Xov Xwm - Kev Kho Mob ntawm Distal Humeral Fractures

Qhov tshwm sim ntawm kev kho mob nyob ntawm qhov hloov chaw ntawm qhov pob txha tawg, kev kho kom ruaj khov ntawm qhov pob txha tawg, kev khaws cia cov ntaub so ntswg mos mos zoo thiab kev tawm dag zog ua haujlwm thaum ntxov.

Kev Tshawb Fawb Txog Lub Cev

Lubdistal humerusmuab faib ua ke ua kem nruab nrab thiab kem sab (Daim Duab 1).

Daim Duab 1 Lub pob txha caj qaum distal muaj ib lub kem medial thiab lateral.

Lub kem medial suav nrog qhov medial ntawm humeral epiphysis, medial epicondyle ntawm humerus thiab medial humeral condyle suav nrog humeral glide.

Cov kem sab muaj xws li sab ntawm lub humeral epiphysis, sab nraud epicondyle ntawm humerus thiab sab nraud condyle ntawm humerus suav nrog humeral tuberosity.

Nruab nrab ntawm ob kab sab yog lub anterior coronoid fossa thiab lub posterior humeral fossa.

Txoj kev raug mob

Cov pob txha tawg ntawm lub pob txha humerus feem ntau yog tshwm sim los ntawm kev poob los ntawm qhov chaw siab.

Cov neeg mob hluas uas muaj pob txha tawg hauv pob qij txha feem ntau yog los ntawm kev raug mob hnyav uas muaj zog heev, tab sis cov neeg mob laus dua tuaj yeem muaj pob txha tawg hauv pob qij txha los ntawm kev raug mob hnyav uas muaj zog tsawg dua vim yog pob txha lwj.

Ntaus ntawv

(a) Muaj cov pob txha tawg supracondylar, cov pob txha tawg condylar thiab cov pob txha tawg intercondylar.

(b) Cov pob txha tawg ntawm lub pob txha caj qaum (supracondylar fractures) ntawm tus pob txha caj qaum (humerus): qhov chaw tawg pob txha nyob saum lub qhov ntawm tus noog.

(d) pob txha tawg ntawm lub pob txha humerus: qhov chaw tawg yog nyob nruab nrab ntawm ob lub pob txha ntawm lub pob txha humerus.

Daim Duab 2 AO ntaus ntawv

Kev ntaus pob txha tawg ntawm AO humeral (Daim Duab 2)

Hom A: pob txha tawg sab nraud.

Hom B: pob txha tawg uas cuam tshuam rau qhov chaw ntawm cov pob qij txha (pob txha tawg ib kem).

Hom C: kev sib cais tag nrho ntawm qhov chaw sib koom ua ke ntawm distal humerus los ntawm lub humeral stem (bicolumnar fracture).

Txhua hom raug muab faib ua 3 hom raws li qib kev tawg ntawm qhov tawg, (1 ~ 3 hom nrog rau qib kev tawg ntxiv raws li qhov kev txiav txim ntawd).

Daim Duab 3 Riseborough-Radin ntaus ntawv

Riseborough-Radin typing ntawm intercondylar fractures ntawm humerus (txhua hom suav nrog supracondylar section ntawm humerus)

Hom I: pob txha tawg yam tsis muaj kev hloov chaw ntawm lub humeral tuberosity thiab talus.

Hom II: kev tawg ntawm intercondylar ntawm humerus nrog kev hloov chaw ntawm qhov tawg ntawm lub condyle yam tsis muaj kev hloov pauv.

Hom III: intercondylar pob txha tawg ntawm humerus nrog kev hloov chaw ntawm qhov tawg ntawm lub condyle nrog kev hloov pauv rotational.

Hom IV: pob txha tawg loj heev ntawm qhov chaw sib koom ua ke ntawm ib lossis ob qho tib si condyles (Daim Duab 3).

Daim Duab 4 Hom I humeral tuberosity tawg

Daim Duab 5 Kev ntsuas qhov tawg ntawm lub humeral tuberosity

Kev tawg ntawm lub humeral tuberosity: kev raug mob ntawm lub distal humerus

Hom I: pob txha tawg tag nrho ntawm tus pob txha humeral tuberosity suav nrog ntug sab ntawm tus pob txha humeral talus (Hahn-Steinthal pob txha tawg) (Daim Duab 4).

Hom II: pob txha tawg subchondral ntawm cov pob txha mos ntawm lub humeral tuberosity (Kocher-Lorenz pob txha).

