Ukulimala kwe-Ankle yinto eqhelekileyo yokulimala kwezemidlalo okwenzeka malunga ne-25% yokulimala kwe-musculoskeletal, kunye nokulimala kwe-lateral collateral ligament (LCL) yinto eqhelekileyo. Ukuba imeko enzima ayiphathwa ngexesha, kulula ukukhokelela kwi-sprains ephindaphindiweyo, kwaye iimeko ezinzulu kakhulu ziya kuchaphazela umsebenzi we-ankle joint. Ngoko ke, kubaluleke kakhulu ukuxilonga nokunyanga ukonzakala kwezigulana kwangethuba. Eli nqaku liza kugxininisa kwizakhono zokuxilonga zokulimala kwe-lateral collateral ligament ye-ankle joint ukunceda oogqirha baphucule ukuchaneka kokuxilongwa.
I. Anatomy
I-talofibular ligament yangaphambili (ATFL): i-flat, ihlanganiswe kwi-capsule yecala, iqala ngaphambili kwi-fibula kunye nokuphela kwangaphambili kumzimba we-talus.
I-Calcaneofibular ligament (CFL): intambo-intambo, evela kumda wangaphambili we-distal lateral malleolus kunye nokuphelisa kwi-calcaneus.
I-Posterior talofibular ligament (PTFL): Ivela kwi-medial surface ye-lateral malleolus kwaye iphela ngasemva kwi-talus ephakathi.
I-ATFL yodwa yenza malunga ne-80% yokulimala, ngelixa i-ATFL idibene nokulimala kwe-CFL malunga ne-20%.
Umzobo weSchematic kunye nomzobo we-anatomical we-lateral collateral ligament ye-ankle joint
II. Indlela yokwenzakala
Ukulimala okuphakanyisiweyo: i-talofibular ligament yangaphambili
I-calcaneofibular ligament varus ukulimala: i-calcaneofibular ligament
III. Ukuhlelwa kokwenzakala
IBakala I: ukunyanzeliswa kwe-ligament, akukho ukugqabhuka kwe-ligament ebonakalayo, kunqabile ukuvuvukala okanye ububele, kwaye akukho zimpawu zokulahlekelwa ngumsebenzi;
IBakala II: i-partial macroscopic rupture of the ligament, intlungu ephakathi, ukuvuvukala, kunye nesisa, kunye nokukhubazeka okuncinci komsebenzi odibeneyo;
IBanga le-III: i-ligament iqhekezwe ngokupheleleyo kwaye ilahlekelwe yingqibelelo yayo, ihamba kunye nokuvuvukala okuphawulekayo, ukuphuma kwegazi kunye nokuthamba, kunye nokulahleka okuphawulekayo komsebenzi kunye nokubonakaliswa kokungazinzi kwamalungu.
IV. Uvavanyo lwezonyango Uvavanyo lwedrowa yangaphambili
Isigulane sihleli kunye nedolo eliguquguqukayo kunye nokuphela kwethole elijingayo, kwaye umhloli ubamba i-tibia endaweni ngesandla esinye kwaye uqhube unyawo phambili emva kwesithende kunye nesinye.
Ngaphandle koko, isigulane siphezulu okanye sihleli ngamadolo egobile kwi-60 ukuya kwi-90 degrees, isithende sigxininiswe phantsi, kwaye umhloli usebenzisa uxinzelelo lwangasemva kwi-distal tibia.
I-positive iqikelela ukuphuka kwe-talofibular ligament yangaphambili.
Uvavanyo loxinzelelo lwe-Inversion
I-ankle esondeleyo yayingashukumi, kwaye uxinzelelo lwe-varus lwalusetyenziswa kwi-ankle ekude ukuvavanya i-angle ye-talus tilt.
Xa kuthelekiswa necala le-contralateral,> i-5 ° iyakrokra, kwaye i-10 ° ilungile; okanye icala elinye>15° lilungile.
I-predictor efanelekileyo ye-calcaneofibular ligament rupture.
Iimvavanyo zomfanekiso
I-X-rays yokulimala kwezemidlalo ye-ankle eqhelekileyo
I-X-ray ayinayo, kodwa i-MRI ibonisa iinyembezi ze-talofibular yangaphambili kunye ne-calcaneofibular ligaments.
Iinzuzo: I-X-ray yinto yokuqala yokukhetha uviwo, olunoqoqosho kwaye lulula; Ubungakanani bomonzakalo bujongwa ngokugweba inqanaba lokuthambekela kwetalus. Ukungalungi: Ukubonakaliswa okungalunganga kwezicubu ezithambileyo, ngokukodwa izakhiwo ze-ligamentous ezibalulekileyo ekugcineni ukuzinza ngokubambisana.
I-MRI
Umzobo.1 Isikhundla se-oblique se-20 ° sibonise eyona nto iphambili ye-talofibular ligament (ATFL); Fig.2 Umgca we-Azimuth we-ATFL scan
Imifanekiso ye-MRI yokulimala kwe-talofibular ligament yangaphambili yangaphambili ibonise ukuba: (A) i-talofibular ligament yangaphambili yokuqina kunye ne-edema; (B) ukukrazuka kwe-talofibular ligament yangaphambili; (C) ukuphuka kwe-talofibular ligament yangaphambili; (D) Ukulimala kwe-talofibular ligament yangaphambili kunye ne-avulsion fracture.
