Ko ngā whati o te metacarpal phalangeal he whati noa i roto i ngā whara ringa, tata ki te 1/4 o ngā tūroro whara ringa. Nā te hanganga ngāwari me te uaua o te ringa me te mahi ngāwari o te nekehanga, ko te hiranga me te hangarau o te maimoatanga whati ringa he tino uaua ake i te maimoatanga o ētahi atu whati wheua roa. Ko te whakarite i te pumau o te whati i muri i te whakaiti te mea nui ki te maimoatanga angitu o ngā whati metacarpal phalangeal. Hei whakaora i te mahi a te ringa, he maha ngā wā e hiahiatia ana te whakatikatika tika mō ngā whati. I mua, i whakamahia te whakatikatika waho o te paraikete, te whakatikatika ā-roto waea Kirschner rānei, engari he maha ngā wā kāore e pai mō te whakangungu whakaora hononga wawe i muri i te pokanga nā te kore whakatikatika tika, te roa rānei o te wā whakatikatika, he nui ake te pānga ki te whakaora i te mahi a te hononga maihao, ā, he uaua ki te whakaora mahi a te ringa. Kei te piki haere te whakamahi a ngā tikanga maimoatanga hou i te whakatikatika ā-roto kaha ake, pērā i te whakatikatika tīwiri pereti-iti.
Ahau.He aha ngā mātāpono maimoatanga?
Ngā mātāpono maimoatanga mō ngā whati o te ringa metacarpal me te phalangeal: te whakaiti i te āhua o te tinana, te whakau māmā me te pūmau, ngā mahi tōmua me te whakangungu mahi. He rite tonu ngā mātāpono maimoatanga mō ngā whati o roto i te hononga me te peri-articular o te ringa ki ērā mō ētahi atu whati o roto i te hononga, arā, ko te whakaora i te āhua o te mata o te hononga me ngā mahi tōmua. I te rongoā i ngā whati o te ringa metacarpal me te phalangeal, me whakapau kaha ki te whakatutuki i te whakaiti āhua o te tinana, ā, kaua e puta te hurihanga, te koki taha, te nekehanga koki rānei >10° ki te taha tuara o te nikau. Mena ka huri, ka neke koki rānei te pito whati o te phalange metacarpal ki te taha, ka huri te ara o te nekehanga piko me te toronga noa o te maihao, ka neke, ka hinga rānei me te maihao tata i te wā piko, ka pā ki te tika o te mahi a te maihao; ā, ina neke te koki ki te taha tuara o te nikau >10°, ka pakaru te mata pa maeneene i waenga i te wheua me te uaua, ka whakanui ake i te ātete me te whānuitanga o te nekehanga o te piko me te toronga o te uaua, ā, ka puta te kino o te uaua mau tonu, ka puta te mōrearea o te pakaru o te uaua.
Tuarua.He aha ngā rauemi ka taea te whiriwhiri mō ngā whati metacarpal?
He maha ngā rauemi whakapiri ā-roto mō ngā whati metacarpal, pērā i ngā waea Kirschner, ngā tīwiri, ngā pereti me ngā whakapiri ā-waho, ā, ko ngā waea Kirschner me ngā pereti iti te mea e whakamahia whānuitia ana. Mō ngā whati metacarpal, he mārama ngā painga o te whakapiri ā-roto pereti iti i te whakapiri waea Kirschner, ā, ka taea te whakamahi tuatahi; mō ngā whati phalanx proximal, he pai ake ngā pereti iti, engari ki te uaua te whakauru i ngā tīwiri mō ngā whati wāhanga tawhiti o te phalanx proximal me te upoko, me whakamahi te whakapiri ā-roto waea Kirschner whakawhiti, he pai ake tēnei mō te whakaora i te mahi a te maihao e pāngia ana; me whakamahi tuatahi ngā waea Kirschner mō te rongoā i ngā whati phalanx waenga.
