Ntugharị ntụgharị na obere ma ọ bụ enweghị nkwubi okwu: n'ihe gbasara mgbaji nke ọkpụkpụ metacarpal (olu ma ọ bụ diaphysis), tọgharịa site na traction ntuziaka. A na-emegharị phalanx dị nso iji kpughee isi nke metacarpal. A na-eme mbepụ ntụgharị nke 0.5-1 cm ma na-atụgharị akaị na-agbatị ogologo ogologo n'etiti ahịrị. N'okpuru ntụzịaka fluoroscopic, anyị tinyere waya ntuziaka 1.0 mm n'akụkụ axis ogologo nke nkwojiaka. Akụchapụrụ ọnụ ọnụ ụzọ ntụzịaka ahụ ka ịzenarị ntinye cortical na iji kwado mbanye n'ime ọwa mmiri medullary. Mgbe emechara ọnọdụ ntuziaka ahụ n'ụzọ fluoroscopically, a na-emegharị efere ọkpụkpụ subchondral site na iji naanị obere mkpọpu oghere. A gbakọrọ ogologo ịghasa kwesịrị ekwesị site na onyonyo tupu eme ya. N'ọtụtụ mgbawa metacarpal, ewezuga metacarpal nke ise, anyị na-eji skru dayameta 3.0mm. Anyị na-eji AutoFIX enweghị isi oghere oghere (obere Ọkpụkpụ Innovations, Morrisville, PA) . Ogologo kachasị eji eme ihe nke 3.0-mm screw bụ 40 mm. Nke a dị mkpụmkpụ karịa nkezi ogologo nke ọkpụkpụ metacarpal (ihe dị ka 6.0 cm), mana ogologo oge iji tinye eriri na medulla iji nweta ndozi nke ịghasa ahụ. Dayameta nke oghere medullary nke metacarpal nke ise na-abụkarị nnukwu, ebe a, anyị na-eji skru 4.0 mm nwere oke nke ruru 50 mm. Na njedebe nke usoro ahụ, anyị na-ahụ na eriri caudal na-eli kpamkpam n'okpuru eriri cartilage. N'aka nke ọzọ, ọ dị mkpa ka ịzere ịkụnye prosthesis nke ọma, karịsịa n'ihe gbasara mgbaji olu.
Fig 14 Na A, a naghị akwụsị mgbawa n'olu na isi na-achọ ntakịrị omimi ka a ga-ejikọta cortex B.
Ụzọ ịwa ahụ maka mgbawa transverse nke phalanx dị nso yiri (Fig 15). Anyị mere nbibi ntụgharị 0.5 cm n'isi nke phalanx dị nso ka anyị na-agbanwekarị nkwonkwo interphalangeal proximal. Ekewapụrụ akwara ndị ahụ wee tụgharịa ogologo oge iji kpughee isi nke phalanx dị nso. Maka ọtụtụ mgbaji nke phalanx proximal, anyị na-eji skru 2.5 mm, mana maka nnukwu phalanges anyị na-eji skru 3.0 mm. Ogologo kacha elu nke 2.5 mm CHS eji ugbu a bụ 30 mm. Anyị na-akpachara anya ka anyị ghara imechi ihe nkedo ahụ. Ebe ọ bụ na skru na-egwupụta onwe ya ma na-akụ onwe ya, ha nwere ike banye na ntọala phalanx na obere nguzogide. A na-eji usoro yiri nke a maka mgbaji n'etiti phalangeal phalangeal, ebe mbepụ na-amalite na isi nke midphalangeal phalanx iji kwe ka ntinyeghachi nke skru.
Fig. 15 Intraoperative ele nke a transverse phalanx case.AA 1-mm guidewire etinyere site na obere transverse mbepụ n'akụkụ longitudinal axis nke proximal phalanx.B The guidewire na-enye ohere maka ezi-n'iji ya gee ntị nke repositioning na mgbazi nke ọ bụla rotations.CA 2.5-mm CHS ka etinyere na isi. N'ihi ọdịdị nke phalanges, mkpakọ nwere ike ịkpata nkewa nke cortex metacarpal. (Otu onye ọrịa dị na foto 8)
Mgbaji agbaji agbaji: mkpakọ na-akwadoghị n'oge ntinye nke CHS nwere ike iduga mbelata metacarpals na phalanges (Fig 16). Ya mere, n'agbanyeghị na a machibidoro iji CHS eme ihe n'ọnọdụ ndị dị otú a, anyị achọpụtala ihe ngwọta maka ọnọdụ abụọ a na-ahụkarị anyị na-eche ihu.
N'IHE 16 AC Ọ bụrụ na akwadoghị mgbaji ahụ nke ọma, imechi ihe nkedo ahụ ga-eme ka ọkpụkpụ gbajiri agbaji n'agbanyeghị mbelata zuru oke.D Ihe atụ sitere na usoro ndị edemede kwekọrọ na ikpe nke kachasị mkpụmkpụ (5 mm). Ahịrị uhie kwekọrọ na ahịrị metacarpal.
