Whati whakawhiti me te iti, te kore rānei o te whati: mēnā he whati o te wheua metacarpal (kaki, diaphysis rānei), me tīmata anō mā te kukume ā-ringa. Ka piko te phalanx proximal kia kitea te pane o te metacarpal. Ka tapahia he tapahi whakawhiti 0.5-1 cm, ā, ka hoki whakamuri te uaua extensor ki te raina waenga. I raro i te arataki fluoroscopic, i whakauruhia he waea arataki 1.0 mm i te tuaka roa o te ringaringa. I whakapōturitia te pito o te waea arataki kia kore ai e uru te cortical me te whakahaere i te reti ki roto i te awa medullary. I muri i te whakatau i te tūranga o te waea arataki mā te fluoroscopic, ka hurihia te pereti wheua subchondral mā te whakamahi i te mata wiri tuwhera anake. I tatauhia te roa o te tīwiri e tika ana mai i ngā whakaahua i mua i te pokanga. I te nuinga o ngā whati metacarpal, haunga te tuarima o te metacarpal, ka whakamahia e mātou he tīwiri 3.0-mm te whānui. I whakamahia e mātou ngā tīwiri kore-upoko AutoFIX (little Bone Innovations, Morrisville, PA). Ko te roa mōrahi o te tīwiri 3.0-mm he 40 mm. He poto ake tēnei i te roa toharite o te wheua metacarpal (tata ki te 6.0 cm), engari he roa hei whakauru i ngā miro ki te medulla kia mau ai te tīwiri. He nui te whānui o te kōhao medullary o te tuarima o ngā metacarpal, ā, i konei i whakamahia e mātou he tīwiri 4.0 mm me te whānui mōrahi tae atu ki te 50 mm. I te mutunga o te tikanga, ka whakarite mātou kia tanumia katoatia te miro caudal ki raro i te rārangi kiriuhi. I tua atu, he mea nui kia kaua e whakatōkia te prosthesis ki te hohonu rawa, inā koa i roto i te take o ngā whati kaki.
Pikitia 14 I roto i te A, kāore te whati kaki noa e pakaru, ā, he iti noa te hohonutanga e hiahiatia ana mō te pane nā te mea ka pēhia te cortex B.
He rite tonu te huarahi pokanga mō te whati whakawhiti o te phalanx proximal (Pikitia 15). I tapahia e mātou he tapahi whakawhiti 0.5 cm te roa ki te pane o te phalanx proximal i a mātou e piko ana i te hononga interphalangeal proximal. I wehea ngā uaua, ā, i hoki whakamuri kia roa ai te wā kia kitea ai te pane o te phalanx proximal. Mō te nuinga o ngā whati o te phalanx proximal, ka whakamahia e mātou he tīwiri 2.5 mm, engari mō ngā phalanx nui ake ka whakamahia e mātou he tīwiri 3.0 mm. Ko te roa mōrahi o te CHS 2.5 mm e whakamahia ana i tēnei wā ko te 30 mm. Ka tūpato mātou kia kaua e tino whakakīkī i ngā tīwiri. Nā te mea he wiri-ā-koe ngā tīwiri, he pato-ā-koe anō hoki, ka taea e rātou te uru ki te turanga o te phalanx me te iti o te ātete. I whakamahia he tikanga rite mō ngā whati phalangeal midphalangeal, me te tapahi ka tīmata i te pane o te phalanx midphalangeal kia taea ai te whakanoho whakamuri o ngā tīwiri.
Pikitia 15 Tirohanga ā-tinana o te kēhi phalanx whakawhiti. I whakanohoia he waea ārahi AA 1-mm mā roto i tētahi tapahi whakawhiti iti i te taha roa o te phalanx proximal. B I whakanohoia te waea ārahi kia taea ai te whakatikatika i te nekehanga me te whakatikatika i ngā hurihanga katoa. Kua whakaurua te CA 2.5-mm CHS, ā, kua tanumia ki roto i te pane. Nā te āhua motuhake o ngā phalanges, ka taea e te pēhanga te wehewehe i te metacarpal cortex. (Ko te tūroro kotahi i te Pikitia 8)
Ngā whati whati: ko te kore tautoko o te pēhanga i te wā e whakaurua ana te CHS ka arahi pea ki te whakapoto i ngā metacarpal me ngā phalanges (Pikitia 16). Nō reira, ahakoa te mea e āraia ana te whakamahinga o te CHS i roto i ēnei take, kua kitea e mātou he otinga mō ngā āhuatanga e rua e tino kitea ana e mātou.
PIKITIA 16 AC Mena kāore te whati i tautokona ki te taha cortical, mā te whakau i ngā tīwiri ka hinga te whati ahakoa te whakaiti katoa.D Ngā tauira noa mai i te raupapa a ngā kaituhi e pā ana ki ngā take o te whakapoto rawa (5 mm). Ko te rārangi whero e pā ana ki te rārangi metacarpal.
