Izindlela ezamukelekayo zokuphulukiswa kokuqhekeka kwe-humeral shaft yi-angionulation yangaphambili nengemuva engaphansi kwama-20°, i-angionulation eseceleni engaphansi kwama-30°, ukujikeleza okungaphansi kwama-15°, kanye nokufinyezwa okungaphansi kwama-3cm. Eminyakeni yamuva nje, njengoba kunesidingo esikhulayo sokusebenza kwezitho zangaphezulu kanye nokululama kwasekuqaleni empilweni yansuku zonke, ukwelashwa ngokuhlinzwa kokuqhekeka kwe-humeral shaft sekuvamile kakhulu. Izindlela ezijwayelekile zifaka phakathi i-anterior, anterolateral, noma posterior plating yokulungiswa kwangaphakathi, kanye ne-intramedullary nailling. Izifundo zibonisa ukuthi izinga lokungahlangani kokulungiswa kwangaphakathi kokunciphisa okuvulekile kwamaqhekeka e-humeral cishe liyi-4-13%, kanti ukulimala kwe-radial nerve kwenzeka cishe kuma-7% wamacala.
Ukuze kugwenywe ukulimala kwemizwa ye-radial radial okubangelwa yi-iatrogenic nokunciphisa izinga lokuncipha okuvulekile okungavumelani, izazi zasekhaya eShayina ziye zasebenzisa indlela ye-medial, zisebenzisa inqubo ye-MIPPO ukulungisa ukuphuka kwe-humeral shaft, futhi zithole imiphumela emihle.
Izinqubo zokuhlinzwa
Isinyathelo sokuqala: Ukuma. Isiguli silele silele phansi, umlenze othintekile ubanjwe ngama-degree angu-90 bese ubekwa etafuleni lokuhlinzwa eliseceleni.
Isinyathelo sesibili: Ukusika ngokuhlinzwa. Ekulungiseni okuvamile kwe-medial single-plate (i-Kanghui) kweziguli, kwenziwa ukusika okubili okude okungaba ngu-3cm ngakunye eduze kweziphetho ze-proximal kanye ne-distal. Ukusika kwe-proximal kusebenza njengomnyango we-partial deltoid kanye ne-pectoralis major approach, kuyilapho ukusika kwe-distal kutholakala ngaphezu kwe-medial epicondyle ye-humerus, phakathi kwe-biceps brachii kanye ne-triceps brachii.
▲ Umdwebo wesimiso wokusika okuseduze.
①: Ukusika ngokuhlinzwa; ②: Umthambo we-Cephalic; ③: I-Pectoralis major; ④: Imisipha ye-deltoid.
▲ Umdwebo wesimiso wokusika okukude.
①: Inzwa ephakathi; ②: Inzwa ye-Ulnar; ③: Imisipha ye-Brachialis; ④: Ukusika ngokuhlinzwa.
Isinyathelo sesithathu: Ukufakwa nokufakwa kwepuleti. Ipuleti lifakwa ngokusika okuseduze, linamathele ebusweni bethambo, lidlule ngaphansi komsipha we-brachialis. Ipuleti liqala liboshwe ekugcineni kokusika okuseduze komgodi we-humeral. Ngemva kwalokho, ngokudonsa okujikelezayo esithweni esingaphezulu, ukuphuka kuyavalwa futhi kuhambisane. Ngemva kokunciphisa okwanelisayo ngaphansi kwe-fluoroscopy, kufakwa isikulufu esijwayelekile ngokusika okukude ukuze kuqiniswe ipuleti ebusweni bethambo. Isikulufu esikhiyayo sibe sesiqiniswa, kuqedwe ukuqina kwepuleti.
▲ Umdwebo wesimiso womhubhe wepuleti ophakeme.
①: Imisipha ye-Brachialis; ②: Imisipha ye-Biceps brachii; ③: Imithambo yegazi kanye nemizwa ephakathi; ④: I-Pectoralis major.
▲ Umdwebo weskimu womhubhe wepuleti elikude.
①: Imisipha ye-Brachialis; ②: Inzwa ephakathi; ③: Inzwa ye-Ulnar.
Isikhathi sokuthunyelwe: Novemba-10-2023
