ʻO 46% o nā haʻi kuʻekuʻe wāwae e hele pū me nā haʻi malleolar hope. ʻO ke ala posterolateral no ka nānā pono ʻana a me ka hoʻoponopono ʻana i ka malleolus hope he ʻano hana maʻamau i hoʻohana ʻia, e hāʻawi ana i nā pono biomechanical maikaʻi aʻe i hoʻohālikelike ʻia me ka hoʻemi pani ʻia a me ka hoʻoponopono ʻana i ka anteroposterior screw. Eia nō naʻe, no nā ʻāpana haʻihaʻi malleolar hope nui a i ʻole nā haʻihaʻi malleolar hope e pili ana i ka colliculus hope o ka medial malleolus, ʻo ke ala posteromedial e hāʻawi i kahi hiʻohiʻona ʻoi aku ka maikaʻi.
No ka hoʻohālikelike ʻana i ka laulā o ka malleolus hope, ka ʻāʻī o ka pūpū neurovascular, a me ka mamao ma waena o ka ʻoki a me ka pūpū neurovascular ma waena o ʻekolu mau ala posteromedial, ua hana nā mea noiʻi i kahi noiʻi cadaveric. Ua paʻi ʻia nā hopena ma ka puke pai FAS. Ua hōʻuluʻulu ʻia nā ʻike penei:
I kēia manawa, ʻekolu mau ala nui posteromedial no ka hōʻike ʻana i ka malleolus hope:
1. Medial Posteromedial Approach (mePM): Ke komo nei kēia ala ma waena o ka ʻaoʻao hope o ka medial malleolus a me ka tibialis posterior tendon (Figure 1 e hōʻike ana i ka tibialis posterior tendon).
2. Modified Posteromedial Approach (moPM): Ke komo nei kēia alahele ma waena o ka tibialis posterior tendon a me ka flexor digitorum longus tendon (Figure 1 e hōʻike ana i ka tibialis posterior tendon, a me ka Figure 2 e hōʻike ana i ka flexor digitorum longus tendon).
3. Hoʻopili Posteromedial (PM): Ke komo nei kēia ala ma waena o ka ʻaoʻao waena o ka tendon Achilles a me ka flexor hallucis longus tendon (Figure 3 e hōʻike ana i ka tendon Achilles, a me ka Figure 4 e hōʻike ana i ka flexor hallucis longus tendon).
E pili ana i ka hoʻopaʻapaʻa ma ka pūpū neurovascular, ʻoi aku ka haʻahaʻa o ka PM approach ma 6.18N i hoʻohālikelike ʻia me ka mePM a me ka moPM, e hōʻike ana i kahi haʻahaʻa haʻahaʻa o ka hōʻeha intraoperative traction i ka pūpū neurovascular.
Ma ke ʻano o ka hoʻolaha ʻana o ka malleolus hope, hāʻawi ka PM approach i kahi ʻike nui aʻe, e ʻae ana i ka 71% ʻike o ka malleolus hope. I ka hoʻohālikelike ʻana, ʻae ka mePM a me ka moPM i ka 48.5% a me 57% ka hoʻolaha ʻana o ka malleolus hope.
● Hōʻike ke kiʻikuhi i ka laulā o ka malleolus hope no nā ala ʻekolu. Hōʻike ʻo AB i ka laulā holoʻokoʻa o ka malleolus hope, hōʻike ʻo CD i ka laulā i hōʻike ʻia, a ʻo CD/AB ka ratio hoʻolaha. Mai luna a lalo, hōʻike ʻia nā pae hoʻolaha no mePM, moPM, a me PM. ʻIke ʻia ka loaʻa ʻana o ka ʻaoʻao PM i ka laulā ākea nui loa.
E pili ana i ka mamao ma waena o ka ʻokiʻoki a me ka pūpū neurovascular, ʻo ka hoʻokokoke PM ʻoi aku ka mamao loa, ʻo 25.5mm ke ana. ʻOi aku kēia ma mua o ka 17.25mm o ka mePM a me ka 7.5mm o ka moPM. Hōʻike kēia i ka hoʻokokoke ʻana o ka PM i ka haʻahaʻa haʻahaʻa loa o ka hōʻeha pūpū neurovascular i ka wā o ke kaʻina.
● Hōʻike ke kiʻikuhi i ka mamao ma waena o ka ʻoki a me ka pūpū neurovascular no nā ala ʻekolu. Mai ka hema a i ka ʻākau, hōʻike ʻia nā mamao no ka mePM, moPM, a me PM. ʻIke ʻia ʻo ka hoʻokokoke PM ka mamao loa mai ka pūpū neurovascular.
Ka manawa hoʻouna: Mei-31-2024
