Distal Radius Fractures: Nhlamuselo Leyi heleleke Ku Suka Eka Anatomy Ku Ya Eka Vuhandzuri

Ku tshoveka ka distal radius ku endla 75% wa ku tshoveka ka mavoko ya le mahlweni naswona swi tolovelekile ngopfu eka tliliniki. Eka xihloko lexi, hi hlengeletile nxaxamelo wa anatomy, classification, tindlela ta vutshunguri, na maendlelo ya vuhandzuri eka distal radius fractures leswaku u ta swi kongomisa.

Pfuxeta

Ku tshoveka ka distal radius i xiphemu xa ku tshoveka ka mavoko. 'Three-column theory' yi nga hlamusela ku antswa endlelo ra pathological ra ku tshoveka ka voko, laha kholomo ya radial, leyi vumbiwaka hi radial tuberosity na navicular fossa, yi nga ya nkoka eka ku hlayisa ku tshamiseka ka nhlangano wa voko.

Ku tshoveka hinkwako ka distal radius, handle ka ku tshoveka ka avulsion ka dorsal margin ya radius, entiyisweni swi vangiwa hi madzolonga ya overextension. Voko ri vekiwa hi ndlela yo hambana loko ri endliwa hi matimba ya le handle, naswona vuyelo bya matimba ya le handle byi hambanile.

1.Flexion violence yinga endla leswaku kuva na dorsally displaced intra- kumbe extra-articular fractures eka ku vaviseka ka eneji yale hansi kufana na ku wa.

2.Shear stress yinga endla leswaku kuva na ku rhurha ka xiphemu xa ti articular surfaces eka tlhelo ra palmar xisweswo swiyisa eka ku nga tshamiseki.

3.Eka ku vaviseka ka matimba lamakulu, madzolonga ya ku tshikileriwa ya tala naswona ku layicha ngopfu ka axial swi yisa eka ku tshikileriwa ka marhambu ya le henhla ka articular.

4.Ndlela yosungula ya fracture dislocation i avulsion injury laha avulsed bone mass hi ntolovelo yinga bony attachment point ya ligament.

Anatomy ya radiologic ya radius ya le kule

1.Tifilimi ta le mahlweni ka le ndzhaku (ku leha ka radial, ku hambuka ka ulnar, ulnar varus) .

2. Tifilimi ta le tlhelo (ku rhelela ka voko) .

Fernandez Ku hlawuriwa ka swilo

Muxaka wa I Ku tshoveka ka metaphyseal flexion

Muxaka wa II Ku tshoveka ka Articular na Shear

Muxaka wa III Ku Pfuxetiwa ka Ntshikelelo wa Vuandlalo bya Articular

Type IV avulsion fracture ya voko ra radial, ku tshoveka

Muxaka wa V Mixed Fractures (Ku tshoveka ka matimba ya le henhla ya ku tshoveka) .

Swikombiso Swa Vuhandzuri

Vunyingi bya ti distal radius fractures ti tshunguriwa hi braking endzhaku ka closed reduction, khombo rakona swotala swa fractures leswi swita rhurhisiwa kutani kuhunguteka kunga amukeleki hi mbuyelo wo biha.

Swilo swa ntlhanu leswi nga tshamisekangiki swi tiviwile hi LaFontaine et al:

1 Ku sungula ka dorsal angulation > 20° (ku rhetela ka voko);

2 Ku tshoveka loku nga nyawuriki ka epiphysis ya le ndzhaku;

3 ku tshoveka ka nhlonge;

4 Ku tshoveka ka ulnar loku fambisanaka na swona;

5 Malembe ya muvabyi > 60 wa malembe.

A ku na swipimelo leswi tiyeke kumbe swiletelo swo kongomisa vutshunguri, naswona tipulani ta vutshunguri ti endliwa hi ku tekela enhlokweni nhlayo leyikulu ya swilo, ku katsa na swihlawulekisi swo sungula swa ku vaviseka, ku kalibhara endzhaku ko vekiwa nakambe, malembe ya muvabyi, khwalithi ya marhambu, swilaveko swa muvabyi, na mimbuyelo leyi lavekaka.

Eka ku hungutiwa loku pfalekeke ka ku tshoveka loku ehleketeleriwa ku tshamiseka, kutani ku landzelerisa lokukulu swa hlohleteriwa. I swa nkoka ku xiya leswaku loko nxaxamelo wa x-rheyi endzhaku ko hunguta wu ringanyeta ku nga tshamiseki kumbe ku rhurha, kutani ku cinca ka vutshunguri ku nga ha laveka. Loko ku tshoveka ku nga ha va ku nga tshamiseki, kutani ku fanele ku tekiwa ti- radiograph ni ku kamberiwa ku kondza ku tshoveka ku horile ni ku tshamiseka.

Vutshunguri bya Vuhlayiseki

Ku tshoveka loku tiyeke kunga humelela hiku pfariwa-ku rhurhisiwa naku tshunguriwa hiku braka, ekusunguleni hi splinting naswona endzhaku hi tubular cast, hi ti radiographs ta vhiki na vhiki kuya fika eka 3 wa mavhiki.

