Muri iki gihe, kuvunika kwa radius ya distal bivurwa mu buryo butandukanye, nko gufunga plaster, gukata no kugabanya internal fixing, gufunga external fixing bracket, nibindi. Muri byo, gufunga palmar plate bishobora gutanga umusaruro ushimishije, ariko inyandiko zimwe na zimwe zivuga ko igipimo cyayo cy’ingorane kiri hejuru ya 16%. Ariko, iyo plate itoranijwe neza, igipimo cy’ingorane gishobora kugabanuka neza. Incamake ngufi y’ubwoko, ibimenyetso n’ubuhanga bwo kubaga palmar plaque ku mvune za radius ya distal iragaragazwa.
I. Ubwoko bw'amagufwa ya radius ya kure
Hari uburyo butandukanye bwo gushyira mu byiciro imvune, harimo uburyo bwa Müller AO bushingiye ku miterere y’umubiri n’uburyo bwa Femandez bushingiye ku buryo imvune yakomeretse. Muri bwo, uburyo bwa Eponymic buhuza ibyiza byo gushyira mu byiciro byabanje, bukubiyemo ubwoko bune bw’ibanze bw’imvune, kandi burimo imvune ya Maleon ifite ibice 4 na imvune ya Chaffer, ishobora kuba ubuyobozi bwiza ku kazi k’ubuvuzi.
1. Icyiciro cya Müller AO - ibice by'amagufwa yo mu mutwe
Icyiciro cya AO gikwiriye cyane ku mvune zo mu gice cya kure kandi kizigabanyamo ubwoko butatu bw'ingenzi: ubwoko bwa A butari ubwa articular, ubwoko bwa B butari ubwa articular, n'ubwoko bwa C butari ubwa articular. Buri bwoko bugabanyijemo amatsinda atandukanye y'udutsiko duto bitewe n'uburemere n'ubukana bw'imvune.
Ubwoko bwa A: Kuvunika kw'inyuma y'ingingo
A1, kuvunika kw'inyuma y'umugongo, radius nk'igikomere (A1.1, kuvunika kw'inyuma y'umugongo; A1.2 kuvunika gusanzwe kwa diaphysis y'umugongo; A1.3, kuvunika kwa comminuted kwa diaphysis y'umugongo).
A2, Gucika kw'umurambararo, byoroshye, hamwe n'ishusho (A2.1, umurambararo udafite aho uhengamiye; A2.2, aho umurambararo uhengamiye inyuma, ni ukuvuga, aho umurambararo wa Pouteau-Colles uhengamiye; A2.3, aho umurambararo uhengamiye ku giti cy'umugongo, ni ukuvuga aho umurambararo wa Goyrand-Smith uhengamiye).
A3, Gucika kw'umurambararo, byagabanijwe (A3.1, kugabanya umurambararo; A3.2 igice cy'umurambararo gifite ishusho nk'iy'agace; A3.3, kuvunika k'umurambararo).
Ubwoko bwa B: kuvunika igice cy'ingingo
B1, kuvunika k'umurambararo, urwego rwa sagittal (B1.1, ubwoko bworoshye bwo ku ruhande; B1.2, ubwoko bwo ku ruhande bugizwe n'imirongo ibiri; B1.3, ubwoko bwo hagati).
B2, Kuvunika kw'umugongo w'urukiramende, ni ukuvuga kuvunika kwa Barton (B2.1, ubwoko bworoshye; B2.2, kuvunika kwa sagittal ku ruhande rumwe; B2.3, kuvunika k'urukiramende ku rundi ruhande).
B3, Kuvunika kw'umurambararo wa metacarpal wa radius, ni ukuvuga kuvunika kwa anti-Barton, cyangwa kuvunika kwa Goyrand-smith type II (B3.1, itegeko ryoroshye ry'ubugore, agace gato; B3.2, kuvunika gusanzwe, agace kanini; B3.3, kuvunika kwagabanutse).
Ubwoko bwa C: kuvunika kw'ingingo zose
C1, kuvunika kw'imirasire hamwe n'ubwoko bworoshye bw'ubuso bw'ingingo n'ubwa metaphyseal (C1.1, kuvunika kw'inyuma y'ingingo; C1.2, kuvunika kw'inyuma y'ingingo; C1.3, kuvunika kw'ubuso bw'inyuma bw'ingingo).
C2, Gucika kw'umurambararo, igice cyoroshye cy'ingingo, metaphysis yagabanutse (C2.1, kuvunika kwa sagittal kw'igice cyo hasi cy'ingingo; C2.2, kuvunika kw'igice cyo hasi cy'ingingo; C2.3, kuvunika kw'ingingo kugera mu gice cyo hasi cy'ingingo).
