Malunion-ka Navicular wuxuu ku dhacaa qiyaastii 5-15% dhammaan jabka ba'an ee lafta navicular, iyadoo necrosis-ka navicular uu ku dhaco qiyaastii 3%. Arrimaha khatarta ah ee malunion-ka navicular waxaa ka mid ah ogaanshaha la'aanta ama dib u dhaca, u dhowaanshaha khadka jabka, barokaca ka weyn 1 mm, iyo jabka oo leh xasillooni la'aan carpal ah. Haddii aan la daaweyn, manuion-ka navicular osteochondral wuxuu inta badan la xiriiraa arthritis-ka naxdinta leh, oo sidoo kale loo yaqaan manuion-ka navicular osteochondral oo leh osteoarthritis-ka oo dumaya.
Tallaalka lafaha oo leh ama aan lahayn daboolka xididdada dhiigga ayaa loo isticmaali karaa in lagu daaweeyo la'aanta lafaha lafaha ee navicular osteochondral. Si kastaba ha ahaatee, bukaanada qaba osteonecrosis ee tiirka u dhow ee lafta navicular, natiijooyinka tallaalka lafaha oo aan lahayn caaradda xididdada dhiigga ma aha kuwo ku qanacsan, heerka bogsashada laftana waa 40%-67%. Taas bedelkeeda, heerka bogsashada ee lafta ee leh daboolka xididdada dhiigga waxay noqon kartaa ilaa 88%-91%. Daboolka lafaha ee ugu waaweyn ee lagu tallaalo xididdada dhiigga ee ku jira dhaqanka caafimaadka waxaa ka mid ah daboolka radius-ka ee 1,2-ICSRA-tipped, tallaalka lafaha + qalabka lagu tallaalo xididdada dhiigga, daboolka radius-ka ee palmar, daboolka lafta iliac ee bilaashka ah oo leh caaradda xididdada dhiigga, iyo daboolka lafta ee femoral condylar medial (MFC VBG), iwm. Natiijooyinka tallaalka lafta ee leh caaradda xididdada dhiigga ayaa ku qanacsan. MFC VBG-ga bilaashka ah ayaa la muujiyay inuu waxtar u leeyahay daaweynta jabka navicular ee leh burburka metacarpal, MFC VBG-na wuxuu adeegsadaa laanta articular-ka ee halbowlaha jilibka ee hoos u dhacaya sidii laanta ugu weyn ee trophic. Marka la barbardhigo dabaqyada kale, MFC VBG waxay bixisaa taageero ku filan oo qaab-dhismeed ah si loo soo celiyo qaabka caadiga ah ee lafta navicular, gaar ahaan osteochondrosis-ka jabka navicular oo leh qaab-dhismeedka dhabarka oo qaloocan (Jaantuska 1). Daaweynta osteonecrosis-ka navicular osteochondral oo leh burbur carpal oo sii socda, daboolka radius-ka fog ee 1,2-ICSRA ayaa la soo sheegay inuu leeyahay heer bogsashada lafta oo ah 40% oo keliya, halka MFC VBG uu leeyahay heer bogsashada lafta oo ah 100%.
Jaantuska 1. Jabka lafta laf-dhabarta oo leh qaab-dhismeed "dhabarka foorarsan", CT wuxuu muujinayaa jabka u dhexeeya lafaha laf-dhabarta xagal qiyaastii 90° ah.
Diyaarinta qalliinka ka hor
Ka dib baaritaanka jireed ee curcurka ay saameysay, waa in la sameeyaa daraasado sawireed si loo qiimeeyo heerka burburka curcurka. Sawirrada caadiga ah ayaa waxtar u leh xaqiijinta goobta jabka, heerka barokaca, iyo joogitaanka dib u soo noqoshada ama sclerosis ee dhamaadka jabay. Sawirrada hore ee dambe waxaa loo isticmaalaa in lagu qiimeeyo burburka curcurka, xasillooni darrada dhabarka ee curcurka (DISI) iyadoo la adeegsanayo saamiga dhererka curcurka ee wax laga beddelay (dhererka/ballaca) ee ≤1.52 ama xagal lunate ah oo ka weyn 15°. MRI ama CT waxay kaa caawin karaan in la ogaado cilladda lafta navicular ama osteonecrosis. Sawirrada dhinaca ama CT-ga sagittal ee lafta navicular oo leh xagal navicular ah oo ka badan 45° waxay soo jeedinayaan gaabinta lafta navicular, taas oo loo yaqaan "leexashada dhabarka ee foorarsan". Calaamadda hoose ee MRI T1, T2 waxay soo jeedinaysaa necrosis ee lafta navicular, laakiin MRI ma laha muhiimad cad oo lagu go'aaminayo bogsashada jabka.
