Mhedzisiro yekurapa inoenderana neanatomical repositioning ye fracture block, kugadzirisa kwakasimba kwekuputsika, kuchengetedzwa kwehutano hwakanaka hunyoro hwekuvhara uye kutanga kushanda kwekuita.
Anatomy
Thedistal humerusyakakamurwa kuita mbiru yepakati uye lateral column (Mufananidzo 1).
Mufananidzo 1 Iyo distal humerus ine yepakati uye lateral column
Mushonga wepakati unosanganisira chikamu chepakati chehumeral epiphysis, iyo yepakati epicondyle yehumerus uye yepakati humeral condyle inosanganisira humeral glide.
Iyo lateral column inosanganisira lateral chikamu chehumeral epiphysis, epicondyle yekunze yehumerus uye kunze kwekondiyo yehumerus kusanganisira humeral tuberosity.
Pakati pemakoramu maviri eparutivi pane anterior coronoid fossa uye posterior humeral fossa.
Kukuvadza nzira
Supracondylar fractures ye humerus inowanzokonzerwa nekudonha kubva kunzvimbo dzakakwirira.
Varwere vechidiki vane intra-articular fractures vanowanzokonzerwa nekukuvara kwechisimba kwepamusoro-simba, asi varwere vakwegura vanogona kuva ne-intra-articular fractures kubva mukukuvara kwepasi-simba kwechisimba nekuda kweosteoporosis.
Typing
(a) Kune supracondylar fractures, condylar fractures uye intercondylar fractures.
(b) Supracondylar fractures of the humerus: nzvimbo yekuputsika iri pamusoro pefossa yehawk.
(c) Humeral condylar fracture: nzvimbo yekutyoka iri muhawk's fossa.
(d) intercondylar fracture ye humerus: nzvimbo yekuputsika iri pakati pemakona maviri ari kure ehumerus.
Mufananidzo 2 AO kutaipa
AO humeral fracture typing (Mufananidzo 2)
Rudzi rweA: extra-articular fractures.
Type B: kuputsika kunosanganisira articular surface (imwe-column fracture).
Rudzi C: kupatsanurwa kwakakwana kweiyo articular surface ye distal humerus kubva kune humeral stem (bicolumnar fracture).
Rudzi rwega rwega runopatsanurwa kuita 3 subtypes zvichienderana nechiyero chekufambisa kwekutyoka, (1 ~ 3 subtypes nekuwedzera dhigirii rekuita mune iyo hurongwa).
Mufananidzo3 Riseborough-Radin kutaipa
Riseborough-Radin typing ye intercondylar fractures ye humerus (marudzi ose anosanganisira supracondylar chikamu chehumerus)
Nyora I: kuputsika pasina kutamiswa pakati pehumeral tuberosity uye talus.
Rudzi rwechipiri: intercondylar fracture ye humerus nekutamiswa kwehuwandu hwekuputsika kwekonikoni pasina kutenderera kushanduka.
Rudzi rwechitatu: intercondylar fracture ye humerus nekutama kwechimedu chekuputsika chekonikoni ine kutenderera kushanduka.
Rudzi rwechipiri IV: kutsemuka kwakakura kweiyo articular pamusoro peimwe kana ese maviri condyles (Mufananidzo 3).
Mufananidzo 4 Rudzi I humeral tuberosity fracture
Mufananidzo 5 Humeral tuberosity fracture staging
Kuputsika kwehumeral tuberosity: kukuvara kweshear ye distal humerus
Tora I: kuputsika kwehumeral tuberosity yose inosanganisira lateral edge ye humeral talus (Hahn-Steinthal fracture) (Mufananidzo 4).
Rudzi rwechipiri: subchondral fracture ye articular cartilage ye humeral tuberosity (Kocher-Lorenz fracture).
Rudzi rwechitatu: kuputsika kwehumeral tuberosity (Mufananidzo 5).
