Nadiifinta Nadiifinta ah waxay ku dhacdaa qiyaastii 5-15% dhammaan jabka daran ee naaska nabarrada, oo leh nasiinno nasiin ah oo ka dhacaya qiyaastii 3%. Waxyaabaha Halista ah ee Kaalmada Naviculation waxaa ka mid ah in la seego ama dib loo dhigay, u dhawaanshaha qurxinta ee khadka jabka, barakaca ka badan 1 mm, iyo jajabka samafalka samafalka. Haddii aan la daaweyn, nadiiradii dheecaanka osteoooofonral-ka ee osteooochonral-ka ah ayaa badanaa la xidhiidha dhaawacyada arthritis-ka, oo sidoo kale loo yaqaanno in dhaqdhaqaaqa osteoooorocralar osteoochonral osteoochar-ka oo ay ku dhacaan osteoarthritis-ka.
Lafaha lafta leh ama aan lahayn qulqulatooyinka xididdada ayaa loo isticmaali karaa in lagu daaweeyo maadada badda ee dhaqdhaqaaqa osteooorochar. Si kastaba ha noqotee, bukaannada qaba osteonecrosis ee cirifka ugu dambeeya ee nabarrada dhaqdhaqaaqa, natiijooyinka giijiska lafaha oo aan lahayn caarada xididdada ayaa ku qanacsanaanta, iyo heerka bogsashada lafta ayaa ah kaliya 40% -67%. Taas bedelkeeda, heerka bogsashada ee gubashada lafaha leh ee ku dhaca marinka vasculas-ka ayaa noqon kara sida 88% -91%. Xargaha lafaha ee ugu weyn ee lafaha ee ku jira ee ku saabsan waxqabadka rugta caafimaad waxaa ka mid ah 1,2-ictsra-zard + daadashada lafaha ee iliac-free comnyius, iwm. MFC VBG VBG waxaa loo muujiyey inuu wax ku ool yahay daaweynta jabka jawiga leh ee burburka metacarpal, iyo MFC VBG waxay isticmaashaa qaybta farshaxanka ee halbowlaha jilibka ah oo ah Trophic-ka Gaseenka oo ah Tropic. Marka la barbar dhigo daloolada kale, MFC VBG waxay bixisaa taageero qaab dhismeed oo ku filan oo ay ku soo celiyaan qaabka caadiga ah ee nabarrada nasiibka, gaar ahaan osteochondrosis-ka ee loo yaqaan 'osteochoolosis' oo lagu jajabiyo (Jaantus 1). Daaweynta osteooncrosis osteooncral osteoncrasis osteonycral oo leh durugsan samafalka samafalka ah, 1-Ictsra-ka-footarius ah ayaa la soo sheegay inuu leeyahay heerka bogsashada lafaha 40%, halka MFC VBG ay leedahay heerka bogsashada lafaha 100%.
Jaantus 1. Jab jabka naaska "dhabarka ee 'Boss'" dhabarka, CT waxay muujineysaa jabka jabka lafaha dhaqdhaqaaqa ee xagal qiyaastii ah qiyaastii 90 °.
Diyaarinta Ka Hortagga
Kadib baaritaanka jireed ee gacanta ay dhibaatadu ka dhacday, daraasadaha sawirka waa in la sameeyaa si loo qiimeeyo heerka burburka curcurka. Idaacadaha cadcad ayaa waxtar leh in la xaqiijiyo meesha jabka, heerka barakaca, iyo joogitaanka dib-u-soo-celinta ama sclerosis dhamaadka jabay. Sawirada dabaqa dambe ayaa loo isticmaalaa in lagu qiimeeyo burburka curcurka, desenal-ka gacanta ee gacanta (dissi) iyadoo la adeegsanayo saamiga dhererka gacanta (dhererka / ballaadhka) ee ≤1.52 ama xagal lugo ah oo ka badan 15 °. MRI ama CT wuxuu gacan ka geysan karaa ogaanshaha galleyda lafaha badda ama osteonecrosis. Idaacadda dambe ee idaacadda leh ee lafaha digsiga ah ee xagal kale oo badda ah> 45 ° waxay soo jeedineysaa soo-gaabinta lafaha badda, kaas oo loo yaqaan 'ecr back', kaas oo loo yaqaan 'T2' oo ah nabarrada naaska, laakiin MRI ma leh muhiimad muuqda oo la gaarsiinayo go'aaminta bogsashada jabka.
