Parizvino, distal radius fractures inobatwa nenzira dzakasiyana-siyana, dzakadai sekugadzirisa plaster, incision uye kuderedza kugadziriswa kwemukati, kunze kwekugadzirisa bracket, etc. Pakati pavo, palmar plate fixation inogona kuwana migumisiro inogutsa, asi mamwe mabhuku anoshuma kuti chiyero chayo chekuvhiringidza chakakwirira kusvika ku16%. Zvisinei, kana ndiro yacho yakanyatsosarudzwa, chiyero chekugadzirisa chinogona kuderedzwa. Mhedziso pfupi yemhando, zviratidzo uye nzira dzekuvhiya dzepalmar plating ye distal radius fractures inoratidzwa.
I. Mhando dze distal radius fractures
Kune akati wandei masisitimu ekutyoka, kusanganisira iyo Müller AO kupatsanurwa kwakavakirwa pane anatomy uye Femandez kupatsanurwa kunoenderana nemaitiro ekukuvara. Pakati pavo, iyo Eponymic classification inosanganisa zvakanakira zveyakapfuura kupatsanurwa, inovhara mana emhando mhando dzekuputsika, uye inosanganisira Maleon 4-chikamu fractures uye Chaffer's fractures, iyo inogona kuva gidhi yakanaka yebasa rekiriniki.
1. Müller AO classification - chikamu intra-articular fractures
Iyo AO classification inonyatsokodzera distal radius fractures uye inokamura iwo mumhando nhatu huru: mhando A yekuwedzera-articular, mhando B partial intra-articular, uye mhando C yakazara majoini mafractures. Rudzi rwega rwega runopatsanurwa zvakare mumisanganiswa yakasiyana yezvikamu zviduku zvichienderana nekuoma uye kuoma kwekutsemuka.
Rudzi rweA: Kuwedzera-articular fracture
A1, ulnar femoral fracture, radius sekukuvadzwa (A1.1, ulnar stem fracture; A1.2 kutsemuka kuri nyore kweiyo ulnar diaphysis; A1.3, comminuted fracture ye ulnar diaphysis).
A2, Kutsemuka kweradius, nyore, ine inset (A2.1, radius isina kurereka; A2.2, dorsal tilt of radius, kureva, Pouteau-Colles fracture; A2.3, palmar tilt of radius, kureva, Goyrand-Smith fracture).
A3, Kutsemuka kweradius, yakaderedzwa (A3.1, axial kupfupisa kweradius; A3.2 chimedu chakaita seweji cheradius; A3.3, kutsemuka kweradius).
Rudzi rweB: chikamu che articular fracture
B1, kuputsika kweradius, sagittal plane (B1.1, lateral simple type; B1.2, lateral comminuted type; B1.3, medial type).
B2, Kutsemuka kwemupendero weradius, kureva, Barton fracture (B2.1, mhando iri nyore; B2.2, yakasanganiswa lateral sagittal fracture; B2.3, yakasanganiswa dorsal dislocation of wrist).
B3, Kutsemuka kwemetacarpal rim reradius, kureva, anti-Barton fracture, kana Goyrand-smith type II fracture (B3.1, mutemo wevakadzi wakapfava, chidimbu chiduku; B3.2, kutsemuka kwakapfava, chidimbu chikuru; B3.3, kuputsika).
Rudzi C: yakazara articular fracture
C1, radial fracture nemhando yakareruka yezvose articular uye metaphyseal surfaces (C1.1, posterior medial articular fracture; C1.2, sagittal fracture ye articular surface; C1.3, kuputsika kwekoronal surface ye articular surface).
C2, Radius fracture, simple articular facet, comminuted metaphysis (C2.1, sagittal fracture ye articular facet; C2.2, coronal facet fracture ye articular facet; C2.3, articular fracture inosvika muradial stem).
C3, radial fracture, comminuted (C3.1, nyore kuputsika kwemetaphysis; C3.2, kuputika kwemetaphysis; C3.3, articular fracture inosvika kune radial stem).
2.Kuronga kwe distal radius fractures.
Zvinoenderana nemaitiro ekukuvara, Femandez kupatsanurwa kunogona kukamurwa kuva 5 marudzi:.
