Metacarpophalangeal fractures ke mokhoa o tloaelehileng oa ho robeha ha letsoho, e leng karolo ea 1/4 ea bakuli bohle ba nang le ts'oaetso ea letsoho. ka lebaka la sebopeho se thata le se rarahaneng sa letsoho le ts'ebetso ea lona e ntle ea motlakase, taolo ea ho robeha ha letsoho e bohlokoa haholo ebile e rarahane ka botekgeniki ho feta kalafo ea maqeba a mang a malelele a li-tubular.
Ho netefatsa botsitso ba ho robeha ka mor'a hore ho behoe bocha ke senotlolo sa katleho ea phekolo ea fracture ea metacarpophalangeal. E le ho tsosolosa mosebetsi oa letsoho, ho robeha hangata ho hloka ho lokisoa hantle, 'me nakong e fetileng, ho lokisa ka ntle ka samente kapa ho lokisa ka hare ka lithakhisa tsa Kirschner ho ne ho tloaelehile ho sebelisoa, empa hangata ka lebaka la ho lokisa ho sa nepahaleng kapa nako e telele ea ho lokisa, e sa thuseng ho tsosolosoa ha lenonyeletso ka mor'a ho buuoa,' me e na le tšusumetso e kholo ho tsosolosoa ha lenonyeletso la metacarpo, ho tlisa mathata a mang a ho tsosolosa lenonyeletso.
Mekhoa ea sejoale-joale ea kalafo e ntse e sebelisa mokhoa o matla oa ho lokisa kahare, joalo ka micro plate screw fixation.
Melao-motheo ea Kalafo
Melao-motheo ea phekolo bakeng sa fractures ea metacarpal le phalangeal ea letsoho ke: repositioning ea anatomic, fixation e khanyang le e tiileng, ho tsamaea pele le boikoetliso bo sebetsang. Melao-motheo ea phekolo bakeng sa fractures ea intra-articular le periarticular ea letsoho e tšoana le ea fractures tse ling tsa intra-articular: ho tsosolosoa ha sebōpeho sa sefahleho sa articular le mosebetsi oa pele oa ts'ebetso. Kalafo ea metacarpal le phalangeal fractures ea letsoho e lokela ho loanela ho finyella boemo ba anatomic ntle le ho potoloha, ho ferekana ka mahlakoreng, kapa ho falla ha angular> 10 ° ho ea karolong ea mokokotlo oa palema. Haeba qetello ea fracture ea metacarpal e pota-potiloe kapa e tlosoa ka thōko ka lehlakoreng le leng, e tla fetola tsela e tloaelehileng ea ho phalla le ho atolosa monoana, ho etsa hore e sutumelle kapa e oe ho tloha monoaneng o haufi nakong ea ho phunya, e amang ho nepahala ha mosebetsi oa monoana; ha ho falla ha angular> 10 ° ho ea dorsum ea palema ho tla senya sebaka se boreleli sa lesapo le tendon, ho eketsa ho hanyetsa le mefuta e mengata ea ho sisinyeha ha tendon ka ho phunya le ho atolosoa, le ho baka kotsi e sa foleng ho tendon, ho baka kotsi ea ho robeha ha tendon. kotsi ea ho phatloha ha tendon.
Metacarpal le phalangeal fractures li tšoana ka bokhoni ba tsona ba ho mamella ho holofala ha rotational, ha metacarpal e mamella ho khutsufatsa ho falla le dorsal angular displacement ho feta phalangeal. Manonyeletso a carpometacarpal le metacarpophalangeal a ka lefella bofokoli ba angular ea metacarpal, 'me monoana o monyenyane oa annular o ikamahanya hantle le ho senyeha ha angular ho feta monoana o bohareng oa index. Ho fokotsa matla a ho tšoara ka lebaka la ho khutsufatsoa ha mesifa ea letsoho ka hare ho bonahala feela ha metacarpal e kenngoa ho feta 30 ° ho ea lehlakoreng la mokokotlo.
Mokhoa oa ho Buoa
Mokhoa oa ho buoa bakeng sa fractures ea metacarpal e batla e le bonolo 'me ka kakaretso e sebelisa mokhoa oa mokokotlo, joalokaha ho bontšitsoe setšoantšong sa 4-14. Metacarpal ea bobeli e chekiloe ka radially ha metacarpal ea bohlano e chekiloe ka ulnarly, 'me metacarpal ea boraro le ea bone hangata e chesoa bohareng. Haeba li-metacarpal tse peli tse haufi li sebelisoa ka nako e le 'ngoe, ho sebelisoa sekhahla sa S-e bōpehileng bohareng ho ela hloko libaka tse peli tsa ho buuoa.
