Distal Radius Fractures: Tsanangudzo Yakakwana Kubva kuAnatomy kuenda Kuvhiyiwa

Distal radius fractures account ye75% yekuputsika kwepamberi uye inonyanya kuwanda mukiriniki. Muchinyorwa chino, isu takanyora rondedzero yeanatomy, kupatsanura, nzira dzekurapa, uye nzira dzekuvhiya kune distal radius fractures yereferensi yako.

Pfupisa

Kutyoka kweiyo distal radius chikamu chekutyoka kwemaoko. 'Three-column theory ' inogona kutsanangura zviri nani nzira yekutyoka kwechanza, umo radial column, ine radial tuberosity uye navicular fossa, yakakosha pakuchengetedza kugadzikana kwechanza chakabatana.

All distal radius fractures, kunze kwekuvhuvhuta kutsemuka kwe dorsal margin ye radius, ichokwadi inokonzerwa nekuwedzera kwemhirizhonga. Ruoko runoiswa zvakasiyana kana ruchiitwa nemasimba ekunze, uye zvinokonzerwa nemasimba ekunze zvakasiyana.

1.Flexion mhirizhonga inogona kukonzera dorsally displaced intra- kana extra-articular fractures mukukuvara kwepasi-simba sekudonha.

2.Shear stress inogona kuita kuti pave nekusagadzikana kwechikamu che articular surfaces padivi remichindwe zvichiita kuti pave nekusagadzikana.

3.Mukukuvadzwa kwepamusoro-simba, mhirizhonga yechisimba inotungamira uye yakawandisa axial loading inotungamirira kumanikidziro e-articular surface bone.

4.The primary mechanism of fracture dislocation is avulsion injury apo avulsed bone mass inowanzova bony attachment point ye ligament.

Radiologic anatomy ye distal radius

1.Anteroposterior films (radial urefu, ulnar deviation, ulnar varus)

2. Lateral mafirimu (palmar inclination)

Fernandez Classification

Tora I Metaphyseal flexion fracture

Type II Articular uye Shear Fracture

Rudzi III Kudzvinyirira Kuputsika kweArticular Surface

Type IV avulsion fracture ye radial wrist, dislocation

Type V Mixed Fractures (High Energy Avulsion Fractures)

Zviratidzo Zvokuvhiyiwa

Mazhinji distal radius fractures anobatwa nebraking mushure mekuvharwa kuderedzwa, zvinosuruvarisa kuti mazhinji ezvimedu izvi achabviswa kana kuderedzwa hakuzogamuchirwe nemhedzisiro yakaipa.

Zvinhu zvishanu zvinokanganisa zvakaonekwa naLaFontaine et al:

① Yekutanga dorsal angulation > 20 ° (palmar tilt);

② Kuputsika kweiyo dorsal epiphysis;

③ kuputsika mujoini;

④ Yakabatanidzwa ulnar kuputsika;

⑤ Zera remurwere > 60 makore.

Hakuchina maitiro akajeka kana mazano ekutungamirira kurapwa, uye zvirongwa zvekurapa zvinogadzirwa zvichitarisa nhamba huru yezvinhu, kusanganisira maitiro ekutanga ekukuvadzwa, kuenzanisa mushure mekugadzirisazve, zera remurwere, hutano hwemapfupa, zvinodiwa nemurwere, uye zvinodiwa.

Nokuda kwekuvhara kuderedzwa kwekuputsika nekufungidzirwa kugadzikana, ipapo kutevera kwepedyo kunokurudzirwa. Zvakakosha kuziva kuti kana mutsara we-x-rays mushure mekuderedzwa unoratidza kusagadzikana kana kutama, ipapo kuchinja kwekurapa kunogona kudiwa. Kana kuputsika kuchigona kusagadzikana, ipapo radiographs inofanira kutorwa uye kuongororwa kusvikira kuputsika kwapora uye kugadzikana.

Conservative Treatment

Kutyoka kwakagadzikana kunogona kubudirira kuvharwa-kutamiswa uye kurapwa nebhureki, kutanga nekutsemuka uye gare gare netubular cast, ine vhiki nevhiki radiographs kusvika kumavhiki matatu.

