- Ket hqfp xtfdng vtfng (co dinh ngo&i)
3.GAY XUONG, TRAT KHdP 6 CO CHAN 1 Trat khdp ddn thuan d cd chan
It gap, thUdng do ban chan bi ved trong m anh, gay trat khdp sau trcng.
Hau het den 90% la trat khdp hd co vet thUdng. Khi bi trat hd, c in md cap ctiu n in vao, khau cac day c h ln g ben ngoai bi rach. Bo bot 6 tu ln . Theo doi ket qua xa la tot, 1 ty le thap bi kem viing khdp cd chan song co 1 ty le cao bi viem khdp thoai hoa.
3.2. Gay xifdng mat ca ngoai
Chi dinh khong mo. neu:
- Gay rieng m lt ca ngoai dadi khe khdp chay sen vdi di lech dudi 3mn.
- Khdp chay sen dUdc nan vao dung giai phau 100%. TrUdng hdp nay. lam bot co de ty de di, de bot 6 tuan.
Theo doi xa nhom benh nhan co thUdng ton nhu vtia neu, so sanh gitia nhom benh nhan dUdc mo cd dinh trong vdi nhom benh nhan khong mo, thi thay ket qua nh a nhau. Nghla la khong nen chi dinh mo.
Nhiing tradng hdp can can nhac giaa cach dieu tri khong md va co mo + M at ca ngoai gay cao ngang hay tren khdp chay sen
+ XUdng sen con bi lech ra ngoai, du chi la bi lech 1mm vi luc nay khdp chay sen bi hong 42% se bi thoai hoa khdp.
+ Tren phim X quang, thay khe khdp giiia xUdng sen va m at ca trong rong ra hdn binh thadng. Binh thadng khe khdp giiia xUdng sen vdi gong mong la deu dan, chifng 3mm.
Luc nay, thadng nen md co dinh xUdng mac, lap lai 100% giai phiu khdp c h ly sen, neu chUa dat 100% c in md kiem tra d m l t ca trong.
3.3. Gay cac mat ca, trat chay sen, toac g?ng mong (hinh 25.1)
Thadng tdn nay nang, song kha pho bien. Thtidng g$p sau nga cao, cd chan bi
- Co chan bi veo ra
- Doi khi co chan bi veo vao
- Co khi co chan bi gay do lUc nen theo true
Hinh 25.1. G iy mat ca, trat xtfdng sen
Co’ chan chong bi stfng to, can kham sd dong mach mu chan va dong mach chay sau d sau m lt ca trong. Neu ban chan bi tim, lanh, cin cap ctfu keo nin thang ban chan de giai phong mach mau.
Sau dc, chup X quang cd chan, cin giii cho ban chan xoay trong 20° de hien ro, deu khe khdp cd chan.
• Cac thiictng ton khi ban chan bi veo ngoai
- Xtfdng mac bi gay cheo xoan, co the co manh rdi, ndi gay cao tren m lt ca ngoai 6-8cm, xtfdng mac gay do ltfc nen.
- M at ca trong bi gay ngang do ltfc keo, khi m lt ca trong khong gay thi bi dtft dSy c h ln g Denta.
- Gong m ong chay mac bi toac, cac day c h ln g c h ly m ac trtfdc va sau bi dtft. M ang lien cot bi rach.
- Xtfdng sen bi lech ra ngoai l-3m m , tham chi 5mm, khdp c h ly sen khong con an khdp. Khe hd gitfa xtfdng sen va m lt ca trong rong ra (binh thtfdng la 3m m)
- Co khi bi gay m lt ca thtf 3, do la tam giac Volkmann cl phia sau dtfdi, dlu cuoi xtfdng chay. Dtfdng gay thap khdp. Cd khi mat khdp cua tam giac Volkmann nay chiem 50% mat khdp dlu dtfdi xtfdng chly.
Ban chan bi veo ra ngoai pho bien nhat.
• Cac thutfng ton khi ban chan bi veo trong. it gap hdn
- M lt ca trong bi gay vat, cd khi gay doc len hanh xtfdng chay, gay c6 manh rdi, do ltfc k6m
- M lt ca ngoai bi gay ngang d nen, dadi khdp chav-m ac. do lac keo Ddi khi m lt ca ngoai khong gay ma day chang sen mac bj keo dat
- Gong mong chay mac bi toac, cac day chang chay mac trade va sau bi dat. - Xadng sen bi lech vao trong. lam hong khdp chay sen
Co the kem vd mat ca tha 3, la tam giac Volkm ann, dien gay mat khdp thadng nhd, chang 20%.
• C ac thitOng ton k h i ban c h a n bi n en th eo tru e, sau nga cao vd ch eo doc d lu
dadi xadng ch ly , vd nhieu manh thau khdp 1/3 dadi xadng chay, vd xadng sen. Khong quen vd xadng got va xep dot song doan ngUc that lang.
