Okukutuka kw’omusuwa gwa extensor oluvannyuma lw’okunyweza volar plate kusigala nga kizibu kinene mu kuddaabiriza okumenya kwa distal radius. Omusuwa ogusinga okukosebwa gwe musuwa gwa extensor pollicis longus (EPL), kubanga gusibirwa munda mu kisenge kya EPL. Ebiseera ebitegeezeddwa eby’okukutuka kw’emisuwa gya EPL oluvannyuma lw’okusiiga volar biri 0.29%–5.7%.
Obulabe bw’okulwawo okukutuka kw’emisuwa gya EPL bweyongera nga waliwo okufuluma kwa sikulaapu y’omugongo, obuvune okuva mu kusima obutereevu mu kulongoosa, n’ebitundutundu by’akasolya k’omugongo naddala mu kumenya ebizinga by’ekibumba kya Lister. Okukebera okufuluma kwa sikulaapu mu kumenyaamenya okw’ewala (distal radius fractures) mu ngeri ya radiographic kizibu olw’enkola ya geometry enzibu eya radius ey’ewala n’obusobozi bw’okumenya kw’omugongo okusaliddwako. Okulaba okw’omugongo (dorsal tangential view) kwe kulaba kwokka okusoboka okw’omubiri (intravital view) okw’ekitundu ky’omubiri ekiyitibwa dorsal radial cortex okusobola okufuna okwekenneenya okwesigika okw’ebanga wakati w’ensonga ya sikulaapu n’ekitundu ky’omugongo.
Obukodyo obw’okwewala obuvune bw’emisuwa egy’okugaziya mulimu okukozesa sikulaapu eziyitibwa monocortical screws n’okwewala okuyingira mu mugongo; wabula obukodyo buno buyinza okukendeeza ku bunywevu bw’ebyuma mu kuddaabiriza okumenya. N’olwekyo, oluusi kyetaagisa okunyweza ebitundu bibiri (bicortical fixation). Okukendeeza ku bulabe bw’okulumwa emisuwa egy’okugaziya, ebigendererwa ebikulu eby’okunyweza okumenya n’okutebenkera tebirina kugwa mu matigga.
Obukodyo obupya obw’okulongoosa
Tunnyonnyola enkola empya okukendeeza ku bulabe bw’okukutuka kw’emisuwa gya EPL oluvannyuma lw’okunyweza volar plate of distal radius fractures awatali kufunza buwanvu bwa sikulaapu oba okuggyawo ebitundutundu by’akasolya ak’emabega. Mu bufunze, enkola eno erimu okuggulawo ekisenge eky’okusatu nga bayita mu kitundu ekitono eky’omugongo.
Singa sikulaapu yali eyingidde mu kisenge ky’omugongo n’efuluma mu kisenge eky’okusatu: twaggya omusuwa gwa EPL mu kisenge kyagwo ne tuggalawo ekisenge nga tutunga omusuwa gw’amaaso nga tuleka omusuwa gwa EPL ku retinaculum eyaddaabirizibwa.
Singa sikulaapu tegenda mu kisenge eky’okusatu: tuleka omusuwa gwa EPL mu kisenge eky’okusatu. Ekiraga enkola yaffe kiri mu balwadde abalina okumenyeka okw’ewala (distal radius fractures) abajjanjabwa n’ebipande ebisiba ebiwujjo (volar locking plates), okumenya n’ebitundutundu by’omugongo oba sikulaapu ebiyinza okuyingira mu kitundu ky’omugongo oba okwonoona omusuwa gwa EPL okwetoloola ekikuta kya Lister. Mu balwadde abalina okumenyaamenya okw’ewala (distal radius fractures) n’obutundutundu bw’omugongo, tusima ebituli okuyingira mu kitundu ky’omugongo ne tulonda sikulaapu ez’obuwanvu obumala okutereeza ebitundu by’omugongo ebitali binywevu.
Okugabana emisango
Tugabana ensonga nga omusuwa gwa EPL gwaggyibwa mu kisenge eky’okusatu olw’okufuluma kwa sikulaapu mu kisenge eky’okusatu mu kiseera ky’okunyweza pulati y’okumenya kwa distal radius okusaliddwako n’obutundutundu bwa dorsomedial. Twakakasa nti omusuwa gwa EPL gwali tegukyuse emyaka 7 oluvannyuma lw’okulongoosebwa, wadde nga sikulaapu yali yeeyoleka mu kisenge eky’okusatu.
Omusango guno gwali mukyala wa myaka 67 ng’azuuliddwa ng’alina okumenya mu bitundu by’omubiri ebitali binywevu (intra-articular unstable distal radius fracture) n’okumenya kw’omugongo ogwa ddyo (right dorsal medial fracture) (Figure 1A-E). Tewali byafaayo bya kunywa ssigala, ssukaali oba okunywa omwenge. Asobola okutambula nga talina mutambuze yenna.
![okumenya kwa radius ey’ewala]()
ekifaananyi 1. Okukuba ebifaananyi nga tebannalongoosebwa kwalaga okumenya kw’omubiri mu bitundu by’omubiri (comminuted intra-articular fracture) okw’ekitundu eky’ewala (distal radius).
A ne B: Okukebera X-ray nga tebannaba kulongoosebwa, .
C ne D: okulaba kwa sagittal ne axial okw’ebifaananyi bya kompyuta, .
