Maendlelo ya xikhale na tithekiniki ta ku nghenisiwa ka naliti leyi pfalekeke eka ku tshoveka ka distal radius

Distal radius fracture i ku tshoveka loku tolovelekeke endzhaku ko rhetela eka gamboko hi xixika, naswona closed reduction na Kirschner wire fixation i tindlela leti tolovelekeke swinene ta vutshunguri.

Xihloko lexi xi kombetela eka K-Wiring Principles and Techniques ku nghenisa tindlela ta vuhandzuri bya ku pfala tiphini.

Endlelo ro khoma tintambhu tinharhu i endlelo ra xikhale ro khoma tintambhu tinharhu

Yin’we hi ku tirhisa lister tubercle.

Yin’we hi ku tirhisa endlelo ra radial styloid.

Yin’wana hi ku tirhisa lunate fossa bone block.

Loko: ku tshoveka lokukulu loku tshovekeke na ku tsana ka marhambu swi humelela, ku nga tirhisiwa tintambhu tin’wana ta Kirschner.

1. Ndlela ya vuhandzuri

Xosungula, kuhungutiwa loku pfalekeke ka ku tshoveka ka endliwa, hiku koka hiku nonoka naku ya emahlweni, naswona dorsal na radial displacement swi lulamisiwa hiku olova ka palmar na ulnar deviation. Endzhaku ko hungutiwa, voko ri vekiwa eka phepha leri rhungeleriweke, ri hlayisa ku olovisiwa ka palmar na ku hambuka ka ulnar (Xifaniso 2a, b), naswona ri lulamisiwa hi kwalomu ka tintambhu tinharhu ta Kirschner leti nghenaka hi nhlonge.

K-wire yosungula yi nghenisiwa eka Lister’s tubercle, yi 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 yiva eka 60° angle kuya eka radial axis, naswona yi nghena eka ulnar cortex proximal eka fracture.

K-wire ya vunharhu yi khomiwa eka xiphemu xa marhambu ya lunate fossa 0.5 cm ekule na layini ya wrist joint, leyi kumekaka exikarhi ka xiyenge xa ​​vumune na xa vuntlhanu xa extensor. K-wire yi khomiwa eka tlhelo ra palmar ra radius eka angle ya 45°, tani hileswi swikombisiweke eka Swifaniso swa a na b laha hansi.

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

 

Ku famba ka tintiho endzhaku ka ku vekiwa ka waya wa Kirschner hi percutaneous swi kombisiwile eka Figures ad laha hansi.

2. Switsundzuxo ni tindlela to endla vuhandzuri

1.Loko K-wire yi rhelela yi nghena eka medullary cavity handle ko nghena eka contralateral cortex, swi nga ha vangiwa hi ku tilt ngopfu loko K-wire yi nghena. Eka xiyimo lexi, vanhu va tala ku tlakusa mavoko ya vona leswaku va hunguta ku rhetela. Kambe entiyisweni, leswi hambaneke ni sweswo i ntiyiso. K-wire yitava na angled naku goveka hindlela ya concave, leswinga 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 leyi kongomisiweke convexly kuya e henhla, ndzhawu yo nghena yi endliwa eka distal cortex handle ka ntshikelelo wa axial, naswona yinga nghena eka distal cortex. Handle ka sweswo, 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 kuya eka ndzhawu leyi lavekaka. Loko se ti hungutiwile, ti K-wires ti yisiwa emahlweni kuya eka swiphemu swa proximal (Swifaniso af laha hansi).

3.Loko tindhawu to nghena na to huma ta waya wa Kirschner ti ri ekusuhi swinene na ku tshoveka, ku tsandzeka ka fixation ku nga 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 2 cm kusuka eka ndzhawu leyi tshovekeke. Vona Swifaniso swa ac laha hansi.

4. Loko dorsal cortex yi tshovekile swinene, ringeta ku nga ngheni eka ndhawu leyi tshovekeke ya xiphemu xa marhambu ya le kule, tanihi leswi leswi swi nga endlaka leswaku ku tsandzeka ku khoma. Tinhlayo ae laha hansi.

