Haʻihaʻi o ke kumu o ka ʻelima Metatarsal

ʻO ka mālama pono ʻole ʻana i nā haʻihaʻi kumu ʻelima hiki ke alakaʻi i ka haʻihaʻi nonunion a i ʻole ka hui hoʻopaneʻe ʻana, a ʻo nā maʻi koʻikoʻi ke kumu o ka maʻi arthritis, he hopena nui i ka nohona o kēlā me kēia lā a me ka hana.

AnatomicalStructure

ʻO ka lima o ka metatarsal he mea nui ia o ke kolamu lateral o ka wāwae, a he hana koʻikoʻi i ke kaumaha a me ke kūpaʻa o ka wāwae. ʻO ka ʻehā a me ka ʻelima mau metatarsals a me ka cuboid e hana i ka hui cuboid metatarsal.

ʻEkolu mau aʻa i hoʻopili ʻia i ke kumu o ka ʻelima metatarsal, hoʻokomo ka peroneus brevis tendon ma ka ʻaoʻao dorsolateral o ka tuberosity ma ke kumu o ka metatarsal ʻelima; ʻo ke kolu o ka ʻiʻo peroneal, ʻaʻole ikaika e like me ka peroneus brevis tendon, e hoʻokomo i ka diaphysis distal i ka ʻelima metatarsal tuberosity; ka fascia plantar Hoʻokomo ka ʻaoʻao ʻaoʻao ma ka ʻaoʻao kumu o ka tuberosity basal o ka ʻelima metatarsal.

Hoʻokaʻawale haʻihaʻi

ʻO nā haʻihaʻi o ke kumu o ka ʻelima metatarsal i hoʻokaʻawale ʻia e Dameron lāua ʻo Lawrence,

ʻO nā haʻihaʻi o ka Zone I he mau haʻihaʻi avulsion o ka tuberosity metatarsal;

Aia ka Zone II ma ka pilina ma waena o ka diaphysis a me ka metaphysis proximal, me nā hui ma waena o nā iwi metatarsal 4 a me 5;

ʻO nā haʻihaʻi o ka Zone III he mau haʻihaʻi koʻikoʻi o ka diaphysis metatarsal proximal i ka 4th/5th intermetatarsal joint.

I ka makahiki 1902, ua wehewehe mua ʻo Robert Jones i ke ʻano o ka haʻihaʻi o ka zone II o ke kumu o ka ʻelima metatarsal, no laila ua kapa ʻia ka ʻāpana ʻāpana II ʻo Jones fracture.

ʻO ka haʻihaʻi avulsion o ka tuberosity metatarsal i loko o ka ʻāpana I ka ʻano maʻamau o ka haʻi kumu ʻelima metatarsal, helu ʻia ma kahi o 93% o nā haʻihaʻi āpau, a ma muli o ka flexion plantar a me ka hana ʻino varus.

ʻO nā haʻihaʻi ma ka ʻāpana II ma kahi o 4% o nā haʻihaʻi āpau ma ke kumu o ka ʻelima metatarsal, a ma muli o ka flexion plantar wāwae a me ka hoʻohui ʻana. No ka mea aia lākou i loko o ka ʻāpana wai o ka hoʻolako koko ma ke kumu o ka ʻelima metatarsal, ʻoi aku ka maikaʻi o nā haʻihaʻi ma kēia wahi i ka nonunion a i ʻole nā ​​​​haʻi lohi.

ʻO nā haʻihaʻi o ka Zone III ma kahi o 3% o ka lima o nā haʻi kumu metatarsal.

ʻO ka mālama mālama ʻana

ʻO nā hōʻailona koʻikoʻi no ka mālama conservative ʻo ia ka hoʻoneʻe ʻana o ka haʻihaʻi ma lalo o 2 mm a i ʻole nā ​​haʻi paʻa. ʻO nā lāʻau lapaʻau maʻamau, ʻo ia ka immobilization me nā kāʻei elastic, nā kāmaʻa paʻa paʻa, ka immobilization me ka plaster casts, nā pahu hoʻopiʻi pahu pahu, a i ʻole nā ​​kāmaʻa hele wāwae.

ʻO nā mea maikaʻi o ka mālama mālama conservative, ʻo ia ke kumu kūʻai haʻahaʻa, ʻaʻohe trauma, a maʻalahi ka ʻae ʻia e nā maʻi; ʻO nā hemahema, ʻo ia ka piʻi ʻana o ka haʻihaʻi nonunion a i ʻole nā ​​pilikia uniona lohi, a me ka ʻoʻoleʻa maʻalahi o ka hui.

