Kugeza ubu kugirango hakosorwe imbere imbere ivunika rya radiyo ya kure, hariho uburyo butandukanye bwo gufunga ibyapa bya anatomiki bikoreshwa mumavuriro. Ibi byakosowe imbere bitanga igisubizo cyiza kubwoko bumwe na bumwe bugoye bwo kuvunika, kandi muburyo bumwe bwagura ibimenyetso byo kubagwa kumeneka ya radiyo idahungabana, cyane cyane abafite osteoporose. Porofeseri Jupiter wo mu bitaro bikuru bya Massachusetts n'abandi basohoye ingingo nyinshi muri JBJS ku byo babonye ku gufunga isahani yo gukosora ibice bya radiyo ya kure hamwe n'ubuhanga bwo kubaga. Iyi ngingo yibanze ku buryo bwo kubaga uburyo bwo gukosora ibice bya radiyo ya kure bishingiye ku gukosora imbere kw’imiterere yihariye.
Ubuhanga bwo kubaga
Inyigisho zinkingi eshatu, zishingiye kubinyabuzima na anatomique biranga radiyo ya kure ya ulnar, niyo shingiro ryiterambere nogukoresha amavuriro ya sisitemu ya plaque 2.4mm. Igabana ryinkingi eshatu ryerekanwe mubishusho 1.
Igishushanyo 1 Inyigisho eshatu zinkingi ya radiyo ya kure ya ulnar.
Inkingi yuruhande ni igice cyuruhande rwa radiyo ya kure, harimo fossa yo mu mazi hamwe na tuberosity ya radial, ifasha amagufwa ya carpal kuruhande rwa radiyo kandi niyo nkomoko ya zimwe mumigozi ihindura intoki.
Inkingi yo hagati ni igice cyo hagati ya radiyo ya kure kandi ikubiyemo fossa yumusazi (ifitanye isano numusazi) hamwe na sigmoid notch (ifitanye isano na ulna ya kure) hejuru yububiko. Mubisanzwe biremerewe, umutwaro uva mumahirwe fossa woherezwa kuri radiyo unyuze kuri fossa. Inkingi ya ulnar, ikubiyemo ulna ya kure, fibrocartilage ya mpandeshatu, hamwe na ulnar-radial yo hepfo, itwara imizigo ivuye mumagufwa ya ulnar carpal kimwe no mubitereko bito bya ulnar-radial kandi bigira ingaruka zihamye.
Inzira ikorwa munsi ya brachial plexus anesthesia kandi amashusho ya C-arm X-ray ni ngombwa. Antibiyotike yinjira mu mitsi yatanzwe byibura iminota 30 mbere yuko itangira ryakozwe kandi hakoreshejwe irushanwa rya pneumatike kugira ngo bigabanye kuva amaraso.
Gutunganya isahani yimikindo
Kubice byinshi byavunitse, uburyo bwikigazi burashobora gukoreshwa mugushushanya hagati ya radiyo ya carpal flexor na arteriire. Nyuma yo kumenya no gukuramo flexor carpi radialis longus, ubuso bwimbitse bwimitsi ya teres imitsi iragaragara kandi gutandukana kwa "L" kuzamurwa. Mubice byinshi bigoye, imitsi ya brachioradialis irashobora kurekurwa kugirango byorohere kugabanuka.
Urupapuro rwa Kirschner rwinjijwe mumirasire ya karpal, ifasha gusobanura intera-ndende ya radiyo. Niba agace gato kavunitse kumurongo wa arctular karahari, icyuma cya palmar 2.4mm cyicyuma gishobora gushyirwa hejuru yumurongo wa kure wa radiyo kugirango gikosorwe. Muyandi magambo, agace gato kavunitse hejuru yubuso bwa lunate gashobora gushyigikirwa na plaque 2.4mm "L" cyangwa "T", nkuko bigaragara ku gishushanyo cya 2.
Kubimuwe byimyanya idasanzwe-ivunika, nibyiza kumenya ingingo zikurikira. Ubwa mbere, ni ngombwa gusubiramo by'agateganyo kuvunika kugirango umenye neza ko nta tissue yoroshye yashyizwe mumutwe wacitse. Icya kabiri, mu barwayi badafite ostéoporose, kuvunika kurashobora kugabanuka hifashishijwe isahani: icya mbere, umugozi wo gufunga ushyirwa kumpera ya kure ya plaque anatomical plaque, ikaba ikingiwe kumutwe wavunitse wimuwe kure, hanyuma ibice byavunitse byegereye kandi byegeranye bikagabanuka hifashishijwe isahani, hanyuma, hanyuma, izindi zindi zigashyirwa hafi.
