Njengamanje ukuze kulungiswe ngaphakathi kwama-fracture e-distal radius, kunezinhlelo ezahlukene ze-anatomical locking plate ezisetshenziswa emtholampilo. Lokhu kulungiswa kwangaphakathi kunikeza ikhambi elingcono kwezinye izinhlobo zokuphuka eziyinkimbinkimbi, futhi ngezindlela ezithile kwandisa izinkomba zokuhlinzwa kwama-fracture e-distal radius angazinzile, ikakhulukazi labo abane-osteoporosis. UProfesa Jupiter waseMassachusetts General Hospital nabanye bashicilele uchungechunge lwezihloko ku-JBJS mayelana nokuthola kwabo mayelana nokulungiswa kwama-fracture e-distal radius kanye namasu okuhlinzwa ahlobene. Lesi sihloko sigxile endleleni yokuhlinzwa yokulungisa ama-fracture e-distal radius ngokusekelwe ekulungisweni kwangaphakathi kwe-fracture block ethile.
Amasu Okuhlinzwa
Ithiyori enamakholomu amathathu, esekelwe ezicini ze-biomechanical kanye ne-anatomical ze-distal ulnar radius, iyisisekelo sokuthuthukiswa kanye nokusetshenziswa kwezokwelapha kohlelo lwepuleti elingu-2.4mm. Ukuhlukaniswa kwamakholomu amathathu kuboniswe kuMfanekiso 1.
Isithombe 1 Ithiyori enamakholomu amathathu yerediyasi ye-ulnar ekude.
Ikholomu eseceleni iyingxenye eseceleni ye-distal radius, okuhlanganisa i-navicular fossa kanye ne-radial tuberosity, esekela amathambo e-carpal ohlangothini lwe-radial futhi iyimsuka yeminye yemisipha eqinisa isihlakala.
Ikholomu ephakathi iyingxenye ephakathi ye-distal radius futhi ihlanganisa i-lunate fossa (ehlotshaniswa ne-lunate) kanye ne-sigmoid notch (ehlotshaniswa ne-distal ulna) ebusweni be-articular. Ngokuvamile ilayishwa, umthwalo ovela ku-lunate fossa udluliselwa ku-radius nge-lunate fossa. Ikholomu eseceleni ye-ulnar, ehlanganisa i-distal ulna, i-triangular fibrocartilage, kanye ne-inferior ulnar-radial joint, ithwala imithwalo evela emathanjeni e-ulnar carpal kanye nasejoyintini le-inferior ulnar-radial futhi inomphumela wokuzinza.
Le nqubo yenziwa ngaphansi kwe-brachial plexus anesthesia futhi ukuthwebula izithombe ze-X-ray ze-C-arm ngesikhathi sokuhlinzwa kubalulekile. Ama-antibiotic afakwa nge-intravenous okungenani imizuzu engama-30 ngaphambi kokuqala kwenqubo futhi kwasetshenziswa i-pneumatic tourniquet ukunciphisa ukopha.
Ukulungiswa kwepuleti lesundu
Kwabaningi abaphukile, indlela yesundu ingasetshenziswa ukubona ngeso lengqondo phakathi kwe-radial carpal flexor kanye ne-radial artery. Ngemva kokubona nokuhoxisa i-flexor carpi radialis longus, ubuso obujulile bomsipha we-pronator teres buyabonakala futhi ukuhlukaniswa okubunjwe "L" kuyaphakanyiswa. Ekwaphukeni okuyinkimbinkimbi kakhulu, i-tendon ye-brachioradialis ingase ikhululwe ukuze kube lula ukunciphisa ukwaphuka.
Iphini likaKirschner lifakwa ejoyintini le-radial carpal, okusiza ekuchazeni imikhawulo ekude kakhulu ye-radius. Uma kukhona inqwaba encane yokuqhekeka emngceleni we-articular, ipuleti lensimbi elingu-2.4mm lesundu lingabekwa phezu kwengxenye ekude ye-articular ye-radius ukuze liqiniswe. Ngamanye amazwi, inqwaba encane yokuqhekeka ebusweni be-articular ye-lunate ingasekelwa ipuleti elingu-2.4mm "L" noma "T", njengoba kuboniswe kuMfanekiso 2.
Uma kwenzeka ukwaphuka kwe-extra-articular okususwe umgogodla, kuyasiza ukuqaphela amaphuzu alandelayo. Okokuqala, kubalulekile ukusetha kabusha okwesikhashana ukwaphuka ukuze kuqinisekiswe ukuthi akukho zicubu ezithambile ezifakwe ekugcineni kokuqhekeka. Okwesibili, ezigulini ezingenayo i-osteoporosis, ukwaphuka kungancishiswa ngosizo lwepuleti: okokuqala, kufakwa isikulufu esikhiyayo ekugcineni okukude kwepuleti le-palmar anatomical, eliboshwe engxenyeni yokuqhekeka ekude esusiwe, bese kuthi izingxenye zokuqhekeka ezikude neziseduze zincishiswe ngosizo lwepuleti, bese kuthi ekugcineni, ezinye izikulufu zibekwe eduze.
