Kugeza ubu, hari uburyo butandukanye bwo kuvura Radiyo Radiyo, nko gukosora, kugabanya gufungura no gukosorwa imbere, nibindi bikosorwa, nibindi bikosorwa mubitabo birashobora kubona ingaruka zifatika zirashobora kuba hejuru ya 16%. Ariko, niba isahani yicyuma yatoranijwe neza, ibibazo byingorane birashobora kugabanuka neza. Uru rupapuro muri make ruvuga ibiranga, ibimenyetso, bivuguruzanya, nuburyo bwo kubaga ubutumwa bwijwi ryikiganiro cyijwi cya Racral.
1. Hano hari ibyiza bibiri byingenzi byisahani yipaki
A.bishobora gutesha agaciro ibice byimbaraga zububiko. Gukosora imiyoboro inoze ishyigikira igice cya kure no kohereza umutwaro kuri shaft ya radiyo (Ishusho 1). Irashobora kubona inkunga idahwitse neza. Sisitemu yo gufunga ntishobora gukosora gusa ibishushanyo mbonera-byingenzi, ariko nanone birashobora kugarura neza imiterere ya anatomical ya intra-archoular subchondral igufwa-archiclar subchondral igufwa / screw "gukosorwa". Kubwoko bwinshi bwo kuvura radiyo bwa kure bwa radiyo, aya sisitemu yo hejuru itanga imbaraga zo gukusanya hakiri kare.
Ishusho 1, a, nyuma yo kwiyubaka bitatu-bitatu-byo kubaka indwara isanzwe ya kure, witondere urwego rwibibazo bya dorsal; b, kugabanya kuvunika, inenge igomba gukosorwa kandi igashyigikirwa nisahani; C, reba kuruhande nyuma ya DVR ikosore, umwambi yerekana kwimura.
B. Kutagira ingaruka kuri tissue yoroshye: Gukosora isahani ya Volar iri munsi yumurongo wamazi, ugereranije nisahani ya tendon, kandi hari umwanya uboneka, kandi hari umwanya uhari, ushobora kurushaho kwirinda neza imitwe na Tendon. Guhura neza. Byongeye kandi, imbaraga nyinshi zirashobora gutwikirwa na pronator quadratos.
2. Yerekana hamwe no kumenyekanisha kwivuza radiyo ya kure hamwe nisahani yijwi
A.indirindirindira: Kunanirwa kugabanya ibipimo bidasanzwe, ibisanzwe bibaho, nko kwimuka kwa dorsali, radiyo ya marsa. Kugabanuka kwa Rariyo Kwimura kuvunika imbere birenze mm 2; Kubera ubucucike bwamagufwa make, biroroshye gutera kongera kwimurwa, niko bimeze cyane kubasaza.
b. Kumenyekanisha: Gukoresha anesthetike zaho, indwara zaho cyangwa sisitemu yanduye, uruhu rubi kuruhande rwuzuye rwikiboko; Ubwoko bwamagufwa no kuvunika ubwoko bwavuzagurika, ubwoko bwa dorsal nko kuvunika kwa Barton, kuvunika radiocaripal hamwe na radiyo styloid iturika, kuvunika ibintu bito byimwondo.
Ku barwayi bafite ibikomere by'ingufu nyinshi nko kuvunika gukabije cyangwa gutakaza amagufwa bikabije, intiti nyinshi ntizisaba gukoresha ibyapa by'ijwi, kuko ibiranga byinshi bikunze gukoresha imiyoboro myiza kandi bigoye kubona kugabanuka kwa Anatomical kandi bigoye kubona kugabanuka kwa Anatomike. Ku barwayi bafite ibice byinshi byacitse hamwe no kwimurwa cyane na osteoporose ikomeye, isahani ya osteoporose, isahani ya Volar iragoye kuba ingirakamaro. Hashobora kubaho ibibazo byinkunga idahwitse mu kuvunika kure, nka screw yinjira mububiko buhuriweho. Ubuvanganzo bwa vuba bwatangaje ko igihe 42 havuwe ibipimo 42 byingenzi byashyizweho n'ijambo ry'agatora, nta mashusho atandukanye yinjiye mu kayira kerekana, yari ifitanye isano ahanini n'umwanya w'isahani.
