Okwangoku, ukwaphuka kwe-distal radius kuphathwa ngeendlela ezahlukeneyo, ezifana nokufakelwa kwe-plaster, ukunqunyulwa kunye nokunciphisa ukufakwa kwangaphakathi, i-external fixation bracket, njl. Phakathi kwazo, ukufakwa kwe-palmar plate kunokufezekisa iziphumo ezanelisayo, kodwa ezinye iincwadi zibika ukuba izinga layo lobunzima liphezulu njenge-16%. Nangona kunjalo, ukuba i-plate ikhethwe ngokufanelekileyo, izinga lobunzima linokuncipha ngempumelelo. Isishwankathelo esifutshane seentlobo, izalathiso kunye neendlela zotyando zokufakelwa kwe-palmar kwii-distal radius fractures sibonisiwe.
I. Iintlobo zee-distal radius fractures
Kukho iinkqubo ezahlukeneyo zokwahlulwa kwamathambo, kuquka udidi lwe-Müller AO olusekelwe kwi-anatomy kunye nodidi lwe-Femandez olusekelwe kwindlela yokwenzakala. Phakathi kwazo, udidi lwe-Eponymic ludibanisa iingenelo zodidi lwangaphambili, lugubungela iintlobo ezine ezisisiseko zokwaphuka kwamathambo, kwaye luquka ukwaphuka kwamathambo kaMaleon okune-part 4 kunye nokuqhekeka kwamathambo kaChaffer, okunokuba sisikhokelo esihle somsebenzi weklinikhi.
1. Udidi lwe-Müller AO - ukwaphuka okuncinci kwangaphakathi kwe-articular
Udidi lwe-AO lufanelekile kakhulu kwiimfanta ze-distal radius kwaye luzahlulahlula zibe ziintlobo ezintathu eziphambili: uhlobo lwe-A extra-articular, uhlobo lwe-B partial intra-articular, kunye nohlobo lwe-C total joint fractures. Uhlobo ngalunye lwahlulwe ngakumbi kwiindidi ezahlukeneyo zamaqela amancinci ngokusekelwe kubunzima kunye nobunzima bokwaphuka.
Uhlobo A: Ukuqhekeka kwe-extra-articular
I-A1, ukwaphuka kwe-ulnar femoral, i-radius njengokwenzakala (i-A1.1, ukwaphuka kwesiqu se-ulnar; i-A1.2 ukwaphuka okulula kwe-ulnar diaphysis; i-A1.3, ukwaphuka okuncinci kwe-ulnar diaphysis).
A2, Ukuqhekeka kweradiyumu, kulula, kunye nenxalenye engaphakathi (A2.1, iradiyumu engenatyekelo; A2.2, ukuthambeka kwedolo kweradiyumu, oko kukuthi, ukwaphuka kwePouteau-Colles; A2.3, ukuthambeka kwesundu kweradiyumu, oko kukuthi, ukwaphuka kweGoyrand-Smith).
A3, Ukuqhekeka kweradiyumu, okuncitshisiweyo (A3.1, ukufinyezwa kweradiyumu nge-axial; A3.2 isiqwenga esimile okwe-wedge seradiyumu; A3.3, ukuqhekeka kweradiyumu okuncitshisiweyo).
Uhlobo B: ukuphuka kwe-articular okuyingxenye
B1, ukwaphuka kweradiyo, i-sagittal plane (B1.1, uhlobo olulula olusecaleni; B1.2, uhlobo olusecaleni olusecaleni; B1.3, uhlobo oluphakathi).
B2, Ukuqhekeka komphetho we-dorsal we-radius, oko kukuthi, ukwaphuka kukaBarton (B2.1, uhlobo olulula; B2.2, ukwaphuka kwe-sagittal ecaleni; B2.3, ukuqhekeka kwe-dorsal kwesandla okudibeneyo).
