Metacarpal phalangeal fractures inowanzoputsika mukukuvadzwa kwemaoko, inoverengera inenge 1/4 yevarwere vanorwadziwa nemaoko. Nekuda kwekutetema uye kuoma kwechimiro cheruoko uye kushanda kwakadzikama kwekufamba, kukosha uye hunyanzvi hwekurapa kwekutyoka kwemaoko kwakaoma zvakanyanya kupfuura kurapwa kwemamwe mabhonzo marefu akatyoka. Kuve nechokwadi chekugadzikana kwekutyoka mushure mekuderedzwa ndiyo kiyi yekubudirira kurapwa kwemetacarpal phalangeal fractures. Kuti udzorere basa reruoko, kuputsika kunowanzoda kugadzirisa kwakakodzera. Munguva yakapfuura, plaster yekunze inogadziriswa kana Kirschner wire yemukati kugadzirisa yaiwanzoshandiswa, asi kazhinji haigone kudzidziswa kwekutanga mushure mekushanda kwejoint rehabilitation nekuda kwekugadzirisa kusina kunaka kana nguva yakareba yekugadzirisa, iyo ine simba guru pakudzorerwa kwebasa rekubatana kwemunwe uye kunounza mamwe matambudziko kukugadzirisa kushanda kweruoko. Nzira dzemazuva ano dzekurapa dziri kuwedzera kushandisa kusimba kwemukati, senge micro-plate screw fixation.
I.Ndezvipi mitemo yekurapa?
Misimboti yekurapa kweruoko metacarpal uye phalangeal fractures: kuderedzwa kweanatomical, kujekesa uye kwakasimba kugadzirisa, mabasa ekutanga uye kudzidziswa kwekushanda. Misimboti yekurapa ye intra-articular uye peri-articular fractures yeruoko yakafanana neyekumwe intra-articular fractures, izvo zvakare kudzoreredza anatomy yejoint surface uye yekutanga kushanda mabasa. Paunenge uchibata ruoko rwemetacarpal uye phalangeal fractures, kuedza kunofanirwa kuitwa kuti uwane kuderedzwa kweanatomical, uye kutenderera, lateral angulation, kana angular displacement ye> 10 ° kune dorsal chikamu chechanza haifaniri kuitika. Kana kuguma kwekuputsika kwemetacarpal phalange kutenderera kana kuti angularly displaces nechemberi, ichashandura nzira yekufamba kwechinyakare uye kuwedzera kwekufamba kwemunwe, zvichiita kuti ishanduke kana kuwira nemunwe uri pedyo panguva yekuputika, inokanganisa kururamisa kwechigunwe basa; uye kana kutenderera kweangular kune dorsal aspect of palm is > 10 °, iyo yakatsetseka inosangana pamusoro pepfupa uye tendon inoparadzwa, kuwedzera kupikisa uye mararamiro ekufamba kwekutenderera uye kuwedzera kwetendon, uye kukuvara kwetambo kusingaperi kunoitika, zvichiita kuti njodzi yetendon kuputika.
II.Ndezvipi zvinhu zvinogona kusarudzwa kune metacarpal fractures?
Kune akawanda emukati ekugadzirisa zvinhu zvemetacarpal fractures, senge Kirschner waya, screws, mahwendefa uye ekunze fixator, pakati peiyo Kirschner waya uye microplates ndiyo inonyanya kushandiswa. Kune metacarpal fractures, microplate yemukati fixation ine mabhenefiti ari pachena pamusoro peKirschner wire fixation uye inogona kushandiswa kutanga; for proximal phalanx fractures, microplates inowanzove yakakwirira, asi kana zvakaoma kuisa screws for proximal phalanx distal segment uye musoro fractures, cross Kirschner wire internal fixation inofanira kushandiswa, iyo inonyanya kubatsira pakudzorerwa kwebasa remunwe wakakanganiswa; Kirschner waya dzinofanira kushandiswa kutanga kurapwa kwepakati phalanx fractures.
