Ama-metacarpal phalangeal fractures aqhekekile ajwayelekile e-Acrauma, abhalwe kabusha cishe ngo-1/4 weziguli zezandla zezandla. Ngenxa yokwakheka okubucayi futhi okuyinkimbinkimbi kwesandla kanye nomsebenzi obucayi wokunyakaza, ukubaluleka nobuchwepheshe bokwelashwa kwesandla okuxakile kuyinkimbinkimbi ngokwedlula ukwelashwa kwamanye amathambo. Ukuqinisekisa ukuqina kokuqhekeka ngemuva kokuncishiswa kuyisihluthulelo sokwelashwa okuphumelelayo kwe-metacarpal phalangeal fractures. Ukuze ubuyisele umsebenzi wesandla, ama-fractures avame ukudinga ukulungiswa okufanele. Esikhathini esedlule, ukulungiswa kwangaphandle kodaka noma ukulungiswa kwe-kirschner wire yangaphakathi kwakuvame ukusetshenziswa ukuqeqeshwa kokuhlangene okuhlangene ngenxa yokulungiswa okulungile noma isikhathi eside, okunomthelela omkhulu ekuvuseleleni umsebenzi wesandla esisebenzayo. Izindlela zokwelashwa zanamuhla ziya ngokuya zisebenzisa ukulungiswa kwangaphakathi okunamandla, njengokulungiswa kwesikulufu sepuleti esincanyana.
I.Yini imigomo yokwelashwa?
Imigomo yokwelashwa ye-Metacarpal kanye ne-Phalangeal Fractures: Ukuncishiswa kwe-anatomical, ukulungiswa okukhanyayo nokulungiswa okuqinile, imisebenzi yokuqala kanye nokuqeqeshwa okusebenzayo. Izimiso zokwelashwa zokuqhekeka kwe-intra-archar kanye ne-peri-articwall yesandla ziyefana nalezo kwamanye ama-intra-articular fractures, okuyizo zokubuyisela i-anatomy yendawo ehlanganyelwe kanye nemisebenzi yokuqala yokusebenza. Lapho belapha i-metacarpal ye-metacarpal kanye ne-phacanteal, kufanele kwenziwe imizamo yokuthola ukuncishiswa kwe-anatomical, nokujikeleza, ukuzulazula kwe-lateral, noma ukuthuthwa kwe-angular, noma ukuhanjiswa kwe-angular kwe-dorsal yesandla akufanele kwenzeke. Uma ukuphela kokuphela kwe-metacarpal phalange kujikeleza noma ngokuzingela ngokungemthetho, kuzoshintsha ngokuhamba kwesikhathi, kuzoshintsha i-trajectory yokuguquguquka okujwayelekile nokuhamba komunwe, okwenza ukuthi kuguqulwe noma ukuwa ngomunwe osondelene ngesikhathi sokuguquguquka, okuthinta ukunemba komsebenzi womunwe; Futhi lapho ukuhanjiswa kwe-angular ku-dorsal pund yesundu kungu> 10 °, indawo yokuxhumana ebushelelezi phakathi kwethambo kanye nethende kubhujiswa, ukwengeza ukumelana kanye nomonakalo we-tendon, nokwenza ingozi ye-tendon.
II.Yiziphi izinto ezingakhethwa ukuqhekeka kwe-metacarpal?
Kunezinto eziningi zokulungiswa kwangaphakathi zeMetacarpal Fractures, ezinjengezintambo ze-kirschner, izikulufo, amapuleti kanye nezifo zangaphandle, phakathi kwazo ama-kirschner wires kanye nama-microplates asetshenziswa kakhulu. Okwe-metacarpal fractures, ukulungiswa kwangaphakathi okucashile kunezinzuzo ezisobala ngaphezulu kokulungiswa kocingo lwe-kirschner futhi kungasetshenziswa kuqala; Okwe-proximal phalanx fractures, ama-minroplatter aphezulu kakhulu, kepha uma kunzima ukufaka izikulufo ze-proximal Plalanx segment distal segment kanye nokuhlunga kwekhanda, okulungiselelwe ukulungiswa kweminwe yangaphakathi; Izintambo zeKirstchner kufanele zisetshenziswe kuqala ekwelapheni ama-Planx Fractures aphakathi.
