Kumeneka kwaguka nyuma yo gukosora plaque ikomeje kuba ikibazo gikomeye mugusana ibice bya radiyo ya kure. Indwara ikunze kwibasirwa cyane ni extensor pollicis longus (EPL), kuko igarukira muri groove ya EPL. Indwara zivugwa ko EPL yamenetse nyuma yo gushira volar ni 0.29% –5.7%.
Ibyago byo gutinda kwa EPL gutinda byiyongera mugihe habaye imiyoboro ya dorsal, gukomeretsa kubwo gucukura mu buryo butaziguye, hamwe nuduce twa dorsal, cyane cyane kuvunika kwizinga ryigituntu cya Lister. Isuzumabumenyi rya radiografiya yerekana ibice byavunitse bya radiyo ya kure biragoye kubera geometrike igoye ya radiyo ya kure hamwe nubushobozi bwo kuvunika dorsal. Dorsal tangential view niyo yonyine ishoboka yo kureba imbere ya cortex ya dorsal kugirango ibone isuzuma ryizewe ryintera iri hagati yisonga rya screw na cortex.
Ubuhanga bwo kwirinda imvune ya extensor tendon harimo gukoresha imiyoboro ya monocortique no kwirinda kwinjirira hejuru ya dorsal; ariko, ubwo buhanga bushobora kugabanya ubukanishi bwo gusana kuvunika. Kubwibyo, gukosora bicortical rimwe na rimwe birasabwa. Kugabanya ibyago byo gukomeretsa kwaguka, intego zibanze zo gukosora kuvunika no gutuza ntigomba guhungabana.
Uburyo bushya bwo kubaga
Turasobanura ubuhanga bushya kugirango tugabanye ibyago byo guturika kwa EPL nyuma yo gukosora plaque ya volar ikosora ivunika rya radiyo ya kure tutagabanije uburebure bwa screw cyangwa ngo ikureho ibisenge byamazu. Muri make, tekinike ikubiyemo gufungura igice cya gatatu binyuze mumutwe muto.
Niba umugozi winjiye muri cortex ya dorsal hanyuma ugasohoka mugice cya gatatu: twakuye tendon ya EPL kumurima wacyo hanyuma dufunga icyumba dushushanya retinaculum dusiga EPL kuri retinaculum yasanwe.
Niba umugozi utaguye mugice cya gatatu: dusiga EPL tendon mugice cya gatatu. Ikimenyetso cya tekinike yacu ni mubarwayi bafite ivunika rya radiyo ya kure bavuwe hamwe na plaque zifunga volar, kuvunika hamwe nuduce twa dorso-parietal cyangwa imigozi ishobora kwinjira muri cortex ya dorsal cyangwa kwangiza imitsi ya EPL ikikije igituntu cya Lister. Mu barwayi bafite imvune ya radiyo ya kure hamwe nuduce twa dorsomedial, turacukura umwobo kugirango twinjire muri cortex ya dorsal hanyuma duhitemo imigozi yuburebure buhagije kugirango dukosore ibice bitameze neza.
Kugabana urubanza
Turasangiye ikibazo aho EPL yakuwe mucyumba cya gatatu kubera gusohoka kwa screw mu gice cya gatatu mugihe cyo gukosora isahani yo kuvunika kwa radiyo ya kure hamwe nuduce twa dorsomedial. Twemeje ko tendon ya EPL itameze neza imyaka 7 nyuma yo kubagwa, nubwo umugozi wagaragaye mugice cya gatatu.
Uru rubanza rwari umukecuru w'imyaka 67 ufite isuzumabumenyi rya radiyo yo mu nda idahungabana kandi ivunika iburyo bwa dorsal (Ishusho 1A-E). Nta mateka yo kunywa itabi, diyabete cyangwa kunywa inzoga. Irashobora kugenda nta muntu ugenda.
![kuvunika kwa radiyo kure]()
Igishushanyo 1. Kwerekana amashusho mbere yo kwerekana byerekanaga gucikamo ibice hagati yimitsi ya radiyo ya kure.
A na B: Imirasire X-mbere,
C na D: sagittal na axial reba amashusho ya tomografi yabazwe,
E: Ishusho ya 3D yabazwe. Ibice bya Dorsal medial lunate ibice nibice bya dorsal apical (asterisks yera) biragaragara.