Umzobo.3 I--15 ° indawo ye-oblique ibonise eyona calcaneofibular ligament (CFI);
Isazobe.4. CFL ukuskena azimuth
Acute, ukukrazuka okupheleleyo kwe-calcaneofibular ligament
Umzobo 5: Umbono weCoronal ubonisa i-posterior talofibular ligament (PTFL);
Fig.6 PTFL scan azimuth
Ukukrazula inxalenye yeligament ye-talofibular yangasemva
Ukuhlelwa koxilongo:
Iklasi I: Akukho monakalo;
IBanga lesi-II: i-ligament contusion, ukuqhubeka kakuhle kwe-texture, ukuqina kwemigqa, i-hypoechogenicity, i-edema yezicubu ezijikelezayo;
IBanga le-III: i-morphology ye-ligament engaphelelanga, ukuncipha okanye ukuphazamiseka okuyingxenye kokuqhubeka kokuthungwa, ukuqina kwee-ligaments, kunye nophawu olwandisiweyo;
IBakala IV: ukuphazamiseka okupheleleyo kokuqhubekeka kwe-ligament, enokuthi ihambisane nokuphulwa kwe-avulsion fractures, ukuqina kwee-ligaments, kunye nokwandiswa kwendawo okanye isignali yokusabalalisa.
Izinto eziluncedo: Isisombululo esiphezulu sezicubu ezithambileyo, ukujonga ngokucacileyo iintlobo zokulimala kwe-ligament; Ingabonisa umonakalo we-cartilage, ukuchithwa kwamathambo, kunye nemeko yonke yokulimala kwe-compound.
Ukungalungi: Akunakwenzeka ukucacisa ngokuchanekileyo ukuba iifractures kunye nomonakalo we-articular cartilage ziphazamisekile; Ngenxa yobunzima be-ankle ligament, ukusebenza kakuhle koviwo aluphezulu; Kuyabiza kwaye kuthatha ixesha.
I-high-frequency ultrasound
Umzobo 1a: Ukulimala kwe-talofibular ligament yangaphambili, ukukrazula inxalenye; Umzobo 1b: I-talofibular ligament yangaphambili iqhekezwe ngokupheleleyo, isiphunzi sigxininisekile, kwaye i-effusion enkulu ibonakala kwindawo yangaphambili yecala.
Umzobo 2a: Ukulimala kwe-Calcaneofibular ligament, ukukrazula inxalenye; Umzobo 2b: Ukulimala kwe-Calcaneofibular ligament, ukuphuka okupheleleyo
Umzobo 3a: I-talofibular ligament eqhelekileyo yangaphambili: umfanekiso we-ultrasound obonisa unxantathu oguqulweyo we-uniform ye-hypoechoic; Umzobo 3b: I-calcaneofibular ligament eqhelekileyo: I-echogenic ephakathi kunye ne-dense filamentous structure kumfanekiso we-ultrasound
Umzobo 4a: Ukukrazula okuyingxenye ye-talofibular ligament yangaphambili kumfanekiso we-ultrasound; Umzobo 4b: Ukukrazula ngokupheleleyo kwe-calcaneofibular ligament kumfanekiso we-ultrasound
Ukuhlelwa koxilongo:
i-contusion: imifanekiso ye-acoustic ibonisa isakhiwo esicacileyo, i-ligaments eqinile kunye nokudumba; Ukukrazula kancinci: Kukho ukudumba kwi-ligament, kukho ukuphazamiseka okuzingileyo kweminye imicu, okanye iifiber zincitshiswe kwindawo. I-Dynamic scans ibonise ukuba i-ligament tension iyancipha kakhulu, kwaye i-ligament iyancipha kwaye yanda kwaye i-elasticity iyancipha kwimeko ye-valgus okanye i-varus.
Ukukrazula okupheleleyo: i-ligament ephazamiseke ngokupheleleyo kwaye ngokuqhubekayo kunye nokwahlukana kwe-distal, ukuskena okuguquguqukayo kubonisa ukuba akukho xinzelelo lwe-ligament okanye ukukrazuka okwandisiweyo, kunye ne-valgus okanye i-varus, i-ligament ihambela kwelinye isiphelo, ngaphandle kokunye ukunwebeka kunye ne-joint ekhululekile.
Izinto eziluncedo: iindleko eziphantsi, kulula ukusebenza, azikho invasive; Isakhiwo esifihlakeleyo soluhlu ngalunye lwezicubu ezingaphantsi kwe-subcutaneous luboniswa ngokucacileyo, oluhambelana nokuqwalaselwa kwezilonda zezicubu ze-musculoskeletal. Uvavanyo lwecandelo elingaqhelekanga, ngokwebhanti ye-ligament ukulandelela yonke inkqubo ye-ligament, indawo yokulimala kwe-ligament icaciswa, kwaye ukunyanzeliswa kwe-ligament kunye neenguqu ze-morphological zibonwa ngamandla.
Ukungalungi: isisombululo esisezantsi se-soft-tissue xa kuthelekiswa ne-MRI; Thembela kumsebenzi wobugcisa obuchwephesha.
Ukuhlolwa kwe-arthroscopy
Izinto eziluncedo: Ukuqwalasela ngokuthe ngqo izakhiwo ze-malleolus esecaleni kunye ne-hindfoot (ezifana ne-talar engaphantsi, i-talofibular ligament yangaphambili, i-calcaneofibular ligament, njl.
Ukungalungi: I-Invasive, inokubangela ezinye iingxaki, ezifana nomonakalo we-nerve, ukusuleleka, njl.
Ixesha lokuposa: Sep-29-2024
