Okwangoku, kukho iindlela ezahlukeneyo zonyango zokuphulwa kwe-distal radius fractures, ezifana nokulungiswa kwe-plaster, ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi, isakhelo sokulungiswa kwangaphandle, njl. Nangona kunjalo, ukuba isitya sensimbi sikhethwe ngokufanelekileyo, iziganeko zeengxaki zinokuncitshiswa ngokufanelekileyo. Eli phepha lishwankathela ngokufutshane iimpawu, izibonakaliso, ukuchasana, kunye neendlela zotyando lonyango lwe-volar plate ye-distal radius fractures.
1. Kukho iinzuzo ezimbini eziphambili zeplate yecala lesundu
A.Inokunciphisa icandelo lamandla okubopha. Ukulungiswa kunye ne-angled fixation screws isekela i-distal fragment kwaye idlulisela umthwalo kwi-shaft radial (Umfanekiso 1). Inokufumana inkxaso ye-subchondral ngokufanelekileyo. Le nkqubo yepleyiti ayinako kuphela ukulungisa ngokuzinzileyo i-distal intra-articular fractures, kodwa inokuphinda ibuyisele ngokufanelekileyo ubume be-anatomical ye-intra-articular subchondral bone ngokusebenzisa isikhonkwane / isikrufu "ukulungiswa kwefan". Kwiintlobo ezininzi ze-distal radius fracture, le nkqubo yophahla ibonelela ngozinzo olongezelelweyo luvumela ukuhlanganiswa kwangaphambili.
Umfanekiso we-1, emva kokwakhiwa ngokutsha kwe-dimensional ye-distal comminuted distal fracture, nikela ingqalelo kwinqanaba lokunyanzeliswa kwe-dorsal; b, ukuncitshiswa okubonakalayo kokuqhekeka, isiphene kufuneka silungiswe kwaye sixhaswe ngepleyiti; c, imbono esecaleni emva kokulungiswa kwe-DVR, utolo lubonisa ukuhanjiswa komthwalo.
B.Impembelelo encinci kwizicubu ezithambileyo: ukulungiswa kweplate ye-volar kuncinci ngaphantsi komgca wamanzi, xa kuthelekiswa neplate ye-dorsal, inokunciphisa ukucaphuka kwi-tendon, kwaye kukho indawo ekhoyo ekhoyo, enokuthi iphephe ngokufanelekileyo ukufakelwa kunye ne-tendon. uqhagamshelwano oluthe ngqo. Ukongeza, uninzi lofakelo lunokugqunywa yipronator quadratus.
2. Izibonakaliso kunye nokuchasana kunyango lwe-distal radius kunye ne-volar plate
Izibonakaliso: Ngokungaphumeleli kokunciphisa okuvaliweyo kweefractures ezingaphezulu kwe-articular, iimeko ezilandelayo zenzeke, ezifana ne-dorsal angulation enkulu kune-20 °, i-dorsal compression enkulu kune-5mm, i-distal radius shortening enkulu kune-3mm, kunye ne-distal fragment fragment displacement enkulu kune-2mm; Ukufuduswa kokuqhekeka kwangaphakathi kukhulu kune-2 mm; ngenxa yokuxinana kwamathambo aphantsi, kulula ukubangela ukufuduka kwakhona, ngoko ke kulungeleka ngakumbi kubantu abadala.
b. Ukuchasana: ukusetyenziswa kwe-anesthetics yendawo, izifo ezithathelwanayo zengingqi okanye zenkqubo, imeko yesikhumba embi kwicala le-volar yesandla; ubunzima bethambo kunye nohlobo lokuphuka kwindawo yokuphuka, uhlobo lwe-dorsal fracture efana ne-Barton fracture, i-radiocarpal joint fracture kunye ne-dislocation, i-radius elula ye-Styloid inkqubo yokuphuka, i-avulsion fracture encinci ye-volar margin.
Kwizigulane ezinokulimala okuphezulu kwamandla afana ne-intra-articular comminuted fractures okanye ukulahleka okukhulu kwamathambo, abaninzi abaphengululi abacebisi ukusetyenziswa kwamacwecwe e-volar, kuba i-distal fractures ixhomekeke kwi-necrosis ye-vascular kwaye kunzima ukufumana ukunciphisa i-anatomical. Kwizigulane ezinamaqhekeza amaninzi kunye nokufuduka okukhulu kunye ne-osteoporosis enzima, i-volar plate inzima ukuba isebenze. Kunokubakho iingxaki ngenkxaso ye-subchondral kwi-distal fractures, njengokungena kwe-screw kwi-joint cavity. Uncwadi lwakutsha nje luchaze ukuba xa iimeko ze-42 ze-intra-articular fractures ziphathwa ngamacwecwe e-volar, akukho zixhobo ze-articular zangena kwi-articular cavity, eyona nto yayinxulumene nokuma kwamacwecwe.
