Engeri y'okujjanjaba abakadde abamenyese mu distal radius!

Okumenyeka kw’ekitundu eky’ewala (distal radius) kye kimu ku bisinga okumenyeka mu bakadde. Abantu abali wakati w’emyaka 50 ne 75 mu kiseera kino boogerwako ng’abakadde. Ebiseera by’okumenyaamenya mu bitundu eby’ewala byeyongera omwaka ku mwaka ng’obuwanvu bw’okutambula mu bantu abakadde bweyongera. Ensonga eyokya mu kukubaganya ebirowoozo ku distal radius fractures ekyaliwo: Okulongoosa kyetaagisa?

Okunoonyereza ku ndwadde ezisaasaana

Okumenya kw’ekitundu eky’ewala (distal radius) kukola nga 18% ku kumenya kwonna okw’omubiri mu bantu abakulu abakadde. Omuwendo gw’abantu aba Caucasian, abalwadde abakyala, n’obulwadde bw’amagumba bye bikulu ebiyinza okuvaako okumenya kw’amagumba ag’ewala. Okugatta ku ekyo, era erimu ensonga za sizoni, gamba ng’abakadde abaseerera ne bagwa abatera okumenya ekitundu eky’ewala mu kiseera ky’obutiti. Okunoonyereza okumu kulaga nti abalwadde abakadde abalina obusobozi bw’okutegeera obutafudde n’enkola y’obusimu (neuromuscular system) bali mu bulabe bwa maanyi obw’okumenyeka mu bitundu eby’ewala (olw’okuba abalwadde balina ebiwujjo eby’amaanyi, bajja kugolola emikono gyabwe mu ngeri ey’okulowooza okuwanirira ettaka nga bagudde, ekivaamu okumenya). .

Okusinziira ku bibalo, mu Amerika, omuwendo gw’obujjanjabi olw’okumenyaamenya okw’ewala mu 2007 gwali nga obukadde bwa ddoola za Amerika 170 (nga ddoola za Amerika nga 1983 / omuntu). Wadde ng’abalwadde abakadde abasinga obungi abalina okumenyeka kw’ebitundu eby’ewala bajjanjabwa mu ngeri ey’okukuuma, omuwendo gw’abalwadde abasalawo okulongoosebwa okunyweza eby’omunda gweyongera omwaka ku mwaka. Ensimbi z’obujjanjabi ezisaasaanyizibwa mu kulongoosa mu kulongoosa zikubisaamu emirundi esatu ez’obujjanjabi obw’okukuuma, era era eyongera ku ssente z’okusula mu ddwaaliro n’ebirala ebikwatagana nabyo.

Waliwo n’enjawulo mu bitundu n’amawanga mu nkozesa y’okunyweza okw’omunda ku kumenya kwa distal radius. Okunoonyereza okwakolebwa ku Medicare kwalaga nti abakyala n’Abacaucasian baali basinga kulongoosebwa, era ekika ky’okulonda okunyweza munda kyali 4.6% okutuuka ku 42.1%. Era yakizuula nti abasawo abatendekeddwa mu kulongoosa emikono be basinga okulonda okulongoosa.

Okwekenenya mu Bujjanjabi

Enkola y‟obuvune bw‟omulwadde n‟okwemulugunya okukulu kulina okwetegereza mu byafaayo by‟obujjanjabi, omuli ekifo obulumi w‟ali, emirimu gy‟emirimu, n‟eddaala ly‟obulema. Mu kiseera kye kimu, era kyetaagisa okutegeera omukono gw’omulwadde ogufuga, ebintu ebitera okusanyusa omulwadde, n’omulimu omulwadde gw’akola. Okugatta ku ekyo, kikulu nnyo okumanya oba omulwadde alina obulwadde bw’amagumba oba ebivaamu ebikosa emirimu gy’ekitundu ky’omubiri ekikoseddwa nga tannafuna buvune. Mu bino, okubuuza abalwadde abakadde oba beetaaga okukozesa emiggo nga batambula era oba basobola okwerabirira mu bulamu obwa bulijjo kikulu nnyo mu kutegeera ebyetaago by’abalwadde n’okukola enteekateeka z’okuzuula n’okujjanjaba.

