Parizvino pakugadzirisa mukati memukati memitsetse yedistal radius, kune masisitimu akasiyana-siyana e anatomical locking plate anoshandiswa mukiriniki. Izvi zvinogadzirisa mukati zvinopa mhinduro iri nani kune mamwe marudzi akaomarara ekutyoka, uye nenzira dzakasiyana zvinowedzera zviratidzo zvekuvhiyiwa kwemitsetse yedistal radius isina kugadzikana, kunyanya avo vane osteoporosis. Purofesa Jupiter vekuMassachusetts General Hospital nevamwe vakaburitsa nyaya dzakatevedzana muJBJS nezvezvavakawana pakugadzirisa mitsetse yedistal radius yakatyoka uye nzira dzekuvhiya dzakabatana nadzo. Chinyorwa chino chinotarisa panzira yekuvhiya yekugadzirisa mitsetse yedistal radius yakavakirwa pakugadzirisa mukati memitsetse ye block chaiyo yekutyoka.
Maitiro Ekuvhiya
Dzidziso yezvikamu zvitatu, yakavakirwa pahunhu hwe biomechanical uye anatomical hwe distal ulnar radius, ndiyo hwaro hwekuvandudzwa uye kushandiswa kwekiriniki kwe 2.4mm plate system. Kupatsanurwa kwezvikamu zvitatu kunoratidzwa muMufananidzo 1.
Mufananidzo 1 Dzidziso ye distal ulnar radius ine makoramu matatu.
Chinyorwa chedivi ndicho chikamu chedivi che distal radius, kusanganisira navicular fossa ne radial tuberosity, iyo inotsigira mapfupa e carpal ari kudivi re radial uye ndiyo mavambo emamwe ma ligaments anodzikamisa ruoko.
Koramu yepakati ndiyo hafu yepakati yedhiramu redhiramu uye inosanganisira lunate fossa (inobatanidzwa nelunate) uye sigmoid notch (inobatanidzwa nedistal ulna) pamusoro pe articular. Kazhinji inotakurwa, mutoro unobva ku lunate fossa unoendeswa kuradius kuburikidza ne lunate fossa. Koramu yerutivi rwe ulnar, inosanganisira distal ulna, triangular fibrocartilage, uye inferior ulnar-radial joint, inotakura mitoro kubva kumapfupa e ulnar carpal pamwe nekubva ku inferior ulnar-radial joint uye ine simba rekudzikamisa.
Maitiro aya anoitwa pasi pebrachial plexus anesthesia uye C-arm X-ray imaging panguva yekuvhiyiwa inokosha. Mishonga inorwisa mabhakitiriya yakapihwa mutsinga maminetsi makumi matatu usati watanga uye pneumatic tourniquet yakashandiswa kuderedza kubuda ropa.
Kugadzika kweplate yepalmar
Kune akawanda maronda akatyoka, nzira yemuchindwe inogona kushandiswa kufungidzira pakati pe radial carpal flexor ne radial artery. Mushure mekuona nekudzosera flexor carpi radialis longus, nzvimbo yakadzika yemhasuru yepronator teres inoonekwa uye kupatsanurwa kwakafanana ne "L" kunosimudzwa. Mumaronda akaomarara, brachioradialis tendon inogona kusunungurwa zvakare kuti ideredze kutyoka.
Pini yeKirschner inopinzwa muchikamu che radial carpal, izvo zvinobatsira kutsanangura miganhu iri kure ye radius. Kana paine chidimbu chidiki chekutyoka pamucheto we articular, ndiro yesimbi yepalmar ye2.4mm inogona kuiswa pamusoro pemucheto we distal articular we radius kuti isimbiswe. Nemamwe mashoko, chidimbu chidiki chekutyoka pamusoro pe articular ye lunate chinogona kutsigirwa ne plate ye 2.4mm "L" kana "T", sezvakaratidzwa muMufananidzo 2.
Kune mapfupa akatyoka ari kunze kwechiuno, zvinobatsira kucherechedza zvinotevera. Chekutanga, zvakakosha kugadzirisa kutyoka kwenguva pfupi kuti uve nechokwadi chekuti hapana nyama yakapfava iri mumucheto wekutyoka. Chechipiri, kune varwere vasina osteoporosis, kutyoka kunogona kuderedzwa nerubatsiro rweplate: chekutanga, sikuruu inokiya inoiswa kumucheto wekumucheto kweplate yepalmar anatomical, iyo yakabatana nechikamu chekutyoka chiri kure, ipapo zvikamu zvekutyoka zviri kure nezviri pedyo zvinoderedzwa nerubatsiro rweplate, uye pakupedzisira, zvimwe zvikuruu zvinoiswa pedyo.
