I-Distal Radius Fracture: Inkcazo ecacileyo yoLungiso lwangaphakathi lweZakhono zokuSebenza iSith iMifanekiso kunye neziBhalo!

1. Iimpawu

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

1. Contraindications

Izigulana ezisele zikhulile ezingalufanelanga utyando.

1. Ukulungiswa kwangaphakathi (indlela yevolar)

Ulungiselelo lwesiqhelo lwaphambi kotyando. I-anesthesia yenziwa ngokusebenzisa i-brachial plexus anesthesia okanye i-anesthesia jikelele

I-1) .Isigulana sibekwe kwindawo yesigxina kunye nelungu elichaphazelekayo libanjwe kwaye libekwe kwisakhelo sotyando. Ukunqunyulwa kwe-8cm kwenziwa phakathi komthambo we-radial we-forearm kunye ne-flexor carpi radialis muscle kwaye yandiswe kwi-wrist crease. Oku kunokutyhila ngokupheleleyo ukwaphuka kwaye kuthintele ukuqhawuka kwesiva. I-incision ayifuni ukungena entendeni yesandla (Umfanekiso 1-36A).

2) .Landela i-incision kwi-flexor carpi radialis tendon sheath (Umfanekiso we-1-36B), vula i-tendon sheath, ugxininise i-bamboo ejulile yangaphambili ukuze uveze i-flexor pollicis longus, sebenzisa umnwe we-index ukuze ubonise i-flexor pollicis longus ukuya kwicala le-ulnar, kunye nenxalenye ye-flexible ye-pollicis ende. Isisu se-muscle sibonakaliswe ngokupheleleyo kwi-pronator quadratus muscle (Umfanekiso 1-36C)

3) .Yenza i-"L" i-shall shaped incision ecaleni kwe-radial ye-radial kwi-radial styloid inkqubo yokutyhila i-pronator quadratus muscle, uze uyikhuphe kwi-radius kunye ne-peeler ukuveza umgca we-bamboo fold (Figure 1-36D, Umfanekiso 1-36E)

4) .Faka i-stripper okanye ithambo elincinci elivela kumgca wokuphuka, kwaye uyisebenzise njenge-lever ukunciphisa ukuphuka. Faka i-dissector okanye i-scissor knife encinci kumgca wokuphuka kwi-cortex yethambo esecaleni ukuze ukhulule ukunyanzeliswa kunye nokunciphisa i-distal fracture fragment, kwaye usebenzise iminwe ukucinezela iqhekeza le-dorsal fracture ukunciphisa iqhekeza le-dorsal fracture.

Xa i-radial styloid fracture iphukile, kunzima ukunciphisa i-radial styloid fracture ngenxa yokutsalwa kwe-brachioradialis muscle. Ukunciphisa amandla okutsalwa, i-brachioradialis ingasetyenziswa okanye ikhutshwe kwi-distal radius. Ukuba kuyimfuneko, i-distal fragment inokulungiswa okwethutyana kwi-proximal fragment kunye neengcingo ze-Kirschner.

Ukuba inkqubo ye-styloid ye-ulnar iqhekeziwe kwaye ihanjiswe, kwaye i-distal radioulnar joint ayizinzile, enye okanye ezimbini iingcingo ze-Kirschner zingasetyenziselwa ukulungiswa kwe-percutaneous, kunye nenkqubo ye-styloid ye-ulnar inokuphinda isetyenziswe ngendlela ye-volar. Ukuqhekeka okuncinci ngokuqhelekileyo akufuni unyango lwezandla. Nangona kunjalo, ukuba i-distal radioulnar joint ayizinzanga emva kokulungiswa kweradius, isiqwenga se-styloid sinokukhutshwa kwaye imiphetho ye-fibrocartilage complex ye-triangular fibrocartilage ifakwe kwinkqubo ye-ulnar styloid ngeeankile okanye imicu yesilika.

