A halin yanzu, ana magance karyewar radius ta nesa ta hanyoyi daban-daban, kamar gyaran filasta, yankewa da rage gyaran ciki, maƙallin gyara na waje, da sauransu. Daga cikinsu, gyaran farantin palmar na iya samun sakamako mai gamsarwa, amma wasu wallafe-wallafe sun ba da rahoton cewa yawan rikitarwarsa ya kai kashi 16%. Duk da haka, idan aka zaɓi farantin yadda ya kamata, za a iya rage yawan rikitarwa yadda ya kamata. An gabatar da taƙaitaccen bayani game da nau'ikan, alamu da dabarun tiyata na plating na palmar don karyewar radius ta nesa.
I. Nau'in karyewar radius mai nisa
Akwai tsarin rarrabuwa da dama don karaya, ciki har da rarrabuwar Müller AO bisa ga tsarin jiki da kuma rarrabawar Femandez bisa ga tsarin rauni. Daga cikinsu, rarrabuwar Eponymic ta haɗa fa'idodin rarrabuwar da ta gabata, ta rufe nau'ikan karaya guda huɗu na asali, kuma ta haɗa da karaya mai sassa 4 na Maleon da karaya ta Chaffer, wanda zai iya zama jagora mai kyau ga aikin asibiti.
1. Rarraba Müller AO - karaya a cikin ƙashi
Rarraba AO ya dace sosai da karyewar radius mai nisa kuma ya raba su zuwa manyan nau'i uku: nau'in A extra-articular, nau'in B partial intra-articular, da nau'in C duka karyewar haɗin gwiwa. Kowane nau'i an ƙara raba shi zuwa gauraye daban-daban na ƙananan ƙungiyoyi bisa ga tsananin da sarkakiyar karyewar.
Nau'i na A: Karyewar ƙashi na musamman
A1, karyewar ulnar femoral, radius a matsayin rauni (A1.1, karyewar ulnar stem; A1.2 karyewar ulnar diaphysis mai sauƙi; A1.3, karyewar ulnar diaphysis mai rauni).
A2, Karyewar radius, mai sauƙi, tare da shigarwar ciki (A2.1, radius ba tare da karkatarwa ba; A2.2, karkatar radius na baya, watau, karyewar Pouteau-Colles; A2.3, karkatar radius na tafin hannu, watau, karyewar Goyrand-Smith).
A3, Karyewar radius, an rage ta (A3.1, rage ta axial na radius; A3.2 guntu mai siffar yanki na radius; A3.3, karyewar radius mai kauri).
Nau'i na B: wani ɓangare na karyewar ƙashi
B1, karyewar radius, jirgin sama mai saurin gudu (B1.1, nau'in simple na gefe; B1.2, nau'in comminuted na gefe; B1.3, nau'in tsakiya).
B2, Karyewar gefen dorsal na radius, watau, Karyewar Barton (B2.1, nau'i mai sauƙi; B2.2, karyewar gefen sagittal mai haɗuwa; B2.3, haɗakar karkacewar wuyan hannu).
B3, Karyewar gefen metacarpal na radius, watau, karyewar anti-Barton, ko karyewar Goyrand-smith nau'in II (B3.1, ƙa'idar femoral mai sauƙi, ƙaramin guntu; B3.2, karyewar sauƙi, babban guntu; B3.3, karyewar da aka yi wa comminuted).
Nau'in C: cikakken karyewar ƙashi
C1, karyewar radial tare da nau'in sassauƙa na sassan articular da metaphyseal (C1.1, karyewar medial medial; C1.2, karyewar sagittal na saman articular; C1.3, karyewar coronal na saman articular).
C2, Karyewar Radius, Simple Articular facet, comminuted metaphysis (C2.1, sagittal fragment of articular facet; C2.2, coronal phaseet fragment of articular facet; C2.3, articular fragment ...
C3, karyewar radial, comminuted (C3.1, karyewar metaphysis mai sauƙi; C3.2, karyewar metaphysis mai comminuted; C3.3, karyewar articular da ke miƙewa zuwa tushen radial).
2. Rarraba karyewar radius mai nisa.
Bisa ga tsarin raunin Femandez rarrabuwa za a iya raba zuwa nau'ikan 5:.
