Njengamanje, ukuhlukana kwe-distal radius kuphathwa ngezindlela ezihlukahlukene, njengokulungiswa kwe-plaster, ukusika nokunciphisa ukulungiswa kwangaphakathi, ubakaki wokulungisa wangaphandle, njll. Phakathi kwazo, ukulungiswa kwepuleti lesundu kungafinyelela imiphumela eyanelisa kakhulu, kodwa ezinye izincwadi zibika ukuthi izinga layo lezinkinga liphezulu njenge-16%. Kodwa-ke, uma ipuleti ikhethwe kahle, izinga lezinkinga lingancishiswa ngokuphumelelayo. Ukubuka kafushane kwezinhlobo, izinkomba kanye nezindlela zokuhlinza ze-palmar plating ye-distal radius fractures kwethulwa.
I.Izinhlobo zokuqhekeka kwerediyasi ekude
Kunezinhlelo eziningana zokuhlukaniswa kwezigaba zokuphuka, okuhlanganisa ukuhlukaniswa kwe-Müller AO okusekelwe ku-anatomy kanye nokuhlelwa kwe-Femandez okusekelwe endleleni yokulimala. Phakathi kwazo, ukuhlukaniswa kwe-Eponymic kuhlanganisa izinzuzo zokuhlukaniswa kwangaphambilini, kuhlanganisa izinhlobo ezine eziyisisekelo zokuqhekeka, futhi kufaka phakathi i-Maleon 4-part fractures kanye ne-Chaffer's fractures, okungaba isiqondiso esihle somsebenzi womtholampilo.
1. Ukuhlukaniswa kwe-Müller AO - ukuphuka kwe-intra-articular ingxenye
Ukuhlukaniswa kwe-AO kukufanelekela kahle ukuhlukana kwe-distal radius futhi kuhlukanise kube izinhlobo ezintathu eziyinhloko: uhlobo A extra-articular, uhlobo B ingxenye ye-intra-articular, kanye nohlobo C inani lokuphuka kwamalunga. Uhlobo ngalunye luphinde luhlukaniswe lube yinhlanganisela ehlukene yamaqoqo amancane ngokusekelwe ebukhulu nobunzima bokuphuka.
Uhlobo A:Ukuphuka kwe-articular eyengeziwe
I-A1, ukuphuka kwe-femoral ye-ulnar, i-radius njengokulimala (A1.1, ukuphuka kwe-ulnar stem; A1.2 ukuphuka okulula kwe-ulnar diaphysis; A1.3, ukuphuka okuhlangene kwe-ulnar diaphysis).
I-A2, Ukuqhekeka kwe-radius, elula, ene-inset (A2.1, irediyasi ngaphandle kokutsheka; A2.2, ukutsheka komkayo we-radius, okungukuthi, ukuphuka kwe-Pouteau-Colles; A2.3, ukutsheka kwe-palmar ye-radius, okungukuthi, ukuphuka kwe-Goyrand-Smith).
I-A3, Ukuqhekeka kwerediyasi, kuhoxisiwe (A3.1, ukufinyezwa kwe-axial yerediyasi; i-A3.2 isiqeshana esimise okwe wedge serediyasi; A3.3, ukuphuka okufinyeziwe kwerediyasi).
Uhlobo B: ukuphuka kwe-articular ingxenye
I-B1, ukuphuka kwe-radius, indiza ye-sagittal (B1.1, uhlobo olulula olungemuva; i-B1.2, uhlobo lwe-lateral comminuted; B1.3, uhlobo oluphakathi).
B2, Ukuphuka komphetho womphetho werediyasi, okungukuthi, ukuphuka kuka-Barton (B2.1, uhlobo olulula; B2.2, ukuphuka kwe-sagittal okuhlangene okuhlangene kwe-sagittal; B2.3, ukugudluka komhlane okuhlangene kwesihlakala).
