Ivunika rya metacarpal phalangeal ni ivunika risanzwe mu ihahamuka ryamaboko, bingana na 1/4 cy’abarwayi bafite ihahamuka. Bitewe nuburyo bworoshye kandi bugoye bwikiganza nigikorwa cyoroshye cyo kugenda, akamaro nubuhanga bwo kuvura kuvunika intoki biragoye cyane kuruta kuvura andi magufa maremare. Kugenzura ituze ryavunitse nyuma yo kugabanuka nurufunguzo rwo kuvura neza kuvunika metacarpal phalangeal. Kugirango ugarure imikorere yukuboko, kuvunika akenshi bisaba gukosorwa bikwiye. Mubihe byashize, plaster yo hanze ikosora cyangwa Kirschner wire imbere yo gukosora byakoreshwaga kenshi, ariko akenshi ntabwo bifasha mumahugurwa yo gutangira kwisubiraho hakiri kare nyuma yo gukosorwa bitewe nigihe cyo gukosorwa nabi cyangwa igihe kirekire cyo gukosora, ibyo bikaba bigira uruhare runini mugusubirana imikorere yintoki kandi bizana ingorane zimwe na zimwe mubikorwa byo gusana amaboko. Uburyo bugezweho bwo kuvura buragenda bukoreshwa muburyo bukomeye bwo gukosora imbere, nka micro-plate screw fixation.
I.Ni ayahe mahame yo kuvura?
Amahame yo kuvura kuvunika metacarpal na phalangeal kuvunika: kugabanya anatomique, gukosora urumuri no gukomera, ibikorwa hakiri kare namahugurwa yimikorere. Amahame yo kuvura kuvunika imbere-arctular na peri-articular kuvunika kwamaboko ni kimwe nayandi mavunja yimbere-arctular, nayo agomba kugarura anatomiya yubuso bwibikorwa hamwe nibikorwa byambere bikora. Mugihe cyo kuvura imvune ya metacarpal na phalangeal, hagomba gushyirwaho ingufu kugirango igabanuke rya anatomique, kandi kuzunguruka, kuruhande, cyangwa kwimura inguni ya> 10 ° kuruhande rwa dorsal kuruhande rwikigazi ntigomba kubaho. Niba imvune yimpera ya metacarpal phalange izunguruka cyangwa igahinduka impande zombi, bizahindura inzira yimikorere isanzwe ihindagurika no kwaguka kwurutoki, bigatuma ihinduka cyangwa igwa nurutoki rwegeranye mugihe cyo guhindagurika, bigira ingaruka kumikorere yibikorwa byurutoki; kandi iyo kwimura inguni kuruhande rwa dorsal kuruhande rwikigazi ni> 10 °, ubuso bworoshye bwo guhuza hagati yamagufwa nigitereko cyangiritse, byongera imbaraga zo kurwanya no kwaguka kwimitsi no kwaguka kw'imitsi, kandi kwangirika kw'imitsi idakira bibaho, bigatera ibyago byo guturika kw'imitsi.
II.Nibihe bikoresho bishobora guhitamo kuvunika metacarpal?
Hano hari ibikoresho byinshi byo gutunganya imbere kuvunika metacarpal, nkinsinga za Kirschner, imigozi, amasahani hamwe nogukosora hanze, muribyo insinga za Kirschner na microplate zikoreshwa cyane. Kuvunika kwa metacarpal, microplate imbere ikosora ifite ibyiza bigaragara kurenza insinga ya Kirschner kandi irashobora gukoreshwa mbere; kumeneka ya phalanx yegeranye, microplates muri rusange irarenze, ariko mugihe bigoye gushyiramo imigozi ya phalanx ya intera ya kure hamwe no kuvunika umutwe, hagomba gukoreshwa insinga ya Kirschner imbere imbere, bigomba gufasha cyane kugarura imikorere yintoki zanduye; Insinga za Kirschner zigomba gukoreshwa mbere yo kuvura imvune zo hagati.
