Ukuqhekeka kwe-distal radius kuphakathi kwezona fractures eziqhelekileyo kubantu abadala. Abantu abaphakathi kweminyaka engama-50 nama-75 ngoku bachazwa njengabantu abadala. Iziganeko ze-distal radius fractures zanda unyaka nonyaka njengoko uluhlu lwentshukumo kubantu abadala lukhula. Umba oshushu kwingxoxo malunga nokuqhekeka kweradius distal uhlala: Ngaba utyando luyimfuneko?
Izifundo ze-Epidemiological
Iifractures ze-distal radius account malunga ne-18% yazo zonke iifractures zomzimba kubantu abadala. Abemi baseCaucasian, abaguli ababhinqileyo, kunye ne-osteoporosis zizinto eziphambili zomngcipheko wokuqhekeka kweradius distal. Ukongeza, ikwabandakanya izinto zamaxesha onyaka, ezinje ngokutyibilika ukuya ekwindla abantu abadala abaqhelene nokuqhekeka kweradius distal ebusika. Olunye uphando luye lwaxela ukuba izigulane ezikhulileyo ezinobuchule obucacileyo kunye nenkqubo ye-neuromuscular isengozini enkulu yokuqhekeka kwe-distal radius (kuba izigulane zinee-reflexes ezinamandla, ziya kulungelelanisa izandla zabo ukuze zixhase umhlaba xa ziwa, ezibangela ukuphuka). .
Ngokwezibalo, eUnited States, iindleko zonyango zokuqhekeka kweradius distal kwi-2007 yayimalunga ne-170 yezigidi zeedola zase-US (malunga ne-1983 yeedola zase-US / umntu). Nangona uninzi lwezigulana ezisele zikhulile ezine-distal radius fractures ziphathwa ngokucokisekileyo, inani lezigulana ezikhetha ukulungiswa kotyando lwangaphakathi liyakhula unyaka nonyaka. Iindleko zonyango zokulungiswa kotyando ziphindwe kathathu kunezo lonyango olulondolozayo, kwaye ikwanyusa iindleko zokuhlala esibhedlele nezinye iindleko ezinxulumene noko.
Kukho ukungafani kommandla kunye nobuhlanga ekusebenziseni ukulungiswa kwangaphakathi kwi-distal radius fractures. Uphononongo kwi-Medicare lubonise ukuba abafazi kunye neCaucasians banokuthi benze utyando, kwaye uluhlu olukhethiweyo lokulungiswa kwangaphakathi lwaluyi-4.6% ukuya kwi-42.1%. Kwaye kwafumanisa ukuba oogqirha abaqeqeshelwe utyando lwezandla babenokukhetha utyando.
Uvavanyo lweklinikhi
Indlela yokulimala yesigulane kunye nezikhalazo eziphambili kufuneka ziphawulwe kwimbali yeklinikhi, kubandakanywa indawo yentlungu, umsebenzi osebenzayo, kunye neqondo lokukhubazeka. Kwangaxeshanye, kukwayimfuneko ukuqonda isandla esilawulayo sesigulana, izinto eziqhelekileyo zokuzonwabisa, kunye nomsebenzi wesigulana. Ukongezelela, kubaluleke kakhulu ukwazi ukuba isigulane sine-osteoarthritis okanye i-sequelae echaphazela imisebenzi esebenzayo yelungu elichaphazelekayo ngaphambi kokulimala. Phakathi kwabo, ukubuza izigulane ezisele zikhulile ukuba ngaba kufuneka zisebenzise iintonga xa zihamba kunye nokuba ziyakwazi ukuzinyamekela kubomi bemihla ngemihla kubaluleke kakhulu ekuqondeni iimfuno zezigulane kunye nokuqulunqa ukuxilongwa kunye nezicwangciso zonyango.
Ngexesha lovavanyo lweklinikhi lomzimba, uvavanyo olucwangcisiweyo nolubanzi lwesihlahla somguli ukusuka kude ukuya kufutshane luyafuneka. Ukunikezelwa kwegazi esihlahleni kwaziwa ngovavanyo lokuzaliswa kwakhona kwe-capillary kunye ne-radial kunye ne-ulnar pulse. Iimeko zoluvo lwe-nerve median, i-nerve ye-ulnar kunye ne-radial nerve zifunyenwe ngovavanyo lokucalucalulwa kwamanqaku amabini kunye novavanyo lokuthintela ukukhanya. Isiganeko se-acute carpal tunnel syndrome kwi-distal radius fractures yi-5.4% ukuya kwi-8.6%, ngoko ke ingqalelo ekhethekileyo kufuneka ihlawulwe kwi-paresthesia kunye ne-numbness kwindawo yokusabalalisa i-nerve median. Umsebenzi wemoto wesigulane uhlolwe ngokuhlola i-interrosseous yangaphambili kunye ne-posterior, i-radial, i-median, kunye ne-ulnar nerves. Ukongezelela, umhloli kufuneka ahlawule ingqalelo kwimeko yesilonda sesikhumba somgulane (njenge-ecchymosis, i-edema, i-fork-like angulation, njl.) Ukugqiba ukuba ngaba i-fracture evulekile. Ngenxa yeemeko ezimbi zezicubu ezithambileyo kunye nolusu olubhityileyo kubantu abadala, i-distal radius fractures ihlala ihamba kunye nokuqhekeka kwesikhumba. Xa kusetyenziswa ukucuthwa kwe-traction evaliweyo, ukusebenza ngokucokisekileyo kuyafuneka ngokukodwa ukuphepha umonakalo owongezelelweyo wezicubu ezithambileyo.
