Indlela yokwelapha i-distal radius fracture yasebekhulile?

Ukuphuka kwe-distal radius kuphakathi kokuhlukana okuvame kakhulu kubantu asebekhulile. Abantu abaneminyaka ephakathi kuka-50 no-75 kumanje bachazwa njengabantu asebekhulile. Izehlakalo zokuhlukana kwe-distal radius nyuka unyaka nonyaka njengoba uhla lokunyakaza kubantu abadala asebekhulile lukhula. Udaba olushisayo engxoxweni mayelana nokuqhekeka kwe-distal radius kusalokhu: Ingabe ukuhlinzwa kuyadingeka?

Izifundo ze-Epidemiological

Ukuphuka kwe-distal radius cishe ku-18% yakho konke ukuphuka komzimba kubantu abadala asebekhulile. Inani labantu baseCaucasus, iziguli zesifazane, kanye ne-osteoporosis yizici ezinkulu eziyingozi zokuqhekeka kwe-distal radius. Ngaphezu kwalokho, kuhlanganisa nezinto zesizini, ezifana nokushelela kuya ekuwa kwabantu abadala abajwayele ukuphuka irediyasi ekude ebusika. Ucwaningo oluthile luye lwabika ukuthi iziguli esezikhulile ezinekhono lokucabanga eliqinile kanye nesistimu ye-neuromuscular zisengozini enkulu yokuhlukana kwe-distal radius (ngoba iziguli zinezingqondo eziqinile, zizokwelula izandla zazo ngokuguquguqukayo ukuze zisekele phansi lapho ziwa, okuholela ekuqhekekeni). .

Ngokusho kwezibalo, e-United States, izindleko zezokwelapha zokuqhekeka kwe-distal radius ngo-2007 zazingaba yizigidi ezingu-170 zamadola aseMelika (cishe ngo-1983 amadola ase-US / umuntu). Nakuba iningi leziguli esezikhulile ezinemifantu ye-distal radius zelashwa ngendlela elondolozayo, inani leziguli ezikhetha ukulungiswa ngaphakathi liyanda unyaka nonyaka. Izindleko zokwelashwa zokulungisa ukuhlinzwa ngokuhlinza ziphindwe kathathu kunezokwelashwa okugcinwa isikhathi eside, futhi zinyusa izindleko zokuhlala esibhedlela nezinye izindleko ezihlobene.

Kukhona futhi umehluko wesifunda nowobuhlanga ekusetshenzisweni kokulungiswa kwangaphakathi kwama-distal radius fractures. Ucwaningo lwe-Medicare lubonise ukuthi abesifazane nabaseCaucasia banamathuba amaningi okuhlinzwa, futhi ububanzi bokukhetha ukulungiswa kwangaphakathi bekuyi-4.6% kuya ku-42.1%. Futhi bathola ukuthi odokotela abaqeqeshelwe ukuhlinza izandla maningi amathuba okuthi bakhethe ukuhlinzwa.

Ukuhlolwa Komtholampilo

Indlela yokulimala kwesiguli kanye nezikhalazo eziyinhloko kufanele kuqashelwe emlandweni womtholampilo, kuhlanganise nendawo yobuhlungu, umsebenzi wokusebenza, kanye nezinga lokukhubazeka. Ngesikhathi esifanayo, kuyadingeka futhi ukuqonda isandla esiphezulu sesiguli, izinto ezijwayelekile zokuzilibazisa, nomsebenzi wesiguli. Ngaphezu kwalokho, kubaluleke kakhulu ukwazi ukuthi isiguli sine-osteoarthritis noma i-sequelae ethinta imisebenzi yokusebenza yesitho esithintekile ngaphambi kokulimala. Phakathi kwabo, ukubuza iziguli esezikhulile ukuthi zidinga yini ukusebenzisa izinduku lapho zihamba nokuthi zingakwazi yini ukuzinakekela ekuphileni kwansuku zonke kubaluleke kakhulu ekuqondeni izidingo zeziguli kanye nokwenza izinhlelo zokuxilongwa nokwelashwa.

Ngesikhathi sokuhlolwa ngokomzimba komtholampilo, ukuhlolwa okuhlelekile nokubanzi kwesihlakala sesiguli kusuka kude kuya eduze kuyadingeka. Ukunikezwa kwegazi kwesihlakala kwaziwa ngokuhlolwa kwe-capillary refill kanye ne-radial ne-ulnar pulse. Izimo zezinzwa ze-nerve median, i-ulnar nerve kanye ne-radial nerve zitholwe ngokuhlolwa kokubandlulula kwamaphuzu amabili kanye nokuhlolwa kokuthinta ukukhanya. Isigameko se-acute carpal tunnel syndrome ku-distal radius fractures yi-5.4% kuya ku-8.6%, ngakho-ke ukunakwa okukhethekile kufanele kukhokhwe ku-paresthesia kanye nokuba ndikindiki endaweni yokusabalalisa ye-nerve median. Umsebenzi wemoto wesiguli wahlolwa ngokuhlola izinzwa zangaphambili nangemuva, i-radial, median, ne-ulnar. Ngaphezu kwalokho, umhloli udinga futhi ukunaka isimo sesilonda sesikhumba sesiguli (njenge-ecchymosis, i-edema, i-angulation efana nemfoloko, njll.) ukuze anqume ukuthi ngabe ukuphuka okuvulekile. Ngenxa yezimo ezingezinhle zezicubu ezithambile kanye nesikhumba esincanyana kubantu asebekhulile, ukuqhekeka kwe-distal radius kuvame ukuhambisana nemicu yesikhumba. Lapho kusetshenziswa ukuncishiswa kokudonsa okuvaliwe, ukusebenza ngokucophelela kuyadingeka ukuze kugwenywe ukulimala okwengeziwe kwezicubu ezithambile.

