Supracondylar fractures na humerus yana daya daga cikin karaya da aka fi sani da yara kuma yana faruwa a mahaɗin ramin humeral dahumeral condyle.
Bayyanar cututtuka
Supracondylar fractures na humerus yawanci yara ne, kuma zafi na gida, kumburi, taushi, da rashin aiki na iya faruwa bayan rauni.Karyar da ba ta gushe ba ta da alamun bayyanannun alamun, kuma fitar gwiwar hannu na iya zama alamar asibiti kawai.Kwakwalwar haɗin gwiwa da ke ƙasa da tsokar gwiwar hannu ita ce mafi girma, inda capsule ɗin haɗin gwiwa mai laushi, wanda kuma aka sani da softspot, za a iya palpated yayin exudation na haɗin gwiwa.Batun sassauci yawanci gaba da layin da ke haɗa tsakiyar radial kai zuwa ƙarshen olecranon.
A cikin yanayin karaya nau'in supracondylar nau'in III, akwai nakasar gwiwar hannu guda biyu, wanda ke ba da siffar S-dimbin yawa.Yawancin lokaci akan sami rauni na subcutaneous a gaban hannun babba mai nisa, kuma idan karayar ta kasance gaba ɗaya daga muhallansu, ƙarshen karyewar ya ratsa cikin tsokar brachialis, kuma zubar da jini na subcutaneous ya fi tsanani.Sakamakon haka, alamar pucker tana bayyana a gaban gwiwar gwiwar hannu, yawanci tana nuni da fitowar ƙashi kusa da karyewar da ke shiga cikin fata.Idan yana tare da raunin jijiya na radial, ƙaddamarwar dorsal na babban yatsan yatsa na iya iyakancewa;Raunin jijiya na tsaka-tsaki na iya haifar da babban yatsan yatsan yatsan hannu da yatsa su kasa jujjuya rayayye;Raunin jijiya na ulnar na iya haifar da iyakancewar rarraba yatsu da tsaka-tsaki.
Bincike
(1) Tushen Bincike
①Yi tarihin rauni;② Alamomin asibiti da alamun: zafi na gida, kumburi, taushi da rashin aiki;③X-ray yana nuna layin karyewar supracondylar da gutsutsutsun gutsutsutsun da aka raba da muhallansu.
(2) Binciken Daban-daban
Ya kamata a biya hankali ga ganowakarkacewa gwiwar hannu, amma ganewar karayar supracondylar mai tsawo daga raunin gwiwar gwiwar hannu yana da wahala.A cikin karayar supracondylar na humerus, epicondyle na humerus yana kula da alakar jiki ta al'ada tare da olecranon.Duk da haka, a cikin karkatar da gwiwar hannu, saboda olecranon yana bayan epicondyle na humerus, ya fi shahara.Idan aka kwatanta da supracondylar fractures, shaharar hannun gaba a cikin karkatar da gwiwar hannu ya fi nisa.Kasancewa ko rashin fricatives na kasusuwa shima yana taka rawa wajen gano karyewar kasusuwa na humerus daga tarwatsewar hadin gwiwar gwiwar hannu, kuma wani lokacin yana da wahala a fitar da gogaggun kashi.Saboda tsananin kumburi da zafi, magudin da ke haifar da ɓacin rai yakan sa yaron ya yi kuka.Saboda haɗarin lalacewar neurovascular.Don haka, ya kamata a guje wa magudin da ke haifar da ɓarkewar kashi.Binciken X-ray zai iya taimakawa ganowa.
