Ukuqhekeka kwe-humerus kwi-supracondylar yenye yezona zifo zixhaphakileyo ebantwaneni kwaye zenzeka kwindawo ekudibana kuyo i-humeral shaft kunye ne-i-humeral condyle.
Iimpawu zeKlinikhi
Ukuqhekeka kwe-Supracondylar ye-humerus ikakhulu ngabantwana, kwaye iintlungu zasekuhlaleni, ukudumba, ukuthamba, kunye nokungasebenzi kakuhle kunokwenzeka emva kokwenzakala. Ukuqhekeka okungasuswanga endaweni akunazo iimpawu ezicacileyo, kwaye ukuphuma kwengqiniba kunokuba lolona phawu lonyango kuphela. I-capsule edibeneyo engaphantsi kwemisipha yengqiniba yeyona ingaphezulu, apho i-capsule edibeneyo ethambileyo, eyaziwa ngokuba yi-softspot, inokutsalwa ngendlebe ngexesha lokukhutshwa kwengqiniba. Indawo yokuguquguquka idla ngokuba ngaphambili kumgca odibanisa umbindi wentloko ye-radial ukuya kwincam ye-olecranon.
Kwimeko yokwaphuka kohlobo lwesithathu lwe-supracondylar, kukho ukukhubazeka okubini kwengqiniba, okwenza ibonakale ngathi yi-S. Ngokuqhelekileyo kukho ukutyumza okungaphantsi komhlaba phambi kwengalo engentla ekude, kwaye ukuba ukwaphuka kususiwe ngokupheleleyo, isiphelo esikude sokwaphuka singena kwimisipha ye-brachialis, kwaye ukopha okungaphantsi komhlaba kuba kubi kakhulu. Ngenxa yoko, kuvela uphawu lwe-pucker phambi kwengqiniba, oluhlala lubonisa ukuvela kwamathambo ecaleni kokwaphuka okungena kwi-dermis. Ukuba kuhamba nokulimala kwemithambo-luvo ye-radial, ukwandiswa kwesithupha esingasemva kunokunciphisa; ukwenzakala kwemithambo-luvo ephakathi kunokubangela ukuba ubhontsi kunye nomnwe wokukhomba zingakwazi ukugoba ngokukhutheleyo; ukwenzakala kwemithambo-luvo ye-ulnar kunokubangela ukwahlulwa okuncinci kweminwe kunye nokudibanisa idijithali.
Uxilongo
(1) Isiseko sokuxilongwa
①Unembali yokwenzakala; ②Iimpawu kunye neempawu zonyango: iintlungu zasekuhlaleni, ukudumba, ukuthamba kunye nokungasebenzi kakuhle; ③I-X-ray ibonisa umgca wokuqhekeka kwe-supracondylar kunye neziqwenga zokuqhekeka ezisusiweyo ze-humerus.
(2) Ukuxilongwa kokwahluka
Kufuneka kuqwalaselwe ukuchongwaukukhubeka kwengqiniba, kodwa ukuchongwa kwamathambo e-supracondylar aqhekekileyo ngenxa yokuqhekeka kwengqiniba kunzima. Kwi-supracondylar fracture ye-humerus, i-epicondyle ye-humerus igcina ubudlelwane obuqhelekileyo bomzimba kunye ne-olecranon. Nangona kunjalo, kwi-elbow dislocation, kuba i-olecranon ikwindawo engasemva kwe-epicondyle ye-humerus, iyabonakala ngakumbi. Xa kuthelekiswa namathambo e-supracondylar fractures, ukubonakala kwengalo ekuqhekekeni kwengqiniba kukude kakhulu. Ukubakho okanye ukungabikho kwamathambo aqhekekileyo kukwadlala indima ekuboneni ukwaphuka kwe-supracondylar ye-humerus ngenxa yokuqhekeka kwejoyinti yengqiniba, kwaye ngamanye amaxesha kunzima ukuvelisa amathambo aqhekekileyo. Ngenxa yokudumba okukhulu kunye nentlungu, ukuqhekezwa okubangela ukuqhekezwa kwamathambo kudla ngokubangela ukuba umntwana akhale. Ngenxa yomngcipheko wokonakala kwemithambo-luvo. Ke ngoko, ukuqhekezwa okubangela ukuqhekezwa kwamathambo kufuneka kuphetshwe. Uvavanyo lwe-X-ray lunokunceda ekuchongeni.
