A halin yanzu don daidaitawar cikin cikin gida mai nisa, akwai tsarin kulle na kunnuwa daban-daban wanda aka yi amfani da shi a asibitin. Wadannan abubuwan gyara na ciki suna ba da mafi kyawun mafita ga wasu nau'ikan karyewa, kuma a wasu hanyoyi suna faɗaɗa abubuwan da aka nuna don tiyata don tiyata ga tsadar radius rauni, musamman waɗanda suke da osteoporosis. Farfesa Jupiter daga asibiti na Massachusetts da wasu sun buga jerin labarai a JBJs akan binciken su a kan kulle farantin madius kararwar rauni da kuma dabarun tarkace. Wannan kasida ya mai da hankali ne akan tsarina don gyara raunin Distal ya danganta da gyaran ciki na takamaiman toshe karaya.
Tukwarin tiyata
Ka'idar shafi guda uku, dangane da halayen biomechical da yanayin tsarin radius na nesa, shine tushen ci gaba da tsarin bincike na tsarin asibiti na 2.4m. Rarraba na kananan hukumomin uku an nuna a cikin hoto 1.
Hoto 1 na shafi na shafi uku na Drar Radius.
Shafin da aka gabatar a gefe shine rabin Radius na Distal, ciki har da wasan kwaikwayo na Daki da Radial, wanda ke goyan bayan wasu jijiyoyin da ke da wuyan hannu.
Shafin tsakiya shine rabin Radius na Distal kuma ya hada da fosta fosta (hade da zurin) da kuma sigmoid ba shi da kuskure (hade da ulna) a kan farfado mai nisa. A yadda aka saba sanya, nauyin daga zabin an watsa shi zuwa radius ta hanyar zabin fossa. Shafin ulnar na ulnar, wanda ya hada da ulna, triangular fizarin ulnar-radial, yana ɗaukar nauyin ulnar-radial tare da tasirin ulnar-radial kuma yana da tasiri mai ɗorewa.
Ana yin wannan hanyar a ƙarƙashin maganin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta Belachi na Belachus da kuma cutar C-arre x-ray suna da mahimmanci. An yi amfani da kwayoyin rigakafin intranovenous a kalla mintuna 30 kafin farkon hanyar da aka yi amfani da su don rage zubar jini.
Palmar Vante ficate
Don mafi yawan rauni, ana iya amfani da tsarin Palmar don hango tsakanin daskararren kifin daskararre da kuma radial artery. Bayan ganowa da kuma sake dawo da kayan kwalliyar Carpi Longus Longus, zurfin farfajiya na Pretory Tsabtace da "l" wanda aka ɗaura rabuwa da shi da "l" wanda aka ɗaura rabuwa. A cikin ƙarin hadaddun karaya, raunin Brakiodialiladidis na iya kara kara don sauƙaƙe rage karaya.
Ana saka kirschner a cikin haɗin gwiwa mai radial, wanda ke taimakawa wajen ayyana na nesa-mafi yawan iyakoki na radius. Idan karamin rauni rauni a cikin wani articulululululululular na yanzu yana nan, a cikin alamar pastmar 2.4mm karfe za a iya sanya kayan ado a kan baƙin ciki mai zurfi na radius don gyarawa. A takaice dai, karamin karaya taro a kan articular saman zabin na 2.4mm "ko" "kamar yadda aka nuna a hoto na 2.
Don dorsally gudun hijira karin-artsular, yana da taimako don lura da wadannan maki. Da fari dai, yana da mahimmanci sake saita karaya na ɗan lokaci don tabbatar da cewa babu nama mai taushi mai taushi a ƙarshen fashewa. Abu na biyu, a cikin marasa lafiya ba tare da osteoporosis, da karar ana iya sanya bangarori na rarrafe a ƙarshen Palmar Anatireally ba
Hoto na 3 na karin magana da radius na rarraƙan radius ya ragu kuma an gyara shi ta hanyar tsarin Palmar. Hoto na 3-A bayan an kammala bayyanar ta hanyar radial carpal flower da radial arery, fil mai santsi, an sanya fil mai santsi na kirser a cikin kayan ado na kayan ado. Hoto na 3-B makaret na metacarpal cortex don sake saita shi.
Hoto na 3-C da Hoto na 3-Da santsi kirschner Pin an sanya shi daga radial tushe ta hanyar karaya don gyara karaya na ɗan lokaci.
Fig. 3-e isasshen gani na filin sarrafawa ana samun nasara ta amfani da mai aiki kafin farantin. Hoto na 3-F Distal jere na kulle-kullen slanka an sanya kusa da kashi subchondral a ƙarshen ninka ninka.
Hoto na 3-g x-ray floroscopy ya kamata a yi amfani da shi don tabbatar da matsayin farantin karfe da kuma rarrafe. Hoto na 3-H da kewayon farantin ya kamata ya fi dacewa da wasu sharewar (kwana 10) daga diforsis don haka za'a iya gyara farantin ga diaphysis don kara sake saita katangar karaya. Hoto na 3-Ina ɗaure sikelin wakili don sake fasalin Palmar tare da dabarun murƙushewar murjani. Cire Kischn PIN kafin an rufe dunƙulen.
Figures 3-J da kuma hotunan rediyo na 3-k intraiogiricic Hotunan sun tabbatar da cewa kararwar da aka sake haɗa ta kuma ƙwararrun farantin suna da gamsarwa.
