Ukuphuka kweqakala kungenye yezinhlobo ezivame kakhulu zokuphuka kweqakala emtholampilo. Ngaphandle kwezinye ukulimala kokujikeleza kweBanga I/II kanye nokulimala kokuthunjwa, ukuphuka kweqakala okuningi kuvame ukubandakanya i-lateral malleolus. Ukuphuka kwe-lateral malleolus yohlobo lwe-Weber A/B kuvame ukuphumela ku-distal tibiofibular syndesmosis ezinzile futhi kungafinyelela ekunciphiseni okuhle ngokubona ngqo kusuka kude kuya ku-proximal. Ngokuphambene nalokho, ukuphuka kwe-lateral malleolus yohlobo lwe-C kuhilela ukungazinzi ku-lateral malleolus kuwo wonke ama-axes amathathu ngenxa yokulimala kwe-distal tibiofibular, okungaholela ezinhlotsheni eziyisithupha zokusuka: ukufinyeza/ukwelula, ukunwebeka/ukuncipha kwesikhala se-distal tibiofibular, ukufuduka kwangaphambili/ngemuva endizeni ye-sagittal, ukuthambekela kwe-medial/lateral endizeni ye-coronal, ukufuduka kokujikeleza, kanye nokuhlanganiswa kwalezi zinhlobo ezinhlanu zokulimala.
Izifundo eziningi zangaphambilini zibonise ukuthi ukufinyeza/ukwelula kungahlolwa ngokuhlola uphawu lwe-Dime, umugqa we-Stenton, kanye ne-angle ye-tibial-gapping, phakathi kwezinye. Ukufuduka ezindizeni ze-coronal kanye ne-sagittal kungahlolwa kahle kusetshenziswa ukubuka kwe-fluoroscopic yangaphambili neyaseceleni; noma kunjalo, ukufuduka kokujikeleza kuyinselele kakhulu ukuhlola ngesikhathi sokuhlinzwa.
Ubunzima bokuhlola ukufuduka kokujikeleza bubonakala kakhulu ekunciphiseni i-fibula lapho kufakwa isikulufu se-tibiofibular esikude. Izincwadi eziningi zibonisa ukuthi ngemva kokufakwa kwesikulufu se-tibiofibular esikude, kuba nokwehla okungekuhle okungu-25%-50%, okuholela ekungaxhumani kahle kanye nokulungiswa kokukhubazeka kwe-fibular. Ezinye izazi ziphakamise ukusebenzisa ukuhlolwa kwe-CT okuvamile kwangaphakathi kokuhlinzwa, kodwa lokhu kungaba nzima ukukusebenzisa ngokusebenzayo. Ukuze kuxazululwe le nkinga, ngo-2019, ithimba likaSolwazi Zhang Shimin waseYangpu Hospital elixhumene neTongji University lashicilela isihloko kumagazini wamazwe ngamazwe we-orthopedic *Injury*, liphakamisa indlela yokuhlola ukuthi ngabe ukujikeleza kwe-lateral malleolus kulungisiwe yini kusetshenziswa i-X-ray yangaphakathi kokuhlinzwa. Izincwadi zibika ukusebenza kahle okukhulu kwezokwelapha kwale ndlela.
Isisekelo semfundiso yale ndlela ukuthi ekubukeni kwe-fluoroscopic kweqakala, i-lateral wall cortex ye-lateral malleolar fossa ikhombisa isithunzi esicacile, esiqondile, esiminyene, esihambisana ne-medial kanye ne-lateral cortices ye-lateral malleolus, futhi itholakala maphakathi nengxenye yesithathu yomugqa oxhumanisa i-medial kanye ne-lateral cortices ye-lateral malleolus.
Umfanekiso wombono we-ankle fluoroscopic obonisa ubudlelwano besimo phakathi kwe-cortex yodonga oluseceleni kwe-lateral malleolar fossa (umugqa b) kanye ne-medial kanye ne-lateral cortices ye-lateral malleolus (imigqa a kanye ne-c). Ngokuvamile, umugqa b utholakala emgqeni wangaphandle wesithathu phakathi kwemigqa a kanye no-c.
Indawo evamile ye-lateral malleolus, ukujikeleza kwangaphandle, kanye nokujikeleza kwangaphakathi kungaveza ukubonakala okuhlukile kwezithombe ekubukeni kwe-fluoroscopic:
- I-Lateral malleolus ijikeleza endaweni evamile**: I-lateral malleolus contour evamile enesithunzi se-cortical odongeni oluseceleni lwe-lateral malleolar fossa, ebekwe emgqeni wangaphandle wesithathu wama-medial kanye nama-lateral cortices e-lateral malleolus.
-Ukukhubazeka kokujikeleza kwangaphandle kwe-malleolus eseceleni**: I-lateral malleolus contour ibonakala "inamaqabunga abukhali," isithunzi se-cortical ku-lateral malleolar fossa siyanyamalala, isikhala se-distal tibiofibular siyancipha, umugqa we-Shenton uyaphela futhi uhlakazeke.
-Ukukhubazeka kokujikeleza kwangaphakathi kwe-malleolus eseceleni**: I-lateral malleolus contour ibonakala "injengesipuni," isithunzi se-cortical ku-lateral malleolar fossa siyanyamalala, futhi isikhala se-distal tibiofibular siyanwebeka.
Ithimba lalihlanganisa iziguli ezingu-56 ezine-C-type lateral malleolar fractures ezihlanganiswe nokulimala kwe-distal tibiofibular syndesmosis futhi zasebenzisa indlela yokuhlola eshiwo ngenhla. Ukuhlolwa kabusha kwe-CT ngemva kokuhlinzwa kubonise ukuthi iziguli ezingu-44 zithole ukwehla kwe-anatomic ngaphandle kokukhubazeka kokujikeleza, kuyilapho iziguli ezingu-12 zithole ukukhubazeka okuncane kokujikeleza (ngaphansi kuka-5°), kanye namacala angu-7 okujikeleza kwangaphakathi kanye namacala angu-5 okujikeleza kwangaphandle. Azikho izimo zokukhubazeka kokujikeleza kwangaphandle okumaphakathi (5-10°) noma okunzima (okungaphezu kuka-10°) okwenzekayo.
Izifundo zangaphambilini zikhombisile ukuthi ukuhlolwa kokunciphisa ukuqhekeka kwe-lateral malleolar kungasekelwa kumapharamitha amathathu ayinhloko e-Weber: ukulingana okuhambisanayo phakathi kwezindawo ezihlangene ze-tibial ne-talar, ukuqhubeka komugqa we-Shenton, kanye nesibonakaliso se-Dime.
Ukuncipha kabi kwe-lateral malleolus kuyinkinga evamile kakhulu emtholampilo. Nakuba ukunakekelwa okufanele kunikezwa ekubuyiselweni kobude, kufanele kubhekwe ukubaluleka okufanayo ekulungisweni kokujikeleza. Njengelungu elithwala isisindo, noma yikuphi ukuncipha kweqakala kungaba nemiphumela emibi kakhulu ekusebenzeni kwalo. Kukholakala ukuthi inqubo ye-fluoroscopic yangaphakathi kokuhlinzwa ephakanyiswe nguSolwazi Zhang Shimin ingasiza ekufinyeleleni ekunciphiseni okunembile kokuqhekeka kwe-lateral malleolar yohlobo lwe-C. Le ndlela isebenza njengereferensi ebalulekile kodokotela abaphambili.
Isikhathi sokuthunyelwe: Meyi-06-2024
