Okwangoku, irediyo yerediyo ye-distang inyangwa ngeendlela ezahlukeneyo, ezinjengokulungiswa kwendawo, ukucutha nokucutha ukulungiswa kwangaphakathi, iplate yangaphandle inokufezekisa iziphumo ezanelisayo, kodwa ezinye iincwadi zincedisa kwi-16%. Nangona kunjalo, ukuba iplate ikhethiwe ngokufanelekileyo, inqanaba lokwenzakala lingancitshiswa ngokufanelekileyo. Isishwankathelo esifutshane seendidi, iimpawu kunye neendlela zokwenza utyando lwe-Palmar ukubethwa kwerediyo ye-didiyo.
I.types zerediyo zerediyo ye-dias
Kukho iinkqubo ezahlukeneyo zokuhlelwa kwengcaciso, kubandakanya i-Müller Ao AO Ukuhlelwa ngokusekwe kwi-anatomy kunye nokukhutshwa kwe-fedendEx ngokusekwe kwindlela yokwenzakala. Phakathi kwazo, ukwahlulahlulahlulahlulahlulahlulahlulahlulahlula izibonelelo zodidi lwangaphambili, kubandakanya iintlobo ezine ezisisiseko zefratshi, kwaye zibandakanya ukwaphuka kwamabala ama-4 kunye ne-chaffer yesahlulo, esinokuba sisikhokelo esihle somsebenzi wekliniki.
I-1. UMüller Ao Discreasisa
Ukuhlelwa kwe-AO kufanelekile ukuba kuhlulwe i-radius radius kwaye uhlule kwiindidi ezintathu eziphambili: Chwetheza i-articular eyongezelelweyo, uhlobo lwe-Intraturial ye-Intral, kunye nohlobo lwe-CARD. Uhlobo ngalunye luphwili lwahlulwe lwahlulahlulahlulahlulahlulahlulahlulahlulwa kwe-subgroups ngokusekwe kubunzima kunye nobunzima bokwaphuka.
Chwetheza
I-A1, i-themoral ye-themoral themoral, radius njengenzakala (A1.1, i-Ulnar Stem Fracture; i-A1.3 ye-A1.3, i-A1.3 ye-A1.3, i-A1.3 ye-Ilnar ye-Ulnar ye-Ulnar Diaphysis.
A2, ukwaphuka kwe-radius, elula, nge-INSET (A2.1, iRadius ngaphandle kwe-radius; I-A2.3.
I-A3, ukwaphuka kwerediyo, ikhutshiwe (i-A3.1, i-axial yeradius; i-A3.2 ye-A3..2 ye-Wester.).
Chwetheza B: I-Artical ye-Articture
B1, ukwaphuka kweRadius, i-Sagittal Feza (B1.1, uhlobo olulula olulula; B1.2, uhlobo lwe-B1.2, uhlobo lwe-B1.3, uhlobo lweMedial).
B2, ukwaphuka kwe-dorsal Rim, okt, ukwaphuka kwe-Barton (B2.1, uhlobo olulula; B2.2, edibeneyo ye-Sagittal uqhekezo;
B3, ukwaphuka kwe-metacarpal yerediyo ye-radius, okt, i-anti-barton fectoral, okanye i-goyerand-smith yolawulo, isiqwenga esilula; b3.3.
Uhlobo c: Iyonke i-articture
I-C1, i-radial thesture ngohlobo olulula lwe-articular kunye ne-metaphyseleal probs (C1.1, i-PoSTAIAR ROPROR ROPROR; C1.2, i-C1.I-P1.2, ukuqhekeka komgangatho womfanekiso oqingqiweyo).
C2, i-radius facture, i-arratus elula ye-artiner, i-Metaphysis (C2.1, i-S2.2, i-S2.2, i-Cor, C2.2, i-CORONAL FRATAT kwi-racture stem stem stem supte).
C3, radial fracture, comminuted (C3.1, simple fracture of metaphysis; C3.2, comminuted fracture of metaphysis; C3.3, articular fracture extending to radial stem).
2.Ukuvakaliswa kwerediyo yerediyo ye-distal.
Ngokwendlela yokuphumelela kwe-fedendoz enokwahlulwa kwindidi ezi-5:.
Chwetheza i-fackings i-artional metaphyseleal ye-metaphyseal ye-metaphyseal yethayile enjengeequlane (i-anguting ye-dorsal) okanye i-smith fectures (i-smith angution). I-cortex ye-bone iqhekeza ithambo phantsi koxinzelelo kunye ne-cortex ye-cortex yenziwa kwaye ifakwe.
