Karya mai jujjuyawa tare da ƙaramin ko babu comminuation: idan akwai karaya na ƙashin metacarpal (wuyansa ko diaphysis), sake saiti ta hanyar gogayya ta hannu. Ƙaƙƙarfan phalanx na kusa yana jujjuyawa don fallasa kan metacarpal. An yi juzu'i na 0.5- 1 cm mai jujjuyawa kuma an ja da jijiyar extensor a tsayi a tsakiyar layi. Ƙarƙashin jagorancin fluoroscopic, mun shigar da waya jagora na 1.0 mm tare da tsayin daka na wuyan hannu. An lumshe titin jagorar don a guje wa shigar cortical da kuma sauƙaƙe zamewa a cikin magudanar ruwa. Bayan an tantance matsayin jagorar a cikin fluoroscopically, an sake gyara farantin ƙashi na subchondral ta amfani da ɗan rami mara ƙarfi kawai. An ƙididdige tsayin dunƙule da ya dace daga hotunan riga-kafi. A mafi yawan karaya na metacarpal, ban da metacarpal na biyar, muna amfani da dunƙule diamita na 3.0mm. Mun yi amfani da AutoFIX skru maras kai (kananan Ƙirƙirar Ƙashi, Morrisville, PA) .Matsakaicin tsayin da ake amfani da shi na 3.0-mm screw shine 40 mm. Wannan ya fi guntu fiye da matsakaicin tsayin ƙashin metacarpal (kimanin 6.0 cm), amma tsayin daka don shigar da zaren a cikin medulla don samun amintaccen gyare-gyare na dunƙule. Diamita na medullary rami na biyar metacarpal yawanci girma, kuma a nan mun yi amfani da dunƙule 4.0 mm tare da matsakaicin diamita na har zuwa 50 mm. A ƙarshen hanya, muna tabbatar da cewa an binne zaren caudal gaba ɗaya a ƙarƙashin layin guringuntsi. Sabanin haka, yana da mahimmanci don kauce wa dasa prosthesis da zurfi sosai, musamman ma idan akwai raunin wuyansa.
Hoto na 14 A cikin A, ba a rage raunin wuyan da aka saba yi ba kuma kai yana buƙatar ƙaramin zurfin zurfi yayin da za a danne kwarjin B.
Hanyar tiyata don juzu'i mai jujjuyawa na phalanx na kusa ya kasance iri ɗaya (Fig. 15). Mun yi juzu'i na 0.5 cm a kan phalanx na kusa yayin da muke jujjuya haɗin gwiwa na kusa. An raba jijiyoyi kuma an ja da baya a tsaye don fallasa kan phalanx na kusa. Ga mafi yawan karaya na phalanx na kusa, muna amfani da dunƙule 2.5 mm, amma don manyan phalanges muna amfani da dunƙule 3.0 mm. Matsakaicin tsayin 2.5mm CHS da ake amfani da shi a halin yanzu shine 30 mm. Muna kula da kada mu wuce gona da iri. Tun da sukullun suna hakowa da kai da bugun kai, za su iya shiga gindin phalanx tare da ƙaramin juriya. An yi amfani da irin wannan dabarar don karyewar phalangeal na tsakiyarphalangeal, tare da ƙaddamarwa daga kan phalanx na tsakiya don ba da damar sake dawo da sukurori.
Hoto 15 Ra'ayin shiga tsakani na shari'ar phalanx mai jujjuyawa. AA 1-mm guidewire an sanya shi ta hanyar ƙaramin juzu'i tare da tsayin daka na phalanx na kusa.B An sanya wariyar jagorar don ba da damar daidaitawa da daidaitawa da gyara kowane ɗayan. rotations.CA 2.5-mm CHS an saka kuma an binne shi a kai. Saboda siffa ta musamman na phalanges, matsawa na iya haifar da rabuwar kurgin metacarpal. (Majinyaci iri ɗaya kamar a cikin hoto na 8)
Karar da aka yanke: matsawa mara tallafi yayin shigar da CHS na iya haifar da gajarta na metacarpals da phalanges (Fig. 16). Saboda haka, duk da cewa an haramta amfani da CHS bisa ka'ida a irin waɗannan lokuta, mun sami mafita ga al'amuran yau da kullum guda biyu da muke fuskanta.
HOTO NA 16 AC Idan ba'a goyan bayan karaya ta cortically ba, kunkuntar skru zai haifar da karyewa duk da raguwar gaba daya.D Misalai na yau da kullun daga jerin marubutan da suka dace da mafi girman guntu (5 mm). Layin ja yayi daidai da layin metacarpal.
