1. Zviratidzo
1). Kutsemuka kwakanyanya kwakachekwa kune kuchinjika kuri pachena, uye pamusoro pechikamu che distal radius unoparadzwa.
2). Kudzikiswa kwemaoko kwakundikana kana kuti kugadziriswa kwekunze kwakundikana kuchengetedza kudzikiswa.
3).Maronda ekare akatyoka.
4). Kutyoka kwemasumbu kana kusabatana. pfupa riripo kumba nekune dzimwe nyika
2. Zvinorambidzwa
Varwere vakwegura vasingakodzeri kuvhiyiwa.
3. Nzira yekuvhiya yekuvhiya yekunze
1. Chinogadzirisa muchinjikwa chekunze chekugadzirisa kutyoka kwerutivi rwedivi
Chinzvimbo uye kugadzirira kuvhiyiwa:
·Kunzwa kwekurwadziwa kwe brachial plexus
·Kurara pasi, gumbo rakakuvara rakati sandara pabhuraketi rinoona zviri pedyo nemubhedha
·Isa tourniquet pachikamu chimwe chete kubva muzvitatu zveruoko rwepamusoro
·Kutarisa maonero
Maitiro Ekuvhiya
Kuisa Sikuruu yeMetacarpal:
Skuruu yekutanga iri pasi pepfupa rechipiri remetacarpal. Kuchekwa kweganda kunoitwa pakati petensor tendon yemunwe wekunongedza nemhasuru yemapfupa ekutanga. Nyama yakapfava inoparadzaniswa zvinyoro nyoro nekushandisa nzira yekuvhiya. Sleeve inodzivirira nyama yakapfava, uye sikuruu yeSchanz ye3mm inoiswa. Skuruu
Kutungamira kwesikuruu kuri 45° kusvika padivi rechanza, kana kuti kunogona kuenzana nedivi rechanza.
Shandisa gwara iri kuti usarudze nzvimbo ye screw yechipiri. Screw yechipiri ye 3mm yakarovererwa mu metacarpal yechipiri.
Upamhi hwepini ye metacarpal haifanirwe kudarika 3mm. Pini yekuisa iri muchikamu che 1/3 che proximal. Kune varwere vane osteoporosis, sikuruu yakanyanya kuswedera inogona kupinda muzvikamu zvitatu zve cortex (pfupa rechipiri re metacarpal nehafu ye cortex yepfupa rechitatu re metacarpal). Nenzira iyi, sikuruu Ruoko rurefu rwekuisa uye torque yakakura yekuisa inowedzera kugadzikana kwepini yekuisa.
Kuiswa kwezvikushi zve radial:
Gadzira ganda pamucheto werutivi rwe radius, pakati pemhasuru ye brachioradialis netsandanyama ye extensor carpi radialis, 3cm pamusoro pemugumo weproximal wemutsetse wekutyoka uye 10cm pedyo nejoinhi reruoko, uye shandisa hemostat kuparadzanisa zvakananga nyama iri pasi peganda nepamusoro pemapfupa. Kungwarira kunotorwa kuchengetedza matavi epamusoro etsinga ye radial inofamba munzvimbo iyi.
Pamwe chete nemasikiru emetacarpal, masiruru maviri e3mm Schanz akaiswa pasi pekutungamirirwa kwegwara rekudzivirira sleeve.
·.Kuderedzwa nekugadzika kwekukuvara:
·.Kuderedza kudhonzwa kwetsandanyama nemaoko uye C-arm fluoroscopy kutarisa kudzikira kwekutyoka kwetsandanyama.
·.Kunamira kwekunze kwejoini reruoko kunoita kuti zviome kudzoreredza angle yekutsvedza kweruoko, saka inogona kusanganiswa nemapini eKapandji kubatsira mukuderedza nekunamira.
·.Kune varwere vane radial styloid fractures, radial styloid Kirschner wire fixation inogona kushandiswa.
·.Paunenge uchichengetedza kuderedzwa, batanidza chigadziriso chekunze woisa nzvimbo yekutenderera yechigadziriso chekunze panzvimbo imwecheteyo nenzvimbo yekutenderera yejoini reruoko.
·.Anteroposterior nelateral fluoroscopy, tarisa kana kureba kweradius, palmar inclination angle uye ulnar deviation angle zvadzorerwa, uye gadzirisa fixation angle kusvika fracture reduction yakwana.
·. Tarisa kudhonzwa kwenyika kwechinhu chinogadzirisa kunze, zvichikonzera kutyoka kwe iatrogenic pa metacarpal screws.
