Ko ngā whati o te humerus i runga i te pane o te hope ko tētahi o ngā whati tino noa i roto i ngā tamariki, ā, ka puta i te hononga o te humerus me te hope.te humerus condyle.
Ngā Whakaaturanga Hauora
Ko ngā whati o te humerus i runga i te tūru o runga o te humerus he mea noa ki ngā tamariki, ā, ka puta pea te mamae ā-rohe, te pupuhi, te ngawari, me te kore mahi i muri i te whara. Kāore he tohu mārama mō ngā whati kāore i nekehia, ā, ko te putanga o te tuke pea te tohu haumanu anake. Ko te kāpū hononga i raro i te uaua tuke te mea tino papaku, te wāhi e taea ai te pā ki te kāpū hononga ngohengohe, e mōhiotia ana ko te ira ngohengohe, i te wā e puta ai te putanga o te hononga. Ko te pūwāhi ngāwari kei mua i te rārangi e hono ana i te pokapū o te pane radial ki te pito o te olecranon.
Mō te whati momo III o te supracondylar, e rua ngā āhua piko o te tuke, e āhua rite ana ki te S. He maha ngā wā ka kitea he maru i raro i te kiri i mua o te ringa o runga, ā, ki te nekehia rawatia te whati, ka uru te pito tawhiti o te whati ki te uaua brachialis, ā, ka nui ake te toto i raro i te kiri. Nō reira, ka puta he tohu pūkohu i mua o te tuke, e tohu ana i te puta o te wheua e tata ana ki te whati e uru ana ki te kiri. Ki te haere tahi me te whara o te io radial, ka iti pea te toronga o te koromatua; ka kore pea e taea e te koromatua me te maihao tohu te piko i te whara o te io waenga; ka iti pea te wehenga o ngā maihao me te hononga o ngā matimati i te whara o te io ulnar.
Tātaritanga
(1) Pūtake Tātaritanga
①He hītori whara tōu; ②Ngā tohu me ngā tohu haumanu: te mamae ā-rohe, te pupuhi, te ngawari me te kore mahi tika; ③E whakaatu ana te hihi-X i te rārangi whati supracondylar me ngā kongakonga whati kua nekehia o te humerus.
(2) Te Tātaritanga Rerekētanga
Me aro nui ki te tautuhi i ngāte nekenekehanga o te tuke, engari he uaua te tautuhi i ngā whati toronga o te supracondylar mai i te nekehanga o te tuke. I roto i te whati supracondylar o te humerus, ka mau tonu te hononga anatomical noa o te epicondyle o te humerus ki te olecranon. Heoi, i roto i te nekehanga o te tuke, nā te mea kei muri te olecranon i te epicondyle o te humerus, he nui ake te kitea. Ki te whakatauritea ki ngā whati supracondylar, ko te kitea o te ringaringa i roto i te nekehanga o te tuke he tawhiti ake. Ko te aroaro, te ngaro rānei o ngā wheua ka whai wāhi anō hoki ki te tautuhi i ngā whati supracondylar o te humerus mai i te nekehanga o te hononga tuke, ā, he uaua i ētahi wā ki te whakaputa i ngā wheua. Nā te pupuhi me te mamae nui, ko ngā mahi e whakaoho ana i ngā wheua ka tangi ai te tamaiti. Nā te mōrearea o te kino o te pūnaha io. Nō reira, me karo i ngā mahi e whakaoho ana i ngā wheua ka pakaru. Ka taea e te whakamātautau hihi-X te āwhina ki te tautuhi.
