1. Zizindikiro
1). Kusweka kwakukulu kwa mafupa kumakhala ndi kusuntha koonekeratu, ndipo pamwamba pa gawo la mbali ya mbali ya mbali ya mbali ya mbali ya thupi lawonongeka.
2). Kuchepetsa kwamanja kwalephera kapena kukhazikika kwakunja kwalephera kusunga kuchepetsa.
3). Mafupa akale osweka.
4). Kusweka kwa malunion kapena non-union. Fupa limapezeka kunyumba ndi kunja
2. Zotsutsana
Odwala okalamba omwe sali oyenera opaleshoni.
3. Njira yopangira opaleshoni yokonza kunja
1. Chogwirizira chakunja chopingasa kuti chikonze kusweka kwa radius yakutali
Malo ndi kukonzekera musanachite opaleshoni:
· Mankhwala oletsa ululu a brachial plexus
·Kugona chagada ndi mwendo wokhudzidwa uli pa bulaketi yowonekera pafupi ndi bedi
·Pakani tourniquet pa gawo limodzi mwa magawo atatu a mkono wapamwamba
· Kuyang'anira maso
Njira Yopangira Opaleshoni
Kuyika kwa Metacarpal Screw:
Sikulu yoyamba ili pansi pa fupa lachiwiri la metacarpal. Kucheka khungu kumapangidwa pakati pa tendon ya extensor ya chala cholozera ndi minofu yolumikizana ya dorsal ya fupa loyamba. Minofu yofewa imalekanitsidwa pang'onopang'ono ndi forceps ya opaleshoni. Chikwamacho chimateteza minofu yofewa, ndipo sikulu ya 3mm Schanz imayikidwa. Sikulu
Kulunjika kwa sikuru kuli pa 45° kufika pa chikhatho cha dzanja, kapena kungakhale kofanana ndi mbali ya chikhatho cha dzanja.
Gwiritsani ntchito chitsogozochi kuti musankhe malo a screw yachiwiri. Screw yachiwiri ya 3mm inalowetsedwa mu metacarpal yachiwiri.
M'mimba mwake mwa pini yolumikizira ya metacarpal sayenera kupitirira 3mm. Pini yolumikizira ili mu 1/3 ya proximal. Kwa odwala omwe ali ndi matenda a osteoporosis, screw yolumikizira kwambiri imatha kulowa m'magawo atatu a cortex (fupa lachiwiri la metacarpal ndi theka la cortex ya fupa lachitatu la metacarpal). Mwanjira imeneyi, screw mkono wautali wolumikizira ndi mphamvu yayikulu yolumikizira imawonjezera kukhazikika kwa pini yolumikizira.
Kuyika kwa zomangira zozungulira:
Pangani khungu m'mphepete mwa radius, pakati pa minofu ya brachioradialis ndi minofu ya extensor carpi radialis, 3cm pamwamba pa mapeto a mzere wosweka ndi pafupifupi 10cm pafupi ndi cholumikizira cha dzanja, ndipo gwiritsani ntchito hemostat kuti mulekanitse minofu ya pansi pa khungu ndi pamwamba pa fupa. Samalani kuti muteteze nthambi zapamwamba za mitsempha ya radial yomwe imayenda m'derali.
Pamalo omwewo monga zomangira za metacarpal, zomangira ziwiri za 3mm Schanz zinayikidwa motsogozedwa ndi chitsogozo cha minofu yofewa yoteteza manja.
·. Kuchepetsa ndi kukhazikika kwa kusweka kwa mafupa:
·.Kuchepetsa kukoka kwa dzanja ndi C-arm fluoroscopy kuti muwone kuchepa kwa kusweka.
·.Kukhazikika kwakunja kwa cholumikizira cha dzanja kumapangitsa kuti zikhale zovuta kubwezeretsa ngodya yonse ya kanjedza, kotero ikhoza kuphatikizidwa ndi mapini a Kapandji kuti athandize kuchepetsa ndi kukhazikika.
·.Kwa odwala omwe ali ndi radial styloid fractures, radial styloid Kirschner wire fixation ingagwiritsidwe ntchito.
·.Mukapitiriza kuchepetsa, lumikizani chogwirizira chakunja ndikuyika pakati pa chogwirizira chakunja pa mzere womwewo ndi pakati pa chogwirizira cha dzanja.
·.Fluoroscopy ya anteroposterior ndi lateral, yang'anani ngati kutalika kwa radius, palmar inclination angle ndi ulnar deviation angle zabwezeretsedwa, ndikusintha fixation angle mpaka fracture reduction ikhale yokwanira.
