1. Alamu
1) Ƙarƙashin ƙwayar cuta mai tsanani yana da ƙayyadaddun ƙaura, kuma an lalatar da gefen radius mai nisa.
2) Ragewa na hannu ya kasa ko gyaran waje ya kasa kula da raguwa.
3).Tsoffin karaya.
4).Karya malunion ko rashin hadin kai.kashi a nan gida da waje
2.Contraindications
Manya marasa lafiya waɗanda basu dace da tiyata ba.
3. External fixation dabaran tiyata
1. Cross-articular mai gyara waje na waje don gyara ɓarkewar radius mai nisa
Matsayi da shirye-shiryen riga-kafi:
· Ciwon Brachial plexus anesthesia
· Matsayi na baya tare da shimfiɗaɗɗen gaɓoɓin da abin ya shafa akan madaidaicin gani kusa da gado
Aiwatar da yawon shakatawa zuwa 1/3 na hannun sama
· Sa ido na hangen nesa
Dabarun tiyata
Shigar Metacarpal Screw:
Na farko dunƙule yana located a gindi na biyu metacarpal kashi.Ana yin yankan fata tsakanin jijiyar extensor na yatsan hannu da tsokar interosseous na dorsal na kashi na farko.An raba nama mai laushi a hankali tare da ƙarfin tiyata.Hannun hannu yana kare nama mai laushi, kuma an saka 3mm Schanz dunƙule.Sukurori
Hanyar dunƙule shine 45° zuwa jirgin dabino, ko kuma yana iya zama daidai da jirgin dabino.
Yi amfani da jagorar don zaɓar matsayi na dunƙule na biyu.An kori dunƙule 3mm na biyu a cikin metacarpal na biyu.
Diamita na fil ɗin gyarawar metacarpal kada ya wuce 3mm.Fitin gyarawa yana cikin kusancin 1/3.Ga marasa lafiya da osteoporosis, mafi kusantar dunƙule zai iya shiga uku yadudduka na cortex (na biyu metacarpal kashi da rabin bawo na uku metacarpal kashi).Ta wannan hanyar, dunƙule Dogon gyaran hannu mai tsayi da ƙaƙƙarfan ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun madaidaicin fil.
Sanya skru radial:
Yi yankan fata a gefen radius na gefe, tsakanin tsokar brachioradialis da tsoka carpi radialis extensor, 3cm sama da kusancin ƙarshen layin karaya kuma kusan 10cm kusa da haɗin gwiwar wuyan hannu, kuma yi amfani da hemostat don raba subcutaneous a hankali. nama zuwa saman kashi.Ana kulawa don kare rassan jijiyar radial da ke cikin wannan yanki.
A kan wannan jirgin sama kamar sukurori na metacarpal, 3mm Schanz screws an sanya su a ƙarƙashin jagorancin jagorar kariyar taushin hannu.
·. Rage karaya da gyarawa:
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·. Gyaran waje a fadin haɗin gwiwar hannu yana da wuya a sake dawo da kusurwar dabino gaba ɗaya, don haka ana iya haɗa shi tare da Kapandji fil don taimakawa wajen ragewa da gyarawa.
· Ga marasa lafiya tare da radial styloid fractures, radial styloid Kirschner waya gyara za a iya amfani da.
· Yayin da ake ci gaba da raguwa, haɗa mai gyaran waje na waje kuma sanya cibiyar jujjuyawar na'urar ta waje a kan wannan axis kamar cibiyar juyawa na haɗin gwiwar hannu.
·.Anteroposterior da lateral fluoroscopy, duba ko an dawo da tsayin radius, kusurwar dabino da kusurwar ulnar, sannan a daidaita kusurwar daidaitawa har sai raguwar karaya ya gamsar.
·Kula da haɗin gwiwar ƙasa na mai gyara na waje, yana haifar da raunin iatrogenic a screws metacarpal.
Karyewar radius mai nisa haɗe tare da rabuwar haɗin gwiwa na radioulnar (DRUJ):
Yawancin DRUJs ana iya rage su ba tare da bata lokaci ba bayan an rage radius mai nisa.
