Sakamakon jiyya ya dogara ne akan gyaran jiki na ƙwayar cuta, ƙayyadaddun ƙaƙƙarfan ƙwanƙwasa, adana kyakkyawan ɗaukar hoto mai laushi da aikin aikin farko.
Jiki
Thedistal humerusan raba shi zuwa ginshiƙi na tsakiya da ginshiƙi na gefe (Figure 1).
Hoto 1 Humerus mai nisa ya ƙunshi ginshiƙi na tsakiya da na gefe
Rukunin tsaka-tsakin ya haɗa da ɓangaren tsakiya na humeral epiphysis, tsakiyar epicondyle na humerus da na tsakiya na tsakiya ciki har da glide na humeral.
Rukunin gefe wanda ya ƙunshi ɓangaren gefe na humeral epiphysis, epicondyle na waje na humerus da kuma na waje na humerus ciki har da humeral tuberosity.
Tsakanin ginshiƙan gefe guda biyu akwai fossa na coronoid na baya da kuma fossa humeral na baya.
Hanyar rauni
Supracondylar fractures na humerus yawanci yakan faru ne ta hanyar faɗuwa daga manyan wurare.
Ƙananan marasa lafiya tare da raunin intra-articular mafi sau da yawa suna haifar da mummunan rauni na tashin hankali, amma tsofaffi marasa lafiya na iya samun raunin intra-articular daga raunin raunin da ya faru na rashin ƙarfi saboda osteoporosis.
Bugawa
(a) Akwai karaya na supracondylar, ɓangarorin ƙwanƙwasa da ɓarnawar intercondylar.
(b) Karaya mai ƙarfi na humerus: wurin karyewar yana sama da burbushin shaho.
(c) Humeral condylar fracture: wurin karaya yana cikin burbushin shaho.
(d) Karyewar tsaka-tsaki na humerus: wurin karyewar yana samuwa a tsakanin magudanar ruwa biyu masu nisa na humerus.
Hoto 2 AO bugawa
AO humeral typing buga (Hoto na 2)
Nau'in A: karin karaya.
Nau'in B: karyewar da ke tattare da farfajiyar articular (karya-gishiri guda).
Nau'in C: cikakken rabuwa na gefen articular na distal humerus daga humeral karaya (bicolumnar fracture).
Kowane nau'in an ƙara raba kashi uku cikin subypes bisa ga matsayin roko na karaya, (1 ~ 3 subtypespes tare da kara digiri a wannan tsari).
Hoto3 Riseborough-Radin yana bugawa
Rubutun Riseborough-Radin na karaya na tsaka-tsaki na humerus (kowane nau'ikan sun haɗa da ɓangaren supracondylar na humerus)
Nau'in I: karaya ba tare da matsaya ba tsakanin humeral tuberosity da talus.
Nau'i na II: karaya ta tsaka-tsaki na humerus tare da kauracewa yawan karaya na condyle ba tare da nakasar juyi ba.
Nau'i na III: karaya na tsaka-tsaki na humerus tare da ƙaurawar gutsuttsura na condyle tare da nakasar juyawa.
Nau'in IV: Mummunan karaya mai tsanani na saman articular na ɗaya ko duka condyles (Hoto na 3).
Hoto 4 Nau'in I humeral tuberosity fracture
Hoto 5 Humeral tuberosity fracture staging
Karaya na humeral tuberosity: rauni mai rauni na distal humerus
Nau'in I: karaya na dukkanin tuberosity na humeral ciki har da gefen gefe na humeral talus (Hahn-Steinthal fracture) (Hoto 4).
Nau'in II: karayar subchondral na guringuntsi na guringuntsi na humeral tuberosity (Kocher-Lorenz fracture).
Nau'in III: comminuted karaya na humeral tuberosity (Hoto 5).
