Karyawar Radius Distal: Cikakken Bayani Daga Jiki Zuwa Tiyata

Karyawar radius mai nisa yana da kashi 75% na karyewar hannu kuma suna da yawa musamman a asibitin. A cikin wannan labarin, mun tattara jerin jikin mutum, rarrabuwa, dabarun jiyya, da hanyoyin tiyata don karyewar radius mai nisa don tunani.

Takaita

Karyewar radius mai nisa wani bangare ne na karaya a wuyan hannu. Ka'idar 'Shafin Uku' na iya mafi kyawun bayani game da tsarin cututtuka na raunin wuyan hannu, wanda ginshiƙin radial, wanda ya ƙunshi tuberosity radial da navicular fossa, yana da mahimmanci don kiyaye kwanciyar hankali na haɗin gwiwar hannu.

Duk karayar radius mai nisa, ban da karyewar rugujewar gefen radius, a haƙiƙanin tashin hankali ne ke haifar da shi. Hannu yana kasancewa daban lokacin da dakarun waje suka yi aiki da shi, kuma tasirin dakarun waje ya bambanta.

1.Flexion tashin hankali zai iya haifar da dorally gudun hijirar ciki- ko extra-articular karaya a low-makamashi rauni kamar faduwa.

2.Shear danniya zai iya haifar da raguwa na sassa na articular a gefen dabino don haka yana haifar da rashin kwanciyar hankali.

3.In high-makamashi raunuka, matsawa tashin hankali predominates da wuce kima axial loading take kaiwa zuwa matsawa na articular surface kashi.

4.Hanyar farko na ɓarkewar ɓarna shine rauni na ɓarna inda yawan ƙasusuwan da aka lalatar shine galibin abin da aka makala kashi na ligament.

Radiologic anatomy na radius mai nisa

1. Fina-finan na baya-bayan nan (tsawon radial, karkacewar ulnar, ulnar varus)

2. Fina-finan gefe (hanyar dabino)

Rarraba Fernandez

Nau'in I Metaphyseal flexion fracture

Nau'in II Articular and Shear Fracture

Nau'in Nau'in Matsi na Ƙarshen Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙwara

Nau'in IV avulsion karaya na radial wuyan hannu, dislocation

Nau'in V Gauraye Masu Gauraye (Ƙarƙashin Ƙarƙashin Ƙarfafa Ƙarfafawa)

Alamomi Ga Tiyata

Yawancin raunin radius mai nisa ana bi da su tare da birki bayan an rufe rufaffiyar, abin takaici da yawa daga cikin karayar za a yi gudun hijira ko raguwar ba za a yarda da shi tare da mummunan sakamako ba.

LaFontaine et al ne suka gano abubuwa guda biyar masu hana zaman lafiya:

① Farkon dorsal angulation> 20° ( karkatar da dabino);

② Ƙarshen karaya na dorsal epiphysis;

③ karaya a cikin haɗin gwiwa;

④ Haɗe-haɗe da karaya;

⑤ Shekarun marasa lafiya> shekaru 60.

Babu ƙayyadaddun ƙayyadaddun ƙa'idodi ko jagororin don jagorantar jiyya, kuma ana yin shirye-shiryen magani tare da la'akari da adadi mai yawa, ciki har da halayen raunin farko, daidaitawa bayan sakewa, shekarun haƙuri, ingancin kashi, buƙatun haƙuri, da sakamakon da ake so.

Don rufaffiyar raguwa na karaya tare da kwanciyar hankali da ake zargi, sa'an nan kuma ana ba da shawarar bibiyar kusa. Yana da mahimmanci a lura cewa idan jerin radiyon x-ray bayan raguwa sun nuna rashin kwanciyar hankali ko ƙaura, to, canjin magani na iya zama dole. Idan karayar ta kasance mai yuwuwar rashin kwanciyar hankali, to sai a dauki hotunan rediyo a tantance har sai karayar ta warke kuma ta daidaita.

Maganin Conservative

Za a iya samun nasarar rufe karyewar da aka yi da shi tare da birki, da farko tare da tsagawa daga baya tare da simintin tubular, tare da radiyo na mako-mako har zuwa makonni 3.

