Karyewar jijiyar extensor bayan gyaran farantin wuta ya kasance babbar matsala wajen gyaran karayar radius mai nisa. Mafi yawan abin da ya fi shafa shine tendon extensor pollicis longus (EPL), kamar yadda yake tsare a cikin tsagi na EPL. Rahoton da aka ruwaito na fashewar tendon EPL bayan an yi amfani da shi shine 0.29% -5.7%.
Haɗarin jinkirin fashewar jijiyar EPL yana ƙaruwa a gaban ƙwanƙwasa ƙwanƙwasa ƙwanƙwasa, rauni daga hakowa kai tsaye na ciki, da gutsuttsuran rufin ƙofa, musamman a cikin faɗuwar tsibiri na tubercle na Lister. Ƙididdigar rediyo na fitowar dunƙule a cikin ɓangarorin radius mai nisa yana da wahala saboda rikitaccen lissafi na radius mai nisa da yuwuwar raunin raunin baya. Ra'ayin tangential na dorsal shine kawai ra'ayi na cikin jiki na radial cortex na dorsal don samun ingantaccen ƙima na nisa tsakanin tip ɗin dunƙule da dorsal cortex.
Dabarun don guje wa raunin jijiya extensor sun haɗa da yin amfani da screws monocortical da kuma nisantar shiga saman dorsal; duk da haka, waɗannan fasahohin na iya rage kwanciyar hankali na inji na gyaran karaya. Saboda haka, ana buƙatar gyaran bicortical wani lokaci. Don rage haɗarin raunin jijiya extensor, ba dole ba ne a lalata manufofin farko na gyaran karaya da kwanciyar hankali.
Sabbin dabarun tiyata
Mun bayyana wata sabuwar dabara don rage haɗarin fashewar tendon EPL bayan gyaran farantin karfe na radius mai nisa ba tare da rage tsayin dunƙule ko cire gutsuttsuran rufin baya ba. A taƙaice, dabarar ta ƙunshi buɗe ɗaki na uku ta hanyar ƙaramin ƙwanƙwasa.
Idan dunƙule ya shiga cikin ƙwanƙolin dorsal kuma ya fito a cikin daki na uku: mun cire jijiyar EPL daga tsagi kuma mun rufe ɗakin ta hanyar sutured ɗin retinaculum yana barin jigon EPL akan retinaculum da aka gyara.
Idan dunƙule ba ta wuce zuwa kashi na uku ba: mun bar jigon EPL a cikin sashi na uku. Alamar dabararmu ita ce a cikin marasa lafiya tare da raunin radius mai nisa da aka bi da su tare da faranti na kulle volar, karaya tare da ɓangarorin dorso-parietal ko screws waɗanda zasu iya shiga cikin dorsal cortex ko lalata jijiyar EPL a kusa da tubercle na Lister. A cikin marasa lafiya masu raunin radius mai nisa tare da ɓangarorin dorsomedial, muna haƙa ramuka don kutsa cikin ƙwanƙolin dorsal kuma mu zaɓi sukurori masu tsayi mai tsayi don gyara ɓangarorin dorsomedial mara ƙarfi.
Raba harka
Muna raba shari'ar da aka cire tendon EPL daga kashi na uku saboda fitowar dunƙule a cikin ɗaki na uku yayin gyaran farantin karfe na ƙwanƙwasa radius mai nisa tare da guntun dorsomedial. Mun tabbatar da cewa jijiyar EPL ta kasance cikakke shekaru 7 bayan aikin, kodayake dunƙule ya shahara a cikin sashi na uku.
Lamarin ya kasance mace mai shekaru 67 tare da ganewar asali na raunin radius na intra-articular mara tsayayye tare da karaya na tsakiya na dama (Hoto 1A-E). Babu tarihin shan taba, ciwon sukari ko shan barasa. Zai iya tafiya ba tare da kowa ba.
![m radius karaya]()
adadi 1. Hoton da aka riga aka yi ya nuna raguwar karaya a cikin radius mai nisa.
A da B: X-ray na farko,
C da D: ra'ayoyin sagittal da axial na hotunan hoto,
E: Hoton lissafta na 3D. Ɓangaren ɓangarori na tsaka-tsaki na lunate ɓarke da ɓangarorin apical ɓangarorin baya (fararen taurari) ana iya gani.
