Njengamanje, kunezindlela ezahlukahlukene zokwelashwa ze-distal radius fractures, njengokuhlelwa kokulula, ukuncishiswa okuvulekile kanye nokulungiswa kwangaphakathi, ukulungiswa kwepuleti yangaphandle kungathola umphumela ogculisayo, kepha kukhona imibiko egculisayo ngokwengeziwe, kepha kunemibiko egculisayo ngokwengeziwe. Kodwa-ke, uma ipuleti lensimbi likhethwe kahle, izehlakalo zezinkinga zingancishiswa ngempumelelo. Leli phepha lifingqa kafushane izici, izinkomba, izivumelwano, kanye namasu okuhlinza wokwelashwa kwe-volar Plate yokwelashwa kwe-distal radius fractures.
1. Kunezinzuzo ezimbili eziphambili zepuleti eseceleni yePalm
A.it angahlukanisa ingxenye ye-Buckling Force. Ukulungiswa ngezikulufo zokulungiswa kwe-angled kusekela isiqephu se-distal futhi kudluliselwa umthwalo emgodini we-radial (Fig. 1). Ingathola ukusekelwa kwegatsha ngempumelelo. Lolu hlelo lwepuleti alukwazi nje kuphela ukulungiswa ngokuqinile ukuqhekeka okungaphakathi kwe-intra-articular, kepha futhi kungabuyisela ngempumelelo ukwakheka kwe-anatomical kwethambo le-intra-archarm subchondral ithambo ngokusebenzisa i-PEG / Screw "Fan-Shape" Fixation ". Okwezinhlobo eziningi ze-radius radius fracture, lolu hlelo ophahleni luhlinzeka ngozi olukhulayo oluvumela ukuhlanganisa kusenesikhathi.
Isithombe 1, A, ngemuva kokwakhiwa kabusha kwezintathu zokwakhiwa kabusha kwe-distal radius evamile, naka iziqu zokucindezela kwe-dorsal; b, ukuncishiswa okubonakalayo kokuqhekeka, isici kumele silungiswe futhi sisekelwa yipuleti; C, ukubukwa okulandelayo ngemuva kokulungiswa kwe-DVR, umcibisholo ukhombisa ukudluliswa komthwalo.
Umthelela we-B. - Ukulungiswa kwezicubu ezithambile: Ukulungiswa kwePlate yeVerar kungaphansi komugqa wamanzi, uma kuqhathaniswa nepuleti ye-dorsal, kunganciphisa ukucasuka kwi-tendon, futhi kunesikhala esikhona, esingakugwema ngempumelelo ukufakwa okufakiwe kanye ne-tendon. ukuxhumana ngqo. Ngokwengeziwe, iningi lezimila zingambozwa yigama elithi Quadratus.
2. Izinkomba kanye nokuphikisana nokwelashwa kwe-distal radius nge-volar plate
A.Izinkinga: Ngokwehluleka ukuncishiswa okuvaliwe kokuqhekeka okuningana okwengeziwe, kuvela imibandela elandelayo, enjengenhloso ye-dorsal enkulu kune-5mm, i-distal radius efinyeza enkulu ngaphezu kwe-2mm; Ukuhanjiswa kokuqhekeka kwangaphakathi kukhulu kune-2 mm; Ngenxa yobuningi bethambo eliphansi, kulula ukudala ukuphuma kabusha, ngakho-ke kufanelekile kakhulu kubantu asebekhulile.
b. Contraindications: Ukusetshenziswa kwezifo ze-anesthetics zasendaweni, izifo zendawo noma ezihlelekile zesikhumba, isimo esingesihle sesikhumba ohlangothini lwe-volar kwesihlaka; I-Bone Mass and Fracture Uhlobo endaweni yokuqhekeka, uhlobo lwe-Dorsal Fracture njenge-Barton Fracture, ukuhlukaniswa okuhlangene kwe-radiocarpal, ukususwa, ukuhlukaniswa okulula kwe-styloid inqubo yokuqhekeka, ukuqhekeka kwe-avulsion encane kwe-fracture, ukwaphuka kwe-avulsion encane ye-margin.
Ezigulini ezinokulimala kwamandla aphezulu njengokuphazamiseka okukhulu kwe-intra-articular arvicular noma ukulahleka kwamathambo, iningi lezifundo azincomi ukusetshenziswa kwamapuleti e-volar, ngoba ukuqhekeka okunjalo okude kuthambekele kwi-vascular necrosis futhi kunzima ukuthola ukuncishiswa kwe-anatomical. Ezigulini ezinezingcezwana eziningi zokuphuka nokufuduka okuthe xaxa kanye ne-osteoporosis enzima, i-volar Plate kunzima ukuphumelela. Kungenzeka kube nezinkinga zokusekelwa kwegatsha ezingaphansi kokuqhekeka okude, njengokungena kwesikulufa ungene endaweni ehlanganisiwe. Izincwadi zakamuva zibika ukuthi lapho amacala angama-42 e-articular fractures aphathwa ngamapuleti eVerar, azikho izikulufo ezi-articular ezingena emgodini wezinto ezibonakalayo, ezazihlobene kakhulu nesikhundla samapuleti.
