Ukwaphuka okunqamlezileyo okunesiphako esincinci okanye esingaphelelanga: kwimeko yokwaphuka kwethambo le-metacarpal (intamo okanye i-diaphysis), kuqalwa ngokutsha ngokutsalwa ngesandla. I-proximal phalanx igobile kakhulu ukuze iveze intloko ye-metacarpal. Kwenziwa ukusika okunqamlezileyo okuyi-0.5-1 cm kwaye i-extensor tendon irhoxiswa ngobude kumgca ophakathi. Phantsi kwesikhokelo se-fluoroscopic, sifake ucingo lwesikhokelo oluyi-1.0 mm ecaleni kwe-axis ende yesandla. Incam yocingo lwesikhokelo yaqiniswa ukuze kuthintelwe ukungena kwe-cortical kunye nokwenza kube lula ukutyibilika ngaphakathi komjelo we-medullary. Emva kokuba indawo yocingo lwesikhokelo ifunyenwe nge-fluoroscopically, ipleyiti yamathambo e-subchondral yalungiswa kusetyenziswa i-hollow drill bit kuphela. Ubude be-screw obufanelekileyo bubalwa kwimifanekiso yangaphambi kotyando. Kwiintlobo ezininzi zokwaphuka kwe-metacarpal, ngaphandle kwe-metacarpal yesihlanu, sisebenzisa i-screw enobubanzi obuyi-3.0-mm. Sisebenzise izikrufu ezingenantloko ze-AutoFIX (little Bone Innovations, Morrisville, PA). Ubude obuphezulu obungasetyenziswayo besikrufu esiyi-3.0-mm yi-40 mm. Oku kufutshane kunobude obuqhelekileyo bethambo le-metacarpal (malunga ne-6.0 cm), kodwa bude ngokwaneleyo ukubamba imisonto kwi-medulla ukuze kufunyanwe ukuqiniswa okukhuselekileyo kwesikrufu. Ububanzi bomngxuma we-medullary we-metacarpal yesihlanu budla ngokuba bukhulu, kwaye apha sisebenzise isikrufu esiyi-4.0 mm esinobubanzi obuphezulu obufikelela kwi-50 mm. Ekupheleni kwenkqubo, siqinisekisa ukuba umsonto we-caudal ungcwatywe ngokupheleleyo ngaphantsi komgca we-cartilage. Ngokwahlukileyo koko, kubalulekile ukuphepha ukufaka i-prosthesis nzulu kakhulu, ingakumbi kwimeko yokwaphuka kwentamo.
Umfanekiso 14 Ku-A, ukwaphuka kwentamo okuqhelekileyo akunqunyulwanga kwaye intloko ifuna ubunzulu obuncinci njengoko i-B cortex iya kucinezelwa
Indlela yotyando yokuqhekeka kwe-proximal phalanx yayifana (Umzobo 15). Senze ukusika okunqamlezileyo okuyi-0.5 cm entloko ye-proximal phalanx ngelixa sigoba kakhulu ijoyinti ye-proximal interphalangeal. Imisipha yahlulwa yaza yarhoxa ngobude ukuze iveze intloko ye-proximal phalanx. Kwiintlobo ezininzi zokuqhekeka kwe-proximal phalanx, sisebenzisa isikrufu se-2.5 mm, kodwa kwii-phalanges ezinkulu sisebenzisa isikrufu se-3.0 mm. Ubude obuphezulu be-2.5 mm CHS esetyenziswayo ngoku yi-30 mm. Siyaqaphela ukuba singaziqinisi kakhulu izikrufu. Ekubeni izikrufu zizigqobhozela kwaye zizicofa, zinokungena kwisiseko se-phalanx ngokumelana okuncinci. Indlela efanayo yasetyenziswa kwiintlobo ze-midphalangeal phalangeal fractures, apho ukusika kuqala entloko ye-midphalangeal phalanx ukuvumela ukubekwa kweekrufu kwakhona.