C3, kuvunika kw'imirasire, kwangiritse (C3.1, kuvunika gusanzwe kwa metaphysis; C3.2, kuvunika kw'imirasire; C3.3, kuvunika kw'imitsi kugeza ku gihimba cy'imirasire).
2. Gushyira mu byiciro imvune zo mu gice cya kure.
Dukurikije uburyo imvune iterwa, Femandez ishobora kugabanywamo ubwoko 5:
Ubwoko bwa I buvunika ni ubuvunika buva mu gice cya kabiri cy’igufwa nk’ubuvunika bwa Colles (gulation y’inyuma) cyangwa ubuvunika bwa Smith (gulation y’igufwa). Igufwa rimwe rivunika bitewe n’imbaraga zaryo, hanyuma agace k’igufwa kakavunikamo.
Kuvunika
Gucika kw'amagufwa yo mu bwoko bwa III ni ugucika kw'amagufwa yo mu gice cy'imbere cy'inyuma, guterwa no gucika intege. Uku kuvunika kw'amagufwa harimo kuvunika kwa Barton mu gituza, kuvunika kwa Barton mu gice cy'inyuma, no kuvunika kw'inyuma mu gice cy'inyuma.
Guhagarika stress
Ubwoko bwa gatatu bw'amagufwa ni imvune zo mu gice cy'imbere cy'ingingo n'iziterwa na metaphyseal bitewe n'imvune zo gukanda, harimo imvune zikomeye zo mu ngingo n'imvune zo mu gice cy'imbere cy'ingingo.
Gushyiramo
Gucika kw'imitsi yo mu bwoko bwa IV ni ukuvunika kw'imitsi ifatana mu gihe cy'ivunika no kwimuka kw'urugingo rwa radial carpal.
Kuvunika kw'ivuko I kwavuye mu mwanya wa mbere
Gucika kw'ubwoko bwa V bituruka ku gukomereka kw'umuvuduko mwinshi ku ngufu nyinshi zo hanze ndetse n'ibikomere bikomeye. (Ivanze I, II, III, IV)
3. Kwandika izina ry'umuntu (eponymic)
II. Kuvura imvune zo mu gice cya kure hakoreshejwe uburyo bwo gupfuka imisumari mu gitanda
Ibimenyetso.
Ku mvune zo hanze y'ingingo nyuma yo kunanirwa kugabanuka kw'ingingo mu bihe bikurikira.
Ubushyuhe bw'inyuma burenga 20°
Igitutu cyo mu nda kirengeje mm 5
Ubugari bw'umurambararo wa kure burenga mm 3
Inzira yo kwimura igice cyo hagati cy'aho umuntu avunitse irenga mm 2
Ku mvune zo mu nda zirengeje uburebure bwa 2mm
Intiti nyinshi ntizisaba ikoreshwa rya metacarpal plates ku mvune zikoresha imbaraga nyinshi, nko kuvunika cyane mu ngingo cyangwa gutakaza amagufwa cyane, kuko utwo duce twavunitse kure dushobora kurwara avascular necrosis kandi biragoye kuyishyira mu mwanya wayo mu buryo bw’umubiri.
Ku barwayi bafite ibice byinshi byavunitse kandi bafite indwara ikomeye yo kuvunika kw'amagufwa, metacarpal plating ntabwo igira icyo ikora. Inkunga ya subchondral y'ibyavunitse byo mu gice cyo hagati cy'ingingo ishobora kuba ikibazo, nko kwinjira mu ngingo mu mwobo.
Uburyo bwo kubaga
Abaganga benshi bakoresha uburyo n'ubuhanga nk'ubwo mu gukosora imvune zo mu gice cya kure cy'umugongo bakoresheje icyuma cy'imitende. Ariko, uburyo bwiza bwo kubaga burakenewe kugira ngo hirindwe neza ibibazo nyuma yo kubagwa, urugero, kugabanya bishobora kugerwaho binyuze mu kurekura imvune mu gukandamizwa no gusubiza igufwa ry'umutima rihoraho. Gufata by'agateganyo hakoreshejwe udupira twa Kirschner 2-3 bishobora gukoreshwa, nibindi.
(I) Guhindura imiterere mbere yo kubagwa no kwifata neza
1. Gukurura bikorerwa mu cyerekezo cy'umuyoboro wa radial hifashishijwe fluoroscopy, igikumwe gikanda agace k'inyuma k'ivunika kamanuka uvuye ku ruhande rw'ikiganza, izindi ntoki zigazamura agace k'inyuma uvuye ku ruhande rw'inyuma.
2. Aho umuntu aryamye, amaguru yafashwe n'ikirenge ku meza y'ikiganza hifashishijwe fluoroscopy.
(II) Aho kwinjira.
