Izindlela zakudala nezindlela zokufaka inaliti evaliwe yokuqhekeka kwe-distal radius

Ukuphuka kwe-Distal radius ukuphuka okuvamile ngemva kokushibilika eqhweni ebusika, futhi ukuncishiswa okuvaliwe nokulungiswa kwentambo ye-Kirschner kuyindlela yokwelapha evame kakhulu.

Lesi sihloko sibhekisela ku-K-Wiring Principles and Techniques ukwethula amasu okuhlinza okuphinwa okuvaliwe.

Indlela yokulungisa izintambo ezintathu iyindlela yakudala yokulungisa izintambo ezintathu

Omunye ngokusebenzisa i-lister tubercle.

Enye ngenqubo ye-radial styloid.

Omunye ngokusebenzisa i-lunate fossa bone block.

Uma: ukuphuka okukhulu okungapheli kanye ne-osteoporosis kwenzeka, izintambo ezengeziwe ze-Kirschner zingasetshenziswa.

1. Indlela yokuhlinza

Okokuqala, ukuncishiswa okuvaliwe kokuphuka kwenziwa, ngokudonsa kancane nokuqhubekayo, futhi ukukhishwa kwe-dorsal ne-radial kulungiswa ngokuguquguquka kwesundu kanye nokuphambuka kwe-ulnar. Ngemva kokuncishiswa, isandla sibekwa eshidini eligoqiwe, sigcine ukugoba kwesundu kanye nokuchezuka kwe-ulnar (Umfanekiso 2a, b), futhi sihlanganiswe okungenani nezintambo ezintathu ze-Kirschner ezine-percutaneous.

I-K-wire yokuqala ifakwa ku-Lister's tubercle, i-engeli engu-45°, futhi iqondiswe ku-palmar cortex ye-proximal bone fragment ku-eksisi ende yerediyasi. Uma iphoyinti lokufaka lisohlangothini lwe-ulnar lwe-Lister's tubercle, ithenda ye-extensor pollicic ingase ilimale.

I-K-wire yesibili ifakwe ubude obungu-0.5 cm kunqubo yesitayela se-radial, i-K-wire iku-engeli engu-60° ku-axis yeradial, futhi ingena ku-ulnar cortex eseduze nokuphuka.

Intambo ye-K yesithathu igxiliswe kucezu lwethambo le-fossa oluyinyanga engu-0.5 cm ubude emugqeni ohlangene wesihlakala, ophakathi kwengxenye yesine neyesihlanu ye-extensor. I-K-wire igxiliswe ohlangothini lwesundu lwerediyasi nge-engeli engu-45°, njengoba kuboniswe ku-Figure a kanye no-b ngezansi.

I-Classic percutaneous percutaneous wire Kirschner wire fixation of distal radius fractures iboniswa kuFigure ae ngezansi.

 

Ukunyakaza kweminwe ngemva kokulungiswa kwentambo ye-Kirschner nge-percutaneous kuboniswa ku-Figure ad ngezansi.

2. Izinyathelo zokuphepha kanye namasu okuhlinzwa

1.Uma i-K-wire ishelela emgodini we-medullary ngaphandle kokungena ku-contralateral cortex, ingase ibangelwe ukutsheka kakhulu lapho i-K-wire ingena. Kulokhu, abantu bavame ukuphakamisa izandla ukuze banciphise ukutsheka. Kodwa eqinisweni, okuphambene kuyiqiniso. I-K-wire izokwenziwa i-engeli futhi igotshwe ngendlela ye-concave, okuholela ekuhlulekeni kokubhoboza kwe-K-wire. Esikhundleni salokho, kufanele ibe yi-convex ngobumnene ibheke phezulu ngokusho kocingo lwe-K, njengoba kukhonjisiwe esithombeni esingezansi.

Ngocingo lwe-K olukhombe ngokuqondile phezulu, indawo yokungena yenziwa ku-distal cortex ngaphandle kwe-axial pressure, futhi ingangena ku-distal cortex. Kungenjalo, indawo yokufaka kufanele ishintshwe futhi iqalwe kusukela ekuqaleni (Izibalo ae ngezansi).

2.Ngendlela ye-Kapandji, izintambo ezimbili kuya kwezintathu ze-K zifakwa endaweni yokuphuka ukuze kuncishiswe futhi kulungiswe izingcezu zokuhlukana kwe-distal endaweni oyifunayo. Uma sezincishisiwe, izintambo ze-K zithuthukisiwe zibe yizicucu eziseduze (Figures af ngezansi).

3.Uma i-Kirschner wire entry kanye nezindawo zokuphuma ziseduze kakhulu nokuphuka, ukwehluleka ukulungisa kungase kwenzeke. Izintambo ezimbili zasemhlane we-Kirschner akufanele zidlule ku-palmar cortex ezingeni elifanayo, futhi indawo yokuphuma yesundu kufanele ibe ngu-2 cm ukusuka endaweni yokuphuka. Bona Izibalo ngezansi.

