A halin yanzu, Distal Radius Karɓar jiki ana bi da su ta hanyoyi daban-daban, kamar kayan zane-zane na cikin gida, intanet na samaniya a tsakaninsu yana da girma kamar 16%. Koyaya, idan an zaɓi farantin da kyau, ana iya rage yawan abubuwan da aka tsara yadda ya kamata. A taƙaice bankwatar nau'ikan, abubuwan alamu da fasahohin Palmar na Palmar Dortares karar.
I.types na Distal Radius Karshe
Akwai tsarin rarrabuwa da yawa don rauni, ciki har da rarrabuwa ta Müller Ato dangane da ilmin jiki da kuma rarrabuwa femany ya dogara da tsarin rauni. Daga gare su, rarrabuwar kawuna ya haɗu da fa'idodin abubuwan da suka gabata, yana rufe nau'ikan ƙwayar cuta guda huɗu, wanda zai iya jagorar karar maleon 4, wanda zai iya zama jagora mai kyau ga aikin asibiti.
1. Müller Ao rarrabuwa
Distance Distance ya dace sosai zuwa Distal Radius Karshe da kuma raba su cikin manyan nau'ikan nau'ikan nau'ikan: Rubuta ƙarin-articular, da nau'in Cultial Intra-artic. Kowane nau'in da aka sake zuwa haɗuwa daban-daban na subgroups dangane da tsananin rauni da rikitarwa na karaya.
Rubuta: karin-articular
A1, Ulnar Femoral karaya, Radius kamar rauni (A1.1, ulnar Stracture na ulnar diaphysis).
A2, karar radius, mai sauƙi, tare da Inter (A2.1, radius-colding na radius, watau, palmar kumburin radius, watau, Pauter-colitth smith smith smith smith smith smith smith smith smitth rauni.
A3, karaya daga radius, mai kamshi (A3.1, raunin radius mai siffa-shaye-waka na radius; a3.3, wanda aka sanya shi daga radius).
Rubuta B: Rashin Karaya
B1, karar radius, jirgin ruwan sagittal (B1.1, nau'in mai sauƙi; B1.2, nau'in compinuted na ƙarshe; b1.3, nau'in medial).
B2, rauni daga cikin dorsal na radius, watau Barton karaya.
B3, karaya daga cikin metacarpal rim na radius, watau, an gina gona karaya, ko kuma wani yanki mai laushi, ƙaramin yanki, babban yanki; B3.3, wanda aka yi amfani da karaya).
Rubuta C: jimlar karaya
C1, radial karaya tare da nau'in kayan zane-zane na kayan zane-zane (C1.1, kashi ɗaya daga cikin karaya na articular; C1.3, kararwar coronal na articular surfular).
C2, radius karaya, mai sauqin kai mai sauki, wanda aka kirkira shi da comphysis (C2.1, sagittal facture na articular facet; c2.3, karaya na facet na facet; c2.3, karaya na fuskoki na baya;
C3, radial karaya, commuted (c3.1, sauki karaya na metaphyis; C3.2, compinuted hadari na metaphyis; c3.3, karaya mai fadi da kara zuwa ga radial tushe).
2.Classification na Distal Radius Karshe.
Dangane da tsarin raunin Fem Belmanz Clotsification 5 :.
Rubuta nani na karin magana da karaya kamar na colles coles (dorsal angration) ko smith rauni). Cortex na ƙashi guda ɗaya a ƙarƙashin tashin hankali da kuma baƙon abu na cortex an kwafa da saka.
Karaya
Type III karar karaya-artulular ne, wanda aka haifar ta hanyar tsananin damuwa. Wadannan kararwarsu sun haɗa da Palmar Barton karar, Dorsal Barton karar, da radial kara karagar.
Tsananin damuwa
Type na III CRACRANTES NE-articularsal da maganganu na iya haifar da raunin da ya faru, gami da rauni na articular.
Shigowa da
Rubuta haƙuri na IV shine rauni mai rauni na abin da aka makala wanda ke faruwa yayin ƙarfin fashewa da haɗin gwiwa na radial hadin gwiwa.
Avulsion karfin gwiwa na dislocation
Rubuta v rauni yana tasowa daga rauni mai ƙarfi wanda ya shafi sojojin waje da yawa da kuma raunuka masu rauni. (Cigaba i, II, IIII, IV)
3. QueLonmic buga
Ii
Alamu.
Don ƙarin rauni-articular bin gazawar rufewa a cikin waɗannan yanayi masu zuwa.
