Ukuqhekeka kwe-tendon extensor emva kokulungiswa kweplate ye-volar kuhlala kuyingxaki enkulu ekulungiseni i-distal radius fractures. I-tendon echaphazelekayo echaphazelekayo yi-tendon ye-pollicis longus (EPL) ye-tendon, njengoko ivalelwe ngaphakathi kwe-EPL groove. Isiganeko esixeliweyo se-EPL tendon rupture emva kwe-volar plating yi-0.29% -5.7%.
Umngcipheko wokulibaziseka kokuqhekeka kwe-tendon ye-EPL uyenyuka kubukho be-screw protrusion ye-dorsal, ukwenzakala kwi-intraoperative ngqo e-drilling, kunye namaqhekeza ophahla lwe-dorsal, ngakumbi kwi-island fractures ye-Lister's tubercle. Uvavanyo lwe-Radiographic ye-screw protrusion kwi-distal radius fractures inzima ngenxa yejometri eyinkimbinkimbi ye-distal radius kunye nokwenzeka kokuqhekeka kwe-dorsal comminuted. Umbono we-dorsal tangential kuphela kwembono enokwenzeka ye-intravital ye-dorsal radial cortex ukufumana uhlolo oluthembekileyo lomgama phakathi kwencam ye-screw kunye ne-dorsal cortex.
Ubuchwephesha bokuphepha ukulimala kwe-tendon ye-extensor kubandakanya ukusetyenziswa kwezikrufu ze-monocortical kunye nokuphepha ukungena kwi-dorsal surface; nangona kunjalo, obu buchule bunokunciphisa ukuzinza komatshini wokulungiswa kwe-fracture. Ke ngoko, ukulungiswa kwe-bicortical ngamanye amaxesha kuyafuneka. Ukunciphisa umngcipheko wokulimala kwe-tendon ye-extensor, iinjongo eziphambili zokulungiswa kwe-fracture kunye nokuzinza akufanele ziphazamiseke.
Ubuchule obutsha botyando
Sichaza indlela entsha yokunciphisa umngcipheko wokuqhekeka kwe-tendon ye-EPL emva kokulungiswa kwepleyiti ye-volar ye-distal radius fractures ngaphandle kokunciphisa ubude be-screw okanye ukususa amaqhekeza ophahla lwe-dorsal. Ngokufutshane, ubuchule bubandakanya ukuvula igumbi lesithathu ngokusikwa okuncinci komqolo.
Ukuba i-screw ingene kwi-cortex ye-dorsal kwaye yaphuma kwi-compartment yesithathu: sisuse i-tendon ye-EPL kwi-groove yayo kwaye savala i-compartment nge-sutured retinaculum eshiya i-tendon ye-EPL kwi-retinaculum elungisiweyo.
Ukuba i-screw ayinwebeki kwi-compartment yesithathu: sishiya i-tendon ye-EPL kwindawo yesithathu. Isalathiso sobuchule bethu kwizigulana ezineradius distal fractures ezinyangwa ngeepleyiti zokutshixa zevolar, iifracture ezinamaqhekeza e-dorso-parietal okanye izikrufu ezinokungena kwi-dorsal cortex okanye zonakalise i-tendon ye-EPL ejikeleze i-tubercle kaLister. Kwizigulane ezine-distal radius fractures ezinamaqhekeza e-dorsomedial, sibhola imingxuma yokungena kwi-cortex ye-dorsal kwaye sikhethe izikrufu zobude obaneleyo ukulungisa amaqhekeza e-dorsomedial angazinzanga.
Ukwabelana ngetyala
Sabelana ngecala apho ithenda ye-EPL yasuswa kwi-compartment yesithathu ngenxa yokunyuka kwe-screw kwindawo yesithathu ngexesha lokulungiswa kweplate ye-comminuted distal radius fracture kunye ne-dorsomedial fragments. Siye saqinisekisa ukuba i-tendon ye-EPL yayiqinile iminyaka eyi-7 emva kokusebenza, nangona i-screw yayivelele kwicandelo lesithathu.
Ityala lalingumfazi oneminyaka engama-67 ubudala kunye nokuxilongwa kwe-intra-articular unstable distal fracture kunye ne-right dorsal medial fracture (Figure 1A-E). Akukho mbali yokutshaya, isifo seswekile okanye ukusetyenziswa kotywala. Uyakwazi ukuhamba ngaphandle komhambi.
![ukwaphuka kweradiyasi ekude]()
umfanekiso 1. I-imaging ye-preoperative ibonise i-comminuted intra-articular fracture ye-distal radius.
A kunye no-B: Ii-X-reyi zangaphambi koqhaqho,
C kunye no-D: iimbono ze-sagittal kunye ne-axial yemifanekiso ye-tomography yekhompyutha,
E: Umfanekiso we-3D owenziwe ngekhompyutha. Amaqhekeza e-Dorsal medial facet facet kunye namaqhekeza e-apical apical (iinkwenkwezi ezimhlophe) ziyabonakala.
