A halin yanzu, akwai hanyoyi daban-daban na jiyya don raunin radius mai nisa, irin su gyaran gyare-gyaren filasta, raguwa na budewa da gyaran ciki, firam ɗin gyaran waje, da dai sauransu. cewa matsalolinsa sun kai 16%.Duk da haka, idan an zaɓi farantin karfe da kyau, za a iya rage yawan rikice-rikicen da ya dace.Wannan takarda a taƙaice ta taƙaita halaye, alamomi, contraindications, da dabarun tiyata na maganin farantin volar na fashewar radius mai nisa.
1. Akwai manyan fa'idodi guda biyu na farantin gefen dabino
A. Yana iya kawar da abin da ke tattare da karfi.Gyarawa tare da ƙwanƙwasa gyare-gyare na kusurwa yana goyan bayan ɓarna mai nisa kuma yana canja wurin kaya zuwa shinge na radial (Fig. 1).Yana iya samun goyan bayan subchondral yadda ya kamata.Wannan tsarin faranti ba wai kawai zai iya daidaita karaya na intra-articular ba kawai ba, amma kuma yana iya dawo da tsarin jikin kashin intra-articular subchondral yadda ya kamata ta hanyar gyara peg/screw “fan-shaped”.Don yawancin nau'ikan karaya na radius mai nisa, wannan tsarin rufin yana ba da ƙarin kwanciyar hankali da ke ba da damar yin motsi da wuri.
Hoto na 1, a, bayan gyare-gyare mai girma uku na raguwar radius na yau da kullun, kula da matakin matsawar dorsal;b, raguwa mai kama da karya, dole ne a gyara lahani kuma a goyi bayan faranti;c, kallon gefe bayan gyaran DVR, kibiya tana nuna canja wurin kaya.
B.Ƙarancin tasiri akan nama mai laushi: Ƙirar farantin wuta yana dan kadan a ƙasa da layin ruwa, idan aka kwatanta da farantin dorsal, zai iya rage fushi ga tendon, kuma akwai ƙarin sararin samaniya, wanda zai iya kauce wa shigarwa da kuma tendon.tuntuɓar kai tsaye.Bugu da ƙari, yawancin abubuwan da aka sanyawa za a iya rufe su ta hanyar pronator quadratus.
2. Alamu da contraindications don lura da distal radius tare da farantin volar
a. Alamu: Don gazawar rufaffiyar raguwa na karaya-hannu, yanayi masu zuwa suna faruwa, irin su dorsal angulation sama da 20 °, matsawar dorsal fiye da 5mm, distal radius yana gajarta fiye da 3mm, da raguwar gutsuttsura mafi girma fiye da 2 mm;Matsar da ɓarna na ciki ya fi 2 mm;saboda ƙananan ƙananan kashi, yana da sauƙi don haifar da sake komawa, don haka ya fi dacewa da tsofaffi.
b.Contraindications: yin amfani da maganin sa barci na gida, cututtuka na gida ko na tsarin jiki, yanayin fata mara kyau a gefen wuyan hannu;nau'in kasusuwa da nau'in karaya a wurin fashe, nau'in raunin dorsal irin su Barton fracture, raunin haɗin gwiwa na radiocarpal da raguwa, raguwa mai sauƙi na Styloid radius, ƙananan karayar ɓarna na gefe.
Ga marasa lafiya da raunin kuzari mai ƙarfi irin su raunin da ya faru na intra-articular comminuted fractures ko hasara mai tsanani, yawancin malamai ba su bayar da shawarar yin amfani da faranti na volar ba, saboda irin wannan raunin da ya faru yana da wuyar samun ciwon necrosis na jijiyoyin jini kuma yana da wuya a sami raguwa a jiki.Ga marasa lafiya tare da ɓarke karya da yawa da ƙaura mai mahimmanci da ƙashi mai tsanani, farantin wuta yana da wuya a yi tasiri.Ana iya samun matsaloli tare da tallafin subchondral a cikin karaya mai nisa, kamar shigar dunƙule cikin rami na haɗin gwiwa.Wani wallafe-wallafen kwanan nan ya ba da rahoton cewa, lokacin da aka bi da 42 lokuta na ɓarna na intra-articular tare da faranti na volar, babu screws da ke shiga cikin rami na articular, wanda ya fi dacewa da matsayi na faranti.