Tilmaamaha iyo waxyaabaha ka hortagga ah:
Navicular osteochondral nonunion oo leh qaab-dhismeed dhabarka foorarsan iyo DISI; MRI waxay muujinaysaa necrosis ischemic ee lafta navicular, dabcinta qalliinka gudahiisa ee wareegga iyo daawashada jabka dhammaadka jabay ee lafta navicular weli waa lafo cad oo sclerotic ah; guuldarada tallaalka lafta ee bilowga ah ama hagaajinta gudaha ee boolalku waxay u baahan tahay tallaal lafo qaab dhismeed VGB oo weyn (＞1cm3). Natiijooyinka qalliinka ka hor ama qalliinka ka hor ee osteoarthritis ee kala-goyska carpal-ka radial; haddii malunion navicular oo muhiim ah oo leh osteoarthritis burburay uu dhacay, markaa waxaa loo baahan karaa in la xakameeyo curcurka, osteotomy navicular, isku-darka afargeeslaha, osteotomy carpal proximal, isku-darka carpal total, iwm.; malunion navicular, necrosis proximal, laakiin leh qaab-dhismeedka lafaha navicular ee caadiga ah (tusaale ahaan, jabka navicular ee aan la barakicin oo leh dhiig yaraanta u socota tiirka proximal); gaabinta malunion navicular oo aan lahayn osteonecrosis. (1,2-ICSRA waxaa loo isticmaali karaa beddelka daboolka radius-ka fog).
Habdhiska La Adeegsaday
MFC VBG waxaa bixiya tiro ka mid ah xididdada yaryar ee trophoblastic interosseous (celcelis ahaan 30, 20-50), iyadoo dhiigga ugu badan uu yahay mid gadaal ka hooseeya kan dheddigga dhexe (celcelis ahaan 6.4), oo ay ku xigto kan hore ee ka sarreeya (celcelis ahaan 4.9) (Jaantuska 2). Xididdada trophoblastic-ga waxaa inta badan bixiya halbowlaha geniculate ee hoos u dhacaya (DGA) iyo/ama halbowlaha geniculate-ka sare (SMGA), kaas oo ah laan ka mid ah halbowlaha dheddigga sare ee sidoo kale keena laamo neerfaha ah oo kala go'an, musculocutaneous, iyo/ama saphenous ah. DGA waxay ka soo bilaabatay halbowlaha dheddigga sare ee u dhow ilaa heerka dhexe ee malleoluska dhexe, ama masaafo dhan 13.7 cm u dhow dusha sare ee articular (10.5-17.5 cm), xasilloonida laantana waxay ahayd 89% muunadaha cadaveric (Jaantuska 3). DGA waxay ka soo bilaabataa halbowlaha femoral-ka ee dusha sare ah oo ah 13.7 cm (10.5 cm-17.5 cm) oo u dhow kala-goysyada malleolus-ka dhexe ama u dhow dusha sare ee articular-ka, iyadoo muunad cadar ah ay muujinayso xasillooni 100% ah oo laamo ah iyo dhexroor qiyaastii 0.78 mm ah. Sidaa darteed, DGA ama SMGA midkood waa la aqbali karaa, inkastoo kan hore uu ku habboon yahay tibiae sababtoo ah dhererka iyo dhexroorka xididka.
Jaantuska 2. Qaybinta afar-geesoodka ah ee xididdada trophoblast-ka MFC ee ku teedsan xariiqda toosan ee u dhaxaysa semitendinosus iyo seedaha dhexe ee A, xariiqda trochanter-ka weyn ee B, xariiqda tiirka sare ee patella C, xariiqda meniscus-ka hore ee D.
