Mɔgɔkɔrɔbaw ka distal radius fracture furakɛcogo?

Distal radius karilenw ye kariw ye minnu ka teli ka kɛ mɔgɔkɔrɔbaw la. Mɔgɔ minnu si bɛ san 50 ni san 75 cɛ, olu bɛ ɲɛfɔ sisan ko mɔgɔkɔrɔbaw. Distal radius fractures (yɔrɔjan yɔrɔ karilenw) hakɛ bɛ caya san o san ni baliku kɔrɔbaw ka lamaga hakɛ bɛ caya. Ko duman min bɛ sɔsɔli la min bɛ kɛ distal radius fractures kan, o tora: Yala opereli ka kan wa?

Banakisɛw jɛnsɛnni dɔnniyaw

Distal radius karilenw bɛ kɛ 18% ɲɔgɔn ye farikolo karilenw bɛɛ la baliku kɔrɔbaw la. Caucase jamanadenw, muso banabagatɔw, ani koloci ye faratiba ye ka ɲɛsin yɔrɔjan karilenw ma. Ka fara o kan, waatiko fɛnw fana b’a la, i n’a fɔ mɔgɔkɔrɔbaw minnu bɛ sɛgɛn ka bin minnu ka teli ka yɔrɔjan karilenw kari nɛnɛ waati. Kalan dɔw y’a jira ko banabagatɔ kɔrɔbaw minnu ka hakililata seko ni u farikolojidɛsɛ tɛ tiɲɛ, olu farati ka bon ka kari yɔrɔjan (i da a kan banabagatɔw ka hakilijagabɔ barikamaw bɛ u la, u bɛna u bolow kɔrɔta ni hakilijagabɔ ye walasa ka duguma dɛmɛ ni u binna, o bɛ na ni kari ye). .

Jateminɛw fɛ, Ameriki jamana na, distal radius fractures furakɛli musakaw san 2007, o tun bɛ se Ameriki dɔrɔmɛ miliyɔn 170 ɲɔgɔn ma (san 1983 Ameriki dɔrɔmɛ / mɔgɔ ɲɔgɔn). Hali ni banabagatɔ kɔrɔba fanba minnu ka yɔrɔjan karilen don, olu furakɛra ni kɔrɔlen ye, banabagatɔ minnu bɛ kɔnɔnafili opereli sugandi, olu hakɛ bɛ ka caya san o san. Furakɛli musaka min bɛ kɛ opereli kɔnɔ, o musaka ka ca ni furakɛli kɔrɔlen ye siɲɛ saba, wa o bɛ dɔ fara dɔgɔtɔrɔso ladonni musakaw kan fana ani musaka wɛrɛw minnu bɛ tali kɛ o la.

Danfara bɛ mara ni siya fana na kɔnɔnafili tali la yɔrɔjan karilenw na. Sɛgɛsɛgɛli dɔ kɛra Medicare kan, o y’a jira ko musow ni Caucasekaw ka teli ka opereli kɛ, wa kɔnɔnafiliko sugandili hakɛ tun ye 4,6% fo 42,1% ye. Ani a y’a ye ko dɔgɔtɔrɔ minnu dege bolo opereli la, olu ka teli ka opereli sugandi.

Kɛnɛyaso ka jateminɛ

Banabagatɔ jogincogo ni a ka ɲininkali kunbabaw ka kan ka kɔlɔsi kɛnɛyaso tariku kɔnɔ, dimi bɛ yɔrɔ min na, a ka baara kɛcogo, ani a ka farikolojidɛsɛ hakɛ. O waati kelen na, a ka kan fana ka banabagatɔ bolo min bɛ fanga la, a ka deli ka ɲɛnajɛ minnu kɛ, ani banabagatɔ ka baara faamuya. Ka fara o kan, a nafa ka bon ka a dɔn ni koloci walima kɔlɔlɔw bɛ banabagatɔ la minnu bɛ nɔ bila farikolo yɔrɔ bananen ka baarakɛcogo la sani a ka jogin. Olu dɔw la, ka banabagatɔ kɔrɔbaw ɲininka ni u ka kan ka berew kɛ taama senfɛ ani n’u bɛ se k’u janto u yɛrɛ la don o don ɲɛnamaya kɔnɔ, o nafa ka bon kosɛbɛ banabagatɔw magow faamuyali la ani ka bana sɛgɛsɛgɛli ni furakɛli bolodalenw labɛn.

