Waqtigan xaadirka ah, jabka foldous waxaa lagu daaweeyaa siyaabo kala duwan, sida hagaajinta malaasta, meesha la jeexay, iwm. Waxaa ka mid ah xaraashka dibedda, laakiin qaar ka mid ah suugaanta ayaa soo sheegta in sicir-bararka uu yahay mid ka sarreeya 16%. Si kastaba ha noqotee, haddii saxanka si sax ah loo xusho, heerka dhibaatooyinka ayaa si hufan loo dhimi karaa. Dulmar kooban oo ku saabsan noocyada, tilmaamaha iyo farsamooyinka qalliinka ee malax-tilmaameedka loogu talagalay jabka foldous ee durugsan ayaa la soo bandhigay.
I.Tortspors of jahwareer durugsan
Waxaa jira dhowr nidaam oo kala-goys ah oo loogu talagalay jabka, oo ay ku jiraan kala-saaridda Müller ao ee ku saleysan anatomy iyo kala-sooca fevermendez ee ku saleysan hababka dhaawaca. Waxaa ka mid ah, kala-saaridda Eplumplentic-ka waxay isku daraan faa iidooyinka kala soocida hore, waxay daboolaysaa afarta nooc ee jajaban ee jabka, waxaana ku jira jajabka jidhka 4-qayb, oo ay ku noqon karaan hage wanaagsan ee shaqada caafimaad.
1. Müller Ao Kala-soocidda - Qeybta Qaybta-Artra
Kala-saaridda AO ee AO waxay si fiican ugu habboon tahay jabka fowdada masaafada waxayna u kala qaybisaa saddex nooc oo waaweyn: Ku qor qayb-dheeraad ah oo farshaxanimo ah, nooca b qayb ahaan qayb-ka-qayb-gal ah, iyo nooc ka mid ah jajabka wadajirka ah. Nooc kastaa waxaa loo qaybiyaa iskudhafyo kala duwan oo koox hoosaadyo ah oo ku saleysan darnaanta iyo kakanaanta jabka.
Ku qor a: Jab aan caadi ahayn oo murugsan
A1, jab jabka qallafku, radius inuu dhaawac yahay (A1.1, Ulnar Chrcal jabka; A1.2 Jab jab jab ah oo ah Ulnar Diakingy; A1.3, waxaa ku dhacay jabka diaphysis-ka).
A2, jab oo ah radius, sahlan, oo leh murgacasho (A2.1, radius iyada oo aan la jeexjeexin, a2.3, palsuu-palt of radius, ie, guntin-smith-ka.
A3, Jab jab oo ku saabsan radius, ayaa loo magacaabay
Nooca B: Jab jaban oo muruq ah
B1, jab ee radius, diyaaradda sagittal (B1..1, nooca dambe ee fudud; B1.2, nooca dambe ee loo safro; B1.3, nooca medial).
B2, Jab-jab ee Rim-ka Dorsal ee radius, yac, Barton jab jab (B2.1, Nooca fudud; B2.2, isku-dhafka nabarrada ah ee loo yaqaan 'scitlucation' ee gacanta).
B3, Jab-jab ee qulqulka metacarpal ee radius, ie, jab jab, ama nooca loo yaqaan 'adayn-smith nooca ii jab (jajabyo fudud, jab, jab jab, jajab weyn, b3.3, jabka.
Nooca C: Wadarta Jabhada Arctular
C1, jab jabka oo leh nooc sagxad ah oo muhiim ah oo ah sagxadaha farshaxanka iyo metaphapaphapaphapaphapaphapaphaphy labadaba.
C2, jab jab, wajiga sacoosan ee fudud, oo loo magacaabay metaphysis (c2, jab jabka wajiga farshaxanka; c3.1, jajabka hal-abuurka coronal-ka;
C3, jab jab, waxaa soo saaray (c3.1, jab jabka metaphysis; c3.2, jabtay jabka metaphysis; c3.3, jajabinta murugada leh ee u fidinta idaacadda radial.
2.Clation of jabka foldos foll.
Sida ku xusan farsamada dhaawaca Franddez waxaa loo qaybin karaa 5 nooc :.
Nooca Iftiilada ah waa jajabado aan caadi ahayn oo farshaxan oo aan caadi ahayn COSTEX-ga hal nabar oo lafaha ah ee kacsan ee kacsan ee xiisadda iyo iskuxirka isbarbardhiga ah ayaa la soosaaray oo la isku dayaa.
