ʻO ka Manunilar ma kahi o nā mea he 5-15% o nā mea āpau o nā mea āpau o ka iwi navicular, me nā necrosis necrosis e like me 3%. ʻO nā mea waiwai no ka hōʻinoʻana o ka nivicular i nā mea i hala a lohi paha i ka diagnosis, proximal proximity of the fracture of the 1 mm, and fracture with carput inctibility. Inā haʻaleleʻia kahi meaʻole,ʻo Navicular Osteochondral e pili ana i ka OncuunisLion i pili pū me Traumaular Oteochondral
ʻO Broar Grafing me a iʻoleʻole e hoʻohanaʻia i kahi kīwaha vasculared i hiki ke hoʻohanaʻia e mālama i ka nontinion ovicularral oteochondral. Eia nō naʻe, no nā mea maʻi me ka osteonecrosis o ka pou proximar o ka iwi o ka iwi,ʻaʻole pono ka hopena o ka iwi vascular, he 40% -67%. I ka hoʻohālikelikeʻana, keʻano hoʻomaha o ka nui o nā iwi iwi me nā braps i hiki ke kiʻekiʻe e like me 88% -91%. ʻO nā'āpana o nā iwi nui o VASCular i loko o ka hoʻomaʻamaʻaʻana i ka mīkini i ka Rup Scan Flap. Ua hōʻikeʻia ka VFC FREE MFG i ka maikaʻi o ka mālamaʻana i nā mea hoʻokele o Navicular me nā lālāʻo Metacarpal, aʻo ka Mfc Vbus ka lālā o ke Kihi Hoʻohālikelikeʻia me nā flaps'ē aʻe, hāʻawi ka mfc vbg i ke kākoʻo kūpono e hoʻihoʻi i keʻano maʻamau I ka mālamaʻana i nā osteonecross osteonecross mesteonencross me ka holomua cartip subpse
Kiʻi 1. Hoʻopili i ka iwi navicular me kahi "kūlou i hope o ka" deformity.
Hoʻomākaukau hoʻomākaukau preoperative
Ma hope o ke nānāʻana i ka nānā kinoʻana o ka pulima i piliʻia, pono e hōʻike i nā haʻawina e pono e loiloi i ke kiʻekiʻe o ka chortse. He mea maikaʻi nā raki uila e hōʻoia i ka wahi o ka fracture, ke kiʻekiʻe o ka neʻeʻana, a me keʻano o ka pauʻana o ka hopena wāwahi. Ua hoʻohanaʻia nā kiʻi kiʻi kiʻi kiʻi kiʻi no ka loiloiʻana no ka Wristpse, Dorsal Instability of the wrist Hiki i ka MRI a iʻole CT hiki ke kōkua i ka diagnose malalgnment o ka iwi navicular a iʻole osteonecrosis. ʻO ka radio uila a iʻole ablique sagitttal ct o ka iwi nevicular a me kahi hōʻailona necrosir
Nā hōʻike a me nā hoʻohālikelike:
ʻO nā inoa inoa inoaʻo Navicularral OvicularLan Hōʻikeʻo MRr i ka necrosmic necrosis o ka iwi navicular ʻO ka hanaʻole o ka Blud Bluck Bluck Granding Blufing a iʻole ka nānāʻana i ka hoʻoponopono kūloko e pono ai i kahi Brbctural Brcctural Bind (> 1cm3). preocerative a iʻole nāʻike inteparative o ka osteoarthritis o ka hui cartip radial; Inā ulu nui ka makeʻana o ka navicular nui me ka hāʻuleʻana o ka osteoarthritis, a lailaʻo wrist deterent ʻO ka mavicular malunion ʻO ka pōkole o ka hōʻino o ka navicular me ka osteonecrosis. (1,2-е-onsra hiki ke hoʻohanaʻia ma keʻano he mea hoʻololi no kahi flap radius disc).
Hoʻokomoʻiaʻo Anatomy
Ua hoʻolakoʻia ka VFC VBG e kekahi helu o nā mokuʻo Spemosseous liʻiliʻi (ʻo ia hoʻi ma keʻano he 3. Ua hāʻawiʻia kēia mau mokuʻo Marpoblassistic e ka meaʻo Gencending Greice (DGA) a me / a iʻole nā lālā o keʻano o keʻano o ka wahine. ʻO ka DGA i hoʻokumuʻia mai ka mea hoʻopiʻi femorial sumficial i ka hana medial o ka manilenonus Ua hoʻokumuʻia ka DGA mai ka Firmficial FEMORETAL FORETERY ma 13.7 CM (10.5 CM-17.5 CM) No laila ua makemakeʻia ka dga a me ka SMAEʻaʻole i kūpono loa,ʻoiai ua kūpono o kā mua no ka nui o ka moku, no ka lōʻihi o ka moku.
