Iwo anonyanya kushandiswa ekufungidzira maparamendi ekuongorora distal radius fractures anowanzo sanganisira volar tilt angle (VTA), ulnar musiyano, uye radial kureba.Sezvo manzwisisiro edu eanatomy yeiyo distal radius yakadzika, mamwe ekufungidzira maparamita akadai seanteroposterior kureba (APD), teardrop angle (TDA), uye capitate-to-axis-of-radius kure (CARD) yakatsanangurwa uye yakashandiswa mukati. kliniki tsika.
Inowanzo shandiswa kufungidzira maparamita ekuongorora distal radius fractures anosanganisira: a: VTA;b:APD;c:TDA;d:CARD.
Mazhinji ekufungidzira ma paramita akakodzera ekuwedzera-articular distal radius fractures, senge radial kureba uye ulnar musiyano.Nekudaro, kune mamwe ma-intra-articular fractures, sekutyoka kwaBarton, zvimiro zvekufungidzira zvechinyakare zvinogona kunge zvichishaikwa mukukwanisa kwavo kunyatsoona zviratidzo zvekuvhiya uye kupa nhungamiro.Zvinowanzotendwa kuti chiratidzo chekuvhiya kune mamwe ma-intra-articular fractures ane hukama hwepedyo nenhanho-kubva yejoint surface.Kuti vatarise dhigirii rekutamiswa kwemukati-articular fractures, nyanzvi dzekune dzimwe nyika dzakaronga chiyero chitsva chekuyera: TAD (Tilt After Displacement), uye yakatanga kushumwa kuti iongororwe posterior malleolus fractures ichiperekedzwa ne distal tibial displacement.
Kumucheto kwekupedzisira kwetibia, muzviitiko zvemashure malleolus fracture ne posterior dislocation ye talus, iyo yakabatana inoumba ma arcs matatu: Arc 1 ndiyo yakatarisana nechepamusoro ye distal tibia, Arc 2 ndiyo yakabatana pamusoro pe posterior malleolus. chidimbu, uye Arc 3 ndiyo yepamusoro petalus.Kana paine posterior malleolus fracture fragment inoperekedzwa nekumashure kutsemuka kwetalus, pakati pedenderedzwa rakaumbwa neArc 1 pane anterior joint surface inoratidzwa sepoint T, uye pakati pedenderedzwa rakaumbwa neArc 3 pamusoro pe. iyo talus inotaridzwa sepoindi A. Nhambwe iri pakati penzvimbo mbiri idzi iTAD (Tilt After Displacement), uye iyo yakakura kusimuka, iyo yakakura kukosha kweTAD.
Chinangwa chekuvhiya ndechekuwana kukosha kweATD (Tilt After Displacement) ye0, zvichiratidza kudzikiswa kweanatomical yejoint surface.
Saizvozvo, muchiitiko chekuputsika kwaBarton:
Zvimedu zve articular zvakabviswa nzvimbo zvinoumba Arc 1.
Iyo lunate facet inoshanda seArc 2.
Iyo dorsal chikamu cheradius (yakajairika bhonzo isina kutyoka) inomiririra Arc 3.
Imwe neimwe yeaya matatu arcs inogona kutorwa semadenderedzwa.Sezvo iyo lunate facet uye volar bone fragment zvichibviswa pamwe chete, Denderedzwa 1 (muyero) inogovera pakati payo neCircle 2 (muchena).ACD inomiririra chinhambwe kubva panzvimbo ino yakagoverwa kusvika pakati peDenderedzwa 3. Chinangwa chekuvhiya ndechekudzorera ACD ku0, zvichiratidza kuderedzwa kweanatomical.
Muchiito chekiriniki yapfuura, yakave yakagamuchirwa zvakanyanya kuti danho repamusoro-soro re <2mm ndiyo chiyero chekudzikisa.Nekudaro, muchidzidzo ichi, iyo Receiver Operating Characteristic (ROC) curve ongororo yeakasiyana ekufungidzira paramita yakaratidza kuti ACD yaive nenzvimbo yepamusoro pasi pe curve (AUC).Ichishandisa cutoff kukosha kwe1.02mm yeACD, yakaratidza 100% kunzwa uye 80.95% chaiyo.Izvi zvinoratidza kuti mukuderedza kuputsika, kuderedza ACD kusvika mukati me1.02mm inogona kunge iri chiyero chinonzwisisika.
kupfuura tsika yechinyakare ye <2mm yakabatana pamusoro nhanho-kubva.
ACD inoratidzika kunge ine kukosha kwakakosha kwekutarisa dhigirii rekutamisa mukati me-intra-articular fractures inosanganisira concentric joints.Pamusoro pekushandiswa kwayo pakuongorora kutsemuka kwetibial plafond uye distal radius fractures sezvambotaurwa, ACD inogona zvakare kushandiswa kuongorora kutsemuka kwegokora.Izvi zvinopa varapi vekiriniki chishandiso chinobatsira pakusarudza nzira dzekurapa uye kuongorora mhedzisiro yekuderedza kuputsika.
Nguva yekutumira: Sep-18-2023