- Kirschner wire:Kirschner wire imbere yo gukosora yakoreshejwe mubikorwa byubuvuzi mumyaka irenga 70 kandi yamye ari ibikoresho bikoreshwa cyane mugutunganya imbere kubuvunika bwa metacarpal na phalangeal. Nibyoroshye gukora, mubukungu kandi bifatika, kandi nuburyo bwa kera bwo gukosora imbere. Nkibisanzwe bikoreshwa imbere mugukemura kuvunika amaboko, biracyakoreshwa cyane. Ibyiza bya Kirschner wire imbere gukosora: ① Biroroshye gukora kandi byoroshye gukoresha; Kwiyambura imyenda yoroheje yoroheje, kutagira ingaruka nke kumaraso yamaraso yamenetse, guhahamuka gake, no gufasha gukira kuvunika; ③ Biroroshye gukuramo urushinge kunshuro ya kabiri; Cost Igiciro gito kandi kigari cyo gukoreshwa, gikwiranye no kuvunika intoki nyinshi (nk'imvune zo mu nda-arctular, kuvunika gukabije no kuvunika kure).
2.Metacarpophalangeal microplates: Gukosora imbere imbere kuvunika intoki nishingiro ryamahugurwa yimikorere hakiri kare hamwe nibisabwa kugirango ugarure imikorere myiza yintoki. AO tekinoroji yo gukosora imbere isaba ko impera zavunitse zisubirwamo neza ukurikije imiterere ya anatomique kandi ko impera zavunitse zihamye mugihe cyimikorere, izwi cyane nko gukosorwa gukomeye, kugirango yemere kugenda hakiri kare. AO ishimangira kandi ibikorwa byo kubaga byibasiye cyane, hibandwa ku kurinda amaraso. Microplate ikosora imbere yo kuvura kuvunika intoki irashobora kugera kubisubizo bishimishije mubijyanye nimbaraga, ituze ryimpera zavunitse, hamwe nigitutu hagati yimpera. Kubijyanye no gukira nyuma yibikorwa, igihe cyo gukira kuvunika, nigipimo cyanduye, abantu bemeza ko imikorere ya plaque ya microtitanium ari nziza cyane ugereranije n’insinga za Kirschner. Byongeye kandi, kubera ko kuvunika igihe cyo gukira nyuma yo gukosorwa hamwe na plaque ya microtitanium ari ngufi cyane ugereranije nubundi buryo bwo gukosora, ni byiza ko abarwayi bakomeza ubuzima busanzwe hakiri kare.
(1) Ni izihe nyungu zo gukosora microplate imbere?
Ugereranije ninsinga za Kirschner, ibikoresho bya microplate screw bifite ubwuzuzanye bwimitsi hamwe nibisubizo byiza; ② Guhagarara kwa sisitemu yo gukosora isahani hamwe nigitutu kumpera yamenetse bituma kuvunika byegereye kugabanuka kwa anatomique, gukosorwa neza, kandi bifasha gukira kuvunika; Exercise Imyitozo ngororangingo hakiri kare iremewe muri rusange nyuma ya microplate ikosowe, ifasha kugarura imikorere yintoki.
(2) Nubuhe buryo bwo kubaga microplates?
Kubaga mubisanzwe bikorwa munsi ya brachial plexus block anesthesia, kandi mubisanzwe birasabwa irushanwa rya pneumatike. Gufata dorsal ya metacarpal phalanges byafashwe, aponeurose ya dorsal yimibare iracibwa cyangwa imitsi ihuza imitsi hamwe namagufwa ya metacarpal yinjiye kugirango yerekane impera zavunitse zamagufwa ya metacarpal cyangwa phalangeal, periosteum iracibwa, kandi kuvunika kugabanuka muburyo bwo kubona neza. Isahani igororotse irakwiriye kuvunika guhinduranya igice cyo hagati no kuvunika kugufi, T-plaque irakwiriye gukosorwa shingiro rya metacarpal na phalanges, na T-plaque cyangwa 120 ° na 150 ° L-plaque ikwiranye no gukosora ibice birebire kandi byavunitse. Isahani isanzwe ishyirwa kuruhande rwamagufwa kugirango wirinde kunyerera no kwambara igihe kirekire, bifasha imyitozo hakiri kare. Nibura imigozi ibiri igomba gukoreshwa kugirango ikosore impande zombi zavunitse, bitabaye ibyo umutekano urakennye, kandi insinga za Kirschner cyangwa imigozi hanze yisahani birakenewe kugirango bifashe gukosorwa kugirango ugere ku ntego yo gukosorwa neza.
