ʻO ka lāʻau lapaʻau maʻamau no nā haʻihaʻi radius distal ʻo ia ka volar Henry approach me ka hoʻohana ʻana i nā papa paʻa a me nā wili no ka hoʻoponopono kūloko. I ka wā o ke kaʻina hana hoʻoponopono kūloko, ʻaʻole pono e wehe i ka capsule hui radiocarpal. Loaʻa ka hoʻohaʻahaʻa hui ʻana ma o ke ʻano hana manipulation waho, a hoʻohana ʻia ka fluoroscopy intraoperative e loiloi i ka alignment o ka ʻili. Ma na hihia o ka intra-articular depressed fractures, e like me Die-punch fractures, kahi o ka ho'ēmi 'ole a me ka loiloi 'ana i mea paʻakikī, pono paha e hoʻohana i ka dorsal ala e kōkua me ka pololei hiʻona a me ka ho'ēmiʻana (e like me ka hoike ana ma ka kiʻi ma lalo).
ʻO nā ligaments extrinsic a me nā ligaments intrinsic o ka hui radiocarpal i manaʻo ʻia he mau hale koʻikoʻi no ka mālama ʻana i ka paʻa o ka hui lima. Me ka holomua o ka noiʻi anatomical, ua ʻike ʻia, ma lalo o ke ʻano o ka mālama ʻana i ka pono o ka ligament radiolunate pōkole, ʻo ka ʻoki ʻana i nā ligaments extrinsic ʻaʻole ia e hopena i ka paʻa ʻole o ka hui lima.
No laila, i kekahi mau kūlana, no ka loaʻa ʻana o ka ʻike maikaʻi o ka ʻili hui, pono paha e hoʻokaʻawale i nā ligaments extrinsic, a ʻike ʻia kēia ʻo ka volar intraarticular extended window approach (VIEW). E like me ka mea i hōʻike ʻia ma ke kiʻi ma lalo nei:
Kiʻi AB: Ma ke ala maʻamau ʻo Henry no ka wehe ʻana i ka ʻili o ka iwi iwi ākea, i mea e komo ai i ka haʻi ʻana o ka ʻaoʻao mamao a me ka ʻaoʻao scaphoid, ua ʻoki mua ʻia ka capsule hui lima. Hoʻohana ʻia kahi retractor e pale i ka ligament radiolunate pōkole. Ma hope mai, ua ʻoki ʻia ka ligament radiolunate lōʻihi mai ka radius distal i ka ʻaoʻao ulnar o ka scaphoid. I kēia manawa, hiki ke hoʻokō i ka nānā pono ʻana o ka ʻili hui.
Kiʻi CD: Ma hope o ka hōʻike ʻana i ka ʻili hui, hana ʻia ka hoʻohaʻahaʻa ʻana o ka sagittal plane depressed joint surface ma lalo o ka nānā pono ʻana. Hoʻohana ʻia nā mea hoʻokiʻekiʻe iwi no ka hoʻoponopono ʻana a hoʻemi i nā ʻāpana iwi, a hiki ke hoʻohana ʻia nā uea Kirschner 0.9mm no ka hoʻoponopono manawa a i ʻole ka hoʻopaʻa hope. I ka manawa e emi pono ai ka ili hui, e hahai ia na hana ma'amau no ka pa'i pa'i a me ka wiliwili. ʻO ka hope, hoʻopaʻa ʻia nā ʻoki i hana ʻia i ka ligament radiolunate lōʻihi a me ka capsule hui lima.
ʻO ke kumu kumu o ka VIEW (volar intraarticular extended window) e pili ana i ka hoʻomaopopo ʻana ʻo ka ʻoki ʻana i kekahi mau ligament extrinsic ami lima lima ʻaʻole ia e hopena i ka paʻa ʻole o ka hui lima. No laila, paipai ʻia no kekahi mau haʻihaʻi radius distal comminuted intra-articular paʻakikī kahi e paʻakikī ai ka hoʻohaʻahaʻa ʻana i ka ʻili o ka fluoroscopic a i ʻole i ka wā e hele ai nā haʻahaʻa. Manaʻo ikaika ʻia ke ala VIEW e hoʻokō i kahi hiʻohiʻona pololei ʻoi aku ka maikaʻi i ka wā o ka hoʻemi ʻana i ia mau hihia.
Ka manawa hoʻouna: Sep-09-2023
