Percutaneous K-waya kugadzirisa ndeimwe yenzira dzinoverengeka dzinoshandiswa kuchengetedza kuderedzwa kweakasarudzwa distal radius fractures. Iyo inonziwo kuvharika kuderedzwa uye percutaneous pinning, nzira iyi inoshandisa Kirschner waya kudzikamisa zvimedu zvekutyoka mushure mekurongeka kwadzoreredzwa.
Haisi mhinduro yepasirese kuruoko rwese rwakatyoka. Kutyoka pateni, kudzikisira kugadzikana, kubatanidzwa kwearticular, hunhu hwemapfupa, mamiriro akapfava-tishu, zvinodiwa nemurwere uye zviripo zvekugadzirisa sarudzo zvese zvinopesvedzera kusarudzwa kwekurapa. Gwaro iri rinotsanangura misimboti uye zvipimo zvedistal radius K-waya kugadzirisa pasina kutsiva kudzidziswa kwekuvhiya kana dhizaini-chaiyo dhizaini.
Key Takeaways
Kugadziriswa kweK-waya kunowanzo kutariswa mushure mekuderedzwa kwekutyoka kana kumwe kudzikamiswa kuchidikanwa uye zvimedu zvinogona kudzorwa newaya.
Radial styloid, dorsal, fragment-specific and intrafocal configurations inotsanangura misimboti yakasiyana kwete imwe chete yepini inosungirwa.
Nhamba yewaya, dhayamita, trajectory uye immobilization zano ndeye- uye mudziyo-chaiyo; havafanirwe kusarudzwa kubva kune general marketing article.
Zvinogona kunetsa zvinosanganisira kurasikirwa kwekudzikisira, hutachiona hwepini-turakiti, kutama kwewaya, nyoro-tishu kushatirwa, tendon kana kukuvara kwetsinga uye kuoma kwemaoko.
K-waya, volar plates uye yekunze fixation imwe neimwe ine tradeoffs dzakasiyana. Humbowo hwazvino hautsigire nzira imwe chete yekugadzirisa seyakakwirira pasi rose kune yega yega isina kugadzikana kana yakazara articular kutyoka.
Chii chinonzi K-Wire Fixation yeDistal Radius Fracture?
Distal radius fracture inoitika pedyo nekumucheto kweruoko rweradius. Kana kuputsika kuchibviswa, vanachiremba vanoongorora kana kurongeka kunogamuchirwa kunogona kudzorerwa uye kuchengetedzwa. Kuderedzwa kwakavharwa kunoreva kudzoreredza kurongeka pasina kuvhura nzvimbo yekuputsika. Percutaneous pinning yobva yaisa waya imwe kana anopfuura akatsetseka kuburikidza nediki rekupinda ganda rekubata zvimedu zvakasarudzwa apo kupora kuchienderera mberi.
Izwi rezvokurapa rinonyanyodiwa nderokuti kuvhara kuderedzwa uye kupinza kwegonyeti , kwete 'kupinza tsono yakavharika.' Waya yeKirschner mudziyo wekugadzirisa kwete tsono yejekiseni. Saka chinyorwa chinofanirwa kushandisa K-waya, waya, pinning uye yekumisikidza izwi nguva dzose.
Sei K-Waya Kuchengeta Kuderedzwa
Waya dzinogona kuyambuka pakatyoka uye kuwana kutenga muchikamu chakatsiga cheradius, kana kuti dzinogona kutsigira zvidimbu zvega mugadziro yakasarudzwa patani yekutyoka. Mechanical kugadzikana kunoenderana nekuwanda kwehuwandu hwewaya. Divergence, fragment control, cortical kutenga, waya dhayamita, mhando yebhonzo uye yekuwedzera immobilization zvese zvinogona kukanganisa kuvaka.
K-Wire Fixation Ndiyo Imwe Kurapa Sarudzo
Mamwe distal radius fractures anogona kutarisirwa pasina kuvhiyiwa, nepo mamwe anogona kurapwa nemapini epercutaneous, volar kana dorsal plate, yekunze fixator kana zano rakasanganiswa. Kuti uwane mhedziso yakafara, ona XC Medico gwara kune iyo kuongororwa, kurongedza uye kurapwa kwe distal radius fractures .
Apo Percutaneous Pinning Inokodzera Mukurapa
Nonoperative Management
Yakasarudzwa yakagadzika fractures kana fractures inoramba yakanyatsoenderana mushure mekuderedzwa inogona kutarisirwa nekukanda kana splint uye kutevera-up imaging. Zera remurwere chete haritauri kurapwa.
