Ukwelashwa okuvame kakhulu kokuqhekeka kwe-distal radius indlela ye-volar Henry ngokusetshenziswa kwamapuleti okukhiya nezikulufu zokulungiswa kwangaphakathi.Phakathi nenqubo yokulungisa yangaphakathi, ngokuvamile akudingekile ukuvula i-capsule ehlangene ye-radiocarpal.Ukunciphisa ngokuhlanganyela kufinyelelwa ngendlela yokukhwabanisa yangaphandle, futhi i-fluoroscopy ye-intraoperative isetshenziselwa ukuhlola ukulungiswa kwendawo ehlangene.Ezimweni zokuphuka kokucindezeleka kwe-intra-articular, njenge-Die-punch fractures, lapho ukunciphisa okungaqondile nokuhlola kuyinselele, kungase kudingeke ukuthi kusetshenziswe indlela ye-dorsal ukuze usize ngokubuka okuqondile nokunciphisa (njengoba kuboniswe esithombeni esingezansi).
Imigqa yangaphandle kanye nemigqa yangaphakathi yejoyinti ye-radiocarpal ibhekwa njengezakhiwo ezibalulekile zokugcina ukuqina kwamalunga esihlakala.Ngokuthuthuka kocwaningo lwe-anatomical, kuye kwatholakala ukuthi, ngaphansi kwesimo sokulondoloza ubuqotho be-radiolunate ligament emfushane, ukusika imigqa yangaphandle akusho ukuthi kubangele ukungazinzi kwesihlakala.
Ngakho-ke, ezimweni ezithile, ukuze kuzuzwe umbono ongcono wendawo ehlangene, kungase kudingeke ukuthi kufakwe ingxenye yemigqa yangaphandle, futhi lokhu kwaziwa ngokuthi i-volar intraarticular extended window approach (VIEW).Njengoba kuboniswe emfanekisweni ongezansi:
Umfanekiso AB: Endleleni evamile ka-Henry yokudalula i-distal radius bone surface, ukuze ufinyelele ukuhlukana kwe-distal radius kanye ne-scaphoid facet, i-capsule ehlangene yesihlakala iyasikwa ekuqaleni.I-retractor isetshenziselwa ukuvikela i-radiolunate ligament emfushane.Ngokulandelayo, umsipha omude we-radiolunate uyasikwa ukusuka endaweni eyi-distal kuya ohlangothini lwe-ulnar lwe-scaphoid.Kuleli qophelo, ukuboniswa okuqondile kwendawo ehlangene kungafinyelelwa.
I-CD yomfanekiso: Ngemva kokudalula indawo ehlangene, ukuncishiswa kwendawo ehlangene ecindezelekile yendiza ye-sagittal kwenziwa ngaphansi kokuboniswa okuqondile.Izinyusi zamathambo zisetshenziselwa ukuphatha nokunciphisa izingcezu zamathambo, futhi izintambo ze-Kirschner ezingu-0.9mm zingase zisetshenziselwe ukulungiswa kwesikhashana noma okokugcina.Uma indawo ehlangene isincishiswe ngokwanele, kulandelwa izindlela ezijwayelekile zokulungisa ipuleti nesikulufu.Ekugcineni, izimbobo ezenziwe emthanjeni omude we-radiolunate kanye ne-capsule ehlangene yesihlakala iyathungwa.
Isisekelo setiyetha sendlela ye-VIEW (volar intraarticular extended window) sisekuqondeni ukuthi ukusika imigqa ethile yangaphandle ehlangene yesihlakala akusho ukuthi kubangele ukuntengantenga kwesihlakala.Ngakho-ke, kunconyelwa ukuhlukana okuthile okuyinkimbinkimbi kwe-intra-articular comminuted distal radius lapho ukuncishiswa kwendawo ehlangene ye-fluoroscopic kuyinselele noma uma kukhona izinyathelo ezisukayo.Indlela ye-VIEW inconywa kakhulu ukuze kuzuzwe ukubonwa okuqondile okungcono ngesikhathi sokunciphisa ezimweni ezinjalo.
Isikhathi sokuthumela: Sep-09-2023
