Amapharamitha okudweba asetshenziswa kakhulu ukuhlola ukwaphuka kwe-distal radius ngokuvamile afaka i-volar tilt angle (VTA), i-ulnar variance, kanye nokuphakama kwe-radial. Njengoba ukuqonda kwethu i-anatomy ye-distal radius kuye kwajula, amapharamitha engeziwe okudweba njenge-anteroposterior distance (APD), i-teardrop angle (TDA), kanye ne-capitate-to-axis-of-radius distance (CARD) kuye kwaphakanyiswa futhi kwasetshenziswa emtholampilo.
Amapharamitha okuthwebula izithombe avame ukusetshenziswa ukuhlola ukwaphuka kwe-distal radius afaka: a：VTA；b：APD；c：TDA；d：CARD。
Iningi lamapharamitha okuthatha izithombe lifanelekela ukwaphuka kwe-extra-articular distal radius, njengokuphakama kwe-radial kanye nokuhlukahluka kwe-ulnar. Kodwa-ke, kwamanye ama-fracture angaphakathi kwe-articular, njengokwaphuka kukaBarton, amapharamitha okuthatha izithombe avamile angase angabi namandla okunquma ngokunembile izinkomba zokuhlinzwa nokunikeza isiqondiso. Ngokuvamile kukholelwa ukuthi isibonakaliso sokuhlinzwa kwamanye ama-fracture angaphakathi kwe-articular sihlobene kakhulu nokusuka kobuso obuhlangene. Ukuze kuhlolwe izinga lokufuduka kwama-fracture angaphakathi kwe-articular, izazi zakwamanye amazwe ziphakamise ipharamitha entsha yokulinganisa: i-TAD (Tilt After Displacement), futhi yaqala ukubikwa ukuze kuhlolwe ukuphuka kwe-posterior malleolus okuhambisana nokufuduka kwe-tibial distal.
Emaphethelweni akude e-tibia, ezimweni zokuphuka kwe-posterior malleolus kanye nokuhlukana kwe-posterior talus, ubuso obuhlangene bakha ama-arcs amathathu: I-Arc 1 iwubuso obuhlangene bangaphambili be-distal tibia, i-Arc 2 iwubuso obuhlangene be-posterior malleolus fragment, kanti i-Arc 3 ingaphezulu kwe-talus. Uma kukhona i-posterior malleolus fracture fragment ehambisana nokuhlukana kwe-posterior talus, isikhungo sendilinga esakhiwe yi-Arc 1 ebusweni obuhlangene bangaphambili sichazwa njengephuzu T, kanti isikhungo sendilinga esakhiwe yi-Arc 3 phezulu kwe-talus sichazwa njengephuzu A. Ibanga phakathi kwalezi zikhungo ezimbili yi-TAD (Tilt After Displacement), futhi uma ukufuduka kukhulu, inani le-TAD liba likhulu.
Inhloso yokuhlinzwa ukufeza inani le-ATD (Tilt After Displacement) elingu-0, okubonisa ukwehla kokwakheka kwendawo yamalunga.
Ngokufanayo, endabeni yokuphuka kukaVolar Barton:
Izingcezu zobuso obuhlanganisiwe ezisusiwe kancane zakha i-Arc 1.
I-lunate facet isebenza njenge-Arc 2.
Isici sangemuva se-radius (ithambo elivamile elingenalo ukwaphuka) simelela i-Arc 3.
Ngayinye yalezi zingqimba ezintathu ingabhekwa njengezindilinga. Njengoba uhlangothi lwenyanga kanye nengxenye yethambo le-volar zihlukaniswa ndawonye, i-Circle 1 (ephuzi) yabelana ngesikhungo sayo ne-Circle 2 (emhlophe). I-ACD imele ibanga ukusuka kulesi sikhungo esabiwe kuya enkabeni ye-Circle 3. Inhloso yokuhlinzwa ukubuyisela i-ACD ku-0, okubonisa ukwehla kwesakhiwo somzimba.
Emikhubeni yezokwelapha yangaphambilini, kuye kwamukelwa kabanzi ukuthi ukunyathela kobuso obuhlangene okungu-<2mm kuyindinganiso yokunciphisa. Kodwa-ke, kulolu cwaningo, ukuhlaziywa kwejika le-Receiver Operating Characteristic (ROC) lamapharamitha ahlukene okuthwebula izithombe kubonise ukuthi i-ACD yayinendawo ephezulu kakhulu ngaphansi kwejika (AUC). Ukusebenzisa inani elinqunyiwe elingu-1.02mm le-ACD, kubonise ukuzwela okungu-100% kanye nokucaciswa okungu-80.95%. Lokhu kusikisela ukuthi enkambisweni yokunciphisa ukuqhekeka, ukunciphisa i-ACD ibe ngaphakathi kuka-1.02mm kungaba yindlela enengqondo kakhulu.
kunendinganiso yendabuko yokusuka endaweni ehlangene engaphansi kwe-<2mm.
Kubonakala sengathi i-ACD inokubaluleka okubalulekile ekuhloleni izinga lokuhamba kwemisipha ephukile ehlanganisa amalunga agxile. Ngaphezu kokusetshenziswa kwayo ekuhloleni ukuphuka kwe-tibial plafond kanye nokuphuka kwe-distal radius njengoba kushiwo ngaphambili, i-ACD ingasetshenziswa futhi ekuhloleni ukuphuka kwe-elbow. Lokhu kunikeza odokotela ithuluzi eliwusizo lokukhetha izindlela zokwelapha kanye nokuhlola imiphumela yokunciphisa ukuphuka kwemisipha.
Isikhathi sokuthunyelwe: Septhemba 18-2023