Momo
Ko te whakarōpūtanga paerewa o ngā whati o te humerus supracondylar ko te wehewehe i a rātou ki te toronga me te piko. He onge te momo piko, ā, e whakaatu ana te hihi-X taha kei mua i te kakau humerus te pito tawhiti o te whati. He mea noa te momo tika, ā, e wehewehea ana e Gartland ki te momo I ki te III (Ripanga 1).
| Momo | Ngā Whakaaturanga Hauora |
| Momo ⅠA | Ngā whati kāore he nekehanga, he hurihanga, he valgus rānei |
| Momo ⅠB | Nekehanga ngawari, te rere o te cortical medial, te raina rohe o mua o te humerus mā roto i te pane o te humerus |
| Momo ⅡA | Te toronga nui, te pumau o te cortical o muri, te pane o te humerus i muri i te raina rohe o mua o te humerus, kāore he hurihanga |
| Momo ⅡB | Te nekehanga whakaroa, te nekehanga hurihuri rānei me te pānga ā-wāhanga ki ia pito o te whati |
| Momo ⅢA | Nekehanga katoa ki muri, kāore he pānga o te cortical, ko te nuinga he nekehanga kei tawhiti ki te medial o muri. |
| Momo ⅢB | Te nekehanga mārama, te kiko ngohengohe kua mau ki te pito whati, te taupatupatu nui, te nekehanga hurihuri rānei o te pito whati |
Ripanga 1 Te whakarōpūtanga Gartland o ngā whati o te humerus supracondylar
Maimoatanga
I mua i te maimoatanga tino pai, me whakau te hononga tuke mō te wā poto ki te tūranga piko 20° ki te 30°, he mea e kore e pai anake mō te tūroro, engari ka whakaitihia hoki te pehanga o ngā hanganga io-toto.
(1) Momo I ngā whati o te humerus supracondylar: me whakamahi noa he maka paraikete, he maka rānei hei whakapiri i waho, i te nuinga o te wā ka piko te tuke 90°, ā, ka hurihia te ringa o te ringa ki te tūranga kūpapa, ka whakamahia he maka ringa roa hei whakapiri i waho mō te 3 ki te 4 wiki.
(2) Ngā whati o te humerus supracondylar momo II: Ko te whakaiti ā-ringa me te whakatikatika i te hyperextension me te angulation o te tuke ngā take matua i roto i te maimoatanga o tēnei momo whati. °) Ka mau tonu te tūranga o te fixation i muri i te whakaiti, engari ka whakanui ake i te mōrearea o te whara neurovascular o te peka e pāngia ana me te mōrearea o te acute fascial compartment syndrome. Nō reira, ko te percutaneousTe whakapiri waea KirschnerHe pai ake i muri i te whakaitinga katia o te whati (Pikitia 1), kātahi ka whakapirihia ki waho mā te whakamahi i te raima parai ki tētahi tūranga haumaru (piko tuke 60°).
Pikitia 1 Whakaahua o te whakapiringa waea Kirschner ki te kiri
(3) Ngā whati o te humerus supracondylar Momo III: Ka whakaitihia ngā whati katoa o te humerus supracondylar momo III mā te whakapiripiri waea Kirschner ā-kiri, koinei te maimoatanga paerewa mō ngā whati o te supracondylar momo III. I te nuinga o te wā ka taea te whakapiripiri kati me te whakapiripiri waea Kirschner ā-kiri, engari me whakapiripiri tuwhera mēnā kāore e taea te whakaiti i te whakaurunga kiko ngohengohe i te taha tinana, mēnā rānei he whara o te uaua brachial (Pikitia 2).
Pikitia 5-3 Ngā kiriata hihi-X i mua i te pokanga me muri i te pokanga o ngā whati o te humerus supracondylar
E whā ngā huarahi pokanga hei whakaiti tuwhera i ngā whati o te hope o te humerus: (1) te huarahi taha o te tuke (tae atu ki te huarahi anterolateral); (2) te huarahi taha o te tuke; (3) te huarahi taha me te taha o te tuke; me te (4) te huarahi taha o muri o te tuke.
