Distal Radius Fractures: Kufotokozera Kwathunthu Kuchokera ku Anatomy kupita ku Opaleshoni

Ma distal radius fractures amakhala ndi 75% ya fractures yam'manja ndipo amapezeka makamaka kuchipatala. M'nkhaniyi, talemba mndandanda wa anatomy, magulu, njira zothandizira, ndi njira zopangira opaleshoni ya distal radius fractures kuti mufotokozere.

Fotokozerani mwachidule

Kuthyoka kwa distal radius ndi gawo la kusweka kwa dzanja. ' Lingaliro la magawo atatu' limatha kufotokozera bwino njira ya pathological ya fractures ya dzanja, momwe radial column, yomwe imakhala ndi radial tuberosity ndi navicular fossa, ndiyofunikira kuti pakhale kukhazikika kwa mgwirizano wa dzanja.

Ma distal radius fractures, kupatulapo fractures ya avulsion of the dorsal margin of the radius, imayambitsidwa ndi chiwawa chowonjezereka. Dzanja limayikidwa mosiyana pamene likugwiritsidwa ntchito ndi mphamvu zakunja, ndipo zotsatira za mphamvu zakunja zimakhala zosiyana.

1.Chiwawa cha Flexion chingayambitse dorsally displaced intra- or extra-articular fractures mu kuvulala kochepa kwa mphamvu monga kugwa.

2.Kupanikizika kwa shear kungapangitse kusamuka pang'ono kwa malo ozungulira kumbali ya palmar motero kumabweretsa kusakhazikika.

3.Pakuvulala kwamphamvu kwambiri, chiwawa choponderezedwa chimakhala chofala kwambiri ndipo kunyamula kwa axial mopitirira muyeso kumabweretsa kupsinjika kwa fupa lapamwamba la articular.

4.Makina oyambirira a fracture dislocation ndi kuvulazidwa kwa avulsion kumene fupa logwedezeka nthawi zambiri ndilo fupa la fupa la ligament.

Radiologic anatomy ya distal radius

1.Makanema a Anteroposterior (kutalika kwa radial, kupatuka kwa ulnar, ulnar varus)

2. Mafilimu otsatizana (kupendekera kwa palmar)

Gulu la Fernandez

Type I Metaphyseal flexion fracture

Type II Articular ndi Shear Fracture

Type III Compression Fracture of Articular Surface

Type IV avulsion fracture of the radial wrist, dislocation

Type V Mixed Fractures (High Energy Avulsion Fractures)

Zizindikiro Zopangira Opaleshoni

Ma distal radius fractures amathandizidwa ndi braking pambuyo pochepetsa kutsekedwa, mwatsoka ambiri a fractures awa adzachotsedwa kapena kuchepetsa sikungavomerezedwe ndi zotsatira zoipa.

Zinthu zisanu zosokoneza zidadziwika ndi LaFontaine et al:

① Kupindika koyambirira kwa dorsal> 20° (kupendekeka kwa kanjedza);

② Kuphulika kwapang'onopang'ono kwa dorsal epiphysis;

③ kuthyoka mu olowa;

④ Kusweka kwa ulnar komwe kumalumikizidwa;

⑤ Zaka za wodwala> zaka 60.

Palibe ndondomeko yotsimikizirika kapena malangizo otsogolera chithandizo, ndipo ndondomeko zachipatala zimapangidwira poganizira zinthu zambiri, kuphatikizapo zizindikiro zoyamba zovulaza, kuwerengetsa pambuyo pokonzanso, zaka za odwala, khalidwe la fupa, zofunikira za odwala, ndi zotsatira zomwe akufuna.

Pofuna kuchepetsa kutsekedwa kwa fractures ndi kukayikira kukhazikika, ndiye kuti kutsatiridwa kwafupi kumalimbikitsidwa. Ndikofunika kuzindikira kuti ngati ma X-ray angapo pambuyo pochepetsa akuwonetsa kusakhazikika kapena kusamuka, ndiye kuti kusintha kwamankhwala kungakhale kofunikira. Ngati kupasukako kungakhale kosakhazikika, ndiye kuti ma radiographs ayenera kutengedwa ndikuwunikiridwa mpaka fractureyo itachira ndikukhazikika.

Chithandizo Chodziletsa

Ziphuphu zokhazikika zimatha kutsekedwa bwino ndikuthandizidwa ndi braking, poyambira ndikumangirira kenako ndi ma tubular cast, ndi ma radiograph a sabata mpaka masabata atatu.

