Supracondlar Fractures yeHumreus ndeimwe yeanonyanya kukanganisika muvana uye ukaitika pakabikwa kwehuwandu hwehuwandu uyeChoral Choku.
Kuratidzwa kwekiriniki
Supracondylar fractures of the humerus are mostly children, and local pain, swelling, tenderness, and dysfunction may occur after injury. Kufungidzira kusinganzwisisike kunoshaya zviratidzo zviri pachena, uye kuendesa kwakabatana kungave chiratidzo chekiriniki. Iyo Joint capsule pazasi pehusiku tsandanyama ndiyo yepamusoro-soro, apo iyo yakapfava capsule capsule, inozivikanwawo se softspot, inogona kuremerwa panguva yekukwazisa kwakabatana. Iyo poindi yekuchinjika inowanzo kujairika kune mutsara unobatanidza pakati peiyo radial musoro kune iyo yeOlecranon.
Munyaya yeiyo supracondylar mhando III inopwanya, pane deform mbiri dzakasungirirwa dzejeri, ichipa chitarisiko chakaumbwa. Panowanzo kuve nekuvhunza kwepamberi kwerudzi rwekumusoro kwerudzi, uye kana kupwanya kwacho kuchinge kwabviswa zvachose, iko kupera kwekupwanya kunoputira brachialis mhasuru, uye kubuda ropa kwakakura kwakanyanya. Nekuda kweizvozvo, chiratidzo chebucker chinoonekwa pamberi peiyo elbow, kazhinji chinoratidza chidimbu chebonde proximal kune bracture inopinza iyo dermis. Kana iri inoperekedzwa nekukuvara kweriya yekukuvara, iyo dorsal yekuwedzera kwechigunwe inogona kushoma; Median nerve kukuvara kunogona kukonzera chigunwe uye index yemunwe kuti usakwanisa kushingaira; Ulnar nerve kukuvara zvinogona kukonzera kushoma kupatsanurana kweminwe uye kutaurirana.
Kuongororwa
(1) Kuongororwa Kwakasarudzika
①ve nhoroondo yekutamba; Îclintical zviratidzo nezviratidzo: kurwadziwa kwenzvimbo, kuzvimba, nyoro uye kushaya simba; ③x-ray inoratidza iyo supracondlar fracture mutsara uye yakatsemurwa inokatyamadza zvidimbu zve humreus.
(2) Kuongororwa kwakasiyana
Kutarisirwa kunofanirwa kubhadharwa kune kuzivikanwa kweElbow dislocation, asi kuzivikanwa kwekuwedzera supracondylar fractures kubva kuElbow dislocation kwakaoma. Mune supracondlar bracture yeHumreus, Epicondyle yeHumreus inochengetedza hukama hwakajairika hweanatomical neiyo olecranon. Nekudaro, mukuisa dislow discation, nekuti olecanon iri kumashure kweiyo Epicondyle yeHumreus, ine mukurumbira. Kuenzaniswa ne Supracondylar Fractures, mukurumbira wemberi muElbow dislocation inonyanya kuitika. Kuvapo kana kusavapo kweBony Fricatives kunoitawo basa mukuzivisa supracondlar zvibodzwa zveMumumaneru kubva kuHumende yekubatana, uye dzimwe nguva zvakaoma kuita kuti adzivirane. Nekuda kwekuzvimba kwakanyanya uye kurwadziwa zvakanyanya, manipulations izvo zvinounza mafungire eBony anowanzoita kuti mwana acheme. Nekuda kwengozi yekukuvara neurovascular kukuvara. Naizvozvo, manipulations iyo inopa mafoni emapfupa anofanira kudzivirirwa. X-ray bvunzo inogona kubatsira kuziva.
