Parizvino, pane nzira dzakasiyana siyana dzekutakura dzeRadius dzakawanda, dzakadai semagetsi eradius, kugadziridzwa kwepamhepo, etcise yekugadziriswa kwemukati, asi kune mishumo mumabhuku ayo matambudziko ayo akanyanya kusvika 16%. Nekudaro, kana iyo simbi ndiro yakasarudzwa nemazvo, zviitiko zvezvinetso zvinogona kuderedzwa zvino. Pepa iri rinopfupisa muchidimbu hunhu, zviratidzo, zvinokanganisa, uye maitiro ekuvhiya emimhanzi kurapa kwe distal radius fantures.
1. Pane zvinhu zviviri zvikuru zvepamhepo zvePalm Land Plate
A.e inogadzira inogona kusarerekera chikamu cheBuckling Simba. Kugadziriswa neNyled Fixation Screws inotsigira iyo distal chidimbu uye inoendesa mutoro kune iyo radial shaft (Fig. 1). Inogona kuwana subondral rutsigiro zvakanyanya. Iyi plate system haigone kugadzirira chete distal Intra-articular Fractures, asi zvakare inogona kudzoreredza chimiro chechiratidzo cheIntra-artular Subchefu kubudikidza Peg / Screw "Yakagadzirirwa" Kugadziriswa. Kune mazhinji mazhinji radius radius fanture marudzi, iyi denga system inopa kuwedzera kugadzikana kubvumira kutanga kufambisa.
Mufananidzo 1, A, Mushure mekuvakirwa-vatatu B, Virtual kuderedzwa kwekupwanya, hurema hunofanirwa kugadziriswa uye kutsigirwa neplate; C, Createral View mushure mekugadziriswa kweDVR, museve unoratidza kutakura mutoro.
B.Less Impuct Pamhepo yakapfava: Volar Plate Filiation zvishoma nezvishoma kutaurirana kwakananga. Pamusoro pezvo, zvigaro zvakawanda zvinogona kuvharwa neye pranator quadatus.
2. Zviratidzo uye zvinokanganisa kurapwa kwe distal radius ne lolar ndiro
A.Idications: Nekutadza kwekudzikiswa kwekuwedzera-kwakashata, mamiriro ezvinhu anotevera anoitika akakura kupfuura 5mm, distal kuturika kwechidimbu chikuru kupfuura 2mm; Kudzikiswa kwekupwanya kwemukati kwakakura kupfuura 2 mm; Nekuda kweiyo pfupa rakadzika-pfupa, zviri nyore kukonzera kudzoreredzwa, saka kwakakodzera zvakanyanya kune vakwegura.
b. Kukanganisa Bone Misa uye Fracture Type saiti, Dorsal Fracture Type yakadai seBarton Bracture, Radiocurpal Joint Fractloid process bracture, madiki avulsion kupwanya marara.
Kune varwere vane mukurumbira-simba kukuvara kwakakura seyakanyanya kuwanda Kune varwere vane zvidimbu zvakawanda zvinokatyamadza uye zvakadzama kudzikama uye zvakakomba osteoporosis, volar ndiro yakaoma kuti ibudirire. Panogona kunge paine matambudziko ekutsigira zvizere mumakaraviso emisangano, senge screw kupinda mubatanidzwa. Mabhuku achangobva kuitika akataura kuti kana zviitiko zveIntra-zvimisikidzwa zvakabatwa nemavhasi emimhanzi, pasina matsvina anopinda mumativi emichero, ayo aive anonyanya kuenderana nenzvimbo yemahara.