Mufananidzo 3 Kutyoka kwechikamu chekunze kwechikamu chedivi remusoro kunoderedzwa uye kunogadziriswa nenzira yepalmar. Mufananidzo 3-A Mushure mekunge chidimbu chapera kuburikidza ne radial carpal flexor ne radial artery, pini yeKirschner yakatsetseka inoiswa mu radial carpal joint. Mufananidzo 3-B Kugadziriswa kwe metacarpal cortex yakabviswa kuti idzokezve.
Mufananidzo 3-C neMufananidzo 3-DA pin yakatsetseka yeKirschner inoiswa kubva padanda reradial kuburikidza nemutsetse wekutyoka kuti igadzirise kwenguva pfupi mugumo wekutyoka.
Mufananidzo 3-E Kuona zvakakwana nzvimbo yekuvhiya kunowanikwa nekushandisa retractor usati waisa plate. Mufananidzo 3-F Mutsara wekure we screws unoiswa pedyo ne subchondral bone pamagumo e distal fold.
Mufananidzo 3-G X-ray fluoroscopy inofanira kushandiswa kusimbisa nzvimbo yeplate nedistal screws. Mufananidzo 3-H Chikamu cheproximal cheplate chinofanira kunge chine nzvimbo yakacheneruka (10 degrees angle) kubva padiaphysis kuitira kuti plate ikwanise kusungirirwa padiaphysis kuti igadzirise zvakare distal fracture block. Mufananidzo 3-I Simbisa proximal screw kuti udzorere patsva palmar inclination yekutyoka kwedistal. Bvisa Kirschner pin usati wanyatsosimbisa screw.
Mifananidzo 3-J uye 3-K Mifananidzo yeX-ray inotorwa panguva yekuvhiyiwa inosimbisa kuti kutyoka kwacho kwakagadziriswazve uye masikuruu eplate akaiswa zvakanaka.
Kugadzika Dorsal Plate Maitiro ekuvhiya ekuratidza dorsal aspect ye distal radius anonyanya kuenderana nerudzi rwekutyoka, uye kana pakatyoka nezvidimbu zviviri kana kupfuura zve intra-articular fractures, chinangwa chekurapa ndechekugadzirisa radial ne medial columns panguva imwe chete. Pakuvhiya, extensor support bands dzinofanira kuchekwa nenzira mbiri huru: kureba mu extensor compartments yechipiri neyechitatu, ne subperiosteal dissection kune 4th extensor compartment uye retraction ye tendon inoenderana nayo; kana support band incision yechipiri pakati pe 4th ne 5th extensor compartments kuti pave ne columns mbiri dzakasiyana (Mufananidzo 4).
Kutsemuka kwacho kunogadziriswa uye kunogadziriswa kwenguva pfupi neKirschner pin isina tambo, uye mifananidzo ye x-ray inotorwa kuti ione kuti kutsemuka kwacho kwabviswa zvakanaka. Tevere, dorsal ulnar (pakati pekoramu) divi reradius rinogadzikiswa ne 2.4 mm "L" kana "T" plate. Dorsal ulnar plate yakagadzirwa kuti ive nechokwadi chekuti inonyatsokwana padivi re dorsal ulnar re distal radius. Ma plate anogonawo kuiswa pedyo ne dorsal aspect ye distal lunate sezvinobvira, sezvo migero inoenderana iri pasi peplate yega yega ichibvumira ma plate kuti akomberedzwe uye aumbwe pasina kukuvadza tambo dziri mumaburi e screw (Mufananidzo 5).
Kugadzirisa radial column plate kuri nyore, sezvo pfupa riri pakati pezvikamu zve extensor zvekutanga nezvechipiri rakati sandara uye rinogona kugadziriswa panzvimbo iyi ne plate yakagadzirwa zvakanaka. Kana Kirschner pin yakaiswa muchikamu che distal chakanyanya che radial tuberosity, mugumo we distal we radial column plate une groove inoenderana neKirschner pin, iyo isingakanganisi nzvimbo yeplate uye inochengetedza kutyoka panzvimbo (Mufananidzo 6).
