Waba uzi gukosora kuvunika metacarpal?

Ivunika rya Metacarpophalangeal ni ivunika risanzwe mu ihahamuka ryamaboko, bingana na 1/4 cy’abarwayi bose bahahamutse. bitewe nuburyo bworoshye kandi bugoye bwikiganza nigikorwa cyacyo cyiza cya moteri, gucunga kuvunika intoki nibyingenzi cyane kandi bigoye mubuhanga kuruta kuvura izindi mvune ndende.

Kugenzura ihagarikwa ryimvune nyuma yo kwimurwa ni urufunguzo rwo gutsinda imiti ivura metacarpophalangeal. Kugirango ugarure imikorere yukuboko, kuvunika akenshi bisaba gukosorwa neza, kandi mugihe cyashize, gukosora hanze hamwe na plaster cyangwa gukosora imbere hamwe na pine ya Kirschner byakoreshwaga cyane, ariko akenshi bitewe no gukosorwa nabi cyangwa igihe kirekire cyo gukosora, bikaba bidafasha cyane gukira kwimikorere ya metacarpophalangeal.

Uburyo bugezweho bwo kuvura bugenda bukoresha imbaraga zo gukosora imbere, nka micro plate plate fixation.

Amahame yo kuvura

Amahame yo kuvura kuvunika metacarpal na phalangeal yamaboko ni: guhinduranya anatomic, kumurika no gukosorwa gukomeye, kugenda hakiri kare no gukora imyitozo ikora. Amahame yo kuvura kuvunika kwimbere-arctular na periarticular yamaboko ni kimwe nayandi mavunja yimbere-arctular: kugarura anatomiya yubuso bwibikorwa nibikorwa byambere. Kuvura imvune za metacarpal na phalangeal zigomba guharanira kugera kuri anatomic repositioning nta kuzunguruka, kuruhande, cyangwa kwimura inguni> 10 ° kuruhande rwikiganza. Niba impera yamenetse ya metacarpal izunguruka cyangwa yimuwe nyuma kuruhande, bizahindura inzira isanzwe yo guhindagurika no kwaguka kwurutoki, bigatuma itera cyangwa igwa kuva murutoki rwegeranye mugihe cyo guhindagurika, bigira ingaruka kumikorere yintoki; mugihe kwimura inguni> 10 ° kuri dorsum yimikindo bizasenya neza guhuza igufwa ryamagufwa nigitereko, byongere imbaraga zo kurwanya no kwaguka kwimitsi ihindagurika no kwaguka, kandi bigatera ibikomere bidakira kumitsi, bitera ibyago byo guturika. ibyago byo guturika.

Ivunika rya metacarpal na phalangeal rirasa mubushobozi bwabo bwo kwihanganira ubumuga bwo guhinduranya, mugihe metacarpal yihanganira kugabanuka kwimuka no kwimuka kwa dorsal neza kuruta phalangeal. Carpometacarpal hamwe na metacarpophalangeal ingingo zirashobora kwishyura indishyi zinguni za metacarpal, kandi urutoki ruto rwa buri mwaka rwahujwe neza nuburinganire bwimiterere ya metacarpal kuruta urutoki rwo hagati. Kugabanya imbaraga zo gufata kubera kugabanuka kwimitsi y'intoki bigaragarira gusa mugihe metacarpal ihagaritse hejuru ya 30 ° kuruhande rwa dorsal.

Uburyo bwo kubaga

Uburyo bwo kubaga kuvunika metacarpal biroroshye kandi mubisanzwe bikoresha uburyo bwa dorsal, nkuko bigaragara ku gishushanyo cya 4-14. Metacarpal ya kabiri irashwanyaguritse mu buryo bwa metacarpal ya gatanu iterwa ulnarly, naho metacarpal ya gatatu n'iya kane akenshi iba ikozwe hagati. Niba metacarpal ebyiri zegeranye zikorerwa icyarimwe, icyuma cya S giciriritse gikoreshwa mukuzirikana ibibanza byombi byo kubaga.

