Classic nzira uye matekiniki eakavharika tsono yekuisa kune distal radius fractures

Distal radius fracture yakajairika kutsemuka mushure mekutsvedza pachando munguva yechando, uye kuvharika kuderedzwa uye Kirschner wire fixation ndiyo yakajairika nzira dzekurapa.

Ichi chinyorwa chinoreva K-Wiring Misimboti uye Tekinoroji kusuma nzira dzekuvhiya dzekuvharika pinning.

Iyo mitatu-waya kugadzirisa tekinoroji ndiyo yakasarudzika matatu-waya kugadzirisa maitiro

Imwe kuburikidza ne lister tubercle.

Imwe kuburikidza neiyo radial styloid maitiro.

Imwe kuburikidza ne lunate fossa bone block.

Kana: Kuputsika kwakanyanya uye osteoporosis kunoitika, mamwe mawaya eKirschner anogona kushandiswa.

1. Kuvhiya nzira

Kutanga, kuderedzwa kwakavharwa kwekuputsika kunoitwa, nekunonoka uye kuenderera mberi, uye dorsal uye radial displacement inogadziriswa nepalmar flexion uye ulnar kutsauka. Mushure mekuderedzwa, ruoko runoiswa papepa rakakungurutswa, kuchengetedza kuchinjika kwepalmar uye kutsauka kweurnar (Mufananidzo 2a, b), uye yakagadziriswa neinenge katatu percutaneous Kirschner waya.

Yekutanga K-waya inoiswa paLister's tubercle, yakanangwa pa45°, uye yakanangwa papalmar cortex yeproximal bone fragment paakisi refu yeradius. Kana nzvimbo yekuisa iri padivi reulnar yeLister's tubercle, iyo extensor pollicis tendon inogona kukuvara.

Yechipiri K-waya inoiswa 0.5 cm kureba kune radial styloid process, iyo K-waya iri pakona ye 60 ° kune radial axis, uye inopinda mu ulnar cortex proximal kusvika pakatyoka.

Yechitatu K-waya yakasungirirwa kune lunate fossa bone fragment 0.5 cm kureba kune wrist joint line, iri pakati pechina neyechishanu extensor compartments. Iyo K-waya inomisikidzwa kudivi remuchindwe reradius pakona ye45 °, sezvakaratidzwa muFigures a uye b pazasi.

Classic percutaneous Kirschner wire fixation ye distal radius fractures inoratidzwa muFigures ae pazasi.

 

Kufamba kwemunwe mushure me percutaneous Kirschner wire fixation inoratidzwa muFigures ad pazasi.

2. Kuchengetedza uye maitiro ekuvhiyiwa

1.Kana iyo K-waya inotsvedza mukati memedullary cavity isina kupinda mu contralateral cortex, inogona kukonzerwa nekurerekera kwakanyanya kana K-waya ichipinda. Muchiitiko ichi, vanhu vanowanzosimudza maoko avo kuderedza kurereka. Asi kutaura zvazviri, zvakasiyana ndezvechokwadi. Iyo K-waya ichave yakakomberedzwa uye yakakotama nenzira yakakomberedzwa, zvichikonzera kutadza kweiyo K-waya puncture. Pane kudaro, inofanira kunge yakanyunguduka zvinyoro-nyoro kumusoro zvichienderana neiyo K-waya, sezvakaratidzwa mumufananidzo uri pazasi.

Iine K-waya yakanongedza convexly kumusoro, nzvimbo yekupinda inogadzirwa mu distal cortex isina axial pressure, uye inogona kupinda mukati distal cortex. Neimwe nzira, nzvimbo yekuisa inofanira kuchinjwa uye kutanga kubva pakutanga (Figures ae pazasi).

2.Mune nzira yeKapandji, maviri kusvika matatu maK-waya anopinzwa munzvimbo yekuputsika kuti kuderedze uye kugadzirisa distal fracture zvidimbu munzvimbo inodiwa. Kana yangoderedzwa, iyo K-waya inokwidziridzwa mukati mezvimedu zveproximal (Figures af pazasi).

