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Dołączył: 21 Lut 2011
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Skąd: England
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 Wysłany: Śro 19:44, 23 Mar 2011 Temat postu: herve leger skirt rkv lgd ijpw kdf |
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Peptide plate fixation for calcaneal intraarticular calcaneal fractures
relTitaniumplateinternalfixation intraarticular calcaneal fractures are more common in clinical practice, accounting for more than Qicheng fractures, non-surgical treatment is ineffective, often complicated by pain, high disability, severely affect the function of the affected foot. Our hospital from June 2001 to June 2007 with plate fixation of calcaneal articular fractures of the calcaneus of 30 feet, satisfactory effect, reported as follows. 1 Data and methods 1.1 General Information The group of 25 cases, the male l8 7 women, aged 18 to 56 years, 10 cases in which the left and right in 10 cases, bilateral in 5 cases. Which falls in 19 cases, 4 cases of accident, the other 2 cases. All patients underwent preoperative calcaneal lateral and axial X amount of lines to horizontal position and status bit CT scan. According to Sanders classification, Ⅱ-type 18 feet, Ⅲ 4-foot, Ⅳ type 3 feet. 1.2 surgical procedure in general anesthesia under tourniquet control, the contralateral lateral position to take unilateral calcaneal fracture, bilateral access prone position, surgical incision to take lateral calcaneal L, 4cm from the tip of the fibula in the lateral and posterior margin with the key, between the midpoint of the heel and lateral bending forward,[link widoczny dla zalogowanych], parallel to the foot until the fifth metatarsal base, full-thickness skin incision,[link widoczny dla zalogowanych], directly to the periosteum, will work with ligament, tendon peroneal block up the skin peeling, with a fine Kirschner wire into the talus and lateral malleolus to retract the flaps to expose the front of the subtalar joint and heel joints. And then into the intra-articular calcaneal Kirschner wire and longitudinal traction and lateral traction manual reduction, confirmed by the perspective reset shaping the appropriate choice of the calcaneus and placed lateral calcaneal plate with screws, then rinse, bleeding, put negative pressure drainage tube,[link widoczny dla zalogowanych], followed by stitching layers, pressure bandage. Without external fixation postoperatively, with conventional antibiotics to prevent infection. After 10 ~ l6 weeks to weight-bearing walking. 2 Results All patients were followed up for 6 to 25 months, all fractures healed without plate fracture, screw loosening. 1 case of postoperative local skin dehiscence healed by dressing change, according to Maryland foot scoring system,[link widoczny dla zalogowanych], excellent in 15 feet, good in 8 feet, 2 feet. 3 Discussion 3.1 The operative indication and timing of Sanders Ⅱ type, Ⅲ type,[link widoczny dla zalogowanych], some type Ⅳ fracture patients can be as long as their circumstances permit open reduction and fixation. The correct treatment is to reduce operative complications. 6h local edema after calcaneal fracture is not very serious, significantly worse after, 24h after the tension often appear in patients with blisters, blisters, or swelling of the time if surgery could easily lead to complications such as skin necrosis and infection, therefore, if the patient's body permits, 6h after injury experts and emergency surgery, or Taigaohuanzhi swelling, swelling until 7 ~ 14h after surgery. 3.2 points surgery recovery Bohler angle and Gissane angle: the key to recovery Bohler angle reduced stresses on the moving blocks of calcaneal tuberosity fracture after reduction and sinking of the articular surface reduction and Kirschner wire can be used with bone chisel or bend tissue cut into pieces following the collapse of the articular surface fracture pry reset; Gissane normal angle of 120 ~ 145. If this angle increases are prompted for displaced articular surface, this angle is the key to recovery will reset the articular surface after the sinking. Restore the height of the calcaneus: restoration of calcaneal height and poking reduction should pay attention to reset the bone defects after bone fill. Allogeneic bone graft used, saving time than from the bone, but note should be slightly larger than the bone allograft, which insert into a more solid, is conducive to the maintenance of Bohler angle. Restore the width of the calcaneus: just use two hands simultaneously inside and outside pressure or tapping with a hammer to the relocation of the lateral wall of the calcaneus. 3.3 The advantages of internal fixation of calcaneal calcaneal plate titanium plate under the heel of the anatomy and biomechanics to design and has good biocompatibility, make anatomical reduction, internal fixation, reliable, functional exercise in patients with early stage can be to avoid is not firmly fixed, calcaneal calcaneal height reduction caused by bad lower heel wider and traumatic arthritis.
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