Omanyi okutereeza okumenya kwa metacarpal?

Metacarpophalangeal fractures are a common fracture in hand trauma, nga ekola nga 1/4 ku balwadde bonna abakwatibwa mu ngalo. Olw’ensengekera enzibu era enzibu ey’omukono n’omulimu gwagwo omulungi ogw’enkola y’omubiri, okuddukanya okumenya kw’emikono kikulu nnyo era kizibu mu by’ekikugu okusinga okujjanjaba okumenya okuwanvu okuwanvu okw’ekika kya tubular.

Okukakasa nti okumenya okunywevu oluvannyuma lw’okuddamu okuteekebwa mu kifo kye kisumuluzo ky’obuwanguzi bw’obujjanjabi bw’okumenya kwa metacarpophalangeal. In order to restore the function of the hand, the fracture often requires proper fixation, and in the past, external fixation with plaster or internal fixation with Kirschner pins was commonly used, but often due to inaccurate fixation or long fixation time, which is not conducive to early postoperative joint rehabilitation, and has a greater impact on the functional recovery of the metacarpophalangeal joint, bringing some difficulties to the functional rehabilitation of the hand.

Enkola z’obujjanjabi ez’omulembe zeeyongera okukozesa okunyweza okw’omunda okw’amaanyi, gamba nga micro plate screw fixation.

Emisingi gy’obujjanjabi .

Emisingi gy’okujjanjaba okumenya kw’omukono ogw’ekika kya metacarpal n’egya phalangeal gye gino: okuddamu okuteeka mu mubiri (anatomic repositioning), okunyweza ekitangaala n’okunyweza, okutambula nga bukyali n’okukola dduyiro. Emisingi gy’okujjanjaba okumenya kw’omukono ogw’omu lubuto n’ogw’okumpi n’omukono gwe gumu n’egyo egy’okumenya okulala okw’omunda: okuzzaawo ensengekera y’omubiri gw’ekitundu ky’omubiri n’emirimu egy’okukola nga bukyali. Okujjanjaba okumenya kwa metacarpal ne phalangeal okw’omukono kulina okufuba okutuuka ku kuzzaawo anatomic awatali kuzimbulukuka, lateral angulation, oba angular displacement >10° to the dorsal aspect of the palm. Singa enkomerero y’emmeeme ya metacarpal ekyusibwa oba okusengulwa mu bbali mu ngeri ey’okukoona, ejja kukyusa enkola eya bulijjo ey’okufukamira n’okutambula kw’olugalo, ekigireetera okusika oba okugwa okuva mu ngalo eriraanyewo mu kiseera ky’okunyiga, ekikosa obutuufu bw’omulimu gw’engalo; Wadde ng’okusengulwa kw’enjuba >10° okutuuka ku mugongo gw’engalo kijja kusaanyawo ekitundu ekigonvu eky’okukwatagana kw’eggumba n’omusuwa, okwongera ku kuziyiza n’okutambula kw’omusuwa mu kufukamira n’okugaziwa, n’okuleeta obuvune obutawona ku kinywa, okuleeta obulabe bw’okukutuka kw’omusuwa. Obulabe bw’okukutuka kw’emisuwa.

Enmenya za metacarpal ne phalangeal zifaanagana mu busobozi bwabyo okugumira okulema kw’enzitowererwa, ate nga metacarpal egumira okufunyisa okusengulwa n’okusengulwa kw’enjuba emabega okusinga phalangeal. Ennyondo za carpometacarpal ne metacarpophalangeal zisobola okusasula obulema bw’enjuba (angular deformity) bwa metacarpal, era engalo entono ey’ensozi etuukagana bulungi n’obulema bw’enjuba (angular deformity) bwa metacarpal okusinga engalo eya wakati eya wakati. Okukendeeza ku maanyi g’okukwata olw’okukendeera kw’ebinywa by’omukono okw’omunda kweyolekera ddala nga metacarpal efunye enkoona okusukka 30° ku ludda lw’omugongo.

Enkola y’okulongoosa .

Enkola y’okulongoosa okumenya kwa metacarpal nnyangu nnyo era okutwalira awamu ekozesa enkola ey’omugongo, nga bwe kiragibwa mu kifaananyi 4-14. Metacarpal eyokubiri etemebwa mu radially ate nga metacarpal eyokutaano etemebwa ulnarly, era metacarpal eyokusatu n’eyokuna zitera okutemebwa wakati. Singa metacarpals bbiri eziriraanye zikolebwako mu kiseera kye kimu, ekitundu eky’omu makkati eky’engeri ya S kikozesebwa okulowooza ku bifo byombi eby’okulongoosa.