5. Eka vuvabyi bya marhambu lebyikulu, swa antswa ku tirhisa tintambhu ta mune ku ya eka ta ntlhanu ta Kirschner ku lulamisa ku tshoveka. Minkarhi yin’wana, leswaku ku hlayisiwa ku leha ka radius, ku tirhisiwa waya wa Kirschner lowu tsemakanyaka ku lulamisa distal radius bone block eka distal ulna.

6. Eka ku tshoveka ka xiphemu xo leha xa makumu ya epiphyseal, waya lowukulu wa Kirschner lowu rhetaka wu nga tirhisiwa ku khoma. Hambiswiritano, waya wa Kirschner wunga rhetela eka medullary cavity naswona swa tika ku wu lulamisa (Swifaniso swa ad laha hansi).

7. Xiphemu xa marhambu xa intra-articular xi pfuriwa xi tlhela xi khomiwa hi waya wa Kirschner lowu tsemakanyaka ehansi ka cartilage ku sungula, ivi xi khomiwa hi tintambhu tinharhu ta Kirschner leti percutaneous hi ndlela leyi tolovelekeke (Swifaniso ad laha hansi).

8. Ku tshoveka lokukulu loku tshovekeke ka radius ya le kule loku fambisanaka na ku koma na ku wa swi lava waya wo engetela wa Kirschner lowu tsemakanyaka ku hundza eka ulna ku hlayisa ku tlakuka ka radius. Ntambhu ya Kirschner yi kongomisiwa kahle kusuka eka tlhelo ra palm ra styloid process kuya eka tlhelo ra dorsal ra ulna, tani hileswi swikombisiweke eka Swifaniso swa a na b laha hansi.

9. Ku tshoveka ka radial styloid na ku rhurha ka dorsal. Endzhaku ko hunguta, lunghisa hi tintambhu timbirhi ta radial styloid Kirschner: yin’wana eka tlhelo ra dorsal kasi yin’wana eka tlhelo ra palmar kuya emakumu ka styloid. (Swifaniso swa a na b laha hansi)

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

11. Loko u tirhisa tintambhu ta Kirschner ta le ndzhaku ni ta voko ku tshungula ku tshoveka loku tshovekeke ka radius ya le kule, loko xiphemu xa voko xa lunate fossa xi nga hungutiwi hi nkarhi wa vuhandzuri, u nga tirhisa ndlela ya mavoko, u tirhisa clamp ya misiha ku hambanisa marhambu, ivi u nghenisa ntambhu ya Kirschner ku suka eka xiphemu xa le tlhelo ka voko eka dorsal cortex. (Swifaniso ah laha hansi)

12. Eka ku tshoveka loku nga erivaleni ka radius ya le kule loku rhurheriweke loku nga hungutiwiki hi ku hunguta loku pfalekeke, waya wa Kirschner wa 3 mm 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 ti fixators ta le handle ku tshungula ku tshoveka loku tshovekeke ka radius ya le kule. Ti fixators tale handle ti lulamerile eka ku tshoveka lokukulu ka comminuted ka distal radius loku fambisanaka na ku pfimba lokukulu, ku tshoveka loku pfulekeke, kumbe swiyimo swa nhlonge ya ndzhawu leswinga pfumeleriki ku khomiwa ka le ndzeni (kufana na plate fixation) (Swifaniso ad laha hansi).

3. Sivela swiphiqo

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

Nyikela nyingiso eka ku khomiwa ka bicortical.

Papalata ku veka ndzhawu yo huma ya naliti yale kule ekusuhi na ndzhawu leyi tshovekeke.

Papalata ti wire hinkwato ta Kirschner leti hlanganaka eka makumu yale kule kuva u hlanganisa matimba.

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

Loko ku ri na vuvabyi bya marhambu, ku laveka ku hlanganisiwa loku engetelekeke ka waya wa Kirschner.

2. Magoza yo sivela ku tluleriwa hi xirho xa naliti

Xosungula u tsema nhlonge, u hambanisa tissue yo olova kuya eka marhambu hi vascular clamp, kutani u tirhisa waya wa Kirschner.

Bora hiku nonoka kuva u sivela thermal necrosis.

Papalata ku endla vuhandzuri hi ku phindha-phindha minkarhi yo tala.

Pfuxeta ntshikelelo wa waya wa Kirschner eka nhlonge.