I-Metacarpal phalangeal fractures ziqhelo eziqhelekileyo kwi-trauma yesandla, kubalwa malunga ne-1/4 yezigulane ze-trauma zesandla. Ngenxa yesakhiwo esithambileyo nesintsokothileyo sesandla kunye nomsebenzi ocekeceke wokushukuma, ukubaluleka kunye nobugcisa bonyango lokwaphuka kwezandla kunzima kakhulu kunonyango lwezinye iifractures ezinde. Ukuqinisekisa ukuzinza kokuphuka emva kokunciphisa kuyisitshixo sonyango oluyimpumelelo lwe-metacarpal phalangeal fractures. Ukuze ubuyisele umsebenzi wesandla, iifractures zihlala zifuna ukulungiswa okufanelekileyo. Ngaphambili, ukulungiswa kwangaphandle kwe-plaster okanye i-Kirschner wire fixation yangaphakathi yayihlala isetyenziswa, kodwa kaninzi ayihambisani noqeqesho lokubuyisela ukubuyisela kwi-postoperative ngenxa yokulungiswa okungachanekanga okanye ixesha elide lokulungisa, elinempembelelo enkulu ekubuyiselweni komsebenzi wokudibanisa umnwe kwaye izisa ubunzima obuthile ekubuyiseleni umsebenzi wesandla. Iindlela zonyango zanamhlanje zisanda zisebenzisa ukulungiswa kwangaphakathi okunamandla, okufana ne-micro-plate screw fixation.
I.Yeyiphi imigaqo yonyango?
Imigaqo yonyango yesandla se-metacarpal kunye ne-phalangeal fractures: ukunciphisa i-anatomical, ukulungiswa kokukhanya kunye nokuqina, imisebenzi yokuqala kunye noqeqesho olusebenzayo. Imigaqo yonyango ye-intra-articular kunye ne-peri-articular fractures yesandla iyafana naleyo yezinye iifractures ze-intra-articular, ezikwasetyenziselwa ukubuyisela i-anatomy yendawo edibeneyo kunye nemisebenzi yokuqala yokusebenza. Xa uphatha i-metacarpal yesandla kunye ne-phalangeal fractures, kufuneka kwenziwe iinzame zokufezekisa ukunciphisa kwe-anatomical, kunye nokujikeleza, ukunyuswa kwecala, okanye ukufuduka kwe-angular> 10 ° ukuya kwinqanaba le-dorsal yesundu akufanele kwenzeke. Ukuba isiphelo se-fracture ye-metacarpal phalange sijikeleza okanye i-angularly displaces ecaleni, iya kutshintsha i-trajectory ye-flexion eqhelekileyo kunye nentshukumo yokwandiswa komnwe, ibangele ukuba iguqule okanye iwe ngomnwe osondeleyo ngexesha lokuhamba, okuchaphazela ukuchaneka komsebenzi womnwe; kwaye xa i-angular displacement ukuya kwinqanaba le-dorsal yesundu> 10 °, indawo edibeneyo yokudibanisa phakathi kwethambo kunye ne-tendon iyatshatyalaliswa, ukwandisa ukuchasana kunye noluhlu lwentshukumo ye-flexion kunye nokwandiswa kwe-tendon, kunye nomonakalo ongapheliyo we-tendon kwenzeka, kubangela umngcipheko wokuphulwa kwe-tendon.
II.Ziziphi izinto ezinokukhethwa kwi-metacarpal fractures?
Kukho izinto ezininzi zangaphakathi zokulungiswa kwe-metacarpal fractures, njenge-Kirschner iingcingo, izikrufu, iiplate kunye nezilungisi zangaphandle, phakathi kwazo i-Kirschner iingcingo kunye ne-microplates zisetyenziswa ngokuqhelekileyo. Ukuqhekeka kwe-metacarpal, ukulungiswa kwangaphakathi kwe-microplate kuneenzuzo ezicacileyo ngaphezu kokulungiswa kweengcingo zaseKirschner kwaye zingasetyenziswa kuqala; kwi-proximal phalanx fractures, i-microplates ngokuqhelekileyo iphezulu, kodwa xa kunzima ukufaka i-screws kwi-proximal phalanx distal segment kunye ne-head fractures, i-cross Kirschner wire fixation yangaphakathi kufuneka isetyenziswe, eyona nto ilungele ukubuyiswa komsebenzi womnwe ochaphazelekayo; Iingcingo zeKirschner kufuneka zisetyenziswe kuqala kunyango lwe-phalanx fractures ephakathi.