B3, Ukuphuka kwe-metacarpal rim ye-radius, okungukuthi, i-anti-Barton fracture, noma i-Goyrand-smith type II fracture (B3.1, umthetho we-femoral olula, ucezwana oluncane; B3.2, ukuphuka okulula, ucezu olukhulu; B3.3, ukuphuka okuncane).
Uhlobo C: isamba sokuqhekeka kwe-articular
I-C1, i-radial fracture enohlobo olulula lwakho kokubili i-articular and metaphyseal surfaces (C1.1, ukuphuka kwe-articular medial posterior; C1.2, ukuphuka kwe-sagittal kwe-articular surface; C1.3, ukuphuka kwe-coronal surface ye-articular surface).
I-C2, i-Radius fracture, i-articular facet elula, i-metaphysis ehlanganisiwe (C2.1, ukuphuka kwe-sagittal kwe-articular facet; i-C2.2, ukuphuka kwe-coronal facet ye-articular facet; i-C2.3, ukuphuka kwe-articular okudlulela esiqwini se-radial).
I-C3, i-radial fracture, i-comminuted (C3.1, ukuphuka okulula kwe-metaphysis; i-C3.2, i-fracture ehlangene ye-metaphysis; i-C3.3, i-articular fracture efinyelela ku-radial stem).
2.Ukuhlukaniswa kwe-distal radius fractures.
Ngokusho komshini wokulimala, ukuhlukaniswa kwe-Femandez kungahlukaniswa ngezinhlobo ezi-5:.
Ukuphuka kohlobo I kuwukuphuka kwe-extra-articular metaphyseal comminuted okufana nama-Colles fractures (i-dorsal angulation) noma ama-Smith fractures (i-metacarpal angulation). I-cortex yethambo elilodwa iphuka ngaphansi kwe-tension futhi i-contralateral cortex iyahlanganiswa futhi ishunyekwe.
Ukuphuka
Uhlobo lwe-III ukuphuka ukuphuka kwe-intra-articular, okubangelwa ukucindezeleka kwe-shear. Lokhu kuphuka kuhlanganisa ukuphuka kwe-palmar Barton fractures, i-dorsal Barton fractures, kanye nokuphuka kwe-radial stem.
Shear stress
Ukuphuka kohlobo lwe-III kungukuphuka kwe-intra-articular kanye nokufakwa kwe-metaphyseal okubangelwa ukulimala kokucindezelwa, okuhlanganisa ukuphuka kwe-articular okuyinkimbinkimbi kanye nokuphuka kwe-radial pilon.
Ukufakwa
Uhlobo lwe-IV lwe-fracture luwukuphuka kwe-avulsion ye-attachment ligamentous okwenzeka ngesikhathi sokuphuka-ukukhishwa kwe-radial carpal joint.
I-Avulsion fracture I dislocation
Uhlobo lwe-V lokuphuka luvela ekulimaleni kwesivinini esiphezulu okubandakanya amandla amaningi angaphandle kanye nokulimala okukhulu. (Inhlanganisela I, II, IIII, IV)
3.Ukuthayipha kwe-eponymic
II.Ukwelashwa kokuqhekeka kweradiyasi ekude nge-palmar plating
Izinkomba.
Ngokuphuka kwe-extra-articular kulandela ukwehluleka kokunciphisa okuvaliwe kwezimo ezilandelayo.
I-Dorsal angulation enkulu kuno-20°
Ukucindezelwa komgogodla okukhulu kuno-5 mm
Ukufinyezwa kwerediyasi ekude enkulu kuno-3 mm
Ukususwa kwebhulokhi yokuphuka okukude okukhulu kuno-2 mm
Ngokwaphuka kwe-intra-articular okukhulu kunokugudluka okungu-2mm
Izazi eziningi azikukhuthazi ukusetshenziswa kwamapuleti e-metacarpal ngokulimala kwamandla aphezulu, njengokuphuka okukhulu kwe-intra-articular comminuted noma ukulahlekelwa okukhulu kwamathambo, ngoba lezi zingcezu ze-distal fracture zivame ukuba necrosis ye-avascular futhi kunzima ukuyibeka kabusha i-anatomically.
