Ko ngā whati pona waewae tētahi o ngā momo whati tino noa i roto i te mahi haumanu. Haunga ētahi whara hurihuri o te taumata I/II me ngā whara tango, ko te nuinga o ngā whati pona waewae e pā ana ki te malleolus taha. Ko ngā whati malleolus taha momo Weber A/B ka hua ake he syndesmosis tibiofibular distal pumau, ā, ka taea te whakatutuki i te whakaiti pai me te tirohanga tika mai i te distal ki te proximal. He rerekē, ko ngā whati malleolus taha momo-C e pā ana ki te kore pumau o te malleolus taha puta noa i ngā toki e toru nā te whara tibiofibular distal, ka taea te arahi ki ngā momo nekehanga e ono: te whakapoto/te roa, te whānui/te whaiti o te wāhi tibiofibular distal, te nekehanga o mua/muri i te papa sagittal, te tilt medial/lateral i te papa coronal, te nekehanga hurihuri, me ngā huinga o ēnei momo whara e rima.
He maha ngā rangahau o mua kua whakaatu mai ka taea te aromatawai i te whakapoto/te roa mā te aromatawai i te tohu Dime, te raina Stenton, me te koki tibial-gapping, me ētahi atu. Ka taea te aromatawai pai i te nekehanga i roto i ngā papa koronal me te sagittal mā te whakamahi i ngā tirohanga fluoroscopic o mua me te taha; heoi, ko te nekehanga hurihuri te mea tino uaua ki te aromatawai i te wā o te pokanga.
Ko te uauatanga o te aromatawai i te nekehanga hurihuri e tino kitea ana i roto i te whakaiti o te fibula i te wā e whakaurua ana te tīwiri tibiofibular distal. Ko te nuinga o ngā tuhinga e tohu ana i muri i te whakaurunga o te tīwiri tibiofibular distal, he 25%-50% te putanga o te whakaiti ngoikore, ka hua ake te malunion me te whakau i ngā āhua fibular. Kua whakaarohia e ētahi tohunga te whakamahi i ngā aromatawai CT i te wā e pokanga ana, engari he uaua pea tēnei ki te whakatinana i roto i te mahi. Hei whakatika i tēnei take, i te tau 2019, i whakaputa te tīma a Ahorangi Zhang Shimin mai i te Hōhipera Yangpu e hono ana ki Te Whare Wānanga o Tongji i tētahi tuhinga i roto i te hautaka orthopedic o te ao *Injury*, e whakaaro ana i tētahi tikanga hei aromatawai mēnā kua whakatikatikaina te hurihanga malleolus taha mā te whakamahi i te hihi-X i te wā e pokanga ana. E whakaatu ana ngā tuhinga i te whai huatanga haumanu nui o tēnei tikanga.
Ko te pūtake ariā o tēnei tikanga, i roto i te tirohanga fluoroscopic o te pona waewae, e whakaatu ana te pakitara taha o te fossa malleolar taha i tētahi atarangi mārama, poutū, matotoru, e whakarara ana ki ngā cortices medial me lateral o te malleolus taha, ā, kei waenganui ki waho o te hautoru o te rārangi e hono ana i ngā cortices medial me lateral o te malleolus taha.
He whakaahua o te tirohanga fluoroscopic o te pona waewae e whakaatu ana i te whanaungatanga tūranga i waenga i te cortex pakitara taha o te fossa malleolar taha (raina-b) me ngā cortices medial me lateral o te malleolus taha (raina a me c). Ko te tikanga, kei te rārangi tuatoru o waho te rārangi-b i waenga i ngā rārangi a me c.
Mā te tūnga noa o te malleolus taha, te hurihanga o waho, me te hurihanga o roto ka puta he āhua whakaahua rerekē i te tirohanga fluoroscopic:
- Te malleolus taha kua hurihia ki te tūranga noa**: He āhua malleolus taha noa me te atarangi cortical i te pakitara taha o te fossa malleolar taha, kei te rārangi tuatoru o waho o ngā cortices medial me lateral o te malleolus taha.
-Te āhua o te hurihanga o waho o te malleolus taha**: He rite te āhua o te taha o te malleolus ki te "rau koi," ka ngaro te atarangi cortical i te fossa malleolar taha, ka whaiti te wāhi tibiofibular distal, ka motumotu, ka marara te rārangi Shenton.
-Te āhua o te hurihanga ā-roto o te malleolus taha**: Ko te āhua o te malleolus taha he "āhua pūnu," ka ngaro te atarangi cortical i te fossa malleolar taha, ā, ka whānui ake te wāhi tibiofibular distal.
I whakaurua ki te tīma he 56 ngā tūroro he whati malleolar taha momo-C me ngā whara syndesmosis tibiofibular distal, ā, i whakamahia te tikanga aromatawai i whakahuatia ake nei. I whakaatuhia e ngā whakamātautau anō CT i muri i te pokanga he 44 ngā tūroro i whiwhi i te whakaiti hanganga me te kore he hapa hurihuri, i te mea he 12 ngā tūroro i pāngia e te hapa hurihuri ngawari (iti iho i te 5°), me te 7 ngā take o te hurihanga ā-roto me te 5 ngā take o te hurihanga ā-waho. Kāore he take o te hapa hurihuri ā-waho ngawari (5-10°) kino rānei (nui atu i te 10°) i puta.
Kua whakaatuhia e ngā rangahau o mua ko te aromatawai i te whakaiti i te whati o te malleolar taha ka taea te hangai ki ngā tawhā matua e toru a Weber: te tawhiti ōrite i waenga i ngā mata o te hononga tibial me te hononga talar, te haere tonu o te rārangi Shenton, me te tohu Dime.
He take tino noa te whakaiti iti o te malleolus taha i roto i ngā mahi haumanu. Ahakoa e aro nui ana ki te whakahokinga mai o te roa, me rite tonu te hiranga ki te whakatikatika i te hurihanga. Hei hononga e pikau ana i te taumaha, ka pā kino te whakaiti kino o te pona ki tana mahi. E whakaponohia ana ka taea e te tikanga fluoroscopic i te wā o te pokanga i whakaarohia e Ahorangi Zhang Shimin te āwhina i te whakatutuki i te whakaiti tika o ngā whati malleolus taha momo-C. He tohutoro nui tēnei tikanga mō ngā tākuta o mua.
Wā tuku: Mei-06-2024
