I tēnei wā, he maha ngā huarahi e rongoatia ai ngā whati o te radius distal, pērā i te whakapiri i te pāreti, te tapahi me te whakaiti i te whakapiri o roto, te whāriki whakapiri o waho, me ētahi atu. I roto i ēnei, ka taea e te whakapiri pereti nikau te whakatutuki i ngā hua pai ake, engari e kī ana ētahi tuhinga he teitei ake te tere o te raruraru ki te 16%. Heoi, ki te whiriwhiria tika te pereti, ka taea te whakaiti i te tere o te raruraru. Ka whakaatuhia he tirohanga poto mō ngā momo, ngā tohu me ngā tikanga pokanga o te whakapiri nikau mō ngā whati radius distal.
I. Ngā momo whati o te radius distal
He maha ngā pūnaha whakarōpūtanga mō ngā whati, tae atu ki te whakarōpūtanga Müller AO i runga i te hanganga tinana me te whakarōpūtanga Femandez i runga i te tikanga o te whara. I roto i ēnei, ka whakakotahi te whakarōpūtanga Eponymic i ngā painga o ngā whakarōpūtanga o mua, ka kapi i ngā momo whati matua e whā, ā, kei roto ko ngā whati Maleon 4-wāhanga me ngā whati Chaffer, he aratohu pai ēnei mō ngā mahi haumanu.
1. Whakarōpūtanga AO a Müller - ngā whati ā-roto-hononga wāhanga
He tino pai te whakarōpūtanga AO mō ngā whati hononga tawhiti, ā, e toru ngā momo matua: momo A whati hononga-kore, momo B whati hononga-wāhanga, me te momo C whati hononga katoa. Ka wehea anō ia momo ki ngā huinga rōpū iti rerekē i runga i te kaha me te uaua o te whati.
Momo A: Whati o waho o te hononga
A1, whati o te femur ulnar, te whara o te radius (A1.1, whati o te kakau ulnar; A1.2 whati māmā o te diaphysis ulnar; A1.3, whati kopikopiko o te diaphysis ulnar).
A2, Whati o te pūtoro, māmā, me te whakaurunga (A2.1, pūtoro kāore he piko; A2.2, piko tuara o te pūtoro, arā, whati Pouteau-Colles; A2.3, piko nikau o te pūtoro, arā, whati Goyrand-Smith).
A3, Whati o te pūtoro, pakarukaru (A3.1, whakapoto tuaka o te pūtoro; A3.2 wāhanga porowhita o te pūtoro; A3.3, whati pakarukaru o te pūtoro).
Momo B: whati hononga wāhanga
B1, whati o te radius, papa sagittal (B1.1, momo taha māmā; B1.2, momo taha kominiti; B1.3, momo waenga).
B2, Whati o te taha tuara o te radius, arā, te whati o Barton (B2.1, momo māmā; B2.2, whati taha taha whakarara whakakotahi; B2.3, whati tuara whakakotahi o te ringaringa).
B3, Whati o te taha metacarpal o te radius, arā, he whati anti-Barton, he whati Goyrand-smith momo II rānei (B3.1, ture femur māmā, kongakonga iti; B3.2, whati māmā, kongakonga nui; B3.3, whati kopikopiko).
Momo C: whati hononga katoa
C1, whati radial me te momo ngāwari o ngā mata hononga me ngā mata metaphyseal (C1.1, whati hononga waenga o muri; C1.2, whati sagittal o te mata hononga; C1.3, whati o te mata koronal o te mata hononga).
C2, Whati o te radius, taha hononga māmā, metaphysis pakaru (C2.1, whati sagittal o te taha hononga; C2.2, whati o te taha korona o te taha hononga; C2.3, whati o te hononga e toro atu ana ki te kakau radial).
C3, whati radial, pakaru kōpikopiko (C3.1, whati māmā o te metaphysis; C3.2, whati kōpikopiko o te metaphysis; C3.3, whati hononga e toro atu ana ki te kakau radial).
