Njengamanje, ukuphuka kwe-distal radius kuphathwa ngezindlela ezahlukene, njengokufakwa kwe-plaster, ukusikwa kanye nokunciphisa ukufakwa kwangaphakathi, i-external fixation bracket, njll. Phakathi kwazo, ukufakwa kwe-palmar plate kungafeza imiphumela eyanelisayo, kodwa ezinye izincwadi zibika ukuthi izinga layo lobunzima liphezulu njengo-16%. Kodwa-ke, uma i-plate ikhethwe kahle, izinga lobunzima lingancishiswa ngempumelelo. Ukubuka okufushane kwezinhlobo, izinkomba kanye namasu okuhlinzwa e-palmar plating for distal radius fractures kuvezwe.
I. Izinhlobo zokuqhekeka kwe-distal radius
Kunezinhlelo eziningana zokuhlukanisa ukwaphuka, okuhlanganisa ukuhlukaniswa kwe-Müller AO okusekelwe ku-anatomy kanye nokuhlukaniswa kwe-Femandez okusekelwe endleleni yokulimala. Phakathi kwazo, ukuhlukaniswa kwe-Eponymic kuhlanganisa izinzuzo zokuhlukaniswa kwangaphambilini, kuhlanganisa izinhlobo ezine eziyisisekelo zokuqhekeka, futhi kuhlanganisa ukwaphuka kwezingxenye ezine ze-Maleon kanye nokuqhekeka kwe-Chaffer, okungaba umhlahlandlela omuhle womsebenzi wezokwelapha.
1. Ukuhlukaniswa kwe-Müller AO - ukuqhekeka okuyingxenye kwangaphakathi kwe-articular
Ukuhlukaniswa kwe-AO kufaneleka kahle ekuqhekekeni kwe-distal radius futhi kuwahlukanisa ngezinhlobo ezintathu eziyinhloko: uhlobo A extra-articular, uhlobo B partial intra-articular, kanye nohlobo C total joint fractures. Uhlobo ngalunye luhlukaniswe futhi ngenhlanganisela ehlukene yama-subgroups ngokusekelwe ebunzimeni kanye nobunzima bokuqhekeka.
Uhlobo A: Ukuphuka kwe-Extra-articular
I-A1, ukuphuka kwe-ulnar femoral, i-radius njengokulimala (i-A1.1, ukuphuka kwesiqu se-ulnar; i-A1.2 ukuphuka okulula kwe-ulnar diaphysis; i-A1.3, ukuphuka okufushane kwe-ulnar diaphysis).
A2, Ukuphuka kwerediyasi, okulula, okunesithombe esingaphakathi (A2.1, irediyasi engenamatheli; A2.2, ukuthambekela komgogodla kwerediyasi, okungukuthi, ukuphuka kwePouteau-Colles; A2.3, ukuthambekela kwesundu kwerediyasi, okungukuthi, ukuphuka kweGoyrand-Smith).
A3, Ukuphuka kwerediyasi, okuncishisiwe (A3.1, ukufinyezwa kwerediyasi; A3.2 ingxenye yerediyasi emise okwesigaxa; A3.3, ukuphuka kwerediyasi okuncishisiwe).
Uhlobo B: ukuphuka kwe-articular okuyingxenye
B1, ukuphuka kwe-radius, indiza ye-sagittal (B1.1, uhlobo olulula oluseceleni; B1.2, uhlobo oluhlanganisiwe oluseceleni; B1.3, uhlobo oluphakathi).
B2, Ukuphuka komngcele womhlane we-radius, okungukuthi, ukuphuka kukaBarton (B2.1, uhlobo olulula; B2.2, ukuphuka komhlane we-sagittal ohlangene; B2.3, ukuhlukana komhlane we-sagittal okuhlangene).
B3, Ukuphuka komphetho we-metacarpal we-radius, okungukuthi, ukuphuka kwe-anti-Barton, noma ukuphuka kwe-Goyrand-smith uhlobo lwesibili (B3.1, umthetho olula we-femoral, i-fragment encane; B3.2, ukuphuka okulula, i-fragment enkulu; B3.3, ukuphuka okufushane).