Nau'in
Daidaitaccen rarrabuwa na karaya na supracondylar humeral shine a raba su zuwa tsawo da jujjuyawa.Nau'in jujjuyawar ba kasafai ba ne, kuma X-ray na gefe yana nuna cewa ƙarshen faɗuwar ya kasance a gaban mashin humeral.Madaidaicin nau'in na kowa ne, kuma Gartland ya raba shi zuwa nau'in I zuwa III (Table 1).
| Nau'in | Bayyanar cututtuka |
| ⅠA nau'in | Karyewa ba tare da ƙaura ba, juyi ko valgus |
| ⅠB nau'in | Maɓalli mai sauƙi, juwawar tsaka-tsaki na cortical, layin kan iyaka na gaban humeral ta kan humeral |
| ⅡA nau'in | Hyperextension, mutuncin cortical na baya, shugaban humeral a bayan layin iyakar humeral na gaba, babu juyawa. |
| ⅡB nau'in | Matsala na tsayi ko juyi tare da tuntuɓar yanki a kowane ƙarshen karaya |
| ⅢA nau'in | Cikakken ƙaura na baya ba tare da tuntuɓar cortical ba, yawanci nisa zuwa matsaya ta baya. |
| ⅢB nau'in | Maɓalli bayyananne, nama mai laushi da aka saka a cikin ƙarshen karaya, babban jefi ko juyawa na ƙarshen karaya. |
Table 1 Gartland Rabe-rabe na supracondylar humerus fractures
Yi magani
Kafin magani mafi kyau, ya kamata a gyara haɗin gwiwar gwiwar dan lokaci a cikin matsayi na 20 ° zuwa 30 °, wanda ba kawai dadi ga mai haƙuri ba, amma kuma yana rage tashin hankali na tsarin neurovascular.
(1) Nau'in I humeral supracondylar fractures: kawai buƙatar simintin filasta ko simintin gyare-gyaren waje don gyarawa na waje, yawanci lokacin da gwiwar hannu ke jujjuya 90 ° kuma an juya hannun gaba a cikin tsaka tsaki, ana amfani da simintin hannu mai tsayi don gyaran waje don 3 zuwa sati 4.
(2) Nau'in nau'i na II humeral supracondylar fractures: Ragewa na hannu da gyaran gyare-gyare na haɗin gwiwar gwiwar hannu da angulation sune mahimman batutuwa a cikin maganin wannan nau'i na fractures.°) Gyaran yana kula da matsayi bayan raguwa, amma yana ƙara haɗarin raunin neurovascular na ɓangaren da ya shafa da kuma haɗarin ciwo mai tsanani na fascial.Saboda haka, percutaneousKirschner waya gyarawaya fi kyau bayan rufewar raguwa na raguwa (Fig. 1), sa'an nan kuma gyare-gyaren waje tare da simintin gyare-gyaren filasta a cikin wani wuri mai aminci (ƙwaƙwalwar gwiwar hannu 60 °).
Hoto 1 Hoton gyaran waya na Kirschner mai kaifi
(3) Type III supracondylar humerus fractures: All type III supracondylar humerus fractures are reduced by percutaneous Kirschner wire fixation, which is currently the standard treatment for type III supracondylar fractures.Rufewar ragewa da gyaran waya na Kirschner mai yuwuwa yawanci, amma ana buƙatar raguwar buɗewa idan ba za a iya rage abin da ke tattare da nama mai laushi ba ta jiki ko kuma idan akwai raunin jijiya brachial (Hoto 2).
Hoto 5-3 Fina-finan X-ray na gaba da baya na karaya na humerus supracondylar
Akwai hanyoyi guda huɗu na fiɗa don buɗe buɗewar raguwar karyewar gaba na humerus: (1) kusancin gwiwar gwiwar hannu (ciki har da tsarin gaba);(2) kusancin gwiwar hannu na tsakiya;(3) haɗin gwiwa na tsaka-tsaki da na gefe;da (4) kusancin gwiwar hannu ta baya.
