Hona jwale bakeng sa ho lokisa ka hare ho distal radius tse robehileng, ho na le ditsamaiso tse fapaneng tsa anatomical locking plate tse sebediswang kliniking. Di-internal plate tsena di fana ka tharollo e betere bakeng sa mefuta e meng e rarahaneng ya ho robeha, mme ka ditsela tse ding di atolosa matshwao a opereishene bakeng sa distal radius tse robehileng tse sa tsitsang, haholoholo tse nang le osteoporosis. Moprofesa Jupiter wa Massachusetts General Hospital le ba bang ba phatlaladitse letoto la dihlooho ho JBJS mabapi le diphihlello tsa bona mabapi le ho lokisa distal plate tsa distal radius tse robehileng le mekgwa e amanang le opereishene. Sengoloa sena se shebane le mokgwa wa opereishene wa ho lokisa distal radius tse robehileng tse itshetlehileng ka ho lokisa ka hare ho distal block e itseng ya ho robeha.
Mekhoa ea ho Buoa
Khopolo-taba ea likholomo tse tharo, e thehiloeng litšobotsing tsa biomechanical le tsa anatomiki tsa radius ea distal ulnar, ke motheo oa nts'etsopele le ts'ebeliso ea kliniki ea sistimi ea poleiti ea 2.4mm. Karohano ea likholomo tse tharo e bontšitsoe ho Setšoantšo sa 1.
Setšoantšo sa 1 Khopolo-taba ea likholomo tse tharo ea radius ea ulnar ea distal.
Kholomo e ka thoko ke karolo e ka thoko ea radius e ka thoko, ho kenyeletsoa le navicular fossa le radial tuberosity, e tšehetsang masapo a carpal ka lehlakoreng la radial 'me ke tšimoloho ea li-ligament tse ling tse tsitsitseng letsoho.
Kholomo e bohareng ke karolo e bohareng ea radius e ka thoko 'me e kenyelletsa lunate fossa (e amanang le lunate) le sigmoid notch (e amanang le distal ulna) holim'a articular. Ka tloaelo e jarisoa, mojaro o tsoang lunate fossa o fetisetsoa radius ka lunate fossa. Kholomo e ka thoko ea ulnar, e kenyeletsang distal ulna, triangolo fibrocartilage, le inferior ulnar-radial joint, e jara meroalo e tsoang masapong a carpal a ulnar hammoho le ho tsoa manonyellong a inferior ulnar-radial 'me e na le phello ea ho tsitsisa.
Mokhoa ona o etsoa tlas'a anesthesia ea brachial plexus 'me litšoantšo tsa X-ray tsa C-arm nakong ea opereishene lia hlokahala. Lithibela-mafu tse kenngoang ka har'a methapo li ile tsa fanoa bonyane metsotso e 30 pele ho qalo ea mokhoa ona 'me ho ile ha sebelisoa tourniquet ea pneumatic ho fokotsa ho tsoa mali.
Ho lokisa poleiti ea palema
Bakeng sa maqeba a mangata a robehileng, mokhoa oa palmar o ka sebelisoa ho bona ka mahlo a kelello pakeng tsa radial carpal flexor le radial artery. Kamora ho tseba le ho hula flexor carpi radialis longus, bokaholimo bo tebileng ba mesifa ea pronator teres boa bonoa 'me karohano e bōpehileng joaloka "L" ea phahamisoa. Maqeba a robehileng a rarahaneng haholoanyane, tendon ea brachioradialis e ka 'na ea lokolloa haholoanyane ho nolofatsa phokotso ea maqeba.
Phini ea Kirschner e kenngoa ka har'a lenonyello la carpal la radial, e thusang ho hlalosa meeli e ka thoko ea radius. Haeba ho na le boima bo bonyenyane ba ho robeha moeling oa articular, poleiti ea tšepe ea palmar ea 2.4mm e ka beoa holim'a moeli oa articular oa distal oa radius bakeng sa ho tiisa. Ka mantsoe a mang, boima bo bonyenyane ba ho robeha holim'a articular ea lunate bo ka tšehetsoa ke poleiti ea "L" kapa "T" ea 2.4mm, joalo ka ha ho bontšitsoe ho Setšoantšo sa 2.
Bakeng sa maqeba a kantle ho articular a tlositsoeng mokokotlong, ho molemo ho ela hloko lintlha tse latelang. Taba ea pele, ho bohlokoa ho seta botjha leqeba ka nakoana ho netefatsa hore ha ho na lisele tse bonolo tse kenelletseng pheletsong ea leqeba. Taba ea bobeli, ho bakuli ba se nang osteoporosis, leqeba le ka fokotsoa ka thuso ea poleiti: ea pele, skrufu e notlelang e beoa pheletsong e hōle ea poleiti ea anatomical ea palmar, e tiisitsoeng karolong ea leqeba e tlositsoeng e tlositsoeng, ebe likarolo tsa leqeba tse hōle le tse haufi lia fokotsoa ka thuso ea poleiti, 'me qetellong, liskrufu tse ling li beoa haufi le tsona.
