I-Distal Radius Fractures: Inkcazo eBanzi ukusuka kwi-Anatomy ukuya kuTyando

I-distal radius fractures i-akhawunti ye-75% ye-forearm fractures kwaye ixhaphake ngokukodwa kwiklinikhi. Kweli nqaku, siqulunqe uluhlu lwe-anatomy, ulwahlulo, izicwangciso zonyango, kunye neendlela zotyando kwiifractures zeradius distal kwireferensi yakho.

Shwankathela

Ukuqhekeka kweradiyasi ekude yinxalenye yokwaphuka kwesihlahla. ' Ithiyori yekholamu ezintathu' inokuchaza ngcono indlela ye-pathological ye-fractures yesandla, apho ikholamu ye-radial, equka i-tuberosity ye-radial kunye ne-navicular fossa, ibalulekile ekugcineni ukuzinza kwe-wrist joint.

Zonke iifractures zeradius ezikude, ngaphandle kokuqhekeka kwe-avulsion ye-dorsal margin ye-radius, ngokwenene kubangelwa ubundlobongela obugqithisileyo. Isandla sibekwe ngokwahlukileyo xa senziwe ngamandla angaphandle, kwaye imiphumo yamandla angaphandle iyahluka.

I-1.Flexion violence ingabangela i-dorsally displaced intra- or extra-articular fractures kwi-low-energy fractures ezifana nokuwa.

I-2.Uxinzelelo lwe-Shear lunokubangela ukufuduka kwenxalenye yeendawo ze-articular kwicala lesundu ngaloo ndlela kukhokelela ekungazinzini.

I-3.Ngokulimala kwamandla aphezulu, ubundlobongela obunyanzeliswayo buhamba phambili kunye nomthwalo ogqithisileyo we-axial ukhokelela ekunyanzelweni kwethambo le-articular surface.

I-4.Inkqubo ephambili yokuchithwa kwe-fracture kukulimala kwe-avulsion apho i-avulsed bone mass idla ngokuba yindawo yokunamathisela amathambo e-ligament.

I-radiologic anatomy yeradiyo ekude

Iifilimu ze-Anteroposterior (ubude be-radial, ukutenxa kwe-ulnar, i-ulnar varus)

2. Iifilimu ezisecaleni (ukuthambekela kwepalmar)

Fernandez Classification

Uhlobo lwe-I Metaphyseal flexion fracture

Uhlobo lwe-II ye-Articular kunye ne-Shear Fracture

Uhlobo lwe-III yoKunyanzeliswa kokuqhekeka kwe-Articular Surface

Uhlobo lwe-IV lwe-avulsion fracture ye-radial wrist, i-dislocation

Uhlobo lwe-V oluxutyiweyo lwezahlulo (Izaphulelo zokuvuswa kwamandla aphezulu)

Iimpawu zoTyando

Uninzi lweefractures ze-distal radius ziphathwa nge-braking emva kokunciphisa okuvaliweyo, ngelishwa ezininzi zezi fractures ziya kususwa okanye ukunciphisa akuyi kwamkeleka ngesiphumo esibi.

Izinto ezintlanu eziphazamisayo zichongiwe nguLaFontaine et al:

① I-angulation yokuqala yomqolo> 20 ° (i-palmar tilt);

② Ukuqhekeka okungapheliyo kwe-epiphysis ye-dorsal;

③ ukwaphuka kwilungu;

④ Ukwaphuka kwe-ulnar enxulumene;

⑤ Ubudala besigulana> 60 iminyaka.

Akukho migangatho ecacileyo okanye izikhokelo zokukhokela unyango, kwaye izicwangciso zonyango zenziwa ngokuthathela ingqalelo inani elikhulu lezinto, kubandakanywa iimpawu zokuqala zokulimala, ukulinganisa emva kokubekwa ngokutsha, ubudala besigulane, umgangatho wamathambo, iimfuno zesigulane, kunye neziphumo ezifunwayo.

Ukunciphisa okuvaliweyo kweefractures kunye nokuzinza okukrokrelwayo, emva koko ulandelelwano olusondeleyo luyacetyiswa. Kubalulekile ukuba uqaphele ukuba ukuba uluhlu lwe-x-rays emva kokunciphisa lubonisa ukungazinzi okanye ukufuduka, ngoko ke utshintsho kunyango lunokufuneka. Ukuba i-fracture inokuthi ingazinzi, ngoko i-radiographs kufuneka ithathwe kwaye ihlolwe de kube ukuphuka kuphuluke kwaye kuzinzile.

Unyango loLondolozo

Iifractures ezizinzileyo zingavalwa ngempumelelo kwaye ziphathwe nge-braking, ekuqaleni ngokuqhawula kwaye kamva kunye ne-tubular cast, kunye ne-radiographs ngeveki ukuya kwiiveki ezi-3.

