Cov pob txha tawg ntawm cov pob txha metacarpal phalangeal yog cov pob txha tawg uas tshwm sim ntau hauv kev raug mob tes, suav txog li 1/4 ntawm cov neeg mob raug mob tes. Vim yog qhov sib txawv ntawm tes thiab kev ua haujlwm ntawm kev txav mus los, qhov tseem ceeb thiab kev txawj ntse ntawm kev kho mob pob txha tawg tes yog qhov nyuaj dua li kev kho mob ntawm lwm cov pob txha tawg ntev. Kev ua kom ruaj khov ntawm qhov tawg tom qab txo qis yog qhov tseem ceeb rau kev kho mob zoo ntawm cov pob txha metacarpal phalangeal. Yuav kom rov qab ua haujlwm ntawm tes, cov pob txha tawg feem ntau xav tau kev kho kom zoo. Yav dhau los, kev kho sab nraud plaster lossis Kirschner hlau sab hauv kev kho tau siv ntau zaus, tab sis nws feem ntau tsis zoo rau kev cob qhia kho pob qij txha tom qab phais vim yog kev kho tsis raug lossis lub sijhawm kho ntev, uas muaj kev cuam tshuam ntau dua rau kev rov qab ua haujlwm ntawm cov ntiv tes thiab coj qee qhov teeb meem rau kev kho tes. Cov txheej txheem kho mob niaj hnub no siv kev kho sab hauv muaj zog dua, xws li kev kho ntsia hlau micro-plate.
Kuv.Cov ntsiab cai kho mob yog dab tsi?
Cov ntsiab cai kho mob rau tes pob txha metacarpal thiab phalangeal tawg: kev txo qis ntawm lub cev, kev kho kom ruaj khov thiab yooj yim, kev ua ub no thaum ntxov thiab kev cob qhia ua haujlwm. Cov ntsiab cai kho mob rau kev tawg hauv tes thiab pob txha peri-articular yog tib yam li cov rau lwm yam kev tawg hauv tes, uas kuj yog los kho qhov anatomy ntawm qhov sib koom ua ke thiab kev ua ub no thaum ntxov. Thaum kho tes pob txha metacarpal thiab phalangeal tawg, yuav tsum tau siv zog ua kom tiav kev txo qis ntawm lub cev, thiab kev tig, lub kaum sab xis, lossis lub kaum sab xis ntawm >10° mus rau sab nraub qaum ntawm xib teg yuav tsum tsis txhob tshwm sim. Yog tias qhov kawg ntawm pob txha metacarpal tig lossis lub kaum sab xis txav mus rau sab nraud, nws yuav hloov pauv txoj kev txav ntawm kev khoov thiab kev txav mus los ntawm tus ntiv tes, ua rau nws hloov lossis poob nrog tus ntiv tes sib ze thaum lub sijhawm khoov, cuam tshuam rau qhov tseeb ntawm kev ua haujlwm ntawm tus ntiv tes; thiab thaum lub kaum sab xis mus rau sab nraub qaum ntawm xib teg yog >10°, qhov chaw sib cuag du ntawm pob txha thiab cov leeg raug rhuav tshem, ua rau muaj kev tiv thaiv thiab ntau yam kev txav mus los ntawm kev khoov thiab txuas ntxiv ntawm cov leeg, thiab kev puas tsuaj ntawm cov leeg mus ntev tshwm sim, ua rau muaj kev pheej hmoo ntawm kev tawg ntawm cov leeg.
II.Cov ntaub ntawv twg tuaj yeem xaiv rau kev tawg pob txha metacarpal?
Muaj ntau yam khoom siv kho sab hauv rau kev tawg pob txha metacarpal, xws li Kirschner xov hlau, ntsia hlau, phaj thiab cov khoom kho sab nraud, ntawm cov uas Kirschner xov hlau thiab microplates yog cov siv ntau tshaj plaws. Rau kev tawg pob txha metacarpal, microplate sab hauv kho muaj qhov zoo dua li Kirschner xov hlau kho thiab tuaj yeem siv ua ntej; rau kev tawg pob txha proximal phalanx, microplates feem ntau zoo dua, tab sis thaum nws nyuaj rau ntxig cov ntsia hlau rau proximal phalanx distal segment thiab taub hau tawg, hla Kirschner xov hlau sab hauv kho yuav tsum tau siv, uas yog qhov zoo dua rau kev rov qab ua haujlwm ntawm tus ntiv tes cuam tshuam; Kirschner xov hlau yuav tsum tau siv ua ntej rau kev kho mob ntawm kev tawg pob txha nruab nrab.