Non-operative kurapwa
Nzira dzekurapa dzisiri-kushanda dze distal humeral fractures dzine basa shoma.Chinangwa chekusashanda kurapwa ndechekuti: kufamba kwekutanga kwekubatana kudzivirira kuoma kwemajoini;varwere vakwegura, avo vanowanzotambura nezvirwere zvakasiyana-siyana, vanofanira kurapwa nenzira yakapfava yekutsemura gokora mu60 ° yekuchinjika kwemavhiki 2-3, ichiteverwa nechiedza.
Kuvhiya kurapwa
Chinangwa chekurapa ndechekudzorera marwadzo-asina kushanda kwehutano hwekufamba kwekubatana (30 ° yekuwedzera kwegokora, 130 ° yegorofu flexion, 50 ° yeanterior uye posterior rotation);kusimba uye kugadzikana kwemukati kugadzirisa kwekuputsika kunobvumira kutanga kwekushanda kwegorofu maitiro mushure mekuporesa kweronda reganda;double plate fixation ye distal humerus inosanganisira: medial uye posterior lateral double plate fixation, kanapakati uye lateraldouble plate fixation.
Kuvhiya nzira
(a) Murwere anoiswa munzvimbo yakakwira lateral ine liner yakaiswa pasi pegumbo rakabatwa.
kuzivikanwa uye kudzivirira kwepakati uye radial tsinga intraoperatively.
Mugokora wepashure unogona kuwedzerwa kuwanikwa kwekuvhiya: ulnar hawk osteotomy kana triceps retraction kuratidza zvakadzika articular fractures.
ulnar hawkeye osteotomy: kuratidzwa kwakakwana, kunyanya kune comminuted fractures ye articular surface.Zvisinei, kuputsika kusina kubatana kunowanzoitika panzvimbo ye osteotomy.Iyo yekutyoka isiri yemubatanidzwa mwero yakaderedzwa zvakanyanya nekunatsiridza ulnar hawk osteotomy (herringbone osteotomy) uye transtension band waya kana plate fixation.
Triceps retraction exposure inogona kuiswa kune distal humeral trifold block fractures pamwe nekubatana, uye yakawedzera kuratidzwa kwehumeral slide inogona kucheka uye kufumura iyo ulnar hawk tip paanenge 1 cm.
Izvo zvakaonekwa kuti mahwendefa maviri anogona kuiswa orthogonally kana akafanana, zvichienderana nerudzi rwekuputsika umo mahwendefa anofanira kuiswa.
Articular surface fractures inofanira kudzorerwa kune flat articular surface uye yakagadziriswa kune humeral stem.
Mufananidzo 6 Mushure mekushanda kwemukati kugadzirisa kwekuputsika kwegokora
Kugadziriswa kwekanguva kwechivharo chekutyoka kwakaitwa nekushandisa K waya, mushure meiyo 3.5 mm simba rekumanikidza ndiro yakagadziridzwa kuita chimiro cheplate zvichienderana nechimiro kuseri kwekoramu ye lateral ye distal humerus, uye 3.5 mm rekuvakazve ndiro yaive yakachekwa kusvika pachimiro chembiru yepakati, kuitira kuti mativi ese endiro aenderane nepamusoro pebhonzo (iyo nyowani yekumberi yekuumba ndiro inogona kurerutsa hurongwa.) (Mufananidzo 6).
Chenjerera kuti usagadzirise articular surface fracture fragment ne-se-threaded cortical screws nekumanikidzwa kubva pakati kusvika kune lateral side.
iyo epiphysis-humerus zviuru zvekutama nzvimbo yakakosha kudzivirira kusabatanidzwa kwekuputsika.
kupa bhonzo kuzadza kuzadza panzvimbo yekuremara kwepfupa, kushandisa iliac cancellous bone grafts kuzadza iyo compression fracture defect: medial column, articular surface uye lateral column, kubatanidza cancellous bone kudivi rine intact periosteum uye compression bone defect pa epiphysis.
Rangarira pfungwa dzinokosha dzekugadzirisa.
Kugadziriswa kweiyo distal fracture fragment nevakawandascrewssezvinobvira.
kugadzirisa kwezvimedu zvakatyoka zvakawanda sezvinobvira nemasiruuru anoyambuka nepakati kuenda kudivi.
