Metacarpal phalangeal fractures ke ho robeha ho tloaelehileng ha ho sithabela ha letsoho, ho nka karolo ea 1/4 ea bakuli ba nang le ts'oaetso ea letsoho. Ka lebaka la sebopeho se thata le se rarahaneng sa letsoho le ts'ebetso e bonolo ea ho sisinyeha, bohlokoa le botekgeniki ba kalafo ea ho robeha ha letsoho li rarahane ho feta kalafo ea ho robeha ha masapo a malelele. Ho netefatsa botsitso ba ho robeha ka mor'a ho fokotseha ke senotlolo sa phekolo e atlehileng ea fractures ea metacarpal phalangeal. E le ho tsosolosa mosebetsi oa letsoho, hangata fractures e hloka ho lokisa ho loketseng. Nakong e fetileng, samente ea ka ntle ea samente kapa terata ea Kirschner ea ka hare e ne e sebelisoa hangata, empa hangata ha e thuse ho koetlisoa ka mor'a ho sebetsa ka mor'a ts'ebetso ka lebaka la ho lokisoa ka mokhoa o sa nepahaleng kapa nako e telele ea ho lokisa, e nang le tšusumetso e kholo ho tsosolosoa ha mosebetsi oa manonyeletso a monoana le ho tlisa mathata a itseng ho tsosolosoa ha letsoho. Mekhoa ea sejoale-joale ea kalafo e ntse e sebelisoa ka matla ho lokisa ka hare, joalo ka micro-plate screw fixation.
I.Melao-motheo ea phekolo ke efe?
Melao-motheo ea phekolo ea letsoho la metacarpal le phalangeal fractures: ho fokotseha ha anatomical, ho lokisa leseli le ho tiisa, mesebetsi ea pele le koetliso ea ts'ebetso. Melao-motheo ea phekolo bakeng sa fractures ea intra-articular le peri-articular ea letsoho e tšoana le ea fractures tse ling tsa intra-articular, tseo hape e leng ho tsosolosa anatomy ea bokaholimo ba motsoako le mesebetsi ea pele ea ts'ebetso. Ha ho phekoloa letsoho la metacarpal le phalangeal fractures, boiteko bo lokela ho etsoa ho finyella phokotso ea anatomical, le ho potoloha, lateral angulation, kapa displacement angular ea> 10 ° ho karolo ea mokokotlo oa palema ha ea lokela ho etsahala. Haeba pheletso ea fracture ea phalange ea metacarpal e potoloha kapa e falla ka mahlakoreng ka mahlakoreng, e tla fetola mokhoa oa mokhoa o tloaelehileng oa ho phunya le ho atolosa monoana, o etsa hore o fetohe kapa o oe ka monoana o haufi nakong ea ho phunya, ho ama ho nepahala ha mosebetsi oa monoana; 'me ha ho falla ha angular ho karolo ea mokokotlo oa palema ke> 10 °, sebaka se boreleli sa ho kopana pakeng tsa lesapo le tendon se senyeha, ho eketsa ho hanyetsa le mefuta e mengata ea ho sisinyeha le ho atolosoa ha tendon, le tšenyo e sa foleng ea tendon e etsahala, ho baka kotsi ea ho phatloha ha tendon.
II.Ke lisebelisoa life tse ka khethoang bakeng sa fractures ea metacarpal?
Ho na le lisebelisoa tse ngata tsa ho lokisa ka hare bakeng sa fractures ea metacarpal, tse kang lithapo tsa Kirschner, li-screw, lipoleiti le li-fixator tse ka ntle, tseo har'a tsona lithapo tsa Kirschner le li-microplates li sebelisoang ka ho fetisisa. Bakeng sa fractures ea metacarpal, ho lokisa microplate ka hare ho na le melemo e totobetseng ho feta ho lokisa mohala oa Kirschner 'me e ka sebelisoa pele; bakeng sa fractures ea proximal phalanx, li-microplates ka kakaretso li phahame, empa ha ho le thata ho kenya li-screws bakeng sa proximal phalanx distal segment le hlooho ea fractures, sefapano sa Kirschner terata ka hare se lokela ho sebelisoa, e leng se loketseng haholoanyane ho hlaphoheloa ha mosebetsi oa monoana o amehileng; Lithapo tsa Kirschner li lokela ho sebelisoa pele bakeng sa phekolo ea fractures e bohareng ea phalanx.