Fig. 2.ʻO ka māhele'āinaʻehā o nā kīʻaha mfopbild ma waena o ka laina o ka paraelle a me keʻano o ka paila nui
Kiʻi 3. Mfc Vascular Anatomy:
Loaʻaʻia kaʻike
Ua hoʻonohoʻia ka mea maʻi ma lalo o ka Asthesia General Anasthesia i ke kūlana popo, me ka lima lima i kauʻia ma ka papa hana o ka lima. ʻO ka maʻamau, ua laweʻia ka balo Blap Blap mai ka Ipsiteranote indial femoral ille, no laila e neʻe ka mea maʻi ma hope o ka hanaʻana. Hiki ke kohoʻia nā kuli kohu i loaʻa inā he mōʻaukala o nā trauma mua a iʻole ka hanaʻana ma kaʻaoʻao like o ke kuli. Hoʻopiliʻia ke kuli a me ke kīwī i keʻano o nā tourniquet a me nā tourniquet a me nā tourniquet iʻelua a me nā haʻahaʻa haʻahaʻa. ʻO ka hoʻokokokeʻana o ka mea hoʻokūkū nui loa, me ka loaʻaʻana o ka inctivis e hoʻomaka ana i keʻano o ka carxpal carcola. ʻO keʻano o ka Tendon Sheth o ka Longissimus Lingisismimus Tendon a ua hukiʻiaʻo Tendon i ka paleʻana i nā iwi o ka moni. E hōʻoia i ka'āpana o ka noninion,ʻo ka maikaʻi o ke kiʻi kiʻi kiʻi kiʻi a me ke kiʻekiʻe o Ischaemia o ka iwi naviciaria. Ma hope o ka weheʻana i ka Tourniquet, e nānā i ka pou proximal o ka iwi navicular no ka hoʻopaʻaʻana i ke koko e hoʻoholo ai inā he ischemic necrosis. Ināʻaʻole piliʻia ka necrosis Necrosis me ka carpal carpal a iʻole intercarp paha
Kiʻi 4.ʻO ke alaʻo Navicular e hoʻomaka ai: (B) Ua hoʻopiliʻia ka sheath o ka tendon o ka radalismus ma Raminimismus ma Tendon a ua hukiʻia ka Branton i ka neʻeʻana o nā uhi (C) E hoʻomaopopo i ka wahi o ka discosinuity ovicular osseous.
ʻO ka 15-20 CM lōʻihi i hanaʻia i ka laina o ke kuli ma keʻano he nui o ka DEMIOR. Ua hoʻokuʻuʻia ka FACCLELE FREECICAR, e mālama pono e pale i ka perosteum a me nā mokuʻo Trispoblastic ma ka papahele bony.
Kiʻi 5. Loaʻa i ke komoʻana i ka MFC: (B) ua hoʻihoʻiʻia kaʻiʻo i keʻano o ke kiʻiʻana i ka hāʻawi koko MFC ..
ʻO ka hoʻomākaukauʻana i ka iwi navicular
Pono e hoʻoponoponoʻia ka Deficular DOI DOI DEMOCTION a me ka wahi o ka mokuahi o ka osteochondral Bone A 0.0625-wāwae (ma kahi o 1.5-mm) i ka pahuʻo Kills Ua hoʻokaʻawaleʻia ka wahi o ka fracture i ka palupalu palupalu a wehe houʻia me kahi pālahalaha pāpū. Hoʻohanaʻia kahi mea liʻiliʻi e hoʻopili ai i ka iwi a me ka hōʻoia e like me keʻano o ka paila o ka palmar. Ma hope o ka weheʻana i ke kīwī, ua ana ka hewa iʻekolu mau dimensions e hoʻoholo i ka nui o ka iwi o ka iwi.
