A halin yanzu don gyaran ciki na ɓarkewar radius mai nisa, akwai nau'ikan tsarin kulle faranti iri-iri da ake amfani da su a asibitin.Waɗannan gyare-gyaren cikin gida suna ba da mafi kyawun bayani ga wasu nau'ikan ɓarna masu rikitarwa, kuma a wasu hanyoyi suna faɗaɗa alamun tiyata don karyewar radius mara ƙarfi, musamman waɗanda ke da osteoporosis.Farfesa Jupiter daga Babban Asibitin Massachusetts da sauransu sun buga jerin kasidu a cikin JBJS game da binciken da suka yi game da kulle farantin karfe na fashewar radius mai nisa da dabarun tiyata masu alaƙa.Wannan labarin yana mayar da hankali kan tsarin aikin tiyata don gyaran gyare-gyaren radius mai nisa dangane da ƙayyadaddun ciki na ƙayyadaddun ƙayyadaddun ƙwayar cuta.
Dabarun tiyata
Ka'idar ginshiƙi uku, dangane da sifofin biomechanical da halayen halayen radius mai nisa, shine tushen ci gaba da aikace-aikacen asibiti na tsarin farantin 2.4mm.Ana nuna rabon ginshiƙan uku a cikin hoto 1.
Hoto 1 Ka'idar ginshiƙi uku na radius mai nisa.
Ƙaƙwalwar gefe ita ce rabi na gefe na radius mai nisa, ciki har da fossa navicular da radial tuberosity, wanda ke goyan bayan kasusuwan carpal a gefen radial kuma shine asalin wasu haɗin gwiwar da ke daidaita wuyan hannu.
Rukunin tsakiya shine matsakaicin rabin radius mai nisa kuma ya haɗa da lunate fossa (wanda ke da alaƙa da lunate) da sigmoid notch (wanda ke da alaƙa da ulna mai nisa) akan farfajiyar articular.Yawanci an ɗora, nauyin daga fossa na lunate ana watsa shi zuwa radius ta hanyar lunate fossa.Ƙungiya ta gefe, wanda ya haɗa da ulna mai nisa, fibrocartilage triangular, da ƙananan ulnar-radial haɗin gwiwa, yana ɗaukar kaya daga ƙasusuwan carpal na ulnar da kuma daga ƙananan ulnar-radial haɗin gwiwa kuma yana da tasiri mai tasiri.
Ana yin aikin ne a ƙarƙashin maganin sa barci na brachial plexus kuma hoton X-ray na C-arm na ciki yana da mahimmanci.An yi amfani da maganin rigakafi na ciki aƙalla mintuna 30 kafin fara aikin kuma an yi amfani da yawon shakatawa na huhu don rage zubar jini.
Gyaran farantin Palmar
Ga mafi yawan karaya, ana iya amfani da hanyar dabino don hange tsakanin radial carpal flexor da radial artery.Bayan ganowa da kuma mayar da flexor carpi radialis longus, an hango zurfin saman tsokar pronator teres kuma an ɗaga rabuwa mai siffar "L".A cikin karaya masu rikitarwa, ana iya ƙara sakin jijiya brachioradialis don sauƙaƙe raguwar karaya.
An saka fil ɗin Kirschner a cikin haɗin gwiwa na carpal na radial, wanda ke taimakawa wajen ayyana mafi yawan iyakokin radius.Idan ƙaramin karaya a gefen articular ya kasance, ana iya sanya farantin karfe 2.4mm na dabino a gefen gefen radius mai nisa don gyarawa.A wasu kalmomi, ƙananan karaya a saman bango na lunate na iya samun goyan bayan farantin "L" ko "T" 2.4mm, kamar yadda aka nuna a hoto na 2.
Don karaya da aka raba da muhallansu, yana da taimako a lura da abubuwa masu zuwa.Da fari dai, yana da mahimmanci don sake saita karyewar na ɗan lokaci don tabbatar da cewa babu nama mai laushi da aka saka a ƙarshen karyewar.Abu na biyu, a cikin marasa lafiya ba tare da osteoporosis ba, ana iya rage karayar tare da taimakon farantin karfe: na farko, ana sanya dunƙule kulle a ƙarshen farantin dabino, wanda aka amintar da shi zuwa ɓangaren ɓarna mai nisa, sa'an nan kuma nisa kuma Ana rage sassan karaya na kusa tare da taimakon farantin, kuma a ƙarshe, ana sanya sauran sukurori kusa.
