Kusweka kwa Metacarpal phalangeal ndi kusweka komwe kumachitika kawirikawiri m'manja, zomwe zimapangitsa pafupifupi 1/4 ya odwala omwe adavulala ndi dzanja. Chifukwa cha kapangidwe kake kosavuta komanso kovuta komanso ntchito yovuta yoyenda, kufunika ndi luso la chithandizo cha kusweka kwa dzanja ndizovuta kwambiri kuposa chithandizo cha kusweka kwa mafupa ena ataliatali. Kuonetsetsa kuti kusweka kwa mafupa kukhazikika pambuyo pochepetsa ndiye chinsinsi cha chithandizo chopambana cha kusweka kwa mafupa a metacarpal phalangeal. Pofuna kubwezeretsa ntchito ya dzanja, kusweka kwa mafupa nthawi zambiri kumafuna kukonzedwa koyenera. Kale, kukonzedwa kwa plaster external kapena Kirschner wire internal fixation nthawi zambiri kunkagwiritsidwa ntchito, koma nthawi zambiri sikuthandiza maphunziro oyambilira a kukonzanso mafupa pambuyo pa opaleshoni chifukwa cha kukonzedwa kosalondola kapena nthawi yayitali yokhazikika, zomwe zimakhudza kwambiri kubwezeretsa ntchito ya chala ndipo zimabweretsa zovuta zina pakukonzanso kwa dzanja. Njira zamakono zochiritsira zikuchulukirachulukira kugwiritsa ntchito kukonzedwa kwamkati mwamphamvu, monga kukonzedwa kwa micro-plate screw.
Ine.Kodi mfundo za chithandizo ndi ziti?
Mfundo zochizira matenda a kusweka kwa dzanja ndi phalangeal: kuchepetsa thupi, kukhazikika kopepuka komanso kolimba, zochita zoyambirira ndi maphunziro ogwira ntchito. Mfundo zochizira matenda a kusweka kwa dzanja ndi intra-articular ndi zofanana ndi za kusweka kwina kwa intra-articular, komwe kumabwezeretsa kapangidwe ka malo olumikizirana ndi ntchito zoyambirira. Pochiza kusweka kwa dzanja ndi phalangeal, kuyesetsa kuyenera kupangidwa kuti kuchepetsa thupi, ndipo kuzungulira, kugwedezeka kwa mbali, kapena kusuntha kwa angular kwa >10° kupita ku mbali ya msana ya kanjedza sikuyenera kuchitika. Ngati kusweka kwa phalange ya metacarpal kutembenuka kapena kusuntha mozungulira, kudzasintha njira yolowera ndi kusuntha kwa chala, zomwe zimapangitsa kuti chisunthe kapena kugwa ndi chala chapafupi panthawi yopindika, zomwe zimakhudza kulondola kwa ntchito ya chala; Ndipo pamene kusuntha kwa ngodya kupita ku mbali ya msana ya chikhato kuli >10°, malo olumikizirana bwino pakati pa fupa ndi tendon amawonongeka, zomwe zimawonjezera kukana ndi kuchuluka kwa kuyenda kwa tendon ndi kutambasuka kwake, ndipo kuwonongeka kwa tendon kosatha kumachitika, zomwe zimapangitsa kuti tendon iphulike.
II.Ndi zipangizo ziti zomwe zingasankhidwe kuti zigwiritsidwe ntchito pochiza kusweka kwa metacarpal?
Pali zinthu zambiri zomangira mkati mwa fractures ya metacarpal, monga mawaya a Kirschner, zomangira, mbale ndi zomangira zakunja, zomwe mawaya a Kirschner ndi ma microplates ndi omwe amagwiritsidwa ntchito kwambiri. Pa fractures ya metacarpal, microplate internal fixation ili ndi ubwino woonekeratu kuposa Kirschner wire fixation ndipo ingagwiritsidwe ntchito poyamba; pa fractures ya proximal phalanx, ma microplates nthawi zambiri amakhala abwino, koma pamene kuli kovuta kuyika zomangira za proximal phalanx distal segment ndi head fractures, cross Kirschner wire internal fixation iyenera kugwiritsidwa ntchito, zomwe zimathandiza kwambiri kuti chala chomwe chakhudzidwa chibwezeretse ntchito yake; mawaya a Kirschner ayenera kugwiritsidwa ntchito poyamba pochiza fractures yapakati pa phalanx.