Maganin marasa aiki
Hanyoyin jiyya marasa aiki don karaya mai nisa suna da iyakataccen matsayi.Manufar maganin marasa aiki shine: farkon motsi na haɗin gwiwa don guje wa taurin haɗin gwiwa;tsofaffi marasa lafiya, waɗanda suka fi fama da cututtuka masu yawa, ya kamata a bi da su tare da hanya mai sauƙi na splinting haɗin gwiwar gwiwar hannu a cikin 60 ° na sassauƙa don makonni 2-3, sannan aikin haske ya biyo baya.
Maganin tiyata
Manufar jiyya ita ce mayar da kewayon aiki mara zafi na motsi na haɗin gwiwa (30 ° na tsawo na gwiwar hannu, 130 ° na ƙwanƙwasa gwiwar hannu, 50 ° na gaba da juyawa na baya);m da kuma barga na ciki gyarawa na karaya damar fara aikin gwiwar hannu darussan bayan fata rauni rauni;Gyaran faranti biyu na humerus mai nisa ya haɗa da: tsaka-tsaki da na baya na gyare-gyaren faranti biyu, kotsaka-tsaki da na gefegyaran faranti biyu.
Hanyar tiyata
(a) An sanya mai haƙuri a cikin matsayi na sama tare da layin da aka sanya a ƙarƙashin ɓangaren da ya shafa.
ganewa da kariya na tsaka-tsaki da radial jijiyoyi a cikin ciki.
Za'a iya tsawaita gwiwar gwiwar hannu na baya ta hanyar tiyata: ulnar hawk osteotomy ko triceps retraction don fallasa karaya mai zurfi.
ulnar hawkeye osteotomy: isasshiyar fallasa, musamman don karyewar farfajiyar articular.Duk da haka, karyewar rashin haɗin kai yakan faru a wurin osteotomy.An rage raguwar karyewar rashin haɗin gwiwa tare da ingantaccen osteotomy na ulnar hawk (herringbone osteotomy) da transtension band wire ko gyaran faranti.
Za'a iya amfani da bayyanar da ja da baya na Triceps zuwa ga karaya mai nisa na humeral trifold tare da haɗin haɗin gwiwa, kuma faɗaɗa bayyanar faifan humeral na iya yankewa da fallasa tip ɗin shaho a kusan 1 cm.
An gano cewa za'a iya sanya faranti guda biyu a orthogon ko a layi daya, ya danganta da irin karayar da ya kamata a sanya faranti.
Ya kamata a maido da karyewar fuskar bangon bango zuwa fili mai lebur sannan a daidaita shi zuwa gangar jikin.
Hoto 6 Gyaran ciki na ciki bayan aiki na karaya
An yi gyaran gyare-gyare na wucin gadi na toshe karaya ta hanyar yin amfani da waya ta K, bayan haka an gyara farantin wutar lantarki na 3.5 mm zuwa siffar farantin bisa ga siffar da ke bayan ginshiƙin gefen humerus mai nisa, kuma farantin gyaran 3.5 mm ya kasance. an gyara shi zuwa siffar ginshiƙin tsakiya, ta yadda ɓangarorin biyu na farantin za su dace da saman kashi (sabon farantin ƙirar gaba zai iya sauƙaƙe aikin.) (Hoto 6).
Kula da kar a gyara ɓarkewar ɓangarorin bangon bango tare da skru masu zare duka tare da matsa lamba daga tsaka-tsaki zuwa gefen gefe.
wurin ƙaura dubun epiphysis-humerus yana da mahimmanci don kauce wa rashin haɗin kai na karaya.
ba da damun kashi a wurin lahani na ƙashi, yin amfani da iliac soke ƙasusuwan kasusuwa don cike gurɓataccen ɓarna: ginshiƙi na tsakiya, farfajiyar articular da ginshiƙan gefe, grafting soke kashi zuwa gefe tare da m periosteum da matsawa ƙashi lahani a epiphysis.
Tuna mahimman abubuwan gyarawa.
Gyara ɓarkewar ɓarna mai nisa tare da yawasukurorikamar yadda zai yiwu.
gyare-gyaren ɓangarorin ɓarkewar ɓarna kamar yadda zai yiwu tare da sukurori suna haye tsaka-tsaki zuwa gefe.
