Ukuhlanza
1.)
2)
3) .Bhekisa.
4) .Fractrure Malonion noma unnonion. Ithambo elikhona ekhaya nakwamanye amazwe
2.ConstrainIcation
Iziguli ezikhulile ezingakulungele ukuhlinzwa.
I-3 inqubo yokuhlelwa kwangaphandle yangaphandle
1. I-Disc-articular yangaphandle yangaphandle yokulungisa i-distal radius fractures
Isikhundla kanye nokulungiselela okusebenzayo:
· Brachial plexus anesthesia
Isikhundla se-supine nesicaba esithintekile ku-Book-ngokusebenzisa kubakaki eceleni kombhede
· Sebenzisa umqhudelwano kuya ku-1/3 yengalo ephezulu
Ukubhekwa kokubuka
Ubuchwepheshe obuhle
Ukufakwa kweMetaCarpal Screw Insert:
Isikulufa sokuqala sitholakala esisekelweni sethambo lesibili le-metacarpal. Kwenziwa isikhumba esivela phakathi kwe-extensor tendon yomunwe we-Index kanye nemisipha ye-Dorsal e-Intessosseve yethambo lokuqala. Izicubu ezithambile zihlukaniswe ngobumnene namandla okuhlinza. Umkhono uvikela izicubu ezithambile, futhi kufakwa isikulufa se-schanz esingu-3mm. Isikulufu
Ukuqondiswa kwesikulufa kungu-45 ° kuya endizeni yesandla, noma kungaba ukufana nendiza yesundu.
Sebenzisa umhlahlandlela ukukhetha isikhundla sesikulufa sesibili. Isikulufa sesibili se-3mm saqhutshwa ku-metacarpal yesibili.
Ububanzi be-metacarpal fidetion PIN akufanele yedlule i-3mm. I-PIN yokulungiswa itholakala kuProximal 1/3. Ezigulini ezinama-osteoporosis, isikulufa se-prosximal kakhulu singangena ezingxenyeni ezintathu ze-cortex (i-satacarpal bone yesibili nengxenye ye-cortex yesithathu ye-metacarpal bone). Ngale ndlela, isikulufa ingalo ende yokulungisa kanye ne-torque enkulu yokulungisa kwandisa ukuqina kwe-PIN yokulungisa.
Ukubekwa Kwezikulungi Ze-Radial:
Yenza ukuvela kwesikhumba onqenqemeni lwamuva lwe-radius, phakathi kwemisipha ye-brachioradialis kanye ne-extensor carpi radialis umsipha, bese usebenzisa i-hemostal ekuhlanganiseni izicubu ezingaphansi komhlaba. Ukunakekelwa kuthathwa ukuvikela amagatsha angelona iqiniso le-radial nerve leyo khosi kule ndawo.
Endizeni efanayo njengezikulufo ze-metacarpal, izikulufo ezimbili ze-schanz ezimbili zabekwa ngaphansi kokuholwa umhlahlandlela wokuvikelwa kwezicubu ezithambile
. .Fracture ukuncishiswa nokulungiswa:
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Ukulungiswa kwangaphandle ngaphesheya kwesihlaselwa esihlangene kwenza kube nzima ukuthola ngokuphelele i-angle yokuthambekela ye-Palmar, ngakho-ke kungahlanganiswa nezikhonkwane ze-kapandji ukusiza ekwehlisweni nasekulungisweni.
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·
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·. Naka ukutholwa kukazwelonke kokulungiswa kwangaphandle, okubangela ukuqhekeka kwe-Iatrogenic ezihlahleni zemetacarpal.
Ukuqhekeka kwe-distal radius kuhlanganiswe ne-distal radioulnar ehlanganisiwe (druj) ukwehlukaniswa:
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· .Or Sebenzisa ama-K-izintambo ukuze ungene e-druj endaweni engathathi hlangothi noma efakwe kancane.