Jaantuska 3. Anatomy-ga xididdada dhiigga ee MFC: (A) Laamaha aan caadiga ahayn iyo anatomy-ga xididdada dhiigga ee MFC trophoblastic, (B) Masaafada asalka xididdada dhiigga ee laga bilaabo xariiqda kala-goysyada
Helitaanka qalliinka
Bukaanka waxaa lagu suuxiyaa suuxdin guud isagoo jiifa, iyadoo xubinta ay dhibaatadu saameysey la saarayo miiska qalliinka gacanta. Guud ahaan, laabta lafta deeq-bixiyaha waxaa laga soo qaadaa condyle-ka dhexe ee femoral-ka, si bukaanku uu ugu dhaqaaqo ulo qalliinka ka dib. Jilibka ka soo horjeeda ayaa sidoo kale la dooran karaa haddii uu jiro taariikh hore oo dhaawac ama qalliin ah oo dhinacaas jilibka ah. Jilibka waa la laalaaban yahay sintana dibadda ayaa loo rogaa, lugahana waxaa lagu dhejiyaa labada cidhif ee sare iyo hoose. Habka qalliinka wuxuu ahaa habka Russe ee la dheereeyey, iyadoo jeexitaanku uu ka bilaabmayo 8 cm meel u dhow tunnel-ka carpal-ka ee isdhaafka ah isla markaana si fog uga fidsan geeska radial-ka ee radial flexor carpi radial tenid, ka dibna wuxuu ku laalaaban yahay tunnel-ka carpal-ka ee isgoyska radial flexor carpi radial, ka dibna wuxuu ku laalaaban yahay tunnel-ka carpal-ka ee isgoyska suulka, isagoo ku dhammaanaya heerka trochanter-ka weyn. Goosha seedaha ee seedaha radial longissimus waa la jeexay ka dibna seedaha ayaa si fiican loo jiiday, lafta navicular-kana waxaa lagu soo bandhigay kala-goyn fiiqan oo ku teedsan seedaha madaxa navicular-ka ee radial lunate iyo radial navicular, iyadoo si taxaddar leh loo kala saarayo unugyada jilicsan ee durugsan ee lafta navicular-ka si loogu oggolaado soo-gaadhista dheeraadka ah ee lafta navicular-ka (Jaantuska 4). Xaqiiji aagga aan midoobin, tayada carjawda articular-ka iyo heerka ischaemia ee lafta navicular-ka. Ka dib marka aad furto wareega, fiiri tiirka u dhow ee lafta navicular-ka si aad u ogaato inuu jiro necrosis ischaemic. Haddii necrosis-ka navicular uusan la xiriirin carpal-ka radial ama arthritis-ka intercarpal, MFC VGB ayaa la isticmaali karaa.
Jaantuska 4. Habka qalliinka Navicular: (A) Jeexitaanku wuxuu ka bilaabmaa 8 cm meel u dhow tunnel-ka carpal-ka ee isdhaafka ah wuxuuna fidsan yahay geeska radial-ka ee radial flexor carpi radial tendon ilaa qaybta fog ee jeexitaanka, kaas oo laalaaban salka suulka ee tunnel-ka carpal-ka ee isdhaafka ah. (B) Go'da seedaha ee seedaha radial longissimus waa la jeexay waxaana seedaha loo jiiday si ulnar ah, lafta navicular-kana waxaa soo ifbaxaya kala-goyn fiiqan oo ku teedsan seedaha radial lunate iyo radial navicular. (C) Aqoonso aagga go'itaanka navicular osseous.
Jeexitaan dhererkiisu yahay 15-20 cm ayaa laga sameeyaa meel u dhow xariiqda kala-goysyada jilibka oo ku taal xadka dambe ee muruqa bawdada dhexe, muruqana waxaa dib loogu celiyaa xagga hore si loo soo bandhigo qulqulka dhiigga ee MFC (Jaantuska 5). Dhiigga MFC waxaa guud ahaan bixiya laamaha kala-goysyada ee DGA iyo SMGA, badanaa waxay qaataan laanta kala-goysyada weyn ee DGA iyo xididka la socda ee u dhigma. Xididdada xididdada dhiigga ayaa si dhow loo sii daayaa, iyadoo la ilaalinayo periosteum-ka iyo xididdada trophoblastic ee dusha sare ee lafaha.
Jaantuska 5. Qalliinka loo maro MFC: (A) Jeexitaan dhererkiisu yahay 15-20 cm ayaa laga sameeyay meel u dhow xadka dambe ee muruqa bowdada dhexe ee ka imanaya khadka kala-goysyada jilibka. (B) Muruqu wuxuu dib ugu laabanayaa xagga hore si uu u muujiyo qulqulka dhiigga ee MFC.
