Isiphumo sonyango sixhomekeke ekubekweni ngokutsha kwe-anatomical block ye-fracture, ukuqina okuqinileyo kwe-fracture, ukugcinwa kwe-soft tissue coverage elungileyo kunye nokuzilolonga kwangethuba.
I-Anatomy
Ii-humerus ekudeyahlulwe yaba yikholamu ephakathi kunye nekholamu esecaleni (Umfanekiso 1).
Umfanekiso 1 I-humerus ekude inekholamu ephakathi kunye necala
Ikholamu ephakathi ibandakanya inxalenye ephakathi ye-humeral epiphysis, i-medial epicondyle ye-humerus kunye ne-medial humeral condyle kuquka ne-humeral glide.
Ikholamu esecaleni equka inxalenye esecaleni ye-humeral epiphysis, i-epicondyle yangaphandle ye-humerus kunye ne-condyle yangaphandle ye-humerus kuquka ne-humeral tuberosity.
Phakathi kweekholamu ezimbini ezisecaleni kukho i-coronoid fossa yangaphambili kunye ne-posterior humeral fossa.
Indlela yokwenzakala
Ukuqhekeka kwe-humerus kwi-supracondylar kudla ngokubangelwa kukuwa kwiindawo eziphakamileyo.
Izigulane ezincinci ezinezaphuko zangaphakathi kwe-articular zihlala zibangelwa kukwenzakala okunamandla aphezulu, kodwa izigulane ezindala zinokuba nezaphuko zangaphakathi kwe-articular ngenxa yokwenzakala okunamandla amancinci ngenxa ye-osteoporosis.
Ukuthayipha
(a)Kukho ukwaphuka kwe-supracondylar, ukwaphuka kwe-condylar kunye nokuqhekeka kwe-intercondylar.
(b)Ukwaphuka kwe-Supracondylar ye-humerus: indawo yokuqhekeka ikwindawo engaphezulu kwe-fossa yehawk.
(c)Ukuqhekeka kwe-humeral condylar: indawo yokuqhekeka ikwi-fossa yehawk.
(d) ukwaphuka kwe-intercondylar ye-humerus: indawo yokuqhekeka iphakathi kwee-condyles ezimbini ezikude ze-humerus.
Umfanekiso 2 Ukuchwetheza i-AO
Uhlobo lwe-AO humeral fracture (Umfanekiso 2)
Uhlobo A: ii-extra-articular fractures.
Uhlobo B: ukwaphuka okubandakanya umphezulu we-articular (ukuqhekeka kwekholamu enye).
Uhlobo C: ukwahlukana okupheleleyo komphezulu we-articular we-humerus ekude kwisiqu se-humeral (ukuqhekeka kwe-bicolumnar).
Uhlobo ngalunye lwahlulwe ngakumbi lwaba ziintlobo ngeentlobo ezi-3 ngokwezinga lokuguquka kwezaphuko, (iintlobo ngeentlobo ezi-1 ukuya kwezi-3 ezinezinga lokuguquka elikhulayo ngaloo ndlela).
Umfanekiso 3 Ukuchwetheza eRiseborough-Radin
Uhlobo lwe-Riseborough-Radin lwezaphuko ze-intercondylar ze-humerus (zonke iintlobo ziquka inxalenye ye-supracondylar ye-humerus)
Uhlobo I: ukwaphuka ngaphandle kokuhamba phakathi kwe-humeral tuberosity kunye ne-talus.
Uhlobo lwesibini: ukwaphuka kwe-intercondylar ye-humerus ngokufuduka kobunzima bokwaphuka kwe-condyle ngaphandle kokukhubazeka okujikelezayo.
Uhlobo lwesithathu: ukwaphuka kwe-intercondylar ye-humerus ngokufuduka kweqhekeza lokuqhekeka kwe-condyle kunye nokukhubazeka okujikelezayo.
Uhlobo lwesine: ukwaphuka okukhulu komphezulu we-articular we-condyle enye okanye zombini (Umfanekiso 3).
Umfanekiso 4 Uhlobo I lwe-humeral tuberosity fracture
Umfanekiso 5 Inqanaba lokuqhekeka kwe-Humeral tuberosity
Ukuqhekeka kwe-humeral tuberosity: ukwenzakala kwe-shear ye-distal humerus
Uhlobo I: ukwaphuka kwe-humeral tuberosity yonke kuquka nomphetho osecaleni we-humeral talus ( ukwaphuka kwe-Hahn-Steinthal) (Umfanekiso 4).
Uhlobo lwesibini: ukwaphuka kwe-subchondral ye-articular cartilage ye-humeral tuberosity ( ukwaphuka kwe-Kocher-Lorenz).
