I tēnei wā, mō te whakapiri ā-roto o ngā whati o te radius distal, he maha ngā pūnaha pereti maukati anatomical e whakamahia ana i roto i te whare hauora. He otinga pai ake ēnei whakapiri ā-roto mō ētahi momo whati uaua, ā, i ētahi huarahi ka whānui ake ngā tohu mō te pokanga mō ngā whati radius distal kāore i te pumau, inā koa ko ērā he osteoporosis. Kua whakaputa a Ahorangi Jupiter o te Hōhipera Whānui o Massachusetts me ētahi atu i tētahi raupapa tuhinga ki JBJS mō ā rātou kitenga mō te whakapiri pereti maukati o ngā whati radius distal me ngā tikanga pokanga e pā ana. Ka arotahi tēnei tuhinga ki te huarahi pokanga ki te whakapiri i ngā whati radius distal i runga i te whakapiri ā-roto o tētahi poraka whati motuhake.
Ngā Tikanga Pokanga
Ko te ariā pou-toru, e ahu mai ana i ngā āhuatanga koiora me te hanganga o te radius ulnar distal, te pūtake mō te whanaketanga me te tono haumanu o te pūnaha pereti 2.4mm. Kei te whakaatuhia te wehenga o ngā pou e toru i te Pikitia 1.
Pikitia 1. Ariā pou-toru o te radius ulnar distal.
Ko te pou taha te haurua taha o te radius distal, tae atu ki te fossa navicular me te tuberosity radial, e tautoko ana i ngā wheua carpal i te taha radial, ā, koinei te pūtake o ētahi o ngā hononga e whakau ana i te ringaringa.
Ko te pou waenga ko te haurua waenga o te radius distal, ā, kei roto ko te fossa lunate (e hono ana ki te lunate) me te notch sigmoid (e hono ana ki te ulna distal) i runga i te mata hononga. I te nuinga o te wā, ka utaina te kawenga mai i te fossa lunate ki te radius mā te fossa lunate. Ko te pou taha ulnar, kei roto ko te ulna distal, te cartilage fibrocartilage tapatoru, me te hononga ulnar-radial o raro, ka kawe i ngā kawenga mai i ngā wheua carpal ulnar me te hononga ulnar-radial o raro, ā, he pānga whakaū.
Ka mahia te tikanga i raro i te whakamoenga o te plexus brachial, ā, he mea nui te whakaahua X-ray C-arm i te wā o te pokanga. I tukuna ngā paturopi ā-uaua i te iti rawa 30 meneti i mua i te tīmatanga o te tikanga, ā, i whakamahia he tourniquet hau hei whakaiti i te toto.
Te whakapiri i te pereti nikau
Mō te nuinga o ngā whati, ka taea te whakamahi i te huarahi nikau hei tiro i waenganui i te radial carpal flexor me te radial artery. Whai muri i te tautuhi me te whakahoki i te flexor carpi radialis longus, ka tirohia te mata hohonu o te uaua pronator teres, ā, ka tangohia te wehenga āhua "L". Mō ngā whati uaua ake, ka tukuna pea te uaua brachioradialis hei āwhina i te whakaiti i te whati.
Ka whakaurua he pine Kirschner ki roto i te hononga carpal radial, hei āwhina i te tautuhi i ngā rohe tawhiti rawa o te radius. Mena he iti noa te pakaru i te taha hononga, ka taea te whakatakoto i tētahi pereti maitai nikau 2.4mm ki runga i te taha hononga tawhiti o te radius hei whakapiri. Arā, ka taea te tautoko i tētahi pakaru iti i runga i te mata hononga o te huha lunate e tētahi pereti "L" "T" rānei 2.4mm, e whakaaturia ana i te Pikitia 2.
Mō ngā whati wheua kua nekehia te tuara ki waho o te hononga, he mea āwhina kia mōhio ki ngā kōrero e whai ake nei. Tuatahi, he mea nui kia tautuhia anō te whati mō te wā poto kia kore ai he kiko ngohengohe e piri ana ki te pito whati. Tuarua, mō ngā tūroro kāore he osteoporosis, ka taea te whakaiti i te whati mā te āwhina o tētahi pereti: tuatahi, ka whakanohoia he tīwiri raka ki te pito tawhiti o tētahi pereti anatomical palmar, e mau ana ki te wāhanga whati tawhiti kua nekehia, kātahi ka whakaitihia ngā wāhanga whati tawhiti me te taha tata mā te āwhina o te pereti, ā, hei whakamutunga, ka whakanohoia ētahi atu tīwiri ki te taha tata.
