Supracondylar fractures yehumerus ndiyo imwe yezvinonyanya kutsemuka muvana uye inoitika pakusangana kwehumeral shaft uyehumeral condyle.
Clinical Manifestations
Supracondylar fractures of the humerus kazhinji vana, uye marwadzo emunharaunda, kuzvimba, unyoro, uye kusashanda kunogona kuitika mushure mekukuvara.Undisplaced fractures inoshaya zviratidzo zviri pachena, uye exudation yemagokora inogona kunge iri chiratidzo chekiriniki chete.Iyo yejoint capsule pazasi pegokora tsandanyama ndiyo yakanyanya pamusoro, apo iyo yakapfava yejoint capsule, inozivikanwawo sesoftspot, inogona kupepetwa panguva yejoint exudation.Iyo poindi yekuchinjika inowanzova anterior kune mutsara unobatanidza pakati peiyo radial musoro kumucheto weolecranon.
Panyaya yekutyoka kwesupracondylar type III, pane maviri aangled deformities egokora, zvichipa chimiro chakaita S.Kazhinji pane subcutaneous mavanga pamberi distal rokumusoro ruoko, uye kana pakakoromoka zvachose kutama, distal kuguma pakatyoka inopinda brachialis tsandanyama, uye subcutaneous kubuda ropa kwakanyanya.Nekuda kweizvozvo, chiratidzo chepucker chinoonekwa pamberi pegokora, kazhinji chinoratidza bony proximal kusvika pakutyoka kunopinda mudermis.Kana iyo inoperekedzwa neradial nerve kukuvara, iyo dorsal yekuwedzera yechigunwe inogona kuganhurirwa;kukuvadzwa kwetsinga yepakati kunogona kuita kuti chigunwe chigunwe uye chigunwe chisakwanise kushanduka-shanduka;Ulnar nerve kukuvadzwa kunogona kukonzera kupatsanurwa kushoma kweminwe uye kupindirana.
Kuongororwa
(1) Nheyo Yokuongorora
①Iva nenhoroondo yekushungurudzika;②Chirwere zviratidzo nezviratidzo: marwadzo emunharaunda, kuzvimba, unyoro uye kusagadzikana;③X-ray inoratidza supracondylar fracture line uye yakasiya nzvimbo yakaputsika zvimedu zvehumerus.
(2) Kuongororwa kwakasiyana
Attention inofanira kubhadharwa pakuzivikanwa kwekutsemuka kwegokora, asi kuzivikanwa kwekuwedzera kwepamusoro supracondylar fractures kubva kugokora dislocation kwakaoma.Mune supracondylar fracture ye humerus, epicondyle yehumerus inochengetedza hukama hwechimiro chechimiro ne olecranon.Zvisinei, mugokora kuputika, nokuti olecranon iri kuseri kwe epicondyle yehumerus, inonyanya kuoneka.Kuenzaniswa ne supracondylar fractures, mukurumbira we forearm mugokora dislocation yakanyanya kure.Kuvapo kana kusavapo kwe bony fricatives kunobatawo basa mukuziva supracondylar fractures ye humerus kubva pakuparara kwegokora rejoint, uye dzimwe nguva zvakaoma kuunza bony fricatives.Nekuda kwekuzvimba kwakanyanya uye kurwadziwa, kunyengedza kunokonzera mapfupa emapfupa kunowanzoita kuti mwana acheme.Nekuda kwenjodzi yekukuvadzwa neurovascular.Naizvozvo, manipulations anokonzera mapfupa emapfupa anofanira kudziviswa.X-ray kuongororwa kunogona kubatsira kuziva.
