Parizvino kune yekugadziriswa kwemukati yeakashata radius radius, pane akasiyana siyana anatomical kukiya masisitimu akashandiswa mukiriniki. Iyi mienzaniso yemukati inopa mhinduro iri nani kune mamwe marudzi akaomesesa, uye neimwe nzira kuwedzera zviratidzo zvekuvhiyiwa zvisina kugadzikana radius radius radius rendi Muzvinafundo Jupita kubva kuMassachusetts General Hospital Chipatara uye vamwe vakaburitsa zvinyorwa zvezvinyorwa muJBJ Chinyorwa ichi chinotarisa pane iyo nzira yekuvhiya yekugadzirisa ye distal radius radius yakavakirwa pane yekugadziriswa kwemukati kweiyo chaiyo bracture block.
Kuvhiya Maitiro
Iyo nhatu-volumn dzidziso, yakavakirwa paBiomechanical uye Anatomical maitiro eiyo Distal Ulnar Radius, iri hwaro hwekushanduka uye kiriniki application ye 2.4mm Plate system. Chikamu chemakoramu matatu chinoratidzwa mumufananidzo 1.
Fig. 1 matatu-matatu-fungidziro yeiyo distal ulnar radius.
Iyo yakazotevera chikamu chehafu yekare yeiyo Distal Radius
Iyo Middle Column ndiyo medial hafu yeiyo Distal radius uye inosanganisira iyo lunate fosssa (yakabatana neyekuvhara) uye sigmoid notch (yakabatana neiyo distal ulna) pane iyo articular pamusoro. Kazhinji inotakura, iyo mutoro kubva kuLunate fossa inoendeswa kune radius kuburikidza neyekupedzisira fossa. Iyo ULNAR LATLARAL Column, iyo inosanganisira iyo distal ulna, iyo peturu fibrartilage, uye yakaderera lnar-radial joint, inotakura madhiri emapopa uye kubva kune yakaderera ulnar-radial jointa uye ine yakajeka inoshanda.
Maitiro anoitwa pasi peBravial plexus anesthesia uye intraoperative c-ruoko x-ray fananidzo yekufungidzira yakakosha. Intravenous mishonga inorwisa mishonga yaipihwa kanokwana maminetsi makumi matatu isati yatanga maitiro uye tarisiro yemukati yakashandiswa kuderedza kubuda ropa.
Palmar ndiro yekugadziriswa
Kune mazhinji okufungidzira, nzira yemichindwe inogona kushandiswa kuona pakati peRadial Carpal Flexor uye iyo Radial artery. Mushure mekuziva uye kudzosera iyo flexor carpi radialis Longus, iyo yakadzika nzvimbo yechidimbu teres mhasuru inoonekwa uye iyo "la" kuparadzaniswa kwekuparadzaniswa kunosimudzwa. Mune mamwe mafuro akaomarara, brachiordialis tendon inogona kuwedzeredzwa kuti ifambe kuderedza kuderedzwa.
Iyo Kirschner PIN inoiswa muRadial Carpal Joint, iyo inobatsira kutsanangura iyo distal-yakawanda miganhu yeradius. Kana chidiki chakapwanyika chivharo pane iyo articular margin iripo, iyo Palmar 2.4m simbi simbi inogona kuiswa pamusoro peiyo distal artular margin yeradius yekugadzirisa radius yekugadzirisa. Mune mamwe mazwi, chidiki chidiki chinovhiringidza pane iyo lunicular pamusoro peiyo communate inogona kutsigirwa ne 2.4mm "l" kana "t" ndiro, sezvakaratidzwa mumufananidzo 2.
Zvekuti Dorylly Akadzingwa Kuwedzera-Kunyepedzera, zvinobatsira kucherechedza zvinotevera pfungwa. Chekutanga, zvakakosha kuti ugadzirise kwenguva pfupi kupunzika kuti uve nechokwadi chekuti hapana tishu nyoro rakapfava mukuputswa kwemugumo. Kechipiri, mune varwere vasingadzoreki, kupwanya kunogona kuderedzwa nerubatsiro rweprogiramu.
