Ukuqhekeka kweRadius eDistal: Inkcazo eneenkcukacha zeZakhono zotyando zangaphakathi zeSith Imifanekiso kunye neMibhalo!

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

1. Izimo zokungahambelani

Izigulana ezindala ezingafanelekanga utyando.

1. Ukulungiswa kwangaphakathi (indlela ye-volar)

Ukulungiselela rhoqo ngaphambi kotyando. I-anesthesia yenziwa kusetyenziswa i-brachial plexus anesthesia okanye i-general anesthesia

1).Isigulana sibekwe kwindawo elele phantsi, ilungu elichaphazelekayo lithathwe lize libekwe kwisakhelo sotyando. Kwenziwa ukusika okuziisentimitha eziyi-8 phakathi komthambo we-radial wengalo kunye nomsipha we-flexor carpi radialis kwaye kwandiswe ukuya kwi-wrist crease. Oku kunokuveza ngokupheleleyo ukwaphuka kwaye kuthintele ukuqhekeka kwesilonda. Ukusika akufuneki kungene entendeni yesandla (Umfanekiso 1-36A).

2).Landela isikhewu kwi-flexor carpi radialis tendon sheath (Umfanekiso 1-36B), vula i-tendon sheath, nqumla i-deep anterior bamboo fascia ukuze uveze i-flexor pollicis longus, sebenzisa umnwe wokukhomba ukuze ubonise i-flexor pollicis longus kwicala le-ulnar, kwaye ukhulule kancinci i-flexor pollicis longus. Isisu semisipha sibonakala ngokupheleleyo kwi-pronator quadratus muscle (Umfanekiso 1-36C)

3). Yenza ukusika okumile okwe-“L” ecaleni kweradial yeradial ukuya kwinkqubo ye-radial styloid ukuze uveze umsipha we-pronator quadratus, uze uwukhuphe kwiradius nge-peeler ukuze uveze umgca wonke we-bamboo fold (Umfanekiso 1-36D, Umfanekiso 1-36E)

4).Faka imela yokuhluza okanye imela encinci yethambo evela kumgca wokuqhekeka, kwaye uyisebenzise njengesixhobo sokunciphisa ukwaphuka. Faka i-dissector okanye imela encinci yesikere kumgca wokuqhekeka ukuya kwi-cortex yethambo elisecaleni ukuze unciphise ukucinezelwa nokunciphisa iqhekeza lokuqhekeka elikude, kwaye usebenzise iminwe ukuze ucinezele iqhekeza lokuqhekeka komqolo ukuze unciphise iqhekeza lokuqhekeka komqolo.

Xa ukwaphuka kwe-radial styloid kuqhekekile, kunzima ukunciphisa ukwaphuka kwe-radial styloid ngenxa yokutsalwa kwemisipha ye-brachioradialis. Ukunciphisa amandla okutsalwa, i-brachioradialis inokuguqulwa okanye isuswe kwi-distal radius. Ukuba kuyimfuneko, i-distal fragment inokuxhonywa okwethutyana kwi-proximal fragment ngeentambo zeKirschner.

Ukuba inkqubo ye-ulnar styloid yaphukile kwaye yasuswa, kwaye i-distal radioulnar joint ayizinzanga, intambo enye okanye ezimbini zeKirschner zingasetyenziselwa ukuqiniswa kwe-percutaneous, kwaye inkqubo ye-ulnar styloid ingaphinda isetyenziswe ngendlela ye-volar. Ukuqhekeka okuncinci kudla ngokungadingi unyango lwesandla. Nangona kunjalo, ukuba i-distal radioulnar joint ayizinzanga emva kokufakwa kwe-radius, i-styloid fragment inokukhutshelwa kwaye imiphetho ye-triangular fibrocartilage complex ifakelwe kwi-ulnar styloid process ngee-anchors okanye imisonto yesilika.

