Ukuqhekeka kwe-distal radius kungenye yezinto ezivame kakhuluukuphukaemtholampilo. Eziningini zokuphuka kwe-distal, imiphumela emihle yokwelapha ingatholakala ngokusebenzisa i-palmar approach plate kanye ne-screw internal fixation. Ngaphezu kwalokho, kunezinhlobo ezahlukene ezikhethekile zokuphuka kwe-distal radius, njenge-Barton fractures, i-Die-punch fractures,Ukuphuka komshayeli, njll., ngayinye idinga izindlela ezithile zokwelapha. Izazi zakwamanye amazwe, ezifundweni zazo zamasampula amakhulu ezimo zokuphuka kwe-distal radius, zibone uhlobo oluthile lapho ingxenye yelunga ihilela ukuphuka kwe-distal radius, kanti izingcezu zamathambo zakha isakhiwo esiyindilinga esinesisekelo "esingunxantathu" (i-tetrahedron), esibizwa ngokuthi uhlobo "lwe-tetrahedron".
Umqondo Wokuqhekeka Kwe-Distal Radius Uhlobo “lwe-Tetrahedron”: Kulolu hlobo lokuqhekeka kwe-distal radius, ukuqhekeka kwenzeka ngaphakathi kwengxenye yejoyinti, okubandakanya kokubili izinhlangothi ze-palmar-ulnar kanye ne-radial styloid, kanye nokwakheka okuyisicaba okuphambene. Umugqa wokuqhekeka ufinyelela ekugcineni kwe-distal ye-radius.
Ukuhluka kwalokhu kuphuka kubonakala ezicini ezihlukile zezingcezu zethambo eliseceleni le-palmar-ulnar ze-radius. Ngakolunye uhlangothi, i-lunar fossa eyakhiwe yizingcezu zethambo eliseceleni le-palmar-ulnar isebenza njengokusekelwa ngokomzimba ngokumelene nokuhlukana kwe-volar kwamathambo e-carpal. Ukulahlekelwa ukwesekwa kulesi sakhiwo kuholela ekuhlukaneni kwe-volar kwejoyinti lesihlakala. Ngakolunye uhlangothi, njengengxenye yendawo ebanzi ye-radial articular yejoyinti le-distal radioulnar, ukubuyisela lesi singcezu sethambo esimweni saso somzimba kuyimfuneko yokubuyisela ukuzinza kwejoyinti le-distal radioulnar.
Isithombe esingezansi sibonisa icala 1: Ukubonakaliswa kwezithombe zokuphuka kwe-distal radius ejwayelekile yohlobo lwe-“Tetrahedron”.
Esifundweni esithathe iminyaka emihlanu, kwatholakala amacala ayisikhombisa alolu hlobo lokuphuka. Ngokuphathelene nezinkomba zokuhlinzwa, ezimweni ezintathu, okuhlanganisa neSigaba 1 esithombeni esingenhla, lapho ekuqaleni kwakukhona khona ukuphuka okungasuswanga endaweni, ukwelashwa okulondolozayo kwakhethwa ekuqaleni. Kodwa-ke, ngesikhathi sokulandelela, wonke amacala amathathu abhekana nokuqhekeka kokuphuka, okwaholela ekuhlinzweni okulandelayo kokulungiswa kwangaphakathi. Lokhu kusikisela izinga eliphezulu lokungazinzi kanye nengozi enkulu yokuphinde kususwe endaweni yokuphuka kwalolu hlobo, okugcizelela inkomba enamandla yokungenelela kokuhlinzwa.
Ngokuphathelene nokwelashwa, amacala amabili ekuqaleni asebenzisa indlela yendabuko ye-volar nge-flexor carpi radialis (FCR) yokubopha ipuleti kanye ne-screw internal fixation. Kwesinye salezi zimo, ukubopha kwehlulekile, okwaholela ekususweni kwamathambo. Ngemva kwalokho, kwasetshenziswa indlela ye-palmar-ulnar, futhi ukubopha okuthile ngepuleti lekholomu kwenziwa ukuze kubuyekezwe ikholomu ephakathi. Ngemva kokwenzeka kokwehluleka kokubopha, amacala amahlanu alandelayo wonke asebenzisa indlela ye-palmar-ulnar futhi alungiswa ngamapuleti angu-2.0mm noma angu-2.4mm.
Icala 2: Kusetshenziswa indlela evamile ye-volar ene-flexor carpi radialis (FCR), kwenziwa ukulungiswa nge-palmar plate. Ngemva kokuhlinzwa, kwabonakala ukuhlukana kwangaphambi kwesihlanganisi sesihlakala, okubonisa ukwehluleka kokulungiswa.
Esimweni sesi-2, ukusebenzisa indlela ye-palmar-ulnar kanye nokubuyekeza nge-column plate kuholele endaweni eyanelisayo yokufakwa kwangaphakathi.
Uma ubheka ukushiyeka kwamapuleti okuphuka kwe-distal radius evamile ekulungiseni lesi siqeshana sethambo, kunezinkinga ezimbili eziyinhloko. Okokuqala, ukusetshenziswa kwendlela ye-volar nge-flexor carpi radialis (FCR) kungabangela ukuvezwa okunganele. Okwesibili, usayizi omkhulu wezikulufo ze-palmar-locking plate kungenzeka zingaziqinisi izingcezu ezincane zamathambo futhi zingase zizisuse ngokufaka izikulufo ezikhaleni eziphakathi kwezingcezu.
Ngakho-ke, izazi ziphakamisa ukusetshenziswa kwamapuleti okukhiya angu-2.0mm noma angu-2.4mm ukuze kuqiniswe ingcezu yethambo lekholomu ephakathi. Ngaphezu kwepuleti elisekelayo, ukusebenzisa izikulufo ezimbili ukulungisa ingcezu yethambo kanye nokunciphisa ipuleti ukuze kuvikelwe izikulufo nakho kuyindlela ehlukile yokuqinisa yangaphakathi.
Kulesi simo, ngemva kokulungisa ingxenye yethambo ngezikulufo ezimbili, ipuleti lafakwa ukuze livikele izikulufo.
Ngamafuphi, ukuphuka kwe-distal radius yohlobo lwe-"Tetrahedron" kubonisa izici ezilandelayo:
1. Ukwanda okuphansi kanye nesilinganiso esiphezulu sokuhlonza okungalungile kokuqala kwefilimu ecacile.
2. Ingozi ephezulu yokungazinzi, kanye nokuthambekela kokuphinde kuthuthwe ngesikhathi sokwelashwa okulondolozayo.
3. Amapuleti okukhiya esundu avamile okuphuka kwe-distal radius anamandla okuqina abuthakathaka, futhi kunconywa ukusebenzisa amapuleti okukhiya angu-2.0mm noma angu-2.4mm ukuze kuqiniswe okuthile.
Ngenxa yalezi zici, emtholampilo, kuyalulekwa ukwenza ama-CT scan noma ukuhlolwa kabusha njalo kweziguli ezinezimpawu ezibalulekile zengalo kodwa ezine-X-ray engemihle. Kulolu hlobo lwe-ukwaphuka, ukungenelela kokuhlinzwa kusenesikhathi ngepuleti eliqondene nekholomu kuyanconywa ukuvimbela izinkinga kamuva.
Isikhathi sokuthunyelwe: Okthoba-13-2023
