Parizvino, kune nzira dzakasiyana-siyana dzokurapa dze distal radius fractures, dzakadai seplaster fixation, kuzarura kuderedzwa uye kugadziriswa kwemukati, kunze kwekugadzirisa furemu, nezvimwewo. Pakati pavo, volar plate fixation inogona kuwana mhedzisiro inogutsa, asi kune mishumo mumabhuku. kuti matambudziko ayo akakwira se16%.Zvisinei, kana ndiro yesimbi yakasarudzwa zvakanaka, chiitiko chezvinetso chinogona kuderedzwa zvinobudirira.Iri bepa rinopfupisa muchidimbu maitiro, zviratidzo, contraindications, uye nzira dzekuvhiya dze volar plate kurapwa kwe distal radius fractures.
1. Pane maviri makuru mabhenefiti epalm side plate
A.Inogona kuderedza chikamu chesimba rekusunga.Kugadziriswa nemakona ekugadziriswa kwekona kunotsigira distal fragment uye kuendesa mutoro kune radial shaft (Fig. 1).Inogona kuwana subchondral rutsigiro zvakanyanya.Iyi plate system haigone chete kugadzirisa distal intra-articular fractures, asi zvakare inogona kunyatso kudzorera anatomical chimiro che intra-articular subchondral bone kuburikidza nepeg/screw "fan-shaped" fixation.Kune akawanda distal radius kutsemuka mhando, iyi denga system inopa yakawedzera kugadzikana inobvumira kutanga kuunganidza.
Mufananidzo 1, a, mushure mekuvakwazve kwetatu-dimensional yeyakajairwa yakagadziriswa distal radius fracture, teerera kune dhigirii rekumanikidza kwedorsal;b, kuderedzwa kwechokwadi kwekuputsika, kukanganisa kunofanira kugadziriswa uye kutsigirwa neplate;c, lateral maonero mushure mekugadzirisa DVR, museve unoratidza kutamisa mutoro.
B.Kusanyanya kukanganiswa pazvinyoro zvinyoro: volar plate fixation zvishoma pasi pemvura yemvura, kana ichienzaniswa neplate yedorsal, inogona kuderedza kutsamwa kune tendon, uye kune nzvimbo yakawanda inowanikwa, iyo inogona kunyatsodzivisa kupinza uye tendon.kuonana kwakananga.Pamusoro pezvo, maimplants mazhinji anogona kuvharwa nepronator quadratus.
2. Zviratidzo uye contraindications pakurapa distal radius ine volar ndiro
a.Indications: Nokuda kwekukundikana kwekuvhara kuderedzwa kwe-extra-articular fractures, zvinotevera zvinoitika, zvakadai se dorsal angulation yakakura kupfuura 20 °, dorsal compression yakakura kudarika 5mm, distal radius shortening yakakura kupfuura 3mm, uye distal fracture fragment displacement yakakura kudarika. 2mm;The displacement of the internal fracture yakakura kupfuura 2 mm;nekuda kwekuderera kwepfupa, zviri nyore kukonzera zvakare kutama, saka inonyanya kukodzera kune vakwegura.
b.Contraindications: kushandiswa kwenzvimbo yeanesthetics, yemunharaunda kana systemic zvirwere zvinotapukira, mamiriro asina kunaka eganda pane volar side of wrist;pfupa remapfupa uye rudzi rwekuputsika panzvimbo yekuputsika, dorsal fracture type yakadai seBarton fracture, radiocarpal joint fracture uye dislocation, simple radius Styloid process fracture, duku avulsion fracture ye volar margin.
Kune varwere vane kukuvadzwa kwepamusoro-simba zvakadai sekuputsika kwakanyanya kwe-intra-articular comminuted fractures kana kurasikirwa kwakanyanya kwepfupa, nyanzvi dzakawanda hadzikurudziri kushandiswa kweplate yevolar, nokuti kuputika kwakadaro kunowanikwa kune vascular necrosis uye zvakaoma kuwana kuderedzwa kweanatomical.Kune varwere vane zvidimbu zvakawanda zvakaputsika uye kutama kukuru uye osteoporosis yakaoma, volar plate yakaoma kushanda.Panogona kunge paine matambudziko nerutsigiro rwe subchondral mu distal fractures, senge screw kupinza mukati mejoint cavity.Imwe mabhuku achangobva kubudiswa akashuma kuti apo 42 zviitiko zve-intra-articular fractures zvakabatwa ne-volar plates, hapana articular screws yakapinda mukati me articular cavity, iyo yainyanya kuenderana nechinzvimbo cheplateti.
