- 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
- Contraindications
Ndị agadi na-adịghị mma maka ịwa ahụ.
- Ndozi nke ime (ụzọ volar)
Nkwadebe tupu ịwa ahụ ọ bụla.A na-eme nhụsianya site na iji brachial plexus anesthesia ma ọ bụ nhụsianya izugbe
1) . A na-etinye onye ọrịa ahụ n'ọnọdụ dị ala na akụkụ ahụ emetụtara a tọọrọ ma tinye ya na etiti ịwa ahụ.A na-eme mbepụ 8cm n'etiti akwara radial nke ogwe aka ya na akwara flexor carpi radialis wee gbatịa ya na nkwojiaka nkwojiaka.Nke a nwere ike ikpughe mgbaji ahụ kpamkpam ma gbochie nkwekọrịta ọnya.Mbipu ahụ adịghị mkpa ịbanye n'ọbụ aka (Fig 1-36A).
2) Na-eso mbepụ na flexor carpi radialis tendon sheath (Nyocha 1-36B), meghee ọkpụkpụ akaị ahụ, gbanye achara achara dị omimi iji kpughee flexor pollicis longus, jiri mkpịsị aka mkpịsị aka na-arụ ọrụ flexor pollicis longus na flexor pollicis longus. ulnar n'akụkụ, ma hapụ akụkụ nke flexor pollicis longus.A na-ekpughe afọ ahụ nke ọma na akwara quadratus pronator (Foto 1-36C)
3) Mee nbibi nke yiri "L" n'akụkụ akụkụ radius na usoro radial styloid iji kpughee akwara pronator quadratus, wee wepụ ya na radius na peeler iji kpughee ahịrị mpịakọta achara dum (Njirimara 1). -36D, foto 1-36E)
4) .Tinye ihe mgbawa ma ọ bụ obere mma ọkpụkpụ site na eriri mgbaji, ma jiri ya dị ka ihe mgbawa iji belata mgbaji ahụ.Fanye dissector ma ọ bụ obere mma n'ofe ahịrị mgbajiri gaa n'akụkụ ọkpụkpụ azụ iji belata mkpakọ ma belata mgbaji ahụ dị anya, ma jiri mkpịsị aka na-akpakọba ọkpụkpụ azụ azụ iji belata mgbaji ọkpụkpụ azụ.
Mgbe ọkpụkpụ radial styloid gbajiri agbaji, ọ na-esiri ike ibelata mgbawa radial styloid n'ihi ịdọrọ nke muscle brachioradialis.Iji belata ike nke ịdọrọ, enwere ike ịmegharị brachioradialis ma ọ bụ kesaa ya na radius dị anya.Ọ bụrụ na ọ dị mkpa, enwere ike idobe iberibe ihe dị anya n'obere akụkụ ya na wires Kirschner.
Ọ bụrụ na usoro ulnar styloid na-agbaji ma na-apụ, na nkwonkwo redioulnar distal adịghị eguzosi ike, otu ma ọ bụ abụọ Kirschner wires nwere ike iji mee ihe maka nhazi nke ọma, na usoro ulnar styloid nwere ike ịtọgharịa site na njedebe volar.Mgbaji dị nta anaghị achọ ọgwụgwọ aka.Otú ọ dị, ọ bụrụ na nkwonkwo redioulnar distal adịghị eguzosi ike n'ihe mgbe edozichara radius ahụ, enwere ike ịpụpụ akụkụ styloid ahụ na akụkụ nke triangular fibrocartilage complex na-adaba na usoro ulnar styloid na arịlịka ma ọ bụ eriri silk.
5) . Site n'enyemaka nke traction, a pụrụ iji nkwonkwo capsule na ligament mee ka a hapụ intercalation ma belata mgbaji.Mgbe agbajichara ahụ belatara nke ọma, chọpụta ọnọdụ ntinye nke efere nchara volar n'okpuru nduzi nke X-ray fluoroscopy wee kụnye ihe nkedo n'ime oghere oval ma ọ bụ oghere na-amị amị iji kwado nhazi ọnọdụ (Fig 1-36F).Jiri oghere mgbịrịgba 2.5mm gwuo etiti etiti oghere oval, ma tinye skru 3.5mm nke onwe.
Ọgụgụ 1-36 Mwapụ akpụkpọ anụ (A);mbepụ nke flexor carpi radialis tendon sheath (B);na-akpụpụ akụkụ nke eriri mkpịsị aka iji kpughee akwara quadratus pronator (C);na-ekewa akwara quadratus pronator iji kpughee radius (D);ikpughe ahịrị mgbaji (E);tinye efere volar na ịghasa na nke mbụ (F)
6) .Jiri C-arm fluoroscopy iji kwado ntinye efere kwesịrị ekwesị.Ọ bụrụ na ọ dị mkpa, kpatụ efere ahụ n'ebe dị anya ma ọ bụ nso ka ị nweta ebe kacha mma nke mkpọsa ihe.
7) . Jiri 2.0mm na-egwupụta ihe na-egwupụta oghere na njedebe dị anya nke efere ígwè ahụ, tụọ omimi na ịghasa na mkpuchi mkpuchi.Ntu kwesịrị ịdị mkpụmkpụ 2mm karịa ebe a tụrụ atụ iji gbochie skru ịbanye na isi na cortex azụ azụ.N'ozuzu, ihe nkedo 20-22mm zuru ezu, na nke edoziri na usoro radial styloid kwesịrị ịdị mkpụmkpụ.Mgbe ị gachara na ịghasa nke dị anya, kpochie ya Fanye nke fọdụrụ nso skru.
N'ihi na a na-emepụta akụkụ nke ihe nkedo ahụ, ọ bụrụ na a na-etinye efere ahụ nso na njedebe dị anya, ihe nkedo ahụ ga-abanye na nkwonkwo nkwojiaka.Were tangential mpekere nke ọkpụkpụ subchondral articular site na coronal na sagittal ọnọdụ iji nyochaa ma ọ na-abanye na nkwonkwo, wee soro ntuziaka a Gbanwee efere ígwè na/ma ọ bụ kposara.
(Figure1-37) Ihe osise 1-37 Ndozi nke mgbawa radius distal na efere ọkpụkpụ volar A. Anteroposterior na mpụta X-ray film nke distal radius fracture tupu arụ ọrụ, na-egosi nkwụsịtụ nke njedebe dị anya na akụkụ volar;B. Ihe nkiri X-ray nke anteroposterior na mpụta nke mgbaji agbajichara, na-egosi mgbaji dị mma na mbelata nkwonkwo aka dị mma.
8) Suture pronator quadratus muscle na sutures na-adịghị absorbable.Rịba ama na akwara agaghị ekpuchi efere ahụ kpamkpam.Ekwesịrị ikpuchi akụkụ dị anya iji wedata kọntaktị dị n'etiti akwara mgbanwe na efere.Enwere ike nweta nke a site na ịkwanye pronator quadratus na nsọtụ brachioradialis, mechie oyi akwa nbipu site na oyi akwa, ma dozie ya na plasta ma ọ bụrụ na ọ dị mkpa.
Oge nzipu: Sep-01-2023
