Ukuphuka okuphambene nokuphazamiseka okuncane noma okungenakho nhlobo: uma kwenzeka ukuphuka kwethambo le-metacarpal (intamo noma i-diaphysis), kuqalwe kabusha ngokudonswa ngesandla. I-proximal phalanx igobeka kakhulu ukuze iveze ikhanda le-metacarpal. Kwenziwa ukusika okuphambene okungu-0.5-1 cm bese i-extensor tendon ihoxiswa ngobude phakathi komugqa. Ngaphansi kwesiqondiso se-fluoroscopic, sifake ucingo lokuqondisa oluyi-1.0 mm eceleni kwe-axis ende yesihlakala. Isihloko socingo lokuqondisa saqiniswa ukuze kugwenywe ukungena kwe-cortical futhi kube lula ukushelela ngaphakathi komsele we-medullary. Ngemva kokuba isikhundla socingo lokuqondisa sitholwe nge-fluoroscopically, ipuleti lethambo le-subchondral lalungiswa kabusha kusetshenziswa i-hollow drill bit kuphela. Ubude besikulufu obufanele babalwa kusukela ezithombeni zangaphambi kokuhlinzwa. Ezindaweni eziningi zokuphuka kwe-metacarpal, ngaphandle kwe-metacarpal yesihlanu, sisebenzisa isikulufu esinobubanzi obuyi-3.0-mm. Sisebenzise izikulufo ezingenalutho ezingenamakhanda ze-AutoFIX (i-little Bone Innovations, i-Morrisville, i-PA). Ubude obuphezulu obungasetshenziswa besikulufo esingu-3.0-mm bungu-40 mm. Lokhu kufushane kunobude obujwayelekile bethambo le-metacarpal (cishe u-6.0 cm), kodwa bude ngokwanele ukuhlanganisa imicu ku-medulla ukuze kutholakale ukuqina okuqinile kwesikulufo. Ububanzi besikulufo se-medullary se-metacarpal yesihlanu buvame ukuba bukhulu, futhi lapha sisebenzise isikulufo esingu-4.0 mm esinobubanzi obuphezulu obufika ku-50 mm. Ekupheleni kwenqubo, siqinisekisa ukuthi intambo ye-caudal igqitshwe ngokuphelele ngaphansi komugqa we-cartilage. Ngokuphambene nalokho, kubalulekile ukugwema ukufaka i-prosthesis ngokujulile kakhulu, ikakhulukazi uma kwenzeka ukuphuka kwentamo.
Isithombe 14 Ku-A, ukuphuka kwentamo okuvamile akukaqedwa futhi ikhanda lidinga ukujula okuncane njengoba i-B cortex izocindezelwa
Indlela yokuhlinzwa yokuphuka okuphambene kwe-proximal phalanx yayifana (Isithombe 15). Senze ukusika okuphambene okungu-0.5 cm ekhanda le-proximal phalanx ngenkathi sigoba kakhulu ijoyinti le-proximal interphalangeal. Imisipha yahlukaniswa futhi yahoxiswa ngobude ukuze iveze ikhanda le-proximal phalanx. Eziningi zezaphuka ze-proximal phalanx, sisebenzisa isikulufu esingu-2.5 mm, kodwa kuma-phalange amakhulu sisebenzisa isikulufu esingu-3.0 mm. Ubude obukhulu be-2.5 mm CHS esetshenziswa njengamanje ngu-30 mm. Siyaqikelela ukuthi asiziqinisi kakhulu izikulufu. Njengoba izikulufu zizibhoboza futhi zizithinta, zingangena phansi kwe-phalanx ngokumelana okuncane. Indlela efanayo yasetshenziswa ekuqhekekeni kwe-midphalangeal phalangeal, lapho ukusika kuqala ekhanda le-midphalangeal phalanx ukuze kuvunyelwe ukubekwa kwezikulufu emuva.
