Shin kun san yadda ake gyara karayar metacarpal?

Metacarpophalangeal fractures wani rauni ne na yau da kullun a cikin rauni na hannu, yana lissafin kusan 1/4 na duk marasa lafiya rauni na hannu. saboda tsari mai laushi da hadaddun hannu da ingantaccen aikin motarsa, sarrafa karayar hannu ya fi mahimmanci da kuma hadaddun fasaha fiye da yadda ake kula da sauran karaya mai tsayi.

Tabbatar da kwanciyar hankali na karaya bayan an sake mayar da shi shine mabuɗin nasarar nasarar maganin karaya na metacarpophalangeal. Don dawo da aikin hannu, raguwa sau da yawa yana buƙatar gyaran gyare-gyaren da ya dace, kuma a baya, an yi amfani da gyaran waje na waje tare da filastar ko gyaran ciki tare da Kirschner fil, amma sau da yawa saboda rashin daidaituwa ko lokaci mai tsawo, wanda ba shi da kyau ga farfadowa na haɗin gwiwa na farko, kuma yana da tasiri mai girma akan farfadowa na aiki na metacarpophalangeha na aikin haɗin gwiwa.

Hanyoyin jiyya na zamani suna ƙara yin amfani da gyare-gyaren ciki mai ƙarfi, kamar ƙananan farantin karfe.

Ka'idojin Jiyya

Ka'idodin maganin metacarpal da phalangeal fractures na hannu sune: gyaran jiki na jiki, haske da ƙayyadaddun ƙayyadaddun lokaci, motsi na farko da aikin motsa jiki. Ka'idodin jiyya na intra-articular da periarticular fractures na hannu sun kasance daidai da na sauran ƙananan ƙwayoyin cuta: maido da jikin jiki na farfajiyar articular da farkon aikin aiki. Jiyya na metacarpal da phalangeal fractures na hannu yakamata suyi ƙoƙari don cimma canjin yanayin jiki ba tare da juyi ba, angulation na gefe, ko ƙaurawar angular> 10° zuwa ɓangaren dorsal na dabino. Idan ƙarshen karaya na metacarpal yana jujjuya ko ƙaura daga baya a kusurwa, zai canza yanayin al'ada na juzu'i da haɓaka motsi na yatsa, haifar da turawa ko fadowa daga yatsan da ke kusa yayin jujjuyawar, yana shafar daidaiton aikin yatsa; yayin da motsi na angular> 10 ° zuwa dorsum na dabino zai lalata shinge mai laushi na kasusuwa da tendon, ƙara juriya da kewayon motsi na tendon a cikin jujjuyawa da tsawo, da kuma haifar da rauni na yau da kullum ga tendon, haifar da hadarin fashewar tendon. hadarin fashewar tendon.

Karyawar metacarpal da phalangeal sun yi kama da ikon jure wa nakasar jujjuyawa, yayin da metacarpal yana jure wa rage matsuguni da ƙaurawar angular dorsal fiye da phalangeal. Ƙungiyar carpometacarpal da metacarpophalangeal haɗin gwiwa na iya ramawa ga nakasar kusurwa na metacarpal, kuma ɗan yatsa na annular ya fi dacewa da nakasar angular na metacarpal fiye da yatsan tsakiya. Rage ƙarfin riko saboda raguwar tsokar hannaye na ciki yana bayyana ne kawai lokacin da aka karkatar da metacarpal fiye da 30° zuwa gefen dorsal.

Hanyar tiyata

Hanyar fiɗa don karyewar metacarpal abu ne mai sauƙi kuma gabaɗaya yana amfani da tsarin dorsal, kamar yadda aka nuna a hoto na 4-14. Metacarpal na biyu ana yanka shi da radially yayin da metacarpal na biyar ana yanka shi a kaikaice, kuma metacarpal na uku da na huɗu galibi ana yanka su ta tsakiya. Idan an yi amfani da metacarpal guda biyu maƙwabta a lokaci guda, ana amfani da incision mai siffa S don yin la'akari da wuraren tiyata duka.

Kafaffen zaɓin hanya

Akwai kayan gyarawa da yawa na ciki don karyewar metacarpophalangeal, irin su Kirschner fil, sukurori, faranti da firam ɗin gyarawa na waje, waɗanda aka fi amfani da fil ɗin Kirschner da microplates. Don karyewar metacarpal, gyare-gyaren ciki tare da microplate yana da fa'ida a bayyane akan gyarawa tare da fil ɗin Kirschner kuma ana iya fifita su; don raunin phalangeal na kusa, ana fi son microplate gabaɗaya, amma lokacin da akwai wahala a sanya sukurori a cikin yanki mai nisa na phalangeal mai kusanci da ɓarkewar kai, gyare-gyaren ciki tare da ƙetare Kirschner fil an fi son, wanda ya fi dacewa don dawo da aikin yatsan da ya shafa; domin lura da tsakiyar phalangeal karaya, Kirschner fil ya kamata a fi son.

