ʻO nā haki kuʻekuʻe wāwae kekahi o nā ʻano haki maʻamau i ka hana lapaʻau. Koe wale nō kekahi mau ʻeha rotational Grade I/II a me nā ʻeha abduction, ʻo ka hapa nui o nā haki kuʻekuʻe wāwae e pili pinepine ana i ka lateral malleolus. ʻO nā haki lateral malleolus ʻano Weber A/B e hopena pinepine i ka distal tibiofibular syndesmosis paʻa a hiki ke hoʻokō i ka hōʻemi maikaʻi me ka ʻike pololei ʻana mai ka distal a i ka proximal. I ka hoʻohālikelike ʻana, pili nā haki lateral malleolus ʻano C i ka paʻa ʻole o ka lateral malleolus ma nā axes ʻekolu ma muli o ka ʻeha distal tibiofibular, hiki ke alakaʻi i ʻeono ʻano o ka neʻe ʻana: ka pōkole/ka hoʻolōʻihi ʻana, ka hoʻonui ʻana/ka hoʻohaiki ʻana o ka distal tibiofibular space, ka neʻe ʻana o mua/posterior ma ka mokulele sagittal, ka medial/lateral tilt ma ka coronal plane, ka neʻe ʻana o ka rotational, a me nā hui pū ʻana o kēia mau ʻano ʻeha ʻelima.
Ua hōʻike ʻia nā haʻawina he nui ma mua e hiki ke loiloi ʻia ka hoʻopōkole ʻana/hoʻolōʻihi ʻana ma o ka loiloi ʻana i ka hōʻailona Dime, ka laina Stenton, a me ke kihi tibial-gapping, a me nā mea ʻē aʻe. Hiki ke loiloi maikaʻi ʻia ka neʻe ʻana ma nā mokulele coronal a me sagittal me ka hoʻohana ʻana i nā hiʻohiʻona fluoroscopic frontal a me lateral; akā naʻe, ʻo ka neʻe ʻana o ka rotational ka mea paʻakikī loa e loiloi i ka wā o ke ʻoki ʻana.
ʻIke nui ʻia ka paʻakikī i ka loiloi ʻana i ka neʻe ʻana o ka rotational i ka hōʻemi ʻana o ka fibula i ka wā e hoʻokomo ai i ka wili tibiofibular distal. Hōʻike ka hapa nui o nā palapala ma hope o ke kau ʻana o ka wili tibiofibular distal, aia kahi hanana 25%-50% o ka hōʻemi maikaʻi ʻole, e hopena ana i ka malunion a me ka hoʻopaʻa ʻana o nā deformities fibular. Ua manaʻo kekahi poʻe akamai e hoʻohana i nā loiloi CT intraoperative maʻamau, akā hiki ke paʻakikī kēia e hoʻokō i ka hana. No ka hoʻoponopono ʻana i kēia pilikia, i ka makahiki 2019, ua paʻi ka hui a Polofesa Zhang Shimin mai ka Halemai ʻo Yangpu e pili ana me ke Kulanui ʻo Tongji i kahi ʻatikala ma ka puke pai orthopedic honua *Injury*, e hāpai ana i kahi ʻano hana no ka loiloi ʻana inā ua hoʻoponopono ʻia ka wili malleolus lateral me ka hoʻohana ʻana i ka X-ray intraoperative. Hōʻike ka palapala i ka pono lapaʻau koʻikoʻi o kēia ʻano hana.
ʻO ke kumu kumumanaʻo o kēia ʻano hana, ʻo ia ma ka nānā fluoroscopic o ke kuʻekuʻe wāwae, hōʻike ka cortex paia ʻaoʻao o ka fossa malleolar ʻaoʻao i kahi aka maopopo, kū pololei, a mānoanoa, e like me nā cortices medial a me lateral o ka malleolus ʻaoʻao, a aia ma waena a i waho o ka hapakolu o ka laina e hoʻohui ana i nā cortices medial a me lateral o ka malleolus ʻaoʻao.
