Navicular malunion waxay ku dhacdaa qiyaastii 5-15% dhammaan jabka degdega ah ee lafta navicular, oo leh necrosis navicular oo ku dhaca qiyaastii 3%. Qodobbada khatarta ah ee malunion navicular-ka waxaa ka mid ah ogaanshaha seegay ama dib-u-dhac ku yimid, u dhawaanshaha xariiqda jabka, barokaca ka weyn 1 mm, iyo jab leh xasiloonida carpal. Haddii aan la daweyn, navicular osteochondral nounion inta badan waxay la xiriirtaa arthritis-ka dhaawacyada leh, oo sidoo kale loo yaqaanno navicular osteochondral nounion oo leh burburka osteoarthritis.
Tallaalka lafaha leh ama la'aanteed daboolka xididdada dhiigga ayaa loo isticmaali karaa in lagu daweeyo navicular osteochondral nonunion. Si kastaba ha noqotee, bukaanada qaba osteonecrosis ee cirifka u dhow ee lafaha navicular, natiijooyinka lafaha lafaha iyada oo aan lahayn caarada xididada xididada ayaa ah mid aan ku qanacsanayn, heerka bogsashada lafaha waa 40% -67% kaliya. Taas bedelkeeda, heerka bogsashada lafaha ku tallaalida lafaha xididaysan waxay noqon kartaa ilaa 88%-91%. Lafaha waaweyn ee xididada xididada leh ee ku jira dhaq-dhaqaaqa kiliinikada waxaa ka mid ah 1,2-ICSRA-caarada radius radius, lafo-tallaalid + xirmooyin xididdada xididada maqaar-galaha, palmar radius flap, lafo iliac oo bilaash ah oo leh caarada xididada xididada leh, iyo garabka laf dhabarta femoral condylar (MFC VBG), iwm. Natiijooyinka ku-tallaalidda lafaha ee caarada xididdada dhiigga leh waa kuwo lagu qanco. MFC VBG ee bilaashka ah ayaa lagu muujiyay inay waxtar u leedahay daaweynta jabka navicular ee burburka metacarpal, iyo MFC VBG waxay isticmaashaa laanta articular ee halbowlaha jilibka ee soo degaya sida laanta ugu weyn ee trophic. Marka la barbar dhigo daboolka kale, MFC VBG waxay bixisaa taageero qaabdhismeed ku filan si loo soo celiyo qaabka caadiga ah ee lafaha navicular, gaar ahaan jabka navicular osteochondrosis oo leh cillad dhabarka ah (Jaantus 1). Daawaynta navicular osteochondral osteonecrosis oo leh burbur carpal oo horumarsan, 1,2-ICSRA-caarada radius radius ayaa lagu soo warramey inuu leeyahay heerka bogsashada lafaha kaliya 40%, halka MFC VBG uu leeyahay heerka bogsashada lafaha 100%.
Jaantuska 1. Jajabka lafta navicular oo leh cillad "dib u foorarsan", CT waxay muujinaysaa jabka jaban ee u dhexeeya lafaha cirifka ee xagal qiyaastii 90 °.
Diyaarinta qalliinka ka hor
Baaritaanka jireed ee curcurka ka dib, daraasado sawir-qaadis ah waa in la sameeyaa si loo qiimeeyo heerka burburka gacanta. Shucaaca caadiga ah ayaa faa'iido leh si loo xaqiijiyo goobta jabka, heerka barokaca, iyo joogitaanka resorption ama sclerosis ee dhamaadka jaban. Sawirada hore ee hore ayaa loo isticmaalaa si loo qiimeeyo curcurka oo burburay, xasilooni darada dhabarka ee curcurka (DISI) iyadoo la isticmaalayo cabbir dhererka cududda oo la beddelay (dhererka/ballaadhka) ≤1.52 ama xagal lunate radial ah oo ka weyn 15°. MRI ama CT waxay kaa caawin karaan in la ogaado cillad la'aanta lafta navicular ama osteonecrosis. Shucaaca dambe ama CT sagittal oblique ee lafaha navicular oo leh xagal navicular> 45 ° waxay soo jeedinaysaa gaabin lafta navicular, taas oo loo yaqaan "qalloocin dhabarka ah" MRI T1, T2 calaamad hoose ayaa soo jeedinaysa necrosis ee lafaha navicular, laakiin MRI ayaa leh. muhiimad muuqda ma laha go'aaminta bogsashada jabka.
