Hona joale bakeng sa ho lokisa ka hare ho fractures ea distal radius, ho na le mekhoa e fapaneng ea ho notlela ea anatomical e sebelisoang tleliniking.Litokiso tsena tsa ka hare li fana ka tharollo e molemo bakeng sa mefuta e meng e rarahaneng ea fracture, 'me ka litsela tse ling li atolosa matšoao a ho buuoa bakeng sa fractures e sa tsitsang ea distal radius, haholo-holo ba nang le lefu la masapo.Moprofesa Jupiter oa Massachusetts General Hospital le ba bang ba phatlalalitse letoto la lingoloa ho JBJS mabapi le seo ba se fumaneng mabapi le ho lokisa poleiti ea ho notlela ea distal radius fractures le mekhoa e amanang le eona ea ho buoa.Sehlooho sena se lebisa tlhokomelo ho mokhoa oa ho buuoa oa ho lokisa li-fractures tsa distal radius tse thehiloeng ho lokisoa ka hare ho thibela e itseng ea fracture.
Mekhoa ea ho Buoa
Khopolo ea likholomo tse tharo, e ipapisitseng le litšobotsi tsa biomechanical le anatomical ea distal ulnar radius, ke motheo oa nts'etsopele le ts'ebeliso ea bongaka ea 2.4mm plate system.Karohano ea litšiea tse tharo e bontšitsoe setšoantšong sa 1.
Setšoantšo sa 1 Kholo-kholomo e meraro ea radius ea distal ulnar.
The lateral column ke halofo ea lateral ea distal radius, ho kenyelletsa le navicular fossa le radial tuberosity, e tšehetsang masapo a carpal ka lehlakoreng la radial 'me ke tšimoloho ea li-ligamente tse ling tse tsitsitseng letsoho.
Karolo e bohareng ke halofo e bohareng ea radius ea distal 'me e kenyelletsa lunate fossa (e amanang le khoeli e holimo) le notch ea sigmoid (e amanang le distal ulna) sebakeng sa articular.Ka tloaelo e laetsoe, mojaro o tsoang ho lunate fossa o fetisetsoa ho radius ka khoeli ea khoeli.Mokokotlo o ka morao, o kenyeletsang distal ulna, triangular fibrocartilage, le ulnar-radial joint e ka tlaase, e jara meroalo ho tloha masapong a ulnar carpal hammoho le ho tloha lenonyeletsong le tlaase la ulnar-radial 'me e na le phello e tsitsitseng.
Tsamaiso e etsoa tlas'a brachial plexus anesthesia le intraoperative C-arm X-ray imaging ke ea bohlokoa.Lithibela-mafu tse kenang ka methapong li ne li fanoa bonyane metsotso e 30 pele ho qala ts'ebetso 'me ho sebelisoa phepelo ea moea ho fokotsa mali.
Ho lokisa poleiti ea Palmar
Bakeng sa fractures tse ngata, mokhoa oa palema o ka sebelisoa ho bona ka mahlo a kelello pakeng tsa radial carpal flexor le radial artery.Ka mor'a ho khetholla le ho khutlisa flexor carpi radialis longus, bokaholimo bo tebileng ba mesifa ea pronator teres bo bonoa 'me karohano ea sebopeho sa "L" e phahamisoa.Ka fractures e rarahaneng haholoanyane, tendon ea brachioradialis e ka boela ea lokolloa ho thusa ho fokotsa ho robeha.
Pini ea Kirschner e kenngoa ka har'a motsoako oa radial carpal, e thusang ho hlalosa meeli ea distal-most ea radius.Haeba ho robeha ho honyenyane moeling oa articular ho le teng, poleiti ea tšepe ea palema ea 2.4mm e ka behoa holim'a moeli oa distal articular ea radius bakeng sa ho lokisoa.Ka mantsoe a mang, ho robeha ha boima bo fokolang holim'a khoeli ea khoeli ho ka tšehetsoa ke poleiti ea 2.4mm "L" kapa "T", joalokaha ho bontšitsoe setšoantšong sa 2.
Bakeng sa dorsally displaced extra-articular fractures, ho molemo ho ela hloko lintlha tse latelang.Ntlha ea pele, ke habohlokoa ho tsosolosa fracture ka nakoana ho etsa bonnete ba hore ha ho na lisele tse bonolo tse kentsoeng qetellong ea fracture.Taba ea bobeli, ho bakuli ba se nang lefu la ho fokola ha masapo, ho robeha ho ka fokotsoa ka thuso ea poleiti: pele, sekoti sa ho notlela se behiloe pheletsong e ka thoko ea poleiti ea anatomical ea palema, e sirelelitsoeng karolong e pharalletseng ea distal fracture, ebe distal le likarolo tsa proximal fracture li fokotsehile ka thuso ea poleiti, 'me qetellong, li-screw tse ling li behoa proximally.