Type I mafractures akawedzera-articular metaphyseal comminuted fractures senge Colles fractures (dorsal angulation) kana Smith fractures (metacarpal angulation). Iyo cortex yebhonzo rimwe inoputsika pasi pekukakavadzana uye iyo contralateral cortex inodzorwa uye yakaiswa mukati.
Kutyoka
Type III fractures intra-articular fractures, inokonzerwa neshear stress. Aya matyoka anosanganisira palmar Barton fractures, dorsal Barton fractures, uye radial stem fractures.
Shear stress
Rudzi rwechitatu fractures intra-articular fractures uye metaphyseal kuiswa kunokonzerwa nekukuvara kwekumanikidza, kusanganisira yakaoma articular fractures uye radial pilon fractures.
Insertion
Type IV fracture is avulsion fracture ye ligamentous attachment inoitika panguva yekutyoka-dislocation ye radial carpal joint.
Avulsion fracture I dislocation
Rudzi rwe V kuputsika kunomuka kubva pakukuvara kwakanyanya kwevelocity kunosanganisira akawanda ekunze masimba uye kukuvara kwakakura. (Musanganiswa I, II, IIII, IV)
3.Eponymic kutaipa
II.Kurapa kwe distal radius fractures nepalmar plating
Zviratidzo.
Nokuda kwekuwedzera-articular fractures inotevera kukundikana kwekuvhara kuderedzwa mumamiriro ezvinhu anotevera.
Dorsal angulation yakakura kupfuura 20°
Dorsal compression yakakura kupfuura 5 mm
Distal radius kupfupisa kupfuura 3 mm
Distal fracture block displacement yakakura kupfuura 2 mm
Kune intra-articular fractures yakakura kupfuura 2mm kutamiswa
Nyanzvi dzakawanda hadzikurudzire kushandiswa kwemetacarpal mahwendefa ekukuvadzwa kwemasimba makuru, akadai seyakanyanya intra-articular comminuted fractures kana kurasikirwa kwakanyanya kwepfupa, nokuti idzi distal fracture zvidimbu zvinowanzoita avascular necrosis uye zvakaoma kudzorera anatomically.
Mune varwere vane zvidimbu zvakawanda zvakaputsika uye kutama kwakakosha kune yakanyanya osteoporosis, metacarpal plating haishande. Iyo subchondral tsigiro ye distal fractures inogona kunetsa, senge screw kupinza mukati mejoint cavity.
Kuvhiya unyanzvi
Vanachiremba vazhinji vanoshandisa nzira yakafanana uye hunyanzvi hwekugadzirisa distal radius fractures nendiro yemichindwe. Zvisinei, nzira yakanaka yekuvhiya inodiwa kuti ibudirire kudzivirira matambudziko epashure, semuenzaniso, kuderedzwa kunogona kuwanikwa nekusunungura chivharo chekuputsika kubva kumanikidziro akaiswa uye kudzorera kuenderera kwe cortical bone. Kugadziriswa kwenguva pfupi ne 2-3 Kirschner pini inogona kushandiswa, nezvimwe.
(I) Preoperative repositioning uye chimiro
1. Kudhonza kunoitwa munzira yeradial shaft pasi pefluoroscopy, nechigunwe chichitsikirira chivharo chekutsemuka chichidzika kubva kudivi remchindwe uye mimwe minwe ichisimudza distal block kumusoro pakona kubva kudivi remushure.
2. Supine position, ine nhengo yakakanganiswa patafura yemaoko pasi pefluoroscopy.
(II) Nzvimbo dzekuwana.
Kune rudzi rwemaitiro ekushandiswa, iyo PCR (radial carpal flexor) yakawedzera palmar nzira inokurudzirwa.
Mugumo wakareba weganda rekucheka unotanga muganda remaoko uye urefu hwayo hunogona kutsanangurwa maererano nerudzi rwekutsemuka.
Iyo radial flexor carpi radialis tendon uye tendon sheath yayo yakanyungudutswa, kureba kune carpal mapfupa uye proximal sepedyo nedivi repamusoro sezvinobvira.