Tilmaamaha iyo waxyaabaha ka hortagga:
Nadiifinta osteooooochonral osteooochonral-ka leh ee leh cilad-darrada dhabarka iyo dissi; MRI wuxuu muujinayaa ischemisis Nechames lafta Nafacuun, intracicait ka furfurista dalxiiska iyo indha indheynta jaban jabku uu weli cadeeyo lafta cadcad; Ku guuldaraysiga ku-guuldaradii hore ee laf-dhabarta laf-dhabarta ama hagaajinta gudaha ee gudaha waxay u baahan tahay graft-ka qaab dhismeedka ah ee VGB (> 1cm3). Ka hel ka hor ama natiijooyinka gelitaanka ee osteoarthritis-ka ee xubnaha ran-radial Haddii xumada nasiinka ee la taaban karo ee la isku dayo ay ku dhacday osteoaarthritis-ka cudurka osteoaarthritis-ka ayaa dhacay, ka dibna hubka gacanta lagu diido, danta danta danta, osteotomali, qufulka dusha sare ee salka, isku-darka roobka salka, iwm. Nadiifinta Nadiifinta, NECRIMOSIMOSIMOSIMOSIMOSE, laakiin leh nafaqo-xumo nafisyo caadi ah (tusaale, jab jaban dab-damis ah oo leh dhiig oo liita cirifka ugu dambeeya); Soo gaabinta nasiinka nasiibka ah oo aan lahayn osteonecrosis. (1,2-ICCRRA waxaa loo isticmaali karaa beddelka dabka duullius ee durugsan).
Loo adeegsaday anatomy
MFC VBG waxaa lagu keenaa dhowr markab oo yar yar oo Traphosseed ah Maraakiibtaas Tranglostels-yada ayaa inta badan ay keentay in halbowlaha caadiga ah ee lagu soo degay (DGA) iyo / ama ka sareeya ee halbowlaha caadiga ah (SMGA), taas oo ah laan halbowle ah, oo ah murqo isku dhafan, muruqyo, iyo / ama / ama / ama / ama ama ama ama ama / ama / ama ama ama / ama / ama ama ama ama / ama ama / ama / ama / ama / ama / ama / ama / ama ama ama / ama / ama ama ama / ama / ama ama ama / ama / ama / ama / ama ama ama / ama / ama / ama ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama / ama ama ama ama ama / ama / ama salka dareemayaasha dareemayaasha. DGA waxay asal ahaan ka soo jeedday Sherximal-ka guud ee loo yaqaan 'Malcimal' ee Mallence ee Malleus ee Malleus, ama masaafo dhan 13.7 cm), iyo xasilloonida laxanka wuxuu ahaa 89% xaraashka cadowga ah (Jaantuska 3). Dalka DGA wuxuu ka soo jeedaa malaha guud ee guud 13.7 cm (10.5 cm-17.5 cm) oo loogu talagalay masaajidka Malleus ee malerical, oo muujinaya xasilloonida farshaxanka, oo ah xasilloonida la-socodka iyo dhexroorka ku dhawaad 0.78 mm. Sidaa darteed, midkoodna DGA ama SMGA waa la aqbali karaa, in kasta oo kii hore uu ku habboon yahay Tibiyada dhererkiisuna yahay dhererka iyo dhexroorka weerarka.
Sawir 2. Afar-afar-meelood afar geesood ee MFC Trangeloblasts ee maraakiibta safka hore ee u dhexeeya semitendosus iyo xargaha taranka oo weyn ee ka sareeya ee patella ee patella c, xariiqa 'mccior' ee 'meniscus'.
