1. Ibimenyetso
1). Amagufwa akomeye yacitse afite aho anyura hagaragara, kandi ubuso bw'agace k'umurambararo wa kure burangirika.
2). Kugabanya intoki byarananiranye cyangwa gufunga inyuma ntibyashoboye gukomeza kugabanya.
3). Amagufwa ashaje.
4). Gucika kw'amagufwa cyangwa kutavamo amagufwa. Igufwa riboneka mu gihugu no mu mahanga
2. Ibibujijwe
Abarwayi bageze mu zabukuru badakwiriye kubagwa.
3. Uburyo bwo kubaga inyuma y'inyuma
1. Umuyoboro wo gukosora inyuma w’ingingo (Cross-articular external fixator) wo gukosora imvune zo mu gice cya kure cy’umuyoboro w’inyuma
Uburyo bwo kuvura no gutegura mbere yo kubagwa:
·Ikinya cyo gupfuka ubwoya bwo mu bwonko
·Imbere y'umubiri, amaguru yangiritse aryamye ku gitereko cy'amaso kiri iruhande rw'igitanda
·Shyira tourniquet kuri 1/3 cy'ukuboko ko hejuru
·Gukurikirana uko ibintu bimeze
Uburyo bwo Kubaga
Gushyiramo screw ya Metacarpal:
Urufuro rwa mbere ruri ku nsi y'igufwa rya kabiri rya metacarpal. Hakorwa icyuho cy'uruhu hagati y'umutsi wo hejuru w'urutoki rw'imbere n'imitsi yo mu igufwa rya mbere. Uduce tworoshye dutandukanywa buhoro buhoro hakoreshejwe forceps zo kubaga. Agapfuko karinda uturemangingo tworoshye, hanyuma hagashyirwamo urufuro rwa 3mm Schanz. Udupfundo
Icyerekezo cy'urushundura ni 45° ugana ku gice cy'ikiganza, cyangwa gishobora kuba gihuye n'igice cy'ikiganza.
Koresha ubuyobozi kugira ngo uhitemo aho vis ya kabiri iherereye. vis ya kabiri ya 3mm yashyizwe muri metacarpal ya kabiri.
Ubugari bw'agapira ko gufata imitsi ya metacarpal ntibugomba kurenza mm 3. Agapira ko gufata imitsi kari muri 1/3 cy'agapira ko mu mubiri. Ku barwayi ba osteoporosis, agapira ko gufata imitsi kari hafi cyane gashobora kwinjira mu bice bitatu bya cortex (igufwa rya kabiri rya metacarpal n'igice cya cortex cy'igufwa rya gatatu rya metacarpal). Muri ubu buryo, agapira ko gufata imitsi: Ukuboko kure kure n'imbaraga nini zo gufata imitsi byongera umutuzo w'agapira ko gufata imitsi.
Imiterere y'ibice bya radial:
Kora icyuho cy'uruhu ku nkengero z'uruhande rw'umuyoboro w'amaraso, hagati y'imitsi ya brachioradialis n'imitsi ya extensor carpi radialis, cm 3 hejuru y'inkombe y'umurongo wavunitse na cm 10 hafi y'ingingo y'ukuboko, hanyuma ukoreshe hemostat kugira ngo utandukanye neza ingingo zo munsi y'umubiri n'igufwa. Hafatwa ingamba zo kurinda amashami yo hejuru y'imitsi ya radial inyura muri ako gace.
Ku murongo umwe n'imisumari ya metacarpal, imisumari ibiri ya Schanz ya 3mm yashyizwe munsi y'ubuyobozi bw'inyuguti zoroshye zirinda amaboko.
·.Kugabanya no guhagarara kw'imvune:
·.Kugabanya imbaraga zo gukurura no gupima C-arm fluoroscopy kugira ngo harebwe niba imvune yavunitse.
·.Gufatana kw'inyuma ku ngingo y'ukuboko bituma bigorana kugarura burundu inguni yo ku ruhande rw'ikiganza, bityo ishobora guhuzwa n'udupira twa Kapandji kugira ngo bifashe mu kugabanya no gufatana.
·.Ku barwayi bafite imvune za radial styloid, radial styloid Kirschner wire fixation irashobora gukoreshwa.
·.Mu gihe ukomeza kugabanya, huza agakoresho ko gufunga inyuma hanyuma ushyire aho gufunga inyuma hakonjesha ku murongo umwe n'aho gufunga hagati mu kuboko.
·.Fluoroscopy yo mu gice cya mbere n'icya kabiri, reba niba uburebure bwa radius, inguni yo mu gituza n'inguni yo kunyura mu gice cya kabiri byuzuye, hanyuma uhindure inguni yo kugena kugeza igihe imvune igabanutse neza.
