Metacarpal phalangeal fractures yog ib qho kev puas tsuaj ntawm tes, suav txog li 1/4 ntawm cov neeg mob tes. Vim yog qhov muag heev thiab cov qauv ntawm tes thiab kev ua haujlwm me me ntawm kev txav mus los, qhov tseem ceeb thiab kev ua haujlwm ntawm kev kho mob ntawm tes yog qhov nyuaj dua li kev kho mob ntawm lwm cov pob txha pob txha ntev. Kev ruaj ntseg ntawm cov pob txha tawg tom qab txo qis yog tus yuam sij rau kev kho kom zoo ntawm cov pob txha metacarpal phalangeal. Txhawm rau rov ua haujlwm ntawm tes, cov pob txha tawg feem ntau xav tau kev kho kom tsim nyog. Yav dhau los, plaster sab nrauv fixation los yog Kirschner hlau sab hauv fixation feem ntau yog siv, tab sis nws yog feem ntau tsis conducive rau thaum ntxov postoperative sib koom rehabilitation kev cob qhia vim tsis raug fixation los yog ntev fixation lub sij hawm, uas muaj ib tug ntau dua rau cov rov qab ntawm cov ntiv tes sib koom ua hauj lwm thiab coj tej yam teeb meem rau lub functional rehabilitation ntawm tes. Cov kev kho mob niaj hnub no tau siv ntau dua kev txhim kho sab hauv, xws li micro-phaj ntsia hlau fixation.
Kuv.Cov qauv kev kho mob yog dab tsi?
Cov qauv kev kho mob rau tes metacarpal thiab phalangeal fractures: anatomical txo, lub teeb thiab ruaj khov kho, kev ua si thaum ntxov thiab kev cob qhia ua haujlwm. Cov qauv kev kho mob rau intra-articular thiab peri-articular fractures ntawm txhais tes yog tib yam li cov rau lwm yam intra-articular fractures, uas kuj yog los kho lub cev nqaij daim tawv ntawm qhov sib koom ua ke thiab kev ua haujlwm thaum ntxov. Thaum kho cov pob txha metacarpal thiab phalangeal pob txha, kev siv zog yuav tsum tau ua kom ua tiav qhov kev txo qis hauv lub cev, thiab kev sib hloov, sab nraub qaum, lossis kev txav ntawm lub kaum sab xis ntawm> 10 ° mus rau sab dorsal ntawm xibtes yuav tsum tsis txhob tshwm sim. Yog hais tias qhov tawg ntawm qhov kawg ntawm lub metacarpal phalange tig los yog angularly displaces tom qab, nws yuav hloov lub trajectory ntawm ib txwm flexion thiab extension txav ntawm tus ntiv tes, ua rau nws hloov los yog poob nrog tus ntiv tes nyob ib sab thaum flexion, cuam tshuam qhov tseeb ntawm tus ntiv tes ua haujlwm; Thiab thaum lub angular hloov mus rau dorsal nam ntawm xibtes yog> 10 °, qhov chaw sib cuag ntawm cov pob txha thiab cov leeg raug puas tsuaj, ua rau muaj kev tiv thaiv thiab ntau yam ntawm cov flexion thiab txuas ntxiv ntawm cov leeg, thiab cov leeg mob ntev tshwm sim, ua rau muaj kev pheej hmoo ntawm cov leeg pob txha.
II.Cov ntaub ntawv dab tsi tuaj yeem xaiv rau cov pob txha metacarpal?
Muaj ntau ntau cov khoom siv kho mob sab hauv rau cov pob txha metacarpal, xws li Kirschner xov hlau, ntsia hlau, daim hlau thiab cov khoom siv sab nraud, ntawm cov xov hlau Kirschner thiab microplates feem ntau siv. Rau cov pob txha metacarpal, microplate sab hauv fixation muaj qhov zoo ntawm Kirschner hlau fixation thiab tuaj yeem siv ua ntej; Rau qhov sib thooj phalanx pob txha, microplates feem ntau zoo dua, tab sis thaum nws nyuaj rau ntxig cov ntsia hlau rau cov phalanx distal ntu thiab lub taub hau tawg, hla Kirschner hlau sab hauv yuav tsum tau siv, uas yog qhov zoo dua rau kev rov ua haujlwm ntawm cov ntiv tes cuam tshuam; Kirschner xov hlau yuav tsum tau siv ua ntej rau kev kho mob ntawm nruab nrab phalanx fractures.
