"He 10% o nā haki kuʻekuʻe wāwae e hele pū ʻia me ka ʻeha syndesmosis tibiofibular distal. Ua hōʻike ʻia nā haʻawina he 52% o nā wili tibiofibular distal e hopena i ka hōʻemi maikaʻi ʻole o ka syndesmosis. ʻO ka hoʻokomo ʻana i ka wili tibiofibular distal e kū pono ana i ka ʻili hui syndesmosis he mea nui ia e pale aku i ka iatrogenic malreduction. Wahi a ka manual AO, ua ʻōlelo ʻia e hoʻokomo i ka wili tibiofibular distal 2 cm a i ʻole 3.5 cm ma luna o ka ʻili articular tibial distal, ma ke kihi o 20-30° i ka mokulele ākea, mai ka fibula a i ka tibia, me ke kuʻekuʻe wāwae ma kahi kūlana kūlike."
ʻO ka hoʻokomo lima ʻana o nā wili tibiofibular distal e hopena pinepine i nā ʻokoʻa ma ke kiko komo a me ke kuhikuhi, a i kēia manawa, ʻaʻohe ala pololei no ka hoʻoholo ʻana i ke kuhikuhi hoʻokomo o kēia mau wili. No ka hoʻoponopono ʻana i kēia pilikia, ua lawe nā kānaka noiʻi haole i kahi ala hou—ʻo ke ʻano 'angle bisector'.
Ma ka hoʻohana ʻana i ka ʻikepili kiʻi mai 16 mau hono kuʻekuʻe wāwae maʻamau, ua hana ʻia he 16 mau hiʻohiʻona i paʻi ʻia ma 3D. Ma nā mamao o 2 cm a me 3.5 cm ma luna o ka ʻili articular tibial, ua kau ʻia ʻelua mau uea Kirschner 1.6 mm e kūlike ana me ka ʻili hui kokoke i nā ʻaoʻao mua a me hope o ka tibia a me fibula. Ua ana ʻia ke kihi ma waena o nā uea Kirschner ʻelua me ka hoʻohana ʻana i kahi protractor, a ua hoʻohana ʻia kahi ʻāpana wili 2.7 mm e wili i kahi lua ma ka laina bisector angle, a ukali ʻia e ka hoʻokomo ʻana o kahi wili 3.5 mm. Ma hope o ka hoʻokomo ʻana o ka wili, ua ʻoki ʻia ka wili ma kona lōʻihi me ka hoʻohana ʻana i kahi ʻoki e loiloi i ka pilina ma waena o ke kuhikuhi o ka wili a me ke axis waena o ka tibia a me fibula.
Hōʻike nā hoʻokolohua laʻana aia kahi kūlike maikaʻi ma waena o ke axis waena o ka tibia a me ka fibula a me ka laina bisector angle, a ma waena o ke axis waena a me ke kuhikuhi o ka wili.
Ma ke ʻano he kumumanaʻo, hiki i kēia ʻano hana ke kau pono i ka wili ma ke kikowaena o ka tibia a me ka fibula. Eia nō naʻe, i ka wā o ke ʻoki ʻana, ʻo ke kau ʻana i nā kaula Kirschner kokoke i nā ʻaoʻao mua a me hope o ka tibia a me ka fibula e hōʻino ai i nā kīʻaha koko a me nā aʻalolo. Eia kekahi, ʻaʻole kēia ʻano hana e hoʻoponopono i ka pilikia o ka iatrogenic malreduction, ʻoiai ʻaʻole hiki ke loiloi pono ʻia ka alignment distal tibiofibular intraoperatively ma mua o ke kau ʻana o ka wili.
Ka manawa hoʻouna: Iulai-30-2024
