Distal radius ƒe gbagbã le gbagbã siwo bɔ wu le ame tsitsiwo me dome. Woɖea amesiwo xɔ tso ƒe 50 va ɖo ƒe 75 gɔme fifia be wonye ame tsitsiwo. Distal radius fractures ƒe dzɔdzɔ dzina ɖe edzi ƒe sia ƒe esime ame tsitsiwo ƒe ʋuʋu ƒe didime le dzidzim ɖe edzi. Nya vevi si le nyaʋiʋli si ku ɖe distal radius fractures ŋu me gakpɔtɔ li: Ðe amekoko hiãa?
Dɔvɔ̃ŋutinunya Ŋuti Nusɔsrɔ̃wo
Distal radius ƒe gbagbãwo nyea ŋutilã ƒe gbagbãwo katã ƒe 18% lɔƒo le ame tsitsiwo me. Caucasustɔwo ƒe xexlẽme, nyɔnu dɔnɔwo, kple ƒumeŋuɖui nye afɔku vevi siwo naa ƒu ƒe gbagbã le didiƒe ʋĩ. Tsɔ kpe ɖe eŋu la, ɣeyiɣi aɖewo hã le eme, abe ame tsitsi siwo ƒua du va dzea anyi bɔbɔe siwo ƒe didime le didiƒe ʋĩ ƒe gbagbã le dzomeŋɔli ene. Numekuku aɖewo ka nya ta be dɔnɔ tsitsi siwo ƒe susuŋutete kple ahɔhɔ̃mekawo ƒe dɔwɔwɔ me gblẽ o la le afɔku gã aɖe me be woagbã le didiƒe ʋĩ (esi wònye be dɔnɔwo ƒe susu ƒe dɔwɔwɔ sesẽ ta la, woakeke woƒe asiwo ɖe enu le susu me be woalé anyigba ne wodze anyi, si ana woagbã). .
Le akɔntabubuwo nu la, le United States la, atikewɔwɔ ƒe ga si wozã ɖe distal radius fractures ŋu le ƒe 2007 me anɔ abe United States dɔlar miliɔn 170 ene (anɔ abe ƒe 1983 United States dɔlar / ame ene). Togbɔ be wowɔa atike na dɔnɔ tsitsi akpa gãtɔ siwo ƒe didiƒe ʋĩ ƒe gbagbã le mɔ si me womezãa nu geɖe le o hã la, dɔnɔ siwo tiae be yewoawɔ dɔ na yewo be yewoatsɔ yewoƒe lãmekawo axe mɔ na yewo la le dzidzim ɖe edzi ƒe sia ƒe. Atikewɔwɔ ƒe ga si wozãna ɖe atike si wotsɔna dzraa nu le amekoko me ŋu nyea ga si wozãna ɖe atikewɔwɔ si me womezãa atike o le ƒe teƒe etɔ̃, eye wòdzia ga si wozãna ɖe kɔdzi nɔnɔ kple ga bubu siwo do ƒome kplii hã ɖe edzi.
Vovototo le nuto kple to vovovo me tɔwo hã le ememe fixation zazã na distal radius fractures me. Numekuku aɖe si wowɔ le Medicare ŋu ɖee fia be nyɔnuwo kple Caucasustɔwo ate ŋu awɔ dɔ na wo wu, eye alesi woate ŋu awɔ dɔ na wo le ememe la nye 4.6% va ɖo 42.1%. Eye wokpɔe be ɖɔkta siwo wona hehee le asidɔwɔwɔ me la tiaa amekoko wu.
