Izindaba - Ukwelashwa kokuqhekeka okude

Umphumela wokwelashwa uncike ekuphakanyisweni kwe-anatomical kwe-fracture block, ukulungiswa okuqinile kokuqhekeka, ukulondolozwa kokuvalwa kwezicubu ezithambile nokuzivocavoca okusebenzayo kokuqala.

Umumo womzimba

Le khasihustal humerusihlukaniswe kwikholamu ye-medial kanye nekholamu lamuva (Umdwebo 1).

Umdwebo 1 I-Distal Hutherus iqukethe ikholamu ye-medial ne-lateral

Ikholamu ye-Medial lifaka ingxenye yempilo ye-epiphysis ethobekile, i-epicondyyle ye-vericondyle ye-humerus kanye ne-coumber comberal commoral kubandakanya i-glider glideral.

Ikholomu lamuva eliqukethe ingxenye yamuva ye-epiphphysis ethobekile, i-epicondyy yangaphandle ye-humerus kanye nentamba yangaphandle ye-humerus kubandakanya ne-tumeral Tuberoluty kubandakanya ne-Tumelity Truberoty.

Phakathi kwamakholomu amabili alandelanayo yi-fossa engaphandle ye-coronoid ne-fossa yangemuva.

Umshini wokulimala

Ama-supracondylar fractures we-humerus avame ukubangelwa ukuwa kusuka ezindaweni eziphakeme.

Iziguli ezincane ezinama-intra-articular fractures zivame ukubangelwa ukulimala kobudlova obunobudlova, kepha iziguli ezindala zingaba nokuqhekeka kwe-Intra-articular fractures kusuka ekulimaleni okunobudlova okuphansi ngenxa ye-osteoporosis ngenxa yethambo.

Ukuthayipha

(a) Kukhona ama-supracondylar fractures, ama-condylar fractures kanye ne-intercondylar fractures.

Umdwebo 2 ao typing

I-Ao humeral Fracture Typing (Umdwebo 2)

Thayipha A: Ukuqhekeka okwengeziwe.

Uhlobo B: Ukuqhekeka okubandakanya indawo ye-articular (ukwaphuka kwekholomu eyodwa).

Uhlobo C: Ukuhlukaniswa okuphelele kobuso bezinzwa ze-husticular ze-huterus distal kusuka esiteshini esiminyelo (i-bicolunar fracture).

Uhlobo ngalunye luphinde luhlukaniswe lube ngama-3 ama-subtypes ngokuya ngezinga lokuphasa kokuqhekeka, (1 ~ 3 ama-subtypes akhuphukayo wokuphawula kulowo myalo).

Umdwebo3 wokubopha-radin-radin ukuthayipha

Ukuthayipha kwe-Bangeroborough-radin kwe-intercondylar fractures ye-humerus (zonke izinhlobo zifaka ingxenye ye-supracondylar ye-humerus)

Uhlobo I: Ukuqhekeka ngaphandle kokufuduka phakathi kwe-Tumelial Truberoluty neTalus.

Uhlobo II: I-Intercondylar Fracture ye-humerus enokuthunyelwa kwesisindo sokuqhekeka kwe-condertyle ngaphandle kokukhubazeka okujikelezayo.

Uhlobo lwe-III: I-Intercondylar Fracture ye-humerus enokuthunyelwa kwesiqephu se-fracture se-condformy nge deformecform.

Uhlobo IV: Ukuqhekeka okukhulu okususiwe kwe-arturicular force of munye noma zombili izindondo (Umdwebo 3).

Umdwebo 4 Uhlobo I Tumelial Tuberaltuluty Fracture

Umdwebo 5 I-Tumelial Tuborsuty Tumber Oracture Staging

Ukuqhekeka kwe-Tumelity Truberal Truberal: Ukulimala kwe-vear ye-veral humerus

Uhlobo I: Ukuqhekeka kwalo lonke i-Tumber Truberul Tumber kufaka phakathi umphetho we-lateral we-talus ethobekile (i-hahn-steinthal fracture) (Umdwebo 4).