FIGURE 3 Ivunika ridasanzwe rya articular ya radiyo ya kure yimuwe iragabanuka kandi igashyirwaho hakoreshejwe uburyo bwa palmar. FIGURE 3-A Nyuma yo kurangiza kwerekanwa hifashishijwe radiyo ya carpal flexor na arteriire ya radiyo, pin ya Kirschner yoroshye ishyirwa mubice bya karpal. Igishushanyo 3-B Gukoresha metacarpal cortex yimuwe kugirango uyisubiremo.
Igishushanyo cya 3-C na Ishusho 3-DA yoroshye ya Kirschner pin ishyirwa kumurongo wa radiyo unyuze kumurongo wacitse kugirango ukosore byigihe gito impera.
Igishushanyo cya 3-E Kubona amashusho ahagije yumurima ukora bigerwaho hifashishijwe retrator mbere yo gushyira isahani. FIGURE 3-F Umurongo wa kure wo gufunga imigozi ushyirwa hafi yamagufa ya subchondral kumpera yubunini bwa kure.
Igishushanyo cya 3-G X-ray fluoroscopi igomba gukoreshwa kugirango hemezwe aho isahani ihagaze. Igishushanyo 3-H Igice cyegeranye cyisahani kigomba kuba gifite icyerekezo (ingero ya dogere 10) uhereye kuri diaphysis kugirango isahani ishobore gushyirwa kuri diaphysis kugirango irusheho gusubiramo ibice byavunitse. Igishushanyo 3-I Kenyera umugozi wa hafi kugirango wongere ugaragaze imikindo yo kuvunika kure. Kuraho pin ya Kirschner mbere yuko screw ikomera.
Igishushanyo cya 3-J na 3-K Amashusho yerekana amaradiyo yerekana ko kuvunika byaje guhindurwa muburyo budasanzwe kandi imigozi ya plaque yari ihagaze neza.
Gushyira Isahani ya Dorsal Uburyo bwo kubaga kugirango bugaragaze icyerekezo cya dorsal ya radiyo ya kure biterwa ahanini nubwoko bwavunitse, kandi mugihe habaye kuvunika hamwe nibice bibiri cyangwa byinshi byavunitse hagati yimitsi, intego yubuvuzi ni ugukosora cyane cyane inkingi ya radiyo na mediya icyarimwe. Muburyo budasanzwe, imirongo yingoboka yagutse igomba gutondekwa muburyo bubiri bwingenzi: igihe kirekire mugice cya 2 nicya 3 cyagutse, hamwe no gutandukana kwa subperiosteal kugeza mugice cya 4 cyagutse no gukuramo imitekerereze ihuye; cyangwa igice cya kabiri gishyigikira umurongo hagati ya 4 na 5 yaguye kugirango yerekane inkingi zombi zitandukanye (Ishusho 4).
Ivunika rikoreshwa kandi rigashyirwaho by'agateganyo hamwe na pin ya Kirschner idasomwe, kandi amashusho ya radiografiya yafashwe kugirango hamenyekane ko kuvunika kwimuwe neza. Ibikurikira, uruhande rwa dorsal ulnar (inkingi yo hagati) ya radiyo ihagaze neza hamwe na plaque 2,4 mm "L" cyangwa "T". Isahani ya ulnar yakozwe kugirango irebe neza neza kuruhande rwa dorsal ulnar ya radiyo ya kure. Isahani irashobora kandi gushirwa hafi yuruhande rwa dorsal rwumusazi wa kure bishoboka, kuko ibinono bihuye kuruhande rwinyuma ya buri sahani bituma amasahani yunama kandi agakorwa atarinze kwangiza imigozi mumyobo (Ishusho 5).
