Gucikamo ibice binyuranyije n'umurongo unyuranyije n'umurongo cyangwa nta gucikamo ibice: mu gihe igufwa rya metacarpal ryavunitse (ijosi cyangwa diaphysis), risubirwamo hakoreshejwe intoki. Phalanx yo hafi irapfundikirwa cyane kugira ngo umutwe wa metacarpal ugaragare. Hakorwa icyuho cya cm 0.5-1, umutsi wo hejuru usubizwa inyuma mu buryo burambuye hagati. Dukoresheje uburyo bwa fluoroscopy, twashyizemo insinga ya mm 1.0 ku murongo muremure w'ukuboko. Isonga ry'insinga y'umurongo ryarapfundikiwe kugira ngo twirinde kwinjira mu gice cy'umutima no koroshya kunyerera mu muyoboro wa medullary. Nyuma y'uko aho insinga y'umurongo iherereye hamenyekanye uburyo bwa fluoroscopy, igice cy'amagufwa cya subchondral cyasubiwemo hakoreshejwe icyuma cyo gucukura gusa. Uburebure bw'insinga bukwiye bwabazwe uhereye ku mashusho mbere yo kubagwa. Mu mavuniko menshi ya metacarpal, usibye metacarpal ya gatanu, dukoresha screw ya mm 3.0 y'umurambararo. Twakoresheje vis za AutoFIX zidafite umutwe (little Bone Innovations, Morrisville, PA). Uburebure ntarengwa bw'vis ya mm 3.0 bushobora gukoreshwa ni mm 40. Iyi ni ngufi ugereranije n'uburebure bw'igufwa rya metacarpal (hafi cm 6.0), ariko ni ndende bihagije kugira ngo imigozi ifatanye muri medulla kugira ngo vis ifate neza. Ubugari bw'umwobo wa medulla wa metacarpal ya gatanu busanzwe ni bunini, kandi hano twakoresheje vis ya mm 4.0 ifite umurambararo ntarengwa ugera kuri mm 50. Mu mpera y'igikorwa, twemeza ko umugozi wa caudal uhishe rwose munsi y'umurongo wa cartilage. Ku rundi ruhande, ni ngombwa kwirinda gushyiramo prosthesis cyane, cyane cyane mu gihe havunitse ijosi.
Igishushanyo cya 14 Muri A, kuvunika ijosi bisanzwe ntibiba byagabanutse kandi umutwe ntukenera uburebure buto kuko cortex ya B izashyirwamo imbaraga
Uburyo bwo kubaga imvune y’agatsinsino k’imbere bwari busa (Ishusho ya 15). Twakoze icyuma gicagagura cya cm 0.5 ku mutwe w’agatsinsino k’imbere mu gihe twakozaga igice kinini cy’imbere. Imitsi yatandukanijwe hanyuma isubizwa inyuma mu buryo burambuye kugira ngo umutwe w’agatsinsino k’imbere ugaragare. Ku mvune nyinshi z’agatsinsino k’imbere, dukoresha screw ya mm 2.5, ariko ku screw nini dukoresha screw ya mm 3.0. Uburebure ntarengwa bwa CHS ya mm 2.5 ikoreshwa ubu ni mm 30. Twitonda kudafunga cyane screw. Kubera ko screws zikora kandi zikorakora, zishobora kwinjira mu gice cyo hasi cya phalanx nta mbaraga nyinshi. Uburyo nk'ubwo bwakoreshejwe ku mvune z’agatsinsino k’imbere, aho screws zitangirira ku mutwe w’agatsinsino k’imbere kugira ngo screws zisubire inyuma.
Ishusho ya 15 Ishusho y'agasanduku k'umugongo kari mu buryo bwa transverse. Umugozi w'umugongo wa AA wa mm 1 washyizwe mu kantu gato ka transverse ku murongo w'insinga ya proximal phalanx. B Umugozi w'umugongo washyizweho kugira ngo habeho uburyo bwo guhindura no gukosora imiterere iyo ari yo yose. CA 2.5 mm CHS yashyizwemo kandi ishyingurwa mu mutwe. Bitewe n'imiterere yihariye ya phalanges, gukanda bishobora gutuma cortex ya metacarpal itandukana. (Umurwayi umwe nk'uko bigaragara ku Ishusho ya 8)
Kuvunika kw'imitsi: gukandamizwa bidashyigikiwe mu gihe cyo gushyiramo CHS bishobora gutuma metacarpal na phalanges bigabanuka (Ishusho ya 16). Kubwibyo, nubwo gukoresha CHS muri rusange bibujijwe muri bene ibyo bihe, twabonye igisubizo ku bintu bibiri bikunze kubaho cyane duhura nabyo.
ISHUSHO YA 16 AC Iyo imvune idashyigikiwe neza n'ingingo, gukaza vis bizatuma imvune igwa nubwo yagabanutse burundu. D Ingero zisanzwe zo mu rutonde rw'abanditsi zijyanye n'imanza zo kugabanya cyane (5 mm). Umurongo utukura uhuye n'umurongo wa metacarpal.