3. Ubuhanga bwo kubaga
Abaganga benshi bakoresha isahani yijwi kugirango bakosore imivuruke ya Ratius muburyo bumwe nubuhanga. Ariko, kwirinda neza ibintu byabayeho nyuma yo kubaga nyuma, kurugero, kugabanuka kurashobora kuboneka mukuzamura kwikuramo guhagarika no kugarura ubutumire bwamagufwa ya cortical. Gukosora by'agateganyo hamwe na Kirchner KIMSCHNER irashobora gukoreshwa. Ku bijyanye nuburyo bwo gukoresha, umwanditsi arasaba PCR (Flexor Carpi radial) kugirango yongere inzira yimyuhure.
A, gukosora by'agateganyo hamwe na kirscner insinga ebyiri, menya ko impengamiro ihindagurika n'ubuso bw'agateganyo ntibisubijwe neza muri iki gihe;
B, insinga ya kirschner ikosora by'agateganyo isahani, witondere gukosora iherezo rya radiyo muriki gihe (ubuhanga bwo gukosora ibice byo gukosora), igice cyagenwe cyo gukosora isahani yo kugarura impengamiro ya radila.
C, ubuso bwa articular ni butunganijwe neza munsi ya arthroscopy, hashyizweho inkubi y'umuyaga / pin
Ingingo z'ingenziyo kwiyegereza: Gutemagura uruhu rwibintu bitangirira kuruhu rwikirere, nuburebure bwacyo burashobora kugenwa hakurikijwe ubwoko bwimivuza. Flexor Carpi radialis tendon na sheath yatandukanijwe kuri bone ya karpal kandi nkibisanzwe bishoboka. Gukurura flexor carpi radialis Tendon Kuri Ulnar kuruhande rwimitsi ya Median na Flexor Tendon. Umwanya wa Parona washyizwe ahagaragara, hamwe na quadrator ya Pronator uherereye hagati ya Flexor HallucUs ndende (Ulnar) hamwe nububiko bwa radiyo (radial). Guterwa kuruhande rwa radiyo ya quandratos, hasigara igice cyometse kuri radiyo nyuma yo kwiyubaka nyuma. Gukurura pronator quadrato kuruhande rwa ulnar cyane byerekana neza inguni yijwi ya radiyo.
Kubwoko bugoye, birasabwa kurekura kuremo kwinjiza imitsi ya Brachioradialis, bishobora gutesha agaciro gukurura ibintu bya radiyo. Muri iki gihe, uruhinja rwihuta rwibice byambere birashobora guterwa kugirango ushireho ivuriro rya kure na stal styloide igiti cya radiyo, hanyuma ugakoresha kose ya radiyo, hanyuma ukoreshe kose ya radiyo kugirango ugabanye urubuga, hanyuma ukoreshe kwisiga bya radiyo, hanyuma ukoreshe kose ya radiyo kugirango ugabanye urubuga, hanyuma ukoreshe Kirschner Insict yo kugabanya intra-arcticular frect blot. Kubwububiko bukomeye bwa Intra-Archarque irashobora gukoreshwa mugufasha kugabanya, gusuzuma, no gutunganya neza ibice byacitse.
Nyuma yo kugabanywa, isahani yijwi irasanzwe. Isahani igomba kuba hafi y'amazi, igomba gupfuka inzira ya Ulnar, kandi iherezo ryisahani rigomba kugera hagati yigiti cya radiyo. Niba ibintu byavuzwe haruguru bitujujwe, ingano yisahani ntabwo ikwiye, cyangwa kugabanuka ntabwo ishimishije, ibikorwa ntibiratunganye.
Ingorane nyinshi zifite byinshi byo gukora aho isahani yashyizwe. Niba isahani ishyizwe mu buryo bugaragara, ingorane zijyanye na flexor haltus ndende zirateganijwe; Niba isahani ishyizwe hafi yumurongo wamazi, flexor digitum ya plambus irashobora kuba ifite ibyago. Kugabanya kugabanya imyuka birashobora gutuma byoroshye isahani yo guhagarika ibyuma ku ruhande rw'uko ku giti cye no kuvugana na Flexor Tendon, amaherezo biganisha kuri mandinitis cyangwa no guturika.
