Ibice bya radiyo ya kure biri mubice bikunze kuvunika mubasaza. Abantu bari hagati yimyaka 50 na 75 basobanuwe nkabasaza. Umubare wimvune ya radiyo ya kure yiyongera uko umwaka utashye uko intera igenda kubantu bakuze yiyongera. Ikibazo gishyushye mu mpaka zerekeranye no kuvunika kwa radiyo kure: Harakenewe kubagwa?
Icyorezo cya Epidemiologiya
Ibice bya radiyo ya kure bingana na 18% byimvune zose zumubiri kubantu bakuze. Abaturage ba Caucase, abarwayi b’abagore, na osteoporose ni ibintu byingenzi bishobora kuvunika radiyo ya kure. Mubyongeyeho, ikubiyemo kandi ibihe byigihe, nkibisaza bikanyerera bikagwa bikunda kuvunika kwa radiyo ya kure mugihe cy'itumba. Ubushakashatsi bumwe bwerekanye ko abarwayi bageze mu za bukuru bafite ubushobozi buke bwo kumenya no sisitemu ya neuromuscular bafite ibyago byinshi byo kuvunika radiyo ya kure (kubera ko abarwayi bafite refleks ikomeye, bazamurambura amaboko kugira ngo bashyigikire hasi iyo baguye, bikaviramo kuvunika). .
Nk’uko imibare ibigaragaza, muri Amerika, ikiguzi cy’ubuvuzi cyavunitse cya radiyo ya kure mu 2007 cyari hafi miliyoni 170 z’amadolari y’Amerika (hafi 1983 US $ / umuntu). Nubwo abarwayi benshi bageze mu za bukuru bafite imvune ya radiyo ya kure bavurwa ku buryo budasubirwaho, umubare w’abarwayi bahitamo kubagwa imbere uragenda wiyongera uko umwaka utashye. Igiciro cyo kwivuza cyo gukosora intraoperative nikubye inshuro eshatu ubuvuzi bwo kubungabunga ibidukikije, kandi binongera amafaranga yo kuguma mubitaro nibindi biciro bijyanye.
Hariho kandi itandukaniro ryakarere n’amoko mugukoresha gukosora imbere kumeneka ya radiyo ya kure. Ubushakashatsi bwakozwe kuri Medicare bwerekanye ko abagore n'Abanyakawasiya bakunze kubagwa, kandi uburyo bwo guhitamo imbere ni 4,6% kugeza 42.1%. Kandi basanze abaganga bahuguwe kubaga intoki bishoboka cyane ko bahitamo kubagwa.
Isuzuma rya Clinical
Uburyo bwo gukomeretsa umurwayi hamwe n’ibibazo by’ibanze bigomba kugaragara mu mateka y’ubuvuzi, harimo aho ububabare, ibikorwa bikora, n’urwego rw’ubumuga. Muri icyo gihe, birakenewe kandi gusobanukirwa ikiganza cyiganje cyumurwayi, ibyo akunda bisanzwe, nakazi k'umurwayi. Byongeye kandi, ni ngombwa kumenya niba umurwayi afite osteoarthritis cyangwa sequelae bigira ingaruka kumikorere yibihimba byanduye mbere yimvune. Muri bo, kubaza abarwayi bageze mu zabukuru niba bakeneye gukoresha inkoni igihe bagenda kandi niba bashobora kwiyitaho mu buzima bwa buri munsi ni ngombwa cyane mu gusobanukirwa ibyo abarwayi bakeneye ndetse no gutegura gahunda yo gusuzuma no kuvura.