Dillaacidda
Jab-jabka III waa jajabka farshaxanka ee farshaxanka ah, oo ay sababaan walaaca xishood. Jabkan waxaa ku jira jajabka Paltr Barron, jabka Dorsal Barton, iyo jabka asliga ah ee radial.
Walaaca xirashada
Noocyada nooca III-qaybinta ah waa jabka-farshaxanka-farshaxanka iyo galinta metaphpapapapapapapapapapapapaphapapals ee ay sababaan dhaawacyada isku-dhafka ah, oo ay ku jiraan jajabka murugada leh ee murugsan iyo jahwareer radial ah.
Gelinta
Nooca jabka IV waa jab kacsan oo ku saabsan lifaaqa lugaynta ee dhaca inta lagu jiro jabinta jajabinta-jabsiga wadajirka ran-radial.
Gabdhawrida jabka
Nooca v Jabka ayaa ka soo baxa dhaawac xawaare sare leh oo ku lug leh xoog badan oo ah ciidamada dibada iyo dhaawacyo balaaran. (Isku qas i, II, III, IV)
3.PONIC CODKA
II.truatment ee jabka foldal ee jajaban oo leh mala awaalka
Tilmaamaha.
Jab-jajab aan caadi ahayn ka dib guuldaradii yareynta hoos udhaca xaaladaha soo socda.
Naqshadda Dorsal ka weyn 20 °
Isu-dhexaadinta Dheerta ka weyn 5 mm
Radaalo folal ah oo ka weyn 3 mm
Jab jaban ayaa xannibay barakaca ka weyn 2 mm
Jab-jajabyada farshaxanka ee 'Artra-Artra' oo ka badan 10mm barokac
Aqoonyahanada badankood kuma talinayaan adeegsiga taarikada metacarpal ee dhaawacyada tamarta, sida jahwareerka culus ee miyir-beelka ah ama lafaha daran ee maskaxda, sababta oo ah jajabyadan jajaban ee jajaban ayaa u nugul necbals-ka oo ay ku adag tahay dib-u-habeyn anatomi ah.
Bukaanka leh jajabyo badan oo jajaban iyo barakacayaal la taaban karo oo leh osteoporosis daran, plat metacaarpal ma ahan wax ku ool ah. Taageerada hoosaadka ee jajabka fog ee jajabka fog ayaa laga yaabaa inay dhibaato jirto, sida inay ku wareegaan godka wadajirka ah godka wadajirka ah.
Farsamada qalliinka
Inta badan dhakhaatiirta qalliinka badankood waxay adeegsadaan qaab la mid ah farsamada iyo farsamada si loo xaliyo jabka foldoius oo leh saxan saxan. Si kastaba ha noqotee, farsamada qalliinka wanaagsan ayaa looga baahan yahay inay si wax ku ool ah uga fogaadaan dhibaatooyinka ka mid ah dhibaatooyinka ka dib, tusaale ahaan, dhimista waxaa lagu gaari karaa iyadoo lagu sii daayo xannibaadaha jabka oo ka soo baxa cadaadiska lafaha iyo sii wadida sii wadida laf-dhabarka. Hagaajinta ku-meelgaarka ah ee leh 2-3 kirschner pins ayaa la isticmaali karaa, iwm.
(I) Dib-u-habeynta horudhaca ah iyo qaabka
1. Qalliinka waxaa lagu sameeyaa jihada shaashadda radial ee ka hooseeya daloolka, oo ay suulka ku cadaadinayso jahwareerka jajaban ee ka soo dhacaya dhinaca kale ee faraha kale ee kor u qaadida xagal ka soo baxa xagal ka soo baxa xagal ka soo baxa dhinaceeda.
2. Meel safiif ah, oo leh addinka ay dhibaatadu saameysey miiska gacanta miiska hoostiisa.
(Ii) dhibcaha gelitaanka.
Nooca qaabka loo istcimaalo, PCR (Fursad roohood oo rayn ah) ayaa lagula talinayaa qaab xaraash ah.
Dhamaadka masaafada maqaarka ayaa ka bilaabmaya maqaarka maqaarka ee gacanta iyo dhererkeeda waxaa lagu go'aamin karaa iyadoo ku raacaya nooca jabka.
Flexor radial fleor radianis tendon the the the the the the the the the the the the the the the the the the the the the Sends gends-ka ayaa lagu soo daayay, oo u dulan lafaha carpal iyo u dhow dhow ee ugu dhow ee suuragalka ah.
