Nkhani - Chithandizo cha Distal Humeral Fractures

Zotsatira za chithandizo zimadalira kuyikanso kwa anatomical kwa chipika chophwanyika, kukhazikika kwamphamvu kwa fracture, kusungidwa kwa minofu yofewa yabwino komanso masewera olimbitsa thupi oyambirira.

Anatomy

Thedistal humerimagawidwa kukhala gawo lapakati ndi gawo lozungulira (Chithunzi 1).

Chithunzi 1 The distal humerus imakhala ndi gawo lapakati komanso lakumbuyo

Chigawo chapakati chimaphatikizapo gawo lapakati la humeral epiphysis, epicondyle yamkati ya humerus ndi condyle yamkati ya humeral kuphatikizapo humeral glide.

Mzere wam'mbali womwe uli ndi gawo la lateral la humeral epiphysis, epicondyle yakunja ya humer ndi condyle yakunja ya humer kuphatikizapo humeral tuberosity.

Pakati pa mizati iwiri yam'mbali pali anterior coronoid fossa ndi posterior humeral fossa.

Njira yovulaza

Kuphulika kwa supracondylar kwa humerus nthawi zambiri kumachitika chifukwa cha kugwa kuchokera kumalo okwezeka.

Odwala ang'onoang'ono omwe ali ndi intra-articular fractures nthawi zambiri amayamba chifukwa cha kuvulala kwamphamvu kwamphamvu, koma odwala okalamba amatha kukhala ndi fractures ya intra-articular chifukwa cha kuvulala kwamphamvu kwamphamvu chifukwa cha matenda a osteoporosis.

Kulemba

(a) Pali ma fractures a supracondylar, condylar fractures ndi intercondylar fractures.

(b) Kuphulika kwa Supracondylar kwa humerus: malo ophwanyika ali pamwamba pa fossa ya hawk.

(d) intercondylar fracture ya humerus: malo ophwanyika ali pakati pa ma condyles awiri akutali a humerus.

Chithunzi 2 AO kulemba

Kulemba kwa fracture kwa AO (Chithunzi 2)

Mtundu A: ma fractures owonjezera.

Mtundu B: kuthyoka komwe kumakhudza pamwamba (kuphulika kwa mzere umodzi).

Mtundu C: kulekanitsa kwathunthu kwa articular pamwamba pa distal humerus kuchokera ku humeral tsinde (bicolumnar fracture).

Mtundu uliwonse umagawidwanso mu 3 subtypes malinga ndi kuchuluka kwa comminution ya fracture, (1 ~ 3 subtypes ndi kuchuluka kwa comminution mu dongosolo).

Chithunzi 3 Kulemba kwa Riseborough-Radin

Kujambula kwa Riseborough-Radin kwa intercondylar fractures ya humerus (mitundu yonse imaphatikizapo gawo la supracondylar la humerus)

Type I: kusweka popanda kusamuka pakati pa humeral tuberosity ndi talus.

Type II: intercondylar fracture ya humerus ndi kusamuka kwa fracture mass of condyle popanda kupunduka kozungulira.

Mtundu III: intercondylar fracture ya humerus ndi kusamuka kwa fracture fragment ya condyle ndi rotational deformity.

Mtundu IV: kusweka kwakukulu kwapang'onopang'ono kwa ma condyles amodzi kapena onse awiri (Chithunzi 3).

Chithunzi 4 Type I humeral tuberosity fracture

Chithunzi 5 Chigawo cha Humeral tuberosity fracture

Kuphulika kwa humeral tuberosity: kumeta ubweya wa distal humerus

Lembani I: kuphulika kwa humeral tuberosity yonse kuphatikizapo m'mphepete mwa nyanja ya humeral talus (Hahn-Steinthal fracture) (Chithunzi 4).

Mtundu Wachiwiri: Kuphulika kwa subchondral kwa articular cartilage ya humeral tuberosity (Kocher-Lorenz fracture).

