- 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
- Zotsutsana
Odwala okalamba omwe sali oyenera opaleshoni.
- Kukhazikika kwamkati (njira ya volar)
Kukonzekera opaleshoni nthawi zonse. Kuletsa kupweteka kumachitika pogwiritsa ntchito mankhwala oletsa kupweteka a brachial plexus kapena mankhwala oletsa kupweteka onse
1). Wodwalayo amaikidwa chagada pomwe mwendo wokhudzidwayo wachotsedwa ndipo waikidwa pa chimango cha opaleshoni. Kuduladula kwa 8cm kumapangidwa pakati pa mtsempha wa radial wa mkono ndi minofu ya flexor carpi radialis ndikutambasulidwa mpaka ku chibwano. Izi zitha kuwonetsa bwino kusweka ndikuletsa kugwedezeka kwa chilonda. Kuduladulako sikuyenera kulowa m'dzanja la dzanja (Chithunzi 1-36A).
2). Tsatirani kudula kwa tendon sheath ya flexor carpi radialis (Chithunzi 1-36B), tsegulani tendon sheath, dulani fascia yakuya ya bamboo anterior kuti muwone flexor pollicis longus, gwiritsani ntchito chala cholozera kuti muwonetse flexor pollicis longus kumbali ya ulnar, ndikumasula pang'ono flexor pollicis longus. Mimba ya minofu imaonekera kwathunthu ku minofu ya pronator quadratus (Chithunzi 1-36C)
3). Pangani chocheka chooneka ngati "L" m'mbali mwa radial ya radius kupita ku radial styloid process kuti muwonetse minofu ya pronator quadratus, kenako muchotse pa radius ndi peeler kuti muwonetse mzere wonse wa nsungwi fold (Chithunzi 1-36D, Chithunzi 1-36E)
4). Ikani mpeni wochotsa mafupa kapena mpeni waung'ono wa fupa kuchokera pamzere wosweka, ndipo mugwiritse ntchito ngati chowongolera kuti muchepetse kusweka. Ikani choyezera kapena mpeni waung'ono wokonza lumo kudutsa mzere wosweka kupita ku lateral bone cortex kuti muchepetse kupsinjika ndikuchepetsa chidutswa cha distal fracture, ndipo gwiritsani ntchito zala kuti muchepetse chidutswa cha fracture cha dorsal kuti muchepetse chidutswa cha fracture cha dorsal.
Pamene kusweka kwa radial styloid kwasweka, zimakhala zovuta kuchepetsa kusweka kwa radial styloid chifukwa cha kukoka kwa minofu ya brachioradialis. Kuti muchepetse mphamvu yokoka, brachioradialis ikhoza kusinthidwa kapena kuchotsedwa kuchokera ku distal radius. Ngati kuli kofunikira, distal fracture ikhoza kukhazikika kwakanthawi ku proximal fracture ndi mawaya a Kirschner.
Ngati njira ya ulnar styloid yasweka ndi kusunthika, ndipo cholumikizira cha distal radioulnar sichikhazikika, waya umodzi kapena iwiri ya Kirschner ingagwiritsidwe ntchito polumikiza percutaneous, ndipo njira ya ulnar styloid ikhoza kubwezeretsedwanso pogwiritsa ntchito njira ya volar. Kusweka kwazing'ono nthawi zambiri sikufuna chithandizo chamanja. Komabe, ngati cholumikizira cha distal radioulnar sichikhazikika pambuyo pokhazikitsa radius, chidutswa cha styloid chikhoza kuchotsedwa ndipo m'mphepete mwa triangular fibrocartilage complex zimangiriridwa ku njira ya ulnar styloid ndi anchors kapena ulusi wa silika.
5). Pogwiritsa ntchito mphamvu yokoka, kapisozi ndi ligament yolumikizirana zingagwiritsidwe ntchito kumasula kulowererana ndikuchepetsa kusweka. Pambuyo poti kusweka kwachepetsedwa bwino, dziwani malo omwe mbale yachitsulo ya volar ikuyikira motsogozedwa ndi X-ray fluoroscopy ndikukulungira screw mu dzenje lozungulira kapena dzenje lotsetsereka kuti muzitha kusintha malo (Chithunzi 1-36F). Gwiritsani ntchito dzenje lobowola la 2.5mm kuboola pakati pa dzenje lozungulira, ndikuyika screw yodzigwira yokha ya 3.5mm.
Chithunzi 1-36 Kudula khungu (A); kudula kwa flexor carpi radialis tendon sheath (B); kuchotsa gawo la flexor tendon kuti liwonetse minofu ya pronator quadratus (C); kugawa minofu ya pronator quadratus kuti liwonetse radius (D); kuwonetsa mzere wosweka (E); ikani mbale ya volar ndikuyika screw mu screw yoyamba (F)
6). Gwiritsani ntchito C-arm fluoroscopy kuti mutsimikizire malo oyenera a plate. Ngati kuli kofunikira, kankhirani plate kutali kapena pafupi kuti mupeze malo abwino kwambiri a distal screw.
7). Gwiritsani ntchito chobowola cha 2.0mm kuti muboole dzenje kumapeto kwa mbale yachitsulo, yesani kuya kwake ndikuyika screw yotsekera. Msomali uyenera kukhala waufupi ndi 2mm kuposa mtunda woyezedwa kuti screw isalowe ndi kutuluka kuchokera ku dorsal cortex. Kawirikawiri, screw ya 20-22mm ndi yokwanira, ndipo yomwe imayikidwa pa radial styloid process iyenera kukhala yaufupi. Mukayika screw ya distal, ikani screw yotsalayo.
Popeza ngodya ya sikuruyi yapangidwa, ngati mbaleyo yayikidwa pafupi kwambiri ndi mapeto akutali, sikuruyi idzalowa mu cholumikizira cha dzanja. Tengani zidutswa za tangential za fupa la articular subchondral kuchokera pamalo a coronal ndi sagittal kuti muwone ngati likulowa mu cholumikizira, kenako tsatirani malangizo. Sinthani mbale zachitsulo ndi/kapena zomangira.
(Chithunzi 1-37) Chithunzi 1-37 Kukonza kusweka kwa distal radius ndi volar bone plate A. Anteroposterior ndi lateral X-ray film ya distal radius fracture isanayambe opaleshoni, kusonyeza kusamuka kwa distal end kupita ku volar side; B. Anteroposterior ndi lateral X-ray film ya postoperative fracture, kusonyeza kusweka kwabwino komanso kutseguka bwino kwa chikhatho cha dzanja
8). Pakani minofu ya pronator quadratus ndi ma suture osayamwa. Dziwani kuti minofuyo sidzaphimba mbale yonse. Gawo lakutali liyenera kuphimbidwa kuti muchepetse kukhudzana pakati pa tendon yopindika ndi mbale. Izi zitha kuchitika poyika ma quadratus a pronator m'mphepete mwa brachioradialis, kutseka gawo la incision ndi gawo, ndikulikonza ndi pulasitala ngati pakufunika kutero.
Nthawi yotumizira: Sep-01-2023
