A halin yanzu, ana magance karayar radius ta hanyoyi daban-daban, kamar gyaran filasta, ƙwanƙwasa da rage gyaran ciki, shingen gyaran waje, da dai sauransu. Daga cikin su, gyaran farantin dabino na iya samun sakamako mai gamsarwa, amma wasu littattafai sun ba da rahoton cewa wahalarsa ya kai 16%. Duk da haka, idan an zaɓi farantin da kyau, za a iya rage yawan rikitarwa yadda ya kamata. An gabatar da taƙaitaccen bayyani na nau'o'i, alamu da dabarun tiyata na palmar plating don karyewar radius mai nisa.
I.Nau'in raunin radius mai nisa
Akwai tsarin rarrabuwa da yawa don karyewa, gami da rarrabuwar Müller AO bisa tsarin jikin mutum da rarrabuwar Femandez bisa tsarin rauni. Daga cikin su, rarrabuwar Eponymic ta haɗu da fa'idodin rarrabuwa na baya, yana rufe nau'ikan ɓarna huɗu na asali, kuma ya haɗa da ɓarke ɓangarorin Maleon 4 da raunin Chaffer, wanda zai iya zama jagora mai kyau don aikin asibiti.
1. Müller AO rarrabuwa - ɓangarori na intra-articular partially
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'i yana ƙara rarraba zuwa ƙungiyoyi daban-daban na ƙungiyoyin ƙungiyoyi dangane da tsanani da rikitarwa na karaya.
Nau'in A: Karaya mai ƙarfi
A1, ulnar femoral fracture, radius as rauni (A1.1, ulnar stem fracture; A1.2 sauki karaya na ulnar diaphysis; A1.3, comminuted fracture na ulnar diaphysis).
A2, Karaya na radius, mai sauƙi, tare da saiti (A2.1, radius ba tare da karkata ba; A2.2, karkatar radius na baya, watau Pouteau-Colles fracture; A2.3, karkatar palmar na radius, watau Goyand-Smith fracture).
A3, Karaya na radius, comminuted (A3.1, axial shortening na radius; A3.2 siffa mai siffa na radius; A3.3, comminuted karaya na radius).
Nau'in B: partial articular fracture
B1, karaya na radius, jirgin sama na sagittal (B1.1, nau'i mai sauƙi na gefe; B1.2, nau'in comminuted na gefe; B1.3, nau'in tsakiya).
B2, Karaya na gefen radius, watau Barton fracture (B2.1, nau'i mai sauƙi; B2.2, haɗuwa ta gefe sagittal fracture; B2.3, haɗuwa dorsal dislocation na wuyan hannu).
B3, Karyewar ɓangarorin metacarpal na radius, watau anti-Barton fracture, ko Goyand-smith type II karaya (B3.1, sauki femoral mulkin, kananan guntu; B3.2, sauki karaya, babban guntu; B3.3, comminuted karaya).
Nau'in C: jimillar karaya
C1, radial fracture tare da nau'i mai sauƙi na nau'i na nau'i na biyu da kuma metaphyseal (C1.1, na baya na tsakiya na tsakiya; C1.2, sagittal fracture of articular surface; C1.3, fracture of coronal surface of articular surface).
C2, Radius fracture, sauki articular facet, comminuted metaphysis (C2.1, sagittal fracture na articular facet; C2.2, coronal facet fracture na articular facet; C2.3, articular fracture mika cikin radial kara).
C3, radial fracture, comminuted (C3.1, sauki karaya na metaphysis; C3.2, comminuted fracture of metaphysis; C3.3, articular fracture mika zuwa radial kara).
2.Classification na distal radius fractures.
Bisa ga inji rauni Femandez rarrabuwa za a iya raba 5 iri:.
Nau'in I fractures sune karin-articular metaphyseal comminuted fractures kamar Colles fractures (dorsal angulation) ko Smith fractures (metacarpal angulation). Bawo na kashi ɗaya yana karyewa a ƙarƙashin tashin hankali kuma an lalata cortex ɗin da aka saɓa kuma an saka shi.