Gukosora isahani ya radiyo iroroshye biroroshye, kuko ubuso bwamagufwa hagati yicyiciro cya mbere nicyakabiri cyagutse birasa neza kandi birashobora gukosorwa muriyi myanya hamwe nisahani ikwiye. Niba pin ya Kirschner ishyizwe mubice bikabije bya tuberosity ya radiyo, impera ya kure yisahani yinkingi ya radiyo ifite umwobo uhuye na pin ya Kirschner, itabangamira umwanya w isahani kandi ikomeza kuvunika ahantu (Ishusho 6).
Igishushanyo cya 4 Kugaragaza ubuso bwa dorsal ya radiyo ya kure. Inkunga yingoboka yafunguwe kuva mugice cya 3 cyagutse cya interosseous compartment hanyuma extensor hallucis longus tendon isubizwa inyuma.
Igishushanyo cya 5 Kugirango ukosore icyerekezo cya dorsal yubuso bwa arctular yubusazi, isahani ya "T" cyangwa "L" isanzwe ikorwa (Ishusho 5-A na Ishusho 5-B). Isahani ya dorsal hejuru yubuso bwa lunate imaze kuboneka, isahani yinkingi ya radiyo iba ifite umutekano (Ishusho 5-C kugeza 5-F). Amasahani abiri ashyirwa ku nguni ya dogere 70 kuri mugenzi we kugirango ateze imbere imbere.
Igishushanyo cya 6 Isahani yinkingi ya radiyo ikozwe neza kandi igashyirwa mu nkingi ya radiyo, ukareba icyerekezo ku mpera yisahani, ituma isahani irinda gukosorwa by'agateganyo pin ya Kirschner bitabangamiye umwanya w’isahani.
Ibitekerezo byingenzi
Ibyerekana kuri plaque ya Metacarpal
Kwimurwa metacarpal intra-articular kuvunika (kuvunika kwa Barton)
bimuwe byavunitse bidasanzwe-byavunitse (Amavunja ya Colles na Smith). Gukosora bihamye birashobora kugerwaho hamwe namasahani ya screw nubwo haba hari osteoporose.
Kwimurwa metacarpal lunate articular ivunika hejuru
Ibyerekana ibyapa bya dorsal
Hamwe no gukomeretsa kwimitsi
Kwimurwa dorsal lunate ihuriweho hamwe kuvunika
Gukata neza radial carpal gufatanya kuvunika
Kurwanya ibyapa bya palmar
Osteoporose ikabije ifite aho igarukira
Dorsal radial ukuboko kuvunika kuvunika
Kubaho kwa comorbidities nyinshi
Kurwanya ibyapa bya dorsal
Inzitizi nyinshi zubuvuzi
Kuvunika kutimuwe
Amakosa yakozwe byoroshye mugukosora plaque
Umwanya w'isahani ni ingenzi cyane kuko ntabwo isahani ishyigikira gusa kuvunika, ariko guhagarara neza biranabuza umugozi wo gufunga intera kure kwinjira mumirasire ya karpal. Witonze witonze amaradiyo, ateganijwe mu cyerekezo kimwe no guhinduranya imirasire ya radiyo ya kure, ituma umuntu ashobora kubona neza neza ubuso bwa arctular yubuso bwa radiyo ya radiyo ya kure, nabwo bushobora kugaragara neza mugushira imigozi ya ulnar mbere mugikorwa.
Kwinjira mu cyerekezo cya dorsal bitwara ibyago byo gutera imitsi ya extensor no gutera imitsi. Gufunga imigozi ikora bitandukanye nibisanzwe, kandi ntabwo ari ngombwa kwinjira muri cortex ya dorsal hamwe na screw.
Amakosa yakozwe byoroshye hamwe no gukosora isahani
Hama hariho ingorane zo kwinjirira mu mitsi ya radiyo ya karpal, kandi bisa nuburyo bwasobanuwe haruguru bujyanye nisahani yimikindo, hagomba gufatwa isasu rinini kugirango hamenyekane niba imyanya ya screw ifite umutekano.
Niba gukosora inkingi ya radiyo bikozwe mbere, imigozi yo mubitereko bya radial izagira ingaruka kumasuzuma yo gukosorwa nyuma yubuso bwa arctular busubukure bwumusazi.
Imiyoboro ya kure idacometse rwose mu mwobo wa screw irashobora guhagarika imitsi cyangwa igatera no guturika.
Igihe cyo kohereza: Ukuboza-28-2023
