Tam sim no rau kev kho sab hauv ntawm cov pob txha tawg distal radius, muaj ntau yam anatomical locking plate systems siv hauv tsev kho mob. Cov kev kho sab hauv no muab cov kev daws teeb meem zoo dua rau qee hom pob txha tawg nyuaj, thiab qee txoj hauv kev nthuav dav cov cim qhia rau kev phais rau cov pob txha tawg distal radius tsis ruaj khov, tshwj xeeb tshaj yog cov uas muaj osteoporosis. Xibfwb Jupiter los ntawm Massachusetts General Hospital thiab lwm tus tau luam tawm ntau cov ntawv hauv JBJS txog lawv cov kev tshawb pom ntawm kev kho phaj xauv ntawm cov pob txha tawg distal radius thiab cov txheej txheem phais cuam tshuam. Tsab xov xwm no tsom mus rau txoj kev phais rau kev kho cov pob txha tawg distal radius raws li kev kho sab hauv ntawm ib qho kev thaiv pob txha tawg tshwj xeeb.
Cov Txheej Txheem Phais Mob
Txoj kev xav ntawm peb-kab, raws li cov yam ntxwv ntawm biomechanical thiab anatomical ntawm distal ulnar radius, yog lub hauv paus rau kev txhim kho thiab kev siv kho mob ntawm 2.4mm phaj system. Kev faib ntawm peb kab tau qhia hauv Daim Duab 1.
Daim Duab 1 Peb-kab kev xav ntawm lub distal ulnar radius.
Lub kem sab yog ib nrab ntawm lub radius distal, suav nrog navicular fossa thiab radial tuberosity, uas txhawb nqa cov pob txha carpal ntawm sab radial thiab yog keeb kwm ntawm qee cov ligaments uas ruaj khov lub dab teg.
Lub kem nruab nrab yog ib nrab ntawm lub distal radius thiab suav nrog lub lunate fossa (cuam tshuam nrog lub lunate) thiab sigmoid notch (cuam tshuam nrog lub distal ulna) ntawm qhov chaw sib koom ua ke. Feem ntau thauj khoom, lub nra hnyav los ntawm lub lunate fossa raug xa mus rau lub radius ntawm lub lunate fossa. Lub ulnar lateral kem, uas suav nrog lub distal ulna, lub triangular fibrocartilage, thiab lub inferior ulnar-radial joint, nqa cov nra hnyav los ntawm cov pob txha ulnar carpal nrog rau los ntawm lub inferior ulnar-radial joint thiab muaj cov nyhuv ruaj khov.
Cov txheej txheem no ua raws li kev siv tshuaj loog brachial plexus thiab kev thaij duab C-arm X-ray thaum lub sijhawm phais yog qhov tseem ceeb. Cov tshuaj tua kab mob tau muab rau hauv cov hlab ntsha tsawg kawg 30 feeb ua ntej pib cov txheej txheem thiab siv lub tshuab cua tourniquet los txo qhov los ntshav.
Kev kho ntawm Palmar phaj
Rau feem ntau ntawm cov pob txha tawg, ib txoj kev palmar siv tau los pom qhov sib txawv ntawm radial carpal flexor thiab radial artery. Tom qab txheeb xyuas thiab rub rov qab flexor carpi radialis longus, qhov tob ntawm cov leeg pronator teres raug pom thiab qhov sib cais zoo li "L". Hauv cov pob txha tawg uas nyuaj dua, cov leeg brachioradialis yuav raug tso tawm ntxiv kom pab txo qhov pob txha tawg.
Ib tug Kirschner pin raug ntxig rau hauv lub radial carpal joint, uas pab txhais cov distal-most limits ntawm lub radius. Yog tias muaj ib qho me me ntawm qhov tawg ntawm lub articular margin, ib lub palmar 2.4mm steel plate tuaj yeem muab tso rau saum lub distal articular margin ntawm lub radius rau kev kho. Hauv lwm lo lus, ib qho me me ntawm qhov tawg ntawm lub articular surface ntawm lub lunate tuaj yeem txhawb nqa los ntawm 2.4mm "L" lossis "T", raws li pom hauv Daim Duab 2.
Rau cov pob txha tawg uas raug tshem tawm ntawm sab nraud ntawm lub pob txha nraub qaum, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov cov ntsiab lus hauv qab no. Ua ntej, nws yog ib qho tseem ceeb uas yuav tsum tau kho qhov pob txha kom rov qab kho dua ib ntus kom paub tseeb tias tsis muaj cov nqaij mos mos nyob hauv qhov kawg ntawm pob txha. Qhov thib ob, rau cov neeg mob uas tsis muaj pob txha tawg, qhov pob txha tawg tuaj yeem txo tau nrog kev pab los ntawm lub phaj: ua ntej, lub ntsia hlau xauv tau muab tso rau ntawm qhov kawg ntawm lub phaj palmar anatomical, uas tau khi rau qhov seem ntawm qhov tawg, tom qab ntawd cov seem ntawm qhov tawg thiab proximal raug txo nrog kev pab los ntawm lub phaj, thiab thaum kawg, lwm cov ntsia hlau tau muab tso rau proximal.
