1.Izinkomba
1) Ukuqhekeka okubi kakhulu kunokususwa okusobala, futhi i-articular surface ye-distal radius iyabhujiswa.
2).Ukwehliswa okwenziwa ngesandla kuhlulekile noma ukulungiswa kwangaphandle kuhlulekile ukugcina ukwehliswa.
3).Ukuphuka amadala.
4).Ukuphuka kwe-malunion noma okungezona igama.ithambo elikhona ekhaya naphesheya
2.Izingqinamba
Iziguli esezikhulile ezingafanele ukuhlinzwa.
3. Indlela yokuhlinza yokulungiswa kwangaphandle
1. I-Fixator yangaphandle ye-Cross-articular ukulungisa ukuphuka kwe-distal radius
Isikhundla kanye nokulungiswa kwangaphambi kokuhlinzwa:
·I-Brachial plexus anesthesia
·Indawo yokulala nesitho esithintekile siphansi kubakaki bokubona eduze kombhede
Sebenzisa i-tourniquet ku-1/3 yengalo engenhla
·Ukubhekwa kombono
I-Surgery Technique
Ukufakwa kwe-Metacarpal Screw:
Isikulufu sokuqala sitholakala phansi kwethambo lesibili le-metacarpal.Ukusika kwesikhumba kwenziwa phakathi kwe-extensor tendon yomunwe wokukhomba kanye nomsipha we-dorsal interosseous wethambo lokuqala.Izicubu ezithambile zihlukaniswa ngobumnene ngama-forceps okuhlinzwa.Umkhono uvikela izicubu ezithambile, bese kufakwa isikulufu esingu-3mm Schanz.Izikulufu
Isiqondiso sesikulufu singama-45 ° endizeni yesundu, noma singahambisana nendiza yesundu.
Sebenzisa umhlahlandlela ukuze ukhethe indawo yesikulufu sesibili.Isikulufu sesibili esingu-3mm sashayelwa ku-metacarpal yesibili.
Ububanzi bephinikhodi yokulungisa i-metacarpal akufanele budlule u-3mm.Iphinikhodi yokulungisa itholakala ku-1/3 eseduze.Ezigulini ezine-osteoporosis, isikulufu esiseduze kakhulu singangena ezingqimbeni ezintathu ze-cortex (ithambo lesibili le-metacarpal kanye nengxenye yethambo lesithathu le-metacarpal).Ngale ndlela, isikulufu Ingalo yokulungisa ende kanye ne-torque enkulu yokulungisa kwandisa ukuqina kwephini lokulungisa.
Ukubekwa kwezikulufu ze-radial:
Yenza ukusika kwesikhumba onqenqemeni olungemuva lwerediyasi, phakathi komsipha we-brachioradialis kanye ne-extensor carpi radialis muscle, u-3cm ngaphezu komkhawulo oseduze womugqa wokuphuka futhi cishe u-10cm oseduze nelunga lesihlakala, futhi usebenzise i-hemostat ukuze uhlukanise ngokusobala i-subcutaneous. izicubu endaweni yamathambo.Ukunakekela kuthathwa ukuze kuvikelwe amagatsha angaphezulu e-radial nerve leyo nkambo kule ndawo.
Endizeni efanayo nezikulufu ze-metacarpal, izikulufu ezimbili ze-Schanz eziyi-3mm zafakwa ngaphansi kokuqondisa komhlahlandlela wethishu ethambile yokuvikela imikhono.
·.Ukuncishiswa nokulungiswa kokuqhekeka:
·.Ukuncishiswa kokudonsa ngesandla kanye ne-C-arm fluoroscopy ukuhlola ukuncishiswa kokuphuka.
·.Ukulungiswa kwangaphandle kokuhlangana kwesihlakala kwenza kube nzima ukubuyisela ngokuphelele i-engeli yokuthambekela kwesundu, ngakho-ke ingahlanganiswa nezikhonkwane ze-Kapandji ukusiza ekwehliseni nasekulungiseni.
·.Ezigulini ezine-radial styloid fractures, i-radial styloid Kirschner wire fixation ingasetshenziswa.
·.Ngenkathi ugcina ukuncishiswa, xhuma isilungisi sangaphandle bese ubeka isikhungo sokujikeleza sesilungisi sangaphandle ku-axis efanayo nesikhungo sokuzungezisa sokuhlangana kwesandla.
·.I-Anteroposterior ne-lateral fluoroscopy, hlola ukuthi ubude berediyasi, i-engeli yokuthambekela kwesundu kanye ne-engeli yokuchezuka kwe-ulnar zibuyiselwe, futhi ulungise i-engeli yokulungisa kuze kube yilapho ukuncishiswa kokuphuka kuyanelisa.
·.Naka ukudonsa kuzwelonke kwesilungisi sangaphandle, okubangela ukuphuka kwe-iatrogenic kuzikulufu ze-metacarpal.
