- 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
- Ibibujijwe
Abarwayi bageze mu zabukuru badakwiriye kubagwa.
- Gufata imbere (uburyo bwo gukora imyitozo ngororamubiri)
Gutegura buri gihe mbere yo kubagwa. Anesthesia ikorwa hakoreshejwe anesthesia ya brachial plexus cyangwa anesthesia rusange
1).Umurwayi ashyirwa mu mwanya wo kuryama, ukuguru kwangiritse gushyizwe ku mubiri w'umurwayi. Hakorwa icyuho cya cm 8 hagati y'imitsi yo ku rutoki n'imitsi ya radialis yo ku rutoki, hanyuma kikagera ku gitereko cy'ukuboko. Ibi bishobora kwerekana neza imvune no gukumira inkovu. Icyuho ntikigomba kujya mu kiganza cy'ukuboko (Ishusho ya 1-36A).
2). Kurikiza aho icibwa ry’umugongo riherereye ku gice cy’imitsi cya flexor carpi radialis (Ishusho ya 1-36B), fungura igice cy’imitsi, shyiramo igice cy’imbere cy’umugano kugira ngo flexor pollicis longus igaragare, koresha urutoki rw’imbere kugira ngo werekeze igice cy’imitsi cya flexor pollicis longus ku ruhande rw’inyuma, hanyuma urekure igice cy’imitsi cya flexor pollicis longus. Inda y’imitsi igaragara neza ku mitsi ya pronator quadratus (Ishusho ya 1-36C)
3). Kora icyuho gifite ishusho ya "L" ku ruhande rw'urukiramende rw'urukiramende kugeza kuri radial styloid process kugira ngo ugaragaze imitsi ya pronator quadratus, hanyuma uyikure kuri radius ukoresheje icyuma gikata kugira ngo ugaragaze umurongo wose w'urukiramende (Ishusho ya 1-36D, Ishusho ya 1-36E)
4). Shyiramo icyuma gito cyo gukuraho imvune cyangwa icyuma gito cy'igufwa kiva ku murongo w'imvune, hanyuma ukikoreshe nk'igikoresho cyo kugabanya imvune. Shyiramo icyuma cyo gukuraho imvune cyangwa icyuma gito cyo gukamura ku murongo w'imvune ugana ku gice cy'igufwa cyo ku ruhande kugira ngo worohereze gukanda no kugabanya igice cyo kwangirika, kandi ukoreshe intoki kugira ngo ukandagire igice cyo kwangirika k'umugongo kugira ngo ugabanye igice cyo kwangirika k'umugongo.
Iyo imvune ya radial styloid yavunitse, biragoye kugabanya imvune ya radial styloid bitewe no gukururwa kw'imitsi ya brachioradialis. Kugira ngo ugabanye imbaraga zo gukururwa, brachioradialis ishobora guhindurwa cyangwa gucibwamo ibice bivuye ku gice cyo hagati. Iyo bibaye ngombwa, igice cyo hagati gishobora gushyirwa by'agateganyo ku gice cyo hafi hakoreshejwe insinga za Kirschner.
Iyo inzira ya styloid ya ulnar yavunitse kandi ikagenda, kandi igice cya distal radioulnar kidahindagurika, insinga imwe cyangwa ebyiri za Kirschner zishobora gukoreshwa mu gufata impande zombi z'umubiri, kandi inzira ya ulnar styloid ishobora kongera gukoreshwa hakoreshejwe uburyo bwa volar. Ubusanzwe imvune nto ntizisaba kuvurwa n'intoki. Ariko, niba igice cya distal radioulnar kidahindagurika nyuma yo gufata radius, igice cya styloid gishobora gukurwamo maze impande za fibrocartilage complex ya thiantungle zigashyirwa kuri styloid ya ulnar hakoreshejwe insinga cyangwa imigozi ya silk.
5). Ukoresheje uburyo bwo gukurura, agapfukamunwa n'imitsi bishobora gukoreshwa mu kurekura intercalation no kugabanya kuvunika. Nyuma yo kugabanuka neza, menya aho icyuma cya volar steel plate giherereye uyobowe na X-ray fluoroscopy hanyuma ushyire screw mu mwobo w'urudodo cyangwa umwobo unyerera kugira ngo woroshye guhindura aho uherereye (Ishusho ya 1-36F). Koresha umwobo w'imbobo wa 2.5mm kugira ngo utobore hagati y'umwobo w'urudodo, hanyuma ushyiremo screw ya 3.5mm yo kwikomanga.
Ishusho ya 1-36 Gukata uruhu (A); gukata igice cy'umutsi wo ku rukenyerero wa carpi radialis (B); gukuraho igice cy'umutsi wo ku rukenyerero kugira ngo umutsi wa pronator quadratus ugaragare (C); gucamo imitsi ya pronator quadratus kugira ngo ugaragare radius (D); gushyira umurongo wa fracture (E); gushyira plate ya volar hanyuma ushyiremo screw ya mbere (F)
6). Koresha C-arm fluoroscopy kugira ngo wemeze ko plate ishyizwe neza. Niba bibaye ngombwa, kanda plate kure cyangwa hafi yayo kugira ngo ubone screw nziza yo kure.
7). Koresha icyuma cya 2.0mm kugira ngo ucukure umwobo uri ku mpera y'icyuma, upime uburebure bw'icyuma hanyuma ushyiremo vis yo gufunga. Umusumari ugomba kuba mugufi kuri mm 2 ugereranije n'intera yapimwe kugira ngo vis idasohoka cyangwa ngo igere ku gice cy'imbere cy'umubiri. Muri rusange, vis ya mm 20-22 irahagije, kandi ishyizwe ku buryo bwa radial styloid igomba kuba ngufi. Nyuma yo gushyiramo vis yo kure, vis Shyiramo vis yo hafi isigaye.
Kubera ko inguni y'urushundura yakozwe, iyo icyuma gishyizwe hafi cyane y'inkombe ya kure, urushundura ruzinjira mu gice cy'ukuboko. Fata ibice bya tangential by'igufwa rya articular subchondral mu myanya ya coronal na sagittal kugira ngo urebe niba ryinjiye mu gice, hanyuma ukurikize amabwiriza. Hindura ibyuma n'ibisumizi.
(Ishusho 1-37) Ishusho 1-37 Gufata imvune ya radius yo hagati hakoreshejwe plate ya volar bone A. Filimi ya X-ray yo hagati n'inyuma y'ivuniko rya radius yo hagati mbere yo kubagwa, igaragaza ko impera y'inyuma ijya ku ruhande rwa volar; B. Filimi ya X-ray yo hagati n'inyuma y'ivuniko rya nyuma yo kubagwa, igaragaza ko imvune yavunitse neza kandi ingingo z'ukuboko zifunguka neza.
8). Shyira imitsi ya pronator quadratus ku mutsi udashobora kunyagirwa. Menya ko imitsi itazapfuka isahani yose. Igice cya kure kigomba gupfukwa kugira ngo ugabanye imikoranire hagati y'imitsi yo kugosora n'isahani. Ibi bishobora kugerwaho ukoresheje gupfuka quadratus ya pronator ku nkengero za brachioradialis, ugafunga urwego rw'isukari ku rundi, hanyuma ukayishyiramo plaster nibiba ngombwa.
Igihe cyo kohereza ubutumwa: Nzeri-01-2023