Mu kiseera ky’okukebera omubiri mu bujjanjabi, kyetaagisa okukebera engalo y’omulwadde mu ngeri entegeke era mu bujjuvu okuva ewala okutuuka okumpi. Omusaayi oguweebwa mu ngalo gumanyiddwa mu kukebera okuddamu okujjuza emisuwa n’okukebera omukka ogw’amaanyi (radial and ulnar pulse). Embeera z’obusimu obw’obusimu obw’omu makkati, obusimu bw’omu kifuba n’obusimu obw’omu kifuba (radial nerve) zafunibwa mu kugezesebwa okw’okusosola okw’ensonga bbiri n’okukebera okukwata ku kitangaala. Obulwadde bwa acute carpal tunnel syndrome mu distal radius fractures buli 5.4% okutuuka ku 8.6%, kale okufaayo okw’enjawulo kulina okussibwa ku paresthesia n’okuzimba mu kitundu eky’okusaasaana kw’obusimu obw’omu makkati. Enkola y’enkola y’omubiri gw’omulwadde yakeberebwa nga bakebera obusimu obw’omu maaso n’obw’emabega obw’amagumba, obw’omu makkati, obw’omu makkati, n’obw’omu kifuba. Okugatta ku ekyo, omukebera era yeetaaga okufaayo ku mbeera y’ekiwundu ky’olususu lw’omulwadde (nga ecchymosis, edema, fork-like angulation, n’ebirala) okuzuula oba kimenyese ekiggule. Olw’embeera embi ey’ebitundu ebigonvu n’olususu olugonvu mu bakadde, okumenya kw’ebitundu eby’ewala kutera okuwerekerwako okukutuka kw’olususu. Bwe kikozesebwa okukendeeza ku kusika okuggaddwa, kyetaagisa okukola n’obwegendereza naddala okwewala okwonooneka kw’ebitundu ebigonvu ebirala.

Okukebera ebifaananyi

Okukebera okuva mu bifaananyi eby’okumenya kw’ebitundu eby’ewala (distal radius fractures) mu ngeri entuufu kuzingiramu ebifaananyi eby’omu maaso n’emabega, eby’ebbali, n’eby’okuserengeta. Enkoona n’okuzimbulukuka kw’okumenya bisobola okutegeerwa nga tuyita mu kukebera ebifaananyi okuzuula oba waliwo okufunza, oba akatundu k’okumenya kasaliddwa, era oba layini y’ekiyungo ewedde. Ebirala ebitongole ebikwata ku bifaananyi byali: okukendeera kw’enkizi (kitegeeza 22°, ebanga: 19°-29°), obugulumivu bw’ekitundu eky’ewala (11-12 mm), n’okuserengeta kw’engalo okw’ekitundu eky’ewala (kitegeeza 11°, ebanga: 11 °-14.5°). X-rays z’omukono ogw’omu maaso n’enkokola nazo zikwatibwa okukebera oba omukono ogw’omu maaso gwonoonese oba enkokola tezitebenkedde. Oluvannyuma lw’okukendeeza okuggaddwa n’okuziyiza okutambula kw’omusipi, firimu endala eya X-ray yeetaagibwa okwekenneenya oba ebipimo by’ekitundu eky’ewala biteredde. Mu bujjanjabi, okukebera CT kutera okukozesebwa okuyamba mu kuzuula n’okugabanyaamu okumenya (okugeza, oba waliwo okumenya mu bitundu by’omubiri, oba waliwo okumenya oba okumenya), okusobola okwongera okuzuula enteekateeka y’obujjanjabi obw’okulongoosa. Mu kiseera kye kimu, okukeberebwa CT nakyo kyetaagisa okwongera okwekenneenya nga bakola okusala amagumba n’okujjanjaba amagumba mu malunion.

