Iikhrayitheriya ezamkelekileyo zokuphiliswa kwezaphuko ze-humeral shaft yi-anterior-posterior angulation engaphantsi kwama-20°, i-lateral angulation engaphantsi kwama-30°, ukujikeleza okungaphantsi kwama-15°, kunye nokufinyezwa okungaphantsi kwama-3cm. Kwiminyaka yakutshanje, ngenxa yokwanda kweemfuno zokusebenza kwamalungu aphezulu kunye nokuphola kwangoko kubomi bemihla ngemihla, unyango lotyando lwezaphuko ze-humeral shaft luye lwaxhaphaka ngakumbi. Iindlela eziqhelekileyo ziquka i-anterior, anterolateral, okanye i-posterior plating yokulungiswa kwangaphakathi, kunye ne-intramedullary nailling. Izifundo zibonisa ukuba izinga lokungahambelani kokulungiswa kwangaphakathi kwezaphuko ze-humeral limalunga ne-4-13%, kunye nokulimala kwe-radial nerve okwenzeka malunga ne-7% yamatyala.
Ukuze kuthintelwe ukwenzakala kwemithambo-luvo ye-radial ebangelwa yi-iatrogenic kunye nokunciphisa izinga lokungahambelani kokunciphisa okuvulekileyo, izazinzulu zasekhaya eTshayina ziye zamkela indlela ye-medial, zisebenzisa indlela ye-MIPPO ukulungisa ukwaphuka kwe-humeral shaft, kwaye zifumene iziphumo ezilungileyo.
Iinkqubo zotyando
Inyathelo lokuqala: Ukuma. Isigulana silele silele phantsi, ilungu elichaphazelekayo litsalwe ngama-90 degrees lize libekwe etafileni yotyando ecaleni.
Inyathelo lesibini: Ukusika ngotyando. Kwindlela eqhelekileyo yokulungisa ipleyiti enye (iKanghui) kwizigulane, kwenziwa imingxunya emibini emide emalunga ne-3cm nganye kufutshane neziphelo zeproximal nezedistal. Ukusika kweproximal kusebenza njengomnyango wendlela ye-deltoid engaphelelanga kunye ne-pectoralis major, ngelixa ukusika kwedistal kukwindawo engaphezulu kwe-medial epicondyle yehumerus, phakathi kwe-biceps brachii kunye ne-triceps brachii.
▲ Umzobo wesicwangciso somqalo okufutshane.
①: Ukusika ngotyando; ②: Umthambo weCephalic; ③: I-Pectoralis major; ④: Imisipha ye-deltoid.
▲ Umzobo wesicwangciso somqalo othe tyaba.
①: I-median nerve; ②: I-Ulnar nerve; ③: Imisipha yeBrachialis; ④: Utyando.
Inyathelo lesithathu: Ukufakwa kwepleyiti kunye nokufakelwa kwayo. Ipleyiti ifakwa nge-proximal incision, inamathele kumphezulu wethambo, idlula ngaphantsi kwemisipha ye-brachialis. Ipleyiti iqalwa iqiniswe kwisiphelo se-proximal se-humeral shaft fracture. Emva koko, ngokutsala okujikelezayo kwilungu elingaphezulu, i-fracture iyavalwa kwaye ilungelelaniswe. Emva kokunciphisa okwanelisayo phantsi kwe-fluoroscopy, i-screw eqhelekileyo ifakwa nge-distal incision ukuze iqinise ipleyiti kumphezulu wethambo. I-screw evalayo iyaqiniswa, igqibezela i-plate fixation.
▲ Umzobo wesicwangciso se-tunnel yepleyiti ephezulu.
①: Izihlunu zeBrachialis; ②: Izihlunu zeBiceps brachii; ③: Imithambo yegazi kunye nemithambo-luvo ephakathi; ④: I-Pectoralis major.
▲ Umzobo wesicwangciso setonela yepleyiti ekude.
①: Izihlunu zeBrachialis; ②: I-median nerve; ③: I-Ulnar nerve.
Ixesha lokuthumela: Novemba-10-2023