Diyaarinta lafta cidhifka
Qalliinka navicular DISI waa in la saxaa oo aagga lafta osteochondral la sameeyaa waa in la diyaariyaa ka hor inta aan la gelin iyadoo la foorarinayo curcurka iyadoo la adeegsanayo fluoroscopy si loo soo celiyo xagal lunate radial caadi ah (Jaantuska 6). Biin Kirschner ah oo 0.0625-foot ah (qiyaastii 1.5-mm) ayaa laga qodaa si toosan laga bilaabo dorsal ilaa metacarpal si loo hagaajiyo kala-goyska lunate-ka radial, farqiga malunion-ka navicular-na waa la soo bandhigaa marka curcurka la toosiyo. Meesha jabka waxaa laga nadiifiyay unugyo jilicsan waxaana si dheeraad ah loogu furay faafiye saxan. Mishiin yar oo is-dhaafsan ayaa loo isticmaalaa in lagu simo lafta loona hubiyo in daboolka la geliyay uu u eg yahay qaab dhismeed leydi ah marka loo eego jeex, taas oo u baahan in farqiga navicular-ka lagu maareeyo meel ballaaran oo dhinaca palmar ah marka loo eego dhinaca dambe. Ka dib marka la furo farqiga, cilladda waxaa lagu cabbiraa saddex cabbir si loo go'aamiyo baaxadda lafta la geliyay, taas oo badanaa ah 10-12 mm dherer ahaan dhammaan dhinacyada la jaray.
Jaantuska 6. Saxitaanka qaab-dhismeedka dhabarka ee qaloocan ee navicular-ka, iyadoo la adeegsanayo foorarsiga fluoroscopic ee curcurka si loo soo celiyo isku-xidhka caadiga ah ee radial-lunar. Biin Kirschner ah oo 0.0625-foot ah (qiyaastii 1.5-mm) ayaa laga qodaa si toosan laga bilaabo dhabarka ilaa metacarpal si loo hagaajiyo kala-goysyada radial lunate, iyadoo la soo bandhigayo farqiga malunion-ka navicular iyo soo celinta dhererka caadiga ah ee lafta navicular marka curcurka la toosiyo, iyadoo cabbirka farqiga uu saadaalinayo cabbirka daboolka u baahan in la qabto.
Lafo-beelka
Meesha xididdada dhiigga ee xuubka femoral-ka ee bartamaha ayaa loo xushay inay tahay aagga laga soo saarayo lafaha, aagga laga soo saarayo lafahana si ku filan ayaa loo calaamadeeyay. Ka taxaddar inaadan dhaawacin seedaha dhexe ee difaaca jirka. Periosteum-ka waa la jeexay, lafta leydi ah oo cabbir ku habboon u leh daboolka la rabo ayaa lagu jaray miinshaar is-dhaafsan, iyadoo la jarayo lafta labaad oo dhinac ah 45° si loo hubiyo daacadnimada daboolka (Jaantuska 7). 7). Waa in taxaddar la sameeyaa si aan loo kala saarin periosteum-ka, lafta cortical-ka, iyo lafta cancellous-ka ee daboolka. Wareegga hoose ee cidhifyada waa in la sii daayaa si loo eego socodka dhiigga ee daboolka, lugta xididdada dhiiggana waa in si dhow loo sii daayaa ugu yaraan 6 cm si loogu oggolaado dhiig-baxa xididdada dhiigga ee xiga. Haddii loo baahdo, xaddi yar oo lafo cancellous ah ayaa lagu sii wadi karaa gudaha condyle-ka femoral-ka. Cilladda condylar-ka femoral-ka waxaa lagu buuxiyaa beddelka lafta, jeexitaankana waa la daadiyaa oo lakab ayaa la xiraa.
Jaantuska 7. Ka saarista daboolka lafaha MFC. (A) Aagga osteotomy ee ku filan inuu buuxiyo booska navicular-ka ayaa la calaamadeeyay, periosteum-ka waa la jarjaray, ka dibna lafta leydi ah oo cabbirkeedu ku habboon yahay daboolka la rabo ayaa lagu jaray miinshaar is-dhaafsan. (B) Laf labaad ayaa laga jaray dhinac 45° si loo hubiyo daacadnimada daboolka.
