Kodi mukudziwa momwe mungakonzere fracture ya metacarpal?

Metacarpophalangeal fractures ndi kuthyoka kofala kwa kuvulala kwamanja, kuwerengera pafupifupi 1/4 ya odwala onse ovulala pamanja. chifukwa cha kusakhwima ndi kuvutikira kwa dzanja ndi ntchito yake yabwino yamagalimoto, kasamalidwe ka fractures yamanja ndi yofunika kwambiri komanso mwaukadaulo wovuta kwambiri kuposa kuchiza matenda ena aatali a tubular.

Kuonetsetsa kukhazikika kwa fracture pambuyo poyimitsanso ndiye chinsinsi cha kupambana kwa chithandizo cha metacarpophalangeal fracture. Kuti abwezeretse ntchito ya dzanja, wothyoka nthawi zambiri kumafuna kukonza koyenera, ndipo m'mbuyomu, kukonza kunja ndi pulasitala kapena kukonza mkati ndi zikhomo za Kirschner zinkagwiritsidwa ntchito, koma nthawi zambiri chifukwa cha kukhazikika kolakwika kapena nthawi yayitali yokhazikika, zomwe sizingagwirizane ndi kukonzanso koyambirira kwa postoperative, ndipo kumakhudza kwambiri kuchira kwa ntchito ya metacarpo, kubweretsa zovuta zakugwira ntchito kwa metacarpo.

Njira zamakono zochizira zimagwiritsa ntchito kwambiri kukhazikika kwamkati, monga kukhazikika kwa mbale yaying'ono.

Mfundo za Chithandizo

Mfundo zochizira metacarpal ndi phalangeal fractures za dzanja ndi: kuyikanso kwa anatomic, kukonza kopepuka komanso kolimba, kuyenda koyambirira komanso kuchita masewera olimbitsa thupi. Mfundo za chithandizo cha intra-articular ndi periarticular fractures za dzanja ndizofanana ndi zina zapakati-articular fractures: kubwezeretsedwa kwa anatomy ya articular pamwamba ndi ntchito yoyambirira yogwira ntchito. Kuchiza kwa metacarpal ndi phalangeal fractures ya dzanja kuyenera kuyesetsa kukwaniritsa mawonekedwe a anatomic popanda kuzungulira, kugwedezeka kwapang'onopang'ono, kapena kusamuka kwa angular> 10 ° kumbali ya dorsal ya kanjedza. Ngati mapeto a fracture a metacarpal akuzunguliridwa kapena kusamutsidwa pambali pambali pa ngodya, idzasintha njira yowonongeka ndi kusuntha kwa chala, ndikupangitsa kuti ikankhire kapena kugwa kuchokera ku chala choyandikana ndi chala panthawi yopindika, zomwe zimakhudza kulondola kwa ntchito ya chala; pamene kusamuka kwa angular> 10 ° ku dorsum ya palmu kudzawononga kugwirizanitsa kosalala kwa fupa ndi tendon, kuonjezera kukana ndi kusuntha kwa tendon mu kupindika ndi kutambasula, ndikupangitsa kuvulala kosatha kwa tendon, kuchititsa ngozi ya tendon kupasuka. chiopsezo cha kusweka kwa tendon.

Metacarpal ndi phalangeal fractures ndizofanana pakutha kwawo kulekerera kupunduka kozungulira, pomwe metacarpal imalekerera kufupikitsa kusamuka komanso kusamuka kwapang'onopang'ono kuposa phalangeal. Malumikizidwe a carpometacarpal ndi metacarpophalangeal amatha kubweza kuwonongeka kwa angular kwa metacarpal, ndipo chala chaching'ono cha annular chimasinthidwa bwino ndi kupunduka kwa angular kwa metacarpal kuposa chala chapakati. Kuchepetsa mphamvu yogwira chifukwa chakufupikitsa kwa minofu ya m'manja kumawonekera pokhapokha metacarpal imapindika kuposa 30 ° kumbali yakumbuyo.

