Ukuphuka kwe-supracondylar kwe-humerus kungenye yezinkinga ezivame kakhulu ezinganeni futhi kwenzeka lapho kuhlangana khona i-humeral shaft kanye ne-humerus.i-humeral condyle.
Ukubonakaliswa Kwezokwelapha
Ukuphuka kwe-Supracondylar kwe-humerus ikakhulukazi kwenzeka ezinganeni, futhi ubuhlungu bendawo, ukuvuvukala, ukuthamba, kanye nokungasebenzi kahle kungase kwenzeke ngemva kokulimala. Ukuphuka okungasuswanga akunazo izimpawu ezicacile, futhi ukuphuma kwendololwane kungaba yisona kuphela isibonakaliso sezokwelapha. I-capsule ehlangene ngaphansi kwemisipha yendololwane iyona engaphezulu kakhulu, lapho i-capsule ehlangene ethambile, eyaziwa nangokuthi i-softspot, ingaphathwa khona ngesikhathi sokukhishwa kwendololwane. Iphuzu lokuguquguquka livame ukuba ngaphambili komugqa oxhumanisa isikhungo sekhanda eliyi-radial nesihloko se-olecranon.
Uma kwenzeka ukwaphuka kohlobo lwesithathu lwe-supracondylar, kunezinhlobo ezimbili zokukhubazeka kwendololwane, okwenza ibonakale sengathi i-S. Ngokuvamile kuba nokuphuka ngaphansi kwesikhumba phambi kwengalo engenhla ekude, futhi uma ukwaphuka kususiwe ngokuphelele, ingxenye ekude yokuphuka ingena emsipheni we-brachialis, futhi ukuphuma kwegazi ngaphansi kwesikhumba kuba kubi kakhulu. Ngenxa yalokho, kuvela uphawu lwe-pucker phambi kwendololwane, ngokuvamile olubonisa ukuvela kwamathambo eduze kokuqhekeka okungena e-dermis. Uma kuhambisana nokulimala kwe-radial nerve, ukwelulwa kwesithupha esingemuva kungase kuncishiswe; ukulimala kwe-median nerve kungabangela ukuthi isithupha nomunwe wokukhomba kungakwazi ukugoba; ukulimala kwe-ulnar nerve kungabangela ukuhlukana okulinganiselwe kweminwe kanye nokwehlukanisa idijithali.
Ukuxilongwa
(1) Isisekelo Sokuxilongwa
①Unomlando wokuhlukumezeka; ②Izimpawu nezimpawu zomtholampilo: ubuhlungu bendawo, ukuvuvukala, ubuthakathaka kanye nokungasebenzi kahle; ③I-X-ray ikhombisa umugqa wokuphuka kwe-supracondylar kanye nezingcezu zokuphuka ezisusiwe ze-humerus.
(2) Ukuxilongwa Okuhlukile
Kufanele kuqashelwe ukuhlonzaukukhumuka kwendololwane, kodwa ukuhlonza ukwaphuka kwe-supracondylar extensional okuvela ekuqhekekeni kwe-elbow kunzima. Ekuqhekekeni kwe-supracondylar kwe-humerus, i-epicondyle ye-humerus igcina ubuhlobo obujwayelekile bomzimba ne-olecranon. Kodwa-ke, ekuqhekekeni kwe-elbow, ngoba i-olecranon itholakala ngemuva kwe-epicondyle ye-humerus, igqame kakhulu. Uma kuqhathaniswa nokuqhekeka kwe-supracondylar, ukuvelela kwengalo ekuqhekekeni kwe-elbow kukude kakhulu. Ukuba khona noma ukungabikho kwe-bony fricatives nakho kudlala indima ekuboneni ukwaphuka kwe-supracondylar kwe-humerus ngenxa yokuqhekeka kwejoyinti le-elbow, futhi ngezinye izikhathi kunzima ukuveza i-bony fricatives. Ngenxa yokuvuvukala okukhulu nobuhlungu, i-manipulation ebangela i-bone fricatives ivame ukubangela ingane ukuba ikhale. Ngenxa yengozi yokulimala kwemithambo yegazi. Ngakho-ke, i-manipulation ebangela i-bone fricatives kufanele igwenywe. Ukuhlolwa kwe-X-ray kungasiza ekutholeni.