B3, Ukuqhekeka komphetho we-metacarpal weradius, oko kukuthi, ukwaphuka kwe-anti-Barton, okanye ukwaphuka kwe-Goyrand-smith type II (B3.1, umthetho olula we-femoral, iqhekeza elincinci; B3.2, ukwaphuka okulula, iqhekeza elikhulu; B3.3, ukwaphuka okuncinci).
Uhlobo C: ukuphuka kwe-articular epheleleyo
I-C1, ukwaphuka kwe-radial okunohlobo olulula lweendawo ezi-articular kunye nezo ze-metaphyseal (i-C1.1, ukwaphuka kwe-articular yangasemva; i-C1.2, ukwaphuka kwe-sagittal yomphezulu we-articular; i-C1.3, ukwaphuka komphezulu we-coronal womphezulu we-articular).
I-C2, ukwaphuka kwe-Radius, i-simple articular facet, i-comminuted metaphysis (i-C2.1, ukwaphuka kwe-sagittal ye-articular facet; i-C2.2, ukwaphuka kwe-coronal facet ye-articular facet; i-C2.3, ukwaphuka kwe-articular okufikelela kwisiqu se-radial).
I-C3, ukwaphuka kwe-radial, okuqhekekileyo (C3.1, ukwaphuka okulula kwe-metaphysis; C3.2, ukwaphuka kwe-metaphysis okuqhekekileyo; C3.3, ukwaphuka kwe-articular okufikelela kwisiqu se-radial).
2. Ukwahlulahlula ii-distal radius fractures.
Ngokwendlela yokwenzakala, udidi lweFemandez lunokwahlulwa lube ziintlobo ezi-5:.
Ukwaphuka kohlobo lwe-I kukwaphuka okuxutywe yi-extra-articular metaphyseal comminuted fractures ezifana neColles fractures (dorsal angulation) okanye iSmith fractures (metacarpal angulation). I-cortex yethambo elinye iyaphuka xa kukho uxinzelelo kwaye i-contralateral cortex iyaqhekeka kwaye ibekwe ngaphakathi.
Ukwaphuka
Ukwaphuka kohlobo lwesithathu kukwaphuka kwamalungu omzimba ngaphakathi kwethambo, okubangelwa kukuxinezeleka kwe-shear. Olu kwaphuka luquka ukwaphuka kwesandla sikaBarton, ukwaphuka kwesandla sikaBarton, kunye nokuqhekeka kwesiqu se-radial.
Phungula ucinzelelo
Ukwaphuka kohlobo lwesithathu kukwaphuka kwangaphakathi kwethambo kunye nokufakwa kwe-metaphyseal okubangelwa kukulimala okucinezelweyo, kubandakanya ukwaphuka kwethambo okuntsonkothileyo kunye nokuqhekeka kwe-radial pilon.
Ukufakwa
Ukuqhekeka kohlobo lwe-IV kukuqhekeka kwe-ligamentous attachment okwenzeka ngexesha lokuqhekeka-ukususwa kwe-radial carpal joint.
Ukuqhekeka kwe-Avulsion I dislocation
Ukwaphuka kohlobo lwe-V kuvela kukwenzakala okukhawulezayo okubandakanya amandla amaninzi angaphandle kunye nokwenzakala okukhulu. (I-Mixed I, II, III, IV)
3. Ukubhala nge-eponymic
II.Unyango lwezaphuko zeradiyo ekude ngeplati yesundu
Iimpawu.
Kwaphuka kwamathambo angaphandle kwe-articular emva kokungaphumeleli kokunciphisa okuvaliweyo kwezi meko zilandelayo.
Ukujikeleza kwe-dorsal okungaphezulu kwama-20°
Uxinzelelo lwe-Dorsal olungaphezulu kwe-5 mm
Ukufinyeza kwerediyasi ekude okungaphezulu kwe-3 mm
Ukufuduka kwebhloko yokuqhekeka okukude okungaphezulu kwe-2 mm
Kwiingozi zangaphakathi kwe-articular ezingaphezulu kwe-2mm
Uninzi lweengcali azicebisi ukusetyenziswa kwee-metacarpal plates kwizilonda ezinamandla aphezulu, ezinje ngokuqhekeka okukhulu kwe-intra-articular comminuted okanye ukulahleka kwamathambo okukhulu, kuba la maqhekeza okuqhekeka akude athambekele kwi-avascular necrosis kwaye kunzima ukuwabeka kwakhona ngokwe-anatomiki.