Nyora
Iyo yakajairwa kuiswa kwe supracondlar vhamu ekuzvipwanya ndeyekuvaparadzanisa mukuwedzera uye kushandurwa. Type yekubhururuka isingawanzo, uye iyo yakazotevera X-ray inoratidza kuti kuguma kwekupwanya kunowanikwa pamberi pehukama hwehukama. Type rakananga rakajairika, uye Gartland dzinozvigovanisa kuti ive mhando ini kuenda kuIII (Tafura 1).
| Nyora | Kuratidzwa kwekiriniki |
| ⅠA Type | Fractures pasina kudzikama, inversion kana valguus |
| Žb mhando | Zvinyoro-nyoro zvekurera, medial cortical fluting, anterior humili muganho mutsara kuburikidza nehuwandu hwemusoro |
| ⅡA Type | Hyperxtesion |
| Žb mhando | Longitudinal kana kutenderera kuturika pamwe necassial kusangana kune chero kupera kwekupwanya |
| ⅢA Type | Yakazara posterior kutama isina kana cortical kusangana, kazhinji distal kune medial posterior kutama |
| Žb mhando | Zviri pachena kuti kudzingwa, zvinyoro nyoro zvakamiswa mukupatsanurwa kwekupedzisira, zvakakura zvinodarika kana kutenderera kwekutenderera kwekupedzisira kupera |
Tafura 1 Gartland Kuongororwa kweSupracondlar Humerus Fractures
Kurapa
Pamberi pekurapa kwakakwana, iyo celbow yakabatiswa kwenguva pfupi munzvimbo makumi maviri
(1.
. °) Iyo gadziriso inochengetedza chinzvimbo mushure mekudzikisira, asi inowedzera njodzi yekukuvara kweiyo neurovascular kukuvara kweiyo yakakanganisika nhengo uye njodzi yeakakora fascial compartment syndreme. Saka, percutaneousKirschner Wire Kugadziriswayakanakisa mushure mekudzikiswa kwakavharwa kweiyo bracture (Fig. 1), uyezve yekugadzirisa kunze nePlaster yakakandwa munzvimbo yakachengeteka (elbow flexion 60 °).
Mufananidzo 1 Mufananidzo wePercutaneous Kirschner Wire Kugadziriswa
. Yakavharwa kudzikiswa uye percutaneous kirschner waya kugadziriswa kazhinji, asi kuderedzwa kwakavhurika kunodiwa kana iyo yakapfava tissu yekunyorova isingakwanisi kuderedzwa kana paine brachial artery kukuvara (Mufananidzo 2).
Nhamba
Kune mana ekuvhiya nzira dzekudzikiswa kwekudzikiswa kweSupracondlar Fractures yeHumreus: (1) Lalteral Elbow nzira (kusanganisira nzira yeanteerolateral); (2) Medial Elbow nzira; (3) yakasanganiswa medial uye yakatevera elbow nzira; uye (4) posterior elbow kusvika.
Zvese zviri zviviri nzira yekufamba-famba uye nzira yepamhepo ine zvakanakira zvidimbu zvisina kukuvara uye zvakareruka chiratidzo chechimiro. Iyo medial incision yakachengeteka pane iyo inotevera incision uye inogona kudzivirira ulnar nerve kukuvara. Iko kushushikana ndechekuti kana kana mumwe wavo anogona kuona zvakanyatso braylateral rutivi rwechiitiko, uye anogona chete kudzikiswa uye akagadziriswa neruoko rwekuvhiya, izvo zvinoda nzira yepamusoro yekuvhiya yemushandi. Iyo yekumusoro yakasarudzika nzira yave ichipokana nekuda kwekuparadzwa kwekuvimbika kweiyo triceps mhasuru uye kukuvara kukuru. Maitiro Akasanganiswa weMedial uye akazotevera elbows anogona kugadzira zvekusagadzikana kwekusakwanisa kunyatsoona zvakananga kuwoneka kwepopota Iyo ine zvakanakira zvemukati uye zvakareruka mishonga incle, iyo inokodzera kuderedza kuderedzwa uye kugadziriswa, uye inogona kuderedza kureba kweiyo yakazotevera incision. Izvo zvinobatsira pakuzorodzwa uye kugovera kwematehwe ekuzvimba; Asi kusasimba kwayo ndekwekuti kunowedzera kuvhiyiwa kwekuvhiya; Zvakare yakakwirira kupfuura nzira yepashure.
