Ukuqhekeka okuguquguqukayo kunye nokuncinci okanye akukho comminution: kwimeko yokuphuka kwethambo le-metacarpal (intamo okanye i-diaphysis), isetyenziselwe ngokutsha nge-manual traction. I-phalanx ejikelezayo iguquguquke kakhulu ukuze iveze intloko ye-metacarpal. I-0.5- 1 cm ye-transverse incision yenziwa kwaye i-tendon ye-extensor ihlehliswa ngokude kumgca ophakathi. Ngaphantsi kwesikhokelo se-fluoroscopic, sifake i-1.0 mm yocingo lwesikhokelo ecaleni kwe-axis ye-longitudinal yesihlahla. Incam ye-guidewire yayinqanyuliwe ukwenzela ukuphepha ukungena kwe-cortical kunye nokuququzelela ukutyibilika ngaphakathi kwe-medullary canal. Emva kokuba indawo ye-guidewire igqitywe nge-fluoroscopically, i-subchondral bone plate yabuyiselwa kwakhona kusetyenziswa kuphela i-drill bitana. Ubude obufanelekileyo besijirufu babalwe kwimifanekiso yangaphambili. Kwiintlobo ezininzi ze-metacarpal fractures, ngaphandle kwe-metacarpal yesihlanu, sisebenzisa i-screw ye-3.0-mm ububanzi. Sasebenzisa i-AutoFIX izikrufu ezingenantloko ezingenantloko (i-Bone Innovations encinci, i-Morrisville, i-PA) .Ubude obusebenzisekayo be-screw ye-3.0-mm yi-40 mm. Oku mfutshane kunobude obuqhelekileyo bethambo le-metacarpal (malunga ne-6.0 cm), kodwa lide ngokwaneleyo ukubandakanya iintambo kwi-medulla ukufumana ukulungiswa okukhuselekileyo kwesikrufu. Idayamitha yecango yemedulari ye-metacarpal yesihlanu idla ngokuba nkulu, kwaye apha sisebenzise isikrufu esiyi-4.0 mm esinobukhulu bedayamitha ukuya kuma-50 mm. Ekupheleni kwenkqubo, siqinisekisa ukuba intambo ye-caudal ingcwatywe ngokupheleleyo ngaphantsi komgca we-cartilage. Ngokuchasene noko, kubalulekile ukuphepha ukufakwa kweprosthesis ngokunzulu, ngakumbi kwimeko yokuphuka kwentamo.
Umzobo we-14 ku-A, ukwaphuka kwentamo okuqhelekileyo akwenziwa kwaye intloko ifuna ubunzulu obuncinci njengoko i-cortex ye-B iya kuxinzelelwa.
Indlela yotyando yokuqhekeka kwe-transverse ye-phalanx ehamba phambili yayifana (umzobo we-15). Senze i-0.5 cm enqamlezayo kwintloko ye-phalanx ejikelezayo ngelixa ubukhulu becala bhetyebhetye i-proximal interphalangeal joint. I-tendon zahlulwa kwaye zahlanjululwa ixesha elide ukuze ziveze intloko ye-phalanx ehamba phambili. Kwiifractures ezininzi ze-phalanx ejikelezayo, sisebenzisa i-screw ye-2.5 mm, kodwa kwiiphalanges ezinkulu sisebenzisa i-screw 3.0 mm. Obona bude buphezulu be-2.5 mm CHS esetyenziswayo ngoku yi-30 mm. Siyakuqaphela ukuba ungaziqinisi kakhulu izikrufu. Ekubeni i-screws i-self-drilling kwaye i-self-tapping, inokungena kwisiseko se-phalanx ngokuchasana okuncinci. Ubuchule obufanayo busetyenziswe kwi-midphalangeal phalangeal fractures, kunye nokusika okuqala kwintloko ye-midphalangeal phalanx ukuvumela ukubuyisela ukubekwa kwezikrufu.
Umzobo we-15 Umbono we-Intraoperative wecala le-phalanx elinqamlezileyo.AA 1-mm guidewire ifakwe kwi-transverse encinci yokunqumla ecaleni kwe-longitudinal axis ye-phalanx ejikelezayo. Ngenxa yesimo esithile se-phalanges, ukunyanzeliswa kunokubangela ukuhlukana kwe-metacarpal cortex. (Isigulana esifana naso kuMfanekiso 8)
Iifractures ezidibeneyo: ukunyanzeliswa okungaxhaswanga ngexesha lokufakwa kwe-CHS kunokukhokelela ekunciphiseni i-metacarpals kunye ne-phalanges (Umfanekiso we-16). Ngoko ke, nangona ukusetyenziswa kwe-CHS kumgaqo-siseko akuvumelekanga kwiimeko ezinjalo, sifumene isisombululo kwiimeko ezimbini eziqhelekileyo esijongene nazo.
I-FIGURE 16 AC Ukuba i-fracture ayixhaswanga nge-cortical, ukuqiniswa kwe-screws kuya kubangela ukuphuka kwe-fracture ngaphandle kokunciphisa ngokupheleleyo.D Imizekelo eqhelekileyo evela kuluhlu lwababhali oluhambelana neemeko zokunciphisa ubuninzi (5 mm). Umgca obomvu uhambelana nomgca we-metacarpal.