- Kirschner hlau:Kirschner hlau kho sab hauv tau siv rau hauv kev kho mob rau ntau tshaj 70 xyoo thiab yeej ib txwm yog cov khoom siv kho sab hauv uas siv ntau tshaj plaws rau kev tawg pob txha metacarpal thiab phalangeal. Nws yooj yim rau kev khiav lag luam, pheej yig thiab siv tau, thiab yog txoj kev kho sab hauv uas zoo tshaj plaws. Raws li kev kho sab hauv uas siv ntau tshaj plaws rau kev kho pob txha tes, nws tseem siv dav. Cov txiaj ntsig ntawm Kirschner hlau kho sab hauv: ① Yooj yim rau kev khiav lag luam thiab yooj ywm heev rau kev siv; ② Tsis tshua muaj cov ntaub so mos mos, tsis muaj kev cuam tshuam rau cov ntshav ntawm qhov kawg ntawm pob txha tawg, tsis muaj kev phais mob, thiab ua rau pob txha kho tau zoo; ③ Yooj yim tshem lub koob rau zaum ob; ④ Tus nqi qis thiab ntau yam kev siv, haum rau feem ntau ntawm kev tawg pob txha tes (xws li kev tawg pob txha hauv pob txha, kev tawg pob txha hnyav thiab kev tawg pob txha distal phalangeal).
2. Cov pob txha me me Metacarpophalangeal: Kev kho kom ruaj khov sab hauv ntawm cov pob txha tawg tes yog lub hauv paus rau kev cob qhia ua haujlwm thaum ntxov thiab yog qhov tsim nyog rau kev rov qab ua haujlwm tes zoo. AO sab hauv kev kho tshuab xav kom cov pob txha tawg yuav tsum tau hloov kho kom raug raws li cov qauv anatomical thiab cov pob txha tawg yuav tsum ruaj khov nyob rau hauv cov xwm txheej ua haujlwm, uas feem ntau hu ua kev kho kom ruaj khov, txhawm rau kom muaj kev txav mus los thaum ntxov. AO kuj tseem hais txog kev phais mob tsawg kawg nkaus, nrog rau kev tsom mus rau kev tiv thaiv cov ntshav. Microplate sab hauv kev kho rau kev kho mob ntawm cov pob txha tawg tes tuaj yeem ua tiav cov txiaj ntsig zoo hauv kev muaj zog, kev ruaj khov ntawm cov pob txha tawg, thiab kev siab ntawm cov pob txha tawg. Hauv kev rov qab ua haujlwm tom qab phais, lub sijhawm kho pob txha tawg, thiab tus nqi kis kab mob, nws ntseeg tau tias qhov ua tau zoo ntawm microtitanium phaj zoo dua li ntawm Kirschner xov hlau. Ntxiv mus, txij li thaum lub sijhawm kho pob txha tawg tom qab kho nrog microtitanium phaj luv dua li ntawm lwm txoj kev kho, nws yog qhov zoo rau cov neeg mob kom rov qab ua neej zoo li qub thaum ntxov.
(1) Cov txiaj ntsig ntawm kev kho kom zoo sab hauv microplate yog dab tsi?
① Piv nrog cov xov hlau Kirschner, cov ntaub ntawv ntsia hlau microplate muaj kev sib raug zoo ntawm cov ntaub so ntswg thiab cov ntaub so ntswg teb zoo dua; ② Kev ruaj khov ntawm lub phaj-ntsia hlau kho qhov system thiab lub siab ntawm qhov kawg ntawm qhov tawg ua rau qhov tawg ze rau qhov txo qis anatomical, kev kho kom ruaj ntseg dua, thiab ua rau kev kho pob txha tawg; ③ Kev tawm dag zog ua haujlwm thaum ntxov feem ntau raug tso cai tom qab microplate fixation, uas ua rau kev rov qab ua haujlwm ntawm tes.
(2) Txoj kev phais rau microplates yog dab tsi?
Feem ntau qhov kev phais mob no yuav ua raws li kev siv tshuaj loog brachial plexus block, thiab feem ntau yuav tsum tau siv lub tshuab cua tourniquet. Yuav tsum tau txiav cov pob txha metacarpal phalanges tom qab, txiav cov pob txha dorsal aponeurosis ntawm cov ntiv tes lossis cov leeg nqaij interosseous thiab pob txha metacarpal kom pom qhov kawg ntawm cov pob txha metacarpal lossis phalangeal, tev tawm ntawm periosteum, thiab qhov tawg yuav raug txo qis thaum pom ncaj qha. Cov phaj ncaj yog qhov tsim nyog rau cov pob txha transverse ntawm qhov nruab nrab thiab cov pob txha luv luv, T-plates yog qhov tsim nyog rau kev kho lub hauv paus ntawm metacarpal thiab phalanges, thiab T-plates lossis 120° thiab 150° L-plates yog qhov tsim nyog rau kev kho cov pob txha ntev ntev thiab cov pob txha tawg. Feem ntau, lub phaj no yuav tsum muab tso rau sab nraub qaum ntawm pob txha kom tiv thaiv kev swb thiab kev hnav mus sij hawm ntev, uas yog qhov zoo rau kev cob qhia ua haujlwm thaum ntxov. Yuav tsum siv tsawg kawg yog ob lub ntsia hlau los kho ob qho kawg ntawm qhov tawg, txwv tsis pub qhov ruaj khov tsis zoo, thiab xav tau cov xov hlau lossis cov ntsia hlau sab nraum lub phaj los pab kho kom ua tiav lub hom phiaj ntawm kev kho kom ruaj khov.
