Ho robeha ha Motheo oa The Fifth Metatarsal

Kalafo e fosahetseng ea fractures ea bohlano ea metatarsal base e ka lebisa ho fracture nonunion kapa ho lieha ho kopana, 'me linyeoe tse matla li ka baka ramatiki, e nang le tšusumetso e kholo bophelong ba letsatsi le letsatsi le mosebetsi oa batho.

AnatomicalStructure

Metatarsal ea bohlano ke karolo ea bohlokoa ea karolo ea lateral ea leoto, 'me e phetha karolo ea bohlokoa ho boima ba 'mele le botsitso ba leoto.Metatarsal ea bone le ea bohlano le cuboid li theha lenonyeletso la metatarsal cuboid.

Ho na le li-tendon tse tharo tse khomaretsoeng botlaaseng ba metatarsal ea bohlano, peoneus brevis tendon e kenya ka lehlakoreng la dorsolateral la tuberosity botlaaseng ba metatarsal ea bohlano;mesifa ea boraro ea peroneal, e seng matla joaloka peroneus brevis tendon, e kenya diaphysis distal ho ea bohlano ea metatarsal tuberosity;the plantar fascia The lateral fascicle e kenya ka lehlakoreng la semela la basal tuberosity ea metatarsal ea bohlano.

Phapang ea ho robeha

Ho robeha ha motheo oa metatarsal ea bohlano ho ile ha aroloa ke Dameron le Lawrence,

Ho robeha ha Zone I ke ho robeha ha fractures ea metatarsal tuberosity;

Zone II e teng moo ho amanang teng pakeng tsa diaphysis le proximal metaphysis, ho kenyelletsa le manonyeletso a pakeng tsa 4th le 5th metatarsal masapo;

Ho robeha ha Zone III ke ho robeha ha khatello ea maikutlo ho proximal metatarsal diaphysis distal ho ea 4th/5th intermetatarsal joint.

Ka 1902, Robert Jones o ile a qala ho hlalosa mofuta oa karolo ea II ea ho robeha ha motheo oa metatarsal ea bohlano, kahoo karolo ea II ea fracture e boetse e bitsoa Jones fracture.

Ho robeha ha methapo ea methapo ea metatarsal sebakeng sa I ke mofuta o tloaelehileng haholo oa bohlano ba metatarsal base fracture, e ikarabellang bakeng sa hoo e ka bang 93% ea fractures eohle, 'me e bakoa ke ho phunyeha ha limela le pefo ea varus.

Ho robeha sebakeng sa II ho etsa hoo e ka bang 4% ea fractures tsohle botlaaseng ba metatarsal ea bohlano, 'me e bakoa ke ho phunyeha ha leoto la limela le pefo ea adduction.Hobane li fumaneha sebakeng sa metsi a phepelo ea mali botlaaseng ba metatarsal ea bohlano, ho robeha sebakeng sena ho tloaelehile ho folisa kapa ho lieha ho fola.

Ho robeha ha Zone III ho etsa hoo e ka bang 3% ea maqeba a bohlano a metatarsal base.

Kalafo e hlokang tlhokomelo

Lipontšo tse ka sehloohong bakeng sa phekolo e tsitsitseng li kenyelletsa ho falla ha fracture ka tlase ho 2 mm kapa fractures e tsitsitseng.Liphekolo tse tloaelehileng li kenyelletsa ho thijoa ka maqhama a rekere, lieta tse solloed thata, ho thijoa ka samente e entsoeng ka samente, lipampitšana tsa lik'hateboto kapa lieta tse tsamaeang.

Melemo ea phekolo e tsitsitseng e kenyelletsa litšenyehelo tse tlaase, ha ho na kotsi, le ho amoheloa habonolo ke bakuli;mefokolo e kenyelletsa maemo a phahameng a ho robeha ha lenonuni kapa ho lieha ho kopana ha mathata, le ho satalla ha manonyeletso habonolo.

Ea buoangTreatment

Matšoao a kalafo ea opereishene ea fractures ea bohlano ea metatarsal e kenyelletsa:

1. fracture displacement e fetang 2 mm;

1. Kenyeletso ea > 30% ea bokaholimo ba mokokotlo oa cuboid distal ho ea ho metatarsal ea bohlano;

1. Ho robeha ho sa khaotseng;

1. Ho robeha ho lieha ho kopana kapa ho se kopane ka mor'a phekolo e sa buuoeng;

1. Bakuli ba bacha ba mafolofolo kapa baatlelete ba lipapali.

Hona joale, mekhoa e tloaelehileng ea ho buoa bakeng sa ho robeha ha motheo oa metatarsal ea bohlano e kenyelletsa "Kirschner wire tension band internal fixation", "anchor suture fixation" ka khoele, "screw internal fixation" le "hook plate" ea ka hare.

1. Kirschner terata tsitsipano sehlopha fixation

Kirschner wire tension band fixation ke ts'ebetso e batlang e tloaelehile ea ho buoa.Melemo ea mokhoa ona oa phekolo e kenyelletsa ho fihlella habonolo lisebelisoa tsa ho lokisa ka hare, theko e tlaase, le phello e ntle ea compression.Mefokolo e kenyelletsa ho halefa ha letlalo le kotsi ea ho theola mohala oa Kirschner.

2. Suture fixation le liankora threaded

Anchor suture fixation e nang le khoele e loketse bakuli ba nang le fractures ea avulsion botlaaseng ba metatarsal ea bohlano kapa ba nang le likhechana tse nyenyane tsa fracture.Melemo e kenyelletsa sekala se senyenyane, ts'ebetso e bonolo, 'me ha ho hlokahale ho tlosoa ha bobeli.Mefokolo e kenyelletsa kotsi ea ho ata ha anchor ho bakuli ba nang le lefu la ho fokola ha masapo..

3. Ho lokisa manala a sekoti

Hollow screw ke kalafo e sebetsang e tsebahalang lefatšeng ka bophara bakeng sa ho robeha ha motheo oa metatarsal ea bohlano, 'me melemo ea eona e kenyelletsa ho tiea ho tiileng le botsitso bo botle.

Ka meriana, bakeng sa fractures tse nyenyane botlaaseng ba metatarsal ea bohlano, haeba li-screws tse peli li sebelisetsoa ho lokisa, ho na le kotsi ea ho refracture.Ha screw e le 'ngoe e sebelisoa bakeng sa ho lokisa, matla a khahlanong le ho potoloha aa fokola,' me ho ka khoneha ho falla.

4. Hook plate e tsitsitse

Ho lokisa poleiti ea hook ho na le matšoao a mangata, haholo-holo ho bakuli ba nang le fractures ea avulsion kapa osteoporotic fractures.Sebopeho sa eona sa moralo se lumellana le motheo oa lesapo la bohlano la metatarsal, 'me matla a khatello ea ho lokisa a batla a phahame.Mefokolo ea ho lokisa poleiti e kenyelletsa litšenyehelo tse phahameng le ts'oaetso e batlang e le khōlō.

Summary

Ha ho phekoloa fractures botlaaseng ba metatarsal ea bohlano, ho hlokahala hore u khethe ka hloko ho ea ka boemo bo itseng ba motho ka mong, phihlelo ea botho ea ngaka le boemo ba botekgeniki, 'me u nahane ka botlalo ka litakatso tsa mokuli.