Kutsemuka kweDistal Radius: Tsananguro Yakadzama yeKugadziriswa Kwemukati Unyanzvi hwekuvhiya Sith Mifananidzo neMagwaro!

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

1. Zvinorambidzwa

Varwere vakwegura vasingakodzeri kuvhiyiwa.

1. Kugadziriswa kwemukati (nzira yekushandura izwi)

Kugadzirira nguva dzose usati wavhiyiwa. Anesthesia inoitwa uchishandisa brachial plexus anesthesia kana general anesthesia

1).Murwere anoiswa panzvimbo yakarara gumbo rakabatwa rakabviswa roiswa pachimiro chekuvhiyiwa. Kuchekwa kwe 8cm kunoitwa pakati pe radial artery yeruoko ne flexor carpi radialis tsandanyama uye kunotambanudzwa kusvika pachiuno. Izvi zvinogona kuburitsa pachena kutyoka uye kudzivirira kuvharika kwemavanga. Kuchekwa hakudi kupinda muchanza cheruoko (Mufananidzo 1-36A).

2).Tevedzera kuchekwa kwe flexor carpi radialis tendon sheath (Mufananidzo 1-36B), vhura tendon sheath, cheka deep anterior bamboo fascia kuti uratidze flexor pollicis longus, shandisa munwe wekunongedzera kuratidza flexor pollicis longus kudivi re ulnar, uye bvisa chikamu che flexor pollicis longus. Dumbu remhasuru rakanyatsoonekwa kune pronator quadratus tsandanyama (Mufananidzo 1-36C)

3). Gadzira chibooreso chakaita se "L" parutivi rweradius kuenda ku radial styloid process kuti uratidze pronator quadratus muscle, wobva wabvisa kubva paradius uchishandisa peeler kuti uratidze tambo yese ye bamboo fold (Mufananidzo 1-36D, Mufananidzo 1-36E)

4). Isa banga diki rekubvisa mapfupa kana banga diki remapfupa kubva pamutsetse wekutyoka, worishandisa sechinodzivira kuderedza kutyoka. Isa chidhindo kana banga diki rechigero pamutsetse wekutyoka kusvika ku lateral bone cortex kuti uderedze kudzvanywa uye kuderedza chidimbu chekutyoka che distal, uye shandisa minwe kudzvanya chidimbu chekutyoka che dorsal kuti uderedze chidimbu chekutyoka che dorsal.

Kana kutyoka kwemusana we radial styloid kwatyoka, zvinonetsa kuderedza kutyoka kwemusana we radial styloid nekuda kwekudhonzwa kwemhasuru ye brachioradialis. Kuti kuderedze simba rekudhonza, brachioradialis inogona kugadziriswa kana kupatsanurwa kubva kure. Kana zvichidikanwa, chidimbu che distal chinogona kusungirirwa kwenguva pfupi kune proximal fragment uchishandisa waya dzeKirschner.

Kana nzira ye styloid ye ulnar ikatyoka uye ikabviswa, uye distal radioulnar joint isina kugadzikana, waya imwe kana mbiri dzeKirschner dzinogona kushandiswa kugadzirisa percutaneous, uye nzira ye ulnar styloid inogona kugadziriswa ne volar approach. Kutyoka kudiki hakudi kurapwa nemaoko. Zvisinei, kana distal radioulnar joint isina kugadzikana mushure mekugadzirisa radius, styloid fragment inogona kubviswa uye mipendero ye triangular fibrocartilage complex inosungirirwa ku ulnar styloid process ne anchors kana silk threads.

5).Nerubatsiro rwekubata, kapisiyumu yejoini ne ligament zvinogona kushandiswa kusunungura kupindirana uye kuderedza kutyoka. Mushure mekunge kutyoka kwadzikiswa zvinobudirira, sarudza nzvimbo ye volar steel plate uchitungamirirwa ne X-ray fluoroscopy uye skuruu mugomba re oval kana gomba rinotsvedza kuti zvive nyore kugadzirisa nzvimbo (Mufananidzo 1-36F). Shandisa gomba rekuboorera re 2.5mm kuboorera pakati pegomba re oval, uye isa screw ye 3.5mm yekuboorera.

Mufananidzo 1-36 Kuchekwa kweganda (A); kuchekwa kwe flexor carpi radialis tendon sheath (B); kubvisa chikamu che flexor tendon kuti kuonekwe musuru we pronator quadratus (C); kupatsanura musuru we pronator quadratus kuti kuonekwe radius (D); kuonekwe kwemutsetse wekutyoka (E); isa volar plate uye sikuruu mu sikuruu yekutanga (F)
6). Shandisa C-arm fluoroscopy kusimbisa kuiswa kweplate kwakakodzera. Kana zvichidikanwa, dzvanya plate kure kana pedyo kuti uwane kuiswa kwakanakisa kwescrews kure.

7). Shandisa chibooreso che 2.0mm kuboora buri riri kure kweplate yesimbi, kuyera kudzika uye kukiya sikuruu. Chipikiri chinofanira kupfupika ne 2mm pane daro rakayerwa kudzivirira sikuruu kuti isapinde uye ibude kubva ku dorsal cortex. Kazhinji, sikuruu ye 20-22mm yakakwana, uye iyo yakasungirirwa pa radial styloid process inofanira kupfupika. Mushure mekukiya sikuruu ye distal, kiya Isa sikuruu yasara ye proximal.

Nekuti kona ye screw yakagadzirwa, kana plate yacho yakaiswa pedyo zvakanyanya nemagumo ekure, screw yacho ichapinda mujoini reruoko. Tora zvidimbu zve tangential zvebhonzo re articular subchondral kubva munzvimbo dze coronal ne sagittal kuti uone kana ichipinda mujoini, wobva watevera mirairo. Gadzirisa ma plate esimbi uye/kana screws.

(Mufananidzo 1-37) Mufananidzo 1-37 Kugadziriswa kwekutyoka kwechikamu chedistal radius ne volar bone plate A. Firimu reX-ray reAnteroposterior nerelateral redistal radius breakdown risati raitwa oparesheni, richiratidza kusuduruka kwechikamu chedistal mugumo kuenda kudivi revolar; B. Firimu reX-ray reAnteroposterior nerelateral repostoperative breakdown, richiratidza kutyoka kwakanaka uye kupatsanurwa kwakanaka kwejoini reruoko.
8). Sungai tsandanyama yepronator quadratus nemasuture asinganyungudike. Cherechedzai kuti tsandanyama haizofukidze ndiro yese. Chikamu chekure chinofanira kuvharwa kuderedza kusangana pakati petsinga yeflexor neplate. Izvi zvinogona kuitwa nekusungirira pronator quadratus kumucheto kwebrachioradialis, kuvhara jira rekucheka nejira, uye kuigadzirisa neplaster kana zvichidikanwa.