Iiparameters zemifanekiso ezisetyenziswa kakhulu ukuvavanya ukwaphuka kweradiyumu ye-distal zihlala ziquka i-volar tilt angle(VTA), i-ulnar variance, kunye nokuphakama kwe-radial. Njengoko ukuqonda kwethu i-anatomy yeradiyumu ye-distal kuye kwanda, iiparameter ezongezelelweyo zemifanekiso ezifana nomgama we-anteroposterior (APD), i-teardrop angle (TDA), kunye nomgama we-capitate-to-axis-of-radius (CARD) ziye zacetyiswa kwaye zasetyenziswa kwizonyango.
Iiparameters zemifanekiso ezisetyenziswa rhoqo ukuvavanya ukwaphuka kwe-distal radius ziquka: a：VTA；b：APD；c：TDA；d：CARD。
Uninzi lweeparamitha zomfanekiso zifanelekile kwiifractures ze-extra-articular distal radius, ezifana nokuphakama kwe-radial kunye nokwahluka kwe-ulnar. Nangona kunjalo, kwezinye iifractures ze-intra-articular, ezifana neefractures zikaBarton, iiparamitha zomfanekiso zemveli zisenokungabi nakho ukumisela ngokuchanekileyo izalathiso zotyando kunye nokubonelela ngesikhokelo. Ngokuqhelekileyo kukholelwa ukuba isalathiso sotyando kwezinye iifractures ze-intra-articular sinxulumene ngokusondeleyo nokusuka komphezulu wejoyinti. Ukuze kuhlolwe inqanaba lokufuduka kweefractures ze-intra-articular, iingcali zamanye amazwe zicebise ipharamitha entsha yokulinganisa: i-TAD (Tilt After Displacement), kwaye yaqala ukuxelwa kuvavanyo lweefractures ze-posterior malleolus ezihamba kunye ne-distal tibial displacement.
Kwisiphelo esikude se-tibia, kwiimeko zokuqhekeka kwe-posterior malleolus kunye nokuqhekeka kwe-posterior talus, umphezulu odibeneyo wenza ii-arcs ezintathu: I-Arc 1 ngumphezulu odibeneyo wangaphambili we-distal tibia, i-Arc 2 ngumphezulu odibeneyo we-posterior malleolus fragment, kwaye i-Arc 3 ngumphezulu we-talus. Xa kukho i-posterior malleolus fracture fragment ehamba kunye nokuqhekeka kwe-posterior talus, iziko lesangqa elenziwe yi-Arc 1 kumphezulu odibeneyo wangaphambili libonakaliswa njengenqaku T, kwaye iziko lesangqa elenziwe yi-Arc 3 phezulu kwe-talus libonakaliswa njengenqaku A. Umgama phakathi kwezi ziko zimbini yi-TAD (Tilt After Displacement), kwaye okukhona ukufuduka kukhulu, kokukhona ixabiso le-TAD liba likhulu.
Injongo yotyando kukufikelela kwixabiso le-ATD (Tilt After Displacement) elingu-0, nto leyo ebonisa ukuncipha kwe-anatomical yomphezulu welungu.
Ngokufanayo, kwimeko yokuqhekeka kukaVolar Barton:
Iziqwenga zomphezulu we-articular ezishiyeke kancinci zenza i-Arc 1.
Icala le-lunate lisebenza njenge-Arc 2.
Icala elingasemva leradius (ithambo eliqhelekileyo elingenakwaphuka) limele iArc 3.
Nganye kwezi arcs zintathu ingathathwa njengezangqa. Ekubeni i-lunate facet kunye ne-volar bone fragment zisuswa kunye, i-Circle 1 (etyheli) yabelana ngesiziba sayo ne-Circle 2 (emhlophe). I-ACD imele umgama ukusuka kwesi siziba esabiweyo ukuya esizibeni se-Circle 3. Injongo yotyando kukubuyisela i-ACD kwi-0, nto leyo ebonisa ukunciphisa i-anatomical.
Kwimisebenzi yeklinikhi yangaphambili, kuye kwamkelwa ngokubanzi ukuba ukunyathela komphezulu odibeneyo we-<2mm ngumgangatho wokunciphisa. Nangona kunjalo, kolu phononongo, uhlalutyo lwejika leReceiver Operating Characteristic (ROC) leeparamitha ezahlukeneyo zomfanekiso lubonise ukuba i-ACD yayinendawo ephezulu phantsi kwejika (AUC). Ukusebenzisa ixabiso lokunqunyulwa kwe-1.02mm kwi-ACD, kubonise uvakalelo lwe-100% kunye nokuchazwa kwe-80.95%. Oku kuthetha ukuba kwinkqubo yokunciphisa ukwaphuka, ukunciphisa i-ACD ukuya kwi-1.02mm kunokuba yindlela efanelekileyo ngakumbi.
kunomgangatho wendabuko wokutsiba umphezulu odibeneyo ongaphantsi kwe-2mm.
Kubonakala ngathi i-ACD inentsingiselo ebalulekileyo ekuvavanyeni umlinganiselo wokufuduka kwizaphuko zangaphakathi kwe-articular ezibandakanya amalungu aqinileyo. Ukongeza ekusetyenzisweni kwayo ekuvavanyeni izaphuko zangaphakathi kwe-tibial plafond kunye nezaphuko zangaphandle kwe-distal radius njengoko bekutshiwo ngaphambili, i-ACD ingasetyenziselwa ukuvavanya izaphuko zengqiniba. Oku kunika oogqirha bezonyango isixhobo esiluncedo sokukhetha iindlela zonyango kunye nokuvavanya iziphumo zokunciphisa izaphuko.
Ixesha lokuthumela: Septemba-18-2023