Complication
Zvinetso zve supracondlar humeral fractures zvinosanganisira: (1) neurovascular kukuvara; (2) acute septal Syndrome; (3) akasvinura; (4) myositis otsologyans; (5) avascular necrosis; (6) Cubitus Varus Kuremara; (7) Cubitus Valgus Kuremara.
Pfupisa
Supracondylar Fractures yeHumreus iri pakati pezvakanyanya kufungidzira muvana. Mumakore achangopfuura, kuderedzwa kusiri kurerutswa kwePupracondlar fractures yeHumreus yakatevera kutariswa kwevanhu. Munguva yakapfuura, Cubitus Valgus vairidzwa kuti vakonzerwa nekusungwa kwekukura kweiyo disaul humphyseal ndiro, pane kudzikisira kushoma. Zvizhinji zveuchapupu hwakasimba zvino hunotsigira kuti kusarongeka kwekudzikisira chinhu chakakosha muCubitus Varus kuremara. Naizvozvo, kuderedzwa kwe supracondlar humerus fractures, kururamisa kweUlnar offset, yakatenderedza kutenderera uye kudzoreredzwa kwe distal humerus kumusoro kukwirira.
Pane nzira dzakawanda dzekurapa dzemapepa ekupaza emununguru, sekudzikiswa kwaanoita + Kugadziriswa kwekunzeNe plaster cast, olecranon traction, yekugadzirisa kwekunze ne splint, kuvhurika kuderedzwa uye kugadziriswa kwemukati, uye kuvhara kudzikiswa uye kugadziriswa kwemukati Munguva yakapfuura, manipulative kuderedza uye plaster yekunze kugadziriswa ndiyo huru kurapa, yeiyo cubitus varus yakakwira yakakwira se50% kuChina. Parizvino, yeType II uye Type III Supracondylar Fractures, Fungidziro yeStuc Assungisa Mushure mekudzora kwetsvina yave kugamuchirwa. Iyo ine zvakanakira kwete kuparadza kupa ropa uye nekukurumidza kupora kupora.
Kune mamwe mafungiro akasiyana munzira uye nhamba yakakwana yeKirschner Wire Kugadziriswa mushure mekudzikiswa kwakavharwa kwemakanganiso. Zvakaitika zveDhitoro ndechekuti iyo Kirschner Wires inofanira kuve yakasungwa nemumwe nemumwe panguva yekugadziriswa. Iyo yekupedzisira kuregedza ndege yekunyepedzera ndeye, iyo yakawanda yakagadzikana. Iyo Kirschner waya haifanire kuyambuka ndege yekukasira, kana zvisina kufanira kutenderera hakuzodzorerwe uye kugadziriswa kuchave kusasimba. Kuchengeta kunofanirwa kutorwa kuti udzivise kukuvadzwa kune iyo Ulnar nerve kana uchishandisa m medial kirschner waya yekugadziriswa. Usatungidze tsono mune yakashandurwa chinzvimbo chejongwe, zvishoma zvakatwasuka kuti ubvumire iyo Ulnar nerve kuti udzokere kumashure, kubata iyo Ulnar nerve uye kusundira iyo kumashure uye yakachengeteka tambo k-waya. Iko kushandiswa kwekuyambuka Kiresi Wire yekugadziriswa kwemukati mune zvingangoita mukudzoreredza basa rekupora, kupwanya kupora, uye chiyero chakanakisa chekupora, icho chinobatsira pakutanga kwekutanga kudzoreredzwa.
Kutumira Nguva: Nov-02-2022