4. Uma i-dorsal cortex inyakaziswa kakhulu, zama ukungafaki indawo yokuphuka kwengxenye yethambo elikude, njengoba lokhu kungase kuholele ekuhlulekeni kokulungisa. Amanani ae ngezansi.

5. Nge-osteoporosis enzima, kungcono ukusebenzisa izintambo ezine kuya kwezinhlanu ze-Kirschner ukulungisa ukuphuka. Kwesinye isikhathi, ukuze kugcinwe ubude berediyasi, intambo ye-Kirschner ephambanayo isetshenziselwa ukulungisa i-distal radius bone block ku-distal ulna.

6. Ezingxenyeni ezinde zengxenye yokuphela kwe-epiphyseal, ucingo olukhulu lwe-Kirschner oluthambekele lungasetshenziselwa ukulungiswa. Kodwa-ke, intambo ye-Kirschner ingase ishelele ingene emgodini we-medullary futhi kunzima ukuyilungisa (Izibalo zesikhangiso ngezansi).

7. I-intra-articular bone fragment iyavulwa futhi ilungiswe ngentambo ye-Kirschner eguquguqukayo ngaphansi kwe-cartilage kuqala, bese ilungiswa ngezintambo ezintathu ze-Kirschner ze-percutaneous ngendlela evamile (Izibalo zesikhangiso ngezansi).

8. Ukuphuka okukhulu okuqhubekayo kwe-distal radius ephelezelwa ukufinyeza nokugoqa kudinga intambo eyengeziwe evundlayo ye-Kirschner ukuze idlule ku-ulna ukuze kugcinwe ukuphakama kwerediyasi. Intambo ye-Kirschner ikhombe kangcono ukusuka ohlangothini lwesundu lwenqubo ye-styloid ukuya ohlangothini lwe-ulna, njengoba kukhonjisiwe ku-Figure A kanye no-b ngezansi.

9. Ukuphuka kwesitayela se-Radial nokugudluka komgogodla. Ngemva kokuncishiswa, lungisa ngezintambo ezimbili ze-Kirschner zesitayela se-radial: enye ingemuva bese enye ibe ohlangothini lwesundu kuze kufike ekugcineni kwe-styloid. (Izibalo u-a no-b ngezansi)

10. Ukuqhekeka okunezingxenye ezine zerediyasi ekude, nokugudluka komgogodla kanye nokuhlukaniswa kwe-lunate fossa ohlangothini lwesundu. Intambo ye-Kirschner ingalungiswa kusukela ku-dorsal cortex ngendlela etshekile kusukela ekude kuya kucezu lwethambo le-metacarpal elikude. (Izibalo u-a no-b ngezansi).

11. Uma usebenzisa izintambo ze-dorsal ne-palmar Kirschner ukuze uphathe ukuhlukana okuphelile kwe-distal radius, uma ucezu lwesundu lwe-lunate fossa lungancishiswanga ngesikhathi sokuhlinzwa, ungasebenzisa indlela yesundu, sebenzisa i-vascular clamp ukuze uhlukanise ithambo, bese ufaka ucingo lwe-Kirschner olusuka ku-palcortex onqenqemeni lwe-palmentdor. (Izibalo ngezansi)

12. Ngokusobala kokuqhekeka kwe-distal radius okungenakuncishiswa ngokuncishiswa okuvaliwe, intambo ye-Kirschner engu-3 mm ingasetshenziswa ukuphakamisa ucezu lwe-distal fracture kusukela ngemuva ukuze kuzuzwe ukunciphisa (Amanani ah ngezansi).

13. Sebenzisa izilungisi zangaphandle ukuze welaphe ukuphuka okunciphile kwe-distal radius. Izilungisi zangaphandle zifanele ukuphuka okukhulu okuqhubekayo kwe-distal radius ehambisana nokuvuvukala okukhulu, ukuphuka okuvulekile, noma izimo zesikhumba zasendaweni ezingakuvumeli ukulungiswa kwangaphakathi (njengokulungiswa kwamapuleti) (Izikhangiso zezibalo ngezansi).

3. Vimbela izinkinga

1.Ukuze uvimbele ukulungiswa okungazinzile, qaphela imisebenzi elandelayo

Naka ukulungiswa kwe-bicortical.

Gwema ukubeka indawo yokuphuma yenaliti eseduze eduze nokuphuka.

Gwema zonke izintambo ze-Kirschner ezihlangana ekugcineni ukuze ugxilise amandla.

Qaphela ukuthi ugweme ukuphenduka okuxekethile lapho ugoba intambo ye-Kirschner.

Uma kwenzeka i-osteoporosis, ukulungiswa okwengeziwe kwe-Kirschner wire kuyadingeka.

2. Izinyathelo zokuvimbela ukutheleleka ngenaliti

Okokuqala usike isikhumba, uhlukanise izicubu ezithambile ethanjeni nge-clamp ye-vascular, bese usebenzisa ucingo lwe-Kirschner.

Geza kancane ukuze uvimbele i-thermal necrosis.

Gwema ukusebenza okuphindaphindiwe izikhathi eziningi kakhulu.

Yehlisa ingcindezi yocingo lwe-Kirschner esikhumbeni.