Njengamanje ukulungiswa kwangaphakathi kwe-distal radius fractures, kunezindlela ezahlukahlukene zokukhiya ze-anatomical ukukhiya ezisetshenziswa emtholampilo. Lokhu kulungiswa kwangaphakathi kuhlinzeka ngesisombululo esingcono sezinhlobo ezithile zezinkinga eziyinkimbinkimbi, futhi ngandlela thile ukwandisa izinkomba zokuhlinzwa ukuze kuqhekezeke kakhulu radius radius fractures, ikakhulukazi labo abane-osteoporosis. USolwazi Jupiter ovela esibhedlela iMassachusetts General Hospital kanti abanye bashicilele uchungechunge lwezihloko eziku-JBJS ekutholeni kwabo ekutholeni ukukhiya ipuleti ye-plate radius fractures kanye namasu ahlobene ahlobene. Le ndatshana igxile ekusondeleni kokusondela ekulungiseni ama-distal radius fractures asuselwa ekuhlelweni kwangaphakathi kwebhlokhi elithile lokuphuka.
Amasu okuhlinza
Umbono wekholomu kathathu, osuselwa kwizici ze-biomechanical ne-anatomical zeRetal Ulnar Radius, yisisekelo sohlelo lokuthuthuka nolokwelashwa kohlelo lwePlate lwe-2.4mm. Ukuhlukaniswa kwamakholomu amathathu kukhonjiswa kuMfanekiso 1.
I-Fig. 1 imfundiso yekholoji emithathu ye-distal ulnar radius.
Ikholamu lamuva liyisigamu se-radius distal radius, kufaka phakathi i-radicular fossa kanye ne-radial tubember, esekela amathambo e-carpal ohlangothini lwe-radial futhi umsuka wamanye ama-ligaments aqinisa isihlakala.
Ikholomu ephakathi yingxenye ye-Medial ye-Distal Radius futhi ifaka i-Lunate Fossa (ehlotshaniswa neLunate) ne-Sigmoid Notch (ehlotshaniswa ne-distal ulna) endaweni eyingqayizivele. Imvamisa ukulayishwa, umthwalo waseLunate Fossa udluliselwa kwi-radius nge-Lunate Fossa. The ulnar lateral column, which includes the distal ulna, the triangular fibrocartilage, and the inferior ulnar-radial joint, carries loads from the ulnar carpal bones as well as from the inferior ulnar-radial joint and has a stabilising effect.
Inqubo yenziwa ngaphansi kweBrachial Plexus Anesthesia kanye ne-Intrapeaperative C-ray imaging kubalulekile. Ama-Intravenous Antibiotic aphethwe okungenani imizuzu engama-30 ngaphambi kokuqala kwenqubo kanye ne-pneumatic tourniquet yasetshenziswa ukunciphisa ukopha.
Ukulungiswa kwepuleti ye-Palmar
Okokuphazamiseka okuningi, indlela ye-Palmar ingasetshenziswa ukubona ngeso lengqondo phakathi kwe-radial carpal flexor kanye ne-radial artery. Ngemuva kokuhlonza nokubuyisa i-flexor carpi radialis longuus, indawo ejulile ye-Projetor TEres Muscy ibonwa nge-pures Kuma-fractures abuyinki amaningi, iBrachiorAdialialis tendon ingahle ikhishwe ukuze isebenze ukuncishiswa kokuqhekeka.
Iphini le-kirschner lifakwa ku-radial carpal Joint, okusiza ukuchaza imikhawulo edayisa kakhulu yeRadius. Uma isisindo esincane sokuqhekeka emugqeni we-articular is akhona, ipuleti yensimbi ye-Palmer 2.4mm ingabekwa phezu kwe-distal artigical margin yerediyo yokulungiswa. Ngamanye amagama, isisindo esincane sokuqhekeka endaweni ye-acticular ye-lunate ingasekelwa ngu-2.4mm "L" noma "T" Plate, njengoba kukhonjisiwe kuMfanekiso 2.