- Waea Kirschner:Neke atu i te 70 tau te whakamahinga o te whakapiri ā-roto waea Kirschner i roto i ngā mahi haumanu, ā, koinei tonu te rauemi whakapiri ā-roto e whakamahia whānuitia ana mō ngā whati metacarpal me te phalangeal. He ngāwari ki te whakahaere, he iti te utu, he whai hua hoki, ā, koia te tikanga whakapiri ā-roto tino rongonui. Hei whakapiri ā-roto e whakamahia whānuitia ana mō te rongoā i ngā whati ringa, kei te whakamahia whānuitia tonutia. Ngā painga o te whakapiri ā-roto waea Kirschner: ① He ngāwari ki te whakahaere, ā, he tino ngāwari ki te whakamahi; ② He iti ake te tango i ngā kiko ngohengohe, he iti ake te pānga ki te rere toto o te pito whati, he iti ake te whara pokanga, ā, he pai ki te whakaora whati; ③ He ngāwari ki te tango i te ngira mō te wā tuarua; ④ He iti te utu me te whānuitanga o te whakamahinga, he pai mō te nuinga o ngā whati ringa (pēnei i ngā whati hononga-ā-roto, ngā whati pakaru kino me ngā whati phalangeal distal).
2. Ngā pereti iti MetacarpophalangealKo te whakatikatika kaha o roto o ngā whati ringa te pūtake mō te whakangungu mahi wawe, ā, he āhuatanga tika hoki mō te whakahoki mai i te mahi pai o te ringa. Ko te hangarau whakatikatika ā-roto a te AO e hiahia ana kia tika te whakanoho i ngā pito whati kia rite ki te hanganga tinana, kia pumau hoki ngā pito whati i raro i ngā āhuatanga mahi, e mōhiotia whānuitia ana ko te whakatikatika kaha, kia taea ai te nekeneke tere wawe. Ka aro nui hoki te AO ki ngā mahi pokanga iti rawa te whakaekenga, me te arotahi ki te tiaki i te rere o te toto. Ka taea e te whakatikatika ā-roto o te microplate mō te maimoatanga o ngā whati ringa te whakatutuki i ngā hua pai e pā ana ki te kaha, te pumau o ngā pito whati, me te pēhanga i waenga i ngā pito whati. Mō te whakaora mahi i muri i te pokanga, te wā whakaora whati, me te tere o te mate, e whakaponohia ana he pai ake te whai huatanga o ngā pereti microtitanium i ngā waea Kirschner. Heoi anō, nā te mea he poto ake te wā whakaora whati i muri i te whakatikatika ki ngā pereti microtitanium i ērā atu tikanga whakatikatika, he pai mō ngā tūroro te hoki wawe ki te oranga noa.
(1) He aha ngā painga o te whakapiri ā-roto o te microplate?
① Ki te whakaritea ki ngā waea Kirschner, he pai ake te hototahitanga o ngā rauemi tīwiri pereti-iti me te urupare pai ake o te kiko; ② Mā te pumau o te pūnaha whakapiri pereti-tīwiri me te pēhanga i te pito whati ka tata ake te whati ki te whakaiti hanganga, ka mau ake te whakapiri, ā, ka pai ake te whakaora i te whati; ③ Ko te tikanga ka whakaaetia te whakakorikori tinana wawe i muri i te whakapiri pereti-iti, he mea pai ake tēnei mō te whakaora i te mahi a te ringa.
(2) He aha te tikanga pokanga mō ngā pereti iti?
I te nuinga o te wā ka mahia te pokanga i raro i te rongoā ārai poraka o te plexus brachial, ā, me whakamahi he tourniquet hau. Ka tapahia te tuara o ngā phalanges metacarpal, ka tapahia te aponeurosis tuara o ngā matimati, ka whakaurua rānei te uaua interosseous me te wheua metacarpal hei whakaatu i ngā pito whati o ngā wheua metacarpal, phalangeal rānei, ka tihorea te periosteum, ā, ka whakaitihia te whati i raro i te tirohanga tika. He pai ngā pereti tika mō ngā whati whakawhiti o te wāhanga waenga me ngā whati poto whakarara, he pai ngā pereti-T mō te whakapiri i te turanga o te metacarpal me ngā phalanges, ā, he pai ngā pereti-T, ngā pereti-L 120° me te 150° rānei mō te whakapiri i ngā whati roa whakarara me ngā whati pakaru. Ko te tikanga ka whakatakotoria te pereti ki te taha tuara o te wheua hei ārai i te paheke o te uaua me te mau roa, he mea pai mō te whakangungu mahi wawe. Me whakamahi kia rua ngā tīwiri, neke atu rānei, hei whakatika i ngā pito e rua o te whati; ki te kore, kāore e pai te pumau, ā, me whakamahi ngā waea Kirschner, ngā tīwiri rānei i waho o te pereti hei āwhina i te whakatika kia tutuki ai te kaupapa o te whakatika pumau.
