Hona joale, fractures ea distal radius e tšoaroa ka litsela tse sa tšoaneng, tse kang plaster fixation, incision le ho fokotsa ho lokisa ka hare, ka ntle ho lokisa bracket, joalo-joalo Har'a bona, palmar plate fixation ka finyella liphello tse khotsofatsang haholoanyane, empa lingoliloeng tse ling li tlaleha hore tekanyo ea eona ea mathata e phahametse 16%. Leha ho le joalo, haeba poleiti e khethiloe ka nepo, sekhahla sa mathata se ka fokotsoa ka katleho. Kakaretso e khuts'oane ea mefuta, matšoao le mekhoa ea ho buoa ea ho roala lifate tsa palema bakeng sa fractures ea distal radius e hlahisoa.
I. Mefuta ea fractures ea distal radius
Ho na le litsamaiso tse 'maloa tsa likarolo tsa fractures, ho kenyelletsa le Müller AO classification e thehiloeng ho anatomy le sehlopha sa Femandez se ipapisitseng le mochini oa kotsi. Har'a bona, sehlopha sa Eponymic se kopanya melemo ea lihlopha tse fetileng, e akaretsa mefuta e mene ea motheo ea fractures, 'me e kenyelletsa Maleon 4-part fractures le Chaffer's fractures, e ka ba tataiso e ntle bakeng sa mosebetsi oa bongaka.
1. Sehlopha sa Müller AO - ho robeha ha karolo ea intra-articular
Sehlopha sa AO se loketse hantle ho robeha ha radius ea distal 'me e li arola ka mefuta e meraro e meholo: mofuta oa A extra-articular, mofuta oa B partial intra-articular, le mofuta oa C kakaretso ea ho robeha ha manonyeletso. Mofuta o mong le o mong o arotsoe hape ka lihlopha tse fapaneng tsa lihlopha tse thehiloeng ho boima le ho rarahana ha ho robeha.
Mofuta oa A: Ho robeha ho eketsehileng
A1, ho robeha ha ulnar femoral, radius e le kotsi (A1.1, fracture ea ulnar stem; A1.2 fracture e bonolo ea ulnar diaphysis; A1.3, comminuted fracture ea ulnar diaphysis).
A2, Ho robeha ha radius, e bonolo, e nang le inset (A2.1, radius ntle le ho sekamela; A2.2, mokokotlo oa mokokotlo oa radius, ke hore, Pouteau-Colles fracture; A2.3, palmar tilt of radius, ke hore, Goyrand-Smith fracture).
A3, Ho robeha ha radius, ho fokotsehile (A3.1, khutsufatso ea axial ea radius; Sekhechana sa radiase se bōpehileng joaloka A3.2; A3.3, ho robeha ha radius).
Mofuta oa B: ho robeha ha karolo e itseng ea articular
B1, ho robeha ha radius, sefofane sa sagittal (B1.1, mofuta o bonolo oa lateral; B1.2, mofuta oa lateral comminuted; B1.3, mofuta oa bohareng).
B2, Ho robeha ha mokokotlo oa mokokotlo oa radius, ke hore, ho robeha ha Barton (B2.1, mofuta o bonolo; B2.2, ho robeha ha lateral sagittal fracture; B2.3, ho ts'oaroa ha mokokotlo oa letsoho ho kopantsoeng).
B3, Ho robeha ha leqhubu la metacarpal la radius, ke hore, ho robeha ha anti-Barton, kapa ho robeha ha mofuta oa Goyrand-smith II (B3.1, molao o bonolo oa botšehali, sekhechana se senyenyane; B3.2, ho robeha ho bonolo, sekhechana se seholo; B3.3, ho robeha ho fokolang).
Mofuta oa C: ho robeha ha articular kakaretso
C1, fracture ea radial e nang le mofuta o bonolo oa libaka tse peli tsa articular le metaphyseal (C1.1, fracture ea morao-rao ea morao-rao; C1.2, fracture ea sagittal ea articular surface; C1.3, ho robeha ha coronal surface ea articular surface).
C2, Radius fracture, bonolo articular facet, comminuted metaphysis (C2.1, sagittal fracture ea articular facet; C2.2, coronal facet fracture ea articular facet; C2.3, articular fracture e fetela ho radial stem).
C3, radial fracture, comminuted (C3.1, fracture e bonolo ea metaphysis; C3.2, fracture fracture ea metaphysis; C3.3, articular fracture e fetela ho radial stem).
2.Classification ea distal radius fractures.