PIKITIA 3 Ka whakaitihia te whati o te radius distal kua nekehia ki tua, ā, ka whakatikahia mā te huarahi nikau. PIKITIA 3-A I muri i te otinga o te whakaaturanga mā te radial carpal flexor me te radial artery, ka whakanohoia he pine Kirschner maeneene ki roto i te hononga radial carpal. Pikitia 3-B Te whakahaere i te metacarpal cortex kua nekehia hei tautuhi anō.
Kua whakatakotoria te pine Kirschner maeneene o te Pikitia 3-C me te Pikitia 3-DA mai i te kakau radial mā te rārangi whati hei whakau i te pito whati mō tētahi wā.
Pikitia 3-E Ka taea te whakaatu tika i te mara pokanga mā te whakamahi i te retractor i mua i te whakatakotoranga o te pereti. Pikitia 3-F Kua whakatakotoria te rarangi tawhiti o ngā tīwiri raka ki te taha o te wheua subchondral i te pito o te kopa tawhiti.
Pikitia 3-G Me whakamahi te whakamātautau hihi-X hei whakaū i te tūranga o te pereti me ngā tīwiri tawhiti. Pikitia 3-H Ko te mea pai, me whai wāhi te wāhanga tata o te pereti (10 nekehanga te koki) mai i te diaphysis kia taea ai te whakapiri i te pereti ki te diaphysis hei tautuhi anō i te poraka whati tawhiti. Pikitia 3-I Whakakīia te tīwiri tawhiti hei whakatū anō i te piko o te nikau o te whati tawhiti. Tangohia te pine Kirschner i mua i te whakakīia katoatia o te tīwiri.
E whakaū ana ngā whakaahua x-ray i te wā o te pokanga kua nekehia te tūranga tinana o te whati, ā, kua pai te whakanoho o ngā tīwiri pereti.
Te Whakamau i te Pereti Tua Ko te huarahi pokanga hei whakaatu i te taha tuara o te radius distal e whakawhirinaki ana ki te momo whati, ā, mēnā he whati e rua, neke atu rānei ngā kongakonga whati o roto i te hononga, ko te whāinga matua o te maimoatanga ko te whakatika i ngā pou radial me ngā pou medial i te wā kotahi. I roto i te pokanga, me tapahi ngā whitiki tautoko extensor i ngā huarahi matua e rua: te taha roa i roto i ngā wāhanga extensor tuarua me tuatoru, me te tapahi i raro i te periosteal ki te wāhanga extensor tuawhā me te whakahoki i te uaua e rite ana; te tapahi tuarua rānei i te whitiki tautoko i waenganui i ngā wāhanga extensor tuawhā me tuarima hei whakaatu motuhake i ngā pou e rua (Pikitia 4).
Ka whakahaeretia te whati, ā, ka whakaukia mō te wā poto ki te pine Kirschner kāore i mirohia, ā, ka tangohia ngā whakaahua ira-X hei whakatau kei te pai te neke o te whati. Muri iho, ka whakauhia te taha dorsal ulnar (pou waenga) o te radius ki te pereti "L" "T" rānei 2.4 mm. Ka hangaia te pereti dorsal ulnar kia piri ai te hononga ki te taha dorsal ulnar o te radius distal. Ka taea hoki te whakanoho i ngā pereti kia tata ki te taha dorsal o te distal lunate, nā te mea ka taea e ngā awaawa e rite ana i raro i ia pereti te piko me te hanga i ngā pereti me te kore e pakaru ngā miro i roto i ngā kōhao tīwiri (Pikitia 5).
He tino māmā te whakau i te pereti pou radial, nā te mea he papatahi te mata o te wheua i waenganui i ngā wāhanga toronga tuatahi me te tuarua, ā, ka taea te whakau i tēnei tūranga mā te whakamahi i tētahi pereti kua tika te āhua. Mena ka whakanohoia te pine Kirschner ki te wāhanga tawhiti rawa o te ngongo radial, he awaawa kei te pito tawhiti o te pereti pou radial e rite ana ki te pine Kirschner, e kore e whakararuraru i te tūranga o te pereti, ā, ka mau tonu te whati ki tōna tūranga (Pikitia 6).
