Waqtigan xaadirka ah, jabka radius fog waxaa lagu daaweeyaa siyaabo kala duwan, sida hagaajinta malaasta, jeexitaan iyo hoos u dhigista gudaha gudaha, dhejinta dibadda, iwm. Waxaa ka mid ah, hagaajinta saxanka calaacalaha waxay gaari kartaa natiijooyin badan oo lagu qanco, laakiin qaar ka mid ah suugaanta ayaa sheegaya in heerka dhibkiisu uu sarreeyo ilaa 16%. Si kastaba ha noqotee, haddii saxanka si habboon loo doorto, heerka dhibka ayaa si wax ku ool ah loo dhimi karaa. Dulmar kooban oo ku saabsan noocyada, tilmaamayaasha iyo farsamooyinka qalliinka ee palmar plating ee jabka radius fog ayaa la soo bandhigay.
I.Noocyada jabka radius fog
Waxaa jira dhowr nidaam oo kala-soocidda jabka, oo ay ku jiraan kala-soocidda Müller AO ee ku salaysan anatomy iyo kala-soocidda Femandez oo ku salaysan habka dhaawaca. Waxaa ka mid ah, kala-soocidda Eponymic waxay isku daraysaa faa'iidooyinka kala-soociddii hore, waxay dabooshaa afarta nooc ee aasaasiga ah ee jabka, oo ay ku jiraan maleon 4-qaybood oo jab ah iyo jabka Chaffer, taas oo noqon karta hage wanaagsan oo shaqo caafimaad ah.
1. Müller AO Kala soocida - qayb ka mid ah jabka gudaha articular
Kala-soocidda AO waxay si fiican ugu habboon tahay jabka radius fog waxayna u kala qaybisaa saddex nooc oo waaweyn: nooca A-gaaban, nooca B qayb ahaan intra-articular, iyo nooca C wadarta jabka wadajirka ah. Nooc kasta oo kale ayaa loo sii kala qaybiyaa kooxo-hoosaadyo kala duwan oo ku salaysan darnaanta iyo kakanaanta jabka.
Nooca A: Jabka laf dhabarta ah
A1, jabka femoral ee ulnar, radius sida dhaawaca (A1.1, jabka ulnar ulnar; A1.2 jab fudud ee ulnar diaphysis; A1.3, jabka jaban ee ulnar diaphysis).
A2, Jajabka radius, fudud, oo leh dhexda (A2.1, radius aan leexleexad lahayn; A2.2, leexashada radius, ie, jabka Pouteau-Colles; A2.3, palmar tilt of radius, ie, Goyland-Smith jab).
A3, Jajabka radius, la gooyay (A3.1, gaabinaya axial ee radius; A3.2 jajab qaabaysan ee radius; A3.3, jabka jaban ee raadiyaha).
Nooca B: qayb ka mid ah jabka articular
B1, jabka radius, diyaaradda sagittal (B1.1, nooca fudud ee lateral; B1.2, nooca comminuted lateral; B1.3, nooca dhexe).
B2, Jebinta cirifka dhabarka ee radius, ie, jabka Barton (B2.1, nooca fudud; B2.2, jabka sagittal lateral ee isku dhafan; B2.3, kala-baxa dhabarka ee curcurka ah).
B3, Jebinta cirifka metacarpal ee raadiyaha, ie, jabka anti-Barton, ama jabka Goyand-smith nooca II (B3.1, qaanuunka femoral fudud, jajab yar; B3.2, jab fudud, jajab weyn; B3.3, jabka jaban).
Nooca C: wadarta jabka articular
C1, jabka radial oo leh nooc fudud oo ah labada dhinac ee articular iyo metaphyseal (C1.1, jabka dhabarka ee dhexdhexaadka ah; C1.2, jabka sagittal ee dusha sare ee articular; C1.3, jabka dusha sare ee wadnaha ee dusha sare ee articular).
C2, Jajabka Radius, Fudud articular facet, Metaphysis la dhammeeyay (C2.1, jabka sagittal ee wajiga articular; C2.2, laf-dhabarka laf-dhabarka laf-dhabarka ee wajiga articular; C2.3, jabka articular oo ku fidsan stem radial).
C3, jabka radial, la gooyey (C3.1, jab fudud ee metaphysis; C3.2, jabka jaban ee metaphysis; C3.3, jabka articular ee fidsan ilaa stem radial).
2. Kala soocida jabka radius fog.
Marka loo eego habka dhaawaca, Kala-saarista Femandez waxaa loo qaybin karaa 5 nooc:.
