ʻO nā ʻeha kuʻekuʻe wāwae he hōʻeha haʻuki maʻamau i loaʻa ma kahi o 25% o nā ʻeha musculoskeletal, me nā ʻeha ligament collateral lateral (LCL) ka mea maʻamau. Inā ʻaʻole mālama ʻia ka maʻi koʻikoʻi i ka manawa, maʻalahi ke alakaʻi i nā sprains hou, a ʻo nā hihia koʻikoʻi e pili ana i ka hana o ka hui kuʻekuʻe wāwae. No laila, he mea koʻikoʻi ka ʻike a mālama ʻana i nā ʻeha o nā maʻi i ka wā mua. E nānā kēia ʻatikala i nā mākau diagnostic o nā ʻeha ligament collateral lateral o ka hui kuʻekuʻe wāwae e kōkua i nā kauka e hoʻomaikaʻi i ka pololei o ka maʻi.
I. Anatomy
Anterior talofibular ligament (ATFL): palahalaha, hoʻopili ʻia i ka capsule lateral, hoʻomaka mua i ka fibula a hoʻopau i mua i ke kino o ka talus.
ʻO ka ligament Calcaneofibular (CFL): ke ʻano o ke kaula, e puka mai ana ma ka palena mua o ka malleolus ʻaoʻao ākea a hoʻopau i ka calcaneus.
ʻO ka ligament talofibular hope (PTFL): Hoʻomaka ma ka ʻaoʻao waena o ka malleolus ʻaoʻao a hoʻopau i hope i ka talus medial.
ʻO ATFL wale nō ka mea i heluʻia ma kahi o 80% o nāʻeha,ʻoiaiʻo ATFL i hui pū me nāʻeha CFL i heluʻia ma kahi o 20%.
Diagram Schematic and anatomical diagram of the lateral collateral ligament of the ankle joint
II. Mechanism o ka eha
Nā ʻeha supinated: ligament talofibular mua
calcaneofibular ligament varus eha: calcaneofibular ligament
III. Ka helu ʻana i ka pōʻino
Papa I: kaʻaʻa ligament, ʻaʻole ʻike ʻia ka haki ʻana o ka ligament, ʻaʻole ka pehu a palupalu paha, ʻaʻohe hōʻailona o ka nalowale o ka hana;
Papa II: ʻāpana macroscopic rupture o ka ligament, ʻeha haʻahaʻa, pehu, a me ka palupalu, a me ka hōʻino liʻiliʻi o ka hana hui;
Papa III: ua haehae loa ka ligament a nalowale kona pono, i hele pū me ka pehu nui, ke koko a me ka palupalu, i hele pū ʻia me ka nalowale o ka hana a me nā hōʻike o ka hui pū ʻana.
IV. ʻO ka hoʻāʻo ʻana i ka lāʻau lapaʻau mua
Noho ka mea maʻi me ka kuli a me ka hope o ka bipi kauō, a paʻa ka mea nānā i ka tibia me ka lima hoʻokahi a hoʻokuʻu i ka wāwae ma hope o ka kuʻekuʻe wāwae me kekahi.
ʻO kahi ʻē aʻe, ʻo ka mea maʻi e hoʻomoe a noho paha me ke kuli e kukuli ma 60 a 90 degere, hoʻopaʻa ʻia ka kuʻekuʻe wāwae i ka honua, a ʻo ka mea nānā e hoʻopili ana i ke kaomi hope i ka tibia distal.
ʻO ka wānana maikaʻi i ka haki ʻana o ka ligament talofibular anterior.
Ho'āʻo koʻikoʻi hoʻohuli
Ua hoʻokuʻu ʻia ka kuʻekuʻe wāwae kokoke, a ua hoʻopili ʻia ke koʻikoʻi varus i ka kuʻekuʻe wāwae lōʻihi e nānā i ke kihi o ka talus tilt.
Ke hoʻohālikelike ʻia me ka ʻaoʻao contralateral, > 5 ° ka mea kānalua maikaʻi, a > 10 ° ka maikaʻi; a i ʻole unilateral >15° ka maikaʻi.
ʻO kahi wānana maikaʻi o ka calcaneofibular ligament rupture.
Nā hoʻokolohua kiʻi
X-ray o nā ʻeha haʻuki kuʻekuʻe wāwae maʻamau
ʻAʻole maikaʻi nā kukui X, akā hōʻike ka MRI i nā waimaka o nā ligaments talofibular anterior a me calcaneofibular.
Pōmaikaʻi: ʻO ka X-ray ka koho mua no ka hoʻokolokolo ʻana, ʻoi aku ka maʻalahi a maʻalahi; Hoʻoholo ʻia ka nui o ka ʻeha ma ka hoʻoholo ʻana i ke kiʻekiʻe o ke ʻano o ka talus. Nā pōʻino: Hōʻike maikaʻi ʻole o nā ʻiʻo palupalu, ʻoi aku ka nui o nā hale ligamentous i mea nui no ka mālama ʻana i ke kūpaʻa hui.
MRI
Fig.1 ʻO ke kūlana oblique 20 ° i hōʻike i ka ligament talofibular anterior maikaʻi loa (ATFL); Fig.2 Laina Azimuth o ATFL scan
Ua hōʻike ʻia nā kiʻi MRI o nā ʻeha ligament talofibular anterior: (A) ka mānoanoa o ka ligament talofibular anterior a me ka edema; (B) haehae mua talofibular ligament; (C) haʻihaʻi o ka ligament talofibular anterior; (D) ʻO kaʻeha ligament talofibular mua me ka haʻihaʻi avulsion.