5) .Ngoncedo lwe-traction, i-capsule edibeneyo kunye ne-ligament ingasetyenziselwa ukukhulula ukudibanisa kunye nokunciphisa ukuphuka. Emva kokuba ukwaphuka kuncitshiswe ngempumelelo, misela indawo yokubeka ipleyiti yensimbi ye-volar phantsi kwesikhokelo se-X-ray fluoroscopy kunye ne-screw a screw kwi-oval hole okanye umngxuma wesilayidi ukuququzelela ukulungiswa kwendawo (Umfanekiso 1-36F). Sebenzisa umngxuma wokubhola oyi-2.5mm ukugrumba embindini womngxuma ombhoxo, kwaye ufake isikrufu sokuzicofa esiyi-3.5mm.

Umzobo 1-36 Ukwenziwa kwesikhumba (A); ukunqunyulwa kwe-flexor carpi radialis tendon sheath (B); ukukhupha inxalenye yethenda ye-flexor ukuveza i-pronator quadratus muscle (C); ukwahlula i-pronator quadratus muscle ukuveza i-radius (D); ukuveza umgca wokuqhekeka (E); beka ipleyiti yevolar kwaye ujije kwisikrufu sokuqala (F)
6) .Sebenzisa i-C-arm fluoroscopy ukuqinisekisa ukubekwa kwepleyiti ngokufanelekileyo. Ukuba kuyimfuneko, tyhala ipleyiti kude okanye ngokusondeleyo ukufumana eyona ndawo ilungileyo yokubeka isikrufu se-distal.

7) .Sebenzisa i-2.0mm drill ukubhoboza umngxuma ekupheleni kude kwepleyiti yentsimbi, ulinganise ubunzulu kunye ne-screw kwisikrufu sokutshixa. Isikhonkwane kufuneka sibe mfutshane nge-2mm kunomgama olinganisiweyo ukunqanda isikrufu ukuba singangeni kwaye siphume kwicortex yomqolo. Ngokuqhelekileyo, i-screw ye-20-22mm yanele, kwaye leyo igxininiswe kwinkqubo ye-radial styloid kufuneka ibe mfutshane. Emva kokujija isikrufu kwi-distal screw, yijije Faka isikrufu esisele sisondele.

Ngenxa yokuba i-angle ye-screw iyilwe, ukuba ipleyiti ibekwe kufuphi kakhulu nesiphelo se-distal, i-screw iya kungena kwi-wrist joint. Thatha izilayi ze-tangential ze-articular subchondral bone ukusuka kwi-coronal kunye ne-sagittal positions ukuvavanya ukuba ingena kwi-joint, kwaye emva koko ulandele imiyalelo Lungisa iipleyiti zentsimbi kunye / okanye izikrufu.

(Umfanekiso1-37) Umzobo 1-37 Ukulungiswa kwe-distal radius fracture kunye ne-volar bone plate A. Ifilimu ye-Anteroposterior kunye ne-lateral ye-X-ray ye-distal radius fracture ngaphambi kokusebenza, ebonisa ukufuduka kwe-distal end ukuya kwicala le-volar; B. Ifilimu ye-X-ray ye-Anteroposterior kunye ne-lateral ye-x-ray yokwaphuka emva kokuhlinzwa, ebonisa ukwaphuka Ukunciphisa okulungileyo kunye nokuhamba kakuhle kwe-wrist joint
8) .Suture i-pronator quadratus muscle kunye ne-sutures engabonakaliyo. Qaphela ukuba i-muscle ayiyi kugubungela ngokupheleleyo i-plate. Inxalenye ekude kufuneka igutyungelwe ukunciphisa umnxibelelwano phakathi kwe-tendon flexor kunye neplate. Oku kunokufezekiswa ngokufaka i-quadratus ye-pronator kumda we-brachioradialis, ukuvala i-incision layer ngoluhlu, kwaye uyilungise nge-plaster ukuba kuyimfuneko.