Ukwaphuka
Chwetheza ii-III III PRARESS zizinto ezinobugcisa, ezibangelwa luxinzelelo lwe-shear. Ezi ntshukumo zibandakanya i-Palmar Barton Prictions, i-dosal barton iqhekeza, kunye neflakisi ye-radial quations.
Phungula ucinzelelo
Chwetheza i-III I-III I-III i-Intra-i-Intra-i-Intra ye-Intra ye-Intra kunye ne-metaphyseal fats ezibangelwa kukulimala kokucinezelwa, kubandakanya ukwaphuka kobugcisa kunye ne-pilol pilon fel.
Ukufakelwa
Chwetheza i-iv facraction yi-aviulsion yokuqhekeka kwe-ligamentius enamathela okwenzeka ngexesha lokufuduswa kwe-propal raidial raidpal raining rabpal jorical.
I-Aviulsion phract i-discourication
Chwetheza i-v jikisa ukusuka kwinto embi kakhulu ebandakanya amandla amaninzi angaphandle kunye nokulimala okubanzi. (I-I, II, IIIIIII, IV)
3.epotic yochwetheza
II.I-raindis yerediyo ye-dias
Izalathiso.
Kwisiqwenga sobugcisa esingaphezulu kokulandela ukusilela ekuvalekeni kwezi meko zilandelayo.
I-dorsal ye-aungetion enkulu kune-20 °
Uxinzelelo lwe-dorsal lungaphezulu kwe-5 mm
I-Direal Radius ifihla ngaphezulu kwe-3 mm
I-distal ye-distal facking shrict engaphezulu kwe-2 mm
Kwiziqwenga ze-intra-factures enkulu kune-2mm
Uninzi lwabaphengululi abakucebisi ukusetyenziswa kweepleyiti zemephunga zokwenzakala okuphezulu, njengokuqhekeka kwethamsanqa, kuba ezi ziqwengana zokuqhekeka zithathwe kwi-aassis repus.
Kwizigulana ezinamaqhekeza amaninzi aqhekekileyo kunye nokufuduka okukhulu kwe-osteoporosis eqatha, i-metacarpal isebenza. Inkxaso yengxinano ye-subchoralral ye-diactions inokuba yingxaki, njengokukrola ungene kwi-cavity edibeneyo.
Ubuchule boNyango
Uninzi logqirha Sebenzisa indlela efanayo kunye nobuchule bokulungisa irediyo ye-didiyo ye-diast ye-palmar plate. Nangona kunjalo, indlela elungileyo yokuhlinzwa iyafuneka ukuba ithintele ukusebenza kakuhle, umzekelo, ukuncitshiswa kunokufezekiswa ngokukhulula ibhloko ye-FARTE ukusuka kwithambo lethambo le-cortical kunye nokubuyisa ukuqhubeka kwethambo lethambo. Ukulungiswa okwethutyana kunye ne-2-3 kirschner izikhonkwane zinokusetyenziswa, njl. Njl.
(I) Ukukhetha kwakhona kunye nokuma
It-1. Itreyitha yenziwa kwicala le-radial shaft phantsi kwe-fluoroscopy, ngesithupha sicinezela ibhloko ye-proximal ye-proximal kwaye eminye iminwe iphakamisa ibhloko ye-parsal ecaleni kwecala elivela kwicala le-dorsal.
2. Indawo yaseSupine, kunye nomlenze ochaphazelekayo kwitafile yesandla phantsi kwe-Fluoroscopy.
(Ii) Amanqaku okufikelela.
Ngohlobo lwendlela oza kusetyenziswa, i-pcc (i-radracial ye-carpal ye-carpal) icetyiswa ngendlela eyandisiweyo ye-palmar.
Ukuphela kokuphela kolusu kuqala kulusu lwesandla kwaye ubude balo lungagqitywa ngohlobo lokuqhekeka.
I-radial radial chepsi quidais tendon kunye ne-shendon yakhe ye-tendoting yenziwayo, i-distal yamathambo e-caripal kunye ne-proximal kufutshane necala lokubonisa.
Ukudonsa i-rabial clexor tendon kwicala le-Ulnar kukhusela i-median nerve kunye ne-flexor thedoon thendon.
