1. Izinkomba
1). Ukuqhekeka okukhulu okuqhekekile kunokuguquguquka okusobala, futhi ubuso obuhlangene be-distal radius buyabhujiswa.
2). Ukunciphisa ngesandla kwehlulekile noma ukulungiswa kwangaphandle kwehlulekile ukugcina ukunciphisa.
3). Ukuphuka kwamathambo amadala.
4). Ukuphuka kwe-malunion noma ukungahlangani. Ithambo likhona ekhaya nakwamanye amazwe
2. Izimo zokuphikisana
Iziguli esezikhulile ezingafaneleki ukuhlinzwa.
3. Indlela yokuhlinzwa yokulungisa ngaphandle
1. I-Cross-articular external fixator yokulungisa ukuphuka kwe-distal radius
Isikhundla kanye nokulungiselela ngaphambi kokuhlinzwa:
·Ukubulala izinzwa kwe-brachial plexus
·Isikhundla sokulala phansi lapho umlenze othintekile ulele khona esibayeni esibonayo eduze kombhede
·Faka i-tourniquet engxenyeni yesithathu yengalo engenhla
·Ukuqapha umbono
Indlela Yokuhlinzwa
Ukufakwa Kwesikulufu Se-Metacarpal:
Isikulufu sokuqala sitholakala phansi kwethambo lesibili le-metacarpal. Kwenziwa ukusika kwesikhumba phakathi kwe-extensor tendon yomunwe wokukhomba kanye nomsipha ohlangene wethambo lokuqala. Izicubu ezithambile zihlukaniswa ngobumnene nge-forceps yokuhlinzwa. Isikhwama sivikela izicubu ezithambile, bese kufakwa isikulufu se-Schanz esingu-3mm. Izikulufu
Isiqondiso sesikulufu singama-45° kuya endizeni yesundu, noma singahambisana nendawo yesundu.
Sebenzisa umhlahlandlela ukukhetha indawo yesikulufu sesibili. Isikulufu sesibili esingu-3mm siqhutshwe saya ku-metacarpal yesibili.
Ububanzi bephini lokulungisa i-metacarpal akufanele budlule u-3mm. Iphini lokulungisa litholakala ku-1/3 ye-proximal. Kubantu abane-osteoporosis, isikulufu esiseduze kakhulu singangena ezingqimbeni ezintathu ze-cortex (ithambo lesibili le-metacarpal kanye nengxenye ye-cortex yethambo lesithathu le-metacarpal). Ngale ndlela, isikulufu Ingalo ende yokulungisa kanye ne-torque enkulu yokulungisa kwandisa ukuzinza kwephini lokulungisa.
Ukubekwa kwezikulufo ze-radial:
Yenza ukusika kwesikhumba emaphethelweni angaseceleni kwe-radius, phakathi kwemisipha ye-brachioradialis kanye nemisipha ye-extensor carpi radialis, 3cm ngaphezu kokuphela komugqa wokuqhekeka kanye cishe no-10cm eduze kwejoyinti lesihlakala, bese usebenzisa i-hemostat ukuze uhlukanise izicubu ezingaphansi komhlaba ngqo ebusweni bethambo. Kuthathwa ukunakekelwa ukuvikela amagatsha angaphezulu enzwa ye-radial ehamba kule ndawo.
Endaweni efanayo nezikulufo ze-metacarpal, izikulufo ezimbili ze-Schanz ezingu-3mm zabekwa ngaphansi kwesiqondiso sesiqondiso sezicubu ezithambile zokuvikela imikhono.
·.Ukunciphisa nokuqina kokuphuka:
·.Ukunciphisa ukudonswa ngesandla kanye ne-C-arm fluoroscopy ukuhlola ukuncipha kokuqhekeka.
·.Ukuqina kwangaphandle kulo lonke ilunga lesihlakala kwenza kube nzima ukubuyisela ngokuphelele i-engeli yokuthambekela kwesundu, ukuze kuhlanganiswe nezikhonkwane zeKapandji ukusiza ekunciphiseni nasekuqiniseni.
·.Kubantu abane-radial styloid fractures, i-radial styloid Kirschner wire fixation ingasetshenziswa.
·.Ngenkathi ugcina ukunciphisa, xhuma i-fixator yangaphandle bese ubeka isikhungo sokujikeleza se-fixator yangaphandle ku-axis efanayo nesikhungo sokujikeleza sejoyinti lesihlakala.
·.I-Anteroposterior kanye ne-lateral fluoroscopy, hlola ukuthi ubude be-radius, i-palmar inclination angle kanye ne-ulnar deviation angle ziyabuyiselwa yini, bese ulungisa i-fixation angle kuze kube yilapho ukuncipha kokuqhekeka kwanele.
·. Naka ukudonswa kwe-fixator yangaphandle kazwelonke, okubangela ukuqhekeka kwe-iatrogenic kuzikulufu ze-metacarpal.
