Metacarpal phalangeal fractures ne na kowa fractures a cikin rauni na hannu, lissafin game da 1/4 na masu fama da rauni na hannu. Saboda tsari mai laushi da rikitarwa na hannu da kuma aikin motsa jiki mai laushi, mahimmanci da fasaha na maganin karyewar hannu sun fi rikitarwa fiye da yadda ake kula da sauran kasusuwa masu tsawo. Tabbatar da kwanciyar hankali na karaya bayan raguwa shine mabuɗin samun nasarar maganin raunin phalangeal na metacarpal. Don dawo da aikin hannu, raguwa sau da yawa yana buƙatar gyaran da ya dace. A da, ana amfani da gyaran gyare-gyare na waje na filasta ko Kirschner waya na ciki na ciki, amma sau da yawa ba ya dace da farkon horo na gyaran gyare-gyare na haɗin gwiwa saboda rashin daidaituwa ko lokaci mai tsawo, wanda yana da tasiri mafi girma akan dawo da aikin haɗin gwiwar yatsa kuma yana kawo wasu matsaloli ga aikin gyaran hannu. Hanyoyin jiyya na zamani suna ƙara yin amfani da ƙaƙƙarfan gyare-gyare na ciki, irin su ƙananan ƙananan faranti.
I.Menene ka'idodin magani?
Ka'idodin kulawa don ƙwayar hannu metacarpal da phalangeal fractures: ragewar jiki, haske da ƙayyadaddun ƙarfi, ayyukan farko da horo na aiki. Ka'idodin kulawa don ɓarna na intra-articular da peri-articular na hannun sun kasance daidai da na sauran ƙananan ƙwayoyin cuta, waɗanda kuma don mayar da jikin jikin haɗin gwiwa da kuma ayyukan aiki na farko. Lokacin da ake kula da karaya ta hannun metacarpal da phalangeal, ya kamata a yi ƙoƙari don cimma raguwar jiki, da juyi, angulation na gefe, ko ƙaurawar angular> 10° zuwa ɓangaren dorsal na dabino bai kamata ya faru ba. Idan ƙarshen ɓarkewar phalange na metacarpal yana juyawa ko angular a gefe, zai canza yanayin yanayin jujjuyawar al'ada da haɓaka motsi na yatsa, yana haifar da motsi ko faɗuwa tare da yatsa kusa yayin jujjuyawar, yana shafar daidaiton aikin yatsa; kuma lokacin da motsi na angular zuwa gefen gefen dabino ya kasance> 10 °, shimfidar wuri mai laushi tsakanin kashi da tendon ya lalace, yana ƙara juriya da kewayon motsi na ƙwanƙwasa da tsawo na jijiyar, kuma lalacewar tendon na yau da kullum ya faru, yana haifar da hadarin fashewar tendon.
II.Wadanne kayan za a iya zaba don karaya na metacarpal?
Akwai kayan gyara da yawa na ciki don karyewar metacarpal, irin su Kirschner wayoyi, screws, faranti da masu gyara waje, daga cikinsu ana amfani da wayoyi na Kirschner da microplates. Don karaya na metacarpal, ƙayyadaddun microplate na ciki yana da fa'ida a bayyane akan gyaran waya na Kirschner kuma ana iya amfani dashi da farko; don raunin phalanx na kusa, ƙananan microplates sun fi girma, amma lokacin da yake da wuya a saka screws don proximal phalanx distal part and head fractures, giciye Kirschner waya na ciki ya kamata a yi amfani da gyara na ciki, wanda ya fi dacewa don dawo da aikin da yatsa ya shafa; Ya kamata a fara amfani da wayoyi na Kirschner don maganin karaya ta tsakiya.
