1.Iimpawu
1). Ukuqhekeka okukhulu okuqhekekileyo kunokubonakala ngathi kuhambile, kwaye umphezulu odibeneyo we-distal radius uyatshatyalaliswa.
2). Ukunciphisa ngesandla akuphumelelanga okanye ukulungiswa kwangaphandle akuphumelelanga ukugcina ukunciphisa.
3).Izaphuko ezindala.
4). Ukwaphuka kwethambo okanye ukungabandakanywanga. Ithambo likhona ekhaya nakwamanye amazwe
2. Izithintelo
Izigulana ezindala ezingafanelekanga utyando.
3. Indlela yotyando yokulungisa izinto zangaphandle
1. Isixhobo sokulungisa iimfanta zangaphandle ezinqamlezileyo ukulungisa ukwaphuka kweradiyo ekude
Indawo kunye nokulungiselela ngaphambi kotyando:
·I-anesthesia ye-brachial plexus
·Indawo yokulala phantsi, ilungu elichaphazelekayo lithe tyaba kwi-bracket ebonakala kakuhle ecaleni kwebhedi
·Faka i-tourniquet kwi-1/3 yengalo engentla
·Ukujonga ngeliso elibukhali
Indlela Yotyando
Ukufakwa kweSikrufu seMetacarpal:
Isikrufu sokuqala sikwisiseko sethambo lesibini le-metacarpal. Kwenziwa ukusika ulusu phakathi kwe-extensor tendon yomnwe wokukhomba kunye nomsipha ongaphakathi wethambo lokuqala. Izicubu ezithambileyo zahlulwe ngobunono nge-forceps yotyando. Isleeve ikhusela izicubu ezithambileyo, kwaye kufakwa isikrufu se-Schanz esingu-3mm.
Icala lesikrufu liyi-45° ukuya kwindawo yesandla sesandla, okanye lingahambelana nendawo yesandla sesandla.
Sebenzisa isikhokelo ukukhetha indawo yesikrufu sesibini. Isikrufu sesibini esingu-3mm siqhutyelwe kwi-metacarpal yesibini.
Ububanzi bephini yokulungisa i-metacarpal akufuneki budlule kwi-3mm. Iphini yokulungisa ikwi-1/3 ye-proximal. Kwizigulana ezine-osteoporosis, isikrufu esiphambili sinokungena kwiileya ezintathu ze-cortex (ithambo lesibini le-metacarpal kunye nesiqingatha se-cortex yethambo lesithathu le-metacarpal). Ngale ndlela, isikrufu Ingalo ende yokulungisa kunye ne-torque enkulu yokulungisa iyandisa uzinzo lwephini yokulungisa.
Ukubekwa kwezikrufu ze-radial:
Yenza ulusu olusikiweyo kumphetho osecaleni weradius, phakathi kwemisipha ye-brachioradialis kunye nemisipha ye-extensor carpi radialis, i-3cm ngaphezulu kwesiphelo esikufutshane somgca wokuqhekeka kwaye malunga ne-10cm ikufutshane nejoyinti yesandla, kwaye sebenzisa i-hemostat ukwahlula ngokucacileyo izicubu ezingaphantsi komhlaba kumphezulu wethambo. Kuthathwa inyameko ukukhusela amasebe angaphezulu e-radial nerve ehamba kule ndawo.
Kwindawo efanayo nezikrufu ze-metacarpal, izikrufu ezibini ze-3mm Schanz zabekwa phantsi kwesikhokelo sesikhokelo sezicubu ezithambileyo zokukhusela imikhono.
·.Ukunciphisa ukwaphuka kunye nokuqina:
·.Ukunciphisa ukutsalwa ngesandla kunye ne-C-arm fluoroscopy ukujonga ukuncipha kokuqhekeka.
·.Ukuqina kwangaphandle kwilungu lesandla kwenza kube nzima ukubuyisela ngokupheleleyo i-engile yokuthambekela kwesundu, ukuze idityaniswe neephini zeKapandji ukunceda ekunciphiseni nasekuqiniseni.
·.Kwizigulane ezine-radial styloid fractures, i-radial styloid Kirschner wire fixation ingasetyenziswa.
·.Ngelixa ugcina ukunciphisa, qhagamshela i-fixator yangaphandle kwaye ubeke iziko lokujikeleza le-fixator yangaphandle kwi-axis efanayo nesikhungo sokujikeleza sejoyinti yesandla.
·.I-fluoroscopy ye-Anteroposterior kunye ne-lateral, jonga ukuba ubude be-radius, i-palmar inclination angle kunye ne-ulnar deviation angle zibuyiselwe na, kwaye ulungise i-fixation angle de kube kuncitshiswa kokuqhekeka okwanelisayo.
