ʻO ka haki ʻana o ka tendon extensor ma hope o ka hoʻopaʻa ʻana o ka volar plate he pilikia nui i ka hoʻoponopono ʻana i nā haʻihaʻi radius distal. ʻO ka tendon i hoʻopili pinepine ʻia ʻo ka extensor pollicis longus (EPL) tendon, no ka mea, paʻa ia i loko o ke awāwa EPL. ʻO ka maʻi i hōʻike ʻia o ka haki ʻana o ka tendon EPL ma hope o ka plating volar he 0.29%-5.7%.
Hoʻonui ʻia ka pilikia o ka haki ʻana o ka tendon EPL ma ke alo o ka puka ʻana o ke kua, ka ʻeha mai ka hoʻoheheʻe ʻana i loko o ka hana, a me nā ʻāpana o ka hale hope, ʻoi aku ka nui o nā haʻi moku o ka tubercle o Lister. He paʻakikī ka loiloi radiographic o ka hoʻoheheʻe ʻana o ka wili i nā haʻihaʻi ākea ma muli o ka geometry paʻakikī o ka radius distal a me ka hiki ke hiki i nā haʻihaʻi hope. ʻO ka hiʻohiʻona dorsal tangential ʻo ia wale nō ka ʻike intravital o ka dorsal radial cortex e loaʻa ai kahi loiloi hilinaʻi o ka mamao ma waena o ka piko wili a me ka cortex hope.
ʻO nā ʻenehana no ka pale ʻana i ka hōʻeha tendon extensor ka hoʻohana ʻana i nā wili monocortical a me ka pale ʻana i ke komo ʻana o ka ʻili o hope; akā naʻe, hiki i kēia mau ʻenehana ke hōʻemi i ke kūpaʻa mechanical o ka hoʻoponopono ʻana i ka haki. No laila, koi ʻia ka hoʻoponopono bicortical i kekahi manawa. No ka ho'ēmiʻana i ka pilikia o kaʻeha tendon extensor,ʻaʻole pono e hoʻololiʻia nā pahuhopu mua o ka hoʻoponoponoʻana i ka haʻihaʻi a me ka paʻa.
Nā ʻenehana hana hou
Hōʻike mākou i kahi ʻenehana hou e hōʻemi i ka pilikia o ka haki ʻana o ka tendon EPL ma hope o ka hoʻopaʻa ʻana o ka pā volar o nā haʻihaʻi radius distal me ka ʻole o ka pōkole ʻana i ka lōʻihi o ka screw a i ʻole ka wehe ʻana i nā ʻāpana o ka hale. ʻO ka pōkole, pili ka ʻenehana i ka wehe ʻana i ke kolu o ke keʻena ma o kahi ʻoki hope liʻiliʻi.
Ina ua komo ka wili i ka dorsal cortex a puka ma ke kolu o ke keena: wehe makou i ka EPL tendon mai kona awawa a pani i ke keena ma ka humuhumu ana i ka retinaculum e waiho ana i ka EPL tendon ma ka retinaculum hooponopono.
Inā ʻaʻole i hoʻonui ʻia ka wili i ke kolu o ka ʻāpana: haʻalele mākou i ka tendon EPL i ke kolu o ka ʻāpana. ʻO ka hōʻailona o kā mākou ʻenehana aia i nā mea maʻi me nā haʻihaʻi radius mamao i mālama ʻia me nā pā laka volar, nā ʻāpana me nā ʻāpana dorso-parietal a i ʻole nā wili e hiki ke komo i ka cortex dorsal a hōʻino paha i ka tendon EPL a puni ka tubercle o Lister. I nā poʻe maʻi me nā haʻihaʻi radius distal me nā ʻāpana dorsomedial, ʻeli mākou i nā lua e komo i loko o ka cortex dorsal a koho i nā wili o ka lōʻihi e hoʻoponopono ai i nā ʻāpana dorsomedial paʻa ʻole.
Kaʻana like
Kaʻana like mākou i kahi hihia kahi i wehe ʻia ai ka tendon EPL mai ke kolu o ka ʻāpana ma muli o ka hoʻokuʻu ʻia ʻana o ka screw i ke kolu o ka ʻāpana i ka wā o ka hoʻopaʻa ʻana o ka pā o kahi haʻihaʻi radius comminuted me nā ʻāpana dorsomedial. Ua hōʻoia mākou ua paʻa ka tendon EPL i 7 mau makahiki ma hope o ka hoʻopaʻa ʻana, ʻoiai ua ʻike ʻia ka wili i ke kolu o ka ʻāpana.
ʻO ka hihia he wahine 67 makahiki me ka hōʻike ʻana o kahi intra-articular unstable distal radius fracture me ka ʻaoʻao dorsal medial fracture (Figure 1A-E). ʻAʻohe mōʻaukala o ka puhi paka, ka maʻi diabetes a me ka ʻai ʻana i ka waiʻona. Hiki ke hele wāwae ʻole.
![haʻihaʻi radius distal]()
kiʻi 1. Ua hōʻike ʻia ke kiʻi preoperative i kahi haki intra-articular comminuted o ka radius distal.
A a me B: Nā hihi X ma mua o ka hana,
C a me D: nā hiʻohiʻona sagittal a me axial o nā kiʻi tomography i helu ʻia,
E: 3D computed tomography kiʻi. ʻIke ʻia nā ʻāpana ʻaoʻao hope o ka lunate a me nā ʻāpana apical hope (keʻokeʻo asterisk).
