Navicular. Mafupa phazi: kaswili

Mu thupi la nambala yaikulu mafupa anthu. Makamaka zambiri za m'madera amenewa yoyamikira thupi mapazi ndi woimbayo. Ambiri mafupa zolumikizana tendons, kuthandiza kugwira ntchito, ndilo kuwerengedwa nyama, koma kuti ena kuposa anyani. A dongosolo zovuta za manja ndi mapazi, ngakhale ali wambirimbiri minofu connective poyera kuti kuvulala zosiyanasiyana ndi matenda. The ambiri kawirikawiri anakumana - wovulala. Lingaliro kugwirizana ndi mafupa vuto ndi kukondera zotheka. Manja ndi mapazi, monga zanenedwa, ambiri matupi awa, amene si amasiyana kukula, kotero muyenera kuchitira iwo nthawi yambiri. Navicular kwambiri atengeke matenda ndi kuvulala.

phazi

mwendo fupa akupereka ndalama yaikulu. Ena mwa iwo ndi ogwirizana ndi dzina wamba phazi. Navicular uli chabe kwa gulu ili. Malowa ali pamtunda pakati talus ndi, cuboid, ndi wapakatikati mafupa zakale. Ndi malo a phazi, kupatulapo zala, nthawi zambiri sachedwa fractures.

Mafupa phazi, thunthu chomwe magulu atatu, ambiri ndithu: ndi Tariso, metatarsus ndi zala. Mafupa metatarsal phazi monga mabungwe awo ndi scaphoid. Malowa ali pamtunda pafupi mbali lamkati la phazi. Pa m'mphepete ake anaika tuberosity la fupa navicular kunsi. Mu mankhwala, mbali ntchito kudziwa m'chipinda chotetezeka, amene ali oyima. X-ray awathandize kumvetsa kapangidwe ka gawo ili la thupi.

burashi

Navicular fupa, kuwonjezera, lili burashi lapansi. Adzaupereka kwa mafupa ka polumikizira. Ndi ambiri amakonda wovulala, monga ili m'mphepete mwa pachikhatho cha. N'zochititsa chidwi kuti munthu amene anathyola mafupa, Kodi Simumva kuwawa kwambiri ndipo sanathe kumva yotupa, ngakhale amphamvu. Choncho, ndi ngozi ndithu. Ngati mulibe dokotala, pangakhale mavuto aakulu. Mwachitsanzo, fupa navicular umatha kukula pamodzi.

dzanja imakhala mafupa 8. Iwo apanga mizere iwiri iliyonse kuphatikizapo anayi a iwo, zomwe zili pakati pa mafupa metacarpal ndi mkono. Scaphoid zovuta kupeza chifukwa malo ake. Ndi pakati pa tendons wa extensor hallucis longus ndi yaitali abductor minofu.

Matenda a mafupa phazi

Kuwonjezera fupa lothyoka ndi phazi navicular fupa poyera ndi kuvulala zina ndi matenda. Mwachitsanzo, matenda Kellerra. Osteohondropatija angathe kutumikira monga mtumiki wa matenda. Zingamvekere mafupa onse phazi. Pang'onopang'ono wawononga minofu. Pa matenda pang'ono magazi umaperekedwa mafupa, ndipo, choncho mpweya ndi zakudya zikusowa. Choncho, maselo samapeza mpweya izi, ndi zina zigawo zikuluzikulu zofunika, pang'onopang'ono. Komabe, n'zimene matenda Keller, popanda alowererepo ya matenda.

Zimayambitsa matenda Keller

matenda Keller sangathe zimachitika palokha. Kwa iye, pali zifukwa zingapo kuti pena kulepheretsa Ndime ya magazi mafupa. Nthawi zambiri ndi choipa phazi Mwachitsanzo, yotupa amphamvu kapena wovulala. Komanso matenda atengeke amene kuvala nsapato wovuta kukula ang'onoang'ono. Arthrosis ndi nyamakazi - matenda amene kumayambitsa matenda Keller a. Kuwonjezera zifukwa pamwamba, kobadwa nako mapindikidwe mafupa phazi angathe kuyambitsa kuwonongeka. Lathyathyathya - wina ziwonongeke chachikulu. Koma zifukwa zomwe zimakhudza maonekedwe a matenda, sanapezeke ngakhale lero.

mawonekedwe

mafupa mwendo poyera mitundu iwiri ya matenda Keller. Zonse zimadalira gawo la phazi salandira zakudya zokwanira ndi oxygen.