Dɔgɔtɔrɔso farikololajɛ senfɛ, banabagatɔ bolokɔni sɛgɛsɛgɛli kɛcogo sigilen ni a bɛɛ lajɛlen ka kan ka kɛ ka bɔ yɔrɔ jan na ka taa a kɛrɛfɛ. bolokɔni joli sɔrɔli bɛ dɔn ni kapilɛri falen sɛgɛsɛgɛli ye ani ni sɔgɔsɔgɔninjɛ ye min bɛ wele ko radial ni ulnar pulse. Senfagabana cɛmancɛ, ulnar nerve ani radial nerve ka dusukunnataw sɔrɔla ni danfara sɛgɛsɛgɛli ye min bɛ kɛ ni yɔrɔ fila ye ani ni magali yeelen ye. Sindrom acute carpal tunnel syndrome (syndrome acute carpal tunnel) sɔrɔli karilenw na, o ye 5,4% fo 8,6% ye, o la, aw ka kan ka jateminɛ kɛrɛnkɛrɛnnen kɛ paresthésie ni numbness (sɔgɔsɔgɔninjɛ) la median nerve jɛnsɛnni yɔrɔ la. Banabagatɔ ka farikoloɲɛnajɛ kɛcogo sɛgɛsɛgɛra ni kolotugudaw ɲɛfɛla ni kɔfɛla, kolotugudaw, cɛmancɛ ani kɔkolo nɛrɛw sɛgɛsɛgɛli ye. Ka fara o kan, sɛgɛsɛgɛlikɛla ka kan fana k’a janto banabagatɔ fari joginda cogoya la (i n’a fɔ sɔgɔsɔgɔninjɛ, sɔgɔsɔgɔninjɛ, kurukuruni i n’a fɔ foroko, a ɲɔgɔnnaw) walasa k’a dɔn ni a ye kari da wulilen ye. K’a sababu kɛ farikolo yɔrɔ nɔgɔlenw cogoya jugu ye ani fari finman ye mɔgɔkɔrɔbaw la, a ka ca a la, farikolo yɔrɔjan karilenw bɛ taa ni fari sɔgɔsɔgɔninjɛ ye. Ni baara bɛ kɛ ni traction reduction closed ye, a ka kan ka baara kɛ ni hakili ye kɛrɛnkɛrɛnnenya la walasa ka farikolo yɔrɔ nɔgɔlen wɛrɛw tiɲɛni bali.

Jaw jateminɛcogo

A ka ca a la, yɔrɔjan karilenw jateminɛni ni rezow ye, o bɛ kɛ ni rezow ye minnu bɛ kɛ ɲɛfɛla kɔfɛ, kɛrɛfɛ ani minnu bɛ kɛ kɛrɛfɛ. Kari in kɛrɛ ni a jiginni bɛ se ka faamuya ni ja sɛgɛsɛgɛliw ye walasa ka a dɔn ni surunya bɛ yen, ni kari yɔrɔ tigɛra, ani ni kolotuguda sira dafalen don. Jala kɛcogo kɛrɛnkɛrɛnnen wɛrɛw tun ye: ulnar declination (kɛrɛnkɛrɛnnenya la 22°, a janya: 19°-29°), yɔrɔjan janya (11-12 mm), ani bolokɔni yɔrɔjan jiginni (11° cɛmancɛ, a janya: 11 °-14,5°). Aw bɛ bolokɔni ni kɔkiliw fana ta walasa ka a lajɛ ni bolokɔni tiɲɛna walima ni kɔkili ma sabati. Dɔgɔyali dagalen kɔfɛ ani sɔgɔsɔgɔninjɛ jɔli kɔfɛ, filimu wɛrɛ ka kan ka kɛ ni X-ray ye walasa ka jateminɛ kɛ ni yɔrɔjan radiyali paramɛtiriw ɲɛnabɔra. Kɛnɛyaso siratigɛ la, a ka ca a la, CT sɛgɛsɛgɛli bɛ kɛ walasa ka dɛmɛ don ka karilenw sɛgɛsɛgɛ ani ka u danfara (misali la, ni bolokɔniw karilen don, ni degun walima sɔgɔsɔgɔninjɛ karilen don), walasa ka opereli furakɛli bolodacogo dɔn ka taa a fɛ. O waati kelen na, CT sɛgɛsɛgɛli fana ka kan ka kɛ walasa ka jateminɛ wɛrɛw kɛ ni koloci ni kolotugudaw furakɛli bɛ kɛ ni kolotugudaw ye.