Dorsal Angulation mafi girma fiye da 20 °
Dorsal matsawa mafi girma fiye da 5 mm
Distal radius gajarta mafi girma fiye da 3 mm
Karkatar da karaya mai ƙarfi fiye da 2 mm
Don ciwon ciki-articular mafi girma fiye da 2mm
Yawancin malamai basa bayar da shawarar yin amfani da faranti na metacarpal don raunin da ya faru, kamar yadda mummunan lalacewar kashi, saboda waɗannan gutsuttsuran kashi, domin waɗannan gutsuttsuran kashi ne masu rarrafe.
A cikin marasa lafiya tare da gutsutsutsuka da yawa da kuma fitowarsu mai mahimmanci tare da tsananin osteoporosis, metacarpal plating ba mai tasiri ba. Tuntushin goyon baya na karkatar da tsorewa na iya zama matsala, kamar ta cikin shigar da kunnawa cikin rami na haɗin gwiwa.
Hanyar tiyata
Yawancin masu aikin tiyata suna amfani da irin wannan tsarin kula da dabaru don gyara Distal Radius Karshe tare da farantin Palmar. Koyaya, ana buƙatar fasaha mai kyau don magance rikice-rikicen da ya dace, misali, ragewa ana iya rage ta hanyar sakin toshewar karagar da kuma dawo da ci gaba da ƙimar ƙwayar cuta. Za'a iya amfani da gyaran na ɗan lokaci tare da filayen kirschner 2-3, da sauransu.
(I) maimaitawa da hali
1. Ana yin harkar ta hanyar madaidaiciyar shaft a karkashin fukai, tare da babban yatsa da kuma sauran yatsunsu da kuma sauran yatsunsu da keɓance da kewayon kusurwa daga kusurwar.
2. Matsayinsu na biyu, tare da reshe wanda aka shafa a kan tebur na hannu a ƙarƙashin Fluoroscopy.
(Ii) m.
Don amfani da nau'in hanyar da za a yi amfani da ita, PCR (radial carpal slowor) ana ba da shawarar hanyar Palmar kusanci.
Kusan ƙarshen fata na farawa a cikin fata crease na wuyan hannu kuma ana iya ƙaddara tsawon karar.
Radial Flexor Carpi Haurialis Hauralid da shi ya zama incied, Distal zuwa Carpal Kasusuwa da kuma kusanci da gefen proximal.
Fitar da radial flight flight jita-jita zuwa ga ulnar yana kiyaye jijiyoyin mediya da kuma hadaddun jijiyoyin.
Sararin Parona ya fallasa da kuma mai jujjuyawa Anai tsoka is locateditorm dirlivor Longus (ulnar gefen) da radial arery (gefen radial).
Ku ci gaba da radial na mai juji na juji mai juji, lura da cewa ya kamata a bar sashi zuwa Radius don dawowa nan gaba.
Raukar da kayan maye na ulman mai jujjuyawa zuwa ga ƙarin bayyanuwar ulnar a kan Radius.
Hanyar Palmar ta fallasa Radius na Distal da kuma yadda ya kamata ya fallasa kusurwar ulnar.
Don hadaddun karaya, ana bada shawara cewa dakatarwar Brakioalisis ta farko, wanda zai iya jujjuya radius sinad da na farko, sannan sake saita shi. toshe-artracular toshe amfani da wani kayan kashin kashin. Don hadaddun karuwa-articular, ana iya amfani da arthroscopy don taimakawa a ragi, kimantawa da kyau-tuning na karar block.
(III) Hanyar Rage.
1. Yi amfani da pry na kashi kamar na lever don sake saita
2. Mataimakin yana jan manya-ƙanƙan haƙuri da yatsunsu na tsakiya, wanda zai zama mai sauƙi don sake saiti.
3. Scren da Kirschn Pin daga radar radial radarsu ga ficewa na ɗan lokaci.
Bayan sakewa ya cika, ana sanya farantin kayan palmar, wanda dole ne ya kasance kusa da mai ruwa, dole ne ya zama mai yiwuwa ga ulnar kara. Idan ba a hade da waɗannan yanayin ba, idan farantin ba girman ya dace ba, ko kuma sake sabuntawa ba shi da gamsuwa, da har yanzu ba cikakke bane.
