I-46% ye-ankle fractures ejikelezayo ihambisana ne-posterior malleolar fractures. Indlela ye-posterolateral yokubuka okuqondile kanye nokulungiswa kwe-posterior malleolus iyindlela yokuhlinzwa evame ukusetshenziswa, enikeza izinzuzo ezingcono ze-biomechanical uma kuqhathaniswa nokunciphisa okuvaliwe kanye nokulungiswa kwesikulufu se-anteroposterior. Kodwa-ke, izingcezu ezinkulu ze-posterior malleolar fracture noma i-posterior malleolar fractures ehlanganisa i-posterior colliculus ye-malleolus ephakathi, indlela ye-posteromedial inikeza umbono ongcono wokuhlinzwa.
Ukuze uqhathanise ububanzi bokuchayeka be-posterior malleolus, ukungezwani kwenqwaba ye-neurovascular, kanye nebanga phakathi kwe-incision ne-neurovascular bundle kuzo zonke izindlela ezintathu ezihlukene ze-posteromedial, abacwaningi benze ucwaningo lwe-cadaveric. Imiphumela isanda kushicilelwa kujenali ye-FAS. Okutholakele kufinyezwa kanje:
Njengamanje, kunezindlela ezintathu eziyinhloko ze-posteromedial zokuveza i-posterior malleolus:
I-1. I-Medium Posteromedial Approach (i-mePM): Le ndlela ingena phakathi komngcele ongemuva we-malleolus ophakathi kanye ne-tendon yangemuva ye-tibialis (Umfanekiso we-1 ubonisa i-tibialis posterior tendon).
2. Indlela Ye-Posteromedial Eguquliwe (i-moPM): Le ndlela ingena phakathi kwe-tendon ye-tibialis posterior kanye ne-flexor digitorum longus tendon (Umfanekiso we-1 ubonisa i-tibialis posterior tendon, futhi Umfanekiso we-2 ubonisa i-flexor digitorum longus tendon).
3. I-Posteromedial Approach (PM): Le ndlela ingena phakathi komkhawulo ophakathi we-tendon ye-Achilles kanye ne-flexor hallucis longus tendon (Umfanekiso we-3 ubonisa i-Achilles tendon, futhi Umfanekiso we-4 ubonisa i-flexor hallucis longus tendon).
Ngokuphathelene nokungezwani kwenqwaba ye-neurovascular, indlela ye-PM inokucindezeleka okuphansi ku-6.18N uma kuqhathaniswa nezindlela ze-mePM ne-moPM, okubonisa amathuba aphansi okulimala kokudonsa kwe-intraoperative ku-neurovascular bundle.
Mayelana nobubanzi bokuchayeka be-posterior malleolus, indlela ye-PM iphinde inikeze ukuchayeka okukhulu, okuvumela ukubonakala okungama-71% kwe-posterior malleolus. Uma kuqhathaniswa, izindlela ze-mePM ne-moPM zivumela ukuchayeka okungu-48.5% no-57% kwe-posterior malleolus, ngokulandelana.
● Umdwebo ubonisa ububanzi bokuchayeka be-posterior malleolus kulezi zindlela ezintathu. U-AB umele ububanzi obuphelele be-posterior malleolus, i-CD imele ububanzi obuveziwe, kanti i-CD/AB imele isilinganiso sokuchayeka. Ukusuka phezulu kuye phansi, ububanzi bokuchayeka be-mePM, i-moPM, ne-PM bayaboniswa. Kusobala ukuthi indlela ye-PM inobubanzi obukhulu bokuchayeka.
Mayelana nebanga eliphakathi kokusika kanye nenqwaba ye-neurovascular, indlela ye-PM nayo inebanga elikhulu kakhulu, elikala u-25.5mm. Lokhu kukhulu kuno-17.25mm we-mePM kanye no-7.5mm we-moPM. Lokhu kubonisa ukuthi indlela ye-PM inamathuba aphansi kakhulu okulimala kwenqwaba ye-neurovascular phakathi nokuhlinzwa.
● Umdwebo ubonisa amabanga phakathi kokusikeka kanye nenqwaba ye-neurovascular yezindlela ezintathu. Kusukela kwesokunxele kuye kwesokudla, amabanga ezindlela ze-mePM, i-moPM, ne-PM ayaboniswa. Kusobala ukuthi indlela ye-PM inebanga elikhulu kakhulu ukusuka ku-neurovascular bundle.
Isikhathi sokuthumela: May-31-2024