Dɔnɔdzikpɔƒe ƒe Dzesidede
Ele be woade dzesi dɔnɔa ƒe abixɔxɔ ƒe mɔnu kple nyatoƒoetoto veviwo le dɔdaƒea ƒe ŋutinya me, siwo dometɔ aɖewoe nye afisi vevesesea le, eƒe dɔwɔwɔ, kple alesi gbegbe wòzu nuwɔametɔ. Le ɣeyiɣi ma ke me la, ehiã hã be woase dɔnɔa ƒe asi si xɔ aƒe ɖe eme, modzakaɖeɖe siwo bɔ, kple dɔ si dɔnɔa wɔna gɔme. Tsɔ kpe ɖe eŋu la, ele vevie wu be woanya ne ƒunukpeƒetetedɔ alo emetsonu siwo gblẽa nu le abɔ kple afɔ si ŋu dɔlélea le ƒe dɔwɔwɔ ŋu hafi axɔ abi la le dɔnɔa ŋu. Le wo dome la, biabia dɔnɔ tsitsiwo nenye be ehiã be woazã atizɔti ne wole zɔzɔm eye ne woate ŋu akpɔ wo ɖokui dzi le gbesiagbegbenɔnɔ me le vevie ŋutɔ na dɔnɔwo ƒe nuhiahiãwo gɔmesese kple ɖoɖowɔwɔ ɖe dɔlélewo didi kple wo dada ŋu.
Le ŋutilãmedɔdada si wowɔna le kɔdzi me la, ehiã be woado dɔnɔa ƒe asibidɛ kpɔ ɖe ɖoɖo nu eye wòade edeƒe tso didiƒe va ɖo teƒe si te ɖe eŋu. Wonya ʋu ƒe sisi le asibidɛa ŋu to ʋuka siwo me ʋu sina tona ƒe dodokpɔ kple radial kple ulnar pulse me. Wokpɔ seselelãme ƒe nɔnɔme siwo le median nerve, ulnar nerve kple radial nerve me to teƒe eve ƒe vovototodedeameme dodokpɔ kple kekeli asikaka dodokpɔ me. Acute carpal tunnel syndrome ƒe dzɔdzɔ le distal radius fractures me nye 5.4% va ɖo 8.6%, eyata ele be woalé ŋku ɖe paresthesia kple numbness ŋu etɔxɛe le median nerve ƒe mama teƒe. Wodo dɔnɔa ƒe lãmekawo ƒe dɔwɔwɔ kpɔ to lãkusi siwo le ŋgɔgbe kple megbe, esiwo le ŋgɔgbe, siwo le titina, kple esiwo le akɔta me la me dzodzro me. Tsɔ kpe ɖe eŋu la, ele be dodokpɔwɔla la nalé ŋku ɖe dɔnɔa ƒe ŋutigbalẽ ƒe abi ƒe nɔnɔme hã ŋu (abe ecchymosis, edema, dzogoe si le abe fɔkpa ene, kple bubuawo ene) be wòanya nenye be enye abi si le ʋuʋu ɖi. Le lãmeka falɛfalɛwo ƒe nɔnɔme madeamedzi kple ŋutigbalẽ si le tsɛ le ame tsitsiwo me ta la, zi geɖe la, ŋutigbalẽ ƒe ʋuʋu kpena ɖe distal radius fractures ŋu. Ne wozã heheɖemegbe si wotu la, ehiã be woawɔ dɔ nyuie vevietɔ be woaƒo asa na lãkusi falɛfalɛ bubuwo ƒe gbegblẽ.
