Ukulungisa kanjani ukuphuka kwe-distal humerus?

Ukuze uthole kabusha ukulungiswa okuzinzile ekumisweni kwe-osteoporotic noma i-comminuted fractures, i-parallel plate technique yokwelashwa kwe-distal humeral fractures isekelwe kumgomo wokuthuthukisa ukulungiswa kwe-distal fractures. Isihluthulelo sokuzinza kwalesi sakhiwo sokulungiswa ukuthi sihlanganisa izici nokuzinza kwe-arch ngenkathi ikhiya amakholomu aphakathi nendawo kanye namakholomu e-distal humerus ndawonye.

Isakhiwo sebhuloho le-Arch

Izikulufu zezingcezu ezikude ziyakhiyana, zinikeza ukuzinza okwengeziwe 'ngebhuloho elikhothamo elivaliwe'. Ukuxhumanisa kutholakala kangcono ngokuthintana phakathi kwezikulufa. Izikulufu eziningi ziphambana eduze, futhi amathambo phakathi kwazo akha 'i-rebar' (ukhonkolo oqinisiwe) isakhiwo.

Izinyathelo zobuchwepheshe

Isinyathelo sokuqala: ukuhlinzwa kokunciphisa ngokuhlanganyela. Izingcezu ezihlangene ezazivame ukuzungeza zihlobene nendiza ye-axial zancishiswa ze-anatomic futhi zalungiswa okwesikhashana ngezintambo ze-Kirschner. Okubalulekile, izintambo ze-K kufanele zibekwe eduze nezinga le-subchondral ukugwema ukuphazamisa ukubekwa kwesikulufu okulandelayo futhi kude nalapho amapuleti abekwe khona kumakholomu asemaceleni naphakathi. Intambo ye-Kirschner eyodwa noma ezimbili ezibekwe ngokufanelekile zingasetshenziselwa ukulungisa okwesikhashana ukuphuka okukude okuhambisana ne-diaphysis.

Isinyathelo sesibili: ukusetshenziswa kwepuleti lensimbi nokulungiswa kwesikhashana. Amapuleti angaphambili aphakathi nendawo abekwe futhi agxilwe ku-distal humerus, kuyilapho ingxenye ebushelelezi engu-2 mm noma engu-2.5 mm ifakwe ngembobo ye-No. Amaphini ukuze kugcinwe ukulungiswa kwesikhashana kwepuleti kanye nokuphuka kwe-distal. Isikulufu sifakwe embotsheni eboshiwe (imbobo engu-5) epuletini ngalinye, kodwa asiqiniswanga ngokugcwele, okushiya inkululeko ethile ukuze ipuleti lihambe eduze phakathi nokucindezelwa. Njengoba indawo engezansi yepuleti ngalinye i-tubular ekugcineni kwe-metaphyseal kanye ne-diaphyseal, ukuqiniswa okuncane kuphela kwezikulufu emigodini eboshiwe kunikeza ukulungiswa okuhle kwesikhashana kwayo yonke i-distal humerus.

Isinyathelo sesi-3: Ukulungiswa okuhlangene. Isikulufu sidlulwa ngembobo engu-No. 1 ku-lateral plate, ngocezu lwe-distal articular ukusuka ohlangothini lwangaphakathi ukuya kwemaphakathi, bese siqiniswa. Phinda lesi sinyathelo usebenzisa imbobo engunombolo 3 ngaphakathi. Ezigulini ezincane, kusetshenziswa izikulufu ze-cortical 3.5 mm (ukuvimbela ukuphuka), kuyilapho ezigulini ze-osteoporotic, kusetshenziswa izikulufu ezinde ezingu-2.7 mm. I-screw distal kufanele ibe yinde ngangokunokwenzeka futhi kufanele idlule izingcezu eziningi ngangokunokwenzeka.

Isinyathelo sesi-4 A: Ukucindezela ku-condyle. Ukucindezelwa kwe-Interfragmentary kuyo yonke i-fracture kunikezwa ezingeni le-suprahumeral kusetshenziswa ama-forceps amakhulu okunciphisa, nekholomu yasemaceleni ilungiswe kuqala. Faka isikulufu kumbobo 4 ku-lateral plate kumodi yokucindezela okuguquguqukayo (inset). Ukuwuqinisa kuqhubeke kuthuthukisa ukucindezelwa kwe-interfragmentary (umcibisholo) ezingeni le-supracondylar, okubangela ukunwebeka okuthile (umcibisholo) onqenqemeni lwe-supracondylar oluphakathi.