Okulonda enkola ennywevu .

Waliwo ebintu bingi eby’omunda eby’okunyweza eby’okumenya kwa metacarpophalangeal, nga ppini za Kirschner, sikulaapu, obubaawo ne fuleemu z’okunyweza ez’ebweru, nga mu zino ppini za Kirschner ne microplates zisinga kukozesebwa. Ku metacarpal fractures, okunyweza okw’omunda ne microplate kulina ebirungi ebyeyoleka okusinga okunyweza ne Kirschner pins era kuyinza okwettanirwa; Ku kumenyeka kwa phalangeal proximal, microplate okutwalira awamu yesinga okwettanirwa, naye bwe wabaawo obuzibu mu kuteeka sikulaapu mu kitundu eky’ewala eky’ekitundu eky’okumpi ekya phalangeal n’okumenya omutwe, okunyweza munda ne ppini za Kirschner ezisalasala kye kisinga okwettanirwa, ekisinga okusobozesa okuzzaawo okukola kw’engalo ekoseddwa; Ku bujjanjabi bw’okumenya phalangeal phalangeal, ppini za Kirschner zirina okwettanirwa.

1、Empiso ya Kirschner: 

Kirschner’s needle internal fixation has been applied in the clinic okumala emyaka egisukka mu 70 era nga kibadde ekintu ekisinga okukozesebwa munda mu metacarpophalangeal fractures, nga kyangu okukozesa, eky’enfuna era nga kya nkola, era nga kye kisinga okukala mu nkola y’okunyweza munda, nga bwe kiragibwa mu kifaananyi 4-15. Nga bwe kiri ku kunyweza okw’omunda okusinga okukozesebwa okujjanjaba okumenya kw’emikono, kukyakozesebwa nnyo. 

Ebirungi ebiri mu kunyweza munda ne Kirschner Pins:

1 Kyangu okukozesa era nga kikyukakyuka nnyo mu kukozesa; 

2 Okuggyamu ebitundu ebigonvu ebitono, okukosa okutono ku kutambula kw’omusaayi ku nkomerero y’okumenya, okulumwa okutono mu kulongoosa, n’okuwona okumenya okumenya; 

3 Easy Okuggya ppini mu ppini ey’okubiri; 

4 Okukozesa ssente entono n’okugaziwa, okukozesebwa ku kumenyeka kw’emikono okusinga (nga okumenya wakati mu bitundu by’omubiri, okumenya okw’amaanyi okw’amaanyi n’okumenya kw’omubiri ogw’enkomerero). 

Ebizibu by’okunyweza okw’omunda: 

(1) Bw’ogeraageranya n’okunyweza pulati, okutebenkera kuba kwa bubi, era okufunza n’okusengulwa kw’enzitowerera tekuyinza kufugibwa ppini emu, ebiseera ebisinga ppini ezisukka mu 2 zeetaagibwa okusobola okunyweza okusalasala; 

(2) tewali kikolebwa kunyigiriza ku nkomerero y’okumenya; 

(3) kungulu kw’ekiyungo okwonooneka olw’okunyweza okusalasala; 

(4) Okunyweza ekiwanga n’okuzibikira kw’omusuwa biremesa ekiyungo ky’omukono okukola dduyiro nga bukyali n’okukosa okuddamu okukola.

Olw’okukulaakulanya okw’amangu okw’obukodyo n’ebyuma eby’omulembe eby’okunyweza munda, okunyweza munda ne ppini za Kirschner kweyongedde okulongoosebwa, era ebisinga bisobola okutereezebwa awatali kusala kiwanga, nga tewali kwonoona nnyo bitundu bigonvu n’emisuwa okwetooloola ekiwanga, era nga tebikosa kutendekebwa kwa kiwanga oluvannyuma lw’okulongoosebwa nga bukyali. Nga tuyambibwako ekyuma kya C-arm X-ray, emisango egimu giyinza n’okutuuka ku bivaamu ebimatiza nga kiggaddwa okukendeeza ku kunyweza okw’omunda ne ppini za clinique, ekyongera okukendeeza ku kwonooneka kw’ebitundu ebigonvu eby’omu kitundu n’okukosebwa kw’omusaayi okutuuka ku nkomerero y’okumenya, bwe kityo ne kitumbula okuwona kw’okumenya. 