Karyewar Nau'i na I sune karyewar da aka samu daga ƙashi mai kama da na ƙashi kamar Colles fractures (ƙugu na dorsal) ko Smith fractures (ƙugu na metacarpal). Ƙwayar ƙashi ɗaya ta karyewa a ƙarƙashin tashin hankali kuma an haɗa ta da ɓangaren da ke tsakanin ƙashi.
Karyewa
Karyewar Nau'i na Uku karaya ce ta cikin jijiyoyin jini, wadda ke faruwa sakamakon matsin lamba. Waɗannan karaya sun haɗa da karyewar palmar Barton, karyewar dorsal Barton, da kuma karyewar radial stem.
Damuwar yankewa
Karyewar Nau'i na III sune karyewar jijiyoyin da ke cikin jijiyoyin da kuma shigar da metaphyseal wanda raunukan matsewa suka haifar, gami da karyewar jijiyoyin da ke da rikitarwa da kuma karyewar radial pilon.
Shigarwa
Karyewar Nau'i na IV wani karyewar avulsion ne na abin da aka makala na ligament wanda ke faruwa yayin karyewa da kuma wargajewar haɗin gwiwa na radial carpal.
Karyar afuskar da aka samu a baya I slabation
Karyewar Nau'in V tana faruwa ne sakamakon raunin da ya shafi ƙarfi da yawa na waje da kuma raunuka masu yawa. (Gurasa ta I, II, III, IV)
3. Rubuta sunaye masu kama da juna
II. Maganin karyewar radius mai nisa tare da plating na palmar
Alamomi.
Don karyewar ƙashi bayan gazawar raguwar rufewa a cikin waɗannan yanayi.
Kusurwar gefe mafi girma fiye da 20°
Matsewar gefe ya fi mm 5
Ragewar radius mai nisa fiye da 3 mm
Murmushi mai nisa na toshewar karyewa fiye da mm 2
Don karaya a cikin haɗin gwiwa fiye da motsi na 2mm
Yawancin malamai ba sa ba da shawarar amfani da faranti na metacarpal don raunin da ke da ƙarfi sosai, kamar karyewar ƙashi mai tsanani a cikin ƙashi ko kuma asarar ƙashi mai tsanani, saboda waɗannan gutsuttsuran karyewar da ke nesa suna iya haifar da cutar avascular necrosis kuma suna da wahalar sake saita su ta hanyar tsarin jiki.
Ga marasa lafiya da suka samu karyewar kashi da yawa da kuma yawan matsuguni da ke tattare da osteoporosis mai tsanani, plating na metacarpal ba shi da tasiri. Tallafin subchondral na karyewar kashi na nesa na iya zama matsala, kamar shigar sukurori cikin ramin haɗin gwiwa.
Fasahar tiyata
Yawancin likitocin tiyata suna amfani da irin wannan hanya da dabara don gyara karyewar radius mai nisa da farantin palmar. Duk da haka, ana buƙatar kyakkyawar dabarar tiyata don guje wa rikitarwa bayan tiyata, misali, ana iya cimma raguwa ta hanyar sakin toshewar karyewar daga matsewar da aka haɗa da kuma dawo da ci gaba da ƙashin cortical. Ana iya amfani da matsewa na ɗan lokaci tare da fil 2-3 na Kirschner, da sauransu.
(I) Sake matsayi da kuma yanayin aiki kafin tiyata
1. Ana yin jan hankali a gefen shaft ɗin radial a ƙarƙashin fluoroscopy, tare da babban yatsan hannu yana danna toshewar karyewar proximal daga gefen tafin hannu da sauran yatsun hannu suna ɗaga toshewar a kusurwa daga gefen baya.
2. Matsayin kwance a ƙasa, tare da gaɓar da abin ya shafa a kan teburi a ƙarƙashin na'urar fluoroscopy.
(II) Wuraren shiga.
Domin irin hanyar da za a yi amfani da ita, ana ba da shawarar amfani da hanyar PCR (radial carpal flexor) extended palmar.
Ƙarshen ƙarshen yankewar fata yana farawa ne daga ƙurar fata ta wuyan hannu kuma ana iya tantance tsawonsa gwargwadon nau'in karyewar.
