News - Minisi mai ban sha'awa mai ban sha'awa na pharangangin da ciyawar metacarpal tare da IntraMedullary ƙwayoyin cuta masu cuta

Transverse karaya tare da kadan ko babu mai amfani: A cikin yanayin karaya na metacarpal kashi (wuyan ko wuya ko diapyis), sake saiti ta hanyar jagora. An fizge wa Phanx Phanxally shine mafi sauyawa don fallasa shugaban metacarpal. A 0.5- 1 cm trverecse na da aka yi kuma masu gabatar da tiyayya sun koma tsawon lokaci a cikin tsakiyar. A karkashin jagorancin haske, mun shigar da wani jagora 1.0 mm tare da axisin gwal na wuyan hannu. Tishen jagora ya yi birgima don guje wa shigar azzakari cikin sauri da kuma sauƙaƙe nunin faifai a cikin Canal na Medullary. Bayan mai jagora ya yanke shawarar yin amfani da filaye, wanda aka sanya kayan ƙashin kashi na mahimmin abu. An lasafta tsinkayen dunƙule mai dacewa daga hotunan preopative. A mafi yawan metacarpal cracarpal, ban da na biyar metacarpal, muna amfani da dunƙule 3.0-mm mm. Munyi amfani da Autofis m ƙwayoyin cuta (ƙananan kayan adon, morrisville, PA) .The mafi yawan kudaden da aka yi amfani da shi 40 mm. Wannan ya fi ƙanƙantar da adadin ƙimar metacarpal (kimanin 6.0 cm), amma da daɗewa ya isa ya shigar da zaren a cikin medulla don samun amintaccen ficewa daga dunƙule. Diamita na ramin medullary na na biyar yawanci manyan, kuma a nan muka yi amfani da dunƙule 4.0 tare da matsakaicin diamita na har zuwa 50 mm. A karshen hanyar, muna tabbatar da cewa zaren caudal an binne shi a ƙasa layin guringage. Hakanan yana da mahimmanci, yana da mahimmanci a guji dasa prosthanting da yawa, musamman a batun karar wuya.

Siffa

Hanyar tiyata ta hanyar jujjuyawa ta phalveral Phalanx yayi kama da (Fig. 15). Mun yi fannoni 0.5 cm a saman babban Phalen Phalan yayin da yake taƙaita madaidaicin haɗin gwiwa. Garin da aka rabu kuma ya koma Loginally don fallasa kai na Phanx Phanx. Don mafi yawan rushewar Phalanx, muna amfani da dunƙule 2.5 mm, amma don manyan filaye Muna amfani da dunƙule 3.0 mm. Matsakaicin tsawon 2.5 mm Chs a halin yanzu shine 30 mm. Muna kulawa kar a karye-fado da ƙara yawan sukurori. Tunda sukurori ne hawan hoda da kuma kunnawa kai, za su iya shiga tushe na Phalanx tare da karancin juriya. An yi amfani da irin wannan dabarar bugun jini na mifaral, tare da incission fara a kan shugabar Midshalaaly na Midfalaarx don ba da izinin Retrograde Localfular da sukurori.

Fig. 15 An saka ra'ayi mai ma'ana na Case.aa 1-mm Advancewire, ta hanyar sake fasalin da aka sanya waƙoƙi.ca 2.5-mm Chs an saka shi da binne shi a kai. Saboda takamaiman siffar filayen, matsawa na iya haifar da rabuwa da metacarpal cortex. (Mai haƙuri iri ɗaya kamar yadda yake cikin hoto na 8)

Murrushe na compinuted: Matsa mara amfani yayin shigar da Chs na iya haifar da ragewar metacarpals da kuma figura (fig. 16). Sabili da haka, duk da cewa amfani da Chs yana cikin ka'idar an haramta shi a cikin irin waɗannan halayen, mun sami mafita ga abubuwan da suka fi dacewa da juna.

