"I-10% ye-ankle fractures ihambisana nokulimala kwe-distal tibiofibular syndesmosis. Ucwaningo luye lwabonisa ukuthi i-52% ye-distal tibiofibular screws ibangela ukuncishiswa okungalungile kwe-syndesmosis. Ukufaka i-distal tibiofibular screw perpendicular ebusweni obuhlangene be-syndesmosis kubalulekile ukugwema ukuhlukunyezwa kwe-iatrogenic. Ngokusho kwe-AO manual, kunconywa ukuthi ufake isikulufa se-distal tibiofibular 2 cm noma u-3.5 cm ngaphezu kwendawo ye-distal tibial articular, nge-engeli engu-20-30 ° ukuya endizeni evundlile, kusukela ku-fibula kuya ku-tibia, neqakala. endaweni engathathi hlangothi."
Ukufakwa mathupha kwezikulufu ze-distal tibiofibular ngokuvamile kubangela ukuchezuka endaweni yokungena nendlela, futhi okwamanje, ayikho indlela enembile yokunquma isiqondiso sokufakwa kwalezi zikulufu. Ukuze kubhekwane nalolu daba, abacwaningi bakwamanye amazwe basebenzise indlela entsha—'indlela ye-angle bisector.
Kusetshenziswa idatha ye-imaging evela ku-16 evamile ye-ankle ehlangene, amamodeli angu-16 aphrintiwe we-3D adalwe. Ebangeni le-2 cm no-3.5 cm ngaphezu kwendawo ye-tibial articular, izintambo ezimbili ze-Kirschner ezimbili ze-1.6 mm ezihambisana nendawo ehlangene zibekwe eduze nemiphetho yangaphambili nangemuva ye-tibia ne-fibula, ngokulandelana. I-engeli ephakathi kwezintambo ezimbili ze-Kirschner ikalwe kusetshenziswa i-protractor, futhi i-drill bit engu-2.7 mm yasetshenziselwa ukubhoboza imbobo ngomugqa ohlukanisa i-engeli, kulandele ukufakwa kwesikulufu esingu-3.5 mm. Ngemva kokufaka isikulufu, isikulufu sasinqanyulwa ngobude baso kusetshenziswa isaha ukuze kuhlolwe ubudlelwano phakathi kokuqondisa kwesikulufu ne-eksisi emaphakathi ye-tibia ne-fibula.
Ukuhlolwa kwe-specimen kubonisa ukuthi kunokuvumelana okuhle phakathi kwe-axis emaphakathi ye-tibia ne-fibula kanye nomugqa ohlukanisa i-engeli, kanye naphakathi kwe-eksisi emaphakathi nendawo yesikulufu.
ngokwengqondo, le ndlela ingabeka ngempumelelo isikulufu eduze kwe-axis emaphakathi ye-tibia ne-fibula. Kodwa-ke, ngesikhathi sokuhlinzwa, ukubeka izintambo ze-Kirschner eduze nemiphetho yangaphambili nangemuva ye-tibia ne-fibula kubangela ingozi yokulimaza imithambo yegazi nezinzwa. Ukwengeza, le ndlela ayixazululi inkinga ye-iatrogenic malreduction, njengoba ukuqondanisa kwe-distal tibiofibular akukwazi ukuhlolwa ngokwanele ngokuhlinzwa ngaphambi kokubeka isikulufu.
Isikhathi sokuthumela: Jul-30-2024