Mantaccen farantin dorsal ya fi karfin tsarin dorsal ya dogara da tsarin dorsal din ya dogara ne da irin karaya na ciki, kuma a yanayin karaya tare da kashi biyu ko sama da haka. Dole ne a ci gaba da hadin gwiwar tallan tallace-tallace a cikin manyan hanyoyin biyu: tsawon lokaci a cikin kayan kwalliya na 2 da na uku, tare da koma baya na 4 da sakewa na munanan habarin; Ko kuma incarshe na goyon baya na biyu tsakanin bangarori na 4 da na 5 don bijirar da ginshiƙum biyu daban daban (Fig. 4).
Kayayyakin da aka haɗa kuma an haɗa shi kuma an daidaita shi na ɗan lokaci tare da filayen na ɗan lokaci wanda ba shi da tsarki, da kuma hotunan rediyo don ƙayyade cewa karar yana da gudun hijira. Bayan haka, ulnar ulnar (Tsarin Kanun) na radius yana tsayawa tare da 2.4 m "ko" t "farantin. Farantin ulnar na dorsal ya kama shi don tabbatar da mummunar dacewa a kan dorsal gefen na radius na Distal. Hakanan za'a iya sanya faranti a kusa da yanayin dorsal na distal sannu, kamar yadda man shafawa ba tare da lalata zaren ba a cikin ramuka ramuka (Fig. 5).
Gyara farantin shafi na radial yana da sauƙi, kamar yadda ɓangaren kashi tsakanin bangarori da na farko da na farko da za a iya gyarawa a wannan matsayin da aka tsara sosai. Idan an sanya kirschner fil a cikin matsanancin karkara na radial tarer shafi, mafi girman ƙarfin radial farantin, wanda ba ya tsoma baki da karfin gwiwa a wurin (Fig. 6).
Hoto 4 yana bayyanar da yanayin dorsal na radius na Distal. An buɗe ƙungiyar tallafi daga ɗakunan ajiya na 3 da mahimmin aikin Longus na Longus ana komawa.
Hoto 5 don gyaran fannin dorsal na farfajiyar abin da aka yi, da daskararru "ko" farantin grers galibi ne (Fig. 5-A da Fig. 5-B). Da zarar farantin dorsal a kan farantin maƙaryaci na abin da ake tsare da shi, farantin kananan kayan aikin da aka aminta (Figurs 5-C ta hanyar 5-F). Ana sanya faranti biyu a wani kusurwa na digiri 70 zuwa junan su don inganta kwanciyar hankali na gyaran cikin gida.
Fig. 6 Farantin kayan aikin radial an tsara shi da kyau kuma an sanya shi a cikin tsarin radial, wanda ke ba da damar farantin don guje wa mafita na ɗan lokaci ba tare da tsoma baki ba tare da matsayin farantin.
Mahimman ra'ayi
Alamar Ingantaccen Tsarin Metacarpal
Metacarpal Interra-articular karaya (Barton karar)
Redrushewararrawa mai rarrafe-articular (coles da smith rauni). Za'a iya samun tsayayyen tsayayyen tare da zane mai laushi ko da a gaban osteoporosis.
Metacarpal letacarpal ampone arfulular surface
Alamar don Ingantaccen Kayan Kayan Dorsal
Tare da raunin Ligitalpal Intercarpal
Gudun hijira 'yan gudun hijira
Dorsally sheared radial carpal hadin hadin gwiwa
Contraindications zuwa pastar farantin
Mai tsananin osteoporosis tare da mahimman iyakoki masu mahimmanci
Dorsal radial wuyan wuyanci
Kasancewar magunguna da yawa
Contraindications zuwa tsayayyen farantin farantin dorsal
Yawancin abin likita na likita
Rashin ƙarfi mara nauyi
Murfin da aka yi a cikin abubuwan da aka yi a cikin kayan ado na Palmar
Matsayin farantin yana da matukar muhimmanci saboda ba wai farantin ba kawai yana tallafawa dunƙurin kulle da ke cikin haɗin gwiwa. A hankali-zumunci na radioograps na hankali, wanda aka kirkira a cikin ja-goranci na karkara, wanda zai iya zama abin hangen nesa ta hanyar sanya kwastomomin ulnar farko yayin aikin.
Dubawa da shigar da shigarwar da dorsal cortex yana ɗaukar haɗarin tsokanar tsokana kuma yana haifar da cututtukan rupture. Kulle abubuwan da aka kulle yi daban daga scors na yau da kullun, kuma ba lallai ba ne don shiga cikin dorsal cortex tare da sukurori.
Kurakurai a sauƙaƙe da aka yi tare da ingantaccen farantin farantin dorsal
Koyaushe akwai haɗarin kundin shigar cikin hanji a cikin tsinkayen kifin mai narkewa a sama dangane dangane da farantin Palmar, dole ne a ɗauki harbin farantin Palmar.
Idan gyaran shafi na radial ana yinsa da farko, sukurori a cikin rurial din radial zai shafi kimar ƙirar mai zuwa ta hanyar jujjuya yanayin da ake jujjuyawa.
Distal skurs waɗanda ba su daɗe da su gaba ɗaya cikin rami dutsen na iya haifar da jijiyoyin ko ma haifar da haɗari.
Lokaci: Dec-28-2023
