Ho robeha ha maqaqailana ke e 'ngoe ea mefuta e atileng haholo ea ho robeha ha litlhare tsa bongaka. Ntle le likotsi tse ling tse potolohang tsa Sehlopha sa I / II le likotsi tsa ho koeteloa, ho robeha ha maqaqailaneng hangata ho ama lateral malleolus. Mofuta oa Weber A / B lateral malleolus fractures hangata o fella ka distal tibiofibular syndesmosis e tsitsitseng mme e ka finyella phokotso e ntle ka pono e tobileng ho tloha distal ho ea ho proximal. Ka lehlakoreng le leng, C-type lateral malleolus fractures e kenyelletsa ho hloka botsitso ho lateral malleolus ho pholletsa le lilepe tse tharo ka lebaka la kotsi ea distal tibiofibular, e ka lebisang ho mefuta e tšeletseng ea ho falla: ho khutsufatsa / ho lelefatsa, ho atolosa / ho fokotsa sebaka sa distal tibiofibular, ho falla ha pele / ka morao. sefofaneng sa sagittal, ho sekamela ha medial / lateral sefofaneng sa coronal, ho falla ho potoloha, le motsoako oa mefuta ena e mehlano ea likotsi.
Liphuputso tse ngata tse fetileng li bontšitse hore ho khutsufatsa / ho lelefatsa ho ka hlahlojoa ka ho hlahloba letšoao la Dime, Stenton line, le tibial-gapping angle, har'a tse ling. Ho falla ha lifofane tsa coronal le sagittal ho ka hlahlojoa hantle ho sebelisoa maikutlo a ka pele le a ka morao a fluoroscopic; leha ho le joalo, phalliso ea potoloho ke eona e phephetsang ka ho fetisisa ho e hlahloba ka mokhoa o sa sebetseng.
Bothata ba ho hlahloba ho falla ha rotational bo bonahala ka ho khetheha ho fokotseha ha fibula ha ho kenngoa distal tibiofibular screw. Lingoliloeng tse ngata li bontša hore ka mor'a ho kenngoa ha sekoti sa distal tibiofibular, ho na le ketsahalo ea 25% -50% ea ho fokotseha ho fokolang, e leng se bakang malunion le ho lokisoa ha bokooa ba fibula. Litsebi tse ling li 'nile tsa etsa tlhahiso ea ho sebelisa liteko tsa CT tse tloaelehileng, empa sena se ka ba phephetso ho se sebelisa. Ho sebetsana le bothata bona, ka 2019, sehlopha sa Moprofesa Zhang Shimin oa Sepetlele sa Yangpu se ikopantseng le Univesithi ea Tongji se phatlalalitse sengoloa koranteng ea machaba ea masapo a *Kotsi*, se sisinya mokhoa oa ho lekola hore na lateral malleolus rotation e lokisitsoe ho sebelisoa X-ray ea intraoperative. Lingoliloeng li tlaleha katleho e kholo ea kliniki ea mokhoa ona.
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Motheo oa khopolo-taba oa mokhoa ona ke hore ponong ea fluoroscopic ea leqaqailaneng, lateral lebota cortex ea lateral malleolar fossa e bontša e hlakileng, paatsepama, le letenya moriti, bapileng le medial le lateral cortices ea lateral malleolus, 'me e teng sebakeng seo. bohareng ho isa ka ntle ho karolo ea boraro ea mola o kopanyang makhapetla a mahareng le a ka morao a lateral malleolus.
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Setšoantšo sa pono ea li-ankle fluoroscopic e bontšang kamano ea boemo pakeng tsa lateral lebota cortex ea lateral malleolar fossa (b-line) le methapo ea bohareng le e ka morao ea lateral malleolus (a le c lines). Ka tloaelo, b-line e fumaneha moleng o ka ntle oa karolo ea boraro pakeng tsa mela a le c.
Boemo bo tloaelehileng ba lateral malleolus, ho potoloha ka ntle, le ho potoloha ka hare ho ka hlahisa ponahalo e fapaneng ea litšoantšo ponong ea fluoroscopic:
- Lateral malleolus e pota-potiloe ka boemo bo tloaelehileng **: Tsela e tloaelehileng ea lateral malleolus contour e nang le moriti oa cortical leboteng la lateral la lateral malleolar fossa, e behiloeng moleng o ka ntle oa karolo ea boraro ea li-cortices tse bohareng le tse ka morao tsa lateral malleolus.
-Lateral malleolus external rotation deformity**: The lateral malleolus contour e bonahala e le "leaf-leafed," moriti oa cortical holim'a lateral malleolar fossa oa nyamela, sebaka sa distal tibiofibular se fokotseha, mohala oa Shenton oa khaotsa le ho qhalana.
-Lateral malleolus internal rotation deformity**: The lateral malleolus contour e hlaha "e bōpehileng joaloka khaba," moriti oa cortical holim'a lateral malleolar fossa oa nyamela, 'me sebaka sa distal tibiofibular sea atoloha.
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Sehlopha se ne se kenyelletsa bakuli ba 56 ba nang le C-type lateral malleolar fractures hammoho le likotsi tsa distal tibiofibular syndesmosis le ho sebelisa mokhoa o boletsoeng ka holimo. Litlhahlobo tsa morao-rao tsa CT li bontšitse hore bakuli ba 44 ba finyelletse phokotso ea anatomic ba se nang bokooa ba ho potoloha, ha bakuli ba 12 ba ne ba e-na le bokooa bo fokolang ba ho potoloha (ka tlase ho 5 °), le linyeoe tsa 7 tsa ho potoloha ka hare le linyeoe tsa 5 tsa ho potoloha ka ntle. Ha ho linyeoe tse itekanetseng (5-10 °) kapa tse matla (tse kholo ho feta 10 °) tse nang le bokooa ba ho potoloha ka ntle.
Liphuputso tse fetileng li bontšitse hore tlhahlobo ea phokotso ea lateral malleolar fracture e ka ipapisa le mekhahlelo e meraro ea mantlha ea Weber: equidistance e ts'oanang lipakeng tsa libaka tse kopaneng tsa tibial le tala, ho tsoela pele ha mohala oa Shenton, le letšoao la Dime.
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Phokotso e mpe ea lateral malleolus ke taba e atileng haholo ts'ebetsong ea bongaka. Le hoja tlhokomelo e nepahetseng e lebisitsoe ho tsosolosoa ha bolelele, bohlokoa bo lekanang bo lokela ho behoa ho lokisoeng ha ho potoloha. Joaloka lenonyeletso le boima, ho fokola leha e le hofe ha leqaqailaneng ho ka ba le liphello tse kotsi mosebetsing oa lona. Ho lumeloa hore mokhoa oa intraoperative fluoroscopic o hlahisitsoeng ke Moprofesa Zhang Shimin o ka thusa ho fihlela phokotso e nepahetseng ea C-type lateral malleolar fractures. Mokhoa ona o sebetsa e le sesupo sa bohlokoa ho baoki ba pele.
Nako ea poso: May-06-2024