Mugihe cyo kwisuzumisha kumubiri, birakenewe gusuzumwa buri gihe kandi byuzuye kuboko k'umurwayi kuva kure kugera hafi. Gutanga amaraso yintoki bizwi na capillary reill test hamwe na radial na ulnar pulse. Imiterere yimyumvire yumutima wa median, ulnar nerv na radial nervice yabonetse mugupimisha ingingo ebyiri ivangura no gupima urumuri. Indwara ya syndrome ikarishye ya carpal mu bice bya radiyo ya kure ni 5.4% kugeza 8,6%, bityo rero hakwiye kwitabwaho byumwihariko kuri paresthesia no kunanirwa mu gice cyo gukwirakwiza imitsi yo hagati. Imikorere ya moteri yumurwayi yasuzumwe hasuzumwa imitsi yimbere ninyuma hagati, imirasire, median, na ulnar. Byongeye kandi, usuzuma agomba kandi kwita ku miterere y’igikomere cy’uruhu rw’umurwayi (nka ecchymose, edema, inguni imeze nk’ibibyimba, n'ibindi) kugira ngo amenye niba ari ukuvunika gukinguye. Bitewe nuburyo bubi bwimyenda yoroheje hamwe nuruhu ruto mubasaza, kuvunika kwa radiyo kure akenshi guherekezwa no gukomeretsa uruhu. Iyo kugabanya gukwega gufunze gukoreshwa, gukora neza birasabwa cyane cyane kugirango wirinde kwangirika kwinyongera.
Isuzuma
Isuzuma rya radiografiya ivunika rya radiyo ya kure mubisanzwe harimo anteroposterior, kuruhande, na radiyo ya radiyo. Kurakara no kuzunguruka kuvunika birashobora kumvikana mugupima amashusho kugirango hamenyekane niba hari kugabanuka, niba igice cyacitse cyatangiye, kandi niba umurongo uhuriweho wuzuye. Ibindi bipimo byerekana amashusho harimo: kugabanuka kwa ulnar (bivuze 22 °, intera: 19 ° -29 °), uburebure bwa radiyo ya kure (11-12 mm), hamwe na palmarike ya radiyo ya kure (bivuze 11 °, intera: 11 ° -14.5 °). X-imirasire yintoki ninkokora nayo irafatwa kugirango harebwe niba ibyangiritse byangiritse cyangwa inkokora idahungabana. Nyuma yo kugabanuka no gufunga immobilisation, indi firime X-ray irasabwa gusuzuma niba ibipimo bya radiyo ya kure byateye imbere. Mubuvuzi, isuzuma rya CT rikoreshwa kenshi mugufasha mugusuzuma no gutondekanya ibice byavunitse (urugero, niba hari kuvunika imbere, niba hari kuvunika cyangwa gukata), kugirango tumenye neza gahunda yo kuvura kubaga. Muri icyo gihe, isuzuma rya CT naryo rirakenewe kugirango risuzumwe neza mugihe ukora osteotomy na orthopedic ivura malunion.
Kuvura
Ukurikije amabwiriza yo kuvura AAOS, nta bwumvikane ku ikoreshwa ry’imicungire y’ibidukikije cyangwa yo kubaga imvune ya radiyo ya kure. Nta bwumvikane buke bwo gukoresha volar gufunga plaque cyangwa gukosora insinga za Kirschner mugukiza kubaga. Kodama n'abandi basaba ko hakoreshwa sisitemu yo gutanga amanota kugirango umenye niba umurwayi akeneye kubagwa. Naho ku barwayi bageze mu zabukuru bafite imyaka 50, ubwoko bwavunitse, impinduka mu bipimo bya radiografiya bifatanyiriza hamwe, imyaka, ikiganza cyiganje, hamwe n’umwuga w’umurwayi bigomba gukoreshwa kugirango hamenyekane gahunda yo kuvura. Mu isesengura ryinshi ryisubiramo, urwego rwo gutangira igice cya radiyo ya volar cyangwa dorsal intera nyuma yo kugabanuka, niba kuvunika kwarimo ijosi rya ulnar, guhindagurika kwa palmar, no guhinduka muri ulna ya kure byari bifitanye isano cyane nubuvuzi.