Uhlobo
Uhlobo oluqhelekileyo lokwaphuka kwe-humeral supracondylar kukwahlulahlula zibe lulwandiso kunye nolwandiso. Uhlobo lokwaphuka aluqhelekanga, kwaye i-X-ray esecaleni ibonisa ukuba isiphelo esikude sokwaphuka siphambi kwe-humeral shaft. Uhlobo oluthe tye luqhelekile, kwaye iGartland iyahlulahlula ibe luhlobo I ukuya ku-III (Itheyibhile 1).
| Uhlobo | Iimpawu zeKlinikhi |
| Uhlobo lwe-ⅠA | Ukuqhekeka ngaphandle kokususwa, ukuguqulwa okanye i-valgus |
| Uhlobo lwe-ⅠB | Ukufuduka okuncinci, ukutyibilika kwe-cortical medial, umgca womda we-humeral anterior ngentloko ye-humeral |
| Uhlobo lwe-ⅡA | I-Hyperextension, i-posterior cortical ingqibelelo, intloko ye-humeral emva komgca womda we-humeral wangaphambili, akukho kujikeleziswa |
| Uhlobo lwe-ⅡB | Ukufuduka okude okanye okujikelezayo kunye noqhagamshelwano oluncinci nakweyiphi na isiphelo sokwaphuka |
| Uhlobo lwe-ⅢA | Ukufuduka ngokupheleleyo emva komgca ngaphandle kokunxibelelana kwe-cortical, ikakhulu ukusuka kude ukuya kwi-medial posterior displacement |
| Uhlobo lwe-ⅢB | Ukufuduka okucacileyo, izicwili ezithambileyo ezifakwe kwisiphelo sesaphuko, ukungqubana okubalulekileyo okanye ukufuduka okujikelezayo kwesiphelo sesaphuko |
Itheyibhile 1 Udidi lweGartland lwezaphuko ze-supracondylar humerus
Unyango
Ngaphambi konyango olufanelekileyo, i-elbow joint kufuneka ibekwe okwethutyana kwindawo ye-20° ukuya kwi-30° flexion, nto leyo engeyonto ikhululekileyo kumguli kuphela, kodwa ikwanciphisa uxinzelelo lwezakhiwo zemithambo-luvo.
(1) Ukwaphuka kwe-humeral supracondylar yohlobo I: kufuneka kuphela i-plaster cast okanye i-cast cast ukuze kufakwe i-external fixation, ngesiqhelo xa ingqiniba igobile ngama-90° kwaye ingalo ijikelezwe ngendlela engathathi cala, i-long arm cast isetyenziselwa ukufakela i-external fixation iiveki ezi-3 ukuya kwezi-4.
(2) Ukwaphuka kwe-humeral supracondylar yohlobo lwesibini: Ukunciphisa ngesandla kunye nokulungiswa kwe-elbow hyperextension kunye ne-angulation zezona zinto ziphambili kunyango lolu hlobo lokwaphuka. °) Ukuqina kugcina indawo emva kokuncipha, kodwa kwandisa umngcipheko wokwenzakala kwemithambo-luvo yelungu elichaphazelekayo kunye nomngcipheko we-acute fascial compartment syndrome. Ke ngoko, i-percutaneousUkulungiswa kwentambo kaKirschnerKungcono emva kokunciphisa ukwaphuka okuvaliweyo (Umfanekiso 1), uze emva koko ufake i-external fixation nge-plaster cast kwindawo ekhuselekileyo (i-elbow flexion 60°).
Umfanekiso 1 Umfanekiso wokufakelwa kwentambo yeKirschner ejikeleze i-percutaneous
(3) Ukwaphuka kwe-humerus ye-supracondylar yohlobo lwesithathu: Zonke iintlobo ze-supracondylar humerus ye-supracondylar yohlobo lwesithathu zincitshiswa ngokuqiniswa kwentambo ye-Kirschner ye-percutaneous, okwangoku yindlela eqhelekileyo yonyango lwe-supracondylar fractures yohlobo lwesithathu. Ukunciphisa okuvaliweyo kunye nokufakelwa kwentambo ye-Kirschner ye-percutaneous ngokuqhelekileyo kunokwenzeka, kodwa ukunciphisa okuvulekileyo kuyadingeka ukuba ukufakwa kwezicubu ezithambileyo akunakuncitshiswa ngokwe-anatomiki okanye ukuba kukho ukwenzakala kwe-brachial artery (Umfanekiso 2).
Umfanekiso 5-3 Iifilimu ze-X-ray zangaphambi kotyando kunye nezo emva kotyando zezaphuko ze-humerus ze-supracondylar
Kukho iindlela ezine zotyando zokunciphisa ngokuvulekileyo ukwaphuka kwe-supracondylar kwi-humerus: (1) indlela ye-lateral elbow (kuquka indlela ye-anterolateral); (2) indlela ye-medial elbow; (3) indlela ye-medial kunye ne-lateral elbow edibeneyo; kunye (4) indlela ye-posterior elbow.
