Ngaba uyayazi indlela yokulungisa i-metacarpal fracture?

I-Metacarpophalangeal fractures kukwaphuka okuqhelekileyo kwi-trauma yesandla, kubalwa malunga ne-1/4 yazo zonke izigulane zokwenzakala kwezandla. ngenxa yesakhiwo esithambileyo nesintsokothileyo sesandla kunye nokusebenza kakuhle kwemoto, ukulawulwa kokwaphuka kwezandla kubaluleke kakhulu kwaye kuntsonkothile ngokobuchwephesha kunonyango lwezinye iifractures ezinde ze-tubular.

Ukuqinisekisa ukuzinza kwe-fracture emva kokubekwa kwakhona kuyisitshixo kwimpumelelo yonyango lwe-metacarpophalangeal fracture. Ukuze ubuyisele umsebenzi wesandla, ukwaphuka kudla ngokufuna ukulungiswa okufanelekileyo, kwaye kwixesha elidlulileyo, ukulungiswa kwangaphandle kunye nodaka okanye ukulungiswa kwangaphakathi kunye nezikhonkwane zeKirschner zazisetyenziswa ngokuqhelekileyo, kodwa ngokuphindaphindiweyo ngenxa yokulungiswa okungachanekanga okanye ixesha elide lokulungiswa, elingabandakanyi ukuvuselelwa kwangaphambili kwamalungu emva kokuhlinzwa, kwaye kunempembelelo enkulu ekubuyiseleni umsebenzi we-metacarpo ukubuyisela umsebenzi onzima we-metacarpo ukuzisa ubunzima bokubuyisela isandla.

Iindlela zonyango zanamhlanje ziya zisanda kusebenzisa ukulungiswa okunamandla kwangaphakathi, okufana ne-micro plate screw fixation.

Imigaqo yoNyango

Imigaqo yonyango ye-metacarpal kunye ne-phalangeal fractures yesandla yile: i-anatomic repositioning, ukukhanya kunye nokulungiswa okuqinileyo, ukuhamba kwangaphambili kunye nokusebenza komsebenzi. Imigaqo yonyango ye-intra-articular kunye ne-periarticular fractures yesandla iyafana naleyo yezinye iifractures ze-intra-articular: ukubuyiselwa kwe-anatomy ye-articular surface kunye nomsebenzi wokuqala wokusebenza. Ukunyangwa kwe-metacarpal kunye ne-phalangeal fractures yesandla kufuneka izame ukufezekisa i-anatomic repositioning ngaphandle kokujikeleza, i-angulation esecaleni, okanye i-angular displacement> 10 ° ukuya kwinqanaba le-dorsal yesundu. Ukuba isiphelo se-fracture ye-metacarpal sijikelezwa okanye sihanjiswe ngasecaleni kwi-angle, siya kutshintsha i-trajectory eqhelekileyo ye-flexion kunye nentshukumo yokwandiswa komnwe, okubangela ukuba iqhube okanye iwa kumnwe osondeleyo ngexesha lokuhamba, okuchaphazela ukuchaneka komsebenzi womnwe; ngelixa i-angular displacement> i-10 ° ukuya kwi-dorsum yesundu iya kutshabalalisa i-smooth face of the bone kunye ne-tendon, ukwandisa ukuchasana kunye noluhlu lwentshukumo ye-tendon kwi-flexion kunye nokwandiswa, kunye nokubangela ukulimala okungapheliyo kwi-tendon, kubangela umngcipheko we-tendon rupture. umngcipheko wokuqhekeka kwethenda.

I-metacarpal kunye ne-phalangeal fractures zifana nokukwazi ukunyamezela ukukhubazeka okujikelezayo, ngelixa i-metacarpal inyamezela ukunciphisa ukufuduka kunye ne-dorsal angular displacement engcono kune-phalangeal. I-carpometacarpal kunye ne-metacarpophalangeal joints inokuhlawulela ukukhubazeka kwe-angular ye-metacarpal, kwaye umnwe omncinci we-annular ulungelelaniswe ngcono kwi-angular deformity ye-metacarpal kune-index middle finger. Ukunciphisa amandla okubamba ngenxa yokunciphisa imisipha yezandla yangaphakathi kubonakala kuphela xa i-metacarpal i-angled ngaphezu kwe-30 ° ukuya kwicala le-dorsal.

