Okwangoku, kukho iindlela ezahlukeneyo zonyango zokuphulwa kwe-distal radius fractures, ezifana nokulungiswa kwe-plaster, ukunciphisa okuvulekileyo kunye nokulungiswa kwangaphakathi, isakhelo sokulungiswa kwangaphandle, njl. ukuba iingxaki zayo ziphezulu njenge-16%.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 lokufakelwa kwezinto lunokugqunywa yipronator quadratus.
2. Izibonakaliso kunye nokuchasana kunyango lwe-distal radius kunye ne-volar plate
Izibonakaliso: Ukusilela kokunciphisa ukucutha okuvaliweyo kweefractures ezingaphezulu kwe-articular fractures, ezi meko zilandelayo 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 kunokuba 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 ekulungiseni isiphelo esikude seradiyasi ngeli xesha (ubuchule bokulungisa iqhekeza le-distal fracture), indawo ekufutshane 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 yecandelo lokuqala le-dorsal inokusikwa ukuze iveze i-distal fracture Vimba icala le-radial kunye nenkqubo ye-styloid ye-radial, ujikeleze ngaphakathi kwi-shaft ye-radial ukuze uhlukane kwindawo yokuphuka, kwaye usebenzise iingcingo zaseKirschner ukunciphisa i-intra. -i-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 idibeneyo, iya kukhokelela ekubuyiseni okwaneleyo kwe-volar inclination, enokuthi ixazululwe ngokusetha kwakhona ipleyiti 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 ziyafana, kwaye ukunciphisa kulahlekile ukulungiswa kwangaphandle, ukulungiswa kwe-Kirschner ngocingo, kunye nokulungiswa kwe-plaster. , izifo zenaliti 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