Jaantus 3. MFC Vascular anatomy: (a) laamood aan loo kala qaadin iyo mfpc tropromlul vasculas-ka anatomy,
Qalliin
Bukaanka waxaa lagu meeleeyaa suuxdinta guud ee jawiga suuxinta, iyadoo addinka saameynta saamiga lagu saaro miiska qalliinka gacanta. Guud ahaan, Flaga tabaruca laf-dhabarka ayaa laga soo qaadaa Connral Fem -Tial ee Maskaxda IP-ga, si bukaanku ula wareego ulaha qalitaanka ka dib. Jilibka isdaba-joog ah ayaa sidoo kale la dooran karaa haddii uu jiro taariikh dhaawacyadii hore ama qalliinka isla dhinaca jilibka. Jeebka ayaa is dabacsan yahay sinta misigta ayaa loo wareejiyaa, iyo dalxiisyada waxaa lagu dabaqayaa labada qaybood ee sare iyo hoose labadaba. Habka qalliinka ayaa ahaa soo-saarkii runta ee Rusese, oo ay ku taal meesha laga soo bilaabo 8 cm ugu dambeysa tunnel-ka-rogida ee rapial ee rooga radial ee rooga ah, ka dibna ku laaban tuubada tuubbada ah ee suulka, oo ku dhammaata heerka loo yaqaan 'trachanter'. Geedka 'Tendon' ee Lendisimus Tendon waa la soo dajiyay oo layaableh si xun loo soo bandhigo, oo nabarrada xargaha leh, iyada oo si taxaddar leh loo kala sooco unugyada jilicsan ee lafaha jilicsan ee lafaha badda (Jaantuska 4). Xaqiiji aagga majaajilnimada, tayada carjawda farshaxanka iyo heerka ischaemia lafta badda. Ka dib markii ay dabeyl ka dib markii ay fiiriyaan cirifka ugu dambeysa ee naaska nabarrada ee loo yaqaan 'Naviculal' ee lafaha nafitka ee loo yaqaan 'Businimal' ee lafaha loo yaqaan 'Naviculal lafta Nafaqoolka loogu talagalay dhiig-baxa dhiig baxa si loo go'aamiyo haddii ay jirto ischosis-ka. Haddii nasiinada nasiibka aan la xidhiidhin raarta raarta ah ama arthritis arthritis-ka, MFC VGB waa la isticmaali karaa.
Jaantus 4. Qaabka qalliinka ee nasiibka: (B) The Sends Genesimus Sendisimus Tendon waa la soo dajiyay oo layaableh si xun loo sawiray, iyo lafta badda ee lagu kala maraayo miraha lugta lugta iyo xargaha rakaabka radial. (C) Aqoonso aagga nasiibka osseula ah ee loo yaqaan 'osseulaus osseus'.
Marka loo jeediyo 15-20 cm ah ayaa loo diyaariyey khadka jilibka ee jilibka ah ee ku teedsan xadka dambe ee muruqa shidaalka, iyo muruqyada MFA-da ayaa guud ahaan la kaashanayaa laanta weyn ee DGA iyo SMGA, oo sida caadiga ah qaadata xididka badan ee DGA. Shexjarka xididka loo yaqaan 'vascular pearl' ayaa loo sii daayaa si caadi ah, oo daryeela si loo ilaaliyo peristosteum iyo maraakiibta trophostlassis ee dusha sare ee barta.
Jaantus 5. Helitaanka qalliinka ee MFC: (B) muruqa dib ayaa loo laabanayaa si tartiib tartiib ah si loo muujiyo bixinta dhiigga ee MFC ..
