Guhindurana no kwinjiza bike cyangwa ntayishyurwa: Mugihe cyo kuvunika metacarpal igufwa (ijosi cyangwa diaphysis), gusubiramo nuburyo bwo gukururwa. Phalanx phaximal ihindagurika cyane kugirango yerekane umutwe wa metakalpal. A.5- 1 cm ya cm yamenetse kandi umuvuduko wagutse wasubiwemo igihembo hagati. Mubuyobozi bwa flueroscopic, twinjije 1,0 mm iyobora kumurongo muremure wintoki. Impanuro yumurongo wa rounterwire yagaragaye murwego rwo kwirinda kwinjira ku bucuruzi no koroshya kunyerera mu miyoboro ya gisabune. Nyuma yumwanya wayobora wagenwe, isahani yamagufwa yamagufa yagaruwe gukoresha sikondo gusa. Uburebure bukwiye bwabazwe mumashusho yinzandiko. Mu miterere myinshi, usibye metarhil ya gatanu, dukoresha imirongo 3.0-mm. Twakoresheje autofi imitwe idahwitse (udushya duto, Morrisville, Pa) .Ibipimo ntarengwa ikoreshwa na prow 30-mm ni mm 40. Ibi ni bigufi kuruta uburebure bwimpuzandengo ya metacarpal amagufwa (hafi ya cm 6,0), ariko birebire bihagije kugirango ushire umugozi muri medulla kugirango ukemure neza. Diameter yo mu cyuho cya medullary ya meticalpal ya gatanu isanzwe, kandi hano twakoresheje Mm 4.0 hamwe na diameter ntarengwa ya mm 50. Iyo nzira irangiye, turemeza ko umugozi wa Caudal washyinguwe rwose munsi yumurongo wa Cartilage. Ibinyuranye, ni ngombwa kwirinda gusenya prostèse cyane, cyane cyane kubijyanye no kuvunika ijosi.
Igishushanyo
Ububa bwo kubaga bwo kuvunika kwandura phaxmal byari bisa (Ishusho 15). Twakoze cm 0.5 mpumura kumutwe wa Phalanx proalanx mugihe uhinduke cyane guhuza Interphalantal. Imitsi yaratandukanye kandi isubirwamo igihe kirekire kugirango yerekane umutwe wa Phalanx prolanx. Kubijyanye cyane na phalanx phaxy, dukoresha Mm 2,5, ariko kuri prolanges nini dukoresha screw 3.0. Uburebure ntarengwa bwa 2.5 mm chs yakoreshejwe ni mm 30. Twitonde ko tutazamurika cyane imigozi. Kubera ko imigozi yiyoroshya no kwiyuhagira, barashobora kwinjira mu rufatiro rwa Phalanx hamwe no kurwanya bike. Tekinike isa nayo yakoreshejwe ku isafuro ya falantal, hamwe no gutemangira guhera ku mutwe wa Phalalalangel Phalalanizal Phalalalangel yemerera Gushyira retrograde Gushyira imiyoboro.
Igishushanyo cya 15 Kubona ibintu byahinduye Phalanx.aa 1-mm 1-mm yashyizwe kumurongo muto wa proaniminal ya prohlanx.b yashyizwe kumurongo. Bitewe nuburyo bwihariye bwa prolanges, compression irashobora kuvamo gutandukana na metacalpal cortex. (Umurwayi umwe nko mu gishushanyo cya 8)
Kugabanuka: Gukuramo bidashyigikiwe mugihe cyo kwinjiza cs birashobora kuganisha kumanura metacalpal na phalanges (FIG. 16). Kubwibyo, nubwo gukoresha CHS biri muburyo bwabwo bubujijwe mubihe nkibi, twabonye igisubizo cyibintu bibiri duhura nabyo.
Igicapo 16 AC niba kuvunika bitashyigikiwe byugarijwe, bikangurira imigozi bizavamo gukandamizwa nubwo kugabanuka kwurutonde rwabanditsi bihuye nibibazo bigabanuka (5 mm). Umurongo utukura uhuye numurongo wa metacarpal.