Type
Iyo yakajairwa kupatsanurwa kwe supracondylar humeral fractures ndeyekukamura iwo mukuwedzera uye kuchinjika.Rudzi rwekunyunguduka haruwanzo, uye lateral X-ray inoratidza kuti kureba kwekuputsika kuri pamberi pehumeral shaft.Rudzi rwakatwasuka rwakajairika, uye Gartland inoikamura kuita mhando I kusvika III (Tafura 1).
| Type | Clinical Manifestations |
| ⅠA mhando | Kutsemuka pasina kutamiswa, inversion kana valgus |
| ⅠB mhando | Mild displacement, medial cortical fluting, anterior humeral border line through humeral head |
| ⅡA mhando | Hyperextension, posterior cortical kutendeseka, humeral musoro kuseri kweanterior humeral border line, hapana kutenderera. |
| ⅡB mhando | Longitudinal kana kutenderera displacement ine chikamu chekubata kune chero kumagumo kwekutyoka |
| ⅢA mhando | Yakwana posterior displacement isina cortical yekubata, kazhinji distal kune medial posterior displacement |
| ⅢB mhando | Kutama kuri pachena, matishu akapfava akanyudzwa mumagumo ekutyoka, kupindirana kwakakosha kana kutenderera kutenderera kwemagumo ekutyoka. |
Tafura 1 Gartland kupatsanurwa kwe supracondylar humerus fractures
Tora
Pamberi pehutano hwakanyanya, jira regokora rinofanira kugadziriswa kwekanguva munzvimbo ye20 ° kusvika ku30 ° flexion, iyo isingagadziki kumurwere chete, asi inoderedzawo kukanganiswa kwemaitiro neurovascular.
(1) Type I humeral supracondylar fractures: inongoda plaster cast kana cast cast kuti igadzirwe kunze, kazhinji kana gokora rakachinjika 90 ° uye forearm inotenderedzwa munzvimbo isina kwayakarerekera, ruoko rurefu rwakakandwa runoshandiswa kugadziridza kunze kwe3. kusvika 4 weeks.
(2) Rudzi rwechipiri humeral supracondylar fractures: Manual kuderedza uye kugadziriswa kwegorofu hyperextension uye angulation ndiyo nyaya dzinokosha mukurapa kwerudzi urwu rwekuputsika.°) Kugadziriswa kunochengetedza chinzvimbo mushure mekuderedzwa, asi kunowedzera njodzi yekukuvara kweurourovascular yenhengo yakakanganiswa uye njodzi yeacute fascial compartment syndrome.Saka, percutaneousKirschner wire fixationzviri nani mushure mekuvhara kuderedzwa kwekuputsika (Fig. 1), uye ipapo Kugadziriswa kwekunze nepurasita yakakanda munzvimbo yakachengeteka (elbow flexion 60 °).
Mufananidzo 1 Mufananidzo we percutaneous Kirschner wire fixation
(3) Rudzi rwechitatu supracondylar humerus fractures: Yese mhando III supracondylar humerus fractures inoderedzwa ne percutaneous Kirschner wire fixation, iyo ikozvino ndiyo yakajairika kurapwa kwerudzi III supracondylar fractures.Yakavharwa kuderedzwa uye percutaneous Kirschner wire fixation inowanzogoneka, asi kuderedzwa kwakazaruka kunodiwa kana iyo yakapfava yematishu embedding isingakwanisi anatomically kuderedzwa kana kana paine brachial artery kukuvara (Mufananidzo 2).
Mufananidzo 5-3 Preoperative uye postoperative X-ray mafirimu e supracondylar humerus fractures
Kune nzira ina dzekuvhiya dzekudzikisa pachena kwe supracondylar fractures ye humerus: (1) lateral elbow approach (kusanganisira anterolateral approach);(2) kusvika pakati pegokora;(3) nzira yakasanganiswa yepakati uye yegokora;uye (4) kumashure kwegokora nzira.
Zvose zviri zviviri lateral elbow approach uye nzira yepakati ine zvakanakira zvenyama isina kukuvadzwa uye nyore anatomical chimiro.Iyo medial incision yakachengeteka kupfuura lateral incision uye inogona kudzivirira ulnar nerve kukuvara.Izvo zvisingabatsiri ndezvokuti hapana mumwe wavo anogona kuona zvakananga kuputsika kwedivi re contralateral rekuchekwa, uye rinogona kuderedzwa chete nekugadziriswa nekunzwa kwemaoko, izvo zvinoda nzira yepamusoro yekuvhiya kune anoshanda.Iyo posterior elbow approach yakave yakakakavadzana nekuda kwekuparadzwa kwekuvimbika kwe triceps muscle uye kukanganisa kukuru.Iyo yakasanganiswa nzira yepakati uye lateral elbows inogona kugadzirisa iyo yakashata yekusakwanisa kuona zvakananga contralateral bone pamusoro peiyo incision.Iine zvakanakira zvemukati uye lateral elbow incisions, iyo inobatsira kuderedza kuputsika uye kugadzirisa, uye inogona kuderedza kureba kwe lateral incision.Inobatsira kusunungura uye kuderera kwekuzvimba kwenyama;asi kuipa kwayo ndeyokuti inowedzera kuvhiyiwa kwekucheka;Uyewo yakakwirira kudarika nzira yekumashure.
