- Ibyerekana
1) .Ivunika rikabije ryavunitse rifite icyerekezo kigaragara, kandi hejuru ya arctular ya radiyo ya kure irasenywa.
2) .Igabanuka ryintoki ryananiwe cyangwa gukosora hanze byananiwe gukomeza kugabanuka.
3) .Ivunika rya kera.
4) .Ivunika rya malunion cyangwa kudahuza.amagufwa ahari murugo no hanze
- Kurwanya
Abarwayi bageze mu zabukuru badakwiriye kubagwa.
- Gukosora imbere (inzira ya volar)
Gahunda yo kwitegura mbere yo gutangira.Anesthesia ikorwa hakoreshejwe anesthesia ya brachial plexus cyangwa anesthesia rusange
1) .Umurwayi ashyirwa mumwanya mwiza hamwe ningingo zanduye zashimuswe zigashyirwa kumurongo wo kubaga.Igice cya 8cm gikozwe hagati yimitsi ya radiyo yimbere yikiganza na flexor carpi radialis imitsi kandi ikaguka kugeza kumaboko.Ibi birashobora kwerekana rwose kuvunika no gukumira kwandura inkovu.Gucibwa ntibikenewe kujya mumikindo (Ishusho 1-36A).
)) uruhande rwa ulnar, kandi igice cyubusa flexor pollicis longus.Inda yimitsi iba yuzuye neza imitsi ya quadratus (Ishusho 1-36C)
) -36D, Ishusho 1-36E)
4). Shyiramo stipper cyangwa icyuma gito cyamagufa kuva kumurongo wavunitse, hanyuma ukoreshe nka leveri kugirango ugabanye kuvunika.Shyiramo icyuma cyangwa icyuma gito cyumukasi hejuru yumurongo wavunitse kugeza kumaguru yinyuma kugirango ugabanye kwikuramo no kugabanya igice cyavunitse, kandi ukoreshe intoki kugirango ugabanye agace kavunitse kugirango ugabanye agace kavunitse.
Iyo ivunika rya radiyo styloide ryacitse, biragoye kugabanya imvune ya styloide ya radiyo kubera gukurura imitsi ya brachioradialis.Kugabanya imbaraga zo gukurura, brachioradialis irashobora gukoreshwa cyangwa gutandukanywa na radiyo ya kure.Nibiba ngombwa, igice cya kure gishobora gushyirwaho by'agateganyo igice cyegeranye hamwe ninsinga za Kirschner.
Niba ulnar styloid inzira yacitse kandi ikimurwa, hamwe na radioulnar ya kure ikaba idahindagurika, insinga imwe cyangwa ebyiri za Kirschner zirashobora gukoreshwa mugukosora percutaneous, kandi inzira ya ulnar styloide irashobora gusubirwamo nuburyo bwa volar.Ivunika rito mubisanzwe ntirisaba kuvurwa nintoki.Ariko, niba intera ya radioulnar ya kure idahindagurika nyuma yo gutunganya radiyo, igice cya styloide kirashobora gucukurwa kandi impande zuruganda rwa fibrocartilage ya triangulaire zashushanyije kuri ulnar styloide hamwe na ankeri cyangwa umugozi wubudodo.
5) .Hifashishijwe ubufasha bwo gukwega, capsule hamwe na ligament birashobora gukoreshwa kugirango urekure intercalation kandi bigabanye kuvunika.Nyuma yo kuvunika kugabanuka neza, menya neza aho icyapa cya plaque gishyizwe hamwe uyobowe na X-ray fluoroscopi hanyuma winjize umugozi mu mwobo wa ova cyangwa umwobo unyerera kugirango byorohereze imyanya (Ishusho 1-36F).Koresha umwobo wa 2,5mm kugirango ucukure hagati yumwobo wa oval, hanyuma ushyiremo icyuma cyo kwikuramo 3.5mm.
Igishushanyo 1-36 Gukata uruhu (A);gutemagura flexor carpi radialis tendon sheath (B);gukuramo igice cya flexor tendon kugirango imenyekanishe imitsi ya quadratus (C);kugabanya imitsi ya quadratus imitsi kugirango yerekane radiyo (D);kwerekana umurongo wavunitse (E);shyira icyapa cya volar na screw mumugozi wambere (F)
6). Koresha C-arm fluoroscopy kugirango wemeze neza ibyapa.Nibiba ngombwa, shyira isahani kure cyangwa hafi kugirango ubone icyerekezo cyiza cya kure.
))Umusumari ugomba kuba mugufi wa 2mm kurenza intera yapimwe kugirango wirinde ko umugozi winjira kandi ugasohokera kuri cortex.Mubisanzwe, imigozi ya 20-22mm irahagije, kandi iyashyizwe kumurongo wa styloide ya radiyo igomba kuba ngufi.Nyuma yo gusunika mumashanyarazi ya kure, shyiramo Shyiramo ibice byegeranye byegeranye.
Kuberako inguni ya screw yateguwe, niba isahani ishyizwe hafi yumutwe wa kure, umugozi uzinjira mumutwe.Fata uduce duto twa magufa ya arctular subchondral uhereye kumyanya ya coronale na sagittal kugirango urebe niba yinjira mu gihimba, hanyuma ukurikize amabwiriza Hindura amasahani yicyuma na / cyangwa imigozi
.B. Filime ya Anteroposterior na X-ray yerekana kuvunika nyuma yibikorwa, byerekana kuvunika Kugabanuka neza no gufatana neza kwamaboko.
8) .Kora imitsi ya quadratus imitsi hamwe na suture idashobora gukururwa.Menya ko imitsi itazapfukirana isahani.Igice cya kure kigomba gutwikirwa kugirango hagabanuke imikoranire hagati ya flexor tendon na plaque.Ibi birashobora kugerwaho mugushushanya kwadratus ya quadratus kumpera ya brachioradialis, gufunga ibice byaciwe, hanyuma ukabishyiraho plaster nibiba ngombwa.
Igihe cyo kohereza: Nzeri-01-2023