Ukuqhekeka kwe-distal radius kuhlangene ne-ulnar styroid fracture: hlola ukuqina kwe-druj kwisifanekisweni, ukungathathi hlangothi kanye nokuhlelwa kwengalo. Uma ukungazinzi kukhona, ukulungiswa okusizwa nge-kirschner izintambo, ukulungiswa kwe-TFCC ligament, noma umgomo webhendi we-tension angasetshenziselwa ukulungiswa kwenqubo ye-ulnar styroid.
Gwema ukudonsa ngokweqile:
· Bheka ukuthi iminwe yesiguli ingenza ukuguquguquka okuphelele nokunyakaza kokungenisa ngaphandle kwengxabano esobala; Qhathanisa isikhala esihlangene se-radiolunate kanye nendawo ehlanganisiwe ye-midCarpal.
· Bheka ukuthi isikhumba esiteshini sesipikili siqine kakhulu. Uma kuqinile kakhulu, yenza i-incision efanelekile ukugwema ukutheleleka.
· Khuthaza iziguli ukuthi zihambise iminwe yazo kusenesikhathi, ikakhulukazi ukuguquguquka nokwandiswa kwamalunga weMetacarPophaleal yeminwe, ukuguquguquka nokwandiswa kwesithupha, nokuthumba.
2. Ukulungiswa kwe-distal radius fractures ngocingo lwangaphandle olunganqamuleli okuhlanganisiwe:
Isikhundla kanye nokulungiselela okusebenzayo: okufanayo nangaphambilini.
Amasu okuhlinza:
Izindawo eziphephile zokubekwa kwe-K-wire ohlangothini lwe-dorsal ye-distal radius yilezi: nhlangothi zombili ze-tubercle ye-lister, nhlangothi zombili ze-extensor pollimis tendon kanye ne-extensor digitorium minimi tendon.
Ngendlela efanayo, izikulufa ezimbili ze-schanz zafakwa emgodini we-radial futhi zixhunywe ngenduku yokuxhuma.
Ngendawo yezokuphepha, izikulufo ezimbili ze-Schanz zifakwe esinqumweni se-distal radius fracture, eyodwa ukusuka ohlangothini lwe-radial kanye nolunye oluvela ohlangothini lwe-dorsal, nge-angle ka-60 ° kuya ku-90 ° komunye nomunye. Isikulufa kufanele sibambe i-cortex yama-cortex, futhi kufanele kuqashelwe ukuthi isicucu sesikulufa esifakiwe ohlangothini lwe-radial alukwazi ukudlula ku-sigmoid notch bese ufaka i-distal radioulnar Joint.
Namathisela isikulufa se-schanz endaweni edayisayo enesixhumanisi esigobile.
Sebenzisa induku exhuma ngokuxhumanisa ukuxhuma izingxenye ezimbili ezaphukile, futhi uqaphele ukuthi ungakhiya i-chuck okwesikhashana. Ngosizo lwesixhumanisi esiphakathi, isiqephu se-distal sincishisiwe.
Ngemuva kokusetha kabusha, khiya i-chuck kwinduku yokuxhuma ukuze uqedele owokugcinaUkulungiswa.
Umehluko phakathi kwe-Finator engaphandle ehlanganayo ehlanganayo kanye noFoxidal wangaphandle ohlanganyelwe:
Ngoba izikulufo eziningi zeSchanz zingafakwa ukuqeda ukuncishiswa nokulungiswa kwezingcezwana zamathambo, izinkomba zokuhlinzwa zokufakelwa kwangaphandle okuhlangene zibanzi kunalezo ezihlangene zangaphandle ezihlangene. Ngaphezu kokuqhekeka okwengeziwe kwezinto eziphilayo, zingasetjenziswa okwesibili kuya kuqhekezi yesithathu. Ukwaphuka kwengxenye ye-intra-acticular.
I-Finator ehlanganisiwe yangaphandle ehlanganayo ilungisa i-Wortist Joint futhi ayivumeli ukuzivocavoca okusebenzayo, ngenkathi i-Finator yangasese ehlanganayo ivumela ukuzivocavoca okuhlangene kwe-postoperative Worpoperative Wriperal Worting.
Isikhathi sePosi: Sep-12-2023
