Ko ngā whara o te pona waewae he whara hākinakina noa e pā ana ki te 25% o ngā whara musculoskeletal, ko ngā whara o te hononga taha taha (LCL) te mea tino noa. Mēnā kāore e rongoatia te mate kino i te wā tika, ka ngāwari te arahi ki ngā whāwhātanga maha, ā, ka pāngia te mahi a te hononga pona e ngā keehi kino ake. Nō reira, he mea nui te tātaritanga me te rongoā i ngā whara o ngā tūroro i te wā tōmua. Ka arotahi tēnei tuhinga ki ngā pūkenga tātaritanga o ngā whara o te hononga taha taha taha o te hononga pona waewae hei āwhina i ngā tākuta ki te whakapai ake i te tika o te tātaritanga.
I. Te Anatomi
Te hononga talofibular o mua (ATFL): he papatahi, he honoa ki te kāpū taha, ka tīmata ki mua o te fibula ka mutu ki mua o te tinana o te talus.
Te hononga calcaneofibular (CFL): he āhua taura, e tīmata ana i te rohe o mua o te malleolus taha tawhiti, ā, ka mutu ki te calcaneus.
Te hononga talofibular o muri (PTFL): Ka tīmata mai i te mata waenga o te malleolus taha ka mutu ki muri i te talus medial.
Tata ki te 80% o ngā whara i ahu mai i te ATFL anake, ā, tata ki te 20% i ahu mai i ngā whara ATFL me te CFL.
Te hoahoa kauwhata me te hoahoa hanganga o te hononga taha o te hononga pona
II. Te tikanga o te whara
Ngā whara i runga i te hope: te hononga talofibular o mua
whara varus o te hononga calcaneofibular: te hononga calcaneofibular
III. Te whakatauranga whara
Wāhanga I: te taumahatanga o te hononga, kāore he pakaru o te hononga e kitea ana, he onge te pupuhi, te ngawari rānei, ā, kāore he tohu o te ngaronga o te mahi;
Wāhanga II: te pakaru ā-whāiti o te hononga, te mamae ngawari, te pupuhi, me te ngawari, me te ngoikore iti o te mahi a te hononga;
Wāhanga III: kua haehae katoa te hononga, kua ngaro tōna āhua pumau, ka pupuhi nui, ka totohu me te ngawari, ka ngaro te mahi a te hononga me ngā tohu o te kore pumau.
IV. Whakamātautau haumanu Whakamātautau pouaka o mua
Ka noho te tūroro me te turi e piko ana, me te pito o te kuao kau e iri ana, ā, ka puritia e te kaitirotiro te tibia ki tōna tūranga ki te ringa kotahi, ā, ka panaia te waewae ki mua i muri i te rekereke ki te ringa o tētahi.
Heoi anō, me takoto te tūroro ki runga i te tinana, me noho rānei me te turi e piko ana i te 60 ki te 90 nekehanga, me te rekereke e mau ana ki te whenua, ā, me pēhi e te kaitirotiro te hope o te tibia distal.
Mā te tohu pai ka kitea te pakaru o te hononga talofibular o mua.
Whakamātautau ahotea hurihanga
I whakaūngia te pona waewae proximal, ā, i whakamahia te ahotea varus ki te pona waewae distal hei aromatawai i te koki honga o te talus.
Ki te whakatauritea ki te taha o mua, he pai pea mēnā he >5°, ā, he pai mēnā he >10°; ki te whakatauritea rānei ki te taha kotahi, he pai mēnā he >15°.
He tohu pai mō te pakaru o te hononga calcaneofibular.
Ngā whakamātautau whakaahua
Ngā hihi-X o ngā whara hākinakina pona noa
Kāore he pānga o ngā hihi-X, engari e whakaatu ana te MRI i ngā pakaru o ngā hononga talofibular o mua me te calcaneofibular.
Ngā Painga: Ko te hihi-X te whiringa tuatahi mō te tirotiro, he mea utu nui, he māmā hoki; Ka aromatawaihia te whānuitanga o te whara mā te aromatawai i te nui o te piko o te hononga. Ngā Huakore: Kāore i te tino kitea ngā kiko ngohengohe, inā koa ngā hanganga hononga e nui ana mō te pupuri i te pumau o ngā hononga.
MRI
Pikitia 1 Ko te tūranga whakarara 20° i whakaatu i te hononga talofibular o mua (ATFL) pai rawa atu; Pikitia 2 Raina azimuth o te matawai ATFL
I whakaatuhia e ngā whakaahua MRI o ngā whara rerekē o te hononga talofibular o mua: (A) te matotoru me te pupuhi o te hononga talofibular o mua; (B) te haehae o te hononga talofibular o mua; (C) te pakaru o te hononga talofibular o mua; (D) Te whara o te hononga talofibular o mua me te whati avulsion.
