1. Zizindikiro
1) . Kuphwanyidwa kwakukulu kwapang'onopang'ono kumakhala ndi kusuntha koonekeratu, ndipo malo ozungulira a distal radius akuwonongeka.
2) .Kuchepetsa kwamanja kunalephera kapena kukonza kunja kunalephera kusunga kuchepetsa.
3) .Miphuno yakale.
4).Kusweka malunion kapena nonunion.fupa lomwe likupezeka kunyumba ndi kunja
2.Contraindications
Odwala okalamba omwe sali oyenera kuchitidwa opaleshoni.
3. Njira yopangira opaleshoni yokonza kunja
1. Kuphatikizika kwakunja kwapakatikati kuti akonze fractures ya distal radius
Udindo ndi kukonzekera kusanachitike:
· Brachial plexus anesthesia
·Pamalo pomwe nthambi yomwe yakhudzidwayo yaphwa pa bulaketi yowona modutsa pafupi ndi bedi
❖ Ikani 1/3 ya kumtunda kwa mkono
· Kuyang'anira kawonedwe
Njira Yopangira Opaleshoni
Kuyika kwa Metacarpal Screw:
Chomangira choyamba chili m'munsi mwa fupa lachiwiri la metacarpal.Kudula khungu kumapangidwa pakati pa tendon extensor ya chala cholozera ndi dorsal interosseous minofu ya fupa loyamba.Minofu yofewa imasiyanitsidwa modekha ndi forceps opaleshoni.Khomo limateteza minofu yofewa, ndipo 3mm Schanz screw imayikidwa.Zomangira
Mayendedwe a screw ndi 45 ° ku ndege ya kanjedza, kapena akhoza kufanana ndi ndege ya kanjedza.
Gwiritsani ntchito bukhuli kuti musankhe malo a screw yachiwiri.Chophimba chachiwiri cha 3mm chinayendetsedwa mu metacarpal yachiwiri.
Kutalika kwa pini ya metacarpal sikuyenera kupitirira 3mm.Pini yokhazikika ili mu proximal 1/3.Kwa odwala matenda osteoporosis, wononga kwambiri proximal wononga akhoza kulowa zigawo zitatu za kotekisi (wachiwiri metacarpal fupa ndi theka kotekisi wachitatu metacarpal fupa).Mwanjira iyi, wononga Dzanja lalitali lokhazikika ndi torque yayikulu yokonzera kumawonjezera kukhazikika kwa pini yokonzera.
Kuyika kwa zomangira za radial:
Pangani chotupa pakhungu m'mphepete mwa m'mphepete mwa utali, pakati pa minofu ya brachioradialis ndi extensor carpi radialis muscle, 3cm pamwamba pa mapeto a mzere wosweka ndi pafupifupi 10cm pafupi ndi mgwirizano wa dzanja, ndipo gwiritsani ntchito hemostat kuti mulekanitse mosabisa minofu ku fupa pamwamba.Chisamaliro chimatengedwa kuteteza nthambi zachiphamaso za mitsempha yozungulira yomwe ili m'derali.
Pandege yomweyi ndi zomangira za metacarpal, zomangira ziwiri za 3mm Schanz zidayikidwa motsogozedwa ndi kalozera wa minofu yofewa yoteteza manja.
·.Kuchepetsa ndi kukonza fracture:
·.Manual traction kuchepetsa ndi C-arm fluoroscopy kuti ayang'ane kuchepetsa fracture.
·.Kukonzekera kwakunja pamtunda wa dzanja kumapangitsa kuti zikhale zovuta kubwezeretsanso mbali ya palmar inclination, kotero ikhoza kuphatikizidwa ndi mapepala a Kapandji kuti athandize kuchepetsa ndi kukonza.
Kwa odwala omwe ali ndi fractures ya radial styloid, radial styloid Kirschner waya fixation ingagwiritsidwe ntchito.
·.Pamene mukusunga kuchepetsa, gwirizanitsani chowongolera chakunja ndikuyika malo ozungulira azitsulo zakunja pamtunda womwewo monga malo ozungulira a mgwirizano wa dzanja.
·.Anteroposterior ndi lateral fluoroscopy, fufuzani ngati kutalika kwa radius, palmar inclination angle ndi ulnar deviation angle akubwezeretsedwa, ndipo sinthani ndondomekoyi mpaka kuchepetsa fracture kumakhala kokwanira.
·.Samalani ndi kukopa kwa dziko la fixator kunja, kuchititsa kuti iatrogenic fractures pazitsulo za metacarpal.
