Ku phatluka ka extensor tendon endzhaku ka volar plate fixation switshama swiri xiphiqo lexikulu eka ku lunghisa ku tshoveka ka distal radius. Tendon leyi khumbekaka ngopfu i extensor pollicis longus (EPL) tendon, tani hileswi yi pfaleriweke endzeni ka EPL groove. Ku vikiwa ka xiendlakalo xa EPL tendon rupture endzhaku ka volar plating i 0.29%–5.7%.
Khombo ra ku hlwela ka ku pandzeka ka EPL tendon ri engeteleka eka vukona bya dorsal screw protrusion, ku vaviseka kusuka eka intraoperative direct drilling, na swiphemu swa dorsal roof, ngopfu ngopfu eka ku tshoveka ka swihlala swa Lister’s tubercle. Ku kamberiwa ka radiographic ka screw protrusion eka distal radius fractures swa tika hikokwalaho ka geometry yo rharhangana ya distal radius xikan’we na vuswikoti bya comminuted dorsal fractures. Dorsal tangential view hi yona ntsena leyi kotekaka ya intravital view ya dorsal radial cortex kuva ku kumiwa nkambisiso lowu tshembekaka wa mpfhuka exikarhi ka screw tip na dorsal cortex.
Maendlelo yo papalata ku vaviseka ka extensor tendon ya katsa ku tirhisiwa ka swikwirikiri swa monocortical na ku papalata ku nghena ka dorsal surface; hambiswiritano, tindlela leti ti nga ha hunguta ku tiya ka michini ya ku lunghisa ku tshoveka. Hikwalaho, minkarhi yin’wana ku laveka ku khomiwa ka bicortical. Ku hunguta khombo ra ku vaviseka ka extensor tendon, tipakani ta nkoka ta ku khomiwa ka fracture na ku tshamiseka a ti fanelanga ku kavanyetiwa.
Maendlelo lamantshwa ya vuhandzuri
Hi hlamusela thekiniki ya novhele yo hunguta khombo ra ku pandzeka ka EPL tendon endzhaku ka volar plate fixation ya distal radius fractures handle ko pfuxeta ku leha ka screw kumbe ku susa swiphemu swa dorsal roof. Hi ku komisa, endlelo leri ri katsa ku pfula xiyenge xa vunharhu hi ku tsemiwa lokutsongo ka le ndzhaku.
Loko xikurufu a xi nghene eka dorsal cortex naswona xi humile eka xiyenge xa vunharhu: hi suse EPL tendon eka groove ya yona ivi hi pfala xiyenge hi ku rhunga retinaculum hi siya EPL tendon eka retinaculum leyi lunghisiweke.
Loko xikurufu xi nga ngheni eka xiyenge xa vunharhu: hi siya tendon ya EPL eka xiyenge xa vunharhu. Xikombiso xa thekiniki ya hina i eka vavabyi lava nga na ku tshoveka ka radius ya le kule lava tshunguriweke hi ti volar locking plates, ku tshoveka hi swiphemu swa dorso-parietal kumbe swikwirikiri leswi nga nghenaka eka dorsal cortex kumbe ku onha tendon ya EPL ku rhendzela tubercle ya Lister. Eka vavabyi lava nga na ku tshoveka ka distal radius na swiphemu swa dorsomedial, hi bora timbobo ku nghena eka dorsal cortex na ku hlawula swikwirikiri swa ku leha loku ringaneke ku lulamisa swiphemu swa dorsomedial leswi nga tshamisekangiki.
Ku avelana milandzu
Hi avelana mhaka leyi eka yona EPL tendon yi susiweke eka xiyenge xa vunharhu hikwalaho ka ku huma ka xikurufu eka xiyenge xa vunharhu hi nkarhi wa ku khomiwa ka plate ya comminuted distal radius fracture na swiphemu swa dorsomedial. Hi tiyisisile leswaku EPL tendon ayi onhakanga 7 years postoperatively, hambi leswi screw ayi vonaka eka xiyenge xa vunharhu.
Mhaka leyi a ku ri wa xisati wa malembe ya 67 hi vukhale loyi a nga na vuvabyi bya intra-articular unstable distal radius fracture leyi nga na right dorsal medial fracture (Xifaniso 1A-E). Ku hava matimu ya ku dzaha fole, vuvabyi bya chukele kumbe ku nwa byala. A nga famba a nga ri na mufambi.
![ku tshoveka ka radius ya le kule]()
xifaniso 1. Swifaniso swa le mahlweni ka vuhandzuri swi kombisile ku tshoveka loku tsemiweke ka le ndzeni ka xirho xa radius ya le kule.
A na B: X-rheyi ya le mahlweni ka vuhandzuri, .
C na D: swivono swa sagittal na axial swa swifaniso swa computed tomography, .
E: Xifaniso xa 3D xa tomography ya khompyuta. Swiphemu swa dorsal medial lunate facet na swiphemu swa dorsal apical (tinyeleti to basa) swa vonaka.
Endlelo ra vuhandzuri
Hi tshungule fambiselo leri ra ku tshoveka hi volar locking plate. Hi nkarhi wa vuhandzuri, hi borile hi dorsal cortex kutani hi hlawula screw yo leha ku ringana ku tiyisisa dorsal cortex hikuva xiphemu xa dorsomedial a xi nga tshamisekanga (Xifaniso 2).
