1.Zviratidzo
1) . Kuputsika kwakakomba kwakakomba kune kusimuka kuri pachena, uye nzvimbo yearticular yeradius distal inoparadzwa.
2) .Kuderedzwa kwebhuku kwakakundikana kana kugadzirisa kwekunze kwakakundikana kuchengetedza kuderedza.
3).Kutyoka kwekare.
4).Kutyoka malunion kana nonunion.pfupa riripo kumba nekune dzimwe nyika
2.Contraindications
Varwere vakwegura vasina kukodzera kuvhiyiwa.
3. Kunze kwekugadzirisa nzira yekuvhiya
1. Cross-articular yekunze fixator kugadzirisa distal radius fractures
Nzvimbo uye preoperative kugadzirira:
· Brachial plexus anesthesia
·Supine position ine nhengo yakabatwa yakati sandarara pabhureki rekuona nepadivi pemubhedha
·Isa tourniquet kune 1/3 yekumusoro ruoko
·Kutariswa kwemaonero
Kuvhiya Technique
Metacarpal Screw Insertion:
Iyo yekutanga screw inowanikwa pazasi pechipiri metacarpal bone.Kuchekwa kweganda kunoitwa pakati peextensor tendon ye index finger uye dorsal interosseous muscle yebhonzo rekutanga.Iyo yakapfava inoparadzaniswa zvinyoro-nyoro nechisimba chekuvhiya.Sleeve inodzivirira nyama yakapfava, uye 3mm Schanz screw inoiswa.Zvikururu
Iyo nzira ye screw ndeye 45 ° kune ndege yechanza, kana inogona kuenderana nendege yechanza.
Shandisa gwara kusarudza chinzvimbo chechipiri screw.Yechipiri 3mm screw yakadhindwa mune yechipiri metacarpal.
Iyo dhayamita yepini yekumisa metacarpal haifanire kudarika 3mm.Iyo pini yekugadzirisa iri mune proximal 1/3.Kune varwere vane osteoporosis, iyo yakanyanya proximal screw inogona kupinda muzvikamu zvitatu zvecortex (yechipiri metacarpal bone uye hafu cortex yechitatu metacarpal bone).Nenzira iyi, screw Irwo ruoko rurefu rwekugadzirisa uye torque yakakura yekugadzirisa inowedzera kugadzikana kwepini yekugadzirisa.
Kuiswa kwe radial screws:
Ita ganda rekucheka pamucheto wepamucheto we radius, pakati pe brachioradialis muscle uye extensor carpi radialis muscle, 3cm pamusoro pekupedzisira kwekupedzisira kwemutsara wekutsemuka uye inenge 10cm kusvika kune chibatanidza chemaoko, uye shandisa hemostat kuti iparadzanise zvakananga iyo subcutaneous. matishu kusvika pamapfupa.Kuchengetedza kunotorwa kuchengetedza matavi epamusoro eiyo radial nerve iyo kosi munzvimbo ino.
Pandege imwe chete neye metacarpal screws, maviri 3mm Schanz screws akaiswa pasi pekutungamira kweiyo sleeve kuchengetedza nyoro dhaidhi.
·.Kuputsika uye kugadzirisa:
·.Manual traction reduction uye C-arm fluoroscopy kutarisa kuderedzwa kwekuputsika.
·.Kugadziriswa kwekunze kwepamusoro pekubatana kwemaoko kunoita kuti zvive zvakaoma kudzorera zvachose palmar inclination angle, saka inogona kusanganiswa neKapandji pini kuti ibatsire mukuderedza nekugadzirisa.
·.Kune varwere vane radial styloid fractures, radial styloid Kirschner wire fixation inogona kushandiswa.
·.Paunenge uchichengetedza kuderedzwa, batanidza chigadziriso chekunze uye uise nzvimbo yekutenderera yekunze kwekunze pane imwe axis seyokutenderera pakati pekubatanidza wrist.
·.Anteroposterior uye lateral fluoroscopy, chengetedza kana kureba kweradius, palmar inclination angle uye ulnar deviation angle yakadzorerwa, uye gadzirisa kugadzirisa kwekona kusvikira kuderedzwa kwekuputsika kunogutsa.
·.Chenjerera kune iyo yenyika traction yekunze fixator, zvichikonzera iatrogenic fractures pa metacarpal screws.