Ukuphuka kweradiyasi ekude kuhlanganiswe nokuhlukaniswa kwejoyinti le-distal radioulnar (DRUJ):
·.Ama-DRUJ amaningi angancishiswa ngokuzenzakalelayo ngemva kokwehliswa kwe-distal radius.
·.Uma i-DRUJ isahlukanisiwe ngemva kokuba i-distal radius incishisiwe, sebenzisa ukuncishiswa kokucindezela okwenziwa ngesandla futhi usebenzise ukulungiswa kwenduku ye-lateral yobakaki bangaphandle.
·.Noma sebenzisa izintambo ze-K ukuze ungene ku-DRUJ usendaweni emaphakathi noma eyekwe kancane.
Ukuphuka kwe-distal radius kuhlanganiswe nokuphuka kwesitayela se-ulnar: Hlola ukuzinza kwe-DRUJ ngokubiza, ukungathathi hlangothi kanye nokuphakamisa ingalo.Uma kukhona ukungazinzi, ukulungiswa okusizwayo ngezintambo ze-Kirschner, ukulungiswa kwentambo ye-TFCC, noma isimiso sebhendi ye-tension kungasetshenziswa ukulungisa inqubo ye-Ulnar styloid.
Gwema ukudonsa ngokweqile:
· Hlola ukuthi iminwe yesiguli ingakwazi yini ukwenza ukugoba okuphelele nokunwetshwa ngaphandle kokucindezeleka okusobala;qhathanisa isikhala esihlangene se-radiolunate kanye nesikhala esihlangene se-midcarpal.
·Hlola ukuthi ingabe isikhumba esiteshini sezinzipho siminyene kakhulu.Uma iminyene kakhulu, yenza imbobo efanele ukuze ugweme ukutheleleka.
·Khuthaza iziguli ukuthi zinyakaze iminwe yazo kusenesikhathi, ikakhulukazi ukugoba nokunwetshwa kwamalunga eminwe e-metacarpophalangeal, ukunwebeka nokunwetshwa kwesithupha, kanye nokuthumba.
2. Ukulungiswa kokuphuka kweradiyasi ekude ngesilungisi sangaphandle esingaweli ilunga:
Isikhundla kanye nokulungiselela ngaphambi kokuhlinzwa: Kuyafana nangaphambili.
Amasu okuhlinza:
Izindawo eziphephile zokubekwa kwe-K-wire ohlangothini lwe-dorsal lwe-distal radius yilezi: nhlangothi zombili ze-tubercle ka-Lister, nhlangothi zombili ze-extensor pollicis longus tendon, naphakathi kwe-extensor digitorum communis tendon kanye ne-extensor digiti minimi tendon.
Ngendlela efanayo, izikulufo ezimbili ze-Schanz zafakwa ku-shaft ye-radial futhi zixhunywe ngentonga yokuxhuma.
Ngendawo yokuphepha, izikulufu ezimbili ze-Schanz zafakwa esiqeshini sokuqhekeka kwerediyasi ekude, esisodwa sisuka ohlangothini lwe-radial nesinye sisuka ohlangothini lwe-dorsal, sine-engeli engu-60° ukuya ku-90° kwenye.Isikulufu kufanele sibambe i-contralateral cortex, futhi kufanele kuqashelwe ukuthi ichopho lesikulufu esifakwe ohlangothini lwe-radial alikwazi ukudlula inothi ye-sigmoid futhi lingene ejoyintini le-distal radioulnar.
Namathisela isikulufu se-Schanz endaweni eyi-distal ngesixhumanisi esigobile.
Sebenzisa induku yokuxhuma emaphakathi ukuze uxhume izingxenye ezimbili eziphukile, futhi qaphela ukuthi ungakhiyi i-chuck okwesikhashana.Ngosizo lwesixhumanisi esiphakathi, i-distal fragment iyancishiswa.
Ngemva kokusetha kabusha, khiya i-chuck entweni yokuxhuma ukuze uqedele okokugcinaukulungiswa.
Umehluko phakathi kwe-non-span-joint fixator yangaphandle ne-cross-joint yangaphandle:
Ngenxa yokuthi izikulufu eziningi ze-Schanz zingabekwa ukuze kuqedelwe ukuncishiswa nokulungiswa kwezingcezu zamathambo, izinkomba zokuhlinzwa zezilungisi zangaphandle ezingahlangani zibanzi kunezixhumi zangaphandle ezihlangene.Ngaphezu kokuphuka kwe-articular extra-articular, zingasetshenziselwa ukuphuka kwesibili kuya kwesithathu.Ukuphuka kwe-intra-articular ngokwengxenye.
Isilungisi sangaphandle esihlangene silungisa isihlakala futhi asikuvumeli ukuvivinya umzimba okusebenzayo kwangaphambi kwesikhathi, kuyilapho isilungisi sangaphandle esingahlangani sivumela ukuvivinya ukusebenza okuhlangene kwesihlakala kwangaphambi kokuhlinzwa.
Isikhathi sokuthumela: Sep-12-2023