Ezigulini ezinezicucu eziningi zokuphuka kanye nokufuduka okuphawulekayo okune-osteoporosis enzima, i-metacarpal plating ayisebenzi. Ukusekelwa kwe-subchondral ye-distal fractures kungase kube yinkinga, njengokungena kwesikulufu emgodini ohlangene.
Indlela yokuhlinza
Odokotela abaningi abahlinzayo basebenzisa indlela efanayo nezindlela zokulungisa ukuphuka kwe-distal radius ngepuleti lesundu. Kodwa-ke, indlela enhle yokuhlinza iyadingeka ukuze kugwenywe ngempumelelo izinkinga zangemva kokuhlinzwa, isb, ukunciphisa kungafinyelelwa ngokukhulula ibhulokhi yokuphuka ekucindezelweni okushunyekiwe nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa kwesikhashana ngezikhonkwane ze-2-3 Kirschner kungasetshenziswa, njll.
(I) Ukumiswa kabusha nokuma kwangaphambi kokuhlinzwa
1. Ukudonswa kwesandla kwenziwa ngendlela ye-radial shaft ngaphansi kwe-fluoroscopy, isithupha sicindezela ibhulokhi yokuphuka eseduze yehle ukusuka ohlangothini lwesundu bese eminye iminwe iphakamisela i-distal block phezulu nge-engeli ukusuka ohlangothini lomhlane.
2. Ukuma kwe-Supine, isitho esithintekile siphezu kwetafula lesandla ngaphansi kwe-fluoroscopy.
(II) Amaphuzu okufinyelela.
Ukuze kusetshenziswe uhlobo lwendlela okufanele isetshenziswe, kunconywa indlela ye-PCR (radial carpal flexor) enwetshiwe yesundu.
Isiphetho esikude sokusikwa kwesikhumba siqala esikhunjeni sesikhumba sesihlakala futhi ubude baso bunganqunywa ngokusho kohlobo lokuphuka.
Ithenda ye-radial flexor carpi radialis kanye ne-tendon sheath yayo ifakwe, i-distal emathanjeni e-carpal futhi i-proximal eduze nohlangothi oluseduze ngangokunokwenzeka.
Ukudonsa i-radial carpal flexor tendon ohlangothini lwe-ulnar kuvikela i-nerve median kanye ne-flexor tendon complex.
Isikhala seParona sivezwa futhi i-anterior rotator ani muscle itholakala phakathi kwe-flexor digitorum longus (uhlangothi lwe-ulnar) kanye nomthambo we-radial (uhlangothi lwe-radial).
Cindezela uhlangothi lwe-radial lwe-anterior rotator ani muscle, uphawula ukuthi ingxenye kufanele ishiywe inamathiselwe engaba ukuze kwakhiwe kabusha kamuva.
Ukudonsa i-anterior rotator ani muscle ohlangothini lwe-ulnar kuvumela ukuchayeka okwanele kophondo lwe-ulnar ohlangothini lwesundu lwe-radius.
Indlela yesundu iveza i-distal radius futhi iveze ngempumelelo i-engeli ye-ulnar.
Ezinhlotsheni eziyinkimbinkimbi zokuphuka, kunconywa ukuthi kukhululwe isitobha se-distal brachioradialis, esinganciphisa ukudonsa kwayo ku-tuberosity e-radial, ngaleso sikhathi umgodla wesundu wegumbi lokuqala lomgogodla ungacutshungulwa, ongadalula i-distal fracture block radial and radial tuberosity, ukuzungeza ngaphakathi i-radius Yu ukuze uyihlukanise kabusha isayithi, ukuhlephula kabusha isayithi, ukuphuka futhi ukuhlukana. vimba usebenzisa iphinikhodi ye-Kirschner. Ngokuhlukana okuyinkimbinkimbi kwe-intra-articular, i-arthroscopy ingasetshenziswa ukusiza ekunciphiseni, ekuhloleni nasekulungiseni kahle ibhulokhi yokuphuka.
