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Re: Артропатия голеностопного сустава?
Александр Стаханов 20 Февраль 2013, 13:06
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Диабетом пациентка не страдает. Может быть какие-то скрытые формы, дообследуем. Лишниий вес в пределах разумного. Недостаточности Tibialis posterior тоже нет(в прикрепенном файле виден выраженный варус).
Думаете, что одного артродеза голеностопного сустава будет недостоточно?
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Re: Артропатия голеностопного сустава?
A.Liberson 24 Февраль 2013, 09:11
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Pantalar with both Ankle and Subtalar joints would be me choice. I do not recall such a deformity, where we could not find a reason for. Alcoholic neuropathy? Is her EMG normal? Concerning Tib Post the proper way is either a supine physical exam or an MRI. Even in case the costs are too high, it will be better to have a diagnosis before surgery which is in geopardy if the cause is not obvious. A pantalar with correction could b done by Ilizarov in case it is cheaper. You go laterally, turn down the fibula above the Ankle, clean both the joints (if you do not see well, a small medial incision helps you. Correct the deformity by wedges or osteotomies. When the alignment is good help yourself with a thick wire from calcaneus to tibia. Then either put an IMN with compression or apparatus. You can prepare the medial surface of fibula with the corresponding tibial one to be included laterally. Another option would be 3-4 long cannula red screws from calcaneum up. This is not as strong. I do pantalar IMN routinely- this is better for the p-nt. A L
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