Distal Radius Fractures: Tlhaloso e Felletseng ho tloha ho Anatomy ho ea ho Opereishene

Distal radius fractures e etsa 75% ea ho robeha ha forearm 'me e tloaelehile haholo tleliniking. Sengoliloeng sena, re hlophisitse lethathamo la anatomy, classification, maano a kalafo, le mekhoa ea ho buoa ho distal radius fractures bakeng sa referense ea hau.

Akaretsa

Ho robeha ha radius ea distal ke karolo ea ho robeha ha letsoho. e 'Khopolo-kholo ea likholomo tse tharo' ka hlalosa hantle mokhoa oa pathological oa ho robeha ha letsoho, moo karolo ea radial, e nang le radial tuberosity le navicular fossa, e leng ea bohlokoa bakeng sa ho boloka botsitso ba letsoho la letsoho.

Likarolo tsohle tsa distal radius, ntle le ho robeha ha maqhubu a mokokotlo oa mokokotlo oa radius, ha e le hantle li bakoa ke pefo e feteletseng. Letsoho le behiloe ka tsela e fapaneng ha le sebelisoa ke matla a ka ntle, 'me liphello tsa matla a ka ntle li fapane.

Pefo ea 1.Flexion e ka fella ka ho senyeha ha dorsally intra- or extra-articular fractures ka likotsi tse tlaase tsa matla tse kang ho oa.

2.Ho imeloa kelellong ho ka fella ka ho falla ha karolo e itseng ea libaka tsa articular ka lehlakoreng la palema kahoo ho lebisa ho se tsitse.

3.Likotsing tse matla haholo, pefo ea khatello e atile 'me ho jara axial ka mokhoa o feteletseng ho lebisa khatellong ea lesapo la holim'a articular.

4.Mokhoa o ka sehloohong oa ho senyeha ha fracture ke kotsi ea avulsion moo masapo a avulsed hangata e leng sebaka sa bony attachment ea ligament.

Anatomy ea radiologic ea radius ea distal

1. Lifilimi tsa Anteroposterior (bophahamo ba radial, ho kheloha ha ulnar, ulnar varus)

2. Lifilimi tsa morao-rao (tšekamelo ea palema)

Fernandez Classification

Mofuta oa I Metaphyseal flexion fracture

Mofuta oa II Articular le Shear Fracture

Mofuta oa III oa Compression Fracture ea Articular Surface

Mofuta oa IV oa ho robeha ha letsoho la radial wrist, dislocation

Mefuta e Kopanehileng ea V Fractures (High Energy Avulsion Fractures)

Lipontšo Tsa Karo

Maqhubu a mangata a distal radius a tšoaroa ka braking ka mor'a ho fokotseha ho koetsoeng, ka bomalimabe tse ngata tsa fractures tsena li tla tlosoa kapa ho fokotseha ho ke ke ha amoheleha ka liphello tse mpe.

Lintlha tse hlano tse senyang botsitso li ile tsa khetholloa ke LaFontaine et al:

① Ho sekama ha mokokotlo ho qala > 20° (ho sekamela ha palema);

② Ho robeha ho sa khaotseng ha dorsal epiphysis;

③ ho robeha ha lenonyello;

④ Ho robeha ha ulnar ho amanang;

⑤ Lilemo tsa mokuli > lilemo tse 60.

Ha ho na litekanyetso tse tobileng kapa litataiso tse tataisang phekolo, 'me merero ea phekolo e etsoa ho nahanela lintlha tse ngata, ho kenyelletsa le litšobotsi tsa pele tsa kotsi, ho lekanya ka mor'a ho behoa bocha, lilemo tsa mokuli, boleng ba masapo, litlhoko tsa mokuli, le liphello tse lakatsehang.

Bakeng sa phokotso e koetsoeng ea fractures ka botsitso bo belaelloang, joale ho khothaletsoa ho latela ts'ebetso e haufi. Ke habohlokoa ho hlokomela hore haeba letoto la x-ray ka mor'a ho fokotseha le fana ka maikutlo a ho se tsitse kapa ho falla, joale phetoho ea phekolo e ka 'na ea hlokahala. Haeba fracture e ka 'na ea se ke ea tsitsa, joale radiographs e lokela ho nkoa le ho hlahlojoa ho fihlela fracture e folile ebile e tsitsitse.

Kalafo ea Conservative

Lithako tse tsitsitseng li ka koaloa ka katleho 'me tsa phekoloa ka braking, qalong ka ho qhekella' me hamorao ka li-tubular cast, ka li-radiograph tsa beke le beke ho fihlela libeke tse 3.

