Ukulimala kweqakala kukwenzakala okuqhelekileyo kwezemidlalo okwenzeka malunga ne-25% yokulimala kwemisipha, kwaye ukwenzakala kwe-lateral collateral ligament (LCL) yeyona ixhaphakileyo. Ukuba imeko enzima ayinyangwa ngexesha, kulula ukukhokelela ekuqhekekeni okuphindaphindiweyo, kwaye iimeko ezinzulu ziya kuchaphazela ukusebenza kwe-ankle joint. Ke ngoko, kubaluleke kakhulu ukuxilonga nokunyanga ukwenzakala kwezigulane kwasekuqaleni. Eli nqaku liza kugxila kwizakhono zokuxilonga ukwenzakala kwe-lateral collateral ligament kwi-ankle joint ukunceda oogqirha baphucule ukuchaneka kokuxilongwa.
I. I-Anatomy
I-Anterior talofibular ligament (ATFL): ithambile, idityaniswe ne-lateral capsule, iqala ngaphambili kwi-fibula ize iphele ngaphambili emzimbeni we-talus.
I-calcaneofibular ligament (CFL): imile okwentambo, ivela kumda ongaphambili we-distal lateral malleolus ize iphele kwi-calcaneus.
I-Posterior talofibular ligament (PTFL): Ivela kumphezulu we-medial malleolus esecaleni ize iphele ngasemva kwi-medial talus.
I-ATFL yodwa ibe ne-80% yokulimala, ngelixa i-ATFL xa idibene ne-CFL yenzakeleyo ibe ne-20%.
Umzobo wesicwangciso kunye nomzobo we-anatomical we-lateral collateral ligament ye-ankle joint
II. Indlela yokwenzakala
Ukulimala okufakwe kwi-sofa: i-anterior talofibular ligament
ukwenzakala kwe-calcaneofibular ligament varus: i-calcaneofibular ligament
III. Ukuhlolwa kokulimala
Ibanga lokuQala: ukuxinana kwemisipha, ukungaqhawuki kwemisipha okubonakalayo, ukudumba okanye ukuthamba okungafane kwenzeke, kwaye akukho zimpawu zokungasebenzi kakuhle;
Ibanga lesiBini: ukuqhekeka kwe-ligament okuncinci, iintlungu eziphakathi, ukudumba, kunye nokuthamba, kunye nokuphazamiseka okuncinci kokusebenza kwamalungu;
Ibanga lesi-3: i-ligament ikrazukile ngokupheleleyo kwaye ilahlekelwa bubume bayo, ihamba nokudumba okukhulu, ukopha kunye nokuthamba, ehamba nokulahlekelwa ngumsebenzi okuphawulekayo kunye nokubonakaliswa kokungazinzi kwamalungu.
IV. Uvavanyo lweklinikhi Uvavanyo lwedrowa yangaphambili
Isigulana sihleli phantsi idolo ligobile kwaye isiphelo sethole sijinga, kwaye umvavanyi ubamba i-tibia ngesandla esinye aze atyhale unyawo phambili ngasemva kwesithende ngesinye.
Okanye, isigulana silele okanye sihleli phantsi idolo ligobile kwi-degrees ezingama-60 ukuya kuma-90, isithende sinamathele emhlabeni, kwaye umvavanyi ebeka uxinzelelo olungasemva kwi-tibia ekude.
I-positive ixela kwangaphambili ukuqhekeka kwe-anterior talofibular ligament.
Uvavanyo loxinzelelo lokuguqulwa
Iqatha elikufutshane lalingasebenzi, kwaye uxinzelelo lwe-varus lwafakwa kwiqatha elikude ukuze kuvavanywe i-engile yokuthambekela kwe-talus.
Xa kuthelekiswa necala elingaphandle, i->5° ilungile ngendlela engaqondakaliyo, kwaye i->10° ilungile; okanye i-unilateral >15° ilungile.