ISITHOMBE 3 Ukuphuka kwe-extra-articular kwe-distal radius esusiwe umgogodla kuyancishiswa futhi kulungiswe ngendlela yesundu. ISITHOMBE 3-A Ngemva kokuqedwa kokuvezwa nge-radial carpal flexor kanye ne-radial artery, iphini elibushelelezi le-Kirschner lifakwa ejoyintini le-radial carpal. Isithombe 3-B Ukuphathwa kwe-cortex ye-metacarpal esusiwe ukuze kuphinde kusetshenziswe.
Iphini likaKirschner elibushelelezi elingu-3-C kanye nelingu-3-DA libekwe kusukela esiqwini se-radial ngokusebenzisa umugqa wokuqhekeka ukuze kulungiswe okwesikhashana ukuphela kokuqhekeka.
Isithombe 3-E Ukubona kahle insimu yokusebenza kufezwa ngokusebenzisa i-retractor ngaphambi kokubeka ipuleti. ISITHOMBE 3-F Umugqa ode kakhulu wezikulufo ezikhiyayo ubekwa eduze kwethambo le-subchondral ekugcineni kokugoqa okude.
I-Figure 3-G X-ray fluoroscopy kufanele isetshenziswe ukuqinisekisa indawo yepuleti kanye nezikulufo ezikude. I-Figure 3-H Ingxenye eseduze yepuleti kufanele ibe nesikhala esithile (i-angle yamadigri ayi-10) ukusuka ku-diaphysis ukuze ipuleti likwazi ukunamathela ku-diaphysis ukuze kusethwe kabusha ibhulokhi yokuqhekeka ekude. I-Figure 3-I Qinisa isikulufo esiseduze ukuze uvuselele ukuthambekela kwesundu kokuqhekeka okukude. Susa iphini likaKirschner ngaphambi kokuba isikulufo siqiniswe ngokuphelele.
Izibalo 3-J kanye ne-3-K Izithombe ze-X-ray zangaphakathi kokuhlinzwa ziqinisekisa ukuthi ukuphuka kwagcina kubekwe kabusha ngokwesimo somzimba futhi izikulufu zepuleti zabekwa ngendlela eyanelisayo.
Ukulungiswa Kwepuleti Le-Dorsal Indlela yokuhlinzwa yokuveza ingxenye yangemuva ye-distal radius incike kakhulu ohlotsheni lokuphuka, futhi uma kwenzeka ukuphuka okunezingcezu ezimbili noma ngaphezulu zokuphuka kwangaphakathi kwe-articular, umgomo wokwelashwa ngokuyinhloko ukulungisa kokubili amakholomu e-radial kanye ne-medial ngesikhathi esisodwa. Phakathi kokuhlinzwa, ama-extensor support bands kumele aqoshwe ngezindlela ezimbili eziyinhloko: ngobude ezindaweni ze-extensor zesibili nezesithathu, ngokuhlukaniswa kwe-subperiosteal endaweni ye-extensor yesine kanye nokuhoxiswa kwe-tendon ehambisanayo; noma ukunqunywa kwesibili kwe-support band phakathi kwezindawo ze-extensor zesine nezesihlanu ukuze kuvezwe amakholomu amabili ngokwehlukana (Umfanekiso 4).
Ukuphuka kuyalungiswa futhi kulungiswe okwesikhashana ngephini likaKirschner elingafakwanga uthayela, bese kuthathwa izithombe ze-x-ray ukuze kutholakale ukuthi ukuphuka kuhambile kahle. Okulandelayo, uhlangothi lwe-dorsal ulnar (ikholomu ephakathi) ye-radius luqiniswa ngepuleti elingu-2.4 mm "L" noma "T". Ipuleti le-dorsal ulnar lakhiwe ngendlela yokuthi liqiniseke ukuthi lilingana kahle ohlangothini lwe-dorsal ulnar ye-distal radius. Amapuleti angabekwa eduze kakhulu nengxenye ye-dorsal ye-distal lunate ngangokunokwenzeka, njengoba imifantu ehambisanayo ngaphansi kwepuleti ngalinye ivumela amapuleti ukuthi agobe futhi akhiwe ngendlela ngaphandle kokulimaza imicu emigodini yezikulufo (Isithombe 5).