- I-Kirschner Wire:Ukulungiswa kwe-kirschner wire yangaphakathi kusetshenziswe emtholampilo ngokungaphezulu kweminyaka engama-70 futhi bekulokhu kuvame ukusetshenziswa okusetshenziswayo kwangaphakathi kwangaphakathi kweMetaCarpal kanye ne-Phalangeal Fractures. Kulula ukusebenza, kwezomnotho futhi okusebenzayo, futhi kuyindlela yokulungiswa kwangaphakathi kwangaphakathi. Njengokulungiswa kwangaphakathi okuvame ukusetshenziswa kakhulu kokwelashwa kokuqhekeka kwezandla, kusasetshenziswa kabanzi. Izinzuzo zeKistschner Wire FUNDATION FUNDA YOKUXHUMANA: ① Kulula ukusebenza futhi kuvumelana nezimo okufanele uzisebenzise; ② Ukwehla kwezicubu ezithambile ezithambile, umthelela omncane ekuhlinzekweni kwegazi kokuphela kokuphela, ukuhliswa okuncane okuncane, futhi okulungele ukuphulukiswa kokuphulukisa; Kulula ukususa inaliti okwesibili; ④ Izindleko eziphansi kanye nohlu olubanzi lwe-application, elilungele ukuqhekeka kwezandla eziningi (njengokuqhekeka kwe-intra-articular fractures, ukuphazamiseka okukhulu okubekiwe kanye nokuqhekeka kwe-distal phacturey).
2.MetacarPophalalalaal mineplates: Ukulungiswa kwangaphakathi okuqinile kokuqhekeka kwezandla kuyisisekelo sokuqeqeshwa kokusebenza kwangaphambi kwesikhathi kanye nesimo esidingekayo sokubuyisela umsebenzi omuhle wesandla. Ubuchwepheshe bokulungiswa kwangaphakathi kwe-AO budinga ukuthi ukuqhekeka okuphelele kuphakanyiswe ngokuqondile ngokuya ngesakhiwo se-anatomical nokuthi ukuqhekeka kugcina kungazinzile ngaphansi kwezimo ezisebenzayo, okuvame ukwaziwa ukunyakaza okusebenzayo. I-AO ibuye igcizelele imisebenzi yokuhlanza okuncane, okugxilwe ekuvikeleni ukunikezwa kwegazi. Ukulungiswa kwangaphakathi kwangaphakathi kokwelashwa kwama-paractures ezandla kungafinyelela imiphumela egculisayo ngokuya ngamandla, ukuqina kweziphetho zokuqhekeka, kanye nengcindezi phakathi kweziphetho. Ngokuya kokulungiswa kokusebenza okusebenzayo, isikhathi sokuphulukisa, kanye nezinga lokutheleleka, kukholelwa ukuthi ukusebenza kahle kwamapuleti ama-microtitanium kungcono kakhulu kunalokho kwe-KIRSchner izintambo. Ngaphezu kwalokho, njengoba isikhathi sokuphulukisa sokulula ngemuva kokuhlelwa ngamapuleti ama-microtitanium sifushane kakhulu kunalokho kwezinye izindlela zokulungiswa, kuyasiza iziguli ukuthi ziqale impilo ejwayelekile kusenesikhathi.
(1) Yiziphi izinzuzo zokulungiswa kwangaphakathi okuncane?
① Uma kuqhathaniswa nezintambo ze-kirschner, izinto zokwakha ezincane zinokuhambisana kwezicubu okungcono kanye nokuphendula kwezicubu ezingcono; ② Ukuqina kohlelo lokulungiswa kwesikulufu seplate-screw kanye nengcindezi ekupheleni kokuphela kwenza ukuqhekeka eduze kokuncishiswa kwe-anatomical, ukulungiswa okuphephe ngokwengeziwe, futhi kulungele ukuphulukiswa kokuphulukisa; ③ Ukuzivocavoca okusebenzayo ngokuvamile kuvunyelwe ngemuva kokulungiswa okucashile, okulungele ukululama komsebenzi wesandla.
(2) Iyiphi indlela yokuhlinzwa minuthani?
Ukuhlinzwa kuvame ukwenziwa ngaphansi kweBrachial Plexus block anesthesia, kanye ne-pneumatic tourniquet kuvame ukudingeka. Ukuvela kwe-dorsal kwama-metacarpal phalanges kuyathathwa, i-aponerosis ye-dorsal yamadijithi asikiwe noma amathambo e-metacarpal afakwa ukuze adalulwe imiphelo ye-metacarpal noma ye-phactios Amapuleti aqondile alungele ukuqhekeka okuguqukayo kwengxenye ephakathi kanye nama-oblique amafushane, amapuleti ama-t-plates alungele ukulungiswa kwesisekelo se-metacarpal kanye nama-phalates, nama-t-plates noma amapuleti angama-150 ° kanti amapulenti angu-150 Ipuleti livame ukubekwa ohlangothini lwe-dorsal lwethambo ukuvikela i-tendon sliding kanye nokugqoka isikhathi eside, okulungele ukuqeqeshwa kokusebenza kwangaphambili. Okungenani izikulufo ezimbili kufanele zisetshenziselwe ukulungisa iziphetho ezimbili zokuqhekeka, ngaphandle kwalokho ukuqina kungokwengeziwe, futhi izintambo ze-kirschner ezingaphandle kwepuleti zidingeka ukusiza ukulungiswa ukuze kufinyelelwe ukulungiswa ukuze kufezekiswe ukufezekisa ukufeza inhloso yokuthola inhloso yokuthola inhloso yokuthola injongo yokuhlelwa okuzinzile.
