Tam sim no, cov pob txha tawg ntawm distal radius raug kho ntau txoj hauv kev, xws li kev kho plaster, kev txiav thiab txo qhov kho sab hauv, kev kho sab nraud, thiab lwm yam. Ntawm lawv, kev kho palmar phaj tuaj yeem ua tiav cov txiaj ntsig zoo dua, tab sis qee cov ntaub ntawv tshaj tawm tias nws qhov teeb meem yog siab txog 16%. Txawm li cas los xij, yog tias lub phaj raug xaiv kom raug, qhov teeb meem tuaj yeem txo qis tau zoo. Kev piav qhia luv luv ntawm cov hom, cov cim qhia thiab cov txheej txheem phais ntawm palmar plating rau cov pob txha tawg ntawm distal radius tau nthuav tawm.
I. Hom kev tawg ntawm lub distal radius
Muaj ntau txoj kev faib tawm rau pob txha tawg, suav nrog Müller AO kev faib tawm raws li lub cev thiab Femandez kev faib tawm raws li txoj kev raug mob. Ntawm lawv, Eponymic kev faib tawm muab cov txiaj ntsig ntawm cov kev faib tawm yav dhau los, npog plaub hom pob txha tawg yooj yim, thiab suav nrog Maleon 4-qhov pob txha tawg thiab Chaffer's pob txha tawg, uas tuaj yeem yog phau ntawv qhia zoo rau kev ua haujlwm hauv tsev kho mob.
1. Müller AO kev faib tawm - ib feem ntawm cov pob txha tawg hauv pob qij txha
Qhov kev faib tawm AO zoo heev rau cov pob txha tawg ntawm qhov distal radius thiab faib lawv ua peb hom tseem ceeb: hom A extra-articular, hom B partial intra-articular, thiab hom C total joint fractures. Txhua hom raug muab faib ua ntau pawg sib txawv raws li qhov hnyav thiab qhov nyuaj ntawm qhov pob txha tawg.
Hom A: Pob txha tawg sab nraud
A1, pob txha ulnar femoral tawg, radius raws li kev raug mob (A1.1, pob txha ulnar; A1.2 pob txha ulnar diaphysis tawg yooj yim; A1.3, pob txha ulnar diaphysis tawg ua tej daim me me).
A2, Qhov tawg ntawm lub pob txha radius, yooj yim, nrog rau inset (A2.1, lub pob txha radius tsis muaj qhov ntxeev; A2.2, qhov ntxeev ntawm lub pob txha radius, piv txwv li, qhov tawg ntawm Pouteau-Colles; A2.3, qhov ntxeev ntawm lub pob txha radius, piv txwv li, qhov tawg ntawm Goyrand-Smith).
A3, Qhov tawg ntawm lub vojvoog, sib tsoo (A3.1, qhov luv ntawm lub vojvoog; A3.2 daim duab zoo li wedge ntawm lub vojvoog; A3.3, qhov tawg ntawm lub vojvoog sib tsoo).
Hom B: pob txha tawg ib nrab
B1, tawg ntawm lub vojvoog, sagittal dav hlau (B1.1, hom yooj yim sab; B1.2, hom sib xyaw sab; B1.3, hom nruab nrab).
B2, Pob txha tawg ntawm ntug nraub qaum ntawm lub pob txha radius, piv txwv li, Pob txha tawg Barton (B2.1, hom yooj yim; B2.2, pob txha tawg ua ke sab nraud; B2.3, pob txha tawg ua ke sab nraub qaum ntawm lub dab teg).
B3, Kev tawg ntawm lub metacarpal rim ntawm lub radius, piv txwv li, kev tawg anti-Barton, lossis kev tawg Goyrand-smith hom II (B3.1, txoj cai femoral yooj yim, daim me me; B3.2, kev tawg yooj yim, daim loj; B3.3, kev tawg comminuted).
Hom C: pob txha tawg tag nrho
C1, pob txha tawg radial nrog hom yooj yim ntawm ob qho tib si articular thiab metaphyseal surfaces (C1.1, posterior medial articular fracture; C1.2, sagittal fracture ntawm articular surface; C1.3, pob txha tawg ntawm coronal surface ntawm articular surface).
C2, Kev tawg ntawm lub pob txha caj qaum (radius fracture), lub ntsej muag pob txha caj qaum yooj yim (simple articular facet), lub metaphysis uas raug sib xyaw ua ke (C2.1, kev tawg ntawm lub ntsej muag pob txha caj qaum sagittal; C2.2, kev tawg ntawm lub ntsej muag pob txha caj qaum coronal; C2.3, kev tawg ntawm lub pob txha caj qaum txuas mus rau hauv lub qia pob txha caj qaum radial).