3. Kwarewar tiyata
Yawancin likitoci suna amfani da gyare-gyaren farantin wuta don karyewar radius ta hanyoyi da dabaru iri ɗaya.Duk da haka, don kauce wa faruwar rikice-rikice na baya-bayan nan, ana buƙatar fasaha mai mahimmanci na tiyata, alal misali, ana iya samun raguwa ta hanyar sake matsewar toshewar karaya da kuma dawo da ci gaba da kashi na cortical.Ana iya amfani da gyaran wucin gadi tare da wayoyi 2-3 na Kirschner.Game da wace hanyar da za a yi amfani da ita, marubucin ya ba da shawarar PCR (flexor carpi radialis) don tsawaita tsarin volar.
a, Gyaran wucin gadi tare da wayoyi biyu na Kirschner, lura cewa ba a sake dawo da yanayin da ake so ba a wannan lokacin;
b, Wayar Kirschner tana gyara farantin na ɗan lokaci, kula da daidaitawar ƙarshen ƙarshen radius a wannan lokacin (dabarun gyaran ɓarke karya mai nisa), an ja sashin kusancin farantin zuwa ga radial shaft don mayar da karkatacciyar karkatar da karkatar da hankali. .
C, Ƙarƙashin ƙwanƙwasa yana da kyau a daidaita shi a ƙarƙashin arthroscopy, an sanya kullun kullewa / fil, kuma radius na kusa yana raguwa kuma an gyara shi.
Mabuɗin mahimmancina kusanci: Ƙarƙashin fata mai nisa yana farawa ne daga ɗigon fata na wuyan hannu, kuma ana iya ƙayyade tsawonta bisa ga nau'in karaya.Jijin radialis mai sassauƙa da ƙwanƙolinsa suna rarraba nesa zuwa ƙashin carpal kuma gwargwadon yiwuwa.Jawo flexor carpi radialis tendon zuwa gefen ulnar yana kare jijiyar tsaka-tsaki da hadaddun jijiya.An fallasa sararin samaniyar Parona, tare da pronator quadratus dake tsakanin flexor hallucis longus (ulnar) da radial artery (radial).An yi ɓarna a gefen radial na pronator quadratus, yana barin wani ɓangaren da aka haɗe zuwa radius don sake ginawa daga baya.Fitar da pronator quadratus zuwa gefen ulnar sosai yana fallasa madaidaicin kusurwar radius.
Don hadaddun nau'in karaya, ana ba da shawarar a saki nisa na tsokar brachioradialis, wanda zai iya kawar da jan hankalinsa akan tsarin radial styloid.A wannan lokacin, za'a iya yanke kumfa na ɓangaren dorsal na farko don fallasa karaya mai nisa Toshe ɓangaren radial da tsarin styloid na radial, a ciki ya juya radial shaft don raba daga wurin fashe, sa'an nan kuma amfani da Kirschner wayoyi don rage intra. -karya toshe.Don hadaddun ɓangarorin intra-articular, ana iya amfani da arthroscopy don taimakawa ragewa, kimantawa, da kuma daidaita ɓarke karya.
Bayan an gama raguwa, ana sanya farantin wuta akai-akai.Dole ne farantin ya kasance kusa da magudanar ruwa, dole ne ya rufe tsarin ulnar, kuma ƙarshen ƙarshen farantin ya kamata ya isa tsakiyar madaidaicin radial.Idan sharuɗɗan da ke sama ba su cika ba, girman farantin bai dace ba, ko ragewa bai gamsar ba, har yanzu aikin bai cika ba.
Yawancin rikitarwa suna da alaƙa da yawa tare da inda aka sanya farantin.Idan farantin an sanya shi sosai radially, matsalolin da suka shafi flexor hallucis longus suna da damuwa;idan an sanya farantin kusa da layin ruwa, flexor digitorum profundus na iya zama cikin haɗari.Rage raguwa zuwa nakasar ƙaura na iya haifar da farantin karfe cikin sauƙi don fitowa zuwa gefen volar kuma kai tsaye ya tuntuɓi tendon mai sassauƙa, a ƙarshe yana haifar da tendinitis ko ma fashewa.
