Maendlelo ya xikhale na tithekiniki ta ku nghenisiwa ka naliti leyi pfalekeke eka ku tshoveka ka radius ya le kule .

Distal radius fracture i ku tshoveka loku tolovelekeke endzhaku ko rhetela eka gamboko hi xixika, naswona kuhunguteka loku pfalekeke na ku khomiwa ka tintambhu ta Kirschner i tindlela leti tolovelekeke swinene ta vutshunguri.

Xihloko lexi xi kombetela eka misinya ya milawu ya K-wiring na tithekiniki ku nghenisa tindlela ta vuhandzuri bya ku pfaleriwa ka tiphini.

Thekiniki ya ku khoma tintambhu tinharhu i thekiniki ya xiyimo xa le henhla ya ku khoma tintambhu tinharhu .

yin’we hi ku tirhisa lister tubercle.

yin’we hi ku tirhisa endlelo ra radial styloid.

Yin’we hi ku tirhisa lunate fossa bone block.

Loko: Ku tshoveka lokukulu ka commineted na osteoporosis swa humelela, ku nga tirhisiwa tintambhu to engetela ta Kirschner.

1. Ndlela ya vuhandzuri .

Xosungula, kuhunguteka loku pfalekeke ka ku tshoveka ku endliwa, na ku koka loku nonokaka na loku yaka emahlweni, naswona dorsal na radial displacement swi lulamisiwa hi palmar flexion na ulnar deviation. Endzhaku ka kuhungutiwa, voko ri vekiwa eka xiphepherhele lexi rhungeleriweke, ri hlayisa palmar flexion na ulnar deviation (Figure 2A, B), naswona ri lulamisiwile hi kwalomu ka ti percutaneous Kirschner wires tinharhu.

K-wire yosungula yi nghenisiwa eka lister’s tubercle, angled eka 45°, naswona yi kongomisiwe eka palmar cortex ya proximal bone fragment eka long axis ya radius. Loko ndzhawu yo nghenisa yiri eka tlhelo ra ulnar ra lister’s tubercle, extensor pollicis tendon yinga vaviseka.

K-wire ya vumbirhi yi nghenisiwa 0.5 cm distal eka radial styloid process, K-wire yi le ka 60° angle eka radial axis, naswona yi nghena eka ulnar cortex proximal kuya eka fracture.

K-wire ya vunharhu yi vekiwile eka xiphemu xa marhambu ya Lunate Fossa 0.5 cm distal eka layini ya nhlangano wa voko, leyi kumekaka exikarhi ka xiyenge xa ​​vumune na xa vuntlhanu xa extensor. K-wire yi khomiwa eka tlhelo ra palmar ra radius eka 45° angle, tani hileswi swikombisiweke eka Swifaniso swa A na B laha hansi.

Classic percutaneous Kirschner wire fixation ya distal radius fractures yi kombisiwile eka Swifaniso swa AE laha hansi.

 

Ku famba ka tintiho endzhaku ka percutaneous Kirschner wire fixation swi kombisiwile eka swifaniso swa AD laha hansi.

2. Switsundzuxo ni tindlela to endla vuhandzuri .

1.Loko K-wire yi rhetela eka medullary cavity handle ko nghena eka contralateral cortex, swi nga ha vangiwa hi ku tilt ngopfu loko K-wire yi nghena. Emhakeni leyi, vanhu va tala ku tlakusa mavoko leswaku va hunguta ku tilata. Kambe entiyisweni, leswi hambaneke i ntiyiso. K-wire yitava na angled naswona yi govekile hindlela ya concave, leswinga ta endla leswaku kuva na ku tsandzeka ka K-wire puncture. Ematshan’wini ya sweswo, yifanele kuva yi rhendzeleka hiku olova kuya e henhla kuya hi contour ya K-wire, tani hileswi swikombisiweke eka xifaniso lexi nga laha hansi.

Hi K-wire pointed convexly kuya e henhla, ndzhawu yo nghena yi endliwa eka distal cortex handle ka ntshikelelo wa axial, naswona yinga nghena eka distal cortex. Hi ndlela yin’wana, ndzhawu yo nghenisa yifanele ku cinciwa naswona yisunguriwa kusukela ekusunguleni (swifaniso ae laha hansi).

2.Eka thekiniki ya Kapandji, ti K-wires timbirhi kuya eka tinharhu ti nghenisiwa eka ndzhawu ya fracture ku hunguta naku lulamisa swiphemu swa distal fracture eka xiyimo lexi lavekaka. Loko se yi hungutiwile, ti K-wires ti yisiwa emahlweni eka swiphemu swa proximal (swifaniso AF laha hansi).

