Parizvino, kune nzira dzakasiyana-siyana dzekurapa kupwanyika kwe distal radius, dzakadai se plaster fixation, open reduction uye internal fixation, external fixation frame, nezvimwewo. Pakati padzo, volar plate fixation inogona kuwana mhedzisiro inogutsa, asi kune mishumo mumabhuku yekuti matambudziko ayo anosvika 16%. Zvisinei, kana simbi yesimbi ikasarudzwa nemazvo, kuwanda kwematambudziko kunogona kuderedzwa zvinobudirira. Pepa iri rinopfupikisa muchidimbu hunhu, zviratidzo, zvinopesana, uye nzira dzekuvhiya dzekurapa volar plate yekupwanyika kwe distal radius.
1. Pane mabhenefiti maviri makuru eplate yemuchindwe
A. Inogona kudzikamisa chikamu chesimba rekubata. Kusunga ne angled fixation screws kunotsigira distal fragment uye kunotamisa mutoro kuenda ku radial shaft (Mufananidzo 1). Inogona kuwana rutsigiro rwe subchondral zvinobudirira. Iyi plate system haingogone kugadzirisa fractures dze distal intra-articular chete, asiwo inogona kudzoreredza chimiro che anatomical che intra-articular subchondral bone kuburikidza ne peg/screw "fan-shaped" fixation. Kune akawanda marudzi e distal radius fractures, iyi denga system inopa kugadzikana kwakawedzerwa kunobvumira kufamba nekukurumidza.
Mufananidzo 1, a, mushure mekuvakwa patsva kwechikamu chedistal radius chakapatsanurwa, teererai mwero wekumanikidzwa kwemusana; b, kuderedzwa kwemusana kwekutyoka, chikanganiso chinofanira kugadziriswa uye kutsigirwa neplate; c, maonero epadivi mushure mekugadziriswa kweDVR, museve unoratidza kutamiswa kwemutoro.
B. Kukanganiswa kushoma panyama yakapfava: kugadzika kweplate yevolar kuri pasi pemutsetse wemvura, zvichienzaniswa neplate yedorsal, kunogona kuderedza kushatirwa kwetendon, uye kune nzvimbo yakawanda iripo, iyo inogona kudzivirira kusangana zvakananga neimplant netendon. Pamusoro pezvo, maimplant mazhinji anogona kuvharwa nepronator quadratus.
2. Zviratidzo uye zvinopesana pakurapa distal radius ne volar plate
a. Zviratidzo: Kana mapfupa ekunze asina kugadzikana, zvinotevera zvinoitika, zvakaita sekunge mapfupa emusana anosvika 20°, kudzvanywa kwemusana kunopfuura 5mm, kupfupika kweredhiyo yedivi iri kupfuura 3mm, uye kupatsanurwa kwechikamu chedivi iri kupfuura 2mm; Kupatsanurwa kwemukati kwemapfupa kwakapfuura 2 mm; nekuda kwekushomeka kwemapfupa, zviri nyore kukonzera kupatsanurwazve, saka zvakakodzera kune vakwegura.
b. Zvinorambidzwa: kushandisa mishonga inonyaradza marwadzo yemuno, zvirwere zvinotapukira zvemuno kana zvemuviri, ganda risina kunaka parutivi rwechiwoko; mapfupa nehunhu hwekutyoka panzvimbo yakatyoka, rudzi rwekutyoka kwemusana senge kutyoka kwaBarton, kutyoka kwejoini nekubva panzvimbo yakatyoka, simple radius Styloid process fracture, kutyoka kudiki kwemusana kwemusana.
Kune varwere vane kukuvara kwakasimba kwakadai sekutyoka kwakanyanya kwemukati mearticular kana kurasikirwa kwakanyanya kwemapfupa, nyanzvi zhinji hadzikurudzire kushandiswa kwema volar plates, nekuti kutyoka kwakadaro kwe distal kunowanzoita vascular necrosis uye zvakaoma kuwana kudzikira kweanatomic. Kune varwere vane zvidimbu zvakawanda zvekutyoka uye kutama kwakakosha uye osteoporosis yakanyanya, volar plate yakaoma kushanda. Panogona kunge paine matambudziko nerutsigiro rwe subchondral mukutyoka kwe distal, senge kupinda kwe screw mu joint cavity. Mabhuku achangoburwa akataura kuti apo zviitiko makumi mana nemaviri zvekutyoka kwe intra-articular zvakarapwa nema volar plates, hapana screws dze articular dzakapinda mu articular cavity, izvo zvaive zvakanyanya kuenderana nenzvimbo yemaplates.