Fig.3 Ua hōʻike ke kūlana oblique -15 ° i ka ligament calcaneofibular maikaʻi loa (CFI);
Fig.4. CFL scanning azimuth
Haehae piha loa o ka ligament calcaneofibular
Kiʻi 5: Hōʻike ka Coronal i ka ligament talofibular hope maikaʻi loa (PTFL);
Fig.6 PTFL scan azimuth
Haehae hapa o ka ligamenti talofibular hope
Ka helu ʻana o ka maʻi maʻi:
Papa I: ʻAʻohe pōʻino;
Papa II: ka hoʻopaʻapaʻa ligament, ka hoʻomau ʻana o ke ʻano maikaʻi, ka mānoanoa o nā ligaments, hypoechogenicity, edema o nā ʻiʻo a puni;
Papa III: ka morphology ligament piha ʻole, ka lahilahi a i ʻole ka haʻihaʻi ʻana o ka hoʻomau ʻana o ke ʻano, ka mānoanoa o nā ligaments, a me ka hoʻonui ʻana i ka hōʻailona;
Papa IV: ka hoʻopau piha ʻana i ka hoʻomau ʻana o ka ligament, hiki ke hele pū me nā haʻihaʻi avulsion, mānoanoa o nā ligaments, a me ka hoʻonui ʻana i ka hōʻailona kūloko a i ʻole diffuse.
Pōmaikaʻi: ʻO ka hoʻonā kiʻekiʻe no nā mea palupalu, ka nānā pono ʻana i nā ʻano ʻeha ligament; Hiki iā ia ke hōʻike i ka pōʻino o ka cartilage, ka ʻāʻī ʻana o ka iwi, a me ke kūlana holoʻokoʻa o ka ʻeha hui.
Nā pōʻino: ʻAʻole hiki ke hoʻoholo pololei inā e hoʻopau ʻia nā haʻihaʻi a me nā ʻeha cartilage articular; Ma muli o ka paʻakikī o ka ligament kuʻekuʻe wāwae, ʻaʻole kiʻekiʻe ka maikaʻi o ka hoʻokolokolo; ʻO ke kumukūʻai a me ka manawa.
ʻO ke kiʻekiʻe-frequency ultrasound
Kiʻi 1a: ʻO ka ʻeha talofibular ligament mua, haʻalulu hapa; Kiʻi 1b: Ua haehae ʻia ka ligament talofibular mua, ua mānoanoa ke kumu, a ʻike ʻia kahi effusion nui ma ka ʻaoʻao mua.
Kiʻi 2a: Calcaneofibular ligament ʻeha, haʻalulu hapa; Kiʻi 2b: Calcaneofibular ligament ʻeha, ʻoki piha
Kiʻi 3a: ʻO ka ligament talofibular mua maʻamau: ke kiʻi ultrasound e hōʻike ana i ke ʻano hypoechoic ʻano huinakolu hoʻohuli; Kiʻi 3b: ʻO ka ligament calcaneofibular maʻamau: ʻO ke ʻano filamentous echogenic a me ka paʻa ma ke kiʻi ultrasound.
Kiʻi 4a: Haehae hapa o ka ligament talofibular mua ma ke kiʻi ultrasound; Kiʻi 4b: Haehae piha o ka ligament calcaneofibular ma ke kiʻi ultrasound
Ka helu ʻana o ka maʻi maʻi:
contusion: hōʻike nā kiʻi acoustic i ke ʻano paʻa, nā ligaments mānoanoa a pehu; Haehae hapa: Aia ka pehu ma ka ligament, ke hoʻomau mau nei ka hoʻopau ʻana i kekahi mau fiber, a i ʻole ka lahilahi o nā ʻili. Ua hōʻike ʻo Dynamic scans ua hoʻonāwaliwali nui ʻia ka ligament, a ua lahilahi a hoʻonui ʻia ka ligament a ua nāwaliwali ka elasticity i ka hihia o valgus a varus.
ʻO ka waimaka piha: kahi ligament i hoʻopau loa a hoʻomau ʻia me ka hoʻokaʻawale ʻana, hōʻike ʻia ka dynamic scan ʻaʻohe ligament tension a i hoʻonui ʻia ka waimaka, a ma valgus a varus, neʻe ka ligament i kekahi ʻaoʻao, me ka ʻole o ka elasticity a me kahi hui wehe.
Nā mea maikaʻi: ke kumu kūʻai haʻahaʻa, maʻalahi e hana,ʻaʻohe invasive; Hōʻike maopopo ʻia ke ʻano maʻalahi o kēlā me kēia papa o ka ʻiʻo subcutaneous, kahi kūpono i ka nānā ʻana i nā ʻili musculoskeletal. ʻO ka nānā ʻana i ka ʻāpana ʻokoʻa, e like me ke kāʻei ligament e ʻimi i ke kaʻina holoʻokoʻa o ka ligament, ua hoʻomaʻamaʻa ʻia ka wahi o ka ʻeha ligament, a ʻike ʻia ke ʻano o ka ligament a me nā loli morphological.
Nā hemahema: haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa i hoʻohālikelike ʻia me MRI; E hilinaʻi i ka hana ʻenehana loea.
Nānā Arthroscopy
Pono: E nānā pono i nā hale o ka malleolus lateral a me ka wāwae wāwae (e like me ka hui talar inferior, ligament talofibular anterior, calcaneofibular ligament, a me nā mea'ē aʻe) e loiloi i ka pono o nā ligaments a kōkua i ke kauka e hoʻoholo i ka hoʻolālā hana.
Nā pōʻino: Invasive, hiki ke hana i kekahi mau pilikia, e like me ka hōʻino ʻana i ke aʻalolo, ka maʻi, a me nā mea ʻē aʻe.
Ka manawa hoʻouna: Sep-29-2024