Kuphulika kwa distal radius kuphatikiza ndi distal radioulnar joint (DRUJ) kupatukana:
·.Ma DRUJs ambiri amatha kuchepetsedwa mwachisawawa atatha kuchepetsedwa kwa distal radius.
·.Ngati DRUJ ikadali yolekanitsidwa pambuyo poti distal radius yachepetsedwa, gwiritsani ntchito kuchepetsa kuponderezedwa kwamanja ndikugwiritsira ntchito lateral ndodo fixation ya bracket yakunja.
Kapena gwiritsani ntchito mawaya a K kuti mulowe mu DRUJ mopanda ndale kapena pang'ono.
Kuthyoka kwa distal radius kuphatikiza ndi ulnar styloid fracture: Yang'anani kukhazikika kwa DRUJ mu matchulidwe, ndale ndi supination wa mkono.Ngati kusakhazikika kulipo, kukonza kothandizira ndi mawaya a Kirschner, kukonza TFCC ligament, kapena tension band mfundo kungagwiritsidwe ntchito pokonza njira ya Ulnar styloid.
Pewani kukoka kwambiri:
· Yang'anani ngati zala za wodwalayo zimatha kuchita mayendedwe athunthu ndikuwongolera popanda kupsinjika koonekera;yerekezerani danga lolumikizana la radiolunate ndi malo olumikizirana a midcarpal.
·Yang'anani ngati khungu panjira ya misomali ndi lothina kwambiri.Ngati yathina kwambiri, chekani moyenerera kuti mupewe matenda.
·Limbikitsani odwala kuti asunthe zala zawo msanga, makamaka kupindika ndi kutambasula mafupa a metacarpophalangeal a zala, kupindika ndi kutambasula chala chachikulu, ndi kuba.
2. Kukonzekera kwa ma distal radius fractures ndi chowongolera chakunja chomwe sichidutsa mgwirizano:
Udindo ndi kukonzekera koyambirira: Mofanana ndi kale.
Njira Zopangira Opaleshoni:
Malo otetezeka a K-waya kuyika kumbali ya dorsal ya distal radius ndi: kumbali zonse za Lister's tubercle, kumbali zonse za extensor pollicis longus tendon, ndi pakati pa extensor digitorum communis tendon ndi extensor digiti minimi tendon.
Momwemonso, zomangira ziwiri za Schanz zinayikidwa mumtsinje wa radial ndikugwirizanitsa ndi ndodo yolumikizira.
Kupyolera m'dera lachitetezo, zomangira ziwiri za Schanz zidayikidwa mugawo la distal radius fracture, imodzi kuchokera mbali ya radial ndi ina kuchokera kumbali yakumbuyo, yokhala ndi ngodya ya 60 ° mpaka 90 ° wina ndi mnzake.Chomangiracho chiyenera kugwira kotekisi yopingasa, ndipo ziyenera kudziwidwa kuti nsonga ya wononga yomwe imayikidwa pa mbali ya radial siyingadutse notch ya sigmoid ndikulowa mgulu la distal radioulnar.
Gwirizanitsani screw ya Schanz patali ndi ulalo wokhotakhota.
Gwiritsani ntchito ndodo yolumikizira yapakatikati kuti mulumikize magawo awiri osweka, ndipo samalani kuti musatseke chuck kwakanthawi.Mothandizidwa ndi chiyanjano chapakati, chigawo cha distal chimachepetsedwa.
Mukayambiranso, tsekani chuck pa ndodo yolumikizira kuti mumalize komalizakukonza.
Kusiyanitsa pakati pa chokonza chakunja chosagwirizana ndi span ndi cholumikizira chakunja cholumikizira:
Chifukwa zomangira zingapo za Schanz zitha kuyikidwa kuti amalize kuchepetsa ndi kukonza zidutswa za mafupa, zisonyezo za opaleshoni ya zolumikizira zakunja zosalumikizana ndizokulirapo kuposa za zolumikizira zakunja zolumikizana.Kuphatikiza pa fractures yowonjezera-articular, angagwiritsidwenso ntchito pa fractures yachiwiri mpaka yachitatu.Kuphulika pang'ono kwa intra-articular.
Cholumikizira chakunja cholumikizira chimakonza cholumikizira cha dzanja ndipo sichimalola kuchita masewera olimbitsa thupi koyambirira, pomwe cholumikizira chakunja chopanda cholumikizira chimalola kuchita masewera olimbitsa thupi koyambirira kwapambuyo pambuyo pa opaleshoni.
Nthawi yotumiza: Sep-12-2023