(III) Izindlela zokunciphisa.
1. Sebenzisa i-bone pry njengesivikelo sokusetha kabusha
2. Umsizi udonsa inkomba yesiguli kanye neminwe ephakathi, okuzoba lula ukusetha kabusha.
3. Khipha iphinikhodi ye-Kirschner kusuka ku-radial tuberosity ukuze ilungiswe isikhashana.
Ngemuva kokuthi ukubekwa kabusha sekuqediwe, ipuleti lesundu libekwa ngokujwayelekile, okumele libe seduze nje nendawo yokuchitha amanzi, kumele limboze ukuphakama kwe-ulnar, futhi kufanele libe seduze nendawo emaphakathi ye-radial stem. Uma lezi zimo zingahlangatshezwana nazo, uma ipuleti ingewona usayizi ofanele, noma uma ukubekwa kabusha kungagculisi, inqubo namanje ayiphelele.
Izinkinga eziningi zihlobene kakhulu nokuma kwepuleti. Uma ipuleti ibekwe kude kakhulu ohlangothini lwe-radial, izinkinga ezihlobene ne-bunion flexor cishe zingenzeka; uma ipuleti ibekwe eduze kakhulu nomugqa wamanzi, i-flexor ejulile yomunwe ingase ibe engozini. Ukukhubazeka okuxoshiwe kokuhlehlisa ukuphuka ohlangothini lwesundu kungabangela kalula ukuthi ipuleti liphumele ohlangothini lwesundu futhi lihlangane ngokuqondile ne-flexor tendon, ekugcineni liholele ku-tendonitis noma ngisho nokuphuka.
Ezigulini ze-osteoporotic, kunconywa ukuthi ipuleti libekwe eduze komugqa wamanzi ngangokunokwenzeka, kodwa hhayi ngaphesheya kwalo. Ukulungiswa kwe-Subchondral kungafinyelelwa kusetshenziswa izikhonkwane ze-Kirschner eziseduze ne-ulna, futhi izikhonkwane ze-Kirschner ezihlangothini nezinhlangothi nezikulufu zokukhiya ziyasebenza ekugwemeni ukugudluka kabusha kokuphuka.
Uma ipuleti selibekwe ngendlela efanele, isiphetho esiseduze siqiniswa ngesikulufu esisodwa futhi isiphetho esikude sepuleti sigxilwe okwesikhashana ngamaphini e-Kirschner emgodini omkhulu we-ulnar. I-intraoperative fluoroscopic orthopantomograms, ukubukwa kwezinhlangothi, namafilimu aseceleni anokuphakama kwengalo engu-30° athathwe ukuze kunqunywe ukuncishiswa kokuphuka kanye nokuma kokulungisa kwangaphakathi.
Uma ipuleti ibekwe ngendlela egculisayo, kodwa iphinikhodi ye-Kirschner i-intra-articular, lokhu kuzoholela ekubuyiseleni okunganele kokuthambekela kwesundu, okungaxazululwa ngokusetha kabusha ipuleti ngokusebenzisa "inqubo yokulungiswa kwe-distal fracture" (Fig. 2, b).
Umfanekiso 2.
a, izikhonkwane ezimbili ze-Kirschner zokulungiswa kwesikhashana, qaphela ukuthi ukuthambekela kwe-metacarpal kanye nezindawo ze-articular azibuyiselwa ngokwanele kuleli phuzu;
b, Iphinikhodi eyodwa ye-Kirschner yokulungiswa kwepuleti yesikhashana, phawula ukuthi i-distal radius igxilile kuleli phuzu (isu lokulungisa ibhulokhi yokuphuka kwe-distal), futhi ingxenye eseduze yepuleti idonselwa esiqwini se-radial ukuze kubuyiselwe i-engeli yokutsheka kwesundu.
