Unoziva here kugadzirisa metacarpal fracture?

Metacarpophalangeal fractures inowanzoputsika mukukuvara kwemaoko, inoverengera ingangoita 1/4 yevarwere vese vanokuvadzwa nemaoko. nekuda kwekutetema uye kuoma kwechimiro cheruoko uye kushanda kwayo kwakanaka kwemota, manejimendi ekutyoka kwemaoko kwakakosha zvakanyanya uye nehunyanzvi hwakaoma pane kurapwa kwemamwe marefu tubular fractures.

Kuve nechokwadi chekugadzikana kwekutyoka mushure mekugadzirisa zvakare ndiyo kiyi yekubudirira kwe metacarpophalangeal fracture kurapwa. Kuti udzorere kushanda kweruoko, kuputsika kunowanzoda kugadziriswa kwakakodzera, uye munguva yakapfuura, kugadziriswa kwekunze nepurasita kana kugadziriswa kwemukati neKirschner pini kwaiwanzoshandiswa, asi kazhinji nekuda kwekugadzirisa kusina kururama kana nguva yakareba yekugadzirisa, iyo isingaiti kune yekutanga postoperative yekubatanidza kugadziriswa, uye ine simba guru pakugadzirisa basa rekugadzirisa kwemetacarpo, kuunza kushanda kwakaoma kwemetacarpo, kuunza kushanda kwakaoma kwemetacarpobilis.

Nzira dzemazuva ano dzekurapa dzinowedzera kushandiswa kwakasimba kwemukati kugadzirisa, senge micro plate screw fixation.

Kurapa Misimboti

Mitemo yekurapa metacarpal uye phalangeal fractures yeruoko ndeye: anatomic repositioning, chiedza uye chakasimba kugadzirisa, kufamba kwekutanga uye kushanda kwebasa. Mitemo yekurapa kwe-intra-articular uye periarticular fractures yeruoko yakafanana neyeimwe intra-articular fractures: kudzorerwa kweanatomy ye articular surface uye basa rekutanga rekushanda. Kurapwa kwemetacarpal uye phalangeal fractures yeruoko inofanira kuedza kuwana anatomic repositioning pasina kutenderera, lateral angulation, kana angular displacement> 10 ° kusvika kune dorsal chikamu chechanza. Kana kuguma kwekuputsika kwemetacarpal kuchitenderedzwa kana kutamiswa nechemberi pakona, inoshandura nzira yakajairika yekutenderera uye kuwedzera kwekufamba kwemunwe, zvichiita kuti isundire kana kudonha kubva kumunwe wakatarisana panguva yekuputika, inokanganisa kururama kwebasa remunwe; apo angular displacement> 10 ° kusvika kune dorsum yemichindwe ichaparadza kushamwaridzana kwakagadzikana kwepfupa uye tendon, kuwedzera kupikisa uye mararamiro ekufamba kwetendon mukuputika uye kuwedzera, uye kukonzera kukuvadzwa kusingaperi kune tendon, zvichiita kuti njodzi yetendon kuputika. njodzi yekuputsika kwetendon.

Iyo metacarpal uye phalangeal fractures yakafanana mukukwanisa kwavo kushivirira kutenderera kutenderera, nepo metacarpal inoshivirira kupfupisa kutama uye dorsal angular displacement zviri nani pane phalangeal. Iyo carpometacarpal uye metacarpophalangeal majoini anogona kutsiva iyo angular deformity yemetacarpal, uye annular kagunwe kanogadziridzwa zvirinani kune angular deformity yemetacarpal pane index yepakati chigunwe. Kudzikira kwesimba rekubata nekuda kwekupfupika kwemhasuru yemaoko kunoonekwa chete kana metacarpal yakatenderedzwa kupfuura 30 ° kudivi redorsal.

