Ụzọ kpochapụwo na usoro ntinye agịga mechiri emechi maka mgbaji radius dị anya

Ọkpụkpụ radius distal bụ mgbaji a na-ahụkarị mgbe ọ gbasasịrị na snow n'oge oyi, na mbelata mechiri emechi na ndozi waya Kirschner bụ ụzọ ọgwụgwọ a na-ahụkarị.

Edemede a na-ezo aka na K-Wiring Principles and Techniques iji webata usoro ịwa ahụ nke ntụtụ mechiri emechi.

The atọ-waya usoro bụ kpochapụwo atọ-waya usoro

Otu site na lister tubercle.

Otu site na usoro radial styloid.

Otu site na lunate fossa ọkpụkpụ ngọngọ.

Ọ bụrụ na: nbibi siri ike na osteoporosis na-eme, enwere ike iji wires Kirschner ọzọ.

1. Usoro ịwa ahụ

Nke mbụ, a na-eme mbelata mgbaji ahụ mechiri emechi, na-eji nwayọ nwayọ na-aga n'ihu, na mgbagharị azụ na radial na-edozi ya site n'ịtụgharị aka n'ọbụ aka na mgbawa n'olu. Mgbe mbelata, a na-etinye aka na mpempe akwụkwọ mpịakọta, na-ejigide mgbanwe nkwụ na nhụsianya ulnar (Figure 2a, b), ma dozie ya ma ọ dịkarịa ala atọ percutaneous Kirschner wires.

A na-etinye eriri K nke mbụ na tubercle nke Lister, nke nwere akụkụ na 45 Celsius, ma gbadoro anya na palmar cortex nke akụkụ ọkpụkpụ dị nso na ogologo axis nke radius. Ọ bụrụ na ebe ntinye ahụ dị n'akụkụ azụ nke tubercle Lister, ọkpụkpụ pollicis extensor nwere ike imerụ ahụ.

A na-etinye K-waya nke abụọ 0.5 cm n'ebe dị anya na usoro radial styloid, K-wire dị na 60 ° n'akuku radial axis, wee banye n'ime ulnar cortex dị nso na mgbaji.

K-waya nke atọ ka edobere na iberibe ọkpụkpụ fossa lunate 0.5 cm dị anya na ahịrị nkwonkwo nkwojiaka, nke dị n'etiti ngalaba nke anọ na nke ise. A na-edozi waya K n'akụkụ palmar nke radius na akụkụ 45°, dị ka egosiri na foto a na b n'okpuru.

Omuma percutaneous Kirschner waya ndozi nke distal radius fractures ka egosiri na ọnụ ọgụgụ ae n'okpuru.

 

Egosiri mmegharị mkpịsị aka mgbe emechara waya Kirschner na-egosi na onyonyo dị n'okpuru.

2. Akpachara anya na usoro maka ịwa ahụ

1.Ọ bụrụ na K-waya na-adaba n'ime oghere medullary na-abanyeghị n'ime cortex contralateral, ọ nwere ike kpatara ya site na ntugharị dị ukwuu mgbe K-waị batara. N'okwu a, ndị mmadụ na-ebuli aka ha elu iji belata tilt. Ma n'eziokwu, ihe dị iche bụ eziokwu. A ga-ekpudo waya K-waịre n'akụkụ wee gbadaa n'ụzọ dị mgbagwoju anya, na-ebute ọdịda nke ntanye K-waịre. Kama, ọ kwesịrị iji nwayọọ gbakọọ elu dị ka contour nke K-wire si dị, dị ka egosiri na foto dị n'okpuru.

Na K-waya na-atụ aka na convexly elu, a na-eme ntinye ntinye na cortex distal na-enweghị nrụgide axial, ọ pụkwara ịbanye na cortex dị anya. N'aka nke ọzọ, a ga-agbanwe ebe ntinye ma malite site na mmalite (Figures ae n'okpuru).

2.Na usoro Kapandji, a na-etinye eriri abụọ na atọ K-waịre n'ime ebe mgbawa iji belata ma mezie ihe mgbawa nke dị anya n'ime ọnọdụ achọrọ. Ozugbo ebelatara, a na-ebuga K-wires n'ime mpekere dị nso (Ọnọdụ dị n'okpuru).

3.Ọ bụrụ na ntinye waya na ụzọ ọpụpụ Kirschner dị nnọọ nso na mgbaji ahụ, nkwụsị nkwụsị nwere ike ime. Ekwentị Kirschner nke azụ abụọ ekwesịghị ịgafe na cortex palmar n'otu ọkwa, ebe ọpụpụ palmar ga-adị 2 cm site na ebe mgbawa ahụ. Lee ihe onyonyo a n'okpuru.