2. Te whakarōpūtanga o ngā whati o te radius distal.
E ai ki te tikanga o te whara, ka taea te wehewehe i te whakarōpūtanga Femandez ki ngā momo e rima:
Ko ngā whati momo I he whati komukumuku metaphyseal i waho o te hononga pērā i te whati Colles (koki tuara) te whati Smith rānei (koki metacarpal). Ka whati te cortex o tetahi wheua i te taumahatanga, ā, ka komukumuku te cortex contralateral, ka mau ki roto.
Whati
Ko ngā whati momo III he whati hononga-roto, i puta mai i te ahotea kutikuti. Kei roto i ēnei whati ko ngā whati o te nikau o Barton, ngā whati o te tuara o Barton, me ngā whati o te kakau radial.
ahotea kutikuti
Ko ngā whati momo III he whati o roto i te hononga me ngā whakaurunga metaphyseal i puta mai i ngā whara pēhanga, tae atu ki ngā whati hononga matatini me ngā whati radial pilon.
Whakaurunga
Ko te whati momo IV he whati avulsion o te hononga ligamentous e puta ana i te wā e whati ana, e nukuhia ana rānei te hononga radial carpal.
Te whatinga o te avulsion I
Ko te whati momo V ka puta mai i tētahi whara tere-rahi e pā ana ki ngā kaha maha o waho me ngā whara whānui. (Whakaranu I, II, IIII, IV)
3. Tātaitanga ingoa-ingoa
II. Te rongoā i ngā whati o te radius distal mā te whakakikorua nikau
Ngā tohu.
Mō ngā whati o waho o te hononga whai muri i te korenga o te whakaiti katia i raro i ngā āhuatanga e whai ake nei.
Te koki o te tuara neke atu i te 20°
Te pēhanga o te tuara neke atu i te 5 mm
Te whakapoto i te radius distal neke atu i te 3 mm
Nekehanga poraka whati tawhiti neke atu i te 2 mm
Mō ngā whati hononga neke atu i te 2mm te nekehanga
Kāore te nuinga o ngā tohunga e taunaki ana i te whakamahinga o ngā pereti metacarpal mō ngā whara kaha nui, pērā i ngā whati kino o roto i te hononga, te ngaronga kino rānei o te wheua, nā te mea he ngāwari te pirau o ēnei kongakonga whati distal ki te kore toto, ā, he uaua ki te nekehia te tūranga tinana.
Mō ngā tūroro he maha ngā whatiwhatinga me te nekenekehanga nui me te osteoporosis kino, kāore e whai hua te whakakikoruatanga metacarpal. Tērā pea he raruraru te tautoko subchondral o ngā whatiwhatinga distal, pērā i te urunga o te tīwiri ki roto i te kōhao hononga.
Tikanga pokanga
He rite tonu te huarahi me te tikanga a te nuinga o ngā taote pokanga mō te whakatika i ngā whati o te radius distal mā te whakamahi i te pereti palmar. Heoi, me whai tikanga pokanga pai hei karo i ngā raruraru i muri i te pokanga, hei tauira, ka taea te whakaiti mā te tuku i te poraka whati mai i te pēhanga kua mau, me te whakahoki mai i te haere tonu o te wheua cortical. Ka taea te whakamahi i te whakapiri rangitahi mā te whakamahi i ngā pine Kirschner e 2-3, me ētahi atu.
(I) Te nekenekehanga me te tū i mua i te pokanga
1. Ka mahia te tōia i te ahunga o te kakau radial i raro i te fluoroscopy, me te pēhi a te koromatua i te poraka whati proximal ki raro mai i te taha nikau, ā, ko ngā maihao kē atu e hiki ake ana i te poraka distal ki runga i te koki mai i te taha tuara.
2. Tū takoto ana ki raro, me te peka e pāngia ana i runga i te tēpu ringa i raro i te tirotiro ā-pūoro.
(II) Ngā pūwāhi urunga.
Mō te momo huarahi e whakamahia ana, e taunakihia ana te huarahi PCR (radial carpal flexor) extended palmar.
Ka tīmata te pito tawhiti o te tapahi kiri i te kopa kiri o te ringaringa, ā, ka taea te whakatau i tōna roa i runga i te momo whati.
