Kutsemuka kweparutivi nekukanganisika kudiki kana kusina: kana pfupa remetacarpal (mutsipa kana diaphysis) ratsemuka, rinodzoserwazve nemaoko. Proximal phalanx inotenderedzwa zvakanyanya kuti ibudise musoro wemetacarpal pachena. Kuchekwa kweparutivi kwe 0.5-1 cm kunogadzirwa uye extensor tendon inodzoserwa kure pakati pemutsara. Tichitungamirirwa ne fluoroscopic, takaisa waya yekutungamira ye 1.0 mm pamwe ne longitudinal axis yeruoko. Musoro wewaya yekutungamira wakagomara kuitira kudzivirira kupinda kwe cortical uye kuti zvive nyore kutsvedza mukati me medullary canal. Mushure mekunge nzvimbo yewaya yekutungamira yaonekwa fluoroscopically, subchondral bone plate yakadzoserwazve uchishandisa hollow drill bit chete. Hurefu hwakakodzera hwe screw hwakaverengerwa kubva pamifananidzo yekuvhiya. Muzhinji fractures dzemetacarpal, kunze kweyechishanu metacarpal, tinoshandisa 3.0-mm dhayamita dhiyamita. Takashandisa screws dzisina musoro dzeAutoFIX (little Bone Innovations, Morrisville, PA). Hurefu hwepamusoro hunoshandiswa hwescrews ye3.0-mm i40 mm. Iyi ipfupi pane avhareji yehurefu hwefupa remetacarpal (inenge 6.0 cm), asi yakareba zvakakwana kuti ibate tambo mumedulla kuti iwane kugadzikana kwakasimba kwescrews. Dhayamita yemedullary cavity yefifth metacarpal inowanzo kuve yakakura, uye pano takashandisa screws ye4.0 mm ine dhayamita yepamusoro inosvika 50 mm. Pakupera kwemaitiro, tinova nechokwadi chekuti tambo ye caudal yakavigwa pasi pemutsara we cartilage. Kusiyana neizvi, zvakakosha kudzivirira kuisa prosthesis zvakanyanya, kunyanya kana mutsipa ukatyoka.
Mufananidzo 14 MuA, kutyoka kwemutsipa kwakajairika hakubviswi uye musoro unoda kudzika kushoma sezvo B cortex ichamanikidzwa
Maitiro ekuvhiya ekutyoka kwechikamu chepamberi che phalanx aive akafanana (Mufananidzo 15). Takaita kucheka kwe 0.5 cm pamusoro pechikamu chepamberi che phalanx uku tichinyatso tendeudza chikamu chepamberi che phalanx. Misungo yakaparadzaniswa uye yakadzoserwa shure kwenguva refu kuti musoro wechikamu chepamberi che phalanx uoneke. Pakutyoka kwakawanda kwechikamu chepamberi che phalanx, tinoshandisa sikuruu ye 2.5 mm, asi pama phalanges makuru tinoshandisa sikuruu ye 3.0 mm. Hurefu hwepamusoro hwe 2.5 mm CHS inoshandiswa parizvino i 30 mm. Tinongwarira kuti tisanyanya kusimbisa masikuruu. Sezvo masikuruu achiboorwa ega uye achizvibata-bata, anogona kupinda pasi pechikamu che phalanx nekusadzivirira kwakanyanya. Imwe nzira yakafanana yakashandiswa pamakuputsika kwechikamu chepakati che phalanx, nekuchekwa kunotanga pamusoro pechikamu chepakati che phalanx kuti zvibvumire kuiswa kwemasikuru.
Mufananidzo 15 Kuonekwa kwechikamu che phalanx chinotenderera mukati mekuvhiyiwa. Waya yekufambisa yeAA 1-mm yakaiswa kuburikidza nekacheka kadiki kanotenderera pamwe chete ne longitudinal axis ye proximal phalanx. B Waya yekufambisa yakaiswa kuti ibvumire kugadziriswa zvakanaka kwenzvimbo uye kugadziriswa kwechero kutenderera. CA 2.5-mm CHS yakaiswa uye yakavigwa mumusoro. Nekuda kwechimiro chaicho chema phalanges, kudzvanywa kunogona kukonzera kuparadzaniswa kwe metacarpal cortex. (Murwere mumwe chete seari muMufananidzo 8)
Kutsemuka kwemapfupa: kudzvanywa kusina rutsigiro panguva yekuiswa kweCHS kunogona kukonzera kupfupika kwemetacarpals nephalanges (Mufananidzo 16). Nokudaro, pasinei nekuti kushandiswa kweCHS hakubvumirwi mumamiriro ezvinhu akadaro, tawana mhinduro kune zviitiko zviviri zvakajairika zvatinosangana nazvo.
Mufananidzo 16 AC Kana kutyoka kusina kutsigirwa ne cortically, kusimbisa screws kuchaita kuti kutyoka kuputsika kunyangwe kuderedzwa zvachose.D Mienzaniso yakajairika kubva munhevedzano yevanyori inoenderana nenyaya dzekupfupika kwakanyanya (5 mm). Mutsetse mutsvuku unoenderana nemutsara we metacarpal.