·. Witondere uburyo icyuma gikurura inyuma gitera kuvunika kw'inyuma, bigatera kuvunika kw'ivunji ku nsingo za metacarpal.
Gucika kw'umurambararo wa kure bivanze no gutandukana kw'ingingo ya distal radioulnar (DRUJ):
·.Inyinshi muri DRUJ zishobora kugabanuka mu buryo butunguranye nyuma yo kugabanya radius ya distal.
·.Niba DRUJ ikomeje gutandukanywa nyuma yuko radius ya distal igabanutse, koresha intoki kugabanya gukanda kandi ukoreshe urwego rwo hejuru rw'inkoni yo hanze.
Cyangwa ukoreshe insinga za K kugira ngo winjire muri DRUJ mu mwanya utagira aho ubogamiye cyangwa uhagaze gato.
Kuvunika kwa radius ya distal hamwe na kuvunika kwa ulnar styloid: Reba neza ko DRUJ ihagaze neza mu kuvugira, mu buryo butagira aho bubogamiye no mu kuboko. Niba hari ukudahagarara neza, gukoresha insinga za Kirschner, gusana ligament ya TFCC, cyangwa se umurongo wa tension band bishobora gukoreshwa mu gufunga. Uburyo bwa Ulnar styloid bushobora gukoreshwa.
Irinde gukurura cyane:
· Reba niba intoki z'umurwayi zishobora gukora ingendo zose zo guhindagurika no kwagura amaguru nta guhangayika kugaragara; gereranya umwanya w'ingingo zikoresha imirasire n'umwanya w'ingingo zo hagati mu gace k'umubiri.
·Reba niba uruhu rwo ku muyoboro w'inzara rufunganye cyane. Niba rufunganye cyane, fata incision ikwiye kugira ngo wirinde kwandura.
·Gushishikariza abarwayi kwimura intoki zabo hakiri kare, cyane cyane kwihuta no kwagura ingingo z'intoki, kwihuta no kwagura igikumwe, no kwibasira.
2. Gufata imvune za radius ya distal ukoresheje fixator yo hanze idaca mu ngingo:
Aho umwana aherereye n'uburyo bwo kumutegura mbere yo kubagwa: Kimwe n'uko byari bimeze mbere.
Uburyo bwo Kubaga:
Ahantu hizewe ho gushyira umugozi wa K ku ruhande rw'inyuma rw'umurongo wa distal ni: ku mpande zombi za Lister's tubercle, ku mpande zombi za extensor pollicis longus tendon, no hagati ya extensor digitorum communis tendon na extensor digiti minimi tendon.
Muri ubwo buryo, vis ebyiri za Schanz zashyizwe mu gice cy’urukiramende gifata amajwi (radial shaft) zihuzwa n’inkoni ihuza amajwi.
Mu gace k’umutekano, hashyizwemo vis ebyiri za Schanz mu gice cya distal radius fracture, kimwe kivuye ku ruhande rwa radial n’ikindi kivuye ku ruhande rw’inyuma, gifite inguni ya 60° kugeza 90° hagati yacyo. vis igomba gufata contralateral cortex, kandi bigomba kumenyekana ko umutwe w’vis ushyizwe ku ruhande rwa radial udashobora kunyura mu gace ka sigmoid notch ngo winjire mu gace ka distal radioulnar.
Shyira screw ya Schanz kuri radius ya kure ukoresheje umugozi ugoramye.
Koresha inkoni yo hagati ihuza ibice bibiri byacitse, kandi witondere kudafunga agace gato. Ukoresheje umurongo wo hagati, igice cya kure kiragabanuka.
Nyuma yo kongera gukoresha, funga agace k'icyuma ku nkoni ihuza kugira ngo urangize igice cya nyumagukosorwa.
Itandukaniro riri hagati y’icyuma gifata ibyuma kidafata ibyuma n’icyuma gifata ibyuma kidafata ibyuma:
Kubera ko hashobora gushyirwaho vis nyinshi za Schanz kugira ngo hagabanuke kandi hakosorwe ibice by'amagufwa, ibimenyetso byo kubaga ku bikoresho byo hanze bitari ingingo ni binini kurusha ibyo gukoresha ibikoresho byo hanze bifatanye. Uretse kuvunika hanze y'ingingo, bishobora no gukoreshwa ku mvune ya kabiri kugeza ku ya gatatu. Kuvunika igice hagati y'ingingo.
Igikoresho cyo gufunga igice cy'ukuboko gihuza ingingo kigakora imyitozo ngororamubiri kandi nticyemerera gukora imyitozo ngororamubiri hakiri kare, mu gihe igikoresho cyo gufunga igice cy'ukuboko kidahuza ingingo kigakora imyitozo ngororamubiri hakiri kare nyuma yo kubagwa.
Igihe cyo kohereza: 12 Nzeri 2023
