Njengamanje ukuze kulungiswe kwangaphakathi ukuhlukana kwe-distal radius, kunezinhlelo ezihlukahlukene zepuleti lokukhiya le-anatomical elisetshenziswa emtholampilo.Lokhu kulungiswa kwangaphakathi kunikeza isisombululo esingcono kwezinye izinhlobo eziyinkimbinkimbi zokuphuka, futhi ngandlela thile zandise izinkomba zokuhlinzwa kokuqhekeka kwe-distal radius engazinzile, ikakhulukazi lezo ezine-osteoporosis.USolwazi Jupiter waseMassachusetts General Hospital kanye nabanye bashicilele uchungechunge lwezihloko ku-JBJS mayelana nabakutholile mayelana nokulungiswa kwamapuleti okukhiya ama-distal radius fractures kanye namasu okuhlinza ahlobene.Lesi sihloko sigxile endleleni yokuhlinzwa yokulungiswa kwama-distal radius fractures ngokusekelwe ekulungiseni kwangaphakathi kwebhulokhi ethile yokuphuka.
Amasu Okuhlinzwa
Ithiyori yamakholomu amathathu, esekelwe kuzici ze-biomechanical kanye ne-anatomical ye-distal ulnar radius, iyisisekelo sokuthuthukiswa kanye nokusetshenziswa komtholampilo kwesistimu yepuleti engu-2.4mm.Ukuhlukaniswa kwamakholomu amathathu kuboniswe kuMfanekiso 1.
Umdwebo 1 ithiyori yamakholomu amathathu werediyasi ye-ulnar ekude.
Ikholomu esemaceleni iyingxenye esemaceleni yerediyasi e-distal, okuhlanganisa i-navicular fossa kanye ne-radial tuberosity, esekela amathambo e-carpal ohlangothini lwe-radial futhi ingumsuka weminye imigqa eqinisa isihlakala.
Ikholomu emaphakathi iyingxenye emaphakathi yerediyasi eyi-distal futhi ihlanganisa i-lunate fossa (ehlotshaniswa ne-lunate) kanye noshi we-sigmoid (okuhlotshaniswa ne-distal ulna) endaweni ye-articular.Ngokujwayelekile ukulayishwa, umthwalo osuka ku-lunate fossa udluliselwa endaweni engaba nge-lunate fossa.Ikholomu ye-ulnar lateral, ehlanganisa i-distal ulna, i-fibrocartilage engunxantathu, kanye nejoyinti elingaphansi kwe-ulnar-radial, ithwala imithwalo esuka emathanjeni e-carpal ulnar kanye nasuka ekuhlanganyeleni okungaphansi kwe-ulnar-radial futhi inomphumela wokuzinzisa.
Inqubo yenziwa ngaphansi kwe-brachial plexus anesthesia kanye ne-intraoperative C-arm X-ray imaging ibalulekile.Ama-antibiotics afakwa emthanjeni anikezwa okungenani imizuzu engu-30 ngaphambi kokuqala kwenqubo futhi i-tourniquet ye-pneumatic yasetshenziselwa ukunciphisa ukopha.
Ukulungiswa kwepuleti lePalmar
Ezingxenyeni eziningi zokuphuka, indlela yesundu ingasetshenziswa ukuze ubone ngeso lengqondo phakathi kwe-radial carpal flexor kanye nomthambo we-radial.Ngemva kokuhlonza nokuhoxisa i-flexor carpi radialis longus, indawo ejulile ye-pronator teres muscle ibonakala ngeso lengqondo futhi ukuhlukaniswa okumise okwe-"L" kuyaphakanyiswa.Ezingxenyeni eziyinkimbinkimbi kakhulu, i-tendon ye-brachioradialis ingase iphinde ikhululwe ukuze kube lula ukunciphisa ukuphuka.
Iphinikhodi ye-Kirschner ifakwa ekuhlanganyeleni kwe-radial carpal, esiza ukuchaza imikhawulo ekude kakhulu yerediyasi.Uma ukuphuka kwesisindo esincane emajini e-articular kukhona, ipuleti lensimbi elingu-2.4mm palmar lingabekwa phezu kwemajini e-distal articular yerediyasi ukuze ilungiswe.Ngamanye amazwi, isisindo esincane sokuphuka endaweni eyi-articular yenyanga singasekelwa ipuleti elingu-2.4mm "L" noma elithi "T", njengoba kuboniswe kuMfanekiso 2.