Mtundu wa III: kuphulika kwapang'onopang'ono kwa humeral tuberosity (Chithunzi 5).

Chithandizo chosagwira ntchito

Njira zochiritsira zosagwira ntchito za distal humeral fractures zimakhala ndi gawo lochepa.Cholinga cha chithandizo chosagwira ntchito ndi: kusuntha koyambirira kwa mgwirizano kuti tipewe kuuma kwamagulu;Odwala okalamba, omwe nthawi zambiri amadwala matenda amtundu wambiri, ayenera kuthandizidwa ndi njira yosavuta yolumikizira chigongono cha 60 ° kwa masabata a 2-3, ndikutsatiridwa ndi ntchito yopepuka.

Chithandizo cha opaleshoni

Cholinga cha chithandizo ndikubwezeretsa kusuntha kosapweteka kosagwira ntchito kwa mgwirizano (30 ° kufalikira kwa chigongono, 130 ° kupindika kwa chigongono, 50 ° ya kutsogolo ndi kumbuyo kwa kuzungulira);olimba ndi khola mkati fixation wa fracture amalola kuyamba zinchito chigongono ntchito pambuyo khungu chilonda machiritso;kukhazikika kwa mbale ziwiri za distal humerus kumaphatikizapo: medial ndi posterior lateral double plate fixation, kapenamedial ndi lateralkukonza mbale ziwiri.

Njira yopangira opaleshoni

(a) Wodwalayo amaikidwa pamalo okwera pamwamba omwe ali ndi chingwe choyikidwa pansi pa mwendo wokhudzidwa.

kuzindikira ndi kuteteza mitsempha yapakati ndi yozungulira mkati mwa opaleshoni.

Chigongono cham'mbuyo chikhoza kuwonjezereka kwa opaleshoni: osteotomy ya ulnar hawk kapena triceps retraction kuti iwonetsere zophulika zakuya.

ulnar hawkeye osteotomy: kuwonetseredwa kokwanira, makamaka pakuphwanyidwa kwapang'onopang'ono kwa articular surface.Komabe, fracture non-union nthawi zambiri imapezeka pa malo osteotomy.Kuwonongeka kosagwirizanitsa kwachepetsedwa kwambiri ndi ulnar hawk osteotomy (herringbone osteotomy) ndi transtension band wire kapena plate fixation.

Kuwonekera kwa triceps retraction kumatha kuyikidwa pazigawo za distal humeral trifold block fractures ndikuphatikizana, ndipo kuwonekera kokulirapo kwa humeral slide kumatha kudulidwa ndikuwulula nsonga ya ulnar hawk pafupifupi 1 cm.

Zapezeka kuti mbale ziwirizi zikhoza kuikidwa orthogonally kapena mofanana, malingana ndi mtundu wa fracture umene mbale ziyenera kuikidwa.

Ma fractures amtundu wa articular ayenera kubwezeretsedwanso kumtunda wapamwamba ndikukhazikika ku tsinde la humeral.

Chithunzi 6 Kukonzekera kwamkati pambuyo pa opaleshoni ya kuphulika kwa chigongono

Kukonza kwakanthawi kwa chipika chophwanyika kunachitika pogwiritsa ntchito waya wa K, kenako mbale yopondereza mphamvu ya 3.5 mm idakonzedwa kuti ikhale yofanana ndi mbaleyo molingana ndi mawonekedwe omwe ali kumbuyo kwa gawo lozungulira la distal humerus, ndipo mbale yomanganso ya 3.5 mm idapangidwanso. anakonza kuti mawonekedwe a mzati medial, kuti mbali zonse za mbale zigwirizane ndi fupa pamwamba (watsopano pasadakhale woumba mbale akhoza kukhala wosalira zambiri ndondomeko.) (Chithunzi 6).

