Umphumela wokwelashwa uncike ekubekweni kabusha kwesakhiwo se-fracture block, ukuqina okuqinile kwe-fracture, ukulondolozwa kokumbozwa okuhle kwezicubu ezithambile kanye nokuzivocavoca kokuqala kokusebenza.
Ukwakheka Komzimba
Ii-humerus ekudeihlukaniswe yaba ikholomu ephakathi nendawo kanye nekholomu eseceleni (Isithombe 1).
Umfanekiso 1 I-humerus ekude yakhiwe ikholomu ephakathi neseceleni
Ikholomu ephakathi ihlanganisa ingxenye ephakathi ye-humeral epiphysis, i-medial epicondyle ye-humerus kanye ne-medial humeral condyle okuhlanganisa ne-humeral glide.
Ikholomu eseceleni equkethe ingxenye eseceleni ye-humeral epiphysis, i-epicondyle yangaphandle ye-humerus kanye ne-condyle yangaphandle ye-humerus okuhlanganisa ne-humeral tuberosity.
Phakathi kwamakholomu amabili aseceleni kukhona i-anterior coronoid fossa kanye ne-posterior humeral fossa.
Indlela yokulimala
Ukuphuka kwe-supracondylar kwe-humerus kuvame ukubangelwa ukuwa okuvela ezindaweni eziphakeme.
Iziguli ezisencane ezinezimpaphe eziphukile ngaphakathi kwe-articular zivame ukubangelwa ukulimala okunamandla amakhulu, kodwa iziguli ezindala zingaba nezimpaphe eziphukile ngaphakathi kwe-articular ngenxa yokulimala okunamandla amancane ngenxa ye-osteoporosis.
Ukuthayipha
(a)Kukhona ukuphuka kwe-supracondylar, ukuphuka kwe-condylar kanye nokuphuka kwe-intercondylar.
(b) Ukuphuka kwe-supracondylar kwe-humerus: indawo yokuphuka itholakala ngaphezu kwe-fossa yoklebe.
(c)Ukuphuka kwe-humeral condylar: indawo yokuphuka itholakala efossa ye-hawk.
(d)ukuphuka kwe-humerus phakathi kwe-intercondylar: indawo yokuphuka itholakala phakathi kwe-condyles ezimbili ezikude ze-humerus.
Umfanekiso 2 Ukuthayipha kwe-AO
Uhlobo lokuphuka kwe-humeral ye-AO (Isithombe 2)
Uhlobo A: ukuphuka kwe-extra-articular.
Uhlobo B: ukuphuka okubandakanya ubuso obuhlangene (ukuphuka kwekholomu eyodwa).
Uhlobo C: ukuhlukaniswa okuphelele kobuso obuhlangene be-humerus ekude kusuka esiqwini se-humeral (ukuphuka kwe-bicolumnar).
Uhlobo ngalunye luhlukaniswe ngezinhlobo ezintathu ngokuya ngezinga lokuguquka kokuphuka, (izinhlobo ezi-1 ~ 3 ezinezinga lokuguquka elikhulayo ngaleyo ndlela).
Umfanekiso 3 Ukuthayipha kwe-Riseborough-Radin
Uhlobo lwe-Riseborough-Radin lokuphuka kwe-intercondylar kwe-humerus (zonke izinhlobo zifaka ingxenye ye-supracondylar ye-humerus)
Uhlobo I: ukuphuka ngaphandle kokuhamba phakathi kwe-humeral tuberosity kanye ne-talus.
Uhlobo II: ukuphuka kwe-intercondylar kwe-humerus ngokufuduka kwesisindo sokuphuka kwe-condyle ngaphandle kokukhubazeka okujikelezayo.
Uhlobo III: ukuphuka kwe-intercondylar kwe-humerus ngokufuduka kwengxenye yokuphuka kwe-condyle enokukhubazeka okujikelezayo.
Uhlobo IV: ukuphuka okukhulu kwengxenye engezansi ye-articular ye-condyle eyodwa noma zombili (Isithombe 3).
Umfanekiso 4 Uhlobo I lwe-humeral tuberosity fracture
Umfanekiso 5 Isigaba sokuqhekeka kwe-Humeral tuberosity
Ukuphuka kwe-humeral tuberosity: ukulimala kwe-shear kwe-distal humerus
Uhlobo I: ukuphuka kwe-humeral tuberosity yonke kufaka phakathi unqenqema oluseceleni lwe-humeral talus (ukuphuka kwe-Hahn-Steinthal) (Isithombe 4).
Uhlobo II: ukuphuka kwe-subchondral kwe-articular cartilage ye-humeral tuberosity (ukuphuka kwe-Kocher-Lorenz).
Uhlobo III: ukuphuka okuhlanganisiwe kwe-humeral tuberosity (Isithombe 5).
