Xov xwm - Kev kho mob ntawm Distal Humeral Fractures

Cov txiaj ntsig ntawm kev kho mob yog nyob ntawm kev hloov pauv ntawm lub cev ntawm cov pob txha pob txha, kev txhim kho muaj zog ntawm pob txha, kev khaws cov ntaub so ntswg zoo thiab kev ua haujlwm thaum ntxov.

Anatomy

Covdistal humerusmuab faib ua ib kem nruab nrab thiab ib sab kem (Daim duab 1).

Daim duab 1 Lub distal humerus muaj ib kab nruab nrab thiab sab nraud

Cov kab nruab nrab suav nrog qhov nruab nrab ntawm qhov humeral epiphysis, medial epicondyle ntawm humerus thiab medial humeral condyle nrog rau humeral glide.

Cov kab mob sab nraud muaj xws li sab nraud ntawm lub humeral epiphysis, sab nraud epicondyle ntawm humerus thiab sab nraud condyle ntawm humerus nrog rau humeral tuberosity.

Nyob nruab nrab ntawm ob kab sab nraud yog anterior coronoid fossa thiab posterior humeral fossa.

Kev raug mob mechanism

Supracondylar fractures ntawm humerus feem ntau tshwm sim los ntawm ntog los ntawm qhov chaw siab.

Cov neeg mob yau uas muaj pob txha pob txha feem ntau yog tshwm sim los ntawm kev raug mob hnyav hnyav, tab sis cov neeg laus tuaj yeem muaj cov pob txha pob txha los ntawm kev raug mob qis zog vim yog pob txha.

Kev ntaus ntawv

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

(b) Supracondylar fractures ntawm humerus: qhov chaw tawg yog nyob rau saum tus hawk's fossa.

(d) intercondylar fracture ntawm humerus: qhov chaw tawg yog nyob nruab nrab ntawm ob lub condyles ntawm lub humerus.

Daim duab 2 AO typing

AO humeral fracture typing (Daim duab 2)

Hom A: cov pob txha pob txha ntxiv.

Hom B: pob txha uas cuam tshuam nrog cov pob txha pob txha (ib kab ke tawg).

Hom C: ua kom tiav kev sib cais ntawm qhov chaw ntawm qhov chaw ntawm qhov distal humerus los ntawm cov qia humeral (bicolumnar puas).

Txhua hom yog ntxiv muab faib ua 3 subtypes raws li qib ntawm comminution ntawm lub pob txha tawg, (1 ~ 3 subtypes nrog nce qib ntawm comminution nyob rau hauv qhov kev txiav txim).

Daim duab 3 Riseborough-Radin typing

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

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

Hom II: intercondylar tawg ntawm lub humerus nrog kev hloov pauv ntawm cov pob txha tawg ntawm lub condyle yam tsis muaj kev sib hloov deformity.

Hom III: intercondylar tawg ntawm lub humerus nrog kev hloov pauv ntawm cov pob txha tawg ntawm lub condyle nrog kev sib hloov deformity.

Hom IV: mob hnyav comminuted pob txha ntawm articular nto ntawm ib los yog ob qho tib si condyles (Daim duab 3).

Daim duab 4 Hom I humeral tuberosity tawg

Daim duab 5 Humeral tuberosity fracture staging

Fracture ntawm humeral tuberosity: shear raug mob ntawm distal humerus

Hom I: tawg ntawm tag nrho humeral tuberosity nrog rau sab ntug ntawm lub humeral talus (Hahn-Steinthal fracture) (Daim duab 4).

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

Hom III: comminuted fracture ntawm humeral tuberosity (Daim duab 5).

Kev kho tsis ua haujlwm

Txoj kev kho tsis ua haujlwm rau cov pob txha humeral distal muaj lub luag haujlwm txwv.Lub hom phiaj ntawm kev kho tsis ua haujlwm yog: kev sib koom ua ke thaum ntxov kom tsis txhob muaj kev sib koom ua ke;Cov neeg laus cov neeg mob, uas feem ntau raug kev txom nyem los ntawm ntau yam kab mob, yuav tsum tau kho nrog ib tug yooj yim txoj kev ntawm splinting lub luj tshib nyob rau hauv 60 ° ntawm flexion rau 2-3 lub lis piam, ua raws li los ntawm lub teeb kev ua si.

Kev kho mob phais

Lub hom phiaj ntawm kev kho mob yog los kho qhov mob tsis muaj kev ua haujlwm ntawm kev sib koom ua ke (30 ° ntawm lub luj tshib txuas ntxiv, 130 ° ntawm lub luj tshib flexion, 50 ° ntawm sab xub ntiag thiab tom qab kev sib hloov);ruaj khov thiab ruaj khov nyob rau hauv fixation ntawm cov pob txha tso cai rau qhov pib ntawm kev ua haujlwm ntawm lub luj tshib tom qab kho daim tawv nqaij;ob chav phaj fixation ntawm lub distal humerus muaj xws li: medial thiab posterior lateral ob chav phaj fixation, los yogmedial thiab lateralob chav phaj fixation.

Txoj kev phais

(a) Tus neeg mob tau muab tso rau hauv txoj hauj lwm sab saud nrog ib lub liner muab tso rau hauv qab ntawm tus ncej puab.

Kev txheeb xyuas thiab kev tiv thaiv ntawm cov hlab ntsha nruab nrab thiab radial intraoperatively.

