Imibandela eyamukelekayo yokuphulukiswa kokuphuka kwe-humeral shaft iwukuhlukaniswa kwe-anterior-posterior okungaphansi kuka-20°, i-angulation ehlangothini engaphansi kuka-30°, ukuzungezisa okungaphansi kuka-15°, kanye nokufinyezwa okungaphansi kuka-3cm. Eminyakeni yamuva nje, ngezidingo ezikhulayo zokusebenza kwesitho esiphezulu kanye nokululama kusenesikhathi ekuphileni kwansuku zonke, ukwelashwa ngokuhlinzwa kokuphuka kwe-humeral shaft sekuvame kakhulu. Izindlela ezijwayelekile zihlanganisa i-anterior, anterolateral, noma i-posterior plating yokulungiswa kwangaphakathi, kanye nokubethelwa kwe-intramedullary. Ucwaningo lubonisa ukuthi izinga le-nonnunion lokunciphisa okuvulekile ukulungiswa kwangaphakathi kwe-humeral fractures cishe i-4-13%, ngokulimala kwe-iatrogenic radial nerve okwenzeka cishe ku-7% wamacala.
Ukuze ugweme ukulimala kwe-iatrogenic radial nerve kanye nokunciphisa izinga lokungahlanganisi lokunciphisa okuvulekile, izazi zasekhaya eShayina zamukele indlela ephakathi, zisebenzisa inqubo ye-MIPPO ukulungisa ukuphuka kwe-humeral shaft, futhi zithole imiphumela emihle.
Izinqubo zokuhlinza
Isinyathelo sokuqala: Ukuma. Isiguli silele endaweni ephansi, isitho esithintekile sithunjwe ama-degree angama-90 futhi sibekwe etafuleni elingemuva lokusebenza.
Isinyathelo sesibili: Ukusika ngokuhlinzwa. Ekulungiseni okujwayelekile kwepuleti elilodwa eliphakathi (Kanghui) ezigulini, ukucutshungulwa okubili kwe-longitudinal cishe okungama-3cm ngakunye kwenziwa eduze neziphetho eziseduze nezikude. I-proximal incision isebenza njengomnyango wendlela enkulu ye-deltoid ne-pectoralis, kuyilapho i-distal incision itholakala ngaphezu kwe-epicondyle ephakathi ye-humerus, phakathi kwe-biceps brachii ne-triceps brachii.
▲ Umdwebo wohlelo lokusikwa okuseduze.
①: Ukusika ngokuhlinzwa; ②: Umthambo we-Cephalic; ③: I-Pectoralis enkulu; ④: Imisipha ye-deltoid.
▲ Umdwebo wohlelo lwe-distal incision.
①: Inzwa ye-Median; ②: I-Ulnar nerve; ③: Imisipha ye-Brachialis; ④: Ukusika ngokuhlinzwa.
Isinyathelo sesithathu: Ukufakwa kwepuleti nokulungiswa. Ipuleti lifakwa ngokusikwa okusondelene, linamathele endaweni yethambo, lidlule ngaphansi komsipha we-brachialis. Ipuleti liqinisekiswa kuqala ekugcineni kwe-humeral shaft fracture. Ngokulandelayo, ngokuzungeza okujikelezayo esithweni esingenhla, ukuphuka kuyavalwa futhi kuhambisane. Ngemva kokwehliswa okwanelisayo ngaphansi kwe-fluoroscopy, isikulufu esijwayelekile sifakwa nge-distal incision ukuze kuvikelwe ipuleti endaweni yethambo. Isikulufu sokukhiya sibe sesiqiniswa, kuqedelwa ukulungiswa kwepuleti.
▲ Umdwebo wohlelo lomhubhe wepuleti ophakeme.
①: Imisipha ye-Brachialis; ②: Imisipha ye-Biceps brachii; ③: Izitsha ezimaphakathi nezinzwa; ④: I-Pectoralis enkulu.
▲ Umdwebo wohlelo lomhubhe we-distal plate.
①: Imisipha ye-Brachialis; ②: Inzwa ye-Median; ③: I-Ulnar nerve.
Isikhathi sokuthumela: Nov-10-2023