Ukwelashwa okungadingi ukuhlinzwa
Izindlela zokwelapha ngaphandle kokuhlinzwa zokuphuka kwe-humeral distal zinendima elinganiselwe. Inhloso yokwelashwa ngaphandle kokuhlinzwa iwukuthi: ukunyakaza kwamalunga kusenesikhathi ukuze kugwenywe ukuqina kwamalunga; iziguli esezikhulile, ezihlushwa kakhulu yizifo eziningi ezihlanganisiwe, kufanele zelashwe ngendlela elula yokuhlukanisa i-elbow joint endaweni engama-60° yokugoba amasonto ama-2-3, kulandelwe umsebenzi olula.
Ukwelashwa ngokuhlinzwa
Inhloso yokwelashwa ukubuyisela ububanzi bokusebenza obungenabuhlungu bokunyakaza kwelunga (ukwandiswa kwendololwane okungu-30°, ukugoba kwendololwane okungu-130°, ukujikeleza kwangaphambi nangemuva okungu-50°); ukuqina nokuzinzile kwangaphakathi kokuphuka kuvumela ukuqala kokuzivocavoca kwendololwane okusebenzayo ngemva kokuphola kwenxeba lesikhumba; ukuqina kwe-double plate ye-distal humerus kuhlanganisa: ukuqina kwe-medial kanye ne-posterior lateral double plate, nomaokuphakathi kanye nokuseceleniukulungiswa kwepuleti eliphindwe kabili.
Indlela yokuhlinzwa
(a) Isiguli sibekwa endaweni ebheke phezulu eceleni bese kufakwa i-liner ngaphansi kwesitho esithintekile.
ukuhlonza nokuvikela imizwa ephakathi nendawo kanye ne-radial ngesikhathi sokuhlinzwa.
Ingalo engemuva inganwetshwa ukuze kutholakale ukufinyelela kokuhlinzwa: i-ulnar hawk osteotomy noma i-triceps retraction ukuze kuvezwe ukuqhekeka okujulile kwe-articular
i-ulnar hawkeye osteotomy: ukuvezwa okwanele, ikakhulukazi ekuqhekekeni okuqhekekile kobuso be-articular. Kodwa-ke, ukungahlangani kwama-fracture kuvame ukwenzeka endaweni ye-osteotomy. Izinga lokungahlangani kwama-fracture liye lehla kakhulu ngokuthuthukiswa kwe-ulnar hawk osteotomy (i-herringbone osteotomy) kanye nokufakwa kwe-transtension band wire noma i-plate.
Ukuvezwa kwe-triceps retraction kungasetshenziswa ekuqhekekeni kwe-humeral trifold block ekude ngokuhlangana kwamalunga, futhi ukuvezwa okwandisiwe kwe-humeral slide kungasika futhi kuveze isihloko se-ulnar hawk cishe ku-1 cm.
Kutholakale ukuthi amapuleti amabili angabekwa ngendlela eqondile noma ehambisanayo, kuye ngohlobo lokuqhekeka okufanele kufakwe kulo amapuleti.
Ukuqhekeka kobuso obuhlangene kufanele kubuyiselwe endaweni eyisicaba ehlangene bese kuqiniswa esiqwini se-humeral.
Umfanekiso 6 Ukulungiswa kwangaphakathi kokuphuka kwendololwane ngemva kokuhlinzwa
Ukulungiswa kwesikhashana kwebhulokhi yokuqhekeka kwenziwa ngokusebenzisa intambo ka-K, ngemva kwalokho ipuleti lokucindezela amandla elingu-3.5 mm lanqunywa ngesimo sepuleti ngokwesimo esingemuva kwekholomu eseceleni ye-humerus ekude, kanti ipuleti lokwakha kabusha elingu-3.5 mm lanqunywa ngesimo sekholomu ephakathi, ukuze izinhlangothi zombili zepuleti zilingane nobuso bethambo (ipuleti elisha lokubumba elithuthukisiwe lingenza inqubo ibe lula.) (Isithombe 6).
Qaphela ukuthi ungalungisi ingxenye yokuphuka kobuso obuhlanganisiwe ngezikulufo ze-cortical ezinezintambo zonke ngokucindezela kusuka ohlangothini oluphakathi kuya ohlangothini oluseceleni.
indawo yokufuduka ye-epiphysis-humerus thousand ibalulekile ukuze kugwenywe ukungahlangani kokuqhekeka.
ukufaka ithambo elihlanganisiwe endaweni lapho ithambo liphukile khona, ukusebenzisa i-iliac cancellous bone grafts ukugcwalisa i-compression fracture defect: ikholomu ephakathi, ubuso obuhlangene kanye nekholomu eseceleni, ukufaka ithambo elihlanganisiwe eceleni eline-periosteum engaphelele kanye ne-compression bone defect e-epiphysis.