Jajabka Nooca I waa jajabyo ka baxsan articular metaphyseal oo la dhammeeyay sida Colles fractures ( dorsal angulation) ama jabka Smith ( metacarpal angulation ). Kiliyaha hal laf ayaa ku jaba xiisadda hoosteeda, kiliyaha iska soo horjeedana waa la gooyay oo la dhex galay.
Jab
Jajabka Nooca III waa jabka gudaha articular, oo ay keento diiqada xiirid. Jebintaan waxaa ka mid ah jabka calaacalaha Barton, jabka dhabarka Barton, iyo jabka asliga ah ee shucaaca.
Cadaadis xiiran
Jajabka Nooca III waa jabka gudaha articular iyo galinta metaphyseal oo ay sababto dhaawacyada cadaadiska, oo ay ku jiraan jabka articular ee adag iyo jabka pilon radial.
Gelida
Nooca IV jabka waa jabka avulsion ee kuxiran ligamentous kaas oo dhaca inta lagu jiro jab-jabka ee wadajirka radial carpal.
Jabka avulsion-ka waxaan kala go'aa
Jabka nooca V wuxuu ka yimaadaa dhaawac xawli sare leh oo ku lug leh xoogag badan oo dibadda ah iyo dhaawacyo badan. (Isku-dhafka I, II, IIII, IV)
3.Qoritaanka Eponymic
II.Daawaynta jabka radius fog ee calaacalaha
Tilmaamaha
Jabka ka baxsan articular ka dib fashilka hoos u dhigista xaaladaha soo socda.
Xagga dorsal ee ka weyn 20°
Cadaadiska dorsal ee ka weyn 5 mm
Radius fog oo gaabinaya in ka badan 3 mm
Barokaca jabka fog ee ka weyn 2 mm
Jabka gudaha articular ee ka weyn barokaca 2mm
Culimada intooda badani kuma talinayaan isticmaalka taarikada metacarpal ee dhaawacyada tamarta sare leh, sida jabka jaban ee gudaha-articular ama lafo daran oo daran, sababtoo ah jajabyadan dillaacsan ee fog ayaa u nugul necrosis avascular waxayna adagtahay in dib loo dhigo.
Bukaannada qaba jajabyo badan oo jajab ah iyo barokac weyn oo leh lafo-jileec daran, dhejinta metacarpal ma aha mid waxtar leh. Taageerada hoose ee jabka fog ayaa laga yaabaa inay dhib leedahay, sida galitaanka furka daloolka wadajirka ah.
Farsamada qaliinka
Dhakhaatiirta qalliinka badankooda waxay isticmaalaan hab la mid ah iyo farsamo si ay ugu hagaajiyaan jabka radius fog ee saxanka calaacalaha ah. Si kastaba ha ahaatee, farsamo qalliin oo wanaagsan ayaa loo baahan yahay si si wax ku ool ah looga fogaado dhibaatooyinka qalliinka kadib, tusaale ahaan, hoos u dhigista waxaa lagu gaari karaa in la sii daayo xannibaadda jabka ee isku-duubnaanta iyo soo celinta sii wadida lafaha kortikal. Hagaajinta ku meel gaadhka ah ee leh 2-3 biinanka Kirschner ayaa la isticmaali karaa, iwm.
(I) Dib-u-dejinta iyo booska shaqada ka hor
1. Jiijinta waxaa lagu sameeyaa jihada shafka shucaaca ee hoosta fluoroscopy, iyadoo suulka uu riixayo xannibaadda u dhow ee dhinaca calaacalaha iyo faraha kale oo kor u qaadaya xannibaadda fog ee xagal ka soo jeeda dhinaca dhabarka.
2. Booska dhabarka, oo leh addinka ay saamaysay oo saaran miiska gacanta ee fluoroscopy hoostiisa.
(II) Goobaha gelitaanka.
Nooca habka loo isticmaalo, PCR (radial carpal flexor) habka calaacalaha fidsan ayaa lagula talinayaa.
Dhamaadka fog ee jeexitaanka maqaarku wuxuu ka bilaabmaa maqaarka maqaarka ee curcurka waxaana dhererkiisa lagu go'aamin karaa iyadoo loo eegayo nooca jabka.
Jilibka radial flexor carpi radialis tendon iyo galka seedaha ayaa la jarjaray, oo fogaanaya lafaha carpal oo u dhow sida ugu dhow ee suurtogalka ah.
U jiidida radial carpal flexor tendon dhinaca ulnar waxay ilaalinaysaa dareemaha dhexdhexaadka ah iyo qallooca ee jilicsan.