Ku endliwe vuhandzuri byo pfula xiyenge xa vunharhu endzhaku ko khomiwa hi swikwirikiri.
Tanihi leswi xikurufu xi ngheneke eka xiyenge xa vunharhu xi tlhela xi huma (Xifaniso 3A), pfula xiphemu xa vunharhu hi ku helela ivi u susa tendon ya EPL ehandle ka groove ya yona (Xifaniso 3B).
Kutani xiyenge xa vunharhu xi pfariwile hi ku rhunga retinaculum (Fig. 3C,D), naswona EPL tendon yi vekiwile ehenhla ka retinaculum leyi lunghisiweke (Fig. 3 E).
Endzhaku ka vuhandzuri, muvabyi u ye etliliniki ya vavabyi lava nga le handle ya xibedlhele xa hina kukondza marhambu ma hola. Muvabyi a nga lavi ku susa hardware.
Ku hola endzhaku ka vuhandzuri
Endzhaku ka malembe ya nkombo a endliwe vuhandzuri, muvabyi u tlhelele exibedlhele leswaku a ya kamberiwa nakambe hikwalaho ka vuvabyi bya ku tsana ka marhambu. Voko ra xinene a ri lamalanga. Xifaniso xa X-ray lexi kombisaka ku tshoveka loku horisiweke loku nga na ku huma ka le ndzhaku ka xikurufu xo pfala xa le kule. Xikunwana xa muvabyi a xi andlariwile hi ku helela, naswona misiha ya EPL a yi nga ri na ntambhu ya vurha leyi nga erivaleni.
Hi ku ringanyeta ka hina, muvabyi u pfumerile ku susa hardware ivi a kambela ti extensor tendons. Eka vuhandzuri, hi kambisise EPL tendon hi ku tirhisa dorsal incision naswona hi pfule xiphemu xa xiyenge xa vunharhu na xa vumune.
Nsinya wa EPL a wu ri ehandle ka xiyenge xa vunharhu eka xiyimo lexi fanaka ni xa vuhandzuri lebyi hundzeke, naswona misiha a yi hlundzukanga.
Hi tiyisisile leswaku xikurufu xi nghene eka xiyenge xa vunharhu loko ti extensor tendons ta tintiho ti tlheriseriwa endzhaku.
Eku heteleleni, hi lunghise swirhendzevutana swa nseketelo ivi hi susa switirhisiwa swa le makaya. Eka nkambisiso wo hetelela endzhaku ka tin’hweti ta 2 endzhaku ko susiwa ka hardware, muvabyi a nga ri na switlhavi naswona a ri na ku engeteriwa ka xikunwana lexi heleleke.
Kanela
Eka maendlelo ya hina, endzhaku ka volar plate fixation ya distal radius fractures, hi pfule xiphemu xa xiyenge xa vunharhu hiku tirhisa incision kwalomu ka 2 cm hiku leha ulnar kuya eka tubercle ya Lister. Hi tive hi ku kongoma tendon ya EPL na le hansi ka xiyenge xa vunharhu xa extensor hi ku tlherisela endzhaku hi vukheta tendon ya EPL.
Loko xikurufu xi nghena eka dorsal cortex eka xiyenge xa vunharhu kumbe xi ri na dorso-parietal debris, a hi endlanga ku cinca ka screw intraoperative kumbe fragmentectomy, kambe hi pfule hi ku helela xiyenge xa vunharhu ivi hi susa EPL tendon eka groove ya yona. Kutani hi pfarile xiyenge lexi hi ku rhunga retinaculum loko hi ri karhi hi veka nsinya wa EPL eka xiyenge xa vunharhu.
Loko xikurufu xi nga nghenanga eka xiyenge xa vunharhu, hi siye xirho xa EPL eka xiyenge xa vunharhu lexi pfulekeke hi xiphemu.
Thekiniki ya hina ya vuhandzuri yi pfumelela ku kamberiwa ko olova ka ku vaviseka ka misiha ya EPL hi ku vona hi ku kongoma hi timinete titsongo ku fana na khume ro engetela. Loko EPL tendon yi vavisekile, yi nga lunghisiwa hi ku kongoma. Endlelo leri ri pfuneta ku sivela ku pandzeka ka secondary EPL tendon endzhaku ka distal radial plate fixation. EPL tendon bowstring yi nga ha humelela, kambe a yi humelelanga eka hina.
Hi ku gimeta
Hi vile na xiyimo lexi eka xona EPL tendon yi nga onhakanga endzhaku ka malembe ya 7 endzhaku ka vuhandzuri, hambi leswi swikwirikiri leswi tirhisiweke ku lulamisa volar plate a swi vonaka eka xiyenge xa vunharhu. Thekiniki ya hina ya vuhandzuri yi hunguta khombo ra ku pandzeka ka EPL tendon endzhaku ka ku khomiwa ka volar plate eka ku tshoveka ka distal radius.
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.
Hi rhumela ehandle emisaveni hinkwayo, leswaku u ta kota tihlanganisi na hina eka email address song@orthopedic-china.com ku kuma xikombelo xa mahala, kumbe u rhumela rungula eka WhatsApp ku kuma nhlamulo ya xihatla +86- 18112515727 .
Loko u lava ku tiva vuxokoxoko byo tala,click CZMEDITECH ku kuma vuxokoxoko byo tala.
