I-Metacarpal phalangeal fractures yizimo ezijwayelekile zokuphuka kwesandla, okubalela cishe i-1/4 yeziguli ezihlukumezekile ngesandla. Ngenxa yesakhiwo esintekenteke nesiyinkimbinkimbi sesandla kanye nokusebenza okuntekenteke kokunyakaza, ukubaluleka kanye nobuchwepheshe bokwelashwa kokuphuka kwezandla kuyinkimbinkimbi kakhulu kunokwelapha okunye ukuphuka kwamathambo amade. Ukuqinisekisa ukuzinza kwe-fracture ngemva kokunciphisa kuyisihluthulelo sokwelashwa okuphumelelayo kwe-metacarpal phalangeal fractures. Ukuze ubuyisele umsebenzi wesandla, ukuphuka ngokuvamile kudinga ukulungiswa okufanele. Esikhathini esedlule, ukulungiswa kwangaphandle kwe-plaster noma i-Kirschner wire fixation yangaphakathi yayivame ukusetshenziswa, kodwa ngokuvamile ayihambisani nokuqeqeshwa kokuvuselelwa kwamalungu okuqala ngemva kokuhlinzwa ngenxa yokulungiswa okungalungile noma isikhathi eside sokulungiswa, okunomthelela omkhulu ekubuyiseleni umsebenzi ohlangene womunwe futhi kuletha ubunzima obuthile ekuvuseleleni ukusebenza kwesandla. Izindlela zokwelapha zesimanje ziya ngokuya zisebenzisa ukulungiswa okuqinile kwangaphakathi, okufana ne-micro-plate screw fixation.
I.Yiziphi izimiso zokwelapha?
Izimiso zokwelashwa kwesandla se-metacarpal kanye ne-phalangeal fractures: ukunciphisa umzimba, ukulungiswa okukhanyayo nokuqinile, imisebenzi yokuqala kanye nokuqeqeshwa kokusebenza. Izimiso zokwelashwa kwe-intra-articular kanye ne-peri-articular fractures yesandla iyafana naleyo yamanye ama-intra-articular fractures, nawo okubuyisela i-anatomy yendawo ehlangene nemisebenzi yokuqala yokusebenza. Lapho ukwelapha ukuphuka kwesandla se-metacarpal ne-phalangeal, kufanele kwenziwe imizamo ukuze kuzuzwe ukuncishiswa kwe-anatomical, futhi ukujikeleza, i-angulation ehlangothini, noma ukususwa kwe-angular kwe> 10 ° kusici somgogodla wesundu akufanele kwenzeke. Uma ukuphela kwe-fracture ye-phalange ye-metacarpal ijikeleza noma i-angularly displaces eceleni, izoshintsha i-trajectory ye-flexion evamile kanye nokunyakaza okunwetshiwe komunwe, okubangela ukuba kuguqulwe noma ukuwa ngomunwe oseduze ngesikhathi sokugoba, okuthinta ukunemba komsebenzi womunwe; futhi lapho ukufuduka kwe-angular kusici se-dorsal yesundu ku> 10 °, indawo yokuxhumana ebushelelezi phakathi kwethambo ne-tendon iyabhujiswa, okwandisa ukumelana nobubanzi bokunyakaza kwe-flexion nokwandiswa kwe-tendon, kanye nokulimala okungapheli kwe-tendon kwenzeka, okwenza kube nengozi yokuphuka kwe-tendon.
II.Yiziphi izinto ezingakhethwa ngenxa ye-metacarpal fractures?
Kunezinto eziningi ezilungiswayo zangaphakathi zokuqhekeka kwe-metacarpal, njengezintambo ze-Kirschner, izikulufu, amapuleti kanye nezilungisi zangaphandle, phakathi kwazo izintambo ze-Kirschner nama-microplates asetshenziswa kakhulu. Ngokuphuka kwe-metacarpal, ukulungiswa kwangaphakathi kwe-microplate kunezinzuzo ezisobala ngaphezu kokulungiswa kocingo lwe-Kirschner futhi kungasetshenziswa kuqala; ngenxa ye-proximal phalanx fractures, ama-microplates ngokuvamile aphakeme, kodwa uma kunzima ukufaka izikrini ze-proximal phalanx distal segment kanye nokuphuka kwekhanda, ukulungiswa kwangaphakathi kwe-Kirschner wire kufanele kusetshenziswe, okuhambisana kakhulu nokubuyiselwa komsebenzi womunwe othintekile; Izintambo ze-Kirschner kufanele zisetshenziswe kuqala ekwelapheni ama-phalanx fractures aphakathi.