Kubarwayi ba Osteoporotike, birasabwa ko isahani ibe hafi yumurongo wamazi ishoboka, ariko ntabwo irya. Kirscner Wire arashobora gukoreshwa mugukosora subhoral yegereye ulna, hamwe nu kuruhande rwinkingi zuzuyemo no gufunga imisumari kandi imiyoboro irashobora kubuza neza kuvunika kuva mu myigaragambyo yo kuvugurura.
Nyuma yisahani ishyirwaho neza, iherezo ryimiterere rikosowe hamwe na screw, kandi umwobo wa Ulnar kurupapuro rwisahani ashyirwa ahagaragara by'agateganyo hamwe n'insinga. Intraroscopy Anteroposteior AnteropoSsorior Reba, Urubanza, Ububiko Bwinshi buringaniye 30 ° Reba kuruhande, kugirango umenye kugabanuka gukabije no gukosora imbere. Niba umwanya wisahani ushimishije, ariko insinga ya kirscreary iri mu ngingo, bizaganisha ku gukira bidahagije, bishobora gukemurwa no gusubiramo isahani binyuze muri tekinike yo gukosora "(Ishusho 2, b).
Niba iherekejwe na dorsal na Ulnar / Ulnar / dorsal ipfa punch) kandi ntishobora kugabanuka neza, tekinike eshatu zikurikira zirashobora gukoreshwa:
1. Kumenyekanisha iherezo rya Radiyo kugirango ribuze kure kurubuga, hanyuma usunike ivunika rya FASSA rigana kuri Carpus binyuze muburyo bwo kwagura PCR;
2. Kora uduce duto kuruhande rwa dorsal yicyumba cya 4 n'icya cya 5 kugirango ugaragaze igice cyo gucika intege, no kubikosora ukoresheje imigozi mu mwobo munini w'isahani y'isahani.
3. Gufunga ibyateganijwe cyangwa bike bitera gukosorwa hifashishijwe arthroscopi.
Nyuma yo kugabanya ni ishimishije kandi isahani irashyirwa neza, gukosora byanyuma biraroroshye. Niba Ulnar Kirschner Wireschner with ihagaze neza kandi nta miyoboro iri mu kajagari, kugabanya anatomique birashobora kuboneka.
Uburambe bwo gutoranya: Kubera ubwinjiriro bukabije bwigufwa rya cortique, uburebure bwa screw bushobora kugorana gupima neza. Imigozi irarerire cyane irashobora gutera kurakara kuri maten, kandi imigozi idafi ntishobora gushyigikira no gukosora igice cyanyuma. Kubera iyo mpamvu, umwanditsi arasaba gukoresha imigozi yo gufunga inkingi hamwe na firelow yo gufunga muburyo bwa radiyo hamwe numwobo wa Ulnar cyane, kandi ukoresha imigozi yinkoni yasize asigaranye imyanya isigaye. Gukoresha inama idahwitse irinde kurakara kandon nubwo isohoka rya dorsal rikoreshwa. Kubijyanye no guhagarika isahani ya plaxic, ibice bibiri bihuza + umugozi umwe usanzwe (ushyizwe muri ellipse) birashobora gukoreshwa mugukosora.
4. Incamake y'inyandiko yuzuye:
Gufunga amasahani yo gufunga imigezi ya marike ya kure birashobora kugera ku mavuriro meza, biterwa ahanini no guhitamo ibimenyetso byerekana no kubaga cyane. Gukoresha ubu buryo birashobora kubona neza prognose hakiri kare, ariko nta tandukaniro mubikorwa byakurikiyeho hamwe nubundi buryo bwo gukosora inka, kandi kugabanuka kwa Kirscleptions, kandi kwangiza imiyoboro ya percative, kandi indwara ya plaque irasanzwe, indwara zurushundire zirasanzwe; no kwagura ibibazo byagutse biramenyerewe muri sisitemu yo kurangiza plaque ya marike. Ku barwayi bafite Osteopose, isahani yijwi iracyari guhitamo bwa mbere.
Igihe cyohereza: Ukuboza-12-2022
