"I-10% ye-ankle fractures ihamba kunye nokulimala kwe-distal tibiofibular syndesmosis. Uphononongo lubonise ukuba i-52% ye-screws ye-distal tibiofibular iphumela ekunciphiseni okungahambi kakuhle kwe-syndesmosis. Ukufaka i-distal tibiofibular screw perpendicular to syndesmosis joint surface kubalulekile ukuphepha iatrogenic malreduction. Ngokutsho kwe-AO manual, kucetyiswa ukuba ufake i-distal tibiofibular screw 2 cm okanye i-3.5 cm ngaphezu kwe-distal tibial articular surface, kwi-angle ye-20-30 ° ukuya kwindiza ethe tye, ukusuka kwi-fibula ukuya kwi-tibia, kunye ne-ankle. kwindawo engathathi hlangothi.
Ukufakwa ngesandla kwe-distal tibiofibular screws kaninzi kubangela ukutenxa kwindawo yokungena kunye nesalathiso, kwaye okwangoku, akukho ndlela echanekileyo yokumisela ulwalathiso lokufakwa kwezi screw. Ukujongana nalo mba, abaphandi bamazwe angaphandle baye bamkela indlela entsha-indlela ye-angle bisector.
Ukusebenzisa idatha ye-imaging evela kwii-16 eziqhelekileyo ze-ankle, iimodeli ze-16 ze-3D eziprintiweyo zenziwe. Kwimigama ye-2 cm kunye ne-3.5 cm ngaphezu kwe-tibial articular surface, ezimbini ii-1.6 mm ze-Kirschner iingcingo ezihambelana nommandla ohlangeneyo zibekwe kufuphi nemida yangaphambili kunye ne-posterior ye-tibia kunye ne-fibula, ngokulandelanayo. I-angle phakathi kweengcingo ezimbini ze-Kirschner yayilinganiswa kusetyenziswa i-protractor, kwaye i-2.7 mm drill bit isetyenziselwe ukubhobhoza umngxuma ecaleni komgca we-angle bisector, kulandele ukufakwa kwe-screw ye-3.5 mm. Emva kokufaka isikrufu, isikrufu sasikwa ngobude baso kusetyenziswa isarha ukuvavanya unxulumano phakathi kolwalathiso lwe-screw kunye ne-axis esembindini ye-tibia kunye ne-fibula.
Iimvavanyo ze-specimen zibonisa ukuba kukho ukuhambelana kakuhle phakathi kwe-axis ephakathi ye-tibia kunye ne-fibula kunye ne-angle bisector line, kunye naphakathi kwe-axis ephakathi kunye ne-screw direction direction.
ngokunyanisekileyo, le ndlela inokubeka ngokufanelekileyo i-screw ecaleni kwe-axis esembindini ye-tibia kunye ne-fibula. Nangona kunjalo, ngexesha lotyando, ukubeka iingcingo ze-Kirschner kufuphi nemida yangaphambili kunye ne-posterior ye-tibia kunye ne-fibula ibeka umngcipheko wokonakalisa imithambo yegazi kunye nemithambo-luvo. Ukongezelela, le ndlela ayisombululi umba we-iatrogenic malreduction, njengoko ulungelelwaniso lwe-distal tibiofibular alukwazi ukuhlolwa ngokufanelekileyo kwi-intraoperatively phambi kokubekwa kwe-screw.
Ixesha lokuposa: Jul-30-2024
