Tam sim no rau kev txhim kho sab hauv ntawm distal radius pob txha lov, muaj ntau yam ntsuas phoo me me phaj siv hauv chaw kho mob. Cov kev daws teeb meem sab hauv no muaj cov tshuaj zoo dua rau qee cov kev sib tw sib tsoo, thiab qee txoj hauv kev kev phais mob rau kev phais mob distus, tshwj xeeb yog cov kis las. Professioness Jupiter Jupiter los ntawm Massachusetts dav dav tsev kho mob thiab lwm tus tau tshaj tawm cov lus ntawm kev sib tw ntawm hluav taws xob thiab muaj feem cuam tshuam kev phais mob. Kab lus no tsom rua kev phais mob kom txhim kho ntawm distal radius me me raws li kev txhim kho sab hauv ntawm cov khoom tawg.
Kev phais mob
Peb-kem lub tswv yim, raws li cov yam ntxwv ntawm Biomechanical thiab anatomical ntawm cov neeg hloov kho ulnar, yog lub hauv paus ntawm kev txhim kho thiab chaw kho mob ntawm 2.4mm lub cev system. Qhov kev faib ntawm peb kab yog qhia hauv daim duab 1.
Daim duab 1 Peb-kem qhov kev xav ntawm cov hluav taws xob ulnar hluav taws xob vojvoog hluav taws xob.
Daim ntawv tom qab yog cov tom qab ntawm lub vojvoog, suav nrog cov pob txha carpicular, uas txhawb nqa cov pob txha carpos, uas txhawb nqa cov pob txha carpos thiab yog keeb kwm ntawm qee lub dab teg uas ruaj khov lub dab teg.
Daim ntawv nruab nrab yog qhov nruab nrab ib nrab ntawm distal radius thiab suav nrog tus txiv neej fossa (cuam tshuam nrog cov txiv neej) thiab sigmoid tsis sib xws (cuam tshuam nrog cov sab nraud ulna) ntawm cov articular. Nquag loaded, lub nra ntawm cov txiv muaj hmoo yog kis tau rau lub vojvoog ntawm cov txiv muaj hmoo. Lub roj txuas rau sab tom qab, uas suav nrog tus Uldna, tus txheej txheem duab hluav taws xob, thiab cov pob txha qis dua li ntawm cov khoom siv roj radial ulnar-radial sib koom ua ke thiab muaj cov nyhuv stamping.
Cov txheej txheem yog ua nyob rau hauv nyob rau hauv lub plex anesthesia thiab intraoperative C-Npab X-Ray kev ua yeeb yam yog qhov tseem ceeb. Cov tshuaj tua kab mob ntawm cov tshuaj tua kab mob tau raug tswj kom tsawg kawg 30 feeb ua ntej pib ntawm cov txheej txheem thiab tus pneumatic tourniquet tau siv los ntshav.
Palmar Phaj Txhim Kho
Rau feem ntau pob txha, ib tug prafar txoj kev tuaj yeem siv los pom ntawm Radial Carpal Flexor thiab cov leeg radial. Tom qab kev txheeb xyuas thiab rov ua dua cov flexor carpi radialis cov lus ntev, qhov sib sib zog nqus ntawm cov leeg cov leeg yog pom thiab "L" qhov sib cais ua "L". Nyob rau hauv ntau nyuaj pob txha lov, tus brachioradialis leeg leeg yuav raug tso tawm ntxiv los pab txhawb kev txo cov pob txha lov.
Ib tus Pin Kirschner pin yog ntxig rau hauv Radial Carpal sib koom ua ke, uas pab txhais cov kev txwv uas nyob deb ntawm lub vojvoog. Yog hais tias ib tug me me pob txha me ntawm cov articular npoo yog tam sim no, ib tug phland 2.4mm steel phaj tuaj yeem tso rau cov npoo disticular ntawm lub vojvoog rau kev txhim kho. Hauv lwm lo lus, ib qho kev sib tw me me ntawm cov articular deg ntawm cov kua txiv tau txais kev txhawb nqa los ntawm 2.4mm "l" lossis "t", raws li qhia hauv daim duab 2.
