Distal radius fractures: tsananguro yakakwana kubva kuAnatomy yekuvhiya

Distal Radius Fractures account ye 75% yeFourarm Fractures uye inonyanya kuzivikanwa mukiriniki. Munyaya ino, isu takanyora rondedzero yeAnatomy, kuiswa, nzira dzekurapa, uye nzira dzekuvhiya kusvika kuKarari Radius Fractures yereferation yako.

Pfupisa

Fractures yeiyo distal radius chikamu chechiuno chekupwanya. yerudzi '' Vatatu- vhezheni

Zvese zveLartil radius fantures, kunze kwekusvirwa kwekutambudzika kweiyo dorsal margin of the radius, vane chokwadi chinokonzerwa nemhirizhonga ye outsextension. Ruoko rwacho rwakaiswa zvakasiyana kana rwakaitwa nemauto ekunze, uye mhedzisiro yemasimba ekunze akasiyana.

1.Flexion mhirizhonga inogona kuguma neDourslly yakadzingwa

2.Shear kushushikana kunogona kuguma nekukasira kwekutengeswa kwenzvimbo dzekunyepedzera paPalmar rutivi nokudaro richitungamira kusanganisa.

3.in yakakwirira-simba kukuvara, kusimbisa mhirizhonga predominates uye zvakawandisa zvinonetsa zvinotakura zvinotungamira mukumanikidza kweiyo yekunyepedzera.

4.Kukurukurirana kwekunyepedzera disclocation kukuvara kunovharirwa kunovharirwa uko kwakavharirwa pfupa rinowanzo kuve neBony yekubatanidza nzvimbo yeiyo ligamentment.

Radiogic anatomy yeiyo distal radius

1.anteeroposter films (Radial kureba, Ulnar kutsauka, Ulnar Varus)

2. Mafirimu akareba (malapar aquention)

Fernandez Classification

Nyora i metaphyseal flexion inopwanya

Type II Articular uye Shear Fracture

Type III Compression inokanganisa yeiyo articular pamusoro

Type IV Avulsion Bracture yeiyo Radial Wrist, dislocation

Nyora v yakasanganiswa fractures (yakakwira simba avulsion fractures)

Zviratidzo Zvekuvhiyiwa

Vazhinji vaHaariyo radius vanobatwa nekukasira mushure mekudzikiswa kwakavharwa, zvinosuruvarisa kuti vazhinji vevakaremara vachadzingwa kana kuderedzwa hakuzogamuchirwe nemhedzisiro isina kunaka.

Zvishanu zvinoparadza zvinhu zvakazivikanwa naLaxontaine et al:

① Wekutanga Dorsal Angation> 20 ° (Palmar Tilt);

② yakajeka kupwanyika kweiyo dorsal epiphyis;

③ kupwanya mubatanidzwa;

④ yakabatana Ulnar inopwanya;

Zera remurwere> makore makumi matanhatu.

Iko hakuna zviyero zvechokwadi kana nhungamiro kutungamira kurapwa, uye zvirongwa zvekurapa zvinofanirwa kufunga nezvehuwandu hukuru hwezvinhu, kusanganisira kutanga kwekukuvara maitiro, kusanganisa hunhu hwekukuvara, kusevha kwemurwere, mapopomerwa, mapopoma, zvinodikanwa zvemaruva, uye zvaunoda zvaunoda.

Yekudzikiswa kwekuvharwa kwezvidimbu nekufungidzirwa kuti kugadzikana, saka padyo nekutevera kunokurudzirwa. Izvo zvakakosha kuti uzive kuti kana nhaurwa yeX-rays mushure mekudzikiswa nekukasira kusagadzikana kana kudzikiswa, saka shanduko yekurapwa inogona kunge iri madikanwa. Kana iyo bracture ichinge isingagoneki, saka radiographs inofanira kutorwa uye kuongororwa kusvikira kupwanywa kwapera uye kugadzikana.

Conservative Kurapa

Kugadzikana kupatsanurwa kunogona kuvharwa zvinobudirira-nekubatwa nekukanda, pakutanga nekupaza uye gare gare ne tubular cast, ine radioghoms kusvika kumavhiki matatu.

