I-Supracondylar fractures ye-humerus ingenye yezifo ezivame kakhulu ezinganeni futhi zenzeka lapho kuhlangana khona i-humeral shaft kanye ne-humerus.i-humeral condyle.
Ukubonakaliswa Komtholampilo
I-Supracondylar fractures ye-humerus ngokuvamile iyizingane, futhi ubuhlungu bendawo, ukuvuvukala, ububele, nokungasebenzi kahle kungase kwenzeke ngemva kokulimala.Ukuphuka okungasuswanga akunazo izimpawu ezisobala, futhi ukuphuma kwendololwane kungase kube ukuphela kophawu lomtholampilo.I-capsule ehlangene engezansi kwe-elbow muscle iyona engaphezulu kakhulu, lapho i-capsule ehlangene ethambile, eyaziwa nangokuthi i-softspot, ingakwazi ukuxubha ngesikhathi sokuphuma kwamalunga.Iphuzu lokuguquguquka ngokuvamile lingaphambili emugqeni oxhuma indawo ephakathi yekhanda elikhazimulayo ekugcineni kwe-olecranon.
Endabeni yokuphuka kwe-supracondylar hlobo III, kukhona ukukhubazeka okubili kwendololwane, okwenza kube nokubukeka okumise okwe-S.Ngokuvamile kukhona ukulimaza okungaphansi kwe-subcutaneous phambi kwengalo engenhla ekude, futhi uma ukuphuka kususwe ngokuphelele, ukuphela okukude kwe-fracture kungena emsipha we-brachialis, futhi ukopha okungaphansi kwesikhumba kubi kakhulu.Ngenxa yalokhu, uphawu lwe-pucker luvela phambi kwendololwane, ngokuvamile lubonisa ukuphuma kwethambo eliseduze nokuphuka okungena ku-dermis.Uma kuhambisana nokulimala kwe-radial nerve, ukunwetshwa komgogodla wesithupha kungase kube nomkhawulo;ukulimala kwenerve median kungase kubangele ukuthi isithupha kanye nomunwe wenkomba ungakwazi ukugoba ngenkuthalo;Ukulimala kwenzwa ye-ulnar kungase kubangele ukuhlukana okulinganiselwe kweminwe kanye nokuxhumana phakathi.
Ukuxilongwa
(1) Isisekelo Sokuxilonga
①Iba nomlando wokuhlukumezeka;②Izimpawu zomtholampilo nezimpawu: ubuhlungu bendawo, ukuvuvukala, ukuzwela kanye nokungasebenzi kahle;③I-X-ray ibonisa ulayini wokuphuka kwe-supracondylar kanye nezingcezu zokuphuka ezisusiwe ze-humerus.
(2) Ukuxilongwa Okuhlukile
Kufanele kuqashelwe ukuhlonzwa kweukugudluka kwendololwane, kodwa ukuhlonzwa kwe-extensional supracondylar fractures kusuka ku-elbow dislocation kunzima.Ekuqhekekeni kwe-supracondylar kwe-humerus, i-epicondyle ye-humerus igcina ubuhlobo obujwayelekile be-anatomical ne-olecranon.Nokho, ekugudlukeni kwendololwane, ngenxa yokuthi i-olecranon itholakala ngemuva kwe-epicondyle ye-humerus, ivelele kakhulu.Uma kuqhathaniswa nokuqhekeka kwe-supracondylar, ukuvelela kwengalo ekukhishweni kwendololwane kukude kakhulu.Ukuba khona noma ukungabikho kwe-bony fricatives nakho kunendima ekuboneni ukuphuka kwe-supracondylar kwe-humerus kusukela ekuqhekezeni kwe-elbow joint, futhi ngezinye izikhathi kunzima ukukhipha i-bone fricatives.Ngenxa yokuvuvukala nobuhlungu obukhulu, ukuxhashazwa okwenza ukuba amathambo aqine ngokuvamile kubangela ukuba ingane ikhale.Ngenxa yengozi yokulimala kwe-neurovascular.Ngakho-ke, ama-manipulations afaka ama-bone fricatives kufanele agwenywe.Ukuhlolwa kwe-X-ray kungasiza ekuboneni.