Indawo yeParona ityhilwe kwaye i-ANI yangaphandle i-ANI iphakathi kweClexor ye-Wibithius ye-Lous (i-Ulnar icala) kunye ne-radial theter (icala le-radial).
Beka icala le-radial yomsipha we-ANTIAL, ukuba inxenye ishiywe ishiywe kwiradiyo yokwakha kamva.
Ukutsala umsipha we-ANTARE
Indlela yePalmar ibeka i-distal radius kwaye ichaze ngokufanelekileyo i-ilnar engle.
Uhlobo lwesahlulo esinzima, kuyacetyiswa ukuba i-distal brachiodis ime enokukhululwa, enokuthi ibonakalise i-radial tursity ye-radial curmal kunye ne-radmal tursity yu ukuba isuse kwindawo yokuqhekeka, kwaye emva koko iphinde iphinde isebenze ibhloko ye-intra-ibhloko ye-Intra isebenzisa iPIN yeKirschner. Ngobugcisa obunzima obunzima, i-arthroscopy inokusetyenziselwa ukunceda ukuncitshiswa, ukuvavanywa kunye nokutsala ibhloko ye-phracred.
(Iii) iindlela zokuncitshiswa.
1. Sebenzisa ithambo lethambo njenge-lever ukuseta kwakhona
2. Umncedisi utsala isalathiso sesigulana kunye neminwe ephakathi, eya kuba lula ukuseta kwakhona.
3. Skrew iPIN ye-kirchner kwi-tuberosity ye radial ukuze ilungiswe okwethutyana.
Emva kokuba uhlengahlengiso lugqityiwe, ipleyiti ye-Palmar ifakwe rhoqo, ekufuneka isondele nje kumanzi, kufuneka igubungele i-ulnar engqongqo, kwaye kufuneka ikhuphe i-proximal ye-radial stem supte. Ukuba ezi meko azifezekiswanga, ukuba iplate ayisiyo ubungakanani obufanelekileyo, okanye ukuba indawo yokuhlala ayonelisi, inkqubo ayikafezekanga.
Iingxaki ezininzi zihambelana kakhulu nesikhundla seplate. Ukuba iplate ibekwe kude kakhulu kwicala le-radial, iingxaki ezinxulumene ne-bunion Floxor inokwenzeka; Ukuba iplate ibekwe kufutshane nomgca wamanzi, ukuqaqanjelwa okunzulu komnwe kunokuba ngumngcipheko. Ukushenxiswa kwe-Fratures yokuqhekeka kwindawo ye-Palmar yecala kunokubangela ipleyiti ukuya kwi-Protrude kwicala lePalmar kwaye ungene ngokuthe ngqo ne-tendonitis, ekugqibeleni kukhokelela kwi-tesonitis okanye ekugqibeleni kukhokelela kwi-tesonitis okanye i-propure.
Kwizigulana ze-osteororotic, kucetyiswa ukuba iplate ibekwe kufutshane nomtya onamanzi kangangoko kunokwenzeka, kodwa ingaphaya kwayo. Ukulungiswa kwe-subchoorral kunokufezekiswa ukusebenzisa izikhonkwane zeKirschner ekufutshane ne-Ulna, kunye ne-kirschner ye-kirschner ye-kirschner ecaleni kwe-kirschner kunye ne-screws zisebenza ngokuphembelela ukupheliswa kwe-phrasiment.
Nje ukuba ipleyiti ibekwe ngokuchanekileyo, isiphelo se-proximal simiselwe ngesikrini esinye kwaye isiphelo seplate simiselwe okwethutyana kunye ne-kirschner pins ngeyona ndawo imbi kakhulu. I-Intraopeetive Fluoroscopic Orthopantograms, iimbono ezilandelayo, kunye neefilimu ezinama-30 tharity enama-30 ° Ukuchonga ukugxininiswa kokuncitshiswa kwesandla kunye nendawo yokulungiswa kwangaphakathi.
Ukuba ipleyiti ibekwe ngokwanelisayo, kodwa iPIN ye-KirsChner i-Intra-Artorilar, oku kuya kukhokelela ekubuyiseleni okungaphelelanga kwe-palmar, enokusonjululwa ngokuseta ipleyithi "yokulungisa i-discare typliqued" (B).
