Uyazi ukuthi ungayilungisa kanjani i-metacarpal fracture?

I-Metacarpophalangeal fractures iwukuphuka okuvamile kokuhlukumezeka kwesandla, okubalelwa cishe i-1/4 yazo zonke iziguli ezihlukumezekile zezandla. ngenxa yesakhiwo esintekenteke nesiyinkimbinkimbi sesandla nokusebenza kwayo okuhle kwemoto, ukuphathwa kokuphuka kwezandla kubaluleke kakhulu futhi kuyinkimbinkimbi ngokobuchwepheshe kunokwelapha okunye ukuphuka kwamashubhu amade.

Ukuqinisekisa ukuzinza kokuphuka ngemva kokubekwa kabusha kuyisihluthulelo sempumelelo yokwelashwa kwe-metacarpophalangeal fracture. Ukuze ubuyisele ukusebenza kwesandla, ukuphuka ngokuvamile kudinga ukulungiswa okufanele, futhi esikhathini esidlule, ukulungiswa kwangaphandle nge-plaster noma ukulungiswa kwangaphakathi ngezikhonkwane ze-Kirschner kwakuvame ukusetshenziswa, kodwa ngokuvamile ngenxa yokulungiswa okungalungile noma isikhathi eside sokulungiswa, okungahambisani nokuvuselelwa kwamalunga okuqala kwangemva kokuhlinzwa, futhi kunomthelela omkhulu ekululameni kokusebenza kwe-metacarpobilious joint, ukuletha ubunzima bokusebenza kwe-metacarpobilious handling.

Izindlela zokwelapha zesimanje ziya ngokuya zisebenzisa ukulungiswa okuqinile kwangaphakathi, okufana nokulungisa isikulufu sepuleti elincane.

Izimiso Zokwelapha

Izimiso zokwelashwa kwe-metacarpal kanye ne-phalangeal fractures yesandla yilezi: ukulungiswa kwe-anatomic, ukulungiswa okukhanyayo nokuqinile, ukuhamba kwangaphambi kwesikhathi kanye nokuzivocavoca okusebenzayo. Izimiso zokwelashwa kwe-intra-articular kanye ne-periarticular fractures yesandla iyafana naleyo yezinye i-intra-articular fractures: ukubuyiselwa kwe-anatomy ye-articular surface kanye nomsebenzi wokuqala wokusebenza. Ukwelashwa kokuphuka kwe-metacarpal kanye ne-phalangeal yesandla kufanele kulwele ukufeza ukumiswa kabusha kwe-anatomic ngaphandle kokujikeleza, i-angulation ehlangothini, noma ukufuduka kwe-angular> 10 ° engxenyeni yomgogodla wesundu. Uma ukuphela kokuphuka kwe-metacarpal kujikelezwa noma kuhanjiswe eceleni kwe-angle, kuzoshintsha umzila ojwayelekile we-flexion kanye nokunyakaza kokunwetshwa komunwe, okubangela ukuba iphushe noma iwe kusukela emunwe oseduze ngesikhathi sokugoba, okuthinta ukunemba komsebenzi womunwe; kuyilapho ukufuduka kwe-angular> 10 ° kuya ku-dorsum yesundu kuzobhubhisa indawo yokuxhumana ebushelelezi yethambo kanye ne-tendon, okwandisa ukumelana nobubanzi bokunyakaza kwe-tendon ekuguqeni nasekukhuliseni, futhi kubangele ukulimala okungapheli ku-tendon, okwenza kube nengozi yokuphuka kwe-tendon. ingozi yokuqhekeka kwe-tendon.

I-metacarpal ne-phalangeal fractures ziyefana ekhonweni lazo lokubekezelela ukukhubazeka okujikelezayo, kuyilapho i-metacarpal ibekezelela ukufinyezwa kokususwa kanye nokugudluka kwe-dorsal angular kangcono kune-phalangeal. Amalunga e-carpometacarpal kanye ne-metacarpophalangeal anganxephezela ukukhubazeka kwe-angular ye-metacarpal, futhi umunwe omncane we-annular uvumelane kangcono nokukhubazeka kwe-angular ye-metacarpal kunomunwe ophakathi wenkomba. Amandla okubambelela ancishisiwe ngenxa yokufinyezwa kwemisipha yesandla engaphakathi kubonakala kuphela lapho i-metacarpal i-engeli engaphezu kuka-30° ohlangothini lwedorsal.