Ngati kusintha kwakukulu kwa kutalika kwa radial, kupendekera kwa palmar, kapena kupatuka kwa mkodzo kumachitika, chithandizo cha opaleshoni chiyenera kuganiziridwa.

Odwala ofooka komanso osowa, chithandizo chotsekedwa nthawi zambiri chimakhala choyenera, ngakhale opaleshoni ikuwonetsedwa.

Kutsekedwa bwererani percutaneous singano fixation

Kuchepetsa kotsekedwa kotsatiridwa ndi pinning percutaneous ndi fixation ndi kothandiza mu distal radius fractures ndi kusakhazikika kwa metaphyseal kapena fractures yosavuta ya intra-articular.

Gawo loyamba ndikuyikanso kwa anatomical, ndiye kukhazikika kumaperekedwa ndi zikhomo za gramu. Kawirikawiri pini yoyamba imadutsa kuchokera ku radial styloid kupita ku radial metaphysis medial kupita ku diaphysis.

Mapini osachepera 2 amagwiritsidwa ntchito kuti apereke malo okhazikika okhazikika mu orthogonal ndi lateral malo, ndipo gawo la mwezi likhoza kusindikizidwa ngati lingafune.

Intrafracture pinning (Kapanji technique) imapereka chithandizo chapakhosi. Postoperative immobilization mu splint imagwiritsidwa ntchito kwa masabata a 2 kuti athe kuwongolera kusinthasintha ndikuchepetsa kukwiya kwa pini, pambuyo pake imatha kusinthidwa ndi kuponya kofewa.

Kukhazikika kwa bulaketi kotsekera kotsekera

Zomangamanga zakunja ndizothandiza pa chithandizo choyambirira kapena chothandizira pazigawo za distal radius fractures.

Kukonzekera kwakunja kumalepheretsa kupanikizika kwa axial komwe kumachitika pamtunda wa distal panthawi yamagulu a minofu yam'mbuyo. Kukonzekera kungakhale kapena kusakhala pa dzanja limodzi, kapena zowonjezera zowonjezera zikhoza kuwonjezeredwa.

Kukokera kofanana sikubwezeretsa kwathunthu kutsata kwa palmar, koma kusalowerera ndale ndikovomerezeka. Pambuyo pa opaleshoni, dzanja limamangiriridwa mu tubular kuponyedwa mozungulira kumbuyo kwa masiku a 10 mpaka ululu ndi edema zitatha.

Kukonza mbale ndi incision ndi repositioning

1, Dorsal mbale mkati kukonza kwa distal radius fracture

Njira yowongoka imapangidwa motsatira mfundo ya Lister, ndipo kumapeto kwake kumadutsa mzere wolumikizana ndi radial carpal ndikumaliza 1 cm pafupi ndi gawo lachiwiri la metacarpal wrist. Mapeto oyandikira amapitilira tsinde la radial kwa 3 mpaka 4 cm, kuwonetsa gawo lapakati kudzera m'munsi mwa gawo lachitatu lokulitsa.

2, Palm mbale mkati fixation wa distal utali wosweka fracture

Kuwombera kwautali kumapangidwa pamodzi ndi mitsempha yamtundu wa carpal flexor tendon, ndi bunion flexor tendon yomwe ili pamtunda wamtundu wa radial carpal flexor tendon, yomwe imachotsedwa ulnarly kuti iwonetsere anterior rotator ani muscle, ndipo anterior rotator ani muscle imadulidwa kumayambiriro kwa mbali ya radial ndi kuthamangitsidwa kwa utali wozungulira.

Mlandu ①

Mlandu ②

Mlandu ③

3. Kukonzekera kwa mbale ya traction ya distal radius fracture

- Kudula kwa 4-cm kwautali kumapangidwa kumtunda kwa tsinde lachitatu la metacarpal, ndipo tendon yotulutsa chala chapakati imapangidwa kuti iwonetse metacarpal yachitatu;

- Kudulidwa kwachiwiri kwa 4-cm kumapangidwa osachepera 4 cm kumbuyo kwa radius yokhazikika;

- Kudulira kwachitatu kwa 2-cm kumapangidwa pa Node ya Lister kuti iwonetsere tendon ya extensor hallucis longus.

Kuchokera ku distal incision, mbale yoyendetsa imayikidwa pafupi ndi ndege pakati pa extensor tendon (chipinda chachinayi cha dorsal), capsule yolumikizana ndi periosteum. The extensor tendon ikhoza kusuntha ngati kuli kofunikira.

4. Kukonzekera kwapayekha kwa fractures yowonongeka ya distal radius yochokera ku dongosolo la TriMed