Duk hanyoyin haɗin gwiwar gwiwar hannu da tsarin tsaka-tsaki suna da fa'idar ƙarancin lalacewa da tsarin jiki mai sauƙi.Ƙarƙashin tsaka-tsakin ya fi aminci fiye da ƙaddamarwa na gefe kuma zai iya hana lalacewar jijiyar ulnar.Lalacewar ita ce, babu ɗayansu da zai iya ganin karaya kai tsaye na gefen ɓarna, kuma za'a iya rage shi kawai kuma a daidaita shi da hannu, wanda ke buƙatar fasaha mafi girma ga mai aiki.Hanyar gwiwar hannu ta baya ta kasance mai rikici saboda lalata mutuncin tsokar triceps da kuma lalacewa mafi girma.Haɗin kai na tsaka-tsakin tsaka-tsaki da na gefe na iya daidaitawa don rashin samun damar ganin kai tsaye kashin kashin da aka saba da shi.Yana da abũbuwan amfãni na tsaka-tsakin tsaka-tsakin tsakiya da na gefe, wanda ke taimakawa wajen rage raguwa da gyarawa, kuma zai iya rage tsawon tsayin daka.Yana da amfani ga sauƙi da raguwa na kumburi na nama;amma illarsa shi ne yana kara jujjuyawar tiyata;Hakanan sama da tsarin baya.
rikitarwa
Matsalolin raunin humeral supracondylar sun haɗa da: (1) rauni na jijiyoyin jini;(2) m septal ciwo;(3) taurin gwiwar hannu;(4) myositis ossificans;(5) necrosis na jijiyoyin jini;(6) Cubitus varus nakasar;(7) Cubitus valgus deformity.
Takaita
Karyawar supracondylar na humerus na cikin mafi yawan karaya a cikin yara.A cikin 'yan shekarun nan, rashin raguwar karaya na supracondylar na humerus ya tada hankalin mutane.A da, an yi la'akari da cubitus varus ko cubitus valgus a matsayin abin da ya haifar da kama ci gaban farantin epiphyseal mai nisa, maimakon raguwa mara kyau.Yawancin shaidu masu ƙarfi a yanzu suna goyan bayan ƙarancin raguwar karaya muhimmin abu ne a cikin nakasar cubitus varus.Saboda haka, raguwar karayar supracondylar humerus, gyaran gyare-gyare na ulnar, jujjuyawar kwance da kuma maido da tsayin humerus mai nisa shine maɓalli.
Akwai hanyoyin magani da yawa don karaya na supracondylar na humerus, kamar ragewar hannu + gyarawa na wajetare da simintin gyare-gyare na plaster, raguwa na olecranon, gyaran waje na waje tare da splint, raguwa da budewa da gyare-gyare na ciki, da raguwar rufewa da gyaran ciki.A da, raguwar magudi da gyaran filastar waje sune manyan jiyya, wanda cubitus varus ya kai kashi 50% a China.A halin yanzu, don nau'in II da nau'in nau'in supracondylar na III, gyaran allura na percutaneous bayan raguwar karaya ya zama hanyar da aka yarda da ita gaba ɗaya.Yana da abũbuwan amfãni na rashin lalata samar da jini da kuma saurin warkar da kashi.
Hakanan akwai ra'ayoyi daban-daban akan hanya da mafi kyawun adadin Kirschner gyare-gyaren waya bayan rufewar raguwar karaya.Kwarewar editan ita ce cewa ya kamata a raba wayoyi na Kirschner tare da juna yayin gyarawa.Da nisa jirgin da ya karye ya kasance, gwargwadon yadda ya kasance.Wayoyin Kirschner kada su ƙetare a jirgin saman fashe, in ba haka ba ba za a sarrafa jujjuyawar ba kuma gyare-gyaren zai zama maras tabbas.Ya kamata a kula don guje wa lalacewa ga jijiyar ulnar lokacin amfani da tsaka-tsakin Kirschner waya gyarawa.Kada a zare allurar a wuri mai lanƙwasa na gwiwar hannu, dan daidaita gwiwar gwiwar don ba da damar jijiyar ulnar ta koma baya, taɓa jijiyar ulnar da babban yatsan hannu sannan a tura ta baya kuma a amince da zaren K-wayar.Aikace-aikacen ƙetare waya ta Kirschner na ciki yana da yuwuwar fa'ida a cikin aikin dawo da aikin bayan aiki, ƙimar waraka, da kyakkyawan ƙimar waraka, wanda ke da fa'ida ga farfaɗowa da wuri.
Lokacin aikawa: Nov-02-2022