An yanke jijiyar radial flexor carpi radialis da kuma murfin jijiyar, suna nesa da ƙasusuwan carpal kuma suna kusa da gefen kusa gwargwadon iyawa.
Jawo jijiyar lankwasawa ta carpal zuwa gefen ulnar yana kare mahaɗin jijiyar tsakiya da kuma jijiyar lankwasawa.
Sararin Parona yana bayyana kuma tsokar da ke juyawa a gaba tana tsakanin flexor digitorum longus (gefen ulnar) da radial jijiyar (gefen radial).
A datse gefen radial na tsokar da ke juyawa a gaba, a lura cewa ya kamata a bar wani ɓangare a haɗe da radius ɗin don sake ginawa daga baya.
Jawo tsokar da ke juyawa ta gaba zuwa gefen ulnar yana ba da damar samun ƙarin haske na ƙahon ulnar a gefen palmar na radius.
Hanyar palmar tana fallasa radius na nesa kuma tana fallasa kusurwar ulnar yadda ya kamata.
Ga nau'ikan karaya masu rikitarwa, ana ba da shawarar a saki tasha ta distal brachioradialis, wanda zai iya rage jan sa akan radial tuberosity, a lokacin ne za a iya yanke murfin palmar na sashin farko na dorsal, wanda zai iya fallasa toshewar karyewar nesa radial da radial tuberosity, a cikin juyawa radius Yu don cire shi daga wurin karaya, sannan a sake saita toshewar karyewar ciki ta amfani da fil na Kirschner. Don karaya mai rikitarwa a cikin arthritic, ana iya amfani da arthroscopy don taimakawa wajen ragewa, kimantawa da daidaita toshewar karyewar.
(III) Hanyoyin ragewa.
1. Yi amfani da ƙashin ƙugu a matsayin lever don sake saitawa
2. Mataimakin yana jan yatsun hannun majiyyaci da na tsakiya, wanda zai yi sauƙin sake saita shi.
3. Murkushe fil ɗin Kirschner daga radial tuberosity don gyarawa na ɗan lokaci.
Bayan an kammala sake sanya wurin, ana sanya farantin palmar akai-akai, wanda dole ne ya kasance kusa da wurin da ruwa ke taruwa, dole ne ya rufe babban ulnar, kuma ya kamata ya kasance kusa da tsakiyar tushen radial. Idan ba a cika waɗannan sharuɗɗan ba, idan farantin bai dace ba, ko kuma idan sake sanya wurin bai dace ba, tsarin har yanzu bai cika ba.
Matsaloli da yawa suna da alaƙa da matsayin farantin. Idan farantin ya yi nisa da gefen radial, akwai yiwuwar samun matsaloli da suka shafi lanƙwasa bunion; idan farantin ya yi kusa da layin ruwa, lanƙwasa mai zurfi na yatsan na iya kasancewa cikin haɗari. Nakasar da aka canja wurin karyewar da aka samu zuwa gefen palmar na iya sa farantin ya fito zuwa gefen palmar cikin sauƙi kuma ya shiga hulɗa kai tsaye da jijiyar lanƙwasa, wanda daga ƙarshe zai haifar da ciwon jijiyoyi ko ma fashewa.
Ga masu fama da ƙashi, ana ba da shawarar a sanya farantin kusa da layin ruwa gwargwadon iyawa, amma ba a saman sa ba. Ana iya samun gyara na subchondral ta amfani da fil ɗin Kirschner mafi kusa da ulna, kuma fil ɗin Kirschner da sukurori masu kullewa suna da tasiri wajen guje wa sake canza wurin karyewa.
Da zarar an sanya farantin daidai, sai a gyara ƙarshen kusa da shi da sukurori ɗaya sannan a gyara ƙarshen farantin na ɗan lokaci da fil ɗin Kirschner a cikin ramin ulnar mafi girma. An ɗauki hotunan orthopantomograms na fluoroscopic a lokacin tiyata, kallon gefe, da fina-finan gefe tare da ɗaga wuyan hannu 30° don tantance raguwar karyewar da kuma matsayin wurin da aka gyara ciki.