Ukwaphulwa kwe-submetacarpal fractures, sisebenzisa ubuchule obulungisiweyo obusekwe kwingqikelelo yezakhiwo zokuqhafaza (oko kukuthi, izinto zesakhiwo ezisetyenziselwa ukuxhasa okanye ukuqinisa isakhelo ngokuchasa ukunyanzeliswa kwe-longitudinal kwaye ngaloo ndlela kuyixhasa). Ngokwenza i-Y-shape nge-screws ezimbini, intloko ye-metacarpal ayidiliki; siyithiye igama lebrayisi yokwakheka kuka-Y. Njengoko kwindlela yangaphambili, i-1.0 mm yocingo lwesikhokelo se-longitudinal kunye ne-tip blunt ifakiwe. Ngelixa ugcina ubude obuchanekileyo be-metacarpal, enye intambo yesikhokelo ifakwe, kodwa kwi-angle ukuya kwintambo yokuqala yesikhokelo, ngaloo ndlela yenza isakhiwo se-triangular. Zombini ezi zikhokelo zaye zandiswa kusetyenziswa i-countersink ekhokelwayo ukwandisa i-medulla. Kwi-screws ye-axial kunye ne-oblique, ngokuqhelekileyo sisebenzisa i-screws ye-3.0 mm kunye ne-2.5 mm ububanzi, ngokulandelanayo. I-axial screw ifakwe kuqala kuze kube yilapho intambo ye-caudal ilingana ne-cartilage. I-screw ye-offset enobude obufanelekileyo iyafakwa emva koko. Ekubeni kungekho ndawo eyaneleyo kwi-canal ye-medullary ye-screws ezimbini, ubude be-oblique screws kufuneka bubalwe ngokucophelela, kwaye i-axial screws kufuneka ifakwe kuphela kwi-screws ye-axial xa sele ingcwatywe ngokwaneleyo kwintloko ye-metacarpal ukuqinisekisa ukuzinza okwaneleyo ngaphandle kwe-screw protrusion. Isikrufu sokuqala siqhubela phambili phambili de singcwatywe ngokupheleleyo. Oku kuthintela ukunciphisa i-axial ye-metacarpal kunye nokuwa kwentloko, enokuthintelwa nge-oblique screws. Senza iimvavanyo ze-fluoroscopic rhoqo ukuze siqinisekise ukuba ukuwa akwenzeki kwaye izikrufu zidibene ngaphakathi kwi-medullary canal (Umfanekiso we-17).
Umzobo 17 AC Y-isibiyeli iteknoloji
Xa i-comminution ichaphazela i-dorsal cortex kwisiseko se-phalanx ejikelezayo, siqulunqe indlela elungisiweyo; siyibize ngokuba yi-axial bracing kuba isikrufu sisebenza njengomqadi ngaphakathi kwephalanx. Emva kokusetha kwakhona i-phalanx ehamba phambili, i-axial guide wire yaziswa kwi-medullary canal njenge-dorsally kangangoko kunokwenzeka. I-CHS mfutshane kancinane kunobude obupheleleyo be-phalanx (2.5 okanye 3.0 mm) emva koko ifakwe de isiphelo sayo sangaphambili sihlangane ne-subchondral plate kwisiseko se-phalanx. Ngeli xesha, iintambo ze-caudal ze-screw zitshixiwe kwi-canal ye-medullary, ngaloo ndlela zisebenza njengenkxaso yangaphakathi kunye ne-bracing isiseko se-phalanx. Iimviwo ezininzi ze-fluoroscopic ziyafuneka ukukhusela ukungena ngokubambisana (Umfanekiso we-18). Ngokuxhomekeke kwipatheni yokuphuka, ezinye izikrufu okanye udibaniso lwezixhobo zokulungisa zangaphakathi zingafuneka (Umfanekiso 19).
Umzobo 19: Iindlela ezahlukeneyo zokulungiswa kwezigulane ezinokulimala okutyumzayo. Ukuqhekeka okukhulu kwe-submetacarpal yomnwe kunye ne-compound dislocation yesiseko somnwe ophakathi (utolo olumthubi olukhomba kwindawo yokwaphuka okuphelile) B Umgangatho we-3.0 mm CHS wesalathisi somnwe wasetyenziswa, i-3.0 mm i-paracentesis yomnwe ophakathi ophakathi, i-y-inkxaso ye-ring-stage ye-4 mm kunye ne-gragraming ye-4 mm. I-CHS ye-pinky finger.F Iiflaphu zasimahla zisetyenziselwe ukugqunywa kwezicubu ezithambileyo.C IiRadiographs kwiinyanga ezi-4. Ithambo le-metacarpal lomnwe omncinci laphiliswa. Ezinye izikhonkwane zamathambo zenziwe kwenye indawo, zibonisa ukuphiliswa kokuphuka kwesibini.D Ngomnye unyaka emva kwengozi, i-flap yasuswa; nangona i-asymptomatic, isikrufu sasuswa kwi-metacarpal yomnwe weringi ngenxa yokukrokrelwa kokungena kwe-intra-articular. Iziphumo ezilungileyo (≥240 ° TAM) zifunyenwe kumnwe ngamnye kutyelelo lokugqibela.Utshintsho kwi-metacarpophalangeal joint of the middle of finger yabonakala kwiinyanga ze-18.
Umzobo 20 Ukuqhekeka komnwe wesalathisi kunye nokwandiswa kwe-intra-articular (eboniswe ngeentolo), eyaguqulelwa kwi-fracture elula ngu-B ukulungiswa kwexeshana kwe-articular fracture usebenzisa i-K-wire.C Oku kudala isiseko esizinzile apho i-screw ye-longitudinal exhasayo ifakwe. Iiveki ezi-3 (iintolo eziphawula amanqaku okungena kwezikrufu ze-basal)
Umzobo we-21 I-posterior orthostatic kunye ne-B ye-radiographs ye-radiographs yesigulane A. Izigulane ezintathu ezinqamlekileyo zesigulane (kwiintolo) ziphathwe nge-screws ze-2.5-mm cannulated. akukho tshintsho lubalulekileyo kumalungu e-interphalangeal abonakala emva kweminyaka emi-2
Ixesha lokuposa: Sep-18-2024