Guhitamo uburyo buhamye

Hano haribikoresho byinshi byo gukosora imbere kumeneka ya metacarpophalangeal, nka pine ya Kirschner, imashini, amasahani hamwe namakadiri yo gukosora hanze, muribyo bikoreshwa na Kirschner na microplate. Kubuvunika bwa metacarpal, gukosora imbere hamwe na microplate bifite ibyiza bigaragara kuruta gukosorwa hamwe na pin ya Kirschner kandi birashobora guhitamo; kubijyanye no kuvunika kwa phalangeal, microplate irakunzwe muri rusange, ariko mugihe habaye ingorane zo gushyira imiyoboro mugice cya kure cya phalangeal yegeranye no kuvunika umutwe, gukosora imbere hamwe na pin ya Kirschner byambukiranya, bikaba byiza cyane mugukiza imikorere yintoki zanduye; kubuvuzi bwavunitse hagati ya phalangeal, pin ya Kirschner igomba guhitamo.

1 inshinge ya Kirschner: 

Urushinge rwa Kirschner rwo gukosora rwakoreshejwe mu ivuriro mu myaka irenga 70 kandi ni rwo rwakoreshejwe cyane mu gutunganya ibintu imbere mu kuvunika metacarpophalangeal, byoroshye gukora, mu bukungu no mu bikorwa, kandi ni bwo buryo bwo gukosora imbere, nk'uko bigaragara ku gishushanyo cya 4-15. nkibisanzwe bikoreshwa imbere mugukiza kuvunika intoki, biracyakoreshwa cyane. 

Ibyiza byo gukosora imbere hamwe na pin ya Kirschner:

① byoroshye gukora kandi byoroshye gukoreshwa; 

Kwiyambura imyenda yoroheje, kutagira ingaruka nke kumaraso kumeneka yamenetse, ihahamuka rito ryo kubaga, kandi bikaba byiza gukira kuvunika; 

Kubona byoroshye pin gusubirana; 

Cost igiciro gito kandi gikoreshwa cyane, gishobora gukoreshwa kuvunika intoki nyinshi (nk'imvune zo mu nda-arctular, kuvunika gukabije no kuvunika kwa phalangeal). 

Ibibi byo gukosora imbere: 

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(2) nta ngaruka zo kwikuramo kumpera yamenetse; 

(3) ubuso bwangiritse bwangijwe no guhuza ibice; 

(4) gukosora ingingo hamwe no guhagarika imitsi birinda ingingo yintoki gukora imyitozo hakiri kare kandi bigira ingaruka kumikorere.

Hamwe niterambere ryihuse ryubuhanga bugezweho bwo gutunganya no gukoresha ibikoresho, gutunganya imbere hamwe na pine ya Kirschner byarushijeho kunonosorwa, kandi ibyinshi muri byo birashobora gukosorwa bitarenze urugingo, hamwe no kwangirika gukabije kwinyama zoroheje hamwe nuduce twizengurutse ingingo, kandi bitagize ingaruka kumahugurwa yo gutangira hakiri kare nyuma yibikorwa. Hifashishijwe imashini ya C-arm X-ray, imanza zimwe na zimwe zirashobora kugera ku bisubizo bishimishije mugukomeza gufunga gukosora imbere imbere hamwe na pinini ya Clinique, bikagabanya cyane kwangirika kwinyama zoroshye zaho ndetse ningaruka kumaraso yatanzwe kugeza kumeneka, bityo bigatera gukira kuvunika. 

Kwirinda gukosora imbere hamwe na Kristen pin: 

Gukosora amagufwa manini hamwe na Kristen pin ya 1.0 ~ 1,2 mm ya diametre, hanyuma umenye aho winjirira nicyerekezo cyo kwinjira ukurikije icyerekezo cyumurongo wacitse; 

② Hagamijwe kugarura umurongo wingufu, kuvunika imbere-articular bigomba guhindurwa muburyo budasanzwe kandi bigakosorwa cyane; 

③ Ntabwo amagufwa yose akeneye gukosorwa hamwe na pin ya Kristen, kandi hashingiwe ku kugera ku iherezo ry’imvune, pin ya Kristen igomba gukoreshwa bike bishoboka; 

Pin Amabati ya Kristen ntabwo akosorwa binyuze mumutwe cyangwa dorsal tendon membrane y'urutoki kugirango habeho imyitozo ikora hakiri kare bishoboka; 

Should hagomba kubaho gahunda ihamye yo gutangira kandi ntisubiremo ibikorwa bidakorewe, bitabaye ibyo guhagarika kuvunika bishobora guhonyorwa cyane cyangwa ntibishobora gukosorwa; 

⑥ muri rusange pin ya Kirschner igomba gushyirwa muruhu kugirango igabanye amahirwe yo kwandura kandi ntabwo bigoye kuyikuraho.

