I tēnei wā, he maha ngā tikanga maimoatanga mō ngā whati o te radius distal, pērā i te whakapiripiri i te pāreti, te whakaiti tuwhera me te whakapiripiri ā-roto, te anga whakapiripiri o waho, me ētahi atu. I roto i ēnei, ka taea e te whakapiripiri pereti volar te whakatutuki i te hua pai ake, engari kei roto i ngā tuhinga he pūrongo kei roto ko ōna raruraru he teitei ake ki te 16%. Heoi, ki te whiriwhiria tika te pereti maitai, ka taea te whakaiti i te auau o ngā raruraru. Ka whakarāpopototia e tēnei pepa ngā āhuatanga, ngā tohu, ngā ārai, me ngā tikanga pokanga o te maimoatanga pereti volar o ngā whati radius distal.
1. E rua ngā painga matua o te pereti taha nikau
A. Ka taea e ia te whakakore i te wāhanga o te kaha piko. Mā te whakapiri me ngā tīwiri whakapiri koki ka tautoko i te kongakonga tawhiti, ka whakawhiti i te kawenga ki te pou radial (Pikitia 1). Ka taea e ia te whiwhi tautoko subchondral kia pai ake te whai hua. Kāore e taea e tēnei pūnaha pereti te whakatika pumau i ngā whati hononga tawhiti, engari ka taea hoki te whakaora i te hanganga anatomical o te wheua subchondral roto mā te whakapiri "āhua-pā" o te titi/wīri. Mō te nuinga o ngā momo whati radius tawhiti, ka whakaratohia e tēnei pūnaha tuanui he pumau ake, ka taea ai te neke wawe.
Pikitia 1, a, whai muri i te hanga anō-toru-ahu o te whati whānui tawhiti kua tapahia, kia aro ki te nui o te kōpeketanga o te tuara; b, whakaiti mariko o te whati, me whakatika te hapa, me tautoko hoki e te pereti; c, tirohanga taha i muri i te whakatikanga o te DVR, ko te pere e tohu ana i te whakawhiti kawenga.
B. He iti ake te pānga ki ngā kiko ngohengohe: kei raro iho i te rārangi wai te piri o te pereti volar, ki te whakaritea ki te pereti tuara, ka taea te whakaiti i te riri o te uaua, ā, he nui ake te wāhi e wātea ana, ka taea ai te karo i te pa tika o te whakatō me te uaua. Hei tāpiri, ka taea te hipoki i te nuinga o ngā whakatō e te pronator quadratus.
2. Ngā tohu me ngā ārai mō te maimoatanga o te radius distal me te pereti volar
a. Ngā Tohu: Mō te korenga o te whakaiti kati i ngā whati o waho o te hononga, ka puta ēnei āhuatanga, pērā i te koki tuara neke atu i te 20°, te pēhanga tuara neke atu i te 5mm, te whakapoto o te radius tawhiti neke atu i te 3mm, me te nekenga o te kongakonga whati tawhiti neke atu i te 2mm; Ko te nekenga o te whati o roto neke atu i te 2 mm; nā te iti o te kiato o te wheua, he ngāwari te neke anō, nō reira he pai ake mō te hunga kaumātua.
b. Ngā Ārai: te whakamahinga o ngā rongoā whakamoe ā-rohe, ngā mate pāwera ā-rohe, ngā mate pāwera ā-tinana, te āhua kiri kino i te taha volar o te ringaringa; te momo wheua me te momo whati i te wāhi whati, te momo whati tuara pēnei i te whati Barton, te whati me te nekehanga o te hononga radiocarpal, te whati radius styloid process māmā, te whati avulsion iti o te taha volar.
Mō ngā tūroro he whara nui te kaha pērā i ngā whati pakaru o roto i te hononga, te ngaronga nui rānei o te wheua, kāore te nuinga o ngā tohunga e taunaki ana i te whakamahinga o ngā pereti volar, nā te mea he ngāwari te pirau o ngā oko toto i roto i aua whati distal, ā, he uaua ki te whakaiti i te hanganga tinana. Mō ngā tūroro he maha ngā kongakonga whati me te nekehanga nui me te osteoporosis kino, he uaua ki te whai hua te pereti volar. Tērā pea he raruraru ki te tautoko subchondral i roto i ngā whati distal, pērā i te urunga o te tīwiri ki roto i te kōhao hononga. I roto i tētahi tuhinga hou, i kōrerohia i te wā i rongoatia ai ngā take 42 o ngā whati o roto i te hononga ki ngā pereti volar, kāore he tīwiri hononga i uru ki roto i te kōhao hononga, ko te nuinga o tēnei e pā ana ki te tūranga o ngā pereti.
