Amapharamitha wokucabanga asetshenziswa kakhulu okuhlola ukuhlukana kwerediyasi ekude ngokuvamile ahlanganisa i-volar tilt angle (VTA), ukuhluka kwe-ulnar, nobude be-radial. Njengoba ukuqonda kwethu i-anatomy ye-distal radius sekujule, imingcele eyengeziwe yokucabanga njengebanga le-anteroposterior (APD), i-teardrop angle (TDA), kanye nebanga le-capitate-to-axis-of-radius (CARD) iphakanyiswe futhi yasetshenziswa ekusebenzeni komtholampilo.
Amapharamitha wokucabanga asetshenziswa kakhulu ekuhloleni ukuphuka kwerediyasi ekude afaka: a: VTA;b:APD;c:TDA;d:CARD.
Amapharamitha amaningi wokucabanga afanele ukuqhekeka kwerediyasi ye-extra-articular distal, njengobude be-radial nokuhluka kwe-ulnar. Kodwa-ke, kokunye ukuphuka kwe-intra-articular, njengokuphuka kuka-Barton, imingcele yendabuko yokucabanga ingase intule emandleni abo okunquma ngokunembile izinkomba zokuhlinzwa kanye nokunikeza isiqondiso. Ngokuvamile kunenkolelo yokuthi inkomba yokuhlinzwa yokuphuka kwe-intra-articular ihlobene eduze nesinyathelo sokusuka endaweni ehlangene. Ukuze kuhlolwe izinga lokususwa kokuphuka kwe-intra-articular, izazi zakwamanye amazwe ziphakamise ipharamitha yokulinganisa entsha: I-TAD (I-Tilt After Displacement), futhi yabikwa okokuqala ngokuhlolwa kokuphuka kwe-posterior malleolus okuhambisana nokugudluka kwe-distal tibial.
Ekupheleni kwe-distal ye-tibia, ezimweni ze-posterior malleolus fracture nge-posterior dislocation ye-talus, indawo ehlangene yenza ama-arcs amathathu: I-Arc 1 iyindawo ehlangene yangaphambili ye-distal tibia, i-Arc 2 iyindawo ehlangene ye-posterior malleolus fragment, futhi i-Arc 3 ingaphezulu kwe-talus. Uma kukhona ucezu lwe-posterior malleolus fracture oluhambisana nokuhlukaniswa kwe-talus ngemuva, isikhungo sendilinga esakhiwe yi-Arc 1 endaweni ehlangene yangaphambili sichazwa njengephuzu T, futhi isikhungo sendingilizi esakhiwe yi-Arc 3 phezulu kwe-talus sichazwa njengephuzu A. Ibanga phakathi kwalezi zikhungo ezimbili yi-TAD enkulu (i-Tilt the Displacement), i-After Displacement enkulu, i-After Displacement.
Inhloso yokuhlinzwa ukuzuza inani le-ATD (Tilt After Displacement) elingu-0, elibonisa ukuncipha kokwakheka kwendawo ehlangene.
Ngokufanayo, esimweni sokuphuka kwe-volar Barton:
Izingcezu ze-articular ezisuswe indawo ngokwengxenye zakha i-Arc 1.
I-lunate facet isebenza njenge-Arc 2.
Isici se-dorsal ye-radius (ithambo elivamile elingenalo ukuphuka) limele i-Arc 3.
Ngayinye kulawa ma-arcs amathathu ingathathwa njengemibuthano. Njengoba i-lunate facet kanye ne-volar bone fragment zisuswa ndawonye, Umbuthano 1 (ophuzi) wabelana maphakathi nendawo noMbuthano 2 (omhlophe). I-ACD imele ibanga ukusuka kulesi sikhungo esabelwe ukuya enkabeni Yombuthano wesi-3. Inhloso yokuhlinzwa ukubuyisela i-ACD ku-0, okubonisa ukuncipha kwe-anatomical.
Emisebenzini yangaphambilini yomtholampilo, kuye kwamukelwa kabanzi ukuthi igxathu elihlangene lendawo engu-<2mm liyindinganiso yokunciphisa. Kodwa-ke, kulolu cwaningo, ukuhlaziywa kwejika le-Receiver Operating Characteristic (ROC) yemingcele ehlukene yokucabanga kubonise ukuthi i-ACD inendawo ephakeme kakhulu ngaphansi kwejika (AUC). Isebenzisa inani elinqunyiwe elingu-1.02mm ku-ACD, ibonise ukuzwela okungu-100% kanye nokucaciswa okungu-80.95%. Lokhu kuphakamisa ukuthi ohlelweni lokunciphisa ukuphuka, ukwehlisa i-ACD ibe phakathi kuka-1.02mm kungase kube umbandela onengqondo kakhudlwana.
kunendinganiso evamile ye-<2mm indawo ehlangene yokusuka.
I-ACD ibonakala inokubaluleka kwereferensi okubalulekile ekuhloleni izinga lokufuduka ekwaphukeni kwe-intra-articular okubandakanya amalunga agxile. Ngaphezu kokusebenza kwayo ekuhloleni ukuphuka kwe-tibial plafond kanye nokuphuka kwe-distal radius njengoba kushiwo ngaphambili, i-ACD ingase futhi isetshenziswe ekuhloleni ukuphuka kwendololwane. Lokhu kunikeza odokotela bezokwelapha ithuluzi eliwusizo lokukhetha izindlela zokwelapha nokuhlola imiphumela yokunciphisa ukuphuka.
Isikhathi sokuthumela: Sep-18-2023
