1.Imiqondiso
I-1) .Izahlulo ezinzima ezidibeneyo zine-displacement ebonakalayo, kwaye i-articular surface ye-distal radius iyatshatyalaliswa.
2) .Ukuncitshiswa kwencwadana kwahluleka okanye ukulungiswa kwangaphandle kwahluleka ukugcina ukunciphisa.
3) .Izahlulo ezindala.
4).Ukuqhekeka malunion okanye nonunion. ithambo elikhoyo ekhaya naphesheya
2.Contraindications
Izigulana ezisele zikhulile ezingalufanelanga utyando.
3. Ubuchule botyando bokulungiswa kwangaphandle
1. I-Fixator yangaphandle ye-cross-articular ukulungisa i-distal radius fractures
Isikhundla kunye nolungiselelo lwangaphambili:
·Brachial plexus anesthesia
·Indawo engqonge imilenze kunye nelungu elichaphazelekayo lisicaba kwisibiyeli sokujonga ngapha kwebhedi
·Faka i-tourniquet kwi-1/3 yengalo engaphezulu
·Uphononongo lwembono
UbuCwangciso bokuSebenza
Ukufakwa kwe-Metacarpal Screw:
Isikrufu sokuqala sibekwe kwisiseko sethambo lesibini le-metacarpal. I-skin incision yenziwa phakathi kwe-tendon ye-extensor yesalathisi somunwe kunye ne-dorsal interosseous muscle yethambo lokuqala. Izicubu ezithambileyo zihlukaniswe ngobumnene kunye ne-forceps yokuhlinzwa. Umkhono ukhusela izicubu ezithambileyo, kwaye i-screw ye-3mm ye-Schanz ifakiwe. Izikrufu
Ulwalathiso lwe-screw ngu-45 ° kwindiza yesundu, okanye inokuhambelana nendiza yesundu.
Sebenzisa isikhokelo ukukhetha indawo yesikrufu sesibini. I-screw yesibini ye-3mm yaqhutyelwa kwi-metacarpal yesibini.
Ububanzi bepini yokulungisa i-metacarpal akufanele idlule i-3mm. I-pin yokulungisa ifumaneka kwi-proximal 1/3. Kwizigulana ezineosteoporosis, esona sikrufu sikufutshane sinokugqobhoza iileya ezintathu ze-cortex (ithambo lesibini le-metacarpal kunye nesiqingatha se-cortex yethambo lesithathu le-metacarpal). Ngale ndlela, i-screw Ingalo yokulungisa ixesha elide kunye ne-torque enkulu yokulungisa yandisa ukuzinza kwepini yokulungisa.
Ukubekwa kwezikrufu zeradial:
Yenza i-skin incision kwi-lateral edge ye-radius, phakathi kwe-brachioradialis muscle kunye ne-extensor carpi radialis muscle, i-3cm ngaphezu kwe-proximal end of the fracture line and about 10cm proximal to the joint wrist, kwaye usebenzise i-hemostat ukuba ihlukanise ngokucacileyo izicubu ezingaphantsi kwethambo. Ukhathalelo luthathiwe ukukhusela amasebe angaphezulu kwi-nerve ye-radial leyo khosi kule ndawo.
Kwinqwelomoya enye nezikrufu ze-metacarpal, izikrufu ezibini ze-3mm ze-Schanz zafakwa phantsi kwesikhokelo sokhuselo lomkhono wesikhokelo sethishu ethambileyo.
·.Ukucuthwa kokwaphuka kunye nokulungiswa:
·.Ukunciphisa ukutsalwa kwezandla kunye ne-C-arm fluoroscopy ukujonga ukuncitshiswa kokwaphuka.
·.Ukulungiswa kwangaphandle kwi-joint ye-wrist kwenza kube nzima ukubuyisela ngokupheleleyo i-angle ye-palmar inclination angle, ngoko inokudibaniswa nezikhonkwane zeKapandji ukuncedisa ekunciphiseni nasekulungiseni.
·.Kwizigulane ezine-radial styloid fractures, i-radial styloid Kirschner wire fixation ingasetyenziswa.
·.Ngelixa ugcina ukunciphisa, qhagamshela i-fixator yangaphandle kwaye ubeke indawo yokujikeleza ye-fixator yangaphandle kwi-axis efanayo kunye neziko lokujikeleza kwe-wrist joint.
·.I-Anteroposterior kunye ne-lateral fluoroscopy, khangela ukuba ubude be-radius, i-angle ye-palmar inclination angle kunye ne-ulnar deviation angle ibuyiselwe, kwaye ulungelelanise i-angle yokulungisa de kube ukuncitshiswa kwe-fracture kuyanelisa.
·. Nika ingqalelo kwi-traction yesizwe ye-fixator yangaphandle, ebangela i-iatrogenic fractures kwi-screws ye-metacarpal.
