Extensor tendon no a ɛpaapae wɔ volar plate fixation akyi no da so ara yɛ ɔhaw kɛse wɔ distal radius fractures a wosiesie mu. Ntini a ɛtaa ka no ne extensor pollicis longus (EPL) ntini no, efisɛ ɛda EPL abura no mu. EPL ntini a ɛpaapae wɔ volar plating akyi a wɔbɔɔ amanneɛ no yɛ 0.29%–5.7%.
Asiane a ɛwɔ hɔ sɛ EPL ntini no bɛkyɛ no kɔ soro bere a akyi skru a ɛpuepue, opira a efi oprehyɛn no mu tẽẽ drilling, ne akyi dan atifi asinasin, titiriw wɔ Lister’s tubercle supɔw so abubu mu no. Radiographic nhwehwɛmu a wɔyɛ wɔ screw protrusion wɔ distal radius fractures mu no yɛ den esiane geometry a ɛyɛ den a ɛwɔ distal radius no mu ne sɛnea ebetumi ama comminuted dorsal fractures aba nti. Dorsal tangential view no nkutoo ne intravital view a ebetumi aba wɔ dorsal radial cortex no mu na ama wɔanya nhwehwɛmu a wotumi de ho to so wɔ kwan a ɛda screw tip ne dorsal cortex ntam no ho.
Akwan a wɔfa so kwati extensor tendon opira no bi ne sɛ wɔde monocortical screws bedi dwuma na wɔakwati sɛ wɔbɛkɔ akyi akɔ; nanso, saa akwan yi betumi atew mfiri a wɔde siesie akisikuru no so. Enti, ɛtɔ mmere bi a ɛho hia sɛ wɔde bicortical fixation di dwuma. Nea ɛbɛyɛ na asiane a ɛwɔ extensor tendon opira mu no so atew no, ɛnsɛ sɛ wɔsɛe botae atitiriw a ɛne sɛ wɔbɛma abubu no asi hɔ na wɔagyina pintinn no.
Oprehyɛn ho akwan foforo
Yɛkyerɛkyerɛ ɔkwan foforo a wɔfa so tew asiane a ɛwɔ hɔ sɛ EPL ntini a ɛpaapae wɔ volar plate fixation a ɛwɔ distal radius fractures akyi a wɔremma skru no tenten nyɛ tiaa anaasɛ wonyi dorsal roof asinasin mfi hɔ mu. Ne tiawa mu no, nea ɛka ɔkwan a wɔfa so yɛ no ho ne sɛ wobebue ɔdan a ɛto so abiɛsa no denam akyi fã ketewaa bi a wɔatwa so.
Sɛ anka skru no hyɛn akyi berɛmo no mu na ɛpuepue wɔ ɔdan a ɛtɔ so mmiɛnsa no mu a: yeyii EPL ntini no fii ne abon no mu na yɛtoo dan no mu denam retinaculum no a yɛpam gyaw EPL ntini no wɔ retinaculum a wɔasiesie no so no so.
Sɛ skru no ntrɛw nkɔ ɔdan a ɛto so abiɛsa no mu a: yegyaw EPL ntini no wɔ ɔdan a ɛto so abiɛsa no mu. Nea ɛkyerɛ ma yɛn kwan no ne ayarefo a wɔwɔ distal radius fractures a wɔde volar locking plates ayɛ wɔn yare, abubu a dorso-parietal fragments anaa screws a ebetumi akɔ dorsal cortex no mu anaasɛ asɛe EPL tendon a atwa Lister’s tubercle ho ahyia no. Wɔ ayarefo a distal radius fractures a dorsomedial asinasin wom mu no, yetutu ntokuru ma ɛhyɛn dorsal cortex no mu na yɛpaw nkɔnsɔnkɔnsɔn a ne tenten yɛ nea ɛfata a yɛde besiesie dorsomedial asinasin a entumi nnyina no.
Asɛm a wɔkyɛ
Yɛkyɛ asɛm bi a woyii EPL ntini no fii ɔdan a ɛto so abiɛsa no mu esiane sɛ skru no puei wɔ ɔdan a ɛto so abiɛsa no mu bere a wɔde mprɛte sii hɔ a ɛyɛ comminuted distal radius fracture a dorsomedial asinasin wom nti. Yɛsii so dua sɛ EPL ntini no ansɛe mfe 7 wɔ oprehyɛn no akyi, ɛwom sɛ na skru no da adi wɔ ɔdan a ɛto so abiɛsa no mu de.
Na asɛm no yɛ ɔbea bi a wadi mfe 67 a wɔahu sɛ ɔwɔ intra-articular unstable distal radius fracture a ne right dorsal medial fracture (Mfonini 1A-E). Sigaretnom, asikreyare anaa nsa a wɔnom ho abakɔsɛm biara nni hɔ. Otumi nantew a onni obiara a ɔnantew.
![distal radius a ɛpaapae]()
mfonini 1. Mfonini a wɔyɛe ansa na wɔreyɛ oprehyɛn no kyerɛe sɛ ntini a ɛwɔ akyirikyiri no mu abubu a abubu.
A ne B: X-ray a wɔyɛ ansa na wɔayɛ oprehyɛn, .
C ne D: kɔmputa so mfonini ahorow a wɔde sagittal ne axial hwɛ, .
E: 3D kɔmputa so tomography mfonini. Dorsal medial lunate facet asinasin ne dorsal apical asinasin (nsoromma fitaa) da adi.