Kudhonza radial carpal flexor tendon kune ulnar side inodzivirira mutsara wepakati uye flexor tendon yakaoma.
Nzvimbo yeParona inoratidzwa uye anterior rotator ani muscle iri pakati pe flexor digitorum longus (ulnar side) uye radial artery (radial side).
Isai rutivi rwe radial ye anterior rotator ani muscle, ichicherechedza kuti chikamu chinofanira kusara chakabatanidzwa kune radius kuitira kuvakazve gare gare.
Kudhonzera anterior rotator ani muscle kune ulnar side inobvumira kuwedzera kwakaringana kuratidzwa kwerunyanga rwepamusoro padivi remuchindwe reradius.
Iyo nzira yepalmar inofumura iyo distal radius uye zvinobudirira kuburitsa iyo ulnar angle.
Kune dzakaoma fracture mhando, zvinokurudzirwa kuti distal brachioradialis stop inogona kusunungurwa, iyo inogona kumisa kudhonza kwayo pane radial tuberosity, panguva iyo palmar sheath yeyokutanga dorsal compartment inogona kucheneswa, iyo inogona kufumura distal fracture block radial uye radial tuberosity, mukati kutenderedza radius Yu kuti iparadze iyo saiti uye kutsemuka zvakare kubva panzvimbo yacho. vhara uchishandisa Kirschner pini. Kune yakaoma intra-articular fractures, arthroscopy inogona kushandiswa kubatsira mukuderedza, kuongorora uye kugadzirisa zvakanaka kwebhuroki yekuputsika.
(III) Nzira dzekuderedza.
1. Shandisa pfupa pry sechibatiso chekugadzirisa zvakare
2. Mubatsiri anodhonza indekisi yemurwere uye zvigunwe zvepakati, izvo zvichange zviri nyore kugadzirisa zvakare.
3. Nyora pini yeKirschner kubva kune radial tuberosity yekugadzirisa kwenguva pfupi.
Mushure mekugadzirisazve kwapera, ndiro yepalmar inogara yakagadzika, iyo inofanirwa kunge iri pedyo nekuyerera kwemvura, inofanira kuvhara ulnar eminence, uye inofanira kunge iri pedyo nechepakati peiyo radial stem. Kana mamiriro aya asina kusangana, kana ndiro yacho isiri iyo yakakura, kana kana repositioning isingafadzi, nzira yacho haisati yakwana.
Matambudziko mazhinji ane hukama zvakanyanya nechinzvimbo cheplate. Kana ndiro yacho ikaiswa kure zvakanyanya kudivi reradial, matambudziko ane chekuita nebunion flexor angangoitika; kana ndiro yacho yakaiswa pedyo zvakanyanya kumutsara wemvura, iyo yakadzika flexor yemunwe inogona kunge iri pangozi. Displaced deformity yekuputsika repositioning kudivi remichindwe inogona kuita nyore nyore kuti ndiro yacho iende kune imwe nzvimbo yemichindwe uye inosangana yakananga ne flexor tendon, pakupedzisira inotungamirira kune tendonitis kana kunyange kuputika.
Mune varwere vane osteoporotic, zvinokurudzirwa kuti ndiro yacho iiswe pedyo nemutsara wemvura sezvinobvira, asi kwete mhiri kwayo. Subchondral fixation inogona kuwanikwa uchishandisa Kirschner pini padyo neurna, uye padivi-ne-parutivi mapini eKirschner uye kukiya screws anoshanda mukudzivirira kuputsika kuchinjika.
Kana ndiro yaiswa nemazvo, iyo proximal yekupedzisira inogadziriswa ne screw imwe uye iyo distal end yeplate inogadziriswa kwechinguva neKirschner pini mune yakanyanya ulnar gomba. Intraoperative fluoroscopic orthopantomograms, lateral maonero, uye lateral mafirimu ane 30 ° wrist elevation akatorwa kuti aone kuderedzwa kwekuputsika uye nzvimbo yekugadzirisa mukati.
