Waqtigan xaadirka ah hagaajinta gudaha ee jabka radius fog, waxaa jira habab kala duwan oo saxan quful ah oo lagu isticmaalo rugta caafimaadka.Qalabayntan gudaha ah waxay siinaya xal fiican oo loogu talagalay qaar ka mid ah noocyada jabka adag, iyo siyaabaha qaarkood waxay ballaariyaan calaamadaha qalliinka ee jabka radius fog ee aan xasilloonayn, gaar ahaan kuwa qaba lafo-jileebka.Professor Jupiter oo ka socda Isbitaalka Guud ee Massachusetts iyo kuwa kale ayaa daabacay maqaalo taxane ah oo ku yaal JBJS natiijooyinkooda ku saabsan hagaajinta saxanka ee jabka radius fog iyo farsamooyinka qalliinka ee la xiriira.Maqaalkani wuxuu diiradda saarayaa habka qalliinka ee lagu hagaajinayo jabka radius fog ee ku salaysan hagaajinta gudaha ee xannibaad gaar ah.
Farsamooyinka Qalliinka
Aragtida saddex-geesoodka ah, oo ku salaysan sifooyinka biomechanical iyo anatomical ee radius ulnar fog, waa saldhigga horumarinta iyo codsiga kiliinikada ee nidaamka saxanka 2.4mm.Qaybinta saddexda tiir waxay ku tusaysaa sawirka 1.
Jaantuska 1 Aragtida saddex-geesoodka ah ee radius ulnar fog.
Tiirka dambe waa qaybta dambe ee radius fog, oo ay ku jiraan fossa navicular iyo tuberosity radial, kaas oo taageera lafaha carpal ee dhinaca radial waana asalka qaar ka mid ah seedaha xasiliya curcurka.
Tiirka dhexe waa badhka dhexe ee raadiyaha fog waxaana ka mid ah fossa lunate (oo la xidhiidha lunate) iyo sigmoid notch (oo la xidhiidha ulna fog) ee dusha articular.Sida caadiga ah loo raro, culeyska ka yimaada fossa lunate waxaa lagu kala qaadaa raadiyaha iyada oo loo marayo fossa lunate.Tiirka lateral, oo ay ku jiraan ulna fog, fibrocartilage saddex xagal ah, iyo ulnar-radial hoose ee hoose, waxay qaadaan culeysyo ka yimaada lafaha carpal ee ulnar iyo sidoo kale wadajirka hoose ee ulnar-radial waxayna leedahay saameyn xasilloon.
Habka waxaa lagu sameeyaa suuxdinta brachial plexus iyo sawirka raajada C-cudud ee gudaha waa lama huraan.Antibiyootikada xididada ayaa la maamulay ugu yaraan 30 daqiiqo ka hor inta aan la bilaabin hawsha waxaana loo isticmaalay dalxiis oofwareen ah si loo yareeyo dhiigbaxa.
hagaajinta saxanka Palmar
Inta badan jabka, habka palmar ayaa loo isticmaali karaa in lagu arko inta u dhaxaysa radial carpal flexor iyo halbowlaha radial.Ka dib markii la aqoonsado oo dib loo soo celiyo flexor carpi radialis longus, dusha qoto dheer ee muruqa teres pronator waa la arki karaa oo kala soocida qaabka "L" ayaa kor loo qaaday.Jabka aadka u adag, jilibka brachioradialis ayaa laga yaabaa in la sii daayo si loo fududeeyo dhimista jabka.
Birta Kirschner ayaa la geliyaa isgoysyada radial carpal, kaas oo ka caawinaya in la qeexo xadka fog ee radius-ka.Haddii cuf yar oo jaban oo ku taal margin articular uu jiro, saxan bir ah oo 2.4mm ah oo timireed ah ayaa la dul dhigi karaa cirifka articular ee radius si loo hagaajiyo.Si kale haddii loo dhigo, jajab yar oo jaban oo ku yaal dusha sare ee lunate waxaa lagu taageeri karaa saxan 2.4mm "L" ama "T", sida ku cad sawirka 2.
Lafo-goysyada ka baxsan articular ee dhabarka barokacay, waxaa waxtar leh in la xuso qodobbada soo socda.Marka hore, waxaa muhiim ah in si ku-meel-gaar ah dib loogu dejiyo jabka si loo hubiyo in aysan jirin unug jilicsan oo ku xiran dhammaadka jabka.Marka labaad, bukaanada aan lahayn lafo-jileecu, jabka waa la dhimi karaa iyadoo la kaashanayo saxan: marka hore, furka qufulka ayaa la dhigayaa dhamaadka fog ee saxanka anatomical palmar, kaas oo lagu hubiyay qaybta jabka fog ee barokacay, ka dibna fogaanta iyo Qaybaha jabka ee u dhow ayaa la dhimay iyadoo la kaashanayo saxanka, iyo ugu dambeyntii, boolal kale ayaa la dhigayaa si dhow.