·. Samalani momwe chogwirira chakunja chimagwirira ntchito, zomwe zimayambitsa kusweka kwa iatrogenic pa zomangira za metacarpal.
Kusweka kwa mbali ya ...
·. Ma DRUJ ambiri amatha kuchepetsedwa mwangozi pambuyo pochepetsa distal radius.
Ngati DRUJ ikadali yolekanitsidwa pambuyo poti radius ya distal yachepetsedwa, gwiritsani ntchito njira yochepetsera kupsinjika ndi manja ndipo gwiritsani ntchito njira yolumikizira ndodo ya lateral ya bracket yakunja.
Kapena gwiritsani ntchito mawaya a K kuti mulowe mu DRUJ mu malo osalowerera kapena otsogozedwa pang'ono.
Kusweka kwa distal radius pamodzi ndi kusweka kwa ulnar styloid: Yang'anani kukhazikika kwa DRUJ pakutchulidwa, kusalowerera ndale komanso kupendekera kwa mkono. Ngati pali kusakhazikika, kuthandizidwa ndi mawaya a Kirschner, kukonza ligament ya TFCC, kapena mfundo ya tension band ingagwiritsidwe ntchito pokonza Ulnar styloid process.
Pewani kukoka kwambiri:
· Yang'anani ngati zala za wodwalayo zingathe kuchita mayendedwe otambasuka komanso otambasuka popanda kugwedezeka koonekeratu; yerekezerani malo olumikizirana a radiolunate ndi malo olumikizirana a midcarpal.
·Onani ngati khungu la msomali ndi lolimba kwambiri. Ngati lalimba kwambiri, chitani ming'alu yoyenera kuti mupewe matenda.
·Limbikitsani odwala kuti asunthe zala zawo msanga, makamaka kupindika ndi kutambasula mafupa a zala, kupindika ndi kutambasula chala chachikulu, ndi kubaya.
2. Kukonza ma fractures a distal radius pogwiritsa ntchito chogwirira chakunja chomwe sichidutsa cholumikizira:
Malo ndi kukonzekera opaleshoni isanayambe: Mofanana ndi kale.
Njira Zopangira Opaleshoni:
Malo otetezeka oikira K-wire kumbali ya dorsal ya distal radius ndi awa: mbali zonse ziwiri za Lister's tubercle, mbali zonse ziwiri za extensor pollicis longus tendon, komanso pakati pa extensor digitorum communis tendon ndi extensor digiti minimi tendon.
Mofananamo, zomangira ziwiri za Schanz zinayikidwa mu radial shaft ndipo zinalumikizidwa ndi ndodo yolumikizira.
Kudzera m'malo otetezeka, zomangira ziwiri za Schanz zinalowetsedwa mu chidutswa cha distal radius fracture, chimodzi kuchokera mbali ya radial ndi china kuchokera mbali ya dorsal, ndi ngodya ya 60° mpaka 90° kwa wina ndi mnzake. Chomangiracho chiyenera kugwira contralateral cortex, ndipo ziyenera kudziwika kuti nsonga ya chomangira chomwe chalowetsedwa mbali ya radial sichingadutse mu notch ya sigmoid ndikulowa mu distal radioulnar joint.
Lumikizani screw ya Schanz pa distal radius ndi ulalo wokhota.
Gwiritsani ntchito ndodo yolumikizira yapakati polumikiza zigawo ziwiri zosweka, ndipo samalani kuti musatseke chuck kwakanthawi. Pogwiritsa ntchito ulalo wapakati, chidutswa chakutali chimachepa.
Mukamaliza kuyambiranso, tsekani chuck pa ndodo yolumikizira kuti mumalize chomaliza.kukonza.
Kusiyana pakati pa chogwirira chakunja chosalumikizana ndi chogwirira chakunja cholumikizana:
Popeza kuti zomangira zingapo za Schanz zitha kuyikidwa kuti zichepetse ndikukhazikitsa zidutswa za mafupa, zizindikiro za opaleshoni ya zomangira zakunja zosalumikizana zimakhala zazikulu kuposa za zomangira zakunja zolumikizana. Kuwonjezera pa kusweka kwa extra-articular, zingagwiritsidwenso ntchito pa kusweka kwachiwiri mpaka kwachitatu. Kusweka kwa gawo la intra-articular.
Chogwirizira chakunja cholumikizirana ndi mafupa chimakonza cholumikizira cha dzanja ndipo sichimalola kuchita masewera olimbitsa thupi koyambirira, pomwe chogwirizira chakunja chosagwirizana ndi mafupa chimalola kuchita masewera olimbitsa thupi koyambirira kwa cholumikizira cha dzanja pambuyo pa opaleshoni.
Nthawi yotumizira: Sep-12-2023