Diyaarinta lafaha badda
Cilladaha Nadiifinta ee Navicular waa in la saxaa oo laxeeyaa lafaha osteooeyral lafdhabarta lafta osteochanral ka hor iyada oo lagu dabacsanayo curcurka hoostiisa si loo soo celiyo xagal jilicsan oo jilicsan (Jaantuska 6). A 0.0225-lug ah (qiyaastii 1.5-mm) Kirskal Pin ayaa laga qodayaa si qarsoodi ah oo laga soo bilaabo god ilaa metacalpal si loo hagaajiyo wadajirka iniintii, iyo farqiga noocaanka ee dheellitirka ah ayaa la toosiyaa. Meesha jabka ayaa laga nadiifiyey unug jilicsan oo dheeri ah oo lagu sii daayaa weel saxan. Muuqaal yar oo is-dhejisan ayaa loo istcimaalaa in lagu kala jajabiyo lafaha oo ay hubiso in gubashada maqaar-galaha ay u egyihiin qaab dhismeedka afarta ah marka loo eego farqiga udhaxeeya ee dhinaca kale ee suumanka ah marka loo eego dhinaca taranka. Ka dib markii la furay farqiga, ciribtirka waxaa lagu cabiraa saddex cabbir si loo ogaado heerka lafaha lafaha, oo badanaa dhererkeedu yahay 10-12 mm oo dherer ah dhammaan dhinacyada la tallaalidda.
Jaantus 6 A 0.0225-lug ah (qiyaastii 1.5-mm) Kirskal Pin ayaa laga qodayaa si tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib tartiib ah.
Osteotomy
Aagga vasculas-ka ee ka mid ah Connect Femsymlen-ka waxaa loo xushay aagga lafaha lafaha, iyo aagga soosaarka lafaha ayaa sifiican loo calaamadeeyay. Ka taxaddar inaadan dhaawicin lugaha dhexdhexaadka ah. Perosteum-ka ayaa la soo daatay, iyo laambadda lafdhabarta ee xajmiga ku habboon ee loo yaqaan 'ruuqa' ruuqa ku habboon ee loo yaqaan 'ruuqa ku habboon' waxaa lagu gooyaa school isbuurin, oo leh lafaha labaad ee lafaha 45 ° oo ay ku dhinto hal dhinac si loo hubiyo daacadnimada duufaanka (Jaantus 7). 7). Daryeel waa in la qaataa si aan loo kala saarin peristosteum, laf dhabarta, iyo lafaha karka leh ee qulqulka. Dalxiisyada hoose ee hoose waa in la siidaayaa si loo dhawro socodka dhiigga ee dusha sare, oo waa in si weyn loogu sii daayaa ugu yaraan 6 cm si loogu oggolaado anastomasis-ka xigta ee xigta. Haddii loo baahdo, qadar yar oo lafaha kacsan ayaa lagu sii wadi karaa gudaha Contyle. Cilka ku-tanaasul-gadhku waxaa ka buuxsamay beddelka qoolleyda lafaha, iyo meesha la jeexay waa la miiray oo lakab xidhan oo lakab xidhan.
Jaantus 7. MFC lafta ka saarida lafta. (A) Aagga osteotomi ee ku filan in la buuxiyo booska badda nasiibka ah, ayaa la gartaa Feriosteum-ka, iyo Fooska lafdhabarta lafdhabarta ee cabirka ku habboon ee loo yaqaan 'line' ee lagu qurxiyo. (B) gabal labaad oo lafaha ah ayaa la jaray hal dhinac 45 ° si loo hubiyo daacadnimada dabka.
