- 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
- Contraindications
Manya marasa lafiya waɗanda basu dace da tiyata ba.
- Gyaran cikin gida (hankali mai ƙarfi)
Shirye-shiryen riga-kafi na yau da kullun.Ana yin maganin sa barci ta hanyar amfani da maganin sa barci na brachial plexus anesthesia ko maganin sa barci na gabaɗaya
1) .An sanya majiyyaci a cikin matsayi mai zurfi tare da raunin da ya shafa da aka sace kuma an sanya shi a kan firam ɗin tiyata.An yi wani yanki na 8cm tsakanin radial artery na goshin hannu da tsokar carpi radialis mai sassauƙa kuma an mika shi zuwa ga wuyan hannu.Wannan zai iya fallasa karayar gaba daya kuma ya hana tabo.Ciwon ba ya buƙatar shiga cikin tafin hannu (Hoto 1-36A).
2) Bi incision zuwa flexor carpi radialis tendon sheath (Hoto 1-36B), bude kullin jijiya, zurfafa zurfin bamboo fascia na baya don fallasa flexor pollicis longus, yi amfani da yatsan yatsa don aiwatar da flexor pollicis longus zuwa ga gefen ulnar, kuma a ɗan 'yantar da flexor pollicis longus.Ciki na tsoka yana bayyana cikakke ga tsokar quadratus pronator (Hoto 1-36C)
3) Yi wani yanki mai siffar "L" tare da gefen radial na radius zuwa tsarin radial styloid don fallasa tsokar pronator quadratus, sa'an nan kuma cire shi daga radius tare da peeler don fallasa duk layin ninka bamboo (Hoto 1) -36D, Hoto 1-36E)
4) Saka ƙwanƙwasa ko ƙaramar wuƙar ƙashi daga layin karaya, kuma a yi amfani da shi azaman lefa don rage karaya.Saka dissector ko karamar wuka mai almakashi a fadin layin karaya zuwa ga kasusuwan kasusuwa na gefe don rage matsewa da rage karaya mai nisa, sannan a yi amfani da yatsu don damfara guntun dorsal don rage gutsurewar dorsal.
Lokacin da radial styloid fracture ya karye, yana da wuya a rage radial styloid fracture saboda ja na brachioradialis tsoka.Don rage ƙarfin ja, ana iya sarrafa brachioradialis ko a raba shi daga radius mai nisa.Idan ya cancanta, za a iya gyara guntun nisa na ɗan lokaci zuwa guntu mai kusa tare da wayoyin Kirschner.
Idan tsarin ulnar styloid ya karye kuma ya yi gudun hijira, kuma haɗin haɗin rediyo na nesa ba shi da kwanciyar hankali, za a iya amfani da wayoyi ɗaya ko biyu na Kirschner don gyarawa na wucin gadi, kuma tsarin ulnar styloid na iya sake saitawa ta hanyar tsarin volar.Ƙananan karaya yawanci baya buƙatar magani na hannu.Koyaya, idan haɗin haɗin radioulnar mai nisa ba shi da kwanciyar hankali bayan gyara radius, za'a iya fitar da guntun sitiloid kuma gefuna na hadaddun fibrocartilage triangular a sutured zuwa tsarin styloid na ulnar tare da anchors ko zaren siliki.
5) . Tare da taimakon traction, ana iya amfani da capsule na haɗin gwiwa da ligament don saki tsaka-tsakin da kuma rage raguwa.Bayan an sami nasarar rage karayar, tantance matsayin sanya farantin karfen volar a ƙarƙashin jagorancin X-ray fluoroscopy kuma ku dunƙule dunƙule cikin rami na oval ko rami mai zamewa don sauƙaƙe daidaitawar matsayi (Hoto 1-36F).Yi amfani da rami mai diamita na 2.5mm don huda tsakiyar ramin oval, kuma saka dunƙule mai ɗaukar kai na 3.5mm.
Hoto 1-36 Ciwon fata (A);ƙaddamar da kumfa na flexor carpi radialis tendon (B);bare wani ɓangare na gyaggyarawa don fallasa tsokar quadratus pronator (C);tsaga tsokar quadratus pronator don fallasa radius (D);fallasa layin karaya (E);sanya farantin wuta da dunƙule a farkon dunƙule (F)
6) .Yi amfani da C-arm fluoroscopy don tabbatar da sanya farantin da ya dace.Idan ya cancanta, tura farantin nesa ko kusa don samun mafi kyawun wuri mai nisa.
7) .Yi amfani da rawar jiki na 2.0mm don yin rami a ƙarshen ƙarshen farantin karfe, auna zurfin da dunƙule a cikin kulle kulle.Ya kamata ƙusa ya zama ya fi guntu mm 2 fiye da nisa da aka auna don hana dunƙulewa daga shiga da fita daga dorsal cortex.Gabaɗaya, dunƙule 20-22mm ya isa, kuma wanda aka gyara akan tsarin radial styloid yakamata ya zama ya fi guntu.Bayan an dunƙule a cikin dunƙule mai nisa, danna shi Saka sauran dunƙule na kusa.
Saboda an tsara kusurwar dunƙule, idan an sanya farantin kusa da ƙarshen nesa, dunƙule zai shiga haɗin gwiwar hannu.Dauki tangential yanka na articular subchondral kashi daga coronal da sagittal matsayi don kimanta ko ya shiga cikin haɗin gwiwa, sa'an nan kuma bi umarnin Daidaita faranti na karfe da/ko sukurori.
(Hoto1-37) Hoto 1-37 Daidaita raunin radius mai nisa tare da farantin karfe na volar A. Anteroposterior da na gefe na X-ray fim na raguwa na radius kafin aiki, yana nuna ƙaurawar ƙarshen ƙarshen zuwa gefen volar;B. Fim ɗin X-ray na gaba da na gefe na ɓarna bayan aiki, yana nuna karaya mai kyau raguwa da kyawawa haɗin gwiwar hannu.
8) Suture pronator quadratus tsoka tare da sutures marasa sha.Lura cewa tsoka ba zai rufe farantin gaba daya ba.Ya kamata a rufe ɓangaren nesa don rage hulɗar tsakanin tendon mai sassauƙa da faranti.Ana iya samun wannan ta hanyar ɗora pronator quadratus zuwa gefen brachioradialis, rufe Layer Layer ta Layer, da kuma gyara shi da filasta idan ya cancanta.
Lokacin aikawa: Satumba-01-2023