Jaantuska 3 Jabka goos gooska dheeraadka ah ee radius fog ee dhabarka barakiciyay waa la dhimay waxaana lagu hagaajiyay hab calaacasha ah.Jaantuska 3-A Ka dib marka la dhammeeyo soo-gaadhista iyada oo loo marayo radial carpal flexor iyo halbowlaha radial, pin Kirschner siman ayaa la geliyaa isku-dhafka carpal ee radial.Jaantuska 3-B Waxqabadka kortex metacarpal ee barokacay si dib loogu dajiyo.
Jaantuska 3-C iyo Jaantuska 3-DA pin Kirschner siman ayaa laga dhigayaa jirida shucaaca iyada oo loo marayo khadka jabka si ku meel gaar ah loo hagaajiyo dhamaadka jabka.
Jaantuska 3-E Muuqaal ku filan goobta qalliinka waxaa lagu gaaraa iyadoo la isticmaalayo dib-u-dejiye kahor meelaynta saxanka.Jaantuska 3-F Safka fog ee furayaasha qufulka ayaa la dhigayaa meel u dhow lafta chondral ee dhamaadka laabka fog.
Jaantuska 3-G X-ray fluoroscopy waa in la isticmaalaa si loo xaqiijiyo booska saxanka iyo boolal fog.Jaantuska 3-H Qaybta u dhow ee saxanku waa inay si fiican u lahaataa wax ka fogaansho (xagal 10 darajo) oo ka soo jeeda diaphysis si saxanka loogu hagaajiyo diaphysis si uu dib ugu habeeyo xannibaadda jabka fog.Jaantuska 3-I Adkee furaha u dhow si aad dib ugu soo celiso u janjeersiga calaacalaha jabka fog.Ka saar biinka Kirschner ka hor inta aan furka si buuxda loo adkayn.
Jaantusyada 3-J iyo 3-K Sawirada shucaaca gudaha ee qaliinka ayaa xaqiijinaya in jabkii ugu dambeyntii dib loo dhigay qaab dhismeed iyo boolal saxan ah oo la dhigay si ku qanacsan.
Qalabaynta Saxanka Dhabarka ah Habka qalliinka ee lagu soo bandhigo dhinaca dhabarka ee radius fog waxay ku xiran tahay inta badan nooca jabka, iyo xaaladda jabka leh laba ama in ka badan oo jajab ah jajab gudaha ah, ujeedada daaweyntu waxay inta badan tahay in la hagaajiyo labadaba. radial iyo tiirarka dhexe isku mar.Hawlgalka gudaha, xargaha taageerada fidiyaha waa in loo gooyaa laba siyaabood oo waaweyn: muddada dheer ee qaybaha 2aad iyo 3aad, oo leh kala-soocida subperiosteal qaybta 4th iyo dib u dhigista seedaha u dhigma;ama xadhig taageero labaad oo la jeexay inta u dhaxaysa 4th iyo 5th extensor waax si loo soo bandhigo labada tiir si gooni ah (Jaantus. 4).
Jabka ayaa la maamulay oo si ku meel gaar ah loogu hagaajiyay pin Kirschner oo aan la akhrin, sawiro shucaac ah ayaa la qaadayaa si loo go'aamiyo in jabku si fiican u barokacay.Marka xigta, ulnar dhabarka (tiirka dhexe) ee raadiyaha waxaa lagu dejiyaa saxan 2.4 mm "L" ama "T".Saxanka xuubka dhabarka ayaa loo qaabeeyey si loo hubiyo inuu si adag ugu habboon yahay dhinaca ulnar-ka dambe ee raadiyaha fog.Taarikada sidoo kale waxaa lagu dhejin karaa sida ugu dhow ee dhinaca dhabarka ee lunate fog sida ugu macquulsan, maaddaama jeexjeexyada u dhigma ee dhinaca hoose ee saxan kasta ay u oggolaadaan taarikada in la foorarsado oo qaabeeyo iyada oo aan waxyeello loo geysan dunta ku jirta godadka istaroogga (Jaantus 5). .
Hagaajinta saxanka tiirka shucaaca waa mid fudud, maadaama oogada lafta ee u dhaxaysa qaybaha hore iyo kan labaad ay tahay mid siman oo lagu hagaajin karo booskan oo leh saxan si habboon u qaabaysan.Haddii pin Kirschner lagu dhejiyo qaybta fog ee tuberosity radial, dhamaadka fog ee saxanka tiirarka radial wuxuu leeyahay jeexdin u dhigma pin Kirschner, kaas oo aan faragelinin booska saxanka oo ilaalinaya jabka meesha. (Jaantuska. 6).
