Kuputika kwe tendon extensor mushure mekugadzirwa kweplate yevolar kunoramba kuri dambudziko guru mukugadzirisa distal radius fractures. Iyo inonyanya kukanganiswa tendon ndeye extensor pollicis longus (EPL) tendon, sezvo inovharirwa mukati meEPL groove. Chiitiko chakataurwa cheEPL tendon kuputika mushure mekuputika kwevolar ndeye 0.29% -5.7%.
Ngozi yekunonoka kweEPL tendon kuputika inowedzerwa muhupo hwe dorsal screw protrusion, kukuvara kubva intraoperative yakananga kuboora, uye dorsal denga zvimedu, kunyanya mukutsemuka kwechitsuwa cheLister's tubercle. Radiographic assessment ye screw protrusion mu distal radius fractures yakaoma nekuda kweiyo yakaoma geometry ye distal radius uye mukana we comminuted dorsal fractures. Iyo dorsal tangential maonero ndiyo chete inogoneka intravital maonero eiyo dorsal radial cortex kuti uwane yakavimbika ongororo yechinhambwe pakati pe screw tip uye dorsal cortex.
Nzira dzekudzivisa kukuvara kwe tendon extensor dzinosanganisira kushandiswa kwe-monocortical screws uye kudzivisa dorsal surface kupinza; zvisinei, maitiro aya anogona kuderedza kugadzikana kwemagetsi kwekugadzirisa kuputsika. Naizvozvo, bicortical fixation dzimwe nguva inodiwa. Kuti kuderedze njodzi yekukuvara kweextensor tendon, zvinangwa zvekutanga zvekuputsika kugadzirisa uye kugadzikana hazvifanirwe kukanganisa.
Maitiro matsva ekuvhiya
Isu tinotsanangura nzira itsva yekudzikisa njodzi yekutsemuka kweEPL tendon mushure mekugadzika kwepureti yedistal radius fractures pasina kupfupisa kureba kwescrew kana kubvisa dorsal denga zvidimbu. Muchidimbu, nzira iyi inosanganisira kuvhura chikamu chechitatu kuburikidza nediki dorsal incision.
Kana iyo screw yakange yapinda mudorsal cortex uye yakabuda muchikamu chechitatu: takabvisa EPL tendon kubva mugomba rayo uye takavhara chikamu nekusutured the retinaculum tichisiya EPL tendon pane yakagadziriswa retinaculum.
Kana iyo screw isingapfuuri muchikamu chechitatu: tinosiya EPL tendon muchikamu chechitatu. Chiratidzo chemaitiro edu chiri muvarwere vane distal radius fractures inobatwa nevolar locking plates, fractures ine dorso-parietal zvidimbu kana screws zvinogona kupinda mudorsal cortex kana kukuvadza EPL tendon yakakomberedza Lister's tubercle. Mune varwere vane distal radius fractures ine dorsomedial fragments, tinochera maburi kuti tipinde mukati me dorsal cortex uye tinosarudza screws dzehurefu hwakakwana kugadzirisa zvidimbu zvisina kugadzikana zvedorsomedial.
Case sharing
Isu tinogovera nyaya iyo iyo EPL tendon yakabviswa kubva muchikamu chechitatu nekuda kweprotrusion ye screw muchikamu chechitatu panguva yekugadziriswa kweplate ye comminuted distal radius fracture ine dorsomedial fragments. Isu takasimbisa kuti iyo EPL tendon yaive yakasimba 7 makore mushure mekushanda, kunyangwe iyo screw yaive yakakurumbira muchikamu chechitatu.
Mhosva iyi yaive mukadzi ane makore makumi matanhatu nemanomwe ekuzvarwa ane chirwere che intra-articular unstable distal radius fracture ine right dorsal medial fracture (Mufananidzo 1A-E). Hapana nhoroondo yekusvuta, chirwere cheshuga kana kunwa doro. Anogona kufamba pasina chero mufambi.
![distal radius fracture]()
mufananidzo 1. Preoperative imaging yakaratidza comminuted intra-articular fracture ye distal radius.
A uye B: Preoperative X-rays,
C uye D: sagittal uye axial maonero emifananidzo computed tomography,
E: 3D computed tomography mufananidzo. Dorsal medial lunate facet zvidimbu uye dorsal apical zvidimbu (white asterisks) zvinoonekwa.