I-3.MMINE SCRECK: Izikulufo ezi-mini zinokuqina okufanayo kumapuleti ensimbi olungiselelweni lokuqhekeka okuthe xaxa, kepha uhla lwezicubu ezithambile, kepha uhla lwezicubu ezithambile, kepha uhla lwezicubu ezithambile, kepha uhla lwezicubu ezithambile, kepha uhla lwezicubu ezithambile, kepha umucu wezicubu ezithambile, kepha umucu wezicubu ezithambile, kepha uhla lwezicubu ezithambile, kepha umucu wezicubu ezithambile, kepha umucu wama-periosteum mncane kunaleso sokulungiswa kwensimbi, okuhambisana nomqondo wokusebenza okuncane. Yize kukhona amapuleti we-T-Type ne-L-Type for fractures aseduzane, ukululama komsebenzi ohlanganyelwe ngemuva kokulandela okusebenzayo kubi ukwedlula lokho kwe-diaphyal fractures. Izikulufo ezi-mini nazo zinezinzuzo ezithile zokulungiswa kokuqhekeka kwe-Intra-articular kanye ne-peri-articular fractures. Izikulufo ezihlelwe kwithambo le-cortical zikwazi ukumelana nomthwalo omkhulu wokucindezela, ngakho-ke ukulungiswa kuqinile, futhi ukulungiswa kwe-Fracture kungacindezelwa ukwenza indawo yokuphulukisa bese kunciphisa ukuphulukiswa kokuphulukisa, njengoba kukhonjiswe kuMfanekiso 4-18. Ukulungiswa kwe-Mini Screw of the wand fractures kusetshenziselwa ikakhulukazi ama-oblique noma ama-spiral fractures of the diaphyseal kanye ne-intra-articway avulsion fractures yamabhulokhi amathambo amakhulu. Kumele kwaziwe ukuthi lapho usebenzisa izikulufa ezi-mini zodwa ukulungisa ama-oblique noma ama-spiral fractures we-diaphyseal ithambo ngesandla, futhi ubude bomugqa we-fracture kufanele okungenani ube kabili kabili kububanzi obukhulu, ububanzi be-bone block kufanele okungenani ububanzi obukhulu bentambo.
I-Finator ye-4.Micro yangaphandle:Ama-metacarpal antedpal phacturel fractures kwesinye isikhathi anzima ukunciphisa noma akwazi ukulungiswa ngokuqinile ngaphakathi ngisho nangemva kwesimo sokuhlinzwa ngenxa yokubhujiswa kokusekelwa kwamathambo. I-Finator yangaphandle ingabuyisela futhi ilondoloze ubude bokuqhekeka okususiwe ngaphansi kwe-troction, ukudlala indima yokulungiswa okuhlobene. Ama-Finator ahlukene we-metacarpal phalangeal afakwa ezikhundleni ezihlukile: I-1st ne-2nd Galanges ye-metacarpal ibekwa ohlangothini lwe-dorsal radial, kanye nama-palange we-metacarpal afakwa ohlangothini lwe-dorsal radial ohlangothini noma ohlangothini lwe-dorsal ulnar ngokuya ngesimo. Naka inaliti yokufaka inaliti ukuvikela ukulimala kwe-tendon. Ama-fractures avaliwe angancishiswa ngaphansi kwama-x-ray. Lapho ukuncishiswa kungekuhle, ukuvela okuncane kungenziwa ukusiza ekunciphiseni.
Yiziphi izinzuzo zangaphandle zangaphandle?
Ukusebenza okulula, kungalungisa ukufuduka okuhlukahlukene kokuphela kokuphela; I-② inganciphisa ngempumelelo futhi ilungise ukuphazanyiswa kwe-intra-articular kwamathambo we-metacarpophalangeal ngaphandle kokulimaza indawo ehlanganyelwe, futhi kungaphazamisa indawo ehlanganyelwe ukuvikela inkohliso ye-capsule ehlanganisiwe ne-collateral ligament; ③ Lapho ama-fractures ahlanganisiwe angeke ancishiswe yi-akomcalically, angahlanganiswa nokulungiswa kwangaphakathi okulinganiselwe, futhi i-Finator yangaphandle inganciphisa ingxenye ethile futhi ilondoloze umugqa wamandla; ④ Vumela izivivinyo zokusebenza kwangaphambi kokuzivocavoca komunwe othintekile ekuhlanganiseni okungafakwanga ukugwema ukuqina okuhlanganyelwe kanye ne-osteoporosis; ⑤ ingalungisa ngempumelelo ukuphazamiseka kwesandla ngaphandle kokuthinta ukwelashwa okuphathelene nesilonda esesandleni esithintekile.
Isikhathi sePosi: DEC-21-2024
