Tam sim no, muaj ntau txoj kev kho mob rau cov pob qij txha ntawm cov pob qij txha, xws li plaster fixation, qhib kev txo qis thiab sab hauv fixation, sab nrauv fixation ncej, thiab lwm yam. Ntawm lawv, volar phaj fixation tuaj yeem tau txais txiaj ntsig zoo dua, tab sis muaj cov lus ceeb toom hauv cov ntaub ntawv. tias nws cov teeb meem yog siab li 16%.Txawm li cas los xij, yog tias cov phaj hlau raug xaiv kom raug, qhov xwm txheej ntawm cov teeb meem tuaj yeem txo tau zoo.Daim ntawv no qhia luv luv cov yam ntxwv, qhia, contraindications, thiab kev phais cov txheej txheem ntawm volar phaj kho ntawm distal radius fractures.
1. Muaj ob lub ntsiab zoo ntawm lub xibtes sab phaj
A.It tuaj yeem cuam tshuam qhov cuam tshuam ntawm buckling quab yuam.Fixation nrog angled fixation screws txhawb lub distal fragment thiab hloov lub load mus rau lub radial ncej (Daim duab 1).Nws tuaj yeem tau txais kev txhawb nqa subchondral zoo dua.Lub phaj txheej txheem no tuaj yeem tsis tsuas yog txhim kho cov pob txha hauv nruab nrab ntawm cov pob txha, tab sis kuj tuaj yeem kho cov qauv anatomical ntawm cov pob txha intra-articular subchondral los ntawm peg / ntsia hlau "ntxuam zoo li" fixation.Rau feem ntau cov kab hluav taws xob distal tawg, lub ru tsev no muab kev ruaj ntseg ntxiv rau kev txav mus los thaum ntxov.
Daim duab 1, a, tom qab peb-dimensional reconstruction ntawm ib tug raug comminuted distal radius tawg, xyuam xim rau lub degree ntawm dorsal compression;b, virtual txo qhov tawg, qhov tsis xws luag yuav tsum tau kho thiab txhawb nqa los ntawm lub phaj;c, lateral saib tom qab DVR fixation, lub xub qhia load hloov.
B. Tsawg cuam tshuam rau cov ntaub so ntswg: volar phaj fixation yog me ntsis hauv qab cov kab dej, piv nrog cov dorsal phaj, nws tuaj yeem txo qhov khaus ntawm cov leeg, thiab muaj ntau qhov chaw, uas tuaj yeem zam qhov kev cog lus thiab cov leeg.tiv tauj ncaj qha.Tsis tas li ntawd, feem ntau cov implants tuaj yeem them los ntawm pronator quadratus.
2. Indications thiab contraindications rau kev kho mob ntawm distal radius nrog volar phaj
a.Indications: Rau qhov tsis ua hauj lwm ntawm kev kaw txo ntawm cov pob txha pob txha ntxiv, cov xwm txheej hauv qab no tshwm sim, xws li dorsal angulation ntau dua 20 °, dorsal compression ntau dua 5 hli, lub voj voog distal shortening ntau dua 3 hli, thiab qhov tawg tawg tawg tawg ntau dua. 2 hli;Qhov kev tshem tawm ntawm cov pob txha sab hauv yog ntau dua 2 hli;vim muaj cov pob txha tsawg, nws yog ib qho yooj yim uas yuav ua rau rov hloov chaw, yog li nws yog qhov tsim nyog rau cov neeg laus.
b.Contraindications: siv cov tshuaj loog hauv zos, cov kab mob hauv zos lossis cov kab mob sib kis, cov tawv nqaij tsis zoo ntawm lub pob ntseg ntawm lub dab teg;pob txha pob txha thiab pob txha pob txha ntawm qhov chaw pob txha, dorsal fracture hom xws li Barton fracture, radiocarpal joint fracture thiab dislocation, yooj yim vojvoog Styloid txheej txheem pob txha, me me avulsion puas ntawm volar margin.
Rau cov neeg mob uas muaj kev raug mob siab zog xws li mob pob txha loj heev los yog cov pob txha loj heev, cov kws tshawb fawb feem ntau tsis pom zoo kom siv cov paib volar, vim tias cov pob txha tawg no feem ntau ua rau vascular necrosis thiab nyuaj kom tau txais anatomical txo.Rau cov neeg mob uas muaj ntau lub pob txha tawg thiab kev hloov pauv tseem ceeb thiab mob pob txha loj heev, volar phaj yog qhov nyuaj rau kev siv tau.Tej zaum yuav muaj teeb meem nrog kev txhawb nqa subchondral hauv cov pob txha tawg, xws li ntsia hlau nkag mus rau hauv qhov sib koom ua ke.Cov ntaub ntawv tsis ntev los no tau tshaj tawm tias thaum 42 tus neeg mob ntawm cov pob txha pob txha tau kho nrog cov paib volar, tsis muaj cov ntsia hlau nkag mus rau hauv cov kab noj hniav, uas feem ntau cuam tshuam nrog txoj haujlwm ntawm daim hlau.
