A halin yanzu, akwai hanyoyin kulawa na kulawa don tsayawa radius karawa, kamar su gyara na ciki, ƙayyadadden kayan girke-girke na waje na iya samun ƙarin gamsarwa, amma akwai rahotannin ciki a cikin wallafe-wallafen da ke tattare da 16%. Koyaya, idan an zaɓi farantin karfe yadda yakamata, abin da ya faru na rikitarwa za'a iya rage yadda ya kamata. Wannan takarda a taƙaice a taƙaice a taƙaice halaye, nuni, alamomi, contraindictions, da fasahohin tiyata a tiyata magani na maganin distal.
1. Akwai manyan fa'idodi biyu na farantin dabino
A.IT na iya magance kayan aikin buncling. Gyara tare da dunƙulen zane-zane mai gyara yana tallafawa yanki mai nisa kuma yana canja wurin nauyin zuwa shaski mai radial (Fig. 1). Zai iya samun tallafin sashi sosai. Wannan tsarin farantin ba zai iya gyara kawai a cikin rikice-rikice-artra-articular ba, har ma yana iya mayar da ƙasusuwa ta ƙasusuwa ta hanyar PEG / dunƙule "mai fasali". Don mafi yawan nau'ikan baƙin ƙarfe na radius, wannan tsarin rufin yana ba da ƙara yawan kwanciyar hankali.
Hoto na 1, a, bayan sake gina abu uku na hali na hali mai zurfi na radius karaya, kula da matakin matsin lamba na dorsal; B, Virtual ragewar karaya, dole ne a gyara lahani da farantin jiki; C, duba a labarun bayan gyaran DVR, kibiya tana nuna canja wurin kaya.
B.less tasiri akan nama mai taushi: Mai samar da kayan masarufi na ɗan ƙasa ne a ƙasa, idan aka sami ƙarin sarari da kuma jijiyoyin jiki. Taɗi kai tsaye. Ari ga haka, mafi yawan implants za su iya rufe shi da prondatus.
2. Alamun da Contraindications don lura da Distal radius tare da farantin volar
A.Dications: Don gazawar rage rufewar cirewa-articular, kamar yadda tsattsauran ra'ayi ya fi girma 5mm, kuma a dorsancin yanki mafi girma fiye da 2mm; Gudun hijira na gangara na ciki ya fi 2 mm; Saboda ƙarancin ƙarancin kashi, yana da sauƙi don haifar da fitarwa, don haka ya fi dacewa ga tsofaffi.
b. Contraindications: Amfani da cututtukan na gida, yanayin kamiltoci, yanayin fata na fata a gefen gefen wuyan hannu; Nau'in kashi da kuma nau'in karaya a cikin rukunin karaya, nau'in karaya na dorsal kamar barcton da kuma rarrabuwa, radius mai kauri, mai saurin tsinkaye na Volar.
Don marasa lafiya da raunin da ya samu mai ƙarfi kamar rauni mai ƙarfi-artic ko asarar kashi, yawancin malamai basa bayar da amfani ga necrosis na vascrosis kuma da wahala don samun raguwar ragi. Don marasa lafiya da yawaitruka da yawa da kuma haɓaka haɓaka da kuma haɓaka haɓaka da matsanancin osteoporosis, farantin jiki, farantin mara nauyi, farantin mara nauyi yana da wahalar yin tasiri. Zai yiwu matsaloli tare da tallafin masu zaman kansu a cikin rarrafe. Bayanan littattafan kwanan nan sun ba da rahoton cewa lokacin da aka kula da shari'o'in 42 na motsa jiki-articular da faranti, babu ƙwayoyin ƙwayoyin cuta na articular, wanda ya kasance yana da alaƙa da matsayin faranti.
3
Yawancin likitocin suna amfani da ingantaccen farantin Volar don tsallake radius rauni a cikin irin hanyoyi da dabaru. Koyaya, don nisanta abin da ya faru na rikice-rikice na gaba, ana buƙatar samun dabarun tiyata ta hanyar sakewa da matsakaicin karar karar karagar karar karagar karagar karagar karagar karagar. Za'a iya amfani da gyaran na ɗan lokaci tare da wayoyi 2-3. Regarding which approach to use, the author recommends PCR (flexor carpi radialis) to extend the volar approach.
A, gyara na ɗan lokaci tare da wayoyi biyu na yau da kullun, Lura cewa ba a sake dawo da farawar masanin magana ba a wannan lokacin;
B, wani waya na Kirschn na ɗan lokaci yana gyara farantin, kula da gyaran ƙarshen radius a wannan lokacin (karkatarwa yanki na gyara), an cire ɓangaren farfadowa zuwa ga shingen ɓoyewa don mayar da hankalin da aka ba da hankali.
C, mai artucular surface ya yi kyau a ƙarƙashin arthroscopy, an sanya murfin kulle ƙulli / an sanya shi, da radius a ƙarshe an sanya shi a ƙarshe radius kuma gyarawa.
Mabuɗinna kusancin: Incharfin fata na farawa a fatar da fatar wuyan hannu, kuma tsawon sa ana iya ƙaddara gwargwadon irin karaya. Hanyoyin Flepor Carpi Radialis na jita-jita da kuma aka rarraba shi distal zuwa kashin carpal kuma a matsayin wakili. Tashi mai sassaucin Carpi Radialis agogon zuwa ga ulnar yana kiyaye jijiyoyin mediya da kuma hadadden jijiyoyin. Sararin Parona ya fallasa, tare da sunan Quadratus wanda ke tsakanin dogon Hallus Longus (Ulnar) da radial arery (radial). An yi buɗewa a gefen radial na pron prendatus, barin wani sashi da aka makala ga radius don dawo da shi daga baya. Ravator da sunan Quadratus zuwa ga ulnar gefe sosai fallata fallasa da volannan kusurwar Ulnar na radius.
