Uyilungisa njani i-distal humerus fracture?

Ukufumana ukulungiswa okuzinzileyo kwi-osteoporotic okanye i-comminuted fractures, i-parallel plate technique yonyango lwe-distal humeral fractures isekelwe kumgaqo wokuphucula ukulungiswa kwe-distal fractures. Isitshixo sokuzinza kwesi sakhiwo sokulungiswa kukuba sidibanisa iimpawu kunye nokuzinza kwe-arch ngelixa uvala iikholomu eziphakathi kunye necala le-distal humerus kunye.

Isakhiwo sebhulorho yeArch

Izikrufu zamaqhekeza akude zitshixene omnye komnye, zibonelela uzinzo olongezelelweyo ngokusebenzisa 'ibhulorho yearch evaliweyo'. I-Interlocking ingcono ngokudibana phakathi kwe-screws. Izikrufu ezininzi ziwela ngokusondeleleneyo, kwaye amathambo phakathi kwazo enza 'i-rebar' (ikhonkrithi eyomeleziweyo) uhlobo lwesakhiwo.

Amanyathelo obugcisa

Isinyathelo sokuqala: utyando lokunciphisa ngokubambisana. Iziqwenga ezidibeneyo ezivame ukujikeleza ngokumalunga nomnye kwi-axial plane zancitshiswa i-anatomic kwaye zilungiswe okwethutyana ngeengcingo zaseKirschner. Okubalulekileyo, i-K-ingcingo kufuneka zibekwe kufuphi nenqanaba le-subchondral ukuphepha ukuphazamisa ukubekwa kwe-screw elandelayo kwaye kude nalapho iiplate zibekwe kwiikholamu zecala kunye ne-medial. Enye okanye ezimbini ezibekwe ngokufanelekileyo iingcingo zeKirschner zingasetyenziselwa ukulungisa okwethutyana i-distal fracture ehambelana ne-diaphysis.

Isinyathelo sesibini: ukusetyenziswa kwepleyiti yensimbi kunye nokulungiswa kwexeshana. Amacwecwe angaphambili kunye ne-lateral preformed plates abekwe kwaye agxininiswe kwi-distal humerus, ngelixa i-smooth 2 mm okanye i-2.5 mm yecandelo ifakwe kwi-No. Izikhonkwane zokugcina ukulungiswa kwesikhashana kweplate kunye ne-distal fracture. Isikrufu safakwa kumngxunya osotyiweyo (umngxuma 5) kwipleyiti nganye, kodwa ayiqiniswanga ngokupheleleyo, ishiya inkululeko ethile yokuba ipleyiti ihambe kufutshane ngexesha loxinzelelo. Ekubeni indawo engezantsi yepleyiti nganye i-tubular kwi-metaphyseal kunye ne-diaphyseal ekupheleni, ukuqiniswa okuncinci kuphela kwezikrufu kwimingxuma edibeneyo kunika ukulungiswa kwesikhashana kwe-humerus yonke ye-distal.

Inyathelo 3: Ukulungiswa okudibeneyo. I-screw idlula kwi-Nombolo ye-1 kwi-plate esecaleni, ngeqhekeza le-distal articular ukusuka kwicala ukuya kwi-medial, kwaye liqiniswe. Phinda eli nyathelo usebenzisa umngxuma inombolo 3 ngaphakathi. Kwizigulane ezincinci, ii-screws ze-cortical 3.5 mm zisetyenziselwa (ukuthintela ukuphuka), ngelixa izigulane ze-osteoporotic, i-screws ende ye-2.7 mm isetyenziswa. Isikrufu se-distal kufuneka sibe side kangangoko kwaye kufuneka sidlule kumaqhekeza amaninzi kangangoko kunokwenzeka.

Inyathelo lesi-4 A: Uxinzelelo kwi-condyle. Ukunyanzeliswa kwe-Interfragmentary kwi-fracture inikezelwa kwinqanaba le-suprahumeral usebenzisa i-forceps enkulu yokunciphisa, kunye nekholamu yecala ehleliweyo kuqala. Beka isikrufu kumngxunya wesi-4 kwipleyiti esecaleni kwimowudi yoxinzelelo oluguquguqukayo (ukufakwa). Ukuyiqinisa ngakumbi kuphucula ukunyanzeliswa kwe-interfragmentary (utolo) kwinqanaba le-supracondylar, ebangela ukunwebeka (utolo) kwi-ridge ye-supracondylar ephakathi.

