Kuvunika kwa Supracondylar kw'umugongo ni kimwe mu bikomere bikunze kugaragara ku bana kandi biba aho umugongo wa humeral uhurira n'umugongo wacondyle ya humeral.
Ibimenyetso by'ubuvuzi
Kuvunika kw'inyuma y'umugongo w'inyuma ahanini biba ari abana, kandi ububabare bwo mu gace, kubyimba, kubabara, no kudakora neza bishobora kubaho nyuma yo gukomereka. Kuvunika kutagira aho bihurira nta bimenyetso bigaragara, kandi gusohoka kw'inkokora bishobora kuba ari cyo kimenyetso cyonyine cy'uburwayi. Agapfukamunwa k'ingingo kari munsi y'imitsi y'inkokora ni ko kagaragara cyane, aho agapfukamunwa koroshye k'ingingo, kazwi kandi nka softspot, gashobora gukubitwa mu gihe cyo gusohora ingingo. Aho guhindagurika akenshi ni imbere y'umurongo uhuza hagati y'umutwe wa radial n'isonga rya olecranon.
Ku bijyanye n'ivunika rya supracondylar type III, hari ubumuga bubiri bw'inkokora butuma isa n'ishusho ya S. Akenshi hari ibikomere byo munsi y'umubiri imbere y'ukuboko ko hejuru, kandi niba imvune yavuyeho burundu, impera y'ivunika yinjira mu mitsi ya brachialis, kandi kuva amaraso mu mubiri biba bikomeye cyane. Kubera iyo mpamvu, ikimenyetso cyo gupfuka kigaragara imbere y'inkokora, akenshi kigaragaza ko hari igufwa risohoka hafi y'ivunika ryinjira mu ruhu. Iyo riherekejwe n'ivunika ry'imitsi, kwaguka kw'igikumwe mu gice cyo hejuru cy'urutoki bishobora kuba bike; imvune yo hagati y'imitsi ishobora gutuma igikumwe n'urutoki rw'icyiciro bidashobora kwihuta; imvune yo mu gice cyo hejuru cy'urutoki ishobora gutuma intoki zitandukana buhoro kandi zigatandukana.
Isuzuma
(1) Ishingiro ry'isuzuma
①Ufite amateka yo gukomereka; ②Ibimenyetso by'ubuvuzi: ububabare bwo mu gace, kubyimba, kubabara no kudakora neza; ③X-ray igaragaza umurongo wa supracondylar fracture line n'ibice bya humerus byakuweho.
(2) Gusuzuma Itandukaniro
Hakwiye kwitabwaho ku kumenyagucika kw'inkokora, ariko kumenya imvune ya supracondylar yongerewe iturutse ku gucika kw'inkokora biragoye. Mu gucika kw'inkokora kwa supracondylar, epicondyle ya humerus ikomeza kugira isano isanzwe n'umubiri wa olecranon. Ariko, mu gucika kw'inkokora, kubera ko olecranon iherereye inyuma ya epicondyle ya humerus, igaragara cyane. Ugereranyije n'imvune ya supracondylar, kugaragara kw'ukuboko mu gucika kw'inkokora ni kure cyane. Kuba hari cyangwa nta mvune ziterwa n'amagufwa bigira uruhare mu kumenya imvune za supracondylar za humerus ziturutse ku gucika kw'inkokora, kandi rimwe na rimwe biragoye gutera imvune ziterwa n'amagufwa. Kubera kubyimba no kubabara cyane, imvune ziterwa n'amagufwa zikunze gutuma umwana arira. Kubera ibyago byo kwangirika kw'imitsi. Kubwibyo, imvune ziterwa n'amagufwa zigomba kwirindwa. Gusuzuma X-ray bishobora gufasha kumenya.
Ubwoko
Uburyo busanzwe bwo gushyira mu byiciro imvune za supracondylar humeral ni ukuzigabanyamo ibice bibiri: kwaguka no guhindagurika. Ubwoko bwo guhindagurika ni gake cyane, kandi X-ray yo ku ruhande igaragaza ko impera y'inyuma y'imvune iri imbere y'umugozi wa humeral. Ubwoko bugororotse ni rusange, naho Gartland ayigabanyamo ubwoko bwa mbere kugeza kuri III (Imbonerahamwe ya 1).