- Kirschner waya:An yi amfani da gyaran gyare-gyaren waya na Kirschner a aikin asibiti fiye da shekaru 70 kuma ya kasance mafi yawan abin da aka fi amfani da shi na kayan gyara na ciki don karaya na metacarpal da phalangeal. Yana da sauƙi don aiki, tattalin arziki da aiki, kuma shine mafi kyawun hanyar gyarawa na ciki. A matsayin gyare-gyaren ciki da aka fi amfani da shi don maganin karyewar hannu, har yanzu ana amfani da shi sosai. Abvantbuwan amfãni na Kirschner waya na ciki gyarawa: ① Mai sauƙin aiki da sauƙin amfani; ② Ƙananan ƙwanƙwasa mai laushi mai laushi, ƙananan tasiri akan samar da jini na ƙarshen karaya, ƙananan ƙwayar cuta, da kuma taimakawa wajen warkar da raunuka; ③ Sauƙi don cire allura a karo na biyu; ④ Ƙananan farashi da aikace-aikacen aikace-aikace masu yawa, wanda ya dace da mafi yawan raunin hannu (kamar intra-articular fractures, comminuted fractures da distal phalangeal fractures).
2.Metacarpophalangeal microplates: Ƙarfafawa mai ƙarfi na ciki na ɓarke hannun hannu shine tushen horo na farko na aiki da kuma yanayin da ya dace don maido da aikin hannu mai kyau. Fasahar gyarawa ta AO ta ciki tana buƙatar ƙarshen ɓarkewar an daidaita shi daidai gwargwadon tsarin halittar jiki kuma cewa ƙarshen ƙarshen ya kasance barga a ƙarƙashin yanayin aiki, wanda aka fi sani da ƙayyadaddun ƙarfi, don ba da izinin motsi na farko. Har ila yau, AO yana jaddada ayyukan fiɗa kaɗan, tare da mai da hankali kan kare samar da jini. Ƙaddamar da microplate na ciki don maganin raunin hannu zai iya samun sakamako mai gamsarwa dangane da ƙarfin, kwanciyar hankali na ƙarewa, da matsa lamba tsakanin ƙarewa. Dangane da farfadowar aikin bayan aiki, lokacin waraka karaya, da adadin kamuwa da cuta, an yi imanin cewa ingancin faranti na microtitanium ya fi na Kirschner wayoyi. Bugu da ƙari, tun lokacin da lokacin warkarwa na karaya bayan gyarawa tare da faranti na microtitanium ya fi guntu fiye da na sauran hanyoyin gyarawa, yana da amfani ga marasa lafiya su ci gaba da rayuwa ta al'ada da wuri.
(1) Menene fa'idodin gyaran microplate na ciki?
① Idan aka kwatanta da Kirschner wayoyi, microplate dunƙule kayan sun fi dacewa da kyallen takarda da mafi kyawun amsawar nama; ② Tsarin kwanciyar hankali na tsarin gyaran gyare-gyare na farantin karfe da kuma matsa lamba akan ƙarshen ɓarke ya sa raguwa ya fi kusa da raguwar ƙwayar jiki, mafi amintaccen gyare-gyare, kuma yana taimakawa wajen warkar da raunuka; ③ Ana ba da izinin motsa jiki na farko bayan gyare-gyaren microplate, wanda ke taimakawa wajen dawo da aikin hannu.
(2) Menene hanyar tiyata don microplates?
Yawancin tiyata ana yin su ne a ƙarƙashin maganin sa barci na plexus, kuma yawanci ana buƙatar yawon shakatawa na pneumatic. Ana ɗaukar ƙwanƙwasa ƙwanƙwasa na metacarpal phalanges, an yanke dorsal aponeurosis na lambobi ko kuma a shigar da tsokar interosseous da kasusuwa na metacarpal don fallasa karaya na ƙarshen metacarpal ko kasusuwan phalangeal, periosteum yana kwasfa, kuma raguwa yana raguwa a ƙarƙashin hangen nesa kai tsaye. Madaidaicin faranti sun dace da ɓarkewar ɓarna na ɓangaren tsakiya da gajerun ɓarkewar ɓarna, T-faranti sun dace da gyaran tushe na metacarpal da phalanges, kuma T-faranti ko 120 ° da 150 ° L-faranti sun dace da gyaran gyare-gyare na dogon lokaci da lalacewa. Gabaɗaya ana sanya farantin a gefen ƙashin baya don hana zamewar jijiyoyi da lalacewa na dogon lokaci, wanda zai dace da horon aiki da wuri. Ya kamata a yi amfani da akalla nau'i biyu don gyara sassan biyu na karaya, in ba haka ba kwanciyar hankali ba ta da kyau, kuma ana buƙatar wayoyi na Kirschner ko screws a waje da farantin don taimakawa wajen daidaitawa don cimma manufar daidaitawa.