Ku bwoko bw'uburyo bukoreshwa, uburyo bwa PCR (radial carpal flexor) extended palmar approach burasabwa.
Impera ya kure y'uruhu itangira mu gice cy'uruhu cyo ku kuboko kandi uburebure bwacyo bushobora kugenwa hakurikijwe ubwoko bw'aho cyavunitse.
Umutsi w'uruti rwa radial flexor carpi radialis hamwe n'agace kawo k'uruti biciwemo ibice, biri kure y'amagufwa ya carpal kandi hafi y'uruhande rw'uruti rw'uruti rwegereye cyane uko bishoboka kose.
Gukurura umutsi wo mu bwoko bwa radial carpal flexor tendon ku ruhande rw'inyuma birinda imitsi yo hagati n'imitsi yo mu bwoko bwa flexor tendon complex.
Umwanya wa Parona ugaragara kandi imitsi ya anterior rotator ani iri hagati ya flexor digitorum longus (uruhande rw'inkombe) n'umutsi wa radial (uruhande rw'inkombe).
Kata uruhande rw'umurambararo rw'umutsi wa anterior rotator ani, urebe ko igice kigomba gusigara gifatanye n'umurambararo kugira ngo nyuma yo kongera kubakwa.
Gukurura imitsi ya anterior rotator ani ku ruhande rw'inyuma bituma ihembe ry'inyuma rigaragara neza ku ruhande rw'inyuma rw'umurambararo.
Uburyo bwa palmar bugaragaza neza radius ya distal kandi bugagaragaza neza inguni y'uruhande rw'imbere rw'inyuma.
Ku bwoko bw'amavunika agoye, ni byiza ko agace k'imbere k'umugongo gashobora kurekurwa, gashobora kugabanya imbaraga zayo ku gice cy'amavunika cya radial, aho igice cya mbere cy'umugongo gishobora gucibwamo ibice, bishobora kugaragaza igice cy'amavunika cya radial na radial tuberosity, bigahindura imbere radius ya Yu kugira ngo biyikure aho yavunitse, hanyuma bigasubiza inyuma igice cy'amavunika cya intra-articular ukoresheje agapira ka Kirschner. Ku mavunika agoye ya intra-articular, arthroscopy ishobora gukoreshwa mu gufasha mu kugabanya, gusuzuma no gutunganya neza igice cy'amavunika.
(III) Uburyo bwo kugabanya.
1. Koresha agace k'igufwa nk'igikoresho cyo kugarura
2. Umufasha akura intoki z'umurwayi zo hagati n'iz'imbere, ibyo bikaba byoroshye kubisubiza mu mwanya wabyo.
3. Kanda agapira ka Kirschner ku gice cy'urukiramende kugira ngo gakomeze gufunga by'agateganyo.
Nyuma yo gusimbuza inkingi, hashyirwaho icyuma cya palmar buri gihe, kigomba kuba kiri hafi y'amazi, kigapfuka uburebure bw'inyuma, kandi kikaba hafi y'igice cyo hagati cy'umurambararo. Iyo ibi bintu bitagezweho, niba ingano idakwiye, cyangwa niba gusimbuza inkingi idashimishije, igikorwa kiba kitaratungana.
Ingorane nyinshi zifitanye isano rikomeye n'aho isahani iherereye. Iyo isahani ishyizwe kure cyane ku ruhande rw'umurambararo, ingorane zijyanye n'ingufu zo mu bwoko bwa bunion zishobora kubaho; iyo isahani ishyizwe hafi cyane y'umurongo w'amazi, ingufu nini y'urutoki ishobora kuba iri mu kaga. Guhinduka kw'ivunika ryinjira ku ruhande rw'umurambararo bishobora gutuma isahani isohoka ku ruhande rw'umurambararo maze igahura n'umurambararo w'umurambararo, amaherezo bigatera indwara y'imitsi cyangwa gucika.
Ku barwayi bafite indwara yo gucika kw'amagufwa, ni byiza ko isahani ishyirwa hafi y'umuyoboro w'amazi uko bishoboka kose, ariko ntibegere aho iri. Gufata subchondral bishobora kugerwaho hakoreshejwe udupira twa Kirschner twegereye ulna, kandi udupira twa Kirschner two ku ruhande rumwe n'udupira two ku ruhande rumwe bigira akamaro mu kwirinda kongera gusimbuka kw'amagufwa.
Iyo isahani imaze gushyirwaho neza, impera y’imbere ishyirwaho vis imwe, impera y’imbere y’isahani igashyirwaho by’agateganyo hifashishijwe udupira twa Kirschner mu mwobo munini w’inyuma. Hafashwe isuzuma rya fluoroscopic orthopantomograms, icyerekezo cy’inyuma, na filimi zo ku ruhande zifite uburebure bwa dogere 30 kugira ngo hamenyekane uburyo imvune yavunitse n’aho ifata imbere.