Ku-tallaalidda iyo hagaajinta booska
Lafaha lafta waxaa loo jarjaray qaabka ku habboon, iyadoo laga taxaddarayo in aan la cadaadin lafta xididdada dhiigga ama laga jarin periosteum-ka. Daboolka si tartiib ah ayaa loogu dhejiyaa aagga cilladda lafaha navicular, iyadoo laga fogaanayo garaaca, waxaana lagu hagaajiyaa boolal navicular godan. Taxaddar ayaa la sameeyay si loo hubiyo in geeska palmar ee baloogga lafaha la geliyay uu ku dahaaran yahay geeska palmar ee lafta navicular ama in uu xoogaa hoos u dhacay si looga fogaado in uu ku dhaco. Fluoroscopy ayaa la sameeyay si loo xaqiijiyo qaab-dhismeedka lafaha navicular, khadka xoogga iyo booska boolal. Xididdada xididdada dhiigga ee laabta ilaa dhammaadka halbowlaha radial iyo caarada xididka ilaa dhammaadka halbowlaha radial (Jaantuska 8). Kaabsal-ka kala-goysyada waa la hagaajiyaa, laakiin farta xididdada dhiigga waa la iska ilaaliyaa.
Jaantuska 8. Ku-tallaalidda laf-dhabarta, hagaajinta, iyo dhiig-baxa xididdada dhiigga. Lafaha si tartiib ah ayaa loogu tallaalaa aagga cilladda lafaha navicular-ka waxaana lagu hagaajiyaa boolal navicular-ka godan ama biinanka Kirschner. Taxaddar ayaa la sameeyaa in geeska metacarpal-ka ee baloogga la beeray uu la socdo geeska metacarpal-ka ee lafta navicular-ka ama si khafiif ah loo niyad jabiyo si looga fogaado in uu ku dhaco. Anastomosis-ka halbowlaha xididdada dhiigga ee u socda halbowlaha radial-ka ayaa la sameeyay dhammaad ilaa dhammaad, waxaana la sameeyay caarada xididka ee xididka radial-ka ee wehelka halbowlaha.
Dhaqancelinta qalliinka kadib
Aspirin afka laga qaato 325 mg maalintii (muddo 1 bil ah), miisaanka qalliinka kadib ee addimada ay dhibaatadu saameysey waa la oggol yahay, joojinta jilibka ayaa yareyn karta raaxo-darrada bukaanka, iyadoo ku xiran awoodda bukaanka ee uu u leeyahay inuu dhaqaaqo waqtiga saxda ah. Taageerada iska soo horjeeda ee hal qalab ayaa yareyn karta xanuunka, laakiin taageerada muddada dheer ee ulaha looma baahna. Tolmada waxaa laga saaray 2 toddobaad ka dib qalliinka waxaana la dhigay Muenster ama gacanta dheer ilaa suulka la saaray muddo 3 toddobaad ah. Intaa ka dib, gacanta gaaban ilaa suulka la tuurayo ayaa la isticmaalaa ilaa jabka uu bogsado. Raajooyin X-ray ah ayaa la qaataa 3-6 toddobaad gudahood, bogsashada jabkana waxaa CT-ga xaqiijisa. Kadib, waa in si tartiib tartiib ah loo bilaabaa dhaqdhaqaaqa dabacsanaanta iyo firfircoonida, xoojinta iyo soo noqnoqoshada jimicsigana waa in si tartiib tartiib ah loo kordhiyaa.
Dhibaatooyinka ugu waaweyn
Dhibaatooyinka ugu waaweyn ee kala-goysyada jilibka waxaa ka mid ah xanuunka jilibka ama dhaawaca neerfaha. Xanuunka jilibka wuxuu inta badan dhacaa 6 toddobaad gudahood qalliinka ka dib, mana jirin wax dareen lumis ah ama neerfo xanuun leh oo ka dhashay dhaawaca neerfaha ee saphenous. Dhibaatooyinka ugu waaweyn ee curcurka waxaa ka mid ahaa la'aanta lafaha aan isku xidhnayn, xanuun, adkaansho kala-goysyada ah, daciifnimo, osteoarthritis-ka sii socda ee curcurka radial ama lafaha intercarpal, iyo khatarta ah in la helo ossification-ka periosteal heterotopic.
Lafaha lafta ee la isku dhejiyay ee loo yaqaan 'Medial Femoral Condyle' oo bilaash ah oo loogu talagalay Scaphoid Nonunions oo leh necrosis-ka xididdada dhiigga ee 'Proximal Pole' iyo 'Carpal' oo burbura
Waqtiga boostada: Maajo-28-2024
