Okwangoku ekulungiseni ngaphakathi ukwaphuka kwe-distal radius, kukho iinkqubo ezahlukeneyo ze-anatomical locking plate ezisetyenziswa ekliniki. Ezi zilungiso zangaphakathi zibonelela ngesisombululo esingcono kwiintlobo ezithile zokwaphuka ezintsonkothileyo, kwaye ngandlela thile zandisa imiqondiso yotyando lwakwaphuka kwe-distal radius okungazinzanga, ingakumbi abo bane-osteoporosis. UNjingalwazi uJupiter waseMassachusetts General Hospital kunye nabanye bapapashe uthotho lwamanqaku kwi-JBJS malunga neziphumo zabo malunga nokulungiswa kwe-locking plate yokwaphuka kwe-distal radius kunye neendlela zotyando ezinxulumene noko. Eli nqaku ligxile kwindlela yotyando yokulungisa ukwaphuka kwe-distal radius ngokusekelwe ekulungiseni kwangaphakathi kwe-fracture block ethile.
Iindlela Zotyando
Ithiyori yeekholamu ezintathu, esekelwe kwiimpawu ze-biomechanical kunye ne-anatomical ze-distal ulnar radius, sisiseko sophuhliso kunye nokusetyenziswa kweklinikhi kwenkqubo yeplate ye-2.4mm. Ulwahlulo lweekholamu ezintathu luboniswe kuMfanekiso 1.
Umzobo 1 Ithiyori eneentsika ezintathu zeradiyo ye-ulnar ekude.
Ikholamu esecaleni yihafu esecaleni yeradiyumu ekude, kuquka i-navicular fossa kunye ne-radial tuberosity, exhasa amathambo e-carpal kwicala le-radiyumu kwaye yimvelaphi yeminye ye-ligaments ezizinzisa isihlakala.
Ikholamu ephakathi yinxenye ephakathi yeradiyo ekude kwaye ibandakanya i-lunate fossa (ehambelana ne-lunate) kunye ne-sigmoid notch (ehambelana ne-distal ulna) kumphezulu we-articular. Ngokwesiqhelo ilayishwa, umthwalo ovela kwi-lunate fossa udluliselwa kwi-radius nge-lunate fossa. Ikholamu esecaleni ye-ulnar, equka i-distal ulna, i-triangular fibrocartilage, kunye ne-inferior ulnar-radial joint, ithwala imithwalo evela kumathambo e-ulnar carpal kunye nakwi-inferior ulnar-radial joint kwaye inefuthe lokuzinza.
Le nkqubo yenziwa phantsi kwe-brachial plexus anaesthesia kwaye i-C-arm X-ray imaging ibalulekile. Ii-antibiotics ezifakwa kwi-intravenous zanikwa ubuncinane imizuzu engama-30 ngaphambi kokuba kuqalwe inkqubo kwaye kwasetyenziswa i-pneumatic tourniquet ukunciphisa ukopha.
Ukulungiswa kwepleyiti yesundu
Kwiintlobo ezininzi zamathambo aqhekekileyo, indlela yesundu ingasetyenziselwa ukubona phakathi kwe-radial carpal flexor kunye ne-radial artery. Emva kokuchonga nokurhoxa i-flexor carpi radialis longus, umphezulu onzulu we-pronator teres muscle uyabonwa kwaye ukwahlukana okumile okwe-"L" kuyaphakanyiswa. Kwiintlobo zamathambo ezintsonkothileyo, i-brachioradialis tendon inokukhululwa ngakumbi ukuze kube lula ukunciphisa ukwaphuka.
Iphini yeKirschner ifakwa kwi-radial carpal joint, enceda ekuchazeni imida ekude kakhulu yeradius. Ukuba kukho i-fracture mass encinci kwi-articular margin, ipleyiti yentsimbi yesundu eyi-2.4mm ingafakwa phezu kwe-distal articular margin yeradius ukuze ifakelwe. Ngamanye amazwi, i-fracture mass encinci kumphezulu we-articular we-lunate inokuxhaswa yi-2.4mm "L" okanye "T" plate, njengoko kubonisiwe kuMfanekiso 2.
Kwizaphuko ze-extra-articular ezifudukelwe ngumqolo, kuyanceda ukuqaphela la manqaku alandelayo. Okokuqala, kubalulekile ukuseta kwakhona ukwaphuka okwethutyana ukuqinisekisa ukuba akukho zicubu zithambileyo ezifakwe kwisiphelo sezaphuko. Okwesibini, kwizigulana ezingenayo i-osteoporosis, ukwaphuka kunokuncitshiswa ngoncedo lwepleyiti: okokuqala, isikrufu esitshixayo sibekwa kwisiphelo se-distal sepleyiti ye-palmar anatomical, ebotshelelwe kwisigaba sezaphuko ze-distal ezifudukelweyo, emva koko izaphuko ze-distal neze-proximal ziyancitshiswa ngoncedo lwepleyiti, kwaye ekugqibeleni, ezinye izikrufu zibekwe kufutshane.
