Okwangoku, i-distal fractures ye-radius iphathwa ngeendlela ezahlukeneyo, ezifana nokulungiswa kwe-plaster, ukusika kunye nokunciphisa ukulungiswa kwangaphakathi, i-bracket fixation yangaphandle, njl. Nangona kunjalo, ukuba i-plate ikhethwe ngokufanelekileyo, izinga lobunzima lingancitshiswa ngokufanelekileyo. Ushwankathelo olufutshane lweentlobo, izalathisi kunye nobuchule botyando lwe-palmar plating ye-distal radius fractures ibonisiwe.
I.Iintlobo zoqhekeko lweradiyasi ekude
Kukho iinkqubo ezininzi zokuhlelwa kweefractures, kubandakanywa ukuhlelwa kwe-Müller AO ngokusekelwe kwi-anatomy kunye nokuhlelwa kwe-Femandez ngokusekelwe kwindlela yokulimala. Phakathi kwabo, i-Eponymic classification idibanisa iingenelo zokwahlula kwangaphambili, igubungela iintlobo ezine ezisisiseko zokuqhekeka, kwaye iquka i-Maleon 4-part fractures kunye ne-Chaffer's fractures, enokuba sisikhokelo esihle somsebenzi wekliniki.
1. Ukuhlelwa kwe-Müller AO - i-partial intra-articular fractures
Ulwahlulo lwe-AO lufanelekile kwiifractures ze-distal radius kwaye luzahlula zibe ziindidi ezintathu eziphambili: uhlobo lwe-A extra-articular, uhlobo lwe-B inxalenye ye-intra-articular, kunye nohlobo lwe-C lulonke lwamathambo adibeneyo. Uhlobo ngalunye lukwahlulahlulwe ngakumbi kwiindidi ezahlukeneyo zee-subgroups ezisekelwe kubunzima kunye nobunzima bokuphuka.
Uhlobo A: Ukwaphuka okungaphezulu kwe-articular
I-A1, i-ulnar femoral fracture, i-radius njengokulimala (i-A1.1, i-ulnar stem fracture; i-A1.2 i-fracture elula ye-ulnar diaphysis; i-A1.3, i-fracture ye-ulnar diaphysis).
I-A2, Ukuqhekeka kweradiyasi, kulula, kunye ne-inset (A2.1, i-radius ngaphandle kwe-tilt; i-A2.2, i-dorsal tilt ye-radius, oko kukuthi, i-Pouteau-Colles fracture; i-A2.3, i-palmar tilt ye-radius, oko kukuthi, i-Goyrand-Smith fracture).
I-A3, i-fracture ye-radius, i-comminuted (A3.1, i-axial yokunciphisa i-radius; i-A3.2 iqhekeza le-wedge ye-radius; i-A3.3, i-fracture edibeneyo ye-radius).
Uhlobo B: i-articular fracture
I-B1, i-fracture ye-radius, i-sagittal plane (i-B1.1, uhlobo olulula olusecaleni; i-B1.2, i-lateral comminuted type; B1.3, uhlobo lwe-medial).
B2, Ukuqhekeka komphetho we-orsal rim yeradius, oko kukuthi, ukwaphuka kwe-Barton (B2.1, uhlobo olulula; i-B2.2, i-lateral sagittal fracture edibeneyo; i-B2.3, i-dislocation dorsal dislocation of the wrist).
I-B3, Ukuqhekeka kwe-metacarpal rim ye-radius, oko kukuthi, i-anti-Barton fracture, okanye i-Goyrand-smith type II fracture (B3.1, umgaqo olula we-femoral, iqhekeza elincinci;
Uhlobo C: i-articular fracture iyonke
I-C1, i-radial fracture kunye nohlobo olulula lwe-articular kunye ne-metaphyseal surfaces (i-C1.1, i-posterior medial articular fracture; i-C1.2, i-sagittal fracture ye-articular surface; i-C1.3, i-fracture ye-coronal surface ye-articular surface).
I-C2, i-Radius fracture, i-articular facet elula, i-metaphysis edibeneyo (i-C2.1, i-sagittal fracture ye-articular facet; i-C2.2, i-coronal facet fracture ye-articular facet; i-C2.3, i-articular fracture eya kwi-radial stem).
I-C3, i-radial fracture, i-comminuted (i-C3.1, i-fracture elula ye-metaphysis; i-C3.2, i-fracture ye-metaphysis; i-C3.3, i-articular fracture yandisa kwi-stem radial).
2.Ukuhlelwa kweefractures zeradius distal.
Ngokwendlela yokulimala ukuhlelwa kwe-Femandez kunokwahlulwa ibe ziindidi ezi-5:.