Isinyathelo 4B: Ngendlela efanayo, sebenzisa ama-forceps amakhulu okunciphisa ukuze ucindezele ikholomu emaphakathi bese ufaka isikulufu ku-medial plate ngemodi yokuminyanisa eguquguqukayo. Uma iphrofayili yepuleti iphansi kancane, i-clamp enkulu yethambo ingasetshenziswa ukuyicindezela ngokumelene ne-metaphysis ukuze kuqhutshekwe cindezela ikhondili.

Isinyathelo sesi-5: Ukulungiswa kokugcina. Izintambo zika-K zakhishwa kwafakwa izikulufu ezisele. Izikulufu ezikude ziyanyakaziswa ukuze kwandiswe ukuqina kwezingcezu ezihlangene ezikude.

I-Severe Bone Defect - I-Supracondylar Shortening

Uma ukulahlekelwa kwethambo le-metaphyseal noma ukuhlanganiswa kuvimbela ukwakhiwa kabusha kwe-anatomical kanye nokuthintana kwamathambo kuhle, i-humerus ingafinyezwa endaweni ye-metaphyseal fracture ngokuqondana okuphelele okuphelele kanye nejometri ye-distal humerus. Le ndlela yokwakhiwa kabusha siyibiza ngokuthi yi-supracondylar shortening. Le nqubo iwusizo ikakhulukazi ezimweni zokuhlanganiswa kwezicubu ezithambile nokulahlekelwa kwamathambo. Ukufinyeza okungu-≤1 cm kunomphumela omncane kumandla okunwetshwa kwetheminali ye-triceps, futhi ezimeni zokuqina kwezicubu ezithambile nokulahlekelwa kwamathambo, ukufinyezwa okungafika ku-2 cm kungabekezelelwa ngaphandle kokuthikameze kakhulu i-elbow biomechanics.

Hlela kabusha i-distal end ye-humeral shaft (ngaphandle kwengxenye ye-articular) ukuze uthuthukise ukuthintana phakathi kwengxenye ye-distal articular kanye ne-diaphysis. Ngokuvamile, inani elincane kuphela lethambo lisuswa ekugcineni kwe-humeral shaft, futhi ngezinye izikhathi ukusuka ohlangothini olulodwa. I-B no-C, efinyezwe isayithi lokuphuka ukuze kuvunyelwe ukucindezelwa kwe-interfragmentary phakathi kwe-trochlear ne-distal diaphysis, phakathi kwe-capitulum ne-distal diaphysis, futhi ukusuka kolunye uhlangothi. Uma lezi zindawo zicindezelwe futhi ziqiniswe ngamapuleti ensimbi, ukuzinza kuqine ngokwanele ukunyakaza nokulungisa ngokushesha. Ingxenye ye-distal ingahunyushwa phakathi noma eceleni, noma kancane ngaphambili, kuyilapho igcina ukulungiswa kokujikeleza kanye ne-valgus.

6 izikulufu kanye 2 plate fixation target

isikulufu

1: Isikulufu ngasinye sidlula epuleti lensimbi.

2: Isikulufu ngasinye kufanele silungise isiqeshana sokuqhekeka kwe-contralateral.

3: Beka inombolo eyanele yezikulufu engxenyeni yokuphuka kwe-distal.

4: Isikulufu ngasinye kufanele sibe side ngangokunokwenzeka.

5: Isikulufu ngasinye kufanele silungise izingcezu eziningi ngangokunokwenzeka.

6: Izikulufu kufanele zikhiye ndawonye ngokungqubuzana, zidale isakhiwo esine-engeli engaguquki.

Ipuleti lensimbi:

1: Kumapuleti asetshenziselwa ukulungiswa, imigomo yokucindezela kufanele ifinyelelwe ezingeni lama-condyles wesifazane wekholomu ephindwe kabili.

2: Ipuleti lensimbi elisetshenziswayo kumele libe namandla futhi liqine ngokwanele ukumelana nokuphuka noma ukugoba.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

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