Kua tapahia te uaua radial flexor carpi radialis me tōna pūrua uaua, kia tawhiti rawa atu i ngā wheua carpal, kia tata rawa atu hoki ki te taha proximal.
Mā te kukume i te uaua piko o te carpal radial ki te taha ulnar ka tiakina te uaua waenga me te uaua piko.
E kitea ana te wāhi Parona, ā, kei waenganui i te flexor digitorum longus (taha ulnar) me te uaua radial (taha radial) te uaua rotator ani o mua.
Tāia te taha radial o te uaua rotator ani o mua, me te mōhio me waiho tētahi wāhanga kia piri ki te radius hei hanga anō i muri mai.
Mā te kukume i te uaua rotator ani o mua ki te taha ulnar ka taea te whakaatu pai ake i te haona ulnar i te taha nikau o te radius.
Mā te huarahi nikau e whakaatu te radius distal, ā, ka kitea hoki te koki ulnar.
Mō ngā momo whati uaua, e taunakihia ana kia tukuna te aukati o te distal brachioradialis, ka taea ai te whakakore i tōna kukume ki te radial tuberosity, i taua wā ka taea te tapahi i te papa nikau o te wāhanga tuara tuatahi, ka taea ai te whakaatu i te poraka whati distal radial me te radial tuberosity, ka huri i roto i te radius Yu hei wehe atu i te wāhi whati, kātahi ka tautuhi anō i te poraka whati hononga-roto mā te whakamahi i te pine Kirschner. Mō ngā whati hononga-roto uaua, ka taea te whakamahi i te arthroscopy hei āwhina i te whakaiti, te aromatawai me te whakatikatika i te poraka whati.
(III) Ngā tikanga whakaiti.
1. Whakamahia te wero wheua hei rīwhi mō te tautuhi anō
2. Ka kumea e te kaiawhina ngā maihao tohu me ngā maihao waenga o te tūroro, he mea ngāwari noa iho te tautuhi anō.
3. Whakawetohia te pine Kirschner mai i te ngongo radial hei whakapiringa rangitahi.
Kia oti te nekenekehanga, ka whakatakotoria he pereti nikau, me tata tonu ki te rohe wai, me taupoki te pito o te ulnar, ā, me tata ki waenganui o te kakau radial. Mēnā kāore ēnei tikanga e tutuki, mēnā kāore te pereti i te rahi tika, mēnā rānei kāore te nekenekehanga i te pai, kāore tonu te tukanga i te tino tika.
He maha ngā raruraru e pā ana ki te tūranga o te pereti. Mēnā ka tawhiti rawa te pereti ki te taha radial, tera pea ka puta ngā raruraru e pā ana ki te piko o te bunion; mēnā ka tata rawa te pereti ki te rārangi wai, tera pea ka tūpono te piko hohonu o te maihao. Mā te nekehanga o te whati ki te taha nikau ka ngāwari te puta o te pereti ki te taha nikau, ka pā tika atu ki te uaua piko, ā, ka mutu, ka puta te mate uaua, ka pakaru rānei.
Mō ngā tūroro osteoporosis, e taunakihia ana kia whakatakotoria te pereti kia tata ki te rārangi wai e taea ana, engari kaua e whiti atu. Ka taea te whakatutuki i te whakapiringa subchondral mā te whakamahi i ngā pine Kirschner e tata ana ki te ulna, ā, he whai hua ngā pine Kirschner taha-ki-taha me ngā tīwiri raka ki te karo i te nekehanga anō o te whati.
Kia tika te whakatakotoranga o te pereti, ka mau te pito tata ki te tīwiri kotahi, ā, ka mau te pito tawhiti o te pereti ki ngā pine Kirschner i roto i te kōhao ulnar. I tangohia ngā orthopantomogram fluoroscopic i te wā o te pokanga, ngā tirohanga taha, me ngā kiriata taha me te teitei o te ringaringa 30° hei whakatau i te whakaiti i te whati me te tūranga o te whakapiringa o roto.
Mena kei te pai te tūnga o te pereti, engari kei roto i te hononga te pine Kirschner, ka kore e pai te whakahokinga mai o te piko o te nikau, ka taea te whakatau mā te tautuhi anō i te pereti mā te whakamahi i te "tikanga whakatika whati distal" (Pikitia 2, b).