Ndi kugonjetsedwa kwa navicular matenda a mafupa amatchedwa matenda Keller 1. Ngati magazi si aperekedwe kwa atsogoleri a mafupa wachiwiri ndi wachitatu metatarsal chopita kusintha iwo, umatchedwa matenda Keller 2.

Komanso, kusiyana magawo angapo:

• Necrosis.
• Psinjika wovulala.
• Kugawikana.
• Kubwezeretsa fupa.

Pa gawo loyamba kufa matabwa osseous, zimene zimapanga monga structural mafupa. Komanso, mapangidwe zidutswa latsopano la fupa, nthawi zambiri kuphwanya chifukwa mphamvu osauka. Ndiye kuyimisa nchito matabwa fupa. Ndipo gawo lomaliza amadziwa mogwirizana ndi udindo.

matenda Keller wa chithandizo

Ayenera pansi mankhwala a mafupa phazi. Matenda a iwo chovuta kwambiri, kotero iwo ndi zobvuta kuchiza. Matenda Keller 1, nthawi zambiri ndi wovulala fupa navicular amapezeka. Iwo angalakwitse chifukwa yotupa, ndipo matenda ndi povuta kuti azindikire. Ngati kokha odwala ngozi musati kuchipatala. Atapita pa njira ya chithandizo. Fupa la dzina chomwecho akali dzanja, koma adzatchedwa kale matenda Ireysera, ngakhale mankhwala mfundo ndi chimodzimodzi.

Ndiwofatsa mankhwala - imodzi mwa njira zothandiza kwambiri mankhwala. Komanso chikangoperekedwa ndi pulasitala. Ambiri phazi ali osavomerezeka kusuntha, chifukwa ngati yaing'ono ndi sagwirizana nazo mu mawonekedwe fupa ndi ovuta kugwila. Pambuyo kuchotsa pulasitala, pofuna kupulumutsa zotsatira, muyenera nthawi zina kuyenda ndi ndodo kapena ndodo, ana adasoka insoles wapadera. Mankhwala akhoza imathandizira maphatikizidwe. zothandiza kwambiri matenthedwe njira.

unacceptably

Ndi yovuta kwambiri pambuyo kuchotsa pulasitala kuzitsutsa. Mwendo tikusowa mtendere wamuyaya. Komanso pali kuthekera kwa maphatikizidwe lolakwika ndi mapangidwe limodzi wonyenga, amene ali ovuta kuchiza. Muyenera opaleshoni. Choncho, ndondomeko konzanso ayenera kugwiridwa mosamala kwambiri. Komanso, inu mukhoza kutenga yekha mankhwala amene ali zotchulidwa dokotala, mwinamwake inu mukhoza zinthu zingangoipiraipira mwendo. Simungathe malangizo a dokotala, chifukwa munthu aliyense ali lake makamaka. Ena mwa mafupa osalimba chibadwire kotero iwo ayenera kulankhula ndi mwapadera kuti mankhwala a matenda.

Bone wovulala kudzanja lake

Monga tanenera kale, navicular manja fupa ndi mapazi kuti atengeke wovulala chiopsezo. Ichi ndi chifukwa chakuti pa phazi, ndi mafupa dzanja anakonza mu malo oterewa omwe zimachitika kawirikawiri kwambiri anavulala. Ngati inu mukuyang'ana pa ziwerengero, mu nkhani ya dzanja wovulala anavutika 61-88% izo navicular.