1. Alurar Kirschner: 

An yi amfani da gyaran gyare-gyaren cikin gida na Kirschner a cikin asibiti fiye da shekaru 70 kuma ya kasance mafi yawan amfani da kayan gyara na ciki don raunin da ya faru na metacarpophalangeal, wanda yake da sauƙin aiki, tattalin arziki da kuma aiki, kuma shine mafi kyawun hanyar gyaran ciki na ciki, kamar yadda aka nuna a cikin Hoto 4-15. a matsayin gyare-gyaren ciki da aka fi amfani da shi don magance karayar hannu, har yanzu ana amfani da shi sosai. 

Abũbuwan amfãni na gyaran ciki tare da Kirschner fil:

① mai sauƙin aiki kuma mai sauƙin amfani; 

② ƙasa mai laushi mai laushi mai laushi, ƙarancin tasiri akan kwararar jini a ƙarshen karaya, ƙarancin ƙwayar cuta, kuma mai dacewa ga waraka; 

③ mai sauƙi na dawo da fil na biyu; 

④ ƙarancin farashi da aikace-aikacen fa'ida, wanda ya dace da mafi yawan raunin hannu (kamar intra-articular fractures, comminuted fractures and end phalangeal fractures). 

Rashin lahani na gyaran ciki: 

(1) idan aka kwatanta da gyaran farantin karfe, kwanciyar hankali ba shi da kyau, kuma raguwa da juyawa ba za a iya sarrafa shi ta hanyar fil guda ɗaya ba, yawanci ana buƙatar fiye da 2 fil don gyaran giciye; 

(2) babu tasirin matsawa akan ƙarshen karaya; 

(3) haɗin haɗin gwiwa ya lalace ta hanyar haɗin haɗin gwiwa; 

(4) gyaran gyare-gyaren haɗin gwiwa da kuma toshewar jijiya ya hana haɗin gwiwar hannu daga motsa jiki na farko kuma yana rinjayar aikin farfadowa.

Tare da saurin ci gaba na fasaha na gyaran gyare-gyare na zamani da kayan aiki, ƙaddamarwa na ciki tare da fil ɗin Kirschner ya zama mai tsabta sosai, kuma mafi yawansu za a iya gyarawa ba tare da ƙetare haɗin gwiwa ba, tare da ƙananan lalacewa ga kyallen takarda mai laushi da tendons a kusa da haɗin gwiwa, kuma ba tare da rinjayar farkon aikin haɗin gwiwa na aikin haɗin gwiwa ba. Tare da taimakon na'urar X-ray na C-arm, wasu lokuta kuma suna iya samun sakamako mai gamsarwa ta hanyar rufaffiyar raguwa na gyare-gyare na ciki tare da maƙallan Clinique, ƙara rage lalacewa ga kyallen takarda mai laushi na gida da kuma tasiri akan samar da jini zuwa ƙarshen karaya, don haka inganta warkar da raguwa. 

Kariya don gyarawa na ciki tare da fil Kristen: 

① Gyara manyan kasusuwa na kasusuwa tare da maƙallan Kristen na 1.0 ~ 1.2 mm a diamita, kuma ƙayyade ma'anar shigarwa da kuma hanyar shigarwa bisa ga jagorancin layin karya; 

② Tare da manufar maido da layin ƙarfi, ɓarkewar intra-articular dole ne a mayar da su ta jiki kuma a daidaita su sosai; 

③ Ba duk kasusuwan kasusuwa ne ake buƙatar gyarawa tare da fil ɗin Kristen ba, kuma a ƙarƙashin jigo na samun kwanciyar hankali na ƙarshen karaya, yakamata a yi amfani da fil ɗin Kristen kaɗan gwargwadon yiwuwa; 

④ Kristen fil ba a gyarawa ta hanyar tendon ko dorsal tendon membrane na yatsa don ƙirƙirar motsa jiki na farko kamar yadda zai yiwu; 

⑤ ya kamata a kasance da tsayayyen shiri kafin a yi aiki kuma kada a sake maimaita aikin a cikin ciki, in ba haka ba toshewar karaya na iya zama mafi murkushewa ko ma ba a iya gyarawa; 

⑥ gabaɗaya yakamata a sanya fil ɗin Kirschner a cikin fata don rage damar kamuwa da cuta kuma ba shi da wahala a cire shi.

2. Metacarpal micro farantin: 

Ƙarfafawar ciki mai ƙarfi na raunin hannu shine tushen aikin motsa jiki na farko kuma yana da mahimmanci don mayar da aikin hannu mai kyau.AO na ciki na gyaran fasaha yana buƙatar daidaitaccen gyaran jiki na ƙarshen karaya da kuma tabbatar da ƙarshen karayar a cikin yanayin aiki, wanda aka fi sani da gyare-gyare mai ƙarfi, don ba da izinin motsi mai aiki da wuri. AO kuma yana jaddada ƙananan hanyoyin tiyata waɗanda ke mai da hankali kan kiyaye kwararar jini. Ƙaddamar da microplate na ciki na raguwa na hannu yana samar da sakamako mai gamsarwa dangane da ƙarfi, kwanciyar hankali na ƙarshen raguwa da matsa lamba tsakanin iyakar. Dangane da dawo da aikin bayan aiki, lokacin warkar da rauni da adadin kamuwa da cuta idan aka kwatanta, ana ɗaukar inganci na faranti na micro titanium mafi kyau fiye da na kerf fil, kuma saboda lokacin waraka bayan gyare-gyaren farantin micro titanium ya fi guntu fiye da na sauran hanyoyin gyarawa, don haka sauƙaƙe farkon dawowar rayuwar mai haƙuri.