Mufananidzo 4 Kuonekwa kwenzvimbo yekumashure ye distal radius. Bandi rekutsigira rinovhurwa kubva pachikamu chechitatu che extensor interosseous uye extensor hallucis longus tendon inodzoserwa kumashure.
Mufananidzo 5 Kuti pave nekugadzika kwechikamu chemusana chepamusoro pemusana, ndiro yemusana "T" kana "L" inowanzo umbwa (Mufananidzo 5-A neMufananidzo 5-B). Kana ndiro yemusana iri pamusoro pemusana yasimbiswa, ndiro yemusana inonamirwa (Mifananidzo 5-C kusvika 5-F). Maplate maviri aya akaiswa pakona yemadhigirii makumi manomwe kune mumwe nemumwe kuti pave nekugadzikana kwekugadzika kwemukati.
Mufananidzo 6. Purati yeradhiyali yakagadzirwa zvakanaka uye yakaiswa mukoramu yeradhiyali, ichicherechedza notch iri kumagumo kwepuratifomu, iyo inobvumira puratifomu kudzivirira kugadzika kwechinguva kwepini yeKirschner pasina kukanganisa nzvimbo yepuratifomu.
Pfungwa dzakakosha
Zviratidzo zveMetacarpal Plate Fixation
Kutyoka kwemapfupa emukati memukati memukati memukati memukati memukati (kutyoka kwaBarton)
Kutsemuka kwetsandanyama kwekunze kwetsandanyama (kutsemuka kwaColles naSmith). Kugadzikana kwakasimba kunogona kuitwa nekushandisa ma screw plates kunyangwe paine osteoporosis.
Kupwanyika kwenzvimbo ye metacarpal lunate articular surface
Zviratidzo zvekugadzika kweplate yemusana
Nekukuvara kwe ligament ye intercarpal
Kutyoka kwejoini remusana rakabviswa panzvimbo yaro
Kutyoka kwejoini re carpal rakachekwa padhorosi
Zvinopesana nekugadzirisa ndiro yemichindwe
Osteoporosis yakanyanya ine zvikanganiso zvakakosha zvekushanda
Kutyoka kweruoko rwemusana
Kuvapo kwezvirwere zvakasiyana-siyana
Zvinopesana nekugadzirisa dorsal plate
Zvirwere zvakawanda zvekurapa
Maronda asina kuputsika
Zvikanganiso zvinoitwa nyore nyore pakugadzika ndiro yemuchindwe
Nzvimbo yeplate yakakosha zvikuru nekuti plate haingotsigire chete fracture mass, asiwo nzvimbo yakakodzera inodzivirira distal locking screw kuti isapinde mu radial carpal joint. MaX-ray ekunyatsoongorora mukati mekuvhiyiwa, akarongwa nenzira imwecheteyo ne radial inclination ye distal radius, anobvumira kuona zvakanaka pamusoro pe articular we radial side ye distal radius, iyo inogonawo kuonekwa zvakanaka nekuisa ulnar screws kutanga panguva yekuvhiyiwa.
Kupinda kwe dorsal cortex kune njodzi yekukonzera extensor tendon uye kukonzera kuputika kwe tendon. Zvikuruu zvinokiya zvinoshanda zvakasiyana nezvikuruu zvakajairika, uye hazvidikanwi kupinda mu dorsal cortex nezvikuruu.
Zvikanganiso zvinoitwa nyore nyore nekuisa danda remusana padanda
Nguva dzose pane njodzi yekuti sikuruu ipinde mu radial carpal joint, uye zvakafanana nenzira yakatsanangurwa pamusoro apa maererano neplate yepalmar, pfuti yakatetepa inofanira kutorwa kuti ione kana nzvimbo yesikuruu yakachengeteka.
Kana kugadziriswa kwe radial column kukatanga kuitwa, screws dziri mu radial tuberosity dzichakanganisa kuongororwa kwekugadziriswa kunotevera kwe articular surface resurfacing ye lunate.
Zvikuruu zviri kure zvisina kuvharwa zvachose muburi rezvikuruu zvinogona kuvhiringa tendon kana kutokonzera kuputika kwetendon.
Nguva yekutumira: Zvita-28-2023