Uhlobo C: ukuphuka okuphelele kwe-articular
I-C1, ukuphuka kwe-radial okunohlobo olulula lwezindawo ezi-articular kanye ne-metaphyseal (C1.1, ukuphuka kwe-articular yangemuva; C1.2, ukuphuka kwe-sagittal kwendawo e-articular; C1.3, ukuphuka kwe-coronal ebusweni be-articular).
I-C2, Ukuphuka kwe-Radius, i-simple articular facet, i-comminuted metaphysis (i-C2.1, ukuphuka kwe-sagittal kwe-articular facet; i-C2.2, ukuphuka kwe-coronal facet kwe-articular facet; i-C2.3, ukuphuka kwe-articular okwelulela esiqwini se-radial).
I-C3, ukuphuka kwe-radial, okuncishisiwe (C3.1, ukuphuka okulula kwe-metaphysis; C3.2, ukuphuka kwe-metaphysis okuncishisiwe; C3.3, ukuphuka kwe-articular okudlulela esiqwini se-radial).
2. Ukuhlukaniswa kwezaphuka ze-distal radius.
Ngokusho kwendlela yokulimala, ukuhlukaniswa kwe-Femandez kungahlukaniswa ngezinhlobo ezi-5:.
Ukuqhekeka kohlobo I kuwukuqhekeka okuhlanganisiwe kwe-extra-articular metaphyseal okufana nokuqhekeka kwe-Colles (dorsal angulation) noma ukuqhekeka kwe-Smith (metacarpal angulation). I-cortex yethambo elilodwa iyaphuka lapho icindezelekile bese i-cortex engezansi iyaqhekeka futhi ihlanganiswe.
Ukuphuka
Ukuphuka kohlobo lwesithathu kuwukuphuka kwangaphakathi kwe-articular, okubangelwa ukucindezeleka kokucheba. Lokhu kuphuka kuhlanganisa ukuphuka kwe-palmar Barton, ukuphuka kwe-dorsal Barton, kanye nokuphuka kwe-radial stem.
Ukucindezeleka okuncishisiwe
Ukuqhekeka kohlobo lwesithathu kuwukuqhekeka kwangaphakathi kwe-articular kanye nokufakwa kwe-metaphyseal okubangelwa ukulimala kokucindezelwa, okuhlanganisa ukuqhekeka okuyinkimbinkimbi kwe-articular kanye nokuqhekeka kwe-radial pilon.
Ukufakwa
Ukuphuka kohlobo lwe-IV kuwukuphuka kwe-avulsion kwe-ligamentous attachment okwenzeka ngesikhathi sokuphuka-ukuhlukana kwe-radial carpal joint.
Ukuphuka kwe-Avulsion I dislocation
Ukuphuka kohlobo V kuvela ekulimaleni okushesha kakhulu okubandakanya amandla amaningi angaphandle kanye nokulimala okukhulu. (Okuxubile I, II, III, IV)
3. Ukuthayipha igama eliyimfihlo
II. Ukwelashwa kokuqhekeka kwe-distal radius nge-palmar plating
Izinkomba.
Kwama-fracture angaphandle kwe-articular ngemuva kokwehluleka kokunciphisa okuvaliwe ezimweni ezilandelayo.
Ukuvuvukala kwe-dorsal okungaphezu kwama-20°
Ukucindezelwa kwe-dorsal okungaphezu kuka-5 mm
Ukufinyezwa kwerediyasi ekude okungaphezu kuka-3 mm
Ukufuduka kwebhulokhi yokuqhekeka okude okungaphezu kuka-2 mm
Uma kwenzeka ukwaphuka kwangaphakathi kwe-articular okungaphezu kokuhamba okungu-2mm
Iningi lezazi alincomi ukusetshenziswa kwama-metacarpal plates ekulimaleni okunamandla aphezulu, njengokuphuka okukhulu kwe-intra-articular comminute noma ukulahlekelwa amathambo okukhulu, ngoba lezi zingcezu zokuphuka kwe-distal zivame ukuba ne-avascular necrosis futhi kunzima ukuzibeka kabusha ngokwesimo somzimba.