Pikitia 3 Ko te tūranga whakarara -15° i whakaatu i te hononga calcaneofibular (CFI) pai rawa atu;
Pikitia 4. Azimuth matawai CFL
He haehae koi, he haehae katoa o te hononga calcaneofibular
Pikitia 5: E whakaatu ana te tirohanga koronari i te hononga talofibular posterior pai rawa atu (PTFL);
Pikitia 6 Azimuth matawai PTFL
He pakaru wāhanga o te hononga talofibular o muri
Te whakatauranga o te mate:
Akomanga I: Kāore he kino;
Wāhanga II: te whara o ngā hononga, te pai o te haere tonu o te kakano, te matotoru o ngā hononga, te ngoikore o te echogenicity, te pupuhi o ngā kiko e karapoti ana;
Taumata III: te āhua o te hononga kāore i oti, te angiangi, te pakaru rānei o te hanganga o te hononga, te matotoru o ngā hononga, me te pikinga o te tohu;
Wāhanga IV: te motumotu katoa o te hononga hononga, ka haere tahi pea me ngā whati o te avulsion, te matotoru o ngā hononga hononga, me te pikinga ake o te tohu ā-rohe, te tohu horapa rānei.
Ngā Painga: He tino mārama te tirohanga ki ngā kiko ngohengohe, he mārama te kitenga i ngā momo whara o te hononga; Ka taea te whakaatu i te kino o te kiriuhi, te whara o te wheua, me te āhua whānui o te whara honohono.
Ngā Huakore: Kāore e taea te whakatau tika mēnā kua pakaru ngā whati me te pakaru o te kiriuhi hononga; Nā te uaua o te hononga pona, kāore i te tino pai te whai huatanga o te tirotiro; He utu nui, he roa hoki te wā.
Ultrasound auau teitei
Pikitia 1a: Whara o te hononga talofibular o mua, haehae wāhanga; Pikitia 1b: Kua haehae katoa te hononga talofibular o mua, kua matotoru te tumu, ā, ka kitea he rerenga nui i te wāhi taha o mua.
Pikitia 2a: Whara o te hononga calcaneofibular, haehae wāhanga; Pikitia 2b: Whara o te hononga calcaneofibular, pakaru katoa
Pikitia 3a: Te hononga talofibular o mua noa: he whakaahua ultrasound e whakaatu ana i te hanganga hypoechoic ōrite o te tapatoru hurihuri; Pikitia 3b: Te hononga calcaneofibular noa: He hanganga miro echogenic me te matotoru i runga i te whakaahua ultrasound
Pikitia 4a: Te haehae wāhanga o te hononga talofibular o mua i te whakaahua ultrasound; Pikitia 4b: Te haehae katoa o te hononga calcaneofibular i te whakaahua ultrasound
Te whakatauranga o te mate:
whara: e whakaatu ana ngā whakaahua oro i te hanganga ora tonu, ngā hononga matotoru me te pupuhi; Haehae wāhanga: He pupuhi kei roto i te hononga, he pakaru tonu ētahi muka, he angiangi ā-rohe rānei ngā muka. I whakaatuhia e ngā matawai hihiri kua tino ngoikore te kukū o te hononga, ā, kua angiangi, kua piki ake te hononga, ā, kua ngoikore te ngāwari i roto i te take o te valgus, te varus rānei.
Te haehae katoa: he hononga kua motu katoa, ā, he wehenga tawhiti, e kī ana te matawai hihiri kāore he taumahatanga o te hononga, he haehae nui rānei, ā, i roto i te valgus, i te varus rānei, ka neke te hononga ki tērā pito, kāore he ngāwari, ā, he hononga wetewete.
Ngā Painga: iti te utu, ngāwari ki te whakahaere, kāore e pokanoa; Ka kitea mārama te hanganga ngawari o ia paparanga o te kiko kiri raro, he mea pai mō te tirotiro i ngā whara o te kiko uaua me te uaua. Mā te tirotiro i te wāhanga tūpono, ka taea te whai i te tukanga katoa o te hononga e ai ki te whitiki hononga, ka mārama te wāhi o te whara hononga, ā, ka kitea te kaha o te hononga me ngā huringa āhua.
Ngā ngoikoretanga: he iti ake te taumira o ngā kiko ngohengohe ki te whakaritea ki te MRI; Ka whakawhirinaki ki ngā mahi hangarau ngaio.
Tirotiro i te arthroscopy
Ngā Painga: Tirohia tika ngā hanganga o te malleolus taha me te waewae o muri (pērā i te hononga talar o raro, te hononga talofibular o mua, te hononga calcaneofibular, me ētahi atu) hei aromatawai i te pakari o ngā hononga, hei āwhina hoki i te taote pokanga ki te whakatau i te mahere pokanga.
Ngā Huakore: Ka uru atu, ka pā mai pea ētahi raruraru, pērā i te kino o te io, te mate, me ētahi atu. E kiia ana koinei te paerewa koura mō te tautuhi i ngā whara o te hononga, ā, e whakamahia ana i tēnei wā hei rongoā i ngā whara o te hononga.
Wā tuku: Hepetema-29-2024