Meesha Parona waa la soo bandhigay oo muruqa hore ee rotator ani muruqa wuxuu ku yaalaa inta u dhaxaysa flexor digitorum longus (dhinaca ulnar) iyo radial artery (dhinaca shucaaca).
Kordhi dhinaca shucaaca ee murqaha rotator-ka hore, adigoo xusaya in qayb looga tago ku dheggan radius dib-u-dhiska dambe.
U soo jiidida muruqa rotator ee hore ee dhinaca ulnar waxay u oggolaaneysaa soo-gaadhis ku filan oo ku filan geeska ulnar ee dhinaca calaacalaha ee raadiyaha.
Habka calaacalaha ayaa daaha ka qaadaya raadiyaha fog wuxuuna si wax ku ool ah u soo bandhigaa xagasha ulnar.
Noocyada jaban ee adag, waxaa lagu talinayaa in joogsiga brachioradialis fog la sii daayo, kaas oo dhexdhexaadin kara jiidistiisa tuberosity radial, markaas oo galka calaacalaha ee qaybta dambe ee ugu horeysa ayaa la gooyn karaa, kaas oo soo bandhigi kara jabka dillaaca fog ee radial iyo tuberosity radial, gudaha gudaha u rogo qulqulka radicalka ee Yuu si uu u leexiyo goobta. jeex jab gudaha articular ah iyadoo la isticmaalayo pin Kirschner. Jajabka kakan ee gudaha articular, arthroscopy waxaa loo isticmaali karaa in lagu caawiyo dhimista, qiimeynta iyo hagaajinta xannibaadda jabka.
(III) Hababka dhimista.
1. U isticmaal birta lafta sidii kabaal si aad dib ugu dejiso
2. Kaaliyaha ayaa jiidaya tusaha bukaanka iyo faraha dhexe, taas oo noqon doonta mid fudud in dib loo dajiyo.
3. Ka marooji pin Kirschner tuberosity radial si loo hagaajiyo ku meel gaar ah.
Ka dib marka dib u habeyntu dhammaato, saxan calaacasha ah ayaa si caadi ah loo dhigaa, kaas oo ah inuu u dhow yahay biyo-mareenka, waa inuu daboolaa sumcadda ulnar, waana inuu u dhow yahay barta dhexe ee jirida radial. Haddii shuruudahan aan la daboolin, haddii saxanku aanu ahayn cabbirka saxda ah, ama haddii dib u habeyntu ay tahay mid aan ku qanacsanayn, nidaamku weli ma qummana.
Dhibaatooyin badan ayaa si xoog leh ula xiriira booska saxanka. Haddii saxanka la dhigo meel aad uga fog dhinaca shucaaca, dhibaatooyinka la xidhiidha dabacsanaanta bunion waxay u badan tahay inay dhacaan; haddii saxanka la dhigo meel aad ugu dhow xariiqda biyuhu, qallafsanaanta qotoda dheer ee fartu waxay noqon kartaa khatar. Kala-baxa kala-baxa ee jabka dib-u-dejinta dhinaca calaacalaha waxay si fudud u sababi kartaa in saxanku u soo baxo dhinaca calaacalaha oo uu si toos ah ula xiriiro jilicsanaanta jilicsan, ugu dambeyntiina keenta tendonitis ama xitaa dillaac.
Bukaannada lafo-beelka, waxaa lagula talinayaa in saxanka la dhigo meel u dhow xariiqda biyaha ee suurtogalka ah, laakiin aan la dhaafin. Qalab-hoosaadka hoose waxaa lagu gaari karaa iyadoo la isticmaalayo biinanka Kirschner ee ugu dhow ulna, iyo biinanka Kirschner- dhinac-dhinac ah iyo biinanka qufulka ayaa waxtar u leh ka fogaanshaha dib-u-dejinta jabka.
Marka saxanka si sax ah loo dhigo, dhamaadka u dhow ayaa lagu hagaajiyaa hal fur oo dhamaadka fog ee saxanka si ku meel gaar ah ayaa loogu dhejiyaa biinanka Kirschner ee godka ugu badan ee ulnar. Fluoroscopic orthopantomograms intraoperative intraoperative, views lateral, iyo filimada lateral leh 30 ° kor u qaadida gacanta ayaa la qaaday si loo go'aamiyo dhimista jabka iyo booska hagaajinta gudaha.