Uhlobo
Ukuhlukaniswa okujwayelekile kokuqhekeka kwe-humeral supracondylar kuwukukuhlukanisa kube ukwandiswa kanye nokugoba. Uhlobo lokugoba aluvamile, kanti i-X-ray eseceleni ikhombisa ukuthi ukuphela kokuqhekeka okukude kutholakala phambi kwe-humeral shaft. Uhlobo oluqondile luvamile, kanti iGartland iluhlukanisa lube uhlobo I kuya ku-III (Ithebula 1).
| Uhlobo | Ukubonakaliswa Kwezokwelapha |
| Uhlobo lwe-ⅠA | Ukuphuka ngaphandle kokususwa, ukuguqulwa noma i-valgus |
| Uhlobo lwe-ⅠB | Ukufuduka okuncane, ukufiphaza kwe-cortex ephakathi, umugqa womngcele we-humeral anterior ngekhanda le-humeral |
| Uhlobo lwe-ⅡA | I-Hyperextension, ubuqotho be-cortical yangemuva, ikhanda eligobile ngemuva komugqa womngcele we-humeral wangaphambili, akukho ukujikeleza |
| Uhlobo lwe-ⅡB | Ukufuduka okude noma okujikelezayo ngokuxhumana okuyingxenye kunoma yikuphi ukuphela kokuqhekeka |
| Uhlobo lwe-ⅢA | Ukufuduka okuphelele ngemuva ngaphandle kokuxhumana kwe-cortical, ikakhulukazi ukusuka kude kuya ekufudukeni okuphakathi kwangemuva |
| Uhlobo lwe-ⅢB | Ukufuduka okusobala, izicubu ezithambile ezifakwe ekugcineni kokuqhekeka, ukugoqana okuphawulekayo noma ukufuduka okujikelezayo kokuphela kokuqhekeka |
Ithebula 1 Ukuhlukaniswa kweGartland kokuqhekeka kwe-supracondylar humerus
Ukwelapha
Ngaphambi kokwelashwa okufanele, ijoyinti lendololwane kufanele libekwe okwesikhashana endaweni yokugoba engu-20° kuya ku-30°, okungagcini nje ngokukhululekile esigulini, kodwa futhi kunciphisa ukucindezeleka kwezakhiwo zemithambo yegazi.
(1) Ukuphuka kwe-humeral supracondylar yohlobo I: kudinga kuphela i-plaster cast noma i-cast cast ukuze kufakwe i-external fixation, ngokuvamile lapho i-elbow igobile ngama-90° futhi ingalo ijikeleziswa endaweni engathathi hlangothi, i-cast ende yengalo isetshenziselwa ukufakwa i-external fixation amasonto ama-3 kuya kwamane.
(2) Ukuphuka kwe-humeral supracondylar yohlobo lwesibili: Ukunciphisa ngesandla nokulungiswa kwe-elbow hyperextension kanye ne-angulation yizinkinga ezibalulekile ekwelapheni lolu hlobo lokuphuka. °) Ukuqina kugcina indawo ngemuva kokuncipha, kodwa kwandisa ingozi yokulimala kwemithambo yegazi yesitho esithintekile kanye nengozi ye-acute fascial compartment syndrome. Ngakho-ke, i-percutaneousUkulungiswa kwentambo kaKirschnerKungcono kakhulu ngemva kokunciphisa ukuphuka okuvaliwe (Isithombe 1), bese kuba ukufakelwa kwangaphandle nge-plaster cast endaweni ephephile (ukugoba kwendololwane ngo-60°).
Isithombe 1 se-percutaneous Kirschner wire fixation
(3) Ukuphuka kwe-humerus ye-supracondylar yohlobo lwesithathu: Zonke izinhlobo zokuphuka kwe-humerus ye-supracondylar yohlobo lwesithathu zincishiswa ngokufakwa kwentambo ye-Kirschner nge-percutaneous, okuyindlela ejwayelekile yokwelapha ukuphuka kwe-supracondylar yohlobo lwesithathu. Ukunciphisa okuvaliwe kanye nokufakwa kwentambo ye-Kirschner nge-percutaneous kuvame ukwenzeka, kodwa ukunciphisa okuvulekile kuyadingeka uma ukufakwa kwezicubu ezithambile kungenakuncishiswa ngokwesimo somzimba noma uma kukhona ukulimala kwemithambo ye-brachial (Isithombe 2).
Umfanekiso 5-3 Amafilimu e-X-ray angaphambi kokuhlinzwa nangemuva kokuhlinzwa okuqhekeka kwe-humerus ye-supracondylar
Kunezindlela ezine zokuhlinzwa zokunciphisa ukuphuka kwe-supracondylar kwe-humerus: (1) indlela ye-lateral elbow (kufaka phakathi indlela ye-anterolateral); (2) indlela ye-medial elbow; (3) indlela ye-medial ne-lateral elbow ehlanganisiwe; kanye (4) nendlela ye-posterior elbow.