Ka furakɛ

Ka kɛɲɛ ni AAOS ka furakɛli laadilikanw ye, bɛnkan tɛ yen ka ɲɛsin yɔrɔjan karilenw furakɛcogo kɔrɔlen walima opereli kɛcogo ma. Bɛnkan tɛ yen ni a bɛ kɛ ni volar locking plate fixation ye walima ni Kirschner wire fixation percutaneous ye opereli furakɛli la. Kodama ni a ɲɔgɔnnaw bɛ a fɔ ko a ka kan ka kari hakɛ jateminɛ fɛɛrɛ dɔ kɛ walasa ka a dɔn ni banabagatɔ mago bɛ opereli la. Ani banabagatɔ kɔrɔbaw minnu si bɛ san ≥50 la, kari suguya, bolokɔni kolotugudaw ka rezow jateminɛcogo caman yeli, u si hakɛ, bolo fangama, ani banabagatɔ ka baara ka kan ka kɛ walasa ka furakɛli bolodacogo dɔn ka taa a fɛ. Sɛgɛsɛgɛli min kɛra ni kɔsegin caman ye, volar walima dorsal distal radius fragment tiɲɛni hakɛ dɔgɔyali kɔfɛ, ni a karilen bɛ ulnar kɔ la, bolokɔni inclination, ani distal ulna caman caman cili, olu ni kɛnɛyaso kɔlɔlɔw bɛ tali kɛ ɲɔgɔn na kosɛbɛ.

Furakɛli min bɛ kɛ ni kɔrɔlen ye

An cɛmancɛ la, a ka ca a la, yɔrɔjan karilenw minnu bɛ bɔ yɔrɔ wɛrɛ la, olu bɛ jɔ ni Sugar tong plaster splint ye kɔkili kan walasa ka dan sigi kɔkili pronation ni supination (aw ye ja 1 lajɛ). Ni kariyɔrɔ jiginni ka bon, Sukaro tong sɔgɔli ka kan ka kɛ a dɔgɔyali datugulen kɔfɛ. Aw ye a kɔlɔsi ko ni aw bɛ pilatiri sɔgɔli kɛ, a jɔli hakɛ ka kan ka jɔ bolokɔni kuncɛ kɛrɛfɛ, walasa bolokɔni lamagacogo ka nɔgɔya ani ka a gɛlɛyali bali. Bandi elastikiw tali walasa ka degun danmadɔw siri, o bɛ se ka dɛmɛ don ka sɔgɔsɔgɔninjɛ kɛ. Kari suguya de bɛ dɔgɔyali dafalen kɛcogo jira. Ni a mago bɛ a la, yɔrɔjan joli-sira-funu-anestezi bɛ se ka sugandi, o kɔfɛ, traction reduction bɛ kɛ ni bolokɔniw samali ye (index ni cɛmancɛ bolokɔniw) walasa ka bɔgɔdaga latilen ani ka radiocarpal joint alignment segin a cogo kɔrɔ la. A ka ca a la, traction reduction bɛ kɛ ni inverse fracture mechanism ye. Traction réduction dans les plans différents de wajibiyalen don walasa ka ligament seginni dafa ani ka fracture fragments, capitulum ani lunate ka ɲɔgɔndɛmɛ segin. Koronawirisi plan na, aw bɛ ulna ni radius, kolo yɔrɔjan yɔrɔ ani radial shaft farikololajɛcogo segin. Colles karilen danmadɔ dɔgɔyali bɛ a ɲini dɛmɛbaga fɛ a ka banabagatɔ bolokɔnincinin minɛ a bolo kelen na, ka banabagatɔ bolokɔnincinin 4 minɛ a bolo tɔ kelen na, ka countertraction kɛ walasa ka kari yɔrɔ in faranfasi ka bɔ radius ka metaphyse la, ka taa a fɛ ka janya janya, ka sɔrɔ ka a bolokɔni minɛ. Flexion ani ulnar deviation walasa ka dɛmɛ don ka kari yɔrɔ dɔgɔya. Banabagatɔ kɔrɔbaw ni u lamini farikolo yɔrɔ nɔgɔlenw tiɲɛna, a ka kan ka u ladilan ni hakili ye dɔ bɔli senfɛ walasa fari kana tigɛ (bɔgɔlan bɛ se ka kɛ dɔgɔyali waati). Yɔrɔ seginni kɔfɛ, farikolojidɛsɛ sɛgɛsɛgɛli kɛra.