- Kirschner waya:Kirschner wire internal fixation yakashandiswa mumakiriniki ekudzidzira kweanopfuura makore makumi manomwe uye yakagara iri iyo inonyanya kushandiswa mukati mekugadzirisa zvinhu zve metacarpal uye phalangeal fractures. Zviri nyore kushanda, zvehupfumi uye zvinoshanda, uye ndiyo yakasarudzika yemukati kugadzirisa nzira. Sezvo inowanzoshandiswa mukati mekugadzirisa kurapa kwekuputsika kwemaoko, ichiri kushandiswa zvakanyanya. Zvakanakira zveKirschner waya yemukati kugadzirisa: ① Zviri nyore kushanda uye zvakanyanya kuchinjika kushandisa; ② Kubvisa zvishoma zvinyoro zvinyoro, kuderera kweropa rekutyoka kwekupedzisira, kurwara kudiki kwekuvhiya, uye kunobatsira kupora kuporeswa; ③ Zviri nyore kubvisa tsono kechipiri; ④ Mutengo wakaderera uye wakasiyana-siyana wekushandisa, wakakodzera kune akawanda mawoko kuputsika (senge intra-articular fractures, yakanyanya comminuted fractures uye distal phalangeal fractures).
2.Metacarpophalangeal microplates: Kugadziriswa kwakasimba kwemukati kwekuputsika kwemaoko ndiyo nheyo yekudzidzira kwekutanga kwekushanda uye mamiriro anodiwa ekudzorera basa rakanaka remaoko. AO mukati mekugadzirisa tekinoroji inoda kuti magumo ekuputsika anyatso kurongeka maererano nechimiro cheanatomical uye kuti kuputsika kunopera kuve kwakadzikama pasi pemamiriro ekushanda, ayo anowanzozivikanwa sekugadzirisa kwakasimba, kuitira kubvumira kufamba kwekutanga kunoshanda. AO inosimbisawo kuvhiya kusinganyanyi kupindira, nekutarisa kuchengetedza ropa. Microplate mukati mekugadzirisa kwekurapa kwekuputsika kwemaoko kunogona kuwana migumisiro inogutsa maererano nesimba, kugadzikana kwekuputsika kunopera, uye kudzvinyirira pakati pekuputsika kunopera. Panyaya ye postoperative functional recovery, kuputsika nguva yekuporesa, uye chirwere chetachiona, zvinotendwa kuti kushanda kwe microtitanium plates kunonyanya nani kupfuura iyo yeKirschner waya. Uyezve, sezvo nguva yekuporesa kuputsika mushure mekugadzirisa ne microtitanium mahwendefa ipfupi zvikuru pane iyo yedzimwe nzira dzekugadzirisa, zvinobatsira kuti varwere vatangezve hupenyu hwemazuva ose kare.
(1) Ndezvipi zvakanakira microplate mukati kugadzirisa?
① Zvichienzaniswa newaya dzeKirschner, microplate screw zvinhu zvine kuwirirana kwetishu uye zvirinani mhinduro yetishu; ② Kugadzikana kweplate-screw fixation system uye kudzvinyirira pamagumo ekuputsika kunoita kuti kuputsika kuswedere kuderedzwa kweanatomical, kugadzirisa kwakachengeteka, uye kunobatsira pakuputsika kwekuporesa; ③ Kwekutanga kurovedza muviri kunowanzo kubvumidzwa mushure mekugadzirisa microplate, iyo inobatsira kudzoreredza basa remaoko.
(2)Ndeipi nzira yekuvhiya yemamicroplates?
Kuvhiyiwa kunowanzoitwa pasi pebrachial plexus block anesthesia, uye pneumatic tourniquet inowanzodiwa. Iyo dorsal incision ye metacarpal phalanges inotorwa, iyo dorsal aponeurosis yemanhamba inochekwa kana interosseous tsandanyama uye metacarpal bhonzo inopindwa kufumura magumo ekutyoka kwemetacarpal kana phalangeal mapfupa, periosteum inopepetwa, uye kutsemuka kunoderedzwa pasi pekuona kwakananga. Mahwendefa akatwasuka akakodzera kutsemuka kwepakati pechikamu chepakati uye mapfupi oblique fractures, T-plates akakodzera kugadziriswa kwechigadziko che metacarpal uye phalanges, uye T-plates kana 120 ° uye 150 ° L-maplate akakodzera kugadzirisa kwenguva refu oblique uye comminuted fractures. Iyo ndiro inowanzoiswa padivi rebhonzo kudzivirira tendon kutsvedza uye kupfeka kwenguva refu, izvo zvinobatsira kudzidziswa kwekutanga kushanda. Anenge maviri screws anofanirwa kushandiswa kugadzirisa magumo maviri ekutyoka, zvikasadaro kugadzikana kwakashata, uye Kirschner waya kana screws kunze kweplate inodiwa kubatsira kugadzirisa kuzadzisa chinangwa chekugadzirisa kwakagadzikana.