C3, tawg radial, sib tsoo (C3.1, tawg yooj yim ntawm metaphysis; C3.2, tawg metaphysis sib tsoo; C3.3, tawg pob qij txha txuas mus rau radial stem).
2. Kev faib tawm ntawm cov pob txha tawg ntawm qhov deb.
Raws li txoj kev raug mob, Femandez kev faib tawm tuaj yeem muab faib ua 5 hom:
Hom pob txha tawg I yog cov pob txha tawg uas tsis sib txuas nrog pob txha sab nraud xws li Colles pob txha tawg (dorsal angulation) lossis Smith pob txha tawg (metacarpal angulation). Lub cortex ntawm ib pob txha tawg thaum muaj kev sib txhuam thiab lub cortex contralateral raug sib txuas thiab muab tso rau hauv.
Pob txha tawg
Cov pob txha tawg hom III yog cov pob txha tawg hauv pob qij txha, uas tshwm sim los ntawm kev ntxhov siab ntawm shear. Cov pob txha tawg no suav nrog palmar Barton pob txha tawg, dorsal Barton pob txha tawg, thiab radial stem pob txha tawg.
Kev ntxhov siab ntawm kev txiav
Cov pob txha tawg hom III yog cov pob txha tawg hauv pob qij txha thiab cov pob txha metaphyseal uas tshwm sim los ntawm kev raug mob ntawm cov pob txha, suav nrog cov pob txha tawg uas nyuaj rau sib koom ua ke thiab cov pob txha tawg radial pilon.
Kev ntxig
Hom pob txha tawg IV yog qhov avulsion pob txha ntawm cov ligamentous txuas uas tshwm sim thaum lub sijhawm pob txha tawg-dislocation ntawm radial carpal pob qij txha.
Kev tawg ntawm avulsion I dislocation
Hom pob txha tawg V tshwm sim los ntawm kev raug mob ceev ceev uas muaj ntau lub zog sab nraud thiab kev raug mob loj heev. (Sib xyaw I, II, IIII, IV)
3. Kev ntaus ntawv hauv ib lub npe
II. Kev kho mob ntawm cov pob txha tawg ntawm lub distal radius nrog palmar plating
Cov cim qhia.
Rau cov pob txha tawg sab nraud tom qab ua tsis tiav ntawm kev txo qis hauv cov xwm txheej hauv qab no.
Lub kaum sab xis ntawm lub nraub qaum ntau dua 20 °
Kev nias ntawm sab nraub qaum ntau dua 5 hli
Qhov distal radius luv dua 3 hli
Qhov tawg ntawm qhov tawg ntawm qhov chaw tawg loj dua 2 hli
Rau cov pob txha tawg hauv pob qij txha uas loj dua 2 hli kev hloov chaw
Cov kws tshawb fawb feem ntau tsis pom zoo kom siv cov phaj metacarpal rau kev raug mob hnyav, xws li cov pob txha tawg loj heev lossis cov pob txha poob loj heev, vim tias cov pob txha tawg no feem ntau yuav ua rau avascular necrosis thiab nyuaj rau kev hloov pauv anatomically.
Hauv cov neeg mob uas muaj ntau qhov tawg thiab muaj kev hloov pauv loj nrog rau kev mob pob txha hnyav, metacarpal plating tsis zoo. Kev txhawb nqa subchondral ntawm cov pob txha tawg distal yuav muaj teeb meem, xws li kev nkag mus rau hauv qhov sib koom ua ke.
Kev phais mob
Feem ntau cov kws phais siv txoj hauv kev thiab cov txheej txheem zoo sib xws rau kev kho cov pob txha tawg ntawm qhov distal radius nrog lub phaj palmar. Txawm li cas los xij, yuav tsum muaj cov txheej txheem phais zoo kom tsis txhob muaj teeb meem tom qab phais, piv txwv li, kev txo qis tuaj yeem ua tiav los ntawm kev tso cov pob txha tawg los ntawm kev nias thiab rov qab ua kom cov pob txha cortical rov qab zoo li qub. Kev kho ib ntus nrog 2-3 Kirschner pins yuav siv tau, thiab lwm yam.
(I) Kev hloov chaw ua ntej phais thiab kev sawv cev
1. Kev rub yog ua raws li qhov radial shaft nyob rau hauv fluoroscopy, nrog rau tus ntiv tes xoo nias lub proximal fracture block nqes los ntawm sab palmar thiab lwm tus ntiv tes tsa lub distal block nce ntawm lub kaum sab xis los ntawm sab dorsal.
2. Zaum pw ntxeev tiaj, nrog rau ceg uas raug mob saum lub rooj tes thiab siv fluoroscopy.
(II) Cov chaw nkag mus.