Isithombe 15 Umbono wokuhlinzwa wekesi le-phalanx eliphambene. Ucingo lokuqondisa lwe-AA oluyi-1 mm lubekwe nge-incision encane ephambene eceleni kwe-axis ende ye-phalanx eseduze. B Ucingo lokuqondisa lubekwe ukuvumela ukulungiswa kahle kokubekwa kabusha nokulungiswa kwanoma yikuphi ukujikeleza. I-CA 2.5-mm CHS ifakiwe futhi yangcwatshwa ekhanda. Ngenxa yesimo esithile sama-phalanges, ukucindezela kungabangela ukuhlukaniswa kwe-cortex ye-metacarpal. (Isiguli esifanayo njengaseMfanekisweni 8)
Ukuqhekeka okuhlanganisiwe: ukucindezelwa okungasekelwa ngesikhathi sokufakwa kwe-CHS kungaholela ekufinyezweni kwama-metacarpals nama-phalanges (Isithombe 16). Ngakho-ke, naphezu kokuthi ukusetshenziswa kwe-CHS ngokwesimiso akuvunyelwe ezimweni ezinjalo, sithole ikhambi lezimo ezimbili ezivame kakhulu esibhekene nazo.
ISITHOMBE 16 AC Uma ukwaphuka kungasekelwa ngendlela ye-cortical, ukuqinisa izikulufu kuzoholela ekuqhekekeni kokuqhekeka naphezu kokuncipha okuphelele.D Izibonelo ezijwayelekile ezivela ochungechungeni lwababhali ezihambisana namacala okufinyezwa okuphezulu (5 mm). Umugqa obomvu uhambelana nomugqa we-metacarpal.
Ngokuqhekeka kwe-submetacarpal, sisebenzisa indlela eguquliwe esekelwe emcabangweni wokwakha we-bracing (okungukuthi, izakhi zesakhiwo ezisetshenziselwa ukusekela noma ukuqinisa uhlaka ngokumelana nokucindezelwa kwe-longitudinal ngaleyo ndlela zilusekele). Ngokwakha isimo se-Y ngezikulufo ezimbili, ikhanda le-metacarpal aliwi; siqambe lokhu ngokuthi i-brace enesimo se-Y. Njengasendleleni yangaphambilini, kufakwa ucingo lokuqondisa oluyi-1.0 mm olunesihloko esibuthuntu. Ngenkathi kugcinwa ubude obufanele be-metacarpal, kufakwa olunye ucingo lokuqondisa, kodwa nge-engela yentambo yokuqondisa yokuqala, ngaleyo ndlela kwakhiwe isakhiwo esingunxantathu. Zombili izintambo zokuqondisa zandiswa kusetshenziswa i-countersink eqondiswayo ukuze kwandiswe i-medulla. Ngezikulufo ze-axial neze-oblique, sivame ukusebenzisa izikulufo ezinobubanzi obungu-3.0 mm no-2.5 mm, ngokulandelana. Isikulufo se-axial sifakwa kuqala kuze kube yilapho intambo ye-caudal ilingana ne-cartilage. Isikulufo esiphambene sobude obufanele sibe sesifakwa. Njengoba kungekho ndawo eyanele emgodini we-medullary wezikulufo ezimbili, ubude bezikulufo ezigobile budinga ukubalwa ngokucophelela, futhi izikulufo ezigobile kufanele zixhunywe kuphela ezikulufo ezigobile uma sezingcwatshwe ngokwanele ekhanda le-metacarpal ukuqinisekisa ukuzinza okwanele ngaphandle kokuvela kwesikulufo. Isikulufo sokuqala sibe sesiqhubekela phambili kuze kube yilapho singcwatshwe ngokuphelele. Lokhu kugwema ukufinyezwa kwe-axial kwe-metacarpal kanye nokuwa kwekhanda, okungavinjelwa ngezikulufo ezigobile. Senza ukuhlolwa kwe-fluoscopic njalo ukuqinisekisa ukuthi ukuwa akwenzeki nokuthi izikulufo zixhumene ngaphakathi komsele we-medullary (Isithombe 17).
