Ukuphuka kwe-Metacarpal phalangeal kuwukuphuka okuvamile ekulimaleni kwesandla, okubalwa cishe ingxenye eyodwa kwezine yeziguli ezilimale ngesandla. Ngenxa yesakhiwo esibucayi nesiyinkimbinkimbi sesandla kanye nomsebenzi obucayi wokunyakaza, ukubaluleka kanye nobuchwepheshe bokwelashwa kokuphuka kwesandla kuyinkimbinkimbi kakhulu kunokwelashwa kwamanye ama-fracture amade ethambo. Ukuqinisekisa ukuqina kokuphuka ngemva kokuncipha kuyisihluthulelo sokwelashwa okuphumelelayo kwama-fracture e-metacarpal phalangeal. Ukuze kubuyiselwe umsebenzi wesandla, ama-fracture avame ukudinga ukulungiswa okufanele. Esikhathini esidlule, ukulungiswa kwangaphandle kwe-plaster noma ukulungiswa kwangaphakathi kwe-Kirschner wire kwakuvame ukusetshenziswa, kodwa ngokuvamile akuhambisani nokuqeqeshwa kokuvuselelwa kwamalunga kwangemva kokuhlinzwa ngenxa yokulungiswa okungalungile noma isikhathi eside sokulungiswa, okunomthelela omkhulu ekubuyiselweni komsebenzi we-joint yeminwe futhi kuletha ubunzima obuthile ekuvuselelweni kokusebenza kwesandla. Izindlela zokwelapha zanamuhla zisebenzisa kakhulu ukulungiswa kwangaphakathi okuqinile, njengokulungiswa kwesikulufo se-micro-plate.
Mina.Yiziphi izimiso zokwelapha?
Izimiso zokwelapha ukwaphuka kwesandla okune-metacarpal kanye ne-phalangeal: ukunciphisa ukwakheka komzimba, ukuqina okulula nokuqinile, imisebenzi yokuqala kanye nokuqeqeshwa kokusebenza. Izimiso zokwelapha ukwaphuka kwesandla okune-intra-articular kanye ne-peri-articular ziyafana nalezo zamanye ukwaphuka kwesandla okune-intra-articular, okuwukubuyisela ukwakheka komzimba wobuso bamalunga kanye nemisebenzi yokuqala yokusebenza. Lapho kwelashwa ukwaphuka kwesandla okune-metacarpal kanye ne-phalangeal, kufanele kwenziwe imizamo yokufeza ukunciphisa ukwakheka komzimba, futhi ukujikeleza, ukugoba kwesandla okune-lateral, noma ukufuduka kwe-angular okungu->10° kuya engxenyeni yangemuva yesandla akufanele kwenzeke. Uma ukuphela kokuphuka kwe-metacarpal phalange kujikeleza noma kushintshela eceleni, kuzoshintsha indlela yokugoba okuvamile kanye nokunyakaza kokwelulwa komunwe, okubangela ukuthi ushintshe noma uwe ngomunwe oseduze ngesikhathi sokugoba, okuthinta ukunemba komsebenzi womunwe; futhi uma ukufuduka kwe-angular kuya engxenyeni yangemuva yesandla kungaphezulu kuka-10°, indawo yokuxhumana ebushelelezi phakathi kwethambo ne-tendon iyabhujiswa, okwandisa ukumelana kanye nobubanzi bokunyakaza kokugoba nokwelulwa kwe-tendon, kanye nomonakalo we-tendon ongapheli kwenzeka, okudala ingozi yokuqhekeka kwe-tendon.
II.Yiziphi izinto ezingakhethwa ukuze kutholakale ukwaphuka kwe-metacarpal?
