"10% ya kusweka kwa akakolo kumayenderana ndi kuvulala kwa tibiofibular syndesmosis ya distal. Kafukufuku wasonyeza kuti 52% ya zomangira za tibiofibular za distal zimapangitsa kuti syndesmosis isachepe bwino. Kuyika screw ya distal tibiofibular yolunjika pamwamba pa syndesmosis ndikofunikira kuti mupewe malreduction ya iatrogenic. Malinga ndi buku la AO, tikukulimbikitsani kuyika screw ya distal tibiofibular 2 cm kapena 3.5 cm pamwamba pa pamwamba pa tibia ya distal articular, pa ngodya ya 20-30° kupita ku ndege yopingasa, kuchokera ku fibula kupita ku tibia, ndi akakolo ali pamalo osalowerera."
Kuyika ma screws a distal tibiofibular pamanja nthawi zambiri kumabweretsa kusintha kwa malo olowera ndi komwe akupita, ndipo pakadali pano, palibe njira yeniyeni yodziwira komwe ma screws awa amalowera. Pofuna kuthana ndi vutoli, ofufuza akunja agwiritsa ntchito njira yatsopano—njira ya 'angle bisector'.
Pogwiritsa ntchito deta yojambula kuchokera ku ziwalo 16 za akakolo, mitundu 16 yosindikizidwa ndi 3D idapangidwa. Pa mtunda wa 2 cm ndi 3.5 cm pamwamba pa malo olumikizirana a tibial, mawaya awiri a Kirschner a 1.6 mm ofanana ndi malo olumikizirana adayikidwa pafupi ndi m'mphepete mwa tibia ndi fibula, motsatana. Ngodya pakati pa mawaya awiri a Kirschner idayesedwa pogwiritsa ntchito protractor, ndipo chobowola cha 2.7 mm chidagwiritsidwa ntchito kuboola dzenje pamzere wa bisector wa ngodya, kutsatiridwa ndi kuyika screw ya 3.5 mm. Pambuyo poyika screw, screw idadulidwa kutalika kwake pogwiritsa ntchito soka kuti iwone ubale womwe ulipo pakati pa screw ndi axis yapakati ya tibia ndi fibula.
Kuyesera kwa zitsanzo kukuwonetsa kuti pali kugwirizana kwabwino pakati pa mzere wapakati wa tibia ndi fibula ndi mzere wa bisector wa ngodya, komanso pakati pa mzere wapakati ndi kolowera kwa screw.
Mwachidule, njira iyi imatha kuyika bwino screw pakati pa tibia ndi fibula. Komabe, panthawi ya opaleshoni, kuyika mawaya a Kirschner pafupi ndi m'mphepete mwa tibia ndi fibula kutsogolo ndi kumbuyo kumabweretsa chiopsezo chowononga mitsempha yamagazi ndi mitsempha. Kuphatikiza apo, njira iyi siyithetsa vuto la iatrogenic malreduction, chifukwa kulinganiza kwa tibiofibular distal sikungayesedwe mokwanira mkati mwa opaleshoni musanayike screw.
Nthawi yotumizira: Julayi-30-2024