Umfanekiso 15 Umbono we-cross-operation case ye-cross-operation. Ucingo lwe-AA oluyi-1 mm lubekwe nge-cross-operation encinci ecaleni kwe-longitudinal axis ye-proximal phalanx.B Ucingo lwe-guidewire lubekwe ukuvumela ukulungiswa kakuhle kokubekwa kwakhona kunye nokulungiswa kwayo nayiphi na imijikelezo. I-CA 2.5-mm CHS ifakiwe kwaye yangcwatywa entloko. Ngenxa yesimo esithile se-phalanges, ucinezelo lunokubangela ukwahlulwa kwe-metacarpal cortex. (Isigulana esifanayo njengakwiMfanekiso 8)
Ukuqhekeka kwemithambo: ukucinezelwa okungaxhaswanga ngexesha lokufakwa kwe-CHS kunokukhokelela ekufinyezweni kwe-metacarpals kunye ne-phalanges (Umzobo 16). Ke ngoko, nangona ukusetyenziswa kwe-CHS kungavumelekanga kwiimeko ezinjalo, sifumene isisombululo kwiimeko ezimbini eziqhelekileyo esijongene nazo.
UMFANELO 16 AC Ukuba ukwaphuka akuxhaswanga ngokwe-cortical, ukuqinisa izikrufu kuya kubangela ukuqhekeka kwaphuka nangona kuncitshiswe ngokupheleleyo.D Imizekelo eqhelekileyo evela kuthotho lwababhali ehambelana namatyala okufutshane okuphezulu (5 mm). Umgca obomvu uhambelana nomgca we-metacarpal.
Kwizaphuko ze-submetacarpal, sisebenzisa indlela eguqulweyo esekelwe kwingcamango yokwakha ye-bracing (oko kukuthi, izinto zokwakha ezisetyenziselwa ukuxhasa okanye ukuqinisa isakhelo ngokuxhathisa ucinezelo olude kwaye ngaloo ndlela zisixhase). Ngokwenza i-Y-shape ngee-screw ezimbini, intloko ye-metacarpal ayiwi; siyibize le nto ngokuba yi-Y-shape brace. Njengakwindlela yangaphambili, kufakwa i-1.0 mm longitudinal guide wire ene-blunt tip. Ngelixa kugcinwa ubude obuchanekileyo be-metacarpal, kufakwa enye i-guide wire, kodwa nge-engile ukuya kwi-guide wire yokuqala, ngaloo ndlela kwakhiwa isakhiwo esingunxantathu. Zombini ii-guide wire zandiswa kusetyenziswa i-countersink ekhokelwayo ukwandisa i-medulla. Kwi-axial kunye ne-oblique screws, sidla ngokusebenzisa ii-screws eziyi-3.0 mm kunye ne-2.5 mm ububanzi, ngokwahlukeneyo. I-axial screw ifakwa kuqala de intambo ye-caudal ilingane ne-cartilage. I-offset screw enobude obufanelekileyo emva koko ifakwa. Ekubeni kungekho ndawo yaneleyo kumjelo we-medullary wezikrufu ezimbini, ubude bezikrufu ezi-oblique kufuneka bubalwe ngononophelo, kwaye izikrufu ze-axial kufuneka zinamathele kuphela kwizikrufu ze-axial xa sele zingcwatywe ngokwaneleyo entloko ye-metacarpal ukuqinisekisa uzinzo olufanelekileyo ngaphandle kokuvela kwesikrufu. Isikrufu sokuqala emva koko sihanjiswa phambili de sibe singcwatywe ngokupheleleyo. Oku kuthintela ukufinyezwa kwe-axial kwe-metacarpal kunye nokuwa kwentloko, okunokuthintelwa zizikrufu ezi-oblique. Senza uvavanyo lwe-fluoroscopic rhoqo ukuqinisekisa ukuba ukuwa akwenzeki kwaye izikrufu zixhumene ngaphakathi komjelo we-medullary (Umzobo 17).