Jaantuska 4 Soo bandhigida dusha dhabarka ee raadiyaha fog.Xaruntu waxay ka furan tahay qaybta 3aad ee extensor interosseous iyo seedaha dheer ee extensor hallucis longus ayaa dib u soo noqday.
Jaantus 5 Si loo hagaajiyo dhinaca dhabarka ee dusha articular ee lunate, saxan dhabarka "T" ama "L" badanaa waa qaabeeya (Jaantus 5-A iyo Fig. 5-B).Marka saxanka dhabarka ee dusha articular ee lunate la sugo, saxanka tiirarka shucaaca waa la hubiyaa (Jaantusyada 5-C ilaa 5-F).Labada taarikada waxaa lagu dhejiyaa xagal 70 darajo midba midka kale si loo hagaajiyo xasilloonida hagaajinta gudaha.
Jaantus 6 Saxanka tiirarka radial si sax ah ayaa loo qaabeeyey oo lagu dhejiyaa tiirka radial, isagoo xusaya cirifka dhamaadka saxanka, kaas oo u oggolaanaya saxanka inuu ka fogaado hagaajinta ku-meel-gaadhka ah ee pin Kirschner iyada oo aan la faragelin booska saxanka.
Fikrado muhiim ah
Tilmaamaha loogu talagalay hagaajinta saxanka Metacarpal
Barokacay jabka xudunta hoose ee wadnaha (Barton fractures)
barokacay jabka ka baxsan articular (Jajabka Colles iyo Smith).Qalabaynta xasiloon waxaa lagu gaari karaa taarikada birta xitaa haddii ay jirto lafo-beel.
Baro-jabka dusha sare ee lunate metacarpal
Tilmaamaha hagaajinta saxanka dhabarka
Iyadoo dhaawaca xididdada intercarpal
Baro jabka wadajirka ah ee lunate dhabarka
Jilibka xiiran ee radial carpal kala go'a wadajirka ah
Contraindications hagaajinta saxanka calaacalaha
Lafo-jileec aad u daran oo leh xaddidnaan shaqeyneed oo weyn
Jajabka radial dorsal ee gacanta
Jiritaanka cudurro badan oo caafimaad
Contraindications hagaajinta saxan dhabarka
Cudurro caafimaad oo badan
Jab aan barakicin
Qaladaadka si fudud loogu sameeyo hagaajinta saxanka calaacalaha
Booska saxanku waa mid aad muhiim u ah sababtoo ah ma aha oo kaliya in saxanku uu taageerayo xajmiga jabka, laakiin meelaynta saxda ah waxay sidoo kale ka hortagtaa qulqulka qufulka fog inuu soo galo wadajirka carpal radial.Shucaacyo taxaddar leh oo gudaha ah, oo lagu saadaaliyay isla jihada u janjeerta shucaaca ee fogaanta fog, waxay u oggolaaneysaa muuqaal sax ah oo ku saabsan dusha articular ee dhinaca shucaaca ee radius fog, kaas oo sidoo kale si sax ah loo arki karo iyadoo la gelinayo boolal ulnar marka hore inta lagu guda jiro hawlgal
Gelitaanka maroodiga ee kiliyaha dorsal wuxuu xambaarsan yahay halista kicinta seedaha fidsan oo sababa dillaaca seedaha.Xirmooyinka qufulku waxay u shaqeeyaan si ka duwan kuwa caadiga ah, mana aha lagama maarmaan in la dhex galo kiliyaha dorsal ee boolal.
Qaladaadka si fudud loogu sameeyo hagaajinta saxanka dhabarka
Had iyo jeer waxaa jirta khatar ah in la dhexgalo isgoysyada radial carpal, oo la mid ah habka kor lagu sharaxay ee la xidhiidha saxanka calaacalaha, tallaalka qallafsan waa in la qaadaa si loo go'aamiyo haddii booska daboolku uu yahay mid sugan.
Haddii hagaajinta tiirka shucaaca marka hore la sameeyo, boolaladaha ku jira tuberosity radial waxay saameyn doonaan qiimeynta hagaajinta xigta ee dib-u-soo-nooleynta dusha articular ee lunate.
Muraayado durugsan oo aan si buuxda loogu xidhin daloolka furuhu waxa ay kicin karaan seedaha ama xataa sababi karaan dillaaca seedaha.
Waqtiga boostada: Dec-28-2023