Okwegendereza okunyweza munda ne Kristen Pins: 

1 Teekawo bulooka z’amagumba ennene nga zirina ppini za kristen eza mm 1.0~1.2 mu buwanvu, era ozuule ekifo we ziyingira n’obulagirizi bw’okuyingira okusinziira ku ndagiriro ya layini y’okumenya; 

2 N’ekigendererwa eky’okuzzaawo layini y’amaanyi, okumenya wakati w’ekitundu (intra-articular fractures) kulina okuddamu okuteekebwa mu nkola mu nsengekera y’omubiri (anatomically repositioned and strongly fixed); 

3 Si buli bbulooka z’amagumba nti zeetaaga okutereezebwa ne ppini za kristen, era wansi w’ensonga y’okutuuka ku kutebenkera kw’enkomerero y’okumenya, ppini za kristen zirina okukozesebwa katono nga bwe kisoboka; 

4 Kristen pins tezitereezebwa nga ziyita mu tendon oba dorsal tendon membrane of the finger okukola nga bukyali functional exercise nga bwekisoboka; 

5 Wabeewo enteekateeka enkakali nga tebannaba kulongoosa n’obutaddamu kulongoosa mu kulongoosebwa, bwe kitaba ekyo ekiziyiza eky’okumenya kiyinza okubetentebwa ennyo oba n’obutatereezebwa; 

4 Okutwalira awamu ppini ya Kirschner erina okuteekebwa mu lususu okukendeeza ku mikisa gy’okukwatibwa obulwadde era si kizibu okugiggyamu.

2、metacarpal micro plate: 

Okunyweza okw’omunda okw’amaanyi okw’okumenya kw’emikono gwe musingi gw’okukola dduyiro nga bukyali era kyetaagisa okuzzaawo enkola ennungi ey’omukono.AO Enkola y’okunyweza munda yeetaaga okuddamu okuteeka mu nkola entuufu ey’omubiri (Anatomical repositioning) enkomerero y’okumenya n’okutebenkeza enkomerero y’okumenya mu nkola ey’emirimu, ekitera okuyitibwa okunyweza okw’amaanyi, okusobola okusobozesa okutambula kw’omusaayi nga bukyali. AO era eggumiza enkola z’okulongoosa ezitali nnyo mu mubiri ezissa essira ku kukuuma omusaayi okutambula. Microplate internal fixation of the hand fracture etuwa ebivaamu ebimatiza mu ngeri y’amaanyi, okutebenkera kw’enkomerero y’okumenya ne puleesa wakati w’enkomerero. Mu nsonga y’okuwona emirimu oluvannyuma lw’okulongoosebwa, obudde bw’okumenya okuwona n’omuwendo gw’okukwatibwa okugeraageranyizibwa, obulungi bwa micro titanium plates butwalibwa nga bulungi nnyo okusinga obwa kerf pins, era olw’okuba okumenya okuwona obudde oluvannyuma lwa micro titanium plate fixation is significantly shorter than of other fixation modalities, thus facilitating the early return to normal life of the patient.

Ebirungi ebiri mu microplate internal fixation treatment: 

(1) Bw’ogeraageranya ne ppini za KERF, sikulaapu za microplate zirina okukwatagana okulungi okukwatagana n’okuddamu kw’ebitundu by’omubiri; 

(2) okutebenkera kw’enkola y’okunyweza omusumaali gw’epulaati n’okunyigirizibwa ku nkomerero y’okumenya bifuula okumenya okumpi n’okuddamu okuteeka mu mubiri, okunyweza okunywevu, ekintu ekiyamba okuwonya okumenya; 

(3) Dduyiro w’emirimu nga bukyali okutwalira awamu akkirizibwa oluvannyuma lw’okunyweza microplate, ekiyamba okuzzaawo omulimu gw’omukono. 