Ubuchwepheshe be-AC Y-bracket Umfanekiso 17
Lapho ukuguquka kuthinta i-dorsal cortex esisekelweni se-proximal phalanx, sakha indlela eguquliwe; sayiqamba ngokuthi i-axial bracing ngoba isikulufu sisebenza njengogongolo ngaphakathi kwe-phalanx. Ngemva kokusetha kabusha i-proximal phalanx, ucingo lokuqondisa lwe-axial lwafakwa emseleni we-medullary ngangokunokwenzeka. I-CHS emfushane kancane kunobude obuphelele be-phalanx (2.5 noma 3.0 mm) ifakwa kuze kube yilapho isiphetho sayo sangaphambili sihlangana nepuleti le-subchondral esisekelweni se-phalanx. Kuleli qophelo, izintambo ze-caudal zesikulufu zikhiywa emseleni we-medullary, ngaleyo ndlela zisebenza njengokusekela kwangaphakathi futhi ziqinise isisekelo se-phalanx. Kudingeka ukuhlolwa okuningi kwe-fluoroscopic ukuvimbela ukungena kwamalunga (Isithombe 18). Kuye ngephethini yokuphuka, kungadingeka ezinye izikulufo noma inhlanganisela yamadivayisi okuqinisa angaphakathi (Isithombe 19).
Isithombe 19: Izindlela ezahlukene zokulungisa iziguli ezinezinhlungu ezibuhlungu. Ukuphuka okukhulu kwe-submetacarpal okuhlanganisiwe komunwe wendandatho kanye nokuhlukana okuhlanganisiwe kwesisekelo somunwe ophakathi (umcibisholo ophuzi okhomba indawo yokuphuka okuhlanganisiwe). B Kusetshenziswe i-CHS ejwayelekile engu-3.0 mm yomunwe wokukhomba, i-paracentesis engu-3.0 mm yomunwe ophakathi ohlanganisiwe, ukusekelwa okungu-y komunwe wendandatho (kanye nokufakelwa kwesici kwesigaba esisodwa), kanye ne-CHS engu-4.0 mm yomunwe opinki. F Ama-Free flaps asetshenziselwa ukumbozwa kwezicubu ezithambile. C Ama-Radiographs ezinyangeni ezingu-4. Ithambo le-metacarpal lomunwe omncane laphola. Amanye ama-scabs ethambo akheka kwenye indawo, okubonisa ukuphulukiswa kokuphuka kwesibili. D Ngonyaka owodwa ngemuva kwengozi, i-flap yasuswa; yize ingenazimpawu, isikulufu sasuswa ku-metacarpal yomunwe wendandatho ngenxa yokungena okusolwayo kwangaphakathi kwe-articular. Imiphumela emihle (≥240° TAM) itholakale kumunwe ngamunye ekuvakasheni kokugcina. Izinguquko esihlanganyelweni se-metacarpophalangeal somunwe ophakathi zabonakala ezinyangeni ezingu-18.
Isithombe 20 Ukuphuka komunwe wokukhomba onesandiso sangaphakathi (okuboniswa yimicibisholo), okwaguqulwa kwaba ukuphuka okulula ngokufakwa kwesikhashana kwe-articular break kusetshenziswa i-K-wire.C Lokhu kwakha isisekelo esizinzile lapho kwafakwa khona isikulufu esisekelayo eside.D Ngemva kokufakwa, ukwakheka kwahlulelwa njengokuzinzile, okuvumela ukunyakaza okusebenzayo ngokushesha.E,F Ububanzi bokunyakaza emavikini ama-3 (imicibisholo ephawula amaphuzu okungena kwezikulufu eziyisisekelo)
Isithombe 21 I-postterior orthostatic kanye ne-B lateral radiographs yesiguli u-A. Ukuphuka okuthathu okuphambene kwesiguli (emicibisholweni) kwelashwa ngezikulufo ezifakwe ku-cannulated ezingama-2.5-mm. Akukho zinguquko ezibalulekile ezinhlanganisweni ze-interphalangeal ezabonakala ngemva kweminyaka emi-2
Isikhathi sokuthunyelwe: Septhemba 18-2024