Hom III: pob txha caj qaum tawg ua tej daim me me (Daim Duab 5).

Kev kho mob tsis phais

Cov kev kho mob uas tsis yog phais rau cov pob txha tawg ntawm lub hauv caug sab nraub qaum muaj lub luag haujlwm tsawg. Lub hom phiaj ntawm kev kho mob uas tsis yog phais yog: kev txav pob qij txha thaum ntxov kom tsis txhob mob pob qij txha; cov neeg mob laus, uas feem ntau raug kev txom nyem los ntawm ntau yam kab mob sib xyaw, yuav tsum tau kho nrog txoj kev yooj yim ntawm kev siv txoj hlua khi pob qij txha ntawm lub luj tshib hauv 60 ° ntawm kev khoov rau 2-3 lub lis piam, tom qab ntawd ua kom lub cev ua si me me.

Kev phais mob

Lub hom phiaj ntawm kev kho mob yog kom rov qab kho qhov mob ntawm qhov sib koom ua haujlwm (30° ntawm lub luj tshib, 130° ntawm lub luj tshib khoov, 50° ntawm kev tig pem hauv ntej thiab tom qab); kev kho kom ruaj khov thiab ruaj khov sab hauv ntawm qhov pob txha tawg tso cai rau kev pib ua haujlwm ntawm lub luj tshib tom qab qhov txhab ntawm daim tawv nqaij kho; kev kho ob daim phaj ntawm distal humerus suav nrog: kev kho ob daim phaj sab hauv thiab tom qab, lossisnruab nrab thiab sab nraudob lub phaj kho.

Txoj kev phais

(a) Tus neeg mob raug muab tso rau hauv txoj hauj lwm sab saud nrog ib daim ntaub qhwv uas muab tso rau hauv qab ceg uas raug mob.

kev txheeb xyuas thiab kev tiv thaiv ntawm cov hlab ntsha median thiab radial thaum lub sijhawm phais.

Lub luj tshib tom qab tuaj yeem txuas ntxiv mus rau qhov chaw phais: ulnar hawk osteotomy lossis triceps retraction kom pom cov pob txha tawg tob.

kev phais pob txha ulnar hawkeye: kev raug mob txaus, tshwj xeeb tshaj yog rau cov pob txha tawg uas tau sib tsoo ntawm qhov chaw sib koom ua ke. Txawm li cas los xij, feem ntau qhov tawg tsis sib koom ua ke tshwm sim ntawm qhov chaw phais pob txha. Qhov feem pua ntawm kev tawg tsis sib koom ua ke tau raug txo qis nrog kev txhim kho ulnar hawk osteotomy (herringbone osteotomy) thiab kev kho cov hlau txuas lossis phaj.

Kev raug mob Triceps retraction tuaj yeem siv rau distal humeral trifold block fractures nrog rau kev sib koom ua ke, thiab kev nthuav dav ntawm humeral slide tuaj yeem txiav thiab nthuav tawm ulnar hawk tip ntawm li 1 cm.

Nws tau pom tias ob lub phaj tuaj yeem muab tso rau orthogonally lossis sib luag, nyob ntawm seb hom pob txha tawg uas cov phaj yuav tsum tau muab tso rau.

Cov pob txha tawg ntawm qhov chaw sib koom ua ke yuav tsum tau kho kom rov qab zoo li qub thiab kho rau ntawm tus ceg ntawm tus pob txha caj qaum.

Daim Duab 6 Kev kho sab hauv ntawm qhov tawg ntawm lub luj tshib tom qab phais

Kev kho ib ntus ntawm qhov tawg tau ua los ntawm kev siv hlau K, tom qab ntawd lub phaj nias fais fab 3.5 hli raug txiav kom zoo li lub phaj raws li lub duab tom qab lub kem sab ntawm lub humerus distal, thiab lub phaj rov tsim kho 3.5 hli raug txiav kom zoo li lub kem nruab nrab, kom ob sab ntawm lub phaj yuav haum rau qhov chaw ntawm pob txha (lub phaj ua kom zoo dua tshiab tuaj yeem ua rau cov txheej txheem yooj yim dua.) (Daim Duab 6).