Indlela Yotyando

Indlela yotyando ye-metacarpal fractures ilula kwaye ngokuqhelekileyo isebenzisa indlela ye-dorsal, njengoko kubonisiwe kwi-Figure 4-14. I-metacarpal yesibini yenziwe ngeradially ngelixa i-metacarpal yesihlanu isenziwa ulnarly, kwaye i-metacarpal yesithathu neyesine zihlala ziqatywe phakathi. Ukuba ii-metacarpals ezimbini ezikufutshane zisebenza ngexesha elinye, i-median-shaped-shaped incision isetyenziselwa ukuqwalasela iindawo zombini zotyando.

Indlela emiselweyo yokukhetha

Kukho izinto ezininzi zangaphakathi zokulungiswa kwe-metacarpophalangeal fractures, njengezikhonkwane ze-Kirschner, izikhonkwane, iiplate kunye nezakhelo zokulungiswa kwangaphandle, phakathi kwazo i-Kirschner pins kunye ne-microplates zisetyenziswa ngokuqhelekileyo. Ukuqhekeka kwe-metacarpal, ukulungiswa kwangaphakathi kunye ne-microplate kuneenzuzo ezicacileyo phezu kokulungiswa kunye nezikhonkwane ze-Kirschner kwaye kunokukhethwa; kwi-proximal phalangeal fractures, i-microplate ikhethwa ngokubanzi, kodwa xa kukho ubunzima bokubeka izikrufu kwi-distal segment ye-proximal phalangeal kunye ne-head fractures, ukulungiswa kwangaphakathi kunye nezikhonkwane ze-Kirschner ezinqamlekileyo zikhethwayo, ezilungele ngakumbi ukubuyiswa komsebenzi womnwe ochaphazelekayo; ukwenzela unyango lwe-phalangeal fractures ephakathi, izikhonkwane ze-Kirschner kufuneka zikhethwe.

1, inaliti kaKirschner: 

Ukulungiswa kwangaphakathi kwenaliti ye-Kirschner isetyenziswe kwiklinikhi iminyaka engaphezu kwe-70 kwaye iyeyona nto isetyenziswa ngokuqhelekileyo i-internal fixation material for metacarpophalangeal fractures, ekulula ukuyisebenzisa, uqoqosho kunye nokusebenza, kwaye iyona ndlela yokulungiswa kwangaphakathi yangaphakathi, njengoko kuboniswe kuMfanekiso 4-15. njengokulungiswa kwangaphakathi okuqhelekileyo kusetyenziswa ukunyanga ukuphuka kwezandla, kusasetyenziswa ngokubanzi. 

Iingenelo zokulungiswa kwangaphakathi kunye nezikhonkwane zeKirschner:

① kulula ukusebenza kwaye bhetyebhetye kakhulu ekusebenziseni; 

② ukuhluthwa kwezicubu ezithambileyo ezincinci, impembelelo encinci ekuhambeni kwegazi ekupheleni kokwaphuka, ukwenzakala okuncinci kotyando, kunye nokuthanda ukuphiliswa kokwaphuka; 

③ kulula ukufumana iphini yesibini; 

④ ixabiso eliphantsi kunye nesicelo esibanzi, esisebenzayo kuninzi lwezahlulo zezandla (ezifana ne-intra-articular fractures, iifractures ezinzima kunye nokuphela kwe-phalangeal fractures). 

Ukungalungi ukulungiswa kwangaphakathi: 

(1) xa kuthelekiswa nokulungiswa kweplate, ukuzinza akubi, kwaye ukucutha kunye nokujikeleza okujikelezayo akukwazi ukulawulwa ngepini enye, ngokuqhelekileyo ngaphezu kwe-2 izikhonkwane ezifunekayo ukulungiswa komnqamlezo; 

(2) akukho mpembelelo yoxinzelelo kwisiphelo sokuphuka; 

(3) indawo edibeneyo yonakaliswe ngokulungiswa kwe-cross-joint; 

(4) ukulungiswa kokubambisana kunye nokuvinjelwa kwe-tendon kuthintela ukudibanisa kwesandla ekusebenzeni kwangaphambili kunye nokuchaphazela ukubuyiswa komsebenzi.

Ngophuhliso olukhawulezayo lweendlela zanamhlanje zokulungiswa kwangaphakathi kunye nezixhobo, ukulungiswa kwangaphakathi kunye nezikhonkwane ze-Kirschner kuye kwaphuculwa ngakumbi, kwaye uninzi lwazo lunokulungiswa ngaphandle kokuwela i-joint, kunye nomonakalo omncinci kwizicubu ezithambileyo kunye neetoni ezijikeleze umdibaniso, kwaye ngaphandle kokuchaphazela ukuqeqeshwa komsebenzi odibeneyo wasemva kokusebenza. Ngoncedo lwe-C-arm umatshini we-X-ray, ezinye iimeko ziyakwazi ukufikelela kwiziphumo ezanelisayo ngokunciphisa okuvaliweyo kokulungiswa kwangaphakathi kunye nezikhonkwane zeClinique, ukunciphisa ngakumbi umonakalo kwizicubu ezithambileyo zendawo kunye nefuthe ekunikezeni igazi ukuya ekupheleni kokuqhekeka, ngaloo ndlela kukhuthazwa ukuphulukiswa kokuphuka. 