3. Mini sukurori: Mini sukurori suna da irin wannan kwanciyar hankali zuwa faranti na ƙarfe a cikin gyaran gyare-gyare na karkace ko tsayin daka, amma kewayon nama mai laushi da cirewar periosteum ya fi ƙanƙanta fiye da na gyaran gyare-gyaren karfe, wanda ya dace don kare samar da jini kuma a layi tare da ra'ayi na aiki mai sauƙi. Kodayake akwai nau'in nau'in T da nau'in L don raunin da ya faru na kusa-articular, farfadowar aikin haɗin gwiwa bayan bin bayan aikin ya fi muni fiye da na diaphyseal fractures. Ƙananan sukurori kuma suna da wasu fa'idodi a cikin gyaran ɓangarorin intra-articular da peri-articular fractures. Ƙunƙarar da aka zana a cikin kasusuwa na cortical na iya jure wa babban nauyin damuwa, don haka gyare-gyare yana da ƙarfi, kuma za a iya matsawa ƙarshen ƙarewa don yin fashe a cikin kusanci, rage raguwar lokacin warkarwa kuma sauƙaƙe warkar da raunin, kamar yadda aka nuna a cikin Hoto 4-18. Ana amfani da ƙaramin gyare-gyaren cikin gida na karyewar hannu don karyewar ɓarna ko karkace na diaphyseal da ɓarnawar ɓarna na ɓoyayyen ƙashi. Ya kamata a lura cewa lokacin amfani da ƙananan sukurori kaɗai don gyara ɓarkewar ɓarna ko karkace na diaphyseal kashi na hannun, tsawon layin karaya ya kamata ya zama aƙalla sau biyu diamita na kashin diaphyseal, kuma lokacin da ake gyara ɓangarorin ɓarna a cikin haɗin gwiwa, toshe kashi ya kamata ya zama aƙalla sau 3 diamita na zaren.
4.Micro external fixator:Ƙarshen ƙwayar phalangeal na metacarpal wani lokaci yana da wuyar ragewa ta jiki ko kuma ba za a iya gyarawa a ciki ba ko da bayan tiyatar tiyata saboda lalata tallafin kashi. Mai gyarawa na waje zai iya mayar da kuma kula da tsawon ɓarkewar ɓarke a ƙarƙashin ɓarna, yana taka rawar gyare-gyaren dangi. Daban-daban na phalangeal na waje na metacarpal an sanya su a wurare daban-daban: 1st da 2nd metacarpal phalanges an sanya su a gefen radial na dorsal, 4th da 5th metacarpal phalanges an sanya su a gefen ulnar dorsal, kuma 3rd metacarpal phalange an sanya shi a kan dorsal dorsal radial ko gefen halin da ake ciki. Kula da wurin saka allura don hana lalacewar tendon. Za a iya rage karayar da aka rufe a ƙarƙashin hasken X-ray. Lokacin da raguwa ba ta dace ba, za a iya yin ƙaramin yanki don taimakawa ragewa.
Menene fa'idodin masu gyara waje?
① Sauƙaƙan aiki, na iya daidaita ƙaura daban-daban na ƙarewar karaya; ② Zai iya ragewa yadda ya kamata da kuma gyara raunin intra-articular na kasusuwa na metacarpophalangeal ba tare da lalata farfajiyar haɗin gwiwa ba, kuma yana iya karkatar da farfajiyar haɗin gwiwa don hana kwangilar capsule na haɗin gwiwa da haɗin gwiwa; ③ Lokacin da comminuted fractures ba za a iya rage anatomically, su za a iya hade tare da iyaka gyare-gyare na ciki, da kuma waje fixator iya partially rage da kuma kula da karfi line; ④ Bada izinin motsa jiki na farko na yatsa mai yatsa a cikin haɗin da ba a gyara ba don kauce wa haɗin gwiwa da osteoporosis; ⑤ Za a iya gyara karyewar hannu yadda ya kamata ba tare da yin tasiri kan maganin raunin da ya faru ba.
Lokacin aikawa: Dec-21-2024