- I-Kirschner wire:I-Kirschner wire fixation yangaphakathi isetshenziswe emisebenzini yomtholampilo iminyaka engaphezu kwengu-70 futhi ibilokhu isetshenziswa kakhulu ukulungiswa kwangaphakathi kwangaphakathi kwe-metacarpal ne-phalangeal fractures. Kulula ukuyisebenzisa, iyonga futhi iyasebenza, futhi iyindlela yangaphakathi yokulungisa yangaphakathi. Njengokulungiswa kwangaphakathi okuvame ukusetshenziswa kakhulu ekwelapheni ukuphuka kwezandla, kusasetshenziswa kabanzi. Izinzuzo ze-Kirschner wire fixation yangaphakathi: ① Kulula ukuyisebenzisa futhi ivumelana nezimo kakhulu ukuyisebenzisa; ② Ukukhumula izicubu ezithambile kancane, umthelela omncane ekunikezeni igazi ekugcineni kokuphuka, ukuhlukumezeka okuncane kokuhlinzwa, futhi okusiza ukuphulukiswa kokuphuka; ③ Kulula ukususa inaliti okwesibili; ④ Izindleko eziphansi kanye nobubanzi obubanzi bokusebenza, bufanele ukuphuka kwezandla okuningi (njengokuphuka kwe-intra-articular, ukuphuka okuqinile okuqinile kanye nokuphuka kwe-distal phalangeal).
2.Metacarpophalangeal microplates: Ukulungiswa okuqinile kwangaphakathi kokuphuka kwezandla kuyisisekelo sokuqeqeshwa kokusebenza kwangaphambi kwesikhathi kanye nesimo esidingekayo sokubuyisela ukusebenza okuhle kwesandla. Ubuchwepheshe bokulungisa kwangaphakathi be-AO budinga ukuthi iziphetho ze-fracture zibekwe kabusha ngokunembile ngokusho kwesakhiwo se-anatomical nokuthi ukuphela kwe-fracture kuzinzile ngaphansi kwezimo zokusebenza, okuvame ukubizwa ngokuthi ukulungiswa okuqinile, ukuze kuvunyelwe ukunyakaza okusebenzayo kusenesikhathi. I-AO iphinde igcizelele ukuhlinzwa okungenakuhlasela kancane, kugxilwe ekuvikeleni ukuhlinzekwa kwegazi. Ukulungiswa kwangaphakathi kwe-Microplate yokwelapha ukuphuka kwezandla kungafinyelela imiphumela eyanelisayo ngokwamandla, ukuzinza kweziphetho zokuphuka, nokucindezela phakathi kokuphela kokuphuka. Mayelana nokuvuselelwa kokusebenza kwangemva kokuhlinzwa, isikhathi sokuphulukiswa kokuphuka, kanye nezinga lokutheleleka, kukholelwa ukuthi ukusebenza kahle kwamapuleti e-microtitanium kungcono kakhulu kunezintambo ze-Kirschner. Ngaphezu kwalokho, njengoba isikhathi sokuphulukiswa kokuphuka ngemva kokulungiswa ngamapuleti e-microtitanium sisifushane kakhulu kunezinye izindlela zokulungisa, kunenzuzo ezigulini ukuba ziphinde ziqale impilo evamile kusenesikhathi.
(1) Yiziphi izinzuzo zokulungiswa kwangaphakathi kwe-microplate?
① Uma kuqhathaniswa nezintambo ze-Kirschner, izikulufo ze-microplate zinokuhambisana okungcono kwezicubu kanye nokusabela okungcono kwezicubu; ② Ukuzinza kwesistimu yokulungisa i-plate-screw kanye nokucindezela ekugcineni kokuphuka kwenza ukuphuka kusondele ekunciphiseni kwe-anatomical, ukulungiswa okuphephile, futhi kubangele ukuphulukiswa kokuphuka; ③ Ukuvivinya umzimba kwangaphambi kwesikhathi ngokuvamile kuvunyelwe ngemva kokulungiswa kwe-microplate, okulungele ukutholwa komsebenzi wesandla.
(2)Iyiphi indlela yokuhlinzwa yama-microplates?
Ukuhlinzwa ngokuvamile kwenziwa ngaphansi kwe-brachial plexus block anesthesia, futhi i-tourniquet yomoya ngokuvamile iyadingeka. I-dorsal incision ye-metacarpal phalanges iyathathwa, i- aponeurosis ye-dorsal yamadijithi iyasikwa noma i-interrosseous muscle kanye nethambo le-metacarpal lifakwa ukuze liveze iziphetho zokuphuka kwe-metacarpal noma amathambo e-phalangeal, i-periosteum iyahlutshwa, futhi ukuphuka kuyancipha ngaphansi kombono oqondile. Amapuleti aqondile afanele ukuqhekeka okuphambene kwengxenye ephakathi kanye nokuqhekeka kwe-oblique emifushane, ama-T-plates afanele ukulungiswa kwesisekelo se-metacarpal ne-phalanges, futhi ama-T-plates noma ama-120 ° no-150 ° L-amapuleti afaneleka ukulungiswa kwama-oblique amade nama-fractures aphelile. Ipuleti ngokuvamile libekwe ohlangothini lwethambo lomgogodla ukuze kuvinjelwe ukushelela kwe-tendon kanye nokugqoka isikhathi eside, okulungele ukuqeqeshwa kokusebenza kwangaphambi kwesikhathi. Okungenani izikulufu ezimbili kufanele zisetshenziselwe ukulungisa iziphetho ezimbili zokuphuka, ngaphandle kwalokho ukuzinza akulungile, futhi izintambo ze-Kirschner noma izikulufu ezingaphandle kwepuleti ziyadingeka ukuze kusize ukulungisa ukuze kufezwe injongo yokulungisa okuzinzile.