Okujjanjaba

Okusinziira ku ndagiriro y’obujjanjabi eya AAOS, tewali kukkiriziganya ku nkozesa y’okuddukanya okukuuma oba okulongoosa okw’okumenya kw’ebitundu eby’ewala. Tewali kukkiriziganya oba okukozesa volar locking plate fixation oba percutaneous Kirschner wire fixation mu bujjanjabi obw’okulongoosa. Kodama et al bateesa okukozesa enkola y’okugereka obubonero bw’okumenya okuzuula oba omulwadde yeetaaga okulongoosebwa. Era ku balwadde abakadde ≥50, ekika ky’okumenya, enkyukakyuka mu radiographic parameters z’ekiwanga ky’engalo, emyaka, omukono ogufuga, n’omulimu gw’omulwadde birina okukozesebwa okwongera okuzuula enteekateeka y’obujjanjabi. Mu kwekenneenya okudda emabega okungi, diguli y’okukendeera kw’ekitundu kya volar oba dorsal distal radius oluvannyuma lw’okukendeeza, oba okumenya kwazingiramu ensingo ya ulnar, okuserengeta kw’engalo, n’okukyukakyuka mu distal ulna byali bikwatagana nnyo n’ebiva mu bujjanjabi.

Obujjanjabi obw’okukuuma

Mu makkati gaffe, okumenyaamenya okw’ewala okusengulwa okutono kutera okutambulizibwa n’ekyuma ekiwanirira pulasita wa Sugar tong waggulu w’enkokola okukomya okufukamira n’okusitama kw’enkokola (laba ekifaananyi 1). Singa okusengulwa kw’okumenya kuba kunene, Sugar tong splint erina okukolebwa oluvannyuma lw’okukendeeza okuggaddwa. Weetegereze nti bw’oba ​​okola okuziyiza okutambula kwa pulasita, obuwanvu bw’okutambula bulina okuyimirira ku nkomerero y’engalo ey’okumpi, okusobola okwanguyiza entambula y’engalo n’okuziyiza okukaluba. Okukozesa bbandi za laasitiki okunyweza okunyigirizibwa okutono kiyinza okuyamba mu kusiba ebisiba. Ekika ky’okumenya kye kisalawo enkola y’okukendeeza okuggaddwa. Bwe kiba kyetaagisa, local hematoma anesthesia of the distal radius esobola okulondebwa, n’oluvannyuma okukendeeza ku kusika kukolebwa nga basika engalo (index ne middle fingers) okutereeza obulema n’okuzzaawo radiocarpal joint alignment. Okukendeeza ku kusika kutera okukolebwa nga tukozesa enkola ya inverse fracture mechanism. Okukendeeza ku kusika mu nnyonyi ez’enjawulo kyetaagisa okumaliriza okuzzaawo emisuwa n’okuzzaawo okukwatagana kw’ebitundutundu by’okumenya, capitulum ne lunate. Ku nnyonyi ya coronal, zzaawo ensengekera y’omubiri (anatomical alignment) ya ulna ne radius, ekitundu ky’amagumba eky’ewala n’ekikondo kya radial. Okukendeeza ku kumenya kwa Colles okwa bulijjo kyetaagisa omuyambi okukwata engalo ensajja ey’omulwadde mu mukono gumu ate engalo z’omulwadde 4 mu mukono omulala, ng’akozesa countertraction okwawula ekitundu ky’okumenya okuva ku metaphysis ya radius, okugenda mu maaso n’okusika okuwanvu, n’oluvannyuma engalo. Flexion ne ulnar deviation okuyamba okukendeeza ku kitundu ky’okumenya. Ku balwadde abakadde abalina okwonooneka kw’ebitundu ebigonvu ebibeetoolodde, kyetaagisa okukozesa n’obwegendereza mu nkola y’okukendeeza okuziyiza okukutuka kw’olususu (paadi ya ppamba esobola okukozesebwa mu kiseera ky’okukendeeza). Oluvannyuma lw’okuddamu okuteeka mu kifo, okukeberebwa emisuwa gy’obusimu (neurovascular examination).

Ekifaananyi 1. (A) Omulwadde eyamenyeka mu kitundu eky’ewala (distal radius fracture) yayimirizibwa mu mbeera y’engalo etali ya maanyi nnyo n’ekyuma ekikuba pulasita eya Sugar tong okuziyiza okuddamu okusengulwa; (B) ne (C) ebifaananyi eby’omu maaso n’eby’ebbali ebiraga okunyweza engalo z’omulwadde nga kulungi. Omusipi gwa pulasita tegusukka mutwe gwa metacarpal engalo zisobole okutambula mu ngeri eya bulijjo.

