution. Qhov chaw: Mann Foot and Ankle Surgery.
Skev txiav ntawm lub qhov ntswg
Qhov kev phais no ua 1 cm deb ntawm qhov kawg ntawm tus fibula mus rau hauv qab ntawm plaub metatarsal. Xyoo 1948, Palmer thawj zaug tau tshaj tawm ib qho kev phais me me hauv sinus tarsi.
Xyoo 2000, Ebmheim et al. siv txoj kev tarsal sinus hauv kev kho mob ntawm cov pob txha tawg calcaneal.
o Muaj peev xwm nthuav tawm tag nrho cov pob qij txha subtalar, posterior articular surface thiab anterolateral fracture block;
o Tsis txhob cia cov hlab ntsha calcaneal sab nraud nkag mus rau hauv pob txha;
o Tsis tas yuav txiav cov calcaneofibular ligament thiab subperoneal retinaculum, thiab qhov chaw sib koom ua ke tuaj yeem nce ntxiv los ntawm kev tig rov qab kom zoo thaum lub sijhawm phais, uas muaj qhov zoo ntawm kev phais me me thiab los ntshav tsawg dua.
Qhov tsis zoo yog tias qhov kev raug mob tsis txaus, uas txwv thiab cuam tshuam rau qhov txo qhov tawg thiab qhov chaw ntawm kev kho sab hauv. Nws tsuas yog haum rau Sanders hom I thiab hom II calcaneal tawg.
Oblique me me txiav
Ib qho kev hloov kho ntawm qhov phais sinus tarsi, ntev li ntawm 4 cm, nyob hauv nruab nrab 2 cm hauv qab lub pob txha lateral malleolus thiab sib luag rau qhov chaw ntawm cov pob txha posterior.
Yog tias kev npaj ua ntej kev phais mob txaus thiab cov xwm txheej tso cai, nws kuj tseem tuaj yeem muaj qhov txo qis zoo thiab kho qhov cuam tshuam rau Sanders hom II thiab III intra-articular calcaneal fractures; yog tias xav tau kev sib koom ua ke subtalar hauv lub sijhawm ntev, tib qho kev phais tuaj yeem siv tau.
PT Peroneal tendon. PF Posterior articular surface ntawm lub calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
Kev txiav tom qab ntev
Pib ntawm nruab nrab ntawm txoj kab ntawm Achilles tendon thiab lub taub hau ntawm lateral malleolus, nws nthuav dav mus rau hauv pob qij txha talar, nrog qhov ntev li 3.5 cm.
Tsis muaj kev phais tsawg dua hauv cov nqaij mos uas nyob deb, yam tsis ua rau puas tsuaj rau cov qauv tseem ceeb, thiab qhov chaw ntawm cov pob qij txha tom qab tau nthuav tawm zoo. Tom qab kev khawb thiab txo qhov mob ntawm daim tawv nqaij, ib lub rooj tsavxwm anatomical tau muab tso rau hauv qab kev taw qhia ntawm lub zeem muag hauv kev phais, thiab lub ntsia hlau percutaneous tau raug thawb thiab kho kom ruaj khov hauv qab kev siab.
Txoj kev no siv tau rau Sanders hom I, II, thiab III, tshwj xeeb tshaj yog rau qhov tawg ntawm qhov chaw tom qab lossis tuberosity.
Txiav pob txha herringbone
Kev hloov kho ntawm qhov phais sinus tarsi. Txij li 3 cm saum toj ntawm lub hau ntawm cov pob txha lateral malleolus, raws ntug ntawm cov pob txha fibula mus rau lub hau ntawm cov pob txha lateral malleolus, thiab tom qab ntawd mus rau hauv paus ntawm cov pob txha metatarsal plaub. Nws tso cai rau kev txo qis thiab kho cov pob txha tawg Sanders hom II thiab III calcaneal, thiab tuaj yeem nthuav dav yog tias tsim nyog los nthuav tawm cov pob txha transfibula, talus, lossis lateral kem ntawm ko taw.
LM pob luj taws sab. MT pob qij txha metatarsal. SPR Supra fibula retinaculum.
Akev txo qis rthroscopically pab
Xyoo 1997, Rammelt tau tawm tswv yim tias kev siv subtalar arthroscopy tuaj yeem siv los txo qhov posterior articular surface ntawm calcaneus thaum pom ncaj qha. Xyoo 2002, Rammelt thawj zaug ua arthroscopically assisted percutaneous reduction thiab screw fixation rau Sanders type I thiab II fractures.
