Nzira yekurapa vakwegura distal radius fracture?

Kuputsika kwedistal radius ndeimwe yezvinowanzoputsika kune vakwegura. Vanhu vari pakati pemakore makumi mashanu kusvika makumi manomwe nemashanu pari zvino vanonzi vakwegura. Chiitiko che distal radius fractures chinowedzera gore negore sezvo huwandu hwekufamba muvakuru vakuru hunowedzera. Nyaya inopisa mukukakavadzana nezve distal radius fractures inoramba iripo: Kuvhiyiwa kunodiwa here?

Epidemiological Studies

Kutyoka kweiyo distal radius account yeanosvika 18% yekutyoka kwemuviri wese muvakuru vakuru. Huwandu hweCaucasian, varwere vechikadzi, uye osteoporosis ndiwo akanyanya kuisa njodzi kune distal radius fractures. Pamusoro pezvo, zvinosanganisirawo mwaka zvinhu, senge vakweguru kutsvedza-ku-kudonha kunowanzoita kuputsika kweiyo distal radius munguva yechando. Zvimwe zvidzidzo zvakashuma kuti varwere vakwegura vane ruzivo rwekuziva uye neuromuscular system vari pangozi yakakura ye distal radius fractures (nokuti varwere vane mafungiro akasimba, vanozotambanudza maoko avo kuti vatsigire pasi pavanowa, zvichiita kuti vaputsika). .

Maererano nehuwandu, muUnited States, mari yekurapa ye distal radius fractures muna 2007 yaiva inenge mamiriyoni 170 emadhora emadhora (anenge 1983 US madhora / munhu). Kunyange zvazvo vazhinji vakwegura varwere vane distal radius fractures vachirapwa nekuchengetedza, nhamba yevarwere vanosarudza kuvhiyiwa kwemukati kugadzirisa iri kuwedzera gore negore. Mutengo wekurapa wekugadzirisa intraoperative inopetwa katatu iyo yekurapa kwekuchengetedza, uye inowedzerawo mutengo wekugara muchipatara uye mamwe mari yakabatana.

Kune zvakare misiyano yedunhu uye yemadzinza mukushandiswa kwemukati kugadzirisa kune distal radius fractures. Chidzidzo cheMedicare chakaratidza kuti vakadzi neCaucasians vangangove vakavhiyiwa, uye sarudzo yekugadziriswa kwemukati yaive 4.6% kusvika 42.1%. Uye akawana kuti vanachiremba vakadzidziswa kuvhiyiwa kwemaoko vainyanya kusarudza kuvhiyiwa.

Clinical Assessment

Nzira yekukuvara kwemurwere uye zvichemo zvikuru zvinofanira kuonekwa munhoroondo yekliniki, kusanganisira nzvimbo yekurwadziwa, basa rekushanda, uye dhigirii yekuremara. Panguva imwecheteyo, zvinodikanwawo kunzwisisa ruoko rune simba rwemurwere, zvinogara zvichiitwa, uye basa remurwere. Mukuwedzera, zvinonyanya kukosha kuziva kana murwere ane osteoarthritis kana sequelae inobata mabasa ekushanda kwenhengo yakakanganiswa isati yakuvadzwa. Pakati pavo, kubvunza varwere vakwegura kana vachida kushandisa madondoro pavanenge vachifamba uye kana vachigona kuzvitarisira muupenyu hwezuva nezuva kunokosha zvikuru pakunzwisisa zvinodiwa nevarwere uye kugadzira zvirongwa zvekuongorora uye kurapwa.

