Panopa kukonza mkati kwa distal radius fractures, pali machitidwe osiyanasiyana a anatomical locking plate omwe amagwiritsidwa ntchito kuchipatala.Kukonzekera kwamkati kumeneku kumapereka njira yabwino yothetsera mitundu ina yovuta yothyoka, ndipo m'njira zina kuwonjezera zizindikiro za opaleshoni ya distal radius fractures yosakhazikika, makamaka omwe ali ndi matenda a osteoporosis.Pulofesa Jupiter wa ku Massachusetts General Hospital ndi ena asindikiza nkhani zingapo mu JBJS pa zomwe adapeza pakukhazikitsa kwa mbale zotsekera za distal radius fractures ndi njira zina zopangira opaleshoni.Nkhaniyi ikuyang'ana njira yopangira opaleshoni yokonza fractures ya distal radius kutengera kukhazikika kwamkati kwa chipika cha fracture.
Njira Zopangira Opaleshoni
Lingaliro la magawo atatu, lotengera mawonekedwe a biomechanical ndi anatomical a distal ulnar radius, ndilo maziko a chitukuko ndi ntchito yachipatala ya 2.4mm plate system.Kugawanika kwa mizati itatu kukuwonetsedwa mu Chithunzi 1.
Chithunzi cha 1 Chiphunzitso cha magawo atatu a ulnar radius yakutali.
Mzere wam'mbali ndi theka la lateral la distal radius, kuphatikizapo navicular fossa ndi radial tuberosity, yomwe imathandizira mafupa a carpal kumbali ya radial ndipo ndi chiyambi cha mitsempha ina yomwe imakhazikika pa mkono.
Mzere wapakati ndi theka lapakati la distal radius ndipo umaphatikizapo lunate fossa (yogwirizana ndi mwezi) ndi notch ya sigmoid (yogwirizana ndi distal ulna) pamtunda.Nthawi zambiri, katundu wochokera ku lunate fossa amatumizidwa ku radius kudzera pa lunate fossa.Mzere wa ulnar lateral, womwe umaphatikizapo distal ulna, triangular fibrocartilage, ndi inferior ulnar-radial joint, amanyamula katundu kuchokera ku mafupa a carpal ulnar komanso kuchokera kumunsi kwa ulnar-radial joint ndipo imakhala ndi mphamvu yokhazikika.
Njirayi imachitidwa pansi pa brachial plexus anesthesia ndipo intraoperative C-arm X-ray imaging ndiyofunikira.Maantibayotiki a mtsempha amaperekedwa kwa mphindi zosachepera 30 isanayambe ndondomekoyi ndipo tourniquet ya pneumatic inagwiritsidwa ntchito kuchepetsa kutuluka kwa magazi.
Kukonzekera kwa mbale ya Palmar
Kwa fractures zambiri, njira ya palmar ingagwiritsidwe ntchito kuwonetsera pakati pa radial carpal flexor ndi radial artery.Pambuyo pozindikira ndikuchotsa flexor carpi radialis longus, pamwamba pa minofu ya pronator teres ikuwoneka ndipo kupatukana kwa mawonekedwe a "L" kumakwezedwa.M'mafupa ovuta kwambiri, tendon ya brachioradialis ikhoza kutulutsidwanso kuti ithandizire kuchepetsa kusweka.
Pini ya Kirschner imayikidwa mumtundu wa radial carpal, womwe umathandiza kufotokozera malire akutali kwambiri a radius.Ngati fupa laling'ono lomwe lili m'mphepete mwa articular lilipo, mbale yachitsulo ya palmar 2.4mm ikhoza kuikidwa pamphepete mwa distal articular ya radius kuti ikonzedwe.M'mawu ena, kuthyoka pang'ono pamtunda wa mwezi kumatha kuthandizidwa ndi mbale ya 2.4mm "L" kapena "T", monga momwe chithunzi 2 chikusonyezera.
Kwa dorsally displaced extra-articular fractures, ndizothandiza kuzindikira mfundo zotsatirazi.Choyamba, ndikofunikira kukonzanso kwakanthawi kochepa kuti muwonetsetse kuti palibe minofu yofewa yomwe ili kumapeto kwa fracture.Kachiwiri, kwa odwala omwe alibe matenda osteoporosis, fracture imatha kuchepetsedwa mothandizidwa ndi mbale: choyamba, chotsekera chotsekera chimayikidwa kumapeto kwa mbale ya palmar anatomical, yomwe imatetezedwa ku gawo la distal fracture, ndiye distal ndi zigawo zosweka pang'onopang'ono zimachepetsedwa mothandizidwa ndi mbale, ndipo pomaliza, zomangira zina zimayikidwa pafupi.