- Kirschner hlau:Kirschner hlau sab hauv fixation tau siv nyob rau hauv kev kho mob rau ntau tshaj 70 xyoo thiab yeej ib txwm yog cov feem ntau siv sab hauv fixation khoom rau metacarpal thiab phalangeal puas. Nws yog ib qho yooj yim rau kev khiav lag luam, kev lag luam thiab cov tswv yim, thiab yog cov classic sab hauv fixation txoj kev. Raws li feem ntau siv sab hauv fixation rau kev kho mob ntawm tes tawg, nws tseem siv dav. Qhov zoo ntawm Kirschner hlau sab hauv fixation: ① Yooj yim rau kev khiav lag luam thiab siv tau yooj yim; ② Tsawg dua cov ntaub so ntswg stripping, tsis tshua muaj kev cuam tshuam rau cov ntshav ntawm cov pob txha tawg, tsawg dua kev phais mob, thiab ua kom zoo rau pob txha; ③ Yooj yim tshem tawm rab koob thib ob; ④ Tus nqi qis thiab ntau yam ntawm daim ntawv thov, haum rau feem ntau cov pob txha pob txha (xws li cov pob qij txha intra-articular, cov pob txha loj comminuted thiab distal phalangeal fractures).
2.Metacarpophalangeal microplates: Lub zog sab hauv kho ntawm tes tawg yog lub hauv paus rau kev cob qhia ua haujlwm thaum ntxov thiab tsim nyog rau kev rov ua haujlwm zoo ntawm tes. AO internal fixation thev naus laus zis yuav tsum tau hais tias qhov tawg ntawm qhov kawg yuav tsum raug hloov kho raws li cov qauv anatomical thiab qhov tawg ntawm qhov kawg yuav ruaj khov nyob rau hauv kev ua haujlwm, uas feem ntau hu ua kev txhim kho muaj zog, thiaj li tso cai rau kev txav mus los thaum ntxov. AO kuj tseem hais txog kev ua haujlwm phais mob me me, nrog rau kev tsom mus rau kev tiv thaiv cov ntshav. Microplate internal fixation rau kev kho mob ntawm tes fractures tuaj yeem ua tiav cov txiaj ntsig zoo ntawm lub zog, ruaj khov ntawm cov pob txha tawg, thiab siab ntawm cov pob txha tawg. Nyob rau hauv cov nqe lus ntawm kev ua haujlwm rov qab ua haujlwm rov qab, lub sijhawm kho pob txha, thiab tus nqi kis tau tus mob, nws ntseeg tias qhov ua tau zoo ntawm microtitanium daim hlau yog qhov zoo dua li cov xov hlau Kirschner. Ntxiv mus, txij li lub sij hawm kho pob txha tom qab kho nrog microtitanium daim hlau yog luv luv dua li ntawm lwm txoj kev kho, nws yog qhov zoo rau cov neeg mob kom rov pib lub neej thaum ntxov.
(1) Qhov zoo ntawm microplate sab hauv fixation yog dab tsi?
① Piv nrog Kirschner xov hlau, microplate ntsia hlau cov ntaub ntawv muaj cov ntaub so ntswg zoo sib xws thiab cov ntaub so ntswg zoo dua; ② Kev ruaj ntseg ntawm lub phaj-ntsia hlau fixation system thiab lub siab ntawm qhov tawg ntawm qhov kawg ua rau cov pob txha tawg los ze zog rau kev txo qis hauv lub cev, kev ruaj ntseg ntau dua, thiab zoo rau kev kho pob txha; ③ Kev ua haujlwm thaum ntxov feem ntau tso cai tom qab kho microplate, uas yog qhov zoo rau kev rov ua haujlwm ntawm tes.
(2) Txoj kev phais rau microplates yog dab tsi?
Kev phais feem ntau yog ua nyob rau hauv brachial plexus thaiv tshuaj loog, thiab pneumatic tourniquet feem ntau yuav tsum tau. Lub dorsal incision ntawm lub metacarpal phalanges yog noj, dorsal aponeurosis ntawm tus lej raug txiav los yog cov leeg nqaij sib txuas thiab cov pob txha metacarpal tau nkag mus rau nthuav tawm cov pob txha tawg ntawm cov pob txha metacarpal lossis phalangeal, lub periosteum yog tev tawm, thiab cov pob txha tawg raug txo qis hauv qhov muag ncaj qha. Cov phaj ncaj yog tsim rau cov pob txha tawg ntawm nruab nrab ntu thiab luv oblique pob txha, T-plates yog tsim rau kho ntawm lub hauv paus ntawm metacarpal thiab phalanges, thiab T-phaj los yog 120 ° thiab 150 ° L-phaj yog tsim rau fixation ntawm oblique ntev thiab comminuted puas. Lub phaj feem ntau muab tso rau ntawm lub dorsal sab ntawm cov pob txha los tiv thaiv cov leeg zawv zawg thiab hnav mus ntev, uas yog qhov tsim nyog rau kev cob qhia thaum ntxov. Yam tsawg kawg yog ob lub screws yuav tsum tau siv los kho ob qhov kawg ntawm qhov tawg, txwv tsis pub qhov kev ruaj ntseg tsis zoo, thiab Kirschner cov xov hlau lossis cov ntsia hlau sab nraum lub phaj yog xav tau los pab kho kom tiav lub hom phiaj ntawm kev ruaj khov.