Kuvhiya Nzira

Nzira yekuvhiya yemetacarpal fractures iri nyore uye inowanzoshandisa nzira yedorsal, sezvinoratidzwa mumufananidzo 4-14. Yechipiri metacarpal inoiswa radially nepo yechishanu metacarpal yakachekwa ulnarly, uye yechitatu neyechina metacarpals inowanzo kuchekwa pakati. Kana metacarpals maviri ari padyo akavhiyiwa panguva imwe chete, yepakati S-yakaumbwa incision inoshandiswa kutarisisa ese ari maviri nzvimbo dzekuvhiya.

Yakagadziriswa nzira sarudzo

Kune zvakawanda zvemukati zvekugadzirisa zvinhu zve metacarpophalangeal fractures, zvakadai seKirschner pins, screws, mahwendefa uye kunze kwekugadzirisa mafaira, pakati payo mapini eKirschner uye microplates anonyanya kushandiswa. Kune metacarpal fractures, kugadzirisa kwemukati ne microplate kune zvakanakira zviri pachena pamusoro pekugadzirisa neKirschner pini uye inogona kusarudzwa; for proximal phalangeal fractures, microplate inowanzodiwa, asi kana pane kuoma kwekuisa screws mu distal segment ye proximal phalangeal uye musoro fractures, kugadziriswa kwemukati neyakayambuka Kirschner pini inosarudzwa, iyo inonyanya kubatsira pakugadzirisa kushanda kwechigunwe chakakanganiswa; kuitira kurapwa kwepakati phalangeal fractures, Kirschner pini inofanira kusarudzwa.

1, tsono yaKirschner: 

Kirschner's internal fixation yetsono yakashandiswa mukiriniki kwemakore anopfuura 70 uye ndiyo inonyanya kushandiswa mukati mekugadzirisa zvinhu zvemetacarpophalangeal fractures, iyo iri nyore kushanda, ine mari uye inoshanda, uye ndiyo inonyanya kushandiswa mukati mekugadzirisa nzira, sezvinoratidzwa mumufananidzo 4-15. sekugadziriswa kwemukati kunonyanya kushandiswa kurapa kuputsika kwemaoko, ichiri kushandiswa zvakanyanya. 

Zvakanakira zvemukati kugadzirisa neKirschner pini:

① nyore kushanda uye inochinjika mukushandisa; 

② kubviswa kwematishu akapfava, kushomeka kwekuyerera kweropa pakupera kwekutyoka, kukuvadzwa kudiki kwekuvhiya, uye kunobatsira kuporeswa kwekutyoka; 

③ nyore kudzoserwa kwepini yechipiri; 

④ mutengo wakaderera uye kushandiswa kwakafara, kunoshanda kune akawanda mawoko kuputsika (senge intra-articular fractures, yakanyanya comminuted fractures uye kupera kwephalangeal fractures). 

Kuipa kwekugadziriswa kwemukati: 

(1) kana ichienzaniswa nekugadzirisa kweplate, kugadzikana kwakashata, uye kupfupisa uye kutenderera kutenderera hakugoni kudzorwa nepini imwe chete, kazhinji kupfuura mapini maviri anodiwa pakugadzirisa muchinjikwa; 

(2) hapana kudzvinyirira mhedzisiro pamagumo ekuputsika; 

(3) iyo yakabatana pamusoro inokuvadzwa ne-cross-joint fixation; 

(4) kugadziriswa kwekubatana uye kuvharwa kwetendon kunodzivirira kubatanidzwa kwemaoko kubva pakurovedza kwekutanga uye kunokanganisa kushanda kwekugadzirisa.

Nekukurumidza kukurumidza kwemaitiro emazuva ano ekugadzirisa mukati uye midziyo, kugadziriswa kwemukati neKirschner pini kwave kuchiwedzera kucheneswa, uye mazhinji acho anogona kugadziriswa pasina kuyambuka mubatanidzwa, pasina kukuvadzwa kudiki kune zvinyoro zvinyoro uye tendon zvakapoteredza mubatanidzwa, uye pasina kukanganisa yekutanga postoperative joint function training. Nekubatsirwa kweC-arm X-ray muchina, zvimwe zviitiko zvinogonawo kuwana mhedzisiro inogutsa nekuvharwa kuderedzwa kwekugadziriswa kwemukati neClinique pins, zvichiwedzera kuderedza kukuvadzwa kwenzvimbo dzakapfava matishu uye kukanganiswa kweropa rekupa kusvika kumagumo ekuputsika, nokudaro kukurudzira kuporeswa kwekuputsika. 

