Kuvunika kwa Metacarpal phalangeal ni imvune ikunze kuvunika mu bikomere byo ku ntoki, igizwe na 1/4 cy'abarwayi bakomeretse ku ntoki. Bitewe n'imiterere yoroheje kandi igoye y'ukuboko n'imikorere yoroshye yo kugenda, akamaro n'ubuhanga bwo kuvura imvune y'ukuboko biragoye cyane kuruta kuvura izindi mvune ndende z'amagufwa. Kwizeza ko imvune ihamye nyuma yo kugabanuka ni ingenzi kugira ngo imvune ya metacarpal phalangeal ivurwe neza. Kugira ngo imvune igaruke, akenshi imvune ikenera gufatirwa neza. Mu bihe byashize, gufatirwa hanze ya plaster cyangwa gufatirwa imbere kwa Kirschner byakunze gukoreshwa, ariko akenshi ntibifasha mu myitozo yo kuvugurura ingingo hakiri kare nyuma yo kubagwa bitewe no gufatirwa nabi cyangwa igihe kirekire cyo gufatirwa, bigira ingaruka zikomeye ku kugarura imikorere y'ingingo z'urutoki kandi bigatera ingorane zimwe na zimwe mu kuvugurura imikorere y'ukuboko. Uburyo bugezweho bwo kuvura burimo gukoresha gufatirwa imbere cyane, nko gufatirwa hasi kwa micro-plate.
I.Ni ayahe mahame ngenderwaho yo kuvura?
Amahame yo kuvura imvune zo mu kiganza na phalangeal: kugabanya imiterere y'umubiri, gufata neza no gukomera, ibikorwa bya mbere n'imyitozo ngororamubiri. Amahame yo kuvura imvune zo mu kiganza na peri-articular ni amwe n'ay'izindi mvune zo mu kiganza, ari nazo zo kugarura imiterere y'ingingo n'imikorere ya mbere. Mu kuvura imvune zo mu kiganza na phalangeal, hagomba gushyirwamo imbaraga kugira ngo hagerwe ku kugabanya imiterere y'umubiri, kandi kuzenguruka, kuzunguruka kw'impande, cyangwa kwimura inguni kuri >10° kugera ku gice cyo mu gituza cy'ikiganza ntibigomba kubaho. Niba impera y'ivunika rya phalange ya metacarpal izunguruka cyangwa ikagenda impande, izahindura inzira isanzwe yo guhindukira no kwagura urutoki, bigatuma ruhinduka cyangwa rugwa hamwe n'urutoki rwegereye mu gihe cyo guhindukira, bigira ingaruka ku mikorere y'urutoki; kandi iyo inguni yimukiye mu gice cyo hejuru cy'ikiganza kiri hejuru ya dogere 10, ubuso bworoshye bwo guhuza igufwa n'imitsi burangirika, byongera imbaraga zo guhangana n'uburyo imitsi igenda no kwaguka, kandi habaho kwangirika kw'imitsi budakira, bigatera ibyago byo gucika kw'imitsi.
II.Ni ibihe bikoresho bishobora gutoranywa mu kuvura imvune za metacarpal?
Hari ibikoresho byinshi byo gufunga imbere mu maraso ya metacarpal, nk'insinga za Kirschner, vis, plaque na fixators zo hanze, muri byo insinga za Kirschner na microplates ni byo bikunze gukoreshwa. Ku maraso ya metacarpal, microplate fixation ifite ibyiza bigaragara kuruta Kirschner wire fixation kandi ishobora gukoreshwa mbere; ku maraso ya proximal phalanx, microplates muri rusange ni nziza, ariko iyo bigoye gushyiramo vis zo gufunga igice cya proximal phalanx distal segment n'umutwe, hagomba gukoreshwa cross Kirschner wire internal fixation, ibyo bikaba byorohereza imikorere y'urutoki rwagize ikibazo; insinga za Kirschner zigomba gukoreshwa mbere mu kuvura imvune zo hagati za phalanx.
