Kugeza ubu, kuvunika kwa radiyo ya kure bivurwa muburyo butandukanye, nko gutunganya plaster, gutema no kugabanya gukosora imbere, gutondekanya hanze, n'ibindi. Muri byo, gutunganya amasahani ya palmar bishobora kugera ku bisubizo bishimishije, ariko ibitabo bimwe bivuga ko igipimo cyacyo kiri hejuru ya 16%. Ariko, niba isahani yatoranijwe neza, igipimo cyingutu kirashobora kugabanuka neza. Incamake ngufi yubwoko, ibimenyetso hamwe nubuhanga bwo kubaga bwa palmar isahani ya radiyo ya kure irerekanwa.
I.Ubwoko bwa radiyo ya kure
Hariho uburyo bwinshi bwo gutondekanya kuvunika, harimo Müller AO itondekanya ishingiye kuri anatomiya na Femandez ishyirwa muburyo bwo gukomeretsa. Muri byo, ibyiciro bya Eponymic bihuza ibyiza byo mubyiciro byabanje, bikubiyemo ubwoko bune bwibanze bwimvune, kandi burimo kuvunika kwa Maleon ibice 4 nibice bya Chaffer, bishobora kuba ubuyobozi bwiza kubikorwa byubuvuzi.
1. Müller AO gutondekanya - kuvunika igice hagati yimitsi
Ibyiciro bya AO bikwiranye no kuvunika kwa radiyo ya kure kandi ikabigabanyamo ubwoko butatu bwingenzi: Ubwoko A budasanzwe, ubwoko B igice cyimbere-articular, nubwoko C bwavunitse. Buri bwoko bwongeye kugabanywamo ibice bitandukanye byitsinda rishingiye ku buremere no kugorana kuvunika.
Ubwoko A: Kuvunika bidasanzwe
A1, kuvunika ulnar femorale, radiyo nkimvune (A1.1, kuvunika stem ulnar; A1.2 kuvunika kworoheje kwa ulnar diaphysis; A1.3, kuvunika kwa diaphysis ulnar).
A2, Kuvunika kwa radiyo, byoroshye, hamwe no gushiramo (A2.1, radiyo itanyeganyega; A2.2, guhindagurika kwa radiyo, ni ukuvuga kuvunika kwa Pouteau-Colles; A2.3, imikindo ya radiyo, ni ukuvuga kuvunika kwa Goyrand-Smith).
A3, Ivunika rya radiyo, ryatangiye (A3.1, kugabanya umurongo wa radiyo; agace ka A3.2 kameze nk'igice cya radiyo; A3.3, kuvunika kwa radiyo)
Ubwoko B: kuvunika igice
B1, kuvunika kwa radiyo, indege ya sagittal (B1.1, ubwoko bworoshye bworoshye; B1.2, ubwoko bwatangiye; B1.3, ubwoko bwo hagati).
B.
B.
Ubwoko C: kuvunika kwose
C.
C.
C.
2.Gushyira ibice byavunitse bya radiyo.
Ukurikije uburyo bwo gukomeretsa Femandez yashyizwe mubice 5:.
Ubwoko bwa I kuvunika ni metafhyseal idasanzwe-ivunika ivunika nka Colles yamenetse (dorsal angulation) cyangwa Smith yamenetse (metacarpal angulation). Cortex yamagufa imwe yamenetse munsi yuburemere kandi cortex itandukanijwe iragabanijwe kandi yashyizwemo.
Kumeneka
Ubwoko bwa III kuvunika ni imvune yimbere-yimbere, iterwa no guhagarika umutima. Ivunika ririmo kuvunika palmar Barton, kuvunika kwa Barton dorsal, hamwe nuduce twa radial.
Guhagarika umutima
Ubwoko bwa III kuvunika ni kuvunika imbere-articular hamwe no kwinjiza metafhyseal biterwa no gukomeretsa kwikomeretsa, harimo kuvunika ingirabuzimafatizo no kuvunika kwa radiyo.
Kwinjiza
Ubwoko bwa IV kuvunika ni avulion avunction ya ligamentous attachment ibaho mugihe cyo kuvunika-gutandukana kwa radiyo karpal.
Kuvunika Avulsion I dislocation
Ubwoko bwa V kuvunika buturuka ku gukomeretsa umuvuduko mwinshi urimo imbaraga nyinshi zo hanze no gukomeretsa cyane. (Ivanze I, II, IIII, IV)
3. Kwandika izina
II.Kuvura ibice bya radiyo ya kure hamwe no gusiga imikindo
Ibyerekana.
Kubuvunika budasanzwe-nyuma yo kunanirwa kugabanuka gufunze mubihe bikurikira.