Jiidashada Flow Polal Smage Smage Tenson dhinaca Ulnar wuxuu ilaaliyaa dareemayaasha dhexe iyo flendor-ka isku dhafka ah.
Booska 'parona' waa la soo bandhigayaa oo muruqyada dusha sare ah ee ariga ayaa ku yaal inta udhaxeysa digitor digitorum dhaadheer (Ulnar dhinaca) iyo halbowlaha radial (dhinaca radial).
ISTICMAALKA SIDOO KOOBAN MADAXWEYNAHA HOOSE EE DHAQANKA, adoo xusaya in qayb laga tago oo ku lifaaqan radius dib-u-dhiska dambe.
Soo jiidashada muruqa dusha sare ee ANI ee Ulnar dhinaca ayaa u oggolaanaya soo-gaadhis ku filan oo ku filan geeska ulnal geeska ulnar ee dhinaca tarcadda leh ee radius.
Habka Palmar wuxuu daaha ka qaadayaa masaafada masaafada iyo si wax ku ool ah u soo bandhigaya xagasha ulnar.
Noocyada jabka ee murugsan, waxaa lagu talinayaa in joogsiga foreragriordis-ka fol fog laga saari karo, kaas oo ka takhalusi kara jiidista xargaha radial, kaas oo ka beddelaya radius yu si ay uga baxaan goobta jabka, ka dibna dib u dejiso Jab jabka iyadoo la adeegsanayo PIN PIN. Jabanjarooyinka murugsan ee murugsan, arthroscopy-gu waxaa loo isticmaali karaa in lagu caawiyo dhimista, qiimeynta iyo ganaax ganaax ah oo ka mid ah jabka jabka.
(Iii) Qaababka yareynta.
1. U adeegso ryfiga lafta sidii kabaal dib u dejinta
2. Kaaliyaha ayaa jiidaya tusmada bukaanka iyo faraha dhexe, kaasoo si fudud loo dejin doono.
3. Ku xoq furaha Kirskannerner ee ka soo baxa qaaxada radia ee hagaajinta ku-meel-gaarka ah.
Dib-u-soo-celinta ka dib markii dib loo dhigo, saxan saxan ayaa si joogto ah loo meeleeyaa, kaas oo ay tahay in ugu dhowaato biyo-hayaha, waa in ay daboolaan sumcadda ulnal, waana inay u noqotaa mid u dhow bartanka geedaha asliga ah. Haddii shuruudahan aan la fulin, haddii saxanku uusan ahayn cabirka saxda ah, ama haddii dib-u-soo-celinta uusan ku qanacsanayn, howsha wali ma ahan mid kaamil ah.
Dhibaatooyin badan ayaa si adag ula xidhiidha booska saxanka. Haddii saxanka la saarayo aad u fog dhinaca radial, dhibaatooyin la xiriira dabacsanaanta qaawantu waxay u badan tahay inay dhacaan; Haddii saxanka la dhigo mid aad ugu dhow safka biyuhu, dabacsanaanta farta ayaa laga yaabaa inay halis ku jirto. Cilladaha soo barakacay ee jiritaanka jabka ee dhinaca Palmariga ah waxay si fudud u sababi karaan saxanka si ay ugu soo celiyaan dhinaca jihada oo ay xiriir toos ah la galaan Flexson, ugu dambeyntiina waxay u horseedday pentonitis ama xitaa dillaac.
Bukaanka osteoporatic, waxaa lagu talinayaa in saxanka loo dhigo meel u dhow khadka ugu dhow ee suuragalka ah, laakiin aan laga gudbin. Xannibaadral-hoosaadka-hoosaadka waxaa lagu gaari karaa biinanka Kirskakner ee ugu dhow Ulna, iyo dhinaca-dhinac-dhinac-ka-xirxirta iyo boolal qufulka ah waxay wax ku ool yihiin inay ka fogaadaan jajabinta jajabinta.
Mar alla markii saxanka si sax ah loo meeleeyo, dhamaadka u dhow ayaa lagu hagaajiyaa hal dabool iyo dhamaadka fog ee saxanka ayaa si kumeelgaar ah loogu hagaajiyaa biinanka Kirskarner-ka ugu badan. Oryaroscogromeram-ka ilkaha, aragtida dambe, iyo filimada dambe, iyo filimaanta dambe oo leh 30 ° curcurka ayaa la qaaday si loo go'aamiyo yareynta jabka iyo booska hagaajinta gudaha.