3. Unyanzvi hwekuvhiya
Vazhinji vanachiremba vanoshandisa volar plate fixation ye distal radius fractures nenzira dzakafanana uye maitiro.Zvisinei, kuti udzivise zvinobudirira kuitika kwemashure ekuvhiyiwa, unyanzvi hwekuvhiya hunodiwa hunodiwa, somuenzaniso, kuderedzwa kunogona kuwanikwa nekusunungura kudzvinyirirwa kwebhokisi rekuputsika uye kudzorera kuenderera kwe cortical bone.Kugadziriswa kwenguva pfupi ne 2-3 Kirschner waya inogona kushandiswa.Nezve nzira ipi yekushandisa, munyori anokurudzira PCR (flexor carpi radialis) kuti iwedzere nzira yevolar.
a, Kugadziriswa Kwenguva pfupi newaya mbiri dzeKirschner, cherechedza kuti volar inclination uye articular surface haina kudzorerwa zvakakwana panguva ino;
b, Waya yeKirschner inogadzirisa ndiro kwekanguva, teerera kune kugadziriswa kweiyo distal end yeradius panguva ino (distal fracture fragment fixation technique), iyo proximal chikamu cheplate chinodhonzwa chakananga kune radial shaft kudzoreredza iyo volar inclination. .
C, Iyo articular surface yakanyatsogadziriswa pasi pe arthroscopy, distal locking screw/pini inoiswa, uye proximal radius inozopedzisira yaderedzwa uye yakagadziriswa.
Pfungwa huruof approach: The distal skin incision inotangira paganda rechanza, uye kureba kwayo kunogona kutariswa zvichienderana nerudzi rwekutyoka.Iyo flexor carpi radialis tendon uye sheath yayo inoparadzaniswa distal kune carpal bone uye seyakareba sezvinobvira.Kudhonza flexor carpi radialis tendon kune ulnar side inodzivirira mutsara wepakati uye flexor tendon yakaoma.Nzvimbo yeParona yakafumurwa, ine pronator quadratus iri pakati peflexor hallucis longus (ulnar) uye radial artery (radial).Incision yakaitwa paradial side ye pronator quadratus, ichisiya chikamu chakabatanidzwa kune radius kuti ivakwezve gare gare.Kudhonzera pronator quadratus kudivi reulnar zvakanyanya kuburitsa pachena volar ulnar angle yeradius.
Pamhando dzakaoma dzekutyoka, zvinokurudzirwa kuburitsa distal kuiswa kwebrachioradialis muscle, iyo inogona kumisa kudhonza kwayo pane radial styloid process.Panguva ino, volar sheath yeyokutanga dorsal compartment inogona kutemwa kufumura distal fracture Vhara iyo radial side uye radial styloid process, mukati tenderedza radial shaft kuti iparadzane kubva panzvimbo yekutyoka, wobva washandisa Kirschner waya kudzikisa intra. -articular fracture block.Kune yakaoma intra-articular fractures, arthroscopy inogona kushandiswa kubatsira kuderedza, kuongorora, uye kugadzirisa zvakanaka kwezvimedu zvekuputsika.
Mushure mokunge kuderedzwa kwapera, ndiro yevolar inogara ichiiswa.Iyo ndiro inofanira kunge iri padyo nemvura, inofanira kuvhara iyo ulnar process, uye iyo proximal yekupedzisira yeplate inofanira kusvika pakati peiyo radial shaft.Kana mamiriro ari pamusoro apa asina kusangana, saizi yeplate haina kukodzera, kana kuderedzwa hakugutsikane, kushanda hakusati kwakwana.
Matambudziko mazhinji ane zvakawanda zvekuita nenzvimbo inoiswa ndiro.Kana ndiro yacho yakaiswa zvakanyanya radially, zvinetso zvine chokuita ne flexor hallucis longus zvakagara zvichitarisirwa;kana ndiro yacho yakaiswa pedyo zvakanyanya kumutsara wemvura, iyo flexor digitorum profundus inogona kunge iri pangozi.Kuputsika kuderedzwa kune volar displacement deformity kunogona kuita nyore nyore kuti ndiro yesimbi iende kune volar side uye inobata zvakananga flexor tendon, pakupedzisira inotungamirira kune tendinitis kana kunyange kuputika.