Njira Yopangira Opaleshoni

Njira yopangira opaleshoni ya fractures ya metacarpal ndiyosavuta ndipo nthawi zambiri imagwiritsa ntchito njira yapakhosi, monga momwe tawonetsera pa Chithunzi 4-14. Metacarpal yachiwiri imayikidwa mozungulira pomwe yachisanu ya metacarpal imapangidwa modumphira, ndipo metacarpal yachitatu ndi yachinayi nthawi zambiri imadulidwa pakati. Ngati ma metacarpals awiri oyandikana akuchitidwa pa nthawi imodzi, kudulidwa kwapakati kwa S kumagwiritsidwa ntchito poganizira malo onse opangira opaleshoni.

Kusankha njira yokhazikika

Pali zida zambiri zokonzera mkati mwazowonongeka za metacarpophalangeal, monga mapini a Kirschner, zomangira, mbale ndi mafelemu okhazikika akunja, omwe mapini a Kirschner ndi ma microplates amagwiritsidwa ntchito kwambiri. Kwa ma fractures a metacarpal, kukonza mkati ndi microplate kuli ndi ubwino wodziwikiratu pakukonzekera ndi zikhomo za Kirschner ndipo zingakhale zokondedwa; kwa proximal phalangeal fractures, microplate nthawi zambiri imakonda, koma kukakhala kovuta kuyika zomangira mu gawo lakutali la proximal phalangeal ndi fractures zamutu, kukonza mkati ndi zikhomo za Kirschner zowoloka ndizokonda, zomwe zimathandiza kwambiri kuti chala chokhudzidwa chizigwiranso ntchito; pochiza ma fractures apakati a phalangeal, zikhomo za Kirschner ziyenera kukondedwa.

1, singano ya Kirschner: 

Kukonzekera kwa mkati kwa singano ya Kirschner kwakhala kukugwiritsidwa ntchito kuchipatala kwa zaka zoposa 70 ndipo wakhala akugwiritsidwa ntchito kwambiri mkati mwazitsulo zowonongeka za metacarpophalangeal, zomwe zimakhala zosavuta kugwira ntchito, zachuma komanso zothandiza, ndipo ndi njira yabwino kwambiri yothetsera mkati, monga momwe tawonetsera pa Chithunzi 4-15. monga momwe amagwiritsidwira ntchito kwambiri mkati kuti athetse fractures zamanja, amagwiritsidwabe ntchito kwambiri. 

Ubwino wa kukonza kwamkati ndi zikhomo za Kirschner:

① yosavuta kugwiritsa ntchito komanso yosavuta kugwiritsa ntchito; 

② kuvula minofu yofewa pang'ono, kuchepa kwa magazi kumapeto kwa fracture, kupweteka kwapang'onopang'ono, komanso kuchiritsa machiritso; 

③ zosavuta kubweza pini yachiwiri; 

④ mtengo wotsika komanso kugwiritsa ntchito kwakukulu, komwe kumagwiritsidwa ntchito pakuthyoka kwa manja ambiri (monga fractures ya intra-articular, fractures yovuta kwambiri komanso kutha kwa phalangeal fractures). 

Kuipa kwa kukonza mkati: 

(1) poyerekeza ndi mbale fixation, bata ndi osauka, ndi kufupikitsa ndi rotational kusamutsidwa sangathe kulamulidwa ndi pini limodzi, kawirikawiri kuposa 2 pini zofunika mtanda fixation; 

(2) palibe psinjika zotsatira pa fracture mapeto; 

(3) olowa pamwamba kuonongeka ndi mtanda olowa fixation; 

(4) kukhazikitsidwa kwa mgwirizano ndi kutsekeka kwa tendon kumalepheretsa mgwirizano wa dzanja kuti uyambe kuchita masewera olimbitsa thupi komanso kumakhudza kuchira.

Ndi chitukuko chofulumira cha njira zamakono zopangira mkati ndi zipangizo, kukonza mkati ndi mapini a Kirschner kwakhala kowonjezereka kwambiri, ndipo ambiri a iwo akhoza kukhazikitsidwa popanda kuwoloka mgwirizano, ndi kuwonongeka pang'ono kwa minyewa yofewa ndi tendons kuzungulira mgwirizano, ndipo popanda kukhudza maphunziro oyambirira a postoperative olowa ntchito. Mothandizidwa ndi makina a C-arm X-ray, zochitika zina zingathenso kupeza zotsatira zokhutiritsa mwa kuchepetsa kutsekedwa kwa kukhazikika kwa mkati ndi zikhomo za Clinique, kuchepetsanso kuwonongeka kwa minofu yofewa ya m'deralo ndi zotsatira za magazi mpaka kumapeto kwa fracture, motero kulimbikitsa machiritso a fracture. 