Pikitia 2.
a, e rua ngā pine Kirschner hei whakapiringa rangitahi, kia mōhio koe kāore anō kia tino whakahokia mai te piko o te metacarpal me ngā mata hononga i tēnei wā;
b, Kotahi te pine Kirschner hei whakapiri i te pereti rangitahi, kia mōhio kei te whakapirihia te pūtoro tawhiti ki tēnei wāhi (tikanga whakapiri poraka whati tawhiti), ā, ka tōia te wāhanga tata o te pereti ki te kakau pūtoro hei whakahoki mai i te koki honga o te nikau.
C, Te whakatikatika i ngā mata hononga ki te arthroscopic, te whakatakotoranga o ngā tīwiri/pine raka o tawhiti, me te tautuhi anō me te whakau whakamutunga o te radius proximal.
Mēnā ka puta ngā whati o te tuara me te tuara i te wā kotahi (ulnar/dorsal Die Punch), kāore e taea te tautuhi anō i te wā e katia ana, ka taea te whakamahi i ēnei tikanga e toru.
Ka hurihia te radius proximal ki mua atu i te wāhi whati, ā, ka panaia te poraka whati o te fossa lunate ki te wheua carpal mā te huarahi whakaroa PCR; ka tapahia he iti ki muri i te wāhanga tuawhā me te tuarima hei whakaatu i te poraka whati, ā, ka whakapirihia ki te foramen ulnar tino nui o te pereti mā te tīwiri. I mahia te whakapiri kati percutaneous, te whakapiri iti rawa rānei me te āwhina arthroscopic.
I muri i te whakatikatika pai me te whakatakotoranga tika o te pereti, ka māmā ake te whakapiringa whakamutunga, ā, ka taea te whakatikatika tinana mēnā kei te tika te whakatakotoranga o te pine kernel ulnar proximal, ā, kāore he tīwiri i roto i te kōhao hononga (Pikitia 2).
(iv) He wheako ki te whiriwhiri tīwiri.
Tērā pea he uaua ki te ine tika i te roa o ngā tīwiri nā te kaha o te pakaru o te wheua cortical o muri. Mēnā he roa rawa ngā tīwiri, ka raru pea ngā uaua, ā, he poto rawa hoki hei tautoko i te whakau o te poraka whati o muri. Nā konei, ka tūtohu ngā kaituhi kia whakamahia ngā whao raka miro me ngā whao raka maha-tuaka i roto i te ngongo radial me te nuinga o ngā foramen ulnar, me te whakamahi i ngā tīwiri raka kakau māmā i ngā tūranga e toe ana. Mā te whakamahi i te pane pūngoi ka karohia te wiri o te uaua ahakoa kua mirohia ki muri. Mō te whakau pereti honohono tata, ka taea te whakamahi i ngā tīwiri honohono e rua me te tīwiri kotahi (kua whakanohoia mā roto i te porowhita) hei whakau.
I whakaatu a Tākuta Kiyohito o Parani i ō rātou wheako ki te whakamahi i ngā pereti raka nikau iti rawa te whakaekenga mō ngā whati o te radius distal, i reira i whakaitihia ai tā rātou tapahi pokanga ki te 1cm tino nui, he mea rerekē tēnei. Ko te tikanga matua o tēnei tikanga he mea mō ngā whati radius distal pumau, ā, ko ōna tohu pokanga he mea mō ngā whati i waho o te hononga o ngā wāhanga AO o ngā momo A2 me A3 me ngā whati i roto i te hononga o ngā momo C1 me C2, engari kāore e tika mō ngā whati C1 me C2 me te hinganga o te papatipu wheua i roto i te hononga. Kāore hoki te tikanga e tika mō ngā whati momo B. E tohu ana hoki ngā kaituhi mēnā kāore e taea te whakatutuki i te whakaiti me te whakapiri pai mā tēnei tikanga, me huri ki te tikanga tapahi tuku iho, kaua hoki e piri ki te tapahi iti iti te whakaekenga.
Wā tuku: Pipiri-26-2024