Nɔnɔmetatawo Ƒe Dzesidede
Zi geɖe la, radiographic ƒe dodokpɔ le distal radius fractures ŋu lɔa anteroposterior, lateral, kple oblique radiographs ɖe eme. Woate ŋu ase dzogoe si me ʋuʋudedia le kple eƒe tɔtrɔ gɔme to nɔnɔmetatawo me dzodzro me be woakpɔe ɖa be ƒunukpeƒea ƒe kakɛa le kpuie, nenye be wogbã ƒunukpeƒea ƒe kakɛa, eye nenye be ƒunukpeƒea ƒe fli la wu enu hã. Nɔnɔmetata bubuwo ƒe nɔnɔme tɔxɛ aɖewoe nye: ulnar ƒe ɖiɖi (mamã dedie 22°, dometsotso: 19°-29°), didiƒe didime ƒe kɔkɔme (11-12 mm), kple asibidɛ ƒe didime si le didiƒe (mamã dedie 11°, dometsotso: 11 °-14.5°). Woɖea abɔta kple abɔta ƒe X-ray hã tsɔ léa ŋku ɖe abɔta ƒe gbagbã alo abɔta ƒe malikenyenye ŋu hã. Le nutsotso si wotu kple splint ƒe ʋuʋu megbe la, wobiaa X-ray film bubu be woatsɔ akpɔe ɖa be distal radius ƒe parameters nyo ɖe edzi hã. Le dɔdamɔnu nu la, wozãa CT dodokpɔ zi geɖe tsɔ kpena ɖe ame ŋu le ƒunukpeƒetetedɔ didi kple wo hatsotsowo me toto me (le kpɔɖeŋu me, nenye be ƒunukpeƒetetedɔ aɖe le ƒunukpeƒewo, nenye be ƒunukpeƒetetedɔ aɖe le ʋuʋu alo lãɖeɖe), ale be woaganya amekoko ƒe atikewɔwɔ ƒe ɖoɖoa. Le ɣeyiɣi ma ke me la, ehiã be woado CT hã hena ŋkuléle ɖe eŋu geɖe wu ne wole ƒumeŋuɖui kple ƒumeŋuɖui ƒe dɔdamɔnu wɔm na ƒumeŋuɖui ƒe dɔmawɔmawɔ nyuie.
Wɔ nu ɖe
Le AAOS ƒe atikewɔwɔ ŋuti mɔfiamewo nu la, amewo ƒe susu mewɔ ɖeka le alesi woazã atike si woatsɔ akpɔ nusiwo le didiƒe ƒe akpa si le didiƒe ʋĩi dzi le mɔ si me woɖea mɔ ɖe nu ŋu le alo amekoko me o. Womelɔ̃ ɖe edzi be woazã volar locking plate fixation alo percutaneous Kirschner wire fixation le amekoko me o. Kodama kple ehatiwo kafui be woazã mɔ̃ si wotsɔ dea dzesi dɔnɔa ƒe gbagbãƒe ƒe dzesiwo be woakpɔe ɖa be ehiã be woawɔ dɔ na dɔnɔa hã. Eye le dɔnɔ tsitsi siwo xɔ ƒe ≥50 gome la, ele be woazã asibidɛ ƒe ƒunukpeƒe ƒe gbagbã ƒomevi, tɔtrɔ siwo va le asibidɛ ƒe ƒunukpeƒe ƒe keklẽŋusẽ ƒe nɔnɔmetatawo me, ƒexɔxɔ, asi si xɔ aƒe ɖe eme, kple dɔ si dɔnɔa awɔ atsɔ anya atikewɔwɔ ƒe ɖoɖoa ɖe edzi. Le numekuku si wowɔ le megbedede geɖe me la, alesi gbegbe volar alo dorsal distal radius fragment ƒe gbagbã le edziɖeɖe vɔ megbe, eɖanye gbagbãa lɔ ulnar kɔ ɖe eme o, asibidɛ ƒe ŋgɔgbedede, kple tɔtrɔ le distal ulna me do ƒome vevie kple dɔdamɔnu me tsonu.