Pakupwanyika kwe submetacarpal, tinoshandisa nzira yakagadziriswa yakavakirwa papfungwa yekuvaka yekusimbisa (kureva, zvinhu zvechimiro zvinoshandiswa kutsigira kana kusimbisa furemu nekuramba kudzvanywa kwenguva refu nekudaro zvichiitsigira). Nekugadzira chimiro che Y chine screws mbiri, musoro we metacarpal hauputsike; takatumidza izvi kuti Y-shape brace. Sezvakamboitwa kare, waya yekutungamira ye 1.0 mm longitudinal ine muromo wakapfava inoiswa. Paunenge uchichengetedza kureba kwakakodzera kwe metacarpal, imwe waya yekutungamira inoiswa, asi pakona kune waya yekutanga yekutungamira, nokudaro ichigadzira chimiro chetriangle. Mawaya ese ekutungamira akawedzerwa uchishandisa guided countersink kuwedzera medulla. Kune axial ne oblique screws, tinowanzo shandisa 3.0 mm uye 2.5 mm dhayamita screws, zvichiteerana. Axial screw inotanga yaiswa kusvika caudal thread yaenzana ne cartilage. Offset screw yehurefu hwakakodzera inoiswa ipapo. Sezvo pasina nzvimbo yakakwana mu medullary canal yezvikururu zviviri, kureba kwezvikururu zve oblique kunofanirwa kuverengerwa nokungwarira, uye zvikururu zve axial zvinofanirwa kungobatanidzwa chete nezvikururu zve axial kana zvanyatsovigwa mumusoro we metacarpal kuti zvive nechokwadi chekugadzikana kwakakwana pasina kubuda kwe screw. Skururu yekutanga inozoendeswa mberi kusvika yavigwa zvizere. Izvi zvinodzivirira kupfupika kwe axial kwe metacarpal nekudonha kwemusoro, izvo zvinogona kudzivirirwa ne oblique screws. Tinoita bvunzo dze fluoroscopic kakawanda kuti tive nechokwadi chekuti kudonha hakuitike uye kuti zvikururu zvakabatana mukati me medullary canal (Mufananidzo 17).
Mufananidzo 17 Tekinoroji yeAC Y-bracket
Kana kubatanidzwa kwacho kwakakanganisa dorsal cortex iri pasi pe proximal phalanx, takagadzira nzira yakagadziriswa; takaitumidza kuti axial bracing nekuti sikuruu inoshanda sedanda mukati me phalanx. Mushure mekugadzirisazve proximal phalanx, waya ye axial guide yakaiswa mu medullary canal sedumbu. CHS ipfupi zvishoma pane hurefu hwese hwe phalanx (2.5 kana 3.0 mm) inozoiswa kusvika mugumo wayo wepamberi wasangana ne subchondral plate iri pasi pe phalanx. Panguva ino, tambo dze caudal dze sikuruu dzinovharirwa mu medullary canal, nokudaro dzichishanda sekutsigira kwemukati uye dzichitsigira hwaro hwe phalanx. Kuongororwa kwakawanda kwe fluoroscopic kunodiwa kudzivirira kupinda kwemajoini (Mufananidzo 18). Zvichienderana nepatani yekutyoka, mamwe masikuruu kana musanganiswa wemidziyo yekuisa mukati inogona kudiwa (Mufananidzo 19).
Mufananidzo 19: Nzira dzakasiyana dzekugadzirisa kukuvara muvarwere vane kukuvara kwakakomba. Kutyoka kwakanyanya kwechikamu chemunwe weringi nekubviswa kwechikamu chepasi pemunwe wepakati (museve weyero uchinongedzera kunzvimbo yekutyoka kwakatyoka).B CHS yakajairika ye3.0 mm yemunwe wekunongedza yakashandiswa, 3.0 mm paracentesis yemunwe wepakati wakatyoka, y-support yemunwe weringi (uye grafting yechikamu chimwe chete chedenda), uye 4.0 mm CHS yemunwe wepingi.F Mafree flaps akashandiswa kufukidza zvidimbu zvakapfava.C Radiographs pamwedzi mina. Pfupa remetacarpal remunwe mudiki rakapora. Mamwe mavanga emapfupa akaumbwa kune imwe nzvimbo, zvichiratidza kupora kwechipiri kwekutyoka.D Gore rimwe mushure metsaona, flap yakabviswa; kunyangwe isina zviratidzo, sikuruu yakabviswa kubva pametacarpal yemunwe weringi nekuda kwekufungidzirwa kuti yakapinda mukati mearticular. Mhedzisiro yakanaka (≥240° TAM) yakawanikwa mumunwe wega wega pakushanya kwekupedzisira. Kuchinja kwechikamu chemetacarpophalangeal chemunwe wepakati kwakaonekwa pazera remwedzi gumi nemisere.
Mufananidzo 20 Kutyoka kwechigunwe chekunongedza chine extension yemukati memutsipa (inoratidzwa nemiseve), iyo yakashandurwa kuita kutyoka kuri nyore neB kugadzirisa kwenguva pfupi kutyoka kwemutsipa uchishandisa waya yeK.C Izvi zvakagadzira hwaro hwakagadzikana umo sikuruu inotsigira yakaiswa.D Mushure mekugadziriswa, chimiro chakaonekwa sechakagadzikana, zvichibvumira kufamba nekukurumidza.E,F Kureba kwekufamba pamavhiki matatu (miseve inoratidza nzvimbo dzekupinda kwesikuruu dzebasal)
Mufananidzo 21 Posterior orthostatic uye B lateral radiographs yemurwere A. Mapundu matatu emurwere akapatsanurwa (pamiseve) akarapwa nezvikushi zve 2.5-mm cannulated. Hapana shanduko huru mumajoini e interphalangeal dzakaonekwa mushure memakore maviri.
Nguva yekutumira: Gunyana-18-2024