Niba isahani ihagaze neza, ariko agapira ka Kirschner kakaba kari hagati y’ingingo, ibi bizatuma imiterere y’ikiganza idakira neza, ibyo bikaba byakemurwa no kongera gushyira isahani mu mwanya wayo hakoreshejwe "uburyo bwo gufata imvune ya distal" (Ishusho ya 2, b).
Ishusho ya 2.
a, udupira tubiri twa Kirschner two gufata by'agateganyo, menya ko aho metacarpal ihurira n'ubuso bw'ingingo bitarasubizwa bihagije kuri iyi ngingo;
b, Agapira kamwe ka Kirschner ko gushyiraho plaque by'agateganyo, menya ko radius ya distal ihagaze kuri iyi ngingo (uburyo bwo gushyiraho break block ya distal), kandi igice cya plaque gikururwa yerekeza ku giti cya radial kugira ngo hagarurwe inguni ya palmar tilt.
C, Gutunganya neza ubuso bw'ingingo hakoreshejwe uburyo bwa Arthroscopic, gushyiraho vis/pins zo gufunga za distal, no gusubiza no gufunga burundu radius ya proximal.
Mu gihe habayeho kuvunika kw'umugongo n'inyuma (ulnar/dorsal Die Punch), bidashobora kongera gukoreshwa neza mugihe hafunzwe, uburyo butatu bukurikira bushobora gukoreshwa.
Umurambararo wa hafi uzunguruka imbere kure y'aho imvune yavunitse, kandi igice cyo kuvunika cya lunate fossa gisunikwa kijya ku igufwa rya carpal binyuze mu buryo bwo kurenza PCR; hakorwa icyuho gito mu gice cya kane n'icya gatanu kugira ngo imvune igaragare, kandi gishyirwa mu gice cyo hejuru cy'uruti rw'umugongo rw'icyuma. Gufunga igice cyo hejuru cyangwa gito cyane byakozwe hifashishijwe uburyo bwa arthroscopic.
Nyuma yo gusimbuza neza no gushyira neza icyuma, gusimbuza burundu biroroha kandi gusimbuza imiterere y'umubiri bishobora kugerwaho niba agapira k'inkono ka proximal ulnar gashyizwe neza kandi nta vis ziri mu mwobo w'ingingo (Ishusho ya 2).
(iv) Ubunararibonye mu guhitamo screws.
Uburebure bw'imisumari bushobora kugorana gupima neza bitewe n'uko amagufwa yo mu mfuruka akomeretse cyane. Imisumari miremire cyane ishobora gutuma imisumari ihindagurika kandi ikaba ngufi cyane ku buryo itabasha gufata neza icyuma cyo mu mfuruka. Kubera iyo mpamvu abanditsi basaba ko hakoreshwa imisumari ifite imisumari myinshi n'imisumari ifite imisumari myinshi ifunga mu gice cy'imisumari ya radial tuberosity na foramen nyinshi za ulnar, ndetse no gukoresha imisumari ifite imisumari ifunga mu mwanya usigaye. Gukoresha umutwe ugororotse birinda gutera ubwoba imisumari nubwo yaba ifite imisumari mu mfuruka. Ku bijyanye no gufata neza plate ifunganye, imisumari ibiri ifunganye hamwe n'umusumari umwe usanzwe (ushyirwa mu gice cy'inyuma) irashobora gukoreshwa mu gufata neza.
Dr Kiyohito wo mu Bufaransa yagaragaje ubunararibonye bwe bwo gukoresha ibyuma bifunga imitende bitagira ingaruka nyinshi mu kuvunika imiyoboro ya distal radius, aho gukata kwabo kwagabanutseho cm 1, ibi bikaba binyuranyije n'ibyo umuntu yatekerezaga. Ubu buryo bukoreshwa cyane cyane ku kuvunika imiyoboro ya distal radius ihamye, kandi ibimenyetso byabwo ni ukuvunika imiyoboro ya AO yo mu bwoko bwa A2 na A3 ndetse n'imiyoboro ya C1 na C2 yo mu bwoko bwa C1, ariko ntabwo bukwiriye kuvunika imiyoboro ya C1 na C2 hamwe no kugwa kw'amagufwa yo mu bwoko bwa B. Abanditsi banagaragaza ko niba uburyo bwo kugabanya no gufunga neza budashobora kugerwaho, ari ngombwa guhindura uburyo bwa gakondo bwo gukata no kudakomeza gukata imiyoboro mito.
Igihe cyo kohereza: Kamena-26-2024