Chengetedzo yekugadziriswa kwemukati neKristen pini: 

① Gadzirisa mabhonzo akakura ane maKristen pini e1.0 ~ 1.2 mm muhupamhi, uye sarudza nzvimbo yekupinda uye negwara rekupinda zvinoenderana negwara remutsara wekutsemuka; 

② Nechinangwa chekudzoreredza mutsara wesimba, intra-articular fractures inofanirwa kudzoreredzwa neanatomically uye yakasimbiswa zvakasimba; 

③ Haasi ese mapfupa emapfupa anoda kugadziriswa neKristen pini, uye pasi pemamiriro ekuwana kugadzikana kwemagumo ekutyoka, Kristen pini anofanirwa kushandiswa zvishoma sezvinobvira; 

④ Kristen mapini haagadzirwe kuburikidza netendon kana dorsal tendon membrane yemunwe kugadzira yekutanga inoshanda maekisesaizi zvakanyanya sezvinobvira; 

⑤ panofanira kunge kune chirongwa chakasimba chepreoperative uye kwete kudzokorora kuvhiyiwa intraoperative, kana zvisina kudaro chivharo chekuputsika chinogona kunyanya kupwanyika kana kusagadziriswa; 

⑥ kazhinji pini yeKirschner inofanira kuiswa muganda kuti ideredze mukana wehutachiona uye haina kunetsa kuibvisa.

2, Metacarpal micro plate: 

Kugadziriswa kwakasimba kwemukati kwekuputsika kwemaoko ndiyo nheyo yekutanga kushanda kwekushanda uye inofanirwa kudzorera basa rakanaka remaoko.AO mukati mekugadzirisa nzira inoda kunyatsogadzirisa anatomical repositioning yekuguma kwekuputsika uye kugadzikana kwekuguma kwekuputsika mumamiriro ekushanda, iyo inowanzonzi kugadzirisa kwakasimba, kuitira kubvumira kufamba kwekutanga kwekushanda.AO inosimbisawo kuyerera kweropa zvishoma nezvishoma, iyo inotarisa pakuvhiya kweropa. AO inosimbisawo maitiro ekuvhiya ane zvishoma anotarisa pakuchengetedza kuyerera kweropa. Microplate mukati mekugadzirisa kwekuputsika kwemaoko kunopa migumisiro inogutsa maererano nesimba, kugadzikana kwekuguma kwekuputsika uye kudzvinyirira pakati pemigumo. Mukutaura kwe postoperative yekushanda kupora, kuputsika nguva yekuporesa uye hutachiona hwehutachiona hunofananidzwa, kushanda kwe micro titanium plates kunofungidzirwa zvakanyanya zviri nani kudarika kerf pins, uye nokuti nguva yekuporesa kuputsika mushure me micro titanium plate fixation yakanyanya kupfupika kupfuura yeimwe nzira dzekugadzirisa, zvichiita kuti zvive nyore kudzoka kwekutanga kuhupenyu hwehupenyu hwemurwere.

Zvakanakira zve microplate yemukati kugadzirisa kurapwa: 

(1) zvichienzaniswa nepini kerf, microplate screws ine histocompatibility iri nani uye mhinduro yetishu; 

(2) kugadzikana kweplate chipikiri yekugadzirisa system uye kudzvanywa pamagumo ekuputsika kunoita kuti kuputsika kuswedere kune anatomical repositioning, yakachengeteka kugadzirisa, iyo inobatsira kupora kuporeswa; 

(3) kurovedza muviri kwekutanga kunowanzo kubvumidzwa mushure mekugadzirisa microplate, iyo inobatsira kudzoreredza basa remaoko. 