Khumbula amaphuzu abalulekile okuqinisa.
Ukulungiswa kwengxenye yokuqhekeka okukude enama-fracture amaningi ngangokunokwenzekaizikulufungangokunokwenzeka.
ukubopha izingcezu eziningi ngangokunokwenzeka zokuphuka kwezingcezu ngezikulufo eziwela phakathi ziye emaceleni.
Amapuleti ensimbi kufanele abekwe ezinhlangothini eziphakathi neziseceleni ze-humerus ekude.
Izinketho zokwelapha: I-Total elbow arthroplasty
Ezigulini ezinesifo sokuphuka kwamathambo esibi kakhulu noma i-osteoporosis, i-total elbow arthroplasty ingabuyisela ukunyakaza kwamalunga e-elbow kanye nokusebenza kwesandla ngemva kweziguli ezingadingi kakhulu; inqubo yokuhlinzwa ifana ne-total arthroplasty yezinguquko eziwohlokayo zelunga le-elbow.
(1) ukusetshenziswa kwe-prosthesis ende yohlobo lwesiqu ukuvimbela ukwanda kokuqhekeka kwe-proximal.
(2) Isifinyezo sokuhlinzwa.
(a) Le nqubo yenziwa kusetshenziswa indlela yendololwane engemuva, ngezinyathelo ezifana nalezo ezisetshenziselwa ukusikwa kwe-humeral fracture kanye ne-internal fixation (ORIF).
Ukuthuthukiswa kwe-nerve ye-ulnar ngaphambili.
ukufinyelela ngazo zombili izinhlangothi ze-triceps ukuze ususe ithambo eliqhekekile (iphuzu elibalulekile: unganqumi ukuma kwe-triceps endaweni ye-ulnar hawk).
I-humerus yonke ekude ehlanganisa ne-hawk fossa ingasuswa bese kufakwa i-prosthesis, engeke ishiye noma yimuphi umphumela obalulekile uma kususwa i-I kuya ku-2 cm eyengeziwe.
ukulungiswa kokucindezeleka kwangaphakathi kwemisipha ye-triceps ngesikhathi sokufakwa kwe-humeral prosthesis ngemva kokususwa kwe-humeral condyle.
Ukusikwa kwesihloko se-proximal ulnar eminence ukuze kuvunyelwe ukufinyelela okungcono kokuchayeka nokufakwa kwengxenye ye-ulnar prosthesis (Isithombe 7).
Umfanekiso 7 I-arthroplasty ye-elbow
Ukunakekelwa ngemva kokuhlinzwa
Ukufakwa kwengxenye yangemuva yelunga lendololwane ngemva kokuhlinzwa kufanele kususwe uma isilonda sesikhumba sesiguli sesipholile, futhi kufanele kuqalwe izivivinyo ezisebenzayo ngosizo; ilunga lendololwane kufanele lilungiswe isikhathi eside ngokwanele ngemva kokufakwa kwelunga ngokuphelele ukuze kukhuthazwe ukuphulukiswa kwesilonda sesikhumba (ilunga lendololwane lingalungiswa endaweni eqondile amasonto ama-2 ngemva kokuhlinzwa ukuze kusizwe ekutholeni umsebenzi wokwelula ongcono); i-bant egxilile esuswayo manje isetshenziswa kakhulu emtholampilo ukuze kube lula uhla lwezivivinyo zokunyakaza lapho ingasuswa njalo ukuze kuvikelwe kangcono isitho esithintekile; ukuzivocavoca okusebenzayo kuvame ukuqala amasonto ayi-6-8 ngemuva kokuba isilonda sesikhumba sesipholile ngokuphelele.
Ukunakekelwa ngemva kokuhlinzwa
Ukufakwa kwengxenye yangemuva yelunga lendololwane ngemva kokuhlinzwa kufanele kususwe uma isilonda sesikhumba sesiguli sesipholile, futhi kufanele kuqalwe izivivinyo ezisebenzayo ngosizo; ilunga lendololwane kufanele lilungiswe isikhathi eside ngokwanele ngemva kokufakwa kwelunga ngokuphelele ukuze kukhuthazwe ukuphulukiswa kwesilonda sesikhumba (ilunga lendololwane lingalungiswa endaweni eqondile amasonto ama-2 ngemva kokuhlinzwa ukuze kusizwe ekutholeni umsebenzi wokwelula ongcono); i-bant egxilile esuswayo manje isetshenziswa kakhulu emtholampilo ukuze kube lula uhla lwezivivinyo zokunyakaza lapho ingasuswa njalo ukuze kuvikelwe kangcono isitho esithintekile; ukuzivocavoca okusebenzayo kuvame ukuqala amasonto ayi-6-8 ngemuva kokuba isilonda sesikhumba sesipholile ngokuphelele.
Isikhathi sokuthunyelwe: Disemba-03-2022