Atikewɔwɔ si Me Womekpɔa Nu Le O
Le míaƒe titina la, zi geɖe la, wotsɔa Sugar tong plaster splint si wotsɔ blaa abɔtae la xea mɔ na distal radius fractures siwo meɖea teƒe boo aɖeke o be woatsɔ axe mɔ ɖe abɔta ƒe akɔta kple eƒe akɔta nɔnɔ nu (kpɔ Nɔnɔmetata 1). Ne gbagbãƒea ƒe ʋuʋu lolo la, ele be woawɔ Sugar tong splint le edzi ɖeɖe kpɔtɔ si wotu vɔ megbe. De dzesii be ne èle aŋɔka ƒe ʋuʋu wɔm la, ele be asibidɛa ƒe nuwuwu si te ɖe eŋu la natɔ te, ale be asibidɛa ƒe ʋuʋu nanɔ bɔbɔe eye wòaxe mɔ ɖe eƒe sesẽ nu. Elastic blages zazã hena compression fixation si seɖoƒe li na ate ŋu akpe ɖe splinting ŋu. Gbagbãƒe ƒomevie afia mɔnu si dzi woato aɖee dzi akpɔtɔ le mɔ si wotu nu. Ne ehiã la, woate ŋu atia local hematoma anesthesia of the distal radius, eye emegbe woawɔ traction reduction to asibidɛawo (index kple titina asibidɛwo) hehe me be woaɖɔ nɔnɔme madeamedzia ɖo eye woagbugbɔ radiocarpal joint ƒe ɖoɖo aɖo anyi. Zi geɖe la, wozãa inverse fracture mechanism tsɔ ɖea traction dzi kpɔtɔna. Wohiã be woaɖe ʋu ƒe hehe dzi akpɔtɔ le yameʋu vovovowo me be woawu lãkusia gbugbɔgaɖoanyi nu eye woagbugbɔ lãkusi kakɛawo, taɖuame kple lunate ƒe sɔsɔme aɖo anyi. Le coronal plane dzi la, gbugbɔ ulna kple radius, distal bone fragment kple radial shaft ƒe ŋutilã ƒe wɔwɔme sɔ kple wo nɔewo. Colles ƒe gbagbã si bɔ dzi ɖeɖe kpɔtɔ bia be kpeɖeŋutɔa nalé dɔnɔa ƒe asibidɛ gã aɖe ɖe asi ɖeka eye wòalé dɔnɔa ƒe asibidɛ 4 ɖe asi evelia me, awɔ countertraction atsɔ ama gbagbãƒea ƒe kakɛa ɖa tso radius ƒe metaphysis gbɔ, ayi edzi anɔ hehem ɖe megbe, eye emegbe wòalé asibidɛ. Flexion kple ulnar deviation be wòakpe ɖe eŋu be woaɖe gbagbã ƒe kakɛa dzi akpɔtɔ. Le dɔnɔ tsitsi siwo ƒe lãmeka falɛfalɛ siwo ƒo xlã wo dome gblẽ gome la, ehiã be woatrɔ asi le wo ŋu nyuie le wo dzi ɖeɖe kpɔtɔ ƒe ɖoɖoa me be woaxe mɔ ɖe ŋutigbalẽ ƒe vuvu nu (woate ŋu azã kotoku le wo dzi ɖeɖe kpɔtɔ me). Esi wogbugbɔ ɖo teƒea vɔ la, wodo ahɔhɔ̃mekawo kpɔ.
![Distal radius ƒe gbagbã]()
Figure 1. (A) Wotsɔ Sugar tong plaster splint na dɔnɔ aɖe si ƒe didiƒe ʋĩ ƒe gbagbã le eƒe asibidɛ ƒe nɔnɔme si mewɔa akpa aɖeke o vie be wòagaʋuʋu o; (B) kple (C) ƒe ŋgɔgbe kple axadzi ƒe fotoɖeɖe siwo ɖe dɔnɔa ƒe asibidɛ ƒe ƒoƒo nyuie fia. Plaster-ka la mekekena yia abɔta ƒe ta gbɔ ale be asibidɛawo nate ŋu aʋuʋu nyuie o.
