I-Distal Radius Fracture: Incazelo Eningiliziwe Yokulungiswa Kwangaphakathi Kwamakhono Okuhlinzwa Sith Izithombe Nemibhalo!

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

1. Contraindications

Iziguli esezikhulile ezingafanele ukuhlinzwa.

1. Ukulungiswa kwangaphakathi (indlela ye-volar)

Ukulungiselela okujwayelekile ngaphambi kokuhlinzwa. I-anesthesia yenziwa kusetshenziswa i-brachial plexus anesthesia noma i-anesthesia ejwayelekile

I-1) .Isiguli sibekwe endaweni ephansi futhi isitho esithintekile sithunjwe futhi sibekwe phezu kohlaka lokuhlinzwa. Ukusika okungu-8cm kwenziwa phakathi komthambo we-radial wengalo kanye nomsipha oguquguqukayo we-carpi radialis futhi kunwetshwe ku-crease yesihlakala. Lokhu kungadalula ngokuphelele ukuphuka futhi kuvimbele ukufinyela kwesibazi. Ukusikwa akudingi ukuthi kungene entendeni yesandla (Umfanekiso 1-36A).

2) .Landela ukusika ku-flexor carpi radialis tendon sheath (Umfanekiso 1-36B), vula umgodla we-tendon, ugobe i-bamboo fascia ejulile yangaphambili ukuze uveze i-flexor pollicis longus, sebenzisa umunwe wenkomba ukuze ubonise i-flexor pollicis longus ohlangothini lwe-ulnar, futhi ingxenye ye-flexious ikhulule i-flexible ende. Isisu se-muscle sivezwe ngokugcwele ku-pronator quadratus muscle (Umfanekiso 1-36C)

3).Yenza ukusika okumise okuka-“L” eceleni kweradial yerediyasi ukuya enqubweni yesitayela se-radial ukuze uveze umsipha we-pronator quadratus, bese uwukhumula endaweni engaba nge- peeler ukuze uveze wonke umugqa wokugoqa uqalo (Umfanekiso 1-36D, Umfanekiso 1-36E)

I-4) .Faka i-stripper noma ummese omncane wethambo kusuka kulayini wokuphuka, futhi uyisebenzise njenge-lever ukuze unciphise ukuphuka. Faka i-dissector noma ummese omncane wesikelo ngaphesheya komugqa wokuphuka ku-lateral bone cortex ukuze ukhulule ukucindezelwa kanye nokunciphisa ucezu lwe-distal fracture, futhi usebenzise iminwe ukuze ucindezele ucezu lwe-dorsal fracture ukuze unciphise ucezu lwe-dorsal fracture.

Lapho i-radial styloid fracture iphuka, kunzima ukunciphisa ukuphuka kwe-styloid ye-radial ngenxa yokudonsa kwemisipha ye-brachioradialis. Ukuze kuncishiswe amandla okudonsa, i-brachioradialis ingashintshwa noma ihlakazwe kusukela ku-distal radius. Uma kunesidingo, i-distal fragment ingalungiswa okwesikhashana ku-proximal fragment ngezintambo ze-Kirschner.

Uma inqubo ye-ulnar styloid iphukile futhi isuswa, futhi i-distal radioulnar ehlangene ingazinzile, intambo eyodwa noma ezimbili ze-Kirschner zingasetshenziswa ukulungisa i-percutaneous, futhi inqubo ye-styloid ye-ulnar ingasethwa kabusha ngendlela ye-volar. Ukuphuka okuncane ngokuvamile akudingi ukwelashwa okwenziwa ngesandla. Kodwa-ke, uma ijoyinti le-distal radioulnar lingazinzile ngemva kokulungiswa kwerediyasi, ucezu lwesitayela lungasikwa futhi imiphetho ye-triangular fibrocartilage complex ihlanganiswe nenqubo yesitayela se-ulnar ngamahange noma imicu kasilika.