Karya
Nau'in nau'in III fractures sune karaya a cikin articular, wanda ya haifar da damuwa mai karfi. Wadannan karaya sun hada da karayar dabino Barton, karaya ta dorsal Barton, da karaya mai tushe na radial.
Tsayar da damuwa
Type na III CRACRANTES NE-articularsal da maganganu na iya haifar da raunin da ya faru, gami da rauni na articular.
Shigarwa
Nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i) nau'i-nau'i-nau'i-nau'i-nau'i.
Karyawar Avulsion Na watsewa
Nau'in nau'in nau'in V ya taso daga mummunan rauni mai saurin gudu wanda ya shafi sojojin waje da yawa da kuma raunuka masu yawa. (Mixed I, II, IIII, IV)
3.Eponymic typing
II.Maganin karyewar radius mai nisa tare da platin dabino
Alamomi.
Don ƙarin karaya bayan gazawar rufaffiyar raguwa a cikin yanayi masu zuwa.
Dorsal angula fiye da 20°
Matsawar dorsal fiye da 5 mm
Nisa radius yana gajarta fiye da 3 mm
Tushewar toshewar nesa fiye da mm 2
Don karyewar cikin-articular fiye da 2mm matsawa
Yawancin malamai ba sa ba da shawarar yin amfani da faranti na metacarpal don raunin kuzari mai ƙarfi, kamar raunin raunin da ya faru na intra-articular ko asarar ƙashi mai tsanani, saboda waɗannan ɓangarorin ɓarna mai nisa suna da haɗari ga necrosis na jijiyoyin bugun jini kuma suna da wahala a sake fasalin jiki.
A cikin marasa lafiya tare da raguwa masu yawa da kuma ƙaura mai mahimmanci tare da osteoporosis mai tsanani, metacarpal plating ba shi da tasiri. Taimakon subchondral na karaya mai nisa na iya zama matsala, kamar shigar dunƙule cikin rami na haɗin gwiwa.
Dabarar tiyata
Yawancin likitocin fiɗa suna amfani da irin wannan hanya da fasaha don gyara karyewar radius mai nisa tare da farantin dabino. Koyaya, ana buƙatar ingantaccen dabarar fiɗa don guje wa rikice-rikicen bayan tiyata yadda ya kamata, misali, ana iya samun raguwa ta hanyar sakin toshewar karaya daga matsewar da aka saka da kuma dawo da ci gaba na kashin cortical. Ana iya amfani da gyare-gyare na ɗan lokaci tare da 2-3 Kirschner fil, da sauransu.
(I) Gyaran matsayi da matsayi
1. Ana yin juzu'i a cikin hanyar radial shaft a ƙarƙashin fluoroscopy, tare da babban yatsan yatsa yana danna toshewar kusanci zuwa ƙasa daga gefen dabino da sauran yatsunsu suna ɗaga toshe mai nisa sama a wani kusurwa daga gefen dorsal.
2. Matsayi na baya, tare da abin da ya shafa a kan tebur na hannu a karkashin fluoroscopy.
(II) Wuraren shiga.
Don nau'in tsarin da za a yi amfani da shi, ana ba da shawarar PCR (radial carpal flexor) tsayin dabino.
Ƙarshen ƙarshen ɓarna fata yana farawa a cikin kurjin fata na wuyan hannu kuma ana iya ƙayyade tsawonsa bisa ga nau'in karaya.
Radial flexor carpi radialis tendon da kullin jijiya an yanka su, nesa da ƙasusuwan carpal da kusanci kusa da gefen kusanci kamar yadda zai yiwu.
Jawo radial carpal flexor tendon zuwa gefen ulnar yana kare jijiyar tsaka-tsaki da hadaddun jijiya.
