I-distal radius fractures ingenye yezinto ezivame kakhuluukuphukaekusebenzeni komtholampilo.Ngobuningi bokuphuka kwe-distal, imiphumela emihle yokwelapha ingatholwa ngepuleti le-palmar approach and screw fixation yangaphakathi.Ngaphezu kwalokho, kunezinhlobo ezahlukene ezikhethekile zokuqhekeka kwe-distal radius, njengokuphuka kwe-Barton, i-Die-punch fractures,Ukuphuka komshayeli wemoto, njll., ngayinye idinga izindlela ezithile zokwelapha.Izazi zakwamanye amazwe, ocwaningweni lwazo lwamasampula amakhulu ezigameko zokuqhekeka kwe-distal radius, ziye zahlonza uhlobo oluthile lapho ingxenye yejoyinti ihilela ukuhlukana kwe-distal radius, futhi izingcezu zamathambo zakha isakhiwo se-conical esinesisekelo "esinxantathu" (tetrahedron), okubizwa ngokuthi “i-tetrahedron” uhlobo.
Umqondo Wokuphuka Kohlobo Lwe-“Tetrahedron” I-Distal Radius Fracture: Kulolu hlobo lokuphuka kwerediyasi ekude, ukuphuka kwenzeka ngaphakathi kwengxenye yelunga, okuhlanganisa kokubili i-palmar-ulnar kanye ne-radial styloid facets, ngokucushwa kukanxantathu ophambanayo.Umugqa wokuphuka udlulela ekugcineni okude kwerediyasi.
Ukuhluka kwalokhu kuphuka kubonakala ezicini ezihlukile zezingcezwana zamathambo ohlangothini lwe-palmar-ulnar engaba.Ngakolunye uhlangothi, i-lunar fossa eyakhiwe yilezi zingcezu zethambo eziseceleni ze-palmar-ulnar isebenza njengokwesekwa ngokomzimba ngokumelene nokukhishwa kwe-volar kwamathambo e-carpal.Ukulahlekelwa ukwesekwa okuvela kulesi sakhiwo kubangela ukugudluka kwe-volar kwelunga lesihlakala.Ngakolunye uhlangothi, njengengxenye ye-distal radioulnar joint's radial articular surface, ukubuyisela lesi siqeshana sethambo endaweni yalo ye-anatomical kuyimfuneko yokubuyisela ukuzinza ekuhlanganyeleni kwe-distal radioulnar.
Isithombe esingezansi sibonisa Ikesi 1: Ukubonakaliswa kwezithombe zohlobo olujwayelekile lwe-“Tetrahedron” yokuphuka kweradiyasi ehlukene.
Ocwaningweni oluthathe iminyaka emihlanu, kutholakale izehlakalo eziyisikhombisa zalolu hlobo lokuphuka.Ngokuphathelene nezinkomba zokuhlinzwa, ezimweni ezintathu, kufaka phakathi I-Case 1 esithombeni esingenhla, lapho ekuqaleni kwakukhona ukuphuka okungasuswanga, ukwelashwa okulondolozayo kwakhethwa ekuqaleni.Kodwa-ke, ngesikhathi sokulandelela, wonke amacala amathathu abhekana nokususwa kwe-fracture, okuholela ekuhlinzekweni kokulungiswa kwangaphakathi okwalandela.Lokhu kuphakamisa izinga eliphezulu lokungazinzi kanye nengozi enkulu yokuguqulwa kabusha ekuqhekekeni kwalolu hlobo, kugcizelela inkomba eqinile yokungenelela kokuhlinzwa.
Ngokuphathelene nokwelashwa, izimo ezimbili ekuqaleni zabhekana nendlela yendabuko ye-volar nge-flexor carpi radialis (FCR) yepuleti nesikulufu ukulungiswa kwangaphakathi.Kwesinye salezi zimo, ukulungiswa kwehlulekile, okuholele ekususweni kwethambo.Kamuva, kwasetshenziswa indlela ye-palmar-ulnar, futhi ukulungiswa okuthile ngepuleti yekholomu kwenziwa ukuze kubuyekezwe ikholomu emaphakathi.Ngemva kokwenzeka kokwehluleka ukulungisa, amacala amahlanu alandelayo wonke ahamba ngendlela ye-palmar-ulnar futhi alungiswa ngamapuleti angu-2.0mm noma angu-2.4mm.
Icala lesi-2: Ukusebenzisa indlela evamile ye-volar ne-flexor carpi radialis (FCR), ukulungiswa ngepuleti lesundu kwenziwa.Ngemva kokuhlinzwa, kwabonwa ukugudluka kwangaphambili kwesihlakala, okubonisa ukwehluleka ukulungisa.
Odabeni 2, ukusebenzisa indlela ye-palmar-ulnar kanye nokubukeza ngepuleti lekholomu kuphumele endaweni egculisayo yokulungiswa kwangaphakathi.
Uma kucatshangelwa ukushiyeka kwamapuleti ajwayelekile e-distal radius fracture ekulungiseni lesi siqeshana sethambo, kunezinto ezimbili eziyinhloko.Okokuqala, ukusetshenziswa kwendlela ye-volar ne-flexor carpi radialis (FCR) kungase kubangele ukuchayeka okwanele.Okwesibili, usayizi omkhulu wezikulufu zepuleti lokukhiya isundu ungase ungavikeli ngokunembile izingcezu zamathambo amancane futhi ungaba namandla wokuwasusa ngokufaka izikulufu ezikhaleni phakathi kwezingcezu.
Ngakho-ke, izazi ziphakamisa ukuthi kusetshenziswe amapuleti okukhiya angu-2.0mm noma angu-2.4mm ukuze kulungiswe okuthile ucezu lwethambo lekholomu emaphakathi.Ngaphezu kwepuleti elisekelayo, ukusebenzisa izikulufu ezimbili ukulungisa ucezu lwethambo nokwenza ipuleti libe maphakathi ukuze uvikele izikulufu kuphinde kube enye inketho yokulungisa yangaphakathi.
Kulesi simo, ngemva kokulungisa ucezu lwethambo ngezikulufu ezimbili, ipuleti lafakwa ukuze kuvikelwe izikulufu.
Kafushane, uhlobo lwe-“Tetrahedron” uhlobo lwe-distal radius fracture lubonisa izici ezilandelayo:
1. Izehlakalo eziphansi ezinenani eliphezulu lokungaxilongwa kahle kwefilimu engenalutho.
2. Ingozi enkulu yokungazinzi, nokuthambekela kokushintshwa kabusha ngesikhathi sokwelashwa okuvamile.
3. Amapuleti ajwayelekile okukhiya ama-palmar okuphuka kwe-distal radius anamandla okulungisa abuthakathaka, futhi kunconywa ukusebenzisa amapuleti okukhiya angu-2.0mm noma angu-2.4mm ukuze kulungiswe okuthile.
Njengoba kunikezwe lezi zici, ekusebenzeni komtholampilo, kuyatuseka ukwenza ama-CT scan noma ukuhlolwa kabusha ngezikhathi ezithile ezigulini ezinezimpawu eziphawulekayo zesihlakala kodwa ama-X ray angemahle.Ukuze lolu hloboukuphuka, ukungenelela kokuhlinzwa kusenesikhathi ngepuleti eliqondene nekholomu kunconywa ukuvimbela izinkinga kamuva.
Isikhathi sokuthumela: Oct-13-2023
