Hanyoyi na gargajiya da dabaru na rufaffiyar shigar allura don karyewar radius mai nisa

Karyawar radius na nesa shine karaya na kowa bayan ya zamewa kan dusar ƙanƙara a cikin hunturu, kuma raguwar rufaffiyar da gyaran waya na Kirschner shine mafi yawan hanyoyin magani.

Wannan labarin yana nufin ƙa'idodin K-Wiring da Dabaru don gabatar da dabarun tiyata na rufaffiyar pinning.

Dabarar gyare-gyaren waya guda uku ita ce fasahar gyaran waya ta gargajiya

Daya ta hanyar lister tubercle.

Daya ta hanyar radial styloid tsari.

Daya ta hanyar lunate fossa toshe kashi.

Idan: karaya mai tsanani da osteoporosis sun faru, ana iya amfani da ƙarin wayoyi na Kirschner.

1. Hanyar tiyata

Na farko, ana yin rufaffiyar raguwa na karaya, tare da raguwa da ci gaba da raguwa, kuma ana gyara dorsal da radial ta hanyar jujjuyawar dabino da karkacewar ulnar. Bayan raguwa, ana sanya hannu a kan takardar birgima, yana riƙe da ƙwanƙwasa dabino da karkatar da ulnar (Hoto 2a, b), kuma an gyara shi tare da aƙalla wayoyi na Kirschner guda uku.

Ana shigar da waya ta farko a bututun Lister, mai kusurwa a 45°, kuma ana nufin gaɓoɓin dabino na guntun ƙashi na kusa akan doguwar axis na radius. Idan wurin shigar ya kasance a gefen ulnar na tubercle na Lister, ana iya raunata tendon policis extensor.

K-waya na biyu an saka 0.5 cm mai nisa zuwa tsarin radial styloid, K-wayar tana a kusurwar 60 ° zuwa radial axis, kuma yana shiga cikin ulnar cortex kusa da karaya.

K-waya na uku an daidaita shi zuwa guntun fossa na lunate 0.5 cm mai nisa zuwa layin haɗin gwiwa na wuyan hannu, wanda ke tsakanin sassan na huɗu da na biyar na extensor. K-wayar tana daidaitawa zuwa gefen dabino na radius a kusurwar 45°, kamar yadda aka nuna a Figures a da b a ƙasa.

Classic percutaneous Kirschner waya gyara na nesa radius karaya aka nuna a Figures a kasa.

 

Ana nuna motsin yatsa bayan gyaran waya na Kirschner a cikin tallan da ke ƙasa.

2. Kariya da dabaru don tiyata

1.Idan K-wayar ta zamewa cikin rami na medullary ba tare da shiga cikin cortex mai cin karo da juna ba, yana iya haifar da karkatar da yawa lokacin da K-wayar ta shiga. A wannan yanayin, mutane sukan ɗaga hannayensu don rage karkatar. Amma a gaskiya, akasin haka. K-wayar za ta kasance a kusurwa da lanƙwasa ta hanyar daɗaɗɗa, wanda zai haifar da gazawar huda K-wayar. Madadin haka, yakamata ya zama mai jujjuyawa sama a hankali bisa ga kwalin-wayar K-waya, kamar yadda aka nuna a hoton da ke ƙasa.

Tare da K-wayar da aka nuna sama a dunƙule, ana yin wurin shigarwa a cikin ƙwanƙolin nesa ba tare da matsin lamba ba, kuma yana iya shiga cikin bawo mai nisa. A madadin haka, yakamata a canza wurin sakawa kuma a fara daga farkon (Hoto a ƙasa).

2.A cikin fasaha na Kapandji, ana saka wayoyi biyu zuwa uku na K-wayoyi a cikin wurin da aka karye don ragewa da gyara ɓarke ​​​​karya mai nisa zuwa matsayin da ake so. Da zarar an rage, K-wayoyin suna ci gaba cikin ɓangarorin da ke kusa (Hoto a ƙasa).

3.Idan Kirschner waya shigarwa da wuraren fita suna kusa da raguwa, rashin daidaituwa na iya faruwa. Wayoyin Kirschner na dorsal biyu kada su wuce ta hanyar dabino a matakin daya, kna dorsal biyu kada su wuce ta hanyar dabino a matakin daya, k2 cm daga wurin karaya. Dubi Figures a ƙasa.