Uhlobo
Ukuhlukaniswa okujwayelekile kwama-supracondylar humeral fractures ukuwahlukanisa ngesandiso kanye nokuguquguquka.Uhlobo lwe-flexion aluvamile, futhi i-X-ray yangemuva ibonisa ukuthi ukuphela kwe-distal ye-fracture itholakala phambi kwe-humeral shaft.Uhlobo oluqondile luvamile, futhi i-Gartland ihlukanisa phakathi kohlobo I kuya ku-III (Ithebula 1).
| Uhlobo | Ukubonakaliswa Komtholampilo |
| ⅠA uhlobo | Ama-fractures ngaphandle kokufuduka, inversion noma i-valgus |
| ⅠB uhlobo | Ukufuduka okumaphakathi, ukutshibilika kwekholarikhi emaphakathi, umugqa womngcele we-humeral wangaphambili phakathi kwekhanda elithambile |
| ⅡUhlobo | I-Hyperextension, i-posterior cortical integrity, ikhanda elithambile ngemuva komugqa womngcele we-humeral wangaphambili, akukho ukuzungezisa |
| ⅡB uhlobo | Ukugudluzwa kwe-longitudinal noma okujikelezayo ngokuthintana ngokwengxenye kunoma yikuphi ukuphela kokuphuka |
| ⅢUhlobo | Ukufuduka okuphelele kwangemuva ngaphandle kokuthintana ne-cortical, ikakhulukazi i-distal kuya ekuthuthweni kwangemuva okuphakathi |
| ⅢB uhlobo | Ukususwa okusobala, izicubu ezithambile ezishumekwe ekugcineni kokuphuka, ukugqagqana okubalulekile noma ukugudluka okujikelezayo kokuphela kokuphuka. |
Ithebula 1 Ukuhlukaniswa kwe-Gartland ye-supracondylar humerus fractures
Yelapha
Ngaphambi kokwelashwa okuphelele, i-elbow joint kufanele imiswe okwesikhashana endaweni ye-20 ° kuya ku-30 ° flexion, engakhululekile nje esigulini, kodwa futhi inciphisa ukungezwani kwezakhiwo ze-neurovascular.
(1) Thayipha I-humeral supracondylar fractures: idinga kuphela i-plaster cast noma i-cast cast ukuze ilungiswe ngaphandle, ngokuvamile lapho indololwane igoba ngo-90 ° futhi umphambili ujikeleziswa endaweni engathathi hlangothi, i-cast ingalo ende isetshenziselwa ukulungiswa kwangaphandle kwe-3. kuya kumaviki angu-4.
(2) Uhlobo lwe-II ye-humeral supracondylar fractures: Ukunciphisa ngesandla nokulungiswa kwe-elbow hyperextension kanye nokuhlukunyezwa yizinkinga eziyinhloko ekwelapheni kwalolu hlobo lokuphuka.°) Ukulungiswa kugcina isimo ngemva kokwehliswa, kodwa kwandisa ingcuphe yokulimala kwemithambo yegazi yesitho esithintekile kanye nengozi ye-acute fascial compartment syndrome.Ngakho-ke, i-percutaneousI-Kirschner wire fixationkungcono kakhulu ngemva kokwehliswa okuvaliwe kokuphuka (Umfanekiso 1), bese Ukulungiswa Kwangaphandle nge-plaster cast endaweni ephephile (i-elbow flexion 60 °).
Umfanekiso 1 Isithombe se-percutaneous Kirschner wire fixation
(3) Uhlobo lwe-III lwe-supracondylar humerus fractures: Zonke izinhlobo ze-supracondylar humerus fractures zohlobo lwe-III zincishiswa ngokulungiswa kocingo lwe-Kirschner nge-percutaneous, okwamanje okuyindlela yokwelapha evamile yohlobo lwe-III lwe-supracondylar fractures.Ukunciphisa okuvaliwe kanye nokulungiswa kwezintambo ze-percutaneous Kirschner ngokuvamile kungenzeka, kodwa ukunciphisa okuvulekile kuyadingeka uma ukushumeka kwezicubu ezithambile kungenakuncishiswa ngokwe-anatomically noma uma kukhona ukulimala komthambo we-brachial (Umfanekiso 2).
Umfanekiso 5-3 Amafilimu e-X-ray ngaphambi kokuhlinzwa kanye nangemuva kokuhlinzwa kwe-supracondylar humerus fractures
Kunezindlela ezine zokuhlinzwa zokunciphisa okuvulekile kwe-supracondylar fractures ye-humerus: (1) indlela ye-elbow lateral (kuhlanganise nendlela ye-anterolateral);(2) indlela yendololwane ephakathi;(3) indlela ehlangene yendololwane ephakathi nendawo;kanye (4) nokusondela kwendololwane ngemuva.