An fallasa sararin samaniyar Parona kuma tsohuwar rotator ani tsoka tana tsakanin flexor digitorum longus (gefen ulnar) da radial artery (gefen radial).
Ƙara gefen radial na tsokar rotator na gaba, lura da cewa ya kamata a bar wani yanki a haɗe zuwa radius don sake ginawa daga baya.
Janye tsokar rotator ko na gaba zuwa gefen ulnar yana ba da damar ƙarin isasshiyar bayyanar ƙahon ulnar a gefen dabino na radius.
Hanyar dabino tana fallasa radius mai nisa kuma yana fallasa kusurwar ulnar yadda ya kamata.
Don hadaddun nau'ikan karaya, ana ba da shawarar cewa za a iya sakin tasha na brachioradialis mai nisa, wanda zai iya kawar da jan hankalinsa a kan tuberosity na radial, a nan ne za'a iya ƙulla kullin dabino na ɓangaren dorsal na farko, wanda zai iya fallasa ɓarnawar radial da radial tuberosity, a ciki ta juya radial ɗin ta, sannan sai a sake jujjuya radial ɗin daga yumbu. toshe karaya ta cikin-articular ta amfani da fil ɗin Kirschner. Don hadaddun ɓangarorin intra-articular, ana iya amfani da arthroscopy don taimakawa ragewa, kimantawa da daidaitawa na toshe karaya.
(III) Hanyoyin ragewa.
1. Yi amfani da pry na kashi azaman lever don sake saiti
2. Mataimakin yana jan alamar majiyyaci da yatsa na tsakiya, wanda zai zama mai sauƙi don sake saitawa.
3. Cire fil ɗin Kirschner daga tuberosity radial don gyarawa na ɗan lokaci.
Bayan an gama sakewa, ana sanya farantin dabino akai-akai, wanda dole ne ya kasance kusa da magudanar ruwa, dole ne ya rufe martabar ulnar, kuma ya kamata ya kasance kusa da tsakiyar tsakiyar radial. Idan waɗannan sharuɗɗan ba a cika su ba, idan farantin ɗin ba daidai ba ne, ko kuma idan sake fasalin bai dace ba, hanyar har yanzu ba ta da kyau.
Yawancin rikitarwa suna da alaƙa da ƙarfi da matsayi na farantin. Idan an sanya farantin da nisa zuwa gefen radial, matsalolin da suka shafi bunion flexor na iya faruwa; idan an sanya farantin a kusa da layin ruwa, mai zurfi mai zurfi na yatsa na iya zama cikin haɗari. Nakasar da aka sauya na karaya ta sake komawa gefen dabino na iya haifar da farantin cikin sauƙi ya fito zuwa gefen dabino kuma ya yi hulɗa kai tsaye tare da lanƙwasa, a ƙarshe yana haifar da tendonitis ko ma fashewa.
A cikin marasa lafiya na osteoporotic, ana ba da shawarar cewa a sanya farantin a kusa da layin ruwa kamar yadda zai yiwu, amma ba a fadinsa ba. Za a iya samun gyare-gyaren subchondral ta amfani da fitilun Kirschner mafi kusa da ulna, da kuma gefe-da-gefe Kirschner fil da kulle sukurori suna da tasiri a guje wa sakewa.
Da zarar an sanya farantin daidai, ana gyara ƙarshen kusanci tare da dunƙule ɗaya kuma an gyara ƙarshen farantin na ɗan lokaci tare da fitattun Kirschner a cikin mafi girman rami na ulnar. Intraoperative fluoroscopic orthopantomograms, ra'ayoyi na gefe, da kuma fina-finai na gefe tare da hawan wuyan hannu na 30 ° an dauki su don ƙayyade raguwar raguwa da matsayi na gyaran ciki.
Idan farantin ya kasance mai gamsarwa, amma Kirschner fil yana cikin intra-articular, wannan zai haifar da rashin isasshen farfadowa na dabino na dabino, wanda za'a iya warware shi ta hanyar sake saita farantin ta amfani da "dabarun gyaran gyare-gyare na nesa" (Fig. 2, b).