Ubuchule botyando
Siyinyange le nkqubo yokuqhekeka ngepleyiti yokutshixa yevolar. I-intraoperative, sabhobhoza kwi-cortex ye-dorsal kwaye sakhetha isikrufu eside ngokwaneleyo ukukhusela i-dorsal cortex kuba iqhekeza le-dorsomedial lalingazinzanga (Umfanekiso 2).
Utyando lwenziwa ukuvula indawo yesithathu emva kokulungiswa kwesijivu.
Ekubeni i-screw ingene kwi-compartment yesithathu kwaye yavela (Umfanekiso 3A), vula ngokupheleleyo i-compartment yesithathu kwaye uhambise i-tendon ye-EPL ngaphandle kwe-groove yayo (Umfanekiso 3B).
Icandelo lesithathu lavalwa ngokufaka i-retinaculum (umzobo 3C, D), kunye ne-tendon ye-EPL yafakwa phezu kwe-retinaculum elungisiweyo (umzobo 3 E).
Emva kotyando, isigulane saya kwikliniki yezigulane zangaphandle kwisibhedlele sethu de ithambo lipholile. Isigulane asifuni ukususa i-hardware.
Ukubuyisela emva kokuhlinzwa
Kwiminyaka esixhenxe emva kotyando, isigulana sabuyela esibhedlele ukuze sixilongwe kwakhona ngenxa ye<em>osteoporosis. Isandla sasekunene asikhubazekanga. Umfanekiso we-X-reyi obonisa ukwaphuka okuphilisiwe kunye ne-dorsal protrusion yesikrufu sokutshixa i-distal. Isithupha sesigulana sandiswa ngokupheleleyo, kwaye i-tendon ye-EPL yayingenayo i-bowstring ecacileyo.
Kwisiphakamiso sethu, isigulane savuma ukususa i-hardware kwaye sihlolisise i-tendon extensor. Ngokungaphangeliyo, siye savavanya i-tendon ye-EPL ngokusebenzisa i-dorsal incision kwaye ngokuyinxenye savula amacandelo esithathu kunye nesine.
I-tendon ye-EPL yayifumaneka ngaphandle kwecandelo lesithathu kwindawo efanayo kunye nokusebenza kwangaphambili, kwaye i-tendon ayizange icaphuke.
Siqinisekisile ukuba i-screw yangena kwigumbi lesithathu xa i-tendon extensor yeminwe ihoxisiwe.
Ekugqibeleni, salungisa iintambo zenkxaso kwaye sasusa i-hardware. Kuvavanyo lokugqibela kwiinyanga ezi-2 emva kokususwa kwe-hardware, isigulane sasingenazintlungu kwaye sandiswa ngokupheleleyo.
Xoxa
Kwindlela yethu, emva kokulungiswa kwepleyiti ye-volar ye-distal radius fractures, savula ngokuyinxenye indawo yesithathu ngokusikwa malunga ne-2 cm ubude be-ulnar kwi-tubercle ye-Lister. Sichonge ngokuthe ngqo i-tendon ye-EPL kunye nomgangatho we-extensor compartment yesithathu ngokubuyisela ngobumnene i-tendon ye-EPL.
Ukuba i-screw ingene kwi-cortex yomqolo kwikhompatimenti yesithathu okanye i-dorso-parietal debris, asizange senze i-intraoperative screw replacement okanye i-fragmentectomy, kodwa savula ngokupheleleyo igumbi lesithathu kwaye sasusa i-tendon ye-EPL kwi-groove yayo. Emva koko sivale i-compartment ngokufaka i-retinaculum ngelixa sibeka i-tendon ye-EPL kwindawo yesithathu.
Ukuba isikrufu asizange singene kwikhompatimenti yesithathu, sishiye ithenda ye-EPL kwigumbi lesithathu elivulwe ngokuyinxenye.
Ubuchwephesha bethu botyando buvumela ukuhlolwa lula kokulimala kwe-tendon ye-EPL ngokubonwa ngokuthe ngqo kwimizuzu eli-10 eyongezelelweyo. Ukuba i-tendon ye-EPL yenzakele, inokulungiswa ngokuthe ngqo. Le nkqubo inceda ukukhusela i-tendon yesibini ye-EPL ukuphuka emva kokulungiswa kweplate ye-distal radial. I-EPL tendon bowstring ingenzeka, kodwa ayizange yenzeke kwimeko yethu.
Ukuququmbela
Siye safumana imeko apho i-tendon ye-EPL yayiqinile iminyaka eyi-7 emva kokusebenza, nangona i-screws esetyenziselwa ukulungisa i-volar plate yayivelele kwi-compartment yesithathu. Ubuchwephesha bethu botyando bunciphisa umngcipheko wokugqabhuka kwe-tendon ye-EPL emva kokulungiswa kwepleyiti yevolar yokwaphuka kweradius distal.
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