Zimayambitsa wovulala

Koma pazifukwa zina pali wovulala fupa? Monga mmene kumapeto, ambiri amavulala ndi kugwa m'manja mwake. Pankhaniyi, katundu pafupifupi kwathunthu kugona fupa. Amasiyana okha fractures: articular ndi kwapakati pa-articular.

zizindikiro

Navicular zambiri maganizo. Koma pambuyo kuswa zimakhala ukuwawa. Ambiri sadziwa basi zindikirani kusapeza kuganiza kuti izo zangokhala yotupa. Komabe, dokotala posachedwapa. Navicular bwino mankhwala, ndipo ngati mulibe enieni kugwiritsa kucuruka kwa maphatikizidwe ake, koma akhale zotsatira mpaka kalekale. Mwatsoka, onse ndipite ku chipatala. Nthawi zambiri anapeza wosweka mwachisawawa. Mukhoza kusankha zizindikiro zina zimene zingathandize kudziwa choipa:

• Ululu fupa navicular.
• Anachitazi mu gulu mfundo manja.
• chopweteka kwambiri kutambasuka kwa utali wozungulira wa.
• Plumpness za m'dera.

diagnostics

Mofanana ndi fractures fupa pa dzanja, ndi navicular choipa fupa pa mwendo wake kwambiri kuthetsa kuvutika. X-ray akuthandizeni kupeza chifukwa cha ululu. Poyamba anachita mu 3D ziyerekezo zida, amene ankafufuza woyendera nthambi mu zolosera atatu. Mu ndime yomaliza kuoneka bwino wovulala (vuto) ndi navicular fupa. Zonsezi ikuchitika chifukwa chakuti fupa navicular zedi bwino n'ngochiritsika, wazunguliridwa ndi matupi ena. Kuti bwino molondola ntchito pulasitala, akusowa ziyerekezo 3D.

Pali subtleties. Mwachitsanzo, zala ayenera wothinikizidwa mu nkhonya a. Ngati wovulala sakhala pomwepo ziwonekera X-ray, ndi zizindikiro zonse ndi, wozunzidwayo ndi pulasitala pafupifupi 2 masabata, ndiye bwezerani kuti ankakhulupirira adafikapo. Chinthu ndi kuti panthawi imeneyi pali resorption ndi fupa lothyoka ndi kuoneka bwino, pokhapokha, ndithudi, ndi kupezeka pa onse. Activities kuthandiza kukhazikitsa matenda ndi mankhwala mankhwala.

chithandizo fupa

Navicular fupa pa dzanja kaŵirikaŵiri waswa kudziwa kovuta. Kudziwa ndi fupa lothyoka ali amachita 3D ziyerekezo. Koma wovulala mankhwala yaitali ndi zovuta. Kuphatikiza fupa abwera mwangwiro chifukwa endosteal callus kuti ndipamene pang'onopang'ono ndipo amafuna ndalama zambiri zomanga thupi (magazi). N'zotheka kusamutsidwa kwa mpukutu wapotalikira. amatsogolera onse pamwamba mapangidwe pseudoarthrosis, ndipo potero complicates kale osati mankhwala mosavuta.

njira 1. Chithandizo cha kuvulala atsopano

Chophweka njira maphatikizidwe manja scaphoid - ndi imposition a pulasitala lapansi. Amapezeka kaŵirikaŵiri, amagwiritsidwanso ntchito mu 90-95% ya milandu. Anakuta amachokera ku mitu ya mafupa metacarpal mpaka m'zigongono, ndi kulanda kuvomerezedwa imatengedwa ndi gulu la phalanx ya chala chaching'ono. Burashi amakhalabe amodzi koma kwa mayiko, anthu a udindo wake ali maonekedwe a kutambasuka yaing'ono. Immobolizatsiya burashi kumatenga 11 milungu. Ngati wovulala zinachitika ndi tubercle, ndi masabata 4 okha. Pambuyo kuchotsa pulasitala ndi kuvomerezedwa x-ray, umene tisonyeze ngati panali maphatikizidwe bwino. Ngati kusiyana ndi wapezeka, ndi pulasitala bandeji umagwiritsidwa kachiwiri, koma kwa miyezi 1-2, ndipo ulamuliro wa maphatikizidwe kumachitika mwezi uliwonse. Pambuyo mankhwala Inde chikuchitika achire.

