ʻO nā kuʻekuʻe wāwae kekahi o nā ʻano haʻihaʻi maʻamau i ka hana lapaʻau. Koe nae no kekahi mau eha hoololi o ka Papa I/II a me na eha lawe pio, ka hapa nui o na ha'i ku'eku'e wāwae e pili mau i ka malleolus lateral. ʻO Weber A/B type lateral malleolus fractures maʻamau ka hopena i ka syndesmosis distal tibiofibular syndesmosis a hiki ke hoʻemi maikaʻi me ka ʻike pololei ʻana mai ka mamao a hiki i kahi kokoke. ʻO ka ʻokoʻa, C-type lateral malleolus fractures e pili ana i ka instability i ka malleolus lateral ma waena o ʻekolu axes ma muli o ka ʻeha tibiofibular distal, hiki ke alakaʻi i nā ʻano ʻeono o ka neʻe ʻana: pōkole / lōʻihi, ākea / ʻokiʻoki o ka wahi tibiofibular distal, ka hoʻoneʻe mua / hope. i ka sagittal plane, medial/lateral tilt in the coronal plane, rotational displacement, a me ka hui pū ʻana o kēia mau ʻano ʻeha ʻelima.
Nui nā haʻawina mua i hōʻike ʻia e hiki ke loiloi ʻia ka pōkole / lōʻihi 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 i nā mokulele coronal a me ka sagittal me ka hoʻohana ʻana i nā hiʻohiʻona fluoroscopic mua a me lateral; akā naʻe, ʻo ka neʻe ʻana o ka rotational ka mea paʻakikī loa e loiloi i ka intraoperatively.
ʻO ka paʻakikī o ka nānā ʻana i ka neʻe ʻana o ka rotational i ʻike ʻia i ka emi ʻana o ka fibula i ka wā e hoʻokomo ai i ka screw tibiofibular distal. ʻO ka hapa nui o nā palapala e hōʻike ana ma hope o ka hoʻokomo ʻana o ka screw tibiofibular distal, aia kahi 25% -50% o ka hōʻemi maikaʻi ʻana, ka hopena i ka malunion a me ka hoʻoponopono ʻana i nā deformities fibular. Ua manaʻo kekahi mau loea 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 ʻo Professor Zhang Shimin mai ka Halemai Yangpu i hui pū me Tongji University i kahi ʻatikala ma ka nūpepa orthopedic international *Injury*, e noi ana i kahi ʻenehana no ka loiloi ʻana inā ua hoʻoponopono ʻia ka lateral malleolus rotation me ka hoʻohana ʻana i ka X-ray intraoperative. Hōʻike ka puke moʻolelo i ka maikaʻi nui o kēia ʻano hana.
ʻO ke kumu kumu o kēia ʻano, ʻo ia ma ka ʻike fluoroscopic o ka kuʻekuʻe wāwae, ʻo ka cortex paia ʻaoʻao o ka fossa malleolar lateral e hōʻike ana i kahi aka akaka, kū pololei, ʻeleʻele, e like me nā cortices medial a me lateral o ka malleolus lateral, a aia ma ka waena a i waho hoʻokahi hapakolu o ka laina e hoʻopili ana i nā cortices waena a me ka ʻaoʻao o ka malleolus ʻaoʻao.
Ke kiʻi o ka ankle fluoroscopic view e hōʻike ana i ka pilina kūlana ma waena o ka cortex paia ʻaoʻao o ka fossa malleolar lateral (laina b) a me nā cortices medial a me nā ʻaoʻao o ka malleolus lateral (a a me c laina). ʻO ka maʻamau, aia ka laina b ma ka laina hoʻokahi hapakolu o waho ma waena o nā laina a me c.
ʻO ke kūlana maʻamau o ka malleolus lateral, ka hoʻololi ʻana i waho, a me ka ʻōwili kūloko hiki ke hana i nā hiʻohiʻona kiʻi like ʻole i ka ʻike fluoroscopic:
- Hoʻololi ʻia ka malleolus ʻaoʻao ma kahi kūlana maʻamau**: He ʻano malleolus ʻaoʻao maʻamau me kahi aka ma ka paia ʻaoʻao o ka ʻaoʻao malleolar fossa, hoʻonoho ʻia ma ka laina ʻekolu o waho o nā cortices medial a me nā ʻaoʻao o ka malleolus ʻaoʻao.
-Lateral malleolus external rotation deformity**: ʻIke ʻia ka ʻaoʻao malleolus contour "sharp-leafed," nalo ke aka ma ka ʻaoʻao malleolar fossa, haiki ka ʻaoʻao tibiofibuler ākea, lilo ka laina Shenton i ka hoʻopau ʻana a hoʻopuehu.
-Ke ʻano hoʻololi o loko o ka ʻaoʻao malleolus**: ʻIke ʻia ke ʻano o ka malleolus ʻaoʻao he "mea ʻano puna," nalo ke aka ma ka ʻaoʻao malleolar fossa, a palahalaha ka ākea tibiofibula.
Hoʻokomo ka hui i nā maʻi 56 me nā ʻāpana malleolar lateral C-type i hui pū ʻia me nā ʻeha syndesmosis tibiofibular distal a hoʻohana i ke ʻano loiloi i ʻōlelo ʻia. Ua hōʻike hou ʻia nā hōʻike hou ʻana o ka postoperative CT i nā maʻi 44 i loaʻa i ka hōʻemi anatomic me ka ʻole o nā deformities rotational, ʻoiai ʻo 12 nā mea maʻi i ʻike i ka deformity rotational haʻahaʻa (emi ma lalo o 5 °), me nā hihia 7 o ka rotation kūloko a me 5 mau hihia o ka rotation waho. ʻAʻohe hihia o ka haʻahaʻa haʻahaʻa (5-10°) a i ʻole koʻikoʻi (ʻoi aku ma mua o 10°) nā ʻino o ka hoʻololi ʻana i waho.
Ua hōʻike ʻia nā haʻawina mua e hiki ke hoʻokumu ʻia ka loiloi o ka hōʻemi ʻana i ka haʻihaʻi malleolar lateral ma nā ʻāpana Weber nui ʻekolu: equidistance like ma waena o nā papa hui tibial a me talar, ka hoʻomau o ka laina Shenton, a me ka hōʻailona Dime.
ʻO ka hōʻemi maikaʻi ʻole o ka malleolus lateral he pilikia maʻamau i ka hana lapaʻau. ʻOiai e hāʻawi ʻia ka nānā pono ʻana i ka hoʻihoʻi ʻana o ka lōʻihi, pono e kau ʻia ka mea nui i ka hoʻoponopono ʻana o ka rotation. Ma keʻano he hui kaumaha, hiki i ka hoʻohaʻahaʻaʻole o ka wāwae ke loaʻa nā hopena pōʻino i kāna hana. Ua manaʻo ʻia ʻo ka ʻenehana fluoroscopic intraoperative i manaʻo ʻia e Professor Zhang Shimin hiki ke kōkua i ka hoʻokō ʻana i ka hōʻemi pololei ʻana o nā haʻihaʻi malleolar lateral C-type. He mea koʻikoʻi kēia ʻenehana no nā kauka lapaʻau mua.
Ka manawa hoʻouna: Mei-06-2024
