Ama-supracondylar fractures of the humerus angenye yezingane ezivame kakhulu ezinganeni futhi zenzeka emhlanganweni we-shaft hotleral kanyei-comeral towle.
Ukubonakaliswa Kwemitholampilo
Ama-supracondylar fractures we-humerus iningi lezingane, kanye nobuhlungu bendawo, ukuvuvukala, ubumnene, futhi ukungasebenzi kungavela ngemuva kokulimala. Ukuqhekeka okungabonakali okungekho ezimpawuni ezisobala, futhi ukukhishwa kwe-elbow kungaba ukuphela kwesibonakaliso somtholampilo. I-capsule ehlanganisiwe ngaphansi komsipha we-elbow yiyona ephakeme kakhulu, lapho i-capsule ehlanganisiwe ethambile, eyaziwa nangokuthi ithafa, ingahanjiswa ngesikhathi sokuxoshwa okuhlangene. Iphuzu lokuguquguquka livame ukungaphandle komugqa oxhumanisa maphakathi nekhanda le-radial liye esicongweni se-Olecranon.
Endabeni yohlobo lwe-supracondylar III gracture, kunezimo ezimbili ezingcolile ze-elbow, zikunikeze ukubukeka okwenziwe nge-S. Kuvame ukulimala okungaphansi kwengalo yangaphezulu ye-distal ephezulu, futhi uma ukuqhekeka kususwe ngokuphelele, ukuphela kwe-distal kokuqhekeka kungena emsipha we-brachialis, bese ukopha okuphansi kubucayi kakhulu. Ngenxa yalokhu, isibonakaliso se-pucker sivela phambi kwe-elbow, imvamisa ekhombisa ubuqili be-bony protomusion kuya ekuqhekekeni bangena kwi-dermis. Uma kuhambisana nokulimala kwezinzwa ze-radial, ukunwetshwa kwesithupha kungakhawulelwa; Ukulimala kwe-Median Nerve kungadala ukuthi isithupha nomunwe we-Index ukuze singakwazi ukuguquguquka ngentshiseko; Ukulimala kwezinzwa ze-ulnar kungahle kuholele ekuhlukaniseni iminwe nokuphazamiseka.
Ukuxilonga
(1) Isisekelo sokuxilonga
①have umlando wokuhlukumezeka; Izimpawu zezimpawu nezimpawu: Ubuhlungu bendawo, ukuvuvukala, ubumnene nokungasebenzi; I-③x-ray ikhombisa umugqa we-supracondylar fracture kanye nezingcezwana ze-attracture ezihanjisiwe ze-humerus.
(2) Ukuxilongwa okuhlukile
Ukunakwa kufanele kukhokhwe kukhonjwa kweukuhanjiswa kwe-elbow, kepha ukukhonjwa kwe-Suppondonylar fractures kusuka e-Elbow ukuhanjiswa kunzima. Emhlanganweni weSupracondylar we-humerus, i-epicondyle ye-humerus igcina ubuhlobo obujwayelekile be-anatomical ne-Olecranon. Kodwa-ke, e-Elbow Subliaction, ngoba i-Olecranon itholakala ngemuva kwe-epicondyle ye-humerus, ivelele kakhulu. Uma kuqhathaniswa ne-supracondylar fractures, ukuvelela kwengalo e-elbow ukuhanjiswa kudalulwa ngokwengeziwe. Ukuba khona noma ukungabikho kwe-Fricatives ye-bony fricatives nakho kudlala indima ekuhlonzeni ukuqhekeka kwe-humectures ye-summacondylar ye-Humerus kusuka ekuhlaseleni kwe-elbow okuhlangene, futhi kwesinye isikhathi kunzima ukuthola ama-fricatives e-bony. Ngenxa yokuvuvukala okunzima nobuhlungu, ukukhohlisa okungukuthi ama-fricatives akwa-bony ama-fricatives avame ukwenza ingane ikhala. Ngenxa yengozi yokulimala kwe-neurovascular. Ngakho-ke, ukukhwabanisa okuthi ama-fricatives amathambo kufanele kugwenywe. Ukuhlolwa kwe-X-ray kungasiza ukukhomba.