Haddii saxanku si ku qanacsan yahay loo dhigo, laakiin pin Kirschner waa intra-articular, tani waxay keeni doontaa soo kabashada ku filan ee calaacalaha, taas oo lagu xallin karo dib u habeynta saxanka iyadoo la adeegsanayo "farsamada hagaajinta jabka fog" (Jaantus 2, b).
Jaantuska 2.
a, laba biin oo Kirschner ah oo loogu talagalay hagaajin ku meel gaar ah, ogow in u janjeersiga metacarpal iyo sagxadaha articular aan si ku filan loo soo celin meeshan;
b, Mid ka mid ah Kirschner pin oo loogu talagalay hagaajinta saxan ku meel gaar ah, ogow in radius-ka fogku uu go'an yahay meeshan (farsamada hagaajinta jabka fogaanta), iyo qaybta u dhow ee saxanka ayaa loo jiidayaa xagasha radial si loo soo celiyo xagasha calaacalaha.
C, Qalabaynta arthroscopic ee sagxadaha articular, meelaynta biinanka qufulka fog, iyo dib u dejinta kama dambaysta ah iyo hagaajinta raadiyaha u dhow.
Marka laga hadlayo jabka dhabarka iyo ulnar-ka ee isku-dhafan (ulnar/dorsal Die Punch), kaas oo aan si ku filan dib loogu dhigi karin xidhitaanka, saddexdan farsamo ee soo socda ayaa la isticmaali karaa.
Radius-ka u dhow ayaa hore u wareegaya oo ka fog goobta jabka, iyo xannibaadda jabka ee fossa lunate ayaa loo riixay lafta carpal iyada oo loo marayo habka dhererka PCR; Jeexid yar ayaa la sameeyaa oo la sii daayaa qolalka 4aad iyo 5aad si loo soo bandhigo jajabka jabay, waxaana lagu dhejiyay saxanka dabada ugu badan. Hagaajinta xirxiran ee xididdada ah ama ka-hortagga ugu yar ayaa lagu sameeyay caawinta arthroscopic.
Ka dib meelayn lagu qanco iyo meelaynta saxda ah ee saxanka, hagaajinta kama dambaysta ah waa sahlan tahay waxaana dib-u-dhigis anatomical ah lagu gaari karaa haddii pin kernel ulnar u dhow si sax ah loo dhigo oo aan wax boolal ahi ku jirin daloolka wadajirka ah (Jaantuska 2).
(iv) Khibrad xulista.
Dhererka boolalku way adkaan kartaa in si sax ah loo cabbiro sababtoo ah burburka laf dhabarta ee daran. Muraayado aad u dheer waxay keeni karaan kacsanaan seedaha oo aad u gaaban si ay u taageeraan hagaajinta xuubka dhabarka. Sababtan awgeed qorayaashu waxay ku talinayaan isticmaalka ciddiyaha qufulka dunta iyo ciddiyaha qufulka multiaxial ee tuberosity radial iyo inta badan ulnar foramen, iyo isticmaalka boolal quful iftiin-stem ee boosaska haray. Isticmaalka madax aan fiicneyn wuxuu ka fogaanayaa kacsanaanta seedaha xitaa haddii si hoose loo duubo. Si loo hagaajiyo saxanka isku xiran ee u dhow, laba boolal oo isku xiran + hal fur oo caadi ah (la geliyey ellipse) ayaa loo isticmaali karaa hagaajinta.
Dr Kiyohito oo u dhashay dalka Faransiiska ayaa soo bandhigay waayo-aragnimadooda isticmaalka taarikada qufulka calaacalaha ee ugu yar ee jabka xididdada fog, halkaas oo jeexiddooda qalliin lagu soo yareeyay 1cm xad dhaaf ah, taas oo ah mid liddi ku ah. Habkani waxa ugu horayn lagu tilmaamay jabka radius fog ee xasiloon, calaamadihiisa qalitaankuna waa jabka dheeraadka ah ee jajabka AO ee noocyada A2 iyo A3 iyo jabka gudaha articular ee noocyada C1 iyo C2, laakiin kuma haboona jabka C1 iyo C2 oo ay weheliso burburka lafaha gudaha ee gudaha. Habka sidoo kale kuma haboona jabka nooca B. Qorayaashu waxay sidoo kale tilmaamayaan in haddii yareyn wanaagsan iyo hagaajin aan lagu gaari karin habkan, ay lagama maarmaan tahay in loo beddelo habka jeexjeexa ee dhaqameed oo aan lagu dhejin jeexjeexyada yaryar ee ugu yar.
Waqtiga boostada: Juun-26-2024