| Ubwoko | Ibimenyetso by'ubuvuzi |
| Ubwoko bwa ⅠA | Kuvunika bidasaba kwimuka, kunyura cyangwa kugabanuka kw'igufwa |
| Ubwoko bwa ⅠB | Kwimuka gake, gucuragura kw'imitsi yo mu mutwe, umurongo w'imbere w'imitsi unyura mu mutwe w'imitsi |
| Ubwoko bwa ⅡA | Hyperextension, posterior cortical integrity, humeral head inyuma y'umurongo w'imbere wa humeral, nta kuzenguruka |
| Ubwoko bwa ⅡB | Kwimuka k'uburebure cyangwa kuzunguruka hamwe no gukoraho igice ku mpera zombi z'aho imvune yavunitse |
| Ubwoko bwa ⅢA | Kwimuka burundu kw'inyuma nta gukorana kw'umutima, ahanini kuva ku gice cyo hagati kugera ku gice cyo hagati cy'inyuma |
| Ubwoko bwa ⅢB | Kwimuka kugaragara, ingingo zoroshye zishyizwe mu mpera y'ivunitse, guhurirana gukomeye cyangwa kwimuka kuzenguruka kw'inyuma y'ivunitse |
Imbonerahamwe ya 1 Gartland ishyirwa mu byiciro ry'ivunika rya supracondylar humerus
Gutanga umuti
Mbere yo kuvurwa neza, ingingo y'inkokora igomba gushyirwa mu mwanya wa 20° kugeza kuri 30°, ibyo bikaba bitoroshye ku murwayi gusa, ahubwo binagabanya umuvuduko w'imitsi n'amaraso.
(1) Gucika kw'inyuma kwa humeral supracondylar yo mu bwoko bwa I: hakenewe gusa plaster cast cyangwa cast cast kugira ngo hakorwe imvange, akenshi iyo inkokora izungurutse 90° kandi ukuboko kuzungurutse mu mwanya utari wo hasi, cast ndende y'ukuboko ikoreshwa mu koroshya imvange mu gihe cy'ibyumweru 3 kugeza kuri 4.
(2) Ubwoko bwa kabiri bw'imvune zo mu gice cya kabiri cy'umugongo: Kugabanya no gukosora ipfundo ry'inkokora no gucika intege ni byo bibazo by'ingenzi mu kuvura ubwo bwoko bw'imvune. °) Gufata neza bikomeza aho umuntu ahagaze nyuma yo kugabanuka, ariko byongera ibyago byo gukomereka kw'imitsi ku gice cyafashwe ndetse n'ibyago byo kurwara indwara yo mu gice cya kabiri cy'umugongo. Bityo, percutaneous syndrome ifata neza.Gushyiraho insinga ya KirschnerNi byiza cyane nyuma yo kugabanya imvune (Ishusho ya 1), hanyuma ugashyiraho plaster ahantu heza (gufata inkokora kuri 60°).
Ishusho ya 1 Ishusho y'insinga ya Kirschner ifatana n'umugozi
(3) Gucika kw'imitsi yo mu bwoko bwa III: Gucika kw'imitsi yo mu bwoko bwa III kugabanuka bitewe no gufunga insinga ya Kirschner, ubu ni bwo buryo busanzwe bwo kuvura imvune yo mu bwoko bwa III. Gufunga no gufunga insinga ya Kirschner yo mu bwoko bwa gatatu birashoboka, ariko gufunga ni ngombwa niba gushyiramo insinga yoroshye bidashobora kugabanuka mu buryo bw'umubiri cyangwa niba hari imvune y'imitsi yo mu bwonko (Ishusho ya 2).
Igishushanyo cya 5-3 Filimi za X-ray mbere yo kubagwa no nyuma yo kubagwa zerekana imvune ya supracondylar humerus
Hari uburyo bune bwo kubaga bwo kugabanya kuvunika kw'inyuma y'umugongo: (1) uburyo bwo ku ruhande rw'inkokora (harimo uburyo bwo ku ruhande rw'imbere); (2) uburyo bwo ku ruhande rw'inkokora; (3) uburyo bwo ku ruhande rw'imbere n'ubwo ku ruhande rw'inyuma; na (4) uburyo bwo ku ruhande rw'inyuma.