Ku mvune zo mu gice cy’inyuma cy’inyuma, dukoresha uburyo bwahinduwe bushingiye ku gitekerezo cy’ubwubatsi bwo gusingira (ni ukuvuga ibintu by’imiterere bikoreshwa mu gushyigikira cyangwa gukomeza icyuma binyuze mu kurwanya gukandamizwa mu buryo burambuye bityo bikagishyigikira). Mu gukora ishusho ya Y hakoreshejwe vis ebyiri, umutwe wa metacarpal ntusenyuka; twawise vis vis Y. Nkuko byagenze mbere, insinga y’ubuyobozi ya 1.0 mm ifite umutwe ugororotse irashyirwamo. Mu gihe hagumana uburebure bukwiye bwa metacarpal, hashyirwamo indi nsinga y’ubuyobozi, ariko ku nguni y’insinga ya mbere y’ubuyobozi, bityo hagakorwa imiterere y’impandeshatu. Insinga zombi z’ubuyobozi zaraguwe hakoreshejwe countersink iyobowe kugira ngo yongere medulla. Ku vis axial na oblique, dukoresha vis 3.0 mm na 2.5 mm z’umurambararo, uko bikurikirana. vis axial ibanza gushyirwamo kugeza ubwo umugozi wa caudal ugororotse hamwe na cartilage. Hanyuma hashyirwamo vis offset ifite uburebure bukwiye. Kubera ko nta mwanya uhagije mu muyoboro wa medullary wo gukoresha vis ebyiri, uburebure bwa vis oblique bugomba kubarwa neza, kandi vis oblique zigomba gushyirwa gusa kuri vis oblique zimaze gushyingurwa bihagije mu mutwe wa metacarpal kugira ngo habeho umutekano uhagije nta vis isohoka. Hanyuma vis ya mbere ishyirwa imbere kugeza ishyinguwe neza. Ibi birinda kugabanya vis oblique ya metacarpal no kugwa k'umutwe, bishobora kwirindwa hakoreshejwe vis oblique. Dukora isuzuma rya fluoscopic kenshi kugira ngo turebe ko kugwa kutabaho kandi ko vis zifunze mu muyoboro wa medullary (Ishusho ya 17).
Ishusho ya 17 Ikoranabuhanga rya AC Y-bracket
Ubwo imikorere y’umubiri yagiraga ingaruka ku gice cy’imbere cy’umutwe w’inyuma cy’umutwe, twatekereje uburyo bwahinduwe; twayise uruziga rw’inyuma kuko uruziga rukora nk’umuraba uri mu gice cy’inyuma. Nyuma yo kongera gushyira ku gice cy’inyuma cy’umutwe, insinga y’inyuma y’umutwe w’inyuma yinjiye mu gice cy’inyuma cy’umutwe w’inyuma mu buryo bushoboka bwose. CHS ngufi gato ugereranije n’uburebure bwose bwa phalanx (2.5 cyangwa 3.0 mm) ishyirwamo kugeza igihe impera yayo y’imbere ihuye n’igice cy’inyuma cy’umutwe w’inyuma ku gice cy’inyuma cy’umutwe w’inyuma. Muri iki gihe, insinga z’inyuma z’umutwe w’inyuma zifungirwa mu gice cy’inyuma cy’umutwe w’inyuma, bityo zigakora nk’inkunga y’imbere kandi zigashyigikira ishingiro rya phalanx. Hakenewe ibizamini byinshi bya fluoscopic kugira ngo ingingo zibuze kwinjira (Ishusho ya 18). Bitewe n’imiterere y’aho imvune yacitse, izindi ruziga cyangwa ibikoresho byo gufata imbere bishobora gukenerwa (Ishusho ya 19).
Ishusho ya 19: Uburyo butandukanye bwo gufata ku barwayi bafite imvune zo gukomereka. Gucika cyane kw'urutoki rw'impeta hamwe no kwimuka kw'urutoki rwo hagati (umwambi w'umuhondo werekana agace k'urutoki rw'impeta). B Hakoreshejwe CHS isanzwe ya mm 3.0 y'urutoki rw'impeta, paracentesis ya mm 3.0 y'urutoki rwo hagati, inkunga y y y'urutoki rw'impeta (n'ishyirwa ry'inenge rimwe), na CHS ya mm 4.0 y'urutoki rw'impinja. F Hakoreshejwe uduce tw'impeta tworoshye. C Radiyografi ku mezi 4. Igufwa rya metacarpal ry'urutoki ruto ryakize. Hari udukoko tw'amagufwa twavutse ahandi, bigaragaza ko imvune ya kabiri yakize. D Nyuma y'umwaka umwe impanuka ibaye, agace k'impeta karakuweho; nubwo nta bimenyetso byagaragaye, hari akantu kavanyweho ku gasongero k'urutoki rw'impeta kubera ko bakekaga ko kageze mu gice kimwe cy'imbere cy'urutoki. Ibisubizo byiza (≥240° TAM) byabonetse muri buri rutoki ubwo rwasurwaga bwa nyuma. Impinduka mu ngingo ya metacarpophalangeal y'urutoki rwo hagati zagaragaye ku mezi 18.
Ishusho ya 20 Ivunika ry'urutoki rw'icyitegererezo hamwe n'inyongera yarwo (igaragazwa n'imyambi), ryahinduwe ivunika ryoroshye binyuze mu gufata B by'agateganyo ivunika ry'inyuma hakoreshejwe umugozi wa K.C. Ibi byatumye habaho ishingiro rihamye aho screw ishyigikira yashyizwemo.D Nyuma yo gufata, imiterere yafashwe nk'ihamye, bigatuma ikora ako kanya. E, F Intera y'imyitwarire mu byumweru 3 (imyambi igaragaza aho screw zo hasi zinjira)
Igishushanyo cya 21 Ishusho ya posterior orthostatic na B lateral radiographs by'umurwayi A. Imvune eshatu z'umurwayi zinyuranyije n'umurongo (ku myambi) zavuwe hakoreshejwe vis za 2.5-mm za cannulated. Nta mpinduka zikomeye zagaragaye mu ngingo za interphalangeal nyuma y'imyaka 2
Igihe cyo kohereza ubutumwa: 18 Nzeri 2024
