Distal Radius Fracture: Tsananguro Yakadzama Yemukati Kugadziriswa Kwekuvhiya Unyanzvi Sith Mifananidzo Uye Zvinyorwa!

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

1. Contraindications

Varwere vakwegura vasina kukodzera kuvhiyiwa.

1. Kugadziriswa kwemukati (volar nzira)

Routine preoperative kugadzirira.Anesthesia inoitwa pachishandiswa brachial plexus anesthesia kana general anesthesia

1) .Murwere anoiswa panzvimbo ye supine negumbo rinenge rabatwa richitorwa ndokuiswa pafiremu yekuvhiya.Iyo 8cm incision inoitwa pakati pe radial artery ye forearm uye flexor carpi radialis tsandanyama uye yakatambanudzirwa kune wrist crease.Izvi zvinogona kuburitsa pachena kutsemuka uye kudzivirira vanga.Iyo incision haidi kupinda muchanza cheruoko (Mufananidzo 1-36A).

2) .Tevedzera kupinza kune flexor carpi radialis tendon sheath (Mufananidzo 1-36B), vhura tendon sheath, incise yakadzika anterior bamboo fascia kuti uise pachena flexor pollicis longus, shandisa index index kuti uite flexor pollicis longus kune ulnar side, uye zvishoma kusunungura flexor pollicis longus.Dumbu remhasuru rakazara pachena kune pronator quadratus muscle (Mufananidzo 1-36C)

3) .Gadzira "L" yakaita kuchekwa padivi peradial yeradius kune radial styloid process yekufumura pronator quadratus tsandanyama, wobva waibvisa kubva paradius ne peeler kufumura mutsara wese wekupeta bamboo (Mufananidzo 1). -36D, Mufananidzo 1-36E)

4) .Isai stripper kana pfupa duku banga kubva pamutsara wekuputsika, uye shandisa sechitsiko kuti uderedze kuputsika.Isai dissector kana diki banga rechigero pamhiri pemutsara wekutyoka kune lateral bone cortex kuti ubvise kudzvanywa uye kuderedza distal fracture fragment, uye shandisa zvigunwe kudzvanya dorsal fracture fragment kuderedza dorsal fracture fragment.

Kana iyo radial styloid fracture yakatsemuka, zvakaoma kuderedza radial styloid fracture nekuda kwekudhonza kwebrachioradialis muscle.Kuderedza simba rekudhonza, brachioradialis inogona kushandiswa kana kuparadzaniswa kubva kune distal radius.Kana zvichidikanwa, iyo distal fragment inogona kugadziriswa kwechinguva kune proximal fragment neKirschner waya.

Kana iyo ulnar styloid process yakatsemuka uye ichibviswa, uye iyo distal radioulnar joint isina kugadzikana, imwe kana mbiri Kirschner waya inogona kushandiswa kugadzirisa percutaneous, uye iyo ulnar styloid process inogona kumisikidzwa neiyo volar nzira.Madiki mafractures kazhinji haadi kurapwa nemaoko.Nekudaro, kana iyo distal radioulnar joint isina kugadzikana mushure mekugadzirisa radius, iyo styloid chimedu chinogona kucheneswa uye mipendero ye triangular fibrocartilage complex yakashongedzwa kune ulnar styloid maitiro ane anchors kana sirika shinda.

5) .Nekubatsirwa kwekutengesa, iyo capsule yekubatana uye ligament inogona kushandiswa kusunungura kupindirana uye kuderedza kuputsika.Mushure mekunge kutsemuka kwadzikiswa zvinobudirira, tarisa nzvimbo yekuiswa kwepureti yesimbi pasi pekutungamirwa kweX-ray fluoroscopy uye sikuruu mugomba reovha kana buri rinotsvedza kuti ribatsire kugadzirisa chinzvimbo (Mufananidzo 1-36F).Shandisa 2.5mm gomba rekuboora pakati pegomba reoval, woisa 3.5mm self-tapping screw.

Mufananidzo 1-36 Kuchekwa kweganda (A);incision ye flexor carpi radialis tendon sheath (B);kubvisa chikamu che flexor tendon kuratidza pronator quadratus muscle (C);kupatsanura pronator quadratus muscle kuratidza radius (D);kufumura mutsara wekutsemuka (E);isa volar plate uye sikuruu musiruu yekutanga (F)
6) .Shandisa C-arm fluoroscopy kuti usimbise kuiswa kweplate yakakodzera.Kana zvichidikanwa, sundidzira ndiro kure kana kureba kuti uwane yakanakisa distal screw yekuiswa.

7).Shandisai 2.0mm kuboora buri kumucheto kwesimbi, kuyera kudzika uye sikuruu muchivharo chekukiya.Chipikiri chinofanira kuva chipfupi 2mm pane chinhambwe chakayerwa kudzivirira sikuruu kuti isapinde nekubuda kubva padorsal cortex.Kazhinji, 20-22mm screw inokwana, uye iyo yakamiswa pane radial styloid process inofanirwa kuve ipfupi.Mushure mekupeta mudistal sikuruu, isa screw yacho Isa proximal screw yasara.

Nekuti kona yescrew yakagadzirwa, kana ndiro ikaiswa padhuze zvakanyanya neiyo distal end, screw inopinda wrist joint.Tora tangential zvimedu zve articular subchondral bone kubva ku coronal uye sagittal nzvimbo kuti uongorore kana ichipinda mujoini, uye wotevera mirairo Gadzirisa mahwendefa esimbi uye / kana screws.

(Mufananidzo 1-37) Mufananidzo 1-37 Kugadziriswa kwekuputsika kwedistal radius nevolar bone plate A. Anteroposterior uye lateral X-ray film ye distal radius fracture isati yashanda, ichiratidza kutama kwekuguma kwekupedzisira kune volar side;B. Anteroposterior uye lateral X-ray firimu rekuputsika kwepashure, kuratidza kutyoka Kuderedzwa kwakanaka uye kubvumidzwa kwakanaka kwechanza
8) .Suture the pronator quadratus muscle ne-non-absorbable sutures.Cherechedza kuti tsandanyama haizovhari zvachose ndiro.Iyo distal chikamu chinofanira kuvharwa kuti kuderedze kusangana pakati pe flexor tendon uye ndiro.Izvi zvinogona kuwanikwa nekusundira pronator quadratus kumucheto kwebrachioradialis, kuvhara iyo incision layer ne layer, uye kuigadzirisa nepurasita kana zvichidikanwa.