Uhlobo lwe-I fractures luzahluko olungaphezulu kwe-articular metaphyseal comminuted ezifana ne-Colles fractures (i-dorsal angulation) okanye i-Smith fractures (i-metacarpal angulation). I-cortex yethambo elinye iphuka phantsi koxinzelelo kwaye i-cortex ye-contralateral ihlanganiswe kwaye ifakwe.
Ukwaphuka
Iifractures zodidi lwe-III ziyi-intra-articular fractures, ezibangelwa uxinzelelo lwe-shear. Ezi zahlulo ziquka i-palmar Barton fractures, i-dorsal Barton fractures, kunye ne-radial stem fractures.
Phungula ucinzelelo
Iifractures zodidi lwe-III ziyi-intra-articular fractures kunye nokufakwa kwe-metaphyseal okubangelwa ukulimala koxinzelelo, kubandakanywa i-articular fractures kunye ne-radial pilon fractures.
Ukufakwa
Uhlobo lwe-IV lwe-fracture yi-avulsion fracture ye-attachment ligamentous eyenzeka ngexesha lokuphuka kwe-fracture-dislocation ye-radial carpal joint.
Ukwaphuka kweAvulsion I dislocation
Uhlobo lwe-V fracture luvela kwingozi ephezulu yesantya ebandakanya amandla amaninzi angaphandle kunye nokulimala okukhulu. (I-Mixed I, II, IIII, IV)
3.Ukuchwetheza ngokufuziselayo
II. Unyango lwezahlulo zeradiyasi ezikude kunye ne-palmar plating
Iimpawu.
Ukophuka kwe-extra-articular fractures emva kokungaphumeleli kokunciphisa okuvaliweyo kwezi meko zilandelayo.
I-angulation yoMva engaphezulu kwe-20°
Uxinzelelo lweDorsal olukhulu kune-5 mm
Ukunciphisa iradiyasi ekude ngaphezu kwe-3 mm
Ukufuduswa kwebhloko ye-distal fracture enkulu kune-2 mm
Ngokwaphuka kwe-intra-articular enkulu kune-2mm yokufuduka
Uninzi lwabaphengululi alucebisi ukusetyenziswa kweepleyiti ze-metacarpal ngenxa yokulimala okuphezulu kwamandla, njengokuqhekeka okukhulu kwe-intra-articular comminuted fractures okanye ukulahleka kwethambo elinzima, kuba ezi ziqhekeza ze-distal fracture zixhomekeke kwi-avascular necrosis kwaye kunzima ukubuyisela i-anatomically.
Kwizigulane ezinamaqhekeza amaninzi kunye nokufuduka okubalulekileyo kunye ne-osteoporosis enzima, i-metacarpal plating ayisebenzi. Inkxaso ye-subchondral ye-distal fractures ingaba yingxaki, njengokungenwa kwe-screw kwi-joint cavity.
Ubuchule botyando
Uninzi lweengcibi zisebenzisa indlela efanayo kunye nobuchule bokulungisa i-distal radius fractures ngepleyiti yesundu. Nangona kunjalo, indlela efanelekileyo yokuhlinzwa iyadingeka ukuze ugweme ngokufanelekileyo iingxaki zasemva kokuhlinzwa, umzekelo, ukunciphisa kunokufezekiswa ngokukhulula ibhloko yokuphuka kwi-compression edibeneyo kunye nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa kwexeshana kunye ne-2-3 Kirschner izikhonkwane zingasetyenziswa, njl.
(I) Ukumiswa kwakhona kwangaphambili kunye nokuma
1. Ukutsalwa kwenziwa kwicala le-radial shaft phantsi kwe-fluoroscopy, kunye nobhontsi ucinezela ibhloko ye-fracture esondeleyo ukusuka kwicala lesundu kunye neminye iminwe iphakamisa i-distal block kwi-engile ukusuka kwicala le-dorsal.
2. Ukuma kwe-Supine, kunye nelungu elichaphazelekayo kwitafile yesandla phantsi kwe-fluoroscopy.
(II) Iindawo zokungena.
Kuhlobo lwendlela yokusetyenziswa, i-PCR (i-radial carpal flexor) indlela eyandisiweyo yesundu iyacetyiswa.
Isiphelo esikude se-skin incision siqala kwi-skin crease yesandla kwaye ubude bayo bunokumiselwa ngokohlobo lokuphuka.
I-radial flexor carpi radialis tendon kunye ne-tendon sheath yayo i-incised, i-distal kumathambo e-carpal kunye ne-proximal ngokusondeleyo kwi-proximal side kangangoko kunokwenzeka.