CHITHUNZI CHACHITATU Kuthyoka kowonjezereka kwa malo otalikirana ndi dorsally displaced displaced kumachepetsedwa ndikukhazikika kudzera munjira ya palmar.CHITHUNZI CHA 3-A Pambuyo pomaliza kuwonetseredwa kudzera mu radial carpal flexor ndi radial artery, pini yosalala ya Kirschner imayikidwa muzitsulo za radial carpal.Chithunzi 3-B Kuwongolera kwa metacarpal cortex yochotsedwa kuti muyikhazikitsenso.
Chithunzi 3-C ndi Chithunzi 3-DA Pini yosalala ya Kirschner imayikidwa kuchokera ku tsinde la radial kudzera pamzere wosweka kuti akonze kwakanthawi kumapeto kwa fracture.
Chithunzi cha 3-E Kuwonetseratu kokwanira kwa malo ogwira ntchito kumatheka pogwiritsa ntchito retractor isanayambe kuyika mbale.CHITHUNZI 3-F Mzere wa distal wa zomangira zokhoma zimayikidwa pafupi ndi fupa la subchondral kumapeto kwa khola lakutali.
Chithunzi 3-G X-ray fluoroscopy iyenera kugwiritsidwa ntchito kutsimikizira malo a mbale ndi zomangira za distal.Chithunzi 3-H Gawo loyandikira la mbale liyenera kukhala ndi chilolezo (madigiri 10) kuchokera ku diaphysis kuti mbaleyo ikhale yokhazikika ku diaphysis kuti ipititsenso kukonzanso chipika cha distal fracture.Chithunzi 3-I Limbitsani screw proximal kuti mukhazikitsenso kupendekera kwa palmar kwa distal fracture.Chotsani pini ya Kirschner musanamizidwe wononga.
Zithunzi za 3-J ndi 3-K Intraoperative radiographic zithunzi zimatsimikizira kuti fracture potsiriza inasinthidwa mwachibadwa ndipo zomangira za mbale zidayikidwa bwino.
Dorsal Plate Fixation Njira yopangira opaleshoni yowonetsera mbali ya dorsal ya distal radius imadalira makamaka mtundu wa fracture, ndipo pakakhala fracture yokhala ndi zidutswa ziwiri kapena zingapo za intra-articular fracture, cholinga cha chithandizo makamaka kukonza zonsezi. mizati yozungulira ndi yapakati pa nthawi yomweyo.Intraoperatively, magulu othandizira owonjezera ayenera kudulidwa m'njira ziwiri zazikulu: motalika mu 2nd ndi 3rd zowonjezera zowonjezera, ndi subperiosteal dissection ku chipinda cha 4 chowonjezera ndi kubweza kwa tendon yofanana;kapena yachiwiri yothandizira gulu incision pakati pa 4th ndi 5th extensor zipinda kuvumbula mizati awiri padera (mkuyu. 4).
Kuphulika kumagwiritsidwa ntchito ndikukonzedwa kwakanthawi ndi pini ya Kirschner yosawerengeka, ndipo zithunzi za radiographic zimatengedwa kuti zitsimikizire kuti fracture imasamutsidwa bwino.Kenako, mbali ya dorsal ulnar (zapakati) mbali ya radius imakhazikika ndi mbale ya 2.4 mm "L" kapena "T".Mbali ya dorsal ulnar imapangidwa kuti iwonetsetse kuti ikhale yolimba kumbali ya dorsal ulnar ya distal radius.Ma mbale amathanso kuikidwa pafupi ndi mbali ya dorsal ya distal lunate momwe angathere, monga momwe ma grooves omwe ali pansi pa mbale iliyonse amalola kuti mbale zikhale zopindika ndikupangika popanda kuwononga ulusi muzitsulo zomangira (mkuyu 5) .
Kukhazikika kwa mbale ya radial column ndikosavuta, chifukwa fupa lapakati pagawo loyamba ndi lachiwiri lokulitsa ndi lathyathyathya ndipo limatha kukhazikitsidwa pamalowa ndi mbale yowoneka bwino.Ngati pini ya Kirschner imayikidwa pamtunda wakutali kwambiri wa radial tuberosity, mapeto a distal a radial column plate ali ndi groove yomwe imagwirizana ndi pini ya Kirschner, yomwe simasokoneza malo a mbaleyo ndikusunga fracture m'malo mwake. (Mkuyu 6).