Isilumkiso esihle sokuqhekeka kwe-calcaneofibular ligament.
Uvavanyo lokufota
Ii-X-ray zokulimala kwezemidlalo okuqhelekileyo eqakaleni
Ii-X-reyi azibonisi zimpawu, kodwa i-MRI ibonisa ukukrazuka kwe-anterior talofibular kunye ne-calcaneofibular ligaments
Iingenelo: I-X-ray lolona khetho lokuqala lokuhlolwa, olungabizi kakhulu kwaye lulula; Ubungakanani bokwenzakala bujongwa ngokugweba ubungakanani bokuthambekela kwe-talus. Iingxaki: Ukubonakaliswa okungalunganga kwezicubu ezithambileyo, ingakumbi izakhiwo ze-ligamentous ezibalulekileyo ekugcineni uzinzo lwamalungu.
I-MRI
Umfanekiso 1 Indawo ethe tyaba engama-20° ibonise eyona ligament iphambili ye-talofibular (ATFL); Umfanekiso 2 Umgca we-Azimuth we-ATFL scan
Imifanekiso ye-MRI yokulimala kwe-ligament ye-talofibular yangaphambili ibonise ukuba: (A) ukuqina kunye nokudumba kwe-ligament ye-talofibular yangaphambili; (B) ukukrazuka kwe-ligament ye-talofibular yangaphambili; (C) ukuqhekeka kwe-ligament ye-talofibular yangaphambili; (D) Ukulimala kwe-ligament ye-talofibular yangaphambili kunye nokuqhekeka kwe-avulsion.
Umfanekiso 3 Indawo ethe tyaba ye -15° ibonise eyona ligament ye-calcaneofibular (CFI) ilungileyo;
Umfanekiso 4. I-CFL scanning azimuth
Ukukrazuka okubukhali nokupheleleyo kwe-calcaneofibular ligament
Umfanekiso 5: Umbono weCoronal ubonisa eyona ligament iphambili ye-posterior talofibular (PTFL);
Umfanekiso 6: I-azimuth yeskena se-PTFL
Ukukrazuka okuncinci kwe-posterior talofibular ligament
Ukuhlolwa kokuxilongwa:
Udidi I: Akukho monakalo;
Ibanga lesiBini: ukudumba kwemisipha, ukuqhubeka kakuhle kobume bemisipha, ukuqina kwemisipha, i-hypoechogenicity, ukudumba kwezicubu ezijikelezileyo;
Ibanga lesi-3: ukwakheka kwe-ligament engaphelelanga, ukuncitshiswa okanye ukuphazamiseka okuncinci kokuqhubeka kwe-texture, ukuqina kwe-ligaments, kunye nokwanda kwesignali;
Ibanga lesi-IV: ukuphazamiseka ngokupheleleyo kokuqhubeka kwemisipha, okunokuhambisana nokuqhekeka kwemisipha, ukuqina kwemisipha, kunye nokwanda kwesignali yendawo okanye yokusasaza.
Iingenelo: Isisombululo esiphezulu kwizicubu ezithambileyo, ukubonwa ngokucacileyo kweentlobo zokulimala kwemisipha; Ingabonisa umonakalo we-cartilage, ukuqhekeka kwamathambo, kunye nemeko iyonke yokwenzakala okudibeneyo.
Iingxaki: Akunakwenzeka ukumisela ngokuchanekileyo ukuba ukwaphuka kunye nomonakalo we-cartilage ye-articular kuyaphazamiseka na; Ngenxa yobunzima be-ankle ligament, ukusebenza kakuhle kovavanyo akuphezulu; Kubiza kakhulu kwaye kuthatha ixesha.
I-ultrasound ephindaphindwayo
Umfanekiso 1a: Ukulimala kwe-talofibular ligament yangaphambili, ukukrazuka okuncinci; Umfanekiso 1b: I-talofibular ligament yangaphambili ikrazukile ngokupheleleyo, isiphunzi sityebile, kwaye kubonakala ukuchitheka okukhulu kwindawo engaphambili esecaleni.
