Muri iki gihe, mu bijyanye no gushyiraho imbere imvune za distal radius, hari uburyo butandukanye bwo gushyiraho plate zifunga umubiri bukoreshwa muri ivuriro. Ubu buryo bwo gushyiraho imbere butanga igisubizo cyiza ku bwoko bumwe na bumwe bw'imvune zigoye, kandi mu buryo bumwe bwongera ibimenyetso byo kubaga imvune za distal radius zidahamye, cyane cyane abafite uburwayi bwo kuvunika kw'amagufwa. Porofeseri Jupiter wo mu bitaro bikuru bya Massachusetts n'abandi basohoye inkuru nyinshi muri JBJS ku byo bavumbuye ku bijyanye no gushyiraho plate zifunga imvune za distal radius hamwe n'uburyo bwo kubaga bujyanye nabyo. Iyi nkuru yibanda ku buryo bwo kubaga imvune za distal radius zishingiye ku gushyiraho imbere imvune runaka.
Ubuhanga bwo Kubaga
Inyigisho y’inkingi eshatu, ishingiye ku miterere y’ibinyabuzima n’imiterere y’umubiri by’umurambararo wa distal ulnar, ni yo shingiro ry’iterambere n’ikoreshwa ry’ubuvuzi rya sisitemu ya 2.4mm. Igabanywa ry’inkingi eshatu rigaragazwa ku Ishusho ya 1.
Igishushanyo cya 1 Inyigisho y'inkingi eshatu z'umurambararo wa distal ulnar.
Inkingi yo ku ruhande ni igice cy’uruhande rw’umurambararo wa distal, harimo navicular fossa na radial tuberosity, ishyigikira amagufwa ya carpal ku ruhande rw’umurambararo kandi ni yo nkomoko y’imitsi imwe n’imwe ituma ukuboko guhagarara neza.
Inkingi yo hagati ni igice cyo hagati cy'umurambararo wa kure kandi irimo lunate fossa (ifitanye isano na lunate) na sigmoid notch (ifitanye isano na distal ulna) ku buso bw'ingingo. Ubusanzwe iremereye, umutwaro uva kuri lunate fossa woherezwa kuri radius binyuze kuri lunate fossa. Inkingi yo ku ruhande rwa ulnar, irimo distal ulna, fibrocartilage y'impandeshatu, n'urugingo rwa ulnar-radial ruciriritse, itwara imizigo iva mu magufwa ya carpal ya ulnar ndetse no mu rugingo rwa ulnar-radial ruciriritse kandi igira ingaruka nziza.
Ubu buryo bukorwa hakoreshejwe uburyo bwo gusinzira mu maraso (brachial plexus anaesthesia) kandi ni ngombwa gufata amashusho ya X-ray mu gihe cyo kubagwa. Imiti ikoreshwa mu mitsi yatanzwe nibura iminota 30 mbere yuko igikorwa gitangira, kandi hakoreshejwe uburyo bwo gusinzira mu maraso kugira ngo bigabanye kuva amaraso.
Gushyiraho plaque ya Palmar
Ku mvune nyinshi, uburyo bwa palmar bushobora gukoreshwa mu kwiyumvisha hagati ya radial carpal flexor n'umutsi wa radial. Nyuma yo kumenya no gusubiza inyuma flexor carpi radialis longus, ubuso bwimbitse bw'imitsi ya pronator teres bugaragara kandi itandukanyirizo ry'imiterere ya "L" rirazamuka. Mu mvune zikomeye, umutsi wa brachioradialis ushobora kurekurwa kurushaho kugira ngo woroshye kugabanya imvune.
Agapira ka Kirschner gashyirwa mu gice cya radial carpal, bigafasha kumenya aho imipaka ya radius igarukira. Iyo hari agace gato k'amasasu gacitse ku mpera y'amasasu, icyuma cya palmar 2.4mm gishobora gushyirwa hejuru y'igice cya distal articular cy'amasasu kugira ngo gikome. Mu yandi magambo, agace gato k'amasasu gacitse ku buso bw'amasasu bwa lunate gashobora gushyigikirwa n'igice cya 2.4mm "L" cyangwa "T", nk'uko bigaragara ku Ishusho ya 2.
Ku mvune zo mu gice cy’umugongo zivunitse inyuma y’ingingo, ni byiza kumenya ingingo zikurikira. Ubwa mbere, ni ngombwa gusubizaho by’agateganyo imvune kugira ngo hamenyekane neza ko nta ngingo yoroshye iri mu gice cy’umuvune. Ubwa kabiri, ku barwayi badafite osteoporosis, imvune ishobora kugabanuka hifashishijwe icyuma gifunga: ubwa mbere, hashyirwa icyuma gifunga ku mpera y’igice cy’umugongo, gifatanye n’igice cy’umuvune cyavunitse inyuma, hanyuma ibice by’umuvune bya kure n’ibya hafi bigagabanuka hifashishijwe icyuma gifunga, hanyuma ibindi bishushanyo bigashyirwa hafi y’igice.