E: Ekifaananyi kya 3D computed tomography. Ebitundutundu by’omugongo (dorsal medial lunate facet fragments) n’ebitundu by’omutwe eby’omugongo (emmunyeenye enjeru) birabika.
Enkola y’okulongoosa
Enkola eno ey’okumenya twagijjanjaba ne volar locking plate. Intraoperatively, twasima okuyita mu dorsal cortex ne tulonda screw empanvu ekimala okunyweza dorsal cortex kubanga dorsomedial fragment yali tenywevu (Figure 2).
Okulongoosebwa kwakolebwa okuggulawo ekisenge eky’okusatu oluvannyuma lw’okunyweza sikulaapu.
Okuva sikulaapu bwe yayingidde mu kisenge eky’okusatu n’efuluma (Ekifaananyi 3A), ggulawo ekisenge eky’okusatu mu bujjuvu era osse omusuwa gwa EPL okuva mu kisenge kyagwo (Ekifaananyi 3B).
Olwo ekisenge eky’okusatu kyaggalwa nga batunga retinaculum (Fig. 3C,D), era omusuwa gwa EPL ne guteekebwa waggulu wa retinaculum eyaddaabirizibwa (Fig. 3 E).
Oluvannyuma lw’okulongoosebwa, omulwadde yagenda mu ddwaaliro ly’abalwadde abatali balwadde mu ddwaaliro lyaffe okutuusa eggumba lwe lyawona. Omulwadde tayagala kuggyawo hardware.
Okuwona oluvannyuma lw’okulongoosebwa
Nga wayise emyaka musanvu bukya bamulongoosa, omulwadde yaddayo mu ddwaaliro okuddamu okwekebejjebwa olw’obulwadde bw’amagumba. Omukono ogwa ddyo tegulema. Ekifaananyi kya X-ray ekiraga okumenya okuwonye nga kuliko okufuluma okw’omugongo okwa sikulaapu y’okusiba ewala. Engalo ensajja y’omulwadde yali egaziyiziddwa mu bujjuvu, era omusuwa gwa EPL gwali tegulina muguwa gweyoleka.
Ku kuteesa kwaffe, omulwadde yakkiriza okuggyawo ebikozesebwa (hardware) n’okukebera emisuwa egy’okugaziya. Mu kulongoosa, twakebera omusuwa gwa EPL nga tuyita mu kitundu eky’omugongo ne tuggulawo ekitundu eky’okusatu n’eky’okuna.
Omusuwa gwa EPL gwali wabweru w’ekisenge eky’okusatu mu kifo kye kimu nga bwe kyali mu kulongoosebwa okwasooka, era omusuwa tegwanyiiga.
Twakakasa nti sikulaapu yayingira mu kisenge eky’okusatu nga emisuwa egy’okugaziya engalo gizze emabega.
Mu nkomerero, twatereeza emiguwa egy’okuwanirira ne tuggyawo ebikozesebwa. Mu kwekenneenya okusembayo nga wayise emyezi 2 nga bamaze okuggyibwako ebikozesebwa, omulwadde yali talina bulumi era ng’agaziyiziddwa engalo ensajja mu bujjuvu.
Okwogerako
Mu nkola yaffe, oluvannyuma lw’okunyweza volar plate of distal radius fractures, twaggulawo ekitundu eky’okusatu nga tuyita mu incision nga 2 cm obuwanvu ulnar okutuuka ku tubercle ya Lister. Twazuula butereevu omusuwa gwa EPL ne wansi w’ekisenge eky’okusatu eky’okugaziya nga tuzzaayo mpola omusuwa gwa EPL.
Singa sikulaapu yayingira mu kisenge eky’omugongo mu kisenge eky’okusatu oba ng’erina ebisasiro eby’omugongo n’omugongo, tetwakola kukyusa sikulaapu mu kulongoosa oba okusalako ebitundutundu, wabula twaggulawo ddala ekisenge eky’okusatu ne tuggyawo omusuwa gwa EPL mu kisenge kyagwo. Oluvannyuma twaggalawo ekisenge nga tutunga retinaculum nga bwe tuddamu okuteeka omusuwa gwa EPL ku kisenge eky’okusatu.
Singa sikulaapu teyagaziwa mu kisenge eky’okusatu, twaleka omusuwa gwa EPL mu kisenge eky’okusatu ekyaggulwawo ekitundu.
Enkola yaffe ey’okulongoosa esobozesa okwekebejja okwangu obuvune bw’emisuwa gya EPL nga tulaba butereevu mu ddakiika ntono nga 10 endala. Singa omusuwa gwa EPL guba gufunye obuvune, gusobola okuddaabirizibwa butereevu. Enkola eno eyamba okuziyiza okukutuka kw’emisuwa gya EPL egy’okubiri oluvannyuma lw’okunyweza distal radial plate. EPL tendon bowstring eyinza okubaawo, naye tekyabaawo mu mbeera yaffe.
Mu kumaliriza
Twafuna embeera ng’omusuwa gwa EPL tegukosebwa emyaka 7 oluvannyuma lw’okulongoosebwa, wadde nga sikulaapu ezaakozesebwa okutereeza volar plate zaali zeeyoleka mu kisenge eky’okusatu. Enkola yaffe ey’okulongoosa ekendeeza ku bulabe bw’okukutuka kw’emisuwa gya EPL oluvannyuma lw’okunyweza volar plate olw’okumenya kwa distal radius.
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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