Metatarsal sinishlarning qanday turlari mavjud?
Yoriqlar jarohatlanish vaqtida yuzaga keladigan o'tkir yoriqlar va takroriy yuklardan to'plangan stressli yoriqlarga bo'linadi. Ko'pincha ikkinchi, uchinchi va beshinchi suyaklar ta'sirlanadi. Beshinchi metatarsal suyak asosining sinishi alohida ko'rib chiqiladi: uning zonalaridan birida qon ta'minoti yomonlashadi va bunday sinish ko'pincha sekin tuzalib, uzoq vaqt davomida tushirish yoki vint bilan mahkamlashni talab qiladi. Stressli sinish yuguruvchilar, raqqosalar, harbiy xizmatchilar va yurish masofasini sezilarli darajada oshiradigan odamlar orasida tez-tez uchraydi va birinchi haftalarda muntazam rentgenogrammalarda ko'rinmaydi.
- To'g'ridan-to'g'ri zarba yoki tushgan ob'ektdan o'tkir sinish
- Beshinchi metatarsal asosning avulsion sinishi
- Beshinchi suyakka qon ta'minoti yomon bo'lgan hududda sinish
- Ikkinchi va uchinchi suyaklarning stress (marsh) sinishi
- Lisfranc bo'g'imidagi sinish dislokatsiyasi - oyoqning o'rta qismidagi og'ir shikastlanish
Sabablari va xavf omillari
O'tkir yoriqlar ko'pincha og'ir narsaning oyoqqa tushishi, g'ildirak ustida yugurishi, balandlikdan sakrashi yoki oyoqning notekis yuzaga buralishi natijasida yuzaga keladi. Stressli yoriqlar yuk va suyakning shifo qobiliyati o'rtasidagi nomuvofiqlik bilan bog'liq: yugurish hajmining keskin oshishi, qattiq yuzalar, eskirgan poyabzal. Suyak zichligi pastligi, D vitamini etishmovchiligi, ovqatlanishning buzilishi, oyoq deformatsiyasi va suyak almashinuviga ta'sir qiluvchi dori-darmonlar xavfi ortadi. Kuchli jismoniy mashqlar tufayli hayz ko'rishni to'xtatgan ayollar ayniqsa yuqori xavf ostida.
- Og'ir narsaning oyoqqa tushishi
- Oyog'ingizni ichkariga burish
- Yugurish yuklarining keskin o'sishi
- Noto'g'ri yoki eskirgan poyabzal
- Osteoporoz va D vitamini etishmovchiligi
- Yassi oyoq va baland kamar
Semptomlar
With an acute fracture, pain occurs instantly, the foot quickly swells, bruising appears on the back and sole, and it is painful or impossible to step on the foot. To'g'ridan-to'g'ri singan suyak ustiga bosish o'tkir mahalliy og'riqni keltirib chiqaradi - bu belgi sinishni umumiy ko'karishdan ajratishga yordam beradi. With a stress fracture, the picture is different: the pain increases over weeks, intensifies during training and subsides with rest, the swelling is moderate and appears later. Bunday vaziyatda davom etadigan yuklar xavflidir - yoriq siljish bilan to'liq sindirishga aylanishi mumkin.
- Oyoqqa og'irlik qo'yganda va yurish paytida og'riq
- Swelling of the dorsum of the foot, bruise
- Point tenderness over the bone
- Crunch and deformation in severe fracture
- Gradually increasing pain from a stress fracture
- Oqsoqlik va yumshoq yurish
Diagnostika
Asosiy usul - bu oyoqning rentgenogrammasi, odatda uchta proektsiyada, chunki suyaklar bir-biriga yopishadi va sinish osonlikcha o'tkazib yuboriladi. If a Lisfranc joint injury is suspected, weight-bearing or CT scans are taken: this injury is often underestimated, and its consequences are severe. Dastlabki ikki-uch hafta ichida rentgen nurlarida stress sinishi ko'rinmaydi, shuning uchun tarix odatiy bo'lsa, MRI buyuriladi. 10-14 kundan keyin takroriy tasvir ham yordam beradi: bu vaqtga kelib tashxisni tasdiqlovchi suyak kallusi paydo bo'ladi.
- To'g'ridan-to'g'ri, lateral va qiya proektsiyalarda oyoqning rentgenogrammasi
- Repeat image after 10–14 days if in doubt
- Singan dislokatsiyasi va maydalangan sinish uchun kompyuter tomografiyasi
- MRI for suspected stress fracture
- Ligamentlar va gematomani baholash uchun yumshoq to'qimalarning ultratovush tekshiruvi
- Takroriy sinishlar uchun osteoporoz uchun skrining
Treatment and return to exercise
Non-displaced fractures are treated with unloading: rigid postoperative shoes, an orthosis or a plaster cast, and walking with crutches are prescribed for a period determined by the doctor. Birinchi kunlarda oyoqning ko'tarilgan holati va mato orqali sovuq yordam beradi. The operation is performed in case of significant displacement, multiple fractures, damage to the Lisfranc joint and fractures of the base of the fifth bone in athletes, when fast and reliable healing is important: the fragments are fixed with a screw, knitting needles or a plate. Birlashgandan so'ng, yuk asta-sekin o'sib boradi, qattiq taglikli poyabzal va kerak bo'lganda ichki tagliklar tanlanadi. Sportchilarga takroriy sinishlarni oldini olish uchun bosqichma-bosqich yugurishga qaytishga ruxsat beriladi.
- Unloading the foot, walking on crutches
- 4-8 hafta davomida qattiq poyabzal, ortez yoki gips
- Elevated position and cold in the first days
- Deplasmanda vint yoki plastinka bilan osteosintez
- Control shots before load release
- Gradual return to walking and running
- D vitamini etishmovchiligini tuzatish va osteoporozni davolash