A halin yanzu don gyara karyewar radius na ciki, akwai tsarin faranti daban-daban na kulle jiki da ake amfani da su a asibitin. Waɗannan gyaran ciki suna ba da mafita mafi kyau ga wasu nau'ikan karyewar jiki masu rikitarwa, kuma a wasu hanyoyi suna faɗaɗa alamun tiyata don karyewar radius na nesa mara ƙarfi, musamman waɗanda ke da osteoporosis. Farfesa Jupiter daga Babban Asibitin Massachusetts da wasu sun buga jerin labarai a cikin JBJS game da bincikensu kan gyaran faranti na kulle karyewar radius na nesa da dabarun tiyata masu alaƙa. Wannan labarin ya mayar da hankali kan hanyar tiyata don gyara karyewar radius na nesa bisa ga gyarawa ta ciki na wani toshe na karyewar ciki.
Dabaru na Tiyata
Ka'idar ginshiƙai uku, bisa ga halayen biomechanical da anatomical na radius na distal ulnar, ita ce tushen ci gaba da amfani da tsarin faranti na 2.4mm a asibiti. An nuna rabuwar ginshiƙai uku a Hoto na 1.
Hoto na 1 Ka'idar ginshiƙi uku na radius na ulnar na nesa.
Ginshiƙin gefe shine rabin gefe na radius na nesa, gami da navicular fossa da radial tuberosity, wanda ke tallafawa ƙasusuwan carpal a gefen radial kuma shine asalin wasu jijiyoyin da ke daidaita wuyan hannu.
Ginshiƙin tsakiya shine rabin tsakiya na radius na nesa kuma ya haɗa da fossa na lunate (wanda ke da alaƙa da lunate) da kuma sigmoid notch (wanda ke da alaƙa da distal ulna) akan saman articular. Yawanci ana ɗora nauyin daga lunate fossa ana aika shi zuwa radius ta hanyar lunate fossa. Ginshiƙin gefe na ulnar, wanda ya haɗa da distal ulna, triangular fibrocartilage, da kuma na baya ulnar-radial haɗin gwiwa, yana ɗaukar kaya daga ƙasusuwan ulnar carpal da kuma daga na baya ulnar-radial haɗin gwiwa kuma yana da tasirin daidaitawa.
Ana yin aikin ne a ƙarƙashin maganin sa barci na brachial plexus kuma yana da mahimmanci a ɗauki hoton X-ray na C-arm a lokacin tiyata. An yi amfani da maganin rigakafi a cikin jijiya aƙalla mintuna 30 kafin a fara aikin, sannan aka yi amfani da tourniquet na numfashi don rage zubar jini.
Gyaran farantin Palmar
Ga yawancin karaya, ana iya amfani da hanyar palmar don hango tsakanin radial carpal flexor da radial jijiyar. Bayan gano da kuma janye flexor carpi radialis longus, ana iya ganin zurfin saman tsokar pronator teres kuma ana ɗaga rabuwar siffar "L". A cikin karaya mafi rikitarwa, ana iya sake sakin jijiyar brachioradialis don sauƙaƙe rage karyewa.
Ana saka fil ɗin Kirschner a cikin haɗin radial carpal, wanda ke taimakawa wajen ƙayyade iyakokin radius mafi nisa. Idan akwai ƙaramin taro na karyewa a gefen articular, ana iya sanya farantin ƙarfe mai girman palmar 2.4mm a kan gefen articular na radius don gyarawa. A wata ma'anar, ana iya ɗaukar ƙaramin taro na karyewa a saman articular na lunate da farantin "L" ko "T" mai girman 2.4mm, kamar yadda aka nuna a Hoto na 2.
