Ukuqhekeka kweqakala lolunye lwezona ntlobo zixhaphakileyo zokuqhekeka kwamathambo kwikliniki. Ngaphandle kwezinye iingozi zokujikeleza zeBanga loku-1/II kunye nokwenzakala kokubiwa kwamathambo, uninzi lokuqhekeka kweqakala ludla ngokubandakanya i-lateral malleolus. Ukuqhekeka kwe-lateral malleolus yohlobo lwe-Weber A/B kudla ngokubangela i-distal tibiofibular syndesmosis ezinzileyo kwaye kunokufezekisa ukunciphisa okuhle ngokubona ngqo ukusuka kwi-distal ukuya kwi-proximal. Ngokwahlukileyo koko, ukuqhekeka kwe-lateral malleolus yohlobo lwe-C kubandakanya ukungazinzi kwi-lateral malleolus kwii-axes ezintathu ngenxa yokwenzakala kwe-distal tibiofibular, okunokukhokelela kwiintlobo ezintandathu zokufuduka: ukufinyezwa/ukwandiswa, ukwanda/ukuncitshiswa kwendawo ye-distal tibiofibular, ukufuduka kwangaphambili/kwangasemva kwi-sagittal plane, ukuthambekela kwe-medial/lateral kwi-coronal plane, ukufuduka okujikelezayo, kunye nokudibanisa kwezi ntlobo zintlanu zokulimala.
Izifundo ezininzi zangaphambili zibonise ukuba ukufinyeza/ukwandisa kunokuvavanywa ngokuvavanya uphawu lweDime, umgca weStenton, kunye ne-tibial-gapping angle, phakathi kwezinye. Ukufuduka kwi-coronal kunye ne-sagittal planes kunokuvavanywa kakuhle kusetyenziswa i-frontal kunye ne-lateral fluoroscopic views; nangona kunjalo, ukufuduka okujikelezayo yeyona nto inzima ukuyivavanya ngexesha lotyando.
Ubunzima bokuvavanya ukufuduka kokujikeleza bubonakala ngakumbi ekunciphiseni i-fibula xa kufakwa isikrufu se-tibiofibular esikude. Uninzi lweencwadi lubonisa ukuba emva kokufakwa kwesikrufu se-tibiofibular esikude, kukho ukuhla okungekuhle kwe-25%-50%, okubangela ukuba i-malunion kunye nokulungiswa kokukhubazeka kwe-fibular. Abanye abaphengululi bacebise ukusebenzisa uvavanyo lwe-CT oluqhelekileyo ngaphakathi kotyando, kodwa oku kunokuba nzima ukukusebenzisa ngokusebenzayo. Ukujongana nale ngxaki, ngo-2019, iqela likaNjingalwazi uZhang Shimin kwiSibhedlele saseYangpu elinxulumene neYunivesithi yaseTongji lapapasha inqaku kwijenali yamazwe ngamazwe ye-orthopedic *Injury*, licebisa indlela yokuvavanya ukuba ukujikeleza kwe-lateral malleolus kulungisiwe na kusetyenziswa i-X-ray yangaphakathi kotyando. Uncwadi lubika ukusebenza kakuhle kweklinikhi kwale ndlela.
Isiseko sethiyori sale ndlela kukuba kwimbonakalo ye-fluoroscopic ye-ankle, i-cortex yodonga olusecaleni lwe-lateral malleolar fossa ibonisa umthunzi ocacileyo, othe nkqo, oxineneyo, ohambelana ne-medial kunye ne-lateral cortices ye-lateral malleolus, kwaye ikwindawo ephakathi ukuya kwesithathu sangaphandle somgca odibanisa i-medial kunye ne-lateral cortices ye-lateral malleolus.
Umfanekiso wombono we-ankle fluoroscopic obonisa ubudlelwane besimo phakathi kwe-cortex yodonga olusecaleni lwe-lateral malleolar fossa (umgca we-b) kunye ne-medial kunye ne-lateral cortices ye-lateral malleolus (imigca ye-a kunye ne-c). Ngokwesiqhelo, umgca we-b ufumaneka kumgca wesithathu ongaphandle phakathi kwemigca ye-a kunye ne-c.
Indawo eqhelekileyo ye-lateral malleolus, ukujikeleza kwangaphandle, kunye nokujikeleza kwangaphakathi kunokuvelisa ukubonakala kwemifanekiso eyahlukileyo kwimbonakalo ye-fluoroscopic:
- I-Lateral malleolus ijikeleza kwindawo eqhelekileyo**: I-lateral malleolus contour eqhelekileyo enesithunzi se-cortical eludongeni olusecaleni lwe-lateral malleolar fossa, ebekwe kumgca wangaphandle wesithathu we-medial kunye ne-lateral cortices ye-lateral malleolus.
-Ukukhubazeka kokujikeleza kwangaphandle kwe-malleolus ecaleni**: I-lateral malleolus contour ibonakala "ineengqayi ezibukhali," isithunzi se-cortical kwi-lateral malleolar fossa siyanyamalala, isithuba se-distal tibiofibular siyancipha, umgca weShenton uyaphela kwaye usasazeke.
-Ukukhubazeka kokujikeleza kwangaphakathi kwe-malleolus ecaleni**: I-lateral malleolus contour ibonakala "imile okwesipuni," isithunzi se-cortical kwi-lateral malleolar fossa siyanyamalala, kwaye indawo ye-distal tibiofibular iyanda.
Iqela liquke izigulana ezingama-56 ezine-C-type lateral malleolar fractures ezidityaniswe nokulimala kwe-distal tibiofibular syndesmosis kwaye zisebenzise indlela yovavanyo ekhankanyiweyo. Uvavanyo lwe-CT emva kotyando lubonise ukuba izigulana ezingama-44 zifikelele ekunciphiseni i-anatomic ngaphandle kokukhubazeka kokujikeleza, ngelixa izigulana ezili-12 zifumana ukukhubazeka okuncinci kokujikeleza (ngaphantsi kwe-5°), kunye namatyala asi-7 okujikeleza kwangaphakathi kunye namatyala ama-5 okujikeleza kwangaphandle. Akukho matyala okukhubazeka okuphakathi (5-10°) okanye okunzima (ngaphezu kwe-10°) okwenzekayo.
Izifundo zangaphambili zibonise ukuba uvavanyo lokunciphisa ukwaphuka kwe-malleolar lateral lunokusekelwe kwiiparameter ezintathu eziphambili zeWeber: ukulingana okulinganayo phakathi kweendawo ze-tibial kunye ne-talar joint, ukuqhubeka komgca weShenton, kunye nophawu lweDime.
Ukuncipha okungalunganga kwe-lateral malleolus yingxaki eqhelekileyo kakhulu kwizonyango. Nangona ingqalelo efanelekileyo inikwa ekubuyiselweni kobude, ukubaluleka okulinganayo kufuneka kubekwe ekulungisweni kokujikeleza. Njengelungu elithwala ubunzima, naluphi na ukuncipha kweqatha kunokuba nemiphumo emibi ekusebenzeni kwalo. Kukholelwa ukuba indlela ye-fluoroscopic yangaphakathi kotyando ecetyiswe nguNjingalwazi uZhang Shimin inokunceda ekufezekiseni ukunciphisa ngokuchanekileyo ukwaphuka kwe-C-type lateral malleolar. Le ndlela isebenza njengesalathiso esibalulekileyo koogqirha abaphambili.
Ixesha leposi: Meyi-06-2024
