Ho robeha ha radius ea distal ke ho robeha ho tloaelehileng ka mor'a ho thella lehloeng mariha, 'me ho fokotsa ho koaloa le ho lokisa mohala oa Kirschner ke mekhoa e tloaelehileng ea phekolo.
Sengoliloeng sena se bua ka Melao-motheo le Mahlale a K-Wiring ho hlahisa mekhoa ea ho buoa ea pinning e koetsoeng.
Mokhoa oa ho lokisa lithapo tse tharo ke mokhoa oa khale oa ho lokisa lithapo tse tharo
E 'ngoe ka har'a lister tubercle.
E 'ngoe ka mokhoa oa radial styloid.
E 'ngoe ka lesapo la lunate fossa.
Haeba: ho robeha ho matla le ho fokola ha masapo ho etsahala, ho ka sebelisoa lithapo tse eketsehileng tsa Kirschner.
1. Mokhoa oa ho buoa
Ntlha ea pele, ho fokotseha ho koetsoeng ha fracture ho etsoa, ka mokhoa o liehang le o tsoelang pele, 'me ho falla ha dorsal le radial ho lokisoa ka ho phalla ha palema le ho kheloha ha ulnar. Ka mor'a ho fokotseha, letsoho le behoa holim'a letlapa le pota-potiloeng, ho boloka phallo ea palema le ho kheloha ha ulnar (Setšoantšo sa 2a, b), 'me se tsitsitsoe ka bonyane lithapo tse tharo tsa percutaneous Kirschner.
![distal radius fractures]( "distal radius fractures")
K-terata ea pele e kengoa ho Lister's tubercle, e lebisitsoe ho 45°, 'me e lebisitsoe ho palmar cortex ea proximal fragment ea axis e telele ea radius. Haeba ntlha ea ho kenya e le lehlakoreng la ulnar la Tubercle ea Lister, tendon ea extensor pollicis e ka 'na ea tsoa likotsi.
K-terata ea bobeli e kenngoa ka 0.5 cm distal ho mokhoa oa radial styloid, K-terata e ka lehlakoreng la 60 ° ho ea ho radial axis, 'me e phunyeletsa ulnar cortex e haufi le ho robeha.
K-terata ea boraro e tsitsitse sekhechana sa lesapo sa lunate sa 0.5 cm ho isa moleng o kopaneng oa letsoho, o pakeng tsa likarolo tsa bone le tsa bohlano tsa extensor. K-terata e tsitsitse lehlakoreng la palema la radius ka angle ea 45 °, joalo ka ha ho bonts'itsoe ho Figure a le b ka tlase.
![distal radius fractures-1]( "distal radius fractures-1")
Mokhoa oa khale oa ho lokisa mohala oa Kirschner oa fractures oa distal radius o bontšoa ho Figures ae ka tlase.
![distal radius fractures-2]( "distal radius fractures-2")
![distal radius fractures-3]( "distal radius fractures-3")
![distal radius fractures-21]( "distal radius fractures-21")
![distal radius fractures-5]( "distal radius fractures-5")
Ho sisinyeha ha menoana ka mor'a percutaneous terata ea Kirschner ho bontšoa ho Figure ad ka tlase.
![distal radius fractures-6]( "distal radius fractures-6")
2. Litlhokomelo le mekhoa ea ho buuoa
1.Haeba terata ea K e thella ka har'a medula ntle le ho phunyeletsa cortex ea contralateral, e ka 'na ea bakoa ke ho sekama ho hoholo ha terata ea K e kena. Tabeng ena, batho ba atisa ho phahamisa matsoho ho fokotsa ho sekama. Empa ha e le hantle, se fapaneng ke ’nete. K-terata e tla kobeha 'me e kobehe ka mokhoa oa concave, e leng se tla fella ka ho hlōleha ha ho phunyeha ha terata ea K. Ho e-na le hoo, e lokela ho ba bonolo ka holimo ho ea holimo ho ea ka khokahanyo ea K-terata, joalokaha ho bontšitsoe setšoantšong se ka tlase.
![distal radius fractures-7]( "distal radius fractures-7")
Ka terata ea K e bonts'itsoeng ka holimo, sebaka sa ho kena se etsoa ka har'a distal cortex ntle le khatello ea axial, 'me e ka phunyeletsa distal cortex. Ntle le moo, ntlha ea ho kenya e lokela ho fetoloa le ho qala ho tloha qalong (Lipalo ae ka tlase).
![distal radius fractures-8]( "distal radius fractures-8")
![distal radius fractures-22]( "distal radius fractures-22")
2.Ka mokhoa oa Kapandji, likhoele tse peli ho isa ho tse tharo tsa K li kenngoa sebakeng sa fracture ho fokotsa le ho lokisa likaroloana tsa distal fracture sebakeng se lakatsehang. Hang ha e fokotsehile, likhoele tsa K li tsoetse pele ho likhechana tsa proximal (Figures af ka tlase).
![distal radius fractures-9]( "distal radius fractures-9")
3.Haeba ho kena ha terata ea Kirschner le lintlha tsa ho tsoa li haufi haholo le ho robeha, ho hlōleha ho lokisa ho ka etsahala. Lithapo tse peli tsa mokokotlo oa Kirschner ha lia lokela ho feta cortex ea palema sebakeng se le seng, 'me ntlha ea ho tsoa ha palema e tlameha ho ba 2 cm ho tloha sebakeng sa ho robeha. Sheba Figures ac ka tlase.