Khetho ea mokhoa o tsitsitseng
Ho na le lisebelisoa tse ngata tsa ho lokisa ka hare bakeng sa fractures ea metacarpophalangeal, tse kang li-pins tsa Kirschner, li-screw, lipoleiti le liforeimi tse ka ntle tsa ho lokisa, tseo har'a tsona li-pin tsa Kirschner le li-microplates li sebelisoang haholo. Bakeng sa fractures ea metacarpal, ho lokisa ka hare ka microplate ho na le melemo e totobetseng ho feta ho lokisoa ka lithapo tsa Kirschner 'me ho ka khethoa; bakeng sa fractures ea proximal phalangeal, microplate e atisa ho khethoa, empa ha ho e-na le bothata ba ho beha li-screws karolong e ka thōko ea phalangeal le fractures ea hlooho, ho lokisoa ka hare ka lithapo tsa Kirschner tse tšelang ho khethoa, e leng ho loketseng haholoanyane ho hlaphoheloa ha monoana o amehileng; bakeng sa kalafo ea fractures e bohareng ea phalangeal, lithakhisa tsa Kirschner li lokela ho khethoa.
1, nale ea Kirschner:
Nale ea Kirschner ea ho lokisa ka hare e 'nile ea sebelisoa tleliniking ka lilemo tse fetang 70' me e 'nile ea e-ba ntho e sebelisoang ka ho fetisisa ea ho lokisa ka hare bakeng sa fractures ea metacarpophalangeal, e leng bonolo ho e sebetsa, ea moruo le e sebetsang,' me ke mokhoa oa khale ka ho fetisisa oa ho lokisa ka hare, joalokaha ho bontšitsoe setšoantšong sa 4-15. e le mokhoa o tloaelehileng oa ho lokisa ka hare bakeng sa ho phekola ho robeha ha matsoho, e ntse e sebelisoa haholo.
Melemo ea ho lokisoa ha ka hare ka lipini tsa Kirschner:
① e bonolo ho sebetsa ebile e tenyetseha ha e sebelisoa;
② ho tlosoa ha lisele tse bonolo, tšusumetso e fokolang ea phallo ea mali qetellong ea ho robeha, ho fokotseha ha ts'oaetso ea ho buuoa, le ho folisa ho robeha;
③ ho khutlisa phini ea bobeli e bonolo;
④ litšenyehelo tse tlase le ts'ebeliso e pharaletseng, e sebetsang ho maqheka a mangata a matsoho (joalo ka maqheka a intra-articular, maqhetsoana a matla le ho robeha ha phalangeal fractures).
Mathata a ho lokisa ka hare:
(1) ha ho bapisoa le ho lokisa poleiti, botsitso bo bobe, 'me ho khutsufatsa le ho falla ha potoloho ho ke ke ha laoloa ke pinana e le' ngoe, hangata ho hlokahala ho feta lithapo tsa 2 bakeng sa ho lokisa sefapano;
(2) ha ho na phello ea compression qetellong ea fracture;
(3) bokaholimo bo kopantsoeng bo senyehile ke ho lokisa motsoako;
(4) ho lokisoa ha motsoako le ho thibela tendon ho thibela letsoho la letsoho ho tloha boikoetliso ba pele le ho ama ts'ebetso ea ho hlaphoheloa.
Ka tsoelo-pele e potlakileng ea mekhoa le lisebelisoa tsa morao-rao tsa ka hare, ho lokisoa ka hare ka lipini tsa Kirschner ho se ho hloekisitsoe le ho feta, 'me boholo ba bona bo ka lokisoa ntle le ho tšela lenonyeletso, ho se na tšenyo e nyenyane ea lisele tse bonolo le li-tendon tse pota-potileng lenonyeletso,' me ntle le ho ama koetliso ea pele ea ts'ebetso ea ho sebetsa. Ka thuso ea mochine oa X-ray oa C-arm, linyeoe tse ling li ka boela tsa finyella liphello tse khotsofatsang ka ho fokotseha ho koetsoeng ha ho lokisoa ha ka hare ka lithapo tsa Clinique, ho fokotsa ho senyeha ha lisele tse bonolo tsa sebaka seo le phello ea phepelo ea mali ho ea qetellong ea fracture, kahoo ho khothalletsa pholiso ea fracture.