ISHUSHO YA 3 Gucika kw'umugongo uva mu gice cyo hejuru cy'umugongo biragabanuka kandi bigakosorwa hakoreshejwe uburyo bwa palmar. ISHUSHO YA 3-A Nyuma yo kurangiza kugaragara binyuze mu gice cyo hejuru cy'umugongo n'imitsi ifata imitsi, agapira ka Kirschner gashyirwa mu gice cyo hejuru cy'umugongo. Ishusho ya 3-B Gukoresha cortex ya metacarpal iva mu mwanya wayo kugira ngo isubire ku murongo.
Ishusho ya 3-C n'Ishusho ya 3-DA agapira ka Kirschner gakozwe neza gashyirwa ku giti cya radial kanyuze ku murongo wa fracture kugira ngo gakosore by'agateganyo impera ya fracture.
Ishusho ya 3-E Gusuzuma neza aho igikorwa cyo kubaga bigerwaho hakoreshejwe agakoresho ko gukuraho icyuma mbere yo gushyira plaque. ISHUSHO YA 3-F Umurongo wa kure w'amakuru afunga ushyirwa hafi y'igufwa rya subchondral ku mpera y'ipfundo rya distal.
Ishusho ya 3-G X-ray fluoroscopy igomba gukoreshwa kugira ngo hemezwe aho plate n'ibice byo kure biherereye. Ishusho ya 3-H Igice cyo hafi y'agace k ...
Ishusho ya 3-J na 3-K Ishusho ya radiyo yo mu gihe cyo kubagwa yemeza ko imvune yasubiwemo mu buryo bw'imiterere y'umubiri ndetse n'imisumari y'icyuma ishyirwa mu buryo bushimishije.
Gufata Plate y'Igufwa Uburyo bwo kubaga kugira ngo hagaragazwe igice cy'igufwa cyo mu gice cy'igufwa gishingiye ahanini ku bwoko bw'aho cyavunitse, kandi mu gihe havunitse ibice bibiri cyangwa byinshi byo mu gice cy'igufwa, intego y'ubuvuzi ni ugufata impande zombi z'igufwa n'iz'igufwa icyarimwe. Mu gihe cyo kubaga, imigozi yo gushyigikira igufwa igomba gucibwa mu buryo bubiri bw'ingenzi: mu buryo burambuye mu gice cya kabiri n'icya gatatu, hamwe no gukata igice cya kane cy'igufwa no gukuraho umutsi ujyanye na wo; cyangwa gukata igice cya kabiri cy'igufwa hagati y'igice cya kane n'icya gatanu cy'igufwa kugira ngo hagaragazwe impande zombi ukwazo (Ishusho ya 4).
Ivuniko rikorwa kandi rigakosorwa by'agateganyo hakoreshejwe agapira ka Kirschner kadafite umugozi, hanyuma hafatwa amashusho ya radiyo kugira ngo hamenyekane ko ivuniko ryacitse neza. Hanyuma, uruhande rw'inyuma rw'umugongo (inkingi yo hagati) rw'umugongo rushyirwaho icyuma cya "L" cyangwa "T" cya mm 2.4. Icyuma cya "inyuma cy'umugongo" gifite imiterere kugira ngo gifate neza uruhande rw'inyuma rw'umugongo rw'umugongo. Ibyo byuma bishobora kandi gushyirwa hafi y'igice cy'inyuma cy'umugongo wa kure uko bishoboka kose, kuko imiyoboro ijyanye nayo iri munsi ya buri cyuma ituma ibyo byuma bigonda kandi bigasa neza nta kwangiza imigozi iri mu myobo yo kugonga (Ishusho ya 5).
Gufata icyuma gifata icyuma gifata icyuma gifata icyuma ni ibintu byoroshye cyane, kuko ubuso bw'amagufwa hagati y'igice cya mbere n'icya kabiri cyo gupakurura icyuma buba buringaniye kandi bushobora gushyirwa muri ubu buryo hakoreshejwe icyuma gishushanyije neza. Iyo icyuma gifata icyuma cya Kirschner gishyizwe mu gice cya kure cyane cy'uruti rw'icyuma, impera y'igice cya icyuma gifata icyuma gifata icyuma ifite umuyoboro uhuye n'icyuma gifata icyuma cya Kirschner, kidahungabanya aho icyuma giherereye kandi kigatuma imvune ikomeza (Ishusho ya 6).