Umzobo 2.
i-pins ye-kirschner ye-kirschner yendlela yokulungisa okwethutyana, qaphela ukuba utyekelo lweMetacarpal kunye nomhlaba wobugcisa awuzange ubuyiselwe ngokwaneleyo okwangoku;
B, i-pirchner enye ye-pirschner ye-pite yethutyana, qaphela ukuba irediyo ye-distal ilungisiwe kule nqanaba (i-distal facture ye-disction), kwaye isahlulo se-distal fackimal itsaliwe ukuya kwi-radial sland i-angle ye-radial ukubuyisela i-angle ye-radmar.
C, i-arthroscopic intle yokutsalwa kwendawo ye-articular, ukubekwa kwezikrelemnqa ezikrini, kunye nokuseta kwakhona kokuseta kwakhona kunye nokulungiswa kwerajius roximal.
Kwimeko ye-dornal ye-dorsal kunye ne-Ulnar Fractures (ilnar / i-dorsal died punch), nto leyo engenakusetyenziswa kwakhona phantsi kokuvalwa, kusetyenziswa ezi ndlela zintathu zilandelayo.
Irediyo ye-proximal ijikelezwe kakhulu kude kwindawo yokuqhekeka, kunye nebhloko ye-frientity ye-fossate fossa ityumkile kwithambo le-propal ngokwendlela ye-PCR ngendlela yokwandisa indlela ye-PCR ngendlela yokwakha i-PCR ngendlela yokwandisa indlela ye-PCR ngendlela yokwakha i-PCR ngendlela eyoyikeka kwindlela yokwakha i-PCR ngendlela yokwakha i-PCR ngendlela yokwandisa indlela ye-PCR ngendlela yokwakha i-PCR ngendlela yokwandisa indlela ye-PCR ngendlela yokwakha i-PCR ngendlela eyandiswa ngayo. I-Igction encinci yenziwa i-dorsal kwi-4 kunye ne-5th Livelishel ukuba ibhenca ibhloko ye-friction, kwaye i-screw-igcinwe kwii-bit zeplate. Ukulungiswa kwe-percutaneous okanye ekuhlaseleni okuncinci kwenziwa ngoncedo lwe-arthroscopic.
Emva kokubekwa ngokwanelisayo kunye nokubekwa ngokuchanekileyo kweplate, ukulungiswa kokugqibela kuyinto elula kwaye i-anatomical yogcino inokufezekiswa ukuba i-proximal ye-proximal kelnel i-pied ye-proximor (umzobo 2).
(iv) amava okhetho lokukhetha.
Ubude bezikrelemnqa kunokuba nzima ukulinganisa ngokuchanekileyo ngenxa yethambo lethambo eliqatha. Izikrelemnqa ezinde zinokukhokelela kwi-thendon agundul kwaye imfutshane kakhulu ukuxhasa ukulungiswa kwebhloko ye-dorsal fris. Ngesi sizathu ababhali bancome ukusetyenziswa kweenzipho ezitshixwayo kunye nezipikili zokutshixshwa kwe-radial kwi-tuberosity ye-raidial tuberasity kunye nokusetyenziswa kwezikrelemnqa okukhanyisiweyo. Ukusetyenziswa kwentloko ye-blunt kufuphi kukuphazamiseka kwi-tendon nokuba inyibilikisiwe. Ukulungelelanisa ukulungiswa kweplate, i-screen ezimbini ze-screws + i-screw enye (ibekwe kwi-Ellipse) inokusetyenziselwa ukulungiswa.
UGqr Kiyohito ovela eFrance wazisa amava abo okusebenzisa iipleyiti zokutshixa i-palmar encinanana ekuhlaseleni irediyo ye-Direjius, apho i-chietional yayo incitshisiwe ibe yi-1cm egqithisileyo. Le ndlela iboniswe ngokuyintloko ngenxa yerediyo yeradiyo e-Direcy, kwaye iimpawu zayo zoqhaqho zenzelwe amaqhezu awongezelelweyo ye-AO kunye ne-A3 kunye ne-A3 kunye ne-A3 kunye ne-C2 ye-C2 kunye ne-C2 ye-Intra-ye-Intra ye-Intra ye-Intra ye-Intra ye-Intra ye-Intra idityaniswe. Indlela ikwangafanelekanga kuhlobo lwe-B. Ababhali bakwakhona ukuba ukuba ukuncitshiswa okuhle kwaye ukulungiswa akunakuphunyezwa ngale ndlela, kuyimfuneko ukutshintshela kwindlela yemveli yesiqhelo kwaye unganamathikisi ekuhlaseleni okuncinci okungahlaseli.
Ixesha lasemva kwexesha: Jun-26 ukuya ku-4024