Ukuthayipha
Ukuhlukaniswa okujwayelekile kwama-supracondylar fractures ukuhlukanisa kubo ukunwetshwa nokuguquguquka. Uhlobo lwe-Flexion aluvamile, futhi i-X-ray yamuva ikhombisa ukuthi ukuphela kwe-distal kokuqhekeka kutholakala phambi kwe-shaft ethobelayo. Uhlobo oluqondile luvamile, futhi i-Gartland iyakuhlukanisa ngohlobo lwe-III (Ithebula 1).
| Ukuthayipha | Ukubonakaliswa Kwemitholampilo |
| Uhlobo lwe-ⅰa | Ama-fractures ngaphandle kokufuduka, ukuguqulwa noma i-valgus |
| Uhlobo lwe-ⅰB | Ukuxoshwa Mnene, Ukuqhaqhazela Kwezindawo Zokudla Kwemvelo, I-Anterioryral Border Line ngekhanda |
| Uhlobo lwe-ⅱa | I-hypereXtension, ubuqotho bangemuva kwe-cortical, ikhanda elithobeziwe ngemuva komugqa womnyango othobekile, akukho ukujikeleza |
| Uhlobo lwe-ⅱB | Isikhathi eside noma ukujikeleza okujikelezayo ngokuxhumana okuyingxenye kunoma yikuphi ukuphela kokuphuka |
| Uhlobo lwe-ⅲa | Qedela ukuhanjiswa okungemuva kokuxhumana okuphathelene ne-cortical oxhumana naye, iningi lide nokufuduka okuzayo |
| Uhlobo lwe-ⅲB | Ukuthuthwa okusobala, izicubu ezithambile ezishumeke ekupheleni kokuphela, ukugqagqana okukhulu noma ukuhanjiswa okujikelezayo kokuphela kokuphela kwe-fracture |
Ithebula 1 Ukuhlukaniswa kweGartland kweSupracondyloar Humerus fractures
Phatha
Ngaphambi kokwelashwa okuphezulu, i-Elbow Joint kufanele ilungiswe okwesikhashana endaweni engama-20 ° kuya ku-30 °, okungagcini nje ngokunethezeka kwizakhiwo zezinhlaka ze-neurovascular.
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. °) Ukulungiswa kugcina isikhundla ngemuva kokuncishiswa, kepha kwandisa ingozi yokulimala kwe-neurovascular yemlenze othintekile kanye nengozi ye-Acute Facial Cards Syndrome. Ngakho-ke, kuhlanzekileUkulungiswa kwe-Wirschner WireKuhle ngemuva kokuncishiswa okuvaliwe kwe-fracture (Fig. 1), bese kuthi kulungiswa kwangaphandle ngodaka okuphonswe endaweni ephephile (i-elbow flexion 60 °).
Umdwebo 1 isithombe sokulungiswa kocingo lwe-percutaneous wire
. Ukulungiswa okuvaliwe kanye nokulungiswa kwe-kirschner ye-percutaneous
Umdwebo 5-3 amafilimu we-X-ray ama-Peracerative and Postpoperative and Postoperative
Kunezindlela ezine zokuhlinza zokuncishiswa okuvulekile kwe-supracondylar fractures ye-humerus: (1) indlela ye-elbow yamuva (kufaka phakathi indlela ye-antental); (2) Indlela ye-Elbow yendlela; (3) Indlela ehlanganisiwe ye-elbow nelbow; kanye (4) nokwendlela okungemuva kwe-elbow.
Zombili izindlela ze-elbow zamuva kanye nendlela ye-medial zinezinzuzo zezicubu ezilimele ezilimele nesakhiwo esilula se-anatomical. I-Medial Incision iphephe kunokufakwa kwe-lateral futhi ingavimba ukulimala kwezinzwa ze-ulnar. The disadvantage is that neither of them can directly see the fracture of the contralateral side of the incision, and can only be reduced and fixed by hand feeling, which requires a higher surgical technique for the operator. Indlela yangemuva ye-Elbow iye yaxabana ngenxa yokubhujiswa kobuqotho bemisipha ye-triceps kanye nomonakalo omkhulu. Indlela ehlanganisiwe ye-Medial and Lateral Elbows ingangenzela ukungathandeki kokungakwazi ukubona ngokuqondile ukubona indawo yamathambo. Inezinzuzo ze-Medial and Lateral Elbow Ukungaboniswa, okuyinto elungele ukuncishiswa nokulungisa, futhi kunganciphisa ubude be-lateral incision. Kuyazuzisa ekukhululekeni nasekusekelweni kokuvuvukala kwezicubu; Kepha ukungathandeki kwaso ukuthi kwandisa ukungezwani kokuhlinzwa; Futhi ephakeme kunendlela engemuva.