- I-Kirschner wire:I-Kirschner wire fixation yangaphakathi isetyenziswe kwiklinikhi iminyaka engaphezu kwe-70 kwaye isoloko isetyenziswa ngokuqhelekileyo izixhobo zokulungiswa kwangaphakathi kwi-metacarpal kunye ne-phalangeal fractures. Kulula ukusebenza, ukonga kunye nokusebenza, kwaye yeyona ndlela yangaphakathi yokulungisa yangaphakathi. Njengoko kusetyenziswa ngokuqhelekileyo ukulungiswa kwangaphakathi kunyango lokuphuka kwezandla, kusasetyenziswa ngokubanzi. Izinto eziluncedo kwiKirschner wire fixation yangaphakathi: ① Kulula ukuyisebenzisa kwaye ibhetyebhetye kakhulu ukuyisebenzisa; ② Ukunciphisa izicubu ezithambileyo ezincinci, impembelelo encinci kunikezelo lwegazi ekupheleni kokwaphuka, ukwenzakala okuncinci kotyando, kunye nokukhuthaza ukuphiliswa kokwaphuka; ③ Kulula ukususa inaliti okwesibini; ④ Iindleko eziphantsi kunye noluhlu olubanzi lwesicelo, olufanelekileyo kwiifractures ezininzi zezandla (ezifana ne-intra-articular fractures, i-fractures enzima kunye ne-distal phalangeal fractures).
2.Metacarpophalangeal microplates: Ukulungiswa okunamandla kwangaphakathi kokuqhekeka kwezandla kusisiseko sokuqeqeshwa kwangaphambili kokusebenza kunye nemeko efunekayo yokubuyisela ukusebenza kakuhle kwezandla. I-AO iteknoloji yokulungiswa kwangaphakathi ifuna ukuba iziphelo zokuqhekeka zibekwe ngokuchanekileyo ngokuhambelana nesakhiwo se-anatomical kwaye i-fracture iphelile ibe yizinzile phantsi kweemeko zokusebenza, eyaziwa ngokuba yi-fixation eqinile, ukwenzela ukuvumela ukunyakaza kwangaphambili okusebenzayo. I-AO iphinda igxininise utyando olungephi, kugxilwe ekukhuseleni unikezelo lwegazi. Ukulungiswa kwangaphakathi kwe-Microplate kunyango lwezahlulo zezandla kunokufikelela kwiziphumo ezanelisayo ngokwamandla, ukuzinza kweziphelo zokuphuka, kunye noxinzelelo phakathi kokuphela kokuphuka. Ngokumalunga nokubuyiselwa kokusebenza kwangemva kokusebenza, ixesha lokuphulukisa ukuphuka, kunye nezinga losulelo, kukholelwa ukuba ukusebenza kwamacwecwe e-microtitanium kubhetele kakhulu kuneengcingo zaseKirschner. Ngaphezu koko, ekubeni ixesha lokuphulukisa ukuphuka emva kokulungiswa kunye neepleyiti ze-microtitanium lifutshane kakhulu kunezinye iindlela zokulungisa, kunenzuzo kwizigulane ukuba ziphinde ziqale ubomi obuqhelekileyo kwangoko.
(1) Ziziphi iingenelo zokulungiswa kwangaphakathi kwe-microplate?
① Xa kuthelekiswa neengcingo zeKirschner, izixhobo ze-microplate screw zinokuhambelana okungcono kwezicubu kunye nokuphendula okungcono kwezicubu; ② Ukuzinza kwenkqubo yokulungisa i-plate-screw kunye noxinzelelo kwisiphelo sokuphuka kwenza ukuba ukuphuka kusondele ekunciphiseni i-anatomical, ukulungiswa okukhuselekileyo, kunye nokukhuthaza ukuphulukiswa kwe-fracture; ③ Ukuzivocavoca kwangaphambili okusebenzayo kuvunyelwe ngokubanzi emva kokulungiswa kwe-microplate, ehambelana nokubuyiselwa komsebenzi wesandla.
(2)Yeyiphi indlela yotyando yeemicroplates?
Utyando ngokuqhelekileyo lwenziwa phantsi kwe-brachial plexus block anesthesia, kwaye i-tourniquet ye-pneumatic idla ngokufuneka. I-dorsal incision ye-metacarpal phalanges ithathwa, i-dorsal aponeurosis yamadijithi iyasikwa okanye i-introsseous muscle kunye nethambo le-metacarpal lingeniswa ukuveza iziphelo zokuphuka kwe-metacarpal okanye i-phalangeal bones, i-periosteum ikhutshwe, kwaye i-fracture iyancipha phantsi kombono othe ngqo. Iipleyiti ezichanekileyo zifanelekile ukuphulwa kwe-transverse yecandelo eliphakathi kunye ne-short oblique fractures, ii-T-plates zifanelekile ukulungiswa kwesiseko se-metacarpal kunye ne-phalanges, kunye ne-T-plates okanye i-120 ° kunye ne-150 ° L-iiplati zifanelekile ukulungiswa kwe-oblique ende kunye ne-comminuted fractures. I-plate ibekwe ngokubanzi kwicala le-dorsal yethambo ukukhusela i-tendon sliding kunye nokugqoka ixesha elide, elihambelana noqeqesho olusebenzayo lokuqala. Ubuncinci i-screws ezimbini kufuneka zisetyenziswe ukulungisa iziphelo ezimbini zokuphuka, ngaphandle koko ukuzinza kubi, kwaye iingcingo ze-Kirschner okanye i-screws ngaphandle kweplate zifunekayo ukuncedisa ukulungiswa ukufezekisa injongo yokulungiswa okuzinzile.