Percutaneous K-Waya Kugadziriswa
Pinning inogona kupa yakawedzera fragment control mushure mekuderedzwa kwemaitiro akasarudzwa. Zvinowanzoda kutariswa kune nzvimbo dzepini, immobilization uye gare gare waya manejimendi.
Plate Fixation
Iyo volar kana dorsal ndiro inopa kugadzirisa kwemukati uye inogona kusarudzwa kune mapatani inoda yakananga fragment control. XC Medico inopa akati wandei distal radius yekuvhara ndiro sarudzo.
External Fixation
Chimiro chinotenderera kana chisingaverengeki chinogona kubatsira kuchengetedza urefu uye kurongeka mune zvakasarudzwa zvisina kugadzikana fractures, kusanganisira zviitiko umo zvinyoro zvinyoro zvinokanganisa kuronga kwemukati kugadzirisa.
Iyo AAOS/ASSH yekiriniki yemaitiro ekutungamira inoshuma hapana mutsauko wakakura muradiographic kana murwere-inoshumwa mhedzisiro pakati pekugadzirisa tekinoroji yakakwana articular kana isina kugadzikana distal radius fractures, kunyange volar yakakiyiwa mahwendefa anogona kupa yekutanga kushanda kupora munguva pfupi. Izvi zvinotsigira kusarudzwa kwemunhu pane kutaura kuti K-waya kana mahwendefa anogara ari nani.
Ndeapi Panogona Kugadziriswa K-Wire Kugadziriswa Kungatariswa?
Kuita sarudzo yekiriniki kunotanga nekuongorora uye kufungidzira. Izvi zvinotevera zvinhu zvinogona kutariswa nenyanzvi dzinokwanisa, asi hazvisi zvekumira-yega zvinoratidza cheki.
Kuputsika Pateni uye Kuderedza Kugadzikana
Pinning inonyanya kubatsira kana zvimedu zvakakosha zvinogona kudzikiswa uye kudzorwa newaya dzakamisikidzwa zvakakodzera. Yakamisikidzwa metaphyseal comminution, zvimedu zvidiki articular kana tsika yekudonha inogona kuderedza kuvimbika kweiyo nyore kugadzira waya uye kufunga nekukurumidza kweimwe kana nzira yekuwedzera.
Bone Hunhu uye Chimedu Saizi
Osteoporotic bone inogona kupa shoma yakavimbika yekutenga waya. Kuwedzera waya hakungoerekani kwakaringana kugadzirisa kusagadzirisa, uye hapana mutemo wepasirese wekuti chero osteoporotic fracture inoda mapini mana kana mashanu. Kuvaka kusarudzwa kunofanirwa kutevedzera fracture pateni, imaging, yakatenderwa nzira uye kuvhiya kutonga.
Murwere uye Soft-Tissue Factors
Mamiriro eganda, kuzvimba, kukuvara kwakavhurika, comorbidities yezvokurapa, zvinoda basa, kugona kutevedzera pini-saiti uye immobilization mirairo uye inotarisirwa kuvandudzwa zvese zvinobatsira pakusarudzwa kwekurapa.
Zera uye Functional Demand
Humbowo hunofanirwa kududzirwa pamwe chete nemurwere-chikamu chezvikonzero. Iyo AAOS/ASSH nhungamiro inoshuma kuti kurapwa kweanoshanda muvanhu vane geriatric hakuwanzo kuvandudza mhedzisiro yenguva refu-inoshumwa nemurwere kana ichienzaniswa nekusashanda, kunyangwe kana radiographic alignment ichisiyana. Kugoverana kuita sarudzo kunoramba kwakakosha.
Muganhu wekiriniki: chinyorwa chedzidzo chese hachigone kuona kana kutsemuka chaiko kunoda K-waya, ndiro, gadziriso yekunze kana kurapwa kusiri kushanda. Sarudzo iyoyo inoda kuongororwa kwemurwere, kufungidzira uye kutonga kwakakodzera kwekurapa.
Zvakajairwa K-Waya Kugadzirisa Misimboti
Mazano akawanda epinning anotsanangurwa mukuita kwemapfupa. Mazita ari pasi apa anoratidza nzira dzakafara; hazvifanirwe kududzirwa senzvimbo dzakatarwa dzekupinda, makona kana waya dzinosungirwa kuverenga.
