Unogadzirisa sei distal humerus fracture?

Kuti uwanezve kugadziriswa kwakagadzikana mukugadzika kwe osteoporotic kana comminuted fractures, iyo parallel plate technique yekurapa distal humeral fractures inobva pamusimboti wekusimudzira kugadzirisa kwe distal fractures. Chinokosha pakugadzikana kwechigadziro ichi chekugadzirisa ndechekuti inobatanidza maitiro uye kugadzikana kwearch paunenge uchivhara mazamu epakati uye ekupedzisira e distal humerus pamwe chete.

Arch bhiriji chimiro

Masiruuru ezvimedu zvedistal anokiyirana, achipa kumwe kugadzikana kuburikidza ne 'zambuko rakavharwa'. Kupindirana kunowanikwa zvakanyanya kuburikidza nekubatana pakati pezviputi. Mascrews akawanda anodhumhana pamwe chete, uye mapfupa ari pakati pawo anoumba 'rebar' (reinforced concrete) chimiro chemhando.

Matanho ounyanzvi

Nhanho yekutanga: kuvhiyiwa kwekudzikisa majoini. Zvimedu zvakabatana zvaida kutenderera zvichienderana neaxial ndege zvakaderedzwa uye zvakagadziriswa kwenguva pfupi neKirschner waya. Zvinonyanya kukosha, iyo K-waya dzinofanirwa kuiswa padhuze neiyo subchondral nhanho kudzivirira kupindira kunotevera screw kuiswa uye kure nepanoiswa mahwendefa pamakoramu emashure uye epakati. Imwe kana mbiri dzakaiswa zvakakodzera Kirschner waya dzinogona kushandiswa kugadzirisa kwechinguva distal fracture yakabatana ne diaphysis.

Nhanho yechipiri: simbi yeplate application uye kugadzirisa kwenguva pfupi. Mahwendefa epakati uye ekupedzisira akagadziriswa akaiswa uye anogadziriswa pa distal humerus, nepo chidimbu che 2 mm kana 2.5 mm chikamu chinopinzwa kuburikidza neNo. Mapini ekuchengetedza kugadzirisa kwechinguva kweplate uye distal fracture. Siruu yakaiswa mugomba rakavharwa (gomba 5) mundiro yega yega, asi isina kunyatsosimbiswa, zvichisiya rusununguko rwekuti ndiro ifambe panguva yekudzvanyirirwa. Sezvo nzvimbo yepasi yeplate imwe neimwe iine tubular pa metaphyseal uye diaphyseal inopera, kungosimbisa zvishomanana kwezvisungo mumakomba ane slotted kunopa kugadzirisa kwakanaka kwenguva pfupi kwese distal humerus.

Danho 3: Joint fixation. Iyo screw inopfuudzwa kuburikidza neNo. 1 buri mu lateral plate, kuburikidza ne distal articular fragment kubva kune lateral kusvika pakati, uye yakasimbiswa. Dzokorora danho iri uchishandisa gomba nhamba 3 mukati. Muvarwere vaduku, 3.5 mm cortical screws inoshandiswa (kudzivirira kuputsika), asi muvarwere vane osteoporotic, 2.7 mm yakareba screws inoshandiswa. Iyo distal screw inofanirwa kureba sezvinobvira uye inofanirwa kupfuura nepakati pezvimedu zvakawanda sezvinobvira.

Nhanho 4 A: Kudzvinyirira pane condyle. Interfragmentary compression mhiri kwekutyoka inopiwa padanho re suprahumeral uchishandisa mahombe ekudzikisa masimba, neiyo lateral column yakagadziriswa kutanga. Isa screw mugomba 4 mu lateral ndiro mune inoshanduka compression mode (inset). Kuisimbisa kunowedzera kuwedzera interfragmentary compression (museve) pane supracondylar level, zvichikonzera kumwe kutambanudza (museve) pane medial supracondylar ridge.

Nhanho 4B: Nenzira imwecheteyo, shandisa mahombe ekudzikisa mafoceps kudzvanya iyo medial column uye isa screw mundiro yemukati mune dynamic compression mode. Kana iyo mbiri yeplate iri shoma shoma, hombe yebhonzo clamp inogona kushandiswa kuitsikirira ichipesana nemetaphysis kuti iwedzere kumanikidza condyle.

Nhanho 5: Kugadziriswa kwekupedzisira. MaK-waya akabviswa uye ma screw akasara akaiswa. Iyo distal screws inodzika kuti iwedzere kugadzirisa kweiyo distal joint zvidimbu.

Yakaoma Bone Defect - Supracondylar Shortening

Kana metaphyseal bone kurasikirwa kana comminution ichikanganisa kuvakwazve kweanatomical uye kubata kwepfupa kwakanaka, iyo humerus inogona kupfupikiswa pane metaphyseal fracture saiti nekuenderana kwakaringana uye geometry ye distal humerus. Isu tinodaidza iyi imwe nzira yekuvakazve supracondylar kupfupisa. Iyi nzira inonyanya kukosha muzviitiko zvekubatanidza zvinyoro zvinyoro uye kurasikirwa kwepfupa. Kupfupisa ≤1 masendimita hakuna zvazvinoita pakuwedzera simba reiyo triceps terminal, uye mune zviitiko zvakanyanya zvinyoro zvinyoro uye kurasikirwa kwemapfupa, kupfupika kweanosvika 2 cm kunogona kushivirirwa pasina kukanganisa zvakanyanya magokora biomechanics.

Gadzirisa iyo distal end of the humeral shaft (kunze kweiyo articular segment) kuti uwedzere kubatana pakati peiyo distal articular segment uye diaphysis. Kazhinji, chikamu chiduku chepfupa chinobviswa kubva kumucheto wakareba wehumeral shaft, uye dzimwe nguva kubva kune rumwe rutivi rwayo. B uye C, yakapfupiswa nenzvimbo yakaputsika kuti ibvumire kupindirana kwepakati pakati petrochlear uye distal diaphysis, pakati pe capitulum uye distal diaphysis, uye kubva kune rumwe rutivi. Kana nzvimbo idzi dzichinge dzakamanikidzwa uye dzakachengetedzwa nemahwendefa esimbi, kugadzikana kwakasimba zvakakwana kuti ifambe uye kugadzirisa pakarepo. Iyo distal segment inogona kushandurwa nepakati kana nechemberi, kana zvishoma nechemberi, ichichengetedza kutenderera uye valgus alignment.

6 screws uye 2 plate fixation targets

screw

1: Siruvha yega yega inopinda mundiro yesimbi.

2: Imwe neimwe screw inofanira kugadzirisa contralateral fracture fragment.

3: Isa huwandu hwakakwana hwema screws mu distal fracture segment.

4: Imwe neimwe screw inofanira kunge yakareba sezvinobvira.

5: Imwe neimwe screw inofanirwa kugadzirisa zvidimbu zvakawanda sezvinobvira.

6: Iyo screws inofanira kukiya pamwe chete necrisscrossing, kugadzira chimiro chine angle yakagadziriswa.

Simbi ndiro:

1: Kune mahwendefa anoshandiswa kugadzirisa, zvinangwa zvekumanikidza zvinofanirwa kuwanikwa pamwero weiyo femoral condyles yekoramu mbiri.

2: Ndiro yesimbi inoshandiswa inofanira kuva yakasimba uye yakasimba zvakakwana kuti irambe kutsemuka kana kukotama.

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