Njengamanje, ama-distal radius ama-fractures aphathwa ngezindlela ezahlukahlukene, njengokuhlelwa kokulungiswa kokulungiswa, ukuncishiswa kokulungiswa kwangaphakathi, ukulungiswa kwemininingwane yangaphandle, eminye imibiko yezincwadi ingafinyelela imiphumela yayo egculisayo, kepha eminye imibiko yayo yengculazi. Kodwa-ke, uma ipuleti likhethwe kahle, izinga lezinkinga lingancishiswa ngempumelelo. Ukubukwa okufushane kwezinhlobo, izinkomba kanye namasu okuhlinza we-Palmar Plating for distal radius radius fractures wethulwa.
I.types of distal radius fractures
Kunezinhlelo eziningana zokuhlukaniswa kwama-fractures, kufaka phakathi ukuhlukaniswa kwe-Müller Ao kususelwa ku-anatomy kanye nokuhlukaniswa kwabesifazane okususelwa kwinqubo yokulimala. Phakathi kwazo, ukuhlukaniswa kwe-epronysic kuhlanganisa izinzuzo zokuhlukaniswa kwangaphambilini, kufaka izinhlobo ezine eziyisisekelo zokuqhekeka, futhi kufaka phakathi ama-sonon 4-part fractures kanye nokuqhekeka kwe-chaffer, kungaba yinkombandlela enhle yomsebenzi wezokwelapha.
1
Ukuhlukaniswa kwe-AO kulungele kahle ukuqhekeka kwe-distal radius futhi kuhlukanise ngezinhlobo ezintathu eziphambili: thayipha izinhlamvu ezingezona ze-acticular, nohlobo lwe-C okuyingxenye ye-Intra. Uhlobo ngalunye luhlukaniswe ngenhlanganisela ehlukene yama-subgroups ngokususelwa ebukhali nobunzima bokuqhekeka.
Thayipha A: Ukuqhekeka okwengeziwe kwe-acticular
I-A1, i-Ulnar Femoral Fracture, iRadius njengokulimala (A1.1, i-Ulnar Stem Fracture; A1.2 Ukuqhekeka okulula kwe-diaphysis ye-ulnar;
I-A2, ukwaphuka kwerediyo, elula, ene-inset (A2.1, irediyo ngaphandle kokutshekiswa; A2.2, ukuqubuka kwe-radius, ie, i-Palmar Sming ye-radius, a2.3, i-goireand-smith fracture).
I-A3, i-Fracture ye-radius, yathunyelwa (A3.1, ukufushanisa kwe-axis kwe-radius; A3.2 Ucezu olumiselwe khona lwe-radius;
Uhlobo B: Ukuqhekeka kwe-Atiracture okuyingxenye
I-B1, ukwaphuka kwerediyo, indiza yeSagittal (B1.1, uhlobo olulula; b1.2, uhlobo olubekiwe olubekiwe; B1.3, uhlobo lwe-Medial).
B2, ukwaphuka komugqa we-dorsal we-radius, okungukuthi, i-barton fracture (B2.1, uhlobo olulula; b2.2, ukuhlukaniswa okuhlanganisiwe kwe-sagittal;
I-B3, ukuqhekeka komugqa we-metacarpal we-radius, okungukuthi, ukuqhekeka kwe-anti-barton, noma uhlobo lohlobo lwe-goiren-smith II, b3.2, ukuqhekeka okulula, i-b3.3, ukuqhekeka okulula).
Thayipha C: Ingqikithi ye-Acticular Fracture
I-C1, i-radial fracture enohlobo olulula lwezindawo zokugcina ze-articular and metaphyeeal (C1.1, i-poterial articular fracture; C1.2, ukuqhekeka kwe-sagittal of articular komhlaba;
C2, i-radius fracture, isici esilula se-articular, i-metaphysis enezinto ezivulelweyo (C2.1, i-sagittal fracture ye-articular facet; c2.2, i-coronal facet fracture ye-articular facet;
I-C3, i-radial fracture, ebiyelwe (C3.1, ukwaphuka okulula kwe-metaphysis; C3.2, ukuqhekeka okwenziwe nge-metaphysis;
2.Classification of distal radius fractures.
Ngokusho kwendlela yokuhlukaniswa kwe-laension ye-feansiz ingahlukaniswa ngezinhlobo ezi-5 :.