Ya kamata a sanya faranti na ƙarfe akan tsaka-tsaki da ɓangarorin gefen humerus mai nisa.
Zaɓuɓɓukan magani: Jimlar ƙwanƙwasa gwiwar hannu
Ga marasa lafiya tare da raunin raunin da ya faru ko osteoporosis, jimlar arthroplasty na gwiwar hannu zai iya dawo da motsin haɗin gwiwar gwiwar hannu da aikin hannu bayan marasa lafiya marasa buƙata;dabarar tiyata tana kama da jimillar arthroplasty don sauye-sauye na lalacewa na haɗin gwiwar gwiwar hannu.
(1) aikace-aikace na dogon lokaci-nau'in prosthesis don hana kusan karaya tsawo.
(2) Takaitacciyar ayyukan tiyata.
(a) Ana yin hanyar ta hanyar amfani da hanyar gwiwar hannu ta baya, tare da matakan kama da waɗanda aka yi amfani da su don ɓarna ɓarna mai nisa da ƙayyadaddun ciki (ORIF).
Anteriorization na jijiyar ulnar.
samun dama ta ɓangarorin biyu na triceps don cire ɓataccen kashi (maɓalli mai mahimmanci: kar a yanke dakatarwar triceps a wurin ulnar hawk).
Za a iya cire dukkan humerus mai nisa ciki har da fossa shaho da kuma sanya ƙwanƙwasa, wanda ba zai bar wani muhimmin mahimmanci ba idan an cire ƙarin I zuwa 2 cm.
daidaitawa na inrinsic tashin hankali na triceps tsoka a lokacin dacewa da humeral prosthesis bayan cirewar humeral condyle.
Ƙarƙashin ƙaƙƙarfan ƙaƙƙarfan ƙaƙƙarfan ulnar na kusa don ba da damar samun damar mafi kyau don fallasa da shigar da sashin prosthesis na ulnar (Hoto na 7).
Hoto na 7 Gyaran gwiwar hannu
Kulawar bayan tiyata
Ya kamata a cire splint na baya na gefen gwiwar gwiwar hannu da zarar raunin fata na majiyyaci ya warke, kuma ya kamata a fara aikin motsa jiki tare da taimako;ya kamata a gyara haɗin gwiwar gwiwar hannu na dogon lokaci bayan jimlar maye gurbin haɗin gwiwa don inganta warkar da rauni na fata (ana iya daidaita haɗin gwiwar gwiwar a madaidaiciyar matsayi na makonni 2 bayan tiyata don taimakawa wajen samun aikin haɓaka mafi kyau);a yanzu ana amfani da tsayayyen tsatsa mai cirewa a asibiti don sauƙaƙe kewayon motsa jiki lokacin da za'a iya cirewa akai-akai don mafi kyawun kare gaɓoɓin da abin ya shafa;Yawan motsa jiki na aiki yana farawa makonni 6-8 bayan raunin fata ya warke gaba daya.
Kulawar bayan tiyata
Ya kamata a cire splint na baya na gefen gwiwar gwiwar hannu da zarar raunin fata na majiyyaci ya warke, kuma ya kamata a fara aikin motsa jiki tare da taimako;ya kamata a gyara haɗin gwiwar gwiwar hannu na dogon lokaci bayan jimlar maye gurbin haɗin gwiwa don inganta warkar da rauni na fata (ana iya daidaita haɗin gwiwar gwiwar a madaidaiciyar matsayi na makonni 2 bayan tiyata don taimakawa wajen samun aikin haɓaka mafi kyau);a yanzu ana amfani da tsayayyen tsatsa mai cirewa a asibiti don sauƙaƙe kewayon motsa jiki lokacin da za'a iya cirewa akai-akai don mafi kyawun kare gaɓoɓin da abin ya shafa;Yawan motsa jiki na aiki yana farawa makonni 6-8 bayan raunin fata ya warke gaba daya.
Lokacin aikawa: Dec-03-2022