Kev phais mob pob qij txha hauv qab talar feem ntau yog ua lub luag haujlwm saib xyuas thiab pab txhawb. Nws tuaj yeem saib xyuas qhov xwm txheej ntawm cov pob qij txha hauv qab qhov muag pom, thiab pab saib xyuas qhov kev txo qis thiab kev kho sab hauv. Kev txiav cov pob qij txha hauv qab talar yooj yim thiab kev phais pob txha osteophyte kuj tseem tuaj yeem ua tau.
Cov cim qhia yog nqaim: tsuas yog rau Sanders hom Ⅱ nrog kev sib tsoo me me ntawm qhov chaw sib koom ua ke thiab AO / OTA hom 83-C2 pob txha tawg; thaum rau Sanders Ⅲ, Ⅳ thiab AO / OTA hom 83-C3 pob txha tawg nrog qhov chaw sib koom ua ke xws li 83-C4 thiab 83-C4 nyuaj dua rau kev khiav lag luam.
lub cev txoj hauj lwm
b. Kev kuaj mob pob luj taws tom qab. c. Nkag mus rau qhov pob txha tawg thiab pob qij txha hauv qab.
Cov ntsia hlau Schantz tau muab tso rau.
e. Rov pib dua thiab kho ib ntus. f. Tom qab rov pib dua.
g. Kho cov pob txha ntawm qhov sib koom ua ib ntus. h. Kho nrog cov ntsia hlau.
i. Kev thaij duab CT sagittal tom qab phais. j. Kev pom axial tom qab phais.
Ntxiv mus, qhov chaw ntawm cov pob qij txha subtalar nqaim heev, thiab xav tau kev rub lossis cov brackets los txhawb qhov chaw ntawm cov pob qij txha kom yooj yim rau kev tso lub arthroscope; qhov chaw rau kev kho mob hauv pob qij txha me me, thiab kev kho tsis saib xyuas tuaj yeem ua rau cov pob txha mos puas tsuaj yooj yim; cov txheej txheem phais tsis muaj kev txawj ntse yuav ua rau muaj kev raug mob hauv zos.
Pkev phais mob angioplasty nrog lub pob balloon ercutaneous
Xyoo 2009, Bano tau tshaj tawm thawj zaug txog kev siv lub tshuab ua kom lub pob txha nthuav dav rau kev kho cov pob txha tawg calcaneal. Rau Sanders hom II pob txha tawg, feem ntau ntawm cov ntaub ntawv xav tias qhov cuam tshuam yuav meej. Tab sis lwm hom pob txha tawg nyuaj dua.
Thaum cov pob txha cement nkag mus rau hauv qhov chaw subtalar pob qij txha thaum lub sijhawm phais, nws yuav ua rau qhov chaw ntawm cov pob qij txha hnav thiab txwv tsis pub cov pob qij txha txav mus los, thiab qhov nthuav dav ntawm lub npas yuav tsis sib npaug rau kev txo qhov tawg.
Kev tso cov cannula thiab cov hlau qhia hauv qab fluoroscopy
Cov duab ua ntej thiab tom qab lub hnab cua tshuab cua
Cov duab X-ray thiab CT ob xyoos tom qab phais.
Tam sim no, cov qauv tshawb fawb ntawm cov thev naus laus zis balloon feem ntau me me, thiab feem ntau ntawm cov pob txha tawg nrog cov txiaj ntsig zoo yog tshwm sim los ntawm kev ua phem tsawg zog. Tseem xav tau kev tshawb fawb ntxiv rau cov pob txha tawg calcaneal nrog kev tawg loj heev. Nws tau ua tiav rau lub sijhawm luv luv, thiab qhov ua tau zoo thiab cov teeb meem mus sij hawm ntev tseem tsis meej.
Calcaneal intramedullary nail
Xyoo 2010, tus ntsia hlau hauv pob txha calcaneal tau tawm los. Xyoo 2012, M.Goldzak tau kho qhov pob txha calcaneal tawg nrog kev ntsia hlau hauv pob txha. Yuav tsum tau hais tias kev ntsia hlau hauv pob txha yuav ua rau qhov pob txha no tsis zoo.
Ntxig tus pin qhia qhov chaw, fluoroscopy
Rov qab tso qhov sib koom ua ke subtalar
Muab lub thav duab tso rau, tsav lub ntsia hlau intramedullary, thiab kho nws nrog ob lub ntsia hlau 5 hli cannulated
Kev xav tom qab muab ntsia hlau rau hauv qab.
Kev ntsia hlau rau hauv pob txha caj qaum tau pom tias ua tau zoo hauv kev kho mob pob txha tawg ntawm Sanders hom II thiab III ntawm cov pob txha calcaneus. Txawm hais tias qee tus kws kho mob tau sim siv rau pob txha tawg ntawm Sanders IV, kev phais txo qis nyuaj thiab kev txo qis zoo tagnrho tsis tuaj yeem tau txais.
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