Mufananidzo 3 Wedzera-Chinyorwa Chekupwanyika cheDorselly Yakadzingwa Radius yakaderedzwa uye yakagadziriswa kuburikidza nePalmar nzira. Mufananidzo 3-a Mushure mekupedza kufumurwa kuburikidza neRadial Carpal Flexor uye Iyo Radial Artery, iyo Yakapusa Kirschner PIN yakaiswa muRadial Carpal Joint. Mufananidzo 3-B Kunyengera kweiyo yakadzingwa metacarpal cortex yekugadzirisa zvakare.
Mufananidzo 3-C uye nhamba 3-da Smoot Kirschner Pin inoiswa kubva kuRadial mutsara kuburikidza neyekutsvaira mutsara kuti ugadzirise kupunzika kwekupwanya.
Fig. 3-e akakwana ekuona kwemunda wekushanda unowanikwa nekushandisa retsoka isati yasvika pakuiswa kweplate. Mufananidzo 3-F Distal Row yekuvhara screws inoiswa padhuze nepfupa rechikamu pakupera kweiyo distal pold.
Mufananidzo 3-G X-Ray Fluoroscopy inofanirwa kushandiswa kusimbisa chinzvimbo cheiyo ndiro uye distal screws. Mufananidzo 3-H iyo Proximal chikamu cheiyo ndiro chaive neyakagadzirirwa imwe clearance (10 degree angle) kubva kuDiaphysis kuti iyo siaphysis kune diaphysis kuti uenderere mberi nekugadzirisa iyo distal bracture block bhaisikopo. Mufananidzo 3-Ini ndinosimbisa iyo proximal screw kuti itangezve muchindwe wekukanganisika kweiyo distal kupwanya. Bvisa iyo Kirschner PIN isati yasimbiswa zvizere.
Mifananidzo 3-j uye 3-k intraoperative radiographic mifananidzo inosimbisa kuti kupunzika kwakazoshandurwa kushamisika uye mapepa emapururu akaiswa pasi patsva.
DorSAl Plate Kugadziriswa Maitiro Ekuvhiya Kufumura Chinhu cheDortal Chimiro cheRefal Intraaoperaratively, iyo Extenstor Support mabhendi anofanirwa kuiswa munzira mbiri huru: Longitudinally mune yechipiri uye 3thd extnsor compartments, ine subperostsor clection kune 4th extrement compartment uye kudzoreredzwa kweiyo tendon. Kana yechipiri yekutsigira bhendi incision pakati pegumi ne5th extnsor compartments kufumura makoramu maviri zvakasiyana (Fig. 4).
Iyo bracture inoshandiswa uye kwenguva pfupi yakarongedzwa nekirabhu isina kuverenga PIN, uye mifananidzo yeRadio inotorwa kuti ione kuti kupwanya kwakatwaswa. Tevere, iyo dorsal ulnar (yepakati column) side of the radius inosimbiswa ne2,4 mm "l" kana "t" ndiro. Iyo Dorsal Ulnar Plate yakavezwa kuti ive nechokwadi chakasimba pane dorsal ulnar rutivi rweiyo distal radius. Mahwendefa anogona kuiswawo pedyo neiyo dorsal chikamu cheiyo discal lunate sezvinobvira, sekusangana kunoenderana neparutivi pemahwendefa kuti vabve masaliti mumakona ari mumakona emakona (Fig. 5).
Kugadziriswa kweiyo radial colate ndiro yakareruka, sechipfuva pakati pekutanga uye yechipiri extnsor compartments ine flat uye inogona kugadziriswa munzvimbo iyi ine ndiro yakavezwa. Kana iyo Kirschner PIN yakaiswa mune yakanyanya distal chikamu cheThe Radil Tubonity, iyo Distal Kupera kweRadial Colate Pin, iyo isingavhiringidze chinzvimbo chePlate uye inochengetedza bracture munzvimbo (Fig. 6).