UMFANELO 3 Ukuqhekeka kwe-extra-articular ye-distal radius efuduselwe emqolo kuyancitshiswa kwaye kulungiswe ngendlela yesundu. UMFANELO 3-A Emva kokugqitywa kokuvezwa nge-radial carpal flexor kunye ne-radial artery, i-Kirschner pin egudileyo ifakwa kwi-radial carpal joint. UMfanekiso 3-B Ukuguqulwa kwe-cortex ye-metacarpal efuduselweyo ukuze ibuyiselwe kwakhona.
Umfanekiso 3-C kunye noMfanekiso 3-DA iphini yeKirschner egudileyo ibekwe ukusuka kwisiqu seradial ukuya kumgca wokuqhekeka ukuze kulungiswe isiphelo sokuqhekeka okwethutyana.
Umfanekiso 3-E Ukubona kakuhle indawo yokusebenza kufezekiswa ngokusebenzisa i-retractor ngaphambi kokubeka ipleyiti. UMFANELO 3-F Umqolo othe tyaba wezikrufu zokutshixa ubekwe kufutshane nethambo le-subchondral ekupheleni kwe-distal fold.
Umfanekiso 3-G X-ray fluoroscopy kufuneka isetyenziswe ukuqinisekisa indawo yepleyiti kunye nezikrufu ezikude. Umfanekiso 3-H Inxalenye ekufutshane yepleyiti kufuneka ibe nendawo ethile (i-engile ye-10 degrees) ukusuka kwi-diaphysis ukuze ipleyiti ikwazi ukunamathela kwi-diaphysis ukuze iqhubeke nokuseta ibhloko yokuqhekeka okukude. Umfanekiso 3-I Qinisa isikrufu esikufutshane ukuze ubuyisele kwakhona ukuthambekela kwesundu kwe-distal fracture. Susa iphini yeKirschner ngaphambi kokuba isikrufu siqiniswe ngokupheleleyo.
Imifanekiso 3-J kunye ne-3-K Imifanekiso ye-X-ray ye-Intraoperative iqinisekisa ukuba ukwaphuka ekugqibeleni kwatshintshwa ngokwe-anatomiki kwaye izikrufu zeplate zabekwa ngendlela eyanelisayo.
Ukulungiswa kwePlate yeDorsal Indlela yotyando yokuveza i-dorsal aspect ye-distal radius ixhomekeke kakhulu kuhlobo lokwaphuka, kwaye kwimeko yokwaphuka okuneenxalenye ezimbini okanye ngaphezulu ze-intra-articular fracture, injongo yonyango ikakhulu kukulungisa zombini ii-radial kunye nee-medial columns ngaxeshanye. Phakathi kotyando, ii-extensor support bands kufuneka zicutshungulwe ngeendlela ezimbini eziphambili: ngobude kwiindawo ze-extensor compartments ze-2 kunye neze-3, kunye ne-subperiosteal dissection ukuya kwindawo ye-extensor compartment ye-4 kunye nokurhoxa kwe-tendon ehambelanayo; okanye i-support band incision yesibini phakathi kweendawo ze-extensor compartments ze-4 kunye neze-5 ukuze kuvele iikholamu ezimbini ngokwahlukeneyo (Umzobo 4).
Ukwaphuka kuyalungiswa kwaye kulungiswe okwethutyana ngephini yeKirschner engafakwanga ntambo, kwaye kuthathwa imifanekiso ye-radiographic ukuze kuqinisekiswe ukuba ukwaphuka kuhambile kakuhle. Okulandelayo, icala le-dorsal ulnar (ikholamu ephakathi) yeradius lizinziswa ngepleyiti ye-2.4 mm "L" okanye "T". Ipleyiti ye-dorsal ulnar imile ukuqinisekisa ukuba ilingana kakuhle kwicala le-dorsal ulnar yeradius ekude. Iipleyiti zinokubekwa kufutshane nombono we-dorsal we-distal lunate kangangoko kunokwenzeka, njengoko imingxunya ehambelanayo engaphantsi kwepleyiti nganye ivumela iipleyiti ukuba zigotywe kwaye zenziwe ngendlela ngaphandle kokonakalisa imisonto kwimingxunya yezikrufu (Umzobo 5).
Ukulungiswa kwepleyiti yekholamu yeradial kulula kakhulu, njengoko umphezulu wethambo phakathi kweendawo zokuqala nezesibini ze-extensor uthe tyaba kwaye unokumiselwa kule ndawo ngepleyiti emile kakuhle. Ukuba iphini yeKirschner ibekwe kwindawo ekude kakhulu ye-radial tuberosity, isiphelo esikude sepleyiti yekholamu yeradial sinomjelo ohambelana nephini yeKirschner, engaphazamisi indawo yepleyiti kwaye igcina ukwaphuka endaweni yayo (Umzobo 6).