- Insinga ya Kirschner:Gufata umugozi wa Kirschner bimaze imyaka irenga 70 bikoreshwa mu buvuzi kandi byagiye bikoreshwa cyane mu gufata umugozi wa metacarpal na phalangeal. Biroroshye gukoresha, bihendutse kandi ni ingirakamaro, kandi ni bwo buryo busanzwe bwo gufata umugozi wa mbere. Nk'uburyo bukoreshwa cyane mu kuvura imvune z'intoki, biracyakoreshwa cyane. Ibyiza byo gufata umugozi wa Kirschner: ① Byoroshye gukoresha kandi byoroshye cyane gukoresha; ② Gukuraho ingingo nke zoroshye, ingaruka nke ku maraso yo ku mpera y'imvune, imvune nke zo kubagwa, kandi bifasha imvune gukira; ③ Byoroshye gukuramo urushinge ku nshuro ya kabiri; ④ Ihendutse kandi ikoreshwa mu buryo butandukanye, ikwiriye imvune nyinshi zo ku ntoki (nk'imvune zo mu nda, imvune zikomeye zo mu gice cy'imbere n'imvune zo mu gice cy'imbere cy'imbere).
2. Udupira duto twa metacarpophalangeal: Gufata neza imbere mu kuvura imvune z'intoki ni ishingiro ry'imyitozo yo gukora neza kandi ni ngombwa kugira ngo intoki zigarure imikorere myiza. Ikoranabuhanga rya AO risaba ko impera z'imvune zigomba gushyirwa mu mwanya wazo hakurikijwe imiterere y'umubiri wazo kandi impera z'imvune zigakomera mu gihe cy'imikorere yazo, izwi nka strong fixation, kugira ngo habeho kugenda neza hakiri kare. AO kandi ishimangira kubaga bidakunze kwangirika, hibandwa ku kurinda amaraso. Microplate internal fixation yo kuvura imvune z'intoki ishobora gutanga umusaruro ushimishije mu bijyanye n'imbaraga, gutuza kw'impera z'imvune, n'umuvuduko hagati y'impera z'imvune. Ku bijyanye no gukira nyuma yo kubagwa, igihe cyo gukira kw'imvune, n'igipimo cy'ubwandu, bikekwa ko ubushobozi bw'amapine ya microtitanium ari bwiza cyane kuruta ubw'insinga za Kirschner. Byongeye kandi, kubera ko igihe cyo gukira kw'imvune nyuma yo gufata amapine ya microtitanium ari gito cyane ugereranyije n'ubundi buryo bwo gufata, ni byiza ko abarwayi bongera kubaho ubuzima busanzwe hakiri kare.
(1) Ni izihe nyungu zo gushyira microplate imbere mu cyuma?
① Ugereranyije n'insinga za Kirschner, ibikoresho bya microplate screw bifite uburyo bwiza bwo guhuza ingirabuzimafatizo n'uburyo umubiri ubyitwaramo neza; ② Gukomera kw'uburyo bwo gufata plate-screw hamwe n'igitutu ku mpera y'aho imvune ivunitse bituma imvune yegereza kugabanuka kw'imiterere y'umubiri, ikomera kurushaho, kandi igatuma imvune ikira; ③ Imyitozo ngororamubiri ikorwa hakiri kare muri rusange yemerewe nyuma yo gufata microplate, ibi bikaba bifasha mu gusubiza imikorere y'intoki.
(2) Ni ubuhe buryo bwo kubaga microplates?
Ubusanzwe kubagwa bikorwa hakoreshejwe uburyo bwo gusinzira brachial plexus block, kandi ubusanzwe bisaba tourniquet y'umwuka. Hakorwa icibwa ry'umugongo rya phalanges za metacarpal, dorsal aponeurosis y'imibare iracibwa cyangwa imitsi n'igufwa bya metacarpal byinjizwamo kugira ngo impera z'amagufwa ya metacarpal cyangwa phalangeal zisange, periosteum irakurwaho, kandi imvune iragabanuka bitewe no kureba neza. Amasahani agororotse akwiriye kuvunika igice cyo hagati n'amagufwa magufi ya oblique, amasahani ya T akwiriye gufunga igice cyo hasi cya metacarpal na phalanges, naho amasahani ya T cyangwa amasahani ya L ya 120° na 150° akwiriye gufunga amagufwa maremare ya oblique n'afite imiterere. Isahani ishyirwa ku ruhande rw'igufwa kugira ngo hirindwe ko imitsi inyerera kandi idashira igihe kirekire, ibyo bikaba byiza ku myitozo yo gukora imyitozo ikiri nto. Nibura vis ebyiri zigomba gukoreshwa mu gukosora impera zombi z'aho imvune yacitse, bitabaye ibyo stable iba mbi, kandi insinga za Kirschner cyangwa vis ziri hanze y'isahani zirakenewe kugira ngo zifashe gukosora kugera ku ntego yo gukosora neza.
