Ukuqhekeka kwethenda ye-extensor ngemva kokulungiswa kwepuleti le-volar kuseyinkinga enkulu ekulungiseni ukuphuka kwe-distal radius. Ithenda evame ukuthinteka kakhulu yi-extensor pollicis longus (EPL) tendon, njengoba ivalelwe ngaphakathi kwe-EPL groove. Isigameko esibikiwe sokuqhekeka kwe-tendon ye-EPL ngemuva kwe-volar plating yi-0.29% -5.7%.
Ingozi yokulibaziseka kokuqhekeka kwe-tendon ye-EPL iyanda lapho kukhona i-screw protrusion yomgogodla, ukulimala okuvela ekubhobozeni okuqondile, kanye nezingcezu zophahla lomnyombo, ikakhulukazi ekuqhekekeni kwesiqhingi se-Lister's tubercle. Ukuhlolwa kwe-Radiographic ye-screw protrusion kuma-distal radius fractures kunzima ngenxa yejiyomethri eyinkimbinkimbi ye-distal radius kanye namandla okuqhekeka komgogodla okuhlangene. Ukubuka kwe-dorsal tangential ukuphela kwendlela engase ibe khona ye-intravital cortex ye-dorsal radial ukuze uthole ukuhlola okuthembekile kwebanga phakathi kwe-screw tip kanye ne-dorsal cortex.
Amasu okugwema ukulimala kwethenda ye-extensor ahlanganisa ukusetshenziswa kwezikulufu ze-monocortical kanye nokugwema ukungena kwendawo yomgogodla; Nokho, lezi zindlela zingase zinciphise ukuzinza kwemishini yokulungisa ukuphuka. Ngakho-ke, ukulungiswa kwe-bicortical ngezinye izikhathi kuyadingeka. Ukuze kuncishiswe ubungozi bokulimala kwethenda ye-extensor, imigomo eyinhloko yokulungisa ukuphuka nokuzinza akumele ibekwe engcupheni.
Amasu amasha okuhlinza
Sichaza indlela entsha yokunciphisa ubungozi bokuqhekeka kwe-tendon ye-EPL ngemva kokulungiswa kwepuleti le-volar lokuqhekeka kwe-distal radius ngaphandle kokunciphisa ubude besikulufu noma ukususa izingcezu zophahla lwe-dorsal. Kafushane, le nqubo ihilela ukuvula igumbi lesithathu ngokusika okuncane komhlane.
Uma isikulufu besingene ku-dorsal cortex futhi saphumela engxenyeni yesithathu: sisuse ithenda ye-EPL emseleni wayo futhi savala indawo ngokushusha i-retinaculum sishiya ithenda ye-EPL ku-retinaculum elungisiwe.
Uma isikulufu singadluleli engxenyeni yesithathu: sishiya ithenda ye-EPL engxenyeni yesithathu. Inkomba yesu lethu isezigulini ezinokuqhekeka kweradiyasi ekude elashwe ngamapuleti akhiyiwe e-volar, ukuphuka ngezingcezu ze-dorso-parietal noma izikulufu ezingase zingene ku-dorsal cortex noma zilimaze ithoni ye-EPL ezungeze i-tubercle ka-Lister. Ezigulini ezinokuqhekeka kwe-distal radius enezicucu ze-dorsomedial, sibhoboza izimbobo ukuze singene ku-dorsal cortex bese sikhetha izikulufu ezinobude obanele ukuze silungise izingcezu ze-dorsomedial ezingazinzile.
Ukwabelana kwecala
Sabelana ngodaba lapho ithenda ye-EPL ikhishwe khona engxenyeni yesithathu ngenxa yokuphuma kwesikulufu engxenyeni yesithathu ngesikhathi sokulungiswa kwepuleti lokuphuka kweradiyasi ehlanganisiwe enezicucu ze-dorsomedial. Siqinisekise ukuthi ithenda ye-EPL yayingashintshile eminyakeni engu-7 ngemva kokuhlinzwa, nakuba isikulufu sasigqamile engxenyeni yesithathu.
Icala kwakungowesifazane oneminyaka engu-67 ubudala owayenokuxilongwa kwe-intra-articular engazinzile ye-distal radius enokwephuka kwe-distal medial kwesokudla (Umfanekiso 1A-E). Awukho umlando wokubhema, isifo sikashukela noma ukuphuza utshwala. Ingakwazi ukuhamba ngaphandle kwanoma yimuphi umhambi.
![ukuhlukana kweradius distal]()
umfanekiso 1. I-imaging yangaphambi kokuhlinzwa ibonise ukuphuka kwe-intra-articular okuncishisiwe kwe-distal radius.
A no-B: I-X-ray ngaphambi kokuhlinzwa,
U-C no-D: ukubukwa kwe-sagittal kanye ne-axial yezithombe ze-tomography zekhompyutha,
E: Isithombe se-3D sekhompuyutha ye-tomography. Izingcezu ze-Dorsal medial facet facet kanye nezingcezu ze-apical apical (izinkanyezi ezimhlophe) ziyabonakala.