Kwizigulane ezineenxalenye ezininzi zamathambo kunye nokufuduka okukhulu kunye ne-osteoporosis enzima, i-metacarpal plating ayisebenzi. Inkxaso ye-subchondral yamathambo aqhekekileyo angase ibe yingxaki, njengokungena kwe-screw kwi-joint cavity.
Indlela yotyando
Uninzi loogqirha basebenzisa indlela efanayo kunye nobuchule bokulungisa ukwaphuka kwe-distal radius ngeplate yesundu. Nangona kunjalo, kufuneka indlela elungileyo yotyando ukuze kuthintelwe ngempumelelo iingxaki emva kotyando, umz., ukunciphisa kunokufezekiswa ngokukhulula ibhloko yokuqhekeka kwi-encrypted compression kunye nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa okwethutyana ngee-2-3 Kirschner pins kungasetyenziswa, njl.
(I) Ukutshintsha indawo kunye nendlela yokuma ngaphambi kotyando
1. Ukutsala kwenziwa kwicala le-radial shaft phantsi kwe-fluoroscopy, ngobhontsi ocinezela ibhloko yokuqhekeka esezantsi ukusuka kwicala lesundu kwaye eminye iminwe iphakamisa ibhloko ekude phezulu nge-engile ukusuka kwicala le-dorsal.
2. Ukulala phantsi, ilungu elichaphazelekayo libekwe etafileni yesandla phantsi kwe-fluoroscopy.
(II) Iindawo zokufikelela.
Kuhlobo lwendlela eza kusetyenziswa, kuyacetyiswa indlela ye-PCR (radial carpal flexor) extended palmar.
Isiphelo esikude sesithintelo sesikhumba siqala kwimiqolo yesikhumba sesandla kwaye ubude baso bunokugqitywa ngokohlobo lokuqhekeka.
I-radial flexor carpi radialis tendon kunye ne-tendon sheath yayo zinqunyiwe, zikude kakhulu kumathambo e-carpal kwaye zikufutshane kakhulu necala elikufutshane kangangoko.
Ukutsala i-radial carpal flexor tendon kwicala le-ulnar kukhusela i-median nerve kunye ne-flexor tendon complex.
Indawo yeParona iyabonakala kwaye umsipha we-rotator ani ongaphambili uphakathi kwe-flexor digitorum longus (icala le-ulnar) kunye nomthambo we-radial (icala le-radial).
Sika icala le-radial le-anterior rotator ani muscle, uqaphele ukuba inxalenye ethile kufuneka ishiywe inamathele kwi-radius ukuze yakhiwe kwakhona kamva.
Ukutsala umsipha we-rotator anterior ani ukuya kwicala le-ulnar kuvumela ukuba uphondo lwe-ulnar lubonakale ngokwaneleyo kwicala lesandla se-radius.
Indlela yesundu ityhila i-distal radius kwaye ityhila ngokufanelekileyo i-ulnar angle.
Kwiintlobo zokwaphuka okuntsonkothileyo, kucetyiswa ukuba i-distal brachioradialis stop ikhululwe, nto leyo enokuthi inciphise ukutsalwa kwayo kwi-radial tuberosity, apho i-palmar sheath ye-dorsal compartment yokuqala inokunqunyulwa, nto leyo enokuthi iveze i-distal fracture block radial kunye ne-radial tuberosity, ijikeleze ngaphakathi i-radius Yu ukuze iyikhuphe kwindawo yokwaphuka, ize ibuyisele kwakhona i-intra-articular fracture block usebenzisa i-Kirschner pin. Kwi-complex intra-articular fractures, i-arthroscopy ingasetyenziselwa ukunceda ekunciphiseni, ekuvavanyeni nasekulungiseni i-fracture block.