Pikitia 4 Te whakaaturanga o te mata tuarā o te radius distal. Ka whakatuwheratia te whitiki tautoko mai i te tuatoru o ngā wāhanga extensor interosseous, ā, ka hoki whakamuri te uaua extensor hallucis longus.
Pikitia 5 Mō te whakapūmau i te taha tuara o te mata hononga o te huha, ka hangaia te pereti tuara "T" "L" rānei (Pikitia 5-A me te Pikitia 5-B). Kia mau te pereti tuara ki te mata hononga o te huha, ka mau te pereti pou radial (Pikitia 5-C ki te 5-F). Ka whakatakotoria ngā pereti e rua ki te koki 70 nekehanga tetahi ki tetahi hei whakapai ake i te pumau o te whakapūmautanga o roto.
Pikitia 6 Kua tika te hanga o te pereti pou porowhita, ā, kua whakanohoia ki roto i te pou porowhita, me te tohu i te kōhao i te pito o te pereti, e āhei ai te pereti ki te karo i te piri rangitahi o te pine Kirschner me te kore e whakararuraru i te tūranga o te pereti.
Ngā ariā nui
Ngā Tohu mō te Whakapūmau i te Pereti Metacarpal
Ngā whatiwhatinga o roto o te hononga metacarpal kua nekehia (ngā whatiwhatinga o Barton)
ngā whati wheua kua nekehia ki waho o te hononga (ngā whati o Colles me Smith). Ka taea te whakatutuki i te pumau mā te whakamahi i ngā pereti tīwiri ahakoa kei te kitea te osteoporosis.
Ngā whati o te mata hononga metacarpal lunate kua nekehia
Ngā tohu mō te whakapiri i te pereti tuara
Me te whara o te hononga intercarpal
Te whati o te mata o te hononga o te tuarā o muri
Te whati o te hononga carpal radial kua kutikutia ki muri
Ngā ārai ki te whakapiri i te pereti palmar
Te osteoporosis kino me ngā herenga mahi nui
Te whati o te ringaringa radial o muri
Te aroaro o ngā mate hauora maha
Ngā ārai ki te whakapiri i te pereti tuara
He maha ngā mate hauora e pā ana ki ngā hononga
Ngā whati kāore i nekehia
Ngā hapa ngāwari e mahia ana i te whakapiri i te pereti nikau
He mea tino nui te tūnga o te pereti nā te mea ehara i te mea ka tautoko noa te pereti i te papatipu whati, engari mā te tūnga tika ka ārai hoki i te tīwiri raka tawhiti kei uru ki roto i te hononga carpal radial. Mā ngā whakaahua X-ray āta i te wā pokanga, e whakaatahia ana i te ahunga kotahi me te piko radial o te radius tawhiti, ka taea te tiro tika i te mata hononga o te taha radial o te radius tawhiti, ka taea hoki te tiro tika ake mā te whakanoho i ngā tīwiri ulnar ki mua i te wā pokanga.
Ka pā te mōrearea o te uaua toronga ina uru te tīwiri ki te dorsal cortex, ā, ka pakaru te uaua. He rerekē te mahi a ngā tīwiri raka i ngā tīwiri noa, ā, kāore e hiahiatia kia uru te tīwiri ki te dorsal cortex.
Ngā hapa e ngāwari ana te mahi mā te whakapiri i te pereti tuara
He tūponotanga tonu kei uru te tīwiri ki roto i te hononga carpal radial, ā, he rite ki te huarahi kua whakaahuatia i runga ake nei e pā ana ki te pereti nikau, me werohia he tīwiri whakarara hei whakatau mena kei te mau te tūranga o te tīwiri.
Ki te mea ko te whakapiri o te pou radial te mahi tuatahi, ka pāngia te aromatawai o te whakapiringa o muri mai o te mata hononga o te lunate e ngā tīwiri i roto i te ngongo radial.
Ka taea e ngā tīwiri tawhiti kāore i te tīwirihia katoatia ki roto i te kōhao tīwiri te whakakorikori i te uaua, te pakaru rānei o te uaua.
Wā tuku: Hakihea-28-2023