Uhlobo II: Ukuqhekeka kwe-Subchondral Fracture ye-Acticular Cartilage ye-Tonberal Tarberal Truberal (Kocher-Lorenz Fracture).

Uhlobo lwe-III: Ukuqhekeka okuvuthiwe kwe-Tumber Truberal Truberal (Umdwebo 5).

Ukwelashwa okungasebenzi

Izindlela zokwelashwa ezingasebenzi zokuqhekeka kwe-distal humeral fractures kunendima elinganiselwe. Inhloso yokwelashwa okungasebenzi yilena: ukunyakaza kokuhlangana kusenesikhathi ukugwema ukuqina okuhlanganyelwe; Iziguli ezikhulile, ezihlaselwa kakhulu ezifweni eziningi ezihlanganisiwe, kufanele ziphathwe ngendlela elula yokuqhafaza i-Elbow Joint ngo-60 ° wokuguquguquka kwamaviki ama-2-3, kulandelwe umsebenzi wokukhanya.

Ukwelashwa okuhlinza

Inhloso yokwelashwa ukubuyisela uhla olusebenzayo olungenazinhlungu lokuhlangana (30 ° ye-Elbow Extension, 130 ° of Elbow Flexion, 50 ° of Anterior Rotation); Ukulungiswa okuqinile nokuzinzile kwangaphakathi kwe-fracture kuvumela ukuqala kokuzivocavoca okusebenzayo ngemuva kokuphulukiswa kwesikhumba; Ukulungiswa kwepuleti ephindwe kabili kwe-huterus distal kufaka phakathi: Ukulungiswa kwepuleti okuhlangenwe nakho okuphezulu nendawo okulandelayo, nomai-medial ne-lateralUkulungiswa kwepuleti kabili.

Indlela yokuhlinzwa

(a) Isiguli sibekwe endaweni ephakeme ye-lateral nge-liner ebekwe ngaphansi komlenze othintekile.

Ukukhonjwa nokuvikelwa kwe-Median ne-Radial Nerves Intraperaipeatively.

I-Elterior Elbow inganwetshwa ukufinyelela kokuhlinzwa: I-Ulnar Hawk Osteotomy noma Ukubuyiselwa Kwe-Triceps ukudalula ukuphazamiseka okujulile kwe-articular

I-Ulnar Hawkekeye Osteotomy: Ukuvezwa okwanele, ikakhulukazi ama-fractures ahlanganisiwe we-articular ebunjiwe. Kodwa-ke, ukwaphuka okungeyona inyunyana kuvame ukwenzeka endaweni ye-osteotomy. Izinga elingeyona inyunyana lincishiswe kakhulu nge-ulnar hawk osteotomy (herringbone osteotomy) kanye ne-transtension band wire noma ukulungiswa kwepuleti.

Ukuvezwa kokubuyiselwa kwama-triceps kungasetshenziswa ekuqhekekeni okuqabulayo kwebhulokhi eluhlaza okokwahlukana ngokuhlangene, nokuvezwa okunwetshiwe kwesilayidi esiminyanyeli kunganqunywa futhi kuveze i-Ulnar Hawk Tip cishe ngo-1 cm.

Kutholakale ukuthi amapuleti amabili angabekwa orthogononally noma ngokufana, kuya ngohlobo lokuqhekeka lapho kufanele kubekwe khona amapuleti.

Ama-articular surface fractures kufanele abuyiselwe endaweni eyizicaba ezifuywayo futhi ahlelwe esiqwini sokutholwa.

Umdwebo 6 Ukulungiswa kwangaphakathi kokusebenza kwangemuva kokuqhekeka kwe-elbow

Ukulungiswa kwesikhashana kwe-Fracture Block kwenziwa ngokufaka isicelo se-K, ngemuva kwalo ipuleti le-3.5 mm elishukunyiswayo lalinyathelwa kwikholamu ye-medial, ukuze ipuleti yokwakhiwa kabusha kwe-3.5 mm lalilingana nenqubo yethambo (ipuleti elisha lesikhathi esisha lingase lula inqubo.) (Umfanekiso 6).