Ishusho ya 4 Igaragara ry'ubuso bw'inyuma bw'umurambararo wa kure. Umugozi wo gushyigikira ufungurwa uturutse ku gice cya 3 cya extensor interosseous hanyuma umutsindo wa extensor hallucis longus urasubira inyuma.
Ishusho ya 5 Kugira ngo hakorwe imiterere y'inyuma y'ubuso bw'inyuma bw'uruti, icyuma cya "T" cyangwa "L" cyo mu isonga gikunze kuba gifite imiterere (Ishusho ya 5-A n'Ishusho ya 5-B). Iyo icyuma cya "inyuma" kiri ku buso bw'inyuma bw'uruti kimaze gufatwa, icyuma cya "radial column plate" kirafatwa (Ishusho kuva kuri 5-C kugeza kuri 5-F). Amasahani abiri ashyirwa ku nguni ya dogere 70 hagati yayo kugira ngo hongerwe uburyo bwo kuguma imbere.
Ishusho ya 6. Isahani y'inkingi ya radial ifite imiterere ikwiye kandi ishyirwa mu nkingi ya radial, igaragaza agace kari ku mpera y'isahani, ibyo bigatuma isahani yirinda gufatana by'agateganyo kw'agapira ka Kirschner bitabangamiye aho isahani iherereye.
Ibitekerezo by'ingenzi
Ibimenyetso byerekana ko hari metacarpal plate ifatana
Amagufwa yavuye mu myanya ya metacarpal intra-articular (amagufwa ya Barton)
Gucika intege kw'ingingo (extra-articular fractures) byacitse (Colles na Smith fractures). Gukomera neza bishobora kugerwaho hakoreshejwe screw plates nubwo haba hari indwara ya osteoporosis.
Kuvunika kw'ubuso bw'ingingo ya metacarpal yavuye mu mwanya wayo
Ibimenyetso byo gufata igice cyo mu mugongo
Hamwe n'imvune hagati y'imitsi
Ipfundo ry'ingingo zo mu mugongo zavunitse
Gucika kw'ingingo za carpal zo mu bwoko bwa radial scared dorsally
Ibibujijwe mu gufata isahani y'ikiganza
Osteoporosis ikomeye ifite imbogamizi zikomeye mu mikorere yayo
Gucika kw'ikiganza cy'umugongo (Dorsal radial)
Kuba hari indwara nyinshi ziterwa n'uburwayi
Ibibujijwe no gufata igice cyo mu mugongo
Indwara nyinshi z'uburwayi
Amagufwa adakuwe mu myanya ndangagitsina
Amakosa yoroshye gukorwa mu gushyiraho isahani y'ikiganza
Aho icyuma giherereye ni ingenzi cyane kuko ntabwo gishyigikira gusa imvune, ahubwo no gushyira neza icyuma gifunga icyuma kidasohoka kirinda kwinjira mu gice cy’umugongo cya radial carpal. Isuzuma ryitondewe rya radiyo mu gihe cyo kubaga, rigaragazwa mu cyerekezo kimwe n’aho radial inyura mu gice cy’umugongo cya distal, rituma habaho ishusho nyayo y’ubuso bw’urubavu rw’urubavu rwa radial, ishobora no kugaragara neza ubanje gushyira screws za ulnar mbere y’igihe cyo kubaga.
Kwinjira kwa screw mu gice cy'imbere cy'umutima (dorsal cortex) bigira ibyago byo gutera tendon extensor ndetse bigatuma tendon yacika. Screws zifunga zikora mu buryo butandukanye n'iz'inyuma zisanzwe, kandi si ngombwa kwinjira muri dorsal cortex ukoresheje screws.
Amakosa yoroshye gukorwa mu gihe cyo gufata plaque yo mu mugongo
Buri gihe hari ibyago byo kwinjira kwa screw mu gice cya radial carpal, kandi kimwe n'uburyo bwavuzwe haruguru ku bijyanye na palmar plate, hagomba gufatwa ishoti rya oblique kugira ngo hamenyekane niba aho screw iherereye ari heza.
Iyo habanje gukorwa uburyo bwo gufunga inkingi ya radial, vis zo muri radial tuberosity zizagira ingaruka ku isuzuma ry’uburyo bwo gufunga imiterere y’ubuso bw’urukiramende nyuma.
Utugozi twa kure tudashyizwe mu mwobo w'utugozi dushobora gutera ubwoba umutsi cyangwa se bigatuma imitsi icika.
Igihe cyo kohereza: Ukuboza-28-2023