3. Ngā tīwiri itiHe rite te pumau o ngā tīwiri iti ki ngā pereti maitai i roto i te whakau i ngā whati porowhita, roa rānei, engari he iti ake te whānuitanga o te tango kiko ngohengohe me te periosteum i tērā o te whakau pereti maitai, he mea pai hei tiaki i te rere toto, ā, e rite ana ki te ariā o te mahi iti rawa te whakaekenga. Ahakoa he pereti momo-T me te momo-L mō ngā whati tata-honohono, he kino ake te whakaoranga o te mahi hononga i muri i te whai muri i te mahi i tērā o ngā whati diaphyseal. He painga anō hoki ō ngā tīwiri iti ki te whakau i ngā whati ā-roto me ngā whati peri-honohono. Ka taea e ngā tīwiri kua whakau ki roto i te wheua cortical te tu atu i te kawenga taumahatanga nui, nō reira he pakari te whakau, ā, ka taea te pēhi i ngā pito whati kia tata ai te mata whati, kia poto ake ai te wā whakaora whati, kia ngāwari ake ai te whakaora i te whati, e whakaaturia ana i te Pikitia 4-18. Ko te whakau ā-roto o ngā whati ringa he tīwiri iti e whakamahia ana mō ngā whati porowhita, porowhita rānei o te diaphyseal me ngā whati avulsion ā-roto o ngā poraka wheua nui ake. Me mārama, ina whakamahia ngā tīwiri iti anake hei whakatika i ngā whati whakarara, porowhita rānei o te wheua diaphyseal o te ringa, me rua te roa o te rārangi whati i te iti rawa o te whānui o te wheua diaphyseal, ā, ina whakatikahia ngā poraka whati kua tangohia i roto i te hononga, me toru te whānui o te poraka wheua i te iti rawa o te whānui o te miro.
4. Kaiwhakatikatika moroiti o waho:He uaua te whakaiti i ngā whati metacarpal phalangeal kua kopikopiko i ētahi wā, kāore rānei e taea te whakatika i roto ahakoa kua tapahia te wheua nā te mea kua pakaru te tautoko wheua. Ka taea e te fixator o waho te whakaora me te pupuri i te roa o te whati kua kopikopiko i raro i te kukume, e mahi ana i te mahi fixing whanaunga. Ka whakanohoia ngā fixator o waho metacarpal phalangeal ki ngā tūranga rerekē: ka whakanohoia ngā metacarpal phalange tuatahi me te tuarua ki te taha radial dorsal, ka whakanohoia ngā metacarpal phalange tuawhā me te tuarima ki te taha ulnar dorsal, ā, ka whakanohoia te metacarpal phalange tuatoru ki te taha radial dorsal, ki te taha ulnar dorsal rānei, e ai ki te āhuatanga. Kia aro ki te pūwāhi weronga ngira hei ārai i te kino o te uaua. Ka taea te whakaiti i ngā whati kua kati i raro i ngā hihi-X. Ki te kore e pai te whakaiti, ka taea te mahi i tētahi tapahi iti hei āwhina i te whakaiti.
He aha ngā painga o ngā taputapu whakatika o waho?
① He māmā noa te mahi, ka taea te whakatika i ngā nekehanga rerekē o ngā pito whati; ② Ka taea te whakaiti me te whakatika i ngā whati hononga-ā-roto o ngā wheua metacarpophalangeal me te kore e kino te mata o te hononga, ā, ka taea te whakararuraru i te mata o te hononga hei ārai i te kukū o te capsule hononga me te ligament collateral; ③ Ina kore e taea te whakaiti i ngā whati pakaru i te āhua tinana, ka taea te whakakotahi me te iti o te whakapiringa ā-roto, ā, ka taea e te whakatikatika o waho te whakaiti me te pupuri i te raina kaha; ④ Tukua ngā mahi whakangungu wawe o te maihao e pāngia ana i roto i te hononga kāore anō kia whakapirihia hei karo i te pakari o te hononga me te osteoporosis; ⑤ Ka taea te whakatika i ngā whati ringa me te kore e pā ki te maimoatanga i muri i te pokanga o te patunga i te ringa e pāngia ana.
Wā tuku: Hakihea-21-2024