3. Amakhono okuhlinza
Iningi lodokotela lisebenzisa ukulungiswa kwe-volar plate for distal radius fractures ngezindlela ezifanayo nakwindlela. Kodwa-ke, ukugwema ngempumelelo ukuvela kwezinkinga ezisebenzayo, isibonelo esiphakeme kakhulu, isibonelo, ukuncishiswa kungatholakala ngokukhipha ukucindezelwa kwebhulokhi ye-Fracture futhi ubuyisele ukuqhubeka kwethambo le-cortical. Ukulungiswa kwesikhashana nge-2-3 kirschner izintambo zingasetshenziswa. Ngokuqondene nokuthi iyiphi indlela ongayisebenzisa, umlobi utusa i-PCR (Flexed Carpi radialis) ukwelula indlela ye-volar.
A, ukulungiswa kwesikhashana ngezintambo ezimbili ze-kirschner, qaphela ukuthi ukuthambekela kwe-volar kanye ne-acturicular komhlaba akubuyiselwe ngokugcwele ngalesi sikhathi;
b, i-kirschner wire okwesikhashana ilungisa ipuleti, unake ukulungiswa kokuphela kwe-distal ye-radius ngalesi sikhathi (Ingxenye ye-Resustal Fracture Fruces Fitcation), ingxenye yeProximal yePlate idonswa emgodini we-radial.
C, indawo enobuhlakani ihlelwe kahle ngaphansi kwe-arthroscopy, isikulufa esikhiyiwe distal
Amaphuzu asemqokaIndlela: Isikhumba se-distal isikhumba siqala esikhunjeni sesihlakala, futhi ubude baso bungaziswa ngokuya ngohlobo lokuqhekeka. I-Flexer Carpi radialis tendon kanye ne-sheath yayo kudluliselwe edayisa ithambo le-carpal futhi njenge-proximal ngangokunokwenzeka. Ukudonsa i-Flevel Carpi radialis tendon ohlangothini lwe-ulnar kuvikela izinzwa ze-Median nerve kanye ne-flexer tendon tandon. Isikhala se-parona sidalulwa, kanye ne-proadratus Pronterratus etholakala phakathi kwe-flequr Hallucis Longus (ulnar) kanye ne-radial artery (radial). Ukuvela kwenziwa ohlangothini lwe-radial lwesichasiselo, kushiya ingxenye enamathiselwe kwirediyo yokwakhiwa kabusha kwakamuva. Ukudonsa i-Quadratus Projrator ohlangothini lwe-ulnar kudalula ngokugcwele i-angle ye-volar ulnar ye-radius.
Ngezinhlobo eziyinkimbinkimbi zokuqhekeka, kunconywa ukudedela ukufakwa kwe-distal kwemisipha ye-brachioradialis, engaphazamisa ukudonsa kwayo kwinqubo ye-styroid ye-radial. Ngalesi sikhathi, umhlanga we-volar wegumbi lokuqala le-dorsal ungasikwa ukudalula i-distal fracture livimba uhlangothi lwe-radial eceleni nenqubo ye-radial styloid, bese usebenzisa izintambo ze-radial ukuze zinciphise ibhlokhi ye-intra-articular fracture. Okwezinkinga eziyinkimbinkimbi ze-intra-articular fractures, i-arthroscopy ingasetshenziselwa ukusiza ukuncishiswa, ukuhlolwa, kanye nokucinishwa okuhle kwezingcezwana zokuqhekeka.
Ngemuva kokuthi ukuncishiswa sekuqediwe, ipuleti elivulekile livaliwe njalo. Ipuleti kumele lisondele kuma-watershed, kufanele limboze inqubo ye-ulnar, futhi ukuphela kwepuleti kufanele kufinyelele maphakathi nomgwaqo we-radial shaft. Uma izimo ezingenhla zingafinyelelwanga, usayizi wepuleti akulungile, noma ukuncishiswa akulolisi, ukusebenza namanje akuphelele.