3.Loko tindhawu to nghena na to huma ta Kirschner wire ti ri ekusuhi swinene na ku tshoveka, ku tsandzeka ka ku khoma swi nga ha humelela. Ti wire timbirhi ta dorsal kirschner ati fanelanga ku hundza eka palmar cortex eka levele yin’we, naswona ndzhawu yo huma ya palmar yifanele kuva yiri eka 2 cm kusuka eka ndzhawu ya fracture. Vona swifaniso swa AC laha hansi.

. Swifaniso ae laha hansi.

5. Eka osteoporosis yo tika, swikahle ku tirhisa mune kuya eka ntlhanu wa ti wire ta Kirschner ku lulamisa ku tshoveka. Minkarhi yin’wana, leswaku kuta hlayisiwa ku leha ka radius, ku tirhisiwa waya wa Kirschner lowu tsemakanyaka ku lulamisa distal radius bone block kuya eka distal ulna.

6. Eka swiphemu swo leha swa ku tshoveka ka makumu ya epiphyseal, waya lowukulu wa Kirschner lowu rhendzelekaka wu nga tirhisiwa ku tiyisisa. Kambe, waya wa Kirschner wunga rhetela eka medullary cavity naswona swa tika kuwu lulamisa (swifaniso ad laha hansi).

7. Xiphemu xa marhambu ya intra-articular xi pfuriwa xi tlhela xi lulamisiwa hi waya wa Kirschner lowu tsemakanyaka ehansi ka cartilage ku sungula, ivi xi lulamisiwa hi tintambhu tinharhu ta percutaneous Kirschner hi ndlela ya ntolovelo (swifaniso swa AD laha hansi).

8. Ku tshoveka lokukulu ka distal radius loku fambisanaka na ku koma na ku wa swi lava waya wo engetela wa transverse Kirschner ku hundza hi le ka ulna ku hlayisa ku tlakuka ka radius. Ntambhu ya Kirschner yi kongoma kahle kusuka eka tlhelo ra palm ra styloid process kuya eka dorsal side ya ulna, tani hileswi swikombisiweke eka Swifaniso swa A na B laha hansi.

9. Ku tshoveka ka radial styloid na ku rhurha ka le ndzhaku. Endzhaku ka kuhunguteka, lulamisa hi ti radial styloid kirschner wires timbirhi: yin’wana eka tlhelo ra dorsal kasi yin’wana eka tlhelo ra palmar kuya fika emakumu ka styloid. (Swifaniso swa A na B laha hansi) .

10. Ku tshoveka ka swiphemu swa mune swa radius ya le kule, na dorsal displacement na ku hambanisiwa ka lunate fossa kusuka eka tlhelo ra palmar. Ntambhu ya Kirschner yinga lulamisiwa kusuka eka dorsal cortex hindlela yo oblique kusuka eka proximal kuya eka distal metacarpal bone fragment. (Swifaniso swa A na B laha hansi).

. (Swifaniso Ah laha hansi) .

12. Eka ku tshoveka loku nga erivaleni ka distal radius loku nga hungutiwiki hi ku hunguteka loku pfalekeke, waya wa 3 mm wa Kirschner wu nga tirhisiwa ku tlakusa xiphemu xa ku tshoveka ka le kule ku suka endzhaku ku fikelela ku hunguteka (Swifaniso AH laha hansi).

13. Tirhisa switirhisiwa swo khoma swilo swa le handle ku tshungula ku tshoveka ka ti-distal radius. Ti fixators tale handle ti lulamerile eka ti comminuted fractures to tika ta distal radius leti fambisanaka na ku pfimba lokukulu, ku tshoveka loku pfulekeke, kumbe swiyimo swa nhlonge ya ndzhawu leswinga pfumeleriki ku khomiwa ka le ndzeni (kufana na ku khomiwa ka ti plate) (Swifaniso AD laha hansi).

3. Ku sivela swiphiqo .

1.Ku sivela ku vekiwa loku nga tshamisekangiki, nyikela nyingiso eka matirhelo lama landzelaka .

Nyikela nyingiso eka bicortical fixation.

Papalata ku veka ndzhawu yo huma ya distal needle ekusuhi na ku tshoveka.

Papalata tintambhu hinkwato ta Kirschner leti hlanganaka emakumu ya le kule leswaku ti ta hlanganisa matimba.

Tivonele leswaku u papalata ku rhendzeleka loku ntshunxekeke loko u gombonyokisa waya wa Kirschner.

Eka xiyimo xa osteoporosis, ku engeteleka ka Kirschner wire fixation swa laveka.

2. Magoza yo sivela ku tluleriwa hi xiphephana xa naliti .

Xo sungula tsema nhlonge, hambanisa tinyama to olova ni marhambu hi xikhomela-vascular, ivi u tirhisa waya wa Kirschner.

Drill hiku nonoka ku sivela thermal necrosis.

Papalata ku tirha hi ku phindha-phindha minkarhi yo tala ngopfu.

Pfuxeta ntshikelelo wa waya wa Kirschner eka nhlonge.