4. Mgbe a na-emebi cortex azụ azụ nke ukwuu, gbalịa ka ị ghara ịbanye na ebe mgbaji nke ọkpụkpụ ọkpụkpụ dị anya, n'ihi na nke a nwere ike ibute ọdịda nhazi. Ihe onyonyo ae n'okpuru.

5. Maka osteoporosis siri ike, ọ kacha mma iji waya Kirschner anọ ruo ise iji dozie mgbaji ahụ. Mgbe ụfọdụ, iji nọgide na-adị ogologo nke radius, a na-eji waya Kirschner transverse eme ka ọkpụkpụ ọkpụkpụ dị anya na ulna dị anya.

6. N'ime ogologo akụkụ nke ọkpụkpụ nke njedebe epiphyseal, enwere ike iji waya Kirschner na-achọsi ike maka nhazi. Otú ọ dị, waya Kirschner nwere ike ịbanye n'ime oghere medullary ma sie ike idozi (Mgbasa ozi dị n'okpuru).

7. The intra-articular ọkpụkpụ iberibe meghere na idozi na transverse Kirschner waya n'okpuru cartilage mbụ, na mgbe ahụ na-edozi na atọ percutaneous Kirschner wires na ot ụzọ (Ọgụgụ ad n'okpuru).

8. Ọkpụkpụ siri ike nke radius dị anya na-esonyere na mkpụmkpụ na ọdịda na-achọkwu waya Kirschner transverse iji gafere ulna iji nọgide na-adị elu nke radius. A na-atụnye waya Kirschner nke ọma site na nkwụ nke usoro styloid ruo n'akụkụ azụ nke ulna, dị ka egosiri na Figure a na b n'okpuru.

9. Mgbaji radial styloid na mgbawa azụ azụ. Mgbe mbelata, dozie ya na abụọ radial styloid Kirschner wires: otu n'akụkụ azụ na nke ọzọ n'akụkụ palmar n'ọnụ ọnụ nke styloid. (Foto a na b n'okpuru)

10. Mgbaji nke akụkụ anọ nke radius distal, na mgbapụ azụ azụ na nkewa nke fossa lunate n'akụkụ ọbụ aka. Enwere ike idozi waya Kirschner site na cortex azụ azụ n'ụzọ doro anya site na nso nso ruo n'iberibe ọkpụkpụ metacarpal dị anya. (Foto a na b n'okpuru).

11. Mgbe ị na-eji dorsal na palmar Kirschner wires na-agwọ ọnyá ndị mebiri emebi nke radius distal, ma ọ bụrụ na akụkụ aka nke lunate fossa adịghị ebelata n'oge ịwa ahụ, ị ​​nwere ike iji ụzọ palmar, jiri eriri vaskụla kewapụ ọkpụkpụ, wee tinye Kirschner waya site na mpempe palmar n'ime cortex. (Foto ndị dị n'okpuru)

12. N'ihi na n'ụzọ doro anya na-apụ apụ distal radius fractures nke na-apụghị ibelata site mechiri emechi, a 3 mm Kirschner waya nwere ike na-ebuli distal fracture iberibe si azụ iji nweta mbelata (Figures ah n'okpuru).

13. Jiri ihe ndozi mpụga na-agwọ mgbaji gbajiri agbaji nke radius dị anya. Ndị na-edozi mpụga dabara adaba maka mgbaji agbaji agbaji agbaji nke radius dị anya na-esonyere nnukwu ọzịza, mgbaji meghere, ma ọ bụ ọnọdụ akpụkpọ anụ mpaghara nke na-anaghị ekwe ka imezi ya dị n'ime (dị ka ndozi efere) (Ọgụgụ mgbasa ozi dị n'okpuru).

3. Gbochie nsogbu

1. Iji gbochie nrụzi na-akwụghị ụgwọ, ṅaa ntị na ọrụ ndị a

Lezienụ anya na nhazi bicortical.

Zere idobe ebe ọpụpụ agịga dị anya nso n'ọkpụkpụ ahụ.

Zenarị wires Kirschner niile na-agbakọta na njedebe dị anya ka itinye uche na ike ahụ.

Kpachara anya ka ị zere ngbanwe rụrụ arụ mgbe ị na-ehulata waya Kirschner.

N'ihe gbasara osteoporosis, a chọrọ nrụzi waya Kirschner ọzọ.

2. Usoro iji gbochie ọrịa traktị agịga

Buru ụzọ bee akpụkpọ ahụ, kewaa anụ ahụ dị nro na ọkpụkpụ site na iji mgbachi vaskụla, wee jiri waya Kirschner mee ihe.

Jiri nwayọ gwuo egwu iji gbochie necrosis thermal.

Zere ịrụ ọrụ ugboro ugboro ọtụtụ oge.

Belata nrụgide nke waya Kirschner na akpụkpọ ahụ.