Njira zopewera kukonza kwamkati ndi zikhomo za Kristen: 

① Konzani midadada yokulirapo ya mafupa okhala ndi zikhomo za Kristen za 1.0 ~ 1.2 mm m'mimba mwake, ndikuzindikira malo olowera ndi komwe mungalowe molingana ndi komwe mzere wosweka; 

② Ndi cholinga chobwezeretsanso mzere wa mphamvu, ma fractures a intra-articular ayenera kusinthidwa mwachibadwa ndikukhazikika mwamphamvu; 

③ Sikuti zitsulo zonse za mafupa ziyenera kukhazikitsidwa ndi zikhomo za Kristen, ndipo pansi pa chidziwitso cha kukwaniritsa kukhazikika kwa mapeto a fracture, zikhomo za Kristen ziyenera kugwiritsidwa ntchito pang'ono momwe zingathere; 

④ Mapiritsi a Kristen samakhazikika kudzera mu tendon kapena dorsal tendon nembanemba ya chala kuti apange masewera olimbitsa thupi oyambilira momwe angathere; 

⑤ payenera kukhala ndondomeko yokhazikika ya preoperative osati kubwereza opaleshoni intraoperative, mwinamwake chipika chophwanyika chikhoza kuphwanyidwa kwambiri kapena chosasinthika; 

⑥ nthawi zambiri pini ya Kirschner iyenera kuyikidwa pakhungu kuti ichepetse mwayi wotenga matenda ndipo sikovuta kuichotsa.

2, Metacarpal yaying'ono mbale: 

Kukhazikika kwamphamvu kwamkati kwa fractures kumanja ndiko maziko a masewera olimbitsa thupi oyambirira ndipo ndikofunikira kubwezeretsa ntchito yabwino ya manja.AO njira yothetsera mkati imafuna kukonzanso bwino kwa anatomical kwa mapeto a fracture ndi kukhazikika kwa mapeto a fracture mu chikhalidwe chogwira ntchito, chomwe nthawi zambiri chimatchedwa kukonza kwamphamvu, kuti alole kusuntha koyambirira. AO imagogomezeranso njira zopangira maopaleshoni ochepa omwe amayang'ana kwambiri kuteteza kutuluka kwa magazi. Kukonzekera kwamkati kwa Microplate kwa kupasuka kwa dzanja kumapereka zotsatira zokhutiritsa ponena za mphamvu, kukhazikika kwa mapeto a fracture ndi kupanikizika pakati pa mapeto. Pankhani ya kuchira kwapambuyo pa opaleshoni, kuchiritsa kwanthawi yayitali komanso kuchuluka kwa matenda poyerekeza, mphamvu ya mbale yaying'ono ya titaniyamu imawonedwa kuti ndi yabwino kwambiri kuposa ya zikhomo za kerf, komanso chifukwa nthawi yochiritsa yosweka pambuyo pokonza mbale yaying'ono ya titaniyamu ndi yayifupi kwambiri kuposa ya njira zina zokonzera, motero kumathandizira kubwerera koyambirira kumoyo wabwinobwino wa wodwalayo.

Ubwino wa microplate internal fixation treatment: 

(1) poyerekeza ndi zikhomo za kerf, zomangira za microplate zimakhala ndi mbiri yabwino komanso kuyankha kwa minofu; 

(2) kukhazikika kwa dongosolo la misomali ya mbale ndi kupanikizika kwa mapeto a fracture kumapangitsa kuti fracture ikhale pafupi ndi kukhazikitsidwa kwa anatomical, kukhazikika kotetezeka, komwe kumapangitsa kuti machiritso awonongeke; 

(3) Kuchita masewera olimbitsa thupi koyambirira nthawi zambiri kumaloledwa pambuyo pa kukonza kwa microplate, komwe kumathandizira kuyambiranso ntchito yamanja. 