DUAB 3 Qhov tawg ntawm sab nraud ntawm lub pob txha caj qaum uas raug tshem tawm raug txo thiab kho kom ruaj khov los ntawm txoj kev palmar. DUAB 3-A Tom qab ua tiav qhov kev raug mob los ntawm radial carpal flexor thiab radial artery, tus pin Kirschner du raug muab tso rau hauv lub pob qij txha radial carpal. DUAB 3-B Kev tswj hwm ntawm lub metacarpal cortex uas raug tshem tawm kom rov pib dua.
Daim Duab 3-C thiab Daim Duab 3-DA tus pin Kirschner du raug muab tso rau ntawm lub qia radial hla txoj kab tawg kom kho qhov kawg ntawm qhov tawg ib ntus.
Daim Duab 3-E Yuav pom tau qhov chaw ua haujlwm zoo los ntawm kev siv lub tshuab rub rov qab ua ntej muab daim phaj tso rau. DAIM DUAB 3-F Kab distal ntawm cov ntsia hlau xauv tau muab tso ze ntawm pob txha subchondral thaum kawg ntawm qhov distal fold.
Daim Duab 3-G Yuav tsum siv X-ray fluoroscopy los xyuas kom meej qhov chaw ntawm lub phaj thiab cov ntsia hlau distal. Daim Duab 3-H Qhov proximal ntawm lub phaj yuav tsum muaj qee qhov kev sib nrug (10 degree lub kaum sab xis) ntawm diaphysis kom lub phaj tuaj yeem kho rau diaphysis kom rov pib dua qhov tawg ntawm distal. Daim Duab 3-I Nias lub ntsia hlau proximal kom rov tsim kho qhov palmar inclination ntawm qhov tawg ntawm distal. Tshem tawm Kirschner tus pin ua ntej lub ntsia hlau raug nruj tag.
Cov Duab 3-J thiab 3-K Cov duab xoo hluav taws xob thaum lub sijhawm phais mob lees paub tias qhov tawg tau hloov chaw raws li qhov xwm txheej thiab cov ntsia hlau tau muab tso rau qhov chaw zoo.
Kev Kho Dorsal Plate Txoj kev phais kom pom qhov dorsal aspect ntawm distal radius feem ntau nyob ntawm hom pob txha tawg, thiab yog tias muaj pob txha tawg nrog ob lossis ntau dua intra-articular fractures, lub hom phiaj ntawm kev kho mob yog kho ob qho tib si radial thiab medial columns tib lub sijhawm. Intraoperative, cov extensor support bands yuav tsum tau txiav ua ob txoj hauv kev tseem ceeb: longitudinally hauv 2nd thiab 3rd extensor compartments, nrog rau subperiosteal dissection mus rau 4th extensor compartment thiab retraction ntawm cov tendon sib xws; lossis thib ob support band incision ntawm 4th thiab 5th extensor compartments kom pom ob kem sib cais (Daim Duab 4).
Qhov pob txha tawg raug kho thiab kho ib ntus nrog tus pin Kirschner uas tsis muaj xov, thiab cov duab radiographic raug coj los txiav txim siab tias qhov pob txha tawg tau raug tshem tawm zoo. Tom ntej no, sab dorsal ulnar (nruab nrab) ntawm lub radius raug ruaj khov nrog 2.4 hli "L" lossis "T" phaj. Lub phaj dorsal ulnar raug puab kom ntseeg tau tias haum nruj rau sab dorsal ulnar ntawm lub distal radius. Cov phaj kuj tseem tuaj yeem tso ze rau sab dorsal ntawm distal lunate li sai tau, vim tias cov grooves sib xws ntawm sab hauv qab ntawm txhua phaj tso cai rau cov phaj kom khoov thiab puab yam tsis ua rau cov xov hauv cov qhov ntsia hlau puas tsuaj (Daim Duab 5).
Kev kho lub phaj radial column yog qhov yooj yim heev, vim tias qhov chaw pob txha ntawm thawj thiab thib ob extensor compartments yog tiaj tus thiab tuaj yeem kho tau rau hauv qhov chaw no nrog lub phaj zoo. Yog tias Kirschner pin raug tso rau hauv qhov kawg ntawm lub radial tuberosity, qhov kawg ntawm lub phaj radial column muaj ib qho groove uas sib xws rau Kirschner pin, uas tsis cuam tshuam rau qhov chaw ntawm lub phaj thiab tswj qhov tawg hauv qhov chaw (Daim duab 6).