Jaa 1. (A) Banabagatɔ dɔ min ka yɔrɔjan karilen don, o jɔlen tora a bolokɔni na yɔrɔ la min tɛ fɛn wɛrɛ ye dɔɔni ni Sugar tong plaster splint ye walasa ka a bali ka wuli ka bɔ a nɔ na; (B) ani (C) ɲɛfɛla ni kɔfɛla jateminɛw minnu b’a jira ko banabagatɔ bolokɔni jɔli ka ɲi. Plastiri sirilan tɛ tɛmɛ bolokɔni kunkolo kan walasa bolokɔniw ka se ka lamaga cogo bɛnnen na.

Opereli Furakɛli

Opereli furakɛli suguya minnu bɛ kɛ banabagatɔ kɔrɔbaw la minnu ka yɔrɔjan karilen don, olu ye: dɔgɔyali dagalen ni kɛnɛma sirili, Kirschner nɛgɛ sirili farikolo la, da wulilen dɔgɔyali, volar/dorsal locking plate fixation, ani kɔfɛla bridge plate fixation (aw ye ja 2 lajɛ). 

Da wulilen dɔgɔyali suguya tɔ min bɛ kɛ ni kɔkanna-plati fixation ye, o bɛ kɛ ka caya joli-sira-funu karilenw furakɛli la. A bɛ se ka joli-sira-funu-yɔrɔ dɔgɔya yeli tilennen kɔrɔ ka sɔrɔ a ma ligament tissue bɔ bolokɔni kolotuguda volar fan fɛ, o bɛ dɔ bɔ kɔfɛ radiocarpal joint basigibaliya la. Ni volar lunate fracture bɛ a la, a ka kan ka a lamaga. Banabagatɔ minnu ka sɔgɔsɔgɔninjɛ karilen don walima ni jogin caman bɛ u la, ni traction plate min bɛ u kɔnɔ, o bɛ se ka kɛ ka dɔ bɔ a la walasa ka dɔ bɔ a la ni ligament restauration ye. O waati kelen na, traction plate fana bɛnnen don ka distal radius fractures comminuted ni osteoporotic fractures dɔgɔya ani ka u jɔ. Aw bɛ furakisɛ bɔ dɔgɔkun 12 opereli kɔfɛ, wa furakɛli nɔ ɲuman tun bɛ se ka sɔrɔ kɛnɛyaso la.

Volar locking plate bɛ se ka radial shortening ni volar tilt ɲɛ, wa gɛlɛyaw sɔrɔli ka dɔgɔn. Ni aw ye a suma ni kɔfɛla ye, bolokɔni min bananen don, o minɛni fanga bɛ se ka ɲɛ kosɛbɛ kalo 6 kɔnɔ opereli kɔfɛ, wa a baara ni dimi bɛ se ka ɲɛ. Gɛlɛya minnu bɛ sɔrɔ i n’a fɔ kɔkolo-plati fixation (yɔrɔ wɛrɛ) jiginni ani extenseur digitorum tendon (extenseur digitorum tendon) dimi, olu bɛ sɔrɔ fo ka se 30% ma. Wa volar plate ka fixation effect fana ka fisa ni Kirschner wire walima externe fixator ta ye.

Cogo min na i bɛ se ka kolotugudaw ni kolotugudaw sancogo?

Kosɔn CZMEDITECH , an bɛ ni fɛn dilannenw ye minnu dafalen don kosɛbɛ kolotugudaw opereli fɛnw na ani minɛn minnu bɛ bɛn o ma, furaw sen bɛ o la kɔkolo doncogo, wulu minnu bɛ kɛ ɲɛgɛnɛsira kɔnɔ, trauma plate, da tuguli plati, kunkolo-kɔnɔ-kɔnɔ-kɔnɔ, prothèse (banakisɛfagalan) min bɛ kɛ, kuran baarakɛminɛnw, kɛnɛma fiɲɛbɔlanw, joli-sira-funu (arthroscopie)., baganmara ladonni n’u dɛmɛnanw sigicogo.

Ka fara o kan, an cɛsirilen don ka to ka fura kuraw labɛn ani ka fɛn dilannenw caya, walasa ka dɔgɔtɔrɔw ni banabagatɔ caman ka opereli magow ɲɛ, ani fana k’an ka tɔn kɛ ɲɔgɔndanba ye diɲɛ kolotugudaw ni minɛnw baara bɛɛ la.

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