Ukuqhekeka kwe-Metacarpal phalangeal kukwaphuka okuqhelekileyo kwintlungu yesandla, okubandakanya malunga ne-1/4 yezigulane ezenzakeleyo ngesandla. Ngenxa yesakhiwo esibuthathaka nesintsonkothileyo sesandla kunye nomsebenzi obuthathaka wokunyakaza, ukubaluleka kunye nobuchwephesha bonyango lokuqhekeka kwesandla kuyinkimbinkimbi kakhulu kunonyango lwezinye izaphuko ezinde zamathambo. Ukuqinisekisa ukuzinza kokuqhekeka emva kokuncipha yeyona nto iphambili kunyango oluphumelelayo lwezaphuko ze-metacarpal phalangeal. Ukuze kubuyiselwe ukusebenza kwesandla, izaphuko zihlala zifuna ukulungiswa okufanelekileyo. Ngaphambili, ukulungiswa kwangaphandle kweplasta okanye ukulungiswa kwangaphakathi kwentambo yeKirschner kwakusoloko kusetyenziswa, kodwa kudla ngokungalungelanga uqeqesho lokuvuselelwa kwamalungu emva kotyando ngenxa yokungalungiswa ngendlela echanekileyo okanye ixesha elide lokulungiswa, okunempembelelo enkulu ekubuyiselweni komsebenzi wejoyinti yeminwe kwaye kuzisa ubunzima obuthile ekubuyiselweni kokusebenza kwesandla. Iindlela zonyango zanamhlanje zisebenzisa ngakumbi ukulungiswa kwangaphakathi okuqinileyo, okufana nokulungiswa kwesikrufu se-micro-plate.
Mna.Zithini imigaqo yonyango?
Imigaqo yonyango lwezaphuko zesandla eziphuma kwi-metacarpal kunye ne-phalangeal: ukunciphisa i-anatomical, ukukhanya nokuqiniswa, imisebenzi yokuqala kunye noqeqesho lokusebenza. Imigaqo yonyango lwezaphuko zesandla eziphuma kwi-intra-articular kunye ne-peri-articular iyafana neyezinye izaphuko zesandla eziphuma kwi-intra-articular, ezikwabuyisela i-anatomy yomphezulu wamalungu kunye nemisebenzi yokuqala yokusebenza. Xa kunyangwa izaphuko zesandla eziphuma kwi-metacarpal kunye ne-phalangeal, kufuneka kwenziwe imizamo yokufezekisa ukunciphisa i-anatomical, kwaye ukujikeleza, i-lateral angulation, okanye i-angular displacement ye->10° ukuya kwicala le-dorsal lesandla akufuneki kwenzeke. Ukuba isiphelo sezaphuko se-metacarpal phalange siyajikeleza okanye sitshintshe i-angularly side, siya kutshintsha indlela yokujika okuqhelekileyo kunye nentshukumo yokwandiswa komnwe, okubangela ukuba utshintshe okanye uwe nomnwe okufutshane ngexesha lokujika, okuchaphazela ukuchaneka komsebenzi womnwe; kwaye xa i-engile isuka iye kwicala le-dorsal lesandla ingaphezulu kwe-10°, umphezulu ogudileyo woqhagamshelwano phakathi kwethambo kunye ne-tendon uyatshatyalaliswa, nto leyo eyandisa ukumelana kunye nomgama wokuhamba kwe-flexion kunye nokwandiswa kwe-tendon, kwaye kwenzeka umonakalo ongapheliyo we-tendon, nto leyo ebangela umngcipheko wokuqhekeka kwe-tendon.
II.Ziziphi izinto ezinokukhethwa xa kuqhekeka i-metacarpal?
Kukho izinto ezininzi zokubopha ngaphakathi kwiingozi ze-metacarpal, ezifana neengcingo zeKirschner, izikrufu, iipleyiti kunye nee-fixators zangaphandle, phakathi kwazo iingcingo zeKirschner kunye nee-microplates zezona zisetyenziswa kakhulu. Kwiingozi ze-metacarpal, ukulungiswa kwangaphakathi kwe-microplate kuneenzuzo ezicacileyo ngaphezu kwe-Kirschner wire fixation kwaye kungasetyenziswa kuqala; kwiingozi ze-proximal phalanx, ii-microplates ngokubanzi zingcono, kodwa xa kunzima ukufaka izikrufu kwiingozi ze-proximal phalanx distal segment kunye neentloko, kufuneka kusetyenziswe ukulungiswa kwangaphakathi kwe-cross Kirschner wire, okunceda ngakumbi ekubuyiseleni umsebenzi womnwe ochaphazelekayo; iingcingo zeKirschner kufuneka zisetyenziswe kuqala kunyango lweengozi ze-middle phalanx.