Chithunzi 4 Kuwonekera kwa dorsal pamwamba pa distal radius.Gulu lothandizira limatsegulidwa kuchokera ku 3rd extensor interosseous compartment ndipo extensor hallucis longus tendon imachotsedwa.
Mkuyu 5 Kukonzekera kwa dorsal mbali ya articular pamwamba pa mwezi, dorsal "T" kapena "L" mbale nthawi zambiri amapangidwa (Fig. 5-A ndi Fig. 5-B).Mbali yam'mbuyo ikakhazikika pamtunda wa mweziwo itatetezedwa, mbale ya radial column imatetezedwa (Zizindikiro 5-C mpaka 5-F).Ma mbale awiriwa amayikidwa pakona ya madigiri 70 kwa wina ndi mzake kuti apititse patsogolo kukhazikika kwa mkati.
Chithunzi cha 6 Chophimba cha radial chimapangidwa bwino ndikuyikidwa muzitsulo za radial, ndikuzindikira notch kumapeto kwa mbale, yomwe imalola kuti mbaleyo ipewe kukhazikitsidwa kwakanthawi kwa pini ya Kirschner popanda kusokoneza malo a mbale.
Mfundo zofunika
Zizindikiro za Metacarpal Plate Fixation
Kuphulika kwa metacarpal intra-articular (Barton fractures)
fractures zowonjezera zowonjezera (Colles ndi Smith fractures).Kukhazikika kokhazikika kumatha kupezeka ndi wononga mbale ngakhale pamaso pa osteoporosis.
Kuphwanyidwa kwa metacarpal lunate articular surface fractures
Zizindikiro za dorsal plate fixation
Ndi kuvulala kwa intercarpal ligament
Kuthyoka kwa dorsal lunate kwapamtunda kwapang'onopang'ono
Dorsally sheared radial carpal joint fracture dislocation
Contraindications kuti palmar mbale fixation
Osteoporosis yoopsa yokhala ndi zofooka zazikulu zogwira ntchito
Dorsal radial wrist fracture dislocation
Kukhalapo kwa ma comorbidities ambiri azachipatala
Contraindications kuti dorsal mbale fixation
Ma comorbidities ambiri azachipatala
Zophwanyika zosasamutsidwa
Zolakwa zimapangidwa mosavuta mu kukonza mbale za palmar
Malo a mbale ndi ofunikira kwambiri chifukwa sikuti mbaleyo imathandizira kuchulukana kwa fracture, komanso kuyika bwino kumalepheretsanso phula la distal locking kuti lisalowe mu mgwirizano wa radial carpal.Ma radiographs osamala opangira ma radiograph, omwe amawonetsedwa molunjika momwe amawonera ma radial a distal radius, amalola kuwonetsetsa kolondola kwa mbali yozungulira ya mbali yozungulira ya distal radius, yomwe imathanso kuwonedwa molondola poyika zomangira za m'mphepete mwa khosi nthawi yoyamba. ntchito.
Kulowa kwa dorsal cortex kumakhala ndi chiopsezo chokwiyitsa tendon yotulutsa ndikupangitsa kuphulika kwa tendon.Zomangira zokhoma zimagwira ntchito mosiyana ndi zomangira zabwinobwino, ndipo sikoyenera kulowa m'khosi la dorsal ndi zomangira.
Zolakwa zimapangidwa mosavuta ndi dorsal plate fixation
Nthawi zonse pamakhala chiwopsezo cholowera cholumikizira cholumikizira cha radial carpal, ndipo mofanana ndi njira yomwe tafotokozera pamwambapa pokhudzana ndi mbale ya palmar, kuwombera kwa oblique kuyenera kutengedwa kuti muwone ngati wononga malowo ndi otetezeka.
Ngati kukonza kozungulira kwa radial kuchitidwa kaye, zomangira mu radial tuberosity zidzakhudza kuwunika kotsatira kwa articular surface resurfacing ya lunate.
Zomangira za distal zomwe sizimangiriridwa kwathunthu mu dzenje la screw zimatha kusokoneza tendon kapena kuyambitsa kuphulika kwa tendon.
Nthawi yotumiza: Dec-28-2023