Umfanekiso 2a: Ukulimala kwe-calcaneofibular ligament, ukukrazuka okuncinci; Umfanekiso 2b: Ukulimala kwe-calcaneofibular ligament, ukuqhekeka okupheleleyo
Umfanekiso 3a: I-ligament ye-talofibular eqhelekileyo yangaphambili: umfanekiso we-ultrasound obonisa unxantathu oguqulweyo ofana nesakhiwo se-hypoechoic; Umfanekiso 3b: I-ligament ye-calcaneofibular eqhelekileyo: Isakhiwo esiphakathi se-echogenic nesixineneyo kwisithombe se-ultrasound
Umfanekiso 4a: Ukukrazuka okuncinci kwe-anterior talofibular ligament kumfanekiso we-ultrasound; Umfanekiso 4b: Ukukrazuka okupheleleyo kwe-calcaneofibular ligament kumfanekiso we-ultrasound
Ukuhlolwa kokuxilongwa:
ukudumba: imifanekiso ye-acoustic ibonisa isakhiwo esipheleleyo, i-ligaments ezijiyileyo nezidumbileyo; Ukukrazuka okuncinci: Kukho ukudumba kwi-ligament, kukho ukuphazamiseka okuqhubekayo kwezinye ii-fibers, okanye ii-fibers zinciphile kwindawo yazo. Ii-Dynamic scans zibonise ukuba uxinzelelo lwe-ligament belubuthathaka kakhulu, kwaye i-ligament inciphile kwaye yanda kwaye ukuthamba kwayo kubuthathaka kwimeko ye-valgus okanye i-varus.
Ukukrazula okupheleleyo: i-ligament ephazamisekileyo ngokupheleleyo nehlala ihleli ene-distal separation, i-dynamic scan ayibonisi ukuba akukho xinzelelo lwe-ligament okanye ukukrazula okwandileyo, kwaye kwi-valgus okanye kwi-varus, i-ligament iya kwelinye icala, ngaphandle kokuguquguquka kwaye ine-joint ekhululekileyo.
Iingenelo: ixabiso eliphantsi, kulula ukuyisebenzisa, ayingenisi; Ulwakhiwo oluncinci lwelaphu ngalinye lezicubu ezingaphantsi komzimba lubonakala ngokucacileyo, nto leyo enceda ekubonweni kwezilonda zezicubu zemisipha. Uvavanyo lwecandelo olungenanjongo, ngokwebhanti yemisipha ukulandelela yonke inkqubo yemisipha, indawo yokwenzakala kwemisipha iyacaciswa, kwaye uxinzelelo lwemisipha kunye notshintsho lwemo yomzimba lujongwa ngokuguquguqukayo.
Iingxaki: isisombululo esiphantsi sezicubu ezithambileyo xa kuthelekiswa ne-MRI; Thembela ekusebenzeni kobuchwephesha obungcali.
Ukuhlolwa kwe-Arthroscopy
Iingenelo: Jonga ngokuthe ngqo izakhiwo ze-lateral malleolus kunye ne-hindfoot (ezifana ne-inferior talar joint, i-anterior talofibular ligament, i-calcaneofibular ligament, njl.njl.) ukuze uvavanye ukuthembeka kwe-ligaments kwaye uncede ugqirha otyandayo ukuba amisele isicwangciso sotyando.
Iingxaki: Ingena emzimbeni, inokubangela iingxaki ezithile, ezinje ngokonakala kwemithambo-luvo, usulelo, njl. Ngokuqhelekileyo ithathwa njengomgangatho obalaseleyo wokuxilonga ukwenzakala kwemisipha kwaye okwangoku isetyenziswa kakhulu kunyango lokwenzakala kwemisipha.
Ixesha leposi: Septemba-29-2024