3. Kev txawj phais
Cov kws kho mob feem ntau siv volar phaj fixation rau distal radius tawg nyob rau hauv txoj kev zoo sib xws thiab cov tswv yim.Txawm li cas los xij, kom tsis txhob muaj qhov tshwm sim ntawm cov teeb meem tom qab phais tas, yuav tsum muaj cov txheej txheem phais zoo tshaj plaws, piv txwv li, kev txo qis tuaj yeem tau txais los ntawm kev tso tawm cov pob txha pob txha thiab kho qhov txuas ntxiv ntawm cov pob txha cortical.Kev kho ib ntus nrog 2-3 Kirschner xov hlau tuaj yeem siv tau.Hais txog kev siv txoj hauv kev twg, tus sau tau pom zoo rau PCR (flexor carpi radialis) txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm
a, Kev kho ib ntus nrog ob lub Kirschner xov hlau, nco ntsoov tias lub volar inclination thiab articular nto tsis tau rov qab los rau lub sijhawm no;
b, Kirschner xaim ib ntus kho lub phaj, them sai sai rau kev kho ntawm qhov kawg ntawm lub vojvoog ntawm lub sijhawm no (cov txheej txheem tawg tawg tawg tawg), qhov sib thooj ntawm lub phaj yog rub mus rau lub radial ncej kom rov qab tau cov volar inclination. .
C, Articular nto yog zoo-tuned nyob rau hauv arthroscopy, lub distal locking ntsia hlau / tus pin yog muab tso rau, thiab lub proximal vojvoog yog thaum kawg txo thiab tsau.
Cov ntsiab lus tseem ceebntawm txoj kev: Lub distal daim tawv nqaij incision pib ntawm daim tawv nqaij quav ntawm lub dab teg, thiab nws ntev tuaj yeem txiav txim siab raws li hom pob txha.Lub flexor carpi radialis leeg thiab nws cov sheath yog dissected distal rau cov pob txha carpal thiab li proximal li sai tau.Rub lub flexor carpi radialis leeg mus rau sab ulnar tiv thaiv cov paj hlwb nruab nrab thiab flexor tendon complex.Qhov chaw Parona raug nthuav tawm, nrog lub pronator quadratus nyob nruab nrab ntawm lub flexor hallucis longus (ulnar) thiab cov hlab ntsha radial (radial).Incision tau ua nyob rau sab radial ntawm lub pronator quadratus, tawm hauv ib feem txuas nrog lub vojvoog rau tom qab kev tsim kho.Rub tus pronator quadratus mus rau sab ulnar ntau dua nthuav tawm lub volar ulnar kaum sab xis ntawm lub vojvoog.
Rau cov hom pob txha nyuaj, nws raug nquahu kom tso tawm qhov distal ntxig ntawm cov leeg brachioradialis, uas tuaj yeem cuam tshuam nws rub ntawm cov txheej txheem radial styloid.Lub sijhawm no, lub volar sheath ntawm thawj dorsal compartment tuaj yeem raug txiav kom nthuav tawm cov pob txha tawg tawg Thaiv lub radial sab thiab radial styloid txheej txheem, sab hauv tig lub radial ncej kom cais tawm ntawm qhov chaw tawg, thiab tom qab ntawd siv Kirschner xov hlau los txo qhov intra. - articular tawg thaiv.Rau cov pob txha pob txha hauv pob txha, arthroscopy tuaj yeem siv los pab txo qis, ntsuas, thiab kho kom zoo ntawm cov pob txha tawg.
Tom qab qhov kev txo qis tiav lawm, lub volar phaj yog niaj zaus muab tso rau.Lub phaj yuav tsum nyob ze rau ntawm qhov dej ntws, yuav tsum npog cov txheej txheem ulnar, thiab qhov kawg ntawm lub phaj yuav tsum ncav cuag qhov nruab nrab ntawm lub radial ncej.Yog tias cov xwm txheej saum toj no tsis tau ntsib, lub phaj loj tsis haum, lossis qhov txo qis tsis txaus siab, kev ua haujlwm tseem tsis zoo tag nrho.
Muaj ntau yam teeb meem muaj ntau yam ua rau qhov chaw ntawm lub phaj tso.Yog hais tias lub phaj yog muab tso rau radially dhau lawm, cov teeb meem muaj feem xyuam rau lub flexor hallucis longus yog predisposed;Yog tias lub phaj muab tso rau ze ze rau ntawm txoj kab dej, qhov flexor digitorum profundus yuav muaj kev pheej hmoo.Kev txo qis rau lub volar displacement deformity yuav yooj yim ua rau cov hlau phaj protrude mus rau lub volar sab thiab ncaj qha mus cuag lub flexor tendon, nws thiaj li ua rau tendinitis los yog rupture.