- Ucingo lweKirschner:Ukufakelwa kwangaphakathi kwentambo kaKirschner kusetyenziswe kwimisebenzi yezonyango kangangeminyaka engaphezu kwama-70 kwaye bekusoloko kuyinto esetyenziswa kakhulu ekufakweni kwangaphakathi kwezaphuko ze-metacarpal kunye ne-phalangeal. Kulula ukuyisebenzisa, ingabizi kwaye iyasebenza, kwaye yeyona ndlela isetyenziswa kakhulu ekufakweni kwangaphakathi. Njengendlela esetyenziswa kakhulu yokufakelwa kwangaphakathi kunyango lwezaphuko zesandla, isasetyenziswa kakhulu. Iingenelo zokufakelwa kwangaphakathi kwentambo kaKirschner: ① Kulula ukuyisebenzisa kwaye iguquguquka kakhulu ukuyisebenzisa; ② Ukuhlutywa kwezicubu ezithambileyo kancinci, impembelelo encinci ekuhanjisweni kwegazi kwinxalenye yezaphuko, ukwenzakala okuncinci kotyando, kunye nokukhuthaza ukuphiliswa kwazaphuko; ③ Kulula ukususa inaliti okwesibini; ④ Ixabiso eliphantsi kunye noluhlu olubanzi lokusetyenziswa, lufanelekile uninzi lwazaphuko zesandla (ezifana nezaphuko zangaphakathi, izaphuko ezinzima kunye nezaphuko ze-phalangeal ezikude).
2. Iiplate ezincinci zeMetacarpophalangeal: Ukulungiswa okuqinileyo kwangaphakathi kwezaphuko zezandla sisiseko soqeqesho olusebenzayo kwangethuba kunye nemeko efunekayo yokubuyisela ukusebenza kakuhle kwezandla. Itekhnoloji yokulungiswa kwangaphakathi kwe-AO ifuna ukuba iziphelo zaphuko zibekwe ngokuchanekileyo ngokwesakhiwo se-anatomical kwaye iziphelo zaphuko zizinzile phantsi kweemeko zokusebenza, ezaziwa ngokuba yi-strong fixation, ukuze kuvunyelwe intshukumo esebenzayo kwangethuba. I-AO ikwagxininisa kwiinkqubo zotyando ezingenelelayo kancinci, kugxilwe ekukhuseleni ukunikezelwa kwegazi. Ukulungiswa kwangaphakathi kwe-Microplate yokunyanga izaphuko zezandla kunokufezekisa iziphumo ezanelisayo ngokubhekiselele kumandla, ukuzinza kweziphelo zaphuko, kunye noxinzelelo phakathi kweziphelo zaphuko. Ngokuphathelele ukubuyiselwa kokusebenza emva kotyando, ixesha lokuphiliswa kwezaphuko, kunye nesantya sosulelo, kukholelwa ukuba ukusebenza kakuhle kweepleyiti ze-microtitanium kungcono kakhulu kunezo zeengcingo zeKirschner. Ngaphezu koko, ekubeni ixesha lokuphiliswa kwezaphuko emva kokulungiswa ngeepleyiti ze-microtitanium lifutshane kakhulu kunezinye iindlela zokulungiswa, kuyanceda ukuba izigulana ziqale ubomi obuqhelekileyo kwangethuba.
(1) Ziziphi iingenelo zokulungiswa kwangaphakathi kwe-microplate?
① Xa kuthelekiswa neengcingo zikaKirschner, izixhobo zesikrufu se-microplate zihambelana ngcono nezicubu kwaye zisabela ngcono kwizicubu; ② Uzinzo lwenkqubo yokubopha isikrufu seplate kunye noxinzelelo kwisiphelo sokwaphuka kwenza ukwaphuka kube kufutshane nokunciphisa umzimba, kuqine ngakumbi, kwaye kuncede ekupholiseni ukwaphuka; ③ Ukuzilolonga kwangethuba kuvumelekile emva kokulungiswa kwesikrufu se-microplate, nto leyo enceda ekubuyiseleni umsebenzi wesandla.
(2) Yeyiphi indlela yotyando lwee-microplates?
Olu tyando ludla ngokwenziwa phantsi kwe-brachial plexus block anesthesia, kwaye kufuneka i-pneumatic tourniquet. Kuthathwa i-dorsal incision ye-metacarpal phalanges, i-dorsal aponeurosis ye-digits iyasikwa okanye kufakwe i-interosseous muscle kunye ne-metacarpal bone ukuze kubonakale iziphelo zokuqhekeka kwamathambo e-metacarpal okanye e-phalangeal, i-periosteum iyaxotyulwa, kwaye ukuqhekeka kuyancitshiswa phantsi kombono othe ngqo. Iipleyiti ezithe tye zifanelekile kwii-transverse fractures ze-middle segment kunye nee-short oblique fractures, ii-T-plates zifanelekile ukuqinisa isiseko se-metacarpal kunye nee-phalanges, kwaye ii-T-plates okanye ii-120° kunye ne-150° L-plates zifanelekile ukuqinisa ii-long oblique fractures kunye ne-comminuted fractures. Ipleyiti idla ngokubekwa kwicala le-dorsal lethambo ukuthintela ukutyibilika kwe-tendon kunye nokuguguleka kwexesha elide, okunceda uqeqesho lokuqala lokusebenza. Ubuncinane izikrufu ezibini kufuneka zisetyenziswe ukulungisa iziphelo ezibini zokwaphuka, kungenjalo uzinzo alulunganga, kwaye iingcingo okanye izikrufu zeKirschner ezingaphandle kwepleyiti ziyafuneka ukunceda ukuqinisa ukuze kufezekiswe injongo yokuqinisa okuzinzileyo.
