ʻO ka ʻaoʻao L ʻaoʻao maʻamau ke ala maʻamau no ka hoʻomaʻamaʻa ʻana i nā haʻi calcaneal. ʻOiai ua piha ka ʻike, ua lōʻihi ka ʻoki ʻana a ua wehe ʻia ka ʻiʻo palupalu, e alakaʻi maʻalahi ai i nā pilikia e like me ka hoʻopaneʻe ʻana i ka hui ʻana o ka ʻiʻo palupalu, necrosis, a me ka maʻi. Hoʻohui ʻia me ka ʻimi ʻana o ka ʻaha kanaka i kēia manawa i nā mea hoʻonaninani liʻiliʻi, ua hoʻomaikaʻi nui ʻia ka hoʻomaʻamaʻa liʻiliʻi liʻiliʻi o nā haʻi calcaneal. Ua hōʻuluʻulu kēia ʻatikala i nā ʻōlelo aʻoaʻo 8.
Me ke ala ākea ākea, hoʻomaka ka ʻaoʻao kūpaʻa o ka ʻoki i kahi kokoke i ka piko o ka fibula a ma mua o ka tendon Achilles. Hana ʻia ke kiʻekiʻe o ka ʻoki ʻia ma kahi mamao loa i ka ʻili ʻeha i hānai ʻia e ke aʻa calcaneal lateral a hoʻokomo ʻia ma ke kumu o ka ʻelima metatarsal. Hoʻopili ʻia nā ʻāpana ʻelua ma ka kuʻekuʻe wāwae e hana i kahi kihi ʻākau ʻākau. Source: Campbell Orthopedic Surgery.
Phoemi poking ercutaneous
I ka makahiki 1920, ua hoʻomohala ʻo Böhler i ke ʻano hana lapaʻau liʻiliʻi liʻiliʻi no ka hoʻēmi ʻana i ka calcaneus ma lalo o ka traction, a no ka manawa lōʻihi ma hope mai, ua lilo ka hoʻohaʻahaʻa poking percutaneous ma lalo o ka traction i ke ʻano kumu nui no ka mālama ʻana i nā haki calcaneus.
He kūpono ia no nā haʻihaʻi me ka liʻiliʻi o ka neʻe ʻana o nā ʻāpana intraarticular i loko o ka hui subtalar, e like me Sanders type II a me kekahi Sanders III lingual fractures.
No Sanders type III a me Sanders type IV fractures me ka nui o ka subtalar articular surface collapse, poking reduction is paʻakikī a paʻakikī ke hoʻokō anatomical reduction o ka hope articular surface o ka calcaneus.
He mea paʻakikī ke hoʻihoʻi i ka laulā o ka calcaneus, a ʻaʻole hiki ke hoʻoponopono maikaʻi ʻia ka deformity. Haʻalele pinepine ia i ka paia ʻaoʻao o ka calcaneus i nā ʻano like ʻole, e hopena i ka hopena o ka malleolus ʻaoʻao haʻahaʻa me ka paia ʻaoʻao o ka calcaneus, ka hoʻoneʻe ʻana a i ʻole ke kaomi ʻana o ka tendon peroneus longus, a me ka hoʻopili ʻana o ka tendon peroneal. ʻO Syndrome, ka ʻeha calcaneal impingement, a me ka tendonitis peroneus longus.
ʻenehana Westhues/Essex-lopresti. A. Ua hōʻoia ʻo Lateral fluoroscopy i ka ʻāpana ʻano alelo i hāʻule; B. Ua hōʻike ʻia kahi hōʻike hōʻike ʻo CT scan i kahi haʻihaʻi Sandess type IIC. Hōʻike maopopo ʻia ka ʻāpana mua o ka calcaneus i nā kiʻi ʻelua. S. Hapai koke.
C. ʻAʻole hiki ke hoʻohana ʻia ka ʻoki ʻaoʻao ma muli o ka pehu ʻana o ka ʻiʻo palupalu a me ka pohū; D. Lateral fluoroscopy e hōʻike ana i ka ʻili kiko (laina kiko) a me ka hāʻule ʻana o ka talar (laina paʻa).
E a me F. Ua kau ʻia ʻelua mau uea alakaʻi kui puka ʻelua e like me ka ʻāpana haʻahaʻa o ka ʻāpana ʻano alelo, a ʻo ka laina kikoo ka laina hui.
G. E wili i ka ami kuli, e ohi i ka pine alakai, a ma ka manawa hookahi e hooloihi i ka wawae waena e hoemi i ka naha: H. Hookahi 6.5 mm wili cannulated i paa i ka iwi cuboid a elua 2.0 mm Kirschner uwea i hoopiliia no ka hoemi ana ma muli o ka calcaneus anterior comminution. Source: Mann Foot and Ankle Surgery.
