I-Distal Radius Fractures: Incazelo Ebanzi Kusukela Ku-Anatomy Kuya Ekuhlinzweni

Ukuphuka kwe-distal radius akhawunti ye-75% yokuphuka kwengalo yengalo futhi kuvame kakhulu emtholampilo. Kulesi sihloko, sihlanganise uhlu lwe-anatomy, ukuhlukaniswa, amasu okwelapha, nezindlela zokuhlinza zokuqhekeka kwe-distal radius ukuze uthole inkomba yakho.

Fingqa

Ukuphuka kwe-distal radius kuyingxenye yokuphuka kwezihlakala. ' Ithiyori yamakholomu amathathu' ingachaza kangcono indlela ye-pathological yokuphuka kwesihlakala, lapho ikholomu ye-radial, ehlanganisa i-radial tuberosity kanye ne-navicular fossa, ibalulekile ekugcineni ukuqina kwelunga lesihlakala.

Wonke ama-distal radius fractures, ngaphandle kokuphuka kwe-avulsion of the dorsal margin of the radius, empeleni kubangelwa udlame olunwetshwe ngokweqile. Isandla sibekwe ngendlela ehlukile uma senziwa amandla angaphandle, futhi imiphumela yamandla angaphandle ihlukile.

1.Udlame oluguquguqukayo lungabangela ukuhlukana kwe-intra- noma i-extra-articular displaced ekulimaleni okunamandla aphansi njengokuwa.

2.Ukucindezeleka kwe-Shear kungabangela ukugudluzwa okuyingxenye kwezindawo ze-articular ohlangothini lwesundu ngaleyo ndlela kuholele ekungazinzini.

I-3.Ekulimaleni kwamandla aphezulu, ubudlova bokucindezelwa bukhulu futhi ukulayisha ngokweqile kwe-axial kuholela ekucindezelweni kwethambo le-articular surface.

I-4.Indlela eyinhloko yokukhishwa kwe-fracture ukulimala kwe-avulsion lapho i-avulsed bone mass ngokuvamile i-attachment point point of a ligament.

I-Radiologic anatomy ye-distal radius

1.Amafilimu e-Anteroposterior (ubude be-radial, ukuchezuka kwe-ulnar, i-ulnar varus)

2. Amafilimu alandelanayo (ukuthambekela kwesundu)

Fernandez Classification

Thayipha i-Metaphyseal flexion fracture

Thayipha II I-Articular ne-Shear Fracture

Uhlobo lwe-III Lokuminyanisa Ukuphuka Kwe-Articular Surface

Thayipha i-IV yokuphuka kokuphuka kwesihlakala se-radial, ukugudluka

Thayipha I-V Mixed Fractures (Ama-High Energy Avulsion Fractures)

Izinkomba Zokuhlinza

Ama-fracture amaningi e-distal radius aphathwa nge-braking ngemva kokwehliswa okuvaliwe, ngeshwa okuningi kwalokhu kuphuka kuzosuswa noma ukuncishiswa ngeke kwamukeleke ngomphumela omubi.

Izinto ezinhlanu eziphazamisayo zikhonjwe nguLaFontaine et al:

① I-angulation yasekuqaleni yomgogodla > 20° (ukutsheka kwesundu);

② Ukuphuka okuphindaphindiwe kwe-dorsal epiphysis;

③ ukuphuka ekuhlanganyeleni;

④ Ukuphuka kwe-ulnar okuhlobene;

⑤ Iminyaka yobudala yesiguli > iminyaka engama-60.

Azikho izindinganiso eziqondile noma iziqondiso zokuqondisa ukwelashwa, futhi izinhlelo zokwelashwa zenziwa kucatshangelwa inani elikhulu lezici, okuhlanganisa izici zokulimala kokuqala, ukulinganisa ngemva kokubekwa kabusha, iminyaka yesiguli, ikhwalithi yamathambo, izidingo zesiguli, nemiphumela efiswayo.

Ngokuncishiswa okuvaliwe kokuphuka ngokuzinza okusolisayo, khona-ke ukulandelela okuseduze kuyanconywa. Kubalulekile ukuqaphela ukuthi uma uchungechunge lwama-x-ray ngemva kokunciphisa lubonisa ukungazinzi noma ukufuduka, khona-ke ukuguqulwa kokwelashwa kungase kudingeke. Uma ukuphuka kungase kungazinzi, khona-ke ama-radiographs kufanele athathwe futhi ahlolwe kuze kube yilapho ukuphuka sekupholile futhi kuzinzile.

Ukwelashwa Kwe-Conservative

Ukuphuka okuzinzile kungavalwa ngokuphumelelayo futhi kuphathwe ngokubhuleka, ekuqaleni ngokuhlukaniswa futhi kamuva nge-tubular cast, ngama-radiographs amasonto onke afika kumaviki angu-3.

