Kukuvara kwegumbo kukuvara kunowanzoitika mumitambo kunoitika muvanhu vanosvika 25% vekukuvara kwemapfupa nemapfupa, uye kukuvara kwe lateral collateral ligament (LCL) ndiko kwakanyanya kuitika. Kana chirwere chakanyanya chisina kurapwa nenguva, zviri nyore kutungamira mukupunzika kakawanda, uye zviitiko zvakakomba zvinokanganisa mashandiro egumbo. Nokudaro, zvakakosha zvikuru kuongorora nekurapa kukuvara kwevarwere pakutanga. Chinyorwa chino chichatarisa pahunyanzvi hwekuongorora kukuvara kwegumbo re lateral collateral ligament kuti zvibatsire vanachiremba kuvandudza kururama kwekuongorora.
I. Hunhu hwemuviri
Anterior talofibular ligament (ATFL): yakatsetseka, yakabatana nekapisiyumu kari kurutivi, ichitangira mberi kune fibula ichipera mberi kwemuviri we talus.
Ligament yeCalcaneofibular (CFL): yakaita setambo, inotangira pamuganhu wepamberi we distal lateral malleolus uye inogumira pa calcaneus.
Posterior talofibular ligament (PTFL): Inobva pamusoro pechikamu chepakati che lateral malleolus uye inoguma kumashure kwechikamu chepakati che vertebrae.
ATFL chete ndiyo yaive ne80% yekukuvara, nepo ATFL pamwe chete nekukuvara kweCFL zvaive ne20%.
Dhiyagiramu yechirongwa uye dhiyagiramu yeanatomiki ye lateral collateral ligament yegumbo
II. Maitiro ekukuvara
Kukuvara kwepahuro: anterior talofibular ligament
kukuvara kwe calcaneofibular ligament varus: calcaneofibular ligament
III. Kuyera kukuvara
Giredhi I: kusvetwa kwemarunda, kusabvaruka kwemarunda kunooneka, kuzvimba kana kurwadza kushoma, uye kusaratidza zviratidzo zvekusashanda zvakanaka;
Giredhi rechipiri: kuputika kwechikamu chikuru che ligament, kurwadziwa kuri pakati nepakati, kuzvimba, uye kunyorova, uye kutadza kushanda zvakanaka kwemajoini;
Giredhi rechitatu: tsinga yacho inobvaruka zvachose yorasikirwa nekuvimbika kwayo, ichiperekedzwa nekuzvimba kukuru, kubuda ropa uye kurwadza, zvichiperekedzwa nekurasikirwa kukuru kwebasa uye zviratidzo zvekusagadzikana kwemajoini.
IV. Kuongororwa kwekiriniki Bvunzo yedhirowa repamberi
Murwere anogara pasi ibvi rakakotama uye magumo emhuru akarembera, uye muongorori anobata tibia panzvimbo neruoko rumwe uye anosundira tsoka mberi shure kwechitsitsinho nerumwe.
Neimwe nzira, murwere anofanira kugara akarara pasi kana kuti akakotama ibvi rake pa 60 kusvika 90 degrees, chitsitsinho chake chakanamira pasi, uye muongorori achiisa kumanikidzwa kwemashure ku distal tibia.
Chinhu chakanaka chinoratidza kuputika kwegomarara re talofibular repamberi.
Kuedza kushushikana kweInversion
Chigunwe chepamberi chakanga chisina kufamba, uye varus stress yakaiswa pagunwe rekure kuti vaone kona yekutsvedza kwetalus.
Kana tichienzanisa nedivi riri parutivi, >5° ine fungidziro yekuti iri positive, uye >10° ine positive; kana unilateral >15° ine positive.
Chiratidzo chakanaka chekuputika kwetsinga ye calcaneofibular.
Miedzo yemifananidzo
X-ray yekukuvara kwemitambo kwakajairika mumakumbo
X-rays haina kunaka, asi MRI inoratidza kubvaruka kwe anterior talofibular ne calcaneofibular ligaments
Zvakanakira: X-ray ndiyo sarudzo yekutanga yekuongorora, iyo inodhura zvishoma uye iri nyore; Hukuru hwekukuvara hunotongwa nekutarisa mwero wekutsvedza kwetalus. Zvakaipa: Kusaratidza zvakanaka kwenyama dzakapfava, kunyanya maumbirwo emakumbo akakosha pakuchengetedza kugadzikana kwemajoini.
MRI
Mufananidzo 1. Nzvimbo yakamanikana ye20° yakaratidza anterior talofibular ligament (ATFL) yakanakisisa; Mufananidzo 2. Mutsetse weAzimuth weATFL scan
Mifananidzo yeMRI yekukuvara kwakasiyana-siyana kwegomarara re talofibular anterior yakaratidza kuti: (A) kukora kwegomarara re talofibular anterior uye kuzvimba; (B) kubvaruka kwegomarara re talofibular anterior; (C) kuputika kwegomarara re talofibular anterior; (D) Kukuvara kwegomarara re talofibular anterior nekutyoka kwe avulsion.