3. Izakhono zotyando
Uninzi lwamagqirha asebenzisa i-volar plate fixation ye-distal radius fractures ngeendlela ezifanayo kunye nobuchule. Nangona kunjalo, ukuphepha ngokufanelekileyo ukwenzeka kweengxaki ze-postoperative, i-superb surgical technique iyadingeka, umzekelo, ukunciphisa kunokufumaneka ngokukhulula ukunyanzeliswa kwebhloko ye-fracture kunye nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa kwexeshana kunye neengcingo ze-2-3 Kirschner zingasetyenziswa. Ngokumalunga nokuba yeyiphi indlela yokusetyenziswa, umbhali uncoma i-PCR (i-flexor carpi radialis) ukwandisa indlela ye-volar.
a, Ukulungiswa okwethutyana kunye neengcingo ezimbini zeKirschner, qaphela ukuba i-volar inclination kunye ne-articular surface ayibuyiswanga ngokupheleleyo ngeli xesha;
b, Ucingo lweKirschner lulungisa okwexeshana ipleyiti, nikela ingqalelo ekulungisweni kwesiphelo esikude seradiyasi ngeli xesha (ubuchule bokulungisa iqhekeza leqhekeza le-distal), indawo esondeleleneyo yepleyiti itsalwa ngakwi-shaft yeradial ukubuyisela ukuthambekela kwevolar.
C, Umphezulu we-articular ulungelelaniswe kakuhle phantsi kwe-arthroscopy, i-screw / pin yokutshixa i-distal ibekwe, kwaye i-radius ye-proximal ekugqibeleni iyancitshiswa kwaye ilungiswe.
Amanqaku aphambiliindlela yokufikelela: I-distal skin incision iqala kwi-fold fold of the wrist, kwaye ubude bayo bunokumiselwa ngokohlobo lokwaphuka. Ithenda ye-flexor carpi radialis kunye ne-sheath yayo ichithwa kwi-distal kwithambo le-carpal kwaye isondele kangangoko kunokwenzeka. Ukutsala i-flexor carpi radialis tendon ukuya kwicala le-ulnar ikhusela i-nerve median kunye ne-flexor tendon complex. Indawo yeParona ibonakalisiwe, kunye nepronator quadratus ephakathi kwe-flexor hallucis longus (ulnar) kunye ne-radial artery (radial). I-incision yenziwe kwicala le-radial ye-quadratus ye-pronator, ishiya inxalenye eqhotyoshelwe kwi-radius yokwakhiwa kwakhona kamva. Ukutsalela i-quadratus ye-pronator kwicala le-ulnar kuveza ngokupheleleyo i-engile ye-volar ye-radius.
Kwiintlobo ezinzima zokuphuka, kucetyiswa ukuba ukhulule ukufakwa kwe-distal ye-brachioradialis muscle, enokuthi ithintele ukutsalwa kwayo kwinkqubo ye-radial styloid. Ngeli xesha, i-volar sheath ye-orsal compartment yokuqala inokunqunyulwa ukuze iveze i-distal fracture Vimbela i-radial side kunye ne-radial styloid inkqubo, ujikeleze ngaphakathi kwi-shaft ye-radial ukuze uhlukane nesayithi lokuqhekeka, kwaye usebenzise iingcingo ze-Kirschner ukunciphisa i-intra-articular fracture block. Kwizinto eziyinkimbinkimbi ze-intra-articular fractures, i-arthroscopy ingasetyenziselwa ukuncedisa ukunciphisa, ukuvavanya, kunye nokulungiswa kakuhle kweeqhekeza.
Emva kokugqitywa kokunciphisa, i-volar plate ibekwe rhoqo. I-plate kufuneka ibe kufuphi ne-watershed, kufuneka igubungele inkqubo ye-ulnar, kwaye isiphelo esiphezulu seplate kufuneka sifikelele kumbindi we-shaft ye-radial. Ukuba le miqathango ingasentla ayifezekanga, ubungakanani beplate ayifanelekanga, okanye ukunciphisa akunelisekanga, ukusebenza akukabikho.
Iingxaki ezininzi zinento eninzi yokwenza apho ipleyiti ibekwe khona. Ukuba ipleyiti ibekwe kakhulu, iingxaki ezinxulumene ne-flexor hallucis longus zibekwe ngaphambili; ukuba i-plate ibekwe kufuphi kakhulu nomgca wamanzi, i-flexor digitorum profundus ingaba yingozi. Ukunciphisa i-fracture kwi-volar displacement deformity kunokubangela ukuba i-plate yensimbi iqhubele phambili kwicala le-volar kwaye idibanise ngokuthe ngqo i-tendon flexor, ekugqibeleni iholele kwi-tendinitis okanye ukuphuka.