(III) Iindlela zokunciphisa.
1. Sebenzisa i-bone pry njengesixhobo sokubuyisela umva
2. Umncedisi utsala iminwe yesalathiso neyesiphakathi yesigulana, nto leyo eya kuba lula ukuyibuyisela.
3. Screw iphini yeKirschner kwi-radial tuberosity ukuze ilungiswe okwethutyana.
Emva kokuba ukutshintshwa kwendawo kugqityiwe, kubekwa ipleyiti yesundu rhoqo, ekufuneka ibe kufutshane nje nomgxobhozo wamanzi, kufuneka igqume ubukhulu be-ulnar, kwaye kufuneka ibe kufutshane nombindi wesiqu se-radial. Ukuba ezi meko azifezekiswanga, ukuba ipleyiti ayilingani ngobukhulu, okanye ukuba ukutshintshwa kwendawo akwanelisi, inkqubo ayikabi gqibelele.
Iingxaki ezininzi zinxulumene kakhulu nendawo yepleyiti. Ukuba ipleyiti ibekwe kude kakhulu kwicala le-radial, iingxaki ezinxulumene ne-bunion flexor zinokwenzeka; ukuba ipleyiti ibekwe kufutshane kakhulu nomgca wamanzi, i-flexor enzulu yomnwe inokuba semngciphekweni. Ukukhubazeka kokuqhekeka okubuyela kwicala lesundu kunokubangela ukuba ipleyiti ivele kwicala lesundu ize idibane ngqo ne-flexor tendon, ekugqibeleni ikhokelele kwi-tendonitis okanye ukuqhekeka.
Kwizigulane ezine-osteoporosis, kucetyiswa ukuba ipleyiti ibekwe kufutshane nomgca wamanzi kangangoko kunokwenzeka, kodwa ingabi ngaphaya kwawo. Ukufakelwa kwe-subchondral kungenziwa ngokusebenzisa iiphini zeKirschner ezikufutshane ne-ulna, kwaye iiphini zeKirschner ezikufutshane kunye nezikrufu zokutshixa ziyasebenza ekuthinteleni ukuphinda kwaphuka.
Nje ukuba ipleyiti ibekwe ngokuchanekileyo, isiphelo esikufutshane siyaqiniswa ngesikrufu esinye kwaye isiphelo esikude sepleyiti siqiniswe okwethutyana ngeephini zeKirschner kumngxuma we-ulnar kakhulu. Ii-orthopantomograms ze-Intraoperative fluoroscopic, iimbono ezisecaleni, kunye neefilimu ezisecaleni ezine-30° wrist elevation zithathwe ukuze kuchongwe ukunciphisa ukwaphuka kunye nendawo yokulungiswa kwangaphakathi.
Ukuba ipleyiti ibekwe ngendlela eyanelisayo, kodwa iphini yeKirschner ingaphakathi kwe-articular, oku kuya kubangela ukubuyiselwa okungonelanga kwe-palmar inclination, enokusonjululwa ngokuseta kwakhona ipleyiti kusetyenziswa "indlela yokulungisa ukuqhekeka kwe-distal" (Umzobo 2, b).
Umfanekiso 2.
a, iiphini ezimbini zeKirschner zokulungisa okwethutyana, qaphela ukuba ukuthambekela kwe-metacarpal kunye neendawo ezidibeneyo azibuyiselwanga ngokwaneleyo ngeli xesha;
b, Iphini enye yeKirschner yokulungisa ipleyiti yexeshana, qaphela ukuba i-distal radius izinzile kweli nqanaba (indlela yokulungisa ibhloko yokuqhekeka kwe-distal), kwaye inxalenye ekufutshane yepleyiti itsalwa iye kwi-radial stem ukubuyisela i-angle yokuthambekela kwesundu.
C, Ukulungiswa kakuhle kwe-arthroscopic kwemiphezulu edibeneyo, ukubekwa kwezikrufu/iiphini zokutshixa ezikude, kunye nokuseta kwakhona kokugqibela kunye nokulungiswa kwerediyasi ekufutshane.