Kubwububiko bwa submetacarpal, dukoresha tekinike yahinduwe dushingiye ku gitekerezo cyubwubatsi bwa Birrating ya Bire (urugero, ibintu byubaka bikoreshwa mu gushyigikira cyangwa gushimangira ikadiri mu kurwanya ikanzu birebire bityo bishyigikira). Mugukora y-imiterere ifite imigozi ibiri, umutwe wa metacarpal ntusenyuka; Twise iyi foce ya y-imiterere. Nko muburyo bwabanjirije, 1,0 mm ubuyobozi bwimigozi hamwe ninama ya blunt yinjijwe. Mugihe ukomeje uburebure bukwiye bwa metacarpal, ikindi cyitwa insinga cyinjijwemo, ariko ku mpande kugera ku nsinga ya mbere, bityo ikora imiterere ya mpandeshatu. Abayobora ubwabo baraguwe bakoresheje inama iyobowe no kwagura Medulla. Kuri screw na oblique screw, mubisanzwe dukoresha mm 3.0 na 2.5 mm imigozi ya mm ya mm. Umuyoboro wa Axial winjijwe bwa mbere kugeza umugozi wa caudal aringaniye hamwe na karitsiye. Intangarugero yuburebure bukwiye noneho cyinjijwe. Kubera ko nta cyumba gihagije cyo guhuza imiyoboro ibiri, uburebure bwimigozi ya oblique igomba kubarwa neza, kandi imigozi ya axiele igomba kubazwa neza kumurongo wogosha umaze gushyingurwa mumutwe wa metacarpal kugirango hashingiwe ku gitsina gake. Umugozi wa mbere ugenda utera imbere kugeza ushyinguwe. Ibi birinda kugabanya insanganyamatsiko ya metacarpal no gusenyuka mumutwe, bishobora gukumirwa nimigozi ya oblique. Dukora ibizamini bya fluoscopique kugirango tumenye neza ko gusenyuka bitabaho kandi ko imigozi ifungirwa mubitabo bitangaje (Ishusho 17).
Igishushanyo 17 AC Y-B-B-BRACKER Ikoranabuhanga
Iyo kwinginga byagize ingaruka ku cortex ya dorsal munsi ya phalanx phalanx, twateguye uburyo bwahinduwe; Twabise gusohora bikabije kuko imitekerereze ikora nk'igiti muri Phalanx. Nyuma yo gusubiramo phalanx phaximal, insinga ya axial yatangijwe mubitabo bitangaje nkuko bigaragara. A CHS igufi kurenza uburebure bwa phalanx (2.5 cyangwa 3.0 mm) noneho yinjizwa kugeza imperuka yimbere yujuje isahani yamakuru kumurongo wa Phalanx. Kuri iyi ngingo, imigozi ya caudal ifungiye mu miyoboro ya kigati, bityo ikora nk'inkunga y'imbere kandi itandukanya ishingiro rya Phalanx. Ibizamini byinshi bya fluorscopique birasabwa gukumira ingingo zihuriweho (Ishusho 18). Ukurikije uburyo bwo kuvunika, izindi screw cyangwa guhuza ibikoresho byo gukosora imbere (Ishusho 19).
Igicapo 19: Uburyo butandukanye bwo Gukosora kubarwayi bafite ibikomere bya Crush. Kuvunika gukabije kwigabanywa urutoki hamwe no kwitegura gukanda urutoki rwo hagati (umwambi wumuhondo yerekana urutoki rwo hagati) .Bes y'urutoki rwijimye.f Flaps yubusa yakoreshejwe muburyo bworoshye-tissue kumara amezi 4. Amagufwa ya metacarpal yintoki ntoya yakize. Ibisebe bimwe byamagufwa byateguwe ahandi, byerekana kuvura kabiri gukira.d umwaka umwe nyuma yimpanuka, flap yakuweho; Nubwo asmppotic, umugozi wakuwe muri litacarpal yintoki yimpeta kubera abakekwaho kwinjira. Ibisubizo byiza (≥240 ° Tam) byabonetse muri buri rutoki ku ruzinduko rwa nyuma.changs mu metakarpophilangeal hamwe n'intoki zo hagati byagaragaye mu mezi 18.
FIG ingingo zo kwinjira mu mashini zibashe)
Igishushanyo cya 21 Inyuma ya Orthostratike na B BYUMA YUBUTIMA A. Kuvunika bitatu byo gupfobya (kumyambi) byavuwe hamwe na mm 7,5. Nta mpinduka zikomeye mu ngingo za Interphalangeal zigaragara nyuma yimyaka 2
Igihe cyo kohereza: Sep-18-2024