SETSHWANTSHO SA 3 Ho robeha ha karolo e ka ntle ho articular ya radius e tlositsweng mokokotlong ho fokotsehile mme ho tsitsitswe ka mokhoa wa palmar. SETSHWANTSHO SA 3-A Kamora ho qeta ho pepesehela ka radial carpal flexor le radial artery, phini e boreleli ya Kirschner e kenngwa ka hara radial carpal joint. Setshwantsho sa 3-B Ho laola metacarpal cortex e tlositsweng ho e seta botjha.
Setšoantšo sa 3-C le Setšoantšo sa 3-DA phini e boreleli ea Kirschner e beoa ho tloha kutung ea radial ho pholletsa le mola oa ho robeha ho lokisa pheletso ea ho robeha ka nakoana.
Setšoantšo sa 3-E Pono e lekaneng ea tšimo ea ts'ebetso e fihlelleha ka ho sebelisa retractor pele ho beoa poleiti. Setšoantšo sa 3-F Mola o ka thoko oa li-screw tse notlelang o behiloe haufi le lesapo la subchondral qetellong ea lesoba le ka thoko.
Setšoantšo sa 3-G X-ray fluoroscopy e lokela ho sebelisoa ho netefatsa boemo ba poleiti le likurufu tse hole. Setšoantšo sa 3-H Karolo e haufi ea poleiti e lokela ho ba le sebaka se itseng (sekhutlo sa likhato tse 10) ho tloha diaphysis e le hore poleiti e ka khomareloa ho diaphysis ho tsosolosa hape block ea ho robeha e hole. Setšoantšo sa 3-I Matlafatsa screw ea ho proximal ho tsosolosa tšekamelo ea letsoho ea ho robeha e hole. Tlosa phini ea Kirschner pele screw e tiisoa ka botlalo.
Litšoantšo tsa X-ray tsa 3-J le 3-K tsa nakong ea opereishene li tiisa hore leqeba le ile la qetella le beiloe sebakeng se seng ka mokhoa oa 'mele 'me li-screw tsa poleiti li behiloe sebakeng se khotsofatsang.
Ho Tiisa Poleiti ea Mokokotlo Mokhoa oa ho buoa ho pepesa karolo ea mokokotlo ea radius ea distal o itšetlehile haholo-holo ka mofuta oa ho robeha, 'me tabeng ea ho robeha ka likarolo tse peli kapa ho feta tsa intra-articular fracture, sepheo sa kalafo ke haholo-holo ho lokisa likholomo tsa radial le tsa medial ka nako e le' ngoe. Nakong ea opereishene, li-band tsa tšehetso ea extensor li tlameha ho sehoa ka litsela tse peli tse kholo: ka bolelele likarolong tsa 2 le 3 tsa extensor, ka ho aroloa ha subperiosteal karolong ea 4 ea extensor le ho hula tendon e tsamaellanang; kapa ho sehoa ha bobeli ha lebanta la tšehetso pakeng tsa likarolo tsa 4 le 5 tsa extensor ho pepesa likholomo tse peli ka thoko (Setšoantšo sa 4).
Ho robeha hoa fetoloa 'me ho lokisoa ka nakoana ka phini ea Kirschner e sa khoeleng, 'me litšoantšo tsa radiographic li nkuoa ho fumana hore ho robeha ho tlositsoe hantle. Ka mor'a moo, lehlakore la dorsal ulnar (kholomo e bohareng) la radius le tsitsisoa ka poleiti ea 2.4 mm "L" kapa "T". Poleiti ea dorsal ulnar e bōpehile ho netefatsa hore e lekana hantle lehlakoreng la dorsal ulnar la radius e hōle. Lipoleiti li ka boela tsa beoa haufi le karolo ea dorsal ea lunate e hōle kamoo ho ka khonehang, kaha li-groove tse tsamaellanang ka tlase ho poleiti ka 'ngoe li lumella lipoleiti ho kobeha le ho bōptjoa ntle le ho senya likhoele tse masobeng a li-screw (Setšoantšo sa 5).
Ho lokisa poleiti ea kholomo ea radial ho bonolo haholo, kaha bokaholimo ba lesapo pakeng tsa likarolo tsa pele le tsa bobeli tsa extensor bo bataletse 'me bo ka tiisoa boemong bona ka poleiti e bōpehileng hantle. Haeba phini ea Kirschner e behiloe karolong e hōle ka ho fetisisa ea radial tuberosity, pheletso e hōle ea poleiti ea kholomo ea radial e na le mokoti o tsamaellanang le phini ea Kirschner, e sa sitiseng boemo ba poleiti le ho boloka ho robeha ho le sebakeng (Setšoantšo sa 6).
