- 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
- Contraindications
Odwala okalamba omwe sali oyenera kuchitidwa opaleshoni.
- Kukonzekera kwamkati (njira ya volar)
Kukonzekera kwanthawi zonse kusanachitike opaleshoni.Anesthesia imachitidwa pogwiritsa ntchito brachial plexus anesthesia kapena anesthesia wamba
1) .Wodwalayo amaikidwa pamalo ogona ndi mwendo wokhudzidwawo kutengedwa ndikuyikidwa pa chimango cha opaleshoni.Kudulira kwa 8cm kumapangidwa pakati pa mtsempha wamagazi wapa mkono ndi flexor carpi radialis minofu ndikupitilira ku dzanja la mkono.Izi zitha kuwulula kwathunthu kuthyoka kwake ndikuletsa kufalikira kwa zipsera.Kudulidwako sikuyenera kulowa m'manja mwa dzanja (Chithunzi 1-36A).
2) . Tsatirani kudulidwa kwa flexor carpi radialis tendon sheath (Chithunzi 1-36B), tsegulani nthiti ya tendon, ikani nsungwi yakuya yamkati kuti muwonetsere flexor pollicis longus, gwiritsani ntchito chala cholozera kuti muwonetsere flexor pollicis longus. mbali ya ulnar, ndikumasula pang'ono flexor pollicis longus.Minofu ya m'mimba imawonekera kwathunthu ku minofu ya pronator quadratus (Chithunzi 1-36C)
3) .Pangani "L" mozungulira mozungulira mbali ya radius kupita ku njira ya radial styloid kuti muwonetse minofu ya pronator quadratus, ndiyeno muichotse patali ndi peeler kuti muwonetse mzere wonse wa nsungwi (Chithunzi 1). -36D, Chithunzi 1-36E)
4) .Lowetsani chowombera kapena mpeni wawung'ono wa fupa kuchokera pamzere wophwanyidwa, ndipo mugwiritseni ntchito ngati lever kuti muchepetse fracture.Ikani chophatikizira kapena mpeni wawung'ono pamzere wosweka kupita ku lateral fupa cortex kuti muchepetse kuponderezana ndi kuchepetsa fracture ya distal fragment, ndipo gwiritsani ntchito zala kuti mupanikizike fracture ya dorsal fragment kuti muchepetse chidutswa cha dorsal fracture.
Pamene fracture ya radial styloid imasweka, zimakhala zovuta kuchepetsa fracture ya radial styloid chifukwa cha kukoka kwa minofu ya brachioradialis.Kuti muchepetse mphamvu yokoka, brachioradialis imatha kusinthidwa kapena kupatulidwa kuchokera kumtunda wakutali.Ngati ndi kotheka, chigawo cha distal chikhoza kukhazikitsidwa kwakanthawi ku chigawo chokhazikika ndi mawaya a Kirschner.
Ngati njira ya ulnar styloid yathyoledwa ndikuchotsedwa, ndipo cholumikizira cha distal radioulnar sichikhazikika, waya umodzi kapena awiri a Kirschner angagwiritsidwe ntchito pokonza percutaneous, ndipo njira ya ulnar styloid ikhoza kukhazikitsidwanso ndi njira ya volar.Zing'onozing'ono zosweka nthawi zambiri sizifuna chithandizo chamanja.Komabe, ngati cholumikizira cha distal radioulnar sichikhazikika pambuyo pa kukhazikika kwa radius, chidutswa cha styloid chimatha kudulidwa ndipo m'mphepete mwa triangular fibrocartilage complex kulumikizidwa ku ulnar styloid process ndi nangula kapena ulusi wa silika.
5) .Ndi chithandizo cha traction, kapsule olowa ndi ligament angagwiritsidwe ntchito kumasula intercalation ndi kuchepetsa fracture.Kuthyokako kumachepetsedwa, dziwani malo omwe mbale yachitsulo imayikidwa motsogozedwa ndi X-ray fluoroscopy ndi wononga wononga mu dzenje chowulungika kapena dzenje lotsetsereka kuti zithandizire kusintha malo (Chithunzi 1-36F).Gwiritsani ntchito bowo la 2.5mm kubowola pakati pa dzenje lozungulira, ndikuyika 3.5mm zodzigudubuza zokha.
Chithunzi 1-36 Kumeta Khungu (A);kudulidwa kwa flexor carpi radialis tendon sheath (B);kuchotsa mbali ya flexor tendon kuti awonetsere pronator quadratus minofu (C);kugawaniza minofu ya pronator quadratus kuti iwonetse utali wozungulira (D);kuwonetsa mzere wosweka (E);ikani mbale ya volar ndi screw mu screw yoyamba (F)
6) .Gwiritsani ntchito fluoroscopy ya C-arm kuti mutsimikizire kuyika mbale moyenera.Ngati ndi kotheka, kankhirani mbale kutali kapena motalikirapo kuti mupeze malo abwino kwambiri oyika wononga.
7).Gwiritsani ntchito kubowola kwa 2.0mm kuboola bowo kumapeto kwenikweni kwa mbale yachitsulo, kuyeza kuya ndi kuwononga kotiko.Msomali uyenera kukhala wamfupi 2mm kuposa mtunda woyezedwa kuti misomali isalowe ndikutuluka kuchokera ku dorsal cortex.Nthawi zambiri, screw ya 20-22mm ndiyokwanira, ndipo yomwe imakhazikika panjira ya radial styloid iyenera kukhala yayifupi.Mukatha kukokoloka pa screw ya distal, pukutani Ikani zomangira zotsalazo.
Chifukwa ngodya ya screw idapangidwa, ngati mbale itayikidwa pafupi kwambiri ndi kumapeto kwa distal, screw idzalowa m'manja.Tengani magawo a tangential a articular subchondral bone kuchokera ku coronal ndi sagittal positions kuti muwone ngati alowa mu mgwirizano, ndiyeno tsatirani malangizo Sinthani mbale zachitsulo ndi/kapena zomangira.
(Chithunzi 1-37) Chithunzi cha 1-37 Kukonzekera kwa distal radius fracture ndi volar bone plate A. Anteroposterior ndi lateral X-ray filimu ya distal radius fracture isanayambe ntchito, kusonyeza kusamuka kwa mapeto a distal ku mbali ya volar;B. Kanema wa Anteroposterior ndi lateral X-ray wa kuthyoka kwa pambuyo pa opaleshoni, kusonyeza kuthyoka Kuchepetsa bwino komanso chilolezo chabwino cha mgwirizano wa dzanja.
8) .Suture minofu ya pronator quadratus ndi sutures osasunthika.Dziwani kuti minofu sidzaphimba mbale kwathunthu.Mbali yakutali iyenera kuphimbidwa kuti muchepetse kulumikizana pakati pa flexor tendon ndi mbale.Izi zikhoza kutheka ndi suturing pronator quadratus m'mphepete mwa brachioradialis, kutseka incision wosanjikiza ndi wosanjikiza, ndi kukonza ndi pulasitala ngati n'koyenera.
Nthawi yotumiza: Sep-01-2023
