Kugeza ubu, kuvunika indwara za kure bya radiyo bifatwa muburyo butandukanye, nkibipabyo, gutemagurira no kugabanya ibicuruzwa byimbere, nibindi bisobanuro byayo, nibindi bisobanuro byibimenyetso byiyongera, ariko amakuru ya SPLAS arashobora kugera kubisubizo byayo ari 16%. Ariko, niba isahani yatoranijwe neza, igipimo cyo kugorana gishobora kugabanuka neza. Incamake ngufi yubwoko, ibimenyetso nuburyo bwo kubaga bya platique platique yo kuvura radiyo ya kure.
I.ypes yo kuvunika indwara za radiyo
Hano hari uburyo bwinshi bwo gutondekanya, harimo na Müller Ao gutondekanya bishingiye kuri anatomiya hamwe nibyiciro bya Femandez bishingiye ku mikorere y'imvune. Muri bo, ibyiciro byambere bihuza ibyiza byimiterere yabanjirije, bikubiyemo ubwoko bune bwibanze bwimiterere, kandi birimo imivuza 4-igice cya chafson hamwe nibikoresho byiza, bishobora kuba umuyobozi mwiza wakazi.
1. Müller Ao gutondekanya - kuvunika igice-arcticular
Icyiciro cya Ao gikwiranye nubusa bwa radiyo bwa kure kandi kigabanya muburyo butatu bwingenzi: andika inyuguti zidasanzwe, andika b igice cya intra-articular, nubwoko bwuzuye. Buri bwoko buragabanijwemo muburyo butandukanye bwo guhuza amatsinda ashingiye ku bukana no kumera kumeneka.
Andika A: kuvunika-bidasanzwe
A1, kuvunika femoral ya Ulmous, Radius nk'imvune (A1.1, kuvunika Ulnar; A1.2 Kuvunika byoroshye kwa Ulnar Diaphys;
A2, kuvunika kwa radiyo, byoroshye, hamwe na reset (A2.1, radiyo itagira impita; a2.2, imipira ya radiyo; a2.2
A3, kuvunika kwa radiyo, byakozwe (A3.1, haragabanyijemo umusozi wa radiyo; a3.2 Igice cya Wedge ya Visidius; A3.3, kuvunika kwa radiyo).
Ubwoko B: Kuvunika igice
B1, kuvunika kwa radiyo, indege ya sagittal (B1.1, ubwoko bworoshye; b1.2, ubwoko bwimiterere bwimiterere; b1.3, ubwoko bwumucana).
B2, kuvunika uruzitiro rwa dorsal ya radiyo, ni ukuvuga kuvunika Barton (B2.1, ubwoko bworoshye;
B3, kuvunika metacarpal rim ya radiyo, ni ukuvuga kuvunika kurwanya ibitero, cyangwa ubwoko bwa goyrand-smith, ibice byoroheje, igituba kinini; b3.
Ubwoko C: Kuvunika burundu
C1, kuvunika kwa radiail hamwe nubwoko bworoshye bwabahanzi na metaphyseal hejuru (C1.1, kuvunika inyuma neza; C1.2, kuvunika inyuma hejuru; c1.3, kuvunika hejuru yubuso bwa articular).
C2, kuvunika kwa radiyo, isura yoroshye ya articulas, yashinzwe na metaphysis (C2.1, kuvunika SINCTION ya ARCTICE INGINGO; C2.2, FIRONAL FARTT ivunika igice cya articular; c2.3, kuvunika ibihangano bitera uruti rwa radiyo).
C3, kuvunika kwa radial, byakozwe (c3.1, kuvunika byoroshye kwa metaphysis; c3
2.Gushyira mu bikorwa ku kuvunika indwara za radiyo.
Nk'uko gahunda yo gukomeretsa Femandez ishobora kugabanywamo ubwoko 5 :.
