Xana u swi lulamisa njhani ku tshoveka ka distal humerus?

Ku kuma hi ndlela yo tlheriseriwa ku khomiwa loku tiyeke eka xiyimo xa ku tshoveka ka marhambu kumbe loku tshovekeke, endlelo ra parallel plate ro tshungula ku tshoveka ka distal humeral ri sekeriwe eka nsinya wa nawu wo ndlandlamuxa ku khomiwa ka ku tshoveka ka marhambu ya le kule. Xilotlelo xaku tshamiseka ka xivumbeko lexi xa fixation hileswaku xihlanganisa swihlawulekisi na ku tshamiseka ka arch loko xiri karhi xi khiya tikholomu ta le xikarhi nale matlhelo ta distal humerus swin’we.

Xivumbeko xa buloho ra arch

Swikwirikiri swa swiphemu swa le kule swi khiya eka xin'wana na xin'wana, leswi nyikaka ku tshamiseka loku engetelekeke hi ku tirhisa 'buloho ra arch leri pfalekeke'. Ku hlanganisiwa swi endliwa kahle hiku khumbana exikarhi ka swikwirikiri. Swikwirikiri swotala swi hlangana swinene, naswona marhambu lawa yanga exikarhi ka swona ya endla xivumbeko xa muxaka wa 'rebar' (reinforced concrete).

Magoza ya xithekiniki

Goza ro sungula: vuhandzuri byo hunguta mahlangano. Swiphemu swa mahlangano leswi a swi tala ku rhendzeleka loko swi pimanisiwa na swin’wana eka axial plane swi hungutiwile hi anatomic naswona swi pfaleriwile swa xinkarhana hi tintambhu ta Kirschner. Xa nkoka, ti K-wires tifanele ku vekiwa ekusuhi na subchondral level kuva ti papalata ku kavanyeta ku vekiwa ka screw loku landzelaka naswona ekule na laha ti plates ti vekiwaka kona eka ti lateral na medial columns. Ntambhu yin’we kumbe timbirhi ta Kirschner leti vekiweke kahle tinga tirhisiwa ku lulamisa swa xinkarhana ku tshoveka ka le kule loku ringanaka na diaphysis.

Goza ra vumbirhi: ku cheriwa ka steel plate na ku vekiwa ka xinkarhana. Ti plates ta medial na lateral leti endliweke ka ha ri emahlweni ti vekiwa no vekiwa eka distal humerus, kasi xiphemu xo olova xa 2 mm kumbe 2.5 mm xi nghenisiwa hi No. 2 hole (leyi nomboriweke distal kuya eka proximal), epicondyle, na distal bone fragment eka plate yin’wana na yin’wana. Tiphini kuva ti hlayisa ku khomiwa ka nkarhinyana ka plate xikan’we naku tshoveka ka distal. Screw yi vekiwile eka slotted hole (hole 5) eka plate yin’wana na yin’wana, kambe yinga tiyisiwanga hiku hetiseka, leswi siyeke ntshunxeko wokarhi leswaku plate yi famba proximally hinkarhi wa compression. Leswi xiphemu xale hansi xa plate yin’wana na yin’wana xinga tubular eka makumu ya metaphyseal na diaphyseal, ntsena ku tiyisiwa nyana ka swikwirikiri eka ti slotted holes swinyika ku khomiwa kahle ka nkarhinyana ka distal humerus hinkwayo.

Goza 3: Ku khomiwa ka mahlangano. Xikurufu xi hundza hi le ka khumbi ra No. 1 eka pulati ya le tlhelo, hi xiphemu xa distal articular ku suka etlhelo ku ya exikarhi, ivi xi tiyisiwa. Phindha goza leri hiku tirhisa hole number 3 endzeni. Eka vavabyi lavatsongo, ku tirhisiwa swikwirikiri swa 3.5 mm swa cortical (ku sivela ku tshoveka), kasi eka vavabyi va osteoporotic, ku tirhisiwa swikwirikiri swo leha swa 2.7 mm. Distal screw yifanele kuva yi lehe hilaha swinga kotekaka hakona naswona yifanele ku hundza eka swiphemu swotala hilaha swinga kotekaka hakona.

Goza ra 4 A: Ku tshikileriwa eka condyle. Interfragmentary compression ku tsemakanya fracture yi nyikiwa eka suprahumeral level hiku tirhisa ti reduction forceps letikulu, laha kholomo yale tlhelo yinga lulamisiwa kusungula. Veka xikurufu eka hole 4 eka lateral plate eka dynamic compression mode (inset). Ku yi tiyisisa swi ya emahlweni swi ndlandlamuxa interfragmentary compression (arrow) eka supracondylar level, leswi vangaka ku ololoka ko karhi (arrow) eka medial supracondylar ridge.

Goza ra 4B: Hi ndlela leyi fanaka, tirhisa ti reduction forceps letikulu ku tshikelela kholomo ya le xikarhi kutani u nghenisa xikurufu eka plate ya le xikarhi eka movha wa dynamic compression. Loko profile ya plate yiri suboptimal nyana, bone clamp leyikulu yinga tirhisiwa ku yi tshikelela eka metaphysis kuva yi tshikelela condyle kuya emahlweni.