3. Zvisikuru.

Microscrews for spiral or long oblique fracture fixation ine kugadzikana kwakafanana semahwendefa esimbi, asi nzvimbo yakapfava uye periosteal stripping nzvimbo idiki pane iyo yesimbi plate fixation, iyo inobatsira kuchengetedzwa kwekuyerera kweropa uye zvinoenderana nepfungwa yekushomeka kwekushanda. Kunyangwe paine T- uye L-mhando splints ye proximal joint fractures, iyo postoperative yekudzoka kushanya kune hurombo pane iyo ye diaphyseal fractures, uye microscrews ine zvimwe zvakanakira intra- uye periarticular fracture fixation. Zvisungo zvakakanyiwa mubhonzo cortex zvinogona kumira zvakanyanya kushushikana mutoro, saka kugadzirisa kwakasimba uye kunogona kuisa kumanikidza pakati pemigumo yekuputsika kuti iunze nzvimbo dzekuputsika muhukama hwepedyo, izvo zvinopfupisa nguva yekuporesa uye kufambisa kuporeswa kwekuputsika, sezvakaratidzwa muMufananidzo 4-18. ma microscrews anonyanya kushandiswa kune oblique kana spiral fractures ye diaphysis uye intra-articular avulsion fractures yemapfupa makuru makuru. Zvakakosha kuziva kuti kureba kweshinda yekutsemuka kunofanirwa kunge kuri kaviri dhayamita yediaphysis kana uchigadzirisa oblique kana spiral kuputsika kwechidzitiro cheruoko uchishandisa microscrew chete, uye kanenge katatu upamhi hwetambo dhayamita pakugadzirisa intra-articular avulsion fracture blocks.

4. Miniature yekunze kugadzirisa brace.

Comminuted metacarpophalangeal fractures dzimwe nguva zvakaoma kugadzirisazve anatomically kunyange nekuvhiyiwa incision kana haigoni kusimbiswa zvakasimba mukati nokuti pfupa scaffold inoparadzwa. Iyo yekunze yekumisikidza brace inobvumira iyo comminuted kuputsika kuti idzoke uye ichengetedze kureba kwayo pasi pemhedzisiro yekudhonza, ichiita basa rakasarudzika, sezvakaratidzwa muFigure 4-19. Kuiswa kwekunze kwekugadziridza brace kunosiyana kune akasiyana metacarpals: iyo 1st uye 2nd metacarpals inoiswa pane dorsal radial side, iyo 4th uye 5th metacarpals inoiswa kune dorsal ulnar side, uye 3rd metacarpal inoiswa pane dorsal radial kana dorsal side inodzivirira kukuvara kune iyo nzvimbo, kubhadhara kune iyo nzvimbo yekukuvara. tendon. Kuputika kwakavharwa kunogona kuvharwa uye kuiswa zvakare pasi peX-ray, uye zviduku zvinogona kuitwa kuti zvibatsire pakugadzirisa zvakare kana repositioning isiri yakanaka.

Zvakanakira zvekunze kwekugadzirisa brace.

(1) iri nyore kushanda uye inogona kugadzirisa kwakasiyana-siyana kusimuka kwekupwanyika kwekupedzisira;

(2) inogona kunyatsogadzirisa uye kugadzirisa intra-articular fractures ye metacarpal phalanges pasina kukuvadza articular surface, uye inogona kukanganisa articular surface kudzivirira chibvumirano chejojo ​​capsule uye lateral collateral ligaments; 

(3) inogona kusanganiswa neyakaganhurirwa yemukati yekumisikidza kune comminuted fractures isingagoni kugadziridzwa anatomically reset, uye yekunze yekumisikidza brace inogona kuita chikamu patsva uye kuchengetedza tambo yesimba; 

(4) inobvumira maekisesaizi ekutanga echigunwe chakakanganisika mujoint isina kumiswa kudzivirira kubatana 

(5) Inogona kunyatsogadzirisa kuputsika kwemaoko pasina kukanganisa kurapwa kwepashure kweronda reruoko rwakabatwa.

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