Dɔwɔwɔ ƒe Atikewɔwɔ
Amekoko ƒe atikewɔwɔ ƒe tiatia siwo woate ŋu awɔ na dɔnɔ tsitsi siwo ƒe didime ƒe didime ƒe gbagbãwo dometɔ aɖewoe nye: nutsotso si wotu kple gotagome ƒe ƒoƒo, Kirschner ka ƒe ƒoƒo to ŋutigbalẽ me, ʋu ƒe ɖiɖi, volar/dorsal locking plate fixation, kple dorsal bridging plate fixation (kpɔ woɖee fia le Nɔnɔmetata 2 me).
![Palm locking plate]()
Wozãa ʋuʋu ƒe ɖeɖeɖa kple akɔta ƒe agbalẽvi ƒe ƒoƒo ƒomevi bubu koŋ tsɔ daa ƒunukpeƒe ƒe gbagbãwo. Ate ŋu aɖe ƒunukpeƒea dzi akpɔtɔ le nukpɔkpɔ tẽ me evɔ maɖe lãkusi ƒe lãkusi si le asibidɛ ƒe ƒunukpeƒe ƒe akpa si nye volar la ɖa o, si aɖe afɔku si li be radiocarpal ƒunukpeƒe ƒe malikenyenye emegbe dzi akpɔtɔ. Ne volar lunate fracture aɖe le eme la, ehiã be woaxe mɔ nɛ. Le dɔnɔ siwo ƒe ʋuka si woyɔna be radial shaft fracture alo esiwo xɔ abi zi geɖe gome la, woate ŋu azã traction plate si wotu ɖe eme la atsɔ akpɔ edziɖeɖe to ligament gbugbɔgaɖoanyi me. Le ɣeyiɣi ma ke me la, traction plate la hã sɔ na comminuted kple osteoporotic distal radius fractures dzi ɖeɖe kpɔtɔ kple wo léle ɖe te. Woɖe agbaa le kwasiɖa 12 le dɔwɔwɔ nɛ vɔ megbe, eye woate ŋu akpɔ dɔdamɔnu nyui aɖe le atikewɔwɔ me.
Volar locking plate ate ŋu ana radial shortening kple volar tilt nanyo ɖe edzi, eye kuxiwo ƒe dzɔdzɔ mebɔ o. Ne wotsɔe sɔ kple akɔta ƒe agbalẽvi la, woate ŋu ana abɔ si ŋu dɔlélea le ƒe asiléle ƒe ŋusẽ nanyo ɖe edzi ŋutɔ le ɣleti 6 me le amekokoa megbe, eye woate ŋu ana dɔwɔwɔ kple vevesesea nanyo ɖe edzi. Kuxiwo abe dorsal plate fixation ƒe tɔtrɔ kple extensor digitorum tendon ƒe dzikudodo ene dzɔna le dɔléle siwo ade 30% me. Eye volar plate ƒe fixation effect hã nyo wu Kirschner ka alo gotagome fixator tɔ.
Ale Si Nàƒle Ƒumeŋuɖuiwo Kple Ƒumeŋuɖui Dɔwɔnuwo?
Elabena CZMEDITECH , míekpɔa adzɔnuwo ƒe hatsotso si de blibo ŋutɔ si me ƒumeŋuɖui ƒe amekoko ƒe nusiwo wotsɔ dea ame me kple dɔwɔnu siwo sɔ kplii, nusiwo dometɔ aɖewoe nye akɔta ƒe akpa siwo wotsɔ dea ame me, ɖa siwo le lãkusi me, trauma plate, ʋuƒo si wotsɔ xea mɔ na nu, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, gotagome fixators, ƒunukpeƒetetedɔ (arthroscopy)., lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe kpeɖeŋutɔ dɔwɔnuwo.
Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi anɔ atike yeyewo wɔm eye míakeke adzɔnuwo ƒe hatsotsowo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho geɖe wu le xexeame katã ƒe ƒumeŋuɖui kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.
Míeɖoa nu ɖe xexeame katã, eyata àte ŋui te ɖe mía ŋu le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .
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