Tilmaamaha iyo diidmada:
Navicular osteochondral nonunion oo leh naafo dhabarka foorarsan iyo DISI; MRI waxay muujinaysaa necrosis ischaemic ee lafta navicular, dabacsanaan intraoperative ee dalxiiska iyo u fiirsashada jab jaban dhamaadka lafta navicular weli waa lafo sclerotic cad; Fashilka ku-tallaalidda lafaha bilowga ah ama maroojinta hagaajinta gudaha waxay u baahan tahay tallaalid qaab dhismeedka VGB weyn (1cm3). Natiijooyinka qalliinka ka hor ama qalliinka ee osteoarthritis ee wadajirka radial carpal; haddii ay dhacdo malunion weyn oo navicular ah oo leh burburka osteoarthritis, ka dibna curcurka curcurka, osteotomy navicular, fusion quadrangular, osteotomy carpal u dhow, wadarta fiyuuska carpal, iwm, ayaa loo baahan karaa; malunion navicular, necrosis proximal, laakiin leh qaab-dhismeedka lafaha navicular caadiga ah (tusaale, jab aan barakicin navicular oo leh dhiig liidata ilaa cirifka u dhow); gaabinta malunion navicular oo aan lafo-osteonecrosis. (1,2-ICSRA waxa loo isticmaali karaa beddelka xabagta radius fog).
Anatomy la dabaqay
MFC VBG waxaa bixiya dhowr weelal trophoblastic ah oo yaryar (macneheedu waa 30, 20-50), oo leh dhiiga ugu badan ee ka hooseeya kondyle femoral dhexdhexaad ah (macnaha 6.4), oo ay ku xigto hore ka sarreeya (macnaha 4.9) ( Sawirka 2). Maraakiibtan trophoblastic waxaa inta badan bixiyay xididada geniculate artery (DGA) iyo / ama halbowlaha dhexe ee dhexdhexaadka ah (SMGA), kaas oo ah laan ka mid ah halbowlaha femoral ee korka ah kaas oo sidoo kale bixiya laamo jilicsan, musculocutaneous, iyo / ama saphenous dareemayaasha dareemayaasha. . DGA waxay asal ahaan ka timid halbowlaha femoral ee dusha sare ee u dhow dhexdhexaadnimada dhexe ee malleolus medial, ama fogaan ah 13.7 cm oo u dhow dusha articular (10.5-17.5 cm), xasiloonida laanta waxay ahayd 89% ee muunadaha cadarka. (Jaantuska 3). DGA waxay ka timaadaa halbowlaha sare ee femoral artery oo ah 13.7 cm (10.5 cm-17.5 cm) oo u dhow xudunta malleolus fissure ama u dhowaanshaha dusha sare ee articular, oo leh muunado cadcad oo muujinaya xasilloonida 100% iyo dhexroor qiyaastii 0.78 mm. Sidaa darteed, midkoodna DGA ama SMGA waa la aqbali karaa, inkastoo kan hore uu aad ugu habboon yahay tibiae sababtoo ah dhererka iyo dhexroorka markabka.
Jaantus 2. Qaybinta afar-geesoodka ah ee maraakiibta trophoblast ee MFC oo ay weheliyaan xariiqda toosan ee u dhaxaysa semitendinosus iyo ligament dhexdhexaad ah oo dhexdhexaad ah, xariiqda trochanter weyn B, xariiqda cirifka sare ee patella C, xariiqda hore ee meniscus D.
