Umgama ophakathi kwe-Arc: Iiparamitha zomfanekiso wokuvavanya ukufuduswa kokwaphuka kukaBarton kwicala lesundu

Ezona parameters ziqhele ukusetyenziswa zokuvavanya idistal radius fractures zibandakanya i-volar tilt angle (VTA), umahluko we-ulnar, kunye nokuphakama kweradial. Njengoko ukuqonda kwethu kwe-anatomy ye-distal radius kuye kwanda, iiparameters ezongezelelweyo zokucinga ezifana nomgama we-anteroposterior (APD), i-angle ye-teardrop (TDA), kunye nomgama we-capitate-to-axis-of-radius (CARD) zicetywayo kwaye zisetyenziswe kwikliniki yokusebenza.

Iiparamitha zokucinga eziqhelekileyo ezisetyenziselwa ukuvavanya iifractures zerediyasi ezikude ziquka: a: VTA;b:APD;c:TDA;d:CARD.

Uninzi lweeparamitha zokucinga zifanelekile kwi-extra-articular distal radius fractures, njengobude beradial kunye nokwahluka kwe-ulnar. Nangona kunjalo, kwezinye iifractures ze-intra-articular, ezifana ne-Barton's fractures, iiparamitha ze-imaging zendabuko zinokuthi ziswele amandla abo okugqiba ngokuchanekileyo izibonakaliso zotyando kunye nokubonelela ngesikhokelo. Ngokuqhelekileyo kukholelwa ukuba isalathisi sotyando kwezinye i-intra-articular fractures inxulumene ngokusondeleyo kunye nesinyathelo-off of the joint surface. Ukuze kuhlolwe iqondo lokufuduka kwe-intra-articular fractures, abaphengululi bamazwe angaphandle baye bacebisa iparameter entsha yokulinganisa: i-TAD (I-Tilt After Displacement), kwaye yaqala ingxelo yovavanyo lwe-posterior malleolus fractures ehamba kunye ne-distal tibial displacement.

Ekupheleni kwe-distal ye-tibia, kwiimeko zokuphuka kwe-malleolus yangasemva kunye ne-posterior dislocation ye-talus, i-joint surface yenza ii-arcs ezintathu: I-Arc 1 yindawo edibeneyo ye-distal tibia, i-Arc 2 yindawo edibeneyo ye-malleolus fragment yangasemva, kunye ne-Arc 3 iphezulu ye-talus. Xa kukho i-posterior malleolus fracture fragment ehamba kunye ne-posterior dislocation ye-talus, i-center of the circle eyenziwe yi-Arc 1 kwi-joint joint surface ichazwa njenge-point T, kunye ne-center of the circle eyenziwe yi-Arc 3 phezulu kwe-talus ichazwa njengenqaku A. Umgama phakathi kwala maziko mabini yi-TAD enkulu (i-Tilt, i-AD), kunye nexabiso elikhulu le-TAD.

Injongo yotyando kukufezekisa ixabiso le-ATD (Tilt After Displacement) le-0, ebonisa ukucutha kwe-anatomical yendawo edibeneyo.

Ngokufanayo, kwimeko yokuqhekeka kwe-volar Barton:

Amaqhekeza omphezulu we-articular ashenxiswa ngokuyinxenye enza i-Arc 1.

Icala lenyanga lisebenza njenge-Arc 2.

Inkalo yedorsal yeradius (ithambo eliqhelekileyo ngaphandle kokwaphuka) imele iArc 3.

Nganye kwezi zintathu ii-arcs zinokuthathwa njengezangqa. Ekubeni i-lunate facet kunye neqhekeza lethambo le-volar lifuduswa kunye, iSangqa soku-1 (esityheli) sabelana ngombindi walo kunye neSangqa sesi-2 (esimhlophe). I-ACD imele umgama ukusuka kweli ziko ekwabelwana ngalo ukuya kumbindi weSangqa 3. Injongo yotyando kukubuyisela i-ACD kwi-0, ebonisa ukuncitshiswa kwe-anatomical.

Kwinkqubo yangaphambili yeklinikhi, yamkelwe ngokubanzi ukuba i-joint surface step-off <2mm ngumgangatho wokunciphisa. Nangona kunjalo, kolu phononongo, i-Receiver Operating Characteristic (ROC) i-curve analysis ye-imaging parameters ibonise ukuba i-ACD ineyona ndawo iphezulu phantsi kwe-curve (AUC). Ukusebenzisa ixabiso le-cutoff ye-1.02mm ye-ACD, ibonise i-100% ye-sensitivity kunye ne-80.95% ekhethekileyo. Oku kuphakamisa ukuba kwinkqubo yokunciphisa i-fracture, ukunciphisa i-ACD ngaphakathi kwe-1.02mm ingaba yinqobo efanelekileyo.

kunomgangatho wemveli <2mm umphezulu odibeneyo wokunyathela.

I-ACD ibonakala inokubaluleka okubalulekileyo ekuhloleni iqondo lokufuduka kwiifractures ze-intra-articular ezibandakanya amalunga ahlangeneyo. Ukongeza kwisicelo sayo ekuhloleni i-tibial plafond fractures kunye ne-distal radius fractures njengoko kuchaziwe ngaphambili, i-ACD ingasetyenziselwa ukuvavanya ukuphuka kwe-elbow. Oku kubonelela abasebenzi beklinikhi ngesixhobo esiluncedo sokukhetha iindlela zonyango kunye nokuvavanya iziphumo zokunciphisa ukuphuka.