Ezigulini ezinezingcezu eziningi zokuphuka kanye nokufuduka okukhulu okune-osteoporosis enzima, i-metacarpal plating ayisebenzi. Ukusekelwa kwe-subchondral kokuphuka kwe-distal kungaba yinkinga, njengokungena kwe-screw emgodini wamalunga.
Indlela yokuhlinzwa
Odokotela abaningi abahlinzayo basebenzisa indlela efanayo kanye nobuchwepheshe bokulungisa ukwaphuka kwe-distal radius nge-palmar plate. Kodwa-ke, inqubo enhle yokuhlinzwa iyadingeka ukuze kugwenywe ngempumelelo izinkinga zangemuva kokuhlinzwa, isib., ukunciphisa kungatholakala ngokukhulula i-fracture block ekucindezelweni okuhlanganisiwe nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa kwesikhashana ngamaphini angu-2-3 e-Kirschner kungasetshenziswa, njll.
(I) Ukuhlelwa kabusha kwesimo somzimba ngaphambi kokuhlinzwa
1. Ukudonsa kwenziwa ngendlela yomgodi we-radial ngaphansi kwe-fluoroscopy, ngesithupha sicindezela ibhulokhi yokuqhekeka eseduze ukusuka ohlangothini lwesundu kanti eminye iminwe iphakamisa ibhulokhi ekude phezulu nge-engela ukusuka ohlangothini lwe-dorsal.
2. Ukulala phansi, umlenze othintekile usetafuleni lesandla ngaphansi kwe-fluoroscopy.
(II) Izindawo zokufinyelela.
Ukuze kusetshenziswe uhlobo lwendlela, kunconywa indlela ye-PCR (radial carpal flexor) extended palmar.
Isiphetho esikude sokusikwa kwesikhumba siqala esikhumbeni sesihlakala futhi ubude baso bunganqunywa ngokuya ngohlobo lokuphuka.
I-radial flexor carpi radialis tendon kanye ne-tendon sheath yayo ziqotshiwe, ziqhelelene namathambo e-carpal futhi ziseduze kakhulu nohlangothi oluseduze ngangokunokwenzeka.
Ukudonsa i-radial carpal flexor tendon ohlangothini lwe-ulnar kuvikela i-median nerve kanye ne-flexor tendon complex.
Isikhala sikaParona siyabonakala futhi umsipha we-rotator ani anterior utholakala phakathi kwe-flexor digitorum longus (uhlangothi lwe-ulnar) kanye nomthambo we-radial (uhlangothi lwe-radial).
Hlaba uhlangothi oluyi-radial lomsipha we-rotator ani wangaphambili, uqaphele ukuthi ingxenye ethile kufanele ishiywe inamathele ku-radius ukuze yakhiwe kabusha kamuva.
Ukudonsa umsipha we-rotator anterior ani ohlangothini lwe-ulnar kuvumela ukuvezwa okwanele kophondo lwe-ulnar ohlangothini lwesandla se-radius.
Indlela yesundu iveza i-distal radius futhi iveza ngempumelelo i-ulnar angle.
Ngezinhlobo zokuphuka okuyinkimbinkimbi, kunconywa ukuthi i-distal brachioradialis stop ingakhululwa, okunganciphisa ukudonsa kwayo ku-radial tuberosity, lapho i-palmar sheath ye-dorsal compartment yokuqala ingasikwa khona, okungaveza i-distal fracture block i-radial kanye ne-radial tuberosity, kujikelezise ngaphakathi i-radius Yu ukuze kuyisuse endaweni yokuphuka, bese usetha kabusha i-intra-articular fracture block usebenzisa iphini likaKirschner. Nge-complex intra-articular fractures, i-arthroscopy ingasetshenziswa ukusiza ekunciphiseni, ekuhloleni nasekulungiseni i-fracture block.
