Kukuvara kweAnkle kukuvara kwemitambo kwakajairika kunoitika munenge 25% yekukuvara kwemusculoskeletal, nekukuvara kwe lateral collateral ligament (LCL) ndiko kunonyanya kuitika. Kana iyo yakakomba mamiriro asina kurapwa munguva, zviri nyore kutungamirira kune akadzokororwa sprains, uye zviitiko zvakakomba zvikuru zvichakanganisa basa rejoka remakumbo. Naizvozvo, zvakakosha zvikuru kuongorora nekurapa kukuvara kwevarwere panguva yekutanga. Ichi chinyorwa chichatarisa kune unyanzvi hwekuongorora kwe lateral collateral ligament kukuvadzwa kwegumbo remakumbo kubatsira varapi kuvandudza kururamisa kwekuongororwa.
I. Anatomy
Anterior talofibular ligament (ATFL): yakatsetseka, yakabatanidzwa kune lateral capsule, kutanga anterior kune fibula uye kupedzisa anterior kune muviri wetalus.
Calcaneofibular ligament (CFL): tambo-yakaita, inobva kumuganhu wepamberi we distal lateral malleolus uye inoguma pa calcaneus.
Posterior talofibular ligament (PTFL): Inotangira pane yepakati pepamusoro ye lateral malleolus uye inopera shure kune medial talus.
ATFL chete yakaverengera nezve 80% yekukuvara, nepo ATFL yakasanganiswa neCFL kukuvara kwakaverengera nezve 20%.
Schematic diagram uye anatomical diagram ye lateral collateral ligament yeankle joint.
II. Nzira yekukuvara
Kukuvara kwakasimudzwa: anterior talofibular ligament
calcaneofibular ligament varus kukuvara: calcaneofibular ligament
III. Kukuvara giredhi
Giredhi I: ligament strain, hapana inooneka ligament kuputika, kashoma kuzvimba kana unyoro, uye hapana zviratidzo zvekurasikirwa nebasa;
Giredhi II: chikamu macroscopic rupture ye ligament, kurwadziwa kwepakati, kuzvimba, uye unyoro, uye kukanganisa kuduku kwebasa rekubatana;
Giredhi III: ligament yakabvaruka zvachose uye inorasikirwa nekutendeseka kwayo, ichiperekedzwa nekuzvimba kukuru, kubuda ropa uye kunyorova, pamwe chete nekurasikirwa kwakajeka kwebasa uye kuratidzwa kwekusagadzikana kwemajoini.
IV. Kuongororwa kwekiriniki Front dhirowa bvunzo
Murwere agere nebvi rakanyunguduka uye kuguma kwemhuru yakarembera, uye muongorori anobata tibia panzvimbo neruoko rumwe uye anosundira rutsoka mberi shure kwechitsitsinho nemumwe.
Zvimwewo, murwere ari supine kana kuti akagara nebvi rakakotama pa 60 kusvika ku90 degrees, chitsitsinho chakagadzika pasi, uye muongorori anoshandisa posterior pressure kune distal tibia.
A positive anofanotaura kuputika kweanterior talofibular ligament.
Inversion stress test
Iyo proximal ankle yakanga isingafambi, uye varus stress yakaiswa kune distal ankle kuti iongorore talus tilt angle.
Kuenzaniswa nedivi rekupokana, > 5 ° inofungira zvakanaka, uye > 10 ° yakanaka; kana unilateral > 15 ° yakanaka.
A positive predictor of calcaneofibular ligament rupture.
Imaging tests
X-rays yezvakajairwa ankle mitambo kukuvara
X-rays haina kunaka, asi MRI inoratidza misodzi yeanterior talofibular uye calcaneofibular ligaments.
Zvakanakira: X-ray ndiyo yekutanga sarudzo yekuongorora, iyo ine mari uye iri nyore; Kukura kwekukuvara kunotongwa nekutonga chiyero chetalus inclination. Kukanganisa: Kuratidzwa kusina kunaka kwezvinyoro zvinyoro, kunyanya zvigadziro zvigamentous zvakakosha pakuchengetedza kugadzikana kwekubatana.
MRI
Fig.1 The 20 ° oblique position yakaratidza yakanakisa anterior talofibular ligament (ATFL); Fig.2 Azimuth mutsara weATFL scan
MRI mifananidzo yeakasiyana anterior talofibular ligament kukuvara kwakaratidza kuti: (A) anterior talofibular ligament thickening uye edema; (B) anterior talofibular ligament misodzi; (C) kuputika kweanterior talofibular ligament; (D) Anterior talofibular ligament kukuvara nekuputika kuputsika.
