Ukuphuka Kwe-Distal Radius: Incazelo Eningiliziwe Yamakhono Okuhlinzwa Angaphakathi Sith Izithombe Nemibhalo!

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

1. Izimo zokuphikisana

Iziguli esezikhulile ezingafaneleki ukuhlinzwa.

1. Ukulungiswa kwangaphakathi (indlela ye-volar)

Ukulungiselela okuvamile ngaphambi kokuhlinzwa. I-anesthesia yenziwa kusetshenziswa i-brachial plexus anesthesia noma i-general anesthesia

1).Isiguli sibekwa silele phansi, isitho esithintekile sithathwe bese sibekwa ohlakeni lokuhlinzwa. Kwenziwa ukusika okungu-8cm phakathi komthambo we-radial wengalo kanye nomsipha we-flexor carpi radialis bese kwelulwa kuze kufike emhlane wesandla. Lokhu kungadalula ngokuphelele ukuphuka futhi kuvimbele ukugoba kwesibazi. Ukusika akudingeki kungene entendeni yesandla (Isithombe 1-36A).

2).Landela ukusikwa kwe-flexor carpi radialis tendon sheath (Isithombe 1-36B), vula i-tendon sheath, usike i-deep anterior bamboo fascia ukuze uveze i-flexor pollicis longus, sebenzisa umunwe wokukhomba ukuze uveze i-flexor pollicis longus ohlangothini lwe-ulnar, bese ukhulula ingxenye ye-flexor pollicis longus. Isisu semisipha sivele ngokuphelele emsipheni we-pronator quadratus (Isithombe 1-36C)

3). Yenza ukusika okubunjwe ngo-“L” ohlangothini lwe-radial lwe-radius uye enqubweni ye-radial styloid ukuze uveze imisipha ye-pronator quadratus, bese uyikhipha ku-radius nge-peeler ukuze uveze yonke intambo ye-bamboo fold (Isithombe 1-36D, Isithombe 1-36E)

4). Faka ummese wokuhlubula noma ummese omncane wethambo ovela emgqeni wokuqhekeka, bese uwusebenzisa njengesivikelo sokunciphisa ukuqhekeka. Faka i-dissector noma ummese omncane wesikelo ngaphesheya komugqa wokuqhekeka uye ku-cortex yethambo eliseceleni ukuze unciphise ukucindezelwa futhi unciphise ingxenye yokuqhekeka ekude, bese usebenzisa iminwe ukuze ucindezele ingxenye yokuqhekeka komgogodla ukuze unciphise ingxenye yokuqhekeka komgogodla.

Uma ukuphuka kwe-radial styloid kuphukile, kunzima ukunciphisa ukuphuka kwe-radial styloid ngenxa yokudonsa kwemisipha ye-brachioradialis. Ukuze kuncishiswe amandla okudonsa, i-brachioradialis ingashintshwa noma ihlukaniswe kusuka ku-distal radius. Uma kudingeka, i-distal fragment ingafakwa okwesikhashana ku-proximal fragment ngezintambo ze-Kirschner.

Uma inqubo ye-ulnar styloid iphukile futhi isusiwe, futhi i-distal radioulnar joint ingazinzile, intambo eyodwa noma ezimbili ze-Kirschner zingasetshenziswa ukuze kufakwe i-percutaneous, futhi inqubo ye-ulnar styloid ingasethwa kabusha ngendlela ye-volar. Ama-fracture amancane ngokuvamile awadingi ukwelashwa ngesandla. Kodwa-ke, uma i-distal radioulnar joint ingazinzile ngemva kokufakwa kwe-radius, i-styloid fragment ingasuswa futhi imiphetho ye-triangular fibrocartilage complex iboshwe enqubweni ye-ulnar styloid ngezikhonkwane noma ngentambo yesilika.

5).Ngosizo lokudonswa, i-capsule ehlangene kanye ne-ligament kungasetshenziswa ukukhulula ukuxhunyaniswa nokunciphisa ukuqhekeka. Ngemva kokuba ukuqhekeka sekuncishisiwe ngempumelelo, nquma indawo yokubekwa kwepuleti lensimbi ye-volar ngaphansi kwesiqondiso se-X-ray fluoroscopy bese ugoqa isikulufu ungene emgodini ogobile noma emgodini oshelelayo ukuze kube lula ukulungisa indawo (Isithombe 1-36F). Sebenzisa imbobo yokubhoboza engu-2.5mm ukubhoboza isikhungo sembobo ogobile, bese ufaka isikulufu sokuzithinta esingu-3.5mm.

Umfanekiso 1-36 Ukusikwa kwesikhumba (A); ukusikwa kwe-flexor carpi radialis tendon sheath (B); ukuhlubula ingxenye ye-flexor tendon ukuze kuvezwe umsipha we-pronator quadratus (C); ukuhlukanisa umsipha we-pronator quadratus ukuze kuvezwe i-radius (D); ukuveza umugqa wokuqhekeka (E); faka ipuleti le-volar bese ufaka isikulufu ku-screw yokuqala (F)
6).Sebenzisa i-C-arm fluoroscopy ukuqinisekisa ukubekwa kwepuleti okufanele. Uma kudingeka, cindezela ipuleti kude noma eduze ukuze uthole ukubekwa kwe-distal screw okungcono kakhulu.

7).Sebenzisa i-drill engu-2.0mm ukubhoboza imbobo ekugcineni kwepuleti lensimbi, ulinganise ukujula bese ugoqa isikulufu sokukhiya. Isipikili kufanele sibe mfushane ngo-2mm kunebanga elilinganisiwe ukuvimbela isikulufu ukuthi singangeni futhi siphume kwi-dorsal cortex. Ngokuvamile, isikulufu esingu-20-22mm sanele, kanti leso esibekwe enkambisweni ye-radial styloid kufanele sibe mfushane. Ngemva kokugoqa isikulufu esikude, sigoqe Faka isikulufu esisele esiseduze.

Ngenxa yokuthi i-engeli yesikulufu yakhelwe, uma ipuleti libekwe eduze kakhulu nokuphela okukude, isikulufu sizongena esihlanganisini sesihlakala. Thatha izingcezu ze-tangential zethambo le-articular subchondral ezindaweni ze-coronal kanye ne-sagittal ukuze uhlole ukuthi liyangena yini esihlanganisini, bese ulandela imiyalelo. Lungisa amapuleti ensimbi kanye/noma izikulufu.

(Isithombe 1-37) Isithombe 1-37 Ukulungiswa kokuphuka kwe-distal radius nge-volar bone plate A. Ifilimu ye-X-ray yangemuva nangaseceleni yokuphuka kwe-distal radius ngaphambi kokuhlinzwa, okubonisa ukufuduka kwengxenye ekude kuya ohlangothini lwe-volar; B. Ifilimu ye-X-ray yangemuva nangaseceleni yokuphuka kwangemva kokuhlinzwa, okubonisa ukuphuka okuhle kokuncipha kanye nokuvuleka okuhle kwejoyinti lesihlakala
8).Thunga imisipha ye-pronator quadratus nge-sutures ezingenakumuncwa. Qaphela ukuthi imisipha ngeke imboze ngokuphelele ipuleti. Ingxenye ekude kufanele imbozwe ukuze kuncishiswe ukuxhumana phakathi kwe-flexor tendon nepuleti. Lokhu kungafezwa ngokuthunga i-pronator quadratus emaphethelweni e-brachioradialis, uvale ungqimba lwe-incision ngesendlalelo, bese ululungisa nge-plaster uma kudingeka.