(III) Izindlela zokunciphisa.
1. Sebenzisa i-bone pry njengesivikelo sokusetha kabusha
2. Umsizi udonsa iminwe yesiguli ekhombayo nephakathi, okuzoba lula ukuyisetha kabusha.
3. Skurufa iphini likaKirschner kusuka ku-radial tuberosity ukuze liqine okwesikhashana.
Ngemva kokuthi ukubekwa kabusha sekuqediwe, kubekwa ipuleti lesundu njalo, okumele libe seduze nje nendawo yokugeleza kwamanzi, kumele limboze ubukhulu be-ulnar, futhi kufanele libe seduze nendawo ephakathi nesiqu se-radial. Uma lezi zimo zingahlangatshezwani, uma ipuleti lingesisayizi esifanele, noma uma ukubekwa kabusha kungagculisi, inqubo ayikapheleli.
Izinkinga eziningi zihlobene kakhulu nendawo yepuleti. Uma ipuleti libekwe kude kakhulu nohlangothi lwe-radial, izinkinga ezihlobene ne-bunion flexor cishe zizovela; uma ipuleti libekwe eduze kakhulu nomugqa wamanzi, i-flexor ejulile yomunwe ingaba sengozini. Ukukhubazeka kokuqhekeka okushiyekile okubekwa ohlangothini lwesundu kungabangela kalula ukuthi ipuleti liphumele ohlangothini lwesundu futhi lihlangane ngqo ne-flexor tendon, ekugcineni kuholele ku-tendonitis noma ngisho nokuqhekeka.
Ezigulini ezine-osteoporosis, kunconywa ukuthi ipuleti libekwe eduze komugqa wamanzi ngangokunokwenzeka, kodwa hhayi ngaphesheya kwalo. Ukufakwa kwe-subchondral kungafezwa kusetshenziswa amaphini e-Kirschner aseduze ne-ulna, futhi amaphini e-Kirschner aseduze nezikulufo ezikhiyayo ayasebenza ekugwemeni ukuphinde kufakwe endaweni yokuqhekeka.
Uma ipuleti selibekwe kahle, ingxenye eseduze iqiniswa ngesikulufu esisodwa bese ingxenye ekude yepuleti iqiniswa okwesikhashana ngamaphini eKirschner emgodini ongaphezulu kakhulu. Kuthathwe ama-orthopantomogram e-Intraoperative fluoroscopic, ukubuka okuseceleni, namafilimu aseceleni anokuphakama kwengalo okungu-30° ukuze kutholakale ukuncipha kokuqhekeka kanye nendawo yokuqina kwangaphakathi.
Uma ipuleti libekwe ngendlela eyanelisayo, kodwa iphini likaKirschner lingaphakathi kwe-articular, lokhu kuzoholela ekubuyiselweni okunganele kokuthambekela kwesundu, okungaxazululwa ngokusetha kabusha ipuleti kusetshenziswa "indlela yokulungisa ukuphuka kwe-distal" (Umfanekiso 2, b).
Umfanekiso 2.
a, izikhonkwane ezimbili zeKirschner zokuqinisa okwesikhashana, qaphela ukuthi ukuthambekela kwe-metacarpal kanye nobuso obuhlangene akukabuyiselwa ngokwanele kuleli phuzu;
b, Iphini elilodwa leKirschner lokulungisa ipuleti lesikhashana, qaphela ukuthi i-distal radius iqinile kuleli phuzu (indlela yokulungisa ibhlogo lokuqhekeka kwe-distal), futhi ingxenye eseduze yepuleti idonswa iye esiqwini se-radial ukuze kubuyiselwe i-angle yokuthambekela kwesundu.