Setšoantšo sa 4 Ho pepeseha ha bokaholimo ba mokokotlo ba radius ea distal. Lebanta la tšehetso le buloa ho tloha karolong ea boraro ea extensor e kopaneng 'me tendon ea extensor hallucis longus e huloa.
Setšoantšo sa 5 Bakeng sa ho tiisa karolo ea mokokotlo oa bokaholimo ba articular ba lunate, poleiti ea mokokotlo ea "T" kapa "L" hangata e bōptjoa (Setšoantšo sa 5-A le Setšoantšo sa 5-B). Hang ha poleiti ea mokokotlo holim'a bokaholimo ba articular ba lunate e tiisitsoe, poleiti ea kholomo ea radial e tiisitsoe (Litšoantšo tsa 5-C ho isa ho 5-F). Lipoleiti tse peli li behiloe ka lehlakoreng la likhato tse 70 ho ea ho tse ling ho ntlafatsa botsitso ba ho tiisa ka hare.
Setšoantšo sa 6 Poleiti ea kholomo ea radial e bōpehile hantle 'me e behiloe kholomong ea radial, e hlokomelang sekheo qetellong ea poleiti, e leng se lumellang poleiti ho qoba ho tiea ha phini ea Kirschner ka nakoana ntle le ho sitisa boemo ba poleiti.
Likhopolo tsa bohlokoa
Matšoao a ho Lokisa Plate ea Metacarpal
Ho robeha ha methapo ea ...
Ho robeha ha masapo a sa laoleheng (ho robeha ha masapo a Colles le Smith). Ho tiea ho ka finyelloa ka li-screw plate esita le ha ho e-na le osteoporosis.
Ho robeha ha bokaholimo ba metacarpal lunate articular bo tlositsoeng sebakeng se itseng
Matšoao a ho tiisa poleiti ea mokokotlo
Ka kotsi ea ligament ea intercarpal
Ho robeha ha bokaholimo ba manonyeletso a mokokotlo a lelekiloeng sebakeng se le seng
Ho robeha ha manonyeletso a carpal a radial a sehiloeng lesapong la mokokotlo
Litšitiso tsa ho lokisa poleiti ea palema
Osteoporosis e matla e nang le mefokolo e meholo ea ts'ebetso
Ho robeha ha letsoho la mokokotlo ka lebaka la radial radial
Boteng ba mafu a mangata a amanang le bongaka
Litšitiso tsa ho lokisa poleiti ea mokokotlo
Mathata a mangata a bongaka
Maqeba a sa kang a falla sebakeng se itseng
Liphoso tse etsoang habonolo ho lokisoeng ha poleiti ea palema
Sebaka sa poleiti se bohlokwa haholo hobane poleiti ha e tshehetse feela boima ba ho robeha, empa ho bewa hantle ho boetse ho thibela skrufu e notlelang ya distal ho kena ka hara lenonyello la carpal la radial. Di-radiograph tse hlokolosi tsa nakong ya opereishene, tse hlahisitsweng ka lehlakoreng le le leng le sekametseng sa radial sa distal radius, di dumella pono e nepahetseng ya bokahodimo ba articular ba lehlakore la radial la distal radius, boo hape bo ka bontshwang ka nepo ka ho beha skrufu tsa ulnar pele nakong ya opereishene.
Ho kenella ha screw ea dorsal cortex ho na le kotsi ea ho qholotsa tendon ea extensor le ho baka ho phatloha ha tendon. Li-screw tse notlellang li sebetsa ka tsela e fapaneng le li-screw tse tloaelehileng, 'me ha ho hlokahale hore ho kene dorsal cortex ka li-screw.
Liphoso tse etsoang habonolo ka ho tiisa poleiti ea mokokotlo
Kamehla ho na le kotsi ea ho kenella ha sekurufu ka har'a lenonyello la carpal la radial, 'me joalo ka mokhoa o hlalositsoeng kaholimo mabapi le poleiti ea palmar, ho tlameha ho nkuoa setšoantšo se otlolohileng ho fumana hore na boemo ba sekurufu bo sireletsehile.
Haeba ho lokisoa ha kholomo ea radial ho etsoa pele, likurufu tse ho radial tuberosity li tla ama tlhahlobo ea ho lokisoa ho latelang ha bokaholimo ba articular ba lunate.
Dikurufu tse hole tse sa koaheloang ka botlalo ka hara lesoba la sekurufu di ka sisinya tendon kapa tsa baka ho phatloha ha tendon.
Nako ea poso: Tshitwe-28-2023