Ukuhlola Ukufanekisa

Ukuhlolwa kwe-Radiographic kokuhlukana kwe-distal radius ngokuvamile kufaka phakathi ama-radiographs e-anteroposterior, lateral, ne-oblique. I-angulation kanye nokujikeleza kwe-fracture kungaqondwa ngokuhlolwa kwe-imaging ukuze kutholakale ukuthi kukhona ukufinyezwa, ukuthi ngabe isiqephu sokuphuka siyasuswa, nokuthi umugqa ohlangene uphelele yini. Amanye amapharamitha wokucabanga athile afakiwe: ukuwohloka kwe-ulnar (okusho u-22°, ububanzi: 19°-29°), ukuphakama kwe-distal radius (11-12 mm), nokuthambekela kwesundu kwerediyasi ekude (isho u-11°, ububanzi: 11 °-14.5°). Kubuye kuthathwe ama-X-ray wengalo nendololwane ukuze kubhekwe ukuthi akukho yini ukulimala kwengalo noma ukuntengantenga kwendololwane. Ngemva kokuncishiswa okuvaliwe kanye nokufakwa kwe-splint immobilization, enye ifilimu ye-X-ray iyadingeka ukuze kuhlolwe ukuthi amapharamitha we-distal radius athuthukile yini. Ngokomtholampilo, ukuhlolwa kwe-CT kuvame ukusetshenziselwa ukusiza ekuxilongeni nasekuhlukaniseni ukuphuka (isb, kungakhathaliseki ukuthi kukhona ukuphuka kwe-intra-articular, kungakhathaliseki ukuthi kukhona ukucindezelwa noma ukuphuka kwe-shear), ukuze kuqhutshekwe nokucacisa uhlelo lokwelashwa kokuhlinzwa. Ngesikhathi esifanayo, ukuhlolwa kwe-CT kuyadingeka ukuze kuhlolwe okuqhubekayo lapho kwenziwa i-osteotomy kanye nokwelashwa kwamathambo e-malunion.

Yelapha

Ngokusho kwemihlahlandlela yokwelapha ye-AAOS, akukho ukuvumelana ekusetshenzisweni kokulawulwa okulondoloziwe noma okuhlinzayo kokuqhekeka kwe-distal radius. Akukho ukuvumelana kokuthi kusetshenziswe ipuleti lokukhiya i-volar noma ukulungisa i-percutaneous Kirschner wire ekwelashweni kokuhlinzwa. U-Kodama et al batusa ukusetshenziswa kwesistimu yokufaka amaphuzu ngokuphuka ukuze kunqunywe ukuthi isiguli sidinga ukuhlinzwa. Futhi ezigulini esezikhulile ezineminyaka engu-≥50 ubudala, uhlobo lokuphuka, izinguquko kumingcele ye-radiographic yelunga lesihlakala, ubudala, isandla esibusayo, kanye nomsebenzi wesiguli kufanele kusetshenziselwe ukuqhubeka nokunquma uhlelo lokwelapha. Ekuhlaziyweni kokuhlehla okuningi, izinga lokuqalwa kwe-volar noma i-dorsal distal radius fragment ngemva kokunciphisa, kungakhathaliseki ukuthi ukuphuka kuhilela intamo ye-ulnar, ukuthambekela kwesundu, nokuhlukahluka kwe-distal ulna kwakuhlotshaniswa kakhulu nemiphumela yomtholampilo.

