Kurapwa kwe distal humeral fractures

Mhedzisiro yekurapa inoenderana neAnatomical kudzoreredza block block, kugadziriswa kwakasimba kwekupwanya, kuchengetedzwa kweakanaka zvibodzwa zvekuvhara uye kwekutanga kurovedza muviri.

Anatomy

The theHumre Humerusyakakamurwa kuita medial ikorumuka uye chikamu chakazotevera (Mufananidzo 1).

Mufananidzo 1 iyo Disal Humerus inosanganisira yemu medial uye yakazotevera column

Iyo madhairi ikhongedzo inosanganisira chikamu cheepial epiphysis, iyo medial epicondyle yeHumerus uye Medial Humeral Centyling inosanganisira humil glides.

Iyo yakazotevera chikamu chinosimbisa chikamu cheEpiera yePIMEPHYS, iyo Ekunze Epicondyle yeHumreus uye kondoti yekunze yeHumareus inosanganisira huwandu hwehukama hwehukama.

Pakati pemakoreti maviri akazotevera ndeye anterior cornoid fossa uye iyo posterior humeral fossa.

Kukuvara maitiro

Supracondylar Fractures yeHumreus inonyanya kukonzerwa nekudonha kubva kunzvimbo dzakakwirira.

Varwere vadiki vane mitsipa-yekufungidzira vanowanzo kukonzerwa nekukuvara kwakanyanya-simba rechisimba, asi varwere vekare vanogona kuve neyenzi-yekunyepedzera kubva mukukuvara kwechisimba-simba nekuda kwesteoporos.

Typing

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Mufananidzo 2 AO Typing

Ao humeral fracture typing (Mufananidzo 2)

Nyora A: Zvakawedzera-chehungwaru.

Type B: kupwanya kunosanganisira iyo yekunyora nzvimbo (imwe-column kupwanya).

Type C: kupatsanurana kwakazara kweiyo articular pamusoro peiyo distal humerus kubva kune humal stem (bicolumnar fracture).

Rudzi rwese rwakagoverwa mukati me3 subty precess pakaenderana nedanho rekutenderera kweiyo bracture, (1 ~ 3 subtypes nekuwedzera degree rekutenderera mune iyo gadziriso).

Mufananidzo3 kusimuka-radin typing

Kusimuka-radin typing yeIntercondylar fractures yeHumerus (marudzi ese anosanganisira iyo supracondlar chikamu cheumwe)

Nyora i: kupwanya pasina kudzikama pakati pehuwandu hwehuwandu hwehuwandu uye talus.

Type II: Intercondylar Bracture yeHumerus uye Kubviswa Kwemukuru weCreature yeConfely isina kuremara kwekutenderera.

Type III: Intercondylar Bracture yeHumerus uye Kubviswa Kwemhombwe Fragment yeChidimbu neKutenderera Kuremara Kwekutenderera.

Type IV: Yakanyanya kufambidzana kupwanyika kweiyo yehunyanzvi pamusoro peimwe kana ese ari maviri conyles (Mufananidzo 3).

Mufananidzo 4 Type i Humeral Tuberisity Fracture

Mufananidzo 5 Hukuru tumerrosity inokatyamadza

Kupwanyika kweiyo humilation tumerosity: Shear kukuvara kweiyo distal humerus

Nyora i: kupwanya kweiyo huwandu hwehuwandu hwehuwandu hwehuwandu hwekusanganisira iyo yakazotevera kumucheto kweiyo humal talus (Hahn-steinthal fracture) (Mufananidzo 4).

Type II: Subchondral Fracture yeiyo articular cartilage yeiyo humara tubority (kocher-lorenz fracture).

Type III: Commined kupwanyika yehuwandu hwehuwandu hwehuwandu (Mufananidzo 5).

Kurapwa kusiri kwekushanda

Nzira dzisingashande yekurapa dzekurapa dze distal humeral fractures vane chikamu chidiki. Chinangwa chekurapa chisiri-chekushanda ndechekuti: Kutanga kusabatana kwekuita kuti udzivise kuomesa; Varwere vakwegura, vanonyanya kutambudzika nezvirwere zvakawanda zvakaringana, vanofanirwa kurapwa nenzira yakapfava yekupaza iyo elbow yakabatanidzwa muna 60 ° yekuchinjika kwemavhiki maviri, ichiteverwa nezviitiko zvechiedza.

Kurapwa kwekuvhiya

Chinangwa chekurapa ndechekudzosera marwadzo emahara-emahara ekufambisa kweiyo mubatanidzwa (30 ° yeElbow yekuwedzera, 50 ° yeAnterior uye Posterior Kutenderera); Yakasimba uye yakagadzikana yemukati yekugadziriswa kwekuputsika inobvumira kutanga kwekushanda kwemabasa ekuridza mushure mekurwadziwa kweganda kupora; kaviri plate kugadziriswa kweiyo distal humerus inosanganisira: medial uye yepashure pepasi pepasi plate yekugadziriswa, kanamedial uye gare garekaviri plate fixation.