Ga marasa lafiya na osteoporotic, ana ba da shawarar cewa farantin ya kasance kusa da layin ruwa kamar yadda zai yiwu, amma ba a fadin shi ba..Za a iya amfani da wayoyi na Kirschner don gyara subchondral mafi kusa da ulna, kuma wayoyi na Kirschner na gefe-gefe da kusoshi da kusoshi na iya hana karaya daga sakewa.
Bayan an sanya farantin daidai, an gyara ƙarshen kusanci tare da dunƙule, kuma ramin ulnar a ƙarshen farantin yana da ɗan lokaci tare da waya Kirschner.Intraoperative fluoroscopy anteroposterior view, ra'ayi na gefe, wuyan hannu haɗin gwiwa haɓaka 30 ° ra'ayi na gefe, don ƙayyade raguwar raguwa da matsayi na ciki.Idan matsayi na farantin yana da gamsarwa, amma Kirschner waya yana cikin haɗin gwiwa, zai haifar da rashin isasshen farfadowa na ƙaddamarwa na volar, wanda za'a iya warware shi ta hanyar sake saita farantin ta hanyar "dabarun gyaran gyare-gyare mai nisa" (Fig. 2. b).
Idan yana tare da raunin baya da ulnar (ulnar / dorsal Die Punch) kuma ba za a iya rage shi gaba ɗaya ba a ƙarƙashin rufewa, ana iya amfani da dabaru guda uku masu zuwa:
1. Ƙaddamar da ƙarshen radius na kusa don nisantar da shi daga wurin karaya, da tura faɗuwar fossa zuwa ga carpus ta hanyar tsawaita PCR;
2. Yi ɗan ƙaramin yanki a gefen dorsal na 4th da 5th don fallasa ɓawon burodi, kuma gyara shi da sukurori a cikin mafi yawan rami na ulnar farantin.
3. Rufe percutaneous ko ƙarancin ɓarna tare da taimakon arthroscopy.
Bayan raguwa yana da gamsarwa kuma an sanya farantin daidai, gyare-gyaren ƙarshe yana da sauƙi.Idan layin ulnar Kirschner na kusa yana matsayi daidai kuma babu sukurori a cikin rami na haɗin gwiwa, ana iya samun raguwar jiki.
Kwarewar zaɓin dunƙule: Saboda tsananin comminution na dorsal cortical kashi, tsawon dunƙule na iya zama da wuya a auna daidai.Sukullun da suka yi tsayi da yawa na iya haifar da haushin jijiya, kuma sukulan da suka yi tsayi da yawa ba za su iya goyan baya da gyara guntun dorsal ba.A saboda wannan dalili, marubucin ya ba da shawarar yin amfani da suturar kulle da aka yi da zaren da kuma ƙulla kulle multiaxial a cikin tsarin radial styloid da mafi yawan ramin ulnar, da yin amfani da kullun kulle sanda mai gogewa a cikin sauran wurare.Yin amfani da baƙar magana yana guje wa ɓacin rai ko da an yi amfani da fitowar dorsal.Don gyare-gyaren faranti na kusa, ana iya amfani da sukurori biyu masu haɗakarwa + guda ɗaya na yau da kullun (wanda aka sanya ta cikin ellipse) don gyarawa.
4. Takaitacciyar cikakken rubutun:
Volar kulle farantin ƙusa gyaran gyare-gyaren radius mai nisa na iya samun ingantaccen inganci na asibiti, wanda galibi ya dogara da zaɓin alamomi da ƙwarewar tiyata.Yin amfani da wannan hanya na iya samun kyakkyawan hangen nesa na aiki da wuri, amma babu wani bambanci a cikin aiki na baya da kuma aikin hoto tare da wasu hanyoyin, abubuwan da suka faru na rikice-rikice na baya-bayan nan sun yi kama da haka, kuma raguwa ya ɓace a gyare-gyare na waje, gyaran waya na Kirschner na percutaneous, da gyaran filasta. , cututtuka na ƙwayar allura sun fi yawa;kuma matsalolin jijiyoyi na extensor sun fi kowa a cikin tsarin gyaran farantin radius mai nisa.Ga marasa lafiya da osteoporosis, farantin wuta har yanzu shine zaɓi na farko.
Lokacin aikawa: Dec-12-2022