3. Ngā pūkenga pokanga
He rite tonu ngā huarahi me ngā tikanga a te nuinga o ngā tākuta ki te whakamahi i te whakapiri pereti volar mō ngā whati radius distal. Heoi, kia kore ai e puta ngā raruraru i muri i te pokanga, me whai tikanga pokanga tino pai, hei tauira, ka taea te whakaiti mā te tuku i te pēhanga o te poraka whati me te whakahoki mai i te haere tonu o te wheua cortical. Ka taea te whakamahi i te whakapiri rangitahi me ngā waea Kirschner e 2-3. Mō te huarahi hei whakamahi, e taunaki ana te kaituhi i te PCR (flexor carpi radialis) hei whakaroa i te huarahi volar.
a, Te whakapiri rangitahi ki ngā waea Kirschner e rua, kia mōhio koe kāore anō kia tino whakahokia mai te pikinga volar me te mata hononga i tēnei wā;
b, Ka whakatikahia te pereti e te waea Kirschner mō te wā poto, kia aro ki te whakatikanga o te pito tawhiti o te radius i tēnei wā (tikanga whakatikanga wāhanga whati tawhiti), ka tōia te wāhanga tata o te pereti ki te kakau radial hei whakahoki mai i te pikinga volar.
C, Ka whakatikatikaina te mata o te hononga i raro i te arthroscopy, ka whakatakotoria te tīwiri/pine raka o te pito tawhiti, ā, ka whakaitihia te radius proximal, ka whakauhia.
Ngā kōrero matuao te whakatata: Ka tīmata te tapahi kiri tawhiti i te kopa kiri o te ringaringa, ā, ka taea te whakatau i tōna roa i runga i te momo whati. Ka tapahia te uaua flexor carpi radialis me tōna pūkahukahu ki tawhiti ki te wheua carpal, kia tata rawa atu. Mā te kukume i te uaua flexor carpi radialis ki te taha ulnar ka tiakina te io waenga me te matatini uaua flexor. Ka kitea te wāhi Parona, me te pronator quadratus kei waenganui i te flexor hallucis longus (ulnar) me te uaua radial (radial). I mahia he tapahi ki te taha radial o te pronator quadratus, ka waiho he wāhanga e piri ana ki te radius mō te hanga anō i muri mai. Mā te kukume i te pronator quadratus ki te taha ulnar ka kitea te koki volar ulnar o te radius.
Mō ngā momo whati uaua, e taunakihia ana kia tukuna te whakaurunga o te uaua brachioradialis ki te pito tawhiti, ka taea te whakakore i tōna kukume ki te tukanga radial styloid. I tēnei wā, ka taea te tapahi i te pūeru volar o te wāhanga tuara tuatahi hei whakaatu i te whati tawhiti. Āraia te taha radial me te tukanga radial styloid, hurihia te poro radial ki roto hei wehe i te wāhi whati, kātahi ka whakamahia ngā waea Kirschner hei whakaiti i te aukati whati hononga-roto. Mō ngā whati hononga-roto uaua, ka taea te whakamahi i te arthroscopy hei āwhina i te whakaiti, te aromatawai, me te whakatikatika i ngā kongakonga whati.
Kia oti te whakaiti, ka whakatakotoria te pereti volar i ia wā. Me tata tonu te pereti ki te rohe wai, me taupoki te tukanga ulnar, ā, me tae te pito tata o te pereti ki waenganui o te poro radial. Mena kāore i tutuki ngā tikanga o runga ake nei, kāore i te tika te rahi o te pereti, kāore rānei i te pai te whakaiti, kāore tonu i te tino tika te mahi.
He maha ngā raruraru e pā ana ki te wāhi i whakatakotoria ai te pereti.. Mēnā ka whakatakotoria te pereti ki te taha radial rawa, ka tūpono pea te puta o ngā raruraru e pā ana ki te uaua flexor hallucis longus; ki te whakatakotoria te pereti ki te taha tata rawa ki te rohe whakawhiti, ka tūpono pea te uaua flexor digitorum profundus. Mā te whakaiti i te whati ki te āhua o te nekehanga volar ka ngāwari te puta o te pereti maitai ki te taha volar ka pā tika ki te uaua flexor, ā, ka mutu, ka puta te tendinitis, ka pakaru rānei.
