Ukuqhekeka kwe-Transvere ngokuxoshwa okuncane noma okungekho I-proximal phalanx iguquguquka kakhulu ukudalula ikhanda le-metacarpal. I-0.5- 1 cm ye-transver Ngaphansi kokuholwa kwe-fluoroscopic, sifake i-1.0 mm Guide Wire eduze kwe-axis endeitudinal yesandla. Ithiphu yomhlahlandlela yayiqhume ukuze igweme ukungena kwe-cortical kanye nokwenza lula ukuslayida ngaphakathi komsele we-medullary. Ngemuva kokuthi isikhundla somhlahlandlela sinqunyelwe ama-fluorooscopically, ipuleti le-subctondral mbone lavuselelwa kusetshenziswa kuphela umshayeli ongenalutho. Ubude obufanelekile besikulungisa babalwa kusuka ezithombeni zokusebenzisana. Esikhathini esiningi se-metacarpal, ngaphandle kwe-metacarpal yesihlanu, sisebenzisa isikulufa sobubanzi be-3.0-mm. Sisebenzise izikulufa ezingenalutho ezingenazinhlekelele ezingenamakhanda (amathambo amancane amabi, uMorrisville, PA). Lokhu kufushane kunobude obuphakathi we-metacarpal bone (cishe ngo-6.0 cm), kepha isikhathi eside ngokwanele ukubandakanya imicu eMedulla ukuthola ukulungiswa okuphephile kwesikulufa. Ububanzi be-medullary cavity ye-metacarpal yesihlanu imvamisa bukhulu, futhi lapha sisebenzise isikulufa se-4.0 mm ngesilinganiso esifinyelela ku-50 mm. Ekupheleni kwenqubo, siqinisekisa ukuthi intambo ye-caudal ingcwatshwa ngokuphelele ngaphansi komugqa we-cartilage. Ngakolunye uhlangothi, kubalulekile ukugwema ukuhlanganisa i-prosthesis ngokujulile, ikakhulukazi esimweni sokuqhekeka kwentamo.
I-Fig. 14 Ku-A, ukuqhekeka kwentamo ejwayelekile akukaze kuthunyelwe futhi ikhanda lidinga ukujula okuncane njengoba i-Bortex ye-B izocindezelwa
Indlela yokuhlinzwa ye-transverver ye-proximal phalanx yayifana (Fig. 15). Senze ukuvela okuguqukayo kwe-0 Ama-tendon ahlukaniswe futhi atholwa ngokuhamba kwesikhathi ukuze adalule inhloko yePhalal Phalanx. Okokuphazamiseka okuningi kwe-proximal phalanx, sisebenzisa isikulufa esingu-2,5 mm, kepha ngama-phalanges amakhulu sisebenzisa isikulufa se-3.0 mm. Ubude obukhulu bama-2,5 mm Chs asetshenziswa njengamanje ngu-30 mm. Siyazinakekela ukungaqiniseki izikulufa. Njengoba izikulufo ziziqhenya futhi zizishaya ngokuzishaya, zingangena kwisisekelo se-phalanx ngokumelana okuncane. Kwasetshenziselwa inqubo efanayo ye-midphalangeal pharacering fractures, ngokuqhamuka ekhanda le-midphalangeal phalanx ukuvumela ukubekwa kabusha kwezikuluzo.
I-Fig. I-15 Ukubukwa okungaphakathi kwe-Intraperative ye-Planversex Case.Aa 1-mm umhlahlandlela wafakwa nge-excation encane eguqukayo eceleni kwe-proximal phalanx.B Umhlahlandlela wanoma yikuphi ukujikeleza kwe- Ngenxa yesimo esithile sama-phalanges, ukucindezela kungahle kuholele ekuhlukanisweni kwe-metacarpal cortex. (Isiguli esifanayo njengaseMfanekiso 8)
Ama-fractures ahlanganisiwe: Ukucindezelwa okungasekelwa ngesikhathi sokufakwa kwe-CHS kungaholela ekunciphiseni kwemetacarpals nama-phalanges (Fig. 16). Ngakho-ke, naphezu kweqiniso lokuthi ukusetshenziswa kwama-CHS kuvunyelwe ezimweni ezinjalo, sithole isisombululo sezimo ezimbili ezivame kakhulu esibhekana nazo.
Umdwebo 16 AC Uma ukuqhekeka kungasekelwa, ukuqinisa izikulufo kuzoholela ekuweni kwe-Fracture naphezu kokunciphisa okuphelele kochungechunge lwe- (5 mm). Umugqa obomvu uhambelana nomugqa wemetacarpal.