Kunezinhlobo eziningi zezinto zokubopha zangaphakathi zokuphuka kwe-metacarpal, njengezintambo ze-Kirschner, izikulufo, amapuleti kanye nezikulufo zangaphandle, phakathi kwazo izintambo ze-Kirschner kanye nama-microplates yizona ezisetshenziswa kakhulu. Kuma-fracture e-metacarpal, ukulungiswa kwangaphakathi kwe-microplate kunezinzuzo ezisobala ngaphezu kokulungiswa kwentambo ye-Kirschner futhi kungasetshenziswa kuqala; kuma-fracture e-proximal phalanx, ama-microplate ngokuvamile angcono kakhulu, kodwa uma kunzima ukufaka izikulufo ze-proximal phalanx distal segment kanye nama-head fractures, kufanele kusetshenziswe ukulungiswa kwangaphakathi kwentambo ye-cross Kirschner, okusiza kakhulu ekubuyiseleni umsebenzi womunwe othintekile; izintambo ze-Kirschner kufanele zisetshenziswe kuqala ekwelapheni ama-fracture e-middle phalanx.
- Ucingo lweKirschner:Ukufakwa kwangaphakathi kwentambo yeKirschner sekusetshenziswe emtholampilo iminyaka engaphezu kwengu-70 futhi bekulokhu kuyindlela yokufakwa kwangaphakathi esetshenziswa kakhulu ekuqhekekeni kwe-metacarpal kanye ne-phalangeal. Kulula ukuyisebenzisa, kuyabiza futhi kuyasebenza, futhi kuyindlela yokufakwa kwangaphakathi ejwayelekile kakhulu. Njengendlela yokufakwa kwangaphakathi esetshenziswa kakhulu ekwelapheni ukuqhekeka kwezandla, isasetshenziswa kabanzi. Izinzuzo zokufakwa kwangaphakathi kwentambo yeKirschner: ① Kulula ukuyisebenzisa futhi kuyaguquguquka kakhulu ukuyisebenzisa; ② Ukukhumula izicubu ezithambile kancane, umthelela omncane ekuhlinzekweni kwegazi ekugcineni kokuqhekeka, ukulimala okuncane kokuhlinzwa, futhi kusiza ekwelapheni ukuqhekeka; ③ Kulula ukususa inalithi okwesibili; ④ Izindleko eziphansi kanye nobubanzi bokusetshenziswa, kufanelekile kakhulu ekuqhekekeni kwezandla okuningi (njengokuqhekeka kwangaphakathi kwe-articular, ukuqhekeka okukhulu okuhlanganisiwe kanye nokuqhekeka kwe-phalangeal okukude).
2. Ama-microplate e-Metacarpophalangeal: Ukulungiswa kwangaphakathi okuqinile kokuphuka kwezandla kuyisisekelo sokuqeqeshwa kokusebenza kwasekuqaleni kanye nesimo esidingekayo sokubuyisela ukusebenza kahle kwezandla. Ubuchwepheshe bokulungiswa kwangaphakathi kwe-AO budinga ukuthi iziphetho zokuphuka zibekwe kabusha ngokunembile ngokwesakhiwo somzimba nokuthi iziphetho zokuphuka zizinzile ngaphansi kwezimo zokusebenza, okuvame ukubizwa ngokuthi ukulungiswa okuqinile, ukuze kuvunyelwe ukunyakaza kwasekuqaleni okusebenzayo. I-AO iphinde igcizelele ukuhlinzwa okungenangozi kangako, kugxilwe ekuvikeleni ukutholakala kwegazi. Ukulungiswa kwangaphakathi kwe-Microplate yokwelapha ukuphuka kwezandla kungafeza imiphumela eyanelisayo maqondana namandla, ukuqina kweziphetho zokuphuka, kanye nokucindezela phakathi kweziphetho zokuphuka. Ngokuphathelene nokululama kokusebenza ngemva kokuhlinzwa, isikhathi sokuphulukiswa kokuphuka, kanye nesilinganiso sokutheleleka, kukholelwa ukuthi ukusebenza kahle kwamapuleti e-microtitanium kungcono kakhulu kunokwezintambo zikaKirschner. Ngaphezu kwalokho, njengoba isikhathi sokuphulukiswa kokuphuka ngemva kokulungiswa ngamapuleti e-microtitanium sifushane kakhulu kunezinye izindlela zokulungisa, kuyazuzisa iziguli ukuthi ziqale kabusha impilo evamile kusenesikhathi.