Ukulungiswa kwepuleti lekholomu ye-radial kulula kakhulu, njengoba ubuso bethambo phakathi kwezingxenye zokuqala nezesibili ze-extensor buyisicaba futhi bungamiswa kulesi simo ngepuleti elibunjwe kahle. Uma iphini likaKirschner libekwe engxenyeni ekude kakhulu ye-radial tuberosity, ukuphela okukude kwepuleti lekholomu ye-radial kunomsele ohambisana nephini likaKirschner, elingaphazamisi isikhundla sepuleti futhi ligcine ukuphuka kusendaweni (Isithombe 6).
Isithombe 4 Ukuvezwa kobuso bomhlane we-distal radius. Ibhande lokusekela livulwa kusukela ku-extensor 3rd interosseous compartment kanye ne-extensor hallucis longus tendon ehoxisiwe.
Isithombe 5 Ukuze kuqiniswe ingxenye yangemuva yobuso obuhlangene be-lunate, ipuleti le-dorsal elithi "T" noma "L" livame ukubunjwa (Isithombe 5-A kanye nesithombe 5-B). Uma ipuleti le-dorsal ebusweni obuhlangene be-lunate seliqinisiwe, ipuleti lekholomu ye-radial liyaqinisiwe (Izithombe 5-C kuya ku-5-F). Amapuleti amabili abekwe nge-engeli yama-degrees angu-70 komunye nomunye ukuze kuthuthukiswe ukuzinza kokuqina kwangaphakathi.
Isithombe 6 Ipuleti lekholomu ye-radial libunjwe kahle futhi libekwe kukholomu ye-radial, liphawula i-notch ekugcineni kwepuleti, okuvumela ipuleti ukuthi igweme ukufakwa kwesikhashana kwephini likaKirschner ngaphandle kokuphazamisa indawo yepuleti.
Imiqondo ebalulekile
Izinkomba Zokulungiswa Kwepuleti Le-Metacarpal
Ukuphuka kwe-metacarpal intra-articular okususiwe (ukuphuka kukaBarton)
Ukuphuka kwe-extra-articular okususiwe (ukuphuka kukaColles noSmith). Ukuqina okuzinzile kungatholakala ngama-screw plate ngisho nalapho kukhona i-osteoporosis.
Ukuqhekeka kobuso be-metacarpal lunate articular okususiwe
Izinkomba zokulungiswa kweplate yangemuva
Ngokulimala kwe-intercarpal ligament
Ukuphuka kobuso belunga lomgogodla elilahlekile
Ukuqhekeka kwejoyinti le-carpal eligundwe esikhumbeni
Izimo zokumelana nokulungiswa kwepuleti lesundu
I-osteoporosis enzima enemikhawulo ebalulekile yokusebenza
Ukuphuka kwesandla okubangelwa yi-dorsal radial
Ukuba khona kwezifo eziningi ezihambisana nezokwelapha
Izimo zokumelana nokulungiswa kwepuleti lomgogodla
Izinkinga eziningi zezokwelapha
Ukuqhekeka okungasuswanga endaweni ethile
Amaphutha enziwa kalula ekufakweni kwepuleti lesundu
Indawo yepuleti ibaluleke kakhulu ngoba ipuleti ayisekeli nje kuphela isisindo sokuqhekeka, kodwa nokubekwa kahle kwayo kuvimbela nesikulufu sokukhiya esikude ukuthi singangeni esihlanganyelweni se-radial carpal. Ama-radiograph aqaphile ngesikhathi sokuhlinzwa, abonakala ngendlela efanayo nokuthambekela kwe-radial ye-distal radius, avumela ukubona ngokunembile ubuso obuhlangene bohlangothi lwe-radial ye-distal radius, okungabonakala ngokunembile ngokubeka izikulufu ze-ulnar kuqala ngesikhathi sokusebenza.
Ukungena kwezikulufo kwe-dorsal cortex kuthwala ingozi yokuvusa i-extensor tendon futhi kubangele ukuqhekeka kwe-tendon. Izikulufo ezikhiyayo zisebenza ngendlela ehlukile kunezikulufo ezivamile, futhi akudingekile ukungena kwi-dorsal cortex ngezikulufo.
Amaphutha enziwa kalula ngokufakwa kweplate yangemuva
Kuhlala kukhona ingozi yokungena kwezikulufo esihlanganyelweni se-radial carpal, futhi ngendlela echazwe ngenhla maqondana nepuleti lesundu, kufanele kuthathwe isibhamu esigobile ukuze kutholakale ukuthi indawo yesikulufo ivikelekile yini.
Uma ukulungiswa kwekholomu ye-radial kwenziwa kuqala, izikulufo eziku-radial tuberosity zizothinta ukuhlolwa kokulungiswa okulandelayo kokulungiswa kabusha kobuso be-articular be-lunate.
Izikulufo ezikude ezingafakwanga ngokuphelele emgodini wesikulufo zingashukumisa umsipha noma zibangele ukuqhekeka komsipha.
Isikhathi sokuthunyelwe: Disemba-28-2023