Umzobo 4 Ukuvezwa komphezulu wangasemva weradiyumu ekude. Ibhendi yokuxhasa ivulwa ukusuka kwi-3rd extensor interosseous compartment kwaye i-extensor hallucis longus tendon irhoxisiwe.
Umzobo 5 Ukuze kulungiswe icala le-dorsal lomphezulu we-articular we-lunate, ipleyiti ye-dorsal ethi "T" okanye "L" idla ngokumila (Umzobo 5-A kunye nomzobo 5-B). Nje ukuba ipleyiti ye-dorsal kumphezulu we-articular we-lunate iqiniswe, ipleyiti ye-radial column iyaqiniswe (Imifanekiso 5-C ukuya ku-5-F). Ezi pleyiti zimbini zibekwe kwi-engile yama-70 degrees omnye komnye ukuphucula uzinzo lwe-internal fixation.
Umzobo 6 Ipleyiti yekholamu yeradial imile kakuhle kwaye ibekwe kwikholamu yeradial, iphawula i-notch ekupheleni kwepleyiti, evumela ipleyiti ukuba iphephe ukuqiniswa okwethutyana kwephini yeKirschner ngaphandle kokuphazamisa indawo yepleyiti.
Iingcamango ezibalulekileyo
Iimpawu zoLungiso lwePlate yeMetacarpal
Ukuqhekeka kwe-metacarpal intra-articular okususiweyo (ukuqhekeka kukaBarton)
Ukuqhekeka kwe-extra-articular okususiweyo (ukuqhekeka kweColles kunye noSmith). Ukuqina okuzinzileyo kunokufezekiswa ngee-screw plates nokuba kukho i-osteoporosis.
Ukuqhekeka komphezulu we-metacarpal lunate articular osusiweyo
Iimpawu zokulungisa ipleyiti yangasemva
Ngokwenzakala kwe-intercarpal ligament
Ukuqhekeka komphezulu welungu lomqolo elilahlekileyo
Ukuqhekeka kwejoyinti ye-carpal egugulweyo emqolo
Izithintelo zokulungiswa kweplate yesundu
I-osteoporosis enzima enemida ebalulekileyo yokusebenza
Ukuqhekeka kwesandla okubangelwa yi-dorsal radial
Ukubakho kwezifo ezininzi ezihambisanayo
Izithintelo zokulungiswa kwepleyiti yangasemva
Iingxaki ezininzi zonyango
Iimfanta ezingasuswanga kwindawo yazo
Iimpazamo ezenziwa lula ekufakweni kwepleyiti yesundu
Indawo yepleyiti ibaluleke kakhulu kuba ayigcini nje ngokuxhasa ubunzima bokuqhekeka, kodwa nendawo eyiyo ikwathintela isikrufu sokukhiya esikude ukuba singangeni kwi-radial carpal joint. Ii-radiographs ezicwangcisiweyo ngexesha lotyando, ezibekwe kwicala elifanayo ne-radial inclination ye-distal radius, zivumela ukubonakala ngokuchanekileyo komphezulu we-articular wecala le-radial le-distal radius, onokubonwa ngokuchanekileyo ngokubeka izikrufu ze-ulnar kuqala ngexesha lokusebenza.
Ukungena kwezikrufu kwi-dorsal cortex kunomngcipheko wokubangela i-extensor tendon kwaye kubangele ukuqhekeka kwe-tendon. Izikrufu ezitshixayo zisebenza ngokwahlukileyo kwizikrufu eziqhelekileyo, kwaye akufuneki ukungena kwi-dorsal cortex ngezikrufu.
Iimpazamo ezenziwa lula ngokuqiniswa kwepleyiti yangasemva
Kusoloko kukho umngcipheko wokungena kwesikrufu kwi-radial carpal joint, kwaye ngendlela echazwe apha ngasentla ngokunxulumene nepleyiti yesundu, kufuneka kuthathwe ishot e-oblique ukuze kuqinisekiswe ukuba indawo yesikrufu ikhuselekile na.
Ukuba ukulungiswa kwekholamu ye-radial kwenziwa kuqala, izikrufu ezikwi-radial tuberosity ziya kuchaphazela uvavanyo lokulungiswa okulandelayo kokulungiswa kwakhona komphezulu we-articular we-lunate.
Izikrufu ezikude ezingafakwanga ngokupheleleyo emngxunyeni wesikrufu zinokuphazamisa umsipha okanye zibangele ukuqhekeka komsipha.
Ixesha lokuthumela: Disemba-28-2023