3. Ebintu ebitonotono (microscrews).

Microscrews for spiral oba long oblique fracture fixation zirina obutebenkevu obufaanagana n’obupande bw’ekyuma, naye ekitundu ekigonvu n’ekifo eky’okuggyamu omugongo bitono okusinga eby’okunyweza ebyuma, ekiyamba okukuuma okutambula kw’omusaayi era nga kikwatagana n’endowooza y’okulongoosa okutali kwa maanyi. Newankubadde nga waliwo t- ne L-type splints for proximal joint fractures, okukyalira postoperative kubi okusinga okwo ku diaphyseal fractures, era microscrews zirina ebimu ku birungi eby’okunyweza intra- ne periarticular fracture. Sikulufu ezisiddwa mu kitundu ky’amagumba zisobola okugumira omugugu omunene ogw’okunyigirizibwa, kale okunyweza kunywevu era kuyinza okuteeka puleesa wakati w’enkomerero z’okumenya okuleeta ebitundu by’okumenya mu kukwatagana okw’okumpi, ekikendeeza ku budde bw’okuwona n’okuyamba okuwona okumenya, nga bwe kiragibwa mu kifaananyi 4-18. Microscrews zisinga kukozesebwa ku oblique oba spiral fractures of the diaphysis ne intra-articular avulsion fractures of larger bone masses. Kikulu okumanya nti obuwanvu bw’oluwuzi lw’okumenya bulina okuba nga waakiri emirundi ebiri ku diamita ya diaphysis nga otereeza oblique oba spiral fractures z’ekikolo ky’omukono nga tukozesa microscrews zokka, era waakiri emirundi esatu obugazi bwa thread diameter nga onyweza intra-articicular avulsion fracture blocks.

4. Miniature Ebweru Fixation brace.

Commitimated metacarpophalangeal fractures oluusi kizibu okuddamu okuteekawo anatomically ne bwetuba nga olongooseddwa incision oba nga tesobola kutereezebwa nnyo munda kubanga eggumba scaffold esaanyizibwawo. Ekikondo ky’okunyweza eky’ebweru kisobozesa okumenya okugatta okuzzaawo n’okukuuma obuwanvu bwakyo wansi w’ekikolwa ky’okusika, okuzannya ekifo ekinywevu ennyo, nga bwe kiragibwa mu kifaananyi 4-19. Okuteekebwa kw’ekikondo ky’okunyweza eky’ebweru kyawukana ku metacarpals ez’enjawulo: 1st ne 2nd metacarpals ziteekebwa ku ludda lw’omugongo olw’omugongo, metacarpals ez’okuna ne 5 ziteekebwa ku ludda lw’omugongo olwa ulnar, ate 3rd metacarpal eteekebwa ku dorsal radial oba dorsal side Omusuwa. Ebimenyese ebiggaddwa bisobola okuggalwa ne biddamu okuteekebwa wansi wa X-ray, era okusalako okutono kuyinza okukolebwa okuyamba mu kuddamu okuteekebwa mu kifo singa okuddamu okuteekebwa mu kifo tekiba kirungi.

Ebirungi ebiri mu kunyweza okw’ebweru.

(1) kyangu okukola era kisobola okutereeza okusengulwa okw’enjawulo okw’enkomerero y’okumenya;

(2) Kiyinza okuddamu okuteekawo obulungi n’okutereeza okumenya kw’omubiri ogw’omunda mu bitundu by’omubiri ebiyitibwa metacarpal phalanges awatali kwonoona ngulu w’ekitundu ky’omubiri, era kisobola okuwugula ku ngulu w’ekitundu okuziyiza okukonziba kw’ekiyungo ky’ekiwanga n’emisuwa egy’oku mabbali egy’ebbali; 

(3) Kiyinza okugattibwa wamu n’okunyweza okw’omunda okutono ku kumenya okugatta okutasobola kuddamu kuteekebwa mu nsengekera y’omubiri, era ekikwaso ky’okunyweza eky’ebweru kisobola okuddamu okuteekebwawo ekitundu n’okukuuma layini y’amaanyi; 

(4) Kisobozesa okukola dduyiro nga bukyali mu kukola engalo ekoseddwa mu kiwanga ekitannaba kutereezebwa okwewala ekiwanga . 

(5) Kiyinza bulungi okutereeza okumenya kw’omukono nga tekukosa bujjanjabi bwa kiwundu obw’omukono ogukoseddwa oluvannyuma lw’okulongoosebwa.

Engeri y'okugulamu amagumba agateekebwamu amagumba n'ebikozesebwa mu kuzimba amagumba) .

A CZMEDITECH , tulina ekintu ekijjuvu ennyo eky'ebintu ebiteekebwa mu kulongoosa amagumba n'ebikozesebwa ebikwatagana, ebintu omuli Ebisimbibwa omugongo ., Emisumaali egy'omu lubuto ., Ekipande ky’okulumwa obuvune ., Essowaani y’okusiba ., Omutwe-Maxillofacial ., Prosthesis ., Ebikozesebwa mu maanyi ., Abatereeza eby’ebweru ., Okukebera ebinywa ., Obulabirizi bw’ebisolo n’ebikozesebwa byabwe ebibayamba.

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