1. Ngā Tohu
1). He mārama te nekehanga o ngā whati pakaru kino, ā, ka pakaru te mata hononga o te radius distal.
2). I rahua te whakaiti ā-ringa, i rahua rānei te pupuri i te whakaiti e te whakapiringa o waho.
3). Ngā whati tawhito.
4). He whati wheua, he whati hononga rānei. Kei te kāinga, kei tāwāhi hoki te wheua.
2. Ngā Āraitanga
Ngā tūroro kaumātua kāore e tika ana mō te pokanga.
3. Tikanga pokanga whakapiri o waho
1. Kaiwhakatikatika o waho whakawhiti-hononga hei whakatika i ngā whati o te radius distal
Te tūranga me te whakarite i mua i te pokanga:
· Te rongoā whakangote plexus brachial
·Tū takoto kau ana me te waewae e pāngia ana kia papatahi ki runga i te whāriki mārama i te taha o te moenga
·Whakapirihia he tourniquet ki te 1/3 o te ringa o runga
·Te tirotiro tirohanga
Tikanga Pokanga
Te Whakaurunga o te Tīwiri o te Pona:
Kei te pūtake o te wheua metacarpal tuarua te tīwiri tuatahi. Ka tapahia he kiri i waenganui i te uaua extensor o te maihao tohu me te uaua interosseous dorsal o te wheua tuatahi. Ka wehea māriretia te kiko ngohengohe ki te kuku pokanga. Ka tiakina e te ringaringa te kiko ngohengohe, ā, ka whakaurua he tīwiri Schanz 3mm. Ngā tīwiri
Ko te ahunga o te tīwiri he 45° ki te papa o te nikau, ka taea rānei te whakarara ki te papa o te nikau.
Whakamahia te aratohu hei tīpako i te tūranga o te tīwiri tuarua. I werohia he tīwiri tuarua 3mm ki roto i te metacarpal tuarua.
Kaua te whānui o te pine whakapiri o te metacarpal e neke ake i te 3mm. Kei te 1/3 tata te pine whakapiri. Mō ngā tūroro e pāngia ana e te osteoporosis, ka taea e te tīwiri tata rawa te uru ki ngā paparanga e toru o te cortex (te wheua metacarpal tuarua me te haurua cortex o te wheua metacarpal tuatoru). Mā tēnei, ka whakanuia e te tīwiri te pumau o te pine whakapiri.
Te whakatakotoranga o ngā tīwiri porowhita:
Tapahia he kiri ki te taha taha o te radius, i waenganui i te uaua brachioradialis me te uaua extensor carpi radialis, 3cm i runga ake i te pito tata o te rārangi whati, ā, tata ki te 10cm i te taha tata ki te hononga o te ringaringa, ka whakamahia he hemostat hei wehe mārire i te kiko o raro ki te mata o te wheua. Me āta tiaki i ngā peka o waho o te io radial e haere ana i tēnei wāhi.
I te papa kotahi me ngā tīwiri metacarpal, e rua ngā tīwiri Schanz 3mm i whakatakotoria i raro i te arataki o te aratohu kiko ngohengohe tiaki ringaringa.
·.Te whakaiti me te whakapiri i te whati:
·.Whakaiti ā-ringa te kume me te tirotiro i te ringa-C hei tirotiro i te whakaitinga o te whati.
·.Nā te whakapiripiri o waho puta noa i te hononga o te ringaringa ka uaua te whakahoki katoa i te koki piko o te nikau, nō reira ka taea te whakakotahi me ngā pine Kapandji hei āwhina i te whakaiti me te whakapiripiri.
·.Mō ngā tūroro he whati radial styloid, ka taea te whakamahi i te whakapiri waea radial styloid Kirschner.
·.Me te pupuri tonu i te whakaiti, honoa te pūmau o waho ka whakanoho i te pokapū hurihuri o te pūmau o waho ki te tuaka kotahi me te pokapū hurihuri o te hononga o te ringaringa.
·.Mā te tirotiro i te fluoroscopy anteroposterior me te lateral, tirohia mēnā kua whakahokia mai te roa o te radius, te koki piko o te nikau me te koki pekapeka o te ulnar, ka whakatikahia te koki whakapiri kia pai ra ano te whakaiti i te whati.
·. Kia tūpato ki te kukume ā-motu o te taputapu whakatika o waho, ka puta ai ngā whati iatrogenic i ngā tīwiri metacarpal.