Kokubili indlela ye-lateral elbow kanye nendlela ye-medial kunezinzuzo zezicubu ezingonakali kakhulu kanye nesakhiwo esilula se-anatomical. I-medial incision iphephile kune-lateral incision futhi ingavimbela ukulimala kwe-ulnar nerve. Inkinga ukuthi akekho kubo ongabona ngqo ukuphuka kohlangothi lwe-contralateral lwe-incision, futhi ingancishiswa futhi ilungiswe kuphela ngokuzwa ngesandla, okudinga indlela yokuhlinzwa ephezulu kumuntu ohlinzayo. Indlela ye-posterior elbow ibilokhu iphikisana ngenxa yokubhujiswa kobuqotho bemisipha ye-triceps kanye nomonakalo omkhulu. Indlela ehlanganisiwe ye-medial kanye ne-lateral elbow ingenza kube nzima ukungakwazi ukubona ngqo ubuso bethambo le-contralateral le-incision. Inezinzuzo ze-medial kanye ne-lateral elbow incisions, ezisiza ekunciphiseni ukuqhekeka kanye nokuqina, futhi zinganciphisa ubude be-lateral incision. Iwusizo ekunciphiseni nasekuncipheni kokuvuvukala kwezicubu; kodwa i-sideless yayo ukuthi yandisa i-incision yokuhlinzwa; Futhi iphakeme kunendlela ye-posterior.
Inkinga
Izinkinga zokuphuka kwe-humeral supracondylar zifaka: (1) ukulimala kwemithambo yegazi; (2) i-acute septal syndrome; (3) ukuqina kwendololwane; (4) ama-myositis ossificans; (5) i-avascular necrosis; (6) i-cubitus varus deformity; (7) i-cubitus valgus deformity.
Fingqa
Ukuphuka kwe-Supracondylar kwe-humerus kuphakathi kokuphuka okuvame kakhulu ezinganeni. Eminyakeni yamuva nje, ukwehla okuncane kokuphuka kwe-supracondylar kwe-humerus kuye kwavusa ukunaka kwabantu. Esikhathini esidlule, i-cubitus varus noma i-cubitus valgus kwakubhekwa njengokubangelwa ukumiswa kokukhula kwepuleti le-distal humeral epiphyseal, kunokuba kube ukwehla okuncane. Ubufakazi obuningi obuqinile manje busekela ukuthi ukwehla okuncane kokuphuka kuyisici esibalulekile ekuwohlokeni kwe-cubitus varus. Ngakho-ke, ukwehla kokuphuka kwe-supracondylar humerus, ukulungiswa kwe-ulnar offset, ukujikeleza okuvundlile kanye nokubuyiselwa kokuphakama kwe-distal humerus kuyizinto ezibalulekile.
Kunezindlela eziningi zokwelapha ukwaphuka kwe-supracondylar kwe-humerus, njengokunciphisa ngesandla + ukulungiswa kwangaphandlenge-plaster cast, i-olecranon traction, i-external fixation ene-splint, i-open reduction kanye ne-internal fixation, kanye ne-closed reduction kanye ne-internal fixation. Esikhathini esidlule, ukunciphisa okukhohlisayo kanye ne-plaster external fixation kwakuyizindlela zokwelapha eziyinhloko, lapho i-cubitus varus yabikwa khona ukuthi iphakeme ngamaphesenti angu-50 eShayina. Njengamanje, ngokuqhekeka kwe-supracondylar yohlobo lwesibili nohlobo lwesithathu, i-percutaneous needle fixation ngemva kokunciphisa ukuqhekeka sekuyindlela eyamukelekayo. Inezinzuzo zokungabhubhisi ukuhlinzekwa kwegazi kanye nokuphulukiswa kwamathambo ngokushesha.
Kukhona nemibono ehlukene ngendlela kanye nenani elifanele lokufakwa kwentambo yeKirschner ngemva kokunciphisa ukuphuka okuvaliwe. Okuhlangenwe nakho komhleli ukuthi izintambo zeKirschner kufanele zihlukaniswe phakathi ngesikhathi sokufakwa. Uma indiza yokuphuka iqhelelene kakhulu, iyazinza kakhulu. Izintambo zeKirschner akufanele ziwele endaweni yokuphuka, ngaphandle kwalokho ukujikeleza ngeke kulawulwe futhi ukufakwa kuzoba okungazinzile. Kufanele kuqashelwe ukugwema ukulimala kwe-ulnar nerve uma usebenzisa i-medial Kirschner wire fixation. Ungafaki inaliti endaweni egobile yendololwane, qondisa kancane indololwane ukuze uvumele i-ulnar nerve ibuyele emuva, thinta i-ulnar nerve ngesithupha bese uyisunduza bese ufaka intambo ye-K ngokuphephile. Ukusetshenziswa kwentambo ye-Kirschner wire fixation yangaphakathi kunezinzuzo ezingaba khona ekubuyiseleni ukusebenza ngemva kokuhlinzwa, izinga lokuphulukiswa kokuphuka, kanye nezinga elihle kakhulu lokuphulukiswa kokuphuka, okuzuzisa ekubuyiseleni kokuqala ngemva kokuhlinzwa.
Isikhathi sokuthunyelwe: Novemba-02-2022