·. Nika ingqalelo kwindlela i-fixator yangaphandle ebamba ngayo isizwe, nto leyo ebangela ukwaphuka kwe-iatrogenic kwizikrufu ze-metacarpal.
Ukuqhekeka kwe-distal radius kunye nokwahlulwa kwe-distal radioulnar joint (DRUJ):
·.Uninzi lwee-DRUJ zinokuncitshiswa ngokuzenzekelayo emva kokunciphisa i-distal radius.
·.Ukuba i-DRUJ isahlukene emva kokuba i-distal radius inciphisiwe, sebenzisa i-manual compression reduction kwaye usebenzise i-lateral rod fixation ye-external bracket.
·.Okanye sebenzisa ii-K-wires ukungena kwi-DRUJ kwindawo engathathi cala okanye ejonge kancinci.
Ukwaphuka kwe-distal radius kunye nokwaphuka kwe-ulnar styloid: Jonga uzinzo lwe-DRUJ kwi-pronation, i-neutral kunye ne-supination yengalo. Ukuba kukho ukungazinzi, uncedo lokuqinisa ngeentambo zeKirschner, ukulungiswa kwe-TFCC ligament, okanye umgaqo we-tension band ungasetyenziselwa ukuqinisa Inkqubo ye-Ulnar styloid.
Kuphephe ukutsala kakhulu:
· Jonga ukuba iminwe yesigulana iyakwazi na ukwenza iintshukumo zokujika ngokupheleleyo kunye nokwandisa ngaphandle koxinzelelo olubonakalayo; thelekisa indawo yamalungu e-radiolunate kunye nendawo yamalungu e-midcarpal.
·Jonga ukuba ulusu olukwimijelo yezinzipho luqinile kakhulu na. Ukuba luqinile kakhulu, yenza ukusika okufanelekileyo ukuze uphephe usulelo.
·Khuthaza izigulane ukuba zishukumise iminwe yazo kwangethuba, ingakumbi ukujija nokwandiswa kwamalungu eminwe angena kwi-metacarpophalangeal, ukujija nokwandiswa kwesithupha, kunye nokubiwa.
2. Ukulungiswa kwee-distal radius fractures nge-external fixator engaweli i-joint:
Indawo kunye nokulungiselela ngaphambi kotyando: Kuyafana nangaphambili.
Iindlela Zotyando:
Iindawo ezikhuselekileyo zokubeka i-K-wire kwicala langasemva le-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, izikrufu ezimbini zeSchanz zafakwa kwi-radial shaft zaza zadityaniswa ngentonga yokudibanisa.
Kwindawo yokhuseleko, izikrufu ezimbini zeSchanz zifakwe kwiqhekeza le-distal radius fracture, esinye sisuka kwicala le-radial nesinye sisuka kwicala le-dorsal, kunye ne-engile ye-60° ukuya kwi-90° enye kwenye. Isikrufu kufuneka sibambe i-contralateral cortex, kwaye kufuneka kuqatshelwe ukuba incam yesikrufu esifakwe kwicala le-radial ayinakudlula kwi-notch ye-sigmoid kwaye ingene kwi-distal radioulnar joint.
Ncamathisela isikrufu seSchanz kwirediyasi ekude ngekhonkco eligobileyo.
Sebenzisa intonga yokudibanisa ephakathi ukudibanisa iindawo ezimbini ezaphukileyo, kwaye lumka ungayitshixi i-chuck okwethutyana. Ngoncedo lwekhonkco eliphakathi, iqhekeza elikude liyancitshiswa.
Emva kokuseta kwakhona, vala i-chuck kwinduku yokudibanisa ukuze ugqibezele okokugqibelaukulungiswa.
Umahluko phakathi kwe-non-span-joint external fixator kunye ne-cross-joint external fixator:
Ngenxa yokuba izikrufu ezininzi zeSchanz zinokubekwa ukuze kugqitywe ukunciphisa nokubopha iziqwenga zamathambo, imiqondiso yotyando lwezilungisi zangaphandle ezingezizo ezidibeneyo ibanzi kunezo zezivilungisi zangaphandle ezidibeneyo. Ukongeza kwiingqukuva ze-extra-articular, zingasetyenziselwa ukwaphuka kwesibini ukuya kwesithathu. Ukuqhekeka kwe-intra-articular okuyingxenye.
Isixhobo sokuxilonga sangaphandle esinamajoyinti anqamlezileyo silungisa ijoyinti yesandla kwaye asivumeli umthambo wokusebenza kwangethuba, ngelixa isixhobo sokuxilonga sangaphandle esinamajoyinti anqamlezileyo sivumela umthambo wokusebenza kwangethuba emva kotyando.
Ixesha lokuthumela: Septemba-12-2023