Indlela Yokuhlinza

Indlela yokuhlinzwa yokuphuka kwe-metacarpal ilula futhi ngokuvamile isebenzisa indlela yomgogodla, njengoba kuboniswe kuMfanekiso 4-14. I-metacarpal yesibili icutshungulwa ngokugqamile kuyilapho i-metacarpal yesihlanu icutshungulwa ulnarly, kanti i-metacarpal yesithathu neyesine ivamise ukusika phakathi. Uma ama-metacarpal amabili ancikene ehlinzwa ngesikhathi esisodwa, ukusika okumise okwe-S okumaphakathi kusetshenziselwa ukucabangela womabili amasayithi okuhlinza.

Ukukhetha indlela engaguquki

Kunezinto eziningi zokulungisa zangaphakathi ze-metacarpophalangeal fractures, njengezikhonkwane ze-Kirschner, izikulufu, amapuleti namafreyimu okulungisa angaphandle, phakathi kwawo okuvame ukusetshenziswa kakhulu izikhonkwane ze-Kirschner nama-microplates. Ngokuphuka kwe-metacarpal, ukulungiswa kwangaphakathi nge-microplate kunezinzuzo ezisobala ngaphezu kokulungiswa ngezikhonkwane ze-Kirschner futhi kungakhethwa; ngenxa ye-proximal phalangeal fractures, i-microplate ngokuvamile ikhethwa, kodwa uma kunobunzima bokubeka izikulufa engxenyeni ekude ye-phalangeal eseduze ne-head fractures, ukulungiswa kwangaphakathi ngezikhonkwane ze-Kirschner eziphambanayo kukhethwa, okuhambisana kakhulu nokubuyiselwa kokusebenza komunwe othintekile; ekwelapheni ukuphuka kwe-phalangeal ephakathi, izikhonkwane ze-Kirschner kufanele zikhethwe.

1, inaliti kaKirschner: 

Ukulungiswa kwangaphakathi kwenaliti ka-Kirschner kusetshenziswe emtholampilo iminyaka engaphezu kwengu-70 futhi bekuyizinto ezivame ukusetshenziswa kakhulu zangaphakathi zokulungisa ama-metacarpophalangeal fractures, okulula ukusebenza, ukonga futhi okusebenzayo, futhi kuyindlela yokulungisa yangaphakathi yakudala, njengoba kuboniswe kuMfanekiso 4-15. njengokulungiswa kwangaphakathi okuvame ukusetshenziswa kakhulu ekwelapheni ukuphuka kwezandla, kusasetshenziswa kabanzi. 

Izinzuzo zokulungiswa kwangaphakathi ngezikhonkwane ze-Kirschner:

① kulula ukusebenza futhi kulula ukuyisebenzisa; 

② ukukhumula izicubu ezithambile kancane, umthelela omncane ekugelezeni kwegazi ekugcineni kokuphuka, ukuhlukumezeka okuncane kokuhlinzwa, kanye nokululama kokuphuka; 

③ ukubuyisa kalula iphinikhodi yesibili; 

④ izindleko eziphansi kanye nokusebenza okubanzi, okusebenzayo ezingxenyeni eziningi zokuphuka kwezandla (njengokuphuka kwe-intra-articular, ukuphuka okuqinile okuhlangene nokuqeda ukuphuka kwe-phalangeal). 

Ukungalungi kokulungiswa kwangaphakathi: 

(1) uma kuqhathaniswa nokulungiswa kwepuleti, ukuzinza akukuhle, futhi ukufinyezwa nokugudluka okujikelezayo akukwazi ukulawulwa iphinikhodi eyodwa, ngokuvamile kudingeka izikhonkwane ezingaphezu kuka-2 ukuze kulungiswe isiphambano; 

(2) awukho umphumela wokucindezela ekugcineni kokuphuka; 

(3) indawo ehlangene yonakaliswa ukuhlanganisa okuhlangene; 

(4) ukulungiswa kwesihlanganisi kanye nokuvinjelwa kwe-tendon kuvimbela ukuhlanganyela kwesandla ekuzivocavoca kwangaphambi kwesikhathi futhi kuthinte ukutakula kokusebenza.

Ngokuthuthuka okusheshayo kwamasu nemishini yesimanje yokulungiswa kwangaphakathi, ukulungiswa kwangaphakathi nezikhonkwane ze-Kirschner sekuye kwacwengwa ngokwengeziwe, futhi iningi lazo lingalungiswa ngaphandle kokuwela i-joint, ngokulimala okuncane kwezicubu ezithambile kanye nama-tendon azungeze i-joint, futhi ngaphandle kokuthinta ukuqeqeshwa kokusebenza okuhlangene kwangaphambi kokuhlinzwa. Ngosizo lomshini we-X-ray we-C-arm, amanye amacala angakwazi futhi ukufeza imiphumela egculisayo ngokunciphisa okuvaliwe kokulungiswa kwangaphakathi ngezikhonkwane ze-Clinique, okuqhubeka nokunciphisa ukulimala kwezicubu ezithambile zendawo kanye nomthelela ekunikezeni igazi ekugcineni kokuphuka, ngaleyo ndlela kukhuthaze ukuphulukiswa kokuphuka. 