3.Mini screws: Mini screws muaj kev ruaj ntseg zoo ib yam rau cov hlau phaj hauv kev txhim kho ntawm kauv los yog ntev oblique fractures, tab sis qhov ntau ntawm cov ntaub so ntswg thiab periosteum stripping yog me dua li ntawm steel phaj fixation, uas yog qhov zoo rau kev tiv thaiv cov ntshav thiab nyob rau hauv txoj kab nrog lub tswv yim ntawm minimally invasive operation. Txawm hais tias muaj T-hom thiab L-hom daim hlau rau ze-articular fractures, kev rov ua haujlwm ntawm kev sib koom ua ke tom qab kev ua haujlwm tom qab ua haujlwm yog qhov phem dua li cov pob txha diaphyseal. Mini screws kuj muaj qee qhov zoo hauv kev txhim kho ntawm cov pob qij txha thiab peri-articular fractures. Cov ntsia hlau ntsia hlau rau hauv cov pob txha cortical tuaj yeem tiv taus qhov kev ntxhov siab loj, yog li kev txhim kho ruaj khov, thiab cov pob txha tawg tuaj yeem raug compressed los ua kom cov pob txha tawg nyob ze, ua rau lub sijhawm kho pob txha thiab pab kho cov pob txha zoo, raws li qhia hauv daim duab 4-18. Mini ntsia hlau sab hauv fixation ntawm tes fractures yog tsuas yog siv rau oblique los yog kauv fractures ntawm diaphyseal thiab intra-articular avulsion fractures ntawm cov pob txha loj. Nws yuav tsum tau muab sau tseg tias thaum siv mini screws ib leeg los kho oblique los yog kauv fractures ntawm cov pob txha diaphyseal ntawm tes, qhov ntev ntawm cov pob txha pob txha yuav tsum yog tsawg kawg yog ob zaug ntawm txoj kab uas hla ntawm cov pob txha diaphyseal, thiab thaum kho avulsed fracture blocks nyob rau hauv lub sib koom tes, qhov dav ntawm cov pob txha thaiv yuav tsum yog tsawg kawg yog 3 npaug ntawm txoj kab uas hla ntawm cov xov.
4.Micro sab nraud fixator:Comminuted metacarpal phalangeal fractures yog qee zaum nyuaj rau anatomically txo lossis tsis tuaj yeem ruaj khov rau sab hauv txawm tias tom qab phais phais vim kev puas tsuaj ntawm pob txha txhawb nqa. Lub fixator sab nraud tuaj yeem kho thiab tswj tau qhov ntev ntawm qhov sib tsoo ntawm qhov sib tsoo hauv qab traction, ua si lub luag haujlwm ntawm kev txheeb ze fixation. Qhov sib txawv metacarpal phalangeal sab nraud fixators yog muab tso rau hauv ntau txoj haujlwm: 1st thiab 2nd metacarpal phalanges muab tso rau ntawm dorsal radial sab, 4 thiab 5th metacarpal phalanges muab tso rau ntawm dorsal ulnar sab, thiab 3rd metacarpal phalange muab tso rau ntawm dorsal radial sab los yog raws li qhov xwm txheej ntawm dorsal. Ua tib zoo mloog rau lub koob ntxig taw tes kom tiv thaiv kev puas tsuaj ntawm cov leeg. Kaw pob txha tuaj yeem txo qis hauv X-rays. Thaum qhov kev txo qis tsis zoo, qhov kev txiav me me tuaj yeem ua tau los pab txo qis.
Dab tsi yog qhov zoo ntawm sab nrauv fixators?
① Kev ua haujlwm yooj yim, tuaj yeem kho ntau yam kev hloov pauv ntawm cov pob txha tawg; ② tuaj yeem txo thiab txhim kho cov pob txha pob txha ntawm cov pob txha metacarpophalangeal yam tsis muaj kev puas tsuaj rau qhov sib koom ua ke, thiab tuaj yeem cuam tshuam qhov sib koom ua ke kom tsis txhob muaj kev sib koom tes ntawm cov tshuaj ntsiav thiab cov khoom pov tseg ligament; ③ Thaum comminuted fractures tsis tuaj yeem txo qis hauv anatomically, lawv tuaj yeem ua ke nrog kev txhim kho sab hauv, thiab cov fixator sab nraud tuaj yeem txo qis thiab tswj cov kab quab yuam; ④ Tso cai rau kev ua haujlwm thaum ntxov ntawm tus ntiv tes cuam tshuam hauv kev sib koom ua ke kom tsis txhob muaj pob txha pob txha; ⑤ tuaj yeem kho cov pob txha ntawm tes zoo yam tsis muaj kev cuam tshuam rau kev kho mob tom qab phais ntawm qhov txhab ntawm tes.
Post lub sij hawm: Dec-21-2024