Indlela yokuhlinza
Siphathe le sistimu yokuphuka ngepuleti lokukhiya le-volar. Ngokuhlinza, sabhoboza i-dorsal cortex futhi sakhetha isikulufu eside ngokwanele ukuze sivikele i-dorsal cortex ngoba ucezu lwe-dorsomedial lwalungazinzile (Umfanekiso 2).
Ukuhlinzwa kwenziwa ukuze kuvulwe indawo yesithathu ngemva kokulungiswa kwezikulufu.
Njengoba isikulufu singene endaweni yesithathu futhi saphumela ngaphandle (Umfanekiso 3A), vula ngokugcwele ingxenye yesithathu bese uhambisa ithenda ye-EPL ngaphandle komsele wayo (Umfanekiso 3B).
Ingxenye yesithathu yabe ivaliwe ngokufaka i-retinaculum (Fig. 3C, D), futhi i-tendon ye-EPL yafakwa phezu kwe-retinaculum elungisiwe (Fig. 3 E).
Ngemva kokuhlinzwa, isiguli saya emtholampilo wangaphandle wesibhedlela sethu kwaze kwaba yilapho ithambo selipholile. Isiguli asifuni ukususa i-hardware.
Ukubuyiselwa kwangemuva kokuhlinzwa
Ngemva kweminyaka engu-7 sihlinziwe, isiguli sabuyela esibhedlela ukuze sihlolwe kabusha ngenxa ye-osteoporosis. Isandla sokudla asikhubazekile. Isithombe se-X ray esibonisa ukuphuka okuphulukisiwe okunomgogodla wesikulufu sokukhiya i-distal. Isithupha sesiguli sanwetshwa ngokugcwele, futhi ithenda ye-EPL yayingenayo intambo yomnsalo esobala.
Ngokuncoma kwethu, isiguli savuma ukususa i-hardware futhi sihlole i-extensor tendons. Ngokuhlinza, sihlole i-tendon ye-EPL ngokusebenzisa i-dorsal futhi savula ingxenye yesithathu neyesine.
I-tendon ye-EPL yayitholakala ngaphandle kwegumbi lesithathu endaweni efanayo nokusebenza kwangaphambilini, futhi i-tendon ayizange ithukuthele.
Siqinisekise ukuthi isikulufu singene engxenyeni yesithathu lapho imisipha ye-extensor yeminwe ihoxiswa.
Ekugcineni, salungisa izintambo zokusekela futhi sasusa ihadiwe. Ekuhlolweni kokugcina izinyanga ezingu-2 ngemva kokususwa kwe-hardware, isiguli sasingenabuhlungu futhi sanwetshwa ngokugcwele isithupha.
Xoxa
Endleleni yethu, ngemva kokulungiswa kwepuleti le-volar lokuqhekeka kwe-distal radius, savula ingxenye yesithathu ngokusika cishe u-2 cm ubude be-ulnar ku-tubercle ye-Lister. Sihlonze ngokuqondile ithenda ye-EPL kanye nesitezi sekhompathimenti yesithathu enwetshiwe ngokuhoxisa kahle ithenda ye-EPL.
Uma isikulufu singene ku-dorsal cortex engxenyeni yesithathu noma sinemfucumfucu ye-dorso-parietal, asizange senze isikulufu esifakwe ngaphakathi kokuhlinzwa noma i-fragmentectomy, kodwa savula ngokuphelele ingxenye yesithathu futhi sasusa ithenda ye-EPL emseleni wayo. Sibe sesivala i-compartment ngokufaka i-retinaculum ngenkathi sibeka kabusha i-tendon ye-EPL engxenyeni yesithathu.
Uma isikulufu singanwebeki engxenyeni yesithathu, sishiye ithenda ye-EPL engxenyeni yesithathu evuleke kancane.
Indlela yethu yokuhlinza ivumela ukuhlolwa okulula kokulimala kwe-tendon ye-EPL ngokubonakala okuqondile emizuzwini eyi-10 eyengeziwe. Uma i-tendon ye-EPL ilimele, ingalungiswa ngokuqondile. Le nqubo isiza ukuvimbela ukugqashuka kwethenda yesibili ye-EPL ngemva kokulungiswa kwepuleti le-distal radial. Intambo yomnsalo ye-tendon ye-EPL ingase yenzeke, kodwa ayizange yenzeke kithi.
Ekuphetheni
Sihlangabezane nenkinga lapho ithenda ye-EPL yayingashintshile eminyakeni engu-7 ngemva kokuhlinzwa, nakuba izikulufu ezisetshenziselwa ukulungisa ipuleti le-volar zazigqame engxenyeni yesithathu. Indlela yethu yokuhlinza inciphisa ubungozi bokugqabuka kwe-tendon ye-EPL ngemva kokulungiswa kwepuleti le-volar lokuphuka kwe-distal radius.
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