Dabarar tiyata
Mun bi da wannan tsarin karaya tare da farantin kullewa. A ciki, mun yi rami ta cikin ƙwanƙolin dorsal kuma mun zaɓi dunƙule mai tsayi mai tsayi don tabbatar da ƙwanƙolin dorsal saboda guntun dorsomedial ba shi da kwanciyar hankali (Hoto 2).
An yi tiyata don buɗe daki na uku bayan gyaran dunƙule.
Tun da dunƙule ya shiga cikin ɗaki na uku kuma ya fito (Hoto 3A), cikakke buɗe sashi na uku kuma matsar da jigon EPL daga tsagi (Hoto 3B).
Sa'an nan kuma an rufe daki na uku ta hanyar suturar retinaculum (Fig. 3C,D), kuma an sanya jigon EPL a kan retinaculum da aka gyara (Fig. 3 E).
Bayan an yi wa majinyacin tiyatar, sai ya je asibitin masu jinya na asibitinmu har sai da kashi ya warke. Mai haƙuri baya son cire kayan aikin.
Farfadowa bayan tiyata
Bayan shekaru bakwai da yi wa majinyacin tiyatar, ya koma asibiti don sake duba lafiyarsa sakamakon ciwon kashi. Hannun dama ba a kashe shi ba. Hoton X-ray yana nuna karaya da aka warke tare da fitowar dorsal na dunƙule nesa. Babban yatsan yatsan majiyyaci ya cika cikakke, kuma jigon EPL ba shi da zaren baka.
A shawararmu, mai haƙuri ya yarda ya cire kayan aikin kuma ya bincika tendons extensor. A ciki, mun bincika jigon EPL ta hanyar ƙwanƙwasa ƙwanƙwasa kuma mun buɗe wani yanki na uku da na huɗu.
Jijin EPL yana waje da ɗaki na uku a daidai matsayin da aka yi a baya, kuma tendon bai yi fushi ba.
Mun tabbatar da cewa dunƙule ya shiga cikin ɗaki na uku lokacin da aka janye tendons na yatsunsu.
A ƙarshe, mun gyara madaurin tallafi kuma mun cire kayan aikin. A kimantawar ƙarshe na watanni 2 bayan cire kayan aikin, mai haƙuri ba shi da zafi kuma yana da cikakken tsayin yatsa.
Tattaunawa
A tsarinmu, bayan gyaran farantin karfe na ɓarkewar radius mai nisa, mun buɗe daki na uku ta wani yanki mai tsayi mai tsayin 2 cm zuwa tubercle na Lister. Mun gano jigon EPL kai tsaye da kuma bene na sashin extensor na uku ta hanyar ja da baya a hankali.
Idan dunƙule ya shiga cikin ɓangarorin dorsal zuwa cikin daki na uku ko kuma yana da tarkacen dorso-parietal, ba mu yi maye gurbin intraoperative ba ko guntuwa ba, amma gaba ɗaya ya buɗe sashi na uku kuma mun cire tendon EPL daga tsagi. Sa'an nan kuma mun rufe sashin ta hanyar suturar retinaculum yayin da muke mayar da jigon EPL akan sashi na uku.
Idan dunƙule bai ƙara zuwa kashi na uku ba, mun bar jigon EPL a cikin ɓangaren da aka buɗe na uku.
Dabarar aikin mu na tiyata tana ba da damar dubawa cikin sauƙi na raunin jijiya EPL tare da hangen nesa kai tsaye a cikin ƙasan ƙarin mintuna 10. Idan tendon EPL ya ji rauni, ana iya gyara shi kai tsaye. Wannan hanya tana taimakawa hana fashewar jijiyar EPL ta biyu bayan gyaran farantin radial mai nisa. EPL tendon string na iya faruwa, amma hakan bai faru ba a yanayinmu.
A karshe
Mun fuskanci shari'ar da tendon EPL ya kasance cikakke shekaru 7 bayan tiyata, kodayake sukurori da aka yi amfani da su don gyara farantin wuta sun yi fice a cikin sashi na uku. Dabarar fiɗarmu tana rage haɗarin fashewar tsokar EPL bayan gyaran farantin wuta don karyewar radius mai nisa.
Yadda Ake Siyan Kayan Gyaran Orthopedic da Instruments?
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