Izilumkiso zokulungiswa kwangaphakathi kunye nezikhonkwane zikaKristen: 

① Lungisa iibhloko ezinkulu zamathambo kunye nezikhonkwane zikaKristen ze-1.0 ~ 1.2 mm ububanzi, kwaye unqume indawo yokungena kunye nolwalathiso lokungena ngokwendlela yomgca wokuphuka; 

② Ngenjongo yokubuyisela umgca wamandla, iifractures ze-intra-articular kufuneka zibekwe ngokutsha ngokwe-anatomically kwaye zilungiswe ngamandla; 

③ Ayizizo zonke iibhloko zethambo ezifuna ukulungiswa kunye nezikhonkwane zikaKristen, kwaye phantsi kwesiseko sokufikelela ukuzinza kwesiphelo sokuqhekeka, izikhonkwane zeKristen kufuneka zisetyenziswe kancinci ngangokunokwenzeka; 

④ Izikhonkwane zeKristen azilungiswanga kwi-tendon okanye i-dorsal tendon membrane yomnwe ukwenza umthambo osebenzayo kwangoko kangangoko kunokwenzeka; 

⑤ kufuneka kubekho isicwangciso esingqongqo sangaphambi kokusebenza kwaye ungaphindi usebenze ngokuphindaphindiweyo, ngaphandle koko ibhloko yoqhekeko inokutyunyuzwa ngakumbi okanye ingenakulungiseka; 

⑥ ngokubanzi i-Kirschner pin kufuneka ibekwe esikhumbeni ukunciphisa amathuba osulelo kwaye akukho nzima ukuyisusa.

2, ipleyiti encinci yeMetacarpal: 

Ukulungiswa okunamandla kwangaphakathi kokuphulwa kwezandla sisiseko sokuzivocavoca kwangaphambili kwaye kuyimfuneko ukubuyisela ukusebenza kakuhle kwesandla.Ubuchule bokulungiswa kwe-AO bangaphakathi bufuna ukulungiswa kwe-anatomical echanekileyo yokuphela kwe-fracture kunye nokuzinziswa kwesiphelo sokuphuka kwimeko yokusebenza, ngokuqhelekileyo kubhekiselwa kuyo njengokulungiswa okunamandla, ukwenzela ukuba kuvunyelwe ukuhamba kwangaphambili okusebenzayo.I-AO iphinda igxininise ekukhuseleni okuncinci kwe-invasive kwi-surgical operation. I-AO iphinda igxininise iinkqubo zotyando oluncinci olugxininisa ekugcineni ukuhamba kwegazi. Ukulungiswa kwangaphakathi kwe-Microplate ye-fracture yesandla kunika iziphumo ezanelisayo ngokwamandla, ukuzinza kokuphela kokuphuka kunye noxinzelelo phakathi kweziphelo. Ngokumalunga nokubuyiselwa komsebenzi wasemva kokusebenza, ixesha lokuphulukisa ukuphuka kunye nesantya sosulelo xa kuthelekiswa, ukusebenza kwe-micro titanium plates kuthathwa njengokungcono kakhulu kunezikhonkwane ze-kerf, kwaye ngenxa yokuba ixesha lokuphulukisa i-fracture emva kokulungiswa kwepleyiti ye-titanium encinci mfutshane kakhulu kunezinye iindlela zokulungisa, ngaloo ndlela kuququzelela ukubuyela kwangoko kubomi obuqhelekileyo besigulane.

Izinto ezilungileyo zonyango lwe-microplate yangaphakathi yokulungiswa: 

(1) xa kuthelekiswa nezikhonkwane ze-kerf, izikrufu ze-microplate zine-histocompatibility engcono kunye nokuphendula kwezicubu; 

(2) ukuzinza kwenkqubo yokulungisa izikhonkwane zepleyiti kunye noxinzelelo kwisiphelo sokuphuka kwenza ukuphuka kusondele kwi-anatomical repositioning, ukulungiswa okukhuselekileyo, okulungele ukuphulukiswa kwe-fracture; 

(3) umsebenzi wokuqala wokusebenza uvumelekile ngokuqhelekileyo emva kokulungiswa kwe-microplate, ehambelana nokubuyisela umsebenzi wesandla. 

