Iindlela ze-Classic kunye nobuchule bokufakwa kwenaliti evaliweyo kwi-distal radius fractures

I-distal radius fracture yinto eqhelekileyo emva kokuhamba kwikhephu ebusika, kunye nokunciphisa okuvaliweyo kunye nokulungiswa kwe-wire Kirschner zezona ndlela ziqhelekileyo zonyango.

Eli nqaku libhekisa kwi-K-Wiring Principles and Techniques ukwazisa ubuchule botyando bokupinwa okuvaliweyo.

Ubuchwephesha bokulungiswa kweengcingo ezintathu bubuchule bokulungiswa kweentambo ezintathu zakudala

Enye nge-lister tubercle.

Enye ngenkqubo ye-radial styloid.

Enye nge-lunate fossa bone block.

Ukuba: iifractures ezinzima kunye ne-osteoporosis zenzeka, iingcingo ezongezelelweyo ze-Kirschner zingasetyenziswa.

1. Indlela yotyando

Okokuqala, ukucuthwa okuvaliweyo kwe-fracture kuyenziwa, kunye ne-traction ecothayo kwaye eqhubekayo, kunye ne-dorsal kunye ne-radial displacement ilungiswa nge-palmar flexion kunye nokuphambuka kwe-ulnar. Emva kokunciphisa, isandla sibekwe kwiphepha eliqengqelekayo, ukugcina i-palmar flexion kunye nokuphambuka kwe-ulnar (Umfanekiso 2a, b), kwaye ugxininise ubuncinane iingcingo ezintathu ze-Kirschner ze-percutaneous.

I-K-wire yokuqala ifakwe kwi-tubercle ye-Lister, i-angle kwi-45 °, kwaye ijoliswe kwi-palmar cortex yeqhekeza lethambo elisondeleyo kwi-axis ende yeradius. Ukuba indawo yokufaka ikwicala le-ulnar ye-tubercle ye-Lister, i-tendon ye-pollicic extensor inokulimala.

I-K-wire yesibini ifakwe i-0.5 cm kude kwi-radial styloid process, i-K-wire ikwi-angle ye-60 ° kwi-axis ye-radial, kwaye ingena kwi-cortex ye-ulnar esondele kwi-fracture.

Olwesithathu i-K-wire igxininiswe kwi-lunate fossa bone fragment 0.5 cm distal ukuya kumgca we-wrist joint, ephakathi kwe-extensor yesine neyesihlanu amacandelo. I-K-wire igxininiswe kwicala le-palmar le-radius kwi-engile ye-45 °, njengoko kubonisiwe kwiMifanekiso a kunye no-b ngezantsi.

I-Classic percutaneous Kirschner wire fixation ye-distal radius fractures iboniswe kwiMifanekiso ae ngezantsi.

 

Ukuhamba kweminwe emva kokulungiswa kocingo lweKirschner kuboniswe kwiMifanekiso yentengiso engezantsi.

2. Ukhuseleko kunye nobuchule botyando

1.Ukuba i-K-wire ityibilika kwi-medullary cavity ngaphandle kokungena kwi-cortex ye-contralateral, inokubangelwa kukuthambeka okukhulu xa i-K-wire ingena. Kule meko, abantu bavame ukuphakamisa izandla zabo ukunciphisa ukuthambeka. Kodwa eneneni, okwahlukileyo koko kuyinyaniso. I-K-wire iya kuba ne-engile kwaye igobe ngendlela ye-concave, ibangele ukusilela kwe-K-wire puncture. Endaweni yoko, kufuneka ijikeke ngobunono ukuya phezulu ngokwekhonto yocingo lwe-K, njengoko kubonisiwe kulo mfanekiso ungezantsi.

Ngocingo lwe-K olubhekiselele phezulu, indawo yokungena yenziwa kwi-distal cortex ngaphandle koxinzelelo lwe-axial, kwaye inokungena kwi-distal cortex. Ngenye indlela, indawo yokufaka kufuneka itshintshwe kwaye iqalwe ukususela ekuqaleni (Amanani ae ngezantsi).

2.Kwindlela yeKapandji, ezimbini ukuya kwezintathu i-K-ingcingo zifakwe kwindawo yokuphuka ukunciphisa kunye nokulungisa iziqhekeza ze-distal fracture kwindawo oyifunayo. Xa sele zincitshisiwe, i-K-ingcingo ziqhubela phambili kwi-proximal fragments (Figures af below).

3.Ukuba i-Kirschner wire entry and exit points isondele kakhulu kwi-fracture, ukungaphumeleli kokulungiswa kunokwenzeka. Iingcingo ezimbini ze-dorsal Kirschner akufanele zidlule kwi-palmar cortex kwinqanaba elifanayo, kwaye indawo yokuphuma ye-palmar kufuneka ibe yi-2 cm ukusuka kwindawo yokuphuka. Jonga iFigures ac ngezantsi.