Lub luj tshib tom qab tuaj yeem txuas ntxiv mus rau kev phais: ulnar hawk osteotomy lossis triceps retraction kom nthuav tawm cov pob txha sib sib zog nqus

ulnar hawkeye osteotomy: txaus raug, tshwj xeeb tshaj yog rau comminuted fractures ntawm articular nto.Txawm li cas los xij, pob txha tsis sib koom ua ke feem ntau tshwm sim ntawm qhov chaw osteotomy.Cov pob txha tsis sib koom ua ke tau txo qis nrog kev txhim kho ulnar hawk osteotomy (herringbone osteotomy) thiab kev hloov pauv band hlau lossis phaj fixation.

Triceps retraction exposure tuaj yeem siv rau qhov distal humeral trifold block fractures nrog kev sib koom ua ke, thiab nthuav dav ntawm lub humeral swb tuaj yeem txiav tawm thiab nthuav tawm cov ulnar hawk taub ntawm txog 1 cm.

Nws tau pom tias ob daim hlau tuaj yeem muab tso rau hauv orthogonally los yog nyob rau hauv parallel, nyob ntawm seb hom puas ntawm cov phaj yuav tsum muab tso rau.

Articular nto fractures yuav tsum tau rov qab mus rau ib tug tiaj tus articular nto thiab tsau rau lub humeral qia.

Daim duab 6 Post-operative internal fixation ntawm lub luj tshib puas

Kev kho ib ntus ntawm cov pob txha pob txha tau ua los ntawm kev siv K xaim, tom qab ntawd 3.5 hli lub zog compression phaj tau muab txiav rau cov duab ntawm lub phaj raws li cov duab tom qab kab ntawm lub distal humerus, thiab 3.5 hli reconstruction phaj yog. trimmed rau cov duab ntawm kab nruab nrab, kom ob sab ntawm lub phaj yuav haum rau cov pob txha nto (tus tshiab ua ntej shaping phaj yuav yooj yim rau txheej txheem.) (Daim duab 6).

Saib xyuas kom tsis txhob txhim kho cov pob txha pob txha pob txha pob txha nrog tag nrho cov xov cortical screws nrog lub siab los ntawm qhov nruab nrab mus rau sab nraud.

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

Muab cov pob txha graft sau ntawm qhov chaw ntawm cov pob txha tsis xws luag, thov iliac cancellous pob txha grafts los sau cov pob txha pob txha pob txha: nruab nrab kem, articular nto thiab lateral kem, grafting cancellous pob txha mus rau sab nrog periosteum thiab compression pob txha defect ntawm lub epiphysis.

Nco ntsoov cov ntsiab lus tseem ceeb ntawm fixation.

Fixation ntawm lub distal tawg fragment nrog ntau npaum li casntsia hlauraws li ua tau.

fixation ntawm ntau li ntau fragmentary puas tawg paj li sai tau nrog screws hla medially mus rau tom qab.

Cov phaj hlau yuav tsum muab tso rau ntawm qhov nruab nrab thiab sab nraud ntawm lub distal humerus.

Cov kev xaiv kho mob: Tag nrho lub luj tshib arthroplasty

Rau cov neeg mob uas muaj kev puas tsuaj loj heev los yog osteoporosis, tag nrho lub luj tshib arthroplasty tuaj yeem kho lub luj tshib sib koom tes thiab tes ua haujlwm tom qab cov neeg mob xav tau tsawg dua;cov txheej txheem phais zoo ib yam li tag nrho arthroplasty rau degenerative hloov ntawm lub luj tshib.

(1) daim ntawv thov ntawm cov qia-hom prosthesis los tiv thaiv kev sib tsoo ntawm qhov txuas ntxiv.

(2) Cov ntsiab lus ntawm kev ua haujlwm phais.

(a) Cov txheej txheem yog ua los ntawm kev siv lub luj tshib tom qab, nrog rau cov kauj ruam zoo ib yam li cov uas siv rau kev phais mob distal humeral fracture incision thiab internal fixation (ORIF).

Anteriorization ntawm lub paj hlwb ulnar.

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

Tag nrho cov distal humerus suav nrog cov hawk fossa tuaj yeem raug tshem tawm thiab siv cov khoom siv sib xyaw ua ke, uas yuav tsis tawm ib qho tseem ceeb sequelae yog tias ntxiv kuv mus rau 2 cm raug tshem tawm.

Kev hloov kho ntawm qhov nro ntawm cov leeg triceps thaum lub sij hawm haum ntawm humeral prosthesis tom qab excision ntawm lub humeral condyle.

Excision ntawm lub ntsis ntawm lub proximal ulnar eminence kom tso cai zoo dua rau kev raug thiab installation ntawm ulnar prosthesis tivthaiv (Daim duab 7).

Daim duab 7 Elbow arthroplasty

Kev kho mob tom qab phais

Postoperative splinting ntawm posterior nam ntawm lub luj tshib sib koom yuav tsum tau muab tshem tawm thaum tus neeg mob daim tawv nqaij qhov txhab zoo, thiab active functional ce nrog kev pab yuav tsum tau pib;Lub luj tshib yuav tsum tau kho kom ntev txaus tom qab tag nrho kev sib koom ua ke los txhawb kev kho mob ntawm daim tawv nqaij (lub luj tshib pob qij txha tuaj yeem kho hauv txoj hauj lwm ncaj nraim rau 2 lub lis piam tom qab kev phais kom tau txais kev ua haujlwm zoo dua qub);ib tug tshem tau tsau splint yog tam sim no feem ntau siv nyob rau hauv kev kho mob los pab txhawb ntau yam kev tawm dag zog lub cev thaum Nws tuaj yeem raug tshem tawm ntau zaus kom zoo dua tiv thaiv cov ceg tawv;nquag ua haujlwm qoj ib ce feem ntau pib 6-8 lub lis piam tom qab daim tawv nqaij qhov txhab tau zoo lawm.