Goza 5: Ku lulamisiwa ko hetelela. Ti K-wires ti susiwile naswona swikwirikiri leswi saleke swi nghenisiwile. Ti distal screws ti staggered kuva ti kurisa fixation ya distal joint fragments.

Xihoxo Lexikulu xa Marhambu - Ku koma ka Supracondylar

Loko ku lahlekeriwa hi marhambu ya metaphyseal kumbe ku tshoveka swi sivela ku pfuxetiwa ka anatomical naswona ku khumbana ka marhambu swiri kahle, humerus yinga hungutiwa eka ndzhawu ya metaphyseal fracture hi ku ringanana loku faneleke hiku angarhela na geometry ya distal humerus. Hi vitana endlelo leri rin’wana ro pfuxeta supracondylar shortening. Endlelo leri ri pfuna ngopfu eka swiyimo swa tinyama to olova leti hlanganisiweke na ku lahlekeriwa hi marhambu. Ku pfuxeta ≤1 cm aswina mbuyelo wutsongo eka matimba yo andzisa ya triceps terminal, naswona eka swiyimo swa soft tissue yo olova swinene na ku lahlekeriwa hi marhambu, ku pfuxeta kuya fika eka 2 cm swinga tiyiseleriwa handle ko khumba swinene elbow biomechanics.

Vumba hi vuntshwa makumu ya le kule ya humeral shaft (ku nga katsiwi xiphemu xa articular) ku ndlandlamuxa ku hlangana exikarhi ka xiphemu xa distal articular na diaphysis. Hi ntolovelo, ku susiwa ntsena marhambu matsongo eka makumu ya le kule ya humeral shaft, naswona minkarhi yin’wana ku suka eka tlhelo rin’we ra yona. B na C, leswi pfuxetiweke hi ndzhawu ya fracture ku pfumelela interfragmentary compression exikarhi ka trochlear na distal diaphysis, exikarhi ka capitulum na distal diaphysis, na kusuka eka tlhelo kuya eka tlhelo. Loko swiphemu leswi swi tshikileriwa naswona swi tiyisiwile hi ti steel plates, ku tiya ka swona swi tiya swinene leswaku swita famba hiku hatlisa naku lunghisiwa. Xiphemu xa le kule xi nga hundzuluxeriwa exikarhi kumbe etlhelo, kumbe emahlweninyana, loko ku ri karhi ku hlayisiwa ku ringanana ka ku rhendzeleka na valgus.

6 wa swikwirikiri na 2 wa swikongomelo swo khoma pulati

xikurufu

1: Xikurufu xin’wana ni xin’wana xi hundza hi le ka pulati ya nsimbi.

2: Xikurufu xin’wana ni xin’wana xi fanele xi lunghisa xiphemu xa ku tshoveka ka le tlhelo.

3: Veka nhlayo leyi eneleke ya swikwirikiri eka xiphemu xa distal fracture.

4: Xikurufu xin’wana ni xin’wana xi fanele xi leha hilaha swi nga kotekaka hakona.

5: Xikurufu xin’wana ni xin’wana xi fanele xi lunghisa swiphemu swo tala hilaha swi nga kotekaka hakona.

6: Swikwirikiri swifanele ku khiya swin’we hiku tsemakanya, ku endla xivumbeko lexinga na angle leyi nga cinciki.

Xiphepherhele xa nsimbi: .

1: Eka ti plates leti tirhisiwaka ku fixation, tipakani ta compression tifanele ku fikeleriwa eka levele ya femoral condyles ya double column.

2: Puleti ya nsimbi leyi tirhisiwaka yi fanele ku tiya naswona yi tiya lerova yi nga tshoveki kumbe ku gombonyoka.

Ndlela Yo Xava Switirhisiwa Swa Marhambu Ni Switirhisiwa Swa Marhambu!

Swa CZMEDITECH , hi na layini ya swikumiwa leyi heleleke swinene ya switirhisiwa swa vuhandzuri bya marhambu na switirhisiwa leswi fambelanaka, swikumiwa ku katsa ku nghenisiwa ka nkolo, swipikiri swa le ndzeni ka medullary, pulati ya khombo, ku pfala pulati, cranial-maxillofacial ya xikandza, xirho xa xitekela, switirhisiwa swa gezi, switirhisiwa swo khoma swilo swa le handle, ku kamberiwa ka marhambu, nhlayiso wa swifuwo na tisethi ta switirhisiwa swa vona swo seketela.

Ku engetela kwalaho, hi tiyimiserile ku ya emahlweni hi hluvukisa switirhisiwa leswintshwa na ku ndlandlamuxa milayeni ya swikumiwa, leswaku hi ta fikelela swilaveko swa vuhandzuri swa madokodela na vavabyi vo tala, na ku tlhela hi endla leswaku khamphani ya hina yi phikizana swinene eka indasitiri hinkwayo ya misava hinkwayo ya switirhisiwa swo nghenisa marhambu na switirhisiwa.

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