46% yeankle fractures inotenderera inoperekedzwa ne posterior malleolar fractures. Iyo posterolateral nzira yekuona zvakananga uye kugadzirisa kwemashure malleolus inzira inowanzoshandiswa yekuvhiya, inopa zvirinani biomechanical zvakanakira zvichienzaniswa nekuvhara kuderedzwa uye anteroposterior screw fixation. Zvisinei, nokuda kwezvimedu zvakakura zvemashure malleolar fractures kana posterior malleolar fractures inosanganisira posterior colliculus ye medial malleolus, iyo posteromedial nzira inopa maonero ari nani ekuvhiya.
Kuti uenzanise kuratidzwa kwemashure emashure malleolus, kushushikana kweurourovascular bundle, uye chinhambwe chiri pakati peiyo incision uye neurovascular bundle kumativi matatu akasiyana emashure emashure, vaongorori vakaita chidzidzo checadaveric. Mhedzisiro yakaburitswa munguva pfupi yapfuura mujenari reFAS. Zvakawanikwa zvinopfupikiswa sezvizvi:
Parizvino, pane nzira nhatu huru dzemashure ekufumura iyo posterior malleolus:
1. Medium Posteromedial Approach (mePM): Iyi nzira inopinda pakati pekupedzisira kwemashure malleolus uye tibialis posterior tendon (Mufananidzo 1 unoratidza tibialis posterior tendon).
2. Modified Posteromedial Approach (moPM): Iyi nzira inopinda pakati petibialis posterior tendon uye flexor digitorum longus tendon (Mufananidzo 1 unoratidza tibialis posterior tendon, uye Mufananidzo 2 unoratidza flexor digitorum longus tendon).
3. Posteromedial Approach (PM): Iyi nzira inopinda pakati pemucheto wepakati weAchilles tendon uye flexor hallucis longus tendon (Mufananidzo 3 unoratidza Achilles tendon, uye Mufananidzo 4 unoratidza flexor hallucis longus tendon).
Nezvekunetsana kuri pa neurovascular bundle, iyo PM nzira ine kuderera kwakadzika pa 6.18N zvichienzaniswa ne mePM uye moPM nzira, zvichiratidza mukana wakaderera we intraoperative traction kukuvara kune neurovascular bundle.
Nezvekuratidzwa kweiyo posterior malleolus, iyo PM nzira inopawo kuratidzwa kukuru, zvichibvumira 71% kuoneka kweiyo posterior malleolus. Mukuenzanisa, iyo mePM uye moPM nzira inobvumira 48.5% uye 57% kuratidzwa kweiyo posterior malleolus, zvichiteerana.
● Dhiagiramu inoratidza kuratidzwa kwemashure emashure malleolus kune matatu maitiro. AB inomiririra huwandu hwese hweiyo posterior malleolus, CD inomiririra yakafumurwa siyana, uye CD/AB ndiyo exposure ratio. Kubva kumusoro kusvika kuzasi, kuratidzwa kwakasiyana kwe mePM, moPM, uye PM kunoratidzwa. Zviripachena kuti PM maitiro ane yakakura kuratidzwa huwandu.
Nezve chinhambwe pakati pekuchekwa uye neurovascular bundle, nzira yePM ine zvakare chinhambwe chikuru, chinoyera 25.5mm. Izvi zvakakura kupfuura mePM's 17.25mm uye moPM's 7.5mm. Izvi zvinoratidza kuti PM maitiro ane mukana wakaderera wekukuvadzwa neurovascular bundle panguva yekuvhiyiwa.
● Dhiagiramu inoratidza madaro ari pakati pekuchekwa uye neurovascular bundle yenzira nhatu idzi. Kubva kuruboshwe kuenda kurudyi, nhambwe dze mePM, moPM, uye PM nzira dzinoratidzwa. Zviri pachena kuti nzira yePM ine chinhambwe chikuru kubva kune neurovascular bundle.
Nguva yekutumira: May-31-2024
