Ukuqhekeka kwe-distal radius yenye yezona zixhaphakileyoukwaphukakwizonyango. Kwinkoliso yee-distal fractures, iziphumo ezilungileyo zonyango zinokufunyanwa ngokusebenzisa i-palmar approach plate kunye ne-screw internal fixation. Ukongeza, kukho iintlobo ezahlukeneyo zee-distal radius fractures, ezifana ne-Barton fractures, i-Die-punch fractures,Ukwaphuka komqhubi, njl., nganye ifuna iindlela ezithile zonyango. Iingcali zamanye amazwe, kwizifundo zazo zeesampulu ezinkulu zeemeko zokuqhekeka kweradiyumu ekude, zichonge uhlobo oluthile apho inxalenye yelungu ibandakanya ukwaphuka kweradiyumu ekude, kwaye iziqwenga zamathambo zenza isakhiwo esifana nesakhelo "esinxantathu" (i-tetrahedron), esibizwa ngokuba luhlobo "lwe-tetrahedron".
Ingcamango yokwaphuka kwe-"Tetrahedron" Uhlobo lwe-Distal Radius Fracture: Kolu hlobo lokuqhekeka kwe-distal radius, ukwaphuka kwenzeka ngaphakathi kwenxalenye yelungu, kubandakanya zombini i-palmar-ulnar kunye ne-radial styloid facets, kunye nolwakhiwo olujikelezayo lwe-triangular. Umgca wokuqhekeka ufikelela kwisiphelo se-distal se-radius.
Ukwahluka kwale ntshabalalo kubonakala kwiimpawu ezahlukileyo zeziqwenga zamathambo ezisecaleni kwe-palmar-ulnar zeradius. Kwelinye icala, i-lunar fossa eyenziwe ziziqwenga zamathambo ezisecaleni kwe-palmar-ulnar isebenza njengenkxaso yomzimba ngokuchasene nokudilika kwe-volar kwamathambo e-carpal. Ukulahlekelwa yinkxaso evela kolu lwakhiwo kubangela ukudilika kwe-volar kwejoyinti yesandla. Kwelinye icala, njengenxalenye yomphezulu we-radial articular wejoyinti ye-distal radioulnar, ukubuyisela eli qhekeza lamathambo kwindawo yalo yomzimba kuyimfuneko yokubuyisela uzinzo kwijoyinti ye-distal radioulnar.
Umfanekiso ongezantsi ubonisa iCandelo 1: Iimpawu zomfanekiso wendlela eqhelekileyo yokuqhekeka kwe-"Tetrahedron" distal radius.
Kwisifundo esithathe iminyaka emihlanu, kuchongwe amatyala asixhenxe olu hlobo lokwaphuka. Ngokuphathelele izibonakaliso zotyando, kumatyala amathathu, kuquka neCandelo loku-1 kumfanekiso ongasentla, apho ekuqaleni kwakukho ukwaphuka okungasuswanga kwindawo ethile, unyango olulondolozayo lwakhethwa ekuqaleni. Nangona kunjalo, ngexesha lokulandelela, onke amatyala amathathu afumana ukufuduka kwaphuka, nto leyo eyakhokelela kutyando lwangaphakathi olulandelayo. Oku kubonisa izinga eliphezulu lokungazinzi kunye nomngcipheko omkhulu wokuphinda kufuduke kwaphuka kolu hlobo, nto leyo egxininisa uphawu oluqinileyo lokungenelela kotyando.
Ngokuphathelele unyango, amatyala amabini ekuqaleni aye asetyenziswa ngendlela yendabuko ye-volar esebenzisa i-flexor carpi radialis (FCR) yokufakela ipleyiti kunye ne-screw internal fixation. Kwelinye lala matyala, ukufakela akuphumelelanga, nto leyo eyabangela ukuba amathambo afuduke. Emva koko, kwasetyenziswa indlela ye-palmar-ulnar, kwaye ukufakela okuthile ngepleyiti yekholamu kwenziwa ukuze kuhlaziywe ikholamu ephakathi. Emva kokuba kubekho ukusilela kokufakela, amatyala amahlanu alandelayo onke aye asetyenziswa ngendlela ye-palmar-ulnar kwaye alungiswa ngeepleyiti ze-2.0mm okanye ze-2.4mm.
Ityala lesi-2: Kusetyenziswa indlela eqhelekileyo ye-volar ene-flexor carpi radialis (FCR), kwenziwe ukufakelwa kwepleyiti yesundu. Emva kotyando, kwabonwa ukukhubeka kwangaphambili kwelungu lesandla, nto leyo ebonisa ukungasebenzi kakuhle kokufakelwa.
Kwityala lesi-2, ukusebenzisa indlela ye-palmar-ulnar kunye nokuhlaziya nge-column plate kuphumele kwindawo eyanelisayo yokulungiswa kwangaphakathi.
Ukuqwalasela iintsilelo zeepleyiti zokuqhekeka kweradiyumu yesiqhelo ekulungiseni le nxalenye yethambo, kukho imiba emibini ephambili. Okokuqala, ukusetyenziswa kwendlela ye-volar kunye ne-flexor carpi radialis (FCR) kunokubangela ukuvezwa okunganelanga. Okwesibini, ubukhulu obukhulu beeskrufu zepleyiti ezitshixayo zesundu zisenokungazibambi ngokuchanekileyo iziqwenga zamathambo amancinci kwaye zinokuzisusa ngokufaka izikrufu kwiindawo eziphakathi kweziqwenga.
Ngoko ke, iingcali zicebisa ukusetyenziswa kweepleyiti zokutshixa ze-2.0mm okanye ze-2.4mm ukuze kufakwe iqhekeza lethambo eliphakathi. Ukongeza kwipleyiti exhasayo, ukusebenzisa izikrufu ezibini ukulungisa iqhekeza lethambo kunye nokunciphisa ipleyiti ukuze kukhuselwe izikrufu kukwayindlela eyahlukileyo yokufakela iqhekeza langaphakathi.
Kule meko, emva kokulungisa iqhekeza lethambo ngezikrufu ezimbini, ipleyiti yafakwa ukukhusela izikrufu.
Ngamafutshane, ukwaphuka kwe-distal radius yohlobo lwe-"Tetrahedron" kubonisa ezi mpawu zilandelayo:
1. Ukwanda kwesifo okuncinci kunye nesantya esiphezulu sokuxilongwa okungalunganga kokuqala kwefilimu ecacileyo.
2. Umngcipheko omkhulu wokungazinzi, kunye notyekelo lokuphinda ufuduke ngexesha lonyango olugcinwe kakuhle.
3. Iipleyiti zokutshixa zesundu eziqhelekileyo zokuqhekeka kweradiyumu ekude zinamandla okuqina abuthathaka, kwaye kuyacetyiswa ukusebenzisa iipleyiti zokutshixa ze-2.0mm okanye ze-2.4mm ukuze zilungiswe ngokuthe ngqo.
Ngenxa yezi mpawu, kwizonyango, kuyacetyiswa ukuba kwenziwe ii-CT scans okanye ukuphinda kuhlolwe rhoqo kwizigulana ezineempawu ezibonakalayo zesandla kodwa ezine-X-rays engentle.ukwaphuka, utyando lwangethuba olusebenzisa ipleyiti ethile yekholamu luyacetyiswa ukuthintela iingxaki kamva.
Ixesha lokuthumela: Oktobha-13-2023