Ho ea ka mochine oa kotsi, sehlopha sa Femandez se ka aroloa ka mefuta e 5:.
Mofuta oa I oa fractures ke maqheka a extra-articular metaphyseal comminuted joalo ka Colles fractures (dorsal angulation) kapa Smith fractures (metacarpal angulation). Karolo ea lesapo le le leng e robeha tlas'a tsitsipano 'me cortex ea contralateral e comminuted le ho kenngoa.
Ho robeha
Ho robeha ha mofuta oa III ke fractures ea intra-articular, e bakoang ke khatello ea ho kuta. Lithako tsena li kenyelletsa fractures ea palema ea Barton, ho robeha ha mokokotlo oa Barton, le ho robeha ha radial stem.
Khatello ea ho kuta
Li-fractures tsa Mofuta oa III ke li-intra-articular fractures le ho kenngoa ha metaphyseal ho bakoang ke likotsi tsa khatello, ho kenyelletsa le ho senyeha ha li-articular fractures le radial pilon fractures.
Kenyeletso
Mofuta oa IV oa ho robeha ke ho robeha ha mokokotlo oa mokokotlo oa ligamentous o hlahang nakong ea fracture-dislocation ea radial carpal joint.
Avulsion fracture Ke dislocation
Mofuta oa V fracture o hlaha ka lebaka la kotsi e phahameng ea lebelo le amanang le matla a mangata a ka ntle le likotsi tse ngata. (Motsoako oa I, II, IIII, IV)
3.Eponymic typing
II.Kalafo ea distal radius fractures ka palmar plating
Lipontšo.
Bakeng sa fractures e eketsehileng ka mor'a ho hlōleha ha phokotso e koetsoeng maemong a latelang.
Ho theoha ha mokokotlo ho feta 20°
Khatello ea mokokotlo e kholo ho feta 5 mm
Ho khutsufatsa radius e kholo ho feta 3 mm
Distal fracture block displacement e kholo ho feta 2 mm
Bakeng sa fractures ea intra-articular e kholo ho feta 2mm displacement
Litsebi tse ngata ha li khothalletse tšebeliso ea lipoleiti tsa metacarpal bakeng sa likotsi tse matla haholo, tse kang ho robeha ho matla ha intra-articular comminuted fractures kapa tahlehelo e matla ea masapo, hobane likaroloana tsena tsa distal fracture li na le bothata ba ho ba le avascular necrosis 'me ho thata ho e beha ka mokhoa oa anatomically.
Ho bakuli ba nang le likhechana tse ngata tsa ho robeha le ho falla ho hoholo ho nang le lefu la ho fokola ha masapo, metacarpal plating ha e sebetse. Tšehetso ea subchondral ea distal fractures e ka 'na ea e-ba bothata, joalo ka ho kenella ka har'a sekoti se kopantsoeng.
Mokhoa oa ho buoa
Lingaka tse ngata tse buoang li sebelisa mokhoa o tšoanang le mokhoa oa ho lokisa fractures ea distal radius ka poleiti ea palema. Leha ho le joalo, ho hlokahala mokhoa o motle oa ho buoa ho qoba mathata ka mor'a ts'ebetso, mohlala, ho fokotseha ho ka finyelloa ka ho lokolla lesapo la fracture ho tloha khatellong e kentsoeng le ho tsosolosa ho tsoela pele ha lesapo la cortical. Tokiso ea nakoana e nang le 2-3 Kirschner pins e ka sebelisoa, joalo-joalo.
(I) Repositioning pele ho opereishene le boemo
1. Ho ts'oaroa ho etsoa ka tataiso ea "radial shaft" tlas'a fluoroscopy, 'me monoana o motona o hatella "proximal fracture block".
2. Boemo ba supine, le leoto le amehileng holim'a tafole ea letsoho tlas'a fluoroscopy.
(II) Libaka tsa phihlello.
Bakeng sa mofuta oa mokhoa o lokelang ho sebelisoa, PCR (radial carpal flexor) mokhoa o atolositsoeng oa palema o buelloa.
Qetello e hole ea lekhalo la letlalo e qala letlalong la letsoho la letsoho mme bolelele ba lona bo ka khethoa ho latela mofuta oa ho robeha.
The radial flexor carpi radialis tendon le sheath ea eona ea tendon e kentsoe, e le distal ho masapo a carpal le proximal haufi le lehlakoreng le haufi ka hohle kamoo ho ka khonehang.
Ho hula radial carpal flexor tendon ho ea lehlakoreng la ulnar ho sireletsa methapo ea bohareng le e rarahaneng ea tendon.
