Muri iki gihe, hari uburyo butandukanye bwo kuvura imvune za radius ya distal, nko gufunga plaster, gufunga open na fixing imbere, gufunga inyuma, nibindi. Muri byo, gufunga volar plate bishobora kugira ingaruka nziza, ariko hari raporo mu nyandiko zigaragaza ko ingorane zayo zingana na 16%. Ariko, iyo plate y'icyuma itoranijwe neza, ingaruka zishobora kugabanuka neza. Iyi nyandiko ivuga muri make imiterere, ibimenyetso, ibibujijwe, n'uburyo bwo kubaga bwa volar plate ku mvune za radius ya distal.
1. Hari ibyiza bibiri by'ingenzi by'igice cyo ku ruhande rw'ikiganza
A. Ishobora kugabanya igice cy'imbaraga zo gufunga. Gufata hakoreshejwe vis zo gufunga bifite inguni bishyigikira igice cyo hagati kandi bigashyira umutwaro ku mugozi wa radial (Ishusho ya 1). Ishobora kubona inkunga ya subchondral neza kurushaho. Iyi sisitemu ya plate ntabwo ishobora gusa gukosora neza imvune zo hagati y'ingingo, ahubwo inashobora kugarura neza imiterere y'igufwa rya subchondral ryo hagati y'ingingo binyuze mu gufata "feni-shaped". Ku bwoko bwinshi bwa distal radius fractures, iyi sisitemu yo hejuru itanga ubushobozi bwo guhagarara neza butuma umuntu yimuka hakiri kare.
Ishusho ya 1, a, nyuma yo kongera gusana igice gisanzwe cya radius ya distal, witondere urwego rwo gukanda kw'inyuma; b, kugabanya imvune mu buryo bufatika, inenge igomba gukosorwa no gushyigikirwa n'isahani; c, kureba ku ruhande nyuma yo gushyiraho DVR, umwambi werekana ko umutwaro wimurirwa.
B. Ingaruka nke ku ngingo zoroshye: gufatana kwa volar plate kuri munsi gato y'umurongo w'amazi, ugereranije n'igice cyo mu mutwe, bishobora kugabanya uburibwe ku mutsi, kandi hari umwanya munini uboneka, ushobora kwirinda gukorana neza na implant na tendon. Byongeye kandi, implant nyinshi zishobora gutwikirwa na pronator quadratus.
2. Ibipimo n'ibibujijwe mu kuvura radius ya distal ukoresheje volar plate
a.Ibimenyetso: Ku kugabanuka kw'amagufwa yo hanze y'ingingo, hari ibi bikurikira, nko kugabanuka kw'amagufwa yo mu mfuruka kurenza 20°, gukanda kw'amagufwa kurenza 5mm, kugabanuka kw'amagufwa yo mu mfuruka kurenza 3mm, no gutandukana kw'amagufwa yo mu mfuruka kurenza 2mm; Gutandukana kw'amagufwa yo mu mfuruka imbere kurenza 2mm; bitewe n'ubucucike buke bw'amagufwa, biroroshye gutuma yongera kwimuka, bityo bikaba byiza cyane ku bageze mu za bukuru.
b. Ibibujijwe: gukoresha imiti igabanya ububabare mu gace, indwara zandura zo mu gace cyangwa mu mubiri, uruhu rudakora neza ku ruhande rw'ukuboko; amagufwa n'ubwoko bw'amagufwa aho yavunitse, ubwoko bw'amagufwa yo mu gice cy'inyuma nka Barton fracture, radiocarpal joint fracture and dislocation, simple radius Styloid process fracture, small avulsion fracture of volar margin.
Ku barwayi bafite imvune nyinshi nko kuvunika cyane mu ngingo cyangwa gutakaza amagufwa cyane, intiti nyinshi ntizisaba gukoresha ibyuma bya volar, kuko bene ibyo bice bya distal bishobora kurwara indwara ya necrosis y'imitsi kandi bigorana kugabanya imiterere y'umubiri. Ku barwayi bafite ibice byinshi byavunitse kandi bidafite aho bihuriye n'indwara ikomeye ya osteoporosis, ibyuma bya volar biragoye kugira icyo bikora. Hashobora kubaho ibibazo byo gushyigikira subchondral mu kuvunika kwa distal, nko kwinjira mu ngingo. Inyandiko ziherutse gusohoka zavuze ko ubwo 42 mu bantu bavunitse mu ngingo bavurwaga hakoreshejwe ibyuma bya volar, nta mashini ya articular yinjiraga mu ngingo, byari bifitanye isano cyane n'aho ibyuma byari biri.