He pai ngā painga o te huarahi tuke taha me te huarahi waenga, arā, he iti ake te pakaru o te kiko, he māmā hoki te hanganga tinana. He haumaru ake te tapahi waenga i te tapahi taha, ā, ka taea te ārai i te kino o te io ulnar. Ko te ngoikoretanga, kāore e taea e tētahi o rāua te kite tika i te whati o te taha taha o te tapahi, ā, ka taea anake te whakaiti me te whakatika mā te pā atu ki te ringa, e hiahia ana kia nui ake te tikanga pokanga mō te kaiwhakahaere. He tautohenga te huarahi tuke o muri nā te mea kua pakaru te kaha o te uaua triceps, ā, he nui ake te kino. Mā te huarahi whakakotahi o ngā tuke waenga me ngā tuke taha ka taea te whakaea te ngoikoretanga o te kore e taea te kite tika i te mata wheua taha o te tapahi. He pai ngā painga o ngā tapahi tuke waenga me ngā tuke taha, he pai ki te whakaiti me te whakau i te whati, ā, ka taea te whakaiti i te roa o te tapahi taha. He pai ki te whakaora me te mimiti i te pupuhi kiko; engari ko tōna ngoikoretanga he whakanui ake i te tapahi pokanga; he teitei ake hoki i te huarahi o muri.
Ngā raruraru
Ko ngā raruraru o ngā whati o te humerus supracondylar ko: (1) te whara neurovascular; (2) te mate septal acute; (3) te pakari o te tuke; (4) te myositis ossificans; (5) te avascular necrosis; (6) te cubitus varus deformity; (7) te cubitus valgus deformity.
Whakarāpopototia
Ko ngā whati o te humerus o runga i te pane o te humerus tētahi o ngā whati tino kitea i roto i ngā tamariki. I ngā tau tata nei, kua arohia te aro o te tangata ki te whakaiti iti o ngā whati o runga i te pane o te humerus. I mua, i whakaarohia ko te cubitus varus, te cubitus valgus rānei, nā te aukati i te tipu o te pereti epiphyseal o te humerus o tawhiti, kaua ko te whakaiti iti. Ko te nuinga o ngā taunakitanga kaha e tautoko ana ināianei ko te whakaiti iti o te whati he mea nui ki te āhua o te cubitus varus. Nō reira, ko te whakaiti i ngā whati o te humerus o runga i te pane o te humerus, te whakatikatika i te nekehanga o te ulnar, te hurihanga whakapae me te whakahoki mai i te teitei o te humerus o tawhiti ngā mea nui.
He maha ngā tikanga maimoatanga mō ngā whati supracondylar o te humerus, pērā i te whakaiti ā-ringa + te whakapiri o wahome te whakarewa paraikete, te kume olecranon, te whakapiringa o waho me te whitiki, te whakaiti tuwhera me te whakapiringa o roto, me te whakaiti kati me te whakapiringa o roto. I mua, ko te whakaiti manipulative me te whakapiringa o waho paraikete ngā maimoatanga matua, ā, i pūrongohia ko te cubitus varus i tae ki te 50% i Haina. I nāianei, mō ngā whati supracondylar momo II me te momo III, kua waiho te whakapiringa ngira percutaneous i muri i te whakaiti i te whati hei tikanga e whakaaetia whānuitia ana. He painga ōna, arā, kāore e whakangaro i te rere o te toto, ā, ka tere te whakaora o te wheua.
He rerekē anō hoki ngā whakaaro mō te tikanga me te maha pai o te whakapiri waea Kirschner i muri i te whakaitinga kati o ngā whati. Ko te wheako o te ētita me wehewehe ngā waea Kirschner tetahi ki tetahi i te wā e whakapirihia ana. Ko te tawhiti atu o te papa whati, ko te pumau ake. Kaua ngā waea Kirschner e whiti i te papa whati, ki te kore, kāore e taea te whakahaere i te hurihanga, ā, ka kore e pumau te whakapiri. Me tūpato kia kore ai e pakaru te io ulnar i te wā e whakamahi ana i te whakapiri waea Kirschner waenga. Kaua e mirohia te ngira i te tūranga piko o te tuke, whakatikatika paku te tuke kia taea ai e te io ulnar te neke whakamuri, pā atu ki te io ulnar ki te koromatua ka pana whakamuri ka miro haumaru i te waea-K. Ko te whakamahinga o te whakapiri ā-roto waea Kirschner kua whiti he painga pea ki te whakaora mahi i muri i te pokanga, te tere whakaora whati, me te tere pai o te whakaora whati, he mea pai ki te whakaora wawe i muri i te pokanga.
Wā tuku: Whiringa-ā-rangi-02-2022