Rau hom kev siv, qhov kev siv PCR (radial carpal flexor) extended palmar yog qhov pom zoo.
Qhov kawg ntawm daim tawv nqaij txiav pib ntawm qhov crease ntawm daim tawv nqaij ntawm lub dab teg thiab nws qhov ntev tuaj yeem txiav txim siab raws li hom pob txha tawg.
Cov leeg radial flexor carpi radialis thiab nws cov leeg sheath raug txiav, distal rau cov pob txha carpal thiab proximal ze rau sab proximal li sai tau.
Rub cov leeg nqaij radial carpal flexor mus rau sab ulnar tiv thaiv cov hlab ntsha median thiab cov leeg nqaij flexor.
Qhov chaw Parona raug nthuav tawm thiab cov leeg nqaij anterior rotator ani nyob nruab nrab ntawm flexor digitorum longus (sab ulnar) thiab cov hlab ntsha radial (sab radial).
Txiav sab radial ntawm cov leeg nqaij anterior rotator ani, sau tseg tias yuav tsum tso ib feem txuas rau sab radius rau kev kho dua tshiab tom qab.
Rub cov leeg nqaij anterior rotator ani mus rau sab ulnar tso cai rau kev nthuav dav ntawm lub ulnar horn ntawm sab palmar ntawm lub radius kom txaus.
Txoj kev palmar qhia txog lub distal radius thiab ua kom pom lub ulnar angle zoo.
Rau cov pob txha tawg uas nyuaj heev, nws raug pom zoo kom tso qhov distal brachioradialis nres, uas tuaj yeem ua rau nws tsis rub rau ntawm radial tuberosity, thaum ntawd lub palmar sheath ntawm thawj dorsal compartment tuaj yeem txiav, uas tuaj yeem nthuav tawm distal fracture block radial thiab radial tuberosity, tig sab hauv lub radius Yu kom tshem nws tawm ntawm qhov chaw tawg, thiab tom qab ntawd rov pib dua qhov intra-articular fracture block siv Kirschner pin. Rau cov pob txha tawg uas nyuaj heev, arthroscopy tuaj yeem siv los pab txo qis, ntsuas thiab kho kom zoo ntawm qhov fracture block.
(III) Cov txheej txheem txo qis.
1. Siv tus pas nrig pob txha ua tus pas rau kev teeb tsa dua tshiab
2. Tus pab rub tus neeg mob cov ntiv tes xoo thiab ntiv tes nruab nrab, uas yuav yooj yim dua.
3. Muab lub Kirschner pin ntsia ntawm lub radial tuberosity rau kev kho ib ntus.
Tom qab hloov chaw tiav lawm, yuav tsum muab ib daim palmar plate tso rau, uas yuav tsum nyob ze rau ntawm qhov dej, yuav tsum npog qhov ulnar eminence, thiab yuav tsum nyob ze rau nruab nrab ntawm lub radial stem. Yog tias cov xwm txheej no tsis raug ua tiav, yog tias daim plate tsis loj txaus, lossis yog tias qhov hloov chaw tsis txaus siab, cov txheej txheem tseem tsis zoo tag nrho.
Muaj ntau yam teeb meem uas cuam tshuam nrog qhov chaw ntawm lub phaj. Yog tias lub phaj raug tso deb dhau rau sab radial, cov teeb meem uas cuam tshuam nrog bunion flexor yuav tshwm sim; yog tias lub phaj raug tso ze dhau rau kab dej, qhov tob ntawm tus ntiv tes flexor yuav muaj kev pheej hmoo. Kev hloov pauv ntawm qhov tawg mus rau sab palmar tuaj yeem ua rau lub phaj tawm mus rau sab palmar thiab kov ncaj qha rau cov leeg flexor, thaum kawg ua rau mob tendon lossis txawm tias tawg.
Rau cov neeg mob pob txha tawg, nws raug pom zoo kom muab lub phaj tso ze rau ntawm txoj kab dej li sai tau, tab sis tsis txhob hla nws. Kev kho Subchondral tuaj yeem ua tiav los ntawm kev siv Kirschner pins ze tshaj plaws rau ulna, thiab Kirschner pins thiab cov ntsia hlau xauv ib sab yog qhov zoo hauv kev tiv thaiv kev tawg rov qab.
Thaum lub phaj raug tso kom raug, qhov kawg proximal raug kho nrog ib lub ntsia hlau thiab qhov kawg distal ntawm lub phaj raug kho ib ntus nrog Kirschner pins hauv qhov ulnar tshaj plaws. Cov duab fluoroscopic orthopantomograms thaum phais, cov duab pom sab nraud, thiab cov yeeb yaj kiab sab nraud nrog 30 ° lub dab teg tsa tau raug coj los txiav txim siab qhov kev txo qis ntawm qhov tawg thiab qhov chaw ntawm kev kho sab hauv.