Panguva yekuongororwa kwepanyama kwekiriniki, kuongororwa kwakarongeka uye kwakadzama kwechanza chemurwere kubva kure kusvika pedyo kunodiwa. Ropa rekupihwa kwechanza rinozivikanwa necapillary refill test uye radial uye ulnar pulse. Mamiriro ekunzwa emutsinga wepakati, ulnar nerve uye radial nerve yakawanikwa ne-two-point discrimination test uye light touch test. Chiitiko che acute carpal tunnel syndrome mu distal radius fractures ndeye 5.4% kusvika 8.6%, saka kunyanya kunofanira kubhadharwa kune paresthesia uye chiveve munzvimbo yekugovera yepakati tsinga. Basa remotokari remurwere rakaongororwa nekuongorora anterior uye posterior interosseous, radial, median, uye ulnar nerves. Pamusoro pezvo, muongorori anodawo kutarisisa mamiriro eganda remurwere (senge ecchymosis, edema, forogo-senge angulation, nezvimwewo) kuti aone kana iko kutsemuka kwakavhurika. Nekuda kwehurombo hunyoro hwematishu mamiriro uye ganda rakatetepa kune vakwegura, distal radius fractures inowanzoperekedzwa neganda rekucheka. Kana yakavharwa traction kuderedza kunoshandiswa, kunyatsoshanda kunonyanya kudiwa kudzivirira kuwedzera kukuvara kwetishu.

Imaging Assessment

Radiographic kuongororwa kwe distal radius fractures inowanzo sanganisira anteroposterior, lateral, uye oblique radiographs. Kushungurudzika uye kutenderera kwekuputsika kunogona kunzwisiswa nekufungidzira kuongororwa kuti uone kana pane kupfupisa, kana chidimbu chekuputsika chinoitwa, uye kana mutsara wekubatana wakakwana. Mamwe chaiwo ekufungidzira maparamendi aisanganisira: ulnar declination (kureva 22 °, huwandu: 19 ° -29 °), kureba kweiyo distal radius (11-12 mm), uye palmar kurerekera kweiyo distal radius (kureva 11 °, renji: 11 ° -14.5 °). X-rays yeruoko negokora inotorwawo kutarisa kukuvara kweruoko kana kusagadzikana kwegokora. Mushure mekuvharwa kuderedzwa uye splint immobilization, imwe X-ray firimu inodiwa kuti iongorore kana maparamita eiyo distal radius yakagadziridzwa. Kliniki, kuongororwa kweCT kunowanzo shandiswa kubatsira mukuongororwa uye kurongwa kwezvakaputsika (semuenzaniso, kana paine intra-articular fracture, kana paine kudzvanywa kana kutsemuka kweshear), kuitira kuti uwedzere kuona chirongwa chekuvhiya. Panguva imwecheteyo, kuongororwa kweCT kunodiwawo kuti uwedzere kuongororwa paunenge uchiita osteotomy uye orthopedic kurapwa kwe malunion.

Tora

Zvinoenderana nemirairo yeAAOS yekurapa, hapana kubvumirana pakushandiswa kwekuchengetedza kana kuvhiya manejimendi edistal radius fractures. Iko hakuna kubvumirana pamusoro pekushandisa volar locking plate fixation kana percutaneous Kirschner waya kugadzirisa mukuvhiya kurapwa. Kodama et al vanokurudzira kushandiswa kwekuputsika scoring system kuti vaone kana murwere achida kuvhiyiwa. Uye kuvarwere vakura ≥50 yemakore, rudzi rwekutyoka, shanduko muradiographic parameters yejoinhi reruoko, zera, ruoko rune simba, uye basa remurwere rinofanira kushandiswa kuenderera mberi nekuona chirongwa chekurapa. Mukuongorora kwakawanda kwekudzokororwa, dhigirii rekufambisa kwechidimbu kana dorsal distal radius fragment mushure mekuderedzwa, kana kuputsika kwaisanganisira mutsipa wehuro, palmar inclination, uye kusiyana kweiyo distal ulna zvakabatanidzwa zvakasimba nemigumisiro yekliniki.

