Ukulimala kweqakala kuwukulimala okuvamile kwezemidlalo okwenzeka cishe kuma-25% okulimala kwemisipha, kanti ukulimala kwe-lateral collateral ligament (LCL) kuyikona okuvamile. Uma isimo esibi singelashwa ngesikhathi, kulula ukuholela ekuqhekekeni okuphindaphindiwe, futhi amacala angathi sína azothinta ukusebenza kwe-ankle joint. Ngakho-ke, kubaluleke kakhulu ukuxilonga nokwelapha ukulimala kweziguli kusenesikhathi. Lesi sihloko sizogxila emakhonweni okuxilonga ukulimala kwe-lateral collateral ligament kwe-ankle joint ukusiza odokotela bathuthukise ukunemba kokuxilongwa.
I. Ukwakheka Kwezinto Eziphilayo
I-anterior talofibular ligament (ATFL): ithambile, ihlanganiswe ne-lateral capsule, iqala ngaphambili kuya ku-fibula bese iphetha ngaphambili komzimba we-talus.
I-ligament ye-calcaneofibular (CFL): imise okwentambo, ivela emngceleni ongaphambili we-distal lateral malleolus bese iphela ku-calcaneus.
I-posterior talofibular ligament (PTFL): Iqala ebusweni be-medial ye-lateral malleolus bese iphetha ngemuva kwe-medial talus.
I-ATFL yodwa yayinecala lokulimala okungaba ngu-80%, kanti i-ATFL kanye nokulimala kwe-CFL kwakunecala elingaba ngu-20%.
Umdwebo wesimiso kanye nomdwebo wokwakheka kwe-ligament ye-lateral collateral ye-ankle joint
II. Indlela yokulimala
Ukulimala okubekwe phezulu: i-anterior talofibular ligament
ukulimala kwe-varus ye-ligament ye-calcaneofibular: i-ligament ye-calcaneofibular
III. Ukuhlolwa kokulimala
Ibanga I: ukucindezelwa kwemisipha, ukungaqhekeki kwemisipha okubonakalayo, ukuvuvukala noma ukuthamba okungajwayelekile, kanye nokungabi nazimpawu zokulahlekelwa ukusebenza;
Ibanga lesi-2: ukuqhekeka kwe-ligament okuyingxenye, ubuhlungu obuphakathi, ukuvuvukala, kanye nobuhlungu, kanye nokukhubazeka okuncane kokusebenza kwamalunga;
Ibanga lesi-3: i-ligament idabukile ngokuphelele futhi ilahlekelwa ubuqotho bayo, ihambisana nokuvuvukala okukhulu, ukopha kanye nobuhlungu, okuhambisana nokulahlekelwa okukhulu kokusebenza kanye nokubonakaliswa kokungazinzi kwamalunga.
IV. Ukuhlolwa kwezokwelapha Ukuhlolwa kwedrowa langaphambili
Isiguli sihlezi idolo ligobile futhi ingxenye yethole ilenga, kanti umhloli ubamba i-tibia ngesandla esisodwa bese esunduza unyawo phambili ngemuva kwesithende ngesinye.
Ngaphandle kwalokho, isiguli silele phansi noma sihlezi phansi idolo ligobile kuma-degree angu-60 kuya kwangu-90, isithende sinamathele phansi, kanti umhloli usebenzisa ingcindezi yangemuva ku-distal tibia.
I-positive ibikezela ukuqhekeka komthambo we-talofibular wangaphambili.
Ukuhlolwa kokucindezeleka kokuguqulwa
Iqakala eliseduze lalingasebenzi, kwathi ukucindezeleka kwe-varus kwafakwa eqakaleni elikude ukuze kuhlolwe i-angle yokuthambekela kwe-talus.
Uma kuqhathaniswa nohlangothi oluphambene, u->5° ubonakala sengathi ulungile, kanti u->10° ubonakala sengathi ulungile; noma u-underside u->15° ubonakala sengathi ulungile.
Isibikezelo esihle sokuqhekeka kwe-calcaneofibular ligament.
Ukuhlolwa kwezithombe
Ama-X-ray okulimala kwezemidlalo okuvamile eqakaleni
Ama-X-ray awabonakali kahle, kodwa i-MRI ikhombisa ukudabuka kwe-anterior talofibular kanye ne-calcaneofibular ligaments
Izinzuzo: I-X-ray iyindlela yokuqala yokuhlolwa, okuyinto engabizi futhi elula; Ubukhulu bokulimala buhlulelwa ngokwahlulela izinga lokuthambekela kwe-talus. Okubi: Ukubonakaliswa okungekuhle kwezicubu ezithambile, ikakhulukazi izakhiwo ze-ligamentous ezibalulekile ekugcineni ukuqina kwamalunga.
I-MRI
Isithombe 1 Indawo engama-20° eqondile ibonise i-anterior talofibular ligament (ATFL) engcono kakhulu; Isithombe 2 Umugqa we-Azimuth wesikeni se-ATFL
Izithombe ze-MRI zokulimala okuhlukene kwe-anterior talofibular ligament zibonise ukuthi: (A) ukuqina kwe-anterior talofibular ligament kanye nokuvuvukala; (B) ukudabuka kwe-anterior talofibular ligament; (C) ukudabuka kwe-anterior talofibular ligament; (D) Ukulimala kwe-anterior talofibular ligament ngokuphuka kwe-avulsion.