Complication
Zvinetso zve supracondylar humeral fractures zvinosanganisira: (1) neurovascular kukuvara;(2) acute septal syndrome;(3) kuoma kwegokora;(4) myositis ossificans;(5) avascular necrosis;(6) cubitus varus deformity;(7) cubitus valgus deformity.
Pfupisa
Supracondylar fractures of the humerus ndeimwe yezvinowanzoputsika muvana.Mumakore achangopfuura, kuderera kwakashata kwe supracondylar fractures ye humerus yakamutsa pfungwa dzevanhu.Munguva yakapfuura, cubitus varus kana cubitus valgus yaifungidzirwa kuti yakakonzerwa nekusungwa kwekukura kwe distal humeral epiphyseal plate, pane kuderedza kuderera.Huzhinji hwehumbowo hwakasimba ikozvino hunotsigira kuti kushomeka kwekutapukira chinhu chakakosha mukubitus varus deformity.Naizvozvo, kuderedzwa kwe supracondylar humerus fractures, kururamisa kwe ulnar offset, horizontal kutenderera uye kudzoreredza distal humerus kureba ndiyo makiyi.
Kune dzakawanda nzira dzekurapa dze supracondylar fractures yehumerus, senge kuderedzwa kwemanyore + kunze kugadzirisaine plaster cast, olecranon traction, kunze kwekugadzirisa ne splint, kuvhura kuderedzwa uye kugadzirisa kwemukati, uye kuvharwa kuderedzwa uye kugadzirisa kwemukati.Munguva yakapfuura, kuderedzwa kwekunyengera uye kugadzirwa kwekunze kwepurasita ndiko kwaive kurapwa kukuru, uko cubitus varus yakanzi yakakwira se50% muChina.Parizvino, yemhando II uye mhando III supracondylar fractures, percutaneous tsono kugadzirisa mushure mekuderedzwa kwekutyoka yave nzira inogamuchirwa kazhinji.Iine zvakanakira kusaparadza kugoverwa kweropa uye kukurumidza kuporesa kwepfupa.
Kunewo maonero akasiyana pamusoro penzira uye nhamba yakakwana yeKirschner wire fixation mushure mekuvharwa kuderedzwa kwekuputsika.Chiitiko chemupepeti ndechekuti mawaya eKirschner anofanirwa kuvharwa pamwe chete panguva yekugadzirisa.Iyo iri kure kure nendege yekuputsika iri, iyo yakanyanya kugadzikana.Mawaya eKirschner haafaniri kuyambuka pane ndege yekuputsika, kana zvisina kudaro kutenderera hakuzodzorwi uye kugadzirisa kuchave kusina kugadzikana.Kuchengetedza kunofanira kutorwa kudzivirira kukanganisa kune ulnar nerve paunenge uchishandisa medial Kirschner wire fixation.Usapinza tsono munzvimbo yakachinjika yegokora, ruramisa gokora zvishoma kuti ubvumire tsinga yeulnar kuti idzokere kumashure, bata tsinga yeulnar nechigunwe woisundidzira kumashure uye wakachengeteka shinda yeK-waya.Iko kushandiswa kwekuyambuka Kirschner waya yemukati kugadzirisa kune zvingangove zvakanakira mushure mekushanda kwekushanda kupora, kuputika kwekupora chiyero, uye yakanakisa mwero wekupwanya kuporeswa, izvo zvinobatsira kukurumidza kupora kupora.
Nguva yekutumira: Nov-02-2022
