Okwangoku ukulungiswa kwangaphakathi kwee-distal radius fractures, kukho iindlela ezahlukeneyo zokutshixa iipleyiti ze-anatomical ezisetyenziswa ekliniki.Ezi zilungiso zangaphakathi zibonelela ngesisombululo esingcono kwezinye iintlobo eziyinkimbinkimbi zokuqhekeka, kwaye ngandlela-thile zandisa izibonakaliso zotyando kwi-distal radius fractures engazinzanga, ngakumbi abo bane-osteoporosis.Unjingalwazi uJupiter ovela kwiSibhedlele esiPhakathi saseMassachusetts kunye nabanye bapapashe uthotho lwamanqaku kwi-JBJS malunga neziphumo zabo malunga nokutshixa ipleyiti yokulungiswa kweefractures ezikude kunye neendlela ezinxulumene notyando.Eli nqaku ligxininisa kwindlela yokuhlinzwa yokulungiswa kweefractures ze-distal radius esekelwe ukulungiswa kwangaphakathi kwebhloko ethile yokuphuka.
IiTeknikhi zoTyando
Ithiyori yeekholomu ezintathu, esekelwe kwiimpawu ze-biomechanical kunye ne-anatomical ye-distal ulnar radius, isiseko sophuhliso kunye nokusetyenziswa kweklinikhi yenkqubo yeplate ye-2.4mm.Ukwahlulwa kwezintlu ezintathu kuboniswe kuMfanekiso 1.
Umzobo 1 ithiyori yekholamu emithathu yeradiyasi ekude ye-ulnar.
Ikholamu esecaleni yisiqingatha secala le-distal radius, kubandakanywa ne-navicular fossa kunye ne-tuberosity ye-radial, exhasa amathambo e-carpal kwicala le-radial kunye nemvelaphi yezinye iigaments ezizinzisa isandla.
Ikholamu ephakathi sisiqingatha esiphakathi seradius distal kwaye ibandakanya i-lunate fossa (ehambelana nenyanga) kunye nenotshi ye-sigmoid (ehambelana ne-distal ulna) kumphezulu we-articular.Ngokuqhelekileyo ilayishiwe, umthwalo osuka kwi-lunate fossa ugqithiselwa kwiradius nge-lunate fossa.Ikholamu yecala le-ulnar, ebandakanya i-distal ulna, i-fibrocartilage ye-triangular, kunye ne-inferior ulnar-radial joint, ithwala imithwalo evela kumathambo e-carpal e-ulnar kunye nakwi-joint ye-ulnar-radial engaphantsi kwaye inefuthe lokuzinzisa.
Inkqubo yenziwa phantsi kwe-brachial plexus anesthesia kunye ne-intraoperative C-arm imaging X-ray ibalulekile.I-antibiotics ye-intravenous yayilawulwa ubuncinane imizuzu engama-30 ngaphambi kokuqala kwenkqubo kunye ne-tourniquet ye-pneumatic yayisetyenziselwa ukunciphisa ukopha.
Ukulungiswa kwepleyiti yePalmar
Uninzi lweefractures, indlela yesundu ingasetyenziselwa ukujonga phakathi kwe-radial carpal flexor kunye ne-radial artery.Emva kokuchonga kunye nokuhoxiswa kwe-flexor carpi radialis longus, indawo enzulu ye-pronator teres muscle ibonakala kwaye i-"L" yokuhlukana okumile iphakanyisiwe.Kwiifractures ezinzima ngakumbi, i-tendon ye-brachioradialis inokuphinda ikhutshwe ukuze iququzelele ukunciphisa ukuphuka.
I-Kirschner pin ifakwe kwi-radial carpal joint, enceda ukucacisa imida ye-distal-most ye-radius.Ukuba ubunzima obuncinci bokuphuka kumda we-articular bukhona, i-palmar 2.4mm ipleyiti yensimbi inokubekwa phezu kwe-distal articular margin ye-radius yokulungiswa.Ngamanye amazwi, ubunzima obuncinci bokuphuka kwi-articular surface yenyanga inokuxhaswa nge-2.4mm "L" okanye "T" ipleyiti, njengoko kuboniswe kuMfanekiso 2.
Kwi-dorally displaced extra-articular fractures, kuyanceda ukuqaphela la manqaku alandelayo.Okokuqala, kubalulekile ukuseta kwakhona ukwaphuka okwethutyana ukuqinisekisa ukuba akukho zicubu zithambileyo ezifakwe kwisiphelo sokwaphuka.Okwesibini, kwizigulane ezingenazo i-osteoporosis, ukuphuka kunokuncitshiswa ngoncedo lwepleyiti: okokuqala, i-screw yokutshixa ibekwe ekupheleni kweplate ye-anatomical palmar, ekhuselwe kwi-distal fracture segment, emva koko i-distal and amacandelo okuqhekeka okusondele ancitshiswe ngoncedo lwepleyiti, kwaye ekugqibeleni, ezinye izikrufu zibekwe kufutshane.