Zakunja mankhwala ndiwofatsa ndi:

• ntchito nthawi.
• Permanent kulamulira madokotala.

njira zina. Chithandizo cha kuvulala akale

Ngati wovulala ndi wapezeka pokhapokha miyezi 3, amaona akale. Pa nthawi imeneyo, nthawi kukula limodzi onyenga. Izi complicates chithandizo. Kugwiritsa X-ray ndi fupa lothyoka malo, komanso kudziwa kupezeka kwa cavities cystoid ndi diastasis pakati zidutswa. Mu nkhani iyi, imposition a pulasitala sangathe kuthandiza. Ntchito imodzi mwa njira zambiri, wotchuka kwambiri:

1. Bone kumezetsanitsa yokhudza kotekisi kumezanitsa.
2. Bone kumezetsanitsa Matti-Russe.

Bone kumezetsanitsa yokhudza kotekisi kumezanitsa

njira anatulukira kumbuyo mu 1928. Izo ntchito ndi fractures sanali ogwirizana ndi mfundo zabodza za fupa navicular. Back-mtengo kupeza ntchito mankhwala ochititsa dzanzi pa opaleshoni. Popanda kuwononga, popanda okhudza mitsempha zozungulira, pali mwayi polumikizira. Rassekanie kapisozi wake amathandiza kuti azindikire olowa onyenga. Pambuyo opaleshoni ndi superimposed adayikamo mofanana kuti tafotokozazi. Ndi, muyenera kutenga 14 masiku. Ndiye kuchotsa matabwa ndi ntchito ali ndi bandeji zozungulira. Ntchito ya mbale fupa zambiri amanyamula kumezanitsa chofewa ngati siponji.

Bone kumezetsanitsa Matti-Russe

Imodzi mwa ntchito zothandiza kwambiri. Koma ndi wosavuta. Iye unakhetsedwa kumunda, koma magazi potero pafupifupi sakhala kuvutika. Ziziyenda bwino mu scaphoid ntchito masipoko. Fupa kumezanitsa wedges. Pre-pamalo a masipoko ndi salola zinyalala kusakanikirana. Immobolizatsiya limatenga 10 masabata. Kuchotsa atayankhula amapezeka pambuyo masabata 8.

phazi wovulala

Monga tanenera kale, mafupa tarsal ambiri atengeke zosiyanasiyana kuvulala. Nthawi zambiri wovulala zimachitika atagwa chinthu chinachake okwana lapansi. Nthawi zina akuvutika sindiwe fupa limodzi, koma zingapo, monga iwo zili umakhala pafupi wina ndi mzake ndi kukula yaing'ono. Mofanana ndi fupa navicular wa polumikizira, musazengereze chithandizo. Komabe, phazi ndi zosavuta kuchitira. Pomwepo navicular wovulala amapezeka mwina chifukwa kugwa chinthu ndi kulemera lalikulu kapena chifukwa psinjika a pakati ena. osiyanasiyana ndithu fupa la thunthu phazi ambiri mitundu.

zizindikiro

Kuwulula wovulala fupa navicular phazi ndi mosavuta kuposa burashi. Mu nkhani ya choipa cha mtundu umenewu kuli kovuta kuyenda bwinobwino, pali kupweteka m'thupi. Komanso, zozungulira zoyenda stupnoy zikusonyeza potsiriza wosweka, fupa zimapangitsa lokha anamva. Koma nthawi zoopsa scaphoid pamodzi ndi kuvulala mafupa ena phazi, makamaka, ndi Tariso.

phazi chithandizo fupa

Kudziwa kukula ndi malo mng'alu ndi, zokwanira kupanga X-ray mu zolosera 2, osati 3, monga izo zinali ndi navicular burashi fupa. Pokhapokha panali anasintha, ndiye superimposed osewera mwachizolowezi. Koma ngati zinachitika, zinandipangitsa muyike pena. Mu Zikavuta kwambiri, oongola mafupa imagwiridwa. ponyani umagwiritsidwa ndi avareji ya masabata 4.

Pomaliza, tinganene kuti kuposa wina aliyense mafupa navicular wa dzanja ndi mwendo poyera kuti choipa. Mankhwala ake amatenga nthawi yaitali nthawi zambiri amachita ntchito. Komabe, merging la fupa pa phazi zambiri msanga ndiponso mosavuta. Azindikire wovulala pa dzanja ndi kovuta, ndipo nthawi zambiri zimachitika mwangozi. Navicular fupa la phazi pamene ming'alu kwambiri ukuwawa.