I-Ankle fractures yenye yezona ntlobo zixhaphakileyo zokuphuka kwi-kliniki yokusebenza. Ngaphandle kokulimala okujikelezayo kwiBanga le-I / II kunye nokulimala kwe-abduction, i-ankle fractures ezininzi zibandakanya i-lateral malleolus. I-Weber A / B uhlobo lwe-lateral malleolus fractures lukhokelela kwi-stable distal tibiofibular syndesmosis kwaye inokufikelela ekunciphiseni okulungileyo kunye nokubonwa ngokuthe ngqo ukusuka kwi-distal ukuya kwi-proximal. Ngokwahlukileyo, i-C-type lateral malleolus fractures ibandakanya ukungazinzi kwi-malleolus esecaleni kwii-axes ezintathu ngenxa yokulimala kwe-distal tibiofibular, enokukhokelela kwiintlobo ezintandathu zokufuduka: ukunciphisa / ukwandisa, ukwandisa / ukunciphisa indawo ye-distal tibiofibular, ukufuduka kwangaphambili / ngasemva. kwindiza ye-sagittal, i-medial / i-lateral tilt kwindiza ye-coronal, ukufuduka okujikelezayo, kunye nokudibanisa kwezi ntlobo zintlanu zokulimala.
Izifundo ezininzi zangaphambili zibonise ukuba ukunciphisa / ukwandiswa kunokuvavanywa ngokuvavanya uphawu lweDime, umgca weStenton, kunye ne-tibial-gapping angle, phakathi kwabanye. Ukufuduka kwiindiza ze-coronal kunye ne-sagittal kunokuvavanywa kakuhle kusetyenziswa iimbono ze-fluoroscopic zangaphambili kunye ne-lateral; nangona kunjalo, ukufuduswa okujikelezayo ngowona mceli mngeni wokuvavanya ngokusebenza.
Ubunzima bokuvavanya ukufuduka okujikelezayo kubonakala ngokukodwa ekunciphiseni i-fibula xa ufaka i-distal tibiofibular screw. Uninzi lweencwadi lubonisa ukuba emva kokufaka i-screw ye-distal tibiofibular screw, kukho i-25% -50% yesiganeko sokunciphisa kakubi, okubangelwa i-malunion kunye nokulungiswa kwe-fibular deformities. Abanye abaphengululi baye bacebisa ukuba kusetyenziswe iimvavanyo ze-CT ze-intraoperative, kodwa oku kunokuba ngumngeni ukuphumeza ekusebenzeni. Ukujongana nalo mba, ngo-2019, iqela likaNjingalwazi uZhang Shimin ovela kwiSibhedlele saseYangpu esinxulumana neYunivesithi yaseTongji lapapasha inqaku kwijenali yezamathambo yamazwe ngamazwe *Ukulimala*, ecebisa indlela yokuvavanya ukuba ngaba ukujikeleza kwe-malleolus okusecaleni kulungisiwe kusetyenziswa i-X-ray ye-intraoperative. Uncwadi lubika ukusebenza okubalulekileyo kweklinikhi yale ndlela.
Isiseko sethiyori yale ndlela kukuba kwimbono ye-fluoroscopic ye-ankle, i-cortex yodonga olusecaleni lwe-lateral malleolar fossa ibonisa isithunzi esicacileyo, esithe nkqo, esixineneyo, esihambelana ne-medial kunye ne-lateral cortices ye-malleolus esecaleni, kwaye ibekwe kwindawo. phakathi ukuya ngaphandle kwisinye kwisithathu somgca odibanisa i-medial kunye ne-lateral cortices ye-lateral malleolus.
Umzobo wombono we-ankle we-fluoroscopic obonisa ubudlelwane bendawo phakathi kwe-lateral wall cortex ye-lateral malleolar fossa (b-line) kunye ne-medial kunye ne-lateral cortices ye-lateral malleolus (a kunye ne-c lines). Ngokuqhelekileyo, umgca we-b ubekwe kumgca wesinye esithathwini ongaphandle phakathi kwemigca a kunye no-c.
Isikhundla esiqhelekileyo se-malleolus esecaleni, ukujikeleza kwangaphandle, kunye nokujikeleza kwangaphakathi kunokuvelisa ukubonakala kwemifanekiso eyahlukeneyo kwimbono ye-fluoroscopic:
- I-Lateral malleolus ijikelezwe kwindawo eqhelekileyo**: Ikhontolo ye-malleolus yecala eqhelekileyo kunye nesithunzi se-cortical kudonga olusecaleni lwe-lateral malleolar fossa, ebekwe kumgca ongaphandle wesinye kwisithathu se-medial kunye ne-lateral cortices ye-lateral malleolus.
-Lateral malleolus yangaphandle ukujikeleza deformity**: I-lateral malleolus contour ibonakala "inamagqabi abukhali," i-cortical shadow kwi-lateral malleolar fossa iyanyamalala, isithuba se-distal tibiofibular siyancipha, umgca we-Shenton uyayeka kwaye usasazeke.
-Lateral malleolus internal rotation deformity**: I-lateral malleolus contour ibonakala "imilo yecephe," isithunzi secortical kwi-lateral malleolar fossa siyanyamalala, kwaye isithuba se-distal tibiofibular siyaba banzi.
Iqela libandakanya izigulane ze-56 ezine-C-type lateral malleolar fractures ezidityaniswe nokulimala kwe-distal tibiofibular syndesmosis kunye nokusebenzisa indlela yokuvavanya ekhankanywe ngasentla. Ukuhlolwa kwakhona kwe-CT ye-postoperative kubonise ukuba izigulane ze-44 ziphumelele ukunciphisa i-anatomic ngaphandle kokukhubazeka okujikelezayo, ngelixa izigulane ze-12 zifumana ukukhubazeka okujikelezayo okuncinci (ngaphantsi kwe-5 °), kunye neemeko ze-7 zokujikeleza kwangaphakathi kunye neemeko ze-5 zokujikeleza kwangaphandle. Akukho matyala aphakathi (5-10 °) okanye anzima (ngaphezulu kwe-10 °) ukukhubazeka kokujikeleza kwangaphandle kwenzeka.
Uphononongo lwangaphambili lubonise ukuba uvavanyo lokunciphisa i-lateral malleolar fracture inokusekelwe kwiiparamitha ezintathu eziphambili ze-Weber: i-parallel equidistance phakathi kwe-tibial kunye ne-talar joint surfaces, ukuqhubeka komgca we-Shenton, kunye nophawu lwe-Dime.
Ukuncitshiswa kakubi kwe-malleolus esecaleni kungumba oxhaphake kakhulu ekusebenzeni kweklinikhi. Nangona ingqalelo efanelekileyo inikezelwa ekubuyiselweni kobude, ukubaluleka okulinganayo kufuneka kubekwe ekulungisweni kokujikeleza. Njengomdibaniso wobunzima, nayiphi na i-malreduction ye-ankle ingaba nemiphumo eyintlekele kumsebenzi wayo. Kukholelwa ukuba ubuchule be-intraoperative fluoroscopic obucetywe nguNjingalwazi uZhang Shimin bunokunceda ekufezekiseni ukucuthwa okuchanekileyo kwe-C-uhlobo lwe-lateral malleolar fractures. Obu buchule busebenza njengesalathiso esibalulekileyo kwiiklinikhi zangaphambili.
Ixesha lokuposa: May-06-2024