3.Imashini nto: Imashini ntoya ifite ituze risa nicyuma mugukosora ibice bya spiral cyangwa birebire birebire, ariko intera yumubiri woroshye hamwe no kwambura periosteum ni ntoya ugereranije no gutunganya ibyuma, ibyo bikaba bifasha kurinda amaraso kandi bijyanye nigitekerezo cyo gukora byibasiye. Nubwo hariho amasahani ya T-na L yo kumeneka hafi ya articular, kugarura imikorere ihuriweho nyuma yo gukurikiranwa nyuma yibikorwa ni bibi kuruta kuvunika diaphyseal. Imashini ntoya nayo ifite ibyiza bimwe na bimwe mugukosora imvune yimbere-yimbere na peri-articular. Imigozi yinjiye mu magufwa ya cortical irashobora kwihanganira umutwaro munini uhangayitse, bityo gukosorwa birakomeye, kandi impera zavunitse zirashobora guhagarikwa kugirango ibice byavunitse bihuze cyane, bigabanya igihe cyo gukira kuvunika kandi byorohereze gukira kuvunika, nkuko bigaragara ku gishushanyo cya 4-18. Mini screw gukosora imbere kuvunika intoki bikoreshwa cyane cyane kumeneka ya oblique cyangwa spiral ya diaphyseal na intra-articular avulsion avunika amagufwa manini. Twabibutsa ko mugihe ukoresheje mini mini yonyine kugirango ukosore ibice byavunitse cyangwa bizunguruka byamagufwa ya diaphyseal yukuboko, uburebure bwumurongo wavunitse bugomba kuba byibuze inshuro ebyiri zumurambararo wamagufwa ya diaphyseal, kandi mugihe ukosora ibice byavunitse byavunitse mubice, ubugari bwikigufwa bwamagufwa bugomba kuba byibuze inshuro 3 zumurambararo.
4.Micro ikosora hanze:Ivunika rya metacarpal phalangeal rimwe na rimwe biragoye kugabanya muburyo budasanzwe cyangwa ntibishobora gukosorwa imbere imbere na nyuma yo kubagwa bitewe no gusenya inkunga yamagufwa. Ikosora yo hanze irashobora kugarura no kugumana uburebure bwavunitse bwagabanutse munsi, bikagira uruhare mukugereranya. Metacarpal phalangeal itandukanye ikosora ishyirwa mumyanya itandukanye: phalanges ya metacarpal ya 1 na 2 ishyirwa kuruhande rwa radiyo ya dorsal, phalanges ya metacarpal ya 4 na 5 ishyirwa kuruhande rwa dorsal ulnar, naho phalange ya 3 ya metacarpal igashyirwa kuruhande rwa dorsal cyangwa kuruhande rwa ulnar. Witondere ingingo yo gushiramo inshinge kugirango wirinde kwangirika. Ivunika rifunze rirashobora kugabanuka munsi ya X-ray. Iyo kugabanuka atari byiza, gutemagura gato birashobora gukorwa kugirango bigabanuke.
Ni izihe nyungu z'abakosora hanze?
Oper Igikorwa cyoroshye, kirashobora guhindura ibintu bitandukanye byimitsi ivunika; ② Irashobora kugabanya neza no gukosora imvune yimbere-yamagambo yamagufa ya metacarpophalangeal itangiza kwangirika kwingingo, kandi irashobora kurangaza urufatiro kugirango irinde kwandura capsule hamwe ningingo zingwate; ③ Iyo kuvunika kugabanijwe bidashobora kugabanywa muburyo budasanzwe, birashobora guhuzwa no gukosora imbere, kandi gukosora hanze birashobora kugabanya igice no gukomeza umurongo wingufu; Emerera imyitozo hakiri kare y'urutoki rwanduye mu ngingo idakosowe kugirango wirinde gukomera hamwe na osteoporose; ⑤ Irashobora gukosora neza kuvunika intoki bitagize ingaruka kumiti nyuma yo kuvurwa igikomere ku kuboko kwanduye.
Igihe cyo kohereza: Ukuboza-21-2024