HOTO NA 3 An rage karaya daga radius mai nisa a baya kuma an daidaita shi ta hanyar dabino.HOTO NA 3-A Bayan kammala bayyanarwa ta hanyar radial carpal flexor da radial artery, an sanya fil ɗin Kirschner mai santsi a cikin haɗin gwiwa na radial carpal.Hoto na 3-B Yin amfani da kogin metacarpal da aka kora don sake saita shi.
Hoto 3-C da Hoto 3-DA santsi Kirschner fil an sanya shi daga radial kara ta layin karaya don gyara ƙarshen karaya na ɗan lokaci.
Hoto 3-E Ana samun isassun gani na filin aiki ta hanyar amfani da mai ɗaukar hoto kafin a sanya faranti.Hoto na 3-F An sanya layin nesa na kulle sukulan kusa da ƙashin ƙasa a ƙarshen ninki mai nisa.
Hoto 3-G X-ray fluoroscopy ya kamata a yi amfani da shi don tabbatar da matsayi na farantin karfe da sukurori mai nisa.Hoto 3-H Yankin kusa da farantin ya kamata ya kasance yana da ɗan sharewa (kusurwar digiri 10) daga diaphysis ta yadda za a iya daidaita farantin zuwa diaphysis don ƙara sake saita toshe fashe na nesa.Hoto na 3-I Matsa madaidaicin dunƙule don sake kafa karkacewar tafin hannu.Cire fil ɗin Kirschner kafin a ɗaure dunƙule gaba ɗaya.
Hotunan 3-J da 3-K Hotunan intraoperative intraoperative Hotuna sun tabbatar da cewa karyewar daga ƙarshe an sake mayar da shi ta hanyar jiki kuma an sanya sukulan faranti mai gamsarwa.
Dorsal Plate Fixation Hanyar tiyata don fallasa ɓangaren baya na radius mai nisa ya dogara ne akan nau'in karaya, kuma a yanayin raunin da ya faru tare da raguwa biyu ko fiye na intra-articular fragment, manufar maganin shine yafi gyara duka biyu. radial da ginshiƙan tsaka-tsaki a lokaci guda.A cikin aikin ciki, dole ne a ƙaddamar da ƙungiyoyin tallafi na extensor ta hanyoyi guda biyu: tsayin daka a cikin 2nd da 3rd extensor compartments, tare da rarraba subperiosteal zuwa 4th extensor sashi da kuma ja da baya na daidai tendon;ko haɗin haɗin tallafi na biyu tsakanin sassan 4th da 5th extensor don fallasa ginshiƙan biyu daban (Fig. 4).
Ana sarrafa karaya kuma an gyara shi na ɗan lokaci tare da fil ɗin Kirschner wanda ba a karanta shi ba, kuma ana ɗaukar hotunan rediyo don sanin cewa karyewar yana da kyau.Bayan haka, gefen radius na dorsal ulnar (shafi na tsakiya) yana daidaitawa tare da farantin "L" 2.4 mm ko "T".Farantin ulnar na baya yana da siffa don tabbatar da dacewa sosai a gefen ulnar na baya na radius mai nisa.Hakanan za'a iya sanya faranti a kusa da gefen dorsal na lunate mai nisa kamar yadda zai yiwu, kamar yadda madaidaicin ramukan da ke ƙarƙashin kowane faranti suna ba da damar lankwasa faranti da siffa ba tare da lalata zaren da ke cikin ramukan dunƙule ba (Fig. 5). .
Gyaran ginshiƙin radial yana da sauƙi mai sauƙi, kamar yadda kasusuwan kasusuwa a tsakanin sassan farko da na biyu na extensor yana da ɗan lebur kuma za'a iya gyarawa a cikin wannan matsayi tare da faranti mai kyau.Idan an sanya fil ɗin Kirschner a cikin matsananciyar nisa na radial tuberosity, ƙarshen ƙarshen ginshiƙi na radial yana da tsagi wanda ya dace da fil ɗin Kirschner, wanda ba ya tsoma baki tare da matsayi na farantin kuma yana kula da raguwa a wurin. (Hoto na 6).