Rau kev tsis sib xws rau kev tawg paj tawg, nws yog ib qho txiaj ntsig kom nco ntsoov cov ntsiab lus hauv qab no. Firstly, nws yog ib qho tseem ceeb rau kev rov qab kho ib ntus kom paub tseeb tias tsis muaj cov nqaij mos uas muaj qhov kawg. Thib ob, hauv cov neeg mob uas tsis muaj pob txha pob txha, tom qab cov kev pab cuam ntawm lub phaj, thiab thaum kawg, lwm yam screws yog muab tso rau qhov sib thooj
Daim duab 3 Ntxiv-articular bacture ntawm dorsally displaced distal distal recivius yog txo thiab tsau mus rau hauv xibtes. Daim duab 3-a tom qab ua tiav ntawm kev raug ntawm cov tshuaj radial carbon monor thiab cov leeg kirschner zoo nkauj, yog ib qho kev sib tw uas tau muab tso rau hauv cov radial carpal sib koom tes. Daim duab 3-b manipulidulululine ntawm lub tsev kawm ntawv tsiv cortex kom rov pib dua nws.
Daim duab 3-C thiab Daim Duab 3-da du Kirschner Pin yog tso los ntawm cov kab radial los ntawm cov kab tawg kom kho qhov kawg.
Daim duab 3-e txaus pom kev ntawm cov kev ua haujlwm tau tiav los ntawm kev siv tus ret luam ua ntej yuav tso rau. Daim duab 3-f distal kab ntawm cov screading screws yog muab nyob ze ntawm cov pob txha subchondral thaum kawg ntawm cov quav.
Daim duab 3-G X-Ray fluoroscopy yuav tsum tau siv kom paub meej tias txoj haujlwm ntawm lub phaj thiab distal screws. Daim duab 3-h Cov neeg sawv cev ntawm lub phaj yuav tsum muaj qee qhov kev tshem tawm (10 degree lub kaum ntse ntse) los ntawm lub diaphysis kom cov diaphysis kom cov diaphysis kom cov diaphysis kom rov pib dua qhov sib cuam tshuam bertal block. Daim duab 3-Kuv zawm cov ntsia hlau ua kom rov ua dua lub palmar inclination ntawm qhov distal tawg. Tshem tawm Kirschner pin ua ntej lub hau ntswj yog nruj.
Daim duab 3-J thiab 3-K InstaOperative imboards tau paub meej tias qhov kev sim siab tau pom zoo thiab lub phaj flats tau txaus siab tau.
Dorsal phaj txhim kho qhov kev phais mob kom ua rau cov pob txha distal, thiab nyob rau hauv cov pob txha lov, thiab nyob rau hauv cov kev kho mob yog feem ntau los kho ob qho tib si radial thiab cov medial kem nyob rau tib lub sijhawm. Intraautivatively, Extensor txhawb nqa bands yuav tsum tau ua nyob rau hauv ob txoj kev tseem ceeb: nyob rau hauv 2 thiab 3 extactor compartment thiab expaction ntawm cov kev coj ua; Los yog ob txoj kev txhawb nqa ob pawg kev txhawb nqa band ntawm 4 thiab 5 Extensor Compartments kom qhia tau ob kab sib cais (Daim duab 4).
Lub pob txha lov yog manipulated thiab ib ntus tsau nrog ib qho tsis txhawb Kirschner Pin, thiab iPhoneGraphic cov duab raug coj los txiav txim tias qhov tawg tau zoo. Tom ntej no, lub dorsal ulnar (nruab nrab kem) sab ntawm lub vojvoog yog ruaj khov nrog 2.4 hli "lossis" t ". Lub Dorsal Ulnar phaj yog qhov zoo li tus kom ntseeg tau tias lub zog haum rau ntawm dorsal ulnar sab ntawm distal radius. Cov phiaj hlau kuj tseem tuaj yeem tso rau hauv dorsal nam ntawm qhov tsis muaj sia nyob rau hauv ib daim phaj distal ntawm txhua lub phaj tso cai rau cov paib uas tsis muaj kev puas tsuaj rau ntawm cov ntsia hlau qhov (Daim duab 5).