Inyathelo lesi-4B: Ngendlela efanayo, sebenzisa i-forceps enkulu yokunciphisa ukucinezela ikholamu ye-medial kwaye ufake isikrufu kwipleyiti ye-medial kwimowudi yoxinzelelo oluguqukayo. Ukuba iprofayili yepleyiti ayilunganga kancinci, intambo enkulu yamathambo ingasetyenziselwa ukuyicinezela ngokuchasene ne-metaphysis ukucinezela ngakumbi i-condyle.

Inyathelo lesi-5: Ukulungiswa kokugqibela. I-K-ingcingo zakhutshwa kwaye izikrufu eziseleyo zafakwa. Izikrufu ze-distal ziyagxadazela ukuze kwandiswe ukulungiswa kwamaqhekeza adibeneyo akude.

I-Severe Bone Defect-Supracondylar Shortening

Ukuba i-metaphyseal bone loss okanye i-comminution ithintela ukwakhiwa kwakhona kwe-anatomical kunye noqhagamshelwano lwamathambo lulungile, i-humerus inokufinyezwa kwindawo yokuphuka kwe-metaphyseal kunye nokulungelelaniswa okufanelekileyo kunye nejometri ye-distal humerus. Siyibiza enye indlela yokwakhiwa ngokutsha kwe-supracondylar shortening. Obu buchule buluncedo ngakumbi kwiimeko zokudibanisa izicubu ezithambileyo kunye nokulahleka kwamathambo. Ukunciphisa ≤1 cm kunempembelelo encinci kumandla okwandisa i-terminal ye-triceps, kwaye kwiimeko zezicubu ezithambileyo ezinzima kunye nokulahleka kwethambo, ukunciphisa ukuya kwi-2 cm kunokunyamezela ngaphandle kokuchaphazela kakhulu i-elbow biomechanics.

Hlaziya isiphelo se-distal ye-humeral shaft (ngaphandle kwe-articular segment) ukuphucula uqhagamshelwano phakathi kwecandelo le-distal articular kunye ne-diaphysis. Ngokuqhelekileyo, kuphela inani elincinci lethambo lisuswa kwi-distal end of shaft humeral, kwaye ngamanye amaxesha ukusuka kwelinye icala. I-B kunye ne-C, imfutshane yindawo yokuphuka ukuvumela ukunyanzeliswa kwe-interfragmentary phakathi kwe-trochlear kunye ne-distal diaphysis, phakathi kwe-capitulum kunye ne-distal diaphysis, kwaye ukusuka kwelinye icala ukuya kwelinye. Emva kokuba ezi ndawo zixinzelelwe kwaye zikhuselekile ngeeplate zetsimbi, ukuzinza kunamandla ngokwaneleyo ukunyakaza kunye nokulungiswa ngokukhawuleza. Inxalenye ye-distal inokuguqulelwa phakathi okanye i-lateral, okanye kancinci ngaphambili, ngelixa igcina ukulungelelaniswa okujikelezayo kunye ne-valgus.

Izikrufu ezi-6 kunye neethagethi ezi-2 zokulungiswa kwepleyiti

isikrufu

1: Isikrufu ngasinye sidlula kwipleyiti yentsimbi.

I-2: I-screw nganye kufuneka ilungise iqhekeza le-fracture ye-contralateral.

I-3: Beka inani elaneleyo le-screws kwi-distal fracture segment.

4: Isikrufu ngasinye kufuneka sibe side kangangoko.

5: Isikrufu ngasinye kufuneka silungise amaqhekeza amaninzi kangangoko kunokwenzeka.

I-6: I-screws kufuneka itshixe kunye nge-crisscrossing, ukudala isakhiwo esine-angle esisigxina.

Ipleyiti yentsimbi:

I-1: Iiplate ezisetyenziselwa ukulungiswa, iinjongo zokunyanzeliswa kufuneka zifezekiswe kwinqanaba le-condyles ye-femal yekholamu ephindwe kabini.

I-2: Isitya sensimbi esisetyenzisiweyo kufuneka sibe namandla kwaye siqine ngokwaneleyo ukuxhathisa ukuphuka okanye ukugoba.

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

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