I-Supracondylar fractures ye-humerus yenye yezona zinto zixhaphakileyo kubantwana kwaye zenzeke ekudibaneni kwe-humeral shaft kunye ne-humerus.i-humeral condyle.
IiMbonakaliso zeklinikhi
I-Supracondylar fractures ye-humerus ininzi yabantwana, kwaye intlungu yendawo, ukuvuvukala, ububele, kunye nokungasebenzi kakuhle kunokuvela emva kokulimala. Ukuqhekeka okungahambi kakuhle akunazo iimpawu ezicacileyo, kwaye ukukhutshwa kwe-elbow inokuba lolona phawu lwekliniki. I-capsule edibeneyo engaphantsi kwe-elbow muscle iyona nto ingaphezulu, apho i-capsule edibeneyo ethambileyo, eyaziwa ngokuba yi-softspot, inokuthi ifakwe kwi-palpation ngexesha lokuphuma ngokubambisana. Inqaku lokuguquguquka ngokuqhelekileyo lingaphambili kumgca odibanisa umbindi wentloko ye-radial ukuya kwincam ye-olecranon.
Kwimeko ye-supracondylar type III fracture, kukho iziphene ezimbini ze-angulated ze-elbow, zinika ukubonakala oku-S. Ngokuqhelekileyo kukho ukutyunyuzwa okungaphantsi kwe-subcutaneous phambi kwengalo engaphezulu ekude, kwaye ukuba i-fracture isuswe ngokupheleleyo, i-distal end of fracture ingena kwi-brachialis muscle, kwaye ukopha kwe-subcutaneous kubi kakhulu. Ngenxa yoko, uphawu lwe-pucker luvela phambi kwengqiniba, ngokuqhelekileyo lubonisa i-bony protrusion proximal ukuya kwi-fracture engena kwi-dermis. Ukuba ihamba kunye nokulimala kwe-nerve ye-radial, ukongezwa kwe-dorsal yesithupha kunokunciphisa; Ukulimala kwe-nerve median kunokubangela ukuba isithupha kunye nesalathisi singakwazi ukuguquguquka ngokusebenzayo; Ukulimala kwe-nerve ye-ulnar kunokubangela ukuhlukana okulinganiselwe kweminwe kunye nokudibanisa.
Uxilongo
(1) Isiseko sokuxilongwa
①Ubanembali yokwenzakala; ② Iimpawu zeklinikhi kunye neempawu: intlungu yendawo, ukudumba, ububele kunye nokungasebenzi kakuhle; ③I-X-ray ibonisa umgca we-supracondylar fracture kunye namaqhekeza aphukileyo e-humerus.
(2) Ukuxilongwa okwahlukileyo
Ingqalelo kufuneka ihlawulwe ekuchongeniukushukuma kwengqiniba, kodwa ukuchongwa kweefractures ezongeziweyo ze-supracondylar ukusuka kwi-elbow dislocation kunzima. Kwi-supracondylar fracture ye-humerus, i-epicondyle ye-humerus igcina ubudlelwane obuqhelekileyo be-anatomical kunye ne-olecranon. Nangona kunjalo, kwi-elbow dislocation, kuba i-olecranon ifumaneka emva kwe-epicondyle ye-humerus, ivelele ngakumbi. Xa kuthelekiswa ne-supracondylar fractures, ukugqwesa kwe-forearm kwi-elbow dislocation i-distal ngakumbi. Ubukho okanye ukungabikho kwe-fricatives yamathambo kudlala indima ekuchongeni i-supracondylar fractures ye-humerus ekukhutshweni kwe-elbow joint, kwaye ngamanye amaxesha kunzima ukukhupha i-bony fricatives. Ngenxa yokudumba neentlungu eziqatha, ukuxhaphazwa okubangela ukuba amathambo aqhekezeke kudla ngokubangela ukuba umntwana akhale. Ngenxa yomngcipheko womonakalo we-neurovascular. Ke ngoko, ii-manipulations ezibangela ukuqhawuka kwamathambo kufuneka ziphetshwe. Uvavanyo lweX-reyi lunokunceda ukuchonga.