Fig. Kuonekera kweiyo dorsal pamusoro peiyo distal radius. Bhendi rokutsigira rakavhurika kubva ku3th extnsor Sindosseus complement uye extensor Hallucis Longon Tendon inotenderwa.
Fig. 5 yekugadziriswa kweiyo dorsal chikamu cheiyo lunicular pamusoro peiyo lunate, iyo dorsal "t" kana "l" ndiro inowanzoumbwa (flate inowanzo kuvezwa (flate inowanzo kuvezwa (Fig. 5-a fig. 5-b). Kamwe chete iyo dorsal ndiro pane iyo yekunyepedzera yemwedzi yakachengetedzwa, iyo radial column ndiro yakachengetedzwa (manhamba 5-c kusvika 5-f). Mahwendefa maviri anoiswa pakona yemadhigiri makumi manomwe kune mumwe nemumwe kuti avandudze kugadzikana kweiyo yemukati gadziriso.
Fig.
Zvakakosha pfungwa
Zviratidzo zveMetacarpal Plate Fixation
Yakadzingwa Metacarpal Intra-Articular Fractures (Barton Fractures)
yakadzingwa yakawedzera-manyepedzeri mapundu (mabandi uye smith fractures). Yakagadzikana kugadziriswa kunogona kuwanikwa ne screw mahwendefa kunyangwe pamberi peSETEOPorosis.
Yakadzingwa metacarpal lunate articular seayo fractures
Zviratidzo zveDorsal Plate Fixation
NeIntercarpal Ligament Kukuvara
Yakadzingwa Dorsal Lunate Joint Surfal Fracture
DorsyLally akademba Radial Carpal Joint Fracture dislocation
Kupokana kuPalmar Plate Fixation
Severe Osteoporosis ine yakakosha inoshanda zvisingakwanisi
DorSAl Radial Watch Bracture dislocation
Kuvapo kwemazhinji ekurapa comorbidities
Kupokana kune dorsal ndiro yekugadziriswa
Multiple Medical comorbidities
Zvisinga tsanangurike-fractures
Kukanganisa kunoitwa nyore muPalmar Plate Fixation
Nzvimbo yendiro yakakosha nekuti kwete chete iyo ndiro chete inotsigira huwandu hwakatambanudzwa, asi chinzvimbo chakakodzera zvakare chinodzivirira zvakare iyo distal yekuvhara screw kubva mukupindira muRadil Carpal Joint. Kunyatso inzwa radiographs, inofungidzirwa kuti yakanangana neyakafunga zvekutangira kweradius nzvimbo yeradius yeradius.
Screw kupinzwa yeiyo dorsal cortix inotakura njodzi yekutsamwisa iyo extensor tendon uye ichikonzera tendon bvisa. Kuvhara zviyero zvinoita zvakasiyana kubva kune zvakajairwa screws, uye hazvidikanwe kupinza dorsal cortex ne screws.
Kukanganisa kunoitwa nyore nyore neDorsal Plate Fixation
Panogara paine njodzi yekupinza mubhadharo muRadial Carpal Join, uye yakafanana neye nzira yakatsanangurwa pamusoro pehukama ndiro yePallique inofanira kutorwa kuti uone kana iyo Screw chinzvimbo chakachengeteka.
Kana kugadziriswa kweiyo radial mutsara unoitwa kutanga, zviyero muThe Radil talubority zvichakanganisa kuongororwa kwekutevera kwekugadziriswa kweiyo mhizha yekufungidzira kwekutangira iyo lunate
Dislal screws isingasviki zvakakwana mugomba rakatsetseka rinogona kusimbisa tendon kana kunyange kukanganisa tendon bvisa.
Kutumira Nguva: Dec-28-2023