Obujjanjabi bw’Okulongoosa

Enkola z’obujjanjabi ez’okulongoosa eri abalwadde abakadde abalina okumenya mu kitundu eky’ewala mulimu: okukendeeza okuggaddwa n’okunyweza ebweru, okunyweza waya ya Kirschner okuyita mu lususu, okukendeeza mu kuggule, okunyweza volar/dorsal locking plate, n’okunyweza dorsal bridging plate (laba ekiragiddwa mu kifaananyi 2). 

Ekika ekirala eky’okukendeeza ku kugguka n’okunyweza epulati y’omugongo kisinga kukozesebwa mu kujjanjaba okumenya kw’ebitundu by’omubiri (intra-articular fractures). Kiyinza okukendeeza ku ngulu w’ennyindo wansi w’okulaba obutereevu awatali kuggyamu bitundu by’omusuwa ku ludda olw’ennyindo (volar side) olw’ekinywa ky’engalo, ekikendeeza ku bulabe bw’obutabeera mu ntebenkevu bw’ekiwanga kya radiocarpal oluvannyuma. Singa okumenya kwa volar lunate kuzingirwamu, kwetaaga okutaataaganyizibwa. Ku balwadde abalina okumenya kw’omugongo (radial shaft fracture) oba obuvune obuwerako, ekipande ekisika ekizimbibwamu kisobola okukozesebwa okutuuka ku kukendeeza okuyita mu kuzzaawo emisuwa. Mu kiseera kye kimu, ekipande ekisika nakyo kituukira ddala ku kukendeeza n’okunyweza okumenya kw’amagumba ag’ewala (comminuted and osteoporotic distal radius fractures). Essuuka yaggyibwawo nga wayise wiiki 12 nga balongooseddwa, era obujjanjabi obulungi obw’obujjanjabi bwali busobola okutuukibwako.

Volar locking plate esobola okulongoosa radial shortening ne volar tilt, era ebizibu ebibaawo bitono. Bw’ogeraageranya ne dorsal plate, amaanyi g’okukwata ekitundu ekikoseddwa gasobola okulongoosebwa ennyo mu myezi 6 oluvannyuma lw’okulongoosebwa, era omulimu n’obulumi bisobola okulongoosebwa. Ebizibu nga okuddamu okusengulwa kw’okunyweza epulati y’omugongo n’okunyiiga kw’omusuwa gwa extensor digitorum bibaawo mu bitundu ebituuka ku 30%. Era fixation effect ya volar plate nayo nnungi okusinga eya Kirschner wire oba external fixator.

Engeri y'okugulamu ebyuma ebiteekebwa mu magumba n'ebikozesebwa mu kulongoosa amagumba?

A CZMEDITECH , tulina layini y’ebintu ebijjuvu ennyo eby’ebiteekebwa mu kulongoosa amagumba n’ebikozesebwa ebikwatagana, ebintu omuli okuteekebwamu omugongo, emisumaali egy’omu lubuto (intramedullary nails)., essuuka y’okulumwa, ebbakuli y’okusiba, cranial-maxillofacial mu maaso, okuzimba omubiri (prosthesis)., ebikozesebwa eby’amasannyalaze, ebinyweza eby’ebweru, okukebera ebinywa, okulabirira ebisolo n’ebikozesebwa byabwe ebibiwagira.

Okugatta ku ekyo, twewaddeyo okugenda mu maaso n’okukola ebintu ebipya n’okugaziya layini z’ebintu, tusobole okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde bangi, era n’okufuula kkampuni yaffe okuvuganya ennyo mu mulimu gwonna ogw’ensi yonna ogw’okussaamu amagumba n’ebikozesebwa.

Tutwala ebweru w’eggwanga mu nsi yonna, kale osobola tukwatagane ku email address song@orthopedic-china.com okufuna quote ku bwereere, oba weereza obubaka ku WhatsApp okufuna eky'amangu +86- 18112515727 .

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