- Kirschner wire:Kirschner wire fixation e 'nile ea sebelisoa ts'ebetsong ea bongaka ka lilemo tse fetang 70' me esale e le lisebelisoa tsa ka hare tse sebelisoang ka ho fetisisa bakeng sa metacarpal le phalangeal fractures. E bonolo ho e sebetsa, e na le chelete ebile e sebetsa, 'me ke mokhoa oa khale ka ho fetisisa oa ho lokisa ka hare. E le mokhoa o tloaelehileng oa ho lokisa ka hare bakeng sa phekolo ea ho robeha ha matsoho, e ntse e sebelisoa haholo. Melemo ea ho lokisa terata ea Kirschner: ① Ho bonolo ho sebetsa ebile ho bonolo ho e sebelisa; ② Ho fokotseha ho fokolang ha lisele tse bonolo, tšusumetso e fokolang ea phepelo ea mali ea ho robeha ha fracture, khatello e fokolang ea ho buuoa, le ho thusa ho folisa ho robeha; ③ Ho bonolo ho tlosa nale ka lekhetlo la bobeli; ④ Theko e tlase le mefuta e mengata ea ts'ebeliso, e loketseng ho robeha ha matsoho a mangata (joalo ka fractures ea intra-articular, fractures e matla ea comminuted le distal phalangeal fractures).
2.Metacarpophalangeal microplates: Ho lokisa ka hare ho matla ka hare ho fractures ea matsoho ke motheo oa koetliso ea pele ea ts'ebetso le boemo bo hlokahalang bakeng sa ho tsosolosa mosebetsi o motle oa matsoho. Theknoloji ea ho lokisa ka hare ea AO e hloka hore qetello ea fracture e behoe ka mokhoa o nepahetseng ho ea ka sebopeho sa anatomical le hore fracture e qetella e tsitsitse tlas'a maemo a sebetsang, ao ka tloaelo a tsejoang e le fixation e matla, e le ho lumella mokhatlo oa pele o sebetsang. AO e boetse e totobatsa ts'ebetso ea opereishene e fokolang haholo, e tsepamisitse maikutlo ho sireletseng phepelo ea mali. Ho lokisa ka hare ho microplate bakeng sa phekolo ea ho robeha ha matsoho ho ka finyella liphello tse khotsofatsang ho latela matla, botsitso ba ho robeha ha lipheletso, le khatello pakeng tsa ho robeha ho fela. Mabapi le ho hlaphoheloa ka mor'a ts'ebetso ea ts'ebetso, nako ea pholiso ea fracture, le sekhahla sa tšoaetso, ho lumeloa hore katleho ea lipoleiti tsa microtitanium e molemo haholo ho feta ea lithapo tsa Kirschner. Ho feta moo, kaha nako ea pholiso ea ho robeha ka mor'a ho lokisoa ka lipoleiti tsa microtitanium e khutšoanyane haholo ho feta ea mekhoa e meng ea ho lokisa, ho molemo hore bakuli ba qale ho phela bophelo bo tloaelehileng pele ho nako.
(1) Melemo ea microplate internal fixation ke efe?
① Ha ho bapisoa le lithapo tsa Kirschner, lisebelisoa tsa microplate screw li na le kamano e ntle ea lisele le karabelo e ntle ea lisele; ② Ho tsitsisa ha mokhoa oa ho lokisa li-plate-screw le khatello ea ho qetela ea ho robeha ho etsa hore fracture e be haufi le ho fokotseha ha anatomical, ho lokisoa ho sireletsehileng haholoanyane, le ho thusa ho folisa fracture; ③ Boikoetliso ba pele bo sebetsang hangata bo lumelloa ka mor'a ho lokisoa ha microplate, e leng se thusang ho hlaphoheloa ha mosebetsi oa matsoho.
(2)Mokhoa oa ho buoa li-microplates ke ofe?
Hangata opereishene e etsoa tlas'a anesthesia ea brachial plexus block, 'me hangata ho hlokahala hore ho be le tourniquet pneumatic. Ho nkiloe mokokotlo oa mokokotlo oa metacarpal phalanges, dorsal aponeurosis ea linomoro e khaoloa kapa mesifa e tebileng le lesapo la metacarpal li kenngoa ho pepesa lipheletsong tsa ho robeha ha masapo a metacarpal kapa phalangeal, periosteum e eboloa, 'me ho robeha ho fokotsehile tlas'a pono e tobileng. Lipoleiti tse otlolohileng li loketse ho robeha ha karolo e bohareng ea karolo e bohareng le fractures e khutšoanyane ea oblique, li-T-plates li loketse ho lokisa motheo oa metacarpal le phalanges, 'me T-plates kapa 120 ° le 150 ° L-plates li loketse ho lokisoa ha fractures e telele ea oblique le e fokolang. Hangata poleiti e behoa ka lehlakoreng la mokokotlo oa lesapo ho thibela ho thella ha tendon le ho apara nako e telele, e leng se loketseng koetliso ea pele ea ts'ebetso. Bonyane li-screw tse peli li lokela ho sebelisoa ho lokisa lipheletsong tse peli tsa ho robeha, ho seng joalo botsitso ha bo bobe, 'me lithapo tsa Kirschner kapa li-screws tse ka ntle ho poleiti lia hlokahala ho thusa ho lokisa ho finyella sepheo sa ho tsitsisa ho tsitsitseng.