3. Unyanzvi hwekuvhiya
Vanachiremba vazhinji vanoshandisa volol plate fixation ye distal radius prractures nenzira dzakafanana nenzira dzakafanana uye maitiro. Nekudaro, kuti udzivise zvinoitika zvezvinhu zvekushandisa zvedzidziso, semuenzaniso, kuderedzwa, kudzikisira kunogona kuwanikwa nekuburitsa kumanikidzwa kweiyo bhajeti uye kudzoreredza kuenderera kweiyo cortical pfupa. Kugadziriswa kwechinguvana ne 2-3 Kirschner waya inogona kushandiswa. Nezve nzira ipi yekushandisa, munyori anokurudzira PCR (Flexor Carpi Radialis) Kuti uwedzere nzira yemhombwe.
A, gadziriso yenguva pfupi ine miviri yeKiriviri waya, ona kuti mhaka yekuda uye yekukanganisa nzvimbo haina kudzoreredzwa panguva ino;
B, a Kirschner waya inogadzirisa zvishoma ndiro, teerera kugadziriswa kwekupedzisira kweradius panguva ino (Disal bracture fragment maitiro)
C, iyo yekunyepedzera ndeyekunyatsorovina
ZVINOKOSHA ZVINOKOSHAYEMAHARA: Iyo yakasarudzika ganda incision inotanga paganda reganda rechiuno, uye kureba kwaro kunogona kutsanangurwa zvichienderana nerudzi rwekupwanya. Iyo Flexor Carpi Radialis Tendon uye Sheath inodzikiswa distal kune iyo Carpal pfupa uye seyakagadziriswa sezvinobvira. Kudhonza iyo flexor carpi radialis tendon kune iyo Ulnar Side inochengetedza iyo yepakati nerve uye flexor tendon yakaoma. Iyo Parona Space inofumurwa, neiyo pronator quadratus iri pakati peFlexor Hallucis Longus (Ulnar) uye iyo Radial artery (Radial). Incision yakagadzirwa nerutivi radial yeiyo pronator quadratus, ichisiya chikamu chakabatanidzwa kune radius yekuvakwazve kwekuvakazve. Kudhonza iyo Pronator Quadratus kune iyo Ulnar Side Possesse akanyatsonaka iyo Volar Ulnar angle yeradius.
Zvemhando dzakaomarara dzinovhiringidza, rinokurudzirwa kusunungura kusawirirana kweBrachior yeBrachioricialis mhasuru, iyo inogona kumutsidzira iyo kudhonza kwayo pane radial styloid process. Panguva ino, iyo thigiri yeiyo yekutanga dorsal compartment inogona kutemwa kufumura nzvimbo yekuvhenekera, uyezve kushandisa Kiresi Wires kuti uderedze iyo Intra-Artular Bracture Block. Zvemukati yakaoma
Mushure mekunge kuderedzwa kwapera, iyo vhoti ravhoti yakaiswa nguva dzose. Iyo ndiro yacho inofanira kunge iri pedyo neyenziya, inofanira kufukidza iyo Ulnar maitiro, uye iyo proximal kupera kweiyo ndiro inofanirwa kusvika pakati peiyo radial shaft. Kana mamiriro ari pamusoro apa asina kusangana, saizi yeplate haina kukodzera, kana kuderedzwa hakutsike, kuvhiya kuchiri kukwana.
Zvakawanda zvinonetsa zvine zvakawanda zvekuita nekwaiiswa ndiro. Kana iyo ndiro yakaiswa zvakanyanya, zvinonetsa zvine chekuita neyefeloxor hallucis Longos anofungidzirwa; Kana ndiro yacho ichiiswa padhuze pedyo neiyo lined lined, iyo flexor digitorum proundus inogona kunge iri panjodzi. Kuderedzwa kuderedzwa kweiyo Volar Kudzingwa Kukonzeresa Plate Kukonzeresa Plate Kuti Tiratidze kudivi renhau uye zvakananga kufambidzana neToxor Tendinitis kana kuputika.