Kiʻi o ka ʻike fluoroscopic kuʻekuʻe wāwae e hōʻike ana i ka pilina kūlana ma waena o ka cortex paia ʻaoʻao o ka fossa malleolar ʻaoʻao (laina-b) a me nā cortices medial a me lateral o ka malleolus ʻaoʻao (nā laina a a me c). ʻO ka maʻamau, aia ka laina-b ma ka laina hapakolu o waho ma waena o nā laina a a me c.
ʻO ke kūlana maʻamau o ka malleolus ʻaoʻao, ka wili ʻana o waho, a me ka wili ʻana o loko e hiki ke hana i nā hiʻohiʻona kiʻi like ʻole ma ka nānā fluoroscopic:
- Ua hoʻohuli ʻia ka malleolus ʻaoʻao i kahi kūlana maʻamau**: He ʻano maʻamau o ka malleolus ʻaoʻao me kahi aka cortical ma ka paia ʻaoʻao o ka fossa malleolar ʻaoʻao, i kau ʻia ma ka laina ʻekolu o waho o nā cortices medial a me lateral o ka malleolus ʻaoʻao.
-ʻO ke ʻano o ka wili ʻana o waho o ka malleolus ʻaoʻao**: ʻIke ʻia ke ʻano o ka malleolus ʻaoʻao he "lau ʻoi," nalo aku ke aka cortical ma ka fossa malleolar ʻaoʻao, emi ka hakahaka tibiofibular distal, lilo ka laina Shenton i mea hoʻomau ʻole a hoʻopuehu ʻia.
-ʻO ke ʻano o ka wili ʻana o loko o ka malleolus ʻaoʻao**: ʻIke ʻia ke ʻano o ka malleolus ʻaoʻao he "ʻano puna," nalo aku ke aka cortical ma ka fossa malleolar ʻaoʻao, a ākea ka hakahaka tibiofibular distal.
Ua hoʻokomo pū ʻia ka hui i 56 mau maʻi me nā haki malleolar lateral C-type i hui pū ʻia me nā ʻeha syndesmosis tibiofibular distal a hoʻohana i ke ʻano loiloi i ʻōlelo ʻia ma luna. Ua hōʻike ʻia nā hoʻokolokolo hou ʻana o ka CT postoperative ua loaʻa i 44 mau maʻi ka hoʻemi anatomical me ka ʻole o nā deformities rotational, ʻoiai he 12 mau maʻi i loaʻa ka deformity rotational akahai (emi ma mua o 5°), me 7 mau hihia o ka rotation kūloko a me 5 mau hihia o ka rotation waho. ʻAʻohe hihia o nā deformities rotation waho waena (5-10°) a i ʻole koʻikoʻi (ʻoi aku ma mua o 10°) i loaʻa.
Ua hōʻike ʻia nā haʻawina mua e hiki ke hoʻokumu ʻia ka loiloi ʻana o ka hōʻemi ʻana o ka haki malleolar lateral ma nā ʻano nui ʻekolu o Weber: ka likelike like ma waena o nā ʻili o ka hui tibial a me talar, ka hoʻomau ʻana o ka laina Shenton, a me ka hōʻailona Dime.
ʻO ka hōʻemi maikaʻi ʻole o ka malleolus ʻaoʻao he pilikia maʻamau loa ia i ka hana lapaʻau. ʻOiai ke hāʻawi ʻia nei ka nānā pono i ka hoʻihoʻi ʻana o ka lōʻihi, pono e kau ʻia ke koʻikoʻi like ma ka hoʻoponopono ʻana i ka wili. Ma ke ʻano he hui e hāpai ana i ke kaumaha, hiki i kekahi hōʻemi ʻana o ke kuʻekuʻe wāwae ke loaʻa nā hopena weliweli i kāna hana. Ua manaʻoʻiʻo ʻia e hiki i ke ʻano fluoroscopic intraoperative i hāpai ʻia e Polofesa Zhang Shimin ke kōkua i ka hoʻokō ʻana i ka hōʻemi pololei ʻana o nā haki malleolar ʻaoʻao C-type. Hana kēia ʻano hana ma ke ʻano he kuhikuhi waiwai no nā kauka lapaʻau mua.
Ka manawa hoʻouna: Mei-06-2024