Uhlobo lwesithathu: ukwaphuka okuncinci kwe-humeral tuberosity (Umfanekiso 5).
Unyango olungasebenzisi utyando
Iindlela zonyango olungasebenziyo xa amalungu eqhekeka e-distal humeral zinendima encinci. Injongo yonyango olungasebenziyo kukwenza oku: ukushukuma kwamalungu kwangoko ukuze kuthintelwe ukuqina kwamalungu; izigulane ezindala, ezinesifo esininzi esibangelwa zizifo ezininzi, kufuneka zinyangwe ngendlela elula yokuqhawula ilungu lengqiniba kwi-60° yokujika kangangeeveki ezi-2-3, kulandele umsebenzi olula.
Unyango lotyando
Injongo yonyango kukubuyisela umgama osebenzayo wokuhamba kwelungu ngaphandle kwentlungu (30° yolwandiso lwengqiniba, i-130° yokujika kwengqiniba, i-50° yokujikeleza kwangaphambili nangasemva); ukulungiswa okuqinileyo nokuzinzileyo kwangaphakathi kokuqhekeka kuvumela ukuqala kokuzivocavoca kwengqiniba emva kokuphola kwenxeba lolusu; ukulungiswa kwe-double plate ye-distal humerus kubandakanya: ukulungiswa kwe-medial kunye ne-posterior lateral double plate, okanyei-medial kunye ne-lateralukulungiswa kwepleyiti ephindwe kabini.
Indlela yotyando
(a) Isigulana sibekwe kwindawo ethe tyaba phezulu, i-liner ibekwe phantsi kwelungu elichaphazelekayo.
ukuchongwa nokukhuselwa kwemithambo-luvo ephakathi kunye ne-radial ngexesha lotyando.
Ingqiniba yangasemva inokwandiswa ukufikelela ngotyando: i-ulnar hawk osteotomy okanye i-triceps retraction ukuze kubonakale ukwaphuka okunzulu kwe-articular
i-ulnar hawkeye osteotomy: ukuvezwa okwaneleyo, ingakumbi kwiimfanta eziqhekekileyo zomphezulu we-articular. Nangona kunjalo, i-fracture non-union idla ngokuvela kwindawo ye-osteotomy. Izinga le-fracture non-union liye lehla kakhulu ngokuphuculwa kwe-ulnar hawk osteotomy (herringbone osteotomy) kunye ne-transtension band wire okanye i-plate fixation.
Ukuvezwa kwe-Triceps retraction exposure kunokusetyenziswa kwi-distal humeral trifold block fractures nge-joint comminution, kwaye ukuvezwa okwandisiweyo kwe-humeral slide kunokusika nokuveza incam ye-ulnar hawk malunga ne-1 cm.
Kufunyenwe ukuba la mapleyiti mabini anokubekwa ngendlela ehambelanayo okanye ngaxeshanye, kuxhomekeke kuhlobo lokuqhekeka apho amapleyiti afanele abekwe khona.
Ukuqhekeka komphezulu odibeneyo kufuneka kubuyiselwe kumphezulu odibeneyo othe tyaba kwaye kunamathele kwisiqu se-humeral.
Umfanekiso 6 Ukulungiswa kwangaphakathi kokuqhekeka kwengqiniba emva kotyando
Ukulungiswa okwethutyana kwebhloko yokuqhekeka kwenziwa ngokusebenzisa ucingo lwe-K, emva koko ipleyiti yokucinezela amandla eyi-3.5 mm yanqunyulwa ngokwemilo yepleyiti ngokwemilo engasemva kwekholamu esecaleni ye-humerus ekude, kwaye ipleyiti yokwakha kwakhona eyi-3.5 mm yanqunyulwa ngokwemilo yekholamu ephakathi, ukuze omabini amacala epleyiti afanele umphezulu wethambo (ipleyiti entsha yokubumba kwangaphambili ingenza lula inkqubo.) (Umfanekiso 6).
Lumka ungalungisi iqhekeza lokwaphuka komphezulu we-articular ngezikrufu ze-cortical ezinemisonto yonke kunye noxinzelelo oluvela kwicala eliphakathi ukuya kwicala elingasecaleni.
Indawo yokufuduka kwe-epiphysis-humerus thousand ibalulekile ukuze kuthintelwe ukungadibani kokwaphuka.
ukunika i-graft yethambo ukuzalisa indawo ye-bone defect, ukusebenzisa i-iliac cancellous bone grafts ukuzalisa i-compression fracture defect: i-medial column, i-articular surface kunye ne-lateral column, ukufaka i-cancellous bone ecaleni kunye ne-periosteum engaphelelanga kunye ne-compression bone defect kwi-epiphysis.
