Ankle fractures ndeimwe yemhando dzakawanda dzekuputsika mumakiriniki maitiro. Kunze kwekumwe kukuvara kwekutenderera kweGiredhi I / II uye kukuvara kwekubira, kuputika kwechidzitiro kwakawanda kazhinji kunosanganisira lateral malleolus. Weber A/B mhando lateral malleolus fractures inokonzeresa yakagadzikana distal tibiofibular syndesmosis uye inogona kuwana kuderedzwa kwakanaka nekuona kwakananga kubva distal kusvika proximal. Kusiyana neizvi, C-type lateral malleolus fractures inosanganisira kusagadzikana mu lateral malleolus kumativi matatu ematemo nekuda kwekukuvara kwe distal tibiofibular, izvo zvinogona kutungamirira kumarudzi matanhatu ekutamisa: kupfupisa / kureba, kuwedzera / kuderedza nzvimbo ye distal tibiofibular, anterior / posterior displacement. mu sagittal plane, medial/lateral tilt mu coronal plane, rotational displacement, uye misanganiswa yemhando idzi shanu dzekukuvara.
Zvakawanda zvidzidzo zvekare zvakaratidza kuti kupfupisa/kurebesa kunogona kuongororwa kuburikidza nekuongorora chiratidzo cheDime, Stenton line, uye tibial-gapping angle, pakati pevamwe. Displacement mu coronal uye sagittal ndege inogona kunyatsoongororwa uchishandisa frontal uye lateral fluoroscopic maonero; zvisinei, kutenderera kwekutenderera ndiko kwakanyanya kunetsa kuongorora intraoperatively.
Kuomerwa kwekuongorora kutenderera kwekutenderera kunonyanya kuoneka mukuderedzwa kwefibula paunenge uchiisa distal tibiofibular screw. Mazhinji mabhuku anoratidza kuti mushure mekuiswa kwe distal tibiofibular screw, pane 25% -50% kuitika kwekuderera kwakashata, zvichiita kuti malunion uye kugadzirisa fibular deformities. Dzimwe nyanzvi dzakafunga kushandisa maitiro ekuongorora CT, asi izvi zvinogona kunetsa kuita mukuita. Kugadzirisa nyaya iyi, muna 2019, timu yaMuzvinafundo Zhang Shimin kubva kuYangpu Hospital yakabatana neTongji University yakaburitsa chinyorwa mupepanhau repasi rose orthopedic *Kukuvara*, vachikurudzira nzira yekuongorora kana lateral malleolus kutenderera yakagadziriswa uchishandisa intraoperative X-ray. Zvinyorwa zvinorondedzera zvakakosha kliniki yehutano yeiyi nzira.
Nheyo yedzidziso yeiyi nzira ndeyokuti mune fluoroscopic maonero echidzitiro, iyo lateral wall cortex ye lateral malleolar fossa inoratidza mumvuri wakajeka, wakatwasuka, wakaoma, wakafanana nepakati uye lateral cortices ye lateral malleolus, uye iri panzvimbo. pakati kusvika kunze kwechikamu chimwe chete muzvitatu chemutsara unobatanidza mazamu emukati uye lateral cortices ye lateral malleolus.
Mufananidzo weankle fluoroscopic maonero anoratidza hukama hwepakati pakati pe lateral wall cortex ye lateral malleolar fossa (b-line) uye yepakati uye yepakati cortices ye lateral malleolus (a uye c mitsara). Kazhinji, b-mutsara unowanikwa kunze kwechetatu mutsetse pakati pemitsara a uye c.
Nzvimbo yakajairwa yeiyo lateral malleolus, kutenderera kwekunze, uye kutenderera kwemukati kunogona kuburitsa maitiro akasiyana ekufungidzira mune fluoroscopic maonero:
- Lateral malleolus yakatenderedzwa munzvimbo yakajairwa **: Yakajairika lateral malleolus contour ine cortical shadow pamadziro emadziro e lateral malleolar fossa, yakamira kunze kwechetatu mutsara wepakati uye lateral cortices ye lateral malleolus.
-Lateral malleolus external rotation deformity **: The lateral malleolus contour inoratidzika "yakapinza-mashizha," mumvuri wecortical pa lateral malleolar fossa inonyangarika, nzvimbo ye distal tibiofibular inotetepa, mutsara weShenton unopera uye wakapararira.
-Lateral malleolus internal rotation deformity**: The lateral malleolus contour inoratidzika "yakaumbwa nechipunu," mumvuri wecortical pa lateral malleolar fossa unonyangarika, uye distal tibiofibular space inowedzera.
Dare racho raisanganisira varwere ve56 vane C-type lateral malleolar fractures pamwe chete nekukuvara kwe distal tibiofibular syndesmosis uye vakashandisa nzira yekuongorora yambotaurwa. Postoperative CT re-exams yakaratidza kuti varwere ve44 vakawana kuderedzwa kweanatomic pasina kukanganisa kutenderera, nepo varwere ve12 vakawana kunyorova kwekutenderera (pasi pe5 °), ne7 zviitiko zvekutenderera kwemukati uye 5 zviitiko zvekunze kutenderera. Hapana zviitiko zvepakati (5-10 °) kana zvakakomba (zvikuru kupfuura 10 °) kunze kwekutenderera kuremara kwakaitika.
Zvidzidzo zvakapfuura zvakaratidza kuti ongororo ye lateral malleolar fracture kuderedzwa inogona kuve yakavakirwa pamitatu mikuru yeWeber paramita: parallel equidistance pakati petibial uye talar yakabatana nzvimbo, kuenderera kwemutsara weShenton, uye chiratidzo cheDime.
Kuderera kuderera kweiyo lateral malleolus inyaya yakajairika mukuita kwekiriniki. Nepo ngwariro yakafanira inopiwa kukudzorerwa kwourefu, ukoshi hwakaenzana hunofanira kuiswa pakururamisa kutenderera. Sejoinhi rinotakura huremu, chero kukanganisa kwechidzitiro kunogona kuva nemigumisiro yakaipa pakushanda kwayo. Zvinotendwa kuti intraoperative fluoroscopic maitiro akakurudzirwa naProfessor Zhang Shimin anogona kubatsira mukuwana kudzikiswa chaiko kweC-type lateral malleolar fractures. Iyi nzira inoshanda sereferensi yakakosha kune vemberi makiriniki.
Nguva yekutumira: Chivabvu-06-2024
