- Alamomi
1). Karyewar da aka samu a cikin ƙashin ƙugu yana da matsi a bayyane, kuma saman haɗin gwiwa na radius na nesa ya lalace.
2). Ragewa da hannu ya gaza ko kuma gyarawa ta waje ya kasa kiyaye raguwar.
3).Tsoffin karyewar jiki.
4). Karyewar ƙashi ko rashin haɗin kai. ƙashi da ke akwai a gida da waje
- Abubuwan da ba su dace ba
Tsofaffin marasa lafiya waɗanda ba su dace da tiyata ba.
- Gyaran ciki (hanyar volar)
Shirye-shiryen yau da kullun kafin tiyata. Ana yin maganin sa barci ta amfani da maganin sa barci na brachial plexus ko kuma maganin sa barci na gaba ɗaya.
1). Ana sanya majiyyaci a kwance, sannan a ɗauko gaɓar da abin ya shafa a kan firam ɗin tiyata. An yi yanke mai tsawon santimita 8 tsakanin jijiyar radial ta hannun hannu da kuma tsokar radialis mai lanƙwasa sannan a miƙa ta zuwa ga ƙugu. Wannan zai iya fallasa karyewar gaba ɗaya da kuma hana tabo ya yi kauri. Ba sai an yi yankewar a tafin hannu ba (Hoto na 1-36A).
2). Bi hanyar yankewa zuwa murfin jijiyar flexor carpi radialis (Hoto na 1-36B), buɗe murfin jijiyar, yanke zurfin fascia na gaba na bamboo don fallasa longus na flexor pollicis, yi amfani da yatsan nuni don nuna longus na flexor pollicis zuwa gefen ulnar, sannan a saki longus na flexor pollicis. Cikin tsoka yana fuskantar tsokar pronator quadratus gaba ɗaya (Hoto na 1-36C)
3). Yi yanke mai siffar "L" tare da gefen radius na radius zuwa tsarin radial styloid don fallasa tsokar pronator quadratus, sannan a cire shi daga radius da mai barewa don fallasa dukkan layin ninki na bamboo (Hoto na 1-36D, Hoto na 1-36E)
4). Saka wani abin cirewa ko ƙaramin wukar ƙashi daga layin karyewar, sannan a yi amfani da shi azaman abin rage karyewar. Saka wani abu mai cirewa ko ƙaramin wukar almakashi a kan layin karyewar zuwa ga ɓangaren ƙashi na gefe don rage matsi da rage ɓarin karyewar da ke nesa, sannan a yi amfani da yatsun hannu don matse ɓarin karyewar da ke bayan baya don rage ɓarin karyewar da ke bayan baya.
Idan aka samu karyewar radial styloid, yana da wuya a rage karyewar radial styloid saboda jan tsokar brachioradialis. Don rage karfin jan, ana iya sarrafa ko kuma a raba brachioradialis daga radius na nesa. Idan ya cancanta, ana iya danne guntun na nesa na ɗan lokaci zuwa guntun kusa da wayoyi na Kirschner.
Idan tsarin ulnar styloid ya karye ya kuma canza, kuma haɗin radioulnar na distal bai da ƙarfi, ana iya amfani da wayoyi ɗaya ko biyu na Kirschner don gyarawa ta hanyar da ta dace, kuma ana iya sake saita tsarin ulnar styloid ta hanyar hanyar volar. Ƙananan karyewar yawanci ba sa buƙatar magani da hannu. Duk da haka, idan haɗin radioulnar na distal bai da ƙarfi bayan an gyara radius ɗin, za a iya cire guntun styloid ɗin kuma a haɗa gefuna na hadaddun fibrocartilage mai siffar triangle zuwa tsarin ulnar styloid da anga ko zaren siliki.
5). Tare da taimakon jan hankali, ana iya amfani da kapsul da jijiyar haɗin gwiwa don sakin haɗin gwiwa da rage karyewar. Bayan an rage karyewar cikin nasara, a tantance matsayin wurin da farantin ƙarfe mai ƙarfi ya sanya ƙarƙashin jagorancin X-ray fluoroscopy sannan a dunƙule sukurori a cikin ramin oval ko ramin zamiya don sauƙaƙe daidaita matsayi (Hoto na 1-36F). Yi amfani da ramin haƙa rami mai girman 2.5mm don haƙa tsakiyar ramin oval, sannan a saka sukurori mai girman 3.5mm mai taɓawa.
Hoto na 1-36 Yanke fata (A); yanke murfin jijiyar flexor carpi radialis (B); cire wani ɓangare na jijiyar flexor don fallasa tsokar pronator quadratus (C); raba tsokar pronator quadratus don fallasa radius (D); fallasa layin karyewa (E); sanya farantin volar kuma a ɗaure a cikin sukurori na farko (F)
6). Yi amfani da na'urar fluoroscopy ta C-arm don tabbatar da wurin da aka sanya faranti yadda ya kamata. Idan ya cancanta, tura faranti a nesa ko kusa don samun mafi kyawun wurin da aka sanya sukurori na nesa.
7). Yi amfani da haƙa rami mai girman 2.0mm don haƙa rami a ƙarshen farantin ƙarfe, auna zurfin kuma kunsa sukurori a cikin sukurori mai kullewa. Ya kamata ƙusa ta yi guntu da 2mm fiye da nisan da aka auna don hana sukurori shiga da fitowa daga cortex na baya. Gabaɗaya, sukurori mai girman 20-22mm ya isa, kuma wanda aka gyara akan tsarin radial styloid ya kamata ya yi gajere. Bayan an yi sukurori a cikin distal, a ɗaure shi. Saka sauran sukurori na kusa.
Domin an tsara kusurwar sukurori, idan farantin ya yi kusa da ƙarshen nesa, sukurori zai shiga haɗin wuyan hannu. Ɗauki yanka mai kama da ƙashin subchondral na articular daga matsayin coronal da sagittal don tantance ko ya shiga haɗin, sannan a bi umarnin. Daidaita faranti na ƙarfe da/ko sukurori.
(Hoto na 1-37) Hoto na 1-37 Daidaita karyewar radius ta nesa tare da farantin ƙashi mai siffar ƙashi A. Fim ɗin X-ray na anteroposterior da na gefe na karyewar radius ta nesa kafin a yi aiki, yana nuna matsar ƙarshen nesa zuwa gefen volar; B. Fim ɗin X-ray na anteroposterior da na gefe na karyewar bayan tiyata, yana nuna karyewa Ragewa mai kyau da kuma kyakkyawan sharewar haɗin gwiwar wuyan hannu
8). A dinka tsokar pronator quadratus da dinkin da ba za a iya sha ba. A lura cewa tsokar ba za ta rufe farantin gaba daya ba. Ya kamata a rufe sashin nesa don rage hulɗa tsakanin jijiyar lankwasawa da farantin. Ana iya cimma wannan ta hanyar dinka pronator quadratus zuwa gefen brachioradialis, a rufe layin yankewa ta hanyar layi, sannan a gyara shi da filasta idan ya cancanta.
Lokacin Saƙo: Satumba-01-2023