Khumbula iingongoma ezibalulekileyo zokulungisa.
Ukulungiswa kweqhekeza le-distal fracture elinamanani amaninziizikrufukangangoko kunokwenzeka.
ukuqiniswa kweziqwenga ezininzi eziqhekekileyo kangangoko kunokwenzeka ngezikrufu ezinqumla phakathi ukuya ecaleni.
Iipleyiti zentsimbi mazibekwe kumacala aphakathi namacala angasemva kwe-humerus ekude.
Iindlela zonyango: I-Total elbow arthroplasty
Kwizigulana ezinezaphuko ezibuhlungu okanye i-osteoporosis, i-total elbow arthroplasty inokubuyisela intshukumo yejoyinti ye-elbow kunye nokusebenza kwesandla emva kwezigulana ezingadingi mfuneko; indlela yotyando ifana ne-total arthroplasty yokutshintsha kwejoyinti ye-elbow.
(1) ukusetyenziswa kweprosthesis ende yohlobo lwesiqu ukuthintela ukwandiswa kokuqhekeka kwangaphambi kokuzala.
(2) Isishwankathelo sotyando.
(a) Le nkqubo yenziwa kusetyenziswa indlela yengqiniba engasemva, kunye namanyathelo afana nalawo asetyenziswa kwi-distal humeral fracture incision kunye ne-internal fixation (ORIF).
Ukulungiswa kwangaphambili kwe-ulnar nerve.
fikelela kumacala omabini e-triceps ukuze ususe ithambo eliqhekekileyo (ingongoma ephambili: ungayinqumli indawo yokuma kwe-triceps kwindawo ye-ulnar hawk).
I-humerus yonke ekude kuquka ne-hawk fossa ingasuswa kwaye kufakwe i-prosthesis, engasayi kushiya naluphi na ulandelayo olubalulekileyo ukuba kususwe i-I ukuya kwi-2 cm eyongezelelweyo.
ukulungiswa koxinzelelo lwangaphakathi lwemisipha ye-triceps ngexesha lokufakwa kwe-humeral prosthesis emva kokususwa kwe-humeral condyle.
Ukusikwa kwencam ye-proximal ulnar eminence ukuvumela ukufikelela okungcono kokuvezwa kunye nokufakelwa kwecandelo le-ulnar prosthesis (Umfanekiso 7).
Umfanekiso 7 I-arthroplasty ye-elbow
Ukhathalelo emva kotyando
Ukufakelwa kwe-pelvis emva kotyando kwenxalenye engasemva ye-elbow joint kufuneka kususwe xa inxeba lesikhumba sesigulana lipholile, kwaye kufuneka kuqalwe imithambo esebenzayo ngoncedo; i-elbow joint kufuneka ilungiswe ixesha elide emva kokutshintshwa kwe-joint epheleleyo ukukhuthaza ukuphiliswa kwenxeba lesikhumba (i-elbow joint ingalungiswa kwindawo ethe tye kangangeeveki ezi-2 emva kotyando ukunceda ukufumana umsebenzi ongcono wokwandisa); i-splint esisigxina esuswayo ngoku isetyenziswa rhoqo eklinikhi ukwenza lula uluhlu lwemithambo yokunyakaza xa inokususwa rhoqo ukukhusela umlenze ochaphazelekayo; umthambo osebenzayo oqhelekileyo uqalwa kwiiveki ezi-6-8 emva kokuba inxeba lesikhumba liphiliswe ngokupheleleyo.
Ukhathalelo emva kotyando
Ukufakelwa kwe-pelvis emva kotyando kwenxalenye engasemva ye-elbow joint kufuneka kususwe xa inxeba lesikhumba sesigulana lipholile, kwaye kufuneka kuqalwe imithambo esebenzayo ngoncedo; i-elbow joint kufuneka ilungiswe ixesha elide emva kokutshintshwa kwe-joint epheleleyo ukukhuthaza ukuphiliswa kwenxeba lesikhumba (i-elbow joint ingalungiswa kwindawo ethe tye kangangeeveki ezi-2 emva kotyando ukunceda ukufumana umsebenzi ongcono wokwandisa); i-splint esisigxina esuswayo ngoku isetyenziswa rhoqo eklinikhi ukwenza lula uluhlu lwemithambo yokunyakaza xa inokususwa rhoqo ukukhusela umlenze ochaphazelekayo; umthambo osebenzayo oqhelekileyo uqalwa kwiiveki ezi-6-8 emva kokuba inxeba lesikhumba liphiliswe ngokupheleleyo.
Ixesha lokuthumela: Disemba-03-2022