3. Izikrufu ezincinci: Izikrufu ezincinci zinozinzo olufanayo neepleyiti zentsimbi ekufakweni kwee-spiral okanye ii-long oblique fractures, kodwa uluhlu lwezicubu ezithambileyo kunye ne-periosteum stripping luncinci kunolo lwe-steel plate fixation, olunceda ekukhuseleni ukuhanjiswa kwegazi kwaye luhambelana nengcamango yokusebenza okuncinci. Nangona kukho iipleyiti zohlobo lwe-T kunye nohlobo lwe-L kwii-close-articular fractures, ukubuyiselwa komsebenzi wamalungu emva kokulandelela emva kotyando kubi kunoko kwee-diaphyseal fractures. Izikrufu ezincinci zikwanazo neengenelo ezithile ekufakweni kwee-intra-articular fractures kunye nee-peri-articular fractures. Izikrufu ezifakwe kwi-cortical bone zinokumelana nomthwalo omkhulu woxinzelelo, ngoko ke i-fixation iqinile, kwaye iziphelo zee-fracture zinokucinezelwa ukwenza umphezulu wee-fracture uqhagamshelane ngokusondeleyo, zinciphise ixesha lokuphiliswa kwee-fracture kwaye zenze kube lula ukuphiliswa kwee-fractures, njengoko kubonisiwe kuMfanekiso 4-18. I-Mini screw fixation yangaphakathi yee-hand fractures isetyenziselwa ikakhulu ii-oblique okanye ii-spiral fractures ze-diaphyseal kunye ne-intra-articular avulsion fractures ze-bone blocks ezinkulu. Kufuneka kuqatshelwe ukuba xa usebenzisa izikrufu ezincinci zodwa ukulungisa ukwaphuka okuthe tyaba okanye okujikelezayo kwethambo le-diaphyseal lesandla, ubude bomgca wokuqhekeka kufuneka bube buphindwe kabini ubukhulu bethambo le-diaphyseal, kwaye xa ulungisa iibhloko zokuqhekeka ezivulsed kwijoyinti, ububanzi bebhloko yethambo kufuneka bube buphindwe kathathu ubukhulu bomsonto.
4. Isixhobo sokuqinikisa sangaphandle seMicro:Ukuqhekeka kwe-metacarpal phalangeal edibeneyo ngamanye amaxesha kunzima ukukunciphisa ngokwe-anatomiki okanye akunakuqiniswa ngaphakathi nasemva kotyando ngenxa yokutshatyalaliswa kwenkxaso yethambo. I-fixator yangaphandle inokubuyisela nokugcina ubude bokwaphuka kwe-comminute phantsi kokutsalwa, idlala indima yokulungiswa okulinganiselweyo. Ii-fixator zangaphandle ze-metacarpal phalangeal ezahlukeneyo zibekwe kwiindawo ezahlukeneyo: ii-phalanges ze-1st kunye neze-2nd metacarpal zibekwe kwicala le-dorsal radial, ii-phalanges ze-4th kunye neze-5th metacarpal zibekwe kwicala le-dorsal ulnar, kwaye i-3rd metacarpal phalange ibekwe kwicala le-dorsal radial okanye kwicala le-dorsal ulnar ngokwemeko. Nika ingqalelo kwindawo yokufaka inaliti ukuthintela umonakalo we-tendon. Ukuqhekeka okuvaliweyo kunokuncitshiswa phantsi kwe-X-rays. Xa ukunciphisa kungafanelekanga, ukunqunyulwa okuncinci kunokwenziwa ukunceda ekunciphiseni.
Ziziphi iingenelo ze-fixators zangaphandle?
① Ukusebenza okulula, kunokulungisa ukufuduka okuhlukeneyo kweziphelo zokuqhekeka; ② Kunokunciphisa ngempumelelo kwaye kulungise ukuqhekeka kwamathambo e-metacarpophalangeal ngaphandle kokonakalisa umphezulu welungu, kwaye kunokuphazamisa umphezulu welungu ukuthintela ukuqiniswa kwe-capsule yelungu kunye ne-collateral ligament; ③ Xa ukuqhekeka okuqhekekileyo kungenakuncitshiswa ngokwe-anatomiki, kunokudityaniswa nokuqina kwangaphakathi okulinganiselweyo, kwaye i-fixator yangaphandle inokunciphisa kancinci kwaye igcine umgca wamandla; ④ Vumela ukuzilolonga kwangethuba komnwe ochaphazelekayo kwilungu elingaqiniswanga ukuze kuthintelwe ukuqina kwamalungu kunye ne-osteoporosis; ⑤ Kunokulungisa ngempumelelo ukuqhekeka kwezandla ngaphandle kokuchaphazela unyango lwasemva kotyando lwenxeba kwisandla esichaphazelekayo.
Ixesha leposi: Disemba-21-2024