Sʻokiʻoki inus tarsi
Hana ʻia ka ʻoki ʻana ma kahi mamao o 1 cm mai ka piko o ka fibula a hiki i ke kumu o ka ʻehā metatarsal. I ka makahiki 1948, ua hōʻike mua ʻo Palmer i kahi ʻoki liʻiliʻi ma ka sinus tarsi.
Ma 2000, Ebmheim et al. ua hoʻohana i ke ala tarsal sinus i ka lapaʻau ʻana i nā haki calcaneal.
o Hiki ke hōʻike piha i ka hui subtalar, hope articular surface a me anterolateral fracture block;
o E pale pono i na aa koko calcaneal aoao;
o ʻAʻole pono e ʻoki i ka ligament calcaneofibular a me ka retinaculum subperoneal, a hiki ke hoʻonui ʻia ka wahi hui e ka hoʻohuli kūpono i ka wā o ka hana, aia nā mea maikaʻi o ka liʻiliʻi liʻiliʻi a me ka liʻiliʻi o ke koko.
ʻO ka hemahema, ʻaʻole lawa ka hoʻolaha ʻana, e kaupalena a pili i ka hōʻemi ʻana i ka haʻihaʻi a me ka hoʻokomo ʻana o ka hoʻoponopono kūloko. He kūpono wale ia no Sanders type I a me type II calcaneal fractures.
Oʻoki liʻiliʻi blique
ʻO kahi hoʻololi o ka ʻoki tarsi sinus, ma kahi o 4 knm ka lōʻihi, i waena o 2 knm ma lalo o ka malleolus ʻaoʻao a kūlike me ka ʻili o hope.
Inā lawa ka hoʻomākaukau preoperative a ʻae nā kūlana, hiki ke loaʻa ka hopena maikaʻi a me ka hoʻoponopono ʻana i ka Sanders type II a me III intra-articular calcaneal fractures; inā makemake ʻia ka fusion hui subtalar i ka wā lōʻihi, hiki ke hoʻohana ʻia ka ʻoki like.
PT Peroneal tendon. PF Mahope o ka ili o ka calcaneus. S sinus tarsi. AP Calcaneal protrusion. .
ʻokiʻoki longitudinal hope
E hoʻomaka ana mai ka waena waena o ka laina ma waena o ka tendon Achilles a me ka piko o ka malleolus ʻaoʻao, e hoʻolōʻihi ʻia i lalo i ka hui kuʻekuʻe talar, me ka lōʻihi ma kahi o 3.5 cm.
Hana ʻia ka ʻoki liʻiliʻi i loko o ka ʻiʻo palupalu lōʻihi, me ka ʻole o ka hōʻino ʻana i nā hale koʻikoʻi, a ʻike maikaʻi ʻia ka ʻaoʻao o hope. Ma hope o ka prying percutaneous a me ka hōʻemi ʻana, ua hoʻokomo ʻia kahi papa anatomical ma lalo o ke alakaʻi ʻana o ka intraoperative perspective, a ua paʻi ʻia ka wili percutaneous a hoʻopaʻa ʻia ma lalo o ke kaomi.
Hiki ke hoʻohana ʻia kēia ʻano hana no Sanders ʻano I, II, a me III, ʻoi aku hoʻi no ka neʻe ʻana o ka ʻaoʻao articular hope a i ʻole nā haʻihaʻi tuberosity.
ʻoki ʻia ka iwi herringbone
ʻO ka hoʻololi ʻana o ka sinus tarsi incision. Mai ka 3 knm ma luna o ka piko o ka malleolus lateral, ma ka palena hope o ka fibula a hiki i ka piko o ka malleolus lateral, a laila i ke kumu o ka hā o ka metatarsal. Hāʻawi ia i ka hoʻohaʻahaʻa maikaʻi a me ka hoʻoponopono ʻana o Sanders type II a me III calcaneal fractures, a hiki ke hoʻonui ʻia inā pono e hōʻike i ka transfibula, talus, a i ʻole kolamu ʻaoʻao o ka wāwae.
LM kuʻekuʻe wāwae. MT metatarsal ami. SPR Supra fibula retinaculum.
Arthroscopically kokua hoemi
I ka makahiki 1997, ua noi ʻo Rammelt e hiki ke hoʻohana ʻia ka subtalar arthroscopy e hōʻemi i ka ʻili hope o ka calcaneus ma lalo o ka ʻike maka. I ka makahiki 2002, ua hana mua ʻo Rammelt i ka hoʻohaʻahaʻa percutaneous i kōkua ʻia me ka arthroscopically a me ka hoʻopaʻa ʻana i ka screw no nā haʻihaʻi Sanders type I a me II.