Izinkinga eziningi zinokuningi okufanele zenze lapho kubekwa khona ipuleti. Uma ipuleti libekwe kakhulu, izinkinga ezihlobene ne-flex hallucis longuus zinqunyelwe; Uma ipuleti libekwe eduze komugqa wamanzi, i-flexer profandus ProFundus kungenzeka ibe sengozini. Ukwehliswa kwe-Fracture ku-volar echibiyele deformement deforment kungadala kalula ipuleti lensimbi ukuba liphumelele ohlangothini lwe-ntacr futhi lixhumane ngqo ne-tendon tendon, ekugcineni liholele kwi-tendinitis noma ngisho nokuqhuma.
Ezigulini ze-osteoporotic, kunconywa ukuthi ipuleti lisondelene nomugqa wamanzi ngangokunokwenzeka, kepha hhayi ngakuwo. Izintambo ze-KIRSchner zingasetshenziswa ukulungisa igatsha eliseduze kakhulu ne-Ulna, kanye ne-kirschner izintambo kanye nama-will izipikili nezikulufa zingavimba ngempumelelo ukwaphuka kokuhlelwa kabusha.
Ngemuva kokuthi ipuleti libekwe kahle, ukuphela kweProximal kulungiswe ngesikulufa, kanye nomgodi we-ulnar ekugcineni kwepuleti okwesikhashana ngocingo lwe-kirschner. I-Intraoperative Fluoroscopy Anteropopeor View, ukubukwa kwe-lateral, ukubuka okuhlangene, ukubuka okuhlangene okuhlangene 30 Uma isikhundla sepuleti sigculisekile, kepha ucingo lwe-kirschner lusekuhlanganiswe, luzoholela ekubuyiselweni okunganele kokuthambekela kwe-ntarar, okungaxazululwa ngokusetha kabusha ipuleti ngokusebenzisa "i-dig. 2, b).
Uma ihambisana ne-dorsal kanye ne-ulnar fractures (ulnar / dorsal die punch) futhi ayikwazi ukuncishiswa ngokuphelele ngaphansi kokuvalwa, lezi zinqubo ezintathu ezilandelayo zingasetshenziswa:
1.
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3. Kuvaliwe ukulungiswa okuhlanzekile noma okuhlaselayo okuncane ngosizo lwe-arthroscopy.
Ngemuva kokuthi ukuncishiswa kugculisekile futhi ipuleti libekwe kahle, ukulungiswa kokugcina kulula kakhulu. Uma i-proximal ulnar kirschner wire ihlelwe kahle futhi akukho zikulungisa eziku-pagetha ehlanganyelwe, ukuncishiswa kwe-anatomical kungatholakala.
Isilinganiso sokukhetha isikulufa: Ngenxa yokuxoshwa okunamandla kwethambo le-dorsal cortical, ubude besikulufa kungaba nzima ukukala ngokunembile. Izikulufo ezinde kakhulu zingadala ukucasuka kwethende, nezikulufo ezimfushane kakhulu ngeke zikwazi ukusekela futhi zilungise isiqephu se-dorsal. Ngalesi sizathu, umlobi utusa ukusebenzisa izikulufo ezikhiyiwe ezihlanganisiwe kanye nezikulufo ezikhiyiwe ze-multiaxial kwinqubo ye-styroid ye-radial kanye nomgodi we-ulnar, futhi usebenzisa izikulufu zokukhiya izinduku ezivulekile ezindaweni zonke. Kusetshenziswa ithiphu eluhlaza kugwema ukucasuka kwethende noma ngabe kusetshenziswa ukuphuma kwe-dorsal. Ngokulungiswa kwepuleti exhumeke kakhulu kwe-proxilal, izikulufa ezimbili zokuxhumanisa + isikulufa esijwayelekile (ezibekwe e-Ellipse) zingasetshenziselwa ukulungiswa.
4. Isifinyezo sombhalo ogcwele:
Ukulungiswa kwe-volar ukukhiya izipikili zepuleti ye-distal radius fractures kungafinyelela ukusebenza kahle kwemitholampilo, okuthi ikakhulukazi kuncike ekukhetheni izinkomba namakhono okuhlinza aphezulu. Ukusebenzisa le ndlela kungenza umehluko ongcono wokusebenza okusebenzayo, kepha akukho mehluko ukusebenza okusebenzayo kanye nokusebenza kwezinye izindlela, futhi ukuncishiswa kwe-Kirchner kuyafana, kanye nokulungiswa kocingo, ukutheleleka kocingo, izifo zenaliti ezivamile kakhulu; Futhi izinkinga ze-tendon ze-extensor zivame kakhulu ezinhlelweni zokulungiswa kwe-distal radius plate. Ezigulini ezine-osteoporosis, ipuleti elivulekile lisakhethwa okokuqala.
Isikhathi sePosi: Dece-12-2022