Kwimeko yokuqhekeka kwamalungu omqolo kunye namalungu omqolo ngaxeshanye (i-ulnar/dorsal Die Punch), engenakukwazi ukuphinda isetyenziswe ngokwaneleyo xa ivaliwe, ezi ndlela zintathu zilandelayo zingasetyenziswa.
I-proximal radius ijikeleziswa ngaphambili kude nendawo yokuqhekeka, kwaye ibhloko yokuqhekeka ye-lunate fossa ityhalelwa kwithambo le-carpal ngendlela yokwandisa i-PCR; kwenziwa umngxuma omncinci kwi-dorsal ukuya kwi-4th kunye ne-5th compartments ukuze kubonakale ibhloko yokuqhekeka, kwaye iqiniswe nge-screw kwi-ulnam foramen yeplate. Ukulungiswa okuvaliweyo kwe-percutaneous okanye okuncinci okungenayo kwenziwa ngoncedo lwe-arthroscopic.
Emva kokutshintshwa okwanelisayo kunye nokubekwa ngokuchanekileyo kwepleyiti, ukulungiswa kokugqibela kulula kwaye ukutshintshwa kwe-anatomical kunokufezekiswa ukuba iphini ye-proximal ulnar kernel ibekwe ngokuchanekileyo kwaye akukho zikrufu zikwi-joint cavity (Umfanekiso 2).
(iv) Amava okukhetha izikrufu.
Ubude bezikrufu bunokuba nzima ukubulinganisa ngokuchanekileyo ngenxa yokuqhekeka kwamathambo e-dorsal cortical. Izikrufu ezinde kakhulu zinokubangela ukushukuma kwemisipha kunye nokumfutshane kakhulu ukuxhasa ukuqiniswa kwebhloko yokuqhekeka kwemisipha. Ngenxa yesi sizathu ababhali bacebisa ukusetyenziswa kwezipikili ezitshixayo ezinemisonto kunye nezipikili ezitshixayo ezininzi kwi-radial tuberosity kunye ne-ulnar foramen eninzi, kunye nokusetyenziswa kwezikrufu ezitshixayo ze-light-stem kwiindawo ezisele. Ukusetyenziswa kwentloko eqaqambileyo kuthintela ukushukuma kwemisipha nokuba ixixiwe ngemisonto. Kwi-proximal interlocking plate fixation, izikrufu ezimbini ezitshixayo kunye ne-screw enye eqhelekileyo (ebekwe nge-ellipse) zingasetyenziselwa ukuxiniswa.
UGqr. Kiyohito waseFransi uveze amava akhe okusebenzisa iipleyiti zokutshixa isundu ezingaphantsi kakhulu kwiindlela zokuqhekeka kweradiyumu ekude, apho ukunqunyulwa kwazo ngotyando kwancitshiswa ukuya kwi-1cm egqithisileyo, nto leyo echaseneyo. Le ndlela iboniswa ikakhulu kwiindlela zokuqhekeka kweradiyumu ekude ezizinzileyo, kwaye izibonakaliso zayo zotyando zezokwaphuka kwe-extra-articular yeenxalenye ze-AO zeentlobo ze-A2 kunye ne-A3 kunye neenxalenye zokuqhekeka kwe-intra-articular zeentlobo ze-C1 kunye ne-C2, kodwa ayifanelekanga kwiindlela zokuqhekeka kwe-C1 kunye ne-C2 ezidibene nokuwa kwethambo elingaphakathi kwe-articular. Le ndlela ayifanelekanga nakwiindlela zokuqhekeka kwe-type B. Ababhali bakwabonisa ukuba ukuba ukunciphisa kunye nokulungiswa okuhle akunakufezekiswa ngale ndlela, kuyimfuneko ukutshintshela kwindlela yokunqunyulwa yendabuko kwaye unganamatheli kwi-minimally invasive small incision.
Ixesha leposi: Juni-26-2024
