U ka lokisa fracture ea distal humerus joang?

Ho reproducibly ho fumana fixation e tsitsitseng sebakeng sa osteoporotic kapa fractures comminuted, mokhoa o ts'oanang oa poleiti bakeng sa phekolo ea distal humeral fractures e thehiloe holim'a molao-motheo oa ho ntlafatsa ho lokisoa ha fractures ea distal. Ntho ea bohlokoa bakeng sa botsitso ba mohaho ona oa ho lokisa ke hore o kopanya likarolo le botsitso ba lehare ha o ntse o koala litšiea tse bohareng le tse ka thōko tsa distal humerus hammoho.

Sebopeho sa borokho ba Arch

Li-screws tsa likhechana tsa distal lia notlelana, li fana ka botsitso bo eketsehileng ka 'borokho bo koetsoeng ba arch'. Ho kopanya ho finyelloa hamolemo ka ho kopana pakeng tsa li-screws. Li-screws tse ngata li hoholeha hammoho, 'me masapo a pakeng tsa tsona a etsa 'rebar' ('reinforced concrete)' sebopeho sa mofuta.

Mehato ea tekheniki

Mohato oa pele: opereishene ea ho fokotsa manonyeletso. Likaroloana tse kopaneng tse neng li tloaetse ho potoloha ha li bapisoa le tse ling ka sefofaneng sa axial li ne li fokotsehile 'me tsa lokisoa ka nakoana ka lithapo tsa Kirschner. Habohlokoa, likhoele tsa K li lokela ho behoa haufi le boemo ba subchondral ho qoba ho kena-kenana le ho behoa ha screw ka mor'a moo le hole le moo lipoleiti li behoang holim'a litšiea tse ka morao le tse bohareng. Khoele e le 'ngoe kapa tse peli tse behiloeng ka mokhoa o nepahetseng oa Kirschner li ka sebelisoa ho lokisa ka nakoana ho robeha ha distal ho tsamaisanang le diaphysis.

Mohato oa bobeli: kopo ea tšepe ea tšepe le ho lokisa nakoana. Lipoleiti tse entsoeng ka hare le tse ka morao li behiloe 'me li tsitsitsoe ho distal humerus, ha karolo e boreleli ea 2 mm kapa 2.5 mm e kenngoa ka lesoba la No. Lithako ho boloka ho lokisoa ha nakoana ha poleiti le ho robeha ha distal. Sekurufu se kentsoe lesobeng le koetsoeng (lesoba la 5) poleiting e 'ngoe le e 'ngoe, empa se sa tiisetsoa ka ho feletseng, se siea bolokolohi bo itseng hore poleiti e tsamaee nako e telele nakong ea khatello. Kaha karolo e ka tlaase ea poleiti e 'ngoe le e' ngoe e na le li-tubular lipheletsong tsa metaphyseal le diaphyseal, ho tiisa hanyenyane feela li-screws ka likoti tse slotted ho fana ka tokiso e ntle ea nakoana ea humerus eohle ea distal.

Mohato oa 3: Ho lokisa manonyeletso. Sekurufu se fetisoa ka lesoba la No. 1 ka har'a poleiti ea lateral, ka sekhechana sa distal articular ho tloha lateral ho ea bohareng, 'me se tiisitsoe. Pheta mohato ona ka ho sebelisa lesoba nomoro 3 ka hare. Ho bakuli ba banyenyane, ho sebelisoa li-screws tsa cortical 3.5 mm (ho thibela ho robeha), ha ho bakuli ba osteoporotic, li-screws tse bolelele ba 2.7 mm li sebelisoa. The distal screw e lokela ho ba nako e telele kamoo ho ka khonehang 'me e lokela ho feta likhechana tse ngata kamoo ho ka khonehang.

Mohato oa 4 A: Khatello holim'a condyle. Khatello ea li-interfragmentary ho pholletsa le fracture e fanoa boemong ba suprahumeral ho sebelisa matla a maholo a ho fokotsa, 'me karolo ea lateral e tsitsitse pele. Beha sekoti ka lesoba la 4 ka har'a poleiti e ka morao ka mokhoa o matla oa ho hatella (kenya). Ho e tiisa ka ho eketsehileng ho matlafatsa khatello ea li-interfragmentary (motsu) boemong ba supracondylar, e leng ho bakang ho otlolla (motsu) holim'a mokokotlo oa supracondylar oa medial.

