ʻO nā palena kiʻi i hoʻohana pinepine ʻia no ka loiloi ʻana i nā haki radius distal e komo pū me ka volar tilt angle（VTA), ulnar variance, a me ke kiʻekiʻe radial. I ka hohonu ʻana o ko mākou ʻike ʻana i ke anatomia o ka radius distal, ua hāpai ʻia a hoʻopili ʻia nā palena kiʻi hou e like me ka anteroposterior distance (APD), teardrop angle (TDA), a me ka capitate-to-axis-of-radius distance (CARD) i ka hana lapaʻau.
ʻO nā palena kiʻi i hoʻohana pinepine ʻia no ka loiloi ʻana i nā haki radius distal: a: VTA; b: APD; c: TDA; d: CARD.
ʻO ka hapa nui o nā palena kiʻi he kūpono no nā haki radius distal extra-articular, e like me ke kiʻekiʻe radial a me ka ʻokoʻa ulnar. Eia nō naʻe, no kekahi mau haki intra-articular, e like me nā haki Barton, ʻaʻole paha i hiki i nā palena kiʻi kuʻuna ke hoʻoholo pololei i nā hōʻailona ʻoki kino a hāʻawi i ke alakaʻi. Manaʻo nui ʻia ʻo ka hōʻailona ʻoki kino no kekahi mau haki intra-articular e pili pono ana i ka step-off o ka ʻili hui. I mea e loiloi ai i ke kiʻekiʻe o ka neʻe ʻana o nā haki intra-articular, ua hāpai nā loea haole i kahi palena ana hou: TAD (Tilt After Displacement), a ua hōʻike mua ʻia no ka loiloi ʻana i nā haki malleolus posterior i hele pū ʻia me ka neʻe ʻana o ka tibial distal.
Ma ka hopena distal o ke tibia, i nā hihia o ka haki ʻana o ka malleolus hope me ka dislocation hope o ka talus, hana ka ʻili hui i ʻekolu mau piʻo: ʻO ka Arc 1 ka ʻili hui mua o ka tibia distal, ʻo ka Arc 2 ka ʻili hui o ka ʻāpana malleolus hope, a ʻo ka Arc 3 ka piko o ka talus. Ke loaʻa kahi ʻāpana haki malleolus hope i hele pū ʻia me ka dislocation hope o ka talus, ua hōʻailona ʻia ke kikowaena o ka pōʻai i hana ʻia e Arc 1 ma ka ʻili hui mua he kiko T, a ʻo ke kikowaena o ka pōʻai i hana ʻia e Arc 3 ma luna o ka talus he kiko A. ʻO ka mamao ma waena o kēia mau kikowaena ʻelua ʻo TAD (Tilt After Displacement), a ʻo ka nui o ka neʻe ʻana, ʻo ka nui o ka waiwai TAD.
ʻO ka pahuhopu o ke ʻoki ʻana, ʻo ia ka hoʻokō ʻana i kahi waiwai ATD (Tilt After Displacement) o 0, e hōʻike ana i ka hoʻemi ʻana o ke kino o ka ʻili o ke hono.
Pēlā nō, ma ke ʻano o ka haki volar Barton:
ʻO nā ʻāpana ʻili articular i hoʻoneʻe hapa ʻia e hana i ka Arc 1.
Hana ka ʻaoʻao lunate ma ke ʻano he Arc 2.
ʻO ka ʻaoʻao dorsal o ka radius (iwi maʻamau me ka ʻole o ka haki) e hōʻike ana i ka Arc 3.
Hiki ke manaʻo ʻia kēlā me kēia o kēia mau piʻo ʻekolu he mau pōʻai. ʻOiai ua hoʻoneʻe ʻia ka ʻaoʻao lunate a me ka ʻāpana iwi volar, ua kaʻana like ʻo Circle 1 (i ka melemele) i kona kikowaena me Circle 2 (i keʻokeʻo). Hōʻike ʻo ACD i ka mamao mai kēia kikowaena i kaʻana like ʻia a i ke kikowaena o Circle 3. ʻO ka pahuhopu ʻoki kino ka hoʻihoʻi ʻana i ka ACD i 0, e hōʻike ana i ka hōʻemi anatomical.
I ka hana lapaʻau ma mua, ua ʻae nui ʻia ʻo ka pae ʻili hui o <2mm ke kūlana no ka hōʻemi ʻana. Eia nō naʻe, i loko o kēia haʻawina, ua hōʻike ka loiloi piʻo Receiver Operating Characteristic (ROC) o nā ʻano kiʻi like ʻole ʻo ACD ka wahi kiʻekiʻe loa ma lalo o ke piʻo (AUC). Ma ka hoʻohana ʻana i ka waiwai cutoff o 1.02mm no ACD, ua hōʻike ia i ka 100% sensitivity a me 80.95% specificity. Hōʻike kēia i ke kaʻina hana o ka hōʻemi ʻana i ka haki, ʻo ka hōʻemi ʻana i ka ACD i loko o 1.02mm he kumu kūpono paha.
ma mua o ke kūlana kuʻuna o <2mm hui ʻilikai step-off.
ʻIke ʻia he koʻikoʻi koʻikoʻi ko ka ACD no ka loiloi ʻana i ke kiʻekiʻe o ka neʻe ʻana i nā haki intra-articular e pili ana i nā hono concentric. Ma waho aʻe o kāna noi i ka loiloi ʻana i nā haki tibial plafond a me nā haki radius distal e like me ka mea i ʻōlelo ʻia ma mua, hiki ke hoʻohana ʻia ka ACD no ka loiloi ʻana i nā haki kuʻekuʻe lima. Hāʻawi kēia i nā kauka lapaʻau me kahi mea hana pono no ke koho ʻana i nā ʻano lapaʻau a me ka loiloi ʻana i nā hopena hōʻemi haki.
Ka manawa hoʻouna: Sep-18-2023