- Waya wa Kirschner:Kukonza mkati mwa waya wa Kirschner kwakhala kukugwiritsidwa ntchito m'chipatala kwa zaka zoposa 70 ndipo nthawi zonse kwakhala chinthu chogwiritsidwa ntchito kwambiri pokonza mkati mwa mafupa a metacarpal ndi phalangeal. N'kosavuta kugwiritsa ntchito, kotsika mtengo komanso kothandiza, ndipo ndi njira yakale kwambiri yokonza mkati. Popeza ndi njira yokonza mkati yomwe imagwiritsidwa ntchito kwambiri pochiza kusweka kwa manja, imagwiritsidwabe ntchito kwambiri. Ubwino wa kukonza mkati mwa waya wa Kirschner: ① N'kosavuta kugwiritsa ntchito komanso kosavuta kugwiritsa ntchito; ② Kuchotsa minofu yofewa pang'ono, kuchepetsa kufalikira kwa magazi kumapeto kwa fracture, kuchepetsa kuvulala kwa opaleshoni, komanso kothandiza kuti fracture ipole; ③ N'kosavuta kuchotsa singano kachiwiri; ④ Mtengo wotsika komanso kugwiritsa ntchito mosiyanasiyana, koyenera kuvulala kwambiri kwa manja (monga kusweka kwa intra-articular, kusweka kwakukulu kwa fractures ndi kusweka kwa distal phalangeal).
2. Ma microplates a Metacarpophalangeal: Kukhazikika kwamphamvu mkati mwa manja osweka ndiye maziko a maphunziro oyambirira a ntchito komanso chofunikira kuti manja agwire bwino ntchito. Ukadaulo wa AO internal fixation umafuna kuti malekezero a fracture asinthidwe bwino malinga ndi kapangidwe ka thupi ndi kuti malekezero a fracture akhale olimba pansi pa mikhalidwe yogwira ntchito, yomwe imadziwika kuti strong fixation, kuti athe kuyenda mofulumira. AO imalimbikitsanso opaleshoni yochepa kwambiri, poyang'ana kwambiri kuteteza magazi. Kukhazikika kwa mkati mwa microplate pochiza malekezero a manja kumatha kupeza zotsatira zabwino pankhani ya mphamvu, kukhazikika kwa malekezero a fracture, ndi kupanikizika pakati pa malekezero a fracture. Ponena za kuchira kwa ntchito pambuyo pa opaleshoni, nthawi yochira ya fracture, ndi kuchuluka kwa matenda, amakhulupirira kuti mphamvu ya ma microtitanium plates ndi yabwino kwambiri kuposa ya mawaya a Kirschner. Komanso, popeza nthawi yochira ya fracture pambuyo pa fracture ndi ma microtitanium plates ndi yochepa kwambiri kuposa njira zina zokhazikitsira, ndibwino kuti odwala ayambirenso moyo wabwinobwino msanga.
(1) Kodi ubwino wa microplate internal fixation ndi wotani?
① Poyerekeza ndi mawaya a Kirschner, zinthu zopangira ma screw a microplate zimakhala ndi mgwirizano wabwino ndi minofu komanso zimayankha bwino minofu; ② Kukhazikika kwa dongosolo lokhazikitsa ma screw a plate ndi kukakamiza kumapeto kwa fracture kumapangitsa kuti fracture ikhale pafupi ndi kuchepetsa thupi, ikhale yolimba kwambiri, komanso yothandiza kuti fracture ipole; ③ Kuchita masewera olimbitsa thupi koyambirira nthawi zambiri kumaloledwa pambuyo pokhazikitsa ma screw a microplate, zomwe zimathandiza kuti dzanja lizigwira ntchito bwino.
(2) Kodi njira yochitira opaleshoni ya microplates ndi iti?
Opaleshoni nthawi zambiri imachitidwa pogwiritsa ntchito mankhwala oletsa ululu otchedwa brachial plexus block anesthesia, ndipo nthawi zambiri pamafunika pneumatic tourniquet. Kudula dorsal incision ya metacarpal phalanges kumachitidwa, aponeurosis ya dorsal ya manambala imadulidwa kapena minofu yolumikizana ndi fupa la metacarpal imalowetsedwa kuti iwonetse malekezero a mafupa a metacarpal kapena phalangeal, periosteum imachotsedwa, ndipo kusweka kumachepetsedwa poona mwachindunji. Ma plate owongoka ndi oyenera kusweka kwapakati komanso kusweka kwafupipafupi, ma T-plate ndi oyenera kukhazikika pansi pa metacarpal ndi phalanges, ndipo ma T-plate kapena ma T-plates a 120° ndi 150° L ndi oyenera kukhazikika kwa kusweka kwakutali kwa oblique ndi comminute. Mbale nthawi zambiri imayikidwa kumbali ya dorsal ya fupa kuti ipewe kutsetsereka kwa tendon ndi kuwonongeka kwa nthawi yayitali, zomwe zimathandiza kuti munthu azichita bwino ntchito. Zomangira ziwiri kapena zitatu ziyenera kugwiritsidwa ntchito kukonza malekezero awiri a choswekacho, apo ayi kukhazikika kwake kumakhala kofooka, ndipo mawaya kapena zomangira za Kirschner zomwe zili kunja kwa mbale zimafunika kuti zithandize kukhazikika kuti zikwaniritse cholinga chokhazikika.