Ukuphuka kwe-distal radius kuhlanganiswe nokuhlukaniswa kwe-distal radioulnar joint (DRUJ):
·.Ama-DRUJ amaningi angancishiswa ngokuzenzekelayo ngemva kokunciphisa i-distal radius.
·.Uma i-DRUJ isahlukene ngemva kokuba i-distal radius incishisiwe, sebenzisa ukunciphisa ukucindezela ngesandla bese usebenzisa i-lateral rod fixation ye-bracket yangaphandle.
Noma sebenzisa izintambo ze-K ukuze ungene ku-DRUJ endaweni engathathi hlangothi noma ebheke phansi kancane.
Ukuphuka kwe-distal radius kuhlanganiswe nokuphuka kwe-ulnar styloid: Hlola ukuqina kwe-DRUJ ekukhulumeni, ekungathathi hlangothi nasekugobeni kwengalo. Uma kukhona ukungazinzi, ukusizwa kokuqina ngezintambo ze-Kirschner, ukulungiswa kwe-TFCC ligament, noma isimiso se-tension band singasetshenziswa ekuqiniseni inqubo ye-Ulnar styloid.
Gwema ukudonsa ngokweqile:
· Hlola ukuthi iminwe yesiguli ingakwazi yini ukwenza ukunyakaza okuphelele kokugoba nokwelula ngaphandle kokucindezeleka okusobala; qhathanisa isikhala samalunga esinomswakama kanye nesikhala samalunga esiphakathi kwe-carpal.
·Hlola ukuthi isikhumba esisemzileni wezinzipho siqine kakhulu yini. Uma siqine kakhulu, yenza isilonda esifanele ukuze ugweme ukutheleleka.
·Khuthaza iziguli ukuthi zishukumise iminwe yazo kusenesikhathi, ikakhulukazi ukugoba kanye nokwelulwa kwamalunga eminwe angenawo umgogodla, ukugoba kanye nokwelulwa kwesithupha, kanye nokuthunjwa.
2. Ukulungiswa kokuqhekeka kwe-distal radius nge-fixator yangaphandle engaweli ijoyinti:
Indawo kanye nokulungiselela ngaphambi kokuhlinzwa: Kufana nakuqala.
Amasu Okuhlinzwa:
Izindawo eziphephile zokubeka i-K-wire ohlangothini lwangemuva lwe-distal radius yilezi: kuzo zombili izinhlangothi ze-tubercle kaLister, kuzo zombili izinhlangothi ze-extensor pollicis longus tendon, naphakathi kwe-extensor digitorum communis tendon kanye ne-extensor digiti minimi tendon.
Ngendlela efanayo, kwafakwa izikulufo ezimbili ze-Schanz ku-radial shaft futhi zaxhunywa ngenduku yokuxhuma.
Ngaphakathi kwendawo yokuphepha, izikulufo ezimbili ze-Schanz zafakwa engxenyeni yokuqhekeka kwe-distal radius, eyodwa isuka ohlangothini lwe-radial kanye nenye isuka ohlangothini lwe-dorsal, nge-engeli engu-60° kuya ku-90° komunye nomunye. Isikulufo kufanele sibambe i-cortex engezansi, futhi kufanele kuqashelwe ukuthi isihloko sesikulufo esifakwe ohlangothini lwe-radial asikwazi ukudlula ku-notch ye-sigmoid bese singena ku-distal radioulnar joint.
Namathisela isikulufu se-Schanz ku-distal radius ngesixhumanisi esigobile.
Sebenzisa induku yokuxhuma ephakathi nendawo ukuxhuma izingxenye ezimbili eziphukile, futhi uqaphele ukuthi ungakhiyi i-chuck okwesikhashana. Ngosizo lwesixhumanisi esiphakathi nendawo, ingxenye ekude iyancishiswa.
Ngemva kokusetha kabusha, vala i-chuck endukwini yokuxhuma ukuze uqedele okokugcinaukulungiswa.
Umehluko phakathi kwe-non-span-joint external fixator kanye ne-cross-joint external fixator:
Ngenxa yokuthi izikulufo eziningi ze-Schanz zingafakwa ukuze kuqedwe ukuncipha nokulungiswa kwezingcezu zamathambo, izinkomba zokuhlinzwa zama-fixator angaphandle angewona amalunga zibanzi kunalezo zama-fixator angaphandle ahlanganayo. Ngaphezu kokuphuka kwe-extra-articular, zingasetshenziswa futhi ekuqhekekeni kwesibili kuya kwesithathu. Ukuphuka kwengxenye yangaphakathi kwe-articular.
I-cross-joint external fixator ilungisa i-wrist joint futhi ayivumeli ukuzivocavoca kwasekuqaleni, kuyilapho i-non-cross-joint external fixator ivumela ukuzivocavoca kwasekuqaleni kwamalunga esihlakala ngemva kokuhlinzwa.
Isikhathi sokuthunyelwe: Septhemba 12-2023