Uvavanyo lomfanekiso
Uvavanyo lweRadiographic of distal radius fractures ngokuqhelekileyo lubandakanya i-anteroposterior, lateral, kunye ne-oblique radiographs. I-angulation kunye nokujikeleza kwe-fracture kunokuqondwa ngokuhlolwa kwemifanekiso ukuze kuqinisekiswe ukuba kukho ukucutha, nokuba i-fragment fragment ihlanganiswe, kwaye ingaba umgca odibeneyo uphelele. Ezinye iiparamitha zokucinga ezikhethekileyo zibandakanya: ukuhla kwe-ulnar (ithetha i-22 °, uluhlu: 19 ° -29 °), ukuphakama kwe-distal radius (11-12 mm), kunye nokuthambekela kwesundu kwi-distal radius (ithetha i-11 °, uluhlu: 11 ° -14.5 °). I-X-ray ye-forearm kunye ne-elbow nayo ithathwa ukujonga umonakalo we-forearm okanye ukungazinzi kwe-elbow. Emva kokunciphisa okuvaliweyo kunye nokuguqulwa kwe-splint immobilization, enye ifilimu ye-X-ray iyadingeka ukuvavanya ukuba iiparamitha ze-distal radius ziphuculwe. Ngokonyango, uvavanyo lwe-CT luhlala lusetyenziselwa ukuxilonga kunye nokuhlelwa kweefractures (umzekelo, nokuba kukho i-intra-articular fracture, nokuba kukho ukunyanzeliswa okanye ukuphuka kwe-shear), ukwenzela ukuba kugqitywe ngakumbi isicwangciso sonyango lotyando. Ngelo xesha, ukuhlolwa kwe-CT kuyafuneka kwakhona ukuvavanya ngakumbi xa kusenziwa i-osteotomy kunye ne-orthopedic unyango lwe-malunion.
Nyanga
Ngokwezikhokelo zonyango ze-AAOS, akukho mvumelwano malunga nokusetyenziswa kokulawulwa kwe-conservative okanye utyando lwe-distal radius fractures. Akukho mvumelwano malunga nokuba kusetyenziswe i-volar locking plate fixation okanye i-percutaneous Kirschner wire fixation kunyango lotyando. I-Kodama et al incoma ukusetyenziswa kwenkqubo yokulinganisa i-fracture ukujonga ukuba isigulane sifuna ukuhlinzwa. Kwaye kwizigulana ezisele zineminyaka engama-≥50 ubudala, uhlobo lokwaphuka, utshintsho kwiparamitha yeradiographic yelunga lesihlahla, ubudala, isandla esilawulayo, kunye nomsebenzi wesigulana kufuneka zisetyenziswe ukucacisa ngakumbi isicwangciso sonyango. Kuhlalutyo oluninzi lokubuyisela, iqondo lokuhamba kwe-volar okanye i-dorsal distal radius fragment emva kokunciphisa, nokuba i-fracture ibandakanya intamo ye-ulnar, inclination palmar, kunye nokuhlukahluka kwi-distal ulna yayinxulumene kakhulu neziphumo zekliniki.