Hoto 2.
a, biyu Kirschner fil don gyarawa na wucin gadi, lura da cewa ba a maido da ƙwaƙƙwaran metacarpal da filaye na articular a wannan lokacin;
b, Daya Kirschner fil don gyaran farantin wucin gadi, lura cewa radius mai nisa yana daidaitawa a wannan lokacin (dabarun gyaran ɓangarorin ɓarna mai nisa), kuma an ja ɓangaren kusa da farantin zuwa radial radial don dawo da kusurwar karkatar dabino.
C, Gyaran gyaran gyare-gyaren arthroscopic na sassan articular, jeri na sukurori/fili mai nisa, da sake saiti na ƙarshe da gyara radius na kusa.
A cikin yanayin ɓangarorin ƙwanƙwasa na bayan gida da ulnar (ulnar/dorsal Die Punch), waɗanda ba za a iya sake saita su daidai ba a ƙarƙashin rufewa, ana iya amfani da waɗannan dabaru guda uku masu zuwa.
Radius na kusa yana jujjuya gaba da gaba daga wurin da aka karye, kuma an tura toshe toshe na lunate fossa zuwa kashin carpal ta hanyar tsawaita PCR; Ana yin wani ɗan ƙaramin yanka a baya zuwa ɗaki na 4 da na 5 don fallasa ɓangarorin da ya karye, kuma an daidaita shi a cikin faranti mafi ƙarancin ulnar. An yi gyaran gyare-gyaren da aka rufe ko kuma ƙaramin ɓarna tare da taimakon arthroscopic.
Bayan daidaitawa mai gamsarwa da daidaitaccen wuri na farantin, gyare-gyaren ƙarshe ya fi sauƙi kuma za'a iya samun gyare-gyaren jiki idan an daidaita madaidaicin kernel na kusa kuma babu sukurori a cikin rami na haɗin gwiwa (Figure 2).
(iv) Kwarewar zaɓin dunƙule.
Tsawon sukurori na iya zama da wahala a iya aunawa daidai saboda murkushe kashin baya mai tsanani. Sukullun da suka yi tsayi da yawa na iya haifar da tada jijiyoyin wuya da gajere sosai don tallafawa gyara toshe karyewar baya. A saboda wannan dalili, marubutan sun ba da shawarar yin amfani da kusoshi na kulle da zaren da kuma kusoshi na kulle multiaxial a cikin radial tuberosity da mafi yawan ulnar foramen, da kuma amfani da kullun kulle-ƙulle a cikin sauran wurare. Yin amfani da kai mai kaifi yana guje wa tashin jijiyar koda koda zaren zare ne a baya. Don gyare-gyaren faranti na kusa, ana iya amfani da sukurori guda biyu masu haɗakarwa + dunƙule guda ɗaya (wanda aka sanya ta cikin ellipse) don gyarawa.
Dokta Kiyohito daga Faransa sun gabatar da kwarewarsu ta yin amfani da faranti na kulle-kulle kadan don karyewar radius, inda aka rage musu fida zuwa wani tsayin daka 1cm, wanda bai dace ba. An nuna wannan hanyar da farko don raunin radius mai tsayi mai tsayi, kuma alamun aikin tiyata shine don ƙarin ɓarnawar ɓarna na AO na nau'ikan A2 da A3 da kuma raunin intra-articular na nau'ikan C1 da C2, amma bai dace da raunin C1 da C2 ba tare da rushewar kasusuwa na ciki. Hanyar kuma ba ta dace da nau'in B ba. Har ila yau, marubutan sun nuna cewa idan ba za a iya samun raguwa mai kyau da gyare-gyare ba tare da wannan hanya, ya zama dole a canza zuwa hanyar ƙetare na al'ada kuma kada a tsaya ga ƙananan ƙananan ƙwayar cuta.
Lokacin aikawa: Yuni-26-2024
