Parizvino, distal radius fantures inobatwa nenzira dzakasiyana-siyana, sekugadziriswa kweplasta, yekugadziriswa uye kuderedzwa kwemukati, asi mimwe mitambo inoshuma iyo chiyero chakawandisa chakakwira seye 16%. Nekudaro, kana ndiro yacho yakasarudzwa nemazvo, huwandu hwenhandare hunogona kuderedzwa zvinobudirira. Kuongororwa muchidimbu kwemhando, zviratidzo uye maitiro ekuvhiya emalmar plating kune distal radius fantures inotaurwa.
I.Types of distal radius fractures
Pane akawanda ekuenzanisa masisitimu ekupwanya, kusanganisira iyo müller ao classion yakavakirwa paAnatomy uye iyo Femandez Classification yakavakirwa pakukuvara kwekukuvara. Pakati pavo.
1. Müller AO Classification - Chikamu Intra-Articular Fractures
Iyo AO Classification yakapihwa zvakanaka kune distal Radius Rudzi rwese rwakawedzerwa mukupatsanurwa mune dzakasiyana musanganiswa we subgroups zvichibva pane kuomarara uye kuoma kwekupwanya.
Nyora A: Kuwedzera-Kunyepedzera kupwanya
A1, ulnar feal fracture, radius search (a1.1
A2, kupwanyika kweRadius, kupusa, neIntet (A2.1, radius pasina;
A3, kupwanyika kweradius, kuenderana (A3.1, axial kupfupiswa kweradius; A3.2 Wakagadziriswa chidimbu cheradius; A3.3, cracture yeradius).
Type B: Chikamu cheLaticular Fracture
B1, kupwanya kweiyo radius, Sagittal ndege (B1.1, LATEL SEPLY TYPEL; B1.2, Literal Commined Type; B1.3, Medial Type).
B2, kupwanyika kweiyo dorsal rim yeradius, kureva, barton bracture (b2.1, yakapusa mhando; b2.2, yakasanganiswa neyakawona
B3, kupwanyika kweMetacarpal Radius, kureva kuti, Barton Fracture, kana Goyrand Tyle Tyle (B3.2 Fragment Mutemo, B3.3 Fragment, B3.3
Type C: Yese Yakatsiga Fracture
C1, radial kupwanya nerudzi rwepamoyo pane zvese zvekunyepedzera uye metaphyseal nzvimbo (C1.2
C2, radius kupwanyika, akareruka metaphysis (C2.1, Sagittal Fracer yeCracet yeMhizha; C2.3, Kubhururuka Kwekuchinjika Kunotambanudza muRadial Stem).
C3, radial kupwanyika, c3.1, yakapusa kupwanyika yefraaphysis; C3.2
2.classudzika ye distal radius fractures.
Sekureva kwemuchina wekukuvara kweHemidez Classification inogona kukamurwa kuita mashanu marudzi :.
Type i fractures ndeyekuwedzera-tracular metaphyseal cractured fraces yakadai se calles fractures (dorsal anging) kana Smith Fracts (Metacarpal Anging). Iyo cortex yeimwe pfupa rinopwanya pasi pekutambudzika uye iyo contralateral cortix inoenderana uye yakanyudzwa.
Kupwanyika
Type III Fractures ndeye Intra-Articular Fractures, inokonzerwa nekushushikana neshungu. Aya maronda anosanganisira Palmar Barton Fracts, Dorsal Barton Fracts, uye Radil Stem Fractures.
Shear Ston
Type III Fractures ndeye Intra-Inticular Fractures uye Metaphyseal Pletnices inokonzerwa nekukuvara kwekumanikidza, kusanganisira kuomarara zvibodzwa uye zvekufungidzira penalon fralures.
Kuisa
Type IV Fracture ndeyekuvhurwa kweiyo fracture yeiyo lighting yekubatanidza iyo inoitika panguva yekuvhiringidzika-dislocation yeRadial Carpal Joint.
Avulsion kupwanya ini ndakabvumidza
Nyora v bracture inomuka kubva kune yakakwira velocity kukuvara inosanganisira akawanda masimba ekunze uye kukuvara kwakanyanya. (Yakasanganiswa i, ii, iii, iv)
3.Ponymic typing
II.tuptment of distal radius fractures ne paMapepa Plating
Zviratidzo.
Zvekuwedzera-mhizha-fungidziro inotevera kutadza kwekudzikiswa kwakavharwa mumamiriro ezvinhu anotevera.
Dorsal anglation yakakura kupfuura 20 °
DorSAl compression yakakura kupfuura mashanu mm
Distal radius kupfupika kupfuura 3 mm
Distal fracture block kutama kwakakura kupfuura 2 mm
YeIntra-Artular Fractures yakakura kupfuura 2mm kutamiswa
Vakawanda nyanzvi havakurudzire kushandiswa kweMetacarpal Mahwendefa ekukuvara kwakanyanya, kwakadai sekuratidzira kwakasimba kwemari, nekuti zvidimbu zvakashata zvepfuma zvinopesana nezvinowanikwa necrosis uye zvakaoma kushandurwa kweanatomically.