Uma kwenzeka izinguquko eziphawulekayo ubude be-radial, ukuthambekela kwesundu, noma ukuchezuka kwe-ulnar, ukwelashwa kokuhlinzwa kufanele kucatshangelwe.

Ezigulini ezibuthakathaka nezingadingeki kakhulu, ukwelashwa okuvaliwe kuvame ukufaneleka, ngisho nalapho kuboniswa ukuhlinzwa.

Kuvaliwe ukusetha kabusha inaliti ye-percutaneous

Ukwehliswa okuvaliwe okulandelwa ukuphina nge-percutaneous kanye nokulungisa kuyasiza ekuqhekekeni kwe-distal radius nokungaqini kwe-metaphyseal noma ama-intra-articular fractures alula.

Isinyathelo sokuqala ukumisa kabusha kwe-anatomical, bese ukuzinza kunikezwa ngezikhonkwane zegram. Ngokuvamile iphinikhodi yokuqala idluliswa isuka ku-radial styloid iye ku-radial metaphysis medial kuya ku-diaphysis.

Okungenani izikhonkwane ezingu-2 zisetshenziselwa ukunikeza ukumisa kabusha okuzinzile okwanele endaweni ye-orthogonal ne-lateral, futhi i-facet yenyanga ingaphinwa uma ifunwa.

Ukuphina nge-intrafracture (inqubo ye-Kapanji) inikeza ukwesekwa komgogodla. I-postoperative immobilization in a splint isetshenziswa amaviki angu-2 ukulawula ukujikeleza nokunciphisa ukucasuka kwephini, ngemva kwalokho ingashintshwa ngokufaka i-forearm ethambile.

Ukulungiswa kukabakaki wokulungisa wangaphandle wokubuyisela okuvaliwe

Izikaki zokulungisa zangaphandle ziwusizo ekwelapheni kokuqala noma okuhambisanayo kumafractures athile e-distal radius.

I-fixator yangaphandle inciphisa ukucindezeleka kwe-axial okusebenza endaweni eyi-distal ngesikhathi sokufinyela kwamaqembu e-forearm muscle. Ukulungiswa kungase kube khona noma kungabi phezu kwengalo, noma ukulungiswa okwengeziwe kungase kwengezwe.

I-Parallel traction ayibuyiseli ngokugcwele ukuthambekela kwesundu, kodwa indawo emaphakathi iyamukeleka. Ngemuva kokuhlinzwa, isihlakala siboshwe nge-tubular cast endaweni engemuva ejikelezayo izinsuku ezingu-10 kuze kube yilapho ubuhlungu ne-edema kuncipha.

Ukulungiswa kwepuleti ngokusika nokubeka kabusha

1, Ukulungiswa kwangaphakathi kwepuleti le-Dorsal lokuphuka kwe-distal radius

Ukusika okuqondile kwenziwa eduze kwenodi ye-Lister, isiphetho esikude sinqamule umugqa ohlanganyelwe we-radial carpal futhi sigcine ngo-1 cm ukusondelana nesisekelo sokuhlangana kwesandla sesandla sesibili se-metacarpal. Umkhawulo osondelene unwebeka eduze kwesiqu se-radial ngo-3 kuya ku-4 cm, uveze ikholomu emaphakathi ngesisekelo sesikhawu se-extensor sesithathu.

2, Ipuleti lesundu ukulungiswa kwangaphakathi kokuhlukana kwe-distal radius

I-longitudinal incision yenziwa eduze kwe-tendon ye-radial carpal flexor, ne-tendon ye-bunion flexor etholakala endaweni ejulile ye-radial carpal flexor tendon, ehlehliswa ulnarly ukuze iveze i-anterior rotator ani muscle, futhi i-anterior rotator ani muscle ihlukaniswa ekuqaleni kwe-radial side futhi ihlehliselwe ukukhishwa kwe-radial ye-radial.

Ikesi ①

Ikesi ②

Ikesi ③

3. Ukulungiswa kwepuleti lokudonsa lokuphuka kwe-distal radius

- I-4-cm ye-longitudinal incision yenziwa i-dorsal kusiqu se-metacarpal sesithathu, futhi i-extensor tendon yomunwe ophakathi inkontileka ukuze iveze i-metacarpal yesithathu;

- Ukusika kwesibili okungu-4-cm kwenziwa okungenani u-4 cm emhlane kuya ku-radius encishisiwe;

- I-2-cm yesithathu yokusika idorsal yenziwa endaweni ye-Lister ukuze kuvezwe i-extensor hallucis longus tendon.

Kusukela ekusikweni kwe-distal, ipuleti lokudonsa lifakwa eduze kwendiza phakathi kwethenda enwetshiwe (indawo yesine yomgogodla), ikhepsuli ehlangene kanye ne-periosteum. I-extensor tendon ingasuswa uma kunesidingo.

4. Ukulungiswa okukodwa kokuqhekeka okushintshile kwerediyasi ekude ngokusekelwe ohlelweni lwe-TriMed