Izinyathelo zokuphepha zokulungiswa kwangaphakathi ngezikhonkwane zikaKristen: 

① Lungisa amabhulokhi amathambo amakhudlwana ngamaphini kaKristen angu-1.0~1.2 mm ububanzi, futhi unqume indawo yokungena kanye nesiqondiso sokungena ngokuya ngesiqondiso somugqa wokuphuka; 

② Ngenhloso yokubuyisela umugqa wamandla, ukuphuka kwe-intra-articular kufanele kubekwe kabusha ngokwemvelo futhi kulungiswe ngokuqinile; 

③ Akuwona wonke amabhulokhi amathambo adinga ukulungiswa ngezikhonkwane zikaKristen, futhi ngaphansi kwesisekelo sokufinyelela ukuqina kokuphela kokuphuka, izikhonkwane zikaKristen kufanele zisetshenziswe kancane ngangokunokwenzeka; 

④ Izikhonkwane zikaKristen azigxili ku-tendon noma ulwelwesi lwe-tendon ye-dorsal yomunwe ukudala ukuvivinya umzimba okusebenzayo kwangaphambi kwesikhathi ngangokunokwenzeka; 

⑤ kufanele kube nohlelo oluqinile lwangaphambi kokuhlinzwa futhi ungaphindi ukuhlinzwa ngokuhlinza, ngaphandle kwalokho ibhulokhi yokuphuka ingase ichitheke kakhulu noma ingalungiseki; 

⑥ ngokuvamile iphinikhodi ye-Kirschner kufanele ibekwe esikhumbeni ukuze kuncishiswe amathuba okutheleleka futhi akunzima ukuyisusa.

2, ipuleti elincane le-Metacarpal: 

Ukulungiswa okuqinile kwangaphakathi kokuphuka kwezandla kuyisisekelo sokuzivocavoca kokuqala kokusebenza futhi kuyadingeka ukuze kubuyiselwe umsebenzi omuhle wesandla.Inqubo ye-AO yokulungisa yangaphakathi idinga ukuhlelwa kabusha kwe-anatomical okunembile kokuphela kokuphuka kanye nokuqiniswa kokuphela kwe-fracture esimweni sokusebenza, okuvame ukubizwa ngokuthi ukulungiswa okuqinile, ukuze kuvunyelwe ukunyakaza okusebenzayo kokuqala.I-AO iphinde igcizelele ukugeleza kwegazi okungavimbeli kancane, okugxila ekuhlinzeni okungavamile. I-AO iphinde igcizelele izinqubo zokuhlinza ezingangeneleli kancane ezigxile ekulondolozeni ukugeleza kwegazi. Ukulungiswa kwangaphakathi kwe-Microplate kokuphuka kwesandla kunikeza imiphumela eyanelisayo ngokwamandla, ukuzinza kokuphela kwe-fracture nokucindezela phakathi kokuphela. Ngokuphathelene nokululama kokusebenza kwangemva kokuhlinzwa, isikhathi sokuphulukiswa kokuphuka kanye nezinga lokutheleleka uma kuqhathaniswa, ukusebenza kahle kwamapuleti amancane e-titanium kubhekwa njengokungcono kakhulu kunezikhonkwane ze-kerf, futhi ngenxa yokuthi isikhathi sokuphulukiswa kokuphuka ngemva kokulungiswa kwepuleti le-micro titanium sifushane kakhulu kunezinye izindlela zokulungisa, ngaleyo ndlela kube lula ukubuyela ngokushesha ekuphileni okuvamile kwesiguli.

Izinzuzo zokwelashwa kokulungiswa kwangaphakathi kwe-microplate: 

(1) uma kuqhathaniswa nezikhonkwane ze-kerf, izikulufu ze-microplate zinokuvumelana okungcono kwe-histocompatibility kanye nokuphendula kwezicubu; 

(2) ukuzinza kwesistimu yokulungisa izipikili zepuleti kanye nokucindezela ekugcineni kokuphuka kwenza ukuphuka kusondele ekubekweni kabusha kwe-anatomical, ukulungiswa okuphephile, okuhambisana nokuphulukiswa kokuphuka; 

(3) Ukuvivinya umzimba okusebenzayo kwangaphambi kwesikhathi ngokuvamile kuvunyelwe ngemva kokulungiswa kwe-microplate, okulungele ukutholwa komsebenzi wesandla. 