C, Ukulungiswa kahle kwe-arthroscopic kwezindawo ezihlangene, ukufakwa kwezikulufo/izikhonkwane zokukhiya ezikude, kanye nokusetha kabusha kokugcina kanye nokulungiswa kwerediyasi eseduze.
Uma kwenzeka ukuphuka komgogodla kanye nokwaphuka kwe-ulnar okuhambisanayo (i-ulnar/dorsal Die Punch), okungenakukwazi ukusethwa kabusha ngokwanele lapho kuvalwa, lezi zindlela ezintathu ezilandelayo zingasetshenziswa.
I-proximal radius ijikeleziswa ngaphambili kude nendawo yokuqhekeka, futhi ibhlogo lokuqhekeka le-lunate fossa lisunduzelwa ethanjeni le-carpal ngendlela yokwelula i-PCR; kwenziwa ukusikwa okuncane endaweni engemuva kwengxenye yesi-4 neyesi-5 ukuze kuvele ibhlogo lokuqhekeka, bese liqiniswa ngezikulufo endaweni ye-ulnar foramen yeplate. Ukufakwa okuvaliwe kwe-percutaneous noma okuncane kakhulu kwenziwa ngosizo lwe-arthroscopic.
Ngemva kokulungiswa kabusha okwanelisayo nokubekwa kahle kwepuleti, ukulungiswa kokugcina kulula futhi ukulungiswa kabusha kwesakhiwo kungatholakala uma iphinikhodi ye-proximal ulnar kernel ibekwe kahle futhi kungekho zikulufo eziku-joint cavity (Isithombe 2).
(iv) Ulwazi lokukhetha izikulufo.
Ubude bezikulufo bungaba nzima ukubulinganisa ngokunembile ngenxa yokuchotshozwa okukhulu kwethambo le-dorsal cortical. Izikulufo ezinde kakhulu zingaholela ekushukumeni kwemisipha futhi zibe zimfushane kakhulu ukusekela ukuqina kwe-dorsal fracture block. Ngenxa yalesi sizathu ababhali batusa ukusetshenziswa kwezinzipho ezikhiyayo ezinezintambo kanye nezinzipho ezikhiyayo eziningi ku-radial tuberosity kanye ne-ulnar foramen eningi, kanye nokusetshenziswa kwezikulufo ezikhiyayo ezinesiqu sokukhanya ezindaweni ezisele. Ukusetshenziswa kwekhanda elibuthuntu kugwema ukushukuma kwemisipha ngisho noma ixhunywe entanyeni. Ukuze kufakwe ipuleti elixhumene eduze, izikulufo ezimbili ezixhumene + isikulufo esisodwa esivamile (esibekwe nge-ellipse) zingasetshenziswa ekushukumeni.
UDkt. Kiyohito waseFrance wethule ulwazi lwakhe lokusebenzisa amapuleti okukhiya esundu angangeni kakhulu ekuqhekekeni kwe-distal radius, lapho ukusikwa kwawo kokuhlinzwa kwehliswa kwaba yi-1cm ngokweqile, okuyinto ephikisanayo. Le ndlela iboniswa kakhulu ekuqhekekeni kwe-distal radius okuzinzile, futhi izinkomba zayo zokuhlinzwa zingokuqhekeka kwe-extra-articular kwezingxenye ze-AO zezinhlobo ze-A2 ne-A3 kanye nokuqhekeka kwe-intra-articular kwezinhlobo ze-C1 ne-C2, kodwa ayifaneleki ekuqhekekeni kwe-C1 ne-C2 kuhlanganiswe nokuwa kwe-bone mass intra-articular. Le ndlela ayifaneleki futhi ekuqhekekeni kohlobo lwe-B. Ababhali baphinde baveze ukuthi uma ukunciphisa nokulungisa okuhle kungenakufezwa ngale ndlela, kubalulekile ukushintshela endleleni yendabuko yokusikwa futhi unganamatheli ekusikweni okuncane okungangeni kakhulu.
Isikhathi sokuthunyelwe: Juni-26-2024