Ngokuphazamiseka okungaphezulu kwe-anticarled okuthe xaxa, kuyasiza ukuqaphela amaphuzu alandelayo. Okokuqala, kubalulekile ukusetha kabusha okwesikhashana ukuqhekeka ukuze uqiniseke ukuthi azikho izicubu ezithambile ezishumeke ekupheleni kokuphela. Okwesibili, ezigulini ezingenayo i-osteoporosis, ukuqhekeka kungancishiswa ngosizo lwepuleti: Okokuqala, isikulufa sokukhiya sibekwe endaweni yokuqhekeka ye-distal anatomical, bese kuthi izingxenye zokuqhekeka ezihlanekezelwe, bese zibekwa ezinye izikulufa zibekwe ngempumelelo
Umdwebo 3 ukuqhekeka okuthe xaxa kwe-distal radius ehlanekezelwe iDorsally kuncishisiwe futhi kulungiswe ngendlela ye-Palmar. Umdwebo 3-A ngemuva kokuphothulwa kokuvezwa nge-radial carpal flexor kanye ne-radial artery, iphini le-kirschner bushelelezi libekwe ekuhlanganiseni kwe-carpal ehlanganisiwe. Umdwebo 3-B ukukhohlisa kwe-metacarpal cortex ebekiwe ukusetha kabusha.
Umdwebo 3-C Futhi Umfanekiso 3-DA Smooth Kirschner Pin ubekwa kusuka ku-radial stem ngomugqa we-fracture ukulungisa okwesikhashana ukuphela kwe-fracture okwesikhashana.
I-Fig. 3-E Ukubona ngeso akwanele kwenkambu yokusebenza kutholakala ngokusebenzisa i-retractor ngaphambi kokubekwa kwepuleti. Umdwebo 3-F umugqa we-distal wezikulufo ezikhiyayo ubekwa eduze nethambo le-subchondral ekugcineni kwe-distal fold.
Umdwebo 3-g x-ray fluoroscopy kufanele asetshenziselwe ukuqinisekisa isikhundla sepuleti nezikulufo ezihlanekezelwe. Umdwebo 3-H Ingxenye yeProximal yepuleti kufanele icashile (10 degree angle) kusuka kudayiso ukuze ipuleti lilungiswe kudayiso ukuze liphinde lisebenze kabusha i-diapl fracture block. Umdwebo 3-Ngiqinisa isikulufa seProxilal ukuvuselela ukuthambekela kwe-Palmar kokuqhekeka kwe-distal. Susa i-KIRSchner Pin ngaphambi kokuqina kwesikulufa ngokuphelele.
Imidwebo 3-J kanye ne-3-K I-Intraoperative Antraoperative Izithombe ze-radiographic ziqinisekisa ukuthi ukuqhekeka kwagcina kuphakanyisiwe nge-anatominal
Ukulungiswa kwepuleti ye-dorsal indlela yokuhlinzwa yokudalula isici se-dorsal se-distal radius kuncike kakhulu kuhlobo lokuqhekeka, futhi esimweni sokuphuka kwezindawo ezimbili noma ngaphezulu kwe-intra-articular fracture, inhloso yokwelashwa ikakhulukazi ukulungisa imisebe kanye nezindawo zokudla ngasikhathi sinye. I-Intraoperatively, amabhendi wokusekelwa abengeziwe kufanele afakwe ngezindlela ezimbili eziphambili: amakhambi amade ku-2nd ne-3rds extensor, ngokuhlaziywa okuphansi kwesilinganiso esisezingeni eliphansi kwi-4th Extensor Comparts kanye ne-Retraction ye-tendon ehambisanayo; noma ukusekelwa kwe-band ye-Secure Yesibili phakathi kwezakhiwo ze-4th ne-5th Extensor zokudalula amakholomu amabili ngokwehlukana (Fig. 4).
Ukuqhekeka kulawulwa futhi kulungiswe okwesikhashana nge-PIN yeKistschner e-Kirschner, kanye nezithombe ze-radiographic zithathwa ukunquma ukuthi ukuqhekeka kudukiswa kahle. Okulandelayo, i-dorsal ulnar (ikholamu ephakathi) uhlangothi lwe-radius luzinzile nge-2.4 mm "l" noma "t" Plate. Ipuleti le-dorsal ulnar libunjwe ukuqinisekisa ukuqina okuqinile ohlangothini lwe-dorsal ulnar lwe-distal radius. Amapuleti anganikezwa eduze nesici se-dorsal se-distal lisate ngangokunokwenzeka, njengoba ama-grooves ahambisanayo engaphansi kwepuleti ngalinye avimba amapuleti awohloka futhi abunjwe ngaphandle kokulimaza imicu ku-screw Holes (Fig. 5).
Ukulungiswa kwepuleti lekholamu ye-radial kulula kakhulu, njengoba umhlaba wethambo phakathi kwengxenye yokuqala neyesibili esondela kuyisicaba futhi ungalungiswa kulesi sikhundla ngepuleti elakhiwe kahle. Uma i-pin ye-kirschner ibekwa engxenyeni ye-radial tubember ye-radial, isiphetho se-distal yepuleti yekholamu ye-radial sinalo i-groove ehambelana ne-pin ye-kirsch, engaphazamisi isikhundla sepuleti (igcina ukuqhekeka endaweni ethile (Fig. 6).