3. Zing'onozing'ono.

Ma microscrews a spiral or oblique fracture fixation amakhala ndi kukhazikika kofanana ndi mbale zachitsulo, koma minofu yofewa ndi malo ochotsera periosteal ndi yaying'ono kuposa yazitsulo zachitsulo, zomwe zimathandiza kuti chitetezo cha magazi chitetezeke komanso mogwirizana ndi lingaliro la ntchito yochepetsetsa pang'ono. Ngakhale pali ma T- ndi L-mtundu wa fractures wa proximal joint, ulendo wobwereza pambuyo pa opaleshoni ndi wosauka kusiyana ndi wa diaphyseal fractures, ndipo ma microscrews ali ndi ubwino wokonza fracture intra- and periarticular. Zitsulo zomwe zimapangidwira mu fupa la fupa zimatha kupirira kupsinjika kwakukulu, kotero kukhazikika kumakhala kolimba ndipo kungathe kuika mphamvu pakati pa mapeto a fracture kuti abweretse malo ophwanyika kuti agwirizane kwambiri, zomwe zimafupikitsa nthawi ya machiritso ndikuthandizira machiritso a fracture, monga momwe tawonetsera pa Chithunzi 4-18. ma microscrews amagwiritsidwa ntchito makamaka pakusweka kwa oblique kapena spiral of the diaphysis ndi ma intra-articular avulsion fractures a mafupa akulu akulu. Nkofunika kuzindikira kuti kutalika kwa ulusi wothyoka ayenera kukhala osachepera kawiri awiri awiri a diaphysis pamene kukonza oblique kapena ozungulira fractures dzanja tsinde ntchito microscrews yekha, ndipo osachepera katatu m'lifupi mwake ulusi awiri pamene kukonza intra-articular avulsion fracture midadada.

4. Kachingwe kakang'ono kamene kamakonza kunja.

Kuphwanyidwa kwa metacarpophalangeal fractures nthawi zina kumakhala kovuta kukonzanso anatomically ngakhale atadulidwa opaleshoni kapena sangathe kukhazikitsidwa mwamphamvu mkati chifukwa scaffold fupa lawonongeka. Chingwe chokhazikika chakunja chimalola kuti kupasuka kwapang'onopang'ono kubwezeretsedwe ndikusunga kutalika kwake pansi pa zotsatira za kukoka, kusewera ndi gawo lokhazikika, monga momwe tawonetsera pa Chithunzi 4-19. Kuyika kwachitsulo chokhazikika chakunja kumasiyana ndi ma metacarpals osiyanasiyana: 1st ndi 2nd metacarpals imayikidwa kumbali ya dorsal radial, 4th ndi 5th metacarpals imayikidwa kumbali ya dorsal ulnar, ndipo 3rd metacarpal imayikidwa pamphepete mwa dorsal radial kapena dorsal molingana ndi kuvulala kwa ulna. tendon. Ziphuphu zotsekedwa zimatha kutsekedwa ndikuyikidwanso pansi pa X-ray, ndipo zing'onozing'ono zingapangidwe kuti zithandizire kuyikanso ngati kuyikanso sikuli bwino.

Ubwino wa brace wokhazikika wakunja.

(1) ndi yosavuta kugwiritsa ntchito ndipo akhoza kusintha displacements zosiyanasiyana fracture mapeto;

(2) imatha kukonzanso bwino ndikukonza ma fractures a metacarpal phalanges popanda kuwononga pamwamba, ndipo imatha kusokoneza malo ozungulira kuti apewe kugundana kwa kapisozi olowa ndi minyewa yam'mbali; 

(3) ikhoza kuphatikizidwa ndi kukhazikika kochepa kwamkati kwa fractures zomwe sizingakhazikitsidwenso mwachilengedwe, ndipo cholumikizira chakunja chakunja chimatha kukonzanso pang'ono ndikusunga chingwe champhamvu; 

(4) imalola kuchita masewera olimbitsa thupi koyambirira kwa chala chomwe chakhudzidwa mumgwirizano wosakhazikika kuti mupewe kulumikizana 

(5) Ikhoza kukonza bwino kupasuka kwa dzanja popanda kukhudza chithandizo cha postoperative cha bala la dzanja lomwe lakhudzidwa.

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