3.Mini screws: Mini screws ine kugadzikana kwakafanana kune mahwendefa esimbi mukugadzirisa kwe spiral kana kureba oblique fractures, asi huwandu hwezvinyoro zvinyoro uye periosteum stripping idiki pane iyo yesimbi plate fixation, iyo inobatsira kudzivirira kugoverwa kweropa uye zvinoenderana nepfungwa yekushomeka kwekushanda. Kunyange zvazvo kune T-type uye L-mhando mahwendefa e-pedo-articular fractures, kudzorerwa kwebasa rekubatana mushure mekutevera mushure mekutevera kwakaipa kudarika diaphyseal fractures. Mini screws zvakare ine zvimwe zvakanakira kugadzirisa intra-articular uye peri-articular fractures. Zvisungo zvakaputirwa mu cortical bone zvinogona kumira mutoro mukuru wekushungurudzika, saka kugadzirisa kwakasimba, uye kupera kwekuputika kunogona kumanikidzirwa kuita kuti nzvimbo yekuputsika iite pedyo nepedyo, kupfupisa nguva yekuporesa kuputsika uye kuita kuti kuporeswa kwekuputsika, sezvinoratidzwa mumufananidzo 4-18. Mini screw mukati mekugadzirisa kwekutyoka kwemaoko inonyanya kushandiswa kune oblique kana spiral fractures ye diaphyseal uye intra-articular avulsion fractures yemabhonzo makuru. Izvo zvinofanirwa kucherechedzwa kuti kana uchishandisa mini screws chete kugadzirisa oblique kana spiral fractures yediaphyseal bhonzo reruoko, kureba kwemutsara wekutsemuka kunofanirwa kunge kuri kaviri dhayamita yebhonzo rediaphyseal, uye kana uchigadzirisa avulsed fracture blocks mujoinhi, hupamhi hwebhonzo bhuroka hunofanirwa kunge hwakapetwa katatu paupamhi hwetambo.
4.Micro yekunze fixator:Comminuted metacarpal phalangeal fractures dzimwe nguva zvakaoma kuti anatomically kuderedza kana haigoni kusimbiswa zvakasimba mukati kunyange mushure mekuvhiyiwa incision nekuda kwekuparadzwa kwekutsigirwa kwepfupa. Iyo yekunze fixator inogona kudzoreredza uye kuchengetedza kureba kweiyo comminuted fracture pasi pe traction, kutamba basa rehukama kugadzirisa. Akasiyana metacarpal phalangeal ekunze anogadzirisa anoiswa munzvimbo dzakasiyana: iyo 1st uye 2nd metacarpal phalanges inoiswa pane dorsal radial side, iyo 4th uye 5th metacarpal phalanges inoiswa pa dorsal ulnar side, uye 3rd metacarpal phalange inoiswa padivi pe dorsal mamiriro kune dorsal mamiriro. Nyatsoteerera panopinzwa tsono kudzivirira kukuvara kwetendon. Yakavharwa kuputsika kunogona kuderedzwa pasi peX-rays. Kana kuderedzwa kusina kunaka, kuchekwa kudiki kunogona kuitwa kubatsira mukuderedza.
Ndezvipi zvakanakira zvekunze zvinogadzirisa?
① Kushanda kuri nyore, kunogona kugadzirisa kwakasiyana siyana kwekutyoka magumo; ② Inogona kunyatso kudzikisa nekugadzirisa intra-articular fractures ye metacarpophalangeal mapfupa pasina kukuvadza nzvimbo yakabatana, uye inogona kuvhiringidza nzvimbo yakabatana kudzivirira chibvumirano chejoint capsule uye collateral ligament; ③ Kana fractures yakagadziriswa haigone kuderedzwa anatomically, inogona kusanganiswa nekugadziriswa kwemukati, uye gadziriso yekunze inogona kuderedza zvishoma uye kuchengetedza mutsara wesimba; ④ Bvumira maekisesaizi ekutanga echigunwe chakakanganisika mujoini isina kugadzika kudzivirira kuomarara kwejoini uye osteoporosis; ⑤ Inogona kunyatsogadzirisa kuputsika kwemaoko pasina kukanganisa kurapwa kwemashure kweronda paruoko rwakakanganiswa.
Nguva yekutumira: Zvita-21-2024