Radial Styloid Pinning
Waya yeradial styloid inogona kutungamirwa pakatyoka kuti itenge muradius. Iyo yekunzwa bazi reiyo radial nerve, tendons, nzvimbo yekubatana uye waya chinzvimbo inoda kutariswa. Chaiyo trajectory inoenderana neanatomy, fracture morphology uye nzira yakasarudzwa.
Illustrative distal radius pinning configuration. Kuiswa kwewaya kwekupedzisira kunofanirwa kuve kwakavakirwa pakutyoka anatomy, fluoroscopic ongororo uye nzira yekuvhiya yakabvumidzwa.
Dorsal uye Fragment-Yakananga Pinning
Waya dzemudhori kana waya dzakanangidzirwa kuchikamu chemwedzi dzingashandiswa kana zvimedu izvi zvinoda kudzora. Dorsal anatomy inosanganisira extensor compartments uye tendon zvinogona kutsamwiswa kana kukuvadzwa nenzvimbo isina kukodzera yekupinda, waya yakakurumbira kana kutama.
Muenzaniso we fragment-oriented wire fixation. Mufananidzo unotsanangura musimboti, kwete wepasi rose-waya template.
Kapandji Intrafocal Pinning
Mune nzira yeKapandji, waya dzinounzwa panzvimbo yekuputsika uye dzinoshandiswa kubatsira kuderedza uye kutsigira distal fragment isati yafambiswa mberi kuchengetedza kuvaka. Nzira yacho yakasiyana nekungoyambuka pakaputsika kubva kune imwe nzvimbo iri kure yekupinda. Kukodzera kunoenderana nekutyoka kwekugadzirisa uye kunaka kwepfupa.
Kapandji intrafocal pinning concept. Saizi chaiyo yewaya, nhamba uye kutungamira zvinofanirwa kubva kune yakasimbiswa tekiniki uye kesi-yakananga kuronga.
Supplemental Pinning uye Combined Fixation
Kutyoka kwakaomarara kungada kuwedzera chidimbu-chakananga kudzora kana chivakwa chakasanganiswa. Zvisinei, waya dzakawanda hadzingoerekana dzaunza kugadzikana kuri nani. Wire convergence, kusakwana kupararira, kushomeka kwecortical kutenga kana kusakwanisa kudzora kiyi chidimbu kunogona kukonzera kurasikirwa kwekuderedzwa.
Comminution inogona kuita nyore pinning kusavimbika. Kuwedzera kana kumwe kugadzirisa kunogona kuongororwa maererano nekufungidzira uye murwere zvinhu.
Imaging uye Fixation Assessment
Kuderedza uye Articular Alignment
Imaging inoshandiswa kuongorora kureba kweradial, kurerekera, kurereka, articular congruity uye distal radioulnar majoini hukama. Chinangwa chinogamuchirwa chinoenderana nemurwere uye kuputsika. Waya yakaiswa zvine hunyanzvi haitsigire kudzikiswa kusingatenderwe.
Wire Position uye Cortical Purchase
Maonero eFluoroscopic anobatsira kuongorora kana waya dzinodzora zvidimbu zvakatarisirwa, kudzivirira radiocarpal uye distal radioulnar nzvimbo dzakabatana pazvinenge zvichidikanwa, uye kuwana kutenga kwakakodzera pasina dambudziko kusimba. Maonero akawanda anogona kudiwa nekuti waya inoratidzika seyakagamuchirwa mune imwe fungidziro inogona kusagamuchirwa mune imwe.
Gadzira Kugadzikana
Kugadzikana kwekuongorora kunotarisa kuputsika, tambo yekugadzirisa uye yakarongwa immobilization pamwechete. Waya dzakaungana munharaunda imwe dzinogona kupa kushoma kutenderera kwekudzora pane yakagovaniswa chivakwa, asi generalized spacing mutemo haufanire kutsiva biomechanical uye kiriniki kutonga.
Wire trajectory uye fracture control inofanira kuongororwa mumaonero akakodzera ekufungidzira kusati kwaitwa kuvaka.
Zvinogona Kukanganisa uye Kufunga Kwengozi
Matambudziko haakwanisi kudzivirirwa zvachose nekuongorora. Chinangwa ndechekuziva njodzi dzakakodzera uye kutevedzera iwo chaiwo implant mirairo, sterile protocol uye postoperative chirongwa.
