1.Ngosipụta
1) .Mgbaji siri ike na-agbaji agbaji nwere nchụpụ doro anya, na-ebibikwa elu elu articular nke radius distal.
2) .Mbelata akwụkwọ ntuziaka dara ma ọ bụ nrụzi nke mpụga emeghị ka mbelata.
3) Agbaji agbaji.
4).Mgbaji malunion ma ọ bụ nonunion. ọkpụkpụ dị ugbu a n'ụlọ na ná mba ọzọ
2.Contraindications
Ndị agadi na-adịghị mma maka ịwa ahụ.
3. Usoro ịwa ahụ nhazi nke mpụga
1. Cross-articular mpụga fixator iji dozie mgbaji radius distal
Ọnọdụ na nkwadebe tupu ịwa ahụ:
· Brachial plexus anesthesia
· Ọnọdụ dị n'azụ na akụkụ aka ahụ emetụtara dị larịị n'elu ihe nrịbama na-ahụ ụzọ n'akụkụ akwa
Tinye ihe nlegharị anya na 1/3 nke ogwe aka elu
· nlele anya
Usoro ịwa ahụ
Ntinye Metacarpal Screw:
Nke mbụ ịghasa dị na ala nke abụọ metacarpal ọkpụkpụ. A na-eme mbepụ akpụkpọ ahụ n'etiti akwara extensor nke mkpịsị aka ndeksi na akwara interosseous azụ nke ọkpụkpụ mbụ. A na-eji ike ịwa ahụ kewapụ anụ ahụ dị nro. Aka uwe ahụ na-echebe anụ ahụ dị nro, a na-etinyekwa 3mm Schanz skru. kposara
Ntuziaka nke ịghasa bụ 45 ° na ụgbọ elu nke nkwụ, ma ọ bụ ọ nwere ike ịdị na ya na ụgbọelu nke nkwụ.
Jiri ntuziaka ka ịhọrọ ọnọdụ nke ịghasa nke abụọ. A chụbatara skru 3mm nke abụọ n'ime metacarpal nke abụọ.
Dayameta nke ntụtụ ndozi metacarpal ekwesịghị gafere 3mm. Ntụtụ ndozi dị na nso 1/3. Maka ndị ọrịa nwere osteoporosis, ihe nkedo kacha nso nwere ike banye n'ụdị cortex atọ (ọkpụkpụ metacarpal nke abụọ na ọkara cortex nke ọkpụkpụ metacarpal nke atọ). N'ụzọ dị otú a, ịghasa Ogwe aka na-edozi ogologo na nnukwu ihe nrụzi na-eme ka nkwụsi ike nke ndochi ahụ dịkwuo elu.
Ndokwa nke skru radial:
Mee mbepụ akpụkpọ anụ n'akụkụ mpụta nke radius, n'etiti akwara brachioradialis na muscle carpi radialis extensor, 3cm n'elu nso nso nke ahịrị mgbaji ahụ na ihe dịka 10cm dị nso na nkwonkwo nkwojiaka, ma jiri hemostat na-ekewapụ anụ ahụ subcutaneous n'elu ọkpụkpụ. A na-elezi anya iji chebe alaka dị elu nke akwara radial na mpaghara a.
N'otu ụgbọ elu dị ka skru metacarpal, a na-etinye skru 3mm Schanz n'okpuru nduzi nke mkpuchi anụ ahụ dị nro.
·. Mbelata mgbaji na ndozi:
·. Mbelata traction ntuziaka na C-arm fluoroscopy iji lelee mbelata nke mgbaji.
· .Mpụga mpụga gafee nkwojiaka nkwonkwo na-eme ka o siri ike kpamkpam weghachi palmar mmasị n'akuku, n'ihi ya, ọ nwere ike na-ejikọta ya na Kapandji atụdo aka na mbenata na fixation.
· Maka ndị ọrịa nwere mgbawa radial styloid, a pụrụ iji radial styloid Kirschner wire fixation.
· Ka ị na-ejigide mbelata, jikọọ onye na-emepụta ihe na-emepụta ihe na-eme ka ọ dị n'èzí ma tinye ebe ntụgharị ntụgharị nke onye na-emepụta ihe dị n'otu axis dị ka ebe ntụgharị nke nkwonkwo nkwojiaka.
·. Anteroposterior na lateral fluoroscopy, lelee ma ogologo radius, palmar inclination angle na ulnar deviation angle na-eweghachite, ma dozie akụkụ nhazi ahụ ruo mgbe mbelata mgbaji ahụ ga-eju afọ.
· Lezienụ anya na traction mba nke mpụga fixator, na-eme ka mgbaji iatrogenic na kposara metacarpal.