Haeba liphetoho tse kholo tsa bolelele ba mahlaseli, tšekamelo ea palema, kapa ho kheloha ha ulnar ho etsahala, phekolo ea ho buuoa e lokela ho nkoa.

Ho bakuli ba fokolang le ba hlokang, phekolo e koetsoeng hangata e loketse, esita le ha ho buuoa ho bontšoa.

Reset reset percutaneous nale fixation

Phokotso e koetsoeng e lateloang ke pinning ea percutaneous le fixation e na le thuso ho fractures ea distal radius ka ho se tsitse ha metaphyseal kapa fractures e bonolo ea intra-articular.

Mohato oa pele ke ho fetola li-anatomical, ebe botsitso bo fanoa ka lithapo tsa gram. Hangata pinana ea pele e fetisoa ho tloha ho radial styloid ho ea ho radial metaphysis medial ho ea ho diaphysis.

Ho sebelisoa bonyane lithakhisa tse 2 ho fana ka sebaka se lekaneng se tsitsitseng sebakeng sa orthogonal le lateral, 'me karolo ea khoeli e ka kenngoa ha e lakatsa.

Intrafracture pinning (mokhoa oa Kapanji) o fana ka tšehetso ea mokokotlo. Postoperative immobilization ka splint e sebelisoa bakeng sa libeke tsa 2 ho laola ho potoloha le ho fokotsa ho teneha ha pin, ka mor'a moo e ka nkeloa sebaka ke forearm e bonolo.

Tokiso e koetsoeng ea bracket ea kantle

Li-braces tsa ho lokisa ka ntle li na le thuso bakeng sa phekolo ea pele kapa ea tlatsetso ho fractures e khethehileng ea distal radius.

Fixator e ka ntle e fokotsa khatello ea axial e sebetsang sebakeng sa distal nakong ea ho fokotseha ha lihlopha tsa mesifa ea forearm. Ho lokisoa ho ka 'na ha se ke ha e-ba teng ka lehlakoreng la letsoho, kapa ho ka eketsoa ho lokisa ho eketsehileng.

Parallel traction ha e tsosolose ka botlalo tšekamelo ea palema, empa boemo ba ho se nke lehlakore boa amoheleha. Ka mor'a ho buuoa, letsoho le ts'oaroa ka lesela la tubular sebakeng se pota-potileng ka morao bakeng sa matsatsi a 10 ho fihlela bohloko le edema li kokobela.

Ho lokisa poleiti ka ho seha le ho behoa bocha

1 、 Ho lokisa poleiti ea mokokotlo ea fracture ea distal radius

Sekhahla se otlolohileng se etsoa haufi le node ea Lister, 'me qetellong ea distal e tšela moeli oa radial carpal le ho qetella ka 1 cm proximal ho ea botlaaseng ba letsoho la bobeli la letsoho la metacarpal. Qetello ea proximal e atoloha haufi le kutu ea radial bakeng sa 3 ho isa ho 4 cm, e pepesa kholomo e bohareng ka botlaaseng ba nako ea boraro ea extensor.

2, Palm poleiti ka hare ho fixation ea distal radius fracture

Sekhahla sa longitudinal se etsoa hammoho le tendon ea radial carpal flexor, e nang le bunion flexor tendon e ka holim'a metsi a tebileng a radial carpal flexor tendon, e khutliselitsoeng ulnarly ho pepesa mesifa ea anterior ea rotator ani, 'me mesifa ea anterior ea rotator ani e khaoloa qalong ea lehlakoreng la radial le ho khutlisetsoa morao.

Taba ①

Nyeoe ②

Nyeoe ③

3. Ho lokisa poleiti ea traction ea distal radius fracture

- Sekhahla sa bolelele ba 4 cm se etsoa mokokotlong ho ea kutu ea boraro ea metacarpal, 'me tendon ea extensor ea monoana o bohareng e kenngoa konteraka ho pepesa metacarpal ea boraro;

- Sekhahla sa bobeli sa 4-cm se entsoe bonyane 4 cm mokokotlong ho radius e fetisitsoeng;

- Karolo ea boraro ea 2-cm ea mokokotlo e etsoa sebakeng sa Lister ho pepesa tendon ea extensor hallucis longus.

Ho tloha sebakeng sa distal, poleiti ea ho hula e kenngoa haufi le sefofane pakeng tsa tendon ea extensor (kamore ea bone ea mokokotlo), capsule e kopanetsoeng le periosteum. The extensor tendon e ka sisinyeha ha ho hlokahala.

4. Ho lokisoa ka bomong ha fractures e sa sebetseng ea radius ea distal e thehiloeng tsamaisong ea TriMed