(1) Yiziphi izinzuzo zokulungiswa kwangaphakathi kwe-microplate?
① Uma kuqhathaniswa nezintambo zikaKirschner, izinto zesikulufu se-microplate zinokuhambisana okungcono kwezicubu kanye nokusabela okungcono kwezicubu; ② Ukuqina kohlelo lokubopha isikulufu se-plate kanye nokucindezela ekugcineni kokuqhekeka kwenza ukuqhekeka kube seduze nokunciphisa umzimba, ukuqina okuphephile, kanye nokwelapha ukuqhekeka; ③ Ukuzivocavoca kokuqala kokusebenza ngokuvamile kuvunyelwe ngemuva kokuqina kwesikulufu se-microplate, okusiza ekubuyiseleni umsebenzi wesandla.
(2) Iyiphi indlela yokuhlinzwa yama-microplates?
Ukuhlinzwa kuvame ukwenziwa ngaphansi kwe-brachial plexus block anesthesia, futhi kuvame ukudingwa i-pneumatic tourniquet. Kuthathwa ukusikwa kwe-dorsal phalanges, kunqunywe i-dorsal aponeurosis yamadijithi noma kufakwe imisipha exubile kanye nethambo le-metacarpal ukuze kubonakale iziphetho zokuphuka kwamathambo e-metacarpal noma e-phalangeal, i-periosteum iyahlutshwa, futhi ukuphuka kuyancishiswa ngaphansi kokubona okuqondile. Amapuleti aqondile afanelekela ukuphuka okuphambene kwesigaba esiphakathi kanye nokuphuka okufushane kwe-oblique, amapuleti e-T afanelekela ukubopha isisekelo se-metacarpal kanye ne-phalanges, kanti amapuleti e-T noma amapuleti e-L angu-120° kanye no-150° afanelekela ukubopha ukuphuka okude kwe-oblique kanye ne-comminute. Ipuleti ngokuvamile libekwa ohlangothini lwe-dorsal lwethambo ukuvimbela ukushelela kwe-tendon kanye nokuguguleka kwesikhathi eside, okusiza ekuqeqeshweni kokuqala kokusebenza. Okungenani izikulufo ezimbili kufanele zisetshenziswe ukulungisa iziphetho ezimbili zokuphuka, ngaphandle kwalokho ukuzinza kuphansi, futhi izintambo noma izikulufo zeKirschner ezingaphandle kwepuleti ziyadingeka ukusiza ukuqinisa ukuze kufezwe injongo yokuqinisa okuzinzile.