Mune varwere vane zvidimbu zvakawanda zvinokatyamadza uye zvakakosheswa zvakakura neakanyanya osteoporosis, metacarpal plating haina kushanda. Iyo Subchondral rutsigiro rwezvakakora matsvanyiriri inogona kunge iri dambudziko, senge screw kupinda mukati mejoini yemukati.
Kuvhiya maitiro
Vazhinji vanachiremba vanoshandisa nzira yakafanana uye maitiro ekugadzirisa distal radius fractures nekapani ndiro. Nekudaro, nzira yakanaka yekuvhiya inodikanwa kuti isabate zvinobudirira matambudziko ekushanda, eg, kuderedzwa kunogona kuwanikwa nekuburitsa block block kubva pakumanikidza nekudzoreredza kuenderera kweiyo cortical pfupa. Kugadziriswa kwechinguvana ne 2-3 Kirschner Pini inogona kushandiswa, nezvimwe
(I) kupatsanurana kudzoreredza uye kutumira
1. Tsamba inoitwa munzira yeiyo radial shaft iri pasi peFluoroscopy block block pasi kubva kuPalmar Side
2.
(Ii) kuwana mapoinzi.
Kuti uwane mhando yekushandiswa, iyo PCR (Radial Carpal Flexor) yakawedzera malmar nzira inokurudzirwa.
Iko kuguma kweiyo nguva yeganda incision kunotanga mune yeganda crease yechiuno uye kureba kwayo kunogona kutsanangurwa zvichienderana nerudzi rwekupwanya.
Iyo Radial Flexor Carpi Radialis Tendon uye yayo Tendon Sheath yakaiswa, distal kumapfupa eCarpal uye proximal sepedyo neiyo proximal divi sezvinobvira.
Kudhonza radial Carpal Flexor Tendon kune iyo Ulnar Side inochengetedza iyo yepakati nerve uye flexor tendon yakaoma.
Iyo Parona Space inofumurwa uye iyo anterior rotorat
Inzira radial side of the anterior rotator ani tsandanyama, kucherechedza kuti chikamu chinofanira kusiiwa chakabatanidzwa kune radius yekuvakazve kuvakwazve.
Kukwevera anterior rotator ani tsandanyama kune iyo Ulnar Side inobvumira kuratidzwa kwakakwana kweiyo Ulnar runyanga paPalmar divi reradius.
Iyo nzira yekunguvana inofumura iyo distal radius uye inobudirira inofumura iyo Ulnar angle.
Zvemhando dzakaomarara, dzinokurudzirwa kuti iyo distal Brachiladiais inogona kusunungurwa, iyo inokwanisa kufumura radius yu kuti ishandise kubva kune yakakwenenzvera saiti, wobva wadzosera iyo intra-artralular Fracture block uchishandisa Kirschner Pin. Zvekunetseka zvakaoma-manhamba, arthroscopy inogona kushandiswa kubatsira mukudzikiswa, kuongororwa uye kwakanaka-kuronga kweiyo yakavharika bhajeti.
(III) Nzira dzekudzikiswa.
1. Shandisa iyo pfupa pry kunge lever yekugadzirisa zvakare
2. Mubatsiri anodhonza indekisi yemurwere uye yepakati zvigunwe, izvo zvichave nyore kugadzirisa zvakare.
3
Mushure mekupindirana kwapera, ndiro yemuchindwe yakaiswa nguva pfupi, iyo inofanira kunge iri pedyo neiyo mvura, inofanira kufukidza iyo Ulnar Emince, uye inofanira kuve yepakati kune iyo midpoint yeiyo radial stem. Kana mamiriro aya asina kusangana, kana iyo ndiro isiri iyo yakakodzera saizi, kana kuti kudzikisira kusingagutsi, maitiro acho achiri asina kukwana.
Zvinetso zvakawanda zvine chekuita nenzvimbo yeplate. Kana iyo ndiro yacho yakaiswa kure kwazvo kune iyo radial divi, zvinonetsa zvine chekuita neBunoon Flexor zvinogona kuitika; Kana ndiro yacho ichiiswa padyo padhuze nepamutsuzi mvura, iyo yakadzika yakashanduka yemunwe inogona kunge iri panjodzi. Kuzvidzora kwekushambadzira kwekuparadzaniswa kwepamhepo kunogona kukonzera iyo ndiro nyore nyore kune iyo capur Side uye ichisangana nendege tendon, pakupedzisira inotungamira kuTendenitis kana kutadza.
