Dhaawacyada anqawgu waa dhaawac isboorti oo caadi ah oo ku dhaca qiyaastii 25% dhaawacyada murqaha, dhaawacyada laf-dhabarka (LCL) ayaa ah kuwa ugu badan. Haddii xaaladda daran aan la daweyn waqtigeeda, way fududahay in ay keento murgacashada soo noqnoqda, iyo kiisas aad u daran ayaa saameyn doona shaqada wadajirka canqowga. Sidaa darteed, waa muhiim in la baaro lana daweeyo dhaawacyada bukaanka marxaladda hore. Maqaalkani wuxuu diiradda saari doonaa xirfadaha ogaanshaha ee dhaawacyada laf-dhabarka dammaanadda ee wadajirka canqowga si uu uga caawiyo dhakhaatiirta inay hagaajiyaan saxnaanta cudurka.
I. Anatomy
Xididdada talofibular ee hore (ATFL): fidsan, ku dheggan kaabsulka lateral, bilawga hore ee fibula oo soo afjaraya hore ee jidhka talus.
Calcaneofibular ligament (CFL): Xadhig-qaabeeya, oo ka soo jeeda xudduudaha hore ee malleolus lateral fog iyo joojinta calcaneus.
Xididdada talofibular ee dambe (PTFL): Waxay ka soo baxdaa dusha dhexe ee malleolus-ka dambe waxayna ku dhammaataa xagga dambe ee talus-dhexe.
ATFL oo kali ah ayaa ku dhawaad 80% ka ah dhaawacyada, halka ATFL oo ay weheliso dhaawacyada CFL ay ka ahaayeen qiyaastii 20%.
Jaantuska jaantuska iyo jaantuska anatomical ee seedaha dammaanadda ee wadajirka canqowga
II. Habka dhaawaca
Dhaawacyada soo noqnoqda: ligament talofibular hore
calcaneofibular ligament varus dhaawaca: seedaha calcaneofibular
III. Qiimaynta dhaawaca
Fasalka 1-aad: Muruqyada seedaha, ma dillaacaan seedaha muuqda, marar dhif ah barar ama jilicsanaan, iyo calaamado lumay shaqada;
Fasalka II: dillaaca qayb ka mid ah makroscopic ee seedaha, xanuun dhexdhexaad ah, barar, iyo jilicsanaan, iyo cillad yar oo ka mid ah shaqada wadajirka ah;
Fasalka III: seedaha si buuxda ayaa loo jeexjeexay oo lumay daacadnimadiisa, oo ay weheliso barar weyn, dhiig-bax iyo jilicsanaan, oo ay weheliso luminta shaqada iyo muujinta xasilloonida wadajirka ah.
IV. Baaritaanka bukaan-socodka Baaritaanka khaanadda hore
Bukaanku waxa uu fadhiyaa jilibka oo qalloocan iyo dhammaadka kubka oo lulanaya, baaraha ayaa hal gacan ku haya tibia meel ku yaal oo uu lugta hore ugu riixo ciribta kan kale.
Beddelka, bukaanku waa jiifa ama fadhiistay jilibka oo foorarsan 60 ilaa 90 darajo, ciribta ayaa ku go'an dhulka, iyo baaraha cadaadiska dambe ee tibia fog.
Si togan ayaa saadaalisa dillaaca seediga hore ee talofibular.
Tijaabada walaaca roga
Anqawga u dhow ayaa ah mid aan dhaqdhaqaaq lahayn, iyo cadaadiska varus ayaa lagu dabaqay anqawga fog si loo qiimeeyo xagasha talus.
Marka la barbardhigo dhinaca iska soo horjeeda,>5° waa shaki la'aan togan,>10°na waa togan; ama hal dhinac>15° ayaa togan.
Saadaasha togan ee dillaaca seedaha calcaneofibular.
Tijaabooyinka sawirka
Raajooyinka dhaawacyada ciyaaraha canqowga ee caadiga ah
Raajadu waa taban, laakiin MRI waxay muujinaysaa ilmada hore ee talofibular iyo seedaha calcaneofibular
Faa'iidooyinka: Raajo ayaa ah doorashada koowaad ee baaritaanka, taas oo ah mid dhaqaale iyo mid fudud; Inta uu le'eg yahay dhaawaca waxaa lagu qiimeeyaa iyadoo la qiimeynayo heerka u janjeersiga talus. Khasaaro: Soo bandhigid liidata ee unugyo jilicsan, gaar ahaan qaababka seedaha ee muhiimka u ah ilaalinta xasiloonida wadajirka ah.
MRI
Jaantus.1 20 ° booska oblique wuxuu muujiyay midka ugu fiican ee hore ee talofibular ligament (ATFL); Sawirka.2 Xariiqda Azimuth ee iskaanka ATFL
Sawirada MRI ee dhaawacyada seedaha hore ee talofibular ee kala duwan ayaa muujiyay in: (A) dhumucda hore ee talofibular ligament iyo bararka; (B) jeexjeexa seediga hore ee talofibular; (C) dillaaca seediga hore ee talofibular; (D) Dhaawaca seediga hore ee talofibular oo leh jab avulsion ah.
