Ukuphuka okuguquguqukayo ngokuhlukana okuncane noma okungekho nhlobo: esimweni sokuphuka kwethambo le-metacarpal (intamo noma i-diaphysis), kusethwe kabusha ngokudonsa ngesandla. I-proximal phalanx igobeka kakhulu ukuze iveze ikhanda le-metacarpal. Ukusika okuphambene okungu-0.5- 1 cm kwenziwa futhi i-extensor tendon ihoxiswa ngobude emgqeni omaphakathi. Ngaphansi kokuqondisa kwe-fluoroscopic, sifake intambo yomhlahlandlela engu-1.0 mm eduze kwe-axis yobude bengalo. Isihloko se-guidewire saba buthuntu ukuze kugwenywe ukungena kwekhohlo futhi kwenziwe lula ukuslayida ngaphakathi kwe-medullary canal. Ngemuva kokuthi indawo ye-guidewire inqunywe nge-fluoroscopically, ipuleti lethambo le-subchondral lashintshwa kusetshenziswa i-drill bit encane kuphela. Ubude obufanele besikulufa bubalwe kusukela ezithombeni zangaphambi kokuhlinzwa. Ezingxenyeni eziningi zokuphuka kwe-metacarpal, ngaphandle kwe-metacarpal yesihlanu, sisebenzisa isikulufu sobubanzi obungu-3.0-mm. Sisebenzise izikulufu ezingenalutho ezingenakhanda ze-AutoFIX (i-Bone Innovations encane, i-Morrisville, i-PA).Ubude obukhulu obusebenzisekayo besikulufu esingu-3.0-mm bungu-40 mm. Lokhu kufushane kunobude obumaphakathi bethambo le-metacarpal (cishe u-6.0 cm), kodwa yinde ngokwanele ukuhlanganisa imicu ku-medulla ukuze kutholakale ukuqiniswa okuvikelekile kwesikulufu. Ububanzi bomgodi we-medullary we-metacarpal yesihlanu ngokuvamile bukhulu, futhi lapha sisebenzise isikulufu esingu-4.0 mm esinobubanzi obukhulu obufika ku-50 mm. Ekupheleni kwenqubo, siqinisekisa ukuthi intambo ye-caudal ingcwatshwe ngokuphelele ngaphansi komugqa we-cartilage. Ngakolunye uhlangothi, kubalulekile ukugwema ukufaka i-prosthesis ngokujulile, ikakhulukazi esimweni sokuphuka kwentamo.
Umfanekiso 14 Ku-A, ukuphuka kwentamo okujwayelekile akuqediwe futhi ikhanda lidinga ukujula okuncane njengoba i-B cortex izocindezelwa
Indlela yokuhlinzwa yokuqhekeka okuphambene kwe-phalanx eseduze yayifana (Fig. 15). Senze i-transverse engu-0.5 cm ekhanda le-proximal phalanx ngenkathi sigoba kakhulu ilunga le-interphalangeal eliseduze. Imisipha yahlukaniswa futhi yahoxiswa ngobude ukuze kuvezwe ikhanda le-proximal phalanx. Ngokuphuka okuningi kwe-proximal phalanx, sisebenzisa isikulufu esingu-2.5 mm, kodwa kumaphalange amakhulu sisebenzisa isikulufu esingu-3.0 mm. Ubude obukhulu be-CHS engu-2.5 mm esetshenziswa njengamanje bungama-30 mm. Siyaqikelela ukuthi singaqinisi kakhulu izikulufu. Njengoba izikulufi zizenzela futhi zizithinta, zingangena ngaphansi kwe-phalanx ngokumelana okuncane. Indlela efanayo yasetshenziswa ekwephukeni kwe-midphalangeal phalangeal, ngokusika kuqala ekhanda le-midphalangeal phalanx ukuze kuvunyelwe ukubekwa kabusha kwezikulufu.