Hoto na 16 ac Idan karaya ba ne ya tallafa wa latsarwar zai haifar da rushewar da ya rage ga mafi girman gajerun gajere (5 mm). Layi na jan ya dace da layin metacarpal.

Don raunin submetacarpal, muna amfani da dabarar da aka tsara dangane da tsarin gine-ginen da aka yi amfani da shi ko ƙarfafa tsarin ta hanyar tsayayya da matsi mai tsayi kuma haka yana tallafawa shi). Ta hanyar samar da y-siffar tare da sukurori biyu, shugaban metacarpal bai rushe; Mun ambaci wannan takalmin y-siffar. Kamar yadda yake a cikin hanyar da ta gabata, an saka wani waya mai tsayi 1.0 tare da tipt mai annashuwa. Yayin da muke rike madaidaicin tsawon metacarpal, wani wata babbar hanyar jagora, amma a wani kusurwa zuwa farkon jagora na farko, don haka samar da tsarin triangular. Dukkanin albidewires sun fadada ta amfani da wani jagora mai jagora don fadada Media. Don axir da aka fitar da kwalliya, yawanci muna amfani da 3.0 mm da kuma 2.5 mm diamita na diamita na 2.5, bi da bi. An saka dunƙulewar axial har sai da caudal thread shine matakin hadari. An saka abin da ya dace da tsawon lokacin da ya dace sannan a saka. Since there is not enough room in the medullary canal for two screws, the length of the oblique screws needs to be carefully calculated, and the axial screws should only be attached to the axial screws once they are sufficiently buried in the metacarpal head to ensure adequate stability without screw protrusion. Sai aka ci gaba da dunƙulen farko har sai an binne shi cikakke. Wannan yana nisantar rage girman metacarpal da durkushe shugaban, wanda ƙasan ƙasan za a iya hana su. Muna yin gwaje-gwaje masu yawa da yawa don tabbatar da cewa rushewar ba ya faruwa kuma ba a sanya riguna a cikin Canal na Medullary Canal (Fig. 17).

Hoto na 17 AC Y-Brackage Fasaha

A lokacin da ƙuduri shafi na dorsal cortex a gindi daga cikin Phalal Phalan, mun shirya hanyar da aka tsara; Mun sanya masa suna saboda murfin dunƙule yayin da yake da abubuwan dunƙule yayin da aka bushe shi a cikin Falanx. Bayan ya sake saita Phanx Phanx, an gabatar da waya mai jagorar axial cikin canal na Medullary kamar yadda zai yiwu. A ChS dan kadan ya fi guntu fiye da jimlar Fatarba (2.5 ko 3.0 mm) har zuwa ƙarshenta ya cika farantin farantin. A wannan gaba, zaren caudal suna kulle a cikin canal medullary canal, don haka aiwatar da tallafi na ciki da kuma takalmin katakon takalmin fata. Ana buƙatar gwaje-gwaje na farashi da yawa don hana shigar da shigar ciki (Hoto 18). Ya danganta da tsarin karaya, wasu sukurori ko haɗuwa na na'urorin gyara na ciki ana iya buƙata (Hoto na 19).

Hoto na 19: hanyoyi daban-daban na ficewa a cikin marasa lafiya da raunuka da suka faru. Mai rauni mai rauni submetacarpal submetacarpal na yatsa Hoto.f Free flaps anyi amfani da shi don taushi ɗaukar hoto mai laushi.C a cikin watanni 4. A metacarpal kashi na kadan yatsa wawan. Wasu scabs na kashi da aka kafa a wani wuri, yana nuna sakandare seconkure na sakandare da warkarwa.D shekara bayan hadarin, an cire murhun wuta; Kodayake asymptomatic, an cire dunƙule daga metacarpal na zobe na zobe saboda wanda ake zargi da shigar azzakari cikin sauri. Kyakkyawan sakamako (≥240 ° Tam) an samo shi ne a cikin kowane yatsa a ƙarshen ziyarar-metacarphalaal na tsakiya ya bayyana a watanni 18 sun bayyana a watanni 18.