3. Ubuhanga bwo kubaga
Abaganga benshi bakoresha uburyo bwo gufata imitsi ya volar plate mu gihe cyo kuvunika kwa radius ya distal mu buryo bumwe na tekiniki. Ariko, kugira ngo hirindwe ingaruka mbi nyuma yo kubagwa, hakenewe uburyo bwiza bwo kubaga, urugero, kugabanya bishobora kuboneka binyuze mu kurekura gukanda kw'igufwa rya fracture no gusubiza igufwa rya cortical rikomeza. Gufata imitsi ya Kirschner by'agateganyo bishobora gukoreshwa. Ku bijyanye n'uburyo bwo gukoresha, umwanditsi asaba PCR (flexor carpi radialis) kugira ngo yongere uburyo bwo gufata imitsi ya volar.
a, Gufata by'agateganyo hakoreshejwe insinga ebyiri za Kirschner, menya ko imiterere ya volar n'ubuso bw'ingingo bitarasubizwa neza muri iki gihe;
b, Insinga ya Kirschner ikora by'agateganyo plaque, witondere uburyo impera ya radius ihagaze muri iki gihe (uburyo bwo gufata ibice bya distal fracture), igice cya plaque gikururwa yerekeza ku mugozi wa radial kugira ngo gisubizeho imiterere ya volar.
C, Ubuso bw'ingingo butunganywa neza hifashishijwe arthroscopy, hashyirwaho screw/pin yo gufunga iri kure, maze radius ya proximal iragabanuka kandi igakosorwa.
Ingingo z'ingenziUburyo bwo kugera: Gukata uruhu rwo kure bitangirira ku ruhu rwo ku kuboko, kandi uburebure bwarwo bushobora kugaragazwa hakurikijwe ubwoko bw'aho rwavunitse. Umutsi wa flexor carpi radialis n'agahu kawo bicibwamo ibice bijya ku igufwa rya carpal kandi hafi uko bishoboka kose. Gukurura umutsi wa flexor carpi radialis ku ruhande rw'inyuma birinda imitsi yo hagati n'imitsi ya flexor. Ahantu ha Parona hagaragara, aho pronator quadratus iherereye hagati ya flexor hallucis longus (ulnar) n'umutsi wa radial (radial). Gukata byakozwe ku ruhande rw'inyuma rwa pronator quadratus, hasigara igice gifatanye na radius kugira ngo cyongere kubakwa. Gukurura pronator quadratus ku ruhande rw'inyuma bigaragaza neza inguni ya volar ulnar ya radius.
Ku bwoko bw'amavunika agoye, ni byiza kurekura imitsi ya brachioradialis, ishobora kugabanya imbaraga zayo ku mikorere ya radial styloid. Muri iki gihe, agace ka volar k'igice cya mbere cy'inyuma gashobora gucibwa kugira ngo hagaragare amavunika agoye. Gufunga uruhande rwa radial na radial styloid, uzunguruke imbere umugozi wa radial kugira ngo utanduke aho amavunika yakomeretse, hanyuma ukoreshe insinga za Kirschner kugira ngo ugabanye amavunika akomeretse. Ku mavunika agoye cyane akomeretse akomeretse akomeretse, arthroscopy ishobora gukoreshwa mu gufasha kugabanya, gusuzuma no gutunganya neza ibice byavunitse.
Nyuma yo kugabanya, plaque ya volar ishyirwa buri gihe. Plaque igomba kuba iri hafi y'amazi, igapfuka inzira ya ulnar, kandi impera y'plaque igomba kugera hagati mu gice cy'umuyoboro wa radial. Niba ibikubiye haruguru bitagezweho, ingano ya plaque ikaba idakwiye, cyangwa kugabanya kwayo kudashimishije, igikorwa kiba kitaratungana.
Ingorane nyinshi zifitanye isano n'aho isahani ishyirwa. Iyo isahani ishyizwe ku buryo bukabije, ingorane zijyanye na flexor hallucis longus ziba zishobora guterwa; iyo isahani ishyizwe hafi cyane y'umuyoboro w'amazi, flexor digitorum profundus ishobora kuba iri mu kaga. Kugabanuka kw'imvune bitewe n'ubusembwa bw'impinduka za volar bishobora gutuma isahani y'icyuma isohoka ku ruhande rwa volar igakora ku mutsi w'impinduka, amaherezo bigatera tendinite cyangwa gucika.