Rau cov neeg mob osteoporotic, nws raug pom zoo tias lub phaj yuav tsum nyob ze rau ntawm txoj kab dej ntws raws li qhov ua tau, tab sis tsis hla nws..Kirschner cov xov hlau tuaj yeem siv los kho cov subchondral ze tshaj plaws rau ulna, thiab Kirschner cov xov hlau nyob ib sab thiab xauv cov ntsia hlau thiab cov ntsia hlau tuaj yeem tiv thaiv kev puas tsuaj los ntawm kev hloov pauv.
Tom qab lub phaj muab tso rau kom raug, qhov kawg ntawm qhov kawg yog kho nrog lub hau ntswj, thiab lub qhov ulnar ntawm qhov kawg ntawm lub phaj yog kho ib ntus nrog Kirschner hlau.Intraoperative fluoroscopy anteroposterior saib, saib sab nraud, lub dab teg sib koom ua ke nce 30 ° sab nraud saib, txhawm rau txiav txim siab pob txha txo qis thiab kho qhov chaw sab hauv.Yog tias txoj hauj lwm ntawm lub phaj yog qhov txaus siab, tab sis Kirschner hlau yog nyob rau hauv qhov sib koom ua ke, nws yuav ua rau tsis txaus rov qab los ntawm lub volar inclination, uas tuaj yeem daws tau los ntawm kev teeb tsa lub phaj los ntawm "distal fracture fixation technique" (Fig. 2, b).
Yog tias nws tau nrog dorsal thiab ulnar fractures (ulnar / dorsal Die Punch) thiab tsis tuaj yeem txo qis hauv kev kaw, peb txoj kev siv hauv qab no tuaj yeem siv:
1. Pronate qhov kawg ntawm lub vojvoog kom nws deb ntawm qhov chaw tawg, thiab thawb lub lunate fossa fracture ntawm carpus los ntawm PCR txuas mus kom ze;
2. Ua ib qho me me ntawm lub dorsal sab ntawm lub 4th thiab 5th compartment kom nthuav tawm cov tawg tawg, thiab kho nws nrog screws nyob rau hauv lub feem ntau ulnar qhov ntawm lub phaj.
3. Kaw percutaneous lossis minimally invasive fixation nrog kev pab ntawm arthroscopy.
Tom qab qhov kev txo qis yog qhov txaus siab thiab cov phaj tau muab tso kom raug, qhov kawg fixation yog qhov yooj yim.Yog hais tias lub zeem muag ulnar Kirschner hlau yog nyob rau hauv kom raug thiab tsis muaj screws nyob rau hauv lub sib koom kab noj hniav, ib tug anatomical txo tau.
Screw xaiv kev paub: Vim yog qhov sib txuas loj ntawm cov pob txha dorsal cortical, qhov ntev ntawm cov ntsia hlau yuav nyuaj rau ntsuas kom raug.Screws uas ntev dhau lawm yuav ua rau khaus ntawm cov leeg, thiab cov ntsia hlau uas luv dhau tsis tuaj yeem txhawb nqa thiab kho cov dorsal fragment.Vim li no, tus kws sau ntawv pom zoo kom siv threaded locking screws thiab multiaxial locking screws nyob rau hauv cov txheej txheem radial styloid thiab feem ntau ulnar qhov, thiab siv polished pas nrig locking screws nyob rau hauv lub so ntawm txoj hauj lwm.Siv lub ntsej muag tsis pom kev tsis txhob khaus ntawm cov leeg txawm tias siv lub dorsal tawm.Rau kev sib txuas ntawm cov phaj sib txuas, ob lub qhov sib txuas sib txuas + ib qho ntsia hlau zoo tib yam (tso los ntawm lub voj voog) tuaj yeem siv rau kev kho.
4. Cov ntsiab lus ntawm cov ntawv nyeem:
Volar locking ntsia thawv phaj fixation ntawm distal radius fractures tuaj yeem ua tiav qhov kev kho mob zoo, uas feem ntau yog nyob ntawm kev xaiv cov kev qhia thiab kev phais zoo heev.Siv txoj kev no tuaj yeem tau txais kev ua haujlwm zoo dua thaum ntxov, tab sis tsis muaj qhov sib txawv hauv kev ua haujlwm tom qab thiab kev ua haujlwm nrog lwm txoj hauv kev, qhov tshwm sim ntawm cov teeb meem tom qab phais zoo ib yam, thiab qhov txo qis hauv kev kho sab nraud, percutaneous Kirschner hlau fixation, thiab plaster fixation. , koob kab mob kis tau ntau dua;thiab extensor tendon teeb meem muaj ntau dua nyob rau hauv distal radius phaj fixation systems.Rau cov neeg mob osteoporosis, volar phaj tseem yog thawj qhov kev xaiv.
Post lub sij hawm: Dec-12-2022