Distal radius fracture yakasanganiswa ne distal radioulnar joint (DRUJ) kuparadzaniswa:
·.Mazhinji DRUJ anogona kuderedzwa pakarepo mushure mekuderedzwa kweradius distal.
·.Kana DRUJ ichiri kuparadzaniswa mushure mekunge distal radius yakaderedzwa, shandisa manual compression kuderedza uye shandisa lateral rod fixation yekunze kwekunze.
·.Kana kushandisa K-waya kupinda DRUJ mune kwazvakarerekera kana zvishoma supinated chinzvimbo.
Kuputsika kweradius distal yakasanganiswa neulnar styloid fracture: Tarisa kugadzikana kweDRUJ mukududzirwa, kusarerekera uye supination ye forearm.Kana kusagadzikana kuripo, yakabatsirwa kugadzirisa neKirschner waya, kugadziriswa kweTFCC ligament, kana tension band musimboti inogona kushandiswa kugadzirisa Ulnar styloid process.
Dzivisa kudhonza zvakanyanya:
· Tarisa uone kana zvigunwe zvemurwere zvichikwanisa kuita kuchinjika uye kufamba kwekuwedzera pasina kushushikana kuri pachena;enzanisa iyo radiolunate joint space uye midcarpal joint space.
•Tarisa kana ganda riri pachiteshi chezvipikiri rakanyanya kusimba.Kana yakanyanya kusimba, cheka zvakakodzera kudzivirira utachiona.
Kurudzirai varwere kufambisa zvigunwe nekukurumidza, kunyanya kuchinjika uye kuwedzera majoini emetacarpophalangeal ezvigunwe, kuchinjika uye kuwedzera chigunwe, uye kubiwa.
2. Kugadziriswa kwe distal radius fractures nekunze kwekugadzirisa iyo isingadariki mubatanidzwa:
Nzvimbo uye preoperative kugadzirira: Zvakafanana sepakutanga.
Nzira dzekuvhiya:
Nzvimbo dzakachengeteka dzekuiswa kweK-waya kudivi remushure reradius distal ndeiyi: kumativi ose eLister's tubercle, kumativi ose e extensor pollicis longus tendon, uye pakati pe extensor digitorum communis tendon uye extensor digiti minimi tendon.
Nenzira imwecheteyo, maviri Schanz screws akaiswa muradial shaft uye akabatanidzwa netambo yekubatanidza.
Kuburikidza nenzvimbo yekuchengetedza, maviri Schanz screws akaiswa mukati me distal radius fracture fragment, imwe kubva kudivi reradial uye imwe kubva kudivi redorsal, ine kona ye60 ° kusvika 90 ° kune imwe neimwe.Iyo screw inofanirwa kubata contralateral cortex, uye zvinofanirwa kucherechedzwa kuti muromo wescrew wakaiswa paradial side haugone kupfuura nepakati sigmoid notch uye kupinda mudistal radioulnar joint.
Batanidza Schanz screw paradius iri kure neyakakombama link.
Shandisa tsvimbo yekubatanidza yepakati kubatanidza zvikamu zviviri zvakaputsika, uye chenjerera kuti usavhare chuck kwenguva pfupi.Nekubatsirwa kwekubatanidza kwepakati, chidimbu che distal chinoderedzwa.
Mushure mekugadzirisazve, kiya chuck padanda rekubatanidza kuti upedze yekupedzisirafixation.
Musiyano uripo pakati pe-non-span-joint yekunze fixator uye muchinjika-joint yekunze fixator:
Nekuti akawanda Schanz screws anogona kuiswa kuti apedze kudzikisira uye kugadzirisa kwemapfupa zvimedu, zviratidzo zvekuvhiya zveasina-akabatana ekunze zvigadziriso zvakapamhama kupfuura izvo zvekuyambuka-joint ekunze zvinogadzirisa.Mukuwedzera kune-extra-articular fractures, inogonawo kushandiswa kwechipiri kusvika kune yechitatu kuputsika.Partial intra-articular fracture.
Muchinjikwa-wakabatana wekunze fixator inogadzirisa iyo wrist joint uye haibvumire kutanga kushanda kwekuita, nepo isiri-yakabatana-yakabatana yekunze fixator inobvumira yekutanga postoperative wrist joint inoshanda kurovedza muviri.
Nguva yekutumira: Sep-12-2023