I-5) .Ngosizo lwe-traction, i-capsule ehlangene kanye ne-ligament ingasetshenziswa ukukhulula ukuhlanganisa nokunciphisa ukuphuka. Ngemva kokuba ukuphuka kwehliswe ngempumelelo, nquma indawo yokubeka ipuleti lensimbi ye-volar ngaphansi kokuqondisa kwe-X-ray fluoroscopy bese ugoqa isikulufu embotsheni eyisiyingi noma imbobo eslayidayo ukuze kube lula ukulungiswa kwendawo (Umfanekiso 1-36F). Sebenzisa imbobo yokubhoboza engu-2.5mm ukuze ubhoboze phakathi nendawo yembobo eyisiyingi, bese ufaka isikulufu esizithephayo esingu-3.5mm.

Umfanekiso 1-36 Ukusikwa kwesikhumba (A); ukusika i-flexor carpi radialis tendon sheath (B); ukuxebula ingxenye ye-flexor tendon ukuze kuvezwe i-pronator quadratus muscle (C); ukuhlukanisa i-pronator quadratus muscle ukuze uveze i-radius (D); ukuveza umugqa wokuphuka (E); beka ipuleti le-volar nesikulufu kusikulufa sokuqala (F)
6).Sebenzisa i-C-arm fluoroscopy ukuze uqinisekise ukubekwa kwepuleti ngendlela efanele. Uma kudingekile, phusha ipuleti kude noma eduze ukuze uthole ukubekwa kwesikulufu se-distal okungcono kakhulu.

7).Sebenzisa i-2.0mm drill ukuze ubhoboze imbobo ekugcineni okukude kwe-steel plate, ulinganise ukujula nesikulufu kusikulufa sokukhiya. Uzipho kufanele lube lufushane ngo-2mm kunebanga elilinganisiwe ukuze kuvinjelwe isikulufu ukuthi singangeni futhi siphume ku-cortex yomhlane. Ngokuvamile, isikulufu esingu-20-22mm sanele, futhi leso esigxiliswe kunqubo ye-radial styloid kufanele sibe sifushane. Ngemva kokujikijela isikulufu se-distal, sisikulufu Faka isikulufu esiseduze esisele.

Ngenxa yokuthi i-engeli yesikulufu idizayinwe, uma ipuleti libekwe eduze kakhulu ne-distal end, isikulufu sizongena ekuhlanganyeleni kwengalo. Thatha izingcezu ze-tangential zethambo le-articular subchondral ukusuka endaweni ye-coronal kanye ne-sagittal ukuze uhlole ukuthi liyangena yini ekuhlanganyeleni, bese ulandela imiyalelo Lungisa amapuleti ensimbi kanye/noma izikulufu.

(Figure1-37) Umfanekiso 1-37 Ukulungiswa kwe-distal radius fracture nge-volar bone plate A. Ifilimu ye-x-ray ye-Anteroposterior kanye ne-lateral ye-distal radius fracture ngaphambi kokusebenza, ebonisa ukufuduka kokuphela kwe-distal ohlangothini lwe-volar; B. Ifilimu ye-X-ray ye-Anteroposterior kanye ne-lateral ye-X-ray yokuphuka kwangemva kokuhlinzwa, ebonisa ukuphuka Ukwehliswa okuhle nokuvunyelwa okuhle kwelunga lesihlakala
8) Suture i-pronator quadratus muscle nge-sutures engabambeki. Qaphela ukuthi umsipha ngeke umboze ngokuphelele ipuleti. Ingxenye ekude kufanele imbozwe ukuze kuncishiswe ukuthintana phakathi kwe-flexor tendon nepuleti. Lokhu kungafezwa ngokufaka i-pronator quadratus emaphethelweni e-brachioradialis, ukuvala ungqimba lwe-incision ngongqimba, nokululungisa nge-plaster uma kunesidingo.