Kiʻi 6.ʻO ka hoʻoponoponoʻana o ke kīwī i ke kūlouʻana o ka navicular, me ka fluoroscopic o ka pulima e hoʻihoʻi hou i ka hana maʻamau. A 0.0625-Lit
Osteotomy
Ua kohoʻia ka wahi o ka vascularous o keʻano o ka maʻi femoral ma keʻano he nui o ka iwi, a me ka'āina o ka iwi iwi. E makaʻala eʻaʻole i hōʻeha i ka ligament collateal electial. Uaʻikeʻia ka periossum, a me kahi iwi rectangular o ka nui kūpono no ka flap i makemakeʻia, uaʻokiʻia kahi'āpana 7). Pono e laweʻia e hoʻokaʻawale i ka iwi o ka iwi, a coctical bone, a cancelus iwi o ka flap. Pono e hoʻokuʻuʻia ka Tourniquet haʻahaʻa haʻahaʻa e nānā i ke kaheʻana o ke koko ma o ka flap, a e hoʻokuʻuʻia ka peta. Inā pono, loaʻa kahi liʻiliʻi liʻiliʻi o ka iwi pale i hiki ke hoʻomauʻia i loko o ka femorial. Hoʻopihaʻia ka hewa o ka femoral condylar i kahi mea i kohoʻia, a ua hoʻoheheʻeʻia ka incisist
Kiʻi 7. Mfc Bone Flap Flap. (A) kahi'āpana osteotomy e hoʻopiha i nā wahi nevicular, ua hōʻailonaʻia, a ua hoʻopiʻi ka iwi i makemakeʻia e ka nui o ka flap (B) kahi'āpana lua o ka iwi eʻokiʻia ma kahiʻaoʻao i ka 45 ° e hōʻoia i ke kūpaʻa o ka flap.
ʻO ka hoʻopiʻiʻana a me ka hoʻoponoponoʻana
Uaʻokiʻia ka iwi o ka iwi i keʻano kūpono,ʻaʻole mālama e mālama i ka pale kaua a iʻole ke kalaʻana i ka periosteum. Ua hoʻohālikelikeʻia ka flap i loko o ka wahi o ka iwi navicular, e pale i ka percussition Mālamaʻia ka mālamaʻana i ka pale o ka balor i ke aniani o ka iwi i hoʻopiliʻia me ka palmar ma kahi o ka iwi navicular. Hanaʻiaʻo Fluorroscopy e hōʻoia i ka morport morpology Anasetomose The Vascular Flap FlaP Ua hoʻoponoponoʻia nā mea hoʻokūkū hoʻokūkū, akā ua paleʻia ka pedale vascular.
Kiʻi 8.ʻO ka Blap Blap Flap, hoʻoponopono, a me ke Anantomomis. Ua hoʻopiliʻia ka iwi o ka iwi i loko o ka wahi o ka iwi navicular a paʻa a paʻa i nā kiʻi paʻi a me nā kirschler mau kiʻi. Laweʻia ka mālamaʻana i ka Matnippal marckarpal o ka block Black Blolanted i hoʻopiliʻia me ka Metacarpal i ka iwi navicular. ʻO Anantomosis o ka FASCUL Flap Flap Flap ma ka hopena o ka radial artery
Postoperative rehabilitation
ʻO Oral Aspirin 325 mg i kēlā me kēia lā (no 1 mahina), hiki i ke kaupaonaʻana ke hōʻemi i ka maʻi maʻi maʻi i ka hopena o ka mea maʻi. Hiki i ke kākoʻo o ke kākoʻo o kahi crutch hoʻokahi hiki ke hōʻemi i kaʻeha, akāʻaʻole pono ke kākoʻo lōʻihi o nā crutches. Ua laweʻia nā stitches i 2 mau pule ma hope o ka hanaʻana a me ka muenster a iʻole ka lima lōʻihi a lōʻihi paha e mālamaʻia i ka thumb i kahi no 3 mau pule. Ma hope o kēlā, ua hoʻohanaʻia ka lima pōkole i nā manamana lima a hiki i nā'āpana o ka pā. Ua laweʻia nā X-Rays ma 3-6 wiki, a ua hōʻoiaʻia ka ho'ōlaʻana i ka ho'ōlaʻana e CT. Ma hope iho,ʻo ka hana ikaika a me ka pāʻoinui e hoʻomaka ai a me ka hoʻonuiʻana i nā hana hou, a pono e nui ka hoʻoikaika o ka hoʻomaʻamaʻaʻana.
Nā hoʻopiʻi nui
ʻO nā hoʻopiʻi nui o ke kuli e pili ana i kaʻehaʻeha a iʻole ka hōʻehaʻeha. Ua loaʻa i nāʻeha kuli ma loko o 6 mau pule ma hope o ka hoʻomaʻamaʻaʻana, aʻaʻohe meaʻehaʻeha a hōʻeha paha ma muli o keʻano o ke kino ma muli o ka hōʻeha o Sapoma ʻO nā hoʻopiʻi nui nā mea hoʻopiʻi hua nui i hoʻopaʻaʻia ai ka iwi pale,ʻeha, palupalu, nā iwi o ka perosatah, a me ka hopena o ka hopena o ka perosathorth, a me ka pilikia o ka perosatath
ʻO nā BOMOLL FREE medle condle condle choscular i hoʻopaʻaʻia no nā snarhod nonusunis me ka cubspur pole avascus a me ka carpal collapse
POST manawa: Mei-28-2024