Kana ndiro yacho yakamira zvinogutsa, asi pini yeKirschner iri intra-articular, izvi zvichaita kuti pave nekusakwana kupora kwechigadziro chepalmar, chinogona kugadziriswa nekugadzirisa zvakare ndiro uchishandisa "distal fracture fixation technique" (Fig. 2, b).
Mufananidzo 2.
a, mapini maviri eKirschner ekugadzirisa kwenguva pfupi, ona kuti metacarpal inclination uye articular surfaces hazvina kudzorerwa zvakakwana panguva ino;
b, Imwe Kirschner pini yekugadziriswa kweplate yenguva pfupi, cherechedza kuti distal radius yakagadziriswa panguva ino (distal fracture block fixation technique), uye chikamu chepamusoro cheplate chinodhonzwa chakananga kune radial stem kuti idzorere palmar tilt angle.
C, Arthroscopic fine-tuning of the articular surfaces, kuiswa kwe distal locking screws/pini, uye kwekupedzisira kusetazve uye kugadzirisa kweproximal radius.
Muchiitiko chekubatanidza dorsal uye ulnar fractures (ulnar / dorsal Die Punch), iyo isingagoni kugadziriswa zvakakwana pasi pekuvhara, nzira nhatu dzinotevera dzinogona kushandiswa.
The proximal radius inotenderedzwa nechemberi kubva panzvimbo yekutyoka, uye bhuroko rekutsemuka kwe lunate fossa rinosundirwa rakananga ku carpal bone kuburikidza nePCR kurebesa nzira; kuchekwa kudiki kunogadzirwa dorsal kune 4th uye 5th compartments kufumura bhuroko rekutyoka, uye inoiswa screw-yakaiswa muplate yakanyanya ulnar forameni. Yakavharwa percutaneous kana minimally invasive fixation yakaitwa nerubatsiro rwearthroscopic.
Mushure mekugadzirisa zvinogutsa uye kuiswa kwakarurama kweplate, kugadzirisa kwekupedzisira kuri nyore uye kugadziriswa kweanatomical kunogona kuwanikwa kana proximal ulnar kernel pin yakanyatsogadziriswa uye pasina screws mujoint cavity (Mufananidzo 2).
(iv) Chiitiko chekusarudza Screw.
Hurefu hwema screws hunogona kuve hwakaoma kuyera nemazvo nekuda kweiyo yakanyanya dorsal cortical bone crush. Zvisungo zvakareba zvakanyanya zvinogona kutungamirira kutendon agitation uye kupfupika kwazvo kutsigira kugadzirisa kwedorsal fracture block. Nechikonzero ichi vanyori vanokurudzira kushandiswa kwe threaded kukiya zvipikiri uye multiaxial kukiya zvipikiri mune radial tuberosity uye akawanda ulnar foramen, uye kushandiswa kwechiedza-stem locking screws munzvimbo dzakasara. Kushandiswa kwemusoro wakabvongodza kunodzivirira kubvongodza kwetendon kunyange kana yakarukwa dorsally. Pakugadziriswa kwendiro yeproximal, maviri akavharira screws + imwe yakajairika screw (yakaiswa kuburikidza neellipse) inogona kushandiswa kugadzirisa.
Dr Kiyohito vanobva kuFrance vakaratidza ruzivo rwavo rwekushandisa mahwendefa ekukiyira emuchindwi ari kure kure, uko kuvhiyiwa kwavo kwakaderedzwa kusvika pa1cm yakanyanyisa, izvo zvinopesana. Iyi nzira inonyanya kuratidzwa kune yakagadzikana distal radius fractures, uye zviratidzo zvayo zvekuvhiya ndezvekuwedzera-articular fractures yeAO mafractures emhando A2 neA3 uye intra-articular fractures yemhando C1 neC2, asi haina kukodzera C1 uye C2 fractures yakasanganiswa ne intra-articular fractures. Iyo nzira hainawo kukodzera mhando B yekutsemuka. Vanyori vanoratidzawo kuti kana kuderedzwa kwakanaka uye kugadzirisa kusingagone kuwanikwa nenzira iyi, zvinodikanwa kuti uchinje kune yechinyakare incision nzira uye kwete kunamatira kune ishoma invasive diki incision.
Nguva yekutumira: Jun-26-2024