D ie u tr i: Trade het can thijf nan bao ton: trade khi n in c i n xac dinh cd che: cd che veo ra thi nan day co-ban chan veo vao; cd che veo vao thi nan day co ban chan veo ra. Xong bo bot rach doc khi bo bot giut cho cd ban chan hdi ngUdc lai vdi di lech, cho o gay dUdc viing. Chup X quang kiem tra.
Tuoi gia thadng ia khong md, X quang thay con di lech it cung chap nhan. Trai lai, gay cd chan khong viing d tuoi tre nen md, vi khdp cd chan khdng chap nhan di lech du it. Khi khdp c h ly sen con lech 1mm, khdp nay se hong 42%. Khi khdp c h ly sen bi lech 5mm thi hong den tren 80% se bi dau, m lt lao dong.
Co chi dinh md, nen mo trade 6 gid. De muon qua 6 gid co chan bi sung ne to nha-nh, nhieu not phong xuat hien do roi loan dinh dadng, khong md dadc nda. Can gac cao chan, quan bang chun hdi ep cho alpha chym otrypsine chd. Sdm nhat phai chd 7 ngay, nhieu khi phai chd 21 ngay cho het han sang ne, tai chd chan, da cau len cao dadc thi mdi mo. Ket qua tat nhien bi han che.
M o dd dang vdi not phong, sang ne co rat nhieu bien chdng.
4. CACH MO
4.1. Gay mat ca ngoai
- Gay thap dadi cho ndi chay mac
+ Ghim 2 dinh K irschner va buoc vong sd 8 + Co' dinh vdi 2 vit, xiet chat ta dadi len
- Gay cao d 1/3 dadi xadng mac, cho gay thadng cheo xoan d tren d lu dadi, thadng 6-8cm. Co dinh vdi 1-2 vit xiet chat, bat vit vuong goc vdi dien gay. Canh dd, dat 1 nep long m ang 1/3 vdi cac vit n g ln cd 3,5mm.
4.2. Gay mat ca trong: ky thuat mo phu thuoc kich thirdc va dudng gay
- M anh gay to, dadng gay ngang b i t 2 vit xiet ch£t. C6 loai vit danh rieng cho mat ca.
- M anh gay be, thi neo ep vdi 2 dinh Kirschner vk buoc vong chi th£p so 8, vong nay bam vao dadi m u 1 cai vit cd dinh v&o xtfdng ch ly d vi tri thich hop. Cd
4.3. Gay mat ca thuf 3 la tam giac Volkm ann d dau dtfdi mat sau xtfdng chav, co ngtfdi goi la gay ( ’otton. M anh gay nay la gay noi khdp sen chay. no chiem 25-30% ngtfdi goi la gay ( ’otton. M anh gay nay la gay noi khdp sen chay. no chiem 25-30% dien khdp sen chay.
Chi dinh mo dfit lai, co dinh manh tam giac Volkm ann, khi:
- Neu no ldn hdn 1/4-1/3 dien tich mat khdp dau dtfdi xtfdng chay. - Neu mat khdp bi khap khenh tren 2mm. Cd 2 cach bat vit co dinh: - Bat vit ttf trtfdc ra sau, khe gay de bi day toac rong ra.
- Bat vit xiet chat ttf sau ra trtfdc, tot hdn.
4.4. Toac gong mong chay mac
Nhin tren phim X qua ng binh thtfdng bong xtfdng chay va xtfdng mac d tren khdp co chan, ch on g len nhau l-6 m m . Ndi nay cao tren khdp chay sen lcm .
Khi bi gay mat ca trat xtfdng sen ra ngoai, gong m ong ch ay mac hay bi toac vdi xtfdng mac bi ddi cho ra sau va ra ngoai. Khi mo nep vit xtfdng mac d lo vit ttfdng tfng vdi 2cm tren khdp ch&y sen, bat 1 vit dai qua 4 ldp vo xtfdng ctfng cua xtfdng mac va xtfdng chay, nha m khep gon g m on g lai. Khi cho tap di, cho ty, vit dai nay co nguy cd bi gay la 30%. Q ua 3 th an g nen lay no ra.
5. DI CHlfNG
Gay mat ca trat xtfdng sen la mot thtfdng ton nang, hay co nhieu di chtfng. - Bi viem dau khdp co chan, nhat la benh nhan cao tuoi hoac bi vd tran xtfdng sen.
- Co chan xtfdng sen khong vtfng do day chang bi rach: De bi bong gan tai dien - Bi trat 1 phan cac gan cd mac ben dai va ngan
- Loan dtfdng Sudeck: teo cd, loang xtfdng, da day len, tham mau. - Voi hoa canh khdp, d mang lien cot, dau.
6. KET QUA
6 ngtfdi tre tuoi, mo sdm co dinh vtfng, tap sdm cho ket qua lau dai va tot. Khi bi gay 2 mat ca di lech, co mo thi trd lai lam viec sau 35 ngay, bo bot khong mo thi m at 107 ngay.