Jabka anqawgu waa mid ka mid ah noocyada ugu badan ee jabka ee ku dhaca dhaqtarka caafimaadka. Marka laga reebo qaar ka mid ah Darajada I/II ee dhaawacyada wareegta ah iyo dhaawacyada afduubka, inta badan jabka canqowga ayaa badanaa ku lug leh malleolus lateral. Weber A/B nooca jabka lateral malleolus wuxuu caadi ahaan keenaa kala fogaanshiyaha tibiofibular syndesmosis wuxuuna ku gaari karaa hoos u dhac wanaagsan iyadoo muuqaal toos ah laga bilaabo fogaan ilaa mid u dhow. Taa bedelkeeda, jabka jaban ee nooca C-ga ah ee malleolus-ka ah wuxuu ku lug leeyahay xasillooni la'aanta malleolus lateral ee saddexda faas sababtoo ah dhaawaca tibiofibular ee fog, taas oo keeni karta lix nooc oo barokac ah: gaaban / dheereynta, ballaarinta / cidhiidhiga booska tibiofibular fog, barokac hore / dambe. diyaaradda sagittal, u janjeersiga dhex dhexaad / lateral ee diyaaradda koronal, barakaca wareega, iyo isku darka shantan nooc ee dhaawacyada.
Daraasado badan oo hore ayaa muujiyay in gaabin/kordhinta lagu qiimayn karo iyada oo la qiimaynayo calaamadda Dime, khadka Stenton, iyo xagasha tibial-gapping, iyo kuwo kale. Barokaca ee diyaaradaha koroniska iyo sagittal si fiican ayaa loo qiimeyn karaa iyadoo la adeegsanayo aragtida fluoroscopic ee hore iyo tan dambe; si kastaba ha ahaatee, barakicinta wareegtadu waa tan ugu dhibka badan si loo qiimeeyo qalliinka gudahiisa.
Dhibka lagu qiimeeyo barokaca wareega ayaa si gaar ah uga muuqda hoos u dhaca fibula marka la geliyo furaha tibiofibular ee fog. Suugaanta intooda badani waxay tilmaamayaan in ka dib markii la geliyo qulqulka tibiofibular ee fog, waxaa jira 25% -50% hoos u dhigista liidata, taasoo keentay khalkhal iyo hagaajinta qallafsanaanta fibular. Qaar ka mid ah culimada ayaa soo jeediyay in la isticmaalo qiimeynta CT ee qalliinka caadiga ah, laakiin tani waxay noqon kartaa mid adag in si dhab ah loo fuliyo. Si arrintan wax looga qabto, sannadka 2019, kooxda Professor Zhang Shimin oo ka socota Isbitaalka Yangpu ee xiriirka la leh Jaamacadda Tongji ayaa daabacay maqaal ku jira joornaalka caalamiga ah ee lafaha * Dhaawaca *, iyagoo soo jeedinaya farsamo lagu qiimeeyo in wareegga dambe ee malleolus la saxay iyadoo la adeegsanayo raajada qalliinka. Suugaanta ayaa ka warbixisay waxtarka caafimaad ee habkan.
![asd (1)](http://www.medtechcah.com/uploads/asd-14.png)
Saldhigga aragtida ee habkani waa in aragtida fluoroscopic ee canqowga, kiliyaha derbiga lateral ee fossa malleolar lateral wuxuu muujinayaa hooska cad, toosan, cufan, oo barbar socda xudunta dhexe iyo lateral ee malleolus lateral, oo ku yaala dhexda ilaa bannaanka saddex-meelood meel bannaan ee xariiqda isku xidha xadhkaha dhexe iyo kan dambe ee malleolus-ka dambe.