Itekhnoloji ye-AC Y-bracket yoMfanekiso 17
Xa i-comminution ichaphazele i-dorsal cortex kwisiseko se-proximal phalanx, saqulunqa indlela eguquliweyo; sayibiza ngokuba yi-axial bracing kuba isikrufu sisebenza njengomqadi ngaphakathi kwi-phalanx. Emva kokuseta kwakhona i-proximal phalanx, ucingo lwe-axial guide lwangeniswa kumjelo we-medullary ngangokunokwenzeka. I-CHS imfutshane kancinci kunobude be-phalanx iyonke (2.5 okanye 3.0 mm) emva koko ifakwa de isiphelo sayo sangaphambili sidibane nepleyiti ye-subchondral kwisiseko se-phalanx. Kule ndawo, imisonto ye-caudal yesikrufu ivalelwe kumjelo we-medullary, ngaloo ndlela isebenza njengenkxaso yangaphakathi kwaye ixhasa isiseko se-phalanx. Uvavanyo oluninzi lwe-fluoroscopic luyafuneka ukuthintela ukungena kwamalungu (Umfanekiso 18). Ngokuxhomekeke kwipateni yokuqhekeka, ezinye izikrufu okanye indibaniselwano yezixhobo zokubopha zangaphakathi zinokufuneka (Umfanekiso 19).
Umfanekiso 19: Iindlela ezahlukeneyo zokulungisa izigulane ezineengozi zokutyumza. Ukuqhekeka okukhulu kwe-submetacarpal yomnwe weringi kunye nokuqhekeka okuhlanganisiweyo kwesiseko somnwe ophakathi (utolo olumthubi olukhomba kwindawo yokuqhekeka okuqhekekileyo).B Kusetyenziswe i-CHS eqhelekileyo ye-3.0 mm yomnwe wokukhomba, i-3.0 mm paracentesis yomnwe ophakathi oqhekekileyo, inkxaso ye-y yomnwe weringi (kunye nokufakelwa kwesiphene kwinqanaba elinye), kunye ne-4.0 mm CHS yomnwe opinki.F Ii-Free flaps zisetyenziselwe ukugubungela izicubu ezithambileyo.C Ii-Radiographs kwiinyanga ezi-4. Ithambo le-metacarpal lomnwe omncinci laphola. Amanye amabala ethambo akheka kwenye indawo, ebonisa ukuphiliswa kokuqhekeka kwesibini.D Kunyaka omnye emva kwengozi, i-flap yasuswa; nangona ingenazimpawu, i-screw yasuswa kwi-metacarpal yomnwe weringi ngenxa yokungena okucingelwayo ngaphakathi kwe-articular. Iziphumo ezilungileyo (≥240° TAM) zifunyenwe kumnwe ngamnye kutyelelo lokugqibela. Utshintsho kwilungu le-metacarpophalangeal lomnwe ophakathi lubonakale kwiinyanga ezili-18.
Umfanekiso 20 Ukwaphuka komnwe wokwalatha onolwandiso lwangaphakathi (oluboniswe ziintolo), oluguqulwe lwaba kukwaphuka okulula ngokuqiniswa okwethutyana kwe-articular kusetyenziswa i-K-wire.C Oku kudala isiseko esizinzileyo apho kufakwa khona isikrufu esixhasayo esinde.D Emva kokufakelwa, ulwakhiwo lwagwetywa njengoluzinzileyo, oluvumela intshukumo esebenzayo kwangoko.E,F Uluhlu lwentshukumo kwiiveki ezi-3 (iintolo eziphawula amanqaku okungena kwezikrufu zesiseko)
Umfanekiso 21 Ii-radiographs ze-posterior orthostatic kunye ne-B lateral zesigulane u-A. Ii-fractures ezintathu zesigulane ezinqamlezileyo (kwiintolo) ziphathwe ngezikrufu ze-cannulated eziyi-2.5-mm. Akukho tshintsho lubalulekileyo kwi-interphalangeal joints olubonakalayo emva kweminyaka emi-2
Ixesha leposi: Septemba-18-2024