Ukuba utshintsho oluphawulekayo kubude be-radial, ukuthambekela kwesundu, okanye ukuphambuka kwe-ulnar kwenzeka, unyango lotyando kufuneka luthathelwe ingqalelo.

Kwizigulane ezibuthathaka kunye nezincinci, unyango oluvaliweyo luhlala lufanelekile, nangona utyando luboniswa.

Ivaliwe ukusetha kwakhona inaliti ye-percutaneous

Ukunciphisa okuvaliweyo okulandelwa yi-percutaneous pinning kunye nokulungiswa luncedo kwi-distal radius fractures kunye nokungazinzi kwe-metaphyseal okanye i-intra-articular fractures elula.

Isinyathelo sokuqala kukutshintshwa kwe-anatomical, emva koko ukuzinza kunikezelwa ngeepini zegram. Ngokuqhelekileyo ipini yokuqala idluliselwa kwi-radial styloid ukuya kwi-radial metaphysis medial ukuya kwi-diaphysis.

Ubuncinci bezikhonkwane ezi-2 zisetyenziselwa ukubonelela ngokuzinza ngokufanelekileyo kwizikhundla ze-orthogonal kunye ne-lateral, kwaye i-facet ye-lunate inokugqithwa ukuba ifunwa.

I-intrafracture pinning (ubuchule beKapanji) bubonelela ngenkxaso yomqolo. I-postoperative immobilization kwi-splint isetyenziswe kwiiveki ze-2 ukulawula ukujikeleza kunye nokunciphisa ukucaphuka kwepini, emva koko inokutshintshwa nge-forearm ethambileyo.

Ukulungiswa kwesibiyeli sokulungiswa kwangaphandle endaweni evaliweyo

Iibrayisi zokulungisa zangaphandle ziluncedo kunyango lokuqala okanye oluncedisayo kwiifractures ezithile ze-distal radius.

I-fixator yangaphandle inciphisa uxinzelelo lwe-axial olusebenza kwi-distal radius ngexesha lokunyanzeliswa kwamaqela emisipha ye-forearm. Ukulungiswa kunokuba okanye kungabikho ngapha kwesihlahla, okanye ukulungiswa okongeziweyo kunokongezwa.

I-parallel traction ayibuyiseli ngokupheleleyo ukuthambekela kwesundu, kodwa indawo engathathi hlangothi iyamkeleka. Emva kokusebenza, i-wrist igxininiswe kwi-tubular cast kwindawo ejikelezayo yangasemva kweentsuku ze-10 de intlungu kunye ne-edema iyancipha.

Ukulungiswa kwepleyiti ngokusikwa kunye nokubekwa ngokutsha

I-1, ipleyiti yeDorsal ukulungiswa kwangaphakathi kwe-distal radius fracture

Ukusikwa okuthe ngqo kwenziwa ecaleni kwe-node ye-Lister, kunye nesiphelo se-distal siwela umgca we-radial carpal joint kunye nokuphela kwe-1 cm esondele kwisiseko se-metacarpal wrist joint yesibini. Ukuphela kwe-proximal kwandisa kunye ne-radial stem kwi-3 ukuya kwi-4 cm, eveza ikholamu ephakathi kwisiseko se-extensor interval yesithathu.

I-2, ipleyiti yePalm ukulungiswa kwangaphakathi kwe-distal radius fracture

I-longitudinal incision yenziwa kunye ne-radial carpal flexor tendon, kunye ne-tendon ye-bunion flexor ehlala kwindawo enzulu ye-radial carpal flexor tendon, ehlanjululwa nge-ulnarly ukuze iveze i-anterior rotator ani muscle, kunye ne-anterior rotator ani muscle inqunyulwe ekuqaleni kwe-radial side ye-radial disruptly kwi-radial ye-radial ephumayo kwi-radial ephazamisayo.

Ityala ①

Ityala ②

Ityala ③

3. Ukulungiswa kwepleyiti yokutsala i-distal radius fracture

- I-4-cm ye-longitudinal incision yenziwa kwi-dorsal kwi-stem yesithathu ye-metacarpal, kunye ne-tendon ye-extensor yomnwe ophakathi ibanjwe ukuba iveze i-metacarpal yesithathu;

- Isibini se-4-cm ukusikeka senziwa ubuncinci be-4 cm kwi-dorsal ukuya kwi-radius edibeneyo;

- I-2-cm yesithathu ye-dorsal incision yenziwa kwi-node ye-Lister ukuveza i-extensor hallucis longus tendon.

Ukusuka kwi-distal incision, i-plate ye-traction ifakwe ngokusondeleyo kunye nendiza phakathi kwe-tendon extensor (igumbi lesine le-dorsal), i-capsule edibeneyo kunye ne-periosteum. Ithenda ye-extensor inokushukunyiswa ukuba kuyimfuneko.

4. Ukulungiswa komntu ngamnye kweefractures ezidibeneyo ze-distal radius ngokusekelwe kwinkqubo ye-TriMed