Sebaka sa Parona se pepesitsoe 'me mesifa ea anterior rotator ani e teng pakeng tsa flexor digitorum longus (lehlakoreng la ulnar) le methapo ea radial (lehlakore la radial).
Hlakola karolo ea radial ea anterior rotator ani muscle, u hlokomele hore karolo e lokela ho sala e khomaretsoe radius bakeng sa ho tsosolosoa hamorao.
Ho hula mesifa ea anterior rotator ani ho ea lehlakoreng la ulnar ho lumella ho pepeseha ka ho lekaneng ha lenaka la ulnar lehlakoreng la palema la radius.
Mokhoa oa palema o pepesa radius ea distal mme o pepesa ka nepo sekhutlo sa ulnar.
Bakeng sa mefuta e rarahaneng ea fracture, ho kgothaletswa hore setopo sa distal brachioradialis se lokolloe, se ka fokotsang ho hula ha eona ho radial tuberosity, ka nako eo sekoahelo sa palema sa kamore ea pele ea mokokotlo se ka kenngoa, se ka pepesang sebaka sa distal fracture block radial le radial tuberosity, ka hare ho potoloha radius Yu ho e senya, ebe e senya sebaka seo ho sona. thibela ho sebelisa phini ea Kirschner. Bakeng sa fractures e rarahaneng ea intra-articular, arthroscopy e ka sebelisoa ho thusa ho fokotsa, ho hlahloba le ho lokisa hantle ho thibela fracture block.
(III) Mekhoa ea ho fokotsa.
1. Sebelisa lesapo pry e le lever bakeng sa reset
2. Mothusi o hula index ea mokuli le menoana e bohareng, e tla ba bonolo ho e tsosolosa.
3. Hlakola phini ea Kirschner ho tloha ho radial tuberosity bakeng sa ho lokisa nakoana.
Ka mor'a hore ho behoa bocha ho phethoe, poleiti ea palema e behoa ka tloaelo, e tlamehang ho ba haufi le sebaka sa metsi, e tlameha ho koahela bokhabane ba ulnar, 'me e lokela ho ba haufi le bohareng ba kutu ea radial. Haeba maemo ana a sa finyelloe, haeba poleiti e se boholo bo nepahetseng, kapa haeba ho tsosolosoa ho sa khotsofatse, mokhoa ona o ntse o sa phethahala.
Mathata a mangata a amana ka matla le boemo ba poleiti. Haeba poleiti e behiloe hole haholo lehlakoreng la radial, mathata a amanang le bunion flexor a ka 'na a etsahala; haeba poleiti e behiloe haufi haholo le moeli oa metsi, flexor e tebileng ea monoana e ka ba kotsing. Ho senyeha ha sebaka sa ho robeha ha fracture ho lehlakoreng la palema ho ka etsa hore poleiti e fetele ka lehlakoreng la palema 'me e kopane ka ho toba le tendon ea flexor, e qetellang e lebisa ho tendonitis kapa esita le ho phatloha.
Ho bakuli ba osteoporotic, ho kgothaletswa hore poleiti e behoe haufi le moeli oa metsi ka hohle kamoo ho ka khonehang, empa eseng ka mose ho eona. Ho lokisa subchondral ho ka finyelloa ho sebelisoa lithakhisa tsa Kirschner tse haufi le ulna, 'me lithapo tsa Kirschner le li-screws tse koalang li sebetsa hantle ho qoba ho falla ha fracture.
Hang ha poleiti e behiloe ka nepo, pheletso ea proximal e ts'oaroa ka sekurufu se le seng 'me pheletso ea poleiti e ts'oaroe ka nakoana ka lithakhisa tsa Kirschner ka lesoba la ulnar haholo. Intraoperative fluoroscopic orthopantomograms, maikutlo a lateral, le lifilimi tsa morao-rao tse nang le bophahamo ba letsoho la 30 ° li ile tsa nkoa ho fumana hore na ho fokotseha ha fracture le boemo ba ho lokisa ka hare.
Haeba poleiti e behiloe ka mokhoa o khotsofatsang, empa pinana ea Kirschner e le intra-articular, sena se tla fella ka ho hlaphoheloa ho sa lekaneng ha tšekamelo ea palema, e ka rarolloang ka ho tsosolosa poleiti ho sebelisa "mokhoa oa ho lokisa fracture ea distal" (Setšoantšo sa 2, b).