Fig. 15 Ukubuka kwangaphakathi kokuhlinza kwekesi le-phalanx eliphambanayo.AA 1-mm guidewire yafakwa endaweni encane ephambene eduze kwe-axis longitudinal ye-proximal phalanx.B I-guidewire yabekwa ukuze kuvunyelwe ukulungiswa kahle kokumiswa kabusha nokulungiswa kwanoma yikuphi ukuzungezisa.I-CA 2.5-mm CHS ifakiwe futhi yagqitshwa ekhanda. Ngenxa yokuma okuthile kwama-phalanges, ukucindezela kungase kubangele ukuhlukana kwe-metacarpal cortex. (Isiguli esifanayo njengasesithombeni 8)
Ukuhlukana okuhlanganisiwe: ukucindezela okungasekelwe ngesikhathi sokufakwa kwe-CHS kungaholela ekunciphiseni ama-metacarpals nama-phalanges (Fig. 16). Ngakho-ke, naphezu kweqiniso lokuthi ukusetshenziswa kwe-CHS ngokomthetho akuvunyelwe ezimweni ezinjalo, sithole isixazululo ezimweni ezimbili ezivame kakhulu esibhekana nazo.
UMFANEKISO 16 AC Uma ukuphuka kungasekelwa i-cortical, ukuqinisa izikulufu kuzoholela ekugoqeni kokuphuka naphezu kokunciphisa okuphelele.D Izibonelo ezijwayelekile ezivela ochungechungeni lwababhali oluhambisana nezimo zokufinyeza okukhulu (5 mm). Umugqa obomvu uhambisana nomugqa we-metacarpal.
Ngokuphuka kwe-submetacarpal, sisebenzisa indlela eguquliwe esekelwe kumqondo wezakhiwo wokubopha (okungukuthi, izakhi zesakhiwo ezisetshenziselwa ukusekela noma ukuqinisa uhlaka ngokumelana nokucindezelwa kwe-longitudinal futhi ngaleyo ndlela ukusekela). Ngokwenza umumo ka-Y ngezikulufo ezimbili, ikhanda le-metacarpal aliwi; lokhu sikuqambe ngebrace yomumo ongu-Y. Njengendlela yangaphambilini, kufakwe intambo yomhlahlandlela wobude obungu-1.0 mm enethiphu elibuthuntu. Nakuba kugcinwa ubude obufanele be-metacarpal, kufakwa enye intambo yokuqondisa, kodwa i-engeli eya ocingweni lokuqala oluqondisayo, ngaleyo ndlela yakhe isakhiwo esingunxantathu. Zombili izintambo zokuqondisa zanwetshwa kusetshenziswa isinki esiqondisiwe ukuze kwandiswe i-medulla. Ngezikulufu ze-axial ne-oblique, ngokuvamile sisebenzisa izikulufu ezinobubanzi obungu-3.0 mm no-2.5 mm, ngokulandelana. I-axial screw ifakwa kuqala kuze kube yilapho intambo ye-caudal ilingana ne-cartilage. Bese kufakwa isikulufu se-offset sobude obufanele. Njengoba ingekho indawo eyanele ku-medullary canal yezikulufu ezimbili, ubude bezikulufi ezitshekile budinga ukubalwa ngokucophelela, futhi izikulufo ze-axial kufanele zixhunywe kuphela ezikulungeni ze-axial uma sezigqitshwe ngokwanele ekhanda le-metacarpal ukuze kuqinisekiswe ukuzinza okwanele ngaphandle kokuvela kwesikulufu. Isikulufu sokuqala sibe sesithuthukiswa phambili size singcwatshwe ngokugcwele. Lokhu kugwema ukufinyezwa kwe-axial ye-metacarpal kanye nokuwa kwekhanda, okungavinjelwa ngezikulufu ze-oblique. Senza ukuhlolwa kwe-fluoroscopic njalo ukuze siqinisekise ukuthi akwenzeki nokuthi izikulufu zixhumene ngaphakathi kwe-medullary canal (Fig. 17).
