Distal radius fractures yog ib qho ntawm feem ntaupob txhahauv kev kho mob.Rau feem ntau ntawm cov pob txha tawg, cov txiaj ntsig kho tau zoo tuaj yeem ua tiav los ntawm palmar txoj kev phaj thiab ntsia hlau sab hauv kho.Tsis tas li ntawd, muaj ntau yam tshwj xeeb ntawm cov pob qij txha tawg, xws li Barton fractures, Die-punch fractures,Chauffeur's fractures, thiab lwm yam., txhua qhov xav tau kev kho mob tshwj xeeb.Cov kws tshawb fawb txawv teb chaws, hauv lawv cov kev tshawb fawb ntawm cov qauv loj ntawm cov kab mob sib kis ntawm cov kab mob sib kis, tau txheeb xyuas ib hom kev sib koom ua ke muaj feem cuam tshuam nrog kev puas tsuaj ntawm cov pob txha, thiab cov pob txha tawg ua cov qauv conical nrog lub hauv paus "triangular" (tetrahedron), hu ua "tetrahedron" hom.
Lub tswv yim ntawm "Tetrahedron" Hom Distal Radius Fracture: Nyob rau hauv hom kev tawg ntawm lub qhov hluav taws xob distal, qhov tawg tau tshwm sim nyob rau hauv ib feem ntawm kev sib koom tes, nrog rau ob qho tib si lub palmar-ulnar thiab radial styloid facets, nrog ib tug transverse triangular configuration.Txoj kab tawg txuas mus rau qhov kawg ntawm lub vojvoog.
Lub uniqueness ntawm no pob txha yog reflected nyob rau hauv cov yam ntxwv ntawm lub palmar-ulnar sab pob txha fragments ntawm lub vojvoog.Ntawm ib sab tes, lub lunar fossa tsim los ntawm cov pob txha ntawm cov pob txha ntawm cov pob txha ntawm cov pob txha ntawm cov pob txha pob txha yog ib qho kev txhawb nqa lub cev tiv thaiv cov pob txha tawg ntawm cov pob txha carpal.Qhov poob ntawm kev txhawb nqa los ntawm cov qauv no ua rau lub cev tsis muaj zog ntawm lub dab teg.Ntawm qhov tod tes, raws li ib feem ntawm lub distal radioulnar sib koom ua ke lub radial articular nto, rov ua kom cov pob txha tawg mus rau nws txoj haujlwm anatomical yog qhov yuav tsum tau ua ua ntej kom tau txais kev ruaj ntseg hauv qhov distal radioulnar sib koom.
Cov duab hauv qab no qhia txog Case 1: Kev kos duab tshwm sim ntawm ib qho "Tetrahedron" hom distal radius tawg.
Nyob rau hauv ib txoj kev tshawb fawb txog tsib xyoos, xya qhov teeb meem ntawm hom pob txha no tau txheeb xyuas.Hais txog kev phais mob, rau peb qhov xwm txheej, suav nrog Case 1 hauv daim duab saum toj no, qhov chaw uas muaj cov pob txha tsis raug tshem tawm, kev saib xyuas kev kho mob tau pib xaiv.Txawm li cas los xij, thaum rov qab los, tag nrho peb qhov xwm txheej tau ntsib kev tawg tawg, ua rau kev phais kho sab hauv.Qhov no qhia tau hais tias muaj kev tsis txaus ntseeg siab thiab muaj kev pheej hmoo loj ntawm kev hloov pauv hauv cov pob txha ntawm hom no, hais txog qhov qhia tau zoo rau kev cuam tshuam kev phais.
Nyob rau hauv cov nqe lus ntawm kev kho mob, ob kis tau pib ua ib txwm volar mus kom ze nrog flexor carpi radialis (FCR) rau phaj thiab ntsia hlau sab hauv fixation.Hauv ib qho ntawm cov xwm txheej no, fixation ua tsis tiav, ua rau cov pob txha hloov chaw.Tom qab ntawd, ib txoj hauv kev ua haujlwm ntawm palmar-ulnar, thiab ib qho kev kho tshwj xeeb nrog lub phaj kem tau ua rau kev hloov kho hauv nruab nrab.Tom qab qhov tshwm sim ntawm fixation tsis ua hauj lwm, tom qab tsib kis tag nrho underwent palmar-ulnar mus kom ze thiab kho nrog 2.0mm los yog 2.4mm daim hlau.
Case 2: Siv cov pa volar mus kom ze nrog flexor carpi radialis (FCR), fixation nrog ib tug palmar phaj.Postoperatively, anterior dislocation ntawm lub dab teg pob qij txha tau pom, qhia tias fixation tsis ua hauj lwm.
Rau Case 2, kev siv lub palmar-ulnar mus kom ze thiab kho nrog ib sab phaj ua rau muaj kev txaus siab rau kev kho sab hauv.
Xav txog qhov tsis txaus ntawm cov pa hluav taws xob distal fractures hauv kev kho cov pob txha tshwj xeeb no, muaj ob qhov teeb meem tseem ceeb.Ua ntej, kev siv volar mus kom ze nrog flexor carpi radialis (FCR) yuav ua rau tsis txaus.Qhov thib ob, qhov loj ntawm lub palmar-locking phaj screws yuav tsis ruaj ntseg cov pob txha me me thiab tuaj yeem cuam tshuam lawv los ntawm kev ntxig cov ntsia hlau rau hauv qhov khoob ntawm cov khoom tawg.
Yog li, cov kws tshawb fawb pom zoo kom siv 2.0mm lossis 2.4mm locking daim hlau rau kev kho tshwj xeeb ntawm cov pob txha hauv nruab nrab.Ntxiv nrog rau cov phaj txhawb nqa, siv ob lub hau ntswj txhawm rau txhim kho cov pob txha tawg thiab nruab nrab ntawm lub phaj los tiv thaiv cov ntsia hlau kuj yog ib qho kev xaiv sab hauv kho.
Nyob rau hauv rooj plaub no, tom qab kho cov pob txha tawg nrog ob lub screws, lub phaj tau muab tso los tiv thaiv cov ntsia hlau.
Hauv cov ntsiab lus, "Tetrahedron" hom distal radius tawg muaj cov yam ntxwv hauv qab no:
1. Tsis tshua muaj tshwm sim nrog tus nqi siab ntawm thawj zaug plain film misdiagnosis.
2. Muaj kev pheej hmoo siab ntawm kev tsis ruaj khov, nrog kev nyiam rau kev rov ua dua tshiab thaum kev kho mob.
3. Palmar locking daim hlau rau distal radius fractures muaj zog fixation tsis muaj zog, thiab nws yog pom zoo kom siv 2.0mm los yog 2.4mm locking daim hlau rau tej fixation.
Muab cov yam ntxwv no, hauv kev kho mob, nws raug nquahu kom ua CT scans lossis rov kuaj xyuas ib ntus rau cov neeg mob uas muaj lub dab teg tseem ceeb tab sis tsis zoo X-rays.Rau hom notawg, kev cuam tshuam kev phais thaum ntxov nrog cov kab ke tshwj xeeb yog pom zoo kom tsis txhob muaj teeb meem tom qab.
Post lub sij hawm: Oct-13-2023
