Kuphulika kwa tendon extensor pambuyo pa kukhazikika kwa mbale ya volar kumakhalabe vuto lalikulu pakukonza ma distal radius fractures. Tendon yomwe imakhudzidwa kwambiri ndi tendon extensor pollicis longus (EPL), chifukwa imakhala mkati mwa EPL groove. Zomwe zanenedwa za kuphulika kwa tendon za EPL pambuyo pa volar plating ndi 0.29% -5.7%.
Chiwopsezo cha kuchedwa kwa EPL kuphulika kwa tendon kumachulukitsidwa pamaso pa dorsal screw protrusion, kuvulala kuchokera pakubowola mwachindunji, ndi zidutswa za denga, makamaka pachilumba cha Lister's tubercle. Kuwunika kwa radiographic kwa screw protrusion mu distal radius fractures kumakhala kovuta chifukwa cha zovuta za geometry ya distal radius komanso kuthekera kwa comminuted dorsal fractures. Mawonedwe a dorsal tangential ndiye njira yokhayo yowonekera ya dorsal radial cortex kuti mupeze kuwunika kodalirika kwa mtunda wapakati pa screw nsonga ndi dorsal cortex.
Njira zopewera kuvulala kwa tendon extensor zimaphatikizapo kugwiritsa ntchito zomangira za monocortical ndikupewa kulowera pamwamba pa dorsal; komabe, njirazi zikhoza kuchepetsa kukhazikika kwa makina okonza fracture. Chifukwa chake, kukonza kwa bicortical nthawi zina kumafunika. Kuti muchepetse chiopsezo cha kuvulala kwa tendon extensor, zolinga zazikulu za kukonza fracture ndi kukhazikika siziyenera kusokonezedwa.
Njira zatsopano zopangira opaleshoni
Timalongosola njira yatsopano yochepetsera chiwopsezo cha kuphulika kwa tendon ya EPL pambuyo pokonza mbale za volar zosweka za distal radius fractures popanda kufupikitsa utali wa screw kapena kuchotsa zidutswa zapadenga. Mwachidule, njirayi imaphatikizapo kutsegula chipinda chachitatu kudzera muzolowera pang'ono.
Ngati zomangirazo zidalowa mu dorsal cortex ndikutuluka mugawo lachitatu: tidachotsa tendon ya EPL kuchokera poyambira ndikutseka chipindacho ndi sutured retinaculum ndikusiya tendon ya EPL pa retinaculum yokonzedwa.
Ngati screw sichikulowa mu chipinda chachitatu: timasiya tendon ya EPL mu chipinda chachitatu. Chizindikiro cha njira yathu ndi odwala omwe ali ndi ma distal radius fractures omwe amachitidwa ndi mbale zotsekera za volar, zophulika ndi zidutswa za dorso-parietal kapena zomangira zomwe zingalowe mu dorsal cortex kapena kuwononga tendon ya EPL kuzungulira tubercle ya Lister. Odwala omwe ali ndi ma distal radius fractures okhala ndi zidutswa za dorsomedial, timabowola mabowo kuti tilowe mu dorsal cortex ndikusankha zomangira zautali wokwanira kukonza zidutswa zosakhazikika za dorsomedial.
Kugawana nkhani
Timagawana nkhani yomwe tendon ya EPL idachotsedwa m'chipinda chachitatu chifukwa cha kuphulika kwa screw mu chipinda chachitatu panthawi yokonza mbale ya comminuted distal radius fracture ndi zidutswa za dorsomedial. Tinatsimikizira kuti tendon ya EPL inali yosasunthika zaka 7 pambuyo pa opaleshoni, ngakhale kuti screwyo inali yotchuka mu chipinda chachitatu.
Mlanduwu unali wazaka 67 wazaka zakubadwa wokhala ndi matenda a intra-articular unstable distal fracture yokhala ndi fracture yakumanja ya dorsal medial (Chithunzi 1A-E). Palibe mbiri ya kusuta, shuga kapena kumwa mowa. Mutha kuyenda popanda woyenda.
![kuphulika kwa distal radius]()
chithunzi 1. Kujambula koyambirira kunawonetsa kuphulika kwa intra-articular fracture ya distal radius.
A ndi B: Ma X-ray a preoperative,
C ndi D: mawonedwe a sagittal ndi axial azithunzi za computed tomography,
E: Chithunzi cha 3D computed tomography. Zidutswa zam'mwamba zam'mwamba zapakatikati ndi ziduswa zakumtunda (nyenyezi zoyera) zimawonekera.
