Transverse bracture ine zvishoma kana kuti isina commintion: Mune nyaya yekupwanya kweiyo metacarpal pfupa (mutsipa kana diaphysis), reset nebhuku racho. Iyo proximal phalanx inokwenenzverwa kufumura musoro wemacacarpal. 0.5- 1 cm kutapurirana incision inogadzirwa uye iyo Extensor Tendon inotenderwa mitezo iri pakati. Pasi peFluoroscopic Kutungamira, takaisa iyo 1.0 mm inotungamira waya padhuze neiyo refuitudinal axis yechiuno. Iyo tipp yeyekutungamira yakarukwa yakarukwa kuitira kuti udzivise kupenya kwekora uye kufambisa kutsvedza mukati meiyo medullary canal. Mushure mekutungamira kwekutungamira kwaive kwakatemerwa fluoroscopically, iyo subchondral bar baronda yakashandurwa uchishandisa chete holo drill zvishoma. Iyo yakakodzera screwrefu yakaverengerwa kubva paMafananidzo ekunzwisisa. Mune mazhinji metacarpal fractures, kunze kwekusarudzika kwechishanu metacarpacpal, isu tinoshandisa 3.0-mm diameter screw. Isu takashandisa Autofix Hellive Hellol Hollow Screws (Little Bone Invents, Morristrole, PA). Izvi ipfupi kupfuura urefu hwemahara weMetacarpal pfupa (anenge 6.0 cm), asi kwenguva yakareba kuti iite tambo mumudhori kuti uwane yakachengeteka gadziriso yeiyo screw. Iyo dhayamita yeiyo medullary cavity yeChishanu Metacarpal inowanzo kuve yakakura, uye pano takashandisa iyo 4.0 mm screw ine yakanyanya kuwanda kusvika pamakumi mashanu emamm. Pakupera kwemaitiro, isu tinoona kuti tambo yekubatira yakavigwa zvachose pazasi pe cartilage mutsara. Zvekare, zvakakosha kuti urege kusimudzidzira prostising zvakadzama, kunyanya mumutsipa wemitsipa.
Fig. 14 MuA, Wakajairwa mutsipa kupwanyika hakufambi uye musoro unoda kudzika zvishoma sezvo b cortix ichamanikidzwa
Iyo nzira yekuvhiya yekuvhenekera kwekuputika kweiyo proximal phalanx yakafanana (Fig. 15). Takagadzira 0.5 cm transverse incision mumusoro weiyo proximal phalanx nepo zvakanyanya kuwanda kushandura iyo proximal interphalanger. Ma tendon yakaparadzaniswa uye kudzoserwa kwenguva refu kuti iburitse musoro weiyo proximal phalanx. Zvekuremara zvakanyanya zveProximal phalanx, isu tinoshandisa 2,5 mm screw, asi yeakakura phalanges tinoshandisa 3.0 mm mm screw. Iyo yakareba urefu hwe2,5 mm chs parizvino inoshandiswa ndeye 30 mm. Isu tinotarisira kuti tirege kupfuudza-kusimbisa zviyero. Sezvo zviyero zviri kuzviuraya uye kuzvishongedza, vanogona kupinda mukati megoji ye phalanx nekudzivisa kushoma. Maitiro akafanana akashandiswa kuFardPhal Phalangeal Fractures, neChiitiko kutanga kumusoro kweiyo midphalangeal phalanx kubvumidza retrograde kuiswa kweiyo screws.
Fig. 15 Intraoperative maonero eiyo phalanx konditi Nekuda kwechimiro chakati chevhavha, kumanikidzwa kunogona kukonzera kuparadzaniswa kweiyo metacarpal cortex. (Murwere mumwechete wemufananidzo 8)
Cressured Fractures: Asingatenderwa kumanikidzwa panguva yekusagadzikana kweCS inogona kutungamira mukupfupika kwemazita uye phalanges (Fig. 16). Naizvozvo, kunyangwe paine chokwadi chekuti kushandiswa kweChs kuri munongedzo kunorambidzwa mune zviitiko zvakadaro, tawana mhinduro yezvinhu zviviri zvakawandisa zvatinosangana nawo.
Mufananidzo 16 AC Kana kukanganisika kwacho kusiri kutsigirwa zvakanyanya, kusimbisa zviyero kuchaguma nekukanganiswa kwekupwanya pamwe.Proctiction mienzaniso kubva kune vanyori vanoenderana nematanho ekupfupisa (5 mm). Mutsara mutsvuku unoenderana nemutsara we metacarpal.