Kev txhim kho ntawm cov kab radial phaj kuj yooj yim, raws li cov pob txha sib npaug yog qhov sib luag thiab tuaj yeem hloov kho hauv txoj haujlwm no nrog cov duab zoo nkauj. Yog tias Kirschner Pin yog muab tso rau hauv qhov deb deb ntawm lub radial cin muaj qhov sib cuam tshuam nrog txoj hauj lwm ntawm lub phaj thiab tswj qhov kev sib tsoo hauv qhov chaw (Daim duab 6).
Daim duab 4 kis ntawm cov dorsal saum npoo ntawm distal vojvoog. Cov pab pawg txhawb nqa tau qhib los ntawm 3RD Extensor InteroSeSous compartic thiab Extensor Hallucis ntev tau tawm.
Daim duab 5 rau kev txhim kho ntawm cov dorsal ntawm cov articular deg ntawm cov txiv yav zoo, lub dorsal "T" lossis "L"-a thiab Daim duab 5-B). Thaum lub dorsal phaj nyob rau ntawm articular nto ntawm cov txiv muaj hmoo tau raug nyab xeeb, lub phaj radial tso cai (daim duab 5-c txog 5-c txog 5-C). Qhov ob daim phiaj tau muab tso rau ntawm kaum sab xis ntawm 70 degrees rau ib leeg los txhim kho kev ruaj ntseg ntawm kev kho sab hauv.
Daim duab 6 Lub phaj radial yog qhov zoo li tus thiab muab tso rau hauv cov ntawv radial, sau cia rau ntawm lub phaj kom tsis txhob cuam tshuam nrog txoj haujlwm ntawm lub phaj.
Tseem Ceeb Cov Ntsiab Lus
Qhia rau Metacarpal Phaj Txhim Kho
Metplaced Metacarpal intra-articular pob txha (barton pob txha lov)
Displaced ntxiv-articular pob txha (colles thiab Smith fractures). Kev ruaj khov kho tau tuaj yeem ua tiav nrog cov ntsia hlau daim hlau txawm nyob rau ntawm lub xub ntiag ntawm epeoporosis.
Metplaced Metacarpal Li Hmoov Zoo Articular Txawv
Qhia rau dorsal phaj txhim kho
Nrog Intercarpal Kev Raug Zoo
Displaced dorsal zoo hmoo sib koom ua ke pob txha lov
Dorsally sheared radial carpal pob txha sib koom ua ke tsis yooj yim
Contraindications rau Palmar Phaj Txhim Kho
Kab mob txha loj nrog cov kev txwv tseem ceeb
Dorsal radial dab teg txha lov
Muaj ntau yam kev kho mob ntawm kev kho mob
Contraindications rau dorsal phaj txhim kho
Ntau tus neeg kho mob muaj kev kho mob
Tsis-Displaced Qaum
Yuam kev yooj yim tsim nyob rau hauv palmar phaj txhim kho
Txoj hauj lwm ntawm lub phaj yog qhov tseem ceeb heev vim tias tsis yog tsuas yog ua kom muaj kev kub ntxhov, tab sis kom muaj kev tiv thaiv kom deb ntawm cov ntsia hlau radial carral sib koom tes. Xyuam xim rau sab hauv intraOperaters, npaj ua tib qho kev pom ntawm lub vojvoog, uas tseem tuaj yeem pom tseeb los ntawm kev tso scread ntawm screws ua ntej thaum lub sijhawm ua haujlwm.
Ntsia thawv nkag ntawm cov dorsex nqa qhov kev pheej hmoo ntawm provensor tendon thiab ua rau cov leeg sib tawg. Locking Screw tau sib txawv ntawm cov screws qub, thiab nws tsis tas yuav nkag mus rau lub dorsex nrog cov ntsia hlau.
Yuam kev yooj yim ua nrog dorsal phaj txhim kho
Yeej ib txwm muaj kev pheej hmoo ntawm ntsia hlau nkag mus rau hauv radial carpal sib koom ua ke nrog rau cov palmar phaj, yuav tsum tau ua los txiav txim siab yog tias lub luag haujlwm ntsia hlau.
Yog tias kev txhim kho ntawm cov kem radial yog ua ua ntej, cov screws hauv kev ntsuas radial
Distal screws uas tsis tau ntsia hlau rau hauv cov ntsia hlau ntsia tej zaum yuav agon lossis txawm ua rau hlwv tawg.
Lub Sijhawm Post: Dec-28-2023
