Supracondylar kuvunika kw'igitereko ni kimwe mu bivunika bikunze kugaragara mu bana kandi bibera aho ihurira rya shitingi ya humeral nahumeral condyle.
Kugaragara kwa Clinical
Ivunika rya Supracondylar yigituba ahanini ni abana, kandi ububabare bwaho, kubyimba, ubwuzu, no kudakora neza bishobora kubaho nyuma yimvune.Kuvunika kudasimbuwe kubura ibimenyetso bigaragara, kandi gusohora inkokora bishobora kuba ikimenyetso cyonyine cyamavuriro.Igice cya capsule kiri munsi yimitsi yinkokora nikigaragara cyane, aho capsule yoroshye, izwi kandi nka softspot, irashobora guterwa mugihe cyo gusohora hamwe.Ingingo yo guhinduka mubisanzwe imbere yumurongo uhuza hagati yumutwe wa radiyo kugeza kumutwe wa olecranon.
Kubijyanye na supracondylar ubwoko bwa III bwavunitse, hariho ubumuga bubiri buringaniye bwinkokora, butanga isura ya S.Mubisanzwe habaho gukomeretsa munsi yububoko bwo hejuru, kandi niba kuvunika kwimuwe burundu, impera ya kure yamenetse yinjira mumitsi ya brachialis, kandi kuva amaraso munsi yubutaka birakomeye.Nkigisubizo, ikimenyetso cya pucker kigaragara imbere yinkokora, mubisanzwe byerekana amagufwa yegeranye no kuvunika kwinjira muri dermisi.Niba iherekejwe no gukomeretsa imitsi ya radial, kwaguka kwa dorsal kurutoki birashobora kuba bike;gukomeretsa imitsi ya median bishobora gutera igikumwe nintoki ntigishobora guhinduka;ulnar imvune yumutima irashobora kuvamo kugabana intoki nke no interdigitation.
Gusuzuma
(1) Ishingiro ryo gusuzuma
AveGira amateka y'ihahamuka;Symptoms Ibimenyetso nibimenyetso: ububabare bwaho, kubyimba, ubwuzu no kudakora neza;③X-ray yerekana umurongo wavunitse ya supracondylar hamwe nuduce twavunitse twimitsi.
(2) Gusuzuma Itandukaniro
Hagomba kwitonderwa kumenyekanishainkokora, ariko kumenya kuvunika kwa supracondylar kwagutse kuva kwimuka kwinkokora biragoye.Mu kuvunika kwa supracondylar ya nyababyeyi, epicondyle yigituba ikomeza umubano usanzwe na olecranon.Ariko, mukwikuramo inkokora, kubera ko olecranon iherereye inyuma ya epicondyle yigitereko, iragaragara cyane.Ugereranije no kuvunika kwa supracondylar, ubwiganze bwikiganza mu kwimura inkokora ni kure cyane.Kubaho cyangwa kutabaho kw'ibikomoka ku magufa nabyo bigira uruhare mu kumenya kuvunika kwa supracondylar ya nyababyeyi yo kuva mu gihimba cy'inkokora, kandi rimwe na rimwe biragoye gutanga amavunja.Kubera kubyimba cyane nububabare, manipulation itera amagufwa ya bone akenshi itera umwana kurira.Kubera ibyago byo kwangirika kwimitsi.Kubwibyo, manipuline zitera amagufwa agomba kwirinda.Ikizamini cya X-ray gishobora gufasha kumenya.
Andika
Itondekanya risanzwe rya supracondylar humeral yamenetse nugucamo ibice no kwaguka.Ubwoko bwa flexion ni gake, kandi X-ray ikurikira irerekana ko impera ya kure yamenetse iherereye imbere yumutwe wa humeral.Ubwoko bugororotse burasanzwe, kandi Gartland iyigabanya mubwoko bwa I kugeza kuri III (Imbonerahamwe 1).
| Andika | Kugaragara kwa Clinical |
| Ubwoko | Kumeneka nta kwimurwa, guhinduranya cyangwa valgus |
| TypeB ubwoko | Kwimura byoroheje, guhindagurika hagati ya cortical, guhuza imbibi zimbere zinyuze mumutwe wa humeral |
| Ubwoko | Hyperextension, inyuma yinyuma ya cortical, umutwe wa humeral inyuma yumupaka wimbere wimbere, nta kuzunguruka |
| TypeB ubwoko | Kwimura birebire cyangwa kuzunguruka hamwe no guhuza igice kumpera zombi zavunitse |
| Ubwoko | Iyimurwa ryimbere ryuzuye ntaho rihurira, cyane cyane kure yimbere yo hagati |
| TypeB ubwoko | Kwimuka kugaragara, tissue yoroshye yashyizwe mumutwe wacitse, guhuzagurika gukomeye cyangwa guhinduranya kuzenguruka kumeneka |
Imbonerahamwe 1 Gartland itondekanya kuvunika supracondylar
Kuvura
Mbere yo kuvurwa neza, ingingo yinkokora igomba gushyirwaho byigihe gito mumwanya wa 20 ° kugeza 30 ° flexion, ntabwo yoroheye umurwayi gusa, ahubwo binagabanya ubukana bwimiterere yimitsi yimitsi.
. kugeza ku byumweru 4.
.°) Gukosora bikomeza umwanya nyuma yo kugabanuka, ariko byongera ibyago byo gukomeretsa imitsi yimitsi yimitsi yibasiwe ningaruka zo kwandura syndrome de acute fascial compartment.KubwibyoKirschner wire fixationnibyiza nyuma yo gufunga kugabanya kuvunika (Igishusho 1), hanyuma gukosorwa hanze hamwe na plaster yataye ahantu hizewe (inkokora flexion 60 °).
