Izindaba - Ukwelashwa kwe-Distal Humeral Fractures

Umphumela wokwelashwa uncike ekumisweni kabusha kwe-anatomical kwebhulokhi yokuphuka, ukulungiswa okuqinile kokuphuka, ukulondolozwa kokumbozwa kwezicubu ezinhle ezithambile kanye nokuzivocavoca kokuqala kokusebenza.

I-Anatomy

Ii-distal humerusihlukaniswe yaba yikholomu emaphakathi kanye nekholomu ehlangothini (Umfanekiso 1).

Umfanekiso 1 I-distal humerus iqukethe ikholomu ephakathi nendawo

Ikholomu ephakathi ihlanganisa ingxenye emaphakathi ye-humeral epiphysis, i-medial epicondyle ye-humerus kanye ne-medial humeral condyle kuhlanganise ne-humeral glide.

Ikholomu yangemuva ehlanganisa ingxenye engemuva ye-humeral epiphysis, i-epicondyle yangaphandle ye-humerus kanye ne-condyle yangaphandle ye-humerus kuhlanganise ne-humeral tuberosity.

Phakathi kwamakholomu amabili asemaceleni kukhona i-anterior coronoid fossa kanye ne-posterior humeral fossa.

Indlela yokulimala

I-Supracondylar fractures ye-humerus ivame ukubangelwa ukuwa okuvela ezindaweni eziphakeme.

Iziguli ezincane ezine-intra-articular fractures zivame ukubangelwa ukulimala okunamandla okunamandla, kodwa iziguli ezindala zingase zibe ne-intra-articular fractures ngenxa yokulimala okunamandla okunamandla ngenxa ye-osteoporosis.

Ukuthayipha

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

(b)Ukuphuka kwe-Supracondylar kwe-humerus: indawo yokuphuka itholakala ngaphezu kwe-fossa yoklebe.

(c)Ukuphuka kwe-humeral condylar: indawo yokuphuka itholakala ku-fossa yoklebe.

(d) ukuphuka kwe-intercondylar kwe-humerus: indawo yokuphuka itholakala phakathi kwama-condyles amabili akude we-humerus.

Ukuthayipha kwe-Figure 2 AO

Ukuthayipha kwe-AO kwe-humeral fracture (Umfanekiso 2)

Uhlobo A: ama-extra-articular fractures.

Uhlobo B: ukuphuka okubandakanya i-articular surface (ukuphuka kwekholomu eyodwa).

Uhlobo C: ukuhlukaniswa okuphelele kwe-articular surface ye-distal humerus kusukela ku-humeral stem (i-bicolumnar fracture).

Uhlobo ngalunye luphinde luhlukaniswe lwaba ama-subtypes angu-3 ngokuya ngezinga lokuqalisa kokuphuka, (ama-subtypes angu-1 ~ 3 anezinga elikhulayo lokuqalisa ngalolo hlelo).

Umfanekiso3 Ukuthayipha kwe-Riseborough-Radin

I-Riseborough-Radin ukuthayipha kwe-intercondylar fractures ye-humerus (zonke izinhlobo zifaka ingxenye ye-supracondylar ye-humerus)

Thayipha I: ukuphuka ngaphandle kokususwa phakathi kwe-humeral tuberosity kanye ne-talus.

Thayipha II:ukuphuka kwe-intercondylar kwe-humerus ngokususwa kwesisindo sokuphuka kwe-condyle ngaphandle kokukhubazeka kokujikeleza.

Uhlobo lwe-III:ukuphuka kwe-intercondylar kwe-humerus nokugudluzwa kocezu oluphukile lwe-condyle ngokukhubazeka okujikelezayo.

Uhlobo IV: ukuphuka okungapheli okungapheli kwe-articular surface ye-condyles eyodwa noma womabili (Umfanekiso 3).

Umfanekiso 4 Uhlobo lwe-I yokuphuka kwe-humeral tuberosity

Umfanekiso 5 Isiteji sokuphuka kwe-humeral tuberosity

Ukuphuka kwe-humeral tuberosity: ukulimala kwe-shear kwe-distal humerus

Thayipha I: ukuphuka kwayo yonke i-humeral tuberosity kuhlanganise nonqenqema olungemuva lwe-humeral talus (i-Hahn-Steinthal fracture) (Umfanekiso 4).