Kana shanduko dzakakosha muhurefu hwerefu, malkari zvekuda, kana kutsauka kunoitika, kurapwa kwekuvhiya kunofanira kufungwa nezvazvo.

Mune vasina simba uye vakaderera-vanodiwa varwere, kurapwa kwakavharwa kunowanzo kuve kwakakodzera, kunyangwe kana kuvhiyiwa kunoratidzwa.

Yakavharwa reset percutaneous filele gadziriso

Kudzikiswa kwakavharwa kwakateverwa nePercutaneous pinning uye kugadziriswa kunobatsira mune distal radius fantures ne metaphyseal kusagadzikana kana nyore intra-artrain fractures.

Nhanho yekutanga ndeye anatomical repositioning, saka kusimbisa kunopihwa ne gram mapini. Kazhinji pini yekutanga yadarika kubva kune radial styloid kune radial metaphysis medhial kune diaphysis.

Mashoma emapuru anoshandiswa kupa zvakakwana kudzikisira kudzikisira muOrthogonal uye Stareral Nzvimbo, uye Funate Facet inogona kupinwa kana yadikanwa.

Intrafracracture pinning (kapanji maitiro) inopa rubatsiro rweDorsal. Postoperative fungidziro mune splint inoshandiswa kwemavhiki maviri kudzora kutenderera uye kuderedza kuparadzanisa pini, mushure meizvozvo zvinogona kutsiviwa neyefemberi.

Yakavharwa-kutsiva yekunze yekugadzirisa Bracket Fixation

Kunze kwekugadziriswa kweBraces kunobatsira kwekutanga kana adjunctive kurapwa mune chaiyo distal radius fantures.

Iyo yekunze fananidzo inomutsira iyo axial inosimbisa kuita pane iyo distal radius panguva yemapoka epamberi. Kugadziriswa kunogona kana kungave kusiri kuyambuka ruoko, kana kuwedzera kugadzirisa kunogona kuwedzerwa.

Kufungidzirwa kwakafanana hakuongorore zvizere muchindwe, asi nzvimbo isina kwayakarerekera inogamuchirika. Postoftoratively, chiwina chakabikwa mu tubular chakakandwa munzvimbo yakatenderedzwa yemazuva gumi kusvika pakurwadziwa neEdema verera.

Plate Fixation ine incision uye kudzoreredza

1, dorsal ndiro yemukati yekugadziriswa kwe distal radius prracture

Chiitiko chakatwasuka chinoitwa pamwe neLister's node, neiyo Distal Ekuyambuka iyo Radial Carpal Joint mutsara uye kupera 1 cm proximal kune iyo yechipiri yechipiri metacarpal. Iyo proximal mugumo inowedzera pamwe radial stem ye3 kusvika ku4 cm, kufumura iyo yepakati chikamu kuburikidza neyekupedzisira yechitatu extnsor nguva yekuwedzera.

2, Palm Plate yemukati yekugadziriswa kwe distal radius kupwanya

A Longitudinal Incision inogadzirwa pamwe neRadial Carpal Flexor Tendon, iyo inodzoreredzwa kuThexor Toton, uye iyo inotenderera yeTolloor yeToxor

Nyaya ①

Nyaya ②

Nyaya ③

3. Traction Plate Fixation ye distal radius kupwanya

- A 4-CM Longitudinal Incision inoitwa Dorsal kune yechitatu metacarpal stem, uye iyo extensor tendon yemunwe wepakati unokwana kufumura wechitatu metacarpacl.

- yechipiri 4-cm incision inogadzirwa kanokwana 4 cm dorsal kune iyo yekambani radius;

- yechitatu 2-cm dorsal incision inogadzirwa paLister's node yekufumura iyo Exturu Hallucis Longos Tendon.

Kubva kuDistal Incision, iyo track turate inoiswa padanho parutivi ndege pakati peiyo extensor tendon (yechina dorsal compartment), iyo kabati capsule uye iyo periostum. Iyo Extnsor Tendon inogona kufambiswa kana zvichidikanwa.

4.