Ukuphuka kwe-ankle kungenye yezinhlobo ezivame kakhulu zokuphuka emisebenzini yomtholampilo. Ngaphandle kokulimala okujikelezayo kweBanga I/II kanye nokulimala kokuthunjwa, ukuphuka kwamaqakala amaningi ngokuvamile kuhilela i-malleolus yangemuva. I-Weber A/B yohlobo lwe-lateral malleolus fractures ngokuvamile iphumela ekuzinzeni kwe-distal tibiofibular syndesmosis futhi ingafinyelela ekuncishisweni okuhle ngokubonakala okuqondile ukusuka kude kuya kokuhamba phambili. Ngokuphambene, uhlobo lwe-C-type lateral malleolus fractures luhilela ukungazinzi ku-malleolus yangemuva kuwo wonke ama-ax amathathu ngenxa yokulimala kwe-distal tibiofibular, okungaholela ezinhlotsheni eziyisithupha zokufuduka: ukunciphisa / ukunwetshwa, ukunwetshwa / ukunciphisa isikhala se-distal tibiofibular, ukufuduka kwangaphambili / ngemuva. endizeni ye-sagittal, i-medial/lateral tilt endizeni ye-coronal, ukufuduka okujikelezayo, kanye nezinhlanganisela zalezi zinhlobo ezinhlanu zokulimala.
Ucwaningo oluningi lwangaphambilini lubonise ukuthi ukufinyeza/ukwelulwa kungahlolwa ngokuhlola uphawu lwe-Dime, umugqa we-Stenton, kanye ne-tibial-gapping angle, phakathi kokunye. Ukufuduka ezindizeni ze-coronal kanye ne-sagittal kungahlolwa kahle kusetshenziswa ukubukwa kwe-fluoroscopic yangaphambili kanye ne-lateral; kodwa-ke, ukugudluka okujikelezayo kuyinselele kakhulu ukuyihlola ngokusebenza.
Ubunzima bokuhlola ukugudluka okujikelezayo bubonakala ikakhulukazi ekuncishisweni kwe-fibula lapho kufakwa isikulufu se-distal tibiofibular. Iningi lezincwadi libonisa ukuthi ngemva kokufakwa kwe-screw ye-distal tibiofibular, kukhona i-25% -50% yesehlakalo sokunciphisa okubi, okuholela e-malunion nokulungiswa kokukhubazeka kwe-fibular. Ezinye izazi ziye zahlongoza ukusebenzisa ukuhlolwa kwe-CT okujwayelekile, kodwa lokhu kungaba inselele ukukusebenzisa ngokwenza. Ukubhekana nalolu daba, ngo-2019, ithimba likaSolwazi uZhang Shimin waseSibhedlela saseYangpu esixhumene neNyuvesi yaseTongji lashicilela indatshana kujenali yamathambo yamazwe ngamazwe *Injury*, iphakamisa indlela yokuhlola ukuthi ingabe i-lateral malleolus rotation ilungisiwe yini kusetshenziswa i-X-ray ye-intraoperative. Izincwadi zibika ukusebenza ngempumelelo komtholampilo kwale ndlela.
Isisekelo sethiyori sale ndlela siwukuthi ekubukeni kwe-fluoroscopic yeqakala, i-lateral wall cortex ye-lateral malleolar fossa ibonisa isithunzi esicacile, esiqondile, esiminyene, esihambisana ne-medial ne-lateral cortices ye-malleolus yangemuva, futhi etholakala endaweni. okuphakathi ukuya kwangaphandle ingxenye eyodwa kwezintathu yomugqa oxhuma ama-cortices aphakathi nendawo ne-lateral ye-malleolus engemuva.
Umfanekiso wombono we-ankle fluoroscopic obonisa ubudlelwane bendawo phakathi kwe-lateral wall cortex ye-lateral malleolar fossa (b-line) kanye nama-cortices aphakathi nendawo we-lateral malleolus (imigqa engu-a kanye no-c). Ngokuvamile, i-b-line itholakala ngaphandle komugqa wesithathu phakathi kwemigqa a kanye no-c.
Ukuma okujwayelekile kwe-malleolus yangemuva, ukuzungezisa kwangaphandle, nokuzungezisa kwangaphakathi kungaveza ukubukeka kwesithombe okuhlukile ekubukeni kwe-fluoroscopic:
- I-Lateral malleolus izungeziswe endaweni evamile**: Ikhontolo ye-malleolus engemuva evamile enethunzi lekholamu odongeni oluseceleni lwe-lateral malleolar fossa, ebekwe emugqeni wangaphandle wengxenye eyodwa kwezintathu ye-cortices emaphakathi neceleni ye-malleolus engemuva.
-Lateral malleolus external rotation deformity**: I-lateral malleolus contour ibonakala "inamaqabunga abukhali," isithunzi se-cortical ku-lateral malleolar fossa siyanyamalala, isikhala se-distal tibiofibular siba sincane, umugqa we-Shenton awuqhubeki futhi uhlakazeke.
-Lateral malleolus internal rotation deformity**: I-lateral malleolus contour ibonakala "imise okwesipuni," isithunzi se-cortical ku-lateral malleolar fossa siyanyamalala, futhi isikhala se-distal tibiofibular siyavuleka.
Ithimba lalihlanganisa iziguli ze-56 ezine-C-type lateral malleolar fractures ezihlangene nokulimala kwe-distal tibiofibular syndesmosis futhi zasebenzisa indlela yokuhlola eshiwo ngenhla. Ukuhlolwa kabusha kwe-CT ye-postoperative kubonise ukuthi iziguli ze-44 zithole ukuncishiswa kwe-anatomic ngaphandle kokukhubazeka kokujikeleza, kuyilapho iziguli ze-12 zithole ukukhubazeka okujikelezayo okuncane (ngaphansi kwe-5 °), nezimo ze-7 zokujikeleza kwangaphakathi kanye namacala angu-5 wokujikeleza kwangaphandle. Azikho izimo zokukhubazeka okujikelezayo okumaphakathi (5-10°) noma okukhulu (okungaphezu kuka-10°) okwenzeka.
Ucwaningo lwangaphambilini lubonise ukuthi ukuhlolwa kokunciphisa ukuphuka kwe-malleolar ehlangothini kungase kusekelwe kumapharamitha amathathu ayinhloko e-Weber: ukulingana okufanayo phakathi kwezindawo ezihlangene ze-tibial ne-talar, ukuqhubeka komugqa we-Shenton, kanye nophawu lwe-Dime.
Ukwehliswa okungekuhle kwe-malleolus yangemuva kuyindaba evame kakhulu ekusebenzeni komtholampilo. Nakuba ukunakekelwa okufanele kunikezwe ukubuyiselwa kobude, ukubaluleka okulinganayo kufanele kubekwe ekulungiseni ukujikeleza. Njengejoyinti elithwala isisindo, noma yikuphi ukungasebenzi kahle kweqakala kungaba nemiphumela eyinhlekelele emsebenzini walo. Kukholakala ukuthi inqubo ye-fluoroscopic yangaphakathi kokusebenza ephakanyiswe nguSolwazi Zhang Shimin ingasiza ekuzuzeni ukuncipha okunembile kokuphuka kwe-malleolar lateral ye-C-type. Le nqubo isebenza njengesithenjwa esibalulekile kubahlengikazi abaphambili.
Isikhathi sokuthumela: May-06-2024