Thayipha II: i-subchondral fracture ye-articular cartilage ye-humeral tuberosity (i-Kocher-Lorenz fracture).

Uhlobo lwe-III: ukuphulwa okuqhubekayo kwe-tuberosity humeral (Umfanekiso 5).

Ukwelashwa okungasebenzi

Izindlela zokwelapha ezingasebenzisi ama-distal humeral fracture zinendima elinganiselwe.Inhloso yokwelashwa okungasebenzisi ukuthi: ukunyakaza kwamalunga kusenesikhathi ukugwema ukuqina kwamalunga;iziguli esezikhulile, ezivame ukuhlushwa izifo eziningi ezihlanganisiwe, kufanele ziphathwe ngendlela elula yokuhlukanisa i-elbow joint ku-60 ° ye-flexion yamaviki angu-2-3, kulandelwa umsebenzi okhanyayo.

Ukwelashwa ngokuhlinzwa

Inhloso yokwelashwa ukubuyisela uhla olusebenzayo olungenabuhlungu lokunyakaza kokujoyina (30 ° yesandiso se-elbow, i-130 ° ye-elbow flexion, i-50 ° yokujikeleza kwangaphambili nangemuva);ukulungiswa kwangaphakathi okuqinile nokuzinzile kwe-fracture kuvumela ukuqala kokuzivocavoca kwe-elbow okusebenzayo ngemuva kokuphulukiswa kwesilonda sesikhumba;ukulungiswa kwepuleti ephindwe kabili ye-distal humerus kuhlanganisa: ukulungiswa kwepuleti eliphakathi nendawo elingemuva, nomamedial kanye lateralukulungiswa kwamapuleti amabili.

Indlela yokuhlinza

(a) Isiguli sibekwe endaweni ebheke phezulu phezulu nomugqa obekwe ngaphansi kwelunga elithintekile.

ukuhlonza nokuvikelwa kwemizwa ephakathi nendawo kanye ne-radial ngokusebenza.

Indololwane yangemuva inganwetshwa ukufinyelela kokuhlinzwa: i-ulnar hawk osteotomy noma i-triceps ihlehla ukuze kuvezwe ukuphuka kwe-articular ejulile

i-ulnar hawkeye osteotomy: ukuchayeka okwanele, ikakhulukazi ukuphuka okuhlangene kwendawo ye-articular.Kodwa-ke, i-fracture non-union ngokuvamile ivela endaweni ye-osteotomy.Izinga lokuphuka okungelona inyunyana lehliswe kakhulu ngokuthuthukiswa kwe-ulnar hawk osteotomy (herringbone osteotomy) kanye ne-transtension band wire noma ukulungiswa kwepuleti.

Ukuchayeka kokuhlehla kwe-Triceps kungasetshenziswa ekuqhekekeni kwebhulokhi e-distal humeral kathathu ngokuhlangana okuhlanganyelwe, futhi ukuvezwa okunwetshiwe kwesilayidi se-humeral kungasika futhi kudalule ithiphu le-ulnar hawk cishe ku-1 cm.

Kutholakale ukuthi amapuleti amabili angabekwa nge-orthogonally noma ngokuhambisana, kuye ngokuthi uhlobo lokuphuka okufanele kubekwe kulo amapuleti.

Ukuphuka kwe-articular surface kufanele kubuyiselwe endaweni eyisicaba ye-articular futhi kugxilwe esiqwini se-humeral.

Umfanekiso 6 Ukulungiswa kwangaphakathi kwangemva kokuhlinzwa kokuphuka kwendololwane

Ukulungiswa kwesikhashana kwebhulokhi yokuphuka kwenziwa kusetshenziswa intambo engu-K, ngemva kwalokho ipuleti lokucindezela lamandla elingu-3.5 mm lasikwa laba sesimweni sepuleti ngokuya ngesimo esingemuva kwekholomu ehlangothini ye-distal humerus, kanye nepuleti lokwakha kabusha elingu-3.5 mm kusikwa ukuze kube nokuma kwekholomu emaphakathi, ukuze izinhlangothi zombili zepuleti zilingane nendawo yethambo (ipuleti lokubumba elithuthukile lingenza inqubo ibe lula.) (Umfanekiso 6).