Ga karaya ta baya da ta ɓace daga baya, yana da kyau a lura da waɗannan abubuwan. Da farko, yana da mahimmanci a sake saita karaya ta ɗan lokaci don tabbatar da cewa babu nama mai laushi da aka saka a ƙarshen karaya. Na biyu, ga marasa lafiya waɗanda ba su da osteoporosis, ana iya rage karayar tare da taimakon faranti: da farko, ana sanya sukurori mai kullewa a ƙarshen farantin jikin mutum na palmar, wanda aka ɗaure shi zuwa ɓangaren karyewar nesa da ta ɓace, sannan a rage sassan karyewar nesa da ta kusanci tare da taimakon faranti, kuma a ƙarshe, ana sanya wasu sukurori kusa da juna
HOTO NA 3 An rage karyewar ƙashi na musamman na radius ɗin nesa da aka canza daga baya kuma an gyara shi ta hanyar amfani da hanyar palmar. HOTO NA 3-A Bayan kammala fallasa ta hanyar lankwasawa ta radial carpal da jijiyar radial, an sanya fil ɗin Kirschner mai santsi a cikin haɗin radial carpal. Hoto na 3-B Sarrafa ƙwayar metacarpal da aka canza don sake saita ta.
An sanya fil ɗin Kirschner mai santsi daga tushe mai radial ta hanyar layin karyewa don gyara ƙarshen karyewar na ɗan lokaci.
Hoto na 3-E Ana samun isassun hotunan filin aikin ta hanyar amfani da na'urar cirewa kafin a sanya faranti. HOTO NA 3-F Layin nesa na sukurori masu kullewa an sanya su kusa da ƙashin subchondral a ƙarshen naɗewar nesa.
Ya kamata a yi amfani da hoton X-ray fluoroscopy na 3-G don tabbatar da matsayin farantin da sukurori na nesa. Hoto na 3-H Ya kamata ɓangaren kusa na farantin ya kasance yana da ɗan sarari (kusurwar digiri 10) daga diaphysis don a iya ɗaure farantin zuwa diaphysis don ƙara sake saita toshewar karyewar nesa. Hoto na 3-I A daure sukurori na kusanci don sake daidaita karkacewar tafin hannu. A cire fil ɗin Kirschner kafin a matse sukurori gaba ɗaya.
Hotunan 3-J da 3-K na rediyo a lokacin tiyata sun tabbatar da cewa an sake gyara karyewar a jikin mutum kuma an sanya sukurori a kan farantin da kyau.
Gyaran Faranti na Dorsal Hanyar tiyata don fallasa ɓangaren baya na radius na nesa ya dogara ne akan nau'in karyewar, kuma idan aka sami karyewar da gutsuttsuran karyewar ciki guda biyu ko fiye, manufar maganin shine a gyara ginshiƙan radial da na tsakiya a lokaci guda. A lokacin tiyata, dole ne a yanke igiyoyin tallafi na extensor ta hanyoyi biyu: a tsaye a cikin sassan extensor na 2 da na 3, tare da yankewa na subperiosteal zuwa sashin extensor na 4 da kuma ja da baya na jijiyar da ta dace; ko kuma yanke na biyu tsakanin sassan extensor na 4 da na 5 don fallasa ginshiƙan biyu daban-daban (Hoto na 4).
Ana sarrafa karyewar kuma ana gyara ta na ɗan lokaci da fil ɗin Kirschner da ba a zare ba, sannan a ɗauki hotunan rediyo don tantance cewa karyewar ta yi rauni sosai. Na gaba, gefen ulnar na tsakiya (ginshiƙi na tsakiya) na radius ɗin an daidaita shi da farantin "L" ko "T" mai girman 2.4 mm. An tsara farantin ulnar na baya don tabbatar da cewa ya yi daidai a gefen ulnar na radius na baya. Hakanan ana iya sanya faranti kusa da ɓangaren ulnar na nesa gwargwadon iko, kamar yadda ramuka masu dacewa a ƙasan kowane faranti suna ba da damar lanƙwasa da siffanta faranti ba tare da lalata zaren da ke cikin ramukan sukurori ba (Hoto na 5).
Daidaita farantin ginshiƙin radial abu ne mai sauƙi, domin saman ƙashi tsakanin sassan extensor na farko da na biyu yana da faɗi sosai kuma ana iya gyara shi a wannan matsayi da farantin da aka tsara yadda ya kamata. Idan an sanya fil ɗin Kirschner a cikin mafi girman ɓangaren nesa na bututun radial, ƙarshen nesa na farantin ginshiƙin radial yana da rami wanda ya dace da fil ɗin Kirschner, wanda ba ya tsoma baki ga matsayin farantin kuma yana kula da karyewar da ke wurin (Hoto na 6).