FIGURE 3 Ho robeha ho hoholo ha sebaka sa marang-rang ho fokotsehile le ho ts'oaroa ka mokhoa oa palema.FIGURE 3-A Kamora ho phethoa ha ho pepeseha ka radial carpal flexor le radial artery, pin ea Kirschner e boreleli e kenngoa ka har'a motsoako oa radial carpal.Setšoantšo sa 3-B Ho qhekella ha metacarpal cortex e lelekiloeng ho e tsosolosa.
Setšoantšo sa 3-C le Setšoantšo sa 3-DA pin ea Kirschner e boreleli e behiloe ho tloha kutu ea radial ho pholletsa le mohala oa ho robeha ho lokisa ka nakoana qetello ea ho robeha.
Setšoantšo sa 3-E Pontšo e lekaneng ea tšimo ea ts'ebetso e finyelloa ka ho sebelisa retractor pele ho beha poleiti.FIGURE 3-F Mola oa distal oa li-screws tsa ho notlela o behiloe haufi le lesapo la subchondral qetellong ea lesapo la distal.
Setšoantšo sa 3-G X-ray fluoroscopy e lokela ho sebelisoa ho netefatsa boemo ba poleiti le distal screws.Setšoantšo sa 3-H Karolo ea proximal ea poleiti e lokela ho ba le tumello e itseng (angle ea 10 degree) ho tloha diaphysis e le hore poleiti e ka ts'oaroa ho diaphysis ho tsosolosa sebaka sa distal fracture block.Setšoantšo sa 3-I Tiisa screw proximal ho tsosolosa tšekamelo ea palema ea distal fracture.Tlosa pini ea Kirschner pele screw e tiisitsoe ka botlalo.
Lipalo 3-J le 3-K Litšoantšo tsa radiographic tsa Intraoperative li tiisa hore ho robeha ho ile ha qetella ho behiloe boemong ba anatomically 'me li-plate screws li behiloe ka mokhoa o khotsofatsang.
Dorsal Plate Fixation Mokhoa oa ho buoa oa ho pepesa karolo ea mokokotlo oa radius ea distal e itšetlehile haholo ka mofuta oa ho robeha, 'me tabeng ea ho robeha ho nang le likaroloana tse peli kapa ho feta tsa fracture ea intra-articular, sepheo sa phekolo ke haholo-holo ho lokisa ka bobeli. litšiea tsa radial le tse bohareng ka nako e le 'ngoe.Ka hare ho ts'ebetso, lihlopha tsa tšehetso tsa extensor li tlameha ho kenngoa ka litsela tse peli tse ka sehloohong: ka nako e telele karolong ea 2nd le 3rd extensor compartments, ka subperiosteal dissection ho ea 4th extensor compartment le ho khutlisetsoa morao ha tendon e lumellanang;kapa ea bobeli tšehetso sehlopha incision pakeng tsa 4th le 5th extensor compartments ho pepesa litšiea tse peli ka thoko (sa feiga. 4).
Ho robeha hoa qhekelloa mme ho lokisoa ka nakoana ka pin ea Kirschner e sa baleheng, 'me litšoantšo tsa radiographic li nkoa ho fumana hore fracture e falla hantle.Ka mor'a moo, karolo ea mokokotlo oa mokokotlo (kholomo e bohareng) ea radius e tsitsisoa ka poleiti ea 2.4 mm "L" kapa "T".The dorsal ulnar plate e bōpehile ho etsa bonnete ba ho lekana ka thata lehlakoreng la mokokotlo oa radius ea distal.Lipoleiti li ka boela tsa behoa haufi le karolo ea mokokotlo ea distal lunate ka hohle kamoo ho ka khonehang, kaha li-grooves tse lumellanang le karolo e ka tlaase ea poleiti e 'ngoe le e' ngoe li lumella lipoleiti hore li kobehe 'me li bōpehe ntle le ho senya likhoele tsa masoba a screw (Setšoantšo sa 5) .
Ho lokisoa ha poleiti ea radial column ho batla ho le bonolo, kaha bokaholimo ba lesapo pakeng tsa likarolo tsa pele le tsa bobeli tsa extensor bo batla bo bataletse 'me bo ka ts'oaroa sebakeng sena ka poleiti e bōpehileng hantle.Haeba pin ea Kirschner e behiloe karolong e feteletseng ea distal tuberosity ea radial, karolo ea distal ea radial column plate e na le groove e lumellanang le pin ea Kirschner, e sa sitiseng boemo ba poleiti le ho boloka ho robeha sebakeng. (Setšoantšo sa 6).