Kutsemuka kwechikamu chedistal radius pamwe chete nekupatsanurwa kwedistal radioulnar joint (DRUJ):
·. MaDRUJ mazhinji anogona kuderedzwa pakarepo mushure mekuderedzwa kwe distal radius.
·.Kana DRUJ ichiri yakaparadzaniswa mushure mekunge distal radius yaderedzwa, shandisa manual compression reduction uye shandisa lateral rod fixation ye external bracket.
·.Kana kushandisa waya dzeK kuti upinde muDRUJ uri panzvimbo isina kusimba kana kuti wakatarira zvishoma.
Kutyoka kwe distal radius pamwe chete nekutyoka kwe ulnar styloid: Tarisa kugadzikana kweDRUJ mukududzira, kusapindirana uye kutenderera kweruoko. Kana paine kusagadzikana, rubatsiro rwekugadzika neKirschner waya, kugadziriswa kweTFCC ligament, kana tension band principle zvinogona kushandiswa kugadzirisa Ulnar styloid process.
Dzivisa kudhonza zvakanyanya:
· Tarisa kana minwe yemurwere ichigona kutenderera nekutambanudza mafambiro ayo pasina kusimba kuri pachena; enzanisa nzvimbo yejoini ine radiolunate nenzvimbo yejoini iri pakati pecarpal.
·Tarisa kana ganda riri panzira yenzara rakanyanya kusimba. Kana rakanyanya kusimba, cheka zvakakodzera kudzivirira hutachiona.
·Kurudzirai varwere kuti vafambe minwe yavo nekukurumidza, kunyanya kugonya nekutambanudza majoini eminwe, kugonya nekutambanudza chigunwe, uye kubatwa.
2. Kugadziriswa kwe distal radius fractures ne external fixator isingayambuke jointi:
Chinzvimbo uye kugadzirira kuvhiyiwa: Zvakafanana nepakutanga.
Maitiro Ekuvhiya:
Nzvimbo dzakachengeteka dzekuisa K-wire parutivi rwekumashure rwe distal radius ndeidzi: kumativi ese eLister's tubercle, kumativi ese e extensor pollicis longus tendon, uye pakati pe extensor digitorum communis tendon ne extensor digiti minimi tendon.
Nenzira imwecheteyo, masikuruu maviri eSchanz akaiswa mu radial shaft ndokubatanidzwa netsvimbo yekubatanidza.
Munzvimbo yekuchengetedza, masikuruu maviri eSchanz akaiswa muchikamu chekupwanyika kweradius yedistal, chimwe kubva kudivi reradial uye chimwe kubva kudivi redorsal, nekona ye60° kusvika 90° kune mumwe nemumwe. Sikuruu iyi inofanira kubata contralateral cortex, uye zvinofanira kucherechedzwa kuti muromo wesikuruu wakaiswa kudivi reradial haugone kupfuura nepakati pe sigmoid notch wopinda mu distal radioulnar joint.
Batanidza sikuruu yeSchanz padivi redhiramu uchishandisa chinongedzo chakakombama.
Shandisa tsvimbo yekubatanidza iri pakati nepakati kuti ubatanidze zvikamu zviviri zvakatyoka, uye chenjerera kuti usavhare chuck kwenguva pfupi. Nekubatsira kwekubatanidza kuri pakati, chidimbu che distal chinoderedzwa.
Mushure mekugadzirisazve, kiya chuck padanda rekubatanidza kuti upedze yekupedzisirakugadziriswa.
Musiyano uripo pakati pechinogadzirisa chekunze chisina span-joint nechinogadzirisa chekunze chine cross-joint:
Nekuti screws dzakawanda dzeSchanz dzinogona kuiswa kuti kupedzise kudzikiswa nekugadziriswa kwemapfupa, zviratidzo zvekuvhiyiwa kwezvigadziriso zvekunze zvisiri zvemajoini zvakakura kupfuura zvezvigadziriso zvekunze zvemajoini. Pamusoro pekutyoka kwekunze kwejoini, zvinogonawo kushandiswa pakutyoka kwechipiri kusvika kwechitatu. Kutyoka kwechikamu chemukati mejoini.
Chinogadzirisa majoini ekunze chinogadzirisa joini yeruoko uye hachibvumidze kurovedza muviri kwekutanga, nepo chinogadzirisa majoini ekunze chisina kupatsanurana chichibvumira kurovedza muviri kwekutanga mushure mekuvhiyiwa.
Nguva yekutumira: Gunyana-12-2023