Litlhokomelo bakeng sa ho lokisa ka hare le Kristen Pins:
① Lokisa liboloko tse kholoanyane tsa masapo tse nang le li-Kristen pins tsa bophara ba 1.0 ~ 1.2 mm, 'me u tsebe moo ho kenang teng le tsela ea ho kena ho latela tataiso ea mola oa ho robeha;
② Ka sepheo sa ho khutlisa mohala oa matla, fractures ea intra-articular e tlameha ho behoa sebakeng sa anatomically le ho ts'oaroa ka matla;
③ Ha se liboloko tsohle tsa masapo tse hlokang ho ts'oaroa ka li-Kristen pins, 'me tlas'a motheo oa ho fihlela botsitso ba pheletso ea ho robeha, Kristen pins e lokela ho sebelisoa hanyenyane kamoo ho ka khonehang;
④ Li-Kristen pins ha li tsitsitse ka har'a tendon kapa dorsal tendon membrane ea monoana ho theha boikoetliso ba pele bo sebetsang ka hohle kamoo ho ka khonehang;
⑤ ho lokela ho ba le moralo o tiileng oa pele ho ts'ebetso le hore o se ke oa pheta ts'ebetso ka hare ho ts'ebetso, ho seng joalo thipa ea fracture e ka 'na ea sithabetsoa kapa ea se ke ea lokisoa;
⑥ ka kakaretso pin ea Kirschner e lokela ho behoa letlalong ho fokotsa monyetla oa tšoaetso 'me ha ho thata ho e tlosa.
![Nale ea Clinique]()
2, poleiti e nyane ea Metacarpal:
Ho lokisa ka hare ho matla ka hare ho fractures ea matsoho ke motheo oa ho ikoetlisa pele ho ts'ebetso 'me hoa hlokahala ho tsosolosa mosebetsi o motle oa letsoho.AO mokhoa oa ho lokisa ka hare o hloka hore ho be le mokhoa o nepahetseng oa ho lokisa anatomical oa qetello ea ho robeha le ho tsitsisa ha qetello ea fracture e le boemong bo sebetsang, boo hangata bo bitsoang fixation e matla, e le ho lumella motsamao oa pele o sebetsang.AO e boetse e hatisa ho phalla ha mali ka mokhoa o fokolang, ho lebisa tlhokomelo ho ts'ebetso e fokolang ea mali. AO e boetse e totobatsa mekhoa ea ho buoa e fokolang haholo e shebaneng le ho boloka phallo ea mali. Ho lokisa ka hare ho microplate ea ho robeha ha letsoho ho fana ka liphello tse khotsofatsang mabapi le matla, botsitso ba qetello ea fracture le khatello pakeng tsa lipheletsong. Mabapi le ho hlaphoheloa ka mor'a ho sebetsa ka mor'a ho sebetsa, nako ea pholiso ea fracture le tekanyo ea tšoaetso ha e bapisoa, katleho ea lipoleiti tsa titanium tse nyenyane li nkoa e le molemo haholo ho feta lipini tsa kerf, le hobane nako ea pholiso ea fracture ka mor'a ho lokisa poleiti ea titanium e khutšoanyane haholo ho feta ea mekhoa e meng ea ho lokisa, kahoo e nolofalletsa ho khutlela bophelong bo tloaelehileng ba mokuli.
Melemo ea phekolo ea ka hare ea microplate fixation:
(1) ha li bapisoa le lipini tsa kerf, li-screw tsa microplate li na le histocompatibility e ntle le karabelo ea lisele;
(2) botsitso ba poleiti ea ho lokisa lipekere le khatello e qetellong ea ho robeha ho etsa hore ho robeha ho atamele ho tsosolosoa ha anatomical, ho lokisa ho sireletsehileng haholoanyane, ho leng molemo ho folisa fracture;
(3) Boikoetliso ba pele bo sebetsang bo lumelloa ka kakaretso ka mor'a ho lokisa microplate, e leng se loketseng ho hlaphoheloa ha mosebetsi oa matsoho.