Kune varwere vane osteoporotic, zvinokurudzirwa kuti ndiro yacho ive pedyo nemutsara wemvura sezvazvinogona, asi kwete kuyambuka..Waya dzeKirschner dzinogona kushandiswa kugadzirisa iyo subchondral iri padyo neurna, uye divi-ne-parutivi waya dzeKirschner uye kukiya zvipikiri uye screws zvinogona kudzivirira zvinobudirira kuputsika kubva pakudzokazve.
Mushure mekunge ndiro yaiswa zvakanaka, iyo proximal end inogadziriswa ne screw, uye ulnar gomba kumucheto kweplate inogadziriswa kwenguva pfupi neKirschner wire.Intraoperative fluoroscopy anteroposterior view, lateral view, wrist joint elevation 30 ° lateral view, kuti uone kuderedza kuputsika uye nzvimbo yekugadzirisa mukati.Kana nzvimbo yeplate ichigutsa, asi tambo yeKirschner iri mumubatanidzwa, ichaita kuti kusakwana kupora kwevolar inclination, iyo inogona kugadziriswa nekugadzirisa zvakare ndiro kuburikidza ne "distal fracture fixation technique" (Fig. 2, Fig. 2). b).
Kana iyo inoperekedzwa nedorsal uye ulnar fractures (ulnar/dorsal Die Punch) uye isingakwanise kuderedzwa zvizere pasi pekuvharwa, nzira nhatu dzinotevera dzinogona kushandiswa:
1. Pronate the proximal end of the radius kuti uichengetedze kure nenzvimbo yekutyoka, uye sunda lunate fossa fracture yakananga kucarpus kuburikidza nePCR yekuwedzera nzira;
2. Ita chidimbu chiduku padivi remusana we4th uye 5th compartment kuti uise pachena chimedu chekuputsika, uye chigadzirise nemascrews mune yakawanda ulnar gomba replate.
3. Yakavharwa percutaneous kana minimally invasive fixation nerubatsiro rwe arthroscopy.
Mushure mokunge kuderedzwa kunogutsa uye ndiro inoiswa zvakanaka, kugadzirisa kwekupedzisira kunenge kuri nyore.Kana iyo proximal ulnar Kirschner waya yakamisikidzwa nemazvo uye pasina screws ari mujoint cavity, kuderedzwa kweanatomical kunogona kuwanikwa.
Chiitiko chekusarudza screw: Nekuda kwekusangana kwakasimba kwe dorsal cortical bone, kureba kwescrew kungave kwakaoma kuyera nemazvo.Zvikururu zvakanyanyorebesa zvinogona kukonzera kushatirwa kwetendon, uye screws dzakanyanya kupfupika hazvigone kutsigira nekugadzirisa dorsal fragment.Nechikonzero ichi, munyori anokurudzira kushandisa ma threaded locking screws uye multiaxial locking screws mune radial styloid process uye yakanyanya ulnar gomba, uye kushandisa yakakwenenzverwa tsvimbo yekukiya screws mune dzimwe nzvimbo dzese.Kushandisa muromo wakashata kunodzivirira kutsamwa kwetendon kunyange kana dorsal exit inoshandiswa.Nekugadziriswa kwendiro yeproximal, maviri akavharira screws + imwe yakajairwa screw (yakaiswa kuburikidza neellipse) inogona kushandiswa kugadzirisa.
4. Pfupiso yezvinyorwa zvizere:
Volar yekuvhara mbambo yezvipikiri kugadzirisa kwe distal radius fractures inogona kuwana yakanaka kiriniki inoshanda, iyo inonyanya kuenderana nekusarudzwa kwezviratidzo uye hunyanzvi hwekuvhiya.Kushandisa nzira iyi kunogona kuita zviri nani kufungidzira kwekutanga kwekushanda, asi hapana mutsauko mukushanda kwekupedzisira uye kuita kwekufungidzira nedzimwe nzira, chiitiko chematambudziko epashure chakafanana, uye kuderedzwa kunorasika mukugadziriswa kwekunze, percutaneous Kirschner wire fixation, uye plaster fixation. , zvirwere zvetsono zvinowanzoitika;uye matambudziko e-extensor tendon anowanzoitika mu distal radius plate fixation systems.Kune varwere vane osteoporosis, iyo volar plate ichiri sarudzo yekutanga.
Nguva yekutumira: Zvita-12-2022