Jaantus 3. MFC vascular anatomy: (A) Laamo ka baxsan iyo MFC trophoblastic vascular anatomy, (B) Fogaanta asalka xididada xididada ee xariiqda wadajirka
Galitaanka qaliinka
Bukaanku waxa lagu meeleeyaa suuxinta guud ee booska dhabarka, iyada oo qaybta ay saamaysay la saaray miiska qalliinka gacanta. Guud ahaan, daboolka lafaha ku-deeqaha ayaa laga soo qaadaa kondhilaha dhexe ee femoral ee ipsilateral, si bukaanku u dhaqaaqo buro qalliinka ka dib. Jilibka iska soo horjeeda ayaa sidoo kale la dooran karaa haddii ay jirto taariikh dhaawac hore ama qaliin dhinaca jilibka ah. Jilibka ayaa jilicsan, sintana dibadda ayaa loo rogaa, dalxiisyada ayaa lagu dabaqaa labada cidhifyada sare iyo hoose. Habka qalliinka ayaa ahaa habka Russe ee la dheereeyey, iyada oo la jeexay laga bilaabo 8 cm oo u dhow tunnelka carpal transverse oo ka sii fogaanaya cidhifka radial ee radial flexor carpi radialis tendon, ka dibna laalaabiyo tunnelka carpal transverse ee salka suulka. , oo ku dhammaanaysa heerka trochanter-ka weyn. Galka seedaha ee radial longissimus tendon waa la jarjaray oo seedaha ayaa si hoose loo soo jiiday, lafta navicular waxaa soo ifbaxaya kala qaybsanaan fiiqan oo ay weheliyaan seedaha radial lunate iyo radial navicular seedaha madaxa, iyada oo si taxadar leh loo kala soocayo unugyada jilicsan ee durugsan ee lafta navicular si loogu oggolaado Soo bandhigid dheeraad ah oo lafta navicular ah (Jaantuska 4). Xaqiiji aagga aan midnimo lahayn, tayada carjawda articular iyo heerka ischaemia ee lafta navicular. Ka dib markaad dabciso dalxiiska, u fiirso cirifka u dhow ee lafta navicular si aad u ogaato in uu jiro necrosis ischaemic. Haddii necrosis navicular uusan la xiriirin radial carpal ama intercarpal arthritis, MFC VGB ayaa la isticmaali karaa.
Jaantus 4. Habka qalliinka ee navicular: (A) Jeexitaanku waxa uu ka bilaabmaa 8 cm oo u dhow tunnel-ka carpal transverse oo wuxuu fidiyaa cidhifka radial ee radial flexor carpi radialis tendon ilaa qaybta fog ee la jeexida, kaas oo la laalaabaya dhinaca salka suulka. ee tunnel-ka carpal transverse. (B) Galka seedaha ee radial longissimus tendon waa la jarjaray oo seedaha ayaa si aan caadi ahayn loo soo jiitay, lafta navicular waxaa soo shaac baxay kala-bax fiiqan oo ay la socdaan seedaha madaxa ee lunate iyo radial navicular. (C) Aqoonso aagga joojinta lafaha navicular.
Jeexitaan dheer oo 15-20 cm ah ayaa lagu sameeyaa meel u dhow xariiqda wadajirka ah ee jilibka oo ku taal xudduudaha dambe ee muruqa femoral ee dhexdhexaadka ah, muruqa ayaa horay u soo noqday si uu u muujiyo saadka dhiigga ee MFC (Jaantus. 5) Sahayda dhiigga ee MFC guud ahaan waa la bixiyaa. Laamaha articular ee DGA iyo SMGA, sida caadiga ah qaadashada laanta weyn ee wadajirka ah ee DGA iyo xididka la socda. Xuubka xididada xididada xididada ayaa si dhow loo sii daayay, iyadoo laga taxadarayo ilaalinta periosteum iyo maraakiibta trophoblastic ee dusha lafta.
Jaantus 5. Qalitaanka MFC ee gelitaanka: (A) Jeexitaan dheer oo ah 15-20 cm ayaa lagu sameeyay meel u dhow xudduudda dambe ee muruqa femoral ee dhexdhexaadka ah ee ka soo baxa khadka wadajirka ah ee jilibka. (B) Muruqa ayaa horay u soo noqday si loo muujiyo saadka dhiigga ee MFC.