Unyango loLondolozo
Kwiziko lethu, i-distal displace fractures ye-distal displaced idla ngokungashukumi kunye ne-Sugar tong plaster splint phezu kwengqiniba ukukhawulela ukubiza kunye nokunyuswa kwengqiniba (jonga uMfanekiso 1). Ukuba ukufuduswa kweqhekeza kukhulu, i-Sugar tong splint kufuneka yenziwe emva kokunciphisa okuvaliweyo. Qaphela ukuba xa usenza i-plaster splint immobilization, ububanzi be-immobilization kufuneka buyeke ekupheleni komnwe, ukwenzela ukuba kube lula ukuhamba komnwe kunye nokukhusela ukuqina. Ukusetyenziswa kwe-elastic bandages yokulungiswa koxinzelelo olulinganiselweyo kunokuncedisa ukudibanisa. Uhlobo lokuqhekeka lumisela indlela yokunciphisa okuvaliweyo. Ukuba kuyimfuneko, i-anesthesia yendawo ye-hematoma ye-distal radius inokukhethwa, kwaye ke ukunciphisa i-traction kuyenziwa ngokutsala iminwe (isalathisi kunye neminwe ephakathi) ukulungisa ukukhubazeka kunye nokubuyisela ukulungelelaniswa kwe-radiocarpal joint. Ukunciphisa ukutsalwa ngokuqhelekileyo kwenziwa kusetyenziswa indlela yokuqhekeka kwe-inverse. Ukunciphisa ukutsalwa kwiindiza ezahlukeneyo kuyadingeka ukugqiba ukubuyiswa kwe-ligament kunye nokubuyisela ukulungelelaniswa kwamaqhekeza aqhekezayo, i-capitulum kunye nenyanga. Kwindiza ye-coronal, buyisela ukulungelelaniswa kwe-anatomical ye-ulna kunye ne-radius, i-distal bone fragment kunye ne-radial shaft. Ukunciphisa i-Colles fracture eqhelekileyo kufuna ukuba umncedisi abambe isithupha sesigulane kwisandla esinye kunye neminwe ye-4 yesigulane kwelinye icala, ukusebenzisa i-countertraction ukuze ukwahlula isiqhekeza kwi-metaphysis ye-radius, ukuqhubeka kwe-longitudinal traction, kunye ne-palmar. Ukuphambuka kweFlexion kunye ne-ulnar ukunceda ukunciphisa iqhekeza leqhekeza. Kwizigulane ezisebekhulile ezinomonakalo ojikelezayo wezicubu ezithambileyo, ukuguqulwa ngokucophelela kuyafuneka ngexesha lenkqubo yokunciphisa ukuthintela ukukrazula kwesikhumba (i-cotton pad ingasetyenziswa ngexesha lokunciphisa). Emva kokubekwa ngokutsha, uvavanyo lwe-neurovascular lwenziwa.
![Ukuqhekeka kweradiyasi ekude]()
Umzobo 1. (A) Isigulane esine-distal radius fracture sasingenakushukunyiswa kwindawo engathathi hlangothi yepalmar kunye ne-Sugar tong plaster splint ukukhusela ukufuduswa; (B) kunye (C) i-anteroposterior kunye ne-radiographs esecaleni ebonisa ukulungiswa kwesandla sesigulane kakuhle. I-plaster splint ayidluli ngaphaya kwentloko ye-metacarpal ukwenzela ukuba iminwe ikwazi ukuhamba ngokuqhelekileyo.
Unyango loMsebenzi
Izinketho zonyango zotyando kwizigulane ezikhulileyo ezinezaphulelo ze-distal radius zibandakanya: ukunciphisa ukuvalwa kunye nokulungiswa kwangaphandle, ukulungiswa kwentambo ye-Kirschner ye-percutaneous, ukunciphisa okuvulekileyo, ukulungiswa kweplate yokutshixa i-volar / dorsal, kunye ne-dorsal bridging plate fixation (jonga kuboniswe kuMfanekiso 2).
![Ipleyiti yokutshixa iPalm]()
Olunye uhlobo lokunciphisa okuvulekileyo kunye nokulungiswa kwepleyiti ye-dorsal ikakhulu isetyenziselwa unyango lwe-intra-articular fractures. Inokunciphisa i-articular surface phantsi kombono othe ngqo ngaphandle kokuhlutha izicubu ze-ligament kwicala le-volar ye-wrist joint, ukunciphisa umngcipheko wokungazinzi kwe-radiocarpal kamva. Ukuba i-volar lunate fracture ibandakanyeka, kufuneka ifakwe immobilized. Kwizigulane ezine-radial shaft fracture okanye ukulimala okuninzi, ipleyiti ye-traction eyakhelwe-ngaphakathi ingasetyenziselwa ukufezekisa ukunciphisa ngokubuyiselwa kwe-ligament. Ngelo xesha, ipleyiti ye-traction nayo ifanelekile ekunciphiseni kunye nokulungiswa kwe-comminuted and osteoporotic distal fractures. Ipleyiti yasuswa kwiiveki ezili-12 emva kokusebenza, kwaye umphumo omhle wekliniki wonyango unokufumaneka.
Ipleyiti yokutshixa iVolar inokuphucula ukuncipha kweradial kunye ne-volar tilt, kwaye izehlo zeengxaki ziphantsi. Xa kuthelekiswa neplate ye-dorsal, amandla okubamba umlenze ochaphazelekayo unokuphuculwa kakhulu kwiinyanga ze-6 emva kokuhlinzwa, kwaye umsebenzi kunye nentlungu inokuphuculwa. Iingxaki ezifana nokutshintshwa kwe-dorsal plate fixation kunye nokucaphuka kwe-tensor digitorum tendon kwenzeka ukuya kwi-30% yamatyala. Kwaye umphumo wokulungiswa kweplate ye-volar nayo ingcono kune-Kirschner wire okanye i-fixator yangaphandle.
Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?
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