3. Izikulufo ezincane.

Ama-Microscrew okulungisa ukuphuka kwe-spiral noma okude okutshekile anokuqina okufanayo njengamapuleti ensimbi, kodwa izicubu ezithambile kanye nendawo yokuhlubula i-periosteal incane kunaleyo yokulungiswa kwamapuleti ensimbi, asiza ekuvikelweni kokugeleza kwegazi futhi ngokuhambisana nomqondo wokusebenza okuhlasela kancane. Nakuba kukhona ama-splints ohlobo lwe-T- kanye no-L lwe-proximal joint fractures, ukuvakasha kokubuya kwangemva kokuhlinzwa kubi kakhulu kunaleyo ye-diaphyseal fractures, futhi ama-microscrew anezinzuzo ezithile zokulungiswa kwe-intra- and periarticular fracture. Izikulufu ezifakwe ku-bone cortex zingakwazi ukumelana nomthwalo omkhulu wokucindezeleka, ngakho-ke ukulungiswa kuqinile futhi kungabeka ingcindezi phakathi kokuphela kwe-fracture ukuletha izindawo zokuphuka zibe seduze, okunciphisa isikhathi sokuphulukisa futhi kusize ukuphulukiswa kwe-fracture, njengoba kuboniswe ku-Figure 4-18. ama-microscrew asetshenziselwa ikakhulukazi ukuphuka kwe-oblique noma okuvunguzayo kwe-diaphysis kanye nokuphuka kwe-intra-articular avulsion yamathambo amakhulu. Kubalulekile ukuqaphela ukuthi ubude bentambo yokuphuka kufanele okungenani buphindwe kabili ububanzi be-diaphysis lapho kulungiswa ukuphuka kwe-oblique noma okuvunguzayo kwesiqu sesandla usebenzisa ama-microscrew kuphela, futhi okungenani izikhathi ezintathu ububanzi bobubanzi bentambo lapho kulungiswa amabhlogo wokuphuka kwe-intra-articular avulsion.

4. I-Brace yokulungisa yangaphandle encane.

Ukuphuka kwe-metacarpophalangeal okuhlanganisiwe ngezinye izikhathi kunzima ukusetha kabusha i-anatomically ngisho nokusikwa ngokuhlinzwa noma akukwazi ukulungiswa ngokuqinile ngaphakathi ngenxa yokuthi i-scaffold yethambo yonakalisiwe. I-brace yokulungisa yangaphandle ivumela i-fracture eqhubekayo ukuthi ilulame futhi igcine ubude bayo ngaphansi komphumela wokudonsa, idlala indima elinganiselwe, njengoba kuboniswe kuMfanekiso 4-19. Ukubekwa kwe-brace yokulungisa yangaphandle kuyahluka kuma-metacarpal ahlukene: i-1st kanye ne-2nd metacarpals ibekwe ohlangothini lwe-dorsal radial, i-4th kanye ne-5th metacarpals ibekwe ohlangothini lwe-dorsal ulnar, futhi i-3rd metacarpal ibekwe phezu kwe-dorsal radial noma i-dorsal side ngokuvumelana nephuzu lokukhokha lokungena endaweni yokungena. umsipha. Ukuqhekeka okuvaliwe kungavalwa futhi kubekwe kabusha ngaphansi kwe-X-ray, futhi kungenziwa ukusikwa okuncane ukusiza ekubekeni kabusha uma ukubekwa kabusha kungafanele.

Izinzuzo ze-brace yokulungisa yangaphandle.

(1) kulula ukusebenza futhi ingalungisa ukufuduka okuhlukahlukene kokuphela kokuphuka;

(2) ingakwazi ukusetha kabusha ngokuphumelelayo futhi ilungise ukuphuka kwe-intra-articular ye-phalanges ye-metacarpal ngaphandle kokulimaza indawo ye-articular, futhi ingaphazamisa i-articular surface ukuvimbela ukuvuthwa kwe-capsule ehlangene kanye nemigqa ye-lateral collateral ligaments; 

(3) ingahlanganiswa nokulungiswa okulinganiselwe kwangaphakathi kokuqhekeka okuqhubekayo okungakwazi ukusetha kabusha i-anatomically, futhi i-brace yokulungisa yangaphandle ingakwazi ukusetha kabusha ingxenye futhi igcine umugqa wamandla; 

(4) ivumela ukuvivinya umzimba kokuqala komunwe othintekile endaweni engagxilile ukuze kugwenywe ukujoyina 

(5) Ingakwazi ukulungisa ngokuphumelelayo ukuphuka kwesandla ngaphandle kokuthinta ukwelashwa kwangemva kokuhlinzwa kwesilonda sesandla esithintekile.

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