Transverse fracture ine zvishoma kana pasina comminution: munyaya yekutyoka kwemetacarpal bone (mutsipa kana diaphysis), reset by manual traction. Iyo proximal phalanx inonyanya kuchinjika kuratidza musoro wemetacarpal. A 0.5- 1 cm transverse incision inogadzirwa uye tendon yekuwedzeredza inodzoserwa kureba mukati mepakati. Tichitungamirirwa nefluoroscopic, takaisa 1.0 mm gwara waya pamwe chete neakisi yakareba yeruoko. Iyo muromo weguidewire yakabvongodzwa kuitira kudzivirira cortical kupinda uye kufambisa kutsvedza mukati me medullary canal. Mushure mekunge nzvimbo yeguidewire yakatemerwa fluoroscopically, iyo subchondral bone plate yakadzokororwa ichishandiswa chete buri dhiri. Iyo yakakodzera screw urefu yakaverengerwa kubva kune preoperative mifananidzo. Muzhinji metacarpal fractures, kunze kwechishanu metacarpal, tinoshandisa 3.0-mm dhayamita screw. Takashandisa AutoFIX headless hollow screws (diki Bone Innovations, Morrisville, PA).Urefu hunokwanisa kushandiswa hwe3.0-mm sikuruu i40 mm. Iyi ipfupi pane avhareji yehurefu hwemetacarpal bone (inoda kusvika 6.0 cm), asi yakareba zvakakwana kuti ibatanidze tambo mu medulla kuti uwane kugadzika kwakachengeteka kwesiruu. Iyo dhayamita yemedullary cavity yemetacarpal yechishanu inowanzova yakakura, uye pano takashandisa 4.0 mm sikuruu ine dhayamita yakakura inosvika 50 mm. Pakupera kwekuita, tinova nechokwadi chekuti tambo ye caudal yakavigwa zvachose pasi pemutsara we cartilage. Kusiyana neizvi, zvakakosha kuti urege kuisa prosthesis yakadzika zvakanyanya, kunyanya munyaya yekuputsika kwemutsipa.
Fig. 14 MuA, kutsemuka kwemutsipa kwakajairwa hakuna kuitwa uye musoro unoda kudzika kudiki sezvo B cortex ichamanikidzwa.
Nzira yekuvhiya yekuputsika kwepakati peproximal phalanx yakanga yakafanana (Fig. 15). Isu takagadzira 0.5 cm transverse incision kumusoro kweproximal phalanx uku tichinyatso kuchinjika iyo proximal interphalangeal joint. Iyo tendon yakaparadzaniswa uye yakadzoserwa kureba kuti ibudise musoro weproximal phalanx. Kune akawanda mafractures eproximal phalanx, tinoshandisa 2.5 mm screw, asi kune yakakura phalanges tinoshandisa 3.0 mm screw. Hurefu hurefu hwe2.5 mm CHS iri kushandiswa parizvino i30 mm. Isu tinongwarira kuti tisanyanya kuomesa screws. Sezvo screws ari kuzvirovera uye kuzvirova-rova, anogona kupinda mujinga re phalanx nekushomeka kushomeka. Imwe nzira yakafanana yakashandiswa kune midphalangeal phalangeal fractures, nekuchekwa kunotanga kumusoro wepakati phalangeal phalanx kubvumira kudzoreredza kuiswa kwe screws.
Fig. 15 Intraoperative view of a transverse phalanx case.AA 1-mm guidewire yakaiswa nekadikidiki kakachekwa padivi pe longitudinal axis ye proximal phalanx.B The guidewire yakaiswa kubvumira kugadziridzwa zvakanaka kwe repositioning uye kugadzirisa chero kutenderera.CA 2.5-mm CHS yakaiswa uye yakavigwa mumusoro. Nekuda kwechimiro cheiyo phalanges, kudzvanya kunogona kukonzera kuparadzaniswa kwemetacarpal cortex. (Murwere mumwechete sepaMufananidzo 8)
Kuputsika kwakagadziriswa: kusungirirwa kusina kutsigirwa panguva yekuiswa kweCHS kunogona kutungamirira kupfupisa kwema metacarpals uye phalanges (Fig. 16). Nokudaro, pasinei nokuti kushandiswa kweCHS mumutemo kunorambidzwa mumamiriro ezvinhu akadaro, takawana mhinduro yezviitiko zviviri zvakajairika zvatinotarisana nazvo.
MUFANANIDZO 16 AC Kana kutyoka kusingatsigirwi cortical, kuomesa masiruu kunozokonzera kupunzika kunyangwe kuderedzwa kwakakwana.D Mienzaniso yemhando kubva kunhete dzevanyori dzinoenderana nezviitiko zvekupfupisa zvakanyanya (5 mm). Mutsara mutsvuku unofanana nemutsara we metacarpal.
