Te Whati o te Pūtau Distal: He Whakamārama Taipitopito mō ngā Pūkenga Pokanga Whakatikatika ā-Roto. Ngā Pikitia me ngā Kuputuhi o te Sith!

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.

1. Ngā ārai

Ngā tūroro kaumātua kāore e tika ana mō te pokanga.

1. Te whakapiri ā-roto (huarahi volar)

Te whakarite i mua i te pokanga. Ka mahia te rongoā whakamoe mā te whakamahi i te rongoā whakamoe plexus brachial, te rongoā whakamoe whānui rānei.

1). Ka whakatakotoria te tūroro ki runga i te tūnga takoto, me te peka e pāngia ana kua tangohia, ka whakatakotoria ki runga i te anga pokanga. Ka tapahia he 8cm te roa i waenganui i te uaua radial o te ringaringa me te uaua flexor carpi radialis, ka toro atu ki te piko o te ringaringa. Ka taea e tēnei te whakaatu katoa i te whati, ā, ka ārai i te kōpeketanga o te koha. Kāore e hiahiatia kia tae te tapahi ki roto i te nikau o te ringa (Pikitia 1-36A).

2). Whāia te tapahi ki te pūtu uaua o te flexor carpi radialis (Pikitia 1-36B), whakatuwheratia te pūtu uaua, tapahia te fascia bamboo o mua kia kitea ai te flexor pollicis longus, whakamahia te maihao tohu hei whakaatu i te flexor pollicis longus ki te taha ulnar, ka wetekina te flexor pollicis longus. Kua kitea katoatia te puku uaua ki te uaua pronator quadratus (Pikitia 1-36C)

3). Hangaia he tapahi āhua "L" i te taha radial o te radius ki te radial styloid process kia kitea ai te uaua pronator quadratus, kātahi ka tihorea mai i te radius mā te whakamahi i te tīhore hei whakaatu i te rārangi katoa o te whāriki bamboo (Pikitia 1-36D, Pikitia 1-36E)

4). Whakauruhia he maripi tapahi wheua, he maripi iti rānei mai i te rārangi whati, ā, whakamahia hei rīwhi hei whakaiti i te whati. Whakauruhia he maripi tapatapahi wheua, he maripi kutikuti iti rānei puta noa i te rārangi whati ki te taha o te wheua hei whakamama i te pēhanga me te whakaiti i te kongakonga whati tawhiti, ā, whakamahia ngā maihao hei pēhi i te kongakonga whati tuara hei whakaiti i te kongakonga whati tuara.

Ina whati te whati radial styloid, he uaua ki te whakaiti i te whati radial styloid nā te kukume o te uaua brachioradialis. Hei whakaiti i te kaha o te kukume, ka taea te whakahaere, te wehe rānei i te brachioradialis mai i te radius distal. Mena e tika ana, ka taea te whakapiri wā poto i te kongakonga distal ki te kongakonga proximal mā te whakamahi i ngā waea Kirschner.

Mena kua whati, kua nekehia te tukanga styloid ulnar, ā, kāore i te pumau te hononga radioulnar distal, ka taea te whakamahi i tētahi, i ētahi rānei waea Kirschner mō te whakapiringa ā-kiri, ā, ka taea te tautuhi anō i te tukanga styloid ulnar mā te huarahi volar. Ko ngā whati iti ake, kāore e hiahiatia he maimoatanga ā-ringa. Heoi, ki te kore e pumau te hononga radioulnar distal i muri i te whakapiringa o te radius, ka taea te tango i te kongakonga styloid, ā, ka tuituia ngā taha o te matatini fibrocartilage tapatoru ki te tukanga styloid ulnar mā te whakamahi i ngā punga, i ngā miro hiraka rānei.

5). Mā te āwhina o te kukume, ka taea te whakamahi i te kāpū hononga me te hononga hei tuku i te hononga whakararo me te whakaiti i te whati. Kia angitu te whakaiti i te whati, whakatauhia te tūranga o te pereti maitai volar i raro i te arataki a te fluoroscopy hihi-X ka whakapirihia he tīwiri ki roto i te kōhao porotītaha, i te kōhao reti rānei hei whakahaere i te whakatikatika tūranga (Pikitia 1-36F). Whakamahia he kōhao wiri 2.5mm hei keri i waenganui o te kōhao porotītaha, ka whakauru i tētahi tīwiri pato-ā-ringa 3.5mm.

Pikitia 1-36 Tapahi kiri (A); tapahi i te anga o te uaua flexor carpi radialis (B); tihorea tetahi wāhanga o te uaua flexor hei whakaatu i te uaua pronator quadratus (C); wehewehe i te uaua pronator quadratus hei whakaatu i te radius (D); whakaatu i te rārangi whati (E); whakanohohia te pereti volar ka whakawirihia te tīwiri tuatahi (F)
6). Whakamahia te tātaritanga ā-ringa-C hei whakaū i te tūnga tika o te pereti. Mena e tika ana, panaia te pereti ki tawhiti, ki te taha tata rānei kia whiwhi ai i te tūnga pai rawa atu o te tīwiri tawhiti.

7). Whakamahia he wiri 2.0mm hei keri i tētahi kōhao ki te pito tawhiti o te pereti maitai, inehia te hohonutanga, kātahi ka tīwiri i te tīwiri raka. Me poto ake te whao i te tawhiti i inehia kia kore ai te tīwiri e uru, e puta mai rānei i te tuara o te kiri. I te nuinga o te wā, he nui te tīwiri 20-22mm, ā, me poto ake te mea e mau ana ki te tukanga styloid radial. Whai muri i te tīwiri i te tīwiri distal, tīwirihia. Whakauruhia te tīwiri proximal e toe ana.

Nā te mea kua hoahoatia te koki o te tīwiri, ki te tata rawa te pereti ki te pito tawhiti, ka uru te tīwiri ki te hononga o te ringaringa. Tangohia ngā poro tangential o te wheua subchondral articular mai i ngā tūranga coronal me sagittal hei aromatawai mēnā ka uru ki te hononga, kātahi ka whai i ngā tohutohu. Whakatikatikahia ngā pereti maitai me/ngā tīwiri rānei.

(Pikitia1-37) Pikitia 1-37 Te whakau i te whati radius distal me te pereti wheua volar A. Te kiriata hihi-X anteroposterior me te taha o te whati radius distal i mua i te pokanga, e whakaatu ana i te nekehanga o te pito distal ki te taha volar; B. Te kiriata hihi-X anteroposterior me te taha o te whati i muri i te pokanga, e whakaatu ana i te whati He pai te whakaiti me te pai o te ātea o te hononga ringaringa
8). Tuia te uaua pronator quadratus ki ngā tuitui kore-mimiti. Kia mahara kāore te uaua e kapi katoa i te pereti. Me hipoki te wāhanga pito ki raro hei whakaiti i te pa atu i waenga i te uaua piko me te pereti. Ka taea tēnei mā te tuitui i te pronator quadratus ki te taha o te brachioradialis, ka kati i te tapahi papatahi i te papatahi, ā, ka whakapiri ki te pāreti mēnā e tika ana.