Ukuze uthole ama-subretacarpal fractures, sisebenzisa inqubo eguquliwe ngokususelwa emcabangweni wezakhiwo wokufaka amafasithi Ngokwakha i-y-shape ngezikulufo ezimbili, inhloko ye-metacarpal ayihlali; saqamba leli st-shake brace. Njengasendleleni edlule, i-1.0 mm onditudinal umhlahlandlela we-wire ngethiphu e-blunt ifakiwe. Ngenkathi kufakwa ubude obufanele be-metacarpal, elinye isiqondisi sentambo lifakiwe, kodwa engela ku-angle ku-wire yomhlahlandlela wokuqala, ngaleyo ndlela wakhe isakhiwo esingunxantathu. Bobabili abaqondisayo banwetshwa besebenzisa i-counterink eqondiswayo yokwandisa i-medulla. Ngezikulufo ezi-axial ne-oblique, sivame ukusebenzisa izikulufo ezingama-3.0 mm nezinkulungwane ezingama-2,5 mm, ngokulandelana. Isikulufa se-axial sifakwa okokuqala kuze kube yilapho intambo ye-caudal ineveli nge-cartilage. Isikulufu se-offset sobude esifanele sifakiwe. Njengoba kungekho gumbi elanele e-Medullary Canal ngezikulufo ezimbili, ubude bezikulufo ezihlanganayo zidinga ukubalwa ngokucophelela, futhi izikulufo ezi-axizial kufanele ziboshwe kuphela kuma-axial screws uma zingcwatshwe ngekhanda le-metacarpal ukuze ziqinisekise ukuqina okulungile ngaphandle kwesikulufa. Isikulufa sokuqala sithuthukile phambili kuze kube yilapho sengcwatshwe ngokuphelele. Lokhu kugwema ukuncishiswa kwe-metacarpal kanye nokuwa kwekhanda, okungavinjelwa ngezikulufo ezi-oblique. Senza izivivinyo ze-fluorooscopic ezijwayelekile ukuqinisekisa ukuthi ukuwa akwenzeki nokuthi izikulufo zixhumeke ngaphakathi komsele we-medullary (Fig. 17).
Umdwebo 17 AC Y-Bracket Technology
Lapho ukuqondiswa kuthinta i-cortex ye-dorsal esisekelweni se-proximal phalanx, sakha indlela elungisiwe; Sikuqambe igama elithi axial ngoba isikulufa senza njengogongolo ngaphakathi kwe-phalanx. Ngemuva kokusetha kabusha i-Phalanx yeProximal Phalanx, i-axial Guide Wire yangeniswa kwi-Medullary Canal njenge-Dorsally ngangokunokwenzeka. I-CHS emfushane kancane kune-Phalanx (2,5 noma i-3.0 mm) ifakwe kuze kube yilapho isiphetho sayo sangaphandle sihlangabezana nepuleti elingaphansi kwe-phalanx. Ngalesi sikhathi, imicu ye-caudal yesikulufa ikhiyiwe emgodini we-medullary, ngaleyo ndlela yenza njengokuxhaswa kwangaphakathi futhi ifake izisekelo ze-phalanx. Izivivinyo eziningi ze-fluoroscopic ziyadingeka ukuvikela ukungena ngokuhlanganyela (Umdwebo we-18). Ngokuya ngephethini yokuphuka, ezinye izikulufa noma ukuhlanganiswa kwamadivayisi angaphakathi kokulungiswa kungadingeka (Umdwebo we-19).
Umdwebo 19: Izindlela ezahlukahlukene zokulungiswa ezigulini ezinokulimala okuchotshoziwe. Ukuqhekeka okukhulu kwe-submetacarpal komunwe wendandatho ngokudilizwa komunwe ophakathi nendawo (i-arver ephuzi ekhomba indawo yomunwe osusiwe) Ngemithombo ethambile yezicubu ze- Ithambo le-metacarpal lomunwe omncane liphulukiswe. Ezinye izihlwathi zamathambo zakha kwenye indawo, zibonisa ukuphulukiswa kokwephulwa kwesibili.d ngonyaka owodwa ngemuva kwengozi, kwasuswa indwangu; Yize i-asymptomatic, isikulufa sasuswa ku-metacarpal yomunwe wendandatho ngenxa yokusola okusolwayo okusolisayo. Imiphumela emihle (≥240 ° tam) yatholakala emculweni ngamunye ekuhambeleni kokugcina.
Fig. 20 Ukuqhekeka komunwe wenkomba ngesandiso se-intra-articular (esiboniswe yimicibisholo), okwakhelwa ukuguquguquka kwesikhashana kwe-K-Activation Screen Screen of Acticulation Screen.e, Uhla lwe-Motion asebenzayo emavikini ama-3 (imicibisholo umaka amaphuzu Ukungena kwezikulufo ezi-basal)
I-Fig. 21 ngemuva kwama-radiostatic ama-radiostatic ama-radiographs asolwandle ayisiguli a. Amahlaya amathathu esiguli (emicibishini) aphathwa ngezikulufo ezi-2,5-mm. Azikho izinguquko ezibalulekile kumajoyinti we-interphalangeal ezabonakala ngemuva kweminyaka emi-2
Isikhathi Sokuposa: Sep-18-2024
