Metacarpal phalangeal fractures ndi zowawa zowawa pamanja, zomwe zimawerengera pafupifupi 1/4 ya odwala ovulala pamanja. Chifukwa cha mawonekedwe osavuta komanso ovuta a dzanja ndi kayendetsedwe kake kake, kufunikira ndi luso la chithandizo cha kuthyoka kwa manja ndizovuta kwambiri kusiyana ndi chithandizo cha mafupa ena aatali. Kuonetsetsa kukhazikika kwa fracture pambuyo pochepetsera ndiye chinsinsi cha chithandizo chopambana cha metacarpal phalangeal fractures. Pofuna kubwezeretsa ntchito ya dzanja, fractures nthawi zambiri amafuna kukonza koyenera. M'mbuyomu, pulasitala kunja fixation kapena Kirschner waya fixation mkati nthawi zambiri ankagwiritsidwa ntchito, koma nthawi zambiri si kothandiza oyambirira postoperative olowa kukonzanso kuphunzitsidwa chifukwa cha kusakhazikika bwino kapena nthawi yaitali fixation, amene zimakhudza kwambiri kuchira ntchito ya chala olowa ndi kubweretsa zovuta zina kukonzanso ntchito za dzanja. Njira zamakono zochizira zikuchulukirachulukira kugwiritsa ntchito kukhazikika kwamkati mwamphamvu, monga kukhazikika kwa micro-plate screw.
Ine.Mfundo za chithandizo ndi chiyani?
Mfundo zochizira dzanja la metacarpal ndi phalangeal fractures: kuchepetsa ma anatomical, kukonza kuwala ndi kolimba, zochitika zoyambirira ndi maphunziro ogwira ntchito. Mfundo zochizira za intra-articular ndi peri-articular fractures za dzanja ndizofanana ndi za ma fractures ena a intra-articular, omwenso amabwezeretsa mawonekedwe a malo olumikizirana komanso zochitika zoyambirira zogwirira ntchito. Pochiza dzanja la metacarpal ndi phalangeal fractures, kuyesayesa kuyenera kuchitidwa kuti kuchepetsa thupi, ndi kuzungulira, kugwedezeka kwapambuyo, kapena kusamuka kwa angular> 10 ° ku mbali ya dorsal ya kanjedza sikuyenera kuchitika. Ngati fracture mapeto a metacarpal phalange atembenuza kapena angularly displaces laterally, izo kusintha trajectory wa flexion yachibadwa ndi kutambasuka kayendedwe ka chala, kuchititsa kusuntha kapena kugwa ndi chala moyandikana pa flexion, zimakhudza kulondola kwa chala ntchito; ndipo pamene kusuntha kwa angular ku mbali ya dorsal ya kanjedza ndi> 10 °, kuyanjana kosalala pakati pa fupa ndi tendon kumawonongeka, kuonjezera kukana ndi kusuntha kwa kayendetsedwe kake ndi kufalikira kwa tendon, ndipo kuwonongeka kwa tendon kosatha kumachitika, kuchititsa ngozi ya kuphulika kwa tendon.
II.Ndi zinthu ziti zomwe zingasankhidwe pakupanga ma metacarpal fractures?
Pali zida zambiri zokonzera mkati mwazowonongeka za metacarpal, monga mawaya a Kirschner, zomangira, mbale ndi zopangira zakunja, zomwe mawaya a Kirschner ndi ma microplates ndi omwe amagwiritsidwa ntchito kwambiri. Kwa fractures ya metacarpal, microplate internal fixation ili ndi ubwino wodziwikiratu kuposa kukonza waya wa Kirschner ndipo ingagwiritsidwe ntchito poyamba; kwa proximal phalanx fractures, ma microplates nthawi zambiri amakhala apamwamba, koma pamene kuli kovuta kuyika zomangira za proximal phalanx distal segment ndi fractures mutu, mtanda wa Kirschner waya wamkati uyenera kugwiritsidwa ntchito, womwe umakhala wothandiza kwambiri kuti abwezeretse ntchito ya chala chomwe chakhudzidwa; Mawaya a Kirschner ayenera kugwiritsidwa ntchito poyamba pochiza fractures yapakati ya phalanx.