UMBONISO 3 Ukwaphuka okungaphezulu kwe-articular yeradiyasi ye-distal displaced iyancipha kwaye ilungiswe ngendlela yepalmar.I-FIGURE 3-A Emva kokugqitywa kwe-exposure nge-radial carpal flexor kunye ne-radial artery, i-smooth Kirschner pin ifakwe kwi-radial carpal joint.Umzobo 3-B Ukusetyenziswa kwe-metacarpal cortex esusiweyo ukusetwa ngokutsha.
Umzobo we-3-C kunye noMfanekiso we-3-DA i-pin ye-Kirschner egudileyo ifakwe kwi-radial stem ngokusebenzisa umgca wokuphuka ukuze ulungise okwethutyana ukuphela kokuphuka.
Umzobo we-3-E Ukuboniswa okwaneleyo kwendawo yokusebenza kufezekiswa ngokusebenzisa i-retractor ngaphambi kokubekwa kwepleyiti.I-FIGURE 3-F Uluhlu olude lwezikrufu zokutshixa lubekwe kufuphi nethambo le-subchondral ekupheleni kwe-distal fold.
Umzobo 3-G X-ray fluoroscopy kufuneka isetyenziswe ukuqinisekisa indawo ipleyiti kunye nezikrufu distal.Umzobo we-3-H Inxalenye esondeleyo yeplate kufuneka ibe ne-clearance ethile (i-angle ye-10 degree) ukusuka kwi-diaphysis ukwenzela ukuba i-plate inokulungiswa kwi-diaphysis ukuqhubela phambili ukusetha kwakhona ibhloko ye-distal fracture.Umzobo 3-I Qinisa isikrufu esisondeleyo ukuze ubuyisele ukuthambekela kwepalmar ye-distal fracture.Susa iphini yeKirschner phambi kokuba isikrufu siqiniswe ngokupheleleyo.
Amanani 3-J kunye ne-3-K Imifanekiso ye-radiographic ye-Intraoperative iqinisekisa ukuba i-fracture ekugqibeleni i-anatomically repositioned kunye nezikrufu zepleyiti zibekwe ngokwanelisayo.
I-Dorsal Plate Fixation Indlela yotyando yokubonisa inkalo ye-dorsal ye-distal radius ixhomekeke ngokukodwa kuhlobo lokuphuka, kwaye kwimeko yokwaphuka kunye neziqhekeza ezimbini okanye ngaphezulu ze-intra-articular fracture, injongo yonyango ikakhulu ukulungisa zombini. i-radial kunye ne-medial columns ngaxeshanye.I-intraoperatively, i-extensor support bands kufuneka ifakwe ngeendlela ezimbini eziphambili: ixesha elide kwi-2nd kunye ne-3rd compartments extensor, kunye ne-subperiosteal dissection ukuya kwi-4th extensor compartment kunye nokuhlehliswa kwe-tendon ehambelanayo;okanye ibhendi yesibini yokuxhasa i-incision phakathi kwe-4 kunye ne-5 ye-extensor compartments ukuveza iikholamu ezimbini ngokwahlukileyo (umzobo 4).
Ukuqhekeka kusetyenziswe kwaye kulungiswe okwesikhashana ngepini ye-Kirschner engafundwanga, kunye nemifanekiso ye-radiographic ithathwa ukugqiba ukuba i-fracture ikhutshwe kakuhle.Emva koko, i-dorsal ulnar (ikholamu ephakathi) icala le-radius lizinziswe nge-2.4 mm "L" okanye "T" ipleyiti.Ipleyiti ye-dorsal ulnar ibunjwe ukuqinisekisa ukulingana okuqinileyo kwicala le-dorsal ulnar yeradiyo ekude.Amacwecwe angaphinda abekwe ngokusondeleyo kwinkalo ye-dorsal ye-distal lunate ngokusemandleni, njengoko i-grooves ehambelanayo engaphantsi kweplate nganye ivumela iiplate ukuba zigobe kwaye zenziwe ngaphandle kokonakalisa imicu kwimingxuma ye-screw (Umfanekiso 5) .
Ukulungiswa kwepleyiti yekholomu ye-radial kulula, njengoko umgangatho wethambo phakathi kwecandelo lokuqala kunye nelesibini le-extensor compartments lithe tyaba kwaye linokulungiswa kule ndawo kunye nepleyiti emile ngokufanelekileyo.Ukuba i-pin ye-Kirschner ifakwe kwi-distal distal part of the radial tuberosity, i-distal end ye-radial column plate ine-groove ehambelana ne-Kirschner pin, engaphazamisi indawo yeplate kwaye igcine ukuphuka kwindawo. (Umfanekiso 6).