ʻokiʻokiThana hou

ʻO nā hōʻailona no ka hoʻomaʻamaʻa ʻana i ka lima o nā haʻihaʻi kumu metatarsal penei:

1. ʻOi aku ka nui o ka haʻihaʻi ma mua o 2 mm;

1. Hoʻokomo ʻia o > 30% o ka ʻili ʻili o ka cuboid distal a hiki i ka ʻelima metatarsal;

1. ʻO ka haʻihaʻi ʻana;

1. ʻO ka haʻihaʻi hoʻopaneʻe ʻana i ka hui ʻana a i ʻole nonunion ma hope o ka mālama ʻole ʻana;

1. ʻO nā poʻe maʻi ʻōpio a i ʻole nā ​​​​mea haʻuki.

I kēia manawa, ʻo nā ʻano hana maʻamau i hoʻohana ʻia no nā haʻihaʻi o ke kumu o ka ʻelima metatarsal, ʻo ia ka Kirschner wire tension band internal fixation, heleuma suture fixation me ka wili, wili i loko o ka hoʻopaʻa ʻana, a me ka hoʻopaʻa ʻana i loko o ka pā hook.

1. Kirschner uea hoʻopaʻa ʻana i ka pahu hoʻopaʻa

ʻO ka hoʻopaʻa ʻana i ke kaula uea Kirschner he hana maʻamau maʻamau. ʻO nā mea maikaʻi o kēia ʻano hana lapaʻau e komo maʻalahi i nā mea hoʻoponopono kūloko, ke kumu kūʻai haʻahaʻa, a me ka hopena hoʻopiʻi maikaʻi. ʻO nā pōʻino e pili ana i ka ʻili ʻili a me ka pilikia o ka wehe ʻana o ka uea Kirschner.

2. Hoʻopaʻa humuhumu me nā heleuma wili

ʻO ka hoʻopaʻa ʻana i ka anchor suture fixation me ke kaula he kūpono ia no nā poʻe maʻi me nā haʻihaʻi avulsion ma ke kumu o ka metatarsal ʻelima a i ʻole me nā ʻāpana haʻi liʻiliʻi. Loaʻa nā pōmaikaʻi i ka incision liʻiliʻi, ka hana maʻalahi, a ʻaʻohe pono no ka wehe lua. ʻO nā hemahema e pili ana i ka pilikia o ka heleuma prolapse i nā maʻi me ka osteoporosis. .

3. Hollow nail fixation

ʻO ka hollow screw kahi lapaʻau maikaʻi i ʻike ʻia ma ke ao holoʻokoʻa no nā haʻihaʻi o ke kumu o ka metatarsal ʻelima, a ʻo kāna mau mea maikaʻi ʻo ia ka paʻa paʻa a me ka paʻa maikaʻi.

ʻO ka maʻi maʻi, no nā haʻihaʻi liʻiliʻi ma ke kumu o ka lima o ka metatarsal, inā hoʻohana ʻia ʻelua mau wili no ka hoʻoponopono ʻana, aia ka pilikia o ka refracture. Ke hoʻohana ʻia kahi wili no ka hoʻoponopono ʻana, nāwaliwali ka ikaika anti-rotation, a hiki ke hoʻololi hou.

4. Paʻa paʻa Hook

ʻO ka hoʻopaʻa ʻana i ka pā Hook he nui nā hōʻailona, ​​ʻoi aku ka nui o nā poʻe maʻi me nā haʻi avulsion a i ʻole nā ​​haʻi osteoporotic. Kūlike kona ʻano hoʻolālā i ke kumu o ka iwi metatarsal ʻelima, a ʻoi aku ka kiʻekiʻe o ka ikaika hoʻopili paʻa. ʻO nā hemahema o ka hoʻopaʻa ʻana o ka pā e komo pū me ke kumukūʻai kiʻekiʻe a me ka ʻeha nui.

Summary

I ka wā e mālama ai i nā haʻihaʻi ma ke kumu o ka ʻelima metatarsal, pono e koho pono e like me ke kūlana kikoʻī o kēlā me kēia kanaka, ka ʻike pilikino o ke kauka a me ka pae ʻenehana, a noʻonoʻo pono i nā makemake pilikino o ka mea maʻi.