Distal Radius Fractures: Kev piav qhia dav dav los ntawm Anatomy mus rau kev phais

Distal radius fractures account rau 75% ntawm forearm fractures thiab tshwj xeeb tshaj yog nyob rau hauv lub tsev kho mob. Hauv tsab xov xwm no, peb tau sau cov npe ntawm lub cev, kev faib tawm, cov tswv yim kho mob, thiab cov txheej txheem phais mob rau cov pob qij txha tawg rau koj siv.

Cov ntsiab lus

Fractures ntawm lub distal radius yog ib feem ntawm lub dab teg fractures. Qhov 'peb-kem txoj kev xav' tuaj yeem piav qhia tau zoo dua cov txheej txheem pathological ntawm pob qij txha pob txha, nyob rau hauv uas lub radial kem, muaj cov radial tuberosity thiab navicular fossa, yog ib qho tseem ceeb rau kev tswj kev ruaj ntseg ntawm lub dab teg.

Tag nrho cov kab hluav taws xob distal tawg, tshwj tsis yog avulsion fractures ntawm dorsal margin ntawm lub vojvoog, yog qhov tseeb tshwm sim los ntawm overextension kev nruj kev tsiv. Lub tes yog positioned txawv thaum ua raws li los ntawm sab nraud rog, thiab cov teebmeem ntawm sab nraud rog yog txawv.

1. Kev nruj nruj tuaj yeem ua rau dorsally hloov chaw intra- lossis ntxiv-articular fractures nyob rau hauv qis-zog raug mob xws li ntog.

2.Shear kev ntxhov siab tuaj yeem ua rau qee qhov kev hloov pauv ntawm cov pob qij txha ntawm sab palmar yog li ua rau tsis ruaj khov.

3.Nyob rau hauv high-zog raug mob, compression kev nruj kev tsiv predominates thiab ntau axial loading ua rau compression ntawm articular nto pob txha.

4.Lub ntsiab mechanism ntawm pob txha dislocation yog kev raug mob avulsion qhov twg cov pob txha avulsed feem ntau yog cov pob txha txuas ntawm ligament.

Radiologic anatomy ntawm lub distal radius

1.Anteroposterior films (radial qhov siab, ulnar sib txawv, ulnar varus)

2. Lateral films (palmar inclination)

Fernandez Classification

Hom I Metaphyseal flexion fracture

Hom II Articular thiab Shear Fracture

Hom III Compression Fracture ntawm Articular Surface

Hom IV avulsion tawg ntawm lub dab teg radial, dislocation

Hom V Mixed Fractures (High Zog Avulsion Fractures)

Indications rau phais

Feem ntau ntawm cov pob txha tawg ntawm qhov distal yog kho nrog kev nres tom qab kaw qhov txo qis, hmoov tsis ntau ntawm cov pob txha no yuav raug tshem tawm lossis qhov kev txo qis yuav tsis tau txais nrog cov txiaj ntsig tsis zoo.

Tsib yam tsis txaus ntseeg tau txheeb xyuas los ntawm LaFontaine li al:

① Pib dorsal angulation> 20 ° (palmar qaij);

② comminuted puas ntawm dorsal epiphysis;

③ pob txha pob txha;

④ Associated ulnar puas;

⑤ Tus neeg mob hnub nyoog> 60 xyoo.

Tsis muaj cov qauv kev cai lossis cov txheej txheem los qhia txog kev kho mob, thiab cov phiaj xwm kho mob tau ua los ntawm ntau yam, suav nrog cov yam ntxwv raug mob thaum pib, kev ntsuas tom qab rov ua dua, cov neeg mob hnub nyoog, pob txha zoo, cov neeg mob xav tau, thiab cov txiaj ntsig xav tau.

Txhawm rau kaw qhov txo qis ntawm cov pob txha uas xav tias muaj kev ruaj ntseg, tom qab ntawd kev soj ntsuam ze yog pom zoo. Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias yog tias cov x-rays tom qab txo qis qhia tias tsis muaj kev ruaj ntseg lossis hloov chaw, ces yuav tsum tau hloov kho. Yog tias cov pob txha tawg tuaj yeem tsis ruaj khov, ces yuav tsum tau siv cov duab hluav taws xob thiab tshuaj xyuas kom txog thaum cov pob txha tau kho thiab ruaj khov.

Kev Kho Kom Zoo

Cov pob txha ruaj khov tuaj yeem ua tiav kaw-tshem tawm thiab kho nrog kev sib tsoo, pib nrog splinting thiab tom qab ntawd nrog cov tubular cam khwb cia, nrog cov xov tooj cua txhua lub lim tiam mus txog 3 lub lis piam.

