Distal radius fractures: tlhaloso e feletšego go tšwa go thulaganyo ya mmele go ya go go buiwa .

Distal radius fractures di tšea 75% ya go robega ga letsogo la pele gomme di tlwaelegile kudu ka kliniki. Sehlogong se, re kgobokeditše lenaneo la thulaganyo ya mmele, go hlopha, maano a kalafo le mekgwa ya go bua ya go robega ga radius ya kgole bakeng sa tšhupetšo ya gago.

Akaretša .

Go robega ga radius ya kgole ke karolo ya go robega ga letsogo. The 'Three-Column Theory' e ka hlalosa gakaone mokgwa wa pathological wa go robega ga letsogo, woo go wona kholomo ya radial, yeo e bopilwego ka tuberosity ya radial le navicular fossa, e lego bohlokwa bakeng sa go boloka go tsepama ga lelokololo la letsogo.

Diphapano ka moka tša radius tša kgole, ka ntle le go robega ga avulsion ga moedi wa morago wa radius, ge e le gabotse di hlolwa ke bošoro bja go feta tekano. Seatla se bewa ka go fapana ge se tšewa ke maatla a ka ntle, gomme ditlamorago tša maatla a ka ntle di fapane.

1.Flexion bošoro bo ka feletša ka dorsally displaced intra- goba extra-articular fractures ka dikgobalo tša maatla a tlase go swana le go wa.

2.Shear khatello ea kelello ka fella ka karolo displacement ya articular bokagodimo ka lehlakoreng palmar ka tsela eo isang ho se tsitse.

3.Ka dikgobalo tša matla a magolo, bošoro bja go gatelela bo a buša gomme go rwala axial ka mo go feteletšego go lebiša go compression ya articular surface lerapo.

4.Mokgwa wa mathomo wa go phatloga ga go robega ke kgobalo ya avulsion moo boima bja marapo bjo bo avulsed gantši e lego ntlha ya kgokagano ya marapo ya ligament.

Anatomy ya radiologic ya radius ya kgole .

1.Anteroposterior lifilimi (bophahamo ba radial, ulnar kheloha, ulnar varus) .

2. Difilimi tša ka mahlakoreng (Palmar Sekamelo) .

Go hlopha ga Fernandez .

Mohuta wa I wa go koba ga metaphyseal .

Mofuta II articular le kuta fracture .

Mohuta wa III go robega ga kgatelelo ya bokagodimo bja articular .

Mofuta IV avulsion fracture ya radial wrist, ho phatloha .

Mofuta V Fractures hlakanywa (phahameng matla avulsion fractures) .

Ditšhupetšo tša go Bua .

Bontši bja distal radius fractures di alafša ka go thibela ka morago ga phokotšo ye e tswaletšwego, ka bomadimabe bontši bja diphapano tše di tla šuthišwa goba phokotšo e ka se amogelwe ka sephetho se se fokolago.

Mabaka a mahlano a go se tsepame a ile a lemogwa ke LaFontaine et al:

1 Angulation ya mathomo ya morago > 20° (Palmar sekama);

2 comminuted fracture ya morago epiphysis;

3 go robega mo lelokololong;

4 go robega ga ulnar mo go amanago;

5 Mengwaga ya molwetši > mengwaga ye 60.

Ga go na maemo a feletšego goba ditlhahlo tša go hlahla kalafo, gomme maano a kalafo a dirwa gore a ele hloko palo e kgolo ya mabaka, go akaretša le dimelo tša mathomo tša dikgobalo, go lekanya ka morago ga go bewa gape, nywaga ya balwetši, boleng bja marapo, dinyakwa tša balwetši le dipoelo tše di nyakegago.

Bakeng sa phokotšo ye e tswaletšwego ya go robega ka go belaelwa ga go tsepama, gona go kgothaletšwa go tswalelwa ga go latela. Go bohlokwa go lemoga gore ge e ba lelokelelo la di-X-ray ka morago ga phokotšo le šišinya go se tsepame goba go šuthišwa, gona phetogo ya kalafo e ka nyakega. Ge e le gore go robega go ka ba le kgonagalo ya go se tsepame, gona di-radiograph di swanetše go tšewa le go hlahlobja go fihlela go robega go fodile le go tsepama.

Kalafo ya go boloka dilo .

Diphapano tše di tsepamego di ka tswalelwa ka katlego-go šuthišwa le go alafša ka go thibela, mathomong ka splinting gomme ka morago ka ba le batšeakarolo ba tubular, ka di-radiograph tša beke le beke go fihla go dibeke tše 3.