Ukwaphuka kweradiyasi ekude kudityaniswe nedistal radioulnar joint (DRUJ) yokwahlula:
·.Ii-DRUJ ezininzi zinokuncitshiswa ngokuzenzekelayo emva kokunciphisa i-distal radius.
·.Ukuba i-DRUJ isahlulwe emva kokuba i-distal radius incitshisiwe, sebenzisa ukucutha ukunyanzeliswa kwe-manual kwaye usebenzise ukulungiswa kwentonga yecala ye-bracket yangaphandle.
·.Okanye sebenzisa i-K-ingcingo ukungena kwi-DRUJ kwindawo engathathi hlangothi okanye ephakanyiswe kancinane.
Ukuqhekeka kwe-distal radius edityaniswe ne-ulnar styloid fracture: Jonga ukuzinza kwe-DRUJ kwi-pronation, i-neutral and supination of forearm. Ukuba kukho ukungazinzi, ukulungiswa okuncediswayo ngeengcingo ze-Kirschner, ukulungiswa kwe-TFCC ligament, okanye umgaqo webhendi yoxinzelelo ingasetyenziselwa ukulungiswa kwenkqubo ye-Ulnar styloid.
Kuphephe ukutsala kakhulu:
· Khangela ukuba iminwe yesigulana iyakwazi ukwenza uguqulo olupheleleyo kunye neentshukumo zokwandisa ngaphandle koxinzelelo olucacileyo; thelekisa i-radiolunate joint space kunye ne-midcarpal joint space.
·Jonga ukuba ulusu kumjelo weenzipho luqinile na. Ukuba iqine kakhulu, yenza isitoli esifanelekileyo ukuphepha ukosuleleka.
·Khuthaza izigulana ukuba zihambise iminwe kwangethuba, ngakumbi ukugoba nokwandiswa kwamalungu eminwe e-metacarpophalangeal, ukugoba nokwandisa ubhontsi, kunye nokuxhwilwa.
2. Ukulungiswa kweefractures zeradius distal kunye ne-fixator yangaphandle engaweli umdibaniso:
Isikhundla kunye nolungiselelo lwaphambi kotyando: Kuyafana nangaphambili.
Ubuchwephesha boTyando:
Iindawo ezikhuselekileyo zokubeka i-K-wire kwi-dorsal ye-distal radius zezi: kumacala omabini e-Lister's tubercle, kumacala omabini e-extensor pollicis longus tendon, naphakathi kwe-extensor digitorum communis tendon kunye ne-extensor digiti minimi tendon.
Ngendlela efanayo, izikrini ezimbini ze-Schanz zifakwe kwi-shaft ye-radial kwaye zixhunywe ngentonga yokudibanisa.
Ngommandla wokhuseleko, izikrufu ezibini ze-Schanz zifakwe kwiqhekeza le-distal radius fracture, enye ukusuka kwicala le-radial kunye nelinye ukusuka kwicala le-dorsal, kunye ne-angle ye-60 ° ukuya kwi-90 ° enye kwenye. I-screw kufuneka ibambe i-cortex ye-contralateral, kwaye kufuneka kuqatshelwe ukuba incam yesikrufu esifakwe kwicala le-radial ayinakudlula inotshi ye-sigmoid kwaye ingene kwi-distal radioulnar joint.
Qhoboshela isikrufu seSchanz kwiradiyasi ekude ngekhonkco eligobileyo.
Sebenzisa intonga yokudibanisa ephakathi ukudibanisa iindawo ezimbini ezaphukileyo, kwaye uqaphele ukuba ungayitshixi i-chuck okwethutyana. Ngoncedo lwekhonkco eliphakathi, i-distal fragment iyancitshiswa.
Emva kokusetha kwakhona, tshixa i-chuck kwintonga yokudibanisa ukuze ugqibezele okokugqibelaukulungiswa.
Umahluko phakathi kwe-non-span-joint fixator yangaphandle kunye ne-cross-joint fixator yangaphandle:
Ngenxa yokuba izikrufu ezininzi ze-Schanz zinokubekwa ukugqiba ukucuthwa kunye nokulungiswa kwamathambo amathambo, izibonakaliso zotyando ze-fixator zangaphandle ezingadibaniyo zibanzi kunezo ze-cross-joint fixator zangaphandle. Ukongeza kwi-fractures eyongezelelweyo, ingasetyenziselwa ukuphuka kwesibini ukuya kweyesithathu. Inxalenye ye-intra-articular fracture.
I-fixator yangaphandle edibeneyo edibeneyo ilungisa i-wrist joint kwaye ayivumeli ukusetyenziswa kwangaphambili kokusebenza, ngelixa i-fixator yangaphandle engekho-yomnqamlezo ivumela umsebenzi osebenzayo we-postoperative we-wrist.
Ixesha lokuposa: Sep-12-2023