Daim Duab 4 Kev nthuav tawm ntawm qhov chaw dorsal ntawm lub distal radius. Lub support band qhib los ntawm qhov 3rd extensor interosseous compartment thiab lub extensor hallucis longus tendon raug rub rov qab.
Daim Duab 5 Rau kev kho qhov dorsal ntawm qhov articular surface ntawm lub lunate, lub dorsal "T" lossis "L" plate feem ntau yog puab (Daim Duab 5-A thiab Daim Duab 5-B). Thaum lub dorsal plate ntawm qhov articular surface ntawm lub lunate tau raug khi ruaj khov lawm, lub radial column plate raug khi ruaj khov (Daim Duab 5-C txog 5-F). Ob lub plates raug muab tso rau ntawm lub kaum sab xis ntawm 70 degrees rau ib leeg kom txhim kho kev ruaj khov ntawm kev kho sab hauv.
Daim Duab 6 Lub phaj radial column tau raug tsim kom zoo thiab muab tso rau hauv radial column, sau tseg qhov notch ntawm qhov kawg ntawm lub phaj, uas tso cai rau lub phaj kom tsis txhob muaj kev kho ib ntus ntawm Kirschner tus pin yam tsis cuam tshuam rau qhov chaw ntawm lub phaj.
Cov ntsiab lus tseem ceeb
Cov cim qhia rau kev kho Metacarpal Plate Fixation
Kev tawg pob txha hauv pob txha metacarpal uas raug tshem tawm (Barton fractures)
cov pob txha tawg sab nraud uas raug tshem tawm (Colles thiab Smith pob txha tawg). Kev kho kom ruaj khov tuaj yeem ua tiav nrog cov phaj ntsia hlau txawm tias muaj pob txha tawg.
Kev tawg ntawm cov pob txha metacarpal lunate articular surface uas raug tshem tawm
Cov cim qhia rau kev kho lub phaj dorsal
Nrog kev raug mob ntawm cov leeg intercarpal
Kev tawg ntawm qhov chaw ntawm lub pob qij txha dorsal lunate
Kev tawg ntawm cov pob qij txha radial carpal uas raug txiav ntawm sab nraub qaum thiab sab caj npab
Contraindications rau palmar phaj fixation
Mob pob txha loj heev uas muaj kev txwv loj heev rau kev ua haujlwm
Kev tawg ntawm lub dab teg radial ntawm dorsal dislocation
Kev muaj ntau yam kab mob sib koom ua ke
Contraindications rau kev kho mob ntawm lub plab mog
Ntau yam kab mob sib koom ua ke
Cov pob txha tawg uas tsis txav chaw
Yuam kev yooj yim ua rau hauv palmar phaj fixation
Qhov chaw ntawm lub phaj yog qhov tseem ceeb heev vim tias tsis yog lub phaj tsuas yog txhawb nqa qhov tawg xwb, tab sis qhov chaw zoo kuj tiv thaiv cov ntsia hlau distal locking kom tsis txhob nkag mus rau hauv cov pob qij txha radial carpal. Cov duab xoo hluav taws xob thaum lub sijhawm phais mob, uas raug tso rau tib qho kev taw qhia li qhov radial inclination ntawm distal radius, tso cai rau kev pom tseeb ntawm qhov chaw ntawm sab radial ntawm distal radius, uas kuj tuaj yeem pom tseeb dua los ntawm kev tso cov ntsia hlau ulnar ua ntej thaum lub sijhawm phais mob.
Kev siv cov ntsia hlau nkag mus rau hauv lub cortex dorsal muaj kev pheej hmoo ntawm kev ua rau cov leeg nqaij extensor thiab ua rau cov leeg nqaij tawg. Cov ntsia hlau xauv ua haujlwm txawv ntawm cov ntsia hlau ib txwm muaj, thiab nws tsis tas yuav tsum nkag mus rau hauv lub cortex dorsal nrog cov ntsia hlau.
Yuam kev yooj yim ua nrog dorsal plate fixation
Yeej ib txwm muaj kev pheej hmoo ntawm cov ntsia hlau nkag mus rau hauv qhov sib koom ua ke radial carpal, thiab zoo ib yam li txoj hauv kev piav qhia saum toj no hauv kev sib raug zoo rau lub phaj palmar, yuav tsum tau txhaj tshuaj oblique kom paub tseeb tias qhov chaw ntsia hlau puas ruaj ntseg.
Yog tias kev kho ntawm cov kab radial raug ua ua ntej, cov ntsia hlau hauv cov tuberosity radial yuav cuam tshuam rau kev ntsuam xyuas ntawm kev kho tom qab ntawm qhov chaw sib koom ua ke ntawm lub lunate.
Cov ntsia hlau sab nraud uas tsis tau ntsia kom tag rau hauv qhov ntsia hlau yuav ua rau cov leeg txav lossis ua rau cov leeg tawg.
Lub sijhawm tshaj tawm: Lub Kaum Ob Hlis-28-2023