Yawancin rikice-rikice suna da alaƙa da matsayin farantin. Idan an sanya farantin yayi nisa sosai ga radial gefe, rikice-rikice masu alaƙa da maɓallin bubashin bunagewa suna iya faruwa; Idan an sanya farantin ma kusa da layin ruwa, madauki mai zurfi na yatsa na iya zama haɗari. Rushewar hanzari na fashewar palmar ta iya haifar da farantin don daidaitawa tare da jiɓin ido, ƙarshe ya kai ga jijiyoyin jiki ko ma gugures.
A cikin osteoporotic marasa lafiya, ana bada shawara cewa a sanya farantin kamar yadda yake kusa da layin ruwa kamar yadda zai yiwu, amma ba fadin shi ba. Za'a iya samun damar haɓaka gyarawa ta amfani da ɗakunan kirschner kusa da ulna, da maɓallin Kishin Kischner na gefe da kuma kulle-gefe suna da tasiri wajen guje wa gyarawa rauni.
Da zarar an sanya farantin daidai, an daidaita ƙarshen atet ɗin tare da dunƙule ɗaya da ƙarshen ƙarshen farantin na ɗan lokaci a cikin ramin ulnar a cikin rami na UMNAR. Intraopraiscopic orthopantomomomogram, labulen a labulen, da kuma shimfidar fina-finai tare da fina-finai 30 ° sit ciki an ɗauke shi don tantance rage kararwa da matsayin gyaran ciki.
Idan farantin yana da gamsuwa da matsayin da ke da ƙarfi, amma kirschner Pin shine Intra-articular, wannan zai iya warware shi ta hanyar sake saita farantin palmar. (Fig. 2, B).
Hoto na 2.
A, pinces biyu na Kirschner na kayan aiki na ɗan lokaci, a lura cewa mahimmin mahimmin mahimmin mahimmin ra'ayi da saman maganganu ba su isa ba a wannan lokacin;
B, Pinaya daga cikin Sircher Pin don ficewa farantin ɗan lokaci, a hankali cewa an cire radius na ɗan lokaci a wannan lokacin (karkatarwa na zurfi), da kuma ƙarshen ɓangaren farantin yana jan zuwa kusurwar radial karklen don mayar da kusurwar radial karko.
C, Arthroscopic lafiya-tuning na articular saman, play, da sake saiti na ƙarshe da kuma gyara na radius na wakili.
Game da yanayin dorsal da ulnar karaya (Ulnar / dorsal Yesu ya mutu), wanda ba za a iya sake saita shi sosai a rufe ba, ana iya amfani da dabaru guda uku masu zuwa.
Radius na wakili ya juya ya wuce gona da iri daga wurin karaya, da kuma karar karar zabin da aka tura zuwa kasusuwa ta Carpal ta hanyar kusancin PCR. Smallan ƙaramin abu ne dorsal zuwa bangarori na 4 da na 5 don bijirar da karar karaya, kuma an daidaita shi a cikin mafi kyawun ulman mafi girma. An rufe percutaneous ko mintimally m rudani an yi shi da taimakon arthroscopic.
Bayan sake sake juyawa da madaidaicin sandar farantin, gyara na ƙarshe shine mafi sauki kuma ana iya daidaitawa idan ulnar Kernel PIN ne daidai kuma babu sukurori da ke cikin haɗin gwiwa (Hoto na 2).
(IV) Kwarewar zaba.
Tsawon dabaru na iya zama da wahala a auna daidai saboda tsananin karfin kashin karaya na dorsal. Scrams waɗanda suke da tsawo suna iya haifar da matsanancin tashin hankali kuma gajerawa don tallafawa haɓaka toshewar karaya. A saboda wannan dalili marubutan suna ba da shawarar amfani da ƙusoshin da ke rufe ƙusoshin da multawa da yawa a cikin rijiyoyin Radial. Yin amfani da kai mai ban sha'awa yana nisanta tashin hankalin da jijiyoyin ko koda kuwa alama ce ta alama. Don ficewa mai gadi, ƙwallon ƙafa biyu + dunƙule ɗaya na yau da kullun (wanda aka sanya ta hanyar ellipse) za'a iya amfani dashi don gyara.
Dr Kiyohito daga Faransa ya gabatar da kwarewar su game da amfani da fararen kulob din Palmar. Wannan hanyar da farko an nuna ta sosai da tsoratarwa na hankali RADIus. Hanyar ba ta dace da nau'in backrates ba. Marubutan suna nuna cewa idan ragi mai kyau da tsayayyen ba za a iya cimma ta hanyar wannan hanyar ba, wajibi ne don canjawa zuwa hanyar rashin kulawa ta gargajiya.
Lokaci: Jun-26-2024
