3
Bölüm 1
A
NDREW
H. C
RENSHAW,
J
R.
Ç
EV
D
R.
S
ERVET
K
ER
· D
R.
A
TILGAN
O
NAY
D
R.
Ö
ZCAN
P
EHL
· D
R.
N
AD
Y
ALÇIN
Cerrahi Teknikler
ve Yaklafl>mlar
Cerrahi teknikler
..............................
4
Turnikeler ..........................................
4
Ameliyathanede röntgen
çekimi ..........................................
6
Hastaya pozisyon verilmesi ............
6
Hastan>n lokal olarak
haz>rlanmas> ..............................
7
Yara y>kama solüsyonlar> ....................
9
Hastan>n örtülmesi ..........................
9
n>n örtülmesi ..........
10
virüsünden (HIV)
korunma ......................................
10
Özel cerrahi teknikler ......................
11
Tendonun kemi¤e tespiti......................
11
Tendonun kemiksel uzant>lar>n>n
kemi¤e tespiti ................................
13
Kemik greftleme ..................................
14
Cerrahi yaklafl>mlar
........................
23
Ayak parmaklar> ..............................
24
m........
24
Bafl parmak metatarsofalangeal
eklemine yaklafl>mlar ....................
24
Ayak ufak parmaklar> metatarsofalangeal
eklemlerine yaklafl>m ....................
25
Kalkaneus ..........................................
25
Medial yaklafl>m ..................................
25
Lateral yaklafl>m ..................................
25
U yaklafl>m ..........................................
25
Kocher yaklafl>m> (kavisli L) ................
27
Tarsus ve ayak bile¤i ........................
27
Anterolateral yaklafl>m ........................
27
Anterior yaklafl>m ................................
28
Tarsus ve ayak bile¤ine kocher
lateral yaklafl>m ............................
29
Tarsusa ollier yaklafl>m> ......................
29
Ayak bile¤ine posterolateral
yaklafl>m ........................................
30
Talus lateral domuna anterolateral
yaklafl>m ........................................
30
Ayak bile¤ine posterior yaklafl>m ........
31
Ayak bile¤ine medial yaklafl>mlar ........
32
Tibia ....................................................
32
Anterior yaklafl>m ................................
32
Medial yaklafl>m ..................................
33
Posterolateral yaklafl>m ........................
33
Tibia superomedial k>sm>na posterior
yaklafl>m ........................................
33
Fibula ..................................................
35
Posterolateral yaklafl>m ........................
35
Diz ......................................................
36
Anteromedial ve anterolateral
yaklafl>mlar....................................
36
Anterolateral yaklafl>m ........................
39
Posterolateral ve posteromedial
yaklafl>mlar....................................
40
Diz ve destek yap>lar>na medial
yaklafl>mlar....................................
42
Menisküslere transvers
yaklafl>mlar....................................
43
Diz ve destek yap>lar>na lateral
yaklafl>mlar....................................
45
Dize genifl yaklafl>mlar ........................
48
Posterior yaklafl>mlar ..........................
51
Femur..................................................
52
Anterolateral yaklafl>m ........................
52
Lateral yaklafl>m ..................................
55
Posterolateral yaklafl>m ........................
55
Posterior yaklafl>m................................
56
Popliteal mesafede femurun
posterior yüzeyine medial
yaklafl>m ........................................
58
Popliteal mesafede femurun
posterior yüzeyine lateral
yaklafl>m ........................................
58
Proksimal flaft ve trokanterik
bölgeye lateral yaklafl>m ................
58
Kalça....................................................
60
Anterior yaklafl>mlar............................
60
Anterolateral yaklafl>m ........................
63
Lateral yaklafl>mlar ..............................
63
Posterolateral yaklafl>m ........................
69
Medial yaklafl>m ..................................
74
Asetabulum ve pelvis ......................
75
Anterior yaklafl>mlar............................
75
Posterior yaklafl>m................................
79
Ekstensil (uzat>lm>fl) asetabular
yaklafl>mlar....................................
81
Uzat>lm>fl iliofemoral yaklafl>m ............
81
89
90
Simfizis pubis ....................................
90
Sakroiliak eklem................................
90
Posterior yaklafl>m................................
90
Anterior yaklafl>m ................................
91
Her iki sakroiliak eklem veya
sakrum ........................................
91
Omurga ..............................................
92
Sternoklaviküler eklem ....................
92
Akromiyoklaviküler eklem ............
92
Omuz ..................................................
92
Anteromedial yaklafl>mlar....................
92
Anterior aksiller yaklafl>m....................
94
Deltoid ay>ran yaklafl>m ......................
95
Transakromiyal yaklafl>m ....................
95
Posterior yaklafl>mlar ..........................
96
Posterior ters U yaklafl>m> ..................
99
Humerus ............................................
100
Anterolateral yaklafl>m ........................
100
Proksimal humerusa posterior
yaklafl>m ........................................
102
Distal humerus flaft>na
yaklafl>mlar....................................
103
Dirsek..................................................
105
Posterolateral yaklafl>m ........................
105
Uzat>lm>fl posterolateral yaklafl>m ......
108
Olekranon osteotomisine posterior
yaklafl>m ........................................
108
Uzat>lm>fl posterior yaklafl>m ..............
109
Lateral yaklafl>m ..................................
111
Lateral J yaklafl>m> ..............................
112
Medial epikondilin osteotomisi
ile medial yaklafl>m........................
112
Medial ve lateral yaklafl>m ..................
113
"Global" yaklafl>m................................
114
Radius ................................................
115
Radius bafl> ve boynu için
posterolateral yaklafl>m ................
115
Posterior yüzeyin proksimal ve
orta üçtebirlik bölümlerine
yaklafl>m ........................................
117
Proksimal flaft ve dirsek eklemine
anterolateral yaklafl>m ..................
117
Radiusun distal yar>s>na
anterior yaklafl>m ..........................
117
Ulna ....................................................
117
Ulnan>n proksimal üçtebirine ve
radiusun proksimal çeyre¤ine
yaklafl>m ........................................
117
El bilek ................................................
122
Dorsal yaklafl>mlar ..............................
122
Volar yaklafl>m ....................................
123
Lateral yaklafl>m ..................................
123
Medial yaklafl>m ..................................
124
El
......................................................
124