3.Izikulufu ezincane: Izikulufu ezincane zinokuzinza okufanayo namapuleti ensimbi ekulungiseni ukuphuka okuzungezayo noma okude okutshekile, kodwa ububanzi bezicubu ezithambile nokukhumula i-periosteum buncane kunalelo lokulungiswa kwepuleti lensimbi, elilungele ukuvikela ukunikezwa kwegazi futhi ngokuhambisana nomqondo wokusebenza okuhlasela kancane. Nakuba kukhona amapuleti ohlobo lwe-T kanye no-L we-fractures eseduze-articular, ukubuyiswa komsebenzi ohlangene ngemva kokulandelwa kokuhlinzwa kubi kakhulu kune-diaphyseal fractures. Izikulufu ezincane nazo zinezinzuzo ezithile ekulungiseni ukuphuka kwe-intra-articular kanye ne-peri-articular. Izikrini ezifakwe ethanjeni le-cortical zingakwazi ukumelana nomthwalo omkhulu wokucindezeleka, ngakho-ke ukulungiswa kuqinile, futhi ukuphela kwe-fracture kungacindezelwa ukuze kwenze indawo yokuphuka isondelene eduze, ifinyeze isikhathi sokuphulukiswa kwe-fracture futhi yenze lula ukuphulukiswa kokuphuka, njengoba kuboniswe ku-Figure 4-18. Ukulungiswa kwangaphakathi kwesikulufu esincane sokuphuka kwesandla sisetshenziselwa ikakhulukazi ukuphuka kwe-oblique noma okuvunguzayo kwe-diaphyseal kanye nokuphuka kwe-intra-articular avulsion yamabhulokhi amakhulu amathambo. Kumele kuqashelwe ukuthi uma usebenzisa izikulufa ezincane kuphela ukulungisa ukuphuka kwe-oblique noma okuvunguzayo kwethambo le-diaphyseal lesandla, ubude bomugqa wokuphuka kufanele bube okungenani kabili ububanzi bethambo le-diaphyseal, futhi lapho kulungiswa amabhlogo aphukile aphukile ekuhlanganyeleni, ububanzi bebhulokhi yethambo kufanele okungenani buphindwe izikhathi ezingu-3 ububanzi bentambo.
4.Isilungisi sangaphandle esincane:I-metacarpal phalangeal fractures ehlanganisiwe ngezinye izikhathi kunzima ukunciphisa i-anatomically noma ayikwazi ukumiswa ngokuqinile ngaphakathi ngisho nangemva kokusikwa kokuhlinzwa ngenxa yokubhujiswa kokusekelwa kwamathambo. I-fixator yangaphandle ingakwazi ukubuyisela futhi igcine ubude be-fracture ehlanganisiwe ngaphansi kwe-traction, idlala indima yokulungiswa okuhlobene. Izilungisi zangaphandle ze-metacarpal phalangeal zangaphandle zibekwe ezindaweni ezihlukene: i-metacarpal phalanges yoku-1 neyesi-2 ibekwe ohlangothini lwe-dorsal radial, i-4th kanye ne-5th metacarpal phalanges ibekwe ohlangothini lwe-dorsal ulnar, kanti i-phalange yesi-3 ye-metacarpal ibekwe ohlangothini lwe-radial ohlangothini lwe-radial ohlangothini lwe-dorsal. Naka indawo yokufaka inaliti ukuze uvimbele ukulimala kwethenda. Ukuphuka okuvaliwe kungancishiswa ngaphansi kwe-X-ray. Uma ukuncishiswa kungalungile, ukusika okuncane kungenziwa ukusiza ekwehliseni.
Yiziphi izinzuzo zezilungisi zangaphandle?
① Ukusebenza okulula, kungalungisa ukugudluka okuhlukahlukene kokuphela kokuphuka; ② Inganciphisa ngempumelelo futhi ilungise ukuphuka kwe-intra-articular yamathambo e-metacarpophalangeal ngaphandle kokulimaza indawo ehlangene, futhi ingaphazamisa indawo ehlangene ukuze ivimbele ukuvuthwa kwe-capsule ehlangene kanye ne-collateral ligament; ③ Uma ama-fractures ahlanganisiwe angeke ancishiswe ngokwe-anatomically, angahlanganiswa nokulungiswa okulinganiselwe kwangaphakathi, futhi isilungisi sangaphandle singanciphisa kancane futhi sigcine umugqa wamandla; ④ Vumela izivivinyo zokusebenza zangaphambi kwesikhathi zomunwe othintekile elunganeni elingagxilile ukugwema ukuqina kwamalunga kanye ne-osteoporosis; ⑤ Ingakwazi ukulungisa kahle ukuphuka kwezandla ngaphandle kokuphazamisa ukwelashwa kwesilonda esandleni esithintekile.
Isikhathi sokuthumela: Dec-21-2024