- Kirschner waya:Kirschner wire internal fixation yakhala ikugwiritsidwa ntchito pazachipatala kwa zaka zoposa 70 ndipo nthawi zonse yakhala ikugwiritsidwa ntchito kwambiri mkati mwazowonongeka za metacarpal ndi phalangeal. Ndiosavuta kugwiritsa ntchito, yotsika mtengo komanso yothandiza, ndipo ndiyo njira yabwino kwambiri yokonzera mkati. Monga momwe zimagwiritsidwira ntchito kwambiri mkati mwachizoloŵezi chochizira fractures zamanja, zimagwiritsidwabe ntchito kwambiri. Ubwino wa Kirschner waya wokhazikika mkati: ① Yosavuta kugwiritsa ntchito komanso yosinthika kugwiritsa ntchito; ② Kuchotsa minofu yofewa pang'ono, kukhudzika pang'ono kwa magazi kumapeto kwa fracture, kuvulala kochepa kwa opaleshoni, komanso kumapangitsa kuti machiritso awonongeke; ③ Chosavuta kuchotsa singano kachiwiri; ④ Zotsika mtengo komanso zogwiritsidwa ntchito mosiyanasiyana, zoyenera kuthyoka manja ambiri (monga fractures ya intra-articular, fractures yayikulu kwambiri ndi distal phalangeal fractures).
2. Metacarpophalangeal microplates: Kukonzekera kwamphamvu kwamkati kwa fractures ya manja ndiko maziko a maphunziro oyambirira ogwira ntchito komanso chikhalidwe chofunikira kuti abwezeretse ntchito yabwino ya manja. Ukadaulo wokhazikika wa AO wamkati umafunikira kuti malekezero a fracture akhazikitsidwe moyenera molingana ndi kapangidwe ka anatomical komanso kuti fracture imatha kukhala yokhazikika pansi pamikhalidwe yogwira ntchito, yomwe imadziwika kuti kukhazikika mwamphamvu, kuti alole kusuntha koyambirira kogwira ntchito. AO imagogomezeranso maopaleshoni omwe amangowononga pang'ono, ndikuwunika kwambiri kuteteza magazi. Kukonzekera kwamkati kwa Microplate pochiza fractures ya manja kungathe kupeza zotsatira zokhutiritsa ponena za mphamvu, kukhazikika kwa mapeto a fracture, ndi kupanikizika pakati pa mapeto a fracture. Pankhani ya kuchira pambuyo pa opaleshoni, nthawi yochizira fracture, komanso kuchuluka kwa matenda, akukhulupirira kuti mphamvu ya mbale za microtitanium ndi yabwino kwambiri kuposa mawaya a Kirschner. Komanso, popeza kuti nthawi yochiza fracture itatha kukonza ndi mbale za microtitanium ndi yochepa kwambiri kuposa njira zina zokonzera, ndizopindulitsa kuti odwala ayambirenso moyo wabwinobwino msanga.
(1) Kodi ubwino wa microplate internal fixation ndi chiyani?
① Poyerekeza ndi mawaya a Kirschner, zomangira za microplate zimakhala ndi kuyanjana kwa minofu komanso kuyankha bwino kwa minofu; ② Kukhazikika kwa mbale-screw fixation system ndi kupanikizika kwa mapeto a fracture kumapangitsa kuti fracture ikhale pafupi ndi kuchepetsa thupi, kukhazikika kotetezeka, ndikuthandizira kuchiritsa kwa fracture; ③ Kuchita masewera olimbitsa thupi koyambirira kumaloledwa pambuyo pa kukonza kwa microplate, komwe kumathandizira kuchira kwa manja.
(2)Kodi njira yopangira opaleshoni ya ma microplates ndi iti?
Opaleshoniyo nthawi zambiri imachitidwa pansi pa anesthesia ya brachial plexus block, ndipo ulendo wa pneumatic umafunika. The dorsal incision of metacarpal phalanges imatengedwa, dorsal aponeurosis ya manambala imadulidwa kapena minofu ya interosseous ndi metacarpal fupa amalowetsedwa kuti awonetse malekezero a mafupa a metacarpal kapena phalangeal, periosteum imachotsedwa, ndipo kupasuka kumachepetsedwa pansi pa masomphenya achindunji. Mimba yowongoka ndi yoyenera kuphulika kwapakati pagawo lapakati ndi fractures zazifupi za oblique, T-plates ndi yoyenera kukhazikitsidwa kwa maziko a metacarpal ndi phalanges, ndi T-plates kapena 120 ° ndi 150 ° L-plates ndi oyenera kukonza fractures yaitali oblique ndi comminuted. Mbaleyi nthawi zambiri imayikidwa pambali pa fupa kuti tendon isasunthike komanso kuvala kwa nthawi yayitali, zomwe zimathandiza kuphunzitsidwa koyambirira. Zopangira zosachepera ziwiri ziyenera kugwiritsidwa ntchito kukonza malekezero awiri a fracture, apo ayi kukhazikika kumakhala kosauka, ndipo mawaya a Kirschner kapena zomangira kunja kwa mbale zimafunikira kuti zithandizire kukonza kukwaniritsa cholinga chokhazikika chokhazikika.
