Nzira ye "expansion window" inoshandiswa ne ultrasound inobatsira kuderedza kuputsika kwe distal radius padivi pejoini.

Nzira inonyanya kushandiswa yekurapa kupwanyika kwe distal radius ndeye volar Henry approach uchishandisa ma locking plates nema screws ekugadzirisa mukati. Munguva ye internal fixation, hazvidikanwi kuvhura radiocarpal joint capsule. Kuderedza majoini kunowanikwa kuburikidza ne external manipulation method, uye intraoperative fluoroscopy inoshandiswa kuongorora kurongeka kwenzvimbo dzejoini. Muzviitiko zvekupwanyika kwe intra-articular depressed, zvakaita seDie-punch fractures, uko kudzikiswa nekuongororwa zvisina kunanga kunonetsa, zvingave zvakakosha kushandisa dorsal approach kubatsira ne direct visualization uye reduction (sezvinoratidzwa mumufananidzo uri pazasi).

Mitsetse yekunze uye mitsetse yemukati mejoini reradiocarpal zvinoonekwa sezvinhu zvakakosha pakuchengetedza kugadzikana kwejoini reruoko. Nekufambira mberi mukutsvaga kwemuviri, zvakaonekwa kuti, kana tichitarisa kuchengetedza kusimba kwejoini pfupi reradiolunate, kucheka mitsetse yekunze hakurevi hako kuti joini reruoko harina kugadzikana.

Saka, mune mamwe mamiriro ezvinhu, kuti uwane kuona zviri nani pamusoro pejoini, zvingave zvakakosha kucheka zvishoma ligaments dzekunze, uye izvi zvinozivikanwa se volar intraarticular extended window approach (VIEW). Sezvakaratidzwa mumufananidzo uri pazasi:

Mufananidzo AB: Munzira yakajairika yaHenry yekuratidza pamusoro pemapfupa eredhius redhius, kuitira kuti pave nekutyoka kwakapatsanurwa kweredhius redhius ne scaphoid facet, kapisiyumu yejoini reruoko inotanga yachekwa. Retractor inoshandiswa kuchengetedza ligament pfupi yeradiolunate. Zvadaro, ligament refu yeradiolunate inochekwa kubva paredhius redhius kuenda kudivi reulnar rescaphoid. Panguva ino, kuona zvakananga pamusoro pejoini kunogona kuitwa.

Mufananidzo CD: Mushure mekuratidzwa kwenzvimbo yejoini, kuderedzwa kwenzvimbo yejoini yakaderedzwa nesagittal plane kunoitwa nekuona zvakananga. Maelevator emapfupa anoshandiswa kugadzirisa nekuderedza zvidimbu zvemapfupa, uye waya dzeKirschner dze0.9mm dzinogona kushandiswa kugadzirisa kwenguva pfupi kana kwekupedzisira. Kana nzvimbo yejoini yaderedzwa zvakakwana, nzira dzakajairika dzekugadzirisa plate nescrew dzinoteverwa. Pakupedzisira, machekwa anoitwa mu ligament refu reradiolunate uye capsule yejoini remaoko anosungirirwa.

Hwaro hwepfungwa dzeVIEW (volar intraarticular extended window) huri mukunzwisisa kuti kucheka mamwe majoini ekunze kwejoini remaoko hakurevi kuti majoini emaoko haachinji. Nokudaro, zvinokurudzirwa kune mamwe majoini akaomarara akabatana nepakati pejoini apo kuderedzwa kwejoini ne fluoroscopic kunonetsa kana kuti kana paine step-offs. Nzira yeVIEW inokurudzirwa zvakasimba kuti ionekwe zviri nani panguva yekudzikisa muzviitiko zvakadaro.