Uhlobo I Fractures yilona ama-Metaphyer Metaphyeeal Metaphyeeal Fraftures afana ne-Colles Fractures (i-Dorsal Mongatur) noma i-Smith Fractures (I-MetaCarpal Intaba). I-cortex ye-cortex ye-bone ikhefu ngaphansi kwengxabano futhi i-cortex yama-cortex ye-corternex yathunyelwa futhi ishumeke.
Ukwaphuka
Uhlobo lwe-III Fractures yi-Intra-articular fractures, okubangelwa ukucindezelwa kwe-shear. Lokhu kuqhekeka kufaka ama-Palmar Barton Fractures, Dorsal Barton Fractures, kanye ne-Radial Stem Fractures.
Ukucindezela kwe-shear
Uhlobo lwe-III Fractures ngama-intra-articular fractures kanye nokuwohloka kwe-metaphyseal okubangelwa ukulimala kwe-compression, kufaka phakathi ukuphanga okuyinkimbinkimbi kwezinto eziyinkimbinkimbi kanye ne-radial Pilon Fractures.
Ukungenisa
Uhlobo lwe-IV Fracture ukuqhekeka kwe-ashulsion kokunamathiselwe okumnandi okwenzeka ngesikhathi sokuhlaselwa kokuhlaselwa kwe-radial carpal.
I-AVusion Fracture ngiyakwazisa
Thayipha v fracture kuvela ekulimaleni okuphezulu kwe-velocity okubandakanya amabutho angaphandle angaphandle kanye nokulimala kakhulu. (Kuxubile I, II, IIII, IV)
Ukuthayipha kwe-3.eponym
I-II.Treatted of distal radius fractures nge plamera plating
Izinkomba.
Ukuqhekeka okwengeziwe kwe-abricular kulandela ukwehluleka kokuncishiswa okuvaliwe kule mibandela elandelayo.
I-Dorsal Ingeraturation inkulu kune-20 °
Ukucindezelwa kwe-Dorsal kukhulu kune-5 mm
I-distal radius ifinyeza enkulu kune-3 mm
I-distal fracture block edonswayo enkulu kune-2 mm
Ukuqhekeka kwe-Intra-articular kungaphezu kokufuduka okungu-2mm
Iningi labafundi alincomi ukusetshenziswa kwamapuleti e-metacarpal ukulimala kwamandla aphezulu, njengokuhlaselwa okukhulu kwe-intra-articular arvicular fractures noma ukuncipha okukhulu kwamathambo, ngoba lezi zingcezwana ze-distal fracture zithambekele kwi-avascular necrosis futhi zinzima ukubekelwa kabusha nge-averascular.
Ezigulini ezinezingcezwana eziningi zokuphuka nokufuduka okuthe xaxa nge-osteoporosis enzima, i-metacarpal plating ayisebenzi. Ukuxhaswa kwe-subctondral of distal fractures kungaba yinkinga, njengokungena kwesikulufa ungene endaweni ehlanganisiwe.
Ubuchwepheshe obuhle
AmaSulumane ashelelayo asebenzisa indlela efanayo nenqubo yokulungisa i-distal radius fractures ngeplate yesundu. Kodwa-ke, inqubo enhle yokuhlinza ukugwema ngempumelelo izinkinga ze-postoperative, isb, ukuncishiswa kungatholakala ngokukhulula ibhulokhi yokuqhekeka kusuka ekucindezelweni okushumekiwe nokubuyisela ukuqhubeka kwethambo le-cortical. Ukulungiswa kwesikhashana nge-2-3 kirschner PINs kungasetshenziswa, njll.
(I) ukuphindaphinda okusebenzayo kanye nokuma
1. Ukuphonsa kwenziwa ngendlela ye-radial shaft ngaphansi kwe-fluoroscopy, ngesithupha ngokucindezela i-proximal fracture block phansi ukusuka ohlangothini lwe-plamer neminye iminwe ephakamisa ibhulokhi e-angle kusuka ohlangothini lwe-dorsal.
2. Isikhundla se-Supine, esinezinyawo ezithintekile etafuleni lesandla ngaphansi kwe-fluoroscopy.
(Ii) Amaphuzu wokufinyelela.
Ngohlobo lwendlela okufanele isetshenziswe, i-PCR (Radial Carpal Flevector) inconyelwe indlela ye-PALMAR.
Ukuphela kwe-distal kokuvela kwesikhumba kuqala ekukhohlisweni kwesikhumba kwesihlakala futhi ubude baso kunganqunywa ngokuya ngohlobo lokuqhekeka.
