I-distal radius fractures: incazelo ephelele evela ku-anatomy ukuyohlinzwa

I-distal radius radius fractures account ngo-75% we-forearm fractures futhi evame kakhulu emtholampilo. Kulesi sihloko, sihlanganise uhlu lwe-anatomy, ukuhlukaniswa, amasu okulashwa, kanye nezindlela zokuhlinza ekwakhiweni okuhlanekezelwe kwerevis radius.

Beka kafushane

Ama-fractures we-distal radius ayingxenye ye-Wrist Fractures. I- theory yekholoji ezintathu '

Yonke imisebe ye-distal radius, ngaphandle kokuqhekeka kwe-auvulsion of the rersal margin yerediyo, empeleni ibangelwa udlame lwe-overextension. Isandla sibekwe ngendlela ehlukile lapho senziwa ngamandla angaphandle, futhi imiphumela yamabutho angaphandle ahlukile.

Udlame lwe-1.flexion lungaholela ekuphumeni okubangelwa yi-intra- noma okungaphezulu kwe-abricular fractures ekulimaleni kwamandla aphansi njengokuwa.

Ukucindezela kwe-2.Shear kungaholela ekuthumeleni okuyingxenye kwezindawo ezibonakalayo ezihlangothini ze-Palmar ngaleyo ndlela kuholela ekungazinzileni.

3.I ukulimala kwamandla aphezulu, udlame lokucindezela lungaphambi kokulayishwa kwe-axial kuholela ekucindezelweni kwethambo le-articular sucali.

4.Indlela eyisisekelo yokudilizwa kwe-Fracture ukulimala kwe-avulsion lapho isisindo samathambo esivela khona imvamisa yindawo yokunamathisela ye-bony ye-ligament.

I-radiologic anatomy ye-distal radius

Amafilimu angu-1.Renophesteror (ubude obuphakeme, ukuphambuka kwe-ulnar, ulnar varias)

2. Amafilimu alandelayo (ukuthambekela kwe-Palmar)

Ukuhlukaniswa kukaFernandez

Thayipha i-Metaphyeeal Flexion Fracture

Uhlobo II abticular and shear waphuka

Uhlobo lwe-III Compression Fracture of Articular Surface

Uhlobo lwe-IV AVulchion Fracture of the radial Wrist, Disloanciation

Thayipha ama-fractures v ahlanganisiwe (amandla aphezulu we-avulsion fractures)

Izinkomba zokuhlinzwa

Iningi le-distal radius fractures liphathwa ngokubopha ngemuva kokuncishiswa okuvaliwe, ngeshwa iningi lalezi zinhlaka lizosuswa noma ukuncishiswa ngeke kwamukeleke ngomphumela ongemuhle.

Izici ezinhlanu zokuhlanza zikhonjwa nguLazontaine et AL:

① I-Dorsal Morsal Molarculation> 20 ° (Talmar Tilt);

I-Fracture ebekiwe ye-Dorsal Epiphysis;

③ Ukuqhekeka ekuhlanganiseni;

④ ehlobene ne-ulnar fracture;

Iminyaka yesiguli ineminyaka engama-60.

Awekho amazinga noma imihlahlandlela echazayo yokuqondisa ukwelashwa, kanye nezinhlelo zokwelashwa zenziwa kucatshangelwa inani elikhulu lezinto, kufaka phakathi izici zokulimala kokuqala, ukulinganisa ngemuva kokuphakamisa, iminyaka yokubekezela, izidingo zesiguli, kanye nemiphumela efiselekayo.

Ngokuncishiswa okuvaliwe kwama-fractures ngokuqina okusolwa ngakho, bese kunconywa ukulandela. Kubalulekile ukuqaphela ukuthi uma uchungechunge lwama-X-ray ngemuva kokuncishiswa kuphakamisa ukungazinzisi noma ukuthuthwa, khona-ke ushintsho ekwelashweni lungadingeka. Uma ukuqhekeka kungazinzile, khona-ke ama-radiographs kufanele athathwe futhi ahlolwe kuze kube yilapho ukuqhekeka kuphulukise futhi kuzinzile.

Ukwelashwa okulondoloziwe

Ama-flable fracties angavalwa ngempumelelo-futhi aphathwe nge-braking, ekuqaleni ngokufaka phakathi futhi kamuva ngesigaxa se-tubular, ngamaviki amasonto onke kuze kube amasonto amathathu.

Uma ushintsho oluphambili ngobude be-radial, ukuthambekela kwe-Palmar, noma ukuphambuka kwe-ulnar kwenzeka, kufanele kubhekwe ukwelashwa okuhlile.