Samalani kuti musakonze fracture ya articular surface fragment yokhala ndi zomangira zonse za cortical zokhala ndi kukakamiza kuchokera pakati kupita kumbali yakumbuyo.

malo a epiphysis-humerus zikwi zosamuka ndikofunika kupewa kusagwirizana kwa fracture.

kupereka fupa kumezanitsa kudzaza pamalo a fupa chilema, ntchito iliac cancellous fupa kumezanitsa kudzaza psinjika fracture chilema: medial mzati, articular pamwamba ndi lateral ndime, Ankalumikiza cancellous fupa mbali ndi intact periosteum ndi compression fupa chilema pa epiphysis.

Kumbukirani mfundo zazikulu za kukonza.

Kukonzekera kwachidutswa cha distal fracture ndi ambirizomangiramomwe zingathere.

kukonza tiziduswa tambirimbiri momwe tingathere ndi zomangira zowoloka pakati kupita kumbali.

Zitsulo zachitsulo ziyenera kuikidwa pakatikati ndi mbali za mbali za distal humer.

Njira zothandizira: Total elbow arthroplasty

Kwa odwala omwe amathyoka kwambiri kapena osteoporosis, arthroplasty yonse ya chigongono imatha kubwezeretsa kusuntha kwa chigongono ndi kugwira ntchito kwa manja pambuyo pa odwala omwe safuna kwambiri;njira yopangira opaleshoni ndi yofanana ndi arthroplasty yonse ya kusintha kosasinthika kwa mgwirizano wa chigongono.

(1) kugwiritsa ntchito prosthesis yamtundu wautali kuti mupewe kufalikira kwapakati.

(2) Chidule cha ntchito za opaleshoni.

(a) Njirayi imachitidwa pogwiritsa ntchito njira ya kumbuyo kwa chigongono, ndi masitepe ofanana ndi omwe amagwiritsidwa ntchito pa distal humeral fracture incision and internal fixation (ORIF).

Anteriorization wa ulnar mitsempha.

mwayi wodutsa mbali zonse ziwiri za triceps kuchotsa fupa logawanika (mfundo yofunika: musadule kuyima kwa triceps pamalo a ulnar hawk).

The distal humerus kuphatikizapo fossa ya hawk ikhoza kuchotsedwa ndikuyika prosthesis, yomwe siidzasiya sequelae yofunikira ngati yowonjezera I mpaka 2 cm ichotsedwa.

Kusintha kwamphamvu yamkati ya minofu ya triceps pakuyenerera kwa humeral prosthesis pambuyo podulidwa kwa humeral condyle.

Kudulidwa kwa nsonga ya proximal ulnar eminence kuti athe kupeza bwino kuti awonetsedwe ndi kukhazikitsa gawo la prosthesis ya ulnar (Chithunzi 7).

Chithunzi 7 Elbow arthroplasty

Kusamalira pambuyo pa opaleshoni

Kugawanika kwa postoperative kwa mbali yakumbuyo kwa chigongono kuyenera kuchotsedwa pamene chilonda cha khungu cha wodwalayo chira, ndipo masewero olimbitsa thupi amayenera kuyambitsidwa;mgwirizano wa chigongono uyenera kukhazikitsidwa kwa nthawi yayitali yokwanira pambuyo polowa m'malo ophatikizana kuti apititse machiritso a chilonda cha khungu (mgwirizano wa chigongono ukhoza kukhazikitsidwa molunjika kwa masabata a 2 mutatha opaleshoni kuti athandize kupeza ntchito yowonjezera);splint yochotsedwa yokhazikika tsopano imagwiritsidwa ntchito kawirikawiri kuchipatala kuti athandize machitidwe osiyanasiyana oyenda pamene Ikhoza kuchotsedwa kawirikawiri kuti iteteze bwino mwendo womwe wakhudzidwa;Kuchita masewera olimbitsa thupi nthawi zambiri kumayamba pakadutsa masabata 6-8 chilonda chakhungu chikachira.