Mō ngā whati o te waewae raro-metacarpal, ka whakamahia e mātou he tikanga whakarerekētia i runga i te ariā hoahoa o te tautoko (arā, ngā huānga hanganga e whakamahia ana hei tautoko, hei whakakaha rānei i tētahi anga mā te ātete i te pēhanga roa, ā, nā reira ka tautokona). Mā te hanga i tētahi āhua-Y me ngā tīwiri e rua, kāore te pane o te waewae-metacarpal e hinga; i tapaina e mātou tēnei ko te tautoko āhua-Y. Pērā i te tikanga o mua, ka whakauruhia he waea arataki roa 1.0 mm me te pito pūkohu. I te pupuri i te roa tika o te waewae-metacarpal, ka whakauruhia tētahi atu waea arataki, engari i te koki ki te waea arataki tuatahi, ā, nā reira ka hangaia he hanganga tapatoru. I whakawhanuitia ngā waea arataki e rua mā te whakamahi i tētahi totohu ārahi hei whakawhanui i te medulla. Mō ngā tīwiri tuaka me ngā tīwiri whakarara, ka whakamahia e mātou he tīwiri 3.0 mm me te 2.5 mm te whānui. Ka whakauruhia tuatahitia te tīwiri tuaka kia taurite te miro hiku ki te kiriuhi. Kātahi ka whakauruhia he tīwiri taurite te roa. Nā te mea kāore i te nui te wāhi i roto i te awaawa medullary mō ngā tīwiri e rua, me tatau marie te roa o ngā tīwiri whakarara, ā, me tāpiri noa ngā tīwiri tuaka ki ngā tīwiri tuaka ina tanumia rawatia ki roto i te pane o te metacarpal kia pai ai te pumau me te kore e puta te tīwiri. Kātahi ka nekehia te tīwiri tuatahi ki mua kia tanumia katoatia. Mā tēnei ka ārai i te whakapoto tuaka o te metacarpal me te hinga o te pane, ka taea te ārai mā ngā tīwiri whakarara. Ka whakahaerehia e mātou he whakamātautau fluoroscopic auau kia kore ai e hinga, ā, kia mau tonu ngā tīwiri ki roto i te awaawa medullary (Pikitia 17).
Pikitia 17 Hangarau AC Y-bracket
I te pānga o te kominution ki te cortex dorsal i te turanga o te proximal phalanx, i hangaia e mātou he tikanga whakarerekē; i tapaina e mātou ko te axial bracing nā te mea he kurupae te tīwiri i roto i te phalanx. Whai muri i te tautuhi anō i te proximal phalanx, i whakaurua te waea ārahi axial ki roto i te awa medullary kia tino taea. Kātahi ka whakaurua he CHS he poto ake i te roa katoa o te phalanx (2.5, 3.0 mm rānei) kia tae rā anō tōna pito o mua ki te pereti subchondral i te turanga o te phalanx. I tēnei wā, ka mau ngā miro caudal o te tīwiri ki roto i te awa medullary, ā, ka mahi hei tautoko ā-roto, hei tautoko hoki i te turanga o te phalanx. Me maha ngā whakamātautau fluoroscopic hei ārai i te urunga o te hononga (Pikitia 18). I runga i te tauira whati, me whakamahi pea ētahi atu tīwiri, ngā huinga taputapu whakapiri ā-roto rānei (Pikitia 19).
Pikitia 19: Ngā tikanga rerekē mō te whakapiri i ngā tūroro he whara kuru. He whati nui o te maihao mowhiti, he pakaru iti, he nekehanga whakakotahi o te turanga o te maihao waenga (he pere kōwhai e tohu ana ki te rohe o te whati pakaru).B I whakamahia te CHS paerewa 3.0 mm o te maihao tohu, te paracentesis 3.0 mm o te maihao waenga pakaru, te tautoko-y o te maihao mowhiti (me te tāpiri kotahi-wāhanga o te hapa), me te CHS 4.0 mm o te maihao pinky.F I whakamahia ngā papaki kore utu mō te hipoki kiko ngohengohe.C Ngā whakaahua X-ray i te 4 marama. Kua ora te wheua metacarpal o te maihao iti. I puta ētahi papaki wheua ki hea atu, e tohu ana i te whakaora tuarua o te whati.D Kotahi tau i muri i te aituā, i tangohia te papaki; ahakoa kāore he tohu, i tangohia he tīwiri mai i te metacarpal o te maihao mowhiti nā te mea i whakapaetia he urunga ki roto i te hononga. I te haerenga whakamutunga, i kitea ngā hua pai (≥240° TAM) i ia maihao. I kitea ngā panonitanga o te hononga metacarpophalangeal o te maihao waenga i te 18 marama.
Pikitia 20 A Te whati o te maihao tohu me te toronga ā-roto-honohono (e whakaaturia ana e ngā pere), i hurihia hei whati māmā ake mā te B te whakapiringa rangitahi o te whati hononga mā te whakamahi i te waea-K.C Nā tēnei i hanga he turanga pumau i whakaurua ai he tīwiri roa tautoko.D Whai muri i te whakapiringa, i whakatauhia he pumau te hanganga, e āhei ai te nekehanga kaha tonu.E,F Te whānuitanga o te nekehanga i te 3 wiki (ngā pere e tohu ana i ngā wāhi whakauru o ngā tīwiri turanga)
Pikitia 21 Ngā whakaahua X-ray orthostatic o muri me te taha B o te tūroro A. I rongoatia ngā whati whakawhiti e toru o te tūroro (i ngā pere) ki ngā tīwiri cannulated 2.5-mm. Kāore i kitea he huringa nui i roto i ngā hononga interphalangeal i muri i ngā tau e 2.
Wā tuku: Hepetema-18-2024