Diyaarinta lafta navicular
Naafanimada DISI ee navicular waa in la saxo oo aagga lafta osteochondral la diyaariyo ka hor intaan la gelinin iyadoo la rogayo curcurka hoosta fluoroscopy si loo soo celiyo xagasha lunate ee caadiga ah (Jaantuska 6). 0.0625-foot (qiyaastii 1.5-mm) Kirschner pin ayaa si toos ah loo qodayaa laga bilaabo dorsal ilaa metacarpal si loo hagaajiyo wadajirka lunate lunate, iyo farqiga navicular malunion wuxuu soo baxaa marka curcurku toosan yahay. Meesha jaban ayaa laga nadiifiyay unug jilicsan waxaana lagu sii fidiyay meel furan oo saxan fidsan. Miishaar yar oo is-celcelis ah ayaa loo isticmaalaa si loo simo lafta iyo in la hubiyo in daboolka la gelinayo uu u ekaado qaab dhismeed leydi ah oo ka badan jeex, kaas oo u baahan in faraqa navicular-ka lagu maamulo farqi ballaaran oo dhinaca calaacalaha ah marka loo eego dhinaca dambe. Ka dib marka la furo farqiga, cilladda waxaa lagu qiyaasaa saddex cabbir si loo go'aamiyo xajmiga lafaha, taas oo inta badan ah 10-12 mm dhererka dhammaan dhinacyada tallaalka.
Jaantuska 6. Saxitaanka qalloocsanaanta dhabarka dhabarka ee navicular, oo leh dabacsanaan fluoroscopic ee curcurka si loo soo celiyo isku xirnaanta radial-lunar caadiga ah. 0.0625-foot (qiyaastii 1.5-mm) Kirschner pin ayaa si toos ah loo qodayaa laga bilaabo dorsal ilaa metacarpal si loo hagaajiyo wadajirka lunate lunate, oo soo bandhigaya farqiga malunion navicular iyo soo celinta dhererka caadiga ah ee lafaha navicular marka curcurku toosan yahay, oo leh cabbirka farqiga u saadaaliyay xajmiga daboolka ee u baahan doona in la dhexgalo.
Lafo-beelka
Meesha xididada xididada leh ee kondyle femoral dhexdhexaad ah ayaa loo doortaa meesha laga soo saaro lafaha, iyo aagga lafaha lafaha ayaa si ku filan loo calaamadeeyay. Ka digtoonow inaad dhaawacdo seedaha dammaanadda dhexdhexaadka ah. Periosteum waa la jarjaray, oo xajin lafta leydi ah ee cabbirka ku habboon ee xajinta la rabo ayaa lagu gooyay miishaar soo noqnoqota, iyada oo lafta labaad la gooyey 45 ° oo dhinac ah si loo hubiyo daacadnimada baalka (Jaantus. 7). 7). Waa in taxaddar la sameeyaa si aan loo kala saarin periosteum, lafta kortikal, iyo lafta baajisa ee baalka. Tamashlaha cirifka hoose waa in la sii daayaa si loo eego qulqulka dhiigga ee ka socda baalka, iyo xuubka xididdada xididada waa in loo sii daayaa meel u dhow ugu yaraan 6 cm si loogu oggolaado anastomosis xididdada xiga. Haddii loo baahdo, qadar yar oo lafo ah ayaa la sii wadi karaa gudaha kondhileyska femoral. Ciladda kondhilarka femoral waxaa ka buuxsamay beddelka lafaha, oo la jeexay waa la miiray oo la xidhay lakab.
Jaantuska 7. Ka saarida garabka lafaha MFC. (A) Meesha osteotomy ee ku filan buuxinta navicular waa la calaamadeeyay, periosteum waa la jarjaray, iyo daboolka lafo leydi ah oo cabbirka ku habboon ee daboolka la rabo ayaa lagu gooyay miishaar soo noqnoqda. (B) Qayb labaad oo laf ah ayaa la gooyaa dhinac dhinac ah 45° si loo hubiyo daacadnimada laabta.