4. Xa i-dorsal cortex ixutywe ngokugqithiseleyo, zama ukungangeni kwindawo yokuphuka kweqhekeza lethambo elikude, njengoko oku kunokukhokelela ekungaphumeleli kokulungiswa. Amanani ae ngezantsi.

5. Kwi-osteoporosis enzima, kungcono ukusebenzisa iingcingo ezine ukuya ezintlanu ze-Kirschner ukulungisa ukuphuka. Ngamanye amaxesha, ukwenzela ukugcina ubude be-radius, ucingo lwe-Kirschner olunqamlekileyo lusetyenziselwa ukulungisa i-distal radius bone block kwi-distal ulna.

6. Kwizahlulo zecandelo elide lesiphelo se-epiphyseal, intambo enkulu ye-Kirschner ethambekele ingasetyenziselwa ukulungiswa. Nangona kunjalo, i-Kirschner wire inokutyibilika kwi-medullary cavity kwaye kunzima ukuyilungisa (Figure ad below).

7. I-fragment ye-intra-articular bone fragment ivuliwe kwaye igxininiswe ngocingo lwe-Kirschner olunqamlekileyo phantsi kwe-cartilage kuqala, kwaye lulungiswe ngeengcingo ezintathu ze-percutaneous Kirschner ngendlela eqhelekileyo (Amanani ad ngezantsi).

8. Ukuqhekeka okukhulu kwe-distal fracture ehamba kunye nokunciphisa kunye nokudilika kufuna ucingo olongezelelweyo lwe-Kirschner olunqamlezayo ukuba ludlule kwi-ulna ukugcina ubude be-radius. I-Kirschner wire ibonakaliswe kakuhle ukusuka kwicala lesundu lenkqubo ye-styloid ukuya kwicala le-dorsal ye-ulna, njengoko kuboniswe kwiMifanekiso a kunye ne-b ngezantsi.

9. I-Radial styloid fracture kunye nokufuduka komqolo. Emva kokunciphisa, lungisa ngeengcingo ezimbini ze-radial styloid Kirschner: enye kwicala le-dorsal kunye nelinye kwicala lesundu ukuya kwincam ye-styloid. (Amanani a kunye no-b ngezantsi)

10. Ukuqhekeka kwamacandelo amane e-distal radius, kunye nokufuduka kwe-dorsal kunye nokuhlukana kwe-lunate fossa ukusuka kwicala lesundu. Ucingo lwe-Kirschner lunokulungiswa kwi-cortex ye-dorsal ngendlela e-oblique ukusuka kwi-proximal ukuya kwi-distal metacarpal bone fragment. (Amanani a kunye no-b ngezantsi).

11. Xa usebenzisa iingcingo ze-dorsal kunye ne-palmar Kirschner ukunyanga i-fractures edibeneyo ye-distal radius, ukuba i-palmar fragment ye-fossa ye-lunate ayincitshiswa ngexesha lotyando, ungasebenzisa indlela yesundu, sebenzisa i-vascular clamp ukwahlula ithambo, uze ufake i-Kirschner wire ukusuka kwi-palmentar edge kwi-palmentdor edge. (Amanani ah ngezantsi)

12. Ngokucacileyo i-distal fractures ye-distal fractures ayinakuncitshiswa ngokunciphisa okuvaliweyo, i-3 mm ye-Kirschner wire ingasetyenziselwa ukuphakamisa i-distal fracture fragment ukusuka ngasemva ukuphumeza ukunciphisa (Amanani ah ngezantsi).

13. Sebenzisa izilungisi zangaphandle ukuze uphathe i-fractures comminuted ye-distal radius. Izilungisi zangaphandle zilungele ukuphuka okuqinileyo kwe-distal radius ehamba kunye nokuvuvukala okukhulu, iifractures ezivulekileyo, okanye iimeko zesikhumba zendawo ezingavumeli ukulungiswa kwangaphakathi (njengokulungiswa kweplate) (Amanani ad ngezantsi).

3. Thintela iingxaki

1.Ukuthintela ukulungiswa okungazinzanga, nikela ingqalelo kule misebenzi ilandelayo

Nika ingqalelo ukulungiswa kwe-bicortical.

Kuphephe ukubeka i-distal inaliti yokuphuma kufuphi ne-fracture.

Zithintele zonke iingcingo zeKirschner eziguquguqukayo kwindawo ekude ukuze ugxininise amandla.

Qaphela ukuphepha ukujikeleza okuxekethileyo xa ugoba ucingo lweKirschner.

Kwimeko ye-osteoporosis, ukulungiswa kocingo olongezelelweyo lweKirschner luyafuneka.

2. Amanyathelo okuthintela usulelo lwenaliti

Okokuqala usike ulusu, uhlukanise izicubu ezithambileyo kwithambo kunye ne-vascular clamp, kwaye usebenzise ucingo lweKirschner.

Yomba kancinane ukukhusela i-thermal necrosis.

Kuphephe ukusebenza ngokuphindaphindiweyo amaxesha amaninzi.

Ukunciphisa uxinzelelo lwe-Kirschner wire esikhumbeni.