Ukwelashwa Kwe-Conservative

Esikhungweni sethu, ukuqhekeka kwe-distal distal displaced kancane ngokuvamile kuvame ukwenziwa ngodaka lwe-Sugar tong plaster phezu kwendololwane ukuze kukhawulwe ukubiza nokukhonjiswa kwendololwane (bona Umfanekiso 1). Uma ukugudluzwa kokuphuka kukhulu, i-Sugar tong splint kufanele yenziwe ngemva kokunciphisa okuvaliwe. Qaphela ukuthi lapho wenza i-plaster splint immobilization, ububanzi bokuvimbela kufanele bume ekugcineni komunwe, ukuze kube lula ukunyakaza komunwe futhi kuvimbele ukuqina. Ukusetshenziswa kwamabhandeshi anwebekayo wokulungiswa kokucindezela okulinganiselwe kungasiza ekuhlukaniseni. Uhlobo lokuphuka lunquma indlela yokunciphisa okuvaliwe. Uma kunesidingo, i-anesthesia yendawo ye-hematoma ye-distal radius ingakhethwa, bese ukuncishiswa kwe-traction kwenziwa ngokudonsa iminwe (inkomba neminwe ephakathi) ukuze kulungiswe ukukhubazeka nokubuyisela ukuqondanisa okuhlangene kwe-radiocarpal. Ukunciphisa ukudonsa ngokuvamile kwenziwa kusetshenziswa indlela yokuphuka ephambene. Ukunciphisa ukudonsa ezindizeni ezahlukene kuyadingeka ukuze kuqedelwe ukubuyiselwa kwe-ligament nokubuyisela ukulungiswa kwezingcezu zokuphuka, i-capitulum kanye nenyanga. Endizeni ye-coronal, buyisela ukuqondanisa kwe-anatomical kwe-ulna ne-radius, i-distal bone fragment kanye ne-radial shaft. Ukuncishiswa kwe-Colles fracture evamile kudinga umsizi ukuthi abambe isithupha sesiguli esandleni esisodwa kanye neminwe yesiguli ye-4 ngakolunye uhlangothi, ukusebenzisa i-countertraction ukuze ahlukanise ucezu lwe-fracture kusuka ku-metaphysis ye-radius, ukuqhubeka kwe-longitudinal traction, bese kuba nesundu. Ukuchezuka kwe-Flexion kanye ne-ulnar ukusiza ukwehlisa ucezu lokuphuka. Ezigulini esezikhulile ezinokulimala kwezicubu ezithambile ezizungezile, ukuguqulwa ngokucophelela kuyadingeka ngesikhathi senqubo yokunciphisa ukuvimbela ukuklebhuka kwesikhumba (i-cotton pad ingasetshenziswa ngesikhathi sokunciphisa). Ngemuva kokufakwa kabusha, ukuhlolwa kwe-neurovascular kwenziwa.

Umfanekiso 1. (A) Isiguli esine-distal radius fracture sangakwazi ukuhamba endaweni yesundu engathathi hlangothi ne-Sugar tong plaster splint ukuze kuvinjelwe ukushintshwa; (B) kanye no (C) ama-radiographs angemuva nangemuva abonisa ukuthi isiguli siqina kahle isihlakala. I-plaster splint ayidluleli ngaphezu kwekhanda le-metacarpal ukuze iminwe ikwazi ukuhamba ngendlela evamile.

Ukusebenza Ukwelashwa

Izinketho zokwelapha zokuhlinzwa ezigulini esezikhulile ezinokuhlukana kwe-distal radius zihlanganisa: ukuncishiswa okuvaliwe nokulungiswa kwangaphandle, ukulungiswa kwe-percutaneous Kirschner wire fixation, ukunciphisa okuvulekile, ukulungiswa kwepuleti lokukhiya i-volar/dorsal, kanye nokulungiswa kwepuleti le-bridging dorsal (bona kuboniswe kuMfanekiso 2). 

Olunye uhlobo lokunciphisa okuvulekile kanye nokulungiswa kwepuleti le-dorsal lisetshenziselwa ikakhulukazi ukwelashwa kwe-intra-articular fractures. Inganciphisa i-articular surface ngaphansi kombono oqondile ngaphandle kokuhlubula izicubu ze-ligament ohlangothini lwe-volar ye-wrist joint, ukunciphisa ingozi yokungaqini kokuhlangana kwe-radiocarpal kamuva. Uma i-volar lunate fracture ihilelekile, idinga ukumiswa. Kuziguli ezine-radial shaft fracture noma ukulimala okuningi, ipuleti ye-traction eyakhelwe ngaphakathi ingasetshenziswa ukuze kuzuzwe ukunciphisa ngokubuyiselwa kwe-ligament. Ngesikhathi esifanayo, ipuleti le-traction libuye lifanele ukuncishiswa nokulungiswa kwe-comminuted and osteoporotic distal radius fractures. Ipuleti lasuswa emasontweni angu-12 ngemva kokuhlinzwa, futhi umphumela omuhle wokwelapha emtholampilo ungatholakala.

Ipuleti lokukhiya i-Volar lingathuthukisa ukufinyeza kwe-radial kanye nokutsheka kwe-volar, futhi izehlakalo zezinkinga ziphansi. Uma kuqhathaniswa nepuleti le-dorsal, amandla okubambelela kwesitho esithintekile angathuthukiswa kakhulu phakathi nezinyanga ezingu-6 ngemva kokuhlinzwa, futhi umsebenzi nobuhlungu kungathuthukiswa. Izinkinga ezifana nokususwa kabusha kwe-dorsal plate fixation kanye nokucasuka kwethenda ye-extensor digitorum kwenzeka ezimweni ezingafika ku-30%. Futhi umphumela wokulungisa wepuleti ye-volar nawo ungcono kunocingo lwe-Kirschner noma i-fixator yangaphandle.

Ungawathenga Kanjani Ama-Orthopedic Implants kanye Nezinsimbi Zamathambo?

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