Ku dhejinta laabta iyo hagaajinta
Xuubka lafta ayaa loo gooyay qaabka ku habboon, iyadoo laga taxadarayo in aan la cadaadin xuubka xididdada dhiigga ama aan ka xayuubin periosteum. Daboolka ayaa si tartiib ah loogu dhejiyaa aagga cilada lafta xudunta, iyada oo laga fogaanayo garaaca, oo lagu hagaajiyo boolal navicular ah oo bannaan. Waxaa la taxadaray si loo hubiyo in cirifka calaacalaha ee lafta la tallaalay ay la socoto cirifka calaacalaha ee lafta xudunta ama in ay yara niyad jabtay si looga fogaado in ay carqaladeyso. Fluoroscopy ayaa la sameeyay si loo xaqiijiyo qaab-dhismeedka lafaha navicular, xariiqda xoogga iyo booska furka. Anastomose xididka garabka xididada ilaa halbowlaha shucaaca dhamaadka ilaa dhinac iyo cidhifka xididka xididka xididka xididka xididka ilaa dhamaadka (Jaantuska 8). Kaabsoosha wadajirka ah waa la hagaajiyay, laakiin xuubka xididdada xididdada waa la iska ilaaliyaa.
Jaantuska 8. Lafaha lafaha ku dhejinta, hagaajinta, iyo anastomosis vascular. Daboolka lafta ayaa si tartiib ah loogu dhejiyaa aagga cilada lafta navicular waxaana lagu hagaajiyaa biinanka navicular ee bannaan ama biinanka Kirschner. Waxaa laga taxadaray in xudunta metacarpal ee xuubka lafaha la geliyey ay la socoto xudunta metacarpal ee lafta navicular ama si khafiif ah u niyad jabsan si looga fogaado carqalad. Anastomosis ee xididdada xuubka xididdada xididdada xididdada xididdada xididdada ayaa la sameeyay dhammaadka ilaa dhammaadka, iyo caarada xididdada xididdada xididdada xididdada xididka ayaa la sameeyay dhammaadka ilaa dhammaadka.
Baxnaaninta qaliinka kadib
Aspirin afka laga qaato 325 mg maalintii (muddo 1 bilood ah), miisaan-qaadid qaliinka ka dib ee qaybta ay saamaysay waa la oggol yahay, jilibka oo la joojiyo waxay yarayn kartaa raaxo la'aanta bukaanka, iyadoo ku xiran awoodda bukaanka ee dhaqdhaqaaqa waqtiga saxda ah. Taageerada iska soo horjeeda ee hal rujin ah ayaa yarayn karta xanuunka, laakiin taageerada muddada dheer ee ulaha looma baahna. Tolmada ayaa la soo saaray 2 usbuuc ka dib qalliinka iyo Muenster ama gacanta dheer ee kabka suulka ayaa lagu haayay meel ilaa 3 toddobaad ah. Intaa ka dib, gacanta gaaban ee suulka kabka ah ayaa la isticmaalayaa ilaa uu jabku ka bogsado. Raajooyinka waxaa la qaadaa 3-6 toddobaad gudahood, bogsashada jabka waxaa xaqiijiyay CT. Ka dib, dhaqdhaqaaq firfircoon oo firfircoon iyo waxqabadyo fidinta waa in si tartiib tartiib ah loo bilaabo, iyo xoojinta iyo inta jeer ee jimicsiga waa in si tartiib tartiib ah loo kordhiyo.
Dhibaatooyinka waaweyn
Dhibaatooyinka ugu waaweyn ee wadajirka jilibka waxaa ka mid ah jilibka xanuunka ama dhaawaca dareemayaasha. Xanuunka jilibka wuxuu inta badan dhacay 6 toddobaad gudahood qalliinka ka dib, mana jirin wax dareen ah oo lumay ama neuroma xanuun leh oo ay ugu wacan tahay dhaawaca neerfaha saphenous. Dhibaatooyinka curcurka ee ugu weyn waxaa ka mid ah lafo-la'aan la'aan, xanuun, qallafsanaan wadajir ah, daciifnimo, osteoarthritis horusocod ah ee curcurka radial ama lafaha intercarpal, iyo khatarta ah ossification heterotopic periosteal ayaa sidoo kale la soo sheegay.
Dhexdhexaadiyaha Femoral Condyle Vascularised Lafo Tallaal ah oo loogu talagalay Scaphoid Nonunions oo leh Proximal Pole Avascular Necrosis iyo Burburka Carpal
Waqtiga boostada: Meey-28-2024