Fig.3 The -15 ° oblique position yakaratidza yakanakisisa calcaneofibular ligament (CFI);
Fig.4. CFL kuongorora azimuth
Acute, misodzi yakakwana yecalcaneofibular ligament
Mufananidzo 5: Coronal view inoratidza yakanakisa posterior talofibular ligament (PTFL);
Fig.6 PTFL scan azimuth
Chikamu chemisodzi ye posterior talofibular ligament
Grading ye diagnostic:
Kirasi I: Hapana kukanganisa;
Giredhi II: ligament contusion, kunaka kuenderera mberi kwemaitiro, kuwedzera kwemarunda, hypoechogenicity, edema yezviputi zvakapoteredza;
Giredhi III: isina kukwana ligament morphology, kuonda kana kukanganiswa kwechikamu chekuenderera kwemavara, kukora kwemarunda, uye kuwedzera chiratidzo;
Giredhi IV: kukanganisa kwakakwana kwekuenderera mberi kwe ligament, iyo inogona kuperekedzwa nekuputsika kwekutsemuka, kukora kwemarunda, uye kuwedzera kwenzvimbo kana kupararira chiratidzo.
Advantages: Kugadziriswa kwepamusoro kune zvinyoro zvinyoro, kunyatsocherechedza kwemhando dzekukuvara kwe ligament; Inogona kuratidza kukuvadzwa kwecartilage, bone contusion, uye mamiriro ese ekukuvara kwekomboni.
Kukanganisa: Hazvibviri kunyatsoona kana kuputsika uye articular cartilage kukuvadzwa kunokanganiswa; Pamusana pekuoma kweankle ligament, kuongororwa kwekuongorora hakusi kwepamusoro; Zvinodhura uye zvinopedza nguva.
High-frequency ultrasound
Mufananidzo 1a: Anterior talofibular ligament kukuvara, chidimbu chemisodzi; Mufananidzo 1b: The anterior talofibular ligament yakabvaruka zvachose, chigutsa chakakora, uye kuputika kukuru kunoonekwa mu anterior lateral space.
Mufananidzo 2a: Calcaneofibular ligament kukuvara, chidimbu chemisodzi; Mufananidzo 2b: Calcaneofibular ligament kukuvara, kupera kwakakwana
Mufananidzo 3a: Normal anterior talofibular ligament: ultrasound image inoratidza inverted triangle uniform hypoechoic structure; Mufananidzo 3b: Yakajairika calcaneofibular ligament: Pakati nepakati echogenic uye dense filamentous chimiro pamufananidzo we ultrasound
Mufananidzo 4a: Kusvimha misodzi kweanterior talofibular ligament pamufananidzo we ultrasound; Mufananidzo 4b: Kubvarura kwakazara kwecalcaneofibular ligament pamufananidzo we ultrasound
Grading ye diagnostic:
contusion: acoustic mifananidzo inoratidza intact structure, gobvu uye kuzvimba ligaments; Kubvaruka zvishoma: Pane kuzvimba mu ligament, pane kuramba kuvhiringika kweimwe faibha, kana mafiibhi akatetepa munharaunda. Dynamic scans yakaratidza kuti ligament tension yakanyanyisa kupera, uye ligament yakatetepa uye yakawedzera uye elasticity yakaderera munyaya ye valgus kana varus.
Kusvimha misodzi: zvachose uye inoramba ichivhiringidzwa ligament ine distal separation, dynamic scan inoratidza kuti hapana ligament tension kana kuwedzera kubvarura, uye mu valgus kana varus, ligament inofamba ichienda kune imwe mugumo, pasina chero elasticity uye nekubatana kwakasununguka.
Zvakanakira: mutengo wakaderera, nyore kushanda, usingapindire; Chimiro chisina kujeka chega yega yega subcutaneous tishu inoratidzwa zvakajeka, iyo inobatsira pakuona kwezvipembenene zvemusculoskeletal tissue. Kuongororwa kwechikamu chekutsvaga, maererano nebhanhire rebhanhire kutsvaga nzira yose yegumbo, nzvimbo yekukuvara kwemakumbo inojekeswa, uye kushushikana kwegumbo uye morphological kuchinja kunoonekwa zvakasimba.
Kukanganisa: kuderera kwezvinyoro zvinyoro zvigadziriswa zvichienzaniswa neMRI; Vimba nehunyanzvi hwekuita basa.
Arthroscopy kuongorora
Zvakanakira: Kunyatsocherechedza zvigadziro zve lateral malleolus uye hindfoot (zvakadai seyakaderera talar joint, anterior talofibular ligament, calcaneofibular ligament, etc.) kuti uongorore kutendeseka kwemasumbu uye kubatsira chiremba anovhiya kuti aone chirongwa chekuvhiya.
Kukanganisa: Kuvhiringidza, kunogona kukonzera zvimwe zvinetso, zvakadai sekukuvara kwetsinga, utachiona, nezvimwewo. Inowanzoonekwa seyero yegoridhe yekuongorora kukuvadzwa kwemakumbo uye ikozvino inonyanya kushandiswa mukurapa kwekukuvara kwemakumbo.
Nguva yekutumira: Sep-29-2024