Kana shanduko huru mukureba kweradial, kurerekera kwepalmar, kana kutsauka kweurnar kukaitika, kurapwa kwekuvhiya kunofanirwa kutariswa.

Mune varwere vasina kusimba uye vasingadi, kurapwa kwakavharwa kunowanzova kwakakodzera, kunyange kana kuvhiyiwa kunoratidzwa.

Yakavharwa reset percutaneous tsono kugadzirisa

Yakavharwa kuderedzwa kunoteverwa nepercutaneous pinning uye kugadzirisa kunobatsira mu distal radius fractures ne metaphyseal kusagadzikana kana nyore intra-articular fractures.

Nhanho yekutanga ndeye anatomical repositioning, ipapo kudzikamisa kunopihwa negiremu pini. Kazhinji pini yekutanga inopfuudzwa kubva kune radial styloid kuenda kune radial metaphysis medial kune diaphysis.

Zvishoma zvemapini maviri anoshandiswa kupa yakakwana yakagadzikana repositioning mune orthogonal uye lateral nzvimbo, uye iyo lunate facet inogona kuroverwa kana ichidikanwa.

Intrafracture pinning (Kapanji technique) inopa dorsal support. Postoperative immobilization mu splint inoshandiswa kwemavhiki maviri kudzora kutenderera uye kuderedza kutsamwa kwepini, mushure mezvo inogona kutsiviwa nekanyoro ye forearm cast.

Yakavharwa-inotsiva kunze kwekugadzirisa bracket kugadzirisa

External fixation braces anobatsira pakurapa kwekutanga kana adjunctive mune chaiyo distal radius fractures.

Iyo yekunze inogadzirisa inogadzirisa iyo axial stress inobata paradius iri kure panguva yekumisikidzwa kweiyo forearm tsandanyama mapoka. Kugadzirisa kunogona kana kusave kuyambuka wrist, kana kumwe kugadzirisa kunogona kuwedzerwa.

Parallel traction haidzorere zvizere kurerekera kwepalmar, asi nzvimbo isina kwayakarerekera inogamuchirwa. Mushure mekushanda, wrist inosungirirwa mune tubula yakakandwa munzvimbo yakatenderedzwa kumashure kwemazuva gumi kusvika marwadzo uye edema yapera.

Plate fixation ine incision uye repositioning

1, Dorsal plate yemukati kugadzirisa kwe distal radius fracture

Iyo yakatwasuka incision inoitwa pamwe neiyo Lister's node, ine distal kupera ichiyambuka radial carpal joint line uye ichipera 1 cm proximal kusvika pazasi pechipiri metacarpal wrist joint. Iyo proximal magumo inotambanukira pamwe neiyo radial hunde ye3 kusvika 4 cm, ichiburitsa mbiru yepakati kuburikidza nepasi pechitatu extensor interval.

2, Palm plate yemukati kugadzirisa kwe distal radius fracture

A longitudinal incision inoitwa pamwe chete neradial carpal flexor tendon, ine bunion flexor tendon iri panzvimbo yakadzika ye radial carpal flexor tendon, iyo inodzoserwa ulnarly kuti ibudise pachena anterior rotator ani muscle, uye anterior rotator ani muscle inoparadzaniswa pakutanga kwekubuda kweradial side uye kuguma kweradial.

Nyaya ①

Nyaya ②

Nyaya ③

3. Traction plate fixation ye distal radius fracture

- A 4-cm longitudinal incision inoitwa dorsal kune yechitatu metacarpal stem, uye extensor tendon yechigunwe chepakati inobatwa kuti ibudise metacarpal yechitatu;

- Yechipiri 4-cm incision inoitwa kanenge 4 cm dorsal kune iyo comminuted radius;

- Yechitatu 2-cm dorsal incision inoitwa panzvimbo yeLister kuratidza extensor hallucis longus tendon.

Kubva kune distal incision, ndiro yekudhonza inoiswa pedyo nendege pakati peextensor tendon (yechina dorsal compartment), iyo capsule yakabatana uye periosteum. Iyo extensor tendon inogona kutamiswa kana zvichidikanwa.

4. Kugadziriswa kwega kwega kwezvakaputsika zvakaputsika zve distal radius zvichibva pane TriMed system