C, ukulungiswa kahle kwe-arthroscopic yezindawo ze-articular, ukubekwa kwezikulufu/izikhonkwane zokukhiya, nokusetha kabusha kokugcina nokulungiswa kwe-proximal radius.
Esimeni sokuqhekeka kwe-dorsal kanye ne-ulnar (i-ulnar/dorsal Die Punch), engakwazi ukusethwa kabusha ngokwanele ngaphansi kokuvalwa, izindlela ezintathu ezilandelayo zingasetshenziswa.
I-proximal radius izungeziswe ngaphambili isuka endaweni yokuphuka, futhi ibhulokhi yokuphuka kwe-lunate fossa iphushwa ibheke ethanjeni le-carpal ngokusebenzisa indlela yokwelula ye-PCR; ukusika okuncane kwenziwa idorsal kuya ku-4th and 5th compartments ukuze kuvezwe ibhulokhi yokuphuka, futhi kugxilwe ngesikulufu kuforameni ye-ulnar kakhulu yepuleti. Ukulungiswa kwe-percutaneous okuvaliwe noma okuhlasela kancane kwenziwa ngosizo lwe-arthroscopic.
Ngemva kokubekwa kabusha ngendlela egculisayo kanye nokubekwa okulungile kwepuleti, ukulungiswa kokugcina kuba lula futhi ukubekwa kabusha kwe-anatomical kungafinyelelwa uma iphinikhodi ye-ulnar kernel eseduze ibekwe ngendlela efanele futhi azikho izikulufo endaweni ehlangene (Umfanekiso 2).
(iv) Umuzwa wokukhetha isikulufu.
Ubude bezikulufi bungase bube nzima ukubulinganisa ngokunembile ngenxa yokuchotshozwa okukhulu kwethambo le-cortical dorsal. Izikulufu ezinde kakhulu zingase ziholele ekunyakazeni kwe-tendon futhi zibe zifushane kakhulu ukuze zisekele ukulungiswa kwebhulokhi yokuphuka komgogodla. Ngenxa yalesi sizathu ababhali batusa ukusetshenziswa kwezipikili zokukhiya ezinentambo kanye nezipikili zokukhiya eziningi ku-radial tuberosity kanye neningi le-ulnar foramen, kanye nokusetshenziswa kwezikulufu zokuvala isiqu esikhanyayo ezindaweni ezisele. Ukusetshenziswa kwekhanda elibuthuntu kugwema ukunyakaza kwethenda noma ngabe ifakwe emhlane. Ukuze kulungiswe ipuleti elixhumene eliseduze, izikulufu ezimbili ezihilelekile + isikulufu esisodwa esivamile (esibekwe nge-ellipse) singasetshenziselwa ukulungiswa.
UDkt Kiyohito wase-France wethule ulwazi lwabo lokusebenzisa amapuleti okukhiya amasundu angavaleki kancane ukuqhekeka kwe-distal radius, lapho ukusika kwabo ngokuhlinzwa kwehliswe kwaba ngu-1cm ngokwedlulele, okuyinto ephikisanayo. Le ndlela iboniswa ngokuyinhloko ekuqhekekeni okuzinzile kwe-distal radius, futhi izinkomba zayo zokuhlinza zingezokwephuka kwezingxenye ze-AO zezinhlobo ze-A2 ne-A3 kanye ne-intra-articular fractures yezinhlobo ze-C1 ne-C2, kodwa ayifanele ukuphuka kwe-C1 ne-C2 kuhlanganiswe ne-intra-artipse ye-bone mass. Indlela futhi ayifanele ukuphuka kohlobo B. Ababhali baphinde baveze ukuthi uma ukuncishiswa okuhle nokulungiswa kungenakufinyelelwa ngale ndlela, kuyadingeka ukuthi ushintshele endleleni evamile yokusika futhi unganamatheli ekusikeni okuncane okungangeneleli.
Isikhathi sokuthumela: Jun-26-2024