Mohato oa 4B: Ka mokhoa o ts'oanang, sebelisa li-forceps tse kholo ho hatella kholomo e bohareng le ho kenya screw ka har'a poleiti ea medial ka mokhoa o matla oa compression. Haeba boemo ba poleiti bo le boemong bo fokolang, ho ka sebelisoa lesela le leholo la masapo ho le hatella khahlanong le metaphysis ho tsoela pele ho hatella condyle.

Mohato oa 5: Ho lokisa ho qetela. Lithapo tsa K li ile tsa ntšoa 'me li-screw tse setseng tsa kenngoa. Li-screws tsa distal lia thekesela ho eketsa ho lokisoa ha likhechana tsa manonyeletso a distal.

Bothata bo Bohloko ba Masapo - Supracondylar Shortening

Haeba tahlehelo ea masapo a metaphyseal kapa ts'ebetso e sitisa ho tsosolosoa ha anatomical le ho kopana ha masapo ho molemo, humerus e ka khutsufatsoa sebakeng sa fracture ea metaphyseal ka ho lumellana ka kakaretso le geometry ea distal humerus. Re bitsa mokhoa ona oa ho aha bocha supracondylar shortening. Mokhoa ona o thusa haholo-holo maemong a ho kopanngoa ha lisele tse bonolo le ho lahleheloa ke masapo. Ho khutsufatsa ≤1 cm ho na le phello e fokolang ho matla a katoloso ea 'triceps' ea 'triceps', 'me maemong a boima bo matla ba lisele tse bonolo le tahlehelo ea lesapo, ho khutsufatsoa ho fihlela ho 2 cm ho ka mamelloa ntle le ho ama ka matla biomechanics ea setsoe.

Fetola pheletso ea distal ea shaft ea humeral (ntle le karolo ea articular) ho matlafatsa kamano pakeng tsa karolo ea distal articular le diaphysis. Hangata, ho tlosoa lesapo le lenyenyane feela ho tloha pheletsong e ka thōko ea sefate sa humeral, 'me ka linako tse ling ho tloha ka lehlakoreng le leng la eona. B le C, e khutsufalitsoeng ke sebaka sa fracture ho lumella khatello ea interfragmentary pakeng tsa trochlear le distal diaphysis, pakeng tsa capitulum le distal diaphysis, le ho tloha ka lehlakoreng le leng. Hang ha libaka tsena li hatelloa le ho tiisoa ka lipoleiti tsa tšepe, botsitso bo matla ka ho lekaneng bakeng sa ho tsamaea le ho lokisoa hang-hang. Karolo ea distal e ka fetoleloa ka hare kapa ka mahlakoreng, kapa hanyenyane ka pele, ha e ntse e boloka ho tsamaisana ha rotational le valgus.

6 screws le 2 plate fixation targets

screw

1: Sekoti se seng le se seng se feta ka poleiti ea tšepe.

2: Sekoti se seng le se seng se lokela ho lokisa sekhechana sa ho robeha ha contralateral.

3: Beha palo e lekaneng ea li-screws karolong ea distal fracture.

4: Sekoti se seng le se seng se lokela ho ba nako e telele kamoo ho ka khonehang.

5: Sekoti se seng le se seng se lokela ho lokisa likhechana tse ngata kamoo ho ka khonehang.

6: Li-screws li lokela ho notlela hammoho ka crisscrossing, ho theha sebopeho se nang le angle e tsitsitseng.

Letlapa la tšepe:

1: Bakeng sa lipoleiti tse sebelisetsoang ho lokisa, lipakane tsa khatello li lokela ho finyelloa boemong ba li-condyles tsa botšehali tsa kholomo e habeli.

2: Letlapa la tšepe le sebelisitsoeng le tlameha ho ba le matla le ho tiea ka ho lekaneng ho hanela ho robeha kapa ho kobeha.

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