Andika i kuvunika ni-arpaphyseal metaphyseal kuvunika nka colles freles (anglation dorsal) cyangwa ibishishwa bya smith (metacarpal angliation). Cortex yinkumi imwe imeneka munsi yimpagarara hamwe na cortex yagenzurwaga na cortex yakozwe kandi yinjizwa.
Kuvunika
Ubwoko bwa III buvunika bubamo ibisobanuro, biterwa no guhangayika. Izi mvuka zirimo kuvunika palmar bartton, kuvunika kwa dorsal
Stress Stress
Ubwoko bwa III ni intera-artaphyseal ibikubiyemo biterwa n'ibikomere, harimo ibikomere bigoye hamwe na pilon ya ralon.
Kwinjiza
Andika kuvunika IV ni ugucikamo ibintu bya ligamentous bibaho mugihe cyo kuvunika-kwigaburira karasi karakaye.
Kuvunika kuvugurura ndatandukanije
Andika Vcracture zikomoka ku gikomere kinini kirimo imbaraga nyinshi zo hanze no gukomeretsa byinshi. (Kuvanga i, II, IIII, iV)
3.PonyCmime
II.Kibyatsi bibi bya radiyo bya kure hamwe na palmar
Ibimenyetso.
Kubintu bidasanzwe-byingenzi bikurikira kunanirwa kugabanuka mubihe bikurikira.
Kurambagiza ibihimbano birenze 20 °
Gutongana Kurenga 5 MM
Marike ya marike igabanya mm irenze mm 3
Kuvunika gukuraho kwimuka kurenza mm 2
Kubwububiko bwa Intra-Articular burenze 2mmm
Intiti nyinshi ntizisaba gukoresha amasahani ya metacarpal kubera ibikomere byingufu nyinshi, nko gutakaza amagufwa gukabije cyangwa kugabanya amagufwa akomeye, kuko ibi bice bikabije byamagufwa bikunze kugaragara kuri necrosic kandi biragoye guturika Anatatoni.
Mu barwayi bafite ibice byinshi byacitse hamwe no kwimurwa cyane hamwe na osteoporose ikabije, ibyorezo bya metacarpal ntabwo ari byiza. Inkunga y'amagambo yo kuvunika kure irashobora kuba ikibazo, nka screw kwinjira mu mwobo uhuriweho.
Tekinike yo kubaga
Abaganga benshi bakoresha uburyo busa na tekinike yo gukosora imiterere ya radiyo ya kure hamwe nisahani ya palmar. Ariko, tekinike nziza yo kubaga isabwa neza kubibazo byo gusarura nyuma, urugero, kugabanya birashobora kugerwaho mukurekura kuvunika guhagarika no kugarura uburebure bwamagufwa ya cortical. Gukosora by'agateganyo hamwe na kirscner pin 2-3 birashobora gukoreshwa, nibindi
(I) Gusubiramo no kwishyiriraho
1. TRACKES ikorwa mu cyerekezo cya Ratial munsi ya Flaroscopy, hamwe n'intoki zikanda kumeneka kuva ku mpande z'imisaha n'izindi nzamura kure
2. Umwanya utanga, hamwe nigitambo cyakozwe kumeza yintoki munsi ya flueroscopi.
(Ii) Ingingo.
Erega ubwoko bwubumwe bugomba gukoreshwa, PCR (CCR Flexor Flexor) yaguye inzira ya palma.
Ikirango cya kure cyuruhu gitangirira mu ruhu rwometse ku ruhu n'uburebure burashobora kugenwa hakurikijwe ubwoko bwo kuvunika.
Flexor Carpi radialis Tendon na Tendon Sheath irangijwe, itandukanijwe namagufa ya karpal na proximil hafi yimpande zikomeye zishoboka.
Gukuramo karuweli ka karuse ya kamera kuri ulnar kuruhande rwimitsi ya median na flaxor tendon.