Uburyo bwo gukata inkokora ku ruhande rw'inyuma n'uburyo bwo hagati bufite ibyiza byo kudakomereka cyane n'imiterere yoroshye y'umubiri. Uburyo bwo gukata hagati ni bwiza kuruta uburyo bwo gukata ku ruhande rw'inyuma kandi bushobora gukumira kwangirika kw'imitsi yo mu gituza. Ingorane ni uko nta n'imwe muri zo ishobora kubona neza aho imvune y'uruhande rw'inyuma rw'icyuho cyacitse, kandi ishobora kugabanuka no gukosorwa gusa no gukora ku ntoki, ibyo bikaba bisaba ubuhanga bwo kubaga buhanitse ku muntu ubikora. Uburyo bwo gukata inkokora inyuma bwagiye buvugwaho rumwe bitewe no kwangirika kw'imitsi ya triceps no kwangirika cyane. Uburyo bwo gukata inkokora hagati n'inyuma bushobora gukosora ingaruka mbi zo kutabasha kubona neza ubuso bw'amagufwa yo hagati y'icyuho. Bufite ibyiza byo gukata inkokora hagati n'inyuma, bituma imvune igabanuka kandi igakomera, kandi bushobora kugabanya uburebure bw'icyuho cyo ku ruhande. Bugira akamaro mu koroshya no kugabanya kubyimba kw'ingingo; ariko ingaruka mbi ni uko byongera uburyo bwo kubaga; Buruta kandi uburyo bwo kubaga inyuma.
Ingorane
Ingorane zo kuvunika kwa supracondylar humeral zirimo: (1) imvune y'imitsi; (2) indwara y'ibinure by'inyuma; (3) gukomera kw'inkokora; (4) myositis ossificans; (5) avascular necrosis; (6) cubitus varus deformity; (7) cubitus valgus deformity.
Shyira mu ncamake
Kuvunika kw'inyuma y'umugongo ni bimwe mu bikunze kugaragara mu bana. Mu myaka ya vuba aha, kugabanuka nabi kw'inyuma y'umugongo byakuruye abantu. Mu bihe byashize, cubitus varus cyangwa cubitus valgus byafatwaga nk'ibiterwa no guhagarika gukura kw'igice cya distal humeral epiphyseal, aho kuba kugabanuka nabi. Ibimenyetso byinshi bikomeye ubu bishyigikira ko kugabanuka nabi kw'inyuma ari ikintu cy'ingenzi mu gutuma cubitus varus idakora neza. Kubwibyo, kugabanuka kw'inyuma y'umugongo, gukosora ulnar offset, kuzenguruka mu buryo butambitse no gusubiza uburebure bwa distal humerus ni byo byingenzi.
Hari uburyo bwinshi bwo kuvura imvune zo mu gice cya supracondylar cy'umugongo, nko kugabanya intoki + gufunga inyumahakoreshejwe plaster cast, olecranon traction, external fixation hamwe na splint, open reduction and internal fixation, and closed reduction and internal fixation. Mu bihe byashize, uburyo bwo kugabanya no gufunga inyuma ya plaster bwari uburyo bw'ingenzi bwo kuvura, aho byavugwaga ko cubitus varus yari hejuru ya 50% mu Bushinwa. Kuri ubu, ku mvune zo mu bwoko bwa II na III supracondylar, gufunga urushinge rwo mu ruhu nyuma yo kugabanya imvune byabaye uburyo bwemewe muri rusange. Bufite ibyiza byo kudasenya amaraso no gukira vuba kw'amagufwa.
Hari kandi ibitekerezo bitandukanye ku buryo n'umubare mwiza w'insinga za Kirschner nyuma yo kugabanya imvune. Ubunararibonye bw'umwanditsi ni uko insinga za Kirschner zigomba guhurira hagati yazo mu gihe cyo kuzishyiraho. Uko imvune ziba kure cyane, ni ko ziba zihamye. Insinga za Kirschner ntizigomba kwambuka ku mvune, bitabaye ibyo kuzunguruka ntizigenzurwa kandi imvune ntizizahindagurika. Hakwiye kwitonderwa kwirinda kwangiza imitsi yo mu gice cy'imbere cy'umugongo mu gihe ukoresha icyuma gifunga imitsi cya Kirschner. Ntugashyire urushinge mu mwanya wo gupfuka inkokora, gorora gato inkokora kugira ngo imitsi yo mu gice cy'imbere cy'umugongo isubire inyuma, kora ku mutsi wo mu gice cy'imbere cy'umugongo ukoresheje igikumwe hanyuma usubize inyuma hanyuma ushyireho umutsi wa K mu buryo bwiza. Gukoresha icyuma gifunga imitsi cya Kirschner gifite ibyiza byinshi mu gukira nyuma yo kubagwa, gukira kw'imvune, no gukira kw'imvune mu buryo bwiza, ibyo bikaba ingirakamaro mu gukira vuba nyuma yo kubagwa.
Igihe cyo kohereza: Ugushyingo-02-2022