Don karaya na ƙasa da ƙasa, muna amfani da gyare-gyaren dabara bisa tsarin gine-gine na takalmin gyaran kafa (watau abubuwan tsarin da aka yi amfani da su don tallafawa ko ƙarfafa firam ta hanyar tsayayya da matsawa a tsaye don haka suna goyan bayansa). Ta hanyar samar da siffar Y tare da sukurori biyu, shugaban metacarpal ba ya rushewa; mun sanya wa wannan sunan takalmin gyaran kafa Y-siffar. Kamar yadda yake a cikin hanyar da ta gabata, an saka waya mai jagora mai tsayin mita 1.0 tare da baƙar magana. Yayin da ake kiyaye daidaitaccen tsayin metacarpal, an saka wata waya mai jagora, amma a kusurwa zuwa wayar jagora ta farko, don haka samar da tsari mai siffar triangular. Dukan wayoyi biyu an faɗaɗa su ta amfani da madaidaicin jagora don faɗaɗa medulla. Domin axial da oblique sukurori, mu yawanci amfani da 3.0 mm da 2.5 mm diamita sukurori, bi da bi. An fara shigar da dunƙule axial har sai zaren caudal ya daidaita tare da guringuntsi. Sannan ana shigar da dunƙule mai tsayin da ya dace. Tun da babu isasshen wuri a cikin tashar medullary don screws guda biyu, tsayin screws na madaidaici yana buƙatar ƙididdige su a hankali, kuma ya kamata a haɗa screws na axial zuwa screws axial kawai da zarar an binne su sosai a cikin shugaban metacarpal don tabbatar da isasshen isa. kwanciyar hankali ba tare da fitowar dunƙule ba. Ana ci gaba da dunƙule na farko a gaba har sai an binne shi sosai. Wannan yana guje wa raguwa axial na metacarpal da rugujewar kai, wanda za a iya hana shi ta hanyar sukurori. Muna yin gwaje-gwaje na fluoroscopic akai-akai don tabbatar da cewa rushewa ba ya faruwa kuma cewa screws suna haɗuwa a cikin tashar medullary (Fig. 17).
Hoto 17 AC Y-bangaren fasaha
Lokacin da comminution ya shafi dorsal cortex a gindin phalanx na kusa, mun ƙirƙiri hanyar da aka gyara; Mun sanya masa suna axial bracing saboda dunƙule yana aiki azaman katako a cikin phalanx. Bayan sake saita phalanx na kusa, an gabatar da wayar jagorar axial a cikin tashar medullary kamar yadda zai yiwu. Ana shigar da CHS ɗan gajeru fiye da jimlar tsayin phalanx (2.5 ko 3.0 mm) sannan ana saka shi har ƙarshen gabanta ya hadu da farantin subchondral a gindin phalanx. A wannan lokaci, zaren caudal na dunƙule suna kulle a cikin tashar medullary, don haka aiki a matsayin goyon baya na ciki da takalmin gyaran kafa na phalanx. Ana buƙatar gwaje-gwajen fluoroscopic da yawa don hana shigar da haɗin gwiwa (Hoto na 18). Dangane da tsarin karaya, ana iya buƙatar wasu sukurori ko haɗin na'urorin gyara na ciki (Hoto 19).
Hoto 19: Hanyoyi daban-daban na gyaran gyare-gyare a cikin marasa lafiya da raunin murkushe. Mummunan comminuted submetacarpal karaya na zobe na yatsa tare da fili dislocation na tushe na tsakiyar yatsa (rawaya kibiya mai nuni zuwa ga yanki na comminuted karaya).B Standard 3.0 mm CHS na yatsan hannu da aka yi amfani, 3.0 mm paracentesis na comminuted tsakiyar. yatsa, y-goyan bayan yatsan zobe (da grafting mataki ɗaya na lahani), da 4.0 mm CHS na yatsan ruwan hoda.F An yi amfani da flaps kyauta don ɗaukar nama mai laushi.C Radiographs a watanni 4. Ƙashin ƙashin ɗan yatsa ya warke. Wasu ɓangarorin ƙashi da aka samu a wani wuri, suna nuna waraka na biyu. ko da yake asymptomatic, an cire dunƙule daga cikin metacarpal na yatsan zobe saboda ana zargin shigar cikin articular. An sami sakamako mai kyau (≥240 ° TAM) a cikin kowane yatsa a ziyarar ta ƙarshe. Canje-canje a cikin haɗin gwiwa na metacarpophalangeal na yatsa na tsakiya ya bayyana a cikin watanni 18.
Hoto 20 Karaya na yatsan hannu tare da tsawo na ciki (wanda aka nuna ta kibiyoyi), wanda aka canza zuwa karaya mai sauƙi ta hanyar B na wucin gadi na karaya ta hanyar amfani da K-waya.C Wannan ya haifar da tushe mai tushe wanda goyon bayan dogon dunƙule an saka.D Bayan gyarawa, an yanke hukuncin ginin ya tsaya tsayin daka, yana ba da izinin motsi nan da nan.
Hoto 21 Hoto na baya na orthostatic da B na radiyo na mai haƙuri A. An yi amfani da ƙwanƙwasa guda uku na marasa lafiya (a kiban) tare da 2.5-mm cannulated screws. Babu wani gagarumin canje-canje a cikin haɗin gwiwar interphalangeal da aka bayyana bayan shekaru 2
Lokacin aikawa: Satumba-18-2024