2 plate Isahani ya micacarpal: 

Gukosora imbere imbere kuvunika kwamaboko nibyo shingiro ryimyitozo ngororamubiri hakiri kare kandi birakenewe kugirango ugarure imikorere myiza yintoki.AO tekinike yo gukosora imbere isaba guhinduranya neza anatomique yimpera yimvune no guhagarika impera yimiterere yimikorere, bikunze kwitwa gukosorwa gukomeye, kugirango yemere ibikorwa byogukora hakiri kare. AO ishimangira kandi uburyo bwo kubaga byibasiye byibanda ku kubungabunga amaraso. Microplate ikosora imbere yo kuvunika intoki itanga ibisubizo bishimishije mubijyanye nimbaraga, ituze ryumuvunika wumuvuduko nigitutu hagati yimpera. Kubyerekeranye no gukira nyuma yibikorwa, igihe cyo gukira kuvunika nigipimo cyanduye ugereranije, efficacy ya plaque ya titanium ifatwa nkibyiza cyane kuruta iy'ibiti bya kerf, kandi kubera ko igihe cyo gukiza kuvunika nyuma ya plaque ya titanium ari gito cyane ugereranije nubundi buryo bwo gukosora, bityo bikoroha gusubira mubuzima busanzwe bwumurwayi.

Ibyiza bya microplate yo kuvura imbere: 

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(3) imyitozo ikora hakiri kare iremewe muri rusange nyuma yo gukosora microplate, ifasha kugarura imikorere yintoki. 

3. Microscrews.

Microscrews yo kuvunika izengurutse cyangwa ndende ya oblique ifite ituze risa nkibisahani byibyuma, ariko agace koroheje hamwe nu gice cyo kwambura periosteal ni gito ugereranije nicyuma cyo gusana ibyuma, bifasha mukurinda umuvuduko wamaraso kandi bijyanye nigitekerezo cyo gukora byibasiye. Nubwo hariho ubwoko bwa T- na L bwo gucikamo ibice byegeranye, gusura nyuma yo gutangira gukorerwa ni bibi cyane kuruta kuvunika diaphyseal, kandi microscrews ifite ibyiza bimwe byo gukomeretsa imbere no hagati. Imiyoboro yinjiye mu magufa irashobora kwihanganira umutwaro uremereye, bityo rero gukosora birakomeye kandi birashobora gushyira igitutu hagati yimpera zavunitse kugirango bizane ibice byavunitse bihuze cyane, bigabanya igihe cyo gukira kandi byorohereza gukira kuvunika, nkuko bigaragara ku gishushanyo cya 4-18. microscrews ikoreshwa cyane cyane kumeneka ya oblique cyangwa spiral ya diaphysis hamwe no kuvunika imbere-articular avulsion avunika amagufwa manini. Ni ngombwa kumenya ko uburebure bwurudodo rwacitse bugomba kuba byibuze inshuro ebyiri zumurambararo wa diaphysis mugihe ukosora ibice byavunitse cyangwa bizunguruka byikiganza cyamaboko ukoresheje microscrew yonyine, kandi byibuze inshuro eshatu ubugari bwumurambararo wa diameter mugihe ukosora ibice bivunika byimbere.

4. Miniature yo hanze ikosora.

Ivunika rya metacarpophalangeal rimwe na rimwe biragoye gusubiramo muburyo budasanzwe ndetse no kubagwa kubagwa cyangwa ntibishobora gukosorwa imbere imbere kuko igufwa ryamagufa ryangiritse. Ikirangantego cyo gukosora cyemerera kuvunika kugabanutse gukira no kugumana uburebure bwacyo bitewe no gukwega, bigira uruhare runini, nkuko bigaragara ku gishushanyo cya 4-19. Ishyirwaho ryimyitozo yo hanze itandukanye kuri metacarpal zitandukanye: metacarpals ya 1 na 2 zishyirwa kuruhande rwa radiyo ya dorsal, metacarpal ya 4 na 5 zishyirwa kuruhande rwa dorsal ulnar, naho metacarpal ya 3 igashyirwa kumurongo wa dorsal cyangwa dorsal ulnar ukurikije uko ibintu byifashe, bikarinda gukomeretsa aho byinjira kugirango hirindwe ko byinjira. Ivunika rifunze rirashobora gufungwa no gusubizwa munsi ya X-ray, kandi hashobora gukorwa uduce duto kugirango dufashe kwimuka niba kuyisubiramo atari byiza.

Ibyiza byo gutondekanya hanze.

(1) biroroshye gukora kandi irashobora guhindura ibintu bitandukanye byimpera zimena;

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