ʻO nā ʻāpana kiʻi maʻamau i hoʻohana ʻia no ka loiloi ʻana i nā haʻihaʻi radius distal ka mea maʻamau e pili ana i ka ʻae hoʻoheheʻe volar (VTA), ʻokoʻa ulnar, a me ke kiʻekiʻe radial.I ka hohonu o ko mākou ʻike ʻana i ke anatomy o ka radius distal, ua noi ʻia a hoʻohana ʻia nā ʻāpana kiʻi hou e like me anteroposterior distance (APD), teardrop angle (TDA), a me ka capitate-to-axis-of-radius distance (CARD). hana lapaʻau.
ʻO nā ʻāpana kiʻi maʻamau i hoʻohana ʻia no ka loiloi ʻana i nā haʻihaʻi radius mamao: a: VTA; b: APD; c: TDA; d: CARD.
ʻO ka hapa nui o nā ʻāpana kiʻi kūpono no nā haʻihaʻi radius distal extra-articular, e like me ke kiʻekiʻe radial a me ka ʻokoʻa ulnar.Eia nō naʻe, no kekahi mau haʻihaʻi intra-articular, e like me nā haʻihaʻi o Barton, nele paha nā ʻāpana kiʻi kuʻuna i ko lākou hiki ke hoʻoholo pololei i nā hōʻailona hōʻailona a hāʻawi i ke alakaʻi.Manaʻo nui ʻia ʻo ka hōʻailona hōʻailona no kekahi mau haʻihaʻi intra-articular e pili kokoke ana i ka haʻalele ʻana o ka ʻili hui.I mea e loiloi ai i ke kiʻekiʻe o ka neʻe ʻana o nā haʻihaʻi intra-articular, ua hāʻawi ka poʻe ʻepekema haole i kahi ʻāpana ana hou: TAD (Tilt After Displacement), a ua hōʻike mua ʻia no ka loiloi ʻana i nā haʻihaʻi malleolus hope i hui pū ʻia me ka distal tibial displacement.
Ma ka hopena hope o ka tibia, i nā hihia o ka haʻihaʻi malleolus hope me ka dislocation hope o ka talus, ʻo ka ʻili hui e hana i ʻekolu arcs: ʻO Arc 1 ka ʻili hui mua o ka tibia distal, ʻo Arc 2 ka ʻili hui o ka malleolus hope. ʻāpana, a ʻo Arc 3 ka piko o ka talus.Ke loaʻa kahi ʻāpana ʻāpana malleolus hope i hui pū ʻia me ka dislocation hope o ka talus, ʻo ke kikowaena o ka pōʻai i hana ʻia e Arc 1 ma ka ʻili hui mua e hōʻike ʻia ʻo ke kiko T, a ʻo ke kikowaena o ka pōʻai i hana ʻia e Arc 3 ma luna o ua kapa ʻia ka talus ma ke 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, ʻoi aku ka nui o ka waiwai TAD.
ʻO ka pahuhopu o ka ʻoki ʻana, ʻo ia ka loaʻa ʻana o kahi waiwai ATD (Tilt After Displacement) o 0, e hōʻike ana i ka hōʻemi anatomical o ka ʻili hui.
Pēlā nō, i ka hihia o ka haʻihaʻi o volar Barton:
ʻO nā ʻāpana ʻāpana articular i hoʻoneʻe ʻia ma ke ʻano he Arc 1.
ʻO ka lunate facet e like me Arc 2.
ʻO ka ʻaoʻao hope o ka radius (iwi maʻamau me ka haki ʻole) ʻo ia ka Arc 3.
Hiki ke noʻonoʻo ʻia kēlā me kēia o kēia mau ʻāpana ʻekolu he mau pōʻai.Ma muli o ka hoʻoneʻe ʻia ʻana o ka ʻaoʻao lunate a me ka ʻāpana iwi volar, ua puʻunaue ka pōʻai 1 (ma ka melemele) i kona kikowaena me ka Circle 2 (keʻokeʻo).Hōʻike ka ACD i ka mamao mai kēia kikowaena kaʻana like a i ke kikowaena o ka Circle 3. ʻO ka pahuhopu o ke kaʻina hana ʻo ia ka hoʻihoʻi ʻana i ka ACD i 0, e hōʻike ana i ka hōʻemi anatomical.
Ma ka hoʻomaʻamaʻa lapaʻau mua, ua ʻae nui ʻia ʻo ka hoʻohaʻahaʻa ʻana o ka ʻili i lalo o <2mm.Eia nō naʻe, i loko o kēia haʻawina, ua hōʻike ka Receiver Operating Characteristic (ROC) curve analysis o nā ʻāpana kiʻi like ʻole he ACD ka wahi kiʻekiʻe ma lalo o ka pihi (AUC).Ke hoʻohana nei i kahi waiwai ʻokiʻoki o 1.02mm no ACD, hōʻike ia i ka 100% sensitivity a me 80.95% specificity.Hōʻike kēia i ke kaʻina o ka hōʻemi haʻihaʻi ʻana, ʻo ka hoʻemi ʻana i ka ACD i loko o 1.02mm hiki ke lilo i kumu kūpono kūpono.
ma mua o ka maʻamau maʻamau o <2mm hoʻokuʻu ʻana i ka ʻili.
ʻIke ʻia he koʻikoʻi koʻikoʻi ko ACD no ka loiloi ʻana i ke kiʻekiʻe o ka neʻe ʻana i nā haʻihaʻi intra-articular e pili ana i nā hui concentric.Ma waho aʻe o kāna noi i ka loiloi ʻana i nā haʻihaʻi tibial plafond a me nā haʻihaʻi radius distal e like me ka mea i ʻōlelo mua ʻia, hiki ke hoʻohana ʻia ʻo ACD no ka loiloi ʻana i nā haʻi kuʻekuʻe.Hāʻawi kēia i nā kauka lapaʻau me kahi mea pono no ke koho ʻana i nā ala lapaʻau a me ka loiloi ʻana i nā hopena hōʻemi haʻihaʻi.
Ka manawa hoʻouna: Sep-18-2023