Ubuhanga bwo kubaga
Twakoresheje sisitemu yo kuvunika hamwe na plaque ya volar. Muburyo budasanzwe, twacukuye tunyuze kuri cortex dorsal hanyuma duhitamo umugozi muremure bihagije kugirango tubone cortex dorsal kuko igice cya dorsomedial kitari gihamye (Ishusho 2).
Habazwe kugirango bafungure igice cya gatatu nyuma yo gukosora screw.
Kubera ko umugozi winjiye mu gice cya gatatu hanyuma ugasohoka (Isanamu 3A), fungura byuzuye igice cya gatatu hanyuma wimure imitsi ya EPL mu mwobo wacyo (Ishusho 3B).
Igice cya gatatu cyahise gifungwa no kudoda retinaculum (Igishusho 3C, D), hanyuma EPL ishyira hejuru ya retinaculum yasanwe (Ishusho 3 E).
Nyuma yo kubagwa, umurwayi yagiye ku ivuriro ry’ibitaro by’ibitaro byacu kugeza igufwa rimaze gukira. Umurwayi ntashaka gukuraho ibyuma.
Gukira nyuma yo gukira
Nyuma yimyaka irindwi nyuma yo kubagwa, umurwayi yasubiye mu bitaro kugira ngo yongere kwisuzumisha kubera osteoporose. Ukuboko kw'iburyo ntabwo guhagarikwa. Ishusho ya X-yerekana kuvunika gukize hamwe no gusohora dorsal ya feri ya kure. Urutoki rw'umurwayi rwaguwe neza, kandi imitsi ya EPL ntabwo yari ifite umuheto ugaragara.
Twabisabye, umurwayi yemeye gukuraho ibyuma no gusuzuma imitekerereze ya extensor. Muburyo butandukanye, twasuzumye icyerekezo cya EPL dukoresheje dorsal hanyuma dufungura igice igice cya gatatu n'icya kane.
Ikirangantego cya EPL cyari giherereye hanze yicyiciro cya gatatu mumwanya umwe nkibikorwa byabanjirije iki, kandi imitsi ntiyarakaye.
Twemeje ko umugozi winjiye mu gice cya gatatu mugihe uduce twagutse twintoki twakuweho.
Hanyuma, twakosoye imishumi yingoboka hanyuma dukuraho ibyuma. Isuzuma ryanyuma amezi 2 nyuma yo gukuraho ibyuma, umurwayi nta bubabare yari afite kandi yaguye igikumwe cyuzuye.
Muganire
Muburyo bwacu, nyuma yo gukosora plaque ya volar yamenetse ya radiyo ya kure, twafunguye igice cya gatatu tunyuze mugice cya ulnar ya cm 2 z'uburebure kugeza igituntu cya Lister. Twagaragaje mu buryo butaziguye icyerekezo cya EPL hamwe na etage ya gatatu yaguye mugice cya gatatu twikuramo buhoro buhoro.
Niba umugozi winjiye muri cortex ya dorsal mukigice cya gatatu cyangwa ukagira imyanda ya dorso-parietal, ntitwigeze dusimbuza insimburangingo cyangwa ibice, ahubwo twafunguye igice cya gatatu rwose dukuramo EPL kumurongo wacyo. Twahise dufunga icyumba dushushanya retinaculum mugihe dusimbuza EPL tendon mugice cya gatatu.
Niba umugozi utaguye mugice cya gatatu, twavuye muri EPL tendon mugice cya gatatu cyafunguwe igice.
Tekinike yacu yo kubaga ituma igenzura ryoroshye ryimvune ya EPL hamwe no kubona neza mu minota 10 yongeyeho. Niba EPL ikomeretse, irashobora gusanwa muburyo butaziguye. Ubu buryo bufasha kwirinda icyiciro cya kabiri cya EPL guturika nyuma yo gukosorwa kure ya radiyo. EPL tendon bowstring irashobora kubaho, ariko siko byagenze muritwe.
Mu gusoza
Twabonye ikibazo aho EPL itameze neza nyuma yimyaka 7 nyuma yo kubagwa, nubwo imiyoboro yakoreshejwe mugukosora icyapa cya volar yagaragaye mugice cya gatatu. Tekinike yacu yo kubaga igabanya ibyago byo guturika kwa EPL nyuma yo gukosora plaque ya plaque ya radiyo ya kure.
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