Umuti wo kubungabunga ibidukikije
Hagati yacu, ivunika rya radiyo ya kure yimuwe cyane mubisanzwe irimurwa hamwe nisukari yisukari yisukuye hejuru yinkokora kugirango igabanye kuvuga no hejuru yinkokora (reba Ishusho 1). Niba kwimura kuvunika ari binini, isukari ya sukari igomba gukorwa nyuma yo kugabanuka gufunze. Menya ko mugihe ukora plaster splint immobilisation, urugero rwa immobilisation rugomba guhagarara kumpera yurutoki, kugirango byorohereze urutoki kandi birinde gukomera. Gukoresha bande ya elastike kugirango igabanye gukosorwa irashobora gufasha mukugabana. Ubwoko bwo kuvunika bugena uburyo bwo kugabanya gufunga. Nibiba ngombwa, anesthesia ya hematoma yaho irashobora gutoranywa, hanyuma kugabanya gukwega gukururwa no gukurura intoki (indangagaciro nintoki zo hagati) kugirango ukosore ubumuga kandi ugarure guhuza radiocarpal. Kugabanya gukwega mubisanzwe bikorwa hakoreshejwe uburyo bwo kuvunika. Kugabanya gukurura indege zitandukanye birasabwa kurangiza kugarura ligamente no kugarura guhuza ibice byavunitse, capitulum nabasazi. Ku ndege ya coronale, subiza anatomical ihuza ulna na radiyo, agace ka magufa ka kure hamwe na radiyo. Kugabanuka kuvunika bisanzwe kwa Colles bisaba umufasha gufata igikumwe cyumurwayi mukiganza kimwe nintoki 4 zumurwayi mukundi kuboko, agashyiraho uburyo bwo gutandukanya ibice byavunitse na metafizisi ya radiyo, bikomeza gukwega birebire, hanyuma palmar. Flexion na ulnar gutandukana kugirango bifashe kugabanya ibice byavunitse. Ku barwayi bageze mu zabukuru bafite ibyangiritse byoroshye, birasabwa gukoreshwa neza mugihe cyo kugabanya kugirango wirinde uruhu (ipamba irashobora gukoreshwa mugihe cyo kugabanya). Nyuma yo kwimurwa, hakozwe isuzuma ry'imitsi.
![Kumeneka kure ya radiyo]()
Igishushanyo cya 1. (B) na (C) anteroposterior na radiografi yerekana impande zerekana umurwayi neza. Igice cya plaster ntikirenga umutwe wa metacarpal kugirango intoki zishobore kugenda bisanzwe.
Kuvura ibikorwa
Uburyo bwo kubaga abarwayi bageze mu zabukuru bafite imvune ya radiyo ya kure harimo: kugabanya gufunga no gukosorwa hanze, gutunganya insinga za Kirschner, kugabanya gufungura, gukosora ibyapa bya volar / dorsal, hamwe no gushiraho icyapa cya dorsal (reba ku gishushanyo cya 2).
![Isahani yo gufunga imikindo]()
Ubundi bwoko bwo kugabanya gufungura no gukosora isahani ya dorsal ikoreshwa cyane cyane mukuvura kuvunika imbere. Irashobora kugabanya ubuso bwa arctular munsi yerekwa itaziguye itambuye ingirangingo ya ligamente kuruhande rwa volar kuruhande rwikiganza, bikagabanya ibyago byo guhungabana kwa radiocarpal nyuma. Niba kuvunika kwa volar lunate birimo, bigomba guhagarikwa. Ku barwayi bafite imvune ya radial cyangwa ibikomere byinshi, isahani yubatswe irashobora gukoreshwa kugirango igabanuke binyuze mu kugarura ligament. Muri icyo gihe, icyapa gikurura nacyo gikwiranye no kugabanya no gutunganya ibice bya radiyo byacitse kandi bya osteoporotic. Isahani yakuweho nyuma y'ibyumweru 12 nyuma yo kubagwa, kandi hashobora kugerwaho ingaruka nziza zo kuvura.
Isahani ifunga plaque irashobora kunoza kugabanuka kwa radiyo no guhindagurika, kandi ibibazo byikibazo ni bike. Ugereranije nisahani ya dorsal, imbaraga zo gufata ingingo zanduye zirashobora kunozwa cyane mugihe cyamezi 6 nyuma yo kubagwa, kandi imikorere nububabare birashobora kunozwa. Ingorane nko gusubiramo ibyapa bya dorsal no kurakara kwa extensor digitorum tendon bibaho mugihe kigera kuri 30%. Kandi ingaruka zo gukosora plaque ya volar nayo ni nziza kuruta iy'umugozi wa Kirschner cyangwa ikosora hanze.
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