Kwizigulane ze-osteoporotic, kucetyiswa ukuba ipleyiti ibe kufuphi nomgca wamanzi ngokusemandleni, kodwa ingabi ngaphaya kwayo.. Iingcingo ze-Kirschner zingasetyenziselwa ukulungisa i-subchondral esondeleyo kwi-ulna, kunye neengcingo ze-Kirschner zecala kunye nezikhonkwane zokutshixa kunye nezikrufu zinokuthintela ngokufanelekileyo ukuphuka kwi-displacement.
Emva kokuba ipleyiti ibekwe ngokuchanekileyo, isiphelo esisondeleyo sigxininiswe nge-screw, kwaye umngxuma we-ulnar ekupheleni kweplate ugxininiswe okwethutyana kunye ne-Kirschner wire. I-intraoperative fluoroscopy i-anteroposterior view, i-lateral view, i-wrist joint elevation 30 ° i-lateral view, ukujonga ukunciphisa ukuphuka kunye nokumisa kwangaphakathi. Ukuba indawo yeplate iyanelisa, kodwa i-Kirschner wire idibene, iya kukhokelela ekubuyiseni okwaneleyo kwe-volar inclination, enokuthi ixazululwe ngokucwangcisa iplate ngokusebenzisa "i-distal fracture fixation technique" (Umfanekiso 2, b).
Ukuba ihamba kunye ne-dorsal kunye ne-ulnar fractures (i-ulnar / dorsal Die Punch) kwaye ayinakuncitshiswa ngokupheleleyo phantsi kokuvalwa, ezi ndlela zintathu zilandelayo zinokusetyenziswa:
1. Phakamisa isiphelo esisondeleyo seradiyasi ukuyigcina kude nesiza sokuphuka, kwaye utyhale i-lunate fossa fracture ukuya kwi-carpus ngokusebenzisa indlela yokwandisa i-PCR;
2. Yenza i-incision encinci kwicala le-dorsal ye-4th kunye ne-5th compartment ukuze uveze iqhekeza le-fragment, kwaye uyilungise nge-screws kwindawo eninzi ye-ulnar yeplate.
3. Ukulungiswa kwe-percutaneous evaliweyo okanye encinci ye-invasive ngoncedo lwe-arthroscopy.
Emva kokunciphisa kuyanelisa kwaye ipleyiti ibekwe ngokuchanekileyo, ukulungiswa kokugqibela kulula. Ukuba i-proximal ulnar Kirschner wire ibekwe ngokuchanekileyo kwaye akukho zikhonkwane kwi-joint cavity, ukuncitshiswa kwe-anatomical kunokufumaneka.
Amava okhetho lweScrew: Ngenxa yokunyathela kanzima kwethambo le-cortical dorsal, ubude be-screw bunokuba nzima ukulinganisa ngokuchanekileyo. Izikrufu ezinde kakhulu zinokubangela ukucaphuka kwethenda, kwaye izikrufu ezimfutshane kakhulu azikwazi ukuxhasa kunye nokulungisa iqhekeza le-dorsal. Ngesi sizathu, umbhali ucebisa ukuba kusetyenziswe izikhonkwane zokutshixa ezinemisonto kunye nezikrufu ze-multiaxial zokutshixa kwinkqubo ye-radial styloid kunye nowona mngxuma we-ulnar, kunye nokusebenzisa izikhonkwane zokutshixa intonga epholisiweyo kwezinye iindawo. Ukusebenzisa i-tip blunt kugwema ukucaphuka kwe-tendon nokuba i-dorsal exit isetyenziswe. Ukulungiswa kweplate edibeneyo edibeneyo, izikrufu ezimbini ezidibeneyo + isikrufu esinye esiqhelekileyo (esibekwe nge-ellipse) singasetyenziselwa ukulungiswa.
4. Isishwankathelo sesicatshulwa esipheleleyo:
Ukulungiswa kwepleyiti ye-volar yokutshixa i-distal radius fractures kunokufikelela kwimpumelelo yeklinikhi, exhomekeke ikakhulu ekukhethweni kwezalathisi kunye nezakhono ezigqwesileyo zotyando. Ukusebenzisa le ndlela kunokufumana i-prognosis engcono yokusebenza kwangaphambili, kodwa akukho mmahluko ekusebenzeni kamva kunye nokusebenza kwemifanekiso kunye nezinye iindlela, iziganeko zeengxaki ze-postoperative zifana, kwaye ukunciphisa kulahlekile ukulungiswa kwangaphandle, i-percutaneous Kirschner wire fixation, kunye ne-plaster fixation , izifo zentsholongwane yenaliti zixhaphake kakhulu; kunye neengxaki ze-tendon ze-extensor zixhaphake kakhulu kwiinkqubo ze-distal plate fixation plate. Kwizigulane ezine-osteoporosis, i-volar plate iselukhetho lokuqala.
Ixesha lokuposa: Dec-12-2022