![distal radius fractures-10]( "distal radius fractures-10")
4. Ha mokokotlo oa mokokotlo o etsoa ka mokhoa o feteletseng, leka ho se kene sebakeng sa ho robeha ha sekhechana sa masapo a distal, kaha sena se ka lebisa ho hlōleha ho lokisa. Lipalo ae ka tlase.
![distal radius fractures-11]( "distal radius fractures-11")
5. Bakeng sa lefu la ho fokola ha masapo, ho molemo ho sebelisa lithapo tse 'nè ho isa ho tse hlano tsa Kirschner ho lokisa fracture. Ka linako tse ling, e le ho boloka bolelele ba radius, terata ea Kirschner e transverse e sebelisoa ho lokisa distal radius bone block ho distal ulna.
6. Ka likarolo tse telele tsa fractures tsa qetello ea epiphyseal, mohala o moholo oa Kirschner o sekametseng o ka sebelisoa bakeng sa ho lokisa. Leha ho le joalo, terata ea Kirschner e ka 'na ea thella ka har'a mokokotlo oa medulla 'me ho thata ho e lokisa (Lipalo tse ka tlase).
![distal radius fractures-12]( "distal radius fractures-12")
7. Sekhechana sa masapo a intra-articular se buloa 'me se tsitsitsoe ka terata ea Kirschner e pota-potileng tlas'a lefufuru pele, ebe e ts'oaroa ka lithapo tse tharo tsa percutaneous Kirschner ka tsela e tloaelehileng (Lipalo tse ka tlase).
![distal radius fractures-13]( "distal radius fractures-13")
8. Ho robeha ho matla ha radius ea distal e tsamaeang le ho khutsufatsa le ho putlama ho hloka hore terata ea Kirschner e fetelletseng e fete ka har'a ulna ho boloka bophahamo ba radius. Mohala oa Kirschner o supile hantle ho tloha lehlakoreng la palema la mokhoa oa styloid ho ea lehlakoreng la mokokotlo oa ulna, joalo ka ha ho bonts'itsoe ho Figure a le b ka tlase.
![distal radius fractures-14]( "distal radius fractures-14")
9. Radial styloid fracture le dorsal displacement. Ka mor'a ho fokotsa, lokisa ka lithapo tse peli tsa radial styloid Kirschner: e 'ngoe ka lehlakoreng la mokokotlo le e' ngoe ka lehlakoreng la palema ho ea ntlheng ea styloid. (Lipalo a le b ka tlase)
![distal radius fractures-15]( "distal radius fractures-15")
10. Ho robeha ha karolo e mene ea radius ea distal, ka ho falla ha mokokotlo le ho arohana ha fossa ea khoeli ho tloha lehlakoreng la palema. Mohala oa Kirschner o ka ts'oaroa ho tloha mokokotlong oa mokokotlo ka mokhoa o oblique ho tloha proximal ho ea distal metacarpal bone fragment. (Lipalo a le b ka tlase).
![distal radius fractures-16]( "distal radius fractures-16")
11. Ha u sebelisa lithapo tsa dorsal le palmar Kirschner ho tšoara fractures ea comminuted ea radius distal, haeba sekhechana sa palema sa fossa ea lunate se sa fokotsehe nakong ea ho buuoa, u ka sebelisa mokhoa oa palema, sebelisa sekontiri sa vascular ho arola lesapo, ebe u kenya mohala oa Kirschner ho tloha palcortex ho tloha palcortex terata. (Lipalo tse ka tlase)
![distal radius fractures-17]( "distal radius fractures-17")
12. Bakeng sa ho hlakile hore fractures ea distal radius e ke keng ea fokotsoa ka ho fokotseha ho koetsoeng, mohala oa 3 mm Kirschner o ka sebelisoa ho phahamisa sekhechana sa distal fracture ho tloha ka morao ho finyella ho fokotseha (Lipalo ah ka tlase).
![distal radius fractures-19]( "distal radius fractures-19")
13. Sebelisa li-fixator tsa ka ntle ho phekola fractures ea comminuted ea radius ea distal. Li-fixator tsa kantle li loketse ho robeha ho matla ha radius ea distal e tsamaeang le ho ruruha ho hoholo, fractures e bulehileng, kapa maemo a letlalo a sebakeng seo a sa lumelleng ho lokisoa ka hare (joalo ka ho lokisa poleiti) (Lipalo tse ka tlase).
![distal radius fractures-20]( "distal radius fractures-20")
3. Thibela mathata
1.Ho thibela ho lokisa ho sa tsitsang, ela hloko ts'ebetso e latelang
Ela hloko ho lokisa bicortical.
Qoba ho beha ntlha ea ho tsoa ea nale haufi le ho robeha.
Qoba lithapo tsohle tsa Kirschner tse kopanang pheletsong ho tsepamisa matla.
Ela hloko ho qoba ho potoloha ha terata ea Kirschner.
Haeba ho na le lefu la ho fokola ha masapo, ho hlokahala ho lokisa mohala o eketsehileng oa Kirschner.
2. Mehato ea ho thibela tšoaetso ea nale
Pele o khaola letlalo, arola lesela le bonolo lesapong ka clamp ea vascular, ebe o sebelisa mohala oa Kirschner.
Koala butle ho thibela necrosis ea mocheso.
Qoba ho sebetsa khafetsa hangata.
Fokotsa khatello ea mohala oa Kirschner letlalong.