ʻenehana ʻokiʻoki
Ua mālama mākou i kēia ʻōnaehana haʻihaʻi me kahi pā paʻa volar. Intraoperatively, ua wili mākou i loko o ka dorsal cortex a koho i kahi wili lōʻihi e hoʻopaʻa i ka dorsal cortex no ka mea ʻaʻole paʻa ka ʻāpana dorsomedial (Figure 2).
Ua hana ʻia ke ʻoki ʻana no ka wehe ʻana i ke kolu o ke keʻena ma hope o ka hoʻopaʻa ʻana i ka screw.
No ka mea ua komo ka wili i ke kolu o ke keena a puka mai (Figure 3A), e wehe piha i ke kolu o ke keena a hoonee i ka EPL tendon mai kona awawa (Figure 3B).
Ua pani ʻia ke kolu o ke keʻena ma ka humuhumu ʻana i ka retinaculum (Fig. 3C, D), a ua kau ʻia ka tendon EPL ma luna o ka retinaculum i hoʻoponopono ʻia (Fig. 3 E).
Ma hope o ka ʻoki ʻana, hele ka mea maʻi i ke keʻena maʻi maʻi o ko mākou haukapila a ola ka iwi. ʻAʻole makemake ka mea maʻi e wehe i ka lako.
Hoʻihoʻi ma hope o ka hana
ʻEhiku mau makahiki ma hope o ka hana, ua hoʻi ka mea maʻi i ka haukapila no ka nānā hou ʻana ma muli o ka osteoporosis. ʻAʻole pio ka lima ʻākau. ʻO ke kiʻi X-ray e hōʻike ana i kahi haʻi i hoʻōla ʻia me ka puka ʻana o ka hope o ka wili laka mamao. Ua hoʻopaneʻe piha ʻia ka manamana lima o ka mea maʻi, a ʻaʻohe kaula i ʻike ʻia i ka tendon EPL.
Ma kā mākou ʻōlelo paipai, ua ʻae ka mea maʻi e wehe i ka hāmeʻa a nānā i nā tendon extensor. Intraoperatively, ua nānā mākou i ka EPL tendon ma o ka dorsal incision a wehe ʻia kekahi hapa i ke kolu a me ka hā.
Aia ka tendon EPL ma waho o ke kolu o ke keʻena ma ke kūlana like me ka hana ma mua, a ʻaʻole i hoʻonāukiuki ka tendon.
Ua hōʻoia mākou ua komo ka wili i ke kolu o ke keʻena i ka wā i hoʻihoʻi ʻia nā tendon extensor o nā manamana lima.
ʻO ka hope, hoʻoponopono mākou i nā kaula kākoʻo a wehe i ka lako. I ka loiloi hope loa 2 mahina ma hope o ka wehe ʻana i ka lako, ʻaʻohe ʻeha o ka mea maʻi a ua hoʻonui ʻia kona manamana lima.
Kūkākūkā
I ko mākou hoʻokokoke ʻana, ma hope o ka hoʻopaʻa ʻana o ka pā volar o nā ʻāpana radius distal, ua wehe mākou i ke kolu o ka ʻāpana ma o kahi ʻoki ʻana ma kahi o 2 cm lōʻihi ulnar i ka tubercle o Lister. Ua ʻike pololei mākou i ka tendon EPL a me ka papahele o ke kolu o ka ʻāpana extensor ma ka hoʻihoʻi mālie ʻana i ka tendon EPL.
Inā komo ka wili i ka dorsal cortex i loko o ke kolu o ka ʻāpana a i ʻole ka ʻōpala dorso-parietal, ʻaʻole mākou i hana i ka hoʻololi ʻana i ka ʻili intraoperative a i ʻole ka fragmentectomy, akā ua wehe loa i ke kolu o ka ʻāpana a wehe i ka tendon EPL mai kona awāwa. A laila pani mākou i ke keʻena ma ke kāʻei ʻana i ka retinaculum i ka wā e hoʻonoho hou ana i ka tendon EPL ma ke kolu o ka ʻāpana.
Inā ʻaʻole i hoʻonui ʻia ka wili i ke kolu o ke keʻena, ua haʻalele mākou i ka tendon EPL ma ka ʻāpana ʻekolu i wehe ʻia.
Hiki i kā mākou ʻenehana ʻokiʻoki ke nānā maʻalahi i nā ʻeha tendon EPL me ka ʻike pololei ʻana i ka liʻiliʻi he 10 mau minuke. Inā ʻeha ka tendon EPL, hiki ke hoʻoponopono pololei. Kōkua kēia kaʻina hana e pale i ka haki ʻana o ka tendon EPL lua ma hope o ka hoʻopaʻa ʻana o ka pā radial distal. Hiki mai paha ke kaula ʻo EPL tendon bowstring, akā ʻaʻole i hiki i kā mākou hihia.
I ka hopena
Ua ʻike mākou i kahi hihia i paʻa ai ka tendon EPL i 7 mau makahiki ma hope o ka hoʻopaʻa ʻana, ʻoiai ua ʻike ʻia nā wili i hoʻohana ʻia no ka hoʻoponopono ʻana i ka pā volar i ke kolu o ka ʻāpana. Hoʻemi ʻia kā mākou ʻenehana ʻokiʻoki i ka hopena o ka haki ʻana o ka tendon EPL ma hope o ka hoʻopaʻa ʻana o ka volar plate no nā haʻihaʻi radius distal.
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