Ukutsala i-radial carpal flexor tendon ukuya kwicala le-ulnar ikhusela i-nerve median kunye ne-flexor tendon complex.
Indawo yeParona ibonakaliswe kwaye i-anterior rotator ani muscle ifumaneka phakathi kwe-flexor digitorum longus (i-ulnar side) kunye ne-radial artery (i-radial side).
Ukunyusa i-radial side ye-anterior rotator ani muscle, uqaphele ukuba inxalenye kufuneka ishiywe iqhotyoshelwe kwi-radius ukuze kwakhiwe kwakhona kamva.
Ukutsala i-anterior rotator ani muscle ukuya kwicala le-ulnar kuvumela ukubonakaliswa okwaneleyo kophondo lwe-ulnar kwicala lesundu le-radius.
Indlela yepalmar iveza i-distal radius kwaye iveza ngokufanelekileyo i-angle ye-ulnar.
Kwiintlobo ezintsonkothileyo zokuphuka, kucetyiswa ukuba i-distal brachioradialis stop inokukhutshwa, enokuthi ithintele ukutsalwa kwayo kwi-tuberosity ye-radial, ngelo xesha i-palmar sheath yecandelo lokuqala le-dorsal inokufakwa, enokuthi iveze i-distal fracture block radial kunye ne-radial tuberosity, ukujikeleza ngaphakathi kwi-radius Yu ukukhupha kwakhona kwi-site fracture kwi-site. block usebenzisa i-Kirschner pin. Ukuxhatshazwa kwe-intra-articular fractures, i-arthroscopy ingasetyenziselwa ukuncedisa ekunciphiseni, ukuvavanya kunye nokulungiswa kakuhle kwebhloko yokuphuka.
(III) Iindlela zokunciphisa.
1. Sebenzisa i-bone pry njenge-lever yokusetha kwakhona
2. Umncedisi utsala isalathisi sesigulane kunye neminwe ephakathi, eya kuba lula ukusetha kwakhona.
3. Krwela ipini ye-Kirschner ukusuka kwi-tuberosity ye-radial ukulungiswa kwexeshana.
Emva kokuba ukubekwa ngokutsha kugqityiwe, ipleyiti yepalmar ibekwe ngokuqhelekileyo, ekufuneka isondele nje kwi-watershed, kufuneka igubungele i-ulnar eminence, kwaye kufuneka ibe kufuphi ne-midpoint ye-radial stem. Ukuba le miqathango ayifezekanga, ukuba ipleyiti ayilona ubungakanani obufanelekileyo, okanye ukuba ukubekwa kwakhona akunelisekanga, inkqubo ayiphelelanga.
Iingxaki ezininzi zihambelana kakhulu kwindawo yeplate. Ukuba ipleyiti ibekwe kude kakhulu kwicala le-radial, iingxaki ezinxulumene ne-bunion flexor zinokuthi zenzeke; ukuba i-plate ibekwe kufuphi kakhulu nomgca wamanzi, i-flexor deep of finger ingaba yingozi. I-deformity displacement of the fracture repositioning in the palmar side ingenza lula ukuba ipleyiti iphumele kwicala lesundu kwaye idibane ngqo ne-flexor tendon, ekugqibeleni iholele kwi-tendonitis okanye ukuphuka.
Kwizigulane ze-osteoporotic, kucetyiswa ukuba ipleyiti ibekwe kufuphi nomgca wamanzi ngokusemandleni, kodwa kungekhona kuwo wonke. Ukulungiswa kwe-Subchondral kunokufezekiswa ngokusebenzisa izikhonkwane ze-Kirschner ezikufutshane ne-ulna, kunye ne-side-side-side Kirschner izikhonkwane kunye ne-screws zokukhiya zisebenza kakuhle ekunqandeni ukuchithwa kwe-fracture.
Emva kokuba ipleyiti ibekwe ngokuchanekileyo, isiphelo esisondeleyo sigxininiswe nge-screw enye kwaye isiphelo se-distal seplate sigxininiswe okwethutyana kunye nezikhonkwane ze-Kirschner kweyona mngxuma ulnar. I-intraoperative fluoroscopic orthopantomograms, iimbono zecala, kunye neefilimu ezisecaleni ezine-30 ° ukuphakama kwesandla ziye zathathwa ukumisela ukunciphisa ukuphuka kunye nokuma kokulungiswa kwangaphakathi.
Ukuba i-plate ibekwe ngokwanelisayo, kodwa i-pin ye-Kirschner i-intra-articular, oku kuya kubangela ukubuyiswa okunganeleyo kwe-palmar inclination, enokuthi ixazululwe ngokusetha kwakhona iplate usebenzisa "i-distal fracture fixation technique" (Umfanekiso 2, b).