Zvinogona kunetsa zvinosanganisira:
Kurasikirwa kwekudzikisa kana kugadzirisa kukundikana
Pin-tract infection kana utachiona hwakadzama
Kusunungura waya, kutama, kuputsika kana kushatirwa kweganda
Kukuvara kana kushatirwa kunosanganisira extensor tendons, tsinga dzekunzwa kana mamwe matishu akapfava
Kupinda kwakabatana kana kusakodzera cortical mukurumbira
Wrist uye kuoma kwemunwe
Malunion, post-traumatic arthritis kana yakaoma region pain syndrome
Kurasikirwa Kwekutapudza
Comminution, urombo husina kunaka hwemapfupa, kusakwana kwekudzora chidimbu, kusakodzera waya configuration kana kusakwana immobilization inogona kuita kuti kusimuka kwechipiri. Kutevera kufungidzira kunogona kushandiswa zvinoenderana neprotocol yeboka rekurapa uye kugadzikana kwekutyoka.
Pin-Tract Infection
Pin-saiti mamiriro anofanirwa kutariswa zvinoenderana nemasangano uye ekuvhiya mirairo. Kuwedzera kutsvuka, mvura, kuzvimba, kurwadziwa, fivha kana zvimwe zvine chekuita nezviratidzo zvinoda kuongororwa kwekiriniki. Ichi chinyorwa hachitauri chirongwa chepini chekuchengetedza.
Tendon, Nerve uye Soft-Tissue Injury
Nzvimbo yekupinda, waya trajectory, mukurumbira uye kutama kunogona kuisa zvivakwa zviri pedyo panjodzi. Lister's tubercle uye dorsal extensor compartments inzvimbo dzekiriniki dzakakosha, nepo radial sensory nerve inoda kutariswa pedyo neradial-sided ekupinda nzvimbo.
Thermal uye Mechanical Tissue Injury
Kudzokororwa kuchera, kupisa kwakanyanya, midziyo isina kukodzera kana nzira isina kunaka inogona kukuvadza bhonzo kana nyoro. Vashandisi vanokwanisa vanofanirwa kutevedzera nzira yakatenderwa, mirairo yemidziyo uye mapuroteni emasangano kwete generic online ekushandisa matanho.
Post-Fixation Kutevera-Up Kufunga
Kutevera-up kunosiyana nekugadzikana kwekutsemuka, kugadzirisa nzira uye zvinhu zvevarwere. Nzvimbo dzakajairika dzakaongororwa dzinosanganisira ronda kana pini-saiti mamiriro, mamiriro eurovascular, kufamba kwemunwe, kuzvimba, marwadzo, radiographic alignment uye zviratidzo zvewaya kusunungura kana kutama.
Immobilization nguva, kudzoreredza, kubviswa kwewaya uye kudzokera kuchiitiko kune mumwe nemumwe. Varwere havafanirwe kushandura splint, kuita maekisesaizi kana kubata waya yakafumurwa yakavakirwa paruzivo rwepamhepo chete.
Kufamba kweminwe uye mamiriro ezvinyama zvakapfava zvinogona kuongororwa panguva yekutevera, nepo kudzoreredzwa kwechanza kunoenderana nekugadzikana kwekuvaka uye chirongwa chemurapi wekurapa.
K-Waya vs Volar Plates vs Yekunze Fixation
Method
General Hunhu
Hunokosha Kufunga
Percutaneous K-waya kugadzirisa
Inoshandisa diki percutaneous implants kuchengetedza zvakasarudzwa zvimedu zvakaderedzwa.
Fragment control, pini nzvimbo, kutama, immobilization uye gare gare waya manejimendi.
Volar kana dorsal plate fixation
Inopa kugadzirisa kwemukati uye inogona kubvumira kutonga kwakananga kwezvidimbu zvakasarudzwa.
Kuratidzwa kwekuvhiya, screw position, tendon kushatirwa, kudyara mbiri uye kubvisa kufunga.
Kugadziriswa kwekunze
Inoshandisa furemu yekunze kuchengetedza urefu uye kurongeka; inogona kunge yakareba kana kuti isina kureba.
Pini nzvimbo, furemu manejimendi, zvinyoro zvinyoro, kuomarara kwemajoini uye kushivirira kwemurwere.
Yakasanganiswa kugadzirisa
Inoshandisa nzira dzinopfuura imwe kana chivakwa chimwe chete chisingagadzirise zvakatyoka.
Kuwedzera kuoma uye nzira-yakananga njodzi; inofanira kurongwa kune mumwe munhu kuputsika.
Kugadziriswa kwekunze ndiyo imwe nzira kana yekuwedzera zano reakasarudzwa asina kugadzikana distal radius fractures. Haisi kuchinjika nepercutaneous pinning mune zvese zviitiko.