Idan farantin yana da isasshen wuri, amma fil ɗin Kirschner yana cikin ƙashin ƙugu, wannan zai haifar da rashin isasshen murmurewa na karkacewar palmar, wanda za'a iya warwarewa ta hanyar sake saita farantin ta amfani da "dabarun gyara karyewar nesa" (Hoto na 2, b).
Hoto na 2.
a, fil ɗin Kirschner guda biyu don gyarawa na ɗan lokaci, lura cewa karkacewar metacarpal da saman haɗin gwiwa ba a gyara su sosai a wannan lokacin ba;
b, fil ɗaya na Kirschner don gyara faranti na ɗan lokaci, lura cewa an gyara radius na nesa a wannan lokacin (dabarun gyara tubalan karyewa na nesa), kuma ana ja ɓangaren kusa na farantin zuwa ga tushen radial don dawo da kusurwar karkatar da palmar.
C, Gyaran saman sassan haɗin gwiwa na arthroscopic, sanya sukurori/fina-fina na nesa, da kuma sake saitawa da kuma daidaita radius na kusanci.
Idan aka samu karaya a duwawu da kuma duwawu (ulnar/dorsal Die Punch), wanda ba za a iya sake saita shi yadda ya kamata ba a lokacin da aka rufe shi, za a iya amfani da wadannan dabaru guda uku.
Ana juya radius na kusa daga inda karayar ta faru a gaba, kuma ana tura toshewar karayar ta lunate fossa zuwa ga kashin carpal ta hanyar amfani da hanyar tsawaita PCR; an yi ƙaramin yankewa a baya zuwa sassa na 4 da 5 don fallasa toshewar karayar, kuma an ɗaure shi da sukurori a cikin mafi girman ulnar foramen na farantin. An yi gyaran da aka rufe ta hanyar amfani da arthroscopic.
Bayan an gyara wurin da ya dace kuma an sanya farantin daidai, gyara na ƙarshe ya fi sauƙi kuma ana iya samun sake saita wurin da ya dace idan an sanya fil ɗin ulnar na proximal daidai kuma babu sukurori a cikin ramin haɗin gwiwa (Hoto na 2).
(iv) Kwarewar zaɓar skru.
Tsawon sukurori na iya zama da wahala a auna daidai saboda tsananin murƙushewar ƙashi na dorsal cortical. Sukurori waɗanda suka yi tsayi da yawa na iya haifar da tashin hankali a jijiya da kuma gajarta don tallafawa gyara tubalin karyewar dorsal. Saboda wannan dalili, marubutan sun ba da shawarar amfani da ƙusoshin kullewa masu zare da ƙusoshin kullewa masu yawa a cikin bututun radial da mafi yawan foramen na ulnar, da kuma amfani da sukurori masu haske a wuraren da suka rage. Amfani da kai mai laushi yana hana tashin hankali na jijiya koda kuwa an zare shi a baya. Don gyara faranti masu haɗuwa, ana iya amfani da sukurori biyu masu haɗuwa + sukurori ɗaya na gama gari (wanda aka sanya ta cikin ellipse) don gyarawa.
Dr. Kiyohito daga Faransa ya gabatar da gogewarsu ta amfani da faranti masu kullewa na palmar masu ƙarancin shiga don karyewar radius na nesa, inda aka rage yankewar tiyatar zuwa matsakaicin 1cm, wanda hakan ba shi da wata ma'ana. Wannan hanyar galibi ana nuna ta ne ga karyewar radius na nesa mai ɗorewa, kuma alamun tiyatar suna nuna karyewar radius na waje na ɓangarorin AO na nau'ikan A2 da A3 da karyewar jijiyar ciki na nau'ikan C1 da C2, amma bai dace da karyewar C1 da C2 tare da rugujewar ƙashi na ciki ba. Hanyar kuma ba ta dace da karyewar nau'in B ba. Marubutan sun kuma nuna cewa idan ba za a iya cimma kyakkyawan raguwa da gyarawa da wannan hanyar ba, ya zama dole a canza zuwa hanyar yankewa ta gargajiya kuma kada a manne wa ƙaramin yankewa mai ƙarancin shiga.
Lokacin Saƙo: Yuni-26-2024