I-radial flexor carpi radialis tendon kanye ne-tendon sheath afakiwe, edelela emathanjeni e-carpal kanye ne-proximal eduze kohlangothi lweProximal ngangokunokwenzeka.
Ukudonsa i-radial carpal flexor tendon ohlangothini lwe-ulnar kuvikela i-nerve ye-median nerve.
Isikhala se-parona sidalulwa futhi i-anterior rotator ani umsipha itholakala phakathi kwe-flexer digitorum i-longuus (uhlangothi lwe-ulnar) kanye ne-radial artery (uhlangothi lwe-radial).
Vimbisa uhlangothi lwe-radial lomgwaqo we-rotator we-anti anti missur, ephawula ukuthi ingxenye kufanele ishiywe ifakwe kwirediyo yokwakhiwa kabusha kwakamuva.
Ukudonsa i-aterior rotator ani umsipha ohlangothini lwe-ulnar luvumela ukuvezwa okwengeziwe kophondo lwe-ulnar ohlangothini lwe-Palmar lwe-radius.
Indlela ye-Palmar iveza i-distal radius futhi iveze ngempumelelo i-angle ye-ulnar.
Ngezinhlobo eziyinkimbinkimbi zokuqhekeka, kunconywa ukuthi ukukhishwa kwe-distal brachioradialis Stop kungadedelwa, okungaphazamisa ukudonswa kwayo kwi-radial tubember, lapho i-Palmer Sheath ye-radius block radial kanye ne-radial turmaction, bese ushintshanisa i-radius yu ukuze uyikhiphe kusuka kusayithi le-fracture, bese usetha kabusha i-intra-articular I-Fracture Block usebenzisa i-Kirschner Pin. Okwezinkinga eziyinkimbinkimbi ze-intra-articular fractures, i-arthroscopy ingasetshenziselwa ukusiza ekwehlisweni, ekuhlolweni nasekuhlelweni okuhle kwe-fracture block.
(Iii) izindlela zokwehliswa.
1. Sebenzisa ithambo i-PRY njenge-lever ukuze usethe kabusha
2. Umsizi udonsa inkomba yesiguli kanye neminwe ephakathi, okuzoba lula ukusetha kabusha.
I-3. Screw the kirschner pin kusuka ku-radial tuberosity yokulungiswa kwesikhashana.
Ngemuva kokuhlongozwa kabusha, kufakwe ipuleti ye-PalmAS Uma lezi zimo zingafinyelelwanga, uma ipuleti ingelona usayizi ofanele, noma uma ukuphindwaphindwa kungagculisi, inqubo ayikaphelele.
Izinkinga eziningi zihlobene kakhulu nesikhundla sepuleti. Uma ipuleti libekwe kude kakhulu ohlangothini lwe-radial, izinkinga ezihlobene ne-bunion flexor kungenzeka zenzeke; Uma ipuleti libekwe eduze kakhulu kulayini wamanzi, i-flexer ejulile yomunwe ingaba sengozini. Ukukhubazeka okubangelwa yi-fracture kubuyiselwe e-Palmar Side kungenza kalula ipuleti liphumelele ohlangothini lwe-Palmar futhi liphinde lixhumane ngqo neFleveror Tendon, ekugcineni liholele ku-tendonitis noma ngisho nokuqhuma.
Ezigulini ze-osteoporotic, kunconywa ukuthi ipuleti libekwe eduze komugqa wamanzi ngangokunokwenzeka, kepha hhayi ngakuwo. Ukulungiswa kwe-SubChondral kungatholakala kusetshenziswa izikhonkwane zeKistschner eziseduzane ne-Ulna, kanye nezikhonkwane eziseceleni kwama-kirschner kanye nezikulufo ezikhiyiwe ziyasebenza ekugwemeni ukuphinda uphumelele.
Lapho ipuleti libekwe kahle, ukuphela kweProximal kulungiswe ngesikulufa esisodwa futhi ukuphela kwe-distal kwepuleti kulungiswe okwesikhashana ngezikhonkwane ze-kirschner emgodini we-ulnar. I-Intraoperative Fluoroscopic Orthopantomograms, ukubukwa okulandelayo, kanye namafilimu alandelanayo aphezulu okuphakanyiswa okungu-30 ° isihlakala athola ukuncishiswa kokuqhekeka kanye nesikhundla sokulungiswa kwangaphakathi.
