Kuvunika guhindagurika hamwe na bike cyangwa ntabishobora: mugihe havunitse igufwa rya metacarpal (ijosi cyangwa diaphysis), gusubiramo ukoresheje intoki. Hafi ya phalanx ihindagurika cyane kugirango igaragaze umutwe wa metacarpal. 0,5- 1 cm ya transvers ya transvers ikorwa kandi tendens ya extensor ikururwa igihe kirekire hagati. Ku buyobozi bwa fluoroscopique, twashyizemo insinga ya mm 1.0 yo kuyobora umurongo muremure wintoki. Isonga ryuyobora ryayobejwe kugirango hirindwe kwinjira no koroshya kunyerera mu muyoboro wa medullary. Umwanya wo kuyobora umaze kugenwa fluoroscopically, isahani yamagufa ya subchondral yongeye gukoreshwa hifashishijwe bito bito gusa. Uburebure bukwiye bwa screw bwabazwe uhereye kumashusho mbere yo gutangira. Mubice byinshi byavunitse, usibye metacarpal ya gatanu, dukoresha umugozi wa mm 3.0 mm. Twifashishije imigozi ya AutoFIX idafite umutwe (udukoryo duto twa Bone, Morrisville, PA) .Uburebure ntarengwa bwakoreshwa bwa 3.0-mm ni 40 mm. Ibi ni bigufi kurenza uburebure buringaniye bwamagufwa ya metacarpal (hafi cm 6.0), ariko birebire bihagije kugirango uhuze insinga muri medulla kugirango ubone gukosorwa neza. Diameter ya cavit medullary ya metacarpal ya gatanu mubisanzwe ni nini, kandi hano twakoresheje umugozi wa mm 4.0 ufite diameter ntarengwa ya mm 50. Mugihe cyo kurangiza inzira, turemeza ko umugozi wa caudal ushyinguwe rwose munsi yumurongo wa karitsiye. Ku rundi ruhande, ni ngombwa kwirinda gutera prothèse cyane, cyane cyane iyo kuvunika ijosi.
Igicapo 14 Muri A, kuvunika ijosi bisanzwe ntibigabanijwe kandi umutwe urasaba ubujyakuzimu buke nkuko cortex ya B izahagarikwa
Uburyo bwo kubaga kumeneka uhindagurika ya phalanx yegeranye byari bisa (Ishusho 15). Twakoze cm 0,5 ya transvers ku mutwe wa phalanx yegeranye mugihe duhinduranya cyane intera ihuza intera. Imitsi yatandukanijwe kandi ikururwa igihe kirekire kugirango yerekane umutwe wa phalanx yegeranye. Kubice byinshi byavunitse bya phalanx yegeranye, dukoresha umugozi wa mm 2,5, ariko kuri phalanges nini dukoresha umugozi wa mm 3.0. Uburebure ntarengwa bwa mm 2,5 mm CHS ikoreshwa ubu ni 30 mm. Twitondeye kutarenza urugero imigozi. Kubera ko imigozi irimo kwikorera no kwikubita hasi, irashobora kwinjira mu nsi ya phalanx hamwe no kurwanya bike. Ubuhanga nk'ubwo bwakoreshejwe mu kuvunika kwa phalangeal midphalangeal, hamwe no gutangirira guhera kumutwe wa midphalangeal phalanx kugirango yemere retrograde gushyira imigozi.
Igishushanyo cya 15 Kureba ibikorwa byerekeranye na falanx transvers.AA 1-mm yubuyobozi yashyizwe mumurongo muto uhinduranya unyuze kumurongo wa longitudinal axe ya phalanx yegeranye. Bitewe nuburyo bwihariye bwa phalanges, kwikuramo bishobora kuvamo gutandukanya cortex metacarpal. (Umurwayi umwe nkuko bigaragara ku gishushanyo cya 8)
Kuvunika gukabije: kwikuramo bidashyigikiwe mugihe cyo kwinjiza CHS birashobora gutuma habaho kugabanuka kwa metacarpals na phalanges (Ishusho 16). Kubwibyo, nubwo bwose gukoresha CHS muburyo bubujijwe mubihe nkibi, twabonye igisubizo kubintu bibiri bikunze guhura nabyo.
FIGURE 16 AC Niba kuvunika kudashyigikiwe na cortique, gukomera imigozi bizaviramo gusenyuka nubwo byagabanutse burundu.D Ingero zisanzwe zivuye murukurikirane rwabanditsi zihuye nibibazo byo kugabanuka kwinshi (5 mm). Umurongo utukura uhuye n'umurongo wa metacarpal.