3. Unyanzvi hwekuvhiya
Vanachiremba vazhinji vanoshandisa kugadziriswa kwe volar plate pakukuvara kwe distal radius nenzira dzakafanana uye matekiniki. Zvisinei, kuti zvibudirire kudzivirira kuitika kwematambudziko mushure mekuvhiyiwa, nzira yakanaka yekuvhiya inodiwa, semuenzaniso, kuderedza kunogona kuwanikwa nekusunungura kudzvanywa kwe fracture block uye kudzoreredza kuenderera mberi kwe cortical bone. Kugadziriswa kwenguva pfupi ne 2-3 Kirschner waya kunogona kushandiswa. Nezve nzira yekushandisa, munyori anokurudzira PCR (flexor carpi radialis) kuti iwedzere nzira ye volar.
a, Kugadziriswa kwenguva pfupi newaya mbiri dzeKirschner, cherechedza kuti kutsveyama kwevolar uye pamusoro pe articular hazvina kudzorerwa zvizere panguva ino;
b, Waya yeKirschner inogadzirisa plate kwenguva pfupi, teererai kugadziriswa kwemugumo wedistal weradius panguva ino (distal fracture fragment fixation technique), chikamu cheproximal cheplate chinokweverwa kudivi reradial shaft kuti chidzorere kutenderera kwevolar.
C, Nzvimbo ye articular inogadziriswa zvakanaka pasi pe arthroscopy, distal locking screw/pin inoiswa, uye proximal radius inozopedzisira yaderedzwa uye yagadziriswa.
Pfungwa huruKusvika kwaro: Kuchekwa kweganda rekure kunotanga paganda rakapetwa paruoko, uye kureba kwaro kunogona kuonekwa zvichienderana nerudzi rwekutyoka. Tendon yeflexor carpi radialis nechikamu chayo zvinopatsanurwa kure kusvika kumapfupa ecarpal uye pedyo nekure sezvinobvira. Kudhonza tendon yeflexor carpi radialis kudivi reulnar kunodzivirira tsinga yepakati ne flexor tendon complex. Nzvimbo yeParona inoonekwa, nepronator quadratus iri pakati peflexor hallucis longus (ulnar) neradial artery (radial). Kuchekwa kwakaitwa kudivi reradial repronator quadratus, zvichisiya chikamu chakabatana neradius kuti chizogadziriswazve gare gare. Kudhonza pronator quadratus kudivi reulnar kunonyatsoratidza angle yevolar ulnar yeradius.
Kune mhando dzakaomarara dzekutyoka, zvinokurudzirwa kusunungura kupinza kwemhasuru yebrachioradialis kure, izvo zvinogona kuderedza kudhonzwa kwayo pamaitiro e radial styloid. Panguva ino, sheath ye volar yechikamu chekutanga che dorsal inogona kuchekwa kuti ibudise pachena kutyoka kwe distal. Vhara divi re radial uye maitiro e radial styloid, tenderera mukati me radial shaft kuti iparadzane nenzvimbo yakatyoka, wobva washandisa waya dzeKirschner kuderedza block ye intra-articular fracture. Kune fracture dzakaomarara dze intra-articular, arthroscopy inogona kushandiswa kubatsira kuderedza, kuongorora, uye kugadzirisa zvidimbu zve fracture.
Mushure mekunge kuderedzwa kwapera, volar plate inoiswa nguva dzose. Plate inofanira kunge iri pedyo newatershed, inofanira kufukidza maitiro eulnar, uye mugumo weproximal plate unofanira kusvika pakati pe radial shaft. Kana mamiriro ari pamusoro apa asina kuzadzikiswa, saizi yeplate isingakodzeri, kana kuderedzwa kusingagutsi, mashandiro acho haasati akwana.
Matambudziko mazhinji ane chekuita nenzvimbo inoiswa ndiroKana ndiro yacho yakaiswa zvakanyanya, matambudziko ane chekuita ne flexor hallucis longus anogona kuitika; kana ndiro yacho yakaiswa pedyo zvakanyanya ne watershed line, flexor digitorum profundus inogona kunge iri panjodzi. Kudzikira kwekutyoka kwe volar displacement deformity kunogona kukonzera kuti simbi ibude kudivi re volar uye ibate zvakananga flexor tendon, zvichizoguma zvaita kuti tendinitis kana kutoputika.