Zombini indlela ye-lateral elbow kunye nendlela ye-medial zinezibonelelo zezicubu ezingonakalanga kangako kunye nesakhiwo esilula se-anatomical. I-medial incision ikhuselekile kune-lateral incision kwaye inokuthintela umonakalo we-ulnar nerve. Ingxaki kukuba akukho namnye kubo onokubona ngokuthe ngqo ukwaphuka kwecala elingasemva kwe-incision, kwaye inokunciphisa kwaye ilungiswe kuphela ngokuziva ngesandla, oku kufuna ubuchule obuphezulu botyando kumqhubi. Indlela ye-posterior elbow ibisoloko iphikisana ngenxa yokutshatyalaliswa kokuthembeka kwemisipha ye-triceps kunye nomonakalo omkhulu. Indlela edibeneyo ye-medial kunye ne-lateral elbow ingenza i-disadvantage yokungakwazi ukubona ngokuthe ngqo umphezulu wethambo elingaphandle kwe-incision. Inezibonelelo ze-medial kunye ne-lateral elbow incisions, ezinceda ekunciphiseni ukwaphuka kunye nokuqina, kwaye zinokunciphisa ubude be-lateral incision. Iluncedo ekukhululeni nasekuthomalaliseni ukudumba kwezicubu; kodwa i-disadvantage yayo kukuba inyusa i-incision yotyando; Ikwaphezulu kune-posterior approach.
Ingxaki
Iingxaki zokuqhekeka kwe-humeral supracondylar ziquka: (1) ukwenzakala kwemithambo-luvo; (2) isifo se-acute septal; (3) ukuqina kwengqiniba; (4) i-myositis ossificans; (5) i-avascular necrosis; (6) i-cubitus varus deformity; (7) i-cubitus valgus deformity.
Shwankathela
Ukuqhekeka kwe-Supracondylar ye-humerus kuphakathi kwezona zinto zixhaphakileyo ebantwaneni. Kwiminyaka yakutshanje, ukuqhekeka kwe-supracondylar ye-humerus okuncinci kuye kwavusa ingqalelo yabantu. Ngaphambili, i-cubitus varus okanye i-cubitus valgus yayithathwa njengebangelwa kukuvalwa kokukhula kweplate ye-distal humeral epiphyseal, endaweni yokuqhekeka okuncinci. Uninzi lobungqina obuqinileyo ngoku buxhasa ukuba ukuqhekeka okuncinci yinto ebalulekileyo ekukhubazekeni kwe-cubitus varus. Ke ngoko, ukuqhekeka kwe-supracondylar humerus, ukulungiswa kwe-ulnar offset, ukujikeleza okuthe tye kunye nokubuyiselwa kokuphakama kwe-distal humerus zezona zinto zibalulekileyo.
Kukho iindlela ezininzi zonyango zokuqhekeka kwe-supracondylar ye-humerus, njengokunciphisa ngesandla + ukulungiswa kwangaphandlenge-plaster cast, i-olecranon traction, i-external fixation ene-splint, i-open reduction kunye ne-internal fixation, kunye ne-closed reduction kunye ne-internal fixation. Ngaphambili, i-manipulative reduction kunye ne-plaster external fixation yayiyeyona ndlela iphambili yonyango, apho i-cubitus varus yayixelwe ukuba iphezulu njenge-50% eTshayina. Okwangoku, kwi-type II kunye ne-type III supracondylar fractures, i-percutaneous needle fixation emva kokunciphisa i-fracture iye yaba yindlela eyamkelekileyo ngokubanzi. Inezibonelelo zokungonakalisi ukuhanjiswa kwegazi kunye nokuphiliswa kwamathambo ngokukhawuleza.
Kukwakho neembono ezahlukeneyo malunga nendlela kunye nenani elifanelekileyo lokufakelwa kwentambo yeKirschner emva kokunciphisa ukwaphuka okuvaliweyo. Amava omhleli kukuba iingcingo zeKirschner kufuneka zidityaniswe ngexesha lokufakelwa. Okukhona iplani yokuqhekeka ikude, kokukhona izinze ngakumbi. Iingcingo zeKirschner akufuneki ziwele kwiplani yokuqhekeka, kungenjalo ukujikeleza akuyi kulawulwa kwaye ukufakwa kuya kuba kungazinzi. Kufuneka kuthathwe unonophelo ukuze kuthintelwe umonakalo kwi-ulnar nerve xa usebenzisa i-medial Kirschner wire fixation. Musa ukufaka inaliti kwindawo egobileyo yengqiniba, yilula kancinci ingqiniba ukuze ivumele i-ulnar nerve ukuba ibuyele umva, chukumisa i-ulnar nerve ngobhontsi uze uyityhale umva kwaye uyifake ngokukhuselekileyo intambo ye-K. Ukusetyenziswa kwentambo yeKirschner wire fixation yangaphakathi kuneengenelo ezinokubakho ekubuyiseleni ukusebenza emva kotyando, izinga lokuphiliswa kwaphuka, kunye nezinga elihle lokuphiliswa kwaphuka, eliluncedo ekubuyiseleni kwangethuba emva kotyando.
Ixesha lokuthumela: Novemba-02-2022