Conservative Treatment

Pakati pedu, distal radius fractures inodzika zvishoma inotamiswa neSugar tong plaster splint pamusoro pegokora kudzikamisa kududzira uye kunyudza kwegokora (ona Mufananidzo 1). Kana kutamiswa kwekutsemuka kwakakura, Shuga tong splint inofanira kuitwa mushure mekuvharwa kuderedzwa. Ziva kuti kana uchiita plaster splint immobilization, chiyero che immobilization chinofanira kumira pamucheto wemunwe, kuitira kufambisa kufamba kwemunwe uye kudzivirira kuoma. Iko kushandiswa kwemabhandeji e-elastic kune mashoma compression fixation inogona kubatsira mukuputika. Mhando yekuputsika inosarudza nzira yekuvhara kuderedzwa. Kana zvichidikanwa, yemunharaunda hematoma anesthesia ye distal radius inogona kusarudzwa, uye ipapo kuderedza kuderedzwa kunoitwa nekukwevera zvigunwe (index neminwe yepakati) kugadzirisa kuremara uye kudzorera radiocarpal joint alignment. Kuderedza kudhonza kunowanzoitwa uchishandisa inverse fracture mechanism. Kuderedza kuderedzwa mundege dzakasiyana-siyana kunodiwa kuti upedze kudzorera ligament uye kudzorera kurongeka kwezvimedu zvekuputsika, capitulum uye lunate. Pane ndege yekona, dzorera kurongeka kweanatomical yeurna uye radius, distal bone fragment uye radial shaft. Kuderedzwa kwechimiro cheColles kuputsika kunoda kuti mubatsiri abate chigunwe chemurwere mune rumwe ruoko uye minwe yemurwere 4 kune rumwe rutivi, kushandisa countertraction kuti aparadzanise chimedu chekuputsika kubva kune metaphysis yeradius, kuenderera mberi kwenguva refu, uye ipapo palmar. Flexion uye ulnar kutsauka kubatsira kudzikisa chidimbu chekutyoka. Kune varwere vakura vane kukuvara kwematishu akapfava akapoteredzwa, kunyengedza nekuchenjerera kunodiwa panguva yekudzikisa ganda kudzivirira kubvaruka (pad yekotoni inogona kushandiswa panguva yekudzikisa). Mushure mekugadzirisazve, kuongororwa kweurourovascular kwakaitwa.

Mufananidzo 1. (A) Murwere ane distal radius fracture akanga asingakwanisi kufamba mune imwe nzvimbo isina kwaakarerekera palmar neSugar tong plaster splint kudzivirira kuchinjwazve; (B) uye (C) anteroposterior uye lateral radiographs inoratidza kugadzirisa kweruoko rwemurwere zvakanaka. Iyo purasita haipfuuri kumusoro kwemetacarpal musoro kuitira kuti zvigunwe zvigone kufamba zvakanaka.

Operation Kurapa

Nzira dzekuvhiya dzevarwere vakwegura vane distal radius fractures dzinosanganisira: kuvharwa kuderedzwa uye kunze kwekugadzirisa, percutaneous Kirschner wire fixation, kuzarura kuderedza, volar / dorsal locking plate fixation, uye dorsal bridging plate fixation (ona inoratidzwa mumufananidzo 2). 

Imwe mhando yekudzikisa yakavhurika uye dorsal plate fixation inonyanya kushandiswa pakurapa intra-articular fractures. Inogona kuderedza articular surface pasi pechiratidzo chakananga pasina kubvisa ligament tissue padivi revolar yejoint wrist, kuderedza dambudziko rekupedzisira radiocarpal joint kusagadzikana. Kana kuputika kwemhepo kunopindirana kunobatanidzwa, inoda kumiswa. Kune varwere vane radial shaft fracture kana kukuvadzwa kwakawanda, iyo yakavakirwa-mukati traction plate inogona kushandiswa kuwana kuderedzwa kuburikidza ne ligament kudzoreredza. Panguva imwecheteyo, iyo traction plate inokodzerawo kuderedza uye kugadzirisa kwe comminuted uye osteoporotic distal radius fractures. Iyo ndiro yakabviswa mavhiki gumi nemaviri mushure mekuvhiyiwa, uye yakanaka yekiriniki yekurapa maitiro inogona kuwanikwa.

Volar yekuvhara ndiro inogona kuvandudza radial kupfupisa uye volar tilt, uye chiitiko chematambudziko chakaderera. Kuenzaniswa neplate ye dorsal, simba rekubata remutezo wakabatwa rinogona kuvandudzwa zvakanyanya mukati memwedzi ye6 mushure mekuvhiyiwa, uye basa uye kurwadziwa zvinogona kuvandudzwa. Matambudziko akadai sekuchinjazve kwe dorsal plate fixation uye kushatirwa kwe extensor digitorum tendon inoitika kusvika ku30% yezviitiko. Uye iyo yekugadzirisa mhedzisiro yeplate yevolar zvakare iri nani pane iyo yeKirschner waya kana yekunze fixator.

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