Ọkpụkpụ radius dị anya jikọtara ya na nkwonkwo redioulnar distal (DRUJ) nkewa:
Ọtụtụ DRUJ nwere ike ibelata n'otu oge mgbe mbelata radius dị anya.
· Ọ bụrụ na DRUJ ka na-ekewapụ mgbe a na-ebelata radius distal, jiri mbelata mkpakọ ntuziaka ma jiri mkpanaka mpụta nke mpụta mpụta.
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Mgbaji nke radius distal jikọtara ya na mgbaji ulnar styloid: Lelee nkwụsi ike nke DRUJ na pronation, nnọpụiche na nchikota nke ogwe aka. Ọ bụrụ na enweghị nkwụsi ike dị, enwere ike ijikwa eriri Kirschner nyere aka, nrụzi ligamenti TFCC, ma ọ bụ ụkpụrụ bandwit maka idozi Ulnar styloid usoro.
Zenarị ndọtị gabiga ókè:
· Lelee ma mkpịsị aka onye ọrịa nwere ike ime mmegharị mgbanwe na mgbatị ahụ zuru oke na-enweghị esemokwu doro anya; tụnyere oghere nkwonkwo rediolunate na oghere nkwonkwo midcarpal.
Lelee ma akpụkpọ ahụ dị n'ọwa ntu esiwo oke ike. Ọ bụrụ na ọ siri oke ike, mee mbepụ kwesịrị ekwesị ka ịzenarị ọrịa.
Gbaa ndị ọrịa ume ka ha na-emegharị mkpịsị aka ha n'oge, karịsịa ntụgharị na mgbatị nke nkwonkwo metacarpophalangeal nke mkpịsị aka, ntụgharị na mgbatị nke mkpịsị aka, na mgbatị.
2. Ndozi nke mgbawa radius distal na onye na-ahụ maka mpụga nke na-adịghị agafe nkwonkwo:
Ọnọdụ na nkwadebe tupu ịwa ahụ: Otu dị ka ọ dị na mbụ.
Usoro ịwa ahụ:
Ebe nchekwa maka itinye K-waya n'akụkụ azụ nke radius dị anya bụ: n'akụkụ abụọ nke tubercle Lister, n'akụkụ abụọ nke akwara extensor pollicis longus, na n'etiti eriri eriri digitorum communis extensor na eriri mkpịsị digiti minimi.
N'otu ụzọ ahụ, a na-etinye screws Schanz abụọ na radial shaft ma jikọta ya na mkpanaka njikọ.
Site na mpaghara nchekwa ahụ, a na-etinye screws Schanz abụọ n'ime iberibe mgbawa radius dị anya, otu site na akụkụ radial na otu site na azụ azụ, na akụkụ nke 60 ° ruo 90 ° na ibe ya. Ihe nkedo ahụ kwesịrị ijide cortex contralateral, ma ekwesịrị ịmara na ọnụ nke ịghasa nke etinyere n'akụkụ radial enweghị ike ịgafe na sigmoid notch wee banye na nkwonkwo redioulnar distal.
Jikọọ ihe nkedo Schanz na radius dị anya na njikọ gbagọrọ agbagọ.
Jiri mkpanaka njikọ etiti jikọọ akụkụ abụọ ndị gbajiri agbaji, ma kpachara anya ka ị ghara igbachi mkpọ ahụ nwa oge. Site n'enyemaka nke njikọ dị n'etiti, a na-ebelata nkebi dị anya.
Mgbe ịtọgharịa, kpọchie chack na mkpanaka njikọ iji mezue ikpeazụndozi.
Ọdịiche dị n'etiti onye na-ahụ maka mpụga na-abụghị nke jikọrọ ọnụ na onye na-eme ihe na-agafe agafe:
N'ihi na enwere ike itinye ọtụtụ screws Schanz iji mechaa mbelata na nhazi nke ọkpụkpụ ọkpụkpụ, ihe ngosi ịwa ahụ maka ndị na-emepụta ihe na-abụghị ndị na-emepụta ihe na-eme ka ndị na-emepụta ihe na-eme ka ndị na-emepụta ihe na-agafe agafe. Na mgbakwunye na mgbaji ọkpụkpụ nke ọzọ, a pụkwara iji ha mee ihe maka mgbaji nke abụọ ruo nke atọ. Ihe mgbawa n'ime akụkụ akụkụ.
Onye na-edozi ihe na-agafe agafe na-edozi nkwonkwo nkwojiaka na-adịghị ekwe ka mmega ahụ na-arụ ọrụ n'oge, ebe onye na-abụghị cross-njikọ mpụga na-enye ohere mgbatị nkwonkwo nkwonkwo n'oge mgbe ọ gasịrị.
Oge nzipu: Sep-12-2023