Distal Radius Fixation Zvigadzirwa uye Zvishandiso
Kune vanogovera uye zvikwata zvemapfupa zvinoongorora distal radius portfolio, zvigadzirwa zvinodikanwa zvinogona kusiyana nemaitiro ekurapa. XC Medico inopa distal radius instrument seti , yekuvhara ndiro sarudzo uye yakafara orthopedic trauma implant solutions .
Nezve kunze kwekugadzirisa zvinodiwa, iyo wrist yekunze fixator ye distal radius uye ulna fractures inosanganisira akati wandei furemu masisitimu. Kuwanikwa kwechigadzirwa, hukuru, chinangwa chekushandiswa, chimiro chisina kuchena uye kubvumidzwa kwemutemo kunofanirwa kusimbiswa kumusika wekuenda usati wahodha.
Bata XC Medico yezvimiro zvechigadzirwa, zvigadziriso zvechiridzwa, catalog ruzivo uye misika-yakananga zvinyorwa zve distal radius fixation zvigadzirwa.
Bata XC Medico
Mibvunzo Inowanzo bvunzwa
Chii chinonzi percutaneous K-waya kugadzirisa?
Iyo inzira yekudzikamisa zvimedu zvakaputsika zvakasarudzwa neKirschner waya dzakaiswa kuburikidza nediki ganda rekupinda nzvimbo, kazhinji mushure mekutsemuka kwakadzikira.
Ko K-waya kugadzirisa kwakakodzera kune yega distal radius kutsemuka?
Kwete Kukodzera kunoenderana nekuputsika morphology, kuderedza kugadzikana, chidimbu chekukura, mapfupa emhando, zvinyoro zvinyoro, zvikonzero zvevarwere uye kukwanisa kwetambo yekuvaka kuchengetedza kurongeka.
Mangani maK-waya anoshandiswa kune distal radius kutsemuka?
Hapana nhamba yepasi rose. Kuverengera kwewaya uye gadziriso inosarudzwa kune iyo yekuputsika pateni uye yakasimbiswa nzira. Humbowo hahutsigire kupa inosungirwa matatu-waya kumisikidzwa kune yega nyaya.
Ndeipi nzira yeKapandji?
Kapandji pinning inzira ye intrafocal umo waya dzinounzwa panzvimbo yekutyoka kubatsira kudzikisa uye kutsigira distal fragment. Ndiyo imwe tekinoroji sarudzo, kwete chiyero chepasirese.
Ndedzipi njodzi dzakajairika dzeK-waya kugadzirisa?
Njodzi dzinogona kuitika dzinosanganisira kurasikirwa kwekuderedza, hutachiona hwepini-turakiti, kusunungura waya kana kutama, kushatirwa kwetishu, tendon kana kukuvara kwetsinga, kupinda pamwe nekuoma.
Ko K-waya zviri nani pane volar locking plate?
Hapana nzira iri nani pasi rose. Mitemo yemazuva ano inotsigira kusarudza kugadzirisa maererano nekuputsika uye murwere. Mahwendefa eVolar anogona kupa kare-nguva pfupi kushanda kupora mune dzimwe dzisina kugadzikana kana articular fractures, nepo migumisiro yenguva refu inogona kufanana nenzira dzose dzekugadzirisa.
References
American Academy yeOrthopedic Surgeons uye American Society yekuvhiya kweRuoko. Kutungamirirwa kweDistal Radius Fractures Clinical Practice Guideline. Ona gwara .
Kamal RN, Shapiro LM. AAOS/ASSH Clinical Practice Guideline Summary: Kutungamirirwa kweDistal Radius Fractures. Ona pfupiso yezvinyorwa zvizere .
Shapiro LM, Kamal RN, et al. Distal Radius Fracture Clinical Practice Guidelines-Updates uye Clinical Implications. Wona iyo PubMed rekodhi .
American Academy yeOrthopedic Surgeons. Zvakakodzera Kushandisa Criteria: Kurapa kweDistal Radius Fractures. Ona chinyorwa chizere-chinyorwa .
Professional-kushandisa chiziviso: Chinyorwa ichi chinopa dzidziso yakajairika kuvashandi vehutano, zvipatara uye vanogovera zvekurapa-mudziyo. Harisi zano rekurapa, chirongwa chekuvhiya kana chinotsiva kudzidziswa, kuongororwa kwakanangana nemurwere, magwaro akabvumidzwa ehunyanzvi hwekuvhiya kana mirairo yekushandisa. Zviratidzo zvechigadzirwa uye mamiriro ekutonga anosiyana nemusika.