Yog tias muaj kev hloov pauv loj hauv radial ntev, palmar inclination, lossis ulnar deviation tshwm sim, kev kho phais yuav tsum tau txiav txim siab.

Hauv cov neeg mob uas tsis muaj zog thiab xav tau tsawg, kev kho mob kaw feem ntau tsim nyog, txawm tias thaum phais tau qhia.

Kaw pib dua percutaneous koob fixation

Kaw txo ua raws li percutaneous pinning thiab fixation yog qhov tseem ceeb nyob rau hauv distal radius fractures nrog metaphyseal instability los yog yooj yim intra-articular fractures.

Thawj kauj ruam yog anatomical repositioning, ces stabilization yog muab nrog gram pins. Feem ntau thawj tus pin yog dhau los ntawm radial styloid mus rau radial metaphysis medial mus rau diaphysis.

Yam tsawg kawg ntawm 2 tus pins yog siv los muab kev ruaj khov txaus nyob rau hauv txoj haujlwm orthogonal thiab lateral, thiab lub lunate facet tuaj yeem pinned yog xav tau.

Intrafracture pinning (Kapanji txheej txheem) muab kev txhawb nqa dorsal. Postoperative immobilization nyob rau hauv ib tug splint yog thov rau 2 lub lis piam los tswj kev sib hloov thiab txo tus pin khaus, tom qab uas nws yuav tsum tau hloov nrog ib tug mos forearm cam khwb cia.

Kaw-hloov sab nraud fixation bracket fixation

Sab nrauv fixation braces muaj txiaj ntsig zoo rau kev kho thawj zaug lossis kev kho mob tshwj xeeb hauv cov pob qij txha pob txha.

Sab nraud fixator neutralizes axial stresses ua rau lub distal vojvoog thaum contraction ntawm lub forearm nqaij pawg. Fixation tej zaum yuav los yog tsis nyob rau hauv lub dab teg, los yog ntxiv fixation ntxiv.

Parallel traction tsis tag nrho rov qab palmar inclination, tab sis ib qho chaw nruab nrab tau txais. Postoperatively, lub dab teg yog braced nyob rau hauv ib tug tubular cam khwb cia nyob rau hauv ib tug rotated posterior txoj hauj lwm rau 10 hnub kom txog thaum qhov mob thiab edema txo.

Phaj fixation nrog incision thiab repositioning

1、Dorsal phaj sab hauv fixation ntawm distal radius puas

Ib qho kev txiav ncaj yog ua raws li Lister qhov ntawm, nrog rau qhov kawg ntawm qhov kawg hla cov kab sib txuas ntawm radial carpal thiab xaus 1 cm ze rau lub hauv paus ntawm ob lub dab teg metacarpal. Qhov kawg ntawm qhov kawg txuas nrog lub qia radial rau 3 mus rau 4 cm, nthuav tawm hauv nruab nrab kem los ntawm lub hauv paus ntawm qhov thib peb extensor interval.

2, Xibtes phaj sab hauv fixation ntawm distal radius puas

Ib qho kev txiav ntev yog ua raws li radial carpal flexor tendon, nrog lub pob txha flexor leeg nyob rau hauv qhov tob ntawm lub radial carpal flexor tendon, uas yog retracted ulnarly kom nthuav tawm lub anterior rotator ani cov leeg, thiab lub anterior rotator ani nqaij yog txiav nyob rau hauv thaum pib ntawm lub radial retracted sab thiab dissipation.

Case ①

Case ②

Case ③

3. Traction phaj fixation ntawm distal radius puas

- Ib tug 4-cm longitudinal incision yog ua dorsal mus rau lub thib peb metacarpal qia, thiab lub extensor tendon ntawm nruab nrab ntiv tes tau cog lus kom nthuav tawm lub thib peb metacarpal;

- Qhov thib ob 4-cm incision yog ua yam tsawg kawg 4 cm dorsal rau lub comminuted radius;

- Qhov thib peb 2-cm dorsal incision yog ua nyob rau ntawm Lister node kom nthuav tawm cov extensor hallucis longus tendon.

Los ntawm qhov distal incision, lub phaj traction yog ntxig rau ntawm lub dav hlau ntawm lub extensor tendon (plaub dorsal compartment), cov tshuaj ntsiav thiab lub periosteum. Lub extensor tendon tuaj yeem txav tau yog tias tsim nyog.

4. Kev kho tus kheej ntawm comminuted fractures ntawm lub vojvoog distal raws li TriMed system