Uma ipuleti selisekelwe ngokunelise, kepha i-kirschner pin iyi-interna-acticular, lokhu kuzoholela ekubuyiselweni okunganele kokuthambekela kwesundu, okungaxazululwa ngokusetha kabusha ipuleti kusetshenziswa "i-dig. 2, b).
Umdwebo 2.
A, izikhonkwane ezimbili ze-kirschner zokulungiswa kwesikhashana, qaphela ukuthi ukuthambekela kwe-metacarpal kanye nezindawo zokuhlobisa izindilinga azibuyiselwe ngokwanele ngalesi sikhathi;
B, i-pin eyodwa ye-kirschner yokulungiswa kwepuleti yesikhashana, qaphela ukuthi irestius ye-distal ilungiswe ngalesi sikhathi (isudi ye-distal fracture block fication), futhi ingxenye yeProximal yePlate idonswa esiqwini se-radial ukubuyisela i-angle ye-Palmar ukuze ubuyisele i-calmar tilt angle.
C, Ukucinishwa kwe-Arthroscopic okuhle kwezindawo ezibonakalayo, ukubekwa kwezikulufo ezikhiyiwe distal
Endabeni ye-dorsal dorsal kanye ne-ulnar fractures (i-ulnar / dorsal die punch), engenakusethwa kabusha ngokwanele ngaphansi kokuvalwa, amasu amathathu alandelayo angasetshenziswa.
I-Proximal Radius ijikeleze engaphandle kude nendawo yokuqhekeka, futhi i-fracture block yeLunate Fossa idonswa ethanjeni le-carpal ngokusebenzisa indlela ye-PCR eyandisa indlela; Ukuvela okuncane kwenziwa i-dorsal ku-4th ne-5th Compartments ukudalula ibhulokhi ye-fracture, futhi kulungiswe isikulufu esigabeni seplate ye-ulnar. Ukulungiswa okuvaliwe noma okuhlaselayo okuncane kwenziwa ngosizo lwe-arthroscopic.
Ngemuva kokuphakanyiswa okugculisayo nokubekwa kahle kwepuleti, ukulungiswa kokugcina kungukuphakanyiswa okulula futhi okuhlolisisayo kungatholakala uma i-proximal kernel pin ifakwe kahle futhi akukho zikhafu eziku-cavity okuhlangene (isithombe 2).
(iv) isipiliyoni sokukhetha isikulufa.
Ubude bezikulufo kungaba nzima ukukala ngokunembile ngenxa ye-cortical cortical bone crush kanzima. Izikulufo ezinde kakhulu zingaholela ekukhulekeni kwe-tendon futhi amafushane kakhulu ukusekela ukulungiswa kwebhlokhi le-dorsal fracture. Ngalesi sizathu abalobi batusa ukusetshenziswa kwezipikili ezikhiyiwe ezihlanganisiwe kanye nezinzipho ezikhiyiwe ze-multimaxial ku-radial Tuberoluty kanye ne-ulnar foramen, kanye nokusetshenziswa kwezikulungwane zokukhiya okukhanyayo ezikhundleni ezisele. Ukusetshenziswa kwekhanda eliqhakaza kugwema ukuphazamiseka kwe-tendon noma ngabe inomuzwa. Ngokulungiswa kwepuleti ye-proximal interlocking, izikulufo ezimbili ezihlanganisiwe + isikulufa esijwayelekile (esibekwe nge-ellipse) singasetshenziselwa ukulungiswa.
UDkt Kiyohito waseFrance wethule okuhlangenwe nakho kwabo kokusebenzisa amapuleti ahlaselayo e-Palsar evararius ukuqhekeka kwe-distal radius fractures, lapho ukufakwa kwabo okuhlinzwa kwancishiswa khona ku-1cm ngokweqile, okuphikisana. Le ndlela iboniswa ngokuyinhloko ku-distal radius radius fractures, futhi izinkomba zayo zokuhlinza zingezelelesi ezengeziwe ze-Ao izingxenyana zezinhlobo zezinhlobo ze-A2 kanye ne-A3 kanye ne-C2 Fractures ezihlanganiswe nokuwa kwesisindo se-Intra-articular bone. Indlela futhi ayilungele uhlobo lwe-B fractures. Ababhali baphinde bakhombe ukuthi uma ukuncipha okuhle nokulungiswa kungatholakali ngale ndlela, kuyadingeka ukushintshela kwindlela yendabuko yendabuko futhi unganamatheli ekuvuseleleni okuncane okuncane.
Isikhathi sePosi: Jun-26-2024