Ge e ba diphetogo tše dikgolo tša botelele bja radial, go sekama ga seatla goba go fapoga ga ulnar di direga, kalafo ya go bua e swanetše go elwa hloko.

Go balwetši bao ba fokolago le bao ba nyakegago kudu, kalafo yeo e tswaletšwego gantši e a swanela, gaešita le ge go bontšhwa go buiwa.

Closed reset percutaneous nale fixation .

Phokotšo ye e tswaletšwego yeo e latelwago ke go kgomaretša ka letlalo le go tsepama e na le mohola ka go robega ga radius ya kgole ka go se tsepame ga metaphyseal goba go robega mo go bonolo ga ka gare ga ditho.

Mohato oa pele ke anatomical repositioning, ebe tsitsisa e filwe le gram diphini. Ka tlwaelo pini ya mathomo e fetišetšwa go tšwa go styloid ya radial go ya go metaphys ya radial medial go ya go diaphysis.

Bonyane bja diphini tše 2 di šomišwa go fa go bewa gape mo go lekanego mo go tsepamego maemong a orthogonal le a ka mahlakoreng, gomme sebopego sa lunate se ka kgomarelwa ge go nyakega.

Intrafracture pinning (Kapanji thekeniki ya) fana ka tšehetso ea dorsal. Ka morago ga go buiwa go se šišinyege ka gare ga splint go dirišwa dibeke tše 2 go laola go dikološa le go fokotša go hlohlona ga diphini, ka morago ga moo go ka tšeelwa legato ke letsopa le boleta la pele.

Koaloa-Replacement ka ntle fixation bracket fixation .

Di-brace tša go tiiša tša ka ntle di na le mohola bakeng sa kalafo ya mathomo goba ya tlaleletšo ka go robega mo go itšego ga radius ya kgole.

The ka ntle fixator neutralizes le axial dikgateletšego sebetsa ka radius distal nakong contraction ya dihlopha mesifa pele. Go tiiša go ka ba goba gwa se be go putla letsogo, goba go tsepama ga tlaleletšo go ka okeletšwa.

Go goga ka go bapelana ga go bušetše ka botlalo tshekamelo ya seatla, eupša boemo bja go se tšee lehlakore bo a amogelega. Ka morago ga go buiwa, letsogo le tiile ka gare ga tubular cast ka boemong bja ka morago bjo bo dikološitšwego ka matšatši a 10 go fihlela bohloko le edema di fokotšega.

Poleiti fixation le incision le repositioning .

1、Dorsal poleiti ka hare fixation ya distal radius fracture .

Go segwa mo go otlologilego go dirwa go bapa le noutu ya lister, ka mafelelo a kgole a tshela mola wa mohlakanelwa wa carpal wa radial le go feleletša 1 cm kgauswi le motheo wa kopanyo ya letsogo ya bobedi ya metacarpal. Bofelo bja proximal bo atologela go bapa le kutu ya radial ka 3 go ya go 4 cm, e pepentšha kholomo ya bogareng ka motheo wa nako ya boraro ya extensor.

2、Palm poleiti ka hare fixation ya distal radius fracture .

A longitudinal incision e etsoa hammoho radial carpal flexor tendon, le bunion flexor tendon e fumanehang ka holim'a tebileng ea radial carpal flexor tendon, eo e khutlela morao ulnarly ho pepesa anterior ani ani mesifa mesifa, le anterior ani a kgaotse ultracted qalong ea ultracted qalong ya ultracted ultracted qalong ya ultracted ultracted qalong ea ultracted qetellong ea tranalted qetellong ea tranalted quo e qaloa Radius.

Taba 1 .

Taba 2 .

Taba 3 .

3. Traction poleiti fixation ya distal radius fracture .

- go segwa ga 4-cm ya go sega ka nako ye telele go dirwa gore e be ya morago go kutu ya boraro ya metacarpal, gomme tendon ya extensor ya monwana wa gare e kokomoga go pepentšha metacarpal ya boraro;

- go segwa ga bobedi ga 4-cm go dirwa bonyane 4 cm ya morago go radius ye e comminuted;

- Go segwa ga boraro ga 2-cm ga morago go dirwa ka noutu ya lister go pepentšha extensor hallucis longus tendon.

Go tšwa go go sega ga kgole, poleiti ya go goga e tsenywa ka thoko go bapa le sefofane magareng ga tendon ya extensor (phapoši ya bone ya morago), capsule ya mohlakanelwa le periosteum. Tendon ya extensor e ka šuthišwa ge go nyakega.

4. Individualized fixation ya comminuted fractures ya distal radius thehiloeng Trimed tsamaiso e khopo .