Kune submetacarpal fractures, isu tinoshandisa yakagadziridzwa nzira yakavakirwa pane yekuvaka pfungwa yebracing (kureva, zvimiro zvemukati zvinoshandiswa kutsigira kana kusimbisa furemu nekuramba kudzvanywa kwelongitudinal nekudaro kuitsigira). Nekugadzira Y-chimiro nemakumbo maviri, musoro we metacarpal hauputsi; takatumidza iyi zita rekuti Y-shape brace. Semune nzira yakapfuura, waya ye 1.0 mm yekureba ine muromo wakagomara inoiswa. Paunenge uchichengetedza hurefu hwakakodzera hwemetacarpal, imwe dhairekitori waya inoiswa, asi pakona kune yekutanga waya yekutungamira, nekudaro ichigadzira chimiro chetriangular. Madhairekitori ese ari maviri akawedzerwa uchishandisa inotungamirwa countersink kuwedzera medulla. Kune axial uye oblique screws, isu tinowanzo shandisa 3.0 mm uye 2.5 mm dhayamita screws, zvichiteerana. Axial screw inotanga kuiswa kusvikira tambo ye caudal yakaenzana ne cartilage. Siruuru yeoffset yehurefu hwakakodzera inobva yaiswa. Sezvo pasina nzvimbo yakakwana mumedullary canal yemakumbo maviri, kureba kweoblique screws inoda kunyatsoverengwa, uye axial screws inofanira kungobatanidzwa kune axial screws kana yanyatsovigwa mumusoro wemetacarpal kuti ione kugadzikana kwakakwana pasina screw protrusion. Iyo screw yekutanga inobva yaendeswa mberi kusvika yanyatsovigwa. Izvi zvinodzivirira axial kupfupisa kwe metacarpal uye kudonha kwemusoro, izvo zvinogona kudzivirirwa ne oblique screws. Isu tinoita kuongororwa kwefluoroscopic nguva dzose kuti tive nechokwadi chokuti kuputsika hakuiti uye kuti zviputi zvakavharwa mukati me medullary canal (Fig. 17).
Mufananidzo 17 AC Y-bracket tekinoroji
Kana comminution yakakanganisa dorsal cortex pazasi peproximal phalanx, takagadzira nzira yakagadziridzwa; takaitumidza kuti axial bracing nekuti screw inoita sedanda mukati me phalanx. Mushure mekugadzirisa zvakare iyo proximal phalanx, iyo axial inotungamira waya yakaunzwa mu medullary canal sedorsally sezvinobvira. A CHS ipfupi zvishoma pane kureba kwese kwe phalanx (2.5 kana 3.0 mm) inozopinzwa kusvika magumo ayo amberi asangana ne subchondral plate pazasi pe phalanx. Panguva ino, tambo dzepaudal dze screw dzinovharirwa mukati me medullary canal, nokudaro dzichiita sechitsigiro chemukati uye kusimudzira hwaro hwephalanx. Kuongororwa kwakawanda kwefluoroscopic kunodiwa kudzivirira kupinda mukati (Mufananidzo 18). Zvichienderana nemaitiro ekuputsika, mamwe screws kana kusanganiswa kwemidziyo yekugadzirisa mukati inogona kudiwa (Mufananidzo 19).
Mufananidzo 19: Nzira dzakasiyana dzekugadzirisa kune varwere vane kukuvara kwekupwanya. Yakanyanya comminuted submetacarpal kutyoka kwechigunwe chemhete pamwe nekutsemuka kwemukomboni kwechigadziko chemunwe wepakati (yellow museve unonongedza nzvimbo yekutyoka kwapera) B Standard 3.0 mm CHS yeindex finger yakashandiswa, 3.0 mm paracentesis yechigunwe chepakati, y-rutsigiro rwechigunwe che4 mm CHS yepinky finger.F Mapepa emahara akashandiswa kuvharika kweganda rakapfava.C Radiographs pa4 months. Bopa remetacarpal remunwe mudiki rapora. Mamwe maronda emapfupa akaumbwa kune imwe nzvimbo, zvichiratidza kupora kwechipiri. kunyange zvazvo isina zviratidzo, screw yakabviswa kubva pametacarpal yechigunwe chemhete nekuda kwekufungidzirwa kwemukati-articular kupinda. Mhedzisiro yakanaka (≥240 ° TAM) yakawanikwa mumunwe mumwe nomumwe panguva yekupedzisira kushanya.Kuchinja kwemetacarpophalangeal joint yemunwe wepakati kwakaonekwa pamwedzi ye18.
Fig. 20 Kuputsika kwechigunwe che index ne intra-articular extension (inoratidzwa nemiseve), iyo yakashandurwa kuva nyore kuputsika neB kugadziriswa kwekanguva kwe articular fracture uchishandisa K-wire.C Izvi zvakagadzira nheyo yakagadzikana iyo inotsigira longitudinal screw yakaiswa.D Mushure mekugadzirisa, iyo inovaka yakagadziriswa, yakagadziriswa Range yakatongerwa kuva immediate, F motion. Masvondo matatu (miseve inomaka mapoinzi ekupinda kwebasal screws)
Fig. 21 Posterior orthostatic uye B lateral radiographs yemurwere A. Murwere matatu akaputika mafractures (pamiseve) akabatwa ne 2.5-mm cannulated screws. hapana shanduko yakakosha mumajoini e interphalangeal yakaonekwa mushure memakore maviri
Nguva yekutumira: Sep-18-2024