3. Zomangira zazing'ono: Zomangira zazing'ono zimakhala ndi kukhazikika kofanana ndi mbale zachitsulo pakukonzekera kwa spiral kapena yaitali oblique fractures, koma mitundu yofewa ya minofu ndi periosteum stripping ndi yaying'ono kuposa yazitsulo zachitsulo, zomwe zimathandiza kuteteza magazi komanso mogwirizana ndi lingaliro la opareshoni yaing'ono. Ngakhale kuti pali T-mtundu ndi L-mtundu mbale kwa pafupi-articular fractures, kubwezeretsa ntchito olowa pambuyo kutsatira pambuyo opaleshoni ndi zoipa kuposa diaphyseal fractures. Zomangira zazing'ono zilinso ndi maubwino ena pakukonza ma intra-articular ndi peri-articular fractures. Zitsulo zomwe zimapangidwira mu fupa la cortical zimatha kupirira kupsinjika kwakukulu, kotero kukhazikika kumakhala kolimba, ndipo mapeto a fracture amatha kupanikizidwa kuti fracture ikhale pafupi kwambiri, kuchepetsa nthawi ya machiritso a fracture ndikuthandizira machiritso a fracture, monga momwe tawonetsera pa Chithunzi 4-18. Kukhazikika kwamkati kwamkati kwa ma fractures am'manja kumagwiritsidwa ntchito makamaka pakuthyoka kwa oblique kapena spiral of diaphyseal ndi intra-articular avulsion fractures ya midadada yayikulu. Tikumbukenso kuti pogwiritsira ntchito zomangira mini okha kukonza oblique kapena ozungulira fractures wa diaphyseal fupa la dzanja, kutalika kwa mzere wosweka kuyenera kukhala osachepera kawiri awiri a diaphyseal fupa, ndipo pokonza avulsed fracture midadada mu olowa, m'lifupi fupa chipika ayenera kukhala osachepera 3 m'mimba mwake wa ulusi.
4. Micro fixator kunja:Kuphulika kwa metacarpal phalangeal fractures nthawi zina kumakhala kovuta kuchepetsa mwachibadwa kapena sikungakhazikitsidwe mwamphamvu mkati ngakhale mutapanga opaleshoni chifukwa cha kuwonongeka kwa fupa. The fixator kunja akhoza kubwezeretsa ndi kusunga kutalika kwa comminuted fracture pansi traction, kusewera mbali ya fixation wachibale. Zosintha zakunja za metacarpal phalangeal zimayikidwa m'malo osiyanasiyana: 1st ndi 2nd metacarpal phalanges amayikidwa pa dorsal radial phalanges, 4th ndi 5th metacarpal phalanges amayikidwa pa dorsal ulnar side, ndipo 3rd metacarpal phalange imayikidwa pambali pa dorsal dorsal. Samalani malo olowetsa singano kuti muteteze kuwonongeka kwa tendon. Kuphulika kotsekedwa kumatha kuchepetsedwa pansi pa X-ray. Pamene kuchepetsa sikuli koyenera, kudulidwa pang'ono kungapangidwe kuti athandize kuchepetsa.
Kodi ubwino wa okonza kunja ndi chiyani?
① Opaleshoni yosavuta, imatha kusintha kusuntha kosiyanasiyana kwa malekezero osweka; ② Imatha kuchepetsa ndikukonza bwino mafupa a metacarpophalangeal mafupa osawononga olowa, ndipo amatha kusokoneza malo olowa kuti apewe kugundana kwa kapisozi ndi minyewa yolumikizirana; ③ Pamene fractures comminuted sangathe anatomically kuchepetsedwa, iwo akhoza kuphatikizidwa ndi kukhazikika pang'ono mkati, ndi fixator kunja akhoza pang'ono kuchepetsa ndi kusunga mphamvu mzere; ④ Lolani kuchita masewera olimbitsa thupi koyambirira kwa chala chomwe chakhudzidwa pagulu losakhazikika kuti mupewe kuuma kwa mafupa ndi mafupa; ⑤ Itha kukonza bwino zosweka zamanja popanda kukhudza chithandizo chapambuyo pa bala pa dzanja lomwe lakhudzidwa.
Nthawi yotumiza: Dec-21-2024