Ngokuqhekeka kwe-extra-articular displaced displaced, kuyasiza ukuqaphela amaphuzu alandelayo.Okokuqala, kubalulekile ukusetha kabusha isikhashana ukuphuka ukuze uqiniseke ukuthi asikho izicubu ezithambile ezifakwe ekugcineni kokuphuka.Okwesibili, ezigulini ezingenazo i-osteoporosis, ukuphuka kungancishiswa ngosizo lwepuleti: okokuqala, isikulufu sokukhiya sibekwe ekugcineni kwepuleti ye-anatomical yesundu, evikelekile engxenyeni ye-distal fracture, bese i-distal kanye amasegimenti okuphuka aseduze ancishiswa ngosizo lwepuleti, futhi ekugcineni, ezinye izikulufu zibekwe eduze
UMFANEKISO 3 Ukuphuka kwe-articular extra-articular ye-distal radius esuswa endaweni engemuva kuyancishiswa futhi kulungiswe ngendlela yesundu.UMFANEKISO 3-A Ngemva kokuqedwa kokuchayeka nge-radial carpal flexor kanye ne-radial artery, iphinikhodi ye-Kirschner ebushelelezi ifakwa ekuhlanganyeleni kwe-carpal ye-radial.Umfanekiso 3-B Ukukhohlisa kwe-metacarpal cortex esusiwe ukuze isethwe kabusha.
Umfanekiso 3-C kanye noMfanekiso 3-DA iphinikhodi ye-Kirschner ebushelelezi ibekwa kusukela esiqwini se-radial ngomugqa wokuphuka ukuze kulungiswe okwesikhashana ukuphela kokuphuka.
Umdwebo 3-E Ukubona ngeso okwanele kwenkambu yokusebenza kufinyelelwa ngokusebenzisa i-retractor ngaphambi kokubekwa kwepuleti.UMFANEKISO 3-F Umugqa we-Distal wezikulufu zokukhiya ubekwe eduze kwethambo le-subchondral ekugcineni kokugoqa okukude.
Umfanekiso 3-G I-X-ray fluoroscopy kufanele isetshenziselwe ukuqinisekisa ukuma kwepuleti nezikulufu ezikude.Umfanekiso 3-H Ingxenye eseduze yepuleti kufanele ibe nendawo ethile yokungena (i-engeli engu-10 degree) kusukela ku-diaphysis ukuze ipuleti likwazi ukumiswa ku-diaphysis ukuze kuqhutshekwe nokusetha kabusha i-distal fracture block.Umfanekiso 3-I Qinisa isikulufu esiseduze ukuze umise kabusha ukuthambekela kwesundu sokuphuka kwe-distal.Susa iphinikhodi ye-Kirschner ngaphambi kokuthi isikulufu siqiniswe ngokugcwele.
Izibalo 3-J kanye ne-3-K izithombe ze-radiographic ze-Intraoperative ziqinisekisa ukuthi ukuphuka kwagcina kubekwe kabusha ngokwemvelo futhi izikulufu zepuleti zazibekwe ngendlela egculisayo.
I-Dorsal Plate Fixation Indlela yokuhlinzwa yokudalula isici se-dorsal ye-distal radius incike ikakhulukazi ohlotsheni lokuphuka, futhi esimweni sokuphuka okunezingcezu ezimbili noma ngaphezulu ze-intra-articular fracture, umgomo wokwelashwa ngokuyinhloko ukulungisa kokubili. amakholomu e-radial naphakathi ngesikhathi esisodwa.I-intraoperatively, ama-extensor support bands kumele afakwe ngezindlela ezimbili eziyinhloko: isikhathi eside ku-2nd kanye ne-3rd extensor compartments, ne-subperiosteal dissection kuya ku-4th extensor compartment kanye nokuhlehla kwe-tendon ehambisanayo;noma ukusika kwebhande lesibili lokusekela phakathi kwezingxenye ze-4th kanye ne-5th extensor ukuze kuvezwe amakholomu amabili ngokuhlukana (Fig. 4).
Ukuphuka kuyaguquguquka futhi kulungiswe okwesikhashana ngephinikhodi ye-Kirschner engafundiwe, futhi izithombe ze-radiographic zithathwa ukuze kunqunywe ukuthi ukuphuka kususwe endaweni efanele.Okulandelayo, uhlangothi lwe-dorsal ulnar (ikholomu emaphakathi) lwerediyasi luzinziswa ngepuleti elingu-2.4 mm "L" noma elithi "T".Ipuleti le-dorsal ulnar libunjwe ukuze kuqinisekiswe ukulingana okuqinile ohlangothini lwe-dorsal ulnar lwerediyasi ekude.Amapuleti angabuye abekwe eduze nesici somgogodla we-distal lunate ngangokunokwenzeka, njengoba imigqa ehambisanayo engaphansi kwepuleti ngalinye ivumela amapuleti ukuba agotshwe futhi akheke ngaphandle kokulimaza izintambo ezimbotsheni zezikulufu (Fig. 5) .