3.Kana Kirschner wire entry uye nzvimbo dzekubuda dziri pedyo zvikuru nekuputsika, kugadzirisa kukanganisa kunogona kuitika. Iwo maviri dorsal Kirschner waya haafanire kupfuura nepalmar cortex padanho rimwe chete, uye nzvimbo yekubuda yemichindwe inofanira kunge iri 2 cm kubva panzvimbo yekutyoka. Ona Figures ac pazasi.

4. Kana dorsal cortex yakanyanyisa, edza kusapinda panzvimbo yekuputsika ye distal bone fragment, sezvo izvi zvingaita kuti kugadzirisa kusakundikana. Figures ae pazasi.

5. Kune osteoporosis yakaoma, zviri nani kushandisa mana kusvika mashanu Kirschner waya kugadzirisa kuputsika. Dzimwe nguva, kuitira kuchengetedza kureba kweradius, waya yeKirschner yakachinjika inoshandiswa kugadzirisa distal radius bone block kune distal ulna.

6. Muchikamu chakareba chakaputsika chemagumo epiphyseal, huru yakarerekera Kirschner wire inogona kushandiswa kugadzirisa. Nekudaro, iyo Kirschner waya inogona kutsvedza mukati me medullary cavity uye yakaoma kugadzirisa (Figures ad pazasi).

7. Iyo intra-articular bone fragment inovhurwa uye inogadziriswa ne transverse Kirschner wire pasi pe cartilage kutanga, uye zvino inogadziriswa neatatu percutaneous Kirschner waya nenzira yakajairika (Figures ad pazasi).

8. Yakanyanya comminuted fracture ye distal radius inoperekedzwa nekupfupisa nekuputsika kunoda yakawedzera transverse Kirschner waya kuti ipfuure nemu ulna kuchengetedza kureba kweradius. Iyo Kirschner waya inonongedza zvakanyanya kubva kudivi remuchindwe re styloid process kusvika kune dorsal side ye ulna, sezvakaratidzwa muFigures a uye b pazasi.

9. Radial styloid fracture ine dorsal displacement. Mushure mekudzikisira, gadzirisa neaviri radial styloid Kirschner waya: imwe kudivi remushure uye imwe padivi remchindwe kusvika kumucheto weiyo styloid. (Zvifananidzo a uye b pazasi)

. Iyo Kirschner waya inogona kugadziriswa kubva kudorsal cortex nenzira yakatsvedza kubva padanho repamusoro kusvika kune distal metacarpal bone fragment. (Zvifananidzo a uye b pazasi).

11. Paunenge uchishandisa dorsal uye palmar Kirschner waya kurapa comminuted fractures ye distal radius, kana palmar fragment ye lunate fossa haina kuderedzwa panguva yekuvhiyiwa, unogona kushandisa palmar nzira, shandisa vascular clamp kuti uparadzanise pfupa, uye wozoisa Kirschner wire kubva pal palcortex mumucheto we fragmentdor. (Mifananidzo ah pazasi)

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13. Shandisa zvigadziriso zvekunze kurapa comminuted fractures ye distal radius. Zvigadziriso zvekunze zvakakodzerwa nekutsemuka kwakakomba kweiyo distal radius inoperekedzwa nekuzvimba kukuru, kutsemuka kwakavhurika, kana ganda mamiriro asingatenderi kugadzirisa kwemukati (senge plate fixation) (Figures ad pazasi).

3. Dzivirira matambudziko

1.Kudzivirira kugadziriswa kusina kugadzikana, teerera kumabasa anotevera

Teerera kune bicortical fixation.

Dzivisa kuisa distal tsono yekubuda nayo pedyo nekutyoka.

Dzivisa mawaya ese eKirschner anotenderera kumucheto kure kuti atarise simba.

Ngwarira kudzivirira kutenderera kwakasununguka paunenge uchikotama waya yeKirschner.

Muchiitiko che osteoporosis, kuwedzera Kirschner wire fixation inodiwa.

2. Matanho ekudzivirira chirwere chetsono

Kutanga cheka ganda, patsanura ganda rakapfava kune pfupa rine vascular clamp, uye ipapo shandisa Kirschner waya.

Bhora zvishoma nezvishoma kudzivirira thermal necrosis.

Dzivisa maoparesheni anodzokororwa kakawanda.

Deredza kudzvinyirira kweKirschner wire paganda.