Haddii saxanka uu si ku habboon yahay, laakiin Kirskachnernerrner Pin waa mid farshaxan-yar, tani waxay ku dambayn doontaa soo kabasho aan ku filnayn, kaas oo lagu xallin karo dib-u-dejinta saxanka iyadoo la adeegsanayo "Fing 2, B).
Jaantus 2.
a, laba biinanka Kirskalner oo ku-meel-gaar ah, la soco in damaca metacarpal iyo sagxadaha farshaxanka aan si ku filan loo soo celin.
B, hal Kirskakner Pin oo loogu talagalay hagaajinta saxanka ku-meelgaarka ah, la soco in radius masaafo ah lagu xalliyo qodobkan (farsamada jabinta jajabka ee fog), oo qaybta ugu dhow ee saxanka waxaa loo jiidaa dhinaca asliga ah si loo soo celiyo xagal farta ah.
C, arthroscopic ganaax ganaax ah oo dusha sare ah, meelaynta boogaha qufulka fog / biinanka, iyo dib-u-dejinta ugu dambeeya iyo hagaajinta radius wakiil.
Xaaladda ay ku saabsan yihiin walxaha la isku haleeyo iyo jabka ulnal (Ulnar / Drsal dhinta Punch), oo aan sifiican u dejin karin xiritaanka, saddexda farsamadood ee soo socda ayaa la isticmaali karaa.
Radius dhawayn ah ayaa si tartiib tartiib ah u wareejiya goobta jabka, iyo xannibaadda jabka ee Founda ee Founda ayaa loo riixayaa dhanka carpal-ka iyada oo loo marayo qaab qoto dheer oo kor u dheer; Meel yar oo la jeexay ayaa laga dhigaa wax lagu dhejiyo qaybaha 4-ta iyo 5aad si loo muujiyo xannibaadda jabka, oo waa mid lagu hagaajiyaa saxanka loo yaqaan 'saxanka' ulnar '. Xannibaadda xidhxidhan ama waqti yar oo lagu sameeyay wax lagu joojiyo oo lagu sameeyay oo lagu sameeyay kaalmada arthroscopic.
Dib-u-habeyn ku saabsan ka dib iyo meelaynta saxda ah ee saxanka, hagaajinta ugu dambeysa ayaa la heli karaa oo dib-u-habeyn anaga ah ayaa lagu gaari karaa haddii loo dhawaaqo si sax ah oo aan ku jirin godka wadajirka ah (Jaantus 2).
(iv) khibradda xulashada xulashada.
Dhererka boogaha ayaa laga yaabaa inay adkaan karto in lagu cabbiro si sax ah sababtuna tahay burburka lafaha daran ee lafaha daran. Boogaha aad u dheer waxay u horseedi karaan isgoysyo iyo mid aad u gaaban si ay u taageeraan hagaajinta xannibaadda jabka. Sababtaas awgeed qorayaashu waxay ku talinayaan adeegsiga ciddiyaha qufulka xidhmooyinka iyo xijaabka badan ee xiniinyaha xargaha iyo und ee loo yaqaan ulnamen, iyo adeegsiga boolal qufulka-stem-ka ee khafiifka ah ee jagooyinka harsan. Isticmaalka madaxa afkeeda ayaa ka fogaada xiisaha loo yaqaan 'the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the sense' hadii ay si hoose isugu xirnaato. Wixii loogu talagalay hagaajinta saxanka safka ee isku dhafka ah, laba boolal oo iskuxiran + hal dabool oo caadi ah (oo lagu meeleeyo ellipse) loo isticmaali karo hagaajinta.
Dr Kioyohito wuxuu ka soo bandhigay waayo-aragnimadooda ee loo adeegsado taarikada miisaska qufulka miinooyinka ah ee jabka fowdada masaafada, halkaas oo meesha qaddarka ay ka soo baxaan 1cm-ka xun, taas oo ka soo horjeedda. Qaabkan waxaa loo muujiyey jajabka masaafada fog ee xasilloon, oo tilmaamaheeda qalliinka ah ee jajabyada ao ee Nooca C1 iyo C2, laakiin ma ku haboona jabka C1 iyo jabka C2 Habka sidoo kale kuma haboona jabka nooca b. Qorayaashu sidoo kale waxay tilmaamayaan in haddii dhimista wanaagsan iyo hagaajinta aan lagu gaari karin qaabkan, waxaa lagama maarmaan ah in loo beddelo habka la jeexay ee dhaqanka oo uusan ku dhegan meesha la jeexay ee yar yar.
Waqtiga Post: Jun-26-2024