Ku barwayi bafite indwara yo gucika kw'amagufwa, ni byiza ko isahani iba hafi y'umuyoboro w'amazi uko bishoboka kose, ariko ntibe iri hakurya yayo.Insinga za Kirschner zishobora gukoreshwa mu gusana igice cy’inyuma cy’umugongo kiri hafi y’umugongo, kandi insinga za Kirschner zo ku ruhande rumwe n’imisumari n’amapine bifunga bishobora gukumira neza kuvunika kwangirika.
Nyuma yo gushyira icyuma neza, impera y'imbere irashyirwaho vis, kandi umwobo w'inyuma ku mpera y'icyuma ushyirwaho by'agateganyo n'insinga ya Kirschner. Intraoperative fluoroscopy anteroposterior view, side view, side lift lift lift 30° side view, kugira ngo hamenyekane uburyo imvune zigabanuka n'aho zihagarara imbere. Niba plate ihagaze neza, ariko wire ya Kirschner iri mu ngingo, bizatuma imiterere ya volar igabanuka idahagije, ibi bikaba byakemurwa no kongera gushyira plate mu mwanya wayo binyuze mu "distal fracture fixation technique" (Ishusho ya 2, b).
Iyo iherekejwe n'imvune zo mu gituza n'izo mu kibuno (ulnar/dorsal Die Punch) kandi idashobora kugabanuka neza iyo ifunze, uburyo butatu bukurikira bushobora gukoreshwa:
1. Shyira impera y'umurongo wa radius hafi y'aho yavunitse, hanyuma usunikire umuvuduko wa lunate fossa werekeza kuri carpus unyuze muri PCR extension approach;
2. Kora akantu gato ku ruhande rw'inyuma rw'igice cya kane n'icya gatanu kugira ngo igice cyavunitse kigaragare, hanyuma ugishyire mu mwobo uri mu gice cy'imbere cy'icyuma.
3. Gufunga igice cyo hejuru cyangwa igice gito cy’umubiri hifashishijwe uburyo bwa arthroscopy.
Nyuma yo kugabanya neza no gushyiramo icyuma neza, uburyo bwo kugabanya buroroshye cyane. Iyo insinga ya Kirschner ihagaze neza kandi nta vis iri mu ngingo, hashobora kuboneka uburyo bwo kugabanya imiterere y'umubiri.
Ubunararibonye bwo guhitamo screws: Bitewe no kwangirika gukomeye kw'igufwa rya cortical ryo mu gice cy'inyuma, uburebure bw'isurufu bushobora kugorana gupima neza. Isurufu ndende cyane zishobora gutera uburibwe bw'imitsi, naho isurufu ngufi cyane ntizishobora gushyigikira no gukosora igice cy'isurufu. Kubera iyo mpamvu, umwanditsi atanga inama yo gukoresha isurufu ifite imigozi n'isurufu ifunganye mu buryo bwa radial styloid no mu mwobo munini w'inyuma, no gukoresha isurufu ifunganye mu yindi myanya. Gukoresha agace k'inyuma birinda uburibwe bw'imitsi nubwo hakoreshwa inzira yo gusohokeramo. Ku bijyanye no gufunga plate ifunganye hafi, isurufu ebyiri zifunganye hamwe n'isurufu imwe isanzwe (ishyirwa mu gice cy'inyuma) zishobora gukoreshwa mu gufunga.
4. Incamake y'inyandiko yuzuye:
Gufata inzara zo mu gice cyo hagati cy’umukara w’inyuma bishobora kugira ingaruka nziza ku buvuzi, ahanini biterwa n’uburyo ibimenyetso byakoreshejwe n’ubuhanga buhanitse bwo kubaga. Gukoresha ubu buryo bishobora gutuma habaho imikorere myiza hakiri kare, ariko nta tandukaniro mu mikorere ya nyuma no mu gukora amashusho hakoreshejwe ubundi buryo, ingaruka z’ingaruka nyuma yo kubagwa zirasa, kandi kugabanuka kwazo biragabanuka mu gufata ibyuma byo hanze, gufata icyuma cya Kirschner, no gufata plaster, kwandura indwara zo mu nzira y’urushinge ni byinshi; kandi ibibazo by’imitsi yo mu gice cyo hagati cy’umukara bikunze kugaragara mu buryo bwo gufata ibyuma byo mu gice cyo hagati cy’umukara w’inyuma. Ku barwayi ba osteoporosis, icyuma cya volar ni cyo gisigaye ari cyo gihitamo cya mbere.
Igihe cyo kohereza: Ukuboza-12-2022