Kune varwere vane osteoporosis, zvinokurudzirwa kuti ndiro yacho ive pedyo nemuganhu wemvura sezvinobvira, asi kwete pamusoro payoWaya dzeKirschner dzinogona kushandiswa kugadzirisa subchondral iri pedyo neulna, uye waya dzeKirschner dziri padivi nepadivi pamwe chete nezvipikiri zvinokiya uye screws zvinogona kudzivirira kuputsika kuti kusadzoserwe panzvimbo payo.
Mushure mekunge ndiro yaiswa nemazvo, mugumo weproximal unogadziriswa nesikuruu, uye buri rekumusoro riri kumucheto kweplate rinogadziriswa kwenguva pfupi newaya yeKirschner. Intraoperative fluoroscopy anteroposterior view, lateral view, wrist joint elevation 30° lateral view, kuti uone kudzikiswa kwekutyoka uye nzvimbo yemukati yekugadziriswa. Kana nzvimbo yeplate ichigutsa, asi waya yeKirschner iri mujoinhi, zvichaita kuti volar inclination isashande zvakanaka, izvo zvinogona kugadziriswa nekugadzirisa plate kuburikidza ne "distal fracture fixation technique" (Mufananidzo 2, b).
Kana ichiperekedzwa nekutyoka kwemusana nepauro (ulnar/dorsal Die Punch) uye isingakwanise kuderedzwa zvizere kana yavharwa, nzira nhatu dzinotevera dzinogona kushandiswa:
1. Isa mugumo weproximal weradius kuti urege kubva panzvimbo yakatyoka, uye sundidzira lunate fossa fracture kuenda kucarpus kuburikidza nePCR extension approach;
2. Gadzira kamucheko kadiki padivi remusana pechikamu chechina nechechishanu kuti chidimbu chakatyoka chionekwe, wochigadzirisa nescrews muburi repamusoro peplate.
3. Kuvharwa kwepercutaneous kana kuti zvishoma nezvishoma kunoisa ganda muganda nerubatsiro rwe arthroscopy.
Kana kuderedzwa kwave kwakanaka uye ndiro yaiswa nemazvo, kugadzirisa kwekupedzisira kuri nyore. Kana waya yeproximal ulnar Kirschner yakaiswa nemazvo uye pasina screws dziri mujointi, kuderedzwa kweanatomiki kunogona kuwanikwa.
Ruzivo rwekusarudza masikuruu: Nekuda kwekukuvara kwakanyanya kwepfupa remusana, kureba kwesikuruu kunogona kuoma kuyera nemazvo. Sikuruu dzakareba zvakanyanya dzinogona kukonzera kutsamwa kwetendon, uye sikuruu dzakapfupika hadzigone kutsigira nekugadzirisa chidimbu chemusana. Nekuda kwechikonzero ichi, munyori anokurudzira kushandisa sikuruu dzakarukwa netambo uye sikuruu dzinokiya dzakawanda mu radial styloid process uye mugomba guru re ulnar, uye kushandisa sikuruu dzinokiya netsvimbo dzakaposhwa munzvimbo dzakasara. Kushandisa blunt tip kunodzivirira kutsamwa kwetendon kunyangwe kana dorsal exit ikashandiswa. Kune proximal interlocking plate fixation, sikuruu mbiri dzinokiya + sikuruu imwe yakajairika (inoiswa kuburikidza neellipse) inogona kushandiswa kugadzirisa.
4. Pfupiso yechinyorwa chakazara:
Kugadziriswa kweplate yenzara yekukiya yekutyoka kwedivi redhiramu kunogona kuita kuti pave nekushanda kwakanaka kwekiriniki, izvo zvinonyanya kuenderana nekusarudzwa kwezviratidzo uye hunyanzvi hwekuvhiya hwakanaka. Kushandisa nzira iyi kunogona kuita kuti pave nekufanotaura kwekutanga kwebasa, asi hapana musiyano mukushanda kwepashure uye kushanda kwemifananidzo nedzimwe nzira, kuwanda kwematambudziko mushure mekuvhiyiwa kwakafanana, uye kudzikira kunorasika mukugadziriswa kwekunze, kugadziriswa kwewaya yeKirschner, uye kugadziriswa kweplasta, hutachiona hwetsono hunowanzoonekwa; uye matambudziko etensor tendon anowanzoonekwa mu distal radius plate fixation systems. Kune varwere vane osteoporosis, volar plate ichiri sarudzo yekutanga.
Nguva yekutumira: Zvita-12-2022