Idan manyan canje-canje a tsayin radial, karkatar dabino, ko karkacewar ulnar sun faru, yakamata a yi la'akari da aikin tiyata.

A cikin marasa lafiya marasa ƙarfi da ƙananan buƙatu, rufaffiyar magani sau da yawa ya dace, koda lokacin da aka nuna tiyata.

Rufewar sake saiti na gyaran allura

Ragewar da aka rufe wanda ke biye da pinning da gyare-gyare yana da amfani a cikin ɓangarorin radius mai nisa tare da rashin kwanciyar hankali na metaphyseal ko ƙananan karaya a cikin articular.

Mataki na farko shine mayar da yanayin jiki, sannan ana samar da kwanciyar hankali tare da fil ɗin gram. Yawancin lokaci fil na farko yana wucewa daga radial styloid zuwa radial metaphysis medial zuwa diaphysis.

Ana amfani da mafi ƙarancin fil 2 don samar da isassun madaidaicin sakewa a cikin madaidaicin matsayi da na gefe, kuma ana iya liƙa fuskar lunate idan ana so.

Intrafracture pinning (Dabarun Kapanji) yana ba da tallafin dorsal. Ana amfani da immobilization na gaba a cikin tsatsa na tsawon makonni 2 don sarrafa jujjuyawar da rage fushin fil, bayan haka za'a iya maye gurbinsa da simintin hannu mai laushi.

Rufe-maye gurbin gyaran kafa na gyaran kafa na waje

Ƙunƙarar gyaran kafa na waje suna da amfani don jiyya na farko ko na haɗin gwiwa a cikin ƙayyadaddun raunin radius na nisa.

Mai gyara na waje yana kawar da matsalolin axial da ke aiki a kan radius mai nisa yayin ƙaddamar da ƙungiyoyin tsoka na gaba. Gyara yana iya ko a'a a fadin wuyan hannu, ko a iya ƙara ƙarin gyarawa.

Juyin layi ɗaya baya cika mayar da karkata zuwa dabino, amma matsakaicin matsayi abin karɓa ne. Bayan an gama aiki, ana ɗaure wuyan hannu a cikin simintin tubular a cikin juyawa na baya na kwanaki 10 har sai zafi da kumburin sun ragu.

Gyaran farantin karfe tare da katsewa da sakewa

1, Dorsal farantin ciki kayyade na distal radius karaya

An yi madaidaicin tsinke tare da kumburin Lister, tare da ƙarshen ƙarshen haye layin haɗin gwiwa na radial carpal kuma yana ƙare 1 cm kusa da tushe na haɗin gwiwar hannu na metacarpal na biyu. Ƙarshen kusanci ya shimfiɗa tare da tushe na radial don 3 zuwa 4 cm, yana fallasa ginshiƙi na tsakiya ta hanyar tushe na tazarar extensor na uku.

2, dabino farantin ciki kayyade na distal radius karaya

An yi tsayin daka mai tsayi tare da radial carpal flexor tendon, tare da bunion flexor tendon wanda yake a kan zurfin farfajiya na radial carpal flexor tendon, wanda aka sake komawa baya don fallasa tsokar rotator na gaba, kuma tsoka mai juyayi na gaba ya katse a farkon ɗigon ɗigon radial da dill. radius.

Kaso ①

Kaso ②

Kaso ③

3. Gyaran farantin gyaran gyare-gyare na radius mai nisa

- An yi ƙaƙƙarfan tsayin tsayin cm 4 zuwa dorsal zuwa tushe na metacarpal na uku, kuma an yi kwangilar jijiyar extensor na yatsan tsakiya don fallasa metacarpal na uku;

- An yi ɓarna na 4-cm na biyu aƙalla 4 cm baya zuwa ƙarshen radius;

- An yi katsewar dorsal 2-cm na uku a kumburin Lister don fallasa jijiyar hallucis longus extensor.

Daga ɓangarorin nesa, ana shigar da farantin gogayya kusa da jirgin tsakanin jijiya mai extensor (banki na dorsal na huɗu), capsule na haɗin gwiwa da periosteum. Za a iya motsa jijiyar extensor idan ya cancanta.

4. Daidaita daidaikun ɓarnawar ɓarna na radius mai nisa dangane da tsarin TriMed