Ceev faj tsis txhob siv cov ntsia hlau cortical uas muaj xov tag nrho los kho qhov tawg ntawm qhov sib koom ua ke nrog kev nias los ntawm sab hauv mus rau sab nraud.

qhov chaw tsiv teb tsaws chaw ntawm epiphysis-humerus txhiab yog qhov tseem ceeb kom tsis txhob muaj kev sib koom ua ke ntawm qhov pob txha tawg.

muab pob txha txuas rau ntawm qhov chaw uas muaj qhov tsis zoo ntawm pob txha, siv cov pob txha iliac cancellous grafts los txuas qhov tsis zoo ntawm qhov tawg ntawm cov pob txha: medial column, articular surface thiab lateral column, txuas cov pob txha cancellous rau sab nrog rau periosteum uas tseem zoo thiab cov pob txha compression defect ntawm epiphysis.

Nco ntsoov cov ntsiab lus tseem ceeb ntawm kev kho kom ruaj khov.

Kev kho qhov tawg ntawm qhov distal nrog ntau li ntau taucov ntsia hlauli sai tau.

kev kho kom ntau li ntau tau ntawm cov pob txha tawg uas tawg ua tej daim me me li sai tau nrog cov ntsia hlau hla mus rau sab hauv.

Cov phaj hlau yuav tsum tau muab tso rau ntawm sab medial thiab sab lateral ntawm distal humerus.

Cov kev xaiv kho mob: Kev phais mob tag nrho lub luj tshib

Rau cov neeg mob uas muaj pob txha tawg loj heev lossis pob txha tawg, kev phais pob qij txha tag nrho ntawm lub luj tshib tuaj yeem rov qab ua kom cov pob qij txha ntawm lub luj tshib txav tau thiab ua haujlwm tes tau tom qab cov neeg mob uas tsis tas yuav siv zog ntau; cov txheej txheem phais zoo ib yam li kev phais pob qij txha tag nrho rau kev hloov pauv ntawm lub luj tshib.

(1) daim ntawv thov ntawm cov khoom siv prosthesis ntev kom tiv thaiv kev tawg proximal.

(2) Kev piav qhia luv luv txog kev phais mob.

(a) Cov txheej txheem no yog ua tiav los ntawm kev siv txoj hauv kev sab nraub qaum, nrog rau cov kauj ruam zoo ib yam li cov uas siv rau kev txiav pob txha tawg ntawm lub cev thiab kev kho sab hauv (ORIF).

Kev nthuav dav ntawm cov hlab ntsha ulnar.

nkag mus rau ob sab ntawm cov leeg triceps kom tshem tawm cov pob txha tawg (qhov tseem ceeb: tsis txhob txiav qhov nres ntawm cov leeg triceps ntawm qhov chaw ulnar hawk).

Tag nrho cov pob txha caj qaum distal suav nrog lub fossa ntawm tus noog hawk tuaj yeem raug tshem tawm thiab muab ib qho prosthesis tso rau, uas yuav tsis tawm qhov teeb meem tseem ceeb yog tias muaj qhov ntxiv I txog 2 cm raug tshem tawm.

kev kho qhov kev nruj ntawm cov leeg nqaij triceps thaum lub sijhawm teeb tsa lub humeral prosthesis tom qab txiav tawm ntawm lub humeral condyle.

Txiav qhov kawg ntawm qhov proximal ulnar eminence kom nkag tau zoo dua rau kev nthuav tawm thiab kev teeb tsa ntawm cov khoom ulnar prosthesis (Daim Duab 7).

Daim Duab 7 Kev Kho Mob Pob Luj Taws

Kev saib xyuas tom qab phais

Tom qab phais mob, yuav tsum tshem daim ntaub qhwv ntawm sab nraub qaum ntawm lub pob qij txha caj npab thaum tus neeg mob daim tawv nqaij zoo lawm, thiab yuav tsum pib ua cov kev tawm dag zog nrog kev pab; yuav tsum kho lub pob qij txha caj npab ntev txaus tom qab hloov pob qij txha tag nrho kom txhawb nqa qhov txhab ntawm daim tawv nqaij zoo (lub pob qij txha caj npab tuaj yeem kho kom ncaj rau 2 lub lis piam tom qab phais mob kom pab tau kom ntev dua); tam sim no feem ntau siv cov ntaub qhwv uas tshem tau los pab txhawb kev tawm dag zog thaum nws tuaj yeem tshem tawm ntau zaus kom tiv thaiv ceg uas raug mob zoo dua; kev tawm dag zog feem ntau pib ua 6-8 lub lis piam tom qab daim tawv nqaij tau zoo tag nrho.