3. Utuzu duto: Udupira duto dufite ubushobozi bwo gukomera nk'udupira tw'icyuma mu gufata imvune zizunguruka cyangwa ndende, ariko uburyo bwo gufata imiterere y'ingingo zoroshye n'uburyo bwo gufata ibyuma ni buto ugereranije n'uburyo ibyuma bifata imvune, ibyo bikaba byiza mu kurinda amaraso no mu buryo bujyanye n'igitekerezo cyo kubaga imvune nke. Nubwo hari udupira two mu bwoko bwa T na L two mu bwoko bwa L two gufata imvune zizengurutse, gusubirana kw'imikorere y'ingingo nyuma yo gukurikiranwa ni bibi kurusha uko imvune zizengurutse nyuma yo kubagwa. Udupira duto dufite kandi inyungu zimwe na zimwe mu gufata imvune zizengurutse inyuma no hagati. Udupira duto dushyirwa mu igufwa rya cortical dushobora kwihanganira umutwaro munini, bityo imvune iba ikomeye, kandi impera z'imvune zishobora gukandamizwa kugira ngo ubuso bw'imvune bufatanye neza, bugabanye igihe cyo gukira kw'imvune kandi bworohereze gukira kw'imvune, nk'uko bigaragara ku Ishusho ya 4-18. Udupira duto two gufata imvune z'intoki ahanini dukoreshwa mu kuvura imvune zizengurutse cyangwa zizengurutse z'imvune zizengurutse inyuma no hagati y'udupira duto tw'amagufwa. Icyitonderwa ni uko iyo ukoresheje utugozi duto twonyine kugira ngo ukosore imvune z’igufwa rya diaphyseal zo mu kiganza, uburebure bw’umurongo w’ivunika bugomba kuba nibura inshuro ebyiri z’umurambararo w’igufwa rya diaphyseal, kandi iyo ushyizeho utugozi tw’igufwa twacitse mu ngingo, ubugari bw’umugozi bugomba kuba nibura inshuro eshatu z’umurambararo w’umugozi.
4. Umuyoboro muto wo hanze:Hari igihe imvune za metacarpal phalangeal zivunitse mu buryo bw'umubiri zigorana kugabanya cyangwa ntizishobora gukosorwa neza imbere ndetse no nyuma yo kubagwa bitewe no kwangirika kw'inkunga y'igufwa. Imashini ifata igufwa ishobora kugarura no kugumana uburebure bw'imvune yavunitse mu gihe cyo gukurura, ikagira uruhare mu gufata igufwa. Imashini zitandukanye zifata igufwa zishyirwa mu myanya itandukanye: phalange za 1 n'iza 2 zishyirwa ku ruhande rw'umugongo, phalange za 4 n'iza 5 zishyirwa ku ruhande rw'umugongo, naho phalange ya 3 ishyirwa ku ruhande rw'umugongo cyangwa uruhande rw'umugongo hakurikijwe uko ibintu bimeze. Witondere aho urushinge rushyirwa kugira ngo wirinde kwangirika kw'imitsi. Imvune zifunze zishobora kugabanuka hakoreshejwe X-rays. Iyo kugabanuka kutari kwiza, hashobora gukorwa icyuho gito kugira ngo bifashe kugabanuka.
Ni izihe nyungu zo gukoresha ibikoresho byo gufunga ibintu byo hanze?
① Gukora byoroshye, bishobora guhindura uburyo butandukanye bwo kwimura impera z'amagufwa yavunitse; ② Bishobora kugabanya no gusana neza imvune zo mu ngingo za metacarpophalangeal zitangiza ubuso bw'ingingo, kandi bishobora kubangamira ubuso bw'ingingo kugira ngo hirindwe ko capsule y'ingingo n'imitsi ya collateral ligament bihagarara; ③ Iyo imvune zavunitse zidashobora kugabanuka mu buryo bw'umubiri, zishobora guhuzwa no gusana imbere mu buryo budahagije, kandi agakoresho ko gusana inyuma gashobora kugabanya igice no gukomeza imbaraga; ④ Kwemerera imyitozo y'urutoki rwagize ikibazo mu ngingo itarakomera kugira ngo hirindwe gukomera kw'ingingo no kuvurwa indwara ya osteoporosis; ⑤ Bishobora gusana neza imvune zo mu ntoki zidagize ingaruka ku kuvura igikomere cyo ku kuboko kwagize ikibazo nyuma yo kubagwa.
Igihe cyo kohereza: Ukuboza-21-2024