Isithombe 3. Indawo eqondile engu--15° ibonise i-calcaneofibular ligament (CFI) engcono kakhulu;
Isithombe 4. I-azimuth yokuskena ye-CFL
Ukudabuka okubukhali, okuphelele kwe-calcaneofibular ligament
Umfanekiso 5: Umbono we-coronal ukhombisa i-posterior talofibular ligament (PTFL) engcono kakhulu;
Umfanekiso 6: i-azimuth yokuskena ye-PTFL
Ukudabuka okuyingxenye kwe-posterior talofibular ligament
Ukuhlolwa kokuxilongwa:
Isigaba I: Akukho monakalo;
Ibanga lesi-2: ukuqhekeka kwemisipha, ukuqhubeka okuhle kokuthungwa, ukuqina kwemisipha, ukungabi khona kwe-echogenicity, ukuvuvukala kwezicubu ezizungezile;
Ibanga lesi-3: ukwakheka kwemisipha okungaphelele, ukuncipha noma ukuphazamiseka okuyingxenye kokuqhubeka kokuthungwa, ukuqina kwemisipha, kanye nokwanda kwesignali;
Ibanga lesi-IV: ukuphazamiseka okuphelele kokuqhubeka kwemisipha, okungase kuhambisane nokuqhekeka kwemisipha, ukuqina kwemisipha, kanye nokwanda kwesignali yendawo noma yokusabalalisa.
Izinzuzo: Isisombululo esiphezulu sezicubu ezithambile, ukubonwa okucacile kwezinhlobo zokulimala kwemisipha; Kungabonisa ukulimala kwe-cartilage, ukuphuka kwamathambo, kanye nesimo sonke sokulimala okuhlanganisiwe.
Okubi: Akunakwenzeka ukunquma ngokunembile ukuthi ukuphuka kanye nomonakalo we-cartilage ye-articular kuyaphazamiseka yini; Ngenxa yobunzima be-ankle ligament, ukusebenza kahle kokuhlola akuphezulu; Kubiza kakhulu futhi kuthatha isikhathi.
I-ultrasound evame kakhulu
Isithombe 1a: Ukulimala kwe-talofibular ligament yangaphambili, ukudabuka okuyingxenye; Isithombe 1b: I-talofibular ligament yangaphambili idabuke ngokuphelele, isiphunzi sijiyile, futhi kubonakala ukungcola okukhulu esikhaleni esingaphambili esiseceleni.
Isithombe 2a: Ukulimala kwe-calcaneofibular ligament, ukudabuka okuyingxenye; Isithombe 2b: Ukulimala kwe-calcaneofibular ligament, ukudabuka okuphelele
Isithombe 3a: I-anterior talofibular ligament evamile: isithombe se-ultrasound esibonisa unxantathu oguquliwe isakhiwo esifanayo se-hypoechoic; Isithombe 3b: I-calcaneofibular ligament evamile: Isakhiwo esimaphakathi se-echogenic nesinogqinsi esithombeni se-ultrasound
Isithombe 4a: Ukudabuka okuyingxenye komsipha we-talofibular wangaphambili esithombeni se-ultrasound; Isithombe 4b: Ukudabuka okuphelele komsipha we-calcaneofibular esithombeni se-ultrasound
Ukuhlolwa kokuxilongwa:
ukuminyana: izithombe ze-acoustic zibonisa isakhiwo esiphelele, imisipha ejiyile nevuvukele; Ukudabuka okuyingxenye: Kukhona ukuvuvukala kumisipha, kukhona ukuphazamiseka okuqhubekayo kweminye imicu, noma imicu incishisiwe endaweni. Ukuskena okunamandla kubonise ukuthi ukucindezeleka kwemisipha kuncishisiwe kakhulu, futhi imisipha incishisiwe futhi yanda kanye nokuqina kwemisipha kuncishisiwe esimweni se-valgus noma i-varus.
Ukudabuka okuphelele: i-ligament ephazamiseke ngokuphelele futhi eqhubekayo ene-distal separation, i-dynamic scan ayibonisi ukucindezeleka kwe-ligament noma ukudabuka okwandisiwe, kanti ku-valgus noma ku-varus, i-ligament iya kolunye uhlangothi, ngaphandle kokuguquguquka futhi ine-joint ekhululekile.
Izinzuzo: izindleko eziphansi, kulula ukuzisebenzisa, azihlaseli; Isakhiwo esicashile sesendlalelo ngasinye sezicubu ezingaphansi kwesikhumba sibonakala ngokucacile, okusiza ekubonweni kwezilonda zezicubu zemisipha nemisipha. Ukuhlolwa kwesigaba okungahleliwe, ngokusho kwebhande lemisipha ukulandelela yonke inqubo yemisipha, indawo yokulimala kwemisipha iyacaciswa, futhi ukucindezeleka kwemisipha nezinguquko zesimo somzimba kubonwa ngokuguquguqukayo.
Okubi: ukuqina kwezicubu ezithambile uma kuqhathaniswa ne-MRI; Thembela ekusebenzeni kobuchwepheshe bochwepheshe.
Ukuhlolwa kwe-Arthroscopy
Izinzuzo: Bheka ngqo izakhiwo ze-lateral malleolus kanye ne-hindfoot (njenge-inferior talar joint, i-anterior talofibular ligament, i-calcaneofibular ligament, njll.) ukuze uhlole ubuqotho be-ligaments futhi usize udokotela ohlinzayo anqume uhlelo lokuhlinzwa.
Okubi: Kuhlasela, kungabangela izinkinga ezithile, njengokulimala kwemizwa, ukutheleleka, njll. Ngokuvamile kubhekwa njengendinganiso yegolide yokuxilonga ukulimala kwemisipha futhi okwamanje isetshenziswa kakhulu ekwelapheni ukulimala kwemisipha.
Isikhathi sokuthunyelwe: Septhemba-29-2024