Setšoantšo sa 4 Ho pepeseha ha bokaholimo ba mokokotlo oa radius ea distal.Sehlopha sa tšehetso se buloa ho tloha karolong ea 3rd extensor interosseous compartment 'me tendon ea extensor hallucis longus e khutlisetsoa morao.
Setšoantšo sa 5 Bakeng sa ho lokisoa ha karolo ea mokokotlo ea sefahleho sa articular ea khoeli, "T" kapa "L" poleiti hangata e bōpehile (Setšoantšo sa 5-A le sa 5-B).Hang ha poleiti ea mokokotlo e holim'a articular ea khoeli e sirelelitsoe, poleiti ea radial column e sirelelitsoe (Lipalo 5-C ho ea ho 5-F).Lipoleiti tse peli li behoa ka lehlakoreng la likhato tse 70 ho tse ling ho ntlafatsa botsitso ba ho lokisa ka hare.
Setšoantšo sa 6 Letlapa la radial le bōpehile hantle 'me le behiloe ka har'a mohala oa radial, ho hlokomela notch qetellong ea poleiti, e lumellang poleiti ho qoba ho lokisoa ha nakoana ha pin ea Kirschner ntle le ho kena-kenana le boemo ba poleiti.
Likhopolo tsa bohlokoa
Lipontšo tsa Metacarpal Plate Fixation
Metacarpal intra-articular fractures e tlositsoeng (ho robeha ha Barton)
displaced extra-articular fractures (Colles le Smith fractures).Ho lokisa ho tsitsitseng ho ka finyelloa ka lipoleiti tsa screw esita le boteng ba lefu la masapo.
Ho robeha ha metsi ka holim'a metacarpal khoeli le khoeli
Lipontšo tsa ho lokisa poleiti ea mokokotlo
Ka leqeba la intercarpal ligament
Ho robeha ha bokaholimo ba lenonyeletso la mokokotlo oa lunate
Ho robeha ha lenonyeletso la mokokotlo oa mokokotlo oa mokokotlo oa mokokotlo oa mokokotlo
Li-contraindications ho lokisa poleiti ea palema
Osteoporosis e matla e nang le mefokolo e kholo ea ts'ebetso
Ho robeha ha mokokotlo oa letsoho la mokokotlo
Ho ba teng ha li-comorbidities tse ngata tsa bongaka
Contraindications ho dorsal plate fixation
Likokoana-hloko tse ngata tsa bongaka
Ho robeha ho se nang mahae
Liphoso tse entsoeng habonolo ka ho lokisa poleiti ea palema
Boemo ba poleiti bo bohlokoa haholo hobane poleiti ha e tšehetse feela boima ba ho robeha, empa boemo bo nepahetseng bo boetse bo thibela "distal locking screw" hore e se ke ea kena ka har'a motsoako oa radial carpal.Li-radial radiographs tse hlokolosi, tse hlahisitsoeng ka nqa e le 'ngoe le tšekamelo ea radial ea radius ea distal, li lumella pono e nepahetseng ea bokaholimo ba karolo ea radial ea distal radius, eo le eona e ka bonoang ka nepo ka ho beha li-screw tsa pele nakong ea sebaka sa marang-rang. ts'ebetso.
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-screws tsa ho notlela li sebetsa ka tsela e fapaneng le li-screw tse tloaelehileng, 'me ha ho hlokahale hore u kene ka har'a cortex ea mokokotlo ka li-screw.
Liphoso tse entsoeng habonolo ka dorsal plate fixation
Ka linako tsohle ho na le kotsi ea ho phunyeletsa ha screw ka har'a motsoako oa radial carpal, 'me ho tšoana le mokhoa o hlalositsoeng ka holimo mabapi le poleiti ea palema, ho tlameha ho nkoa ho thunngoa ho oblique ho fumana hore na boemo ba screw bo sireletsehile.
Haeba ho lokisoa ha kholomo ea radial ho etsoa pele, li-screws tsa radial tuberosity li tla ama tlhahlobo ea ho lokisoa ho latelang ha sebaka sa articular surface resurfacing ea lunate.
Li-screws tsa distal tse sa keneng ka ho feletseng ka har'a lesoba la screw li ka 'na tsa sisinya tendon kapa tsa baka ho phatloha ha tendon.
Nako ea poso: Dec-28-2023