3. Izikruru.

I-Microscrews ye-spiral or long oblique fracture fixation inozinzo olufanayo njengamacwecwe ensimbi, kodwa i-tissue ethambileyo kunye ne-periosteal stripping area incinci kune-steel plate fixation, eyenza ukukhuselwa kokuhamba kwegazi kunye nokuhambelana nombono wokusebenza okuncinci. Nangona kukho i-T- kunye ne-L-type splints ye-proximal joint fractures, utyelelo lokubuyela emva kokuhlinzwa luhluphekile kunoko lwe-diaphyseal fractures, kwaye i-microscrews ineenzuzo ezithile zokulungiswa kwe-intra- kunye ne-periarticular fracture. I-Screw screwed kwi-bone cortex inokumelana nomthwalo omkhulu wokuxinzezeleka, ngoko ukulungiswa kuqinile kwaye kunokubeka uxinzelelo phakathi kweephelo zokuphuka ukuzisa iindawo eziqhekezayo kuqhagamshelwano olusondeleyo, olunciphisa ixesha lokuphulukisa kwaye luququzelele ukuphulukiswa kwe-fracture, njengoko kuboniswe kwi-Figure 4-18. i-microscrews isetyenziswa ikakhulu kwi-oblique okanye i-spiral fractures ye-diaphysis kunye ne-intra-articular avulsion fractures yamathambo amakhulu. Kubalulekile ukuba kuqatshelwe ukuba ubude intambo ukwaphuka kufuneka ubuncinane kabini ububanzi diaphysis xa ukulungisa oblique okanye spiral ukwaphuka kwesiqu isandla usebenzisa microscrews yedwa, kwaye ubuncinane izihlandlo ezithathu ububanzi intambo ububanzi xa kulungiswa intra-articular avulsion fracture blocks.

4. Ibrace yokulungiswa kwangaphandle encinci.

I-metacarpophalangeal fractures edibeneyo ngamanye amaxesha kunzima ukuseta kwakhona i-anatomically nangona i-scular incision okanye ayinakulungiswa ngamandla ngaphakathi ngenxa yokuba i-scaffold yamathambo itshatyalalisiwe. I-brace yokulungiswa kwangaphandle ivumela ukuphulwa kwe-comminuted ukubuyisela kwaye igcine ubude bayo phantsi kwempembelelo ye-traction, idlala indima emiselweyo, njengoko kuboniswe kuMfanekiso 4-19. Ukubekwa kwe-brace yokulungiswa kwangaphandle kuyahluka kwii-metacarpals ezahlukeneyo: i-1st kunye ne-2nd metacarpals ibekwe kwicala le-dorsal radial, i-4th kunye ne-5 ye-metacarpals ibekwe kwicala le-dorsal ulnar, kunye ne-3rd metacarpal ibekwe kwi-radial dorsal okanye i-dorsal ingqwalasela yokuthintela ukuhlaselwa kwimeko yokungena kwimeko yokulimala. umthambo. Iifractures ezivaliweyo zingavalwa kwaye zibekwe phantsi kwe-X-ray, kwaye izithintelo ezincinci zingenziwa ukuncedisa ekubuyiseleni kwakhona ukuba ukubekwa kwakhona akufanelekile.

Izinto eziluncedo kwibrace yokulungiswa kwangaphandle.

(1) kulula ukuyisebenzisa kwaye inokulungelelanisa ukufuduka okwahlukeneyo kwesiphelo sokwaphuka;

(2) inokubuyisela ngokufanelekileyo kwaye ilungise i-intra-articular fractures ye-metacarpal phalanges ngaphandle kokulimaza i-articular surface, kwaye inokuphazamisa indawo ye-articular ukukhusela i-contracture ye-capsule edibeneyo kunye ne-lateral collateral ligaments; 

(3) inokudibaniswa nokulungiswa okulinganiselweyo kwangaphakathi kwiifractures ezigqityiweyo ezingenako ukusetwa kwakhona kwe-anatomically, kwaye i-brace yokulungisa yangaphandle inokusetha kwakhona kwaye igcine umgca wamandla; 

(4) ivumela ukusetyenziswa kwangaphambili kokusebenza komnwe ochaphazelekayo kwindawo engaguqukiyo ukuphepha ukudibanisa 

(5) Iyakwazi ukulungisa ngokufanelekileyo ukuphuka kwesandla ngaphandle kokuchaphazela unyango lwe-postoperative yesilonda sesandla esichaphazelekayo.

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

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