Umfanekiso 17 AC Y-bakakaki ubuchwepheshe
Lapho i-comminution ithinta i-dorsal cortex phansi kwe-proximal phalanx, sakha indlela eguquliwe; siyiqambe ngokuthi i-axial bracing ngoba isikulufu sisebenza njengenduku ngaphakathi kwe-phalanx. Ngemva kokusetha kabusha i-proximal phalanx, i-axial guide wire yangeniswa kumsele we-medullary ngangokunokwenzeka. I-CHS emfushane kancane kunobude obuphelele be-phalanx (2.5 noma 3.0 mm) bese ifakwa kuze kube yilapho isiphetho sayo sangaphambili sihlangana ne-subchondral plate phansi kwe-phalanx. Kuleli qophelo, imicu ye-caudal yesikulufu ikhiyelwe ku-medullary canal, ngaleyo ndlela isebenze njengesisekelo sangaphakathi futhi iqinise isisekelo se-phalanx. Ukuhlolwa kwe-fluoroscopic okuningi kuyadingeka ukuze kuvinjelwe ukungena ngokuhlanganyela (Umfanekiso 18). Kuye ngephethini yokuphuka, ezinye izikulufu noma inhlanganisela yamadivayisi okulungisa angaphakathi angase adingeke (Umfanekiso 19).
Umfanekiso we-19: Izindlela ezihlukene zokulungisa iziguli ezinokulimala kokuchotshozwa. Ukuphuka kanzima kwe-submetacarpal komunwe wendandatho nokugudluka okuhlanganisiwe kwesisekelo somunwe ophakathi (umcibisholo ophuzi okhomba endaweni yokuphuka okuphelile).B Kusetshenziswe Izinga elingu-3.0 mm CHS lomunwe wenkomba, i-paracentesis engu-3.0 mm yomunwe ophakathi nendawo, ukusekela okungu-y komunwe wesitezi esingu-4 no-4 mm. I-CHS yomunwe opinki.F Iziphepho zamahhala zazisetshenziselwa ukumboza kwezicubu ezithambile.C Ama-Radiographs ezinyangeni ezi-4. Ithambo le-metacarpal lomunwe omncane lipholile. Olunye utwayi lwamathambo lwakheka kwenye indawo, okubonisa ukuphulukiswa kokuphuka kwesibili.D Ngonyaka owodwa ngemva kwengozi, i-flap yasuswa; nakuba i-asymptomatic, isikulufu sikhishiwe ku-metacarpal yomunwe wendandatho ngenxa yokusola ukungena kwe-intra-articular. Imiphumela emihle (≥240° TAM) itholwe emunweni ngamunye ekuvakasheni kokugcina.Izinguquko ekuhlanganyeleni kwe-metacarpophalangeal yomunwe ophakathi zabonakala ezinyangeni ezingu-18.
Umfanekiso 20 Ukuphuka komunwe wenkomba onesandiso se-intra-articular (eboniswe ngemicibisholo), eyaguqulwa yaba ukuphuka okulula ngokulungiswa kuka-B kwesikhashana kokuphuka kwe-articular kusetshenziswa i-K-wire.C Lokhu kwakha isisekelo esizinzile lapho kwafakwa khona isikulufu se-longitudinal esisekelayo. Amaviki angu-3 (imicibisholo emaka amaphuzu okungena kwezikulufu ze-basal)
Umfanekiso 21 Ama-radiographs angemuva kwe-orthostatic kanye ne-B ehlangothini lwesiguli A. Ukuphuka kwesiguli okuphambanayo okuthathu (kwimicibisholo) zelashwe ngezikulufu ze-cannulated ezingu-2.5-mm. azikho izinguquko eziphawulekayo emalungeni e-interphalangeal abonakala ngemva kweminyaka emi-2
Isikhathi sokuthumela: Sep-18-2024