Don hadaddun karaya, ana bada shawara don sakin sakewa na tsoka na Brakiladaliz, wanda zai iya kawar da jingina a kan tsarin mai salo. A wannan lokacin, za a iya yanke wannan hanyar aikin dorsal na farko don bijirar da tsadar karaya da kuma samar da wayoyi mai narkewa don rage toshewar karaya-articular. Don hadaddun karuwa-articular, ana iya amfani da arthroscopy don taimakawa wajen rage, ƙididdigar, da kuma dogaro da rubutattun gutsutsuren.
Bayan ragi an gama, farantin kayan masarufi ana sanya shi akai-akai. Farantin dole ne kusa da ruwa mai ruwa, dole ne ya rufe tsarin ulnar, kuma ƙarshen farantin ya kamata ya kai ga tsakiyar shakin radial. Idan ba a hade da yanayin da ke sama ba, girman farantin bai dace ba, ko rage ba mai gamsarwa ba, har yanzu ba cikakke bane.
Rikice-rikice-rikice-rikice-rikice-rikice-rikice-rikice suna da yawa da za a yi da inda aka sanya farantin. Idan an sanya farantin maɗaukaki, rikice-rikice waɗanda ke da alaƙa da Flexor Hallus Longus Longus an yi hasashen; Idan an sanya farantin ma kusa da layin ruwa, mai sassauƙa digo na dila na iya zama haɗari. Rage rabuwa ga nakasar fitowar ta Volar na iya haifar da farantin karfe don daidaitaccen farantin karfe da kuma kai tsaye tuntuɓar sinaden flleinitis ko ma gubture.
Don marasa lafiya marasa lafiya, ana ba da shawarar cewa farantin ya kasance kusa da layin ruwa kamar yadda zai yiwu, amma ba a ƙetare shi ba. Za'a iya amfani da wayoyi na Kirschner don gyara subchondral mafi kusa da ulna, da wayoyi na gefe-gefe da kuma kulle ƙusoshi da kuma kulle ƙusoshin iya hana fashewar daga sake fasalin abubuwa.
Bayan an sanya farantin daidai, ƙarshen ƙarshen ente an gyara shi da dunƙule, da rami na uln a ƙarshen ƙarshen farantin yana daidaita tare da waya na Kirschner. Abun hangen nesa, Viewor Viewroory, a labulen jigo, wuyan hannu na hannu, don ƙimar rage karaya da matsayin tsayayyen ciki. Idan matsayin farantin ya gamsu, amma waya ta Kirschner yana cikin haɗin gwiwa, zai haifar da isasshen dabarar motsa jiki, wanda za'a iya magance shi ta hanyar sake saita dabarar "Distal compraquaniquetique m", b).
Idan an bi shi da dorsal da ulnar / ulnar / dorsal mutu punch) kuma ba za a iya amfani da shi sosai a karkashin rufewa, da za a iya amfani da dabaru guda uku masu zuwa:
1. Sanya ƙarshen tsarin radius don kiyaye shi daga wurin karaya, kuma tura zabin fosa karaya zuwa gajiya ta hanyar kusancin mai tsayarwar PCR;
2. Yi karamin incision a kan dorsal gefen na 4th da na 5thment don bijirar da guntun rauni, kuma gyara shi tare da sukurori a cikin mafi yawan Uln ramin farantin.
3. Rufe percutaneous ko ministi mai ban sha'awa tare da taimakon artroscopy.
Bayan rage ya gamsu da farantin kuma an sanya farantin daidai, gyaran ƙarshe yana da sauki. Idan waya ta wakili na ulnar Kirirchner waya an sanya shi daidai kuma babu skors suna cikin haɗin gwiwa, ana iya samun raguwar ragi.
Kwarewar Zabe: Saboda mummunan aikin da aka yiwa kashin karaya na dorsal, tsawon dunƙule na iya zama da wuya a auna daidai. Scrams waɗanda suke da yawa suna iya haifar da haushi na agon, da kuma sukurori waɗanda suke gajeru ba za su iya tallafawa kuma gyara yanki na dorsal ba. A saboda wannan dalili, marubucin ya ba da shawarar amfani da sassan katako da kuma kulawar kulle-kullewa a cikin tsari mai ɗorewa da kuma babban rami mai ɗaukar hoto a cikin sauran mukamai. Yin amfani da tip na m ke guje wa haushi da jijiya koda ana amfani da mafita na dorsal. Don ficewa mai gadi, ƙwallon ƙafa biyu + ya kulla dunƙule na biyu (an sanya shi ta hanyar ellipse) za'a iya amfani dashi don gyara.
4. Takaitaccen bayanin cikakken rubutu:
Volari na kulle ƙusa ƙusa na Distal Radius Karji na iya samun kyakkyawan ingancin asibiti, wanda yafi ya dogara da zaɓi na alamu da ƙwarewar tiyata. Yin amfani da wannan hanyar na iya samun kyakkyawan tasirin aiki, amma babu wani banbancin aiki daga baya, abin da ya faru a cikin gyara na waje, da kuma raguwar kayan adirction, da kuma shinge na kayan haɗin kai sun zama ruwan dare. Kuma matsalolin hadadden jijiyoyin jini sun fi kowa gama gari a cikin tsarin gyaran tsarin radius. Don marasa lafiya da osteoporosis, farantin m farantin har yanzu zaɓi na farko.
Lokaci: Dec-12-2022