Kune submetacpal fractures, isu tinoshandisa nzira dzakagadziridzwa zvichibva pane yekuvaka pfungwa yekuvandudza (kureva, zvinhu zvakamira zvinoshandiswa kutsigira kana kusimbisa chimiro nekudzivisa kumanikidza kwenguva refu uye nekudaro tichitsigira). Nekugadzira iyo y-chimiro ine maviri screws, iyo musoro weMetacarpal haina kudonha; Takatumidza iyi iyo y-chimiro brace. Sezvazviri munzira yapfuura, iyo 1,0 mm Longitudinal inotungamira waya ine tip yekuputika inoiswa. Nepo kuchengetedza kureba kwe metacarpal, imwe aya inotungamira inoiswa, asi pakona kune waya yekutanga yekutungamira, nokudaro ichigadzira chimiro chetatu. Vese vatinofambisa vakawedzera kushandisa iyo inotungamirwa kuverenga kuti uwedzere medulla. Kune axial uye oblique screws, isu tinowanzo shandisa 3.0 mm uye 2.5 mm diameter screws, zvichiteerana. Iyo axial screw inotanga kuiswa kudzamara tambo ye caudal iri pakati pe cartilage. Chikanganiso chekubvisa chehurefu chakakodzera chinobva chaiswa. Sezvo pasina nzvimbo yakakwana mumugodhi madiki ezvikamu zviviri, kureba kweiyo oblique screws inofanirwa kuvigwa kune yakakwana mumusoro metacarpacl Iyo yekutanga screw inobva yasvika kumberi kusvikira yavigwa zvizere. Izvi zvinodzivirira kupfupika kweiyo metacarpal uye kudonha kwemusoro, izvo zvinogona kudzivirirwa ne oblique screws. Isu tinoita nguva zhinji muongorori webhuruu kuti vave nechokwadi chekuti kudonha hakuna kuitika uye kuti zviyero zvakabatanidzwa mukati meiyo medullary canal (Fig. 17).
Mufananidzo 17 AC Y-Bracket Technology
Kana kutongerwa kukanganisika kwakakanganisa dortil cortex pachigadziko cheiyo proximal phalanx, isu takagadzira nzira yakagadziridzwa; Taitumidza kutixial bracing nekuti banga rinoita kunge danda mukati mePhalanx. Mushure mekugadzirisa iyo proximal phalanx, iyo axial gitua waya yakaunzwa muMidllary canal se dorselly sezvinobvira. A Chs zvishoma kupfupika pane huwandu hwehurefu hwePhalanx (2,5) Panguva ino, tambo dzechikara dzechikepe chakakiiwa muzvipindurudzo, nokudaro vachiita sokutsigirwa kwemukati uye nekuvhundutsa chigadziko che phalanx. Muedzo wehuwandu Zvichienderana neyekuvhiringidza maitiro, mamwe madhiri kana kusanganisa kwemidziyo yemukati gadziriso inogona kudiwa (Mufananidzo 19).
Mufananidzo 19: Nzira dzakasiyana dzekugadzirira muvarwere nevarwere vane kukuvara kwekukuvadza. Subred Pinky zvigunwe.f yemahara aishandiswa kune zvinyoro-nyoro-tishuswe yekuvhara. radiographs mumwedzi mina. Iyo metacarpal pfupa remunwe mudiki akapora. Dzimwe pfuma dzinoumbwa kune imwe nzvimbo, zvichiratidza sekondari kupora.dgore rimwe mushure metsaona, iyo ful yakabviswa; Kunyangwe asymptomatic, screw yakabviswa kubva kune metacarpal yechigunwe yemhete nekuda kwekufungidzirwa kuti intra-articular kupinda. Migumisiro yakanaka (≥240 ° tam) yakawanikwa mumunwe mumwe nemumwe pakushanya kwekupedzisira.
File Kuisa pfungwa dzekupinda kweiyo basal screws)
Fig. 21 Posterior Orthostatic uye B Lateral Radiographs yemurwere A. Murwere vatatu vanofudza (pamiseve) vakabatwa ne2,5-mm cannulated screws. Hapana shanduko dzakakosha mumabatirwo emajoini majoini aya akaonekwa mushure memakore maviri
Kutumira Nguva: Sep-18-2024