Maka mgbaji mgbaji submetacarpal, anyị na-eji usoro emezigharịrị dabere n'echiche ụkpụrụ ụlọ nke nkwado nkwado (ya bụ, ihe arụrụ arụ a na-eji akwado ma ọ bụ kwado etiti site na iguzogide mkpakọ ogologo ogologo wee si otú a kwado ya). Site n'ịmepụta ụdị Y nke nwere skru abụọ, isi nke metacarpal adịghị ada; anyị kpọrọ nke a ihe nkwado ụdị Y. Dị ka ọ dị na usoro gara aga, a na-etinye eriri ndu ogologo ogologo 1.0mm nwere ọnụ na-adịghị mma. Mgbe ị na-edobe ogologo nke metacarpal ziri ezi, a na-etinye waya nduzi ọzọ, mana n'akụkụ n'akụkụ waya nduzi nke mbụ, si otú a na-emepụta usoro triangular. A gbasawanyere akwụkwọ ntuziaka abụọ ahụ site na iji countersink eduzi iji gbasaa medulla. Maka skru axial na oblique, anyị na-ejikarị skru 3.0 mm na 2.5 mm dayameta, n'otu n'otu. A na-ebu ụzọ tinye screw axial ruo mgbe eriri caudal dị larịị na cartilage. A na-etinyezi skru nke ogologo dabara adaba. Ebe ọ bụ na enweghị ohere zuru ezu na medullary ọwa mmiri maka skru abụọ, ọ dị mkpa iji nlezianya gbakọọ ogologo nke screws oblique, na a ga-ejikọta screws axial na kposara axial ozugbo a na-eli ha nke ọma na isi metacarpal iji hụ na nkwụsi ike zuru oke na-enweghị ịghasa protrusion. Nke mbụ ịghasa na-aga n'ihu ruo mgbe e liri ya nke ọma. Nke a na-ezere mbelata axial nke metacarpal na ọdịda nke isi, nke enwere ike igbochi ya site na skru oblique. Anyị na-eme nyocha nke fluoroscopic ugboro ugboro iji hụ na ọdịda adịghị eme yana na kposara skru n'ime oghere medullary (Fig 17).
Ọgụgụ 17 AC Y-technology bracket
Mgbe comminution metụtara dorsal cortex na ala nke proximal phalanx, anyị chepụtara usoro gbanwere; anyị kpọrọ ya aha nkwado axial n'ihi na skru na-arụ ọrụ dị ka doo n'ime phalanx. Mgbe emezigharịrị phalanx dị nso, e webatara waya ntuziaka axial n'ime ọwa medullary dị ka o kwere mee. A na-etinyezi CHS dị mkpụmkpụ karịa ngụkọta ogologo nke phalanx (2.5 ma ọ bụ 3.0 mm) ruo mgbe njedebe ihu ya zutere efere subchondral dị na ala nke phalanx. N'oge a, a na-akpọchi eriri caudal nke ịghasa n'ime oghere medullary, si otú a na-eme dị ka nkwado dị n'ime ma na-eme nkwado ndabere nke phalanx. A na-achọ ọtụtụ nyocha fluoroscopic iji gbochie ịbanye n'ime nkwonkwo (Fig 18). Dabere n'ụkpụrụ mgbawa ahụ, skru ndị ọzọ ma ọ bụ ngwakọta nke ngwaọrụ ndozi ime nwere ike ịchọrọ (Foto 19).
Ọgụgụ 19: Ụzọ dị iche iche nke idozi na ndị ọrịa nwere mmerụ ahụ. Ọkpụkpụ submetacarpal siri ike nke gbajiri agbaji nke mkpịsị aka mgbanaka na mgbapụ nke isi nke etiti mkpịsị aka (akụ na-acha odo odo na-atụ aka na mpaghara nke mgbaji agbaji).B Standard 3.0 mm CHS nke mkpịsị aka mkpịsị aka ejiri, 3.0 mm paracentesis nke comminuted etiti mkpịsị aka, y-na nkwado nke mgbanaka mm. CHS nke mkpịsị aka pinky.F A na-eji flaps efu eme ihe maka mkpuchi anụ ahụ dị nro.C Radiographs na ọnwa anọ. Ọkpụkpụ metacarpal nke obere mkpịsị aka ahụ gwọọ ya. Ụfọdụ skaabs nke ọkpụkpụ kpụrụ n'ebe ọzọ, na-egosi mgbaji mgbaji nke abụọ.D Otu afọ mgbe ihe mberede ahụ gasịrị, e wepụrụ flap ahụ; ọ bụ ezie na asymptomatic, e wepụrụ skru na metacarpal nke mkpịsị aka mgbanaka n'ihi nke a na-enyo enyo na ntinye n'ime-articular. A na-enweta nsonaazụ dị mma (≥240 ° TAM) na mkpịsị aka ọ bụla na nleta ikpeazụ. Mgbanwe na nkwonkwo metacarpophalangeal nke mkpịsị aka etiti pụtara ìhè na ọnwa 18.
Fig. 20 A Fracture nke mkpịsị aka mkpịsị aka na intra-articular ndọtị (gosipụtara site akụ), nke e converted ka a dị mfe mgbaji ọkpụkpụ site B nwa oge fixation nke articular mgbaji ọkpụkpụ iji a K-waya.C Nke a kere a kwụsiri ike isi nke a na-akwado longitudinal ịghasa etinyere.D Mgbe ndozi, na-ewu na-ekpe ikpe na-arụsi ọrụ ike izu 3. (akụ na-aka akara ebe ntinye nke skru basal)
Fig. 21 N'azụ orthostatic na B n'akụkụ redio nke onye ọrịa A. A na-emeso ọkpụkpụ transverse atọ nke onye ọrịa ahụ na 2.5-mm kposara cannulated. Ọ dịghị mgbanwe dị ịrịba ama na nkwonkwo interphalangeal pụtara ìhè mgbe afọ 2 gasịrị
Oge nzipu: Sep-18-2024