![asd (2)](http://www.medtechcah.com/uploads/asd-26.png)
Sawirka aragtida fluoroscopic canqowga oo muujinaysa xidhiidhka mawqifka ah ee ka dhexeeya kortex derbiga lateral ee fossa malleolar lateral (b-line) iyo kortiks dhexdhexaad ah iyo lateral ee malleolus lateral (a iyo c khadadka). Caadi ahaan, xariiqda b-ku waxay ku taallaa saddex meelood meel bannaanka ee u dhexeeya xariiqyada a iyo c.
Mawqifka caadiga ah ee malleolus lateral, wareegga dibadda, iyo wareegga gudaha ayaa soo saari kara muuqaallo sawireed oo kala duwan ee aragtida fluoroscopic:
- Malleolus-ka dambe wuxuu u wareegay si caadi ah **: Koontaroolka malleolus lateral ee caadiga ah oo leh hooska kortikal ee gidaarka dambe ee fossa malleolar lateral, oo ku taagan xariiqda dibadda ee saddex-meelood meel bannaan ee xudunta dhexe iyo lateral ee malleolus lateral.
Qallooca wareegga dibadda ee malleolus ***: Koontaroolka malleolus lateral wuxuu u muuqdaa "caleemo fiiqan," hooska kortikal ee fossa malleolar lateral wuu baaba'aa, meesha bannaan ee tibiofibular fog ayaa cidhiidhi ah, khadka Shenton wuxuu noqdaa mid joogsanaya oo kala firdhiyey.
-Dib-u-dhac malleolus gudaha ah oo wareeg ah ***: Koontaroolka malleolus-ka dambe wuxuu u muuqdaa "qaado-qaabeysan", hooska kortikal ee fossa malleolar lateral wuu baaba'aa, meesha bannaan ee tibiofibular ee foguna way ballaaran tahay.
![sida (3)](http://www.medtechcah.com/uploads/asd-34.png)
![asd (4)](http://www.medtechcah.com/uploads/asd-44.png)
Kooxdu waxay ku jirtay bukaanada 56 ee qaba jabka lateral ee nooca C-da oo ay weheliyaan dhaawacyada tibiofibular syndesmosis ee fog waxayna isticmaaleen habka qiimeynta ee kor ku xusan. Dib-u-eegistii CT-ga ee qalliinka kadib waxay muujisay in bukaannada 44 ay heleen hoos u dhac ku yimaada anatomic iyada oo aan lahayn cillado wareeg ah, halka bukaannada 12 ay la kulmeen naafo yar oo wareeg ah (in ka yar 5 °), oo leh 7 xaaladood oo wareeg ah oo gudaha ah iyo 5 xaaladood oo wareeg ah. Ma jiraan xaalado dhexdhexaad ah (5-10°) ama daran (ka weyn 10°) qalloocyada wareega dibadda oo dhacay.
Daraasadihii hore waxay muujiyeen in qiimeynta dhimista jabka malleolar-ka dambe ay ku saleysnaan karto saddexda cabbir ee Weber-ka: sinnaanta isku midka ah ee u dhexeeya sagxadaha wadajirka ah ee tibial iyo talar, sii wadida khadka Shenton, iyo calaamadda Dime.
![sida (5)](http://www.medtechcah.com/uploads/asd-52.png)
Hoos-u-dhis liidata ee malleolus-ka dambe ayaa ah arrin aad caan u ah marka la eego waxqabadka kiliinikada. Iyadoo fiiro gaar ah la siinayo dib u soo celinta dhererka, muhiimada siman waa in la saaraa hagaajinta wareegga. Sida laf-dhabarta culeyska, hoos u dhac kasta oo canqowga ah wuxuu yeelan karaa saameyn musiibo ah shaqadiisa. Waxaa la rumeysan yahay in farsamada fluoroscopic intraoperative ee uu soo jeediyay Professor Zhang Shimin ay gacan ka geysan karto in la gaaro hoos u dhigista saxda ah ee nooca C-da ee jabka lateral. Farsamadani waxay tixraac qiimo leh u tahay dhakhaatiirta safka hore.
Waqtiga boostada: May-06-2024