3. Izikulufo ezincane: Izikulufo ezincane zinokuqina okufanayo namapuleti ensimbi ekuqiniseni ukuqhekeka okujikelezayo noma okude okugobile, kodwa ububanzi bezicubu ezithambile kanye nokuqhekeka kwe-periosteum buncane kunobokuqiniswa kwepuleti lensimbi, okusiza ekuvikeleni ukuhlinzekwa kwegazi futhi kuhambisana nomqondo wokusebenza okuncane kakhulu. Nakuba kunezikulufo zohlobo lwe-T kanye nohlobo lwe-L zokuqhekeka okuseduze kwe-articular, ukubuyiselwa komsebenzi wamalunga ngemva kokulandela ngemuva kokuhlinzwa kubi kakhulu kunokwaphuka kwe-diaphyseal. Izikulufo ezincane nazo zinezinzuzo ezithile ekuqiniseni ukuqhekeka okungaphakathi kwe-articular kanye ne-peri-articular. Izikulufo ezifakwe ethanjeni le-cortical zingamelana nomthwalo omkhulu wokucindezeleka, ngakho-ke ukuqiniswa kuqinile, futhi iziphetho zokuqhekeka zingacindezelwa ukuze zenze ubuso bokuqhekeka bube seduze, kufinyezwe isikhathi sokuphulukiswa kokuqhekeka futhi kube lula ukuphulukiswa kokuqhekeka, njengoba kuboniswe kuMfanekiso 4-18. Ukuqiniswa kwangaphakathi kwe-mini screw yokuqhekeka kwesandla kusetshenziselwa kakhulu ukuqhekeka okugobile noma okujikelezayo kokuqhekeka kwe-diaphyseal kanye ne-intra-articular avulsion kwamabhulokhi amakhulu ethambo. Kufanele kuqashelwe ukuthi uma usebenzisa izikulufo ezincane zodwa ukulungisa ukuphuka okuqondile noma okujikelezayo kwethambo le-diaphyseal lesandla, ubude bomugqa wokuphuka kufanele okungenani bube kabili ububanzi bethambo le-diaphyseal, futhi uma ulungisa amabhlogo okuphuka avulsed esihlanganisini, ububanzi bebhloko lethambo kufanele okungenani bube kathathu ubukhulu bentambo.
4. I-Micro yangaphandle fixator:Ukuphuka kwe-metacarpal phalangeal okuhlanganisiwe ngezinye izikhathi kunzima ukukunciphisa ngokwesimo somzimba noma akunakuqiniswa ngaphakathi ngisho nangemva kokusikwa kokuhlinzwa ngenxa yokubhujiswa kokusekelwa kwethambo. I-fixator yangaphandle ingabuyisela futhi igcine ubude bokuphuka kwe-comminute ngaphansi kokudonswa, idlala indima yokuqina okuhlobene. Ama-fixator angaphandle e-metacarpal phalangeal ahlukene abekwe ezindaweni ezahlukene: ama-phalanges okuqala nawesibili e-metacarpal abekwe ohlangothini lwe-dorsal radial, ama-phalanges amane nawesihlanu e-metacarpal abekwe ohlangothini lwe-dorsal ulnar, kanti i-phalange yesithathu ye-metacarpal ibekwe ohlangothini lwe-dorsal radial noma ohlangothini lwe-dorsal ulnar ngokwesimo. Naka indawo yokufaka inaliti ukuvimbela ukulimala kwe-tendon. Ukuphuka okuvaliwe kungancishiswa ngaphansi kwe-X-rays. Uma ukunciphisa kungalungile, ukusikwa okuncane kungenziwa ukusiza ekunciphiseni.
Yiziphi izinzuzo ze-fixators zangaphandle?
① Ukusebenza okulula, kungalungisa ukuhlukana okuhlukahlukene kweziphetho zokuphuka; ② Kunganciphisa futhi kulungise ngempumelelo ukuphuka kwamathambo e-metacarpophalangeal ngaphandle kokulimaza ubuso bamalunga, futhi kungaphazamisa ubuso bamalunga ukuvimbela ukugoba kwe-capsule yamalunga kanye ne-collateral ligament; ③ Lapho ukuphuka okuqhekekile kungenakuncishiswa ngokwesimo somzimba, kungahlanganiswa nokuqina kwangaphakathi okulinganiselwe, kanti i-fixator yangaphandle inganciphisa kancane futhi igcine umugqa wamandla; ④ Vumela ukuzivocavoca kwasekuqaleni komunwe othintekile ejoyintini elingagxilile ukuze kugwenywe ukuqina kwamalunga kanye ne-osteoporosis; ⑤ Kungalungisa ngempumelelo ukuphuka kwezandla ngaphandle kokuthinta ukwelashwa kwesilonda ngemuva kokuhlinzwa esandleni esithintekile.
Isikhathi sokuthunyelwe: Disemba-21-2024