Kubuvunika bwa submetacarpal, dukoresha tekinike yahinduwe ishingiye kumyubakire yububiko (nukuvuga, ibintu byubatswe bikoreshwa mugushigikira cyangwa gushimangira ikadiri mukurwanya kwikuramo igihe kirekire bityo tukabishyigikira). Mugukora Y-shusho ifite imigozi ibiri, umutwe wa metacarpal ntusenyuka; twise iyi Y-shusho. Nkuburyo bwabanjirije iki, hashyizwemo insinga ya 1.0 mm ndende yo kuyobora. Mugihe ukomeje uburebure bukwiye bwa metacarpal, hashyizwemo urundi rugozi ruyobora, ariko kuruhande rwumugozi wambere uyobora, bityo rukaba rufite inyabutatu. Imiyoboro yombi yaguwe ikoresheje comptabilite iyobora kwagura medula. Kumashanyarazi ya axial na oblique, mubisanzwe dukoresha 3.0 mm na mm 2,5 z'umurambararo. Umuyoboro wa axial ubanza kwinjizwamo kugeza urudodo rwa caudal ruringaniye na karitsiye. Igice cya offset yuburebure bukwiye noneho cyinjizwamo. Kubera ko nta cyumba gihagije kiri mu muyoboro wa medullary ku miyoboro ibiri, uburebure bw’imigozi ya oblique bugomba kubarwa neza, kandi imigozi ya axial igomba guhuzwa gusa n’imigozi ya axial imaze gushyingurwa bihagije mumutwe wa metacarpal kugirango habeho ituze rihagije nta mashanyarazi. Igice cya mbere noneho gitera imbere kugeza gishyinguwe byuzuye. Ibi birinda kugabanya axial ya metacarpal no kugwa k'umutwe, bishobora gukumirwa n'imigozi ya oblique. Dukora ibizamini bya fluoroscopique kenshi kugirango tumenye ko gusenyuka bitabaho kandi ko imigozi ifatanye mu muyoboro wa medullary (Ishusho 17).
Igicapo 17 AC Y-tekinoroji
Iyo comminution yagize ingaruka kuri cortex ya dorsal munsi ya phalanx yegeranye, twashizeho uburyo bwahinduwe; twayise axial bracing kuko screw ikora nk'igiti muri phalanx. Nyuma yo gusubiramo phalanx yegeranye, insinga yo kuyobora axial yinjijwe mumuyoboro wa medullary nkuko bishoboka. CHS ngufi gato kurenza uburebure bwuzuye bwa phalanx (mm 2,5 cyangwa 3.0 mm) noneho yinjizwamo kugeza impera yimbere ihuye nisahani ya subchondral munsi yigitereko. Kuri iyi ngingo, imigozi ya caudal ya screw ifunzwe mumuyoboro wa medullary, bityo ikora nkinkunga yimbere kandi ikomatanya umusingi wa phalanx. Ibizamini byinshi bya fluoroscopique birasabwa kugirango wirinde kwinjirira hamwe (Ishusho 18). Ukurikije uburyo bwo kuvunika, izindi screw cyangwa guhuza ibikoresho byo gutunganya imbere birashobora gukenerwa (Ishusho 19).
Igishushanyo 19: Uburyo butandukanye bwo gukosora abarwayi bafite ibikomere. Ivunika rikabije rya submetacarpal y'urutoki rw'impeta hamwe no gutandukanya ibice by'urutoki rwo hagati (umwambi w'umuhondo werekana agace kavunitse) ubwishingizi.C Radiografi kumezi 4. Amagufwa ya metacarpal y'urutoki ruto yakize. Ibibyimba bimwe byamagufwa byakozwe ahandi, byerekana kuvunika kwa kabiri.D Umwaka umwe nyuma yimpanuka, flap yakuweho; nubwo bidafite ibimenyetso, umugozi wakuwe muri metacarpal y'urutoki rw'impeta kubera gukekwaho kwinjira mu nda. Ibisubizo byiza (≥240 ° TAM) byabonetse muri buri rutoki mugihe cyanyuma.
Igishushanyo cya 20 Ivunika ryurutoki rwerekanwe hamwe no kwaguka kwimbere (kwerekanwa n imyambi), byahinduwe kuvunika byoroheje na B gukosora byigihe gito kuvunika kwa arctular ukoresheje K-wire.C Ibi byashizeho urufatiro ruhamye rwinjizwamo umugozi muremure.
Igishushanyo cya 21 Inyuma ya orthostatike na B yerekana amaradiyo yumurwayi A. Ibice bitatu by’umurwayi byavunitse (ku myambi) byavuwe hakoreshejwe imigozi ya mm 2,5. nta mpinduka nini zifatika zifatanije zagaragaye nyuma yimyaka 2
Igihe cyo kohereza: Nzeri-18-2024