Uhlobo
Ukwahlula okusemgangathweni kwe-supracondylar humeral fractures kukukwahlula kwisandiso kunye ne-flexion. Uhlobo lwe-flexion alunqabile, kwaye i-X-ray yecala ibonisa ukuba i-distal end of fracture ifumaneka phambi kwe-humeral shaft. Uhlobo oluchanekileyo luqhelekileyo, kwaye i-Gartland iyahlula kwi-I ukuya kwi-III (Itheyibhile 1).
| Uhlobo | IiMbonakaliso zeklinikhi |
| ⅠUdidi | Iifractures ngaphandle kokufuduswa, inversion okanye i-valgus |
| ⅠB uhlobo | Ukufuduswa okuphakathi, ukuphaphatheka kwecortical yangaphakathi, umgca womda we-humeral ongaphambili ngentloko enesidima |
| ⅡUdidi | I-Hyperextension, ingqibelelo ye-cortical yangasemva, intloko ye-humeral emva komgca womda we-humeral wangaphambili, akukho ukujikeleza |
| ⅡB uhlobo | Ukufuduswa kwexesha elide okanye okujikelezayo kunye noqhagamshelwano oluyinxenye kulo naliphi na isiphelo sokwaphuka |
| ⅢUdidi | Gqibezela ukufuduswa ngasemva ngaphandle konxibelelwano lwecortical, ubukhulu becala bukude ukuya kwindawo yangasemva. |
| ⅢB uhlobo | Ukufuduka okucacileyo, izicubu ezithambileyo ezifakwe kwisiphelo sokuqhekeka, ukugqithelana okubalulekileyo okanye ukufuduswa okujikelezayo kwesiphelo sokuphuka. |
Itheyibhile 1 Ukuhlelwa kweGartland ye-supracondylar humerus fractures
Nyanga
Ngaphambi konyango oluchanekileyo, i-elbow joint kufuneka imiselwe okwethutyana kwindawo ye-20 ° ukuya kwi-30 ° flexion, engakhululekile nje kwisigulane, kodwa iyanciphisa ukunyanzeliswa kwezakhiwo ze-neurovascular.
(1) Uhlobo lwe-I i-humeral supracondylar fractures: kufuneka kuphela i-plaster cast okanye i-cast cast for fixation yangaphandle, ngokuqhelekileyo xa i-elbow iguquguquka i-90 ° kwaye i-forearm ijikelezwe kwindawo engathathi hlangothi, intsimbi ende yengalo isetyenziselwa ukulungiswa kwangaphandle kwiiveki ezi-3 ukuya kwezi-4.
(2) Uhlobo lwe-II ye-humeral supracondylar fractures: Ukunciphisa i-Manual kunye nokulungiswa kwe-elbow hyperextension kunye ne-angulation yimiba ephambili yonyango olu hlobo lweefractures. °) Ukulungiswa kugcina isikhundla emva kokunciphisa, kodwa kwandisa umngcipheko wokulimala kwe-neurovascular yelungu elichaphazelekayo kunye nomngcipheko we-acute fascial compartment syndrome. Ngoko ke, i-percutaneousUkulungiswa kweengcingo zaseKirschnerkungcono emva kokunciphisa okuvaliweyo kwe-fracture (umzobo 1), kwaye emva koko ukulungiswa kwangaphandle kunye ne-plaster cast kwindawo ekhuselekileyo (i-elbow flexion 60 °).
Umzobo 1 Umfanekiso we-percutaneous Kirschner fixation yocingo
(3) Uhlobo lwe-III i-supracondylar humerus fractures: Zonke iintlobo ze-III supracondylar humerus fractures zincitshiswa nge-percutaneous Kirschner wire fixation, okwangoku yonyango oluqhelekileyo lwe-III i-supracondylar fractures. Ukunciphisa okuvaliweyo kunye ne-percutaneous Kirschner wire fixation ngokuqhelekileyo kunokwenzeka, kodwa ukunciphisa okuvulekileyo kuyadingeka ukuba ukufakwa kwezicubu ezithambileyo akunakuncitshiswa ngokwe-anatomically okanye ukuba kukho ukulimala komthambo we-brachial (Umfanekiso 2).
Umzobo 5-3 Iifilimu ze-X-ray zangaphambili kunye ne-postoperative ye-supracondylar humerus fractures
Kukho iindlela ezine zokuhlinzwa zokunciphisa okuvulekileyo kwe-supracondylar fractures ye-humerus: (1) indlela ye-elbow ye-lateral (kubandakanywa nendlela ye-anterolateral); (2) indlela yengqiniba ephakathi; (3) indlela edibeneyo ye-elbow ephakathi kunye ne-lateral; kunye (4) nendlela yengqiniba yangasemva.