Surgical nzira

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Kuzivikanwa uye kuchengetedzwa kweiyo mwero uye radial nerves intraoperaratively.

Posterior elbow inogona kuwedzerwa kuvhiya kuwana: Ulnar hawk osteotomy kana triceps kudzoreredza kufumura zvakadzika zvidimbu

Ulnar hawkeye osteotomy: kuratidzwa kwakakwana, kunyanya kune cractined cractures yeiyo articular pamusoro. Nekudaro, kupunzika non-Unc-Union kazhinji kunoitika paOsteotomy saiti. Iyo bracture isiri-Uncal rate yakave yakaderedzwa zvakanyanya neyakagadziriswa ulnar hawk osteotomy (herringbone osteotomy) uye trintersien band waya kana plate filix.

Triceps Retraction kuratidzwa inogona kuiswa kune distal humeral trifold trifold trifold cractures neChinzvimbo Yekutenderera, uye yakawedzera kuratidzwa kwehukama hwehukama

Iyo yakawanikwa kuti mahwendefa maviri anogona kuiswa orthogonally kana kufanana, zvichienderana nerudzi rwehupamhi umo mahwendefa.

Ingupiramo pamusoro maficha anofanirwa kudzoreredzwa kune iyo flat incular pamusoro uye yakarongedzwa kune humbowo stem.

Mufananidzo 6 Post-Inoshanda Zvemukati Kugadziriswa kweElbow Fracture

Kugadziriswa kwechinguvana kweBlock block kwakaitwa nekunyorera k waya yeK Wire, mushure memativi emugodhi wekonzo (Mufananidzo 6).

Chenjera kuti urege kugadzirisa iyo yekunyepedzera pamusoro pekupwanya chidimbu chine zvese-zvakarukwa cortical screws nekumanikidzwa kubva kune menduru kusvika kune imwe neimwe ride.

Iyo Epiphysis-Humerus Zviuru Zvekufambisa saiti yakakosha kudzivirira usiri-mubatanidzwa wekupwanya.

Kupa bone graft kuzadza panzvimbo yefuma yepfuma, kushandisa Iliac kuronga kuremara kuremara kukonzeresa nzvimbo neine nzvimbo yekumanikidza uye yekumanikidza pfupa kuremara kuEpiphysis.

Rangarira zvakakosha pfungwa dzekugadzirisa.

Kugadziriswa kweiyo distal frallate chidimbu chine akawandascrewssezvinobvira.

Kugadziriswa kwezvinhu zvakawanda zvekunyepedzera zvinokatyamadza sezvinobvira uine screws kuyambuka nepakati kusvika gare gare.

Mahwendefa wetsiva anofanirwa kuiswa pane medial uye gare gare mativi eiyo distal humerus.

Sarudzo dzekurapa: yakazara elbow arthroplasty

Kune varwere vane dzakakura dzakatarisana nematare. Iyo yekuvhiya maitiro yakafanana nehuwandu hweArthroplasty yekuchinja-deggeerative shanduko yeiyo elbow Joint.

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(2) pfupiso yekuvhiya mashandiro.

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Anteriozization yeUlnar nerve.

Kupinda mumativi ese emhando yekubvisa pfupa rakakamurwa

Iyo yese ye distal humerus inosanganisira iyo hawk fossa inogona kubviswa uye prosthesis yakarongedzwa, iyo isingazosiyi chero yakakosha sequeee kana imwe chete i kusvika ku2 cm yabviswa

Kugadziriswa kweiyo intrinsic tension yemhasuru yemhasuru panguva yakakodzera yehuwandu hwekupaza huwandu mushure mekufadzwa kwevanhu vehukama.

Tsanangudzo yeiyo tip yeiyo proximal ulnar emincidence kubvumira kuwana zviri nani kuwana uye kuiswa kweiyo Ulnar prosthesis (Mufananidzo 7).

Mufananidzo 7 Elbow Arthroplasty

Kutarisirwa Kwekutarisirwa

Postopengere Iyo Elbow Joint inofanirwa kugadziriswa kwenguva yakareba mushure mekupora kweganda yekuporesa kweganda Splinable inobvisa splint ikozvino inowanzo shandiswa clinky kuti ifambise huwandu hwedzinza kana inogona kubviswa kazhinji kuti idimbise zvakakanganisika. Inoshanda inoshanda kurovedza muviri kunowanzotanga vhiki 6-8 mushure mekunge ronda ramborora.

Kutarisirwa Kwekutarisirwa

Postopengere Iyo Elbow Joint inofanirwa kugadziriswa kwenguva yakareba mushure mekupora kweganda yekuporesa kweganda Splinable inobvisa splint ikozvino inowanzo shandiswa clinky kuti ifambise huwandu hwedzinza kana inogona kubviswa kazhinji kuti idimbise zvakakanganisika. Inoshanda inoshanda kurovedza muviri kunowanzotanga vhiki 6-8 mushure mekunge ronda ramborora.