Fig. 4 Ukuvezwa kwendawo ye-dorsal ye-distal radius. Ibhendi yokusekelwa ivulwa kusuka engxenyeni ye-3RD Extensor Compastem kanye ne-Extensor Hallucis Hallous Tendon iyabuyiselwa.
Fig. 5 Ukulungiswa kwesici se-dorsal sobuso be-artucar of the lisate, i-dorsal "t" noma "l" ipuleti livame ukwakheka (umkhiphelo. 5-A kanye ne-Fig. 5-B). Lapho ipuleti le-dorsal ebusweni bezinhlamvu ze-lunate livikelwe, ipuleti lekholamu le-radial livikelwe (amanani 5-C nge-5-F). La mapuleti amabili abekwe engela lama-degree angama-70 komunye nomunye ukuze athuthukise ukuqina kokulungiswa kwangaphakathi.
I-Fig. 6 Ipuleti lekholamu le-radial libunjwe kahle futhi libekwe kwikholamu ye-radial, liphawula i-notch ekugcineni kwepuleti, elivumela ipuleti ukugwema ukulungiswa kwesikhashana kwe-kirschner pin ngaphandle kokuphazamisa isikhundla sepuleti.
Imiqondo ebalulekile
Izinkomba zokulungiswa kwepuleti yemetacarpal
Ukuqhekeka kwe-metacarpal kwe-metacarpal intra-articular fractures (ama-barton fractures)
Ukuqhekeka okuthe xaxa okuthe xaxa (collec kanye nokwehla kwama-smith). Ukulungiswa okuzinzile kungatholakala ngamapuleti esicabha ngisho nasekubakhona kwe-osteoporosis.
I-Pracicarpal Lunatate Acticular Suracte Fractures Fractures
Izinkomba zokuhlelwa kwepuleti ye-dorsal
Ngokulimala kwe-intercarpal ligament
Ukuhlukaniswa okuhlangene kwe-Dorsal Lunata
I-radial carpal carpal ehlanganisiwe yokuhlaselwa kwe-fracture
I-Contraindication to Palmar Plate Fiftation
Isifo se-osteoporosis esinamandla ngokulinganiselwa okubalulekile kokusebenza
I-dorsal radial wrist fracture dislocation
Ukuba khona kwama-comorbidity amaningi ezokwelapha
I-Contraindication to Dorsal Plate Fiftation
I-Multiple Medical Comorbidities
Ama-fractures angadingiswanga
Amaphutha enziwe kalula ku-Palmar Plate Fiftation
Isikhundla sepuleti sibaluleke kakhulu ngoba hhayi kuphela ipuleti lisekela isisindo sokuphuka, kepha ukuma okufanele futhi kuvimbela isikulufu sokukhiya dist kusuka ekuhlanganeni kwe-radial carpal ngokuhlangene. I-radiographs enakekela ngokucophelela ye-radiopographs, ecatshangelwe ngendlela efanayo nokuthambekela kwe-radial ye-distal radius, vumela ukubona okunembile kwendawo yezindaba ze-radial radius ye-radius ye-distal radius ye-distal radius ye-distal radius okokuqala ngesikhathi sokusebenza.
Ukungena kokungena kwe-cortex ye-dorsal kuthwala ingozi yokuvusa i-extensor tendon nokubangela ukuqhuma kwe-tendon. Izikulufa ezikhiya zenza ngendlela ehlukile kwizikulufo ezijwayelekile, futhi akudingekile ukungena kwi-dortex ye-dorsal ngezikulufo.
Amaphutha enziwe kalula ngokulungiswa kwepuleti ye-dorsal
Kuhlala kubeka engcupheni yokungena kwisiko elihlanganayo le-radial carpal, futhi kufana nendlela echazwe ngenhla maqondana neplate ye-Palmar, kumele kuthathwe ukudutshulwa kwesikulufa.
Uma kulungiswa i-radial ikholomu yenziwa kuqala, izikulufo eziku-radial tubember zizothinta ukuhlolwa kokulungiswa okulandelayo kwe-articular suplacethance resurfacetha ye-lunate.
Izikulufo ezihlanekezelwe ezingafakwanga ngokuphelele emgodini wesikulufa zinganciphisa umthambo noma zize zibangele ukuba kukhuphuke.
Isikhathi sePosi: Dece-28-2023
