Ukulimala kwe-ankle kuwukulimala kwezemidlalo okuvamile okwenzeka cishe ku-25% yokulimala kwe-musculoskeletal, nokulimala kwe-lateral collateral ligament (LCL) kuvame kakhulu. Uma isimo esinzima singelashwa ngesikhathi, kulula ukuholela ekuqhumeni okuphindaphindiwe, futhi amacala amabi kakhulu azothinta umsebenzi we-ankle joint. Ngakho-ke, kubaluleke kakhulu ukuxilonga nokwelapha ukulimala kweziguli kusenesikhathi. Lesi sihloko sizogxila emakhono okuxilonga okulimala kwe-lateral collateral ligament ye-ankle joint ukusiza odokotela bathuthukise ukunemba kokuxilongwa.
I. I-Anatomy
I-anterior talofibular ligament (ATFL): isicaba, ihlanganiswe ku-capsule yangemuva, iqala i-anterior kuya ku-fibula futhi igcine ingaphambili emzimbeni we-talus.
I-Calcaneofibular ligament (CFL): okumise okwentambo, kusukela emngceleni wangaphambili we-distal lateral malleolus futhi inqamula ku-calcaneus.
I-posterior talofibular ligament (PTFL): Isuka endaweni ephakathi ye-malleolus ehlangene futhi igcina ngemuva kwe-talus ephakathi.
I-ATFL iyodwa yenza cishe u-80% wokulimala, kuyilapho i-ATFL ihlangene nokulimala kwe-CFL kubalele cishe u-20%.
Umdwebo we-schematic kanye nomdwebo we-anatomical we-lateral collateral ligament ye-ankle joint
II. Indlela yokulimala
Ukulimala okuphakanyisiwe: i-talofibular ligament yangaphambili
I-calcaneofibular ligament varus ukulimala: i-calcaneofibular ligament
III. Ukulinganisa ukulimala
IBanga I: ukungezwani kwemisipha, akukho ukugqashuka kwethambo elibonakalayo, akuvamile ukuvuvukala noma ukuthamba, futhi azikho izimpawu zokulahlekelwa umsebenzi;
IBanga lesi-II: ukuphuka okuncane kwe-macroscopic ye-ligament, ubuhlungu obuphakathi, ukuvuvukala, nokuzwela, nokukhubazeka okuncane kokusebenza kwamalunga;
Ibanga lesi-III: i-ligament idabukile ngokuphelele futhi ilahlekelwa ubuqotho bayo, ihambisana nokuvuvukala okuphawulekayo, ukopha nokuzwela, okuhambisana nokulahlekelwa okuphawulekayo kokusebenza nokubonakaliswa kokungaqini kwamalunga.
IV. Ukuhlolwa komtholampilo Ukuhlolwa kwedrowa elingaphambili
Isiguli sihlezi idolo ligobile futhi ukuphela kwethole kulenga, futhi umhloli ubamba i-tibia endaweni ngesandla esisodwa futhi uqhube unyawo phambili ngemuva kwesithende ngesinye.
Ngaphandle kwalokho, isiguli sihlezi phansi noma sihlezi idolo ligobile ku-60 kuya ku-90 degrees, isithende sigxilwe phansi, futhi umhloli usebenzisa ingcindezi yangemuva ku-distal tibia.
Okuhle kubikezela ukuphuka kwe-talofibular ligament yangaphambili.
Ukuhlolwa kokucindezeleka kwe-Inversion
I-ankle eseduze yayinganyakazi, futhi ukucindezeleka kwe-varus kwafakwa eqakaleni elikude ukuze kuhlolwe i-angle ye-talus enyakazayo.
Uma kuqhathaniswa nohlangothi oluphambene, i->5° ilungile ngokusolisayo, futhi i->10° ivuma; noma i-unilateral >15° ivuma.
Isibikezelo esihle sokuphuka kwe-calcaneofibular ligament.
Ukuhlolwa kwezithombe
Ama-X-ray okulimala kwezemidlalo kweqakala okuvamile
I-X-ray ayinayo, kodwa i-MRI ibonisa izinyembezi ze-talofibular yangaphambili kanye nemigqa ye-calcaneofibular.
Izinzuzo: I-X-ray iyisinqumo sokuqala sokuhlolwa, okonga futhi kulula; Ubukhulu bokulimala buhlulelwa ngokwahlulela izinga lokuthambekela kwe-talus. Ukungalungi: Ukuboniswa okungalungile kwezicubu ezithambile, ikakhulukazi izakhiwo ze-ligamentous ezibalulekile ekugcineni ukuzinza kwamalungu.
I-MRI
Umdwebo.1 Isikhundla se-oblique esingu-20 ° sibonise i-talofibular ligament yangaphambili engcono kakhulu (ATFL); Umugqa we-Fig.2 we-Azimuth wokuskena kwe-ATFL
Izithombe ze-MRI zokulimala okuhlukile kwe-talofibular ligament yangaphambili zibonise ukuthi: (A) i-anterior talofibular ligament thickening kanye ne-edema; (B) ukudabuka kwe-talofibular ligament yangaphambili; (C) ukuphuka kwe-talofibular ligament yangaphambili; (D) Ukulimala kwe-talofibular ligament yangaphambili ngokuphuka kwe-avulsion.