Ukulungiswa kwepuleti lekholomu ye-radial kulula uma kuqhathaniswa, njengoba indawo yethambo phakathi kwengxenye yokuqala neyesibili ye-extensor iphansi uma kuqhathaniswa futhi ingaqiniswa kule ndawo ngepuleti elimise kahle.Uma iphinikhodi ye-Kirschner ibekwe engxenyeni ekude kakhulu ye-radial tuberosity, isiphetho esikude se-radial column plate sine-groove ehambisana nephinikhodi ye-Kirschner, engaphazamisi indawo yepuleti futhi igcine ukuphuka endaweni. (Umdwebo 6).
Umdwebo 4 Ukuvezwa kwendawo engemuva yerediyasi ekude.Ibhendi yokusekela ivulwa kusukela ku-3rd extensor interosseous compartment futhi i-extensor hallucis longus tendon iyahoxiswa.
Umdwebo 5 Ukuze kulungiswe isici se-dorsal ye-articular surface yenyanga, ipuleti le-dorsal "T" noma "L" livame ukubunjwa (Fig. 5-A kanye Fig. 5-B).Uma ipuleti elingemuva elisendaweni eyi-articular yenyanga selivikelekile, ipuleti lekholomu ye-radial livikelekile (Izibalo 5-C ukuya ku-5-F).Amapuleti amabili abekwe nge-engeli ye-70 degrees komunye nomunye ukuze kuthuthukiswe ukuzinza kokulungiswa kwangaphakathi.
Umfanekiso 6 Ipuleti lekholomu ye-radial lime ngendlela efanele futhi libekwe kukholomu ye-radial, iphawula inothi ekugcineni kwepuleti, okuvumela ipuleti ukuthi ligweme ukulungiswa kwesikhashana kwephinikhodi ye-Kirschner ngaphandle kokuphazamisa ukuma kwepuleti.
Imiqondo ebalulekile
Izinkomba ze-Metacarpal Plate Fixation
I-metacarpal intra-articular fractures esusiwe (i-Barton fractures)
ukuphuka kwe-articular extra-articular (ukuphuka kwama-Colles no-Smith).Ukulungiswa okuzinzile kungatholakala ngamapuleti angama-screw ngisho nalapho kukhona i-osteoporosis.
I-metacarpal lunate articular surface fractures esusiwe
Izinkomba zokulungisa i-dorsal plate
Ngokulimala kwe-intercarpal ligament
Ukuphuka kwendawo ehlangene ye-dorsal lunate esusiwe
Ukususwa kokuphuka kwejoyinti le-radial carpal eligundiwe
Ukuphikisana nokulungiswa kwepuleti lesundu
I-osteoporosis enzima enemikhawulo ebalulekile yokusebenza
Ukususwa kokuphuka kwesihlakala se-Dorsal radial
Ukuba khona kwezifo eziningi zezokwelapha
Contraindications ekulungiseni ipuleti le-dorsal
Izifo eziningi zezokwelapha
Ukuphuka okungasuswanga
Amaphutha enziwa kalula ekulungiseni ipuleti lesundu
Ukuma kwepuleti kubaluleke kakhulu ngoba ipuleti alisekeli nje kuphela isisindo sokuphuka, kodwa ukuma ngendlela efanele futhi kuvimbela isikulufu sokukhiya esikude ukuba singangeni ekuhlanganyeleni kwe-radial carpal.Ama-radiograph e-intraoperative aqaphile, aklanyelwe ohlangothini olufanayo nokuthambekela kwe-radial ye-distal radius, avumela ukubonakala okunembile kwendawo ye-articular yohlangothi lwe-radial lwe-distal radius, engabuye ibonakale ngokunembe kakhudlwana ngokubeka izikulufu ze-ulnar kuqala ngesikhathi ukusebenza.
Ukungena kwe-screw ku-dorsal cortex kunengozi yokucasula i-tendon extensor futhi kubangele ukuphuka kwe-tendon.Izikulufu zokukhiya zisebenza ngendlela ehlukile kuzikulufu ezivamile, futhi akudingekile ukungena ku-dorsal cortex ngezikulufo.
Amaphutha enziwa kalula nge-dorsal plate fixation
Kuhlale kunengozi yokungena ngesikulufu kujoyinti ye-carpal eyi-radial, futhi ngokufana nendlela echazwe ngenhla ngokuhlobene nepuleti lesundu, kufanele kuthathwe isibhamu esitshekile ukuze kunqunywe ukuthi indawo yesikulufu ivikelekile yini.
Uma ukulungiswa kwekholomu ye-radial kwenziwa kuqala, izikulufu ku-radial tuberosity zizothinta ukuhlolwa kokulungiswa okulandelayo kwe-articular surface resurfacing of the lunate.
Izikulufu ezikude ezingajingiwe ngokuphelele embobeni yesikulufu zingase ziphazamise ithoni noma zibangele nokugqabuka kwethenda.
Isikhathi sokuthumela: Dec-28-2023