3.Izikrufu ezincinci: Izikrufu ezincinci zinozinzo olufanayo kwiiplati zetsimbi ekulungiseni i-spiral okanye i-oblique fractures ende, kodwa uluhlu lwezicubu ezithambileyo kunye ne-periosteum stripping lincinci kunokulungiswa kwepleyiti yensimbi, efanelekileyo ekukhuseleni ukunikezelwa kwegazi kunye nokuhambelana nombono wokusebenza okuncinci. Nangona kukho i-T-type kunye ne-L-type plates ye-articular fractures, ukubuyiswa komsebenzi odibeneyo emva kokulandelelaniswa kwe-postoperative kubi kakhulu kune-diaphyseal fractures. Izikrufu ezincinci zineengenelo ezithile ekulungiseni i-intra-articular kunye ne-peri-articular fractures. I-screws efakwe kwithambo le-cortical inokumelana nomthwalo omkhulu wokuxinzezeleka, ngoko ukulungiswa kuqinisiwe, kwaye iziphelo ze-fracture zinganyanzeliswa ukuze zenze i-fracture surface ngokusondeleyo, ukunciphisa ixesha lokuphulukisa ukuphuka kunye nokuququzelela ukuphulukiswa kokuphazamiseka, njengoko kuboniswe kwi-Figure 4-18. I-mini screw fixation yangaphakathi ye-fractures yezandla isetyenziselwa ubukhulu becala i-oblique okanye i-spiral fractures ye-diaphyseal kunye ne-intra-articular avulsion fractures yeebhloko ezinkulu zamathambo. Kufuneka kuqatshelwe ukuba xa usebenzisa izikrufu ezincinci zodwa ukulungisa i-oblique okanye i-spiral fractures yethambo le-diaphyseal yesandla, ubude bomgca wokuqhekeka kufuneka bube ubuncinane kabini ububanzi bethambo le-diaphyseal, kwaye xa ulungisa iibhloko eziqhekezayo eziqhekezayo kwi-joint, ububanzi bebhloko yethambo kufuneka bube ubuncinane amaxesha ama-3 ububanzi bomsonto.
4. Isilungisi sangaphandle esincinci:I-Metacarpal phalangeal fractures edibeneyo ngamanye amaxesha kunzima ukunciphisa i-anatomically okanye ayikwazi ukuqina ngokuqinileyo ngaphakathi nasemva kokutshatyalaliswa kokuhlinzwa ngenxa yokutshatyalaliswa kwenkxaso yethambo. I-fixator yangaphandle inokubuyisela kwaye igcine ubude be-fracture ye-comminuted phantsi kwe-traction, idlala indima yokulungiswa kwesihlobo. I-metacarpal phalangeal fixators yangaphandle yangaphandle ifakwe kwiindawo ezahlukeneyo: i-1st kunye ne-2 ye-metacarpal phalanges ibekwe kwicala le-dorsal radial, i-4th kunye ne-5 ye-metacarpal phalanges ibekwe kwicala le-dorsal ulnar, kwaye i-3rd metacarpal phalange ibekwe kwi-radial side kwi-dorsal okanye kwi-radial side kwi-dorsal. Nika ingqalelo kwindawo yokufaka inaliti ukukhusela umonakalo we-tendon. Ukuqhekeka okuvaliweyo kunokuncitshiswa phantsi kwe-X-reyi. Xa ukuncitshiswa kungafanelekanga, ukusika okuncinci kunokwenziwa ukuncedisa ekunciphiseni.
Ziziphi iingenelo zezilungisi zangaphandle?
① Ukusebenza okulula, kunokulungelelanisa iindawo ezahlukeneyo zokufuduswa kweziphelo zokwaphuka; ② Inokunciphisa ngokufanelekileyo kwaye ilungise i-intra-articular fractures yamathambo e-metacarpophalangeal ngaphandle kokulimaza indawo edibeneyo, kwaye inokuphazamisa indawo edibeneyo yokukhusela i-contracture ye-capsule edibeneyo kunye ne-collateral ligament; ③ Xa i-fractures edibeneyo ayinakuncitshiswa i-anatomically, inokudibaniswa nokulungiswa okulinganiselwe kwangaphakathi, kwaye isilungisi sangaphandle sinokunciphisa ngokuyinxenye kwaye sigcine umgca wamandla; ④ Vumela ukusetyenziswa kwangaphambili kokusebenza komnwe ochaphazelekayo kwindawo engaguqukiyo ukuphepha ukuqina kwamalungu kunye ne-osteoporosis; ⑤ Unokulungisa ngokufanelekileyo ukuphuka kwezandla ngaphandle kokuchaphazela unyango lwangemva kwenxeba kwisandla esichaphazelekayo.
Ixesha lokuposa: Dec-21-2024