Te whati o te radius distal me te wehenga o te hononga distal radioulnar (DRUJ):
·.Ka taea te whakaiti i te nuinga o ngā DRUJ i muri i te whakaiti i te radius distal.
·.Mēnā kei te wehea tonu te DRUJ i muri i te whakaitinga o te radius distal, whakamahia te whakaiti pēhanga ā-ringa, ā, whakamahia te whakapiri tokotoko taha o te whāriki o waho.
·.Mā te whakamahi rānei i ngā waea-K hei wero i te DRUJ i te tūranga kūpapa, i te tūranga piko paku rānei.
Te whati o te radius distal me te whati o te ulnar styloid: Tirohia te pumau o te DRUJ i te pronation, te neutral me te supination o te ringaringa. Mena he kore pumau, ka taea te whakamahi i te āwhina whakapiri ki ngā waea Kirschner, te whakatika i te hononga TFCC, te mātāpono whitiki tārewa rānei hei whakapiri i te tukanga ulnar styloid.
Āta karohia te kukume nui rawa:
· Tirohia mēnā ka taea e ngā maihao o te tūroro te mahi i ngā nekehanga piko me te toronga katoa me te kore e kitea he pēhanga; whakatairitea te wāhi hononga radiolunate me te wāhi hononga midcarpal.
·Tirohia mēnā he kikī rawa te kiri i te awa o ngā maikuku. Ki te kikī rawa, tapahia he wahi tika hei karo i te mate.
·Whakatenatenahia ngā tūroro kia neke wawe i ō rātou maihao, inā koa ko te piko me te toronga o ngā hononga metacarpophalangeal o ngā maihao, te piko me te toronga o te koromatua, me te tango.
2. Te whakatika i ngā whati o te radius distal mā te whakamahi i tētahi taputapu whakatika o waho kāore e whiti i te hononga:
Te tūranga me te whakaritenga i mua i te pokanga: Pērā i mua.
Ngā Tikanga Pokanga:
Ko ngā wāhi haumaru mō te whakatakotoranga K-wire ki te taha tuara o te radius distal ko: i ngā taha e rua o te tubercle a Lister, i ngā taha e rua o te uaua extensor pollicis longus, me waenganui i te uaua extensor digitorum communis me te uaua extensor digiti minimi.
Pērā anō, i whakanohoia ngā tīwiri Schanz e rua ki te kakau radial, ā, i honoa ki tētahi tokotoko hono.
Mā roto i te rohe haumaru, i whakaurua ngā tīwiri Schanz e rua ki roto i te kongakonga whati radius distal, tētahi mai i te taha radial, tētahi mai i te taha dorsal, me te koki o te 60° ki te 90° tetahi ki tetahi. Me pupuri e te tīwiri te cortex contralateral, ā, me mōhio kāore e taea e te pito o te tīwiri i whakaurua ki te taha radial te haere mā roto i te notch sigmoid ka tomo ki te hononga radioulnar distal.
Āpitihia te tīwiri Schanz ki te pūtoro tawhiti mā te whakamahi i tētahi hononga piko.
Whakamahia he tokotoko hononga waenga hei hono i ngā wāhanga whati e rua, ā, kia tūpato kei raka te pūwero mō te wā poto. Mā te awhina o te hononga waenga, ka whakaitihia te kongakonga pito.
Kia tautuhia anō, rakahia te pūwero i runga i te tokotoko hono hei whakaoti i te mahi whakamutungate whakapūmau
Ko te rerekētanga i waenga i te whakatikatika o waho hononga kore-whānui me te whakatikatika o waho hononga-whiti:
Nā te mea ka taea te whakanoho i ngā tīwiri Schanz maha hei whakaoti i te whakaiti me te whakapiri i ngā kongakonga wheua, he whānui ake ngā tohu pokanga mō ngā whakatikatika o waho kāore e honoa ki te hononga i ērā mō ngā whakatikatika o waho whakawhiti-hononga. Haunga ngā whati i waho o te hononga, ka taea hoki te whakamahi mō ngā whati tuarua ki te tuatoru. He whati wāhanga i roto i te hononga.
Ka whakatikahia te hononga o waho whakawhiti-hononga e te hononga ringaringa, ā, kāore e āhei te whakakorikori tinana wawe, ko te whakakorikori tinana kore-whakawhiti ia ka āhei te whakakorikori tinana wawe i te hononga ringaringa i muri i te pokanga.
Wā tuku: Hepetema-12-2023