Umwanya wa Parona washyizwe ahagaragara hamwe na Rotator ya Anior Ani Imitsi iherereye hagati ya flexor Digitum ndende (uruhande rwa Ulnar) hamwe nububiko bwa radiyo (uruhande rwa radiyo).
Shyira uruhande rwa Ratail ya Rotator ya Anior Ani Imitsi, ibona ko igice kigomba gusigara kuri radiyo nyuma yo kwiyubaka nyuma.
Gukuramo rotator motoior ani imitsi kugeza kuri Ulnar kuruhande ruhagije rwihembe ryihembe rya Ulnar kuruhande rwa ralius.
Uburyo bwa palmar bwerekana radiyo ya kure kandi neza byerekana inguni ya ulnar.
Kubwoko bugoye, birasabwa ko kurera Brachioradialis ya kure ishobora kurekurwa, ishobora gutesha agaciro gukurura inyenzi zaciwe kandi zikaba zerekeza kuri radiyo yubatswe, hanyuma igashyiraho umuvuduko wa radiyo, hanyuma ugaragaze radiyo Yuberous, hanyuma ugaragaze ko yagabanijweho ya radiyo, hanyuma igashyiraho imipaki ya kure, hanyuma igashyiraho imipaki ya radiyo, hanyuma igashyiraho imipaki ya radiyo, hanyuma igasubiramo Intra-arcticular frect Guhagarika ukoresheje Kirchner Pin. Kubwububiko bukomeye bwa Intra-Archarque, Arthroscopi irashobora gukoreshwa mugufasha mugugabanuka, gusuzuma no gutunganya neza kuvura.
(Iii uburyo bwo kugabanuka.
1. Koresha igufwa ryamagufwa nkinyongera kugirango usubize
2. Umufasha akurura indangagaciro z'umurwayi n'intoki zo hagati, zizaba zororoka gusubiramo.
3. Kuramo Kirschner PIN uhereye kuri retaile kugirango ikosorwe by'agateganyo.
Nyuma yo kwishyiriraho birangiye, hashyirwa ikiganiro cya palmar kirasanzwe, kigomba kuba hafi yubwikunde bwamazi, kigomba gupfukirana ulnar icyubahiro, kandi kigomba kuba cyagereranijwe hagati yigiti cya radiyo. Niba ibi bintu bitujujwe, niba icyapa kitari ubunini bukwiye, cyangwa niba gusubiramo bidashimishije, inzira iratungana.
Ingorane nyinshi zifitanye isano cyane numwanya wisahani. Niba isahani ishyizwe kure kuruhande rwa radiyo, ingorane zijyanye na Flexor birashoboka ko bizabaho; Niba isahani ishyizwe hafi yumurongo wamazi, guhindagurika kwinshi k'urutoki birashobora kuba bifite ibyago. Ubumuga bwo kwimurwa bwo guhagarika uruhande rwa Palmar burashobora gutuma byoroshye isahani yo gusohoka kuruhande rwa palmar hanyuma tukavugana na flakor, amaherezo biganisha kuri mandanitis cyangwa no guturika.
Mu barwayi ba Osteoporotike, birasabwa ko isahani ishyirwaho hafi yumurongo wamazi ishoboka, ariko sindi hejuru yayo. Gukosora ibicuruzwa birashobora kugerwaho ukoresheje Kirkoner pin yegereye ulna, kandi kuruhande-kuruhande rwa kirsclener pin hamwe nimigozi yo gufunga bifite akamaro mu kwirinda kuvuka.
Iyo isahani imaze gushyirwaho neza, iherezo ryimiterere rikosowe hamwe na screw imwe kandi irangizwa ryisahani rikoreshwa by'agateganyo hamwe na kirsclener pin mu mwobo wa Ulnar. Intraoscopic orthopantomograms, ibitekerezo byuruhande, hamwe na firime zanyuma hamwe nintoki za 30 ° hejuru yintoki kugirango hamenyekane kugabanuka kwomeke hamwe numwanya wo gukosora imbere.
