El Bileği Biyomekaniği ve Karpal Bağ Yaralanmalarının Patomekaniği
Özet
El bileği, ön kol kemiklerini ele bağlayan oldukça hareketli bir bileşik eklemdir. El bileğinin karmaşık mekanizmalarını açıklamak için farklı teoriler önerilmiştir, ancak el bileği kinematiğinin \“evrensel\” bir teorisi üzerinde fikir birliği yoktur. El bileği, proksimal karpal sıranın oldukça hareketli kemikleri etrafında eli ön kola bağlayan iki eklemli bir sistem olarak düşünülebilir. El bileği hareketi, ele harici bir kuvvet uygulandığında pasif olarak veya ön kol kasları kasıldığında aktif olarak gerçekleşebilir. Proksimal karpal sıranın üç kemiği, daha az sıkı bağlı olmaları nedeniyle distal karpal sıradaki kemiklere göre birbirlerine daha yakındır. El bileğinin radialden ulnara rotasyonu sırasında proksimal ve distal karpal sıralar farklı düzlemlerde hareket eder. Kaslar el bileğinin stabilizasyonunda önemli bir rol oynar. İki yaralanma mekanizması karpal disfonksiyona neden olabilir: doğrudan ve dolaylı. Tipik bir doğrudan karpal instabilite mekanizması, transvers karpal arkın ezilmesiyle ortaya çıkar. Dorsal perilunat dislokasyonların çoğu indirekt yaralanma mekanizmasının sonucudur. İlerleyici karpal instabilitenin dört aşaması tanımlanmıştır: SL ayrışması/scaphoid kırığı, LC çıkığı, LT ayrışması/triquetrum kırığı ve lunat çıkığı. El bileğinin biyomekaniğini anlamak, karpal patolojiyi tam olarak anlamak ve başarılı bir şekilde tedavi etmek için çok önemlidir.
The wrist is a highly mobile composite joint that connects the forearm bones to the hand. Different theories have been proposed to explain the complex mechanisms of the wrist, but there is no consensus on a "universal" theory of wrist kinematics. The wrist can be thought of as a two-joint system that connects the hand to the forearm around the highly mobile bones of the proximal carpal row. Wrist movement can occur passively when an external force is applied to the hand or actively when the forearm muscles contract. The three bones of the proximal carpal row are closer to each other than the bones in the distal carpal row due to being less tightly bound. During rotation of the wrist from radial to ulnar, the proximal and distal carpal rows move in different planes. Muscles play an important role in stabilizing the wrist. Two injury mechanisms can cause carpal dysfunction: direct and indirect. A typical direct mechanism of carpal instability occurs with crushing of the transverse carpal arch. Most dorsal perilunate dislocations are the result of an indirect injury mechanism. Four stages of progressive carpal instability have been described: SL dissociation/scaphoid fracture, LC dislocation, LT disruption/triquetrum fracture, and lunate dislocation. Understanding the biomechanics of the wrist is crucial for fully understanding and successfully treating carpal pathology.
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