Guhindagurika kwa Dorsal kurenza 20 °
Kwikuramo dorsal kurenza mm 5
Kugabanuka kwa radiyo kure kurenza mm 3
Kwimura kure kuvunika kurenze mm 2
Kuvunika imbere-arctular irenze 2mm kwimurwa
Intiti nyinshi ntizisaba ko hakoreshwa isahani ya metacarpal mu gukomeretsa ingufu nyinshi, nk'imvune zikomeye zo mu nda-articular zavunitse cyangwa gutakaza amagufwa akomeye, kubera ko ibyo bice byavunitse bya kure bikunda kwibasirwa na nérosose yo mu mitsi kandi bigoye kuyisubiramo.
Ku barwayi bafite ibice byinshi byavunitse hamwe no kwimurwa gukomeye hamwe na osteoporose ikabije, gufata metacarpal ntabwo ari byiza. Inkunga ya subchondral yimvune ya kure irashobora kuba ikibazo, nkurugero rwinjira mumyanya ihuriweho.
Ubuhanga bwo kubaga
Abaganga benshi babaga bakoresha uburyo nubuhanga bwo gukosora ibice bya radiyo ya kure hamwe nisahani yimikindo. Nyamara, tekinike nziza yo kubaga irasabwa kugirango wirinde neza ingorane nyuma yo kubagwa, urugero, kugabanuka kurashobora kugerwaho no kurekura imvune zivuyemo no kwikuramo amagufwa ya cortique. Gukosora by'agateganyo hamwe na pin ya Kirschner 2-3 birashobora gukoreshwa, nibindi.
(I) Gusubiramo mbere yo gutangira no guhagarara
1.
2. Umwanya mwiza, hamwe ningingo zanduye kumeza yintoki munsi ya fluoroscopi.
(II) Ingingo zo kugera.
Kubwoko bwuburyo bwakoreshwa, PCR (radial carpal flexor) yagutse yimikindo irasabwa.
Impera ya kure yo gutema uruhu itangirira kumurongo wuruhu rwintoki kandi uburebure bwarwo burashobora kugenwa ukurikije ubwoko bwavunitse.
Imiyoboro ya radial flexor carpi radialis tendon hamwe nicyatsi cyayo cyarashizwemo, kure yamagufwa ya carpal kandi yegeranye hafi yuruhande rushoboka bishoboka.
Gukurura radial carpal flexor tendon kuruhande rwa ulnar birinda imitsi ya median na flexor tendon complex.
Umwanya wa Parona uragaragara kandi imitsi y'imbere ya ani imitsi iri hagati ya flexor digitorum longus (uruhande rwa ulnar) na arteriire (uruhande rwa radial).
Ongera uruhande rwa radial yimbere yimbere ya ani imitsi, wibuke ko igice kigomba gusigara gifatanye na radiyo kugirango cyongere kwiyubaka.
Gukurura imitsi yimbere ya ani imitsi kuruhande rwa ulnar ituma hashobora kumenyekana bihagije ihembe rya ulnar kuruhande rwa palmar ya radiyo.
Uburyo bwa palmar bwerekana radiyo ya kure kandi bugaragaza neza inguni ya ulnar.
Kubwoko bugoye bwo kuvunika, birasabwa ko ihagarikwa rya kure rya brachioradialis rishobora kurekurwa, rishobora guhagarika gukurura kwarwo kuri radiyo yigituba, icyo gihe icyuma cyitwa palmar cyicyiciro cya mbere cya dorsal gishobora gutwikwa, gishobora kwerekana ibice byavunitse byavunitse bya radiyo na radiyo, hanyuma bikazenguruka ibice byavunitse. Kubuvunike bugoye imbere-articular, arthroscopie irashobora gukoreshwa mugufasha kugabanya, gusuzuma no gutunganya neza ibice byavunitse.
(III) Uburyo bwo kugabanya.
1. Koresha igufwa ryamagufwa nkigikoresho cyo gusubiramo
2. Umufasha akurura urutonde rwumurwayi nintoki zo hagati, bizoroha gusubiramo.
3. Kuramo pin ya Kirschner uhereye kuri tuberosity ya radial kugirango ikosorwe byigihe gito.
Nyuma yo guhinduranya byuzuye, isahani yimikindo ishyirwa mubisanzwe, igomba kuba yegereye hafi y’amazi, igomba gupfukirana ulnar eminence, kandi igomba kuba yegereye hagati y’uruti rwa radiyo. Niba ibi bintu bitujujwe, niba isahani itari ingano ikwiye, cyangwa niba iyimurwa ridashimishije, inzira iracyari nziza.
Ingorane nyinshi zifitanye isano cyane nu mwanya wa plaque. Niba isahani ishyizwe kure kuruhande rwa radiyo, ingorane zijyanye na flexion ya bunion zirashobora kubaho; niba isahani ishyizwe hafi yumurongo wamazi, flexor yimbitse yintoki irashobora kuba mukaga. Ubumuga bwimuwe bwimvune isubira kuruhande rwikigazi birashobora gutuma byoroshye isahani igana kuruhande rwikigazi hanyuma igahura neza na flexor tendon, amaherezo iganisha kuri tendonitis cyangwa no guturika.