ʻO ka subtalar arthroscopy ka mea nui i ka nānā ʻana a me ka hana kōkua. Hiki iā ia ke nānā i ke kūlana o ka subtalar articular surface ma lalo o ka ʻike pololei, a kōkua i ka nānā ʻana i ka hoʻemi a me ka hoʻoponopono kūloko. Hiki ke hana ʻia ka ʻokiʻoki ʻana o ka hui subtalar a me ka wehe ʻana o ka osteophyte.
He haiki nā hōʻailona: no Sanders type Ⅱ wale nō me ka haʻahaʻa haʻahaʻa o ka ʻili o ka articular a me ka ʻano AO / OTA ʻano 83-C2 mau haki; ʻoiai no Sanders Ⅲ, Ⅳ a me AO/OTA ʻano 83-C3 ʻO nā haʻihaʻi me ka hāʻule o ka ʻili articular e like me 83-C4 a me 83-C4 ʻoi aku ka paʻakikī o ka hana.
kūlana kino
b. ʻO ke kuʻekuʻe wāwae hope. c. Loaʻa i ka haʻi a me ka hui subtalar.
Ua hoʻokomo ʻia nā wili Schantz.
e. Hoʻoponopono hou a hoʻoponopono manawa. f. Ma hope o ke kau hou ʻana.
g. Hoʻoponopono manawaleʻa i ka poloka iwi ʻili. h. Hoʻopaʻa me nā wili.
i. Ma hope o ka hana ʻana i ka sagittal CT scan. j. Kuanaʻike axial postoperative.
Eia hou, he haiki ka subtalar joint space, a he pono ka traction a brackets e kākoʻo i ka lumi hui e maʻalahi ai ke kau ʻana o ka arthroscope; liʻiliʻi ka wahi no ka hoʻoponopono intra-articular, a hiki i ka hoʻopololei mālama ʻole ke hoʻopilikia maʻalahi i ka ʻili cartilage iatrogenic; ʻAʻole hiki ke hoʻonohonoho ʻia nā ʻenehana ʻokiʻoki ʻike ʻole.
Percutaneous baluna angioplasty
I ka makahiki 2009, ua hāʻawi mua ʻo Bano i ka ʻenehana dilatation baluna no ka mālama ʻana i nā haki calcaneal. No nā haʻihaʻi Sanders type II, manaʻo ka hapa nui o nā palapala i ka hopena. Akā ʻoi aku ka paʻakikī o nā ʻano haʻihaʻi ʻē aʻe.
I ka manawa e komo ai ka iwi sima i loko o ka subtalar joint space i ka wā o ka hana, e hoʻopau ʻia ka ʻili o ka articular a me ka palena o ka neʻe hui ʻana, a ʻaʻole e kaulike ka hoʻonui ʻana i ka baluna no ka hōʻemi ʻana i ka haki.
Hoʻokomo ʻia ka cannula a me ke kaula alakaʻi ma lalo o ka fluoroscopy
Nā kiʻi ma mua a ma hope o ka piʻi ʻana o ka airbag
Nā kiʻi X-ray a me CT i ʻelua makahiki ma hope o ke ʻoki ʻana.
I kēia manawa, liʻiliʻi nā laʻana noiʻi o ka ʻenehana baluna, a ʻo ka hapa nui o nā haʻihaʻi me nā hopena maikaʻi ke kumu o ka ikaika haʻahaʻa. Pono e noiʻi hou ʻia no nā haʻi calcaneal me ka haʻihaʻi koʻikoʻi. Ua hana ʻia no kahi manawa pōkole, a ʻaʻole maopopo ka hopena o ka wā lōʻihi a me nā pilikia.
Calcaneal intramedullary nail
I ka makahiki 2010, ua puka mai ka calcaneal intramedullary nail. Ma 2012, M.Goldzak minimally invasive lapaʻau o calcaneal fractures me intramedullary nailing. Pono e hoʻoikaika ʻia ʻaʻole hiki ke hoʻemi ʻia me ka nailing intramedullary.
E hoʻokomo i ka pine alakaʻi kūlana, fluoroscopy
Hoʻonohonoho hou i ka hui subtalar
E kau i ka pahu hoʻonohonoho, e hoʻokele i ka nail intramedullary, a hoʻopaʻa iā ia me ʻelua mau pahu cannulated 5 mm.
Nānā ma hope o ka hoʻokomo ʻana i nā kui intramedullary.
Ua hōʻike ʻia ʻo Intramedullary nailing i ka kūleʻa i ka mālama ʻana o Sanders type II a me III fractures o ka calcaneus. ʻOiai ua hoʻāʻo kekahi mau kauka e hoʻopili iā Sanders IV fractures, ua paʻakikī ka hana hoʻohaʻahaʻa a ʻaʻole hiki ke loaʻa ka hōʻemi kūpono.
Mea Hoʻopili: Yoyo
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Ka manawa hoʻouna: Mei-31-2023