Kuvhiya unyanzvi
Takabata iyi fracture system nevolar locking plate. Intraoperatively, takaboora dorsal cortex uye takasarudza sikururu yakareba zvakakwana kuchengetedza dorsal cortex nekuti dorsomedial fragment yakanga isina kugadzikana (Mufananidzo 2).
Kuvhiya kwakaitwa kuvhura chikamu chechitatu mushure mekugadzirisa screw.
Sezvo screw yakapinda muchikamu chechitatu uye yakabuda (Mufananidzo 3A), vhura zvizere chikamu chechitatu uye fambisa tendon yeEPL kubva mugomba rayo (Mufananidzo 3B).
Chikamu chechitatu chakabva chavharwa ne suturing retinaculum (Fig. 3C, D), uye EPL tendon yakaiswa pamusoro pekugadzirisa retinaculum (Fig. 3 E).
Mushure mekuvhiyiwa, murwere akaenda kukiriniki yekunze kwechipatara chedu kusvikira pfupa rapora. Murwere haadi kubvisa hardware.
Postoperative kupora
Makore manomwe avhiyiwa, murwere akadzokera kuchipatara kuti anoongororwazve nemhaka yeosteoporosis. Ruoko rwerudyi haruna kuremara. Mufananidzo weX-ray unoratidza kutsemuka kwapora nedorsal protrusion ye distal locking screw. Chigunwe chemurwere chaive chakareba, uye EPL tendon yaive isina tambo yeuta.
Pakurudziro yedu, murwere akabvuma kubvisa hardware uye kuongorora extensor tendons. Intraoperatively, takaongorora tendon yeEPL kuburikidza nekuputika kwedorsal uye chikamu chakazarura chikamu chechitatu nechina.
EPL tendon yakanga iri kunze kwechikamu chechitatu munzvimbo imwechete seyakaitwa kare, uye tendon haina kutsamwiswa.
Isu takasimbisa kuti screw yakapinda mukamuri yechitatu apo extensor tendon yeminwe yakadzoswa.
Pakupedzisira, takagadzirisa mabhanhire ekutsigira uye takabvisa hardware. Pakuongororwa kwekupedzisira 2 mwedzi mushure mekubviswa kwehardware, murwere aive asina kurwadziwa uye aine chigunwe chakazara.
Kurukurai
Munzira yedu, mushure mekugadzirwa kweplate yevolar ye distal radius fractures, isu takazarura chikamu chechitatu kuburikidza necheka inenge 2 cm kureba ulnar kune tubercle yeLister. Isu takaona zvakananga EPL tendon uye pasi rechitatu extensor compartment nekudzoreredza zvinyoronyoro EPL tendon.
Kana screw yakapinda mudorsal cortex muchikamu chechitatu kana iine dorso-parietal tsvina, isu hatina kuita intraoperative screw replacement kana fragmentectomy, asi takavhura zvachose chikamu chechitatu ndokubvisa EPL tendon kubva mugomba rayo. Isu takazovhara iyo compartment ne suturing retinaculum tichiisazve EPL tendon pane yechitatu compartment.
Kana iyo screw isina kupinda muchikamu chechitatu, takasiya EPL tendon muchikamu chechitatu chakavhurwa chikamu.
Maitiro edu ekuvhiya anobvumira kuongororwa kuri nyore kwekukuvara kweEPL tendon nekuona kwakananga mune zvishoma semamwe maminetsi e10. Kana iyo EPL tendon yakakuvara, inogona kugadziriswa zvakananga. Iyi nzira inobatsira kudzivirira yechipiri EPL tendon kuputika mushure me distal radial plate fixation. EPL tendon bowstring inogona kuitika, asi haina kuitika kwatiri.
Mukupedzisa
Takaona nyaya iyo iyo EPL tendon yakanga yakasimba 7 makore mushure mekuvhiyiwa, kunyange zvazvo screws yakashandiswa kugadzirisa ndiro yevolar yakanga yakakurumbira muchikamu chechitatu. Nzira yedu yekuvhiya inoderedza njodzi yeEPL tendon kuputika mushure mekugadzirwa kweplate yevolar kune distal radius fractures.
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