Qikelela ukuthi ungalungisi i-articular surface fracture fragment ngezikulufo ze-cortical ezihlanganisiwe zonke ezinomfutho ovela ku-medial uye ohlangothini olusemuva.

I-epiphysis-shourus eyinkulungwane yokufuduka kubalulekile ukugwema ukungasebenzi kokuphazamiseka.

Ukunikeza i-Bone Graild Foont endaweni ye-Bone Defect, ukusebenzisa ama-Iliac akhanyisa amathambo ukugcwalisa isici se-Fracture Fracture: Ikholomu ye-Medical, indawo ye-articular kanye nekholamu elikhanyisiwe eceleni kwe-epiphysis.

Khumbula amaphuzu asemqoka wokulungiswa.

Ukulungiswa kwesiqephu se-distal fracture nabaningiisikulufungangokunokwenzeka.

Ukulungiswa kwezingcezu eziningi ze-fracture ezingahlukaniswa ngangokunokwenzeka ngezikulufo eziwela ngokuqondile ngokulandelana.

Amapuleti ensimbi kufanele abekwe ezinhlangothini ze-medial nasemuva kwe-huterus distal.

Izinketho zokwelashwa: Ingqikithi ye-Elbow Arthroplasty

Ezigulini ezinama-fractures abucayi afakiwe noma i-osteoporosis, ingqikithi ye-elbow arthroplasty ingabuyisela ukunyakaza okuhlangene kwe-elbow nomsebenzi wesandla ngemuva kweziguli ezifunwayo; Indlela yokuhlinza ifana nephelele ye-arthroplasty yezinguquko ezihlangene ze-elbow Joint.

(1) Ukusetshenziswa kohlobo olude lwe-stem-hlobo prosthesis ukuvikela ukunwetshwa kwe-proximal fracture.

(2) Isifinyezo sokuhlinzwa.

Ukunganqunyelwe kwe-ulnar nerve.

Finyelela ngokusebenzisa izinhlangothi zombili ze-triceps ukuze ususe ithambo elihlukanisiwe (iphuzu eliyisihluthulelo: ungasinqumi ukuma kwama-triceps esizeni se-ulnar Hawk).

Yonke imihume ye-disul distal kufaka phakathi i-hawk fossa ingasuswa futhi i-prosthesis ifakiwe, engeke ishiye noma yiliphi i-sequelae ebalulekile uma kufakwa okungeziwe ukuthi i-2 cm iyasuswa

Ukulungiswa kwengxabano engaphakathi yemisipha ye-triceps ngesikhathi esifanelekile kwe-prostheral prosthesis ngemuva kokulungiselela i-coumberal towlesle.

I-Excusion of the tip of the proximal ulnar ukuvelela ukuvumela ukufinyelela okungcono kokuvezwa nokufakwa kwengxenye ye-ulnar prosthentis (Umdwebo 7).

Umdwebo 7 Elbow Arthroplasty

Ukunakekelwa kwe-postoperative

Ukuchithwa kwe-postoperative kwesici sangemuva sangemuva kwe-elbow kuhlangene kufanele kususwe uma isikhumba sesiguli siphulukise, kanye nokuzivocavoca okusebenzayo okusebenzayo kufanele kuqalwe; I-Elbow Joint kufanele ilungiswe isikhathi eside esanele ngemuva kokubuyiselwa imali ehlanganisiwe yokuphakamisa ukuphulukiswa kwesikhumba (i-elbow Joint ingalungiswa endaweni eqondile amasonto ama-2 ngemuva kokuthola ukuhlinzwa okungcono); I-splint ekhishwe okususwayo manje isetshenziswa emtholampilo ukuze lula uhla lokuzivocavoca lokunyakaza lapho lingasuswa kaningi ukuze luvikele umlenze othintekile; Ukuzivocavoca okusebenzayo kuvame ukuqalwa emavikini ama-6-8 ngemuva kokuthi isilonda sesikhumba siphulukise ngokuphelele.