5).Ngoncedo lokutsalwa, i-capsule edibeneyo kunye ne-ligament zingasetyenziselwa ukukhulula i-intercalation kunye nokunciphisa ukwaphuka. Emva kokuba ukwaphuka kuncitshisiwe ngempumelelo, misela indawo yokubekwa kwepleyiti yentsimbi ye-volar phantsi kwesikhokelo se-X-ray fluoroscopy kwaye ujije isikrufu kumngxuma o-oval okanye umngxuma otyibilikayo ukuze kube lula ukulungisa indawo (Umfanekiso 1-36F). Sebenzisa umngxuma wokubhola oyi-2.5mm ukubhoboza embindini womngxuma o-oval, kwaye ufake isikrufu sokuzicofa esiyi-3.5mm.

Umfanekiso 1-36 Ukusikwa kwesikhumba (A); ukusikwa kwe-flexor carpi radialis tendon sheath (B); ukuxobula inxalenye ye-flexor tendon ukuze kuvele umsipha we-pronator quadratus (C); ukwahlukanisa umsipha we-pronator quadratus ukuze kuvele i-radius (D); ukutyhila umgca wokuqhekeka (E); beka ipleyiti ye-volar kwaye ukrufule isikrufu sokuqala (F)
6).Sebenzisa i-C-arm fluoroscopy ukuqinisekisa indawo efanelekileyo yepleyiti. Ukuba kuyimfuneko, tyhala ipleyiti kude okanye kufutshane ukuze ufumane indawo efanelekileyo yeskrubu.

7).Sebenzisa i-drill eyi-2.0mm ukugqobhoza umngxuma kwisiphelo esikude sepleyiti yentsimbi, ulinganise ubunzulu uze ukrufule isikrufu sokutshixa. Isikhonkwane kufuneka sibe mfutshane nge-2mm kunomgama olinganisiweyo ukuthintela isikrufu ukuba singangeni kwaye siphume kwi-dorsal cortex. Ngokubanzi, isikrufu esingama-20-22mm sanele, kwaye eso sinamathele kwinkqubo ye-radial styloid kufuneka sibe mfutshane. Emva kokukrufula isikrufu esikude, sikrufule Faka isikrufu esisele esikufutshane.

Ngenxa yokuba i-engile yesikrufu yenzelwe, ukuba ipleyiti ibekwe kufutshane kakhulu nesiphelo esikude, isikrufu siya kungena kwijoyinti yesandla. Thatha izilayi ezithambileyo zethambo le-articular subchondral kwiindawo ze-coronal kunye ne-sagittal ukuze uvavanye ukuba ingena na kwijoyinti, uze ulandele imiyalelo. Lungisa iipleyiti zentsimbi kunye/okanye izikrufu.

(Umfanekiso 1-37) Umfanekiso 1-37 Ukulungiswa kokuqhekeka kweradiyumu ekude ngepleyiti yethambo le-volar A. Ifilimu ye-X-ray engasemva nangasecaleni yokuqhekeka kweradiyumu ekude ngaphambi kotyando, ebonisa ukufuduka kwesiphelo esikude ukuya kwicala le-volar; B. Ifilimu ye-X-ray engasemva nangasecaleni yokuqhekeka emva kotyando, ebonisa ukuqhekeka Ukunciphisa okuhle kunye nokuvuleka kakuhle kwelungu lesandla
8). Thambisa umsipha we-pronator quadratus nge-sutures ezingenakufunxwa. Qaphela ukuba umsipha awuyi kuwugubungela ngokupheleleyo ipleyiti. Inxalenye ekude kufuneka igqunywe ukuze kuncitshiswe ukudibana phakathi kwe-flexor tendon kunye nepleyiti. Oku kunokufezwa ngokuthungela i-pronator quadratus kumphetho we-brachioradialis, uvale umaleko wokusika ngomnyele, kwaye uwulungise nge-plaster ukuba kuyimfuneko.