Fig.3 I--15° indawo etshekile ibonise i-calcaneofibular ligament (CFI);
Fig.4. I-azimuth yokuskena ye-CFL
Okubukhali, ukudabuka okuphelele kwe-calcaneofibular ligament
Umfanekiso we-5: Ukubuka kwe-Coronal kubonisa i-posterior talofibular ligament (PTFL) engcono kakhulu;
Fig.6 PTFL scan azimuth
Izinyembezi eziyingxenye ye-posterior talofibular ligament
Ibanga lokuxilongwa:
Ikilasi I: Akukho monakalo;
Ibanga lesi-II: i-ligament contusion, ukuqhubeka okuhle kokuthungwa, ukuqina kwemigqa, i-hypoechogenicity, i-edema yezicubu ezizungezile;
IBanga lesi-III: i-morphology ye-ligament engaphelele, ukuphazamiseka okuncane noma okuyingxenye kokuqhubeka kokuthungwa, ukuqina kwemigqa, nokwanda kwesignali;
IBanga lesi-IV: ukuphazanyiswa okuphelele kokuqhubeka kwe-ligament, okungase kuhambisane nokuphuka kwe-avulsion, ukuqina kwemigqa, nokwanda kwesignali yendawo noma yokusabalalisa.
Izinzuzo: Ukulungiswa okuphezulu kwezicubu ezithambile, ukubhekwa okucacile kwezinhlobo zokulimala kwe-ligament; Ingabonisa ukulimala kwe-cartilage, ukuguquguquka kwamathambo, kanye nesimo sonke sokulimala okuhlanganisiwe.
Ukungalungi: Akunakwenzeka ukucacisa ngokunembile ukuthi ukuphuka nokulimala kwe-articular cartilage kuyaphazamiseka; Ngenxa yobunzima be-ankle ligament, ukusebenza kahle kokuhlolwa akuphakeme; Kuyabiza futhi kudla isikhathi.
I-high-frequency ultrasound
Umfanekiso we-1a: Ukulimala kwe-talofibular ligament yangaphambili, izinyembezi eziyingxenye; Umfanekiso 1b: Umsipha we-talofibular wangaphambili udabuke ngokuphelele, isiphunzi sishubile, futhi ukukhishwa okukhulu kubonakala endaweni engaphambili engemuva.
Umfanekiso we-2a: Ukulimala kwe-Calcaneofibular ligament, izinyembezi eziyingxenye; Umfanekiso 2b: Ukulimala kwe-Calcaneofibular ligament, ukuphuka okuphelele
Umfanekiso we-3a: I-talofibular ligament yangaphambili evamile: isithombe se-ultrasound esibonisa unxantathu ohlanekezelwe iyunifomu yesakhiwo se-hypoechoic; Umfanekiso 3b: I-calcaneofibular ligament evamile: Isakhiwo esine-echogenic futhi esiminyene se-filamentous esithombeni se-ultrasound
Umfanekiso we-4a: Ukudabuka kwengxenye ye-talofibular ligament yangaphambili esithombeni se-ultrasound; Umfanekiso 4b: Ukudabuka okuphelele kwe-calcaneofibular ligament esithombeni se-ultrasound
Ibanga lokuxilongwa:
ukungqubuzana: izithombe ze-acoustic zibonisa ukwakheka okuqinile, imigqa eqinile futhi evuvukele; Izinyembezi eziyingxenye: Kukhona ukuvuvukala emgqeni, kukhona ukuphazamiseka okuqhubekayo kweminye imicu, noma imicu iyancipha endaweni. Ukuskena okunamandla kwabonisa ukuthi ukungezwani kwemisipha kwaba buthaka kakhulu, futhi umsipha waba mncane futhi wanda futhi ukunwebeka kwaba buthakathaka esimweni se-valgus noma i-varus.
Ukudabuka okuphelele: umgudu ophazamiseke ngokuphelele futhi ophikelelayo ngokuhlukana kwe-distal, ukuskena okuguquguqukayo kuphakamisa ukuthi akukho ukungezwani kwemisipha noma ukudabuka okwenyukayo, futhi ku-valgus noma i-varus, umsipha uya komunye umkhawulo, ngaphandle kokunwebeka kanye nelunga elixegayo.
Izinzuzo: izindleko eziphansi, kulula ukuyisebenzisa, azihlaseli; Isakhiwo esicashile sengqimba ngayinye yezicubu ezingaphansi kwesikhumba siboniswa ngokucacile, okulungele ukubhekwa kwezilonda zezicubu ze-musculoskeletal. Ukuhlolwa kwesigaba esinqunyiwe, ngokusho kwebhande le-ligament ukulandelela yonke inqubo ye-ligament, indawo yokulimala kwe-ligament icaciswa, futhi ukungezwani kwe-ligament kanye nezinguquko ze-morphological zibonwa ngamandla.
Ukungalungi: ukulungiswa okuphansi kwezicubu ezithambile uma kuqhathaniswa ne-MRI; Thembela ekusebenzeni kobuchwepheshe obuchwepheshile.
Ukuhlolwa kwe-arthroscopy
Izinzuzo: Bheka ngokuqondile izakhiwo ze-lateral malleolus kanye ne-hindfoot (njenge-inferior talar joint, i-talofibular ligament yangaphambili, i-calcaneofibular ligament, njll.) ukuze uhlole ubuqotho bemigqa futhi usize udokotela ohlinzayo anqume uhlelo lokuhlinza.
Ukungalungi: Ukuhlasela, kungase kubangele ezinye izinkinga, njengokulimala kwezinzwa, ukutheleleka, njll. Ngokuvamile kubhekwa njengezinga legolide lokuhlola ukulimala kwemisipha futhi okwamanje lisetshenziswa kakhulu ekwelapheni ukulimala kwemisipha.
Isikhathi sokuthumela: Sep-29-2024
