"10% ya fractures ya ankle imatsagana ndi kuvulala kwa distal tibiofibular syndesmosis." Kafukufuku wasonyeza kuti 52% ya zomangira za distal tibiofibular zimapangitsa kuchepetsa kuchepa kwa syndesmosis. Kuyika distal tibiofibular screw perpendicular to syndesmosis joint surface n'kofunika kuti tipewe kuwonongeka kwa iatrogenic. Malinga ndi buku la AO, tikulimbikitsidwa kuti muyike distal tibiofibular screw 2 cm kapena 3.5 cm pamwamba pa distal tibial articular pamwamba, pamtunda wa 20-30 ° kupita ku ndege yopingasa, kuchokera ku fibula kupita ku tibia, ndi bondo. m'malo osalowerera ndale."
Kuyika pamanja zomangira za distal tibiofibular nthawi zambiri kumabweretsa kupatuka polowera ndi komwe akulowera, ndipo pakadali pano, palibe njira yeniyeni yodziwira komwe zomangira izi zimayikidwa. Pofuna kuthana ndi vutoli, ofufuza akunja atengera njira yatsopano—njira ya 'angle bisector.
Pogwiritsa ntchito deta yojambula kuchokera kumagulu 16 amtundu wamba, zitsanzo za 16 zosindikizidwa za 3D zinapangidwa. Pamtunda wa 2 masentimita ndi 3.5 masentimita pamwamba pa tibial articular pamwamba, mawaya awiri a 1.6 mm a Kirschner ofanana ndi olowa pamwamba adayikidwa pafupi ndi m'mphepete mwa kutsogolo ndi kumbuyo kwa tibia ndi fibula, motero. Ngodya yapakati pa mawaya awiri a Kirschner ankayezedwa pogwiritsa ntchito pulokitala, ndipo chobowola cha 2.7 mm chinagwiritsidwa ntchito kubowola bowo motsatira mzere wa bisector, kenako ndikuyika 3.5 mm screw. Pambuyo poika wononga, wonongayo idadulidwa kutalika kwake pogwiritsa ntchito macheka kuti awone ubale wapakati pa screw direction ndi axis yapakati ya tibia ndi fibula.
Mayesero owonetsera amasonyeza kuti pali kugwirizana kwabwino pakati pa axis yapakati ya tibia ndi fibula ndi mzere wa bisector angle, komanso pakati pa axis yapakati ndi screw direction.
mwachidziwitso, njirayi imatha kuyika wononga pakatikati pa tibia ndi fibula. Komabe, panthawi ya opaleshoni, kuyika mawaya a Kirschner pafupi ndi kutsogolo ndi kumbuyo kwa tibia ndi fibula kumapangitsa kuti pakhale chiopsezo chowononga mitsempha ya magazi ndi mitsempha. Kuonjezera apo, njirayi sithetsa vuto la iatrogenic malreduction, monga distal tibiofibular alignment silingayesedwe mokwanira intraoperatively pamaso pa screw placement.
Nthawi yotumiza: Jul-30-2024