Jaantus.3 Goobta -15 ° booska oblique waxay muujisay ligament calcaneofibular (CFI);
Jaantuska.4. CFL iskaanka azimuth
Ba'an, jeex dhammaystiran ee seediga calcaneofibular
Jaantus 5: Aragtida korantada waxay muujinaysaa ligament talofibular dambe ee ugu fiican (PTFL);
Sawirka.6 PTFL scan azimuth
Jeexitaanka qayb ka mid ah seedaha talofibular ee dambe
Qiimaynta cudurka:
Fasalka I: Wax dhaawac ah ma jiro;
Fasalka II: qulqulka seedaha, sii wadida texture wanaagsan, dhumucda seedaha, hypoechogenicity, bararka unugyada ku wareegsan;
Fasalka III: qaabdhismeedka seedaha oo aan dhamaystirnayn, khafiifinta ama carqaladaynta qayb ka mid ah sii wadida texture, dhumucyada seedaha, iyo calaamada kordhay;
Fasalka IV: khalkhal dhammaystiran oo sii wadida seedaha, kaas oo laga yaabo in ay la socdaan jabka avulsion, dhumucyada seedaha, iyo kor u kaca ishaarada gudaha ama fidsan.
Faa'iidooyinka: Xallinta sare ee unugyada jilicsan, indho-indheynta cad ee noocyada dhaawaca seedaha; Waxay muujin kartaa dhaawaca carjawda, qallafsanaanta lafaha, iyo xaaladda guud ee dhaawaca isku dhafka ah.
Khasaaro: Suurtagal maaha in si sax ah loo go'aamiyo in jabka iyo dhaawaca carjawda articular la gooyo; Sababtoo ah kakanaanta lafdhabarta canqowga, waxtarka baaritaanku maaha mid sarreeya; Qaali iyo waqti badan.
Ultrasound-soo noqnoqda sare
Jaantuska 1a: Dhaawaca seedaha talofibular ee hore, jeexjeexa qayb ahaan; Jaantuska 1b: Siliga hore ee talofibular gabi ahaanba waa jeexjeexay, kurtu way dhumucday, dareere weyn ayaa lagu arkay booska hore ee dambe.
Jaantus 2a: Dhaawaca seedaha Calcaneofibular, jeexjeexa qayb ahaan; Jaantuska 2b: Dhaawaca seedaha Calcaneofibular, dillaac dhamaystiran
Jaantus 3a: Jidka hore ee talofibular ee caadiga ah: sawirka ultrasound oo muujinaya qaab-dhismeedka hypoechoic lebbiska saddexagalka ah; Jaantus 3b: Calcaneofibular ligament ee caadiga ah: Dhexdhexaad echogenic iyo qaab dhismeedka fiilamentous cufan ee sawirka ultrasound
Jaantuska 4a: Jeexitaanka qayb ka mid ah seedaha talofibular ee hore ee sawirka ultrasound; Jaantuska 4b: Jeexitaanka dhamaystiran ee seedaha calcaneofibular ee sawirka ultrasound
Qiimaynta cudurka:
murugada: sawirada dhawaaqa ayaa muujinaya qaabdhismeed aan hagaagsanayn, seedaha dhumuc iyo bararsan; Jeexitaanka qayb ka mid ah: Waxaa jira barar ku jira seedaha, waxaa jira khalkhal joogto ah oo fiilooyinka qaar ah, ama fiilooyinka ayaa ah kuwo gudaha ah oo khafiif ah. Baadhitaanno firfircooni ah ayaa muujiyay in xiisadda seedaha si weyn u daciiftay, seediguna way khafiiftay oo korodhay iyo dabacsanaanta daciifka ah ee valgus ama varus.
Jeex dhammaystiran: seedaha si dhammaystiran oo joogto ah u go'ay oo leh kala fogaansho fog, baarista firfircooni waxay soo jeedinaysaa in aanay jirin wax xajin ah ama jeexan oo kordhay, iyo valgus ama varus, seedu waxay u dhaqaaqdaa dhinaca kale, iyada oo aan lahayn wax dabacsanaan ah oo leh kala-goys dabacsan.
Faa'iidooyinka: qiimo jaban, fududahay in la shaqeeyo, aan duulin; Qaab dhismeedka qarsoodiga ah ee lakab kasta oo ka mid ah unugyada subcutaneous ayaa si cad loo soo bandhigay, kaas oo ku habboon in la eego nabarrada unugyada musculoskeletal. Baadhitaanka qaybta aan loo baahnayn, sida ku cad suunka suunka si loo raadiyo dhammaan geeddi-socodka seedaha, goobta dhaawaca seedaha ayaa la caddeeyaa, xiisadda seedaha iyo isbeddellada morphological ayaa si firfircoon loo arkay.
Khasaaro: xallinta unugyada jilicsan ee hooseeya marka loo eego MRI; Ku tiirso hawl farsamo xirfadeed.
Hubinta arthroscopy
Faa'iidooyinka: Si toos ah u fiirso qaab-dhismeedka malleolus lateral iyo dhabarka cagaha (sida lafaha hoose ee hoose, ligament talofibular hore, calcaneofibular ligament, iwm.) si loo qiimeeyo daacadnimada seedaha oo ka caawi dhakhtarka qalliinka inuu go'aamiyo qorshaha qalliinka.
Khasaaro: Invasive, wuxuu sababi karaa dhibaatooyin qaarkood, sida dhaawaca neerfaha, caabuqa, iwm. Guud ahaan waxaa loo tixgeliyaa inay tahay heerka dahabka ee lagu ogaanayo dhaawacyada seedaha waxaana hadda inta badan loo isticmaalaa daaweynta dhaawacyada seedaha.
Waqtiga boostada: Seb-29-2024