Ɔkwan a wɔfa so yɛ oprehyɛn
Yɛde volar locking plate saa abubuw nhyehyɛe yi yare. Wɔ oprehyɛn no mu no, yɛtutu fam faa akyi berɛmo no mu na yɛpaw skru a ɛware sɛnea ɛbɛyɛ a ɛbɛkyekye akyi berɛmo no efisɛ na dorsomedial asinasin no ntumi nnyina (Mfonini 2).
Wɔyɛɛ oprehyɛn de buee ɔdan a ɛto so abiɛsa no bere a wɔde skru ahyɛ mu akyi.
Esiane sɛ skru no akɔhyɛn ɔdan a ɛto so abiɛsa no mu na apue (Mfonini 3A) nti, bue ɔdan a ɛto so abiɛsa no koraa na fa EPL ntini no fi ne abon no mu (Mfonini 3B).
Afei wɔde retinaculum no a wɔpam no too dan a ɛto so abiɛsa no mu (Mfonini 3C,D), na wɔde EPL ntini no sii retinaculum a wɔasiesie no so (Mfonini 3 E).
Bere a wɔyɛɛ ɔyarefo no oprehyɛn wiei no, ɔkɔɔ yɛn ayaresabea hɔ ayaresabea a wɔhwɛ ayarefo a wɔda abɔnten kosii sɛ dompe no sa. Ɔyarefo no mpɛ sɛ obeyi hardware no afi hɔ.
Oprehyɛn akyi a obi ho tɔ no
Oprehyɛn no akyi mfe ason no, ɔyarefo no san kɔɔ ayaresabea hɔ kɔhwɛɛ no bio esiane nnompe mu yare nti. Nsa nifa nyɛ dɛmdi. X-ray mfonini a ɛkyerɛ akisikuru a asa a ɛwɔ akyi a ɛpuepue wɔ distal locking screw no mu. Ná ɔyarefo no nsateaa no atrɛw koraa, na na EPL ntini no nni agyan a ɛda adi pefee.
Wɔ yɛn nyansahyɛ so no, ɔyarefo no penee so sɛ obeyi hardware no na wahwɛ extensor ntini no mu. Wɔ oprehyɛn no mu no, yɛhwɛɛ EPL ntini no denam akyi a wɔatwa so na yebuee ɔfã a ɛto so abiɛsa ne anan no fã bi.
Ná EPL ntini no wɔ ɔdan a ɛto so abiɛsa no akyi wɔ beae koro no ara a na ɛte wɔ oprehyɛn a atwam no mu, na na ntini no nhyɛ abufuw.
Yesii so dua sɛ skru no hyɛn ɔdan a ɛto so abiɛsa no mu bere a wɔtwee nsateaa no ntini a ɛtrɛw no akyi no.
Awiei koraa no, yesiesiee nhama a wɔde gyina so no na yeyii nneɛma a wɔde yɛ adwuma no fii hɔ. Wɔ nhwehwɛmu a etwa to no mu wɔ asram 2 akyi wɔ bere a woyii hardware no fii hɔ akyi no, na ɔyarefo no nte ɛyaw biara na na ne nsateaa atrɛw koraa.
Pɛnsɛpɛnsɛ mu
Wɔ yɛn kwan no mu no, bere a yɛde volar plate fixation of distal radius fractures akyi no, yebuee dan a ɛto so abiɛsa no fã bi denam incision a ne tenten bɛyɛ cm 2 ulnar so kɔɔ Lister tubercle no so. Yɛkyerɛɛ EPL ntini no ne extensor dan a ɛto so abiɛsa no fam tẽẽ denam EPL ntini no a yɛtwee no brɛoo no so.
Sɛ skru no hyɛn akyi berɛmo no mu kɔɔ ɔdan a ɛtɔ so mmiɛnsa no mu anaasɛ na ɛwɔ akyi berɛmo no mu nneɛma a asɛe a, yɛanyɛ skru a wɔde besi ananmu wɔ oprehyɛn no mu anaasɛ yɛatwa fragmentectomy, na mmom yɛbuee ɔfa a ɛtɔ so mmiɛnsa no koraa na yeyii EPL ntini no fii ne groove no mu. Afei yɛtoo ɔdan no mu denam retinaculum no a yɛpam bere a yɛsan de EPL ntini no si ɔdan a ɛto so abiɛsa no so no so.
Sɛ skru no antrɛw ankɔ ɔdan a ɛto so abiɛsa no mu a, yegyaw EPL ntini no wɔ ɔdan a ɛto so abiɛsa a wɔabue fã bi no mu.
Yɛn oprehyɛn kwan no ma ɛyɛ mmerɛw sɛ wɔbɛhwehwɛ EPL ntini mu apirakuru no mu denam wɔn ani so tẽẽ wɔ simma 10 foforo mu. Sɛ EPL ntini no apira a, wobetumi asiesie no tẽẽ. Saa kwan yi boa ma wosiw EPL ntini a ɛto so abien a ɛpaapae bere a wɔde distal radial plate fixation akyi no ano. Ebia EPL tendon bowstring bɛba, nanso ansi wɔ yɛn fam.
Sɛ yɛde rewie a
Yehuu asɛm bi a na EPL ntini no ansɛe mfe 7 wɔ oprehyɛn no akyi, ɛwom sɛ na nkɔnsɔnkɔnsɔn a wɔde siesie volar mprɛte no da adi wɔ ɔdan a ɛto so abiɛsa no mu de. Yɛn oprehyɛn kwan no ma asiane a ɛwɔ hɔ sɛ EPL ntini no bɛpaapae bere a wɔde volar plate fixation ama distal radius fractures akyi no so tew.
Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!
Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.
Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.
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