Setšoantšo sa 2.
a, lithakhisa tse peli tsa Kirschner bakeng sa ho lokisoa ha nakoana, hlokomela hore tšekamelo ea metacarpal le libaka tsa articular ha lia tsosolosoa ka ho lekaneng sebakeng sena;
b, Pini e le 'ngoe ea Kirschner bakeng sa ho lokisa poleiti ea nakoana, hlokomela hore radius ea distal e tsitsitse sebakeng sena (mokhoa oa ho lokisa distal fracture block), 'me karolo e haufi ea poleiti e huleloa ho leba kutu ea radial ho tsosolosa sebaka sa palema se sekame.
C, tlhophiso e ntle ea Arthroscopic ea libaka tsa articular, ho behoa ha li-screws/pins tsa distal, le ho tsosolosa ha ho qetela le ho lokisa radius ea proximal.
Tabeng ea ho robeha ha mokokotlo le mokokotlo oa mokokotlo (ulnar / dorsal Die Punch), e ke keng ea tsosolosoa ka mokhoa o lekaneng tlas'a ho koaloa, mekhoa e meraro e latelang e ka sebelisoa.
Sebaka sa proximal radius se pota-potiloe ka ntle ho tloha sebakeng sa fracture, 'me sebaka sa ho robeha ha fossa ea lunate se sutumetsoa ho lesapo la carpal ka mokhoa oa ho lelefatsa oa PCR; sekoa se senyenyane se etsoa mokokotlong ho ea karolong ea 4 le ea 5 ho pepesa sekoahelo sa fracture, 'me se kentsoe ka sekoti ka har'a foramen ea ulnar ea poleiti. Ho koaloa ha percutaneous kapa ho fokotseha ho fokolang ho ile ha etsoa ka thuso ea arthroscopic.
Ka mor'a ho tsosolosa ka mokhoa o khotsofatsang le ho beha poleiti ka tsela e nepahetseng, ho lokisa ho qetela ho bonolo 'me ho behoa bocha ha anatomical ho ka finyelloa haeba pin ea proximal ulnar kernel e behiloe ka nepo 'me ha ho na li-screw tse ka har'a lesoba le kopantsoeng (Setšoantšo sa 2).
(iv) Boiphihlelo ba khetho ea Screw.
Bolelele ba li-screws bo ka ba thata ho lekanya ka nepo ka lebaka la ho sithabela ho matla ha dorsal cortical bone. Li-crews tse telele haholo li ka lebisa ho tsitsinyeheng ha tendon le ho khutsufatsa haholo ho tšehetsa ho lokisoa ha mokokotlo oa mokokotlo oa mokokotlo. Ka lebaka lena bangoli ba khothaletsa tšebeliso ea lipekere tse notletsoeng tse notletsoeng le lipekere tsa ho notlela multiaxial ka har'a radial tuberosity le foramen e ngata ea ulnar, le ts'ebeliso ea li-screws tsa ho notlela tse bobebe libakeng tse setseng. Tšebeliso ea hlooho e hlabang e qoba ho tsitsinyeha ha tendon esita le haeba e kentsoe mokokotlong. Bakeng sa ho lokisa poleiti ea proximal interlocking, li-screw tse peli tse hokahaneng + screw e le 'ngoe e tloaelehileng (e behiloeng ka ellipse) e ka sebelisoa bakeng sa ho lokisa.
Ngaka Kiyohito oa Fora o hlahisitse boiphihlelo ba bona ba ho sebelisa lipoleiti tse notlellang tsa palema bakeng sa fractures ea distal radius, moo ho seha ha bona ho fokotsehileng ho fihla ho 1cm e feteletseng, e leng ntho e hananang. Mokhoa ona o bontšoa haholo-holo bakeng sa fractures e batlang e tsitsitse ea distal radius, 'me lipontšo tsa eona tsa ho buuoa ke tsa ho robeha ho eketsehileng ha likaroloana tsa AO tsa mefuta ea A2 le A3 le li-intra-articular fractures tsa mefuta ea C1 le C2, empa ha e tšoanelehe bakeng sa fractures ea C1 le C2 e kopantsoeng le lesapo la intra-artipse. Mokhoa ona o boetse ha o loketse mefuta ea B fractures. Bangoli ba boetse ba bontša hore haeba phokotso e ntle le ho lokisoa li ke ke tsa finyelloa ka mokhoa ona, hoa hlokahala hore u fetohele mokhoeng o tloaelehileng oa ho khaola le ho se khomarele mokhoa o fokolang o fokolang.
Nako ea poso: Jun-26-2024