3. Cov ntsia hlau me me: Cov ntsia hlau me me muaj kev ruaj khov zoo ib yam li cov phaj hlau hauv kev kho cov pob txha tawg uas muaj kauv lossis ntev oblique, tab sis qhov ntau ntawm cov ntaub so ntswg mos thiab periosteum stripping yog me dua li ntawm cov phaj hlau kho, uas yog qhov zoo rau kev tiv thaiv cov ntshav thiab ua raws li lub tswv yim ntawm kev ua haujlwm tsawg kawg nkaus. Txawm hais tias muaj cov phaj T-hom thiab L-hom rau cov pob txha tawg ze-articular, kev rov qab los ntawm kev ua haujlwm sib koom ua ke tom qab kev saib xyuas tom qab phais mob yog qhov phem dua li ntawm cov pob txha tawg diaphyseal. Cov ntsia hlau me me kuj muaj qee qhov zoo hauv kev kho cov pob txha tawg hauv pob txha thiab peri-articular. Cov ntsia hlau ntsia hlau rau hauv pob txha cortical tuaj yeem tiv taus qhov hnyav ntawm kev ntxhov siab, yog li qhov kev kho yog khov kho, thiab qhov kawg ntawm pob txha tawg tuaj yeem raug nias kom ua rau qhov chaw tawg ze ze, luv lub sijhawm kho pob txha tawg thiab pab kho qhov tawg, raws li pom hauv Daim Duab 4-18. Mini ntsia hlau sab hauv kho tes tawg feem ntau yog siv rau oblique lossis kauv pob txha tawg ntawm diaphyseal thiab intra-articular avulsion tawg ntawm cov pob txha loj dua. Yuav tsum nco ntsoov tias thaum siv cov ntsia hlau me me ib leeg los kho qhov tawg oblique lossis kauv ntawm pob txha diaphyseal ntawm tes, qhov ntev ntawm kab tawg yuav tsum yog tsawg kawg yog ob npaug ntawm txoj kab uas hla ntawm pob txha diaphyseal, thiab thaum kho cov pob txha tawg avulsed hauv qhov sib koom ua ke, 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:Cov pob txha tawg metacarpal phalangeal uas raug txiav ua tej daim me me qee zaum nyuaj rau txo lossis tsis tuaj yeem kho kom ruaj khov sab hauv txawm tias tom qab phais vim yog kev puas tsuaj ntawm kev txhawb nqa pob txha. Lub cuab yeej kho sab nraud tuaj yeem kho thiab tswj qhov ntev ntawm qhov tawg uas raug txiav hauv qab kev rub, ua lub luag haujlwm ntawm kev kho kom zoo. Cov cuab yeej kho sab nraud metacarpal phalangeal sib txawv tau muab tso rau hauv ntau qhov chaw sib txawv: 1st thiab 2nd metacarpal phalanges tau muab tso rau sab dorsal radial, 4th thiab 5th metacarpal phalanges tau muab tso rau sab dorsal ulnar, thiab 3rd metacarpal phalange tau muab tso rau sab dorsal radial lossis dorsal ulnar raws li qhov xwm txheej. Ua tib zoo saib qhov chaw ntxig koob kom tiv thaiv kev puas tsuaj rau cov leeg. Cov pob txha tawg kaw tuaj yeem txo tau hauv qab X-rays. Thaum qhov kev txo qis tsis zoo tagnrho, qhov kev txiav me me tuaj yeem ua tau los pab txo qis.
Cov txiaj ntsig ntawm cov khoom siv kho sab nraud yog dab tsi?
① Kev ua haujlwm yooj yim, tuaj yeem hloov kho ntau yam kev hloov pauv ntawm qhov kawg ntawm pob txha tawg; ② Muaj peev xwm txo thiab kho qhov tawg ntawm cov pob txha metacarpophalangeal yam tsis ua rau qhov sib koom ua ke puas tsuaj, thiab tuaj yeem cuam tshuam qhov sib koom ua ke kom tiv thaiv kev cog lus ntawm cov pob qij txha thiab cov leeg sib koom ua ke; ③ Thaum cov pob txha tawg uas raug txiav tsis tuaj yeem txo qis anatomically, lawv tuaj yeem ua ke nrog kev kho kom ruaj khov sab hauv, thiab lub cuab yeej kho sab nraud tuaj yeem txo qee qhov thiab tswj hwm txoj kab quab yuam; ④ Tso cai rau kev tawm dag zog ua haujlwm thaum ntxov ntawm tus ntiv tes cuam tshuam hauv qhov sib koom ua ke tsis ruaj khov kom tsis txhob muaj pob qij txha thiab osteoporosis; ⑤ Muaj peev xwm kho qhov tawg ntawm tes yam tsis cuam tshuam rau kev kho mob tom qab phais ntawm qhov txhab ntawm tes cuam tshuam.
Lub sijhawm tshaj tawm: Lub Kaum Ob Hlis-21-2024