Niba isahani ihagaze neza, ariko krsclener pin irahuye, ibi bizavamo gukiranirwa bidahagije, ibi bishobora gukemurwa no gusubiramo isahani yo gukoresha isahani ya "Flat Fliction yo gukosora".
Ishusho ya 2.
Amapine ya Kirscler yo gukosorwa by'agateganyo, menya ko impengamiro nziza hamwe n'ubuso bwa articular budasubirwaho bihagije kuri iyi ngingo;
B, Kirschner imwe ya PIN ya plate yamalaaperi, menya ko Radiyo ya kure yakosowe kuri iyi ngingo (kuvuza guhagarika ubuhanga bwo gukosora), hamwe nigice kinini cyisahani ikururwa kuruhande rwa ralmal kugirango igarure inkoni ya palmar.
C, guhuza arthroscopique hejuru yubuso bwa articular, gushyira imiyoboro yo gufunga cyane / pin, no gusubiramo byanyuma no gukosora radiyo ya proxisi.
Kubijyanye no guhuza dorsal na Ulnar / dorsar gupfa punch), bidashobora gusubiramo bihagije, tekinike eshatu zikurikira zishobora gukoreshwa.
Radiyo ya Proximine izunguruka imbere kurubuga, kandi guhagarika Futsa Yubusa yasunitswe kumagufwa ya karpal binyuze muri PCR kurambura inzira. Gucika intege gato kugeza ku bice bya 4 n'iya 5 no kwerekana imivura ivunika, kandi birashizweho mu masaha ya Ulnar cyane. Gufunga ibyateganijwe cyangwa bike bitera gukosorwa byakozwe nubufasha bwa Arthroscopique.
Nyuma yo guhatira no gushyiramo isahani, gukosora byanyuma ni byoroga kandi bya anatolike birashobora kugerwaho niba ibipimo bya Ulnar Kernel bihagaze neza kandi nta mashini zihuriweho na cuint (Ishusho 2).
(iv) Uburambe bwo gutoranya.
Uburebure bwimigozi bushobora kugorana gupima neza kubera amakosa akomeye ya dortal cortique ya cortique. Imigozi irangiye cyane irashobora kuganisha kuri teston ashishikajwe no kuba mugufi cyane kugirango ushyigikire gukosorwa kuvunika dorsal. Kubera iyo mpamvu abanditsi basaba gukoresha imisumari yo gufunga imisumari hamwe nimisumari yo gufunga imisumari ya radial hamwe na foramen nyinshi, hamwe no gukoresha imigozi yo gufunga urumuri mumyanya isigaye. Gukoresha umutwe utagaragara wirinda guhagarika ingendo nubwo byanditse neza. Kubijyanye no guhagarika isahani ya plaxic, ibice bibiri bihuza + screw imwe (yashyizwe muri ellipse) irashobora gukoreshwa mugukosora.
Dr Kiyohito ukomoka mu Bufaransa yerekanye uburambe bwabo bwo gukoresha amasahani y'ibinyago bidafite impungenge z'igitsina gabo, aho guhagarika kwabaga byagabanutse kuri 1cm ikabije, irwanya. Ubu buryo bugaragazwa cyane cyane kumiterere ya radiyo ihagaze neza, nibimenyetso byayo byo kubaga ni kubivuza bidasanzwe byamoko C1 na C2, ariko ntabwo bikwiranye na C1 na C2 bihuye namagufwa igusenyuka. Uburyo nabwo ntabwo bukwiriye ubwoko B kuvunika b. Abanditsi nabo bagaragaza ko niba kugabanya neza no gukosora bidashobora kugerwaho nubu buryo, birakenewe guhindura muburyo bwa gakondo kandi ntibakomere kuri stre ntoya.
Igihe cya nyuma: Jun-26-2024