Umzobo we-4 Ukuvezwa komphezulu wedorsal weradiyasi ekude.Ibhendi yokuxhasa ivulwa ukusuka kwi-3rd extensor interosseous compartment kunye ne-extensor hallucis longus tendon ihoxiswa.
Umzobo we-5 Ukulungiswa kwenkalo ye-dorsal ye-articular surface ye-lunate, i-dorsal "T" okanye "L" ipleyiti idla ngokubunjwa (umzobo 5-A kunye nomfanekiso 5-B).Emva kokuba ipleyiti yomqolo kumphezulu we-articular wenyanga ikhuselekile, i-radial column plate ikhuselekile (Amanani 5-C ukuya ku-5-F).Amacwecwe amabini afakwe kwi-angle ye-70 degrees ukuya komnye nomnye ukuphucula ukuzinza kokulungiswa kwangaphakathi.
Umzobo we-6 I-plate yekholomu ye-radial ifakwe ngokufanelekileyo kwaye ifakwe kwikholomu ye-radial, iphawula inotshi ekupheleni kweplate, evumela ukuba i-plate igweme ukulungiswa kwesikhashana kwe-pin ye-Kirschner ngaphandle kokuphazamisa indawo yeplate.
Iingcamango ezibalulekileyo
Iimpawu zeMetacarpal Plate Fixation
Ukwaphuka kwe-metacarpal intra-articular esusiweyo (ukwaphuka kukaBarton)
Ukwaphuka okungaphezulu kwe-articular (iiColles kunye noSmith fractures).Ukulungiswa okuzinzile kunokufezekiswa ngeeplati ze-screw nangona kukho i-osteoporosis.
Ukwaphuka komphezulu we-metacarpal lunate lunate articular surface
Iimpawu zokulungiswa kwepleyiti ye-dorsal
Ngokulimala kwe-intercarpal ligament
Ukwaphuka komphezulu odibeneyo we-dorsal lunate
I-Dorsally sheared radial carpal joint fracture dislocation
Ukuchasana nokulungiswa kwepleyiti yesundu
I-osteoporosis enzima kunye nemida ebalulekileyo yokusebenza
Ukuqhawuka kokwaphuka kwesihlahla seDorsal radial
Ubukho bezifo ezininzi zonyango
Ukuchasana nokulungiswa kweplate ye-dorsal
Izifo ezininzi zonyango
Iifracture ezingagxothwanga
Iimpazamo zenziwe ngokulula kwi-palmar plate fixation
Indawo yepleyiti ibaluleke kakhulu kuba ayipheleli nje ekuxhaseni ipleyiti yobunzima bokuqhekeka, kodwa ukubekwa ngokufanelekileyo kukwathintela isikrufu sokutshixa i-distal ekungeneni kwi-joint carpal radial.I-radiographs enonyanzeliso lwe-intraoperative, eqikelelwa kwicala elinye njengokuthambekela kwe-radial kwiradiyasi ekude, ivumela ukubonwa okuchanekileyo komphezulu we-articular wecala le-radial ye-distal radius, enokuthi kwakhona ibonwe ngokuchanekileyo ngakumbi ngokubeka izikrufu ze-ulnar kuqala ngexesha ukusebenza.
Ukungena kwe-Screw kwi-dorsal cortex inomngcipheko wokucaphukisa i-tendon extensor kunye nokubangela ukuphuka kwe-tendon.Izikrufu zokutshixa zisebenza ngokwahlukileyo kwizikrufu eziqhelekileyo, kwaye akuyomfuneko ukuba kungene i-cortex ye-dorsal ngezikrufu.
Iimpazamo ezenziwe ngokulula kunye nokulungiswa kwepleyiti ye-dorsal
Kuhlala kukho umngcipheko wokungena kwi-screw kwi-radial carpal joint, kwaye ngokufana nendlela echazwe ngasentla malunga ne-palmar plate, i-oblique shot shot kufuneka ithathwe ukugqiba ukuba indawo ye-screw ikhuselekile.
Ukuba ukulungiswa kwekholomu ye-radial kwenziwa kuqala, i-screws kwi-tuberosity ye-radial iya kuchaphazela ukuvavanywa kokulungiswa okulandelayo kwe-articular surface resurfacing of the lunate.
Izikrufu ezikude ezingajijwanga ngokupheleleyo kwi-screw hole zinokuphazamisa i-tendon okanye zibangele ukugqabhuka kwe-tendon.
Ixesha lokuposa: Dec-28-2023