Njira ya opaleshoni
Tidachiza dongosolo loswekali ndi mbale yotsekera ya volar. Mwamtsempha, tidabowola mu dorsal cortex ndikusankha zomangira zazitali kuti titeteze dorsal cortex chifukwa chidutswa cha dorsomedial chinali chosakhazikika (Chithunzi 2).
Opaleshoni inachitidwa kuti atsegule chipinda chachitatu pambuyo pa kukonza wononga.
Popeza wonongayo yalowa muchipinda chachitatu ndikutuluka (Chithunzi 3A), tsegulani gawo lachitatu ndikusuntha tendon ya EPL kuchoka pamphamba yake (Chithunzi 3B).
Chipinda chachitatu chinatsekedwa ndi suturing retinaculum (mkuyu 3C, D), ndipo tendon ya EPL inayikidwa pa retinaculum yokonzedwanso (mkuyu 3 E).
Pambuyo pa opaleshoni, wodwalayo anapita ku chipatala chachipatala chathu mpaka fupa litachira. Wodwala sakufuna kuchotsa hardware.
Kuchira pambuyo pa opaleshoni
Patatha zaka 7 atachitidwa opaleshoniyo, wodwalayo anabwereranso ku chipatala kuti akamupendenso chifukwa cha matenda a mafupa. Dzanja lamanja si lolemala. Chithunzi cha X-ray chosonyeza kuthyoka kochira kokhala ndi dorsal protrusion ya distal locking screw. Chala chachikulu cha wodwalayo chidatalikitsidwa, ndipo tendon ya EPL inalibe ulusi wowonekera.
Pamalingaliro athu, wodwalayo adavomera kuchotsa zidazo ndikuwunika ma tendon owonjezera. M'kati mwa opaleshoni, tinayang'ana tendon ya EPL kupyolera mu dorsal incision ndipo tinatsegula pang'ono zipinda zachitatu ndi zinayi.
EPL tendon inali kunja kwa chipinda chachitatu pamalo omwewo monga momwe zinalili kale, ndipo tendonyo sinakwiyidwe.
Tidatsimikizira kuti screw idalowa mchipinda chachitatu pomwe minyewa yotulutsa zala idachotsedwa.
Pomaliza, tinakonza zingwe zothandizira ndikuchotsa zida. Pakuwunika komaliza miyezi 2 atachotsa zida, wodwalayo anali wopanda ululu ndipo anali ndi chowonjezera chala chachikulu.
Kambiranani
M'njira yathu, titatha kukonza mbale zophulika za distal radius fractures, tinatsegula pang'ono chipinda chachitatu kupyolera mu incision pafupifupi 2 cm ulnar ku tubercle ya Lister. Tinazindikira mwachindunji tendon ya EPL ndi pansi pa chipinda chachitatu chowonjezera pochotsa pang'onopang'ono tendon ya EPL.
Ngati zomangirazo zidalowa ku dorsal cortex kuchipinda chachitatu kapena kukhala ndi zinyalala za dorso-parietal, sitinachite intraoperative screw replacement kapena fragmentectomy, koma tinatsegula kwathunthu chipinda chachitatu ndikuchotsa tendon ya EPL poyambira. Kenako tinatseka chipindacho powombera retinaculum ndikuyikanso tendon ya EPL pagawo lachitatu.
Ngati phula silinapitirire mu chipinda chachitatu, tinasiya tendon ya EPL mu chipinda chachitatu chotsegulidwa pang'ono.
Njira yathu yopangira opaleshoni imalola kuyang'ana kosavuta kwa kuvulala kwa tendon ya EPL ndikuwonera mwachindunji mumphindi zochepa za 10. Ngati tendon ya EPL yavulala, ikhoza kukonzedwa mwachindunji. Njirayi imathandiza kupewa kuphulika kwa tendon yachiwiri ya EPL pambuyo pa kukonza mbale ya distal. Ulusi wa EPL tendon ukhoza kuchitika, koma sizinachitike kwa ife.
Pomaliza
Tinakumana ndi vuto lomwe tendon ya EPL inali yosasunthika zaka 7 pambuyo pa opaleshoni, ngakhale kuti zomangira zomwe zimagwiritsidwa ntchito pokonza mbale ya volar zinali zodziwika mu chipinda chachitatu. Njira yathu yopangira opaleshoni imachepetsa chiwopsezo cha kuphulika kwa tendon ya EPL pambuyo pokhazikika kwa volar plate for distal radius fractures.
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