![Metacarpal micro plate]()
3. Likokoana-hloko.
Li-microscrews bakeng sa spiral or long oblique fracture fixation li na le botsitso bo ts'oanang le lipoleiti tsa tšepe, empa sebaka se senyenyane le sebaka sa periosteal stripping se senyenyane ho feta sa tšepe ea tšepe, e leng se loketseng ho sireletsa phallo ea mali le ho lumellana le khopolo ea ts'ebetso e fokolang haholo. Le hoja ho na le li-splints tsa mofuta oa T-le L bakeng sa ho robeha ha manonyeletso a proximal, leeto la ho khutlela ka mor'a ts'ebetso le futsanehile ho feta bakeng sa fractures ea diaphyseal, 'me li-microscrews li na le melemo e itseng bakeng sa ho lokisa fracture ea intra- le periarticular. Li-screws tse kenngoeng ka har'a cortex ea bone li ka mamella khatello e kholo ea khatello ea kelello, kahoo ho lokisoa ho tiile 'me ho ka beha khatello pakeng tsa ho robeha ha fracture ho tlisa libaka tsa fracture haufi-ufi, e leng ho khutsufatsang nako ea ho folisa le ho thusa pholiso ea fracture, joalokaha ho bontšitsoe setšoantšong sa 4-18. li-microscrews li sebelisoa haholo-holo bakeng sa ho robeha ha oblique kapa spiral of the diaphysis le intra-articular avulsion fractures ea masapo a maholoanyane. Ke habohlokoa ho hlokomela hore bolelele ba khoele ea fracture e lokela ho ba bonyane habeli bophara ba diaphysis ha lokisa oblique kapa spiral fractures ea bakoang letsoho sebelisa microscrews mong, 'me bonyane ka makhetlo a mararo bophara ba khoele bophara ha lokisa intra-articular avulsion fracture diboloko.
![Li-Screws tse nyane]()
4. Letlapa le lenyenyane la ho lokisa ka ntle.
Metacarpophalangeal fractures ka linako tse ling ho thata ho tsosolosa anatomically esita le ka ho kenngoa ha opereishene kapa e ke ke ea lokisoa ka matla ka hare hobane scaffold ea masapo e senyehile. Setsi sa ho lokisa se ka ntle se lumella ho robeha ha comminuted ho hlaphoheloa le ho boloka bolelele ba eona tlas'a phello ea ho hula, ho bapala karolo e batlang e le e tsitsitseng, joalokaha ho bontšitsoe setšoantšong sa 4-19. Ho behoa ha lesela la ho lokisa ka ntle ho fapane bakeng sa metacarpals e fapaneng: 1st le 2nd metacarpals li behoa ka lehlakoreng la dorsal radial, 4th le 5th metacarpals li behoa ka lehlakoreng la mokokotlo oa mokokotlo, 'me metacarpal ea 3 e behoa mokokotlong oa dorsal radial kapa dorsal ho thibela ho kena ka lehlakoreng le leng le le leng. tendon. Li-fractures tse koetsoeng li ka koaloa 'me tsa behoa tlas'a X-ray,' me ho ka etsoa likaroloana tse nyenyane ho thusa ho tsosolosa haeba ho behoa ho sa tšoanelehe.
![Borakete ea ho lokisa kantle]()
Melemo ea brace ea ho lokisa kantle.
(1) e bonolo ho sebetsa mme e ka fetola mefuta e fapaneng ea ho falla ha pheletso ea fracture;
(2) e ka khona ho tsosolosa ka katleho le ho lokisa fractures ea intra-articular ea metacarpal phalanges ntle le ho senya bokaholimo ba li-articular, 'me e ka sitisa sebaka sa marang-rang ho thibela konteraka ea capsule e kopanetsoeng le li-lateral collateral ligaments;
(3) e ka kopanngoa le ho lokisoa ho fokolang ka hare bakeng sa fractures e sa khaotseng e ke keng ea tsosolosoa ka mokhoa oa anatomically, 'me brace ea ka ntle ea ho lokisa e ka tsosolosa karolo e itseng le ho boloka mohala oa matla;
(4) e lumella ho ikoetlisa pele ho ts'ebetso ea monoana o amehileng ka lenonyeletso le sa tsitsang ho qoba ho kopana
(5) E ka lokisa ka katleho ho robeha ha letsoho ntle le ho ama phekolo ea morao-rao ea leqeba la letsoho le amehileng.
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