Txoj kev kho mob tshaj plaws rau cov pob qij txha ntawm lub qhov muag yog qhov volar Henry mus kom ze nrog kev siv cov ntawv xauv thiab cov ntsia hlau rau kev kho sab hauv.Thaum lub sij hawm kho cov txheej txheem sab hauv, nws yog feem ntau tsis tsim nyog los qhib lub radiocarpal sib koom tshuaj ntsiav.Kev sib koom ua ke yog ua tiav los ntawm kev siv sab nraud, thiab kev siv tshuaj fluoroscopy yog siv los ntsuas qhov sib koom ua ke ntawm qhov chaw.Nyob rau hauv cov ntaub ntawv ntawm intra-articular depressed fractures, xws li tuag-punch fractures, qhov twg indirect txo thiab kev ntsuam xyuas yog nyuaj, nws yuav tsum tau siv ib tug dorsal mus kom ze los pab nrog ncaj qha kev pom thiab txo (raws li qhia nyob rau hauv daim duab hauv qab no).
Cov ligaments extrinsic thiab intrinsic ligaments ntawm radiocarpal sib koom yog suav tias yog cov qauv tseem ceeb rau kev tswj lub dab teg kev ruaj ntseg.Nrog rau kev nce qib hauv kev tshawb fawb anatomical, nws tau pom tias, nyob rau hauv cov xwm txheej ntawm kev khaws cov kev ncaj ncees ntawm luv luv radiolunate ligament, txiav cov ligaments extrinsic tsis tas yuav ua rau lub dab teg sib koom ua ke.
Yog li ntawd, hauv qee qhov xwm txheej, kom ua tiav qhov pom zoo ntawm qhov sib koom ua ke, nws yuav tsum tau ua ib feem ntawm cov ligaments extrinsic ligaments, thiab qhov no yog hu ua volar intraarticular extended window mus kom ze (VIEW).Raws li pom hauv daim duab hauv qab no:
Daim duab AB: Nyob rau hauv cov pa Henry mus kom ze rau exposing lub distal radius pob txha nto, nyob rau hauv thiaj li yuav nkag mus rau ib tug phua fracture ntawm lub distal radius thiab scaphoid facet, lub dab teg sib koom capsule yog pib incised.Lub retractor yog siv los tiv thaiv luv luv radiolunate ligament.Tom qab ntawd, ntev radiolunate ligament yog incised los ntawm lub distal radius mus rau ulnar sab ntawm lub scaphoid.Lub sijhawm no, kev pom ncaj qha ntawm qhov sib koom ua ke tuaj yeem ua tiav.
Daim duab CD: Tom qab nthuav tawm qhov sib koom ua ke, qhov txo qis ntawm lub dav hlau sagittal kev nyuaj siab sib koom ua ke yog ua raws li kev pom ncaj qha.Cov pob txha elevator yog siv los tswj thiab txo cov pob txha tawg, thiab 0.9 hli Kirschner xov hlau yuav siv tau rau kev kho ib ntus lossis zaum kawg.Thaum qhov sib koom ua ke yog txo kom txaus, cov qauv txheej txheem rau phaj thiab ntsia hlau fixation yog ua raws.Thaum kawg, qhov incisions ua nyob rau hauv ntev radiolunate ligament thiab lub dab teg sib koom capsule yog sutured.
Lub hauv paus theoretical ntawm VIEW (volar intraarticular extended window) mus kom ze nyob rau hauv kev nkag siab tias kev txiav qee yam dab teg sib koom tes extrinsic ligaments tsis tas yuav ua rau lub dab teg sib koom ua ke.Yog li ntawd, nws raug pom zoo rau qee qhov nyuaj intra-articular comminuted distal radius fractures qhov twg fluoroscopic sib koom ua ke ntawm qhov sib tw yog qhov nyuaj lossis thaum muaj cov kauj ruam tawm.VIEW txoj hauv kev tau pom zoo kom ua tiav qhov pom kev ncaj qha zoo dua thaum txo cov xwm txheej zoo li no.
Post lub sij hawm: Sep-09-2023
