- 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
- Contraindications
Izigulana ezisele zikhulile ezingalufanelanga utyando.
- 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 1-36B), vula i-tendon sheath, ugxininise i-bamboo yangaphambili ye-bamboo fascia ukuze uveze i-flexor pollicis longus, sebenzisa umnwe wesalathisi ukucwangcisa i-flexor pollicis longus icala le-ulnar, kwaye ikhulule ngokuyinxenye i-flexor pollicis longus.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 process ukuze uveze i-pronator quadratus muscle, kwaye emva koko uyikhuphe kwi-radius kunye ne- peeler ukuveza umgca we-bamboo fold fold (Umfanekiso 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.
Ixesha lokuposa: Sep-01-2023