3.Li-screws tse nyane: Li-screws tse nyenyane li na le botsitso bo ts'oanang le lipoleiti tsa tšepe ha ho etsoa fractures ea spiral kapa e telele ea oblique, empa mefuta e mengata ea lithane tse bonolo le periosteum stripping e nyenyane ho feta ea tšepe ea tšepe, e leng se loketseng ho sireletsa phepelo ea mali le ho lumellana le khopolo ea ts'ebetso e fokolang haholo. Le hoja ho na le lipoleiti tsa mofuta oa T le mofuta oa L bakeng sa fractures e haufi le articular, ho tsosolosoa ha mosebetsi oa manonyeletso ka mor'a ts'ebetso ea morao-rao e mpe ho feta ea ho robeha ha diaphyseal. Li-screws tse nyenyane li boetse li na le melemo e itseng ho lokisoeng ha fractures ea intra-articular le peri-articular. Li-screws tse kenngoeng ka har'a lesapo la cortical li ka mamella boima bo boholo ba khatello ea kelello, kahoo ho lokisoa ho tiile, 'me lipheletso tsa fracture li ka hatelloa ho etsa hore sebaka sa fracture se kopane haufi-ufi, se khutsufatse nako ea ho folisa fracture le ho thusa ho folisa ho robeha, joalokaha ho bontšitsoe setšoantšong sa 4-18. Mini screw ka hare ho fixation ea matsoho fractures haholo-holo sebelisoa bakeng sa oblique kapa spiral fractures ea diaphyseal le intra-articular avulsion fractures ea masapo a maholoanyane. Hoa lokela ho hlokomeloa hore ha u sebelisa li-screws tse nyenyane feela ho lokisa fractures ea oblique kapa ea spiral ea lesapo la diaphyseal la letsoho, bolelele ba mohala oa fracture e lokela ho ba bonyane habeli bophara ba lesapo la diaphyseal, 'me ha ho lokisoa li-blocks tsa avulsed fracture ka kopanelo, bophara ba lesapo la lesapo e lokela ho ba bonyane makhetlo a 3 bophara ba khoele.
4. Micro fixator ea kantle:Ka linako tse ling ho senyeha ha metacarpal phalangeal ho thata ho fokotsa kapa ho ke ke ha e-ba thata ho tiisa ka hare ho eona esita le ka mor'a ho buuoa ka lebaka la ho senyeha ha tšehetso ea masapo. Fixator ea ka ntle e ka tsosolosa le ho boloka bolelele ba ho robeha ha comminuted tlas'a ts'ebetso, ho bapala karolo ea ho lokisa ho lekanyelitsoeng. Li-fixator tse fapaneng tsa metacarpal phalangeal kantle li behiloe maemong a fapaneng: 1st le 2nd metacarpal phalanges li behiloe ka lehlakoreng la dorsal radial, 4th le 5th metacarpal phalanges li behiloe ka lehlakoreng la mokokotlo oa mokokotlo, 'me 3rd metacarpal phalange e behiloe lehlakoreng la mokokotlo kapa lehlakoreng la mokokotlo. Ela hloko ntlha ea ho kenya nale ho thibela tšenyo ea tendon. Li-fractures tse koetsoeng li ka fokotsoa tlas'a X-rays. Ha phokotso e sa nepahale, ho ka etsoa sekhahla se senyenyane ho thusa ho fokotsa.
Melemo ea li-fixator tsa kantle ke efe?
① Opereishene e bonolo, e ka fetola phallo e fapaneng ea lipheletso tsa fracture; ② E khona ho fokotsa le ho lokisa fractures ea intra-articular ea masapo a metacarpophalangeal ntle le ho senya bokaholimo bo kopaneng, 'me e ka sitisa bokaholimo bo kopaneng ho thibela konteraka ea capsule e kopaneng le ligament ea collateral ligament; ③ Ha li-fractures tse entsoeng li ke ke tsa fokotsoa ka mokhoa oa anatomically, li ka kopanngoa le ho lokisoa ho fokolang ka hare, 'me sekontiri se ka ntle se ka fokotsa le ho boloka moeli oa matla; ④ Lumella ho ikoetlisa pele ho nako ea monoana o amehileng lenonyeletsong le sa tsitsang ho qoba ho satalla ha manonyeletso le lefu la ho fokola ha masapo; ⑤ E ka lokisa ka katleho ho robeha ha matsoho ntle le ho ama phekolo ea ka morao ea leqeba letsohong le amehileng.
Nako ea poso: Dec-21-2024