Loko ku cinca lokukulu eka ku leha ka radial, ku rhetela ka mavoko kumbe ku hambuka ka ulnar ku humelela, vutshunguri bya vuhandzuri byi fanele ku tekeriwa enhlokweni.

Eka vavabyi lava tsaneke ni lava nga laviwiki ngopfu, hakanyingi vutshunguri lebyi pfalekeke bya fanela, hambiloko ku kombisiwile vuhandzuri.

Ku pfala ku tlheriseriwa ka percutaneous naliti fixation

Kuhunguteka loku pfalekeke loku landzeriwaka hi percutaneous pinning na fixation swa pfuna eka distal radius fractures leyingana metaphyseal instability kumbe simple intra-articular fractures.

Goza rosungula i anatomical repositioning, kutani stabilization yi nyikiwa hi ti gram pins. Hi ntolovelo pini yosungula yi hundziseriwa kusuka eka radial styloid kuya eka radial metaphysis medial kuya eka diaphysis.

Nhlayo yale hansi ya 2 wa ti pins titirhisiwa kuva tinyika repositioning leyi ringaneleke eka swiyimo swa orthogonal na lateral, naswona lunate facet yinga pinned loko swilaveka.

Intrafracture pinning (Kapanji technique) yinyika nseketelo wa dorsal. Postoperative immobilization eka splint yi cheriwa kuringana 2 wa mavhiki ku lawula ku rhendzeleka naku hunguta ku pfimba ka pin, endzhaku ka sweswo yinga siviwa hi soft forearm cast.

Ku pfaleriwa-ku cinciwa ka le handle fixation bracket fixation

Ti braces ta le handle ta fixation ta pfuna eka vutshunguri byo sungula kumbe byo engetela eka ku tshoveka ko karhi ka distal radius.

Fixator yale handle yi herisa ntshikelelo wa axial lowu tirhaka eka distal radius hi nkarhi wa ku hunguteka ka mintlawa ya misiha ya voko ra le mahlweni. Ku khomiwa ku nga ha va kumbe ku nga ri ku tsemakanya voko, kumbe ku khomiwa loku engetelekeke ku nga engeteriwa.

Parallel traction ayi vuyiseli hiku hetiseka palmar inclination, kambe xiyimo xa neutral xa amukeleka. Endzhaku ka vuhandzuri, voko ri tiyisiwa eka tubular cast eka xiyimo xale ndzhaku lexi rhendzelekaka kuringana 10 wa masiku kufikela loko kuvava na edema swihunguteka.

Ku vekiwa ka pulati hi ku tsemiwa na ku vekiwa nakambe

1、Ku khomiwa ka le ndzeni ka pulati ya le ndzhaku ka ku tshoveka ka radius ya le kule

Ku tsemiwa loku kongomeke ku endliwa kuya hi Lister’s node, laha makumu yale kule ya tsemakanyaka layini ya radial carpal joint naswona ya helela eka 1 cm proximal kuya ehansi ka nhlangano wa vumbirhi wa metacarpal wrist. Makumu ya proximal ya anama kuya hi radial stem kuringana 3 kuya eka 4 cm, ya paluxa kholomo yale xikarhi hiku tirhisa base ya third extensor interval.

2、Ku khomiwa ka le ndzeni ka pulati ya mavoko ya ku tshoveka ka radius ya le kule

Ku tsemiwa ka longitudinal ku endliwa etlhelo ka radial carpal flexor tendon, laha bunion flexor tendon yi kumekaka eka vuandlalo byo enta bya radial carpal flexor tendon, leyi tlheriseriwaka endzhaku ulnarly ku paluxa anterior rotator ani muscle, naswona anterior rotator ani muscle yi tsemiwa ekusunguleni ka radial side naswona yi tlheriseriwa endzhaku ulnarly ku paluxa distal end ya radius ya xirhendzevutani.

Mhaka ya 1

Mhaka ya 2

Mhaka ya 3

3. Ku khomiwa ka pulati yo koka ya ku tshoveka ka radius ya le kule

- Ku tsemiwa ka 4-cm hiku leha ku endliwa dorsal kuya eka nsinya wa vunharhu wa metacarpal, naswona extensor tendon ya rintiho ra le xikarhi yi hlanganisiwa ku paluxa metacarpal ya vunharhu;

- Ku tsemiwa ka vumbirhi ka 4-cm ku endliwa kwalomu ka 4 cm endzhaku kuya eka radius leyi tsemiweke;

- Ku tsemiwa ka vunharhu ka 2-cm ka le ndzhaku ku endliwa eka node ya Lister ku paluxa extensor hallucis longus tendon.

Kusuka eka distal incision, traction plate yi nghenisiwa proximally kuya hi plane exikarhi ka extensor tendon (fourth dorsal compartment), joint capsule na periosteum. Extensor tendon yinga fambisiwa loko swilaveka.

4. Ku vekiwa ka munhu hi xiyexe ka ku tshoveka loku tshovekeke ka radius ya le kule loku sekeriweke eka sisiteme ya TriMed