Igishushanyo 1 Ishusho ya Kirschner itunganijwe neza
.Kugabanuka gufunze no gutandukanya insinga za Kirschner mubisanzwe birashoboka, ariko kugabanuka kumugaragaro birasabwa niba gushyiramo ingirangingo zoroshye zidashobora kugabanuka muburyo budasanzwe cyangwa niba hari ibikomere byamaraso (Ishusho 2).
Igicapo 5-3 Amafirime mbere yo gutangira na nyuma ya X-ray ya supracondylar yamenetse
Hariho uburyo bune bwo kubaga uburyo bwo kugabanya kumugaragaro kuvunika kwa supracondylar:(2) inzira y'inkokora yo hagati;(3) uburyo bwo guhuza inkokora hagati no kuruhande;na (4) inzira yinkokora yinyuma.
Byombi inzira yinkokora kuruhande hamwe nuburyo bwo hagati bifite ibyiza byo kwangirika kwinyuma hamwe nuburyo bworoshye bwa anatomique.Gucibwa hagati ni byiza kuruta gutembera kuruhande kandi birashobora gukumira kwangirika kwa ulnar.Ikibi ni uko nta n'umwe muri bo ushobora kubona mu buryo butaziguye kuvunika kw'uruhande rutambutse, kandi bishobora kugabanuka no gukosorwa gusa no kumva intoki, bisaba ubuhanga buhanitse bwo kubaga uwabikoraga.Uburyo bw'inkokora yinyuma ntivugwaho rumwe kubera kwangiza ubusugire bwimitsi ya triceps no kwangirika kwinshi.Uburyo bukomatanyije bwinkokora yo hagati hamwe nu mpande zirashobora kuzuza ibibi byo kutabasha kubona mu buryo butaziguye amagufwa atandukanijwe.Ifite ibyiza byo gukata inkokora yo hagati no kuruhande, ifasha kugabanya kuvunika no gukosorwa, kandi irashobora kugabanya uburebure bwuruhande.Ni ingirakamaro kuruhuka no kugabanuka kubyimba ingirangingo;ariko ibibi byayo nuko byongera kubaga kubaga;Na none hejuru yuburyo bwinyuma.
Ingorabahizi
Ingorane zo kuvunika kwa supracondylar zirimo: (1) gukomeretsa imitsi;(2) syndrome ikaze ya septal;(3) gukomera kw'inkokora;(4) ossificans ya myosite;(5) imitsi y'amaraso;(6) ubumuga bwa cubitus varus;(7) ubumuga bwa cubitus.
Vuga muri make
Supracondylar kuvunika kw'igituba biri mubice bikunze kuvuka mubana.Mu myaka yashize, kugabanuka nabi kuvunika kwa supracondylar ya nyababyeyi byatumye abantu bumva.Mu bihe byashize, cubitus varus cyangwa cubitus valgus byafatwaga nk’ifatwa ry’ikura ry’ikibaho cya epiphyseal ya kure, aho kugabanuka nabi.Ibyinshi mu bimenyetso bifatika ubu bishyigikira ko kugabanya kuvunika nabi ari ikintu cyingenzi muri cubitus varus.Kubwibyo, kugabanya kuvunika kwa supracondylar humerus, gukosora ulnar offset, kuzenguruka gutambitse no kugarura uburebure bwa humerus intera nurufunguzo.
Hariho uburyo bwinshi bwo kuvura kuvunika supracondylar ya humerus, nko kugabanya intoki + gukosorwa hanzehamwe na plaster, gukurura olecranon, gukosora hanze hamwe na spint, kugabanya gufungura no gukosora imbere, no kugabanya gufunga no gukosora imbere.Mu bihe byashize, kugabanya manipulative no gutunganya plaster ni byo byingenzi byavuwe, muri byo bivugwa ko varus cubitus igera kuri 50% mu Bushinwa.Kugeza ubu, kubwoko bwa II nubwoko bwa III supracondylar kuvunika, gutunganya inshinge za percutaneous nyuma yo kugabanya kuvunika byabaye uburyo bwemewe muri rusange.Ifite ibyiza byo kutangiza amaraso no gukira amagufwa byihuse.
Hariho kandi ibitekerezo bitandukanye kuburyo nuburyo bwiza bwa Kirschner wire ikosora nyuma yo kugabanya gufunga ibice.Ubunararibonye bwubwanditsi nuko insinga za Kirschner zigomba gutandukanywa mugihe cyo gukosora.Iyo kure cyane indege yamenetse, niko ihagaze neza.Insinga za Kirschner ntizigomba kwambukiranya indege yamenetse, bitabaye ibyo kuzenguruka ntibizagenzurwa kandi gukosorwa bizaba bitajegajega.Hagomba kwitonderwa kugirango wirinde kwangiza imitsi ya ulnar mugihe ukoresheje insinga ya Kirschner yo hagati.Ntugahindure urushinge mumwanya uhindagurika winkokora, ugorora gato inkokora kugirango ureke imitsi ya ulnar isubire inyuma, kora imitsi ya ulnar igikumwe hanyuma uyisunike inyuma hanyuma uhindure neza K-wire.Gukoresha insinga za Kirschner zambukiranya imbere zifite ibyiza bishobora gukira nyuma yo gukira nyuma yubuvuzi, igipimo cyo gukira kuvunika, nigipimo cyiza cyo gukira kuvunika, bifasha mugukiza hakiri kare nyuma yibikorwa.
Igihe cyo kohereza: Ugushyingo-02-2022