Mufananidzo 3. Nzvimbo ye -15° yakaonda yakaratidza calcaneofibular ligament (CFI) yakanakisa;
Mufananidzo 4. CFL scanning azimuth
Kubvaruka kwakasimba, kwakazara kwe calcaneofibular ligament
Mufananidzo 5: Maonero eCoronal anoratidza posterior talofibular ligament (PTFL) yakanakisa;
Mufananidzo 6: PTFL scan azimuth
Kubvaruka kwechikamu cheposterior talofibular ligament
Kuongororwa kwechirwere:
Kirasi I: Hapana kukuvara;
Giredhi rechipiri: kupwanyika kwemasumbu, kuenderera mberi kwakanaka kwemasumbu, kukora kwemasumbu, hypoechogenicity, kuzvimba kwemasumbu akakomberedza;
Giredhi III: chimiro chisina kukwana che ligament, kutetepa kana kukanganiswa kwechikamu chekuenderera mberi kwemavara, kukora kwe ligaments, uye kuwedzera kwechiratidzo;
Giredhi IV: kukanganiswa kwakakwana kwekuenderera mberi kwemarunda, izvo zvinogona kuperekedzwa nekutyoka kwemarunda, kukora kwemarunda, uye kuwedzera kwechiratidzo chemunharaunda kana chekupararira.
Zvakanakira: Inokwanisa kusimba zvakanyanya panyama dzakapfava, kunyatsoongorora mhando dzekukuvara kwemarunda; Inogona kuratidza kukuvara kwekatsi, kupwanyika kwemapfupa, uye mamiriro ese ekukuvara kwakabatana.
Zvakashata: Hazvigoneki kunyatsoona kana kutyoka uye kukuvara kwekatsi yemutsipa zvichikanganiswa; Nekuda kwekuoma kwetsinga yegumbo, kushanda zvakanaka kwekuongorora hakuna kukwira; Zvinodhura uye zvinotora nguva.
Ultrasound yepamusoro-soro
Mufananidzo 1a: Kukuvara kwemusana we talofibular anterior, kubvaruka zvishoma; Mufananidzo 1b: Musana we talofibular anterior wabvaruka zvachose, chigunwe chakora, uye kubuda kwemvura kukuru kunoonekwa munzvimbo yekumberi.
Mufananidzo 2a: Kukuvara kwemutezo weCalcaneofibular, kubvaruka zvishoma; Mufananidzo 2b: Kukuvara kwemutezo weCalcaneofibular, kuputika zvachose
Mufananidzo 3a: Mutsetse we talofibular wepamberi wakajairika: mufananidzo we ultrasound unoratidza mativi matatu akapinduka akafanana nechimiro che hypoechoic; Mufananidzo 3b: Mutsetse we calcaneofibular wakajairika: Mutsetse we echogenic uye wakakora pamufananidzo we ultrasound
Mufananidzo 4a: Kubvaruka kwechikamu chegomarara repamberi retalofibular pamufananidzo weultrasound; Mufananidzo 4b: Kubvaruka kwese kwegomarara recalcaneofibular pamufananidzo weultrasound
Kuongororwa kwechirwere:
kuvhunika: mifananidzo yeacoustic inoratidza chimiro chisina kukuvadzwa, mitsetse yakakora uye yakazvimba; Kubvaruka kwechikamu: Kune kuzvimba mumitsetse, kune kukanganiswa kunogara kuripo kwemamwe mitsetse, kana kuti mitsetse yacho yakatetepa munharaunda. Dynamic scans yakaratidza kuti kusimba kwemitsetse kwakanga kwaderera zvakanyanya, uye mitsetse yakatetepa uye yakawedzera uye kusimba kwakaderera kana paine valgus kana varus.
Kubvaruka kwakazara: tsinga inongoerekana yavharwa zvachose uye inogara ichivharwa ine distal separation, dynamic scan inoratidza kuti hapana kushushikana kwematsinga kana kubvaruka kwakawedzera, uye mu valgus kana varus, tsinga inofamba ichienda kune rimwe divi, isina kana elasticity uye ine jointi yakasununguka.
Zvakanakira: mutengo wakaderera, nyore kushandisa, hazvipindi; Maumbirwo asina kusimba echikamu chimwe nechimwe chenyama iri pasi peganda anoratidzwa zvakajeka, izvo zvinobatsira pakuona maronda emapfupa nemapfupa. Kuongororwa kwechikamu chisina kurongeka, zvichienderana nebhandi remagomarara kuti utarise maitiro ese egomarara, nzvimbo yekukuvara kwemagomarara inojekeswa, uye kushushikana kwemagomarara nekuchinja kwechimiro chemuviri zvinoonekwa zvine simba.
Zvakashata: kusasimba kwenyama dzakapfava zvishoma kana tichienzanisa neMRI; Kuvimba nekushanda kwehunyanzvi.
Kuongorora Arthroscopy
Zvakanakira: Tarisa zvakananga maumbirwo e lateral malleolus ne hindfoot (zvakadai se inferior talar joint, anterior talofibular ligament, calcaneofibular ligament, nezvimwewo) kuti uongorore kusimba kwema ligaments uye ubatsire chiremba wepfungwa kusarudza chirongwa chekuvhiya.
Zvakashata: Zvinokanganisa tsinga, zvinogona kukonzera mamwe matambudziko, akadai sekukuvadzwa kwetsinga, hutachiona, nezvimwewo. Kazhinji zvinoonekwa senzira yepamusoro yekuongorora kukuvara kwetsinga uye parizvino ndiyo inonyanya kushandiswa mukurapa kukuvara kwetsinga.
Nguva yekutumira: Gunyana-29-2024