Hoto na 4 Bayyanar saman duwawu na nesa. An buɗe madaurin tallafi daga sashin extensor na 3 kuma an ja jijiyar extensor hallucis longus.
Hoto na 5 Don daidaita ɓangaren ƙwanƙolin saman haɗin gwiwa na lunate, farantin "T" ko "L" na ƙwanƙolin yawanci ana siffanta shi (Hoto na 5-A da Hoto na 5-B). Da zarar an haɗa farantin ƙwanƙolin a saman haɗin gwiwa na lunate, ana ɗaure farantin ginshiƙin radial (Hoto na 5-C zuwa 5-F). An sanya faranti biyu a kusurwar digiri 70 a junansu don inganta kwanciyar hankali na haɗin gwiwa na ciki.
Hoto na 6 An tsara farantin ginshiƙin radial daidai kuma an sanya shi a cikin ginshiƙin radial, yana lura da ma'aunin da ke ƙarshen farantin, wanda ke ba farantin damar guje wa matse fil ɗin Kirschner na ɗan lokaci ba tare da tsoma baki a wurin farantin ba.
Muhimman ra'ayoyi
Alamomi don Gyaran Farantin Metacarpal
Karyewar ƙasusuwan da suka yi rauni a cikin ƙashin baya (ƙarya a cikin ƙashin baya na metacarpal)
Karyewar ƙasusuwa masu kama da na ƙasusuwa (karyewar ƙasusuwa da na ƙasusuwa). Ana iya samun daidaiton daidaito ta hanyar amfani da faranti na sukurori ko da kuwa akwai ƙasusuwa masu kama da na ƙasusuwa.
Karyewar saman articular metacarpal lunate da aka kora
Alamomi don gyara farantin dorsal
Tare da raunin jijiyar intercarpal
Karyar saman haɗin gwiwa na dorsal lunate da aka kora
Rushewar karyewar haɗin gwiwa na carpal mai kauri a gefen dama
Contraindications ga gyaran farantin palmar
Babban osteoporosis tare da ƙuntatawa mai mahimmanci na aiki
Rushewar karyewar wuyan hannu na radial
Kasancewar cututtuka masu alaƙa da lafiya da yawa
Contraindications ga gyara farantin dorsal
Cututtukan da suka shafi lafiya da yawa
Karyewar da ba ta motsa jiki ba
Kurakuran da ake samu cikin sauƙi a gyaran farantin palmar
Matsayin farantin yana da matuƙar muhimmanci domin ba wai kawai farantin yana tallafawa ƙarfin karyewar ba ne, har ma da daidaita wurin da aka sanya shi, haka kuma yana hana sukurin kullewa na nesa shiga cikin haɗin radial carpal. Rikodin rediyo a cikin tiyata a hankali, waɗanda aka haska a daidai alkiblar da karkacewar radius na nesa, suna ba da damar ganin saman haɗin gwiwa na gefen radius na nesa, wanda kuma za a iya ganinsa daidai ta hanyar sanya sukuran ulnar da farko yayin aikin.
Shigar sukurori a cikin dorsal cortex yana ɗauke da haɗarin haifar da jijiyar extensor da kuma haifar da fashewa a jijiyar. Sukurori masu kulle suna aiki daban da sukurori na yau da kullun, kuma ba lallai ba ne a shiga dorsal cortex da sukurori.
Kurakuran da ake samu cikin sauƙi idan aka gyara farantin baya
Akwai haɗarin shigar sukurori cikin haɗin radial carpal, kuma kamar yadda aka bayyana a sama dangane da farantin palmar, dole ne a ɗauki hoton da ba shi da ma'ana don tantance ko wurin sukurori yana da aminci.
Idan an fara gyara ginshiƙin radial, sukurori a cikin bututun radial zai shafi kimantawa na gyarawa na gaba na sake farfaɗo da saman articular na lunate.
Sukulu masu nisa waɗanda ba a dunƙule su gaba ɗaya a cikin ramin sukurin ba na iya tayar da jijiya ko ma haifar da fashewar jijiya.
Lokacin Saƙo: Disamba-28-2023