Ezigulini ezibuthakathaka neziphansi, ukwelashwa okuvaliwe kuvame ukuhambisana, noma ngabe kuboniswa ukuhlinzwa.

Kuvaliwe ukusetha kabusha inaliti yenaliti

Ukuncishiswa okuvaliwe okulandelwa yi-Percutaneous Pinning kanye nokulungiswa kuwusizo ekuqhekekeni kwe-distal radius ukuphazamiseka ngokuqina kwe-metaphyeeli noma ukuqhekeka okulula kwe-intra-articular fractures.

Isinyathelo sokuqala ukuphindisela kwe-anatomical, khona-ke ukuzinza kunikezwe ngezikhonkwane zegramu. Imvamisa iphini lokuqala lidluliswa kusuka ku-styloid radial ku-radial metaphys medial kudayiso.

Kusetshenziselwa izikhonkwane ezimbalwa ezi-2 ukuhlinzeka ngezindawo ezizinzile ezizinzile ezikhundleni ze-orthogonal nasemuva, kanti i-lunate facet ingaphindwa uma ifuneka.

I-Intrafrature Pinning (Kapanji Technique) inikeza ukwesekwa kwe-dorsal. Ukungasebenzi kahle kwe-postoperative ku-splint kufakwa amaviki ama-2 ukulawula ukujikeleza nokunciphisa ukucasuka kwe-PIN, ngemuva kwalokho kungathathelwa indawo ngentambo ye-forearm ethambile.

Ukulungiswa kwe-bracket kwangaphandle okuvaliwe

Ukulungiswa kokulungiswa kwangaphandle kuyasiza ekwelashweni kokuqala noma kokukhunjulwa ku-Distal Radius Cractures ethile.

I-Finator yangaphandle ingathathitha izingcindezi ze-axial ezisebenza ngendlela edayisayo ngesikhathi sokugxekwa kwamaqembu emisipha engaphambili. Ukulungiswa kungenzeka noma kungahle kungabi ngaphesheya kwesihlakala, noma ukulungiswa okwengeziwe kungangezwa.

I-parallel tractions ayibuyiseli ngokuphelele ukuthambekela kwe-PalmAr, kepha ukungathathi hlangothi kuyamukeleka. Ngempela potrontoively, isihlakala sibhalwe phansi esimweni esijikelezayo se-tubular esimweni esijikelezayo sangemva kwezinsuku eziyi-10 kuze kube yilapho ubuhlungu ne-edema bencipha.

Ukulungiswa kwepuleti nge-incision kanye nokubuyisela kabusha

1, i-dorsal plate flocing yangaphakathi ye-distal radius fracture

I-incision eqondile yenziwa eceleni kwe-node ye-lister, ngokuphela kwesiphetho esiwela umugqa ohlangothini lwe-radial carpal kanye nokuphela kwe-1 cm proximal kuya kwisisekelo sesibili se-metacarpal wracarpal wracarpal wracarplal wracarplal wrist ihlanganisiwe. Ukuphela kweProximal kunwebeka eceleni kwesiqu se-radial ku-3 kuye ku-4 cm, kuveze ikholomu ephakathi esisekelweni sokuphumula kwesithathu.

2, ukulungiswa kwePalm Plate yangaphakathi ye-distal radius fracture

I-incitudinal incision yenziwa kanye ne-radial carpal flexor tendon, nge-bunion flexor tendon etholakala endaweni ejulile ye-radial carpal flexor tendon, futhi i-anterator rotator umsipha incike ekuqaleni kohlangothi lwe-radial futhi yabuyiselwa olnarly ukuveza isiphetho se-radial.

Icala ①

Icala ②

Icala ③

3. Ukulungiswa kwepuleti ye-traction ye-distal radius fracture

- Ukuvela okungu-4-cm okude kwenziwa i-dorsal ku-metacarpal yesithathu, futhi i-extensor tendon yomunwe ophakathi inenkontileka yokudalula i-metacarpal yesithathu;

- I-incision yesibili engu-4-cm yenziwa okungenani i-4 cm dorsal emsakanjini osusiwe;

- I-Dorsal Incision yesithathu yenziwe nge-node ye-lister ukuveza i-extensor hallucis tandon.

Ukusuka ekwakhiweni kwe-distal, ipuleti le-traction ifakiwe ngendiza eduze kwendiza phakathi kwe-extensor tendon (igumbi lesine le-dorsal), i-capsule ehlangene ne-periosteum kanye ne-periosteum. I-extensor tendon ingahanjiswa uma kunesidingo.

I-4. Ukulungiswa komuntu ngamunye kokuqhekeka okuvuthiwe kwe-distal radius kususelwa ohlelweni olunqunyiwe