Yog tias lub phaj nyob rau hauv qhov chaw zoo, tab sis Kirschner tus pin nyob rau hauv-articular, qhov no yuav ua rau tsis txaus rov qab ntawm palmar inclination, uas tuaj yeem daws tau los ntawm kev teeb tsa lub phaj siv "distal fracture fixation technique" (Daim duab 2, b).
Daim Duab 2.
a, ob lub Kirschner pins rau kev kho ib ntus, nco ntsoov tias qhov metacarpal inclination thiab articular surfaces tsis tau rov qab zoo txaus ntawm lub sijhawm no;
b, Ib tug Kirschner pin rau ib ntus phaj fixation, nco ntsoov tias lub distal radius yog fixed ntawm lub point (distal fracture block fixation technique), thiab lub proximal feem ntawm lub phaj yog rub mus rau lub radial stem kom rov qab tau lub palmar tilt angle.
C, Kev kho kom zoo ntawm cov pob qij txha, kev tso cov ntsia hlau/pins xauv qhov chaw deb, thiab kev teeb tsa zaum kawg thiab kev kho qhov proximal radius.
Yog tias muaj kev tawg ntawm dorsal thiab ulnar (ulnar/dorsal Die Punch), uas tsis tuaj yeem rov pib dua kom zoo hauv qab kev kaw, peb txoj kev hauv qab no yuav siv tau.
Lub proximal radius tig mus rau pem hauv ntej ntawm qhov chaw tawg, thiab qhov tawg ntawm lub lunate fossa raug thawb mus rau ntawm pob txha carpal los ntawm PCR lengthening approach; ib qho kev phais me me raug ua dorsal rau 4th thiab 5th compartments kom pom qhov tawg, thiab nws raug ntsia hlau-fixed rau hauv lub phaj feem ntau ulnar foramen. Kaw percutaneous lossis minimally invasive fixation tau ua tiav nrog arthroscopic kev pab.
Tom qab hloov qhov chaw kom zoo thiab muab lub phaj tso rau qhov chaw raug, kev kho zaum kawg yooj yim dua thiab kev hloov qhov chaw raws li lub cev tuaj yeem ua tiav yog tias tus pin proximal ulnar kernel tau tso rau qhov chaw raug thiab tsis muaj cov ntsia hlau nyob hauv qhov sib koom ua ke (Daim Duab 2).
(iv) Kev paub txog kev xaiv cov ntsia hlau.
Qhov ntev ntawm cov ntsia hlau yuav nyuaj rau ntsuas kom raug vim yog qhov mob hnyav ntawm cov pob txha dorsal cortical. Cov ntsia hlau uas ntev dhau yuav ua rau cov leeg txav thiab luv dhau los txhawb kev kho ntawm qhov tawg ntawm dorsal. Vim li no, cov kws sau ntawv pom zoo kom siv cov ntsia hlau xauv thiab cov ntsia hlau xauv ntau yam hauv cov tuberosity radial thiab feem ntau ulnar foramen, thiab siv cov ntsia hlau xauv lub teeb hauv cov chaw seem. Kev siv lub taub hau blunt zam kev txav ntawm cov leeg txawm tias nws yog threaded dorsally. Rau kev kho phaj proximal interlocking, ob lub ntsia hlau sib txuas + ib lub ntsia hlau sib xws (muab tso los ntawm lub ellipse) tuaj yeem siv rau kev kho.
Dr. Kiyohito los ntawm Fabkis tau nthuav tawm lawv qhov kev paub txog kev siv cov phaj palmar locking minimally invasive rau cov pob txha tawg distal radius, qhov twg lawv qhov kev phais tau txo qis mus rau 1cm heev, uas yog qhov tsis zoo. Txoj kev no feem ntau yog qhia rau cov pob txha tawg distal radius ruaj khov, thiab nws cov lus qhia phais yog rau cov pob txha tawg extra-articular ntawm AO fractions ntawm hom A2 thiab A3 thiab cov pob txha tawg intra-articular ntawm hom C1 thiab C2, tab sis nws tsis haum rau cov pob txha tawg C1 thiab C2 ua ke nrog cov pob txha tawg intra-articular. Txoj kev no kuj tsis haum rau cov pob txha tawg hom B. Cov kws sau ntawv kuj taw qhia tias yog tias kev txo qis zoo thiab kev kho tsis tuaj yeem ua tiav nrog txoj kev no, nws yog qhov tsim nyog hloov mus rau txoj kev phais ib txwm muaj thiab tsis txhob lo rau qhov kev phais me me minimally invasive.
Lub sijhawm tshaj tawm: Lub Rau Hli-26-2024