Kokubili indlela yendololwane ye-lateral ne-medial approach inezinzuzo zezicubu ezonakaliswe kancane kanye nesakhiwo esilula se-anatomical.I-incision ephakathi iphephile kune-lateral incision futhi ingavimbela ukulimala kwenzwa ye-ulnar.Ububi ukuthi akekho kubo ongakwazi ukubona ngokuqondile ukuphuka kohlangothi oluhlangene lwe-incision, futhi kungancishiswa kuphela futhi kulungiswe ngokuzwa kwesandla, okudinga indlela yokuhlinzwa ephakeme yomqhubi.Indlela ye-elbow yangemuva iye yaba nengxabano ngenxa yokubhujiswa kobuqotho be-triceps muscle kanye nomonakalo omkhulu.Indlela ehlanganisiwe yezindololwane ezimaphakathi nezasemaceleni ingenza kube nobubi bokungakwazi ukubona ngqo i-contralateral bone surface of the incision.Inezinzuzo zokusikwa kwendololwane okuphakathi nendawo, okuvumela ukuncishiswa nokulungisa ukuphuka, futhi kunganciphisa ubude bokusika kwe-lateral.Kuyasiza ekusizeni nasekunciphiseni ukuvuvukala kwezicubu;kodwa okubi kwayo ukuthi kwandisa ukusika ngokuhlinzwa;Futhi ephakeme kunendlela yangemuva.
Inkinga
Izinkinga ze-supracondylar humeral fractures zihlanganisa: (1) ukulimala kwe-neurovascular;(2) i-acute septal syndrome;(3) ukuqina kwendololwane;(4) i-myositis ossificans;(5) i-avascular necrosis;(6) ukukhubazeka kwe-cubitus varus;(7) ukukhubazeka kwe-cubitus valgus.
Fingqa
I-Supracondylar fractures ye-humerus iphakathi kokuhlukana okuvame kakhulu ezinganeni.Eminyakeni yamuva, ukuncishiswa okungekuhle kokuphuka kwe-supracondylar kwe-humerus kuye kwavusa ukunaka kwabantu.Esikhathini esidlule, i-cubitus varus noma i-cubitus valgus yayicatshangwa ukuthi ibangelwa ukuboshwa kokukhula kwepuleti ye-distal humeral epiphyseal, kunokunciphisa okuncane.Iningi lobufakazi obuqinile manje busekela ukuthi ukuncishiswa okungekuhle kokuqhekeka kuyisici esibalulekile ekukhubazekeni kwe-cubitus varus.Ngakho-ke, ukuncishiswa kwe-supracondylar humerus fractures, ukulungiswa kwe-ulnar offset, ukujikeleza okuvundlile nokubuyiselwa kokuphakama kwe-distal humerus yizihluthulelo.
Ziningi izindlela zokwelapha zokuphuka kwe-supracondylar kwe-humerus, njengokunciphisa ngesandla + ukulungiswa kwangaphandlenge-plaster cast, i-olecranon traction, ukulungiswa kwangaphandle nge-splint, ukunciphisa okuvulekile nokulungiswa kwangaphakathi, nokunciphisa okuvaliwe nokulungiswa kwangaphakathi.Esikhathini esedlule, ukuncishiswa okukhohlisayo kanye nokufakwa kukakhonkolo kwangaphandle kwakuyizindlela zokwelapha eziyinhloko, lapho i-cubitus varus kubikwe ukuthi iphakeme ngendlela engama-50% eShayina.Njengamanje, ngohlobo lwe-II kanye nohlobo lwe-III i-supracondylar fractures, ukulungiswa kwenaliti ye-percutaneous ngemva kokunciphisa ukuphuka sekuyindlela eyamukelwa ngokuvamile.Inezinzuzo zokungabhubhisi ukunikezwa kwegazi nokuphulukiswa kwamathambo okusheshayo.
Kukhona nemibono eyahlukene mayelana nendlela kanye nenani eliphelele lokulungiswa kwezintambo ze-Kirschner ngemva kokwehliswa okuvaliwe kokuphuka.Okuhlangenwe nakho komhleli ukuthi izintambo ze-Kirschner kufanele zihlukaniswe kabili ngesikhathi sokulungiswa.Lapho indiza ephuka iqhelelene, izinze kakhulu.Izintambo ze-Kirschner akufanele ziwele endizeni yokuphuka, ngaphandle kwalokho ukujikeleza ngeke kulawulwe futhi ukulungiswa kuyoba okungazinzile.Ukunakekelwa kufanele kuthathwe ukuze kugwenywe ukulimala kwenzwa ye-ulnar lapho usebenzisa ukulungiswa kwe-wire Kirschner okuphakathi.Ungayilungi inaliti endaweni egobile yendololwane, qondisa kancane indololwane ukuze uvumele inzwa ye-ulnar ukuthi ihlehle, thinta inzwa ye-ulnar ngesithupha bese uyibuyisela emuva futhi uxhume ngokuphephile i-K-wire.Ukusetshenziswa kokulungiswa kwangaphakathi kwentambo ye-Kirschner kunezinzuzo ezingaba khona ekululameni kokusebenza kwangemva kokuhlinzwa, izinga lokuphulukiswa kokuphuka, kanye nezinga elihle kakhulu lokuphulukiswa kokuphuka, okuzuzisa ukululama kwangaphambi kokuhlinzwa.
Isikhathi sokuthumela: Nov-02-2022