Ubunzima
Izinkinga ze-supracondylar fractures zibandakanya: (1) ukulimala kwe-neurovascular; (2) Isifo se-septal acute; (3) Ukuqina kwe-elbow; (4) Myositis Ossificants; (5) I-Avascular Necrosis; (6) Cubitus Varus deform; (7) Ukukhubazeka kweCubitus Valgus.
Beka kafushane
Ama-supracondylar fractures we-humerus aphakathi kokuqhekeka okuvame kakhulu ezinganeni. Eminyakeni yamuva nje, ukwehliswa okungekuhle kwe-suptacondylar fractures ye-humerus kwavusa ukunakwa kwabantu. Esikhathini esedlule, i-cubitus varus noma i-cubitus Valgus yathathwa njengento ebangelwa ukuboshwa kokukhula kwepuleti ye-epiphyseal disteral, kunokuba kuncishiswe kabi. Iningi lobufakazi obuqinile manje selisekela ukuthi ukuncishiswa kwe-fracture okumpofu kuyinto ebalulekile ku-cubitus varus deform. Ngakho-ke, ukwehliswa kwe-supracondylar humerus fractures, ukulungiswa kwe-ulnar offset, ukujikeleza okuvundlile kanye nokubuyiselwa kwemali yokuphakama kwe-humorus izikhiye.
Kunezindlela eziningi zokwelashwa ze-supracondylar fractures ze-humerus, njengokuncishiswa kwezandla + Ukulungiswa kwangaphandleNgodaka waphonswa ngodaka, ukugcwala kwangaphandle, ukulungiswa kwangaphandle nge-splint, ukuncishiswa okuvulekile nokulungiswa kwangaphakathi, nokuncishiswa okuvaliwe kanye nokulungiswa kwangaphakathi. Esikhathini esedlule, ukuncishiswa okukhohlisayo kanye nokulungiswa kwangaphandle kodaka kwakukhona ukwelashwa okuyinhloko, okwabikwa ukuthi i-cubitus VarUS yangezo ezingama-50% eChina. Njengamanje, ngohlobo II kanye nohlobo lwe-III Supracondylar Fractures, Ukulungiswa kwenaliti eqondile ngemuva kokuncishiswa kokuphulwa kwendlela sekuphenduke indlela eyamukelwe ngokuvamile. Inezinzuzo zokungabhubhisi ukulethwa kwegazi nokuphulukiswa kwamathambo okusheshayo.
Kunemibono ehlukene ngendlela nenombolo efanelekile yokulungiswa kocingo lwe-kirschner ngemuva kokuncishiswa okuvaliwe kwama-fractures. Isipiliyoni somhleli ukuthi izintambo ze-kirschner kufanele ziboshwe ngomunye nomunye ngesikhathi sokulungiswa. Ukuhlukana nendiza eqhelelekile, kuwukuzinza kakhulu. Izintambo ze-kirschner akufanele ziwele endizeni ye-fracture, ngaphandle kwalokho ukujikeleza ngeke kulawulwe futhi kulungiswe ukulungiswa kuzobe kungazinzile. Ukunakekelwa kufanele kuthathwe ukugwema ukulimala kwe-ulnar nerve lapho usebenzisa i-Medial Kirstchner Fire Fitnation. Musa ukuhlanganisa inaliti esendaweni eguquguqukayo ye-elbow, qondisa kancane i-elbow ukuvumela i-ulnar nerve ukuba ibuyele emuva, thinta i-ulnar nerve ngesithupha bese uyicindezela i-K-Wire. Ukusetshenziswa kokulungiswa kwe-kirschner wirschner wire kwangaphakathi kunezinzuzo ezingaba khona ekuvuseleleni okusebenzayo kwe-postuperative, Fracture Healing Rate, nezinga eliphakeme lokuphulukiswa kokuphulukisa, okuwusizo ekubuyiselweni kokuqala kwe-postoperative.
Isikhathi sePosi: Nov-02-2022