Mahwendefa esimbi anofanirwa kuiswa pamativi epakati uye eparutivi rwe distal humerus.
Nzira dzekurapa: Yese elbow arthroplasty
Kune varwere vane zvakanyanya comminuted fractures kana osteoporosis, yakazara elbow arthroplasty inogona kudzoreredza majoini egokora uye kushanda kwemaoko mushure mevarwere vasingade;nzira yekuvhiya yakafanana neyose arthroplasty yekuchinja kuderera kwegokora rakabatana.
(1) kushandiswa kwenguva refu-stem-type prosthesis kudzivirira proximal kuputsika kuwedzera.
(2) Pfupiso yekuvhiya.
(a) Iyo nzira inoitwa pachishandiswa nzira yekumashure kwegokora, ine matanho akafanana neaya anoshandiswa kune distal humeral fracture incision uye mukati mekugadzirisa (ORIF).
Anteriorization yeurnar nerve.
kupinda nemativi ese e triceps kubvisa pfupa rakatsemuka (kiyi kiyi: usacheke kumira kweiyo triceps panzvimbo yeulnar hawk).
Iyo yose distal humerus inosanganisira iyo hawk fossa inogona kubviswa uye prosthesis yakaiswa, iyo isingazosiyi chero yakakosha sequelae kana imwe yekuwedzera I kusvika 2 cm ikabviswa.
Kugadziriswa kwemukati tension ye triceps muscle panguva yekukodzera kwehumeral prosthesis mushure mekubviswa kwehumeral condyle.
Kubviswa kwechipimo cheiyo proximal ulnar eminence kubvumira kuwanikwa kuri nani kwekuratidzwa uye kuiswa kweiyo ulnar prosthesis chikamu (Mufananidzo 7).
Mufananidzo 7 Elbow arthroplasty
Kuchengetwa kwepashure
Postoperative splinting ye posterior chikamu chegokora yejoini inofanira kubviswa kana ronda remurwere rapora, uye kushingaira kunoshanda kudzidzira nerubatsiro kunofanira kutangwa;mubatanidzwa wegokora unofanirwa kugadzikwa kwenguva yakareba yakakwana mushure mekutsiviwa kwejoints kuti ukurudzire kuporeswa kweronda reganda (gokora regokora rinogona kugadzikwa munzvimbo yakatwasuka kwemavhiki maviri mushure mekuvhiyiwa kuti ibatsire kuwana zvirinani basa rekuwedzera);splint inobviswa yakagadziriswa ikozvino inowanzoshandiswa kuchipatara kuti ifambise huwandu hwemafambiro ekufambisa apo Inogona kubviswa kakawanda kuitira kuchengetedza zviri nani nhengo yakakanganiswa;kushingaira kunoshanda kurovedza muviri kunowanzotanga 6-8 mavhiki mushure mekunge ronda reganda rapora zvachose.
Kuchengetwa kwepashure
Postoperative splinting ye posterior chikamu chegokora yejoini inofanira kubviswa kana ronda remurwere rapora, uye kushingaira kunoshanda kudzidzira nerubatsiro kunofanira kutangwa;mubatanidzwa wegokora unofanirwa kugadzikwa kwenguva yakareba yakakwana mushure mekutsiviwa kwejoints kuti ukurudzire kuporeswa kweronda reganda (gokora regokora rinogona kugadzikwa munzvimbo yakatwasuka kwemavhiki maviri mushure mekuvhiyiwa kuti ibatsire kuwana zvirinani basa rekuwedzera);splint inobviswa yakagadziriswa ikozvino inowanzoshandiswa kuchipatara kuti ifambise huwandu hwemafambiro ekufambisa apo Inogona kubviswa kakawanda kuitira kuchengetedza zviri nani nhengo yakakanganiswa;kushingaira kunoshanda kurovedza muviri kunowanzotanga 6-8 mavhiki mushure mekunge ronda reganda rapora zvachose.
Nguva yekutumira: Zvita-03-2022