Hoto 4 Fitar da saman dorsal na radius mai nisa.Ana buɗe band ɗin tallafi daga 3rd extensor interosseous part kuma an ja da baya jijiyar hallucis longus.
Hoto 5 Don gyarawa na ƙwanƙwasa na ƙwanƙwasa na ƙwanƙwasa na lunate, dorsal "T" ko "L" farantin yawanci yana da siffar (Fig. 5-A da Fig. 5-B).Da zarar farantin dorsal a saman bangon lunate ya amintu, an adana farantin radial (Hoto 5-C zuwa 5-F).Ana sanya faranti biyu a kusurwar digiri na 70 zuwa juna don inganta kwanciyar hankali na gyaran ciki.
Hoto 6 Tsarin radial na radial an tsara shi da kyau kuma an sanya shi a cikin ginshiƙan radial, yana lura da ƙima a ƙarshen farantin, wanda ya ba da damar farantin don kauce wa gyare-gyare na wucin gadi na Kirschner fil ba tare da tsoma baki tare da matsayi na farantin ba.
Muhimman ra'ayoyi
Alamu don Gyaran Farantin Metacarpal
Ƙunƙarar ɓoyayyiyar ɓarna na intra-articular (Barton fractures)
Redrushewararrawa mai rarrafe-articular (coles da smith rauni).Za'a iya samun gyare-gyaren kwanciyar hankali tare da faranti har ma a gaban osteoporosis.
Maƙasudin ɓarna na lunate articular ƙwanƙwasa
Alamu don gyaran farantin dorsal
Tare da raunin ligament intercarpal
Maƙalar dorsal lunate haɗin gwiwa saman karaya
Dorally sheared radial carpal hadin gwiwa karaya
Contraindications zuwa dabino farantin gyarawa
Osteoporosis mai tsanani tare da gazawar ayyuka masu mahimmanci
Ragewar wuyan hannu na dorsal
Kasancewar cututtukan cututtuka masu yawa
Contraindications zuwa dorsal farantin gyarawa
Cututtukan likita da yawa
Karyar da ba ta gushe ba
Kuskure cikin sauki a gyara farantin dabino
Matsayin farantin yana da mahimmanci sosai saboda ba wai kawai farantin yana goyan bayan adadin karaya ba, amma matsayi mai kyau kuma yana hana kullun makullin nesa daga kutsawa cikin haɗin gwiwa na radial carpal.Hannun radiyo na intraoperative, wanda aka tsara a cikin hanya ɗaya da raɗaɗin radial na radius mai nisa, yana ba da damar ganin daidaitaccen hangen nesa na gefen radial na radius mai nisa, wanda kuma za'a iya gani da kyau ta hanyar sanya sukurori na ulnar a farkon lokacin. aiki.
Kuskure shigar da dorsal cortex yana ɗauke da haɗarin tsokanar jijiyar extensor da haifar da tsagewa.Kulle sukurori yi daban-daban da na al'ada sukurori, kuma ba lallai ba ne a shiga cikin dorsal cortex tare da sukurori.
Kuskure cikin sauƙi da aka yi tare da gyaran farantin dorsal
Koyaushe akwai haɗarin kutsawa cikin dunƙule cikin haɗin gwiwa na radial carpal, kuma kama da tsarin da aka kwatanta a sama dangane da farantin dabino, dole ne a ɗauki harbin da ba a taɓa gani ba don sanin ko matsayin dunƙule yana amintacce.
Idan an fara yin gyaran gyare-gyare na ginshiƙan radial, ƙuƙwalwar da ke cikin tuberosity na radial zai shafi kimantawa na gyare-gyare na gaba na farfadowa na articular surface na lunate.
Sukurori masu nisa waɗanda ba a dunƙule su gaba ɗaya a cikin ramin dunƙule ba na iya tada jijiyoyin ko ma haifar da tsagewar tsoka.
Lokacin aikawa: Dec-28-2023