4. Lokacin da dorsal cortex ya ƙare sosai, gwada kada ku shiga wurin da ya karye na guntun kashi mai nisa, saboda wannan na iya haifar da gazawar gyarawa. Figures ae a kasa.

5. Don ciwon osteoporosis mai tsanani, yana da kyau a yi amfani da waya Kirschner hudu zuwa biyar don gyara karaya. Wani lokaci, don kiyaye tsayin radius, ana amfani da waya mai jujjuyawar Kirschner don gyara shingen radius mai nisa zuwa ulna mai nisa.

6. A cikin tsayin daka mai tsayi na ƙarshen epiphyseal, ana iya amfani da babbar waya Kirschner mai karkata don gyarawa. Koyaya, waya ta Kirschner na iya zamewa cikin rami medullary kuma yana da wahalar gyarawa (tallafin da ke ƙasa).

7. An buɗe guntun kashi na intra-articular kuma an gyara shi tare da waya mai jujjuyawar Kirschner a ƙarƙashin guringuntsi na farko, sa'an nan kuma an gyara shi tare da wayoyi na Kirschner guda uku na percutaneous a cikin hanyar al'ada (Figures ad da ke ƙasa).

8. Mummunan karaya mai tsanani na radius mai nisa tare da raguwa da rugujewa yana buƙatar ƙarin madaidaicin waya Kirschner don wucewa ta cikin ulna don kula da tsayin radius. Wayar Kirschner an fi nuna shi daga gefen dabino na tsarin styloid zuwa gefen dorsal na ulna, kamar yadda aka nuna a Figures a da b a ƙasa.

9. Radial styloid fracture tare da dorsal gudun hijira. Bayan raguwa, gyara tare da wayoyi Kirschner radial styloid guda biyu: daya a gefen dorsal kuma ɗayan a gefen dabino zuwa ƙarshen styloid. (Hoto a da b a ƙasa)

10. Karaya mai kashi hudu na radius mai nisa, tare da rarrabuwar dorsal da kuma rabuwa da lunate fossa daga gefen dabino. Za'a iya gyara waya ta Kirschner daga dorsal cortex ta hanyar da ba ta dace ba daga kusanci zuwa guntun kashi na metacarpal mai nisa. (Hoto a da b a ƙasa).

11. Lokacin amfani da wayoyi na dorsal da dabino Kirschner don magance karaya daga radius mai nisa, idan ba a rage guntuwar dabino na lunate fossa yayin tiyata ba, zaku iya amfani da hanyar dabino, amfani da matsewar jijiyoyin jini don raba kashi, sannan a saka waya Kirschner daga guntun dabino a cikin cortex. (Hoto ah a kasa)

12. Don ɓarna a fili mai nisa radius da ba za a iya ragewa ta hanyar raguwa ba, za a iya amfani da waya Kirschner na 3 mm don ɗaga guntun ɓarna daga baya don cimma raguwa (Figures ah a ƙasa).

13. Yi amfani da masu gyara waje don magance karyewar radius mai nisa. Masu gyara na waje sun dace da ɓarkewar ɓarna mai tsanani na radius mai nisa tare da babban kumburi, buɗaɗɗen karaya, ko yanayin fata na gida waɗanda ba sa ba da izinin gyaran ciki (kamar gyaran farantin karfe) (Figures ad da ke ƙasa).

3. Hana rikitarwa

1.Don hana rashin daidaituwa, kula da ayyuka masu zuwa

Kula da gyaran bicortical.

Ka guji sanya wurin fitan allura mai nisa kusa da karaya.

A guji duk wayoyi na Kirschner suna haɗuwa a ƙarshen nesa don tattara ƙarfi.

Yi hankali don guje wa jujjuyawar jujjuyawar lokacin lankwasa wayar Kirschner.

Idan akwai osteoporosis, ana buƙatar ƙarin gyaran waya na Kirschner.

2. Matakan hana kamuwa da cutar ta hanyar allura

Da farko yanke fata, raba nama mai laushi zuwa kashi tare da matsewar jijiyoyin jini, sannan amfani da waya Kirschner.

Dra a hankali don hana thermal necrosis.

Guji maimaita ayyuka sau da yawa.

Rage matsi na waya Kirschner akan fata.