Mu barwayi ba osteoporotique, birasabwa ko isahani ishyirwa hafi y'umurongo w'amazi bishoboka, ariko ntibirenze. Gukosora Subchondral birashobora kugerwaho ukoresheje pin ya Kirschner yegereye ulna, kandi impande zombi za Kirschner hamwe nudukingirizo two gufunga bifite akamaro mukwirinda gucikamo ibice.
Isahani imaze gushyirwaho neza, impera yegeranye ikosorwa hamwe na screw imwe hanyuma impera ya kure yisahani igashyirwaho byigihe gito hamwe na pine ya Kirschner mumwobo wa ulnar cyane. Intraoperative fluoroscopic orthopantomogrammes, kureba kuruhande, hamwe na firime zegeranye hamwe na 30 ° hejuru yintoki zafashwe kugirango hamenyekane kugabanuka kuvunika nu mwanya wo gukosora imbere.
Niba isahani ihagaze neza, ariko pin ya Kirschner iri hagati yimbere, ibi bizavamo gukira bidahagije kwifata ryimikindo, bishobora gukemurwa no gusubiramo isahani ukoresheje "tekinike yo kuvunika kure" (Ishusho 2, b).
Igishushanyo 2.
a, ibipapuro bibiri bya Kirschner kugirango bikosorwe byigihe gito, menya ko impengamiro ya metacarpal hamwe nubuso bwa arctular bitagaruwe bihagije muriki gihe;
b, Imwe ya Kirschner pin kugirango ikosorwe byigihe gito, menya ko radiyo ya kure yashyizweho kuri ubu (tekinike yo kuvunika kure), kandi igice cyegeranye cyisahani gikururwa kigana kumurongo wa radiyo kugirango ugarure inguni ya palmar.
C.
Kubijyanye no kuvunika kwa dorsal na ulnar (ulnar / dorsal Die Punch), bidashobora gusubirwamo bihagije mugihe cyo gufunga, tekinike eshatu zikurikira zirashobora gukoreshwa.
Iradiyo yegeranye izunguruka imbere y’ahantu havunitse, kandi agace kavunitse ka lossate fossa gasunikwa ku magufa ya karpal binyuze muburyo bwa PCR; agace gato gakozwe dorsal kugeza ku gice cya 4 n'icya 5 kugirango berekane agace kavunitse, kandi gashizwemo imigozi muri plaque ya ulnar cyane. Gufunga percutaneous cyangwa byibura byibasiye byakosowe hifashishijwe ubufasha bwa arthroscopique.
Nyuma yo guhindurwa gushimishije no gushyira neza isahani, gukosora byanyuma biroroshye kandi guhinduranya anatomique birashobora kugerwaho mugihe hafi ya ulnar kernel pin yegeranye ihagaze neza kandi ntamugozi uri mumurwango uhuriweho (Ishusho 2).
(iv) Uburambe bwo guhitamo.
Uburebure bwimigozi burashobora kugorana kubipima neza kuberako amagufwa akomeye ya cortical cortical. Imiyoboro miremire irashobora kuganisha kumutwe kandi mugufi cyane kugirango ushyigikire ikibanza cyavunitse. Kubera iyo mpamvu, abanditsi barasaba ko hakoreshwa imisumari ifunze imisumari hamwe na misile yo gufunga imisumari muri tuberosity ya radial hamwe na ulnar foramen benshi, hamwe no gukoresha imiyoboro ifunga urumuri-mumwanya usigaye. Gukoresha umutwe utajenjetse birinda guhagarika umutima nubwo byaba bifatanye neza. Kuburyo bwo guhuza isahani yegeranye, imigozi ibiri ihuza + umugozi umwe usanzwe (ushyizwe kuri ellipse) urashobora gukoreshwa mugukosora.
Dr Kiyohito ukomoka mu Bufaransa yerekanye ubunararibonye bwabo bwo gukoresha amasahani yo gufunga imikindo ntoya kugira ngo avunike radiyo ya kure, aho kubagwa kwabo kwagabanutse kugera kuri 1cm ikabije, ibyo bikaba bivuguruzanya. Ubu buryo bwerekanwe cyane cyane kumeneka ya radiyo ihagaze neza, kandi ibimenyetso byayo byo kubaga ni ibyavunitse bidasanzwe bya AO ibice byubwoko bwa A2 na A3 hamwe no kuvunika hagati yubwoko bwa C1 na C2, ariko ntibikwiriye kuvunika C1 na C2 hamwe no gusenyuka kwamagufwa yimbere. Uburyo nabwo ntibukwiriye kuvunika ubwoko B. Abanditsi berekana kandi ko niba kugabanya no gukosora neza bidashobora kugerwaho hifashishijwe ubu buryo, ni ngombwa guhindukira ku buryo bwa gakondo bwo gutemagura kandi ntitugumane ku gipimo gito giteye.
Igihe cyo kohereza: Jun-26-2024