3. Zomangira zazing'ono: Zomangira zazing'ono zimakhala ndi kukhazikika kofanana ndi mbale zachitsulo pakukhazikitsa ma spiral kapena ang'onoang'ono oblique fractures, koma kuchuluka kwa minofu yofewa ndi periosteum stripping ndi kochepa kuposa komwe kumakhazikitsa spiral plate, komwe kumathandiza kuteteza magazi ndikugwirizana ndi lingaliro la opaleshoni yochepa kwambiri. Ngakhale pali ma spirals amtundu wa T ndi mtundu wa L a ma fractures a near-articular, kubwezeretsa ntchito ya mafupa pambuyo potsatira opaleshoni kumakhala koipa kuposa komwe kumakhazikitsa ma fractures a diaphyseal. Zomangira zazing'ono zimakhalanso ndi ubwino wina pakukhazikitsa ma fractures a intra-articular ndi peri-articular. Zomangira zomwe zimakulungidwa mu fupa la cortical zimatha kupirira kupsinjika kwakukulu, kotero kukhazikikako kumakhala kolimba, ndipo malekezero a fracture amatha kukanikiza kuti pamwamba pa fracture pakhale pafupi, kufupikitsa nthawi yochira fracture ndikupangitsa kuti fracture ichiritsidwe, monga momwe zasonyezedwera pa Chithunzi 4-18. Kukhazikitsa mkati mwa spiral scratch ya manja kumagwiritsidwa ntchito makamaka pa ma fractures a oblique kapena spiral a diaphyseal ndi intra-articular avulsion fractures a mafupa akuluakulu. Tiyenera kudziwa kuti mukamagwiritsa ntchito zomangira zazing'ono zokha kukonza kusweka kwa fupa la diaphyseal la dzanja, kutalika kwa mzere wosweka kuyenera kukhala kawiri kuposa m'mimba mwake wa fupa la diaphyseal, ndipo mukakonza zomangira zosweka zomwe zasweka mu cholumikizira, m'lifupi mwa chomangira cha fupa muyenera kukhala osachepera katatu kuposa m'mimba mwake wa ulusi.
4. Chogwirizira chakunja cha Micro:Kusweka kwa phalangeal ya metacarpal yodulidwa nthawi zina kumakhala kovuta kuchepetsa kapena sikungatheke kukhazikika mkati ngakhale mutachita opaleshoni chifukwa cha kuwonongeka kwa chithandizo cha fupa. Chogwirizira chakunja chimatha kubwezeretsa ndikusunga kutalika kwa kusweka komwe kwadulidwa pansi pa kukoka, kuchita gawo la kukhazikika kofanana. Zogwirizira zakunja za metacarpal phalangeal zodulidwa zimayikidwa m'malo osiyanasiyana: phalanges ya 1st ndi 2nd metacarpal imayikidwa mbali ya radial ya dorsal, phalanges ya 4th ndi 5th metacarpal imayikidwa mbali ya dorsal ulnar, ndipo phalange ya 3rd metacarpal imayikidwa mbali ya radial ya dorsal kapena mbali ya dorsal ulnar malinga ndi momwe zinthu zilili. Samalani malo oikira singano kuti mupewe kuwonongeka kwa tendon. Kusweka kotsekedwa kumatha kuchepetsedwa pansi pa X-ray. Ngati kuchepetsa sikuli koyenera, kudula pang'ono kumatha kuchitika kuti kuthandize kuchepetsa.
Kodi ubwino wa fixators zakunja ndi ziti?
① Ntchito yosavuta, imatha kusintha kusuntha kwa malekezero osiyanasiyana a fracture; ② Imatha kuchepetsa ndikukonza bwino kusweka kwa mafupa a metacarpophalangeal popanda kuwononga pamwamba pa cholumikizira, ndipo imatha kusokoneza pamwamba pa cholumikizira kuti ipewe kukokana kwa capsule ya cholumikizira ndi ligament ya collateral; ③ Ngati kusweka kwa mafupa komwe kwachotsedwa sikungathe kuchepetsedwa mwachibadwa, kumatha kuphatikizidwa ndi kukhazikika pang'ono kwamkati, ndipo cholumikizira chakunja chingachepetse pang'ono ndikusunga mzere wa mphamvu; ④ Lolani kuchita masewera olimbitsa thupi koyambirira kwa chala chokhudzidwacho m'malo osakhazikika kuti mupewe kuuma kwa cholumikizira ndi osteoporosis; ⑤ Imatha kukonza bwino kusweka kwa manja popanda kukhudza chithandizo cha bala padzanja lokhudzidwa pambuyo pa opaleshoni.
Nthawi yotumizira: Disembala-21-2024