Amfanin jiyya na gyaran ciki na microplate: 

(1) idan aka kwatanta da kerf fil, microplate sukurori suna da mafi ingancin histocompatibility da nama amsa; 

(2) kwanciyar hankali na tsarin gyaran ƙusa na farantin karfe da kuma matsa lamba akan ƙarshen ƙusa ya sa raguwa ya fi kusa da gyaran jiki, mafi aminci ga gyarawa, wanda ya dace da waraka; 

(3) aikin motsa jiki na farko ana ba da izinin gabaɗaya bayan gyaran microplate, wanda ke da amfani ga dawo da aikin hannu. 

3. Microscrews.

Microscrews don karkace ko tsayin daka mai tsauri yana da irin wannan kwanciyar hankali kamar faranti na ƙarfe, amma nama mai laushi da yanki na periosteal ya fi ƙanƙanta fiye da na gyare-gyaren farantin karfe, wanda ya dace da kariyar jinin jini kuma ya yi daidai da ra'ayi na aiki kadan. Ko da yake akwai nau'in T- da L don raunin haɗin gwiwa na kusa, ziyarar dawowa bayan aiki ya fi talauci fiye da na diaphyseal fractures, kuma microscrews suna da wasu abũbuwan amfãni ga intra- da periarticular karaya gyarawa. Screws da aka zana a cikin kasusuwa na kasusuwa na iya jure wa babban nauyin danniya, don haka gyare-gyaren yana da ƙarfi kuma zai iya sanya matsa lamba tsakanin ƙarewar karaya don kawo ɓangarorin da ke cikin kusanci, wanda ya rage lokacin warkaswa kuma yana sauƙaƙe waraka, kamar yadda aka nuna a cikin Hoto 4-18. Ana amfani da microscrews musamman don ɓarnawar ɓarna ko karkace na diaphysis da ɓarnawar ɓarna na intra-articular na manyan ƙasusuwa. Yana da mahimmanci a lura cewa tsayin zaren karya ya kamata ya zama akalla sau biyu diamita na diaphysis lokacin da ake gyara ɓarkewar ɓarna ko karkace na hannun hannu ta amfani da microscrews kadai, kuma aƙalla sau uku nisa na diamita na zaren lokacin gyara intra-articular avulsion fracture tubalan.

4. Karamin takalmin gyaran kafa na waje.

Ƙarƙashin raunin metacarpophalangeal wasu lokuta yana da wahala a sake saita shi ta jiki koda tare da tiyata ko kuma ba za a iya gyarawa da ƙarfi a ciki ba saboda ƙashin ƙashin yana lalata. Ƙaƙƙarfan gyaran kafa na waje yana ba da damar ƙwanƙwasa ƙwanƙwasa don farfadowa da kuma kula da tsawonsa a ƙarƙashin tasirin raguwa, yana taka rawa mai mahimmanci, kamar yadda aka nuna a cikin Hoto 4-19. Sanya takalmin gyaran kafa na waje ya bambanta don nau'i-nau'i daban-daban: 1st da 2nd metacarpals an sanya su a gefen radial na dorsal, 4th da 5th metacarpals an sanya su a gefen ulnar dorsal, da kuma 3rd metacarpal an sanya shi a kan radial dorsal ko dorsal ulnar, mai kula da hankali ga yanayin da ake ciki. Za a iya rufe karaya da aka rufe kuma a mayar da su a ƙarƙashin X-ray, kuma za a iya yin ƙananan ƙullun don taimakawa wajen mayar da matsayi idan mayar da shi bai dace ba.

Amfanin takalmin gyaran kafa na waje.

(1) yana da sauƙi don aiki kuma yana iya daidaita ƙaura daban-daban na ƙarshen karaya;

(2) zai iya sake saitawa da kyau da kuma gyara ɓarkewar intra-articular na metacarpal phalanges ba tare da lalata farfajiyar articular ba, kuma yana iya karkatar da farfajiyar articular don hana kwangilar capsule na haɗin gwiwa da ligaments na gefe; 

(3) ana iya haɗa shi tare da ƙayyadaddun gyare-gyare na ciki don ƙayyadaddun raunin da ba za a iya sake saitawa ta jiki ba, kuma takalmin gyaran kafa na waje zai iya sake saitawa da kula da layin karfi; 

(4) yana ba da damar fara aikin motsa jiki na yatsa mai yatsa a cikin haɗin da ba a daidaita ba don kauce wa haɗin gwiwa 

(5) Yana iya gyara karyewar hannu yadda ya kamata ba tare da shafar maganin raunin hannun da ya shafa ba.

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