Isku-darka mushaarka iyo hagaajinta
Flaga lafta ayaa loo gooyaa qaabka ugu habboon, oo daryeela ma aha inuu ku cadaadiyo tuugada xididdada xididka ama xargaha periosteum. Flap-ka waxaa si tartiib ah loogu dhexjiraa aagga cirifka lafaha ee nasiibka, ka fogaanshaha qandaraasyada, oo lagu hagaajiyaa xoqida batoonka ee godka ah. Daryeel ayaa loo qaaday si loo hubiyo in xadka tarcadda ah ee lafaha la isku dhejiyay ay ku qulqulayaan xadka tarcadda badhtamaha lafta badda ama in ay wax yar ka fogaato inaad ka fogaato carqalad. Fluoroscopy-ka waxaa loo sameeyay si loo xaqiijiyo qaab-dhismeedka nasiibka ee nasiibka, xariiqda xoogga iyo booska daboolka. Anastomose flup flup-ka xididdada xididdada xididdada ee dhinaceeda iyo caarada xunxun ee shucaaca shucaaca shucaaca shucaaca ee xididada xididka ee xididdada xinjirowga dhamaadka (Jaantuska 8). Kaabsalka wadajirka ah waa la hagaajiyaa, laakiin waa laga fogaadaa dharka xididdada xididdada xididada.
Jaantus 8. Igagala-dhiska lafaha, hagaajinta, iyo anastomosis xididdada. Flaga lafta ayaa si tartiib ah loogu shubayaa aagga cirifka naaska ee nasiibka ah oo lagu hagaajiyaa boorarka badda ee hubka ah ama biinanka kirschner. Daryeel ayaa la qaadaa in xadka metacarpal ee lafaha la isku dhejiyay ay ku daadato xadka metacarpal ee naaska ama niyad jabka si looga fogaado in laga fogaado carqalad. Anastomosisis ee halbowlaha wadnaha ee xididada ee halbowgareedka radial ayaa loo qabtay dhamaadka, iyo caloosha xididka xididka shucaaca xasaasiga ah ayaa la qabtay dhamaadka dhamaadka.
Baxnaaninta kadib
As As as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as as As Aspirin) Maalintii (muddo 1 bil ah), qaadista culeyska postifit-ka ee ciyaarta la saameeyay waa la oggol yahay, bir bir-ku-biirinta bukaanka, iyadoo kuxiran awoodda bukaanka ee u guuritaanka waqtiga saxda ah ee lagu dhaqaaqo waqtiga saxda ah ee lagu dhaqaaqo. Caawinta isdaba-joog ah ee hal xajin ayaa yareyn kara xanuunka, laakiin taageerada muddada-dheer ee xargaha daruuriga looma baahna. Intoobaanay ayaa laga saaray 2 toddobaad qalliinka ka dib qaliinka ama gacanta dheer si loo ilaaliyo suulka suulka 3 toddobaad ah. Intaas ka dib, gacanta gaaban ee dhiigga suulka ayaa la istcimaalaa ilaa jabku ka bogsado. Raajooyin ayaa loo qaadaa 3-6 toddobaad oo usbuuc ah, iyo bogsashada jabka waxaa lagu xaqiijiyaa CT. Intaa ka dib, dabacsanaan firfircoon oo firfircoon iyo nashaadaadyo fidinta waa in si tartiib tartiib ah loo bilaabayaa, iyo xoogga iyo inta jeer ee jimicsiga waa in si tartiib tartiib ah loo kordhiyaa.
Dhibaatooyinka waaweyn
Dhibaatooyinka ugu waaweyn ee wadajirka jilibka waxaa ka mid ah xanuunka jilibka ama dhaawaca dareemaha. Xanuunka jilibka ayaa inta badan dhacay 6 toddobaad gudahood qalliinka ka dib, oo khasaaro dareemo ama xanuun xanuun leh ayaa la helay dhaawaca dareemayaasha dareemayaasha saphenous. Dhibaatooyinka curcurka ugu weyn waxaa ka mid ahaa laf-dhabarka laf-dhabarka, xanuunka, daciifnimada wadarta, daciifnimada, osteoaarthritis-ka, osteoarthritis-ka, lafaha dhexdhexaadka ah, iyo khatarta lafdhabarta, iyo halista osteotopic oterotopic-ka ayaa sidoo kale la soo sheegay.
Feat Featial Connectir Kasoof gaar ah oo gidaliting lafaha gitaritka ah ee loogu tala galay galka muranka oo leh cirif qurux badan
Waqtiga Post: Mee-28-2024