Kune varwere vekunze, zvinokurudzirwa kuti ndiro yacho ive padyo nenhamba yemvura sezvinobvira, asi kwete kuyambuka. Kirschner waya inogona kushandiswa kugadzirisa iyo subchondral iri padyo neUlna, uye parutivi-parutivi Kirschner waya uye kukwezva zvipikiri uye zviyero zvinogona kudzivirira zvinokwanira kupwanya kubva kuRefal.
Mushure mekunge ndiro yakaiswa nenzira kwayo, iyo proximal mugumo yakarongedzwa neclrew, uye iyo ulnar gomba pakupera kweiyo ndiro yakarongedzwa kwenguva pfupi neyeKiriviri waya waya. Intraoperative Fluoroscopy anteroposters, anotevera maonero, wrist Joint kukwirira 30 ° Yakazotevera maonero, kuona kuderedzwa kwekudzikisira uye nzvimbo yemukati yekugadzirisa. Kana chinzvimbo cheplate chinogutsa, asi iyo kiredchner waya iri mune yakabatanidzwa, ichaita kuti isimbe kupora kweiyo tolar yekuda kwekuda kuburikidza ne "Distal Fixture maitiro" (Fig. 2, b) 2, b) 2, b) 2, b).
Kana ikaperekedzwa neDorsal uye Ulnar Fractures (Ulnar / Dorsal Die punch) uye haigone kuderedzwa zvakakwana pasi pekuvhara, nzira nhatu dzinotevera dzinogona kushandiswa:
1. Tambanudza iyo proximal kupera kweiyo radius kuti irambe kure neyekuvhiringidza saiti, uye sundidzira iyo lunate fossa inopwanya yakananga kuCarpus kuburikidza nePRC yekuwedzera nzira;
2. Gadzira chidimbu chidiki pane dorsil chikamu cheiyo 4th compartment yekufumura chidimbu chakapwanyika, uye chigadzirise nemakonzo muhari yehupfu hwakanyanya.
3. Yakavharwa percutaneous kana zvishoma kusanzwisisika gadziriso nerubatsiro rwe arthroscopy.
Mushure mekudzikisira uku kuchigutsa uye ndiro inoiswa nenzira kwayo, iyo yekupedzisira gadziriso iri nyore. Kana iyo proximal ulnar Kirschner waya yaimiswa nenzira kwayo uye hapana screws iri mubatanidzwa wemukati, kuderedzwa kweAnatomical kunogona kuwanikwa.
Screw kusarudza ruzivo: Nekuda kwekutenderera kwakanyanya kweiyo dorsal cortical pfupa, kureba kwechibhanga kungave kwakaoma kuyera chaizvo. Screw ayo akareba anogona kukonzera kushatirwa kweTendon, uye zviyero zvakapfupika hupfupi haugone kutsigira uye kugadzirisa chidimbu che dorsal. Nechikonzero ichi, munyori anokurudzira kushandisa screated inovhara screws uye meriyaxial kuvhara zviyero mune radial styloid procrecred procreck uye yakasvibirira gomba, uye kushandisa tsvimbo inovhara screws mune yakasara yenzvimbo. Uchishandisa tip tip inodzivisa kutsamwiswa kweiyo tendon kunyangwe kana iyo dorsal yekubuda ichishandiswa. Zvekupedza Proplocking Plate Fixation, maviri ekuvhiringidza screws + imwe yakajairika screw (yakaiswa kuburikidza neEllipse) inogona kushandiswa kugadziriswa.
4. Pfupiso yezvinyorwa zvizere:
Volar Locking Plate Plate Fixation yeKarari Radius Fractial Eliniki Ekiriniki Ekisiki, iyo inowanzoenderana nesarudzo yezviratidzo uye hunyanzvi hwekuvhiya. Uchishandisa nzira iyi inogona kuwana zviri nani zvekushanda proong, uye Extnsor Tendon matambudziko akajairika mune distal radius plate gadziriso. Kune varwere vane osteoporosis, iyo Volar ndiro ichiri yekutanga sarudzo.
Kutumira Nguva: Dec-12-2022