Mune varwere veOsteoporoti, inokurudzirwa kuti ndiro yacho iiswe padyo nenhamba yemvura sezvinobvira, asi kwete kuyambuka. Subchondral Fixation inogona kuwanikwa ichishandisa kirschner pini iri padyo neUlna, uye padivi-ne-side kyschner pini uye kukiya zviyero zvinoshanda mukudzivirira kupunzika kwetsvina.
Kamwe chete ndiro yakaiswa nenzira kwayo, iyo proximal mugumo yakagadziriswa necrew imwe uye yekupedzisira kupera kweiyo ndiro yakarongedzwa kwenguva pfupi neKirschner gomba rakanyanya Ulnar gomba. Intrapaoperative Fluoroscopic Orthourtopic Orthourmograms, Lateral maonero, uye mafirimu akareba aine makumi matatu ° ruoko kumusoro akatorwa kuti azive kuderedzwa kwekudzikisira uye chinzvimbo chekugadziriswa kwemukati.
Kana iyo ndiro ikamiswa zvinogutsa, asi iyo Kirschner Pine-artracular, izvi zvichaguma nekudzoreredzwa kwemuchindwe, iyo inogona kugadziriswa nekugadzirisa iyo ndiro uchishandisa iyo "Distal Fracture maitiro" (Fig. 2, b) 2, b).
Mufananidzo 2.
A, miviri kirkner mapini ekugadzirisa kwenguva pfupi, ona kuti metacarpal incarity uye nzvimbo dzekunyepedzera hadzidzorerwi zvakakwana panguva ino;
B, imwe Kirchner Pin yeChidimbu Plate Fixation, Distal Radius yakagadziriswa pane ino (Distal Fracties)
C, arthroscopic yakanaka-kuronga kwenzvimbo dzekunyepedzera, kuiswa kwe distal kuvhara zviyero / mapini, uye yekupedzisira resetting uye kugadziriswa kweiyo Proximal radius.
Munyaya yeCoffitant Dorsal uye Ulnar Fractures (ULNAR / Dorsal Die punch), iyo isingakwanisi kugadziriswazve kuvharwa, nzira nhatu dzinotevera dzinogona kushandiswa.
Iyo proximal radius inotenderera anteriorly kure neyekuvhiringidza saiti, uye block block yeiyo lunate fosssa inodururwa yakananga kune iyo Carpal pfupa kuburikidza nePRC kurekura nzira; Chidimbu chidiki chakaitwa dorsal kune 4th uye 5th compartments kufumura block block, uye iri screw-yakagadziriswa mumapani mazhinji emapleti. Yakavharwa percutaneous kana zvishoma kusanzwisisika gadziriso yakaitwa neArthroscopic rubatsiro.
Mushure mekudzoreredza kudzikisira uye kuiswa kwakakodzera kweplate, kugadziriswa kwekupedzisira kuri nyore uye anatomical reposition inogona kuwanikwa kana iyo proximal ulnar kernel pini yakamiswa uye isina screws iri mumubatanidzwa wemukati (Mufananidzo 2).
(iv) screw kusarudza ruzivo.
Kureba kwezvibodzwa kungave kwakaoma kuyera nenzira kwayo nekuda kweiyo yakaoma dorsal cortical pfupa kupwanya. Zviyero zvakanyanyisa kureba zvinogona kutungamira kune tendon kusagadzikana uye kupfupi kutsigira kugadziriswa kweiyo dorsal bracture block block. Nechikonzero ichi vanyori vanokurudzira kushandiswa kwechipfuva chakarukwa uye multiaxial kuvhara zvipikiri muThe Radil talubority uye yakawanda Ulnar Foramen, uye kushandiswa kwechiedza kukwira zviyero munzvimbo dzasara. Iko kushandiswa kwemusoro unopokana kunodzivirira kusundira kweiyo tendon kunyangwe ikatsemuka dorsally. Zvekupedza Proplocking Plate Fixation, maviri ekuvhiringidza screws + imwe yakajairika screw (yakaiswa kuburikidza neEllipse) inogona kushandiswa kuti ishandiswe.
Dr Kyohito kubva kuFrance vakaburitsa ruzivo rwavo rwekushandisa zvishoma kusapinda maPalmar locking mahwendefa ekuvhiringidzika, uko kuvhiya kwavo kwekuvhiya kwakanyanyisa kune yakanyanya 1cm, iri kupokana. Iyi nzira inonyanya kuratidzwa kune yakasarudzika yeradius radius radius, uye yayo yekuzvimiririra yemifananidzo yeA2 uye cractures yeC1 uye C2. Iyo nzira zvakare haina kukodzera mhando B Fractures. Vanyori vanonongedzerawo kuti kana kuderedzwa kwakanaka uye kugadziriswa hakugone kuwanikwa nenzira iyi, zvinodikanwa kuti ushandure kune iyo yechinyakare nzira yekunzwisisa uye kusanamatira kune zvishoma kusanzwisisika kusanzwisisika.
Kutumira Nguva: Jun-26-2024