Umfanekiso wesi-2.
a, izikhonkwane ezimbini zeKirschner zokulungiswa kwexeshana, qaphela ukuba i-metacarpal inclination kunye ne-articular surfaces ayibuyiswanga ngokwaneleyo ngeli nqanaba;
b, I-Kirschner pin yokulungiswa kwepleyiti yethutyana, qaphela ukuba i-distal radius igxininiswe kweli nqanaba (i-distal fracture block fixation technique), kwaye inxalenye esondeleyo yepleyiti itsalwa ukuya kwi-radial stem ukubuyisela i-angle yokuthambeka kwe-palmar.
C, i-Arthroscopic i-fine-tuning ye-articular surfaces, ukubekwa kwezikrufu / izikhonkwane zokuvala i-distal, kunye nokusetha kwakhona kokugqibela kunye nokulungiswa kwe-radius proximal.
Kwimeko ye-dorsal ehambelanayo kunye ne-ulnar fractures (i-ulnar / dorsal Die Punch), engenakho ukusetwa ngokufanelekileyo phantsi kokuvalwa, ezi ndlela zintathu zilandelayo zingasetyenziswa.
I-radius ye-proximal ijikelezwe ngaphambili ukusuka kwindawo yokuphuka, kwaye ibhloko ye-fracture ye-lunate fossa iqhutywe ngokubhekiselele kwithambo le-carpal ngokusebenzisa indlela yokwandisa i-PCR; i-screen encinci yenziwe kwi-dorsal ukuya kwi-4th kunye ne-5th compartments ukuveza ibhloko ye-fracture, kwaye i-screw-fixed kwi-plate's most ulnar foramen. Ukulungiswa kwe-percutaneous evaliweyo okanye encinci ye-invasive yenziwa ngoncedo lwe-arthroscopic.
Emva kokubekwa kwindawo eyonelisayo kunye nokubekwa ngokuchanekileyo kwepleyiti, ukulungiswa kokugqibela kulula kwaye ukulungiswa kwe-anatomical kunokufezekiswa ukuba i-proximal ulnar kernel pin ibekwe ngokuchanekileyo kwaye akukho zikhonkwane kwi-joint cavity (Umfanekiso 2).
(iv) Amava okukhetha isikruru.
Ubude be-screws bunokuba nzima ukulinganisa ngokuchanekileyo ngenxa ye-dorsal cortical bone crush. Izikrweqe ezide kakhulu zinokukhokelela ekuphazamisekeni kwe-tendon kwaye zifutshane kakhulu ukuxhasa ukulungiswa kwebhloko ye-dorsal fracture. Ngenxa yesi sizathu ababhali bacebisa ukusetyenziswa kwezikhonkwane zokutshixa ezinemisonto kunye nezikhonkwane zokutshixa i-multiaxial kwi-tuberosity ye-radial kunye ne-foramen eninzi ye-ulnar, kunye nokusetyenziswa kwe-screws yokuvala i-stem yokukhanya kwiindawo eziseleyo. Ukusetyenziswa kwentloko enqabileyo igwema ukuphazamiseka kwethenda nokuba ifakwe kwi-dorsally. Ukulungiswa kwepleyiti edibeneyo edibeneyo, izikrufu ezimbini ezidibeneyo + isikhonkwane esinye esiqhelekileyo (esibekwe nge-ellipse) singasetyenziselwa ukulungiswa.
UGqr. Kiyohito waseFransi ubonise amava abo okusebenzisa iipleyiti zokutshixa zesundu ezingavalekiyo kwidistal radius fractures, apho uqhaqho lwabo lotyando lwancitshiswa lwaya kutsho kwi-1cm egqithisileyo, nto leyo echaseneyo. Le ndlela ibonakaliswe ngokukodwa kwi-distal fractures ye-distal fractures, kwaye izibonakaliso zayo zotyando zezongeziweyo ze-AO amaqhezu eentlobo ze-A2 kunye ne-A3 kunye ne-intra-articular fractures yeentlobo ze-C1 kunye ne-C2, kodwa ayifanelekanga i-C1 kunye ne-C2 i-fractures edityaniswe ne-intrallatipse ye-bone mass. Indlela nayo ayifanelekanga kuhlobo lwe-B fractures. Ababhali baphinda babonise ukuba ukuba ukunciphisa okulungileyo kunye nokulungiswa akukwazi ukufezekiswa ngale ndlela, kuyimfuneko ukutshintshela kwindlela yendabuko yokuqhawula kwaye ungabambeleli kwi-incision encinci encinci.
Ixesha lokuposa: Jun-26-2024