Qaphela ukuthi ungalungisi isiqeshana se-articular surface fracture ngezikulufu ze-cortical ezinemicu yonke ngokucindezela ukusuka kokuphakathi ukuya ohlangothini olusemaceleni.

i-epiphysis-humerus thousand migration site ibalulekile ukuze ugweme ukungahlangani kokuhlukana.

ukunikeza ukugcwaliswa kwamathambo endaweni yesiphambeko samathambo, kusetshenziswa ukuxhunyelelwa kwethambo le-iliac ukukhansela ukugcwalisa isici sokuqhekeka kokucindezelwa: ikholomu ephakathi, ikholomu ye-articular kanye nekholomu ehlangothini, ukuxhunyelelwa kwethambo elikhansela eceleni eline-periosteum engaguquki kanye ne-compression bone defect ku-epiphysis.

Khumbula amaphuzu abalulekile wokulungisa.

Ukulungiswa kocezu lwe-distal fracture nabaningiizikulufungangokunokwenzeka.

ukulungiswa kwezingcezu eziningi zokuqhekeka kwezingcezu ngangokunokwenzeka ngezikulufu eziwela ngokumaphakathi ziye eceleni.

Amapuleti ensimbi kufanele abekwe ezinhlangothini ezimaphakathi nezinhlangothi ze-distal humerus.

Izinketho zokwelapha: I-arthroplasty ephelele ye-elbow

Ezigulini ezinokuphuka okukhulu okungapheli noma i-osteoporosis, i-arthroplasty ephelele ye-elbow ingabuyisela ukunyakaza okuhlangene kwe-elbow kanye nokusebenza kwesandla ngemva kweziguli ezidinga kancane;indlela yokuhlinza ifana ne-arthroplasty ephelele yezinguquko eziwohlokayo zelunga lendololwane.

(1) ukusetshenziswa kwe-stem-type prosthesis ende ukuvimbela ukunwetshwa kokuphuka okuseduze.

(2) Isifinyezo sokuhlinza.

(a) Inqubo yenziwa kusetshenziswa indlela yendololwane yangemuva, enezinyathelo ezifanayo nalezo ezisetshenziselwa ukusika i-distal humeral fracture kanye nokulungiswa kwangaphakathi (ORIF).

I-Anteriorization ye-nerve ye-ulnar.

ukufinyelela kuzo zombili izinhlangothi ze-triceps ukususa ithambo elihlukanisiwe (iphuzu eliyinhloko: ungasiki ukuma kwe-triceps endaweni ye-ulnar hawk).

I-distal humerus yonke ehlanganisa i-hawk fossa ingasuswa futhi ifakwe i-prosthesis, engeke ishiye noma iyiphi i-sequelae ebalulekile uma i-I eyengeziwe kuya ku-2 cm ikhishwa.

ukulungiswa kwengcindezi yangaphakathi yomsipha we-triceps ngesikhathi sokufakwa kwe-humeral prosthesis ngemva kokusishulwa kwe-condyle e-humeral.

Ukukhishwa kwethiphu ye-proximal ulnar eminence ukuvumela ukufinyelela okungcono kokuchayeka nokufakwa kwengxenye yokwenziwa kwe-ulnar (Umfanekiso 7).

Umfanekiso 7 I-elbow arthroplasty

Ukunakekelwa kwangemva kokuhlinzwa

Ukuhlukaniswa kwe-postoperative yesici esingemuva kwe-elbow joint kufanele kususwe lapho isilonda sesikhumba sesiguli siphola, futhi ukuzivocavoca okusebenzayo okusebenzayo ngosizo kufanele kuqalwe;i-elbow joint kufanele ilungiswe isikhathi eside ngokwanele ngemva kokushintshwa okuphelele kwamalunga ukuze kuthuthukiswe ukuphulukiswa kwesilonda sesikhumba (i-elbow joint ingalungiswa endaweni eqondile amaviki angu-2 ngemva kokuhlinzwa ukuze kusize ukuthola umsebenzi ongcono wokunwetshwa);i-splint engagudluki ekhishwayo manje isetshenziswa ngokuvamile emtholampilo ukuze kube lula ukuzivocavoca okuhlukahlukene uma Ingasuswa njalo ukuze kuvikelwe kangcono isitho esithintekile;Ukuvivinya umzimba okusebenzayo okusebenzayo kuvame ukuqalwa emavikini angama-6-8 ngemuva kokuba isilonda sesikhumba saphola ngokuphelele.