Zombini i-lateral elbow approach kunye ne-medial approach ineenzuzo zezicubu ezonakalisiweyo ezincinci kunye nesakhiwo esilula se-anatomical. I-incision medial ikhuselekile kune-lateral incision kwaye inokuthintela umonakalo we-nerve ye-ulnar. Ukungalungi kukuba akukho namnye kubo onokubona ngokuthe ngqo ukwaphuka kwecala le-contralateral lokusikeka, kwaye kunokwehliswa kuphela kwaye kulungiswe yimvakalelo yesandla, efuna ubuchule obuphezulu botyando kumsebenzisi. Indlela ye-elbow yangasemva iye yaphikisana ngenxa yokutshatyalaliswa kwengqibelelo ye-triceps muscle kunye nomonakalo omkhulu. Indlela edibeneyo ye-elbows ephakathi kunye ne-lateral ingenza umonakalo wokungakwazi ukubona ngokuthe ngqo i-bone surface ye-contralateral ye-incision. Ineenzuzo zokuchongwa kwe-elbow ephakathi kunye ne-lateral, ehambelana nokunciphisa i-fracture kunye nokulungiswa, kwaye inokunciphisa ubude be-lateral incision. Kuyanceda ukukhululeka kunye nokunciphisa ukudumba kwezicubu; kodwa ukungonakali kwayo kukuba yonyusa uqhaqho lotyando; Kwakhona iphezulu kunendlela yangasemva.
Ukuntsonkotha
Iingxaki ze-supracondylar humeral fractures ziquka: (1) ukulimala kwe-neurovascular; (2) i-acute septal syndrome; (3) ukuqina kwengqiniba; (4) i-myositis ossificans; (5) i-avascular necrosis; (6) ukukhubazeka kwecubitus varus; (7) ukukhubazeka kwecubitus valgus.
Shwankathela
I-Supracondylar fractures ye-humerus iphakathi kwezona fractures eziqhelekileyo kubantwana. Kwiminyaka yakutshanje, ukuncitshiswa kakubi kwe-supracondylar fractures ye-humerus kuye kwavusa ingqalelo yabantu. Kwixesha elidlulileyo, i-cubitus varus okanye i-cubitus valgus yayithathwa njengento ebangelwa ukubanjwa kokukhula kwe-distal humeral epiphyseal plate, kunokuba kuncitshiswe kakubi. Uninzi lobungqina obuqinileyo ngoku buxhasa ukuba ukuncitshiswa kwe-fracture embi yinto ebalulekileyo kwi-cubitus varus deformity. Ngoko ke, ukunciphisa i-supracondylar humerus fractures, ukulungiswa kwe-ulnar offset, ukujikeleza okuthe tye kunye nokubuyiselwa kokuphakama kwe-distal humerus zizitshixo.
Zininzi iindlela zonyango zokwaphuka kwe-supracondylar ye-humerus, njengokunciphisa ngesandla + ukulungiswa kwangaphandlenge-plaster cast, i-olecranon traction, ukulungiswa kwangaphandle kunye ne-splint, ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi, kunye nokunciphisa okuvaliweyo kunye nokulungiswa kwangaphakathi. Kwixesha elidlulileyo, ukucutha okukhohlisayo kunye nokulungiswa kwangaphandle kodaka yayilunyango oluphambili, apho i-cubitus varus yaxelwa phezulu ukuya kuma-50% e-China. Okwangoku, uhlobo lwe-II kunye nohlobo lwe-III i-supracondylar fractures, ukulungiswa kwenaliti ye-percutaneous emva kokunciphisa ukuphuka kuye kwaba yindlela eyamkelekileyo ngokubanzi. Ineenzuzo zokungabhubhisi ukunikezelwa kwegazi kunye nokuphulukiswa kwamathambo ngokukhawuleza.
Kukho neembono ezahlukeneyo kwindlela kunye nenani elifanelekileyo lokulungiswa kwentambo ye-Kirschner emva kokunciphisa okuvaliweyo kweefractures. Amava omhleli kukuba iingcingo ze-Kirschner kufuneka zidibaniswe kunye nomnye ngexesha lokulungiswa. Okukhona kuqelelene inqwelomoya yokuphuka, kokukhona izinzile. Iingcingo zeKirschner akufanele ziwele kwi-plane yokuphuka, ngaphandle koko ukujikeleza akuyi kulawulwa kwaye ukulungiswa kuya kuzinza. Ukunyamekela kufuneka kuthathwe ukuphepha umonakalo kwi-nerve ye-ulnar xa usebenzisa ukulungiswa kwe-wire Kirschner medial. Musa ukuthunga inaliti kwindawo eguquguqukayo yengqiniba, yolula kancinane ingqiniba ukuvumela i-nerve ye-ulnar ibuyele ngasemva, chukumisa i-ulnar nerve ngobhontsi kwaye uyityhale ngasemva kwaye ngokukhuselekileyo umsonto we-K-wire. Ukusetyenziswa kwe-cross Kirschner wire fixation yangaphakathi kunenzuzo enokuthi ifumaneke ekubuyiseleni umsebenzi emva kokusebenza, izinga lokuphulukisa i-fracture, kunye nesantya esiphezulu sokuphulukiswa kwe-fracture, eyinzuzo ekubuyiseleni kwangoko emva kokuhlinzwa.
Ixesha lokuposa: Nov-02-2022