Idan har yanzu DRUJ ta rabu bayan an rage radius mai nisa, yi amfani da raguwar matsawa na hannu kuma yi amfani da gyaran sandar gefe na sashin waje.
Ko amfani da K-wayoyi don kutsawa cikin DRUJ a cikin tsaka tsaki ko dan kadan.
Karyewar radius mai nisa haɗe tare da karaya ta ulnar styloid: Bincika daidaiton DRUJ a cikin pronation, tsaka tsaki da karkatar da hannun gaba.Idan rashin kwanciyar hankali ya kasance, ana iya amfani da gyare-gyaren gyare-gyare tare da wayoyi na Kirschner, gyaran ligament na TFCC, ko ka'idar bandeji don gyara tsarin Ulnar styloid.
Guji wuce gona da iri:
· Bincika ko yatsun majiyyaci na iya yin cikakkiyar jujjuyawar motsi da haɓakawa ba tare da tashin hankali ba;kwatanta sararin haɗin gwiwa na radiolunate da sararin haɗin gwiwa na tsakiya.
· Bincika ko fatar da ke tashar ƙusa ta matse sosai.Idan ya matse sosai, yi abin da ya dace don guje wa kamuwa da cuta.
Ƙarfafa majiyyata su motsa yatsunsu da wuri, musamman jujjuyawa da haɓaka haɗin gwiwar metacarpophalangeal na yatsunsu, ƙwanƙwasa da ƙarar yatsan hannu, da kuma sacewa.
2. Gyara raunin radius mai nisa tare da mai gyara waje wanda baya ketare haɗin gwiwa:
Matsayi da shiri na farko: Daidai kamar da.
Dabarun tiyata:
Wuraren aminci don sanya K-waya a gefen dorsal na radius mai nisa sune: a ɓangarorin biyu na tubercle na Lister, a ɓangarorin biyu na jijiyar polycis longus extensor, kuma tsakanin extensor digitorum communis tendon da extensor digiti minimi tendon.
Hakazalika, an sanya screws guda biyu na Schanz a cikin radial shaft kuma an haɗa su tare da sandar haɗi.
Ta hanyar yankin aminci, an saka screws guda biyu na Schanz a cikin ɓangarorin radius mai nisa, ɗaya daga gefen radial kuma ɗaya daga gefen dorsal, tare da kusurwa na 60 ° zuwa 90 ° zuwa juna.Ya kamata dunƙule ya riƙe bawo mai cin karo da juna, kuma ya kamata a lura cewa tip ɗin dunƙule da aka saka a gefen radial ba zai iya wucewa ta sigmoid notch kuma ya shiga haɗin haɗin radioulnar mai nisa.
Haɗa dunƙule Schanz a radius mai nisa tare da hanyar haɗi mai lanƙwasa.
Yi amfani da sandar haɗin tsaka-tsaki don haɗa sassan biyu da suka karye, kuma a yi hattara kar ku kulle gungu na ɗan lokaci.Tare da taimakon tsaka-tsakin tsaka-tsakin, an rage raguwa mai nisa.
Bayan sake saiti, kulle chuck akan sandar haɗi don kammala wasan ƙarshegyarawa.
Bambanci tsakanin mai gyara waje na waje da ba na haɗin gwiwa ba da mai gyara waje mai haɗin gwiwa:
Saboda ana iya sanya screws da yawa na Schanz don kammala raguwa da gyaran gyare-gyare na kashi, alamun tiyata don masu gyara waje na waje ba tare da haɗin gwiwa ba sun fi girma fiye da na masu haɗin gwiwar waje.Bugu da ƙari ga karaya mai ƙarfi, ana iya amfani da su don karaya na biyu zuwa na uku.Fassara ɓangarori na intra-articular.
Mai gyara waje na giciye yana gyara haɗin gwiwar wuyan hannu kuma baya ba da izinin motsa jiki na farko, yayin da mai gyara waje ba tare da haɗin gwiwa ba yana ba da damar aikin haɗin gwiwa na haɗin gwiwa na farko.
Lokacin aikawa: Satumba-12-2023