Mō ngā tūroro osteoporosis, e taunakihia ana kia tata te pereti ki te rohe whakawhiti i te pereti, engari kaua e whiti atu.Ka taea te whakamahi i ngā waea Kirschner hei whakatika i te subchondral e tata ana ki te ulna, ā, ka taea e ngā waea Kirschner taha-ki-taha me ngā whao me ngā tīwiri raka te ārai i te nekehanga anō o te whati.
Kia tika te whakatakotoranga o te pereti, ka mau te pito tata ki te tīwiri, ā, ka mau te kōhao ulnar i te pito tawhiti o te pereti ki te waea Kirschner mō te wā poto. Tirohanga anteroposterior, tirohanga taha, tirohanga taha 30° te teitei o te hononga ringaringa, hei whakatau i te whakaiti i te whati me te tūranga whakau o roto. Mēnā he pai te tūranga o te pereti, engari kei roto te waea Kirschner i te hononga, ka kore e ranea te whakahokinga mai o te pikinga volar, ka taea te whakatau mā te tautuhi anō i te pereti mā te "tikanga whakau whati distal" (Pikitia 2, b).
Mena kei te haere tahi mai ngā whati o te tuara me te tuara (ulnar/dorsal Die Punch) ā, kāore e taea te whakaiti katoa i te wā e katia ana, ka taea te whakamahi i ēnei tikanga e toru:
1. Whakatōkia te pito tata o te radius kia matara atu i te wāhi whati, ka panaia te whati o te fossa lunate ki te carpus mā te huarahi toronga PCR;
2. Hangaia he tapahi iti ki te taha tuarā o te wāhanga tuawhā me te tuarima kia kitea ai te kongakonga whati, ka whakapirihia ki ngā tīwiri ki te kōhao pito rawa o te pereti.
3. Te whakapiri ā-kiri, te whakapiri iti rawa rānei mā te āwhina o te arthroscopy.
Kia ea te whakaitinga, ā, kia tika te whakatakotoranga o te pereti, he māmā noa iho te whakau whakamutunga. Mēnā kua tika te whakatakotoranga o te waea Kirschner o te pito o mua o te hononga, ā, kāore he tīwiri i roto i te kōhao hononga, ka taea te whiwhi whakaitinga ā-tinana.
He wheako whiriwhiri tīwiriNā te tino pakaru o te wheua cortical dorsal, he uaua pea te ine tika i te roa o te tīwiri. Ka pāngia pea te uaua e ngā tīwiri roa rawa, ā, kāore e taea e ngā tīwiri poto rawa te tautoko me te whakau i te wāhanga dorsal. Nā tēnei take, e taunaki ana te kaituhi kia whakamahia ngā tīwiri raka miro me ngā tīwiri raka maha-tuaka i roto i te tukanga styloid radial me te kōhao ulnar tino nui, me te whakamahi i ngā tīwiri raka tokotoko kua orohia i ngā tūranga e toe ana. Mā te whakamahi i te pito pūngoi ka karohia te whakau o te uaua ahakoa te putanga dorsal e whakamahia ana. Mō te whakau pereti honohono proximal, ka taea te whakamahi i ngā tīwiri honohono e rua me te tīwiri noa kotahi (kua whakanohoia mā roto i te porowhita) hei whakau.
4. Whakarāpopototanga o te tuhinga katoa:
Mā te whakau i ngā whati o te radius distal o te whara ka taea te whakatutuki i te whai huatanga haumanu pai, e whakawhirinaki ana ki te whiriwhiri i ngā tohu me ngā pūkenga pokanga tino pai. Mā te whakamahi i tēnei tikanga ka taea te whakapai ake i te matapae mahi wawe, engari kāore he rerekētanga i roto i te mahi ā muri ake nei me te mahi whakaahua me ētahi atu tikanga, he rite tonu te maha o ngā raruraru i muri i te pokanga, ā, ka ngaro te whakahekenga i roto i te whakau o waho, te whakau waea Kirschner percutaneous, me te whakau papa, he nui ake te maha o ngā mate ngira; ā, he nui ake te maha o ngā raruraru uaua extensor i roto i ngā pūnaha whakau pereti radius distal. Mō ngā tūroro he osteoporosis, ko te pereti volar tonu te whiringa tuatahi.
Wā tuku: Hakihea-12-2022
