Gukomeretsa amaguru ni imvune ya siporo isanzwe igaragara hafi ya 25% yimvune yimitsi, hamwe n’imvune zomugongo (LCL) zikunze kugaragara. Niba imiterere ikaze itavuwe mugihe, biroroshye kuganisha kumitsi inshuro nyinshi, kandi ibibazo bikomeye bizagira ingaruka kumikorere yibirenge. Niyo mpamvu, ari ngombwa cyane gusuzuma no kuvura ibikomere by'abarwayi hakiri kare. Iyi ngingo izibanda ku buhanga bwo gusuzuma bwo gukomeretsa ku mpande zombi zifata amaguru kugira ngo bifashe abaganga kunonosora neza indwara.
I. Anatomy
Imbere ya talofibular ligament (ATFL): iringaniye, ihujwe na capsule yinyuma, itangirira imbere ya fibula ikarangira imbere yumubiri wa talus.
Ligamenti ya Calcaneofibular (CFL): imeze nk'umugozi, ikomoka kumupaka wimbere wa malleolus ya kure kandi ikarangirira kuri calcane.
Inyuma ya talofibular ligament (PTFL): Ikomoka ku buso bwo hagati bwa malleolus ya nyuma ikarangirira inyuma ya talus yo hagati.
ATFL yonyine niyo yagize 80% by'imvune, mu gihe ATFL ifatanije n’imvune za CFL zingana na 20%.
Igishushanyo mbonera nigishushanyo cya anatomicale yingingo zegeranye zingingo zifatizo
II. Uburyo bwo gukomeretsa
Ibikomere birenze urugero: talofibular ligament imbere
calcaneofibular ligament varus igikomere: calcaneofibular ligament
III. Gutanga amanota
Icyiciro cya I: kunanirwa kw'imitsi, nta kugaragara kugaragara guturika, gake kubyimba cyangwa ubwuzu, kandi nta kimenyetso cyo gutakaza imikorere;
Icyiciro cya II: macroscopique igice cyo guturika k'ururimi, ububabare buciriritse, kubyimba, n'ubwuzu, no kubangamira gato imikorere ihuriweho;
Icyiciro cya III: ligamente yacitse burundu kandi itakaza ubunyangamugayo, iherekejwe no kubyimba gukomeye, kuva amaraso no kugira ubwuzu, biherekejwe no gutakaza imikorere igaragara no kwigaragaza guhungabana.
IV. Ikizamini cya Clinical Ikizamini cyimbere
Umurwayi yicaye hamwe n'amavi ahindagurika kandi iherezo ry'inyana rimanikwa, kandi umugenzuzi afata tibia mu kuboko kumwe maze asunika ikirenge imbere inyuma y'agatsinsino n'ikindi.
Ubundi, umurwayi ni supine cyangwa yicaye hamwe n ivi ryunamye kuri dogere 60 kugeza kuri 90, agatsinsino gashizwe hasi, hamwe nuwabisuzumisha akoresha igitutu cyinyuma kuri tibia ya kure.
Ibyiza bihanura guturika kw'imbere ya talofibular ligament.
Ikizamini cyo guhangayika
Ikirenge cyegeranye nticyahagaritswe, kandi guhangayikishwa na varus byashyizwe ku kaguru ka kure kugira ngo harebwe inguni ya talus.
Ugereranije n’impande zinyuranye,> 5 ° biteye inkeke, kandi> 10 ° ni byiza; cyangwa uruhande rumwe> 15 ° nibyiza.
Ihanura ryiza rya calcaneofibular ligament yaturika.
Kwerekana amashusho
X-imirasire yimvune yimikino isanzwe
X-imirasire ni mibi, ariko MRI yerekana amarira ya talofibular yimbere na calcaneofibular ligaments
Ibyiza: X-ray niyo nzira yambere yo gusuzuma, ikaba yubukungu kandi yoroshye; Ingano yimvune igenzurwa no gusuzuma urugero rwa talus. Ibibi: Kugaragaza nabi imyenda yoroheje, cyane cyane imiterere yimiterere ifite akamaro mukubungabunga umutekano hamwe.
MRI
Igishushanyo.1 Umwanya wa 20 ° oblique werekanye ibyiza bya talofibular imbere (ATFL); Igishushanyo.2 Azimuth umurongo wa ATFL scan
Amashusho ya MRI yimvune zinyuranye za talofibular ligament yerekanaga ko: (A) imbere ya talofibular ligament yimbere no kubyimba; (B) amarira yimbere ya talofibular amarira; (C) guturika kw'imbere ya talofibular ligament; (D) Imvune yimbere ya talofibular ligament hamwe no kuvunika avulsion.
Igishushanyo.3 -15 ° umwanya uhagaze werekanye ligamente nziza ya calcaneofibular (CFI);
Igishushanyo.4. CFL gusikana azimuth
Amarira akaze, yuzuye ya calcaneofibular ligament
Igishushanyo 5: Reba Coronal yerekana ibyiza byimbere ya talofibular ligament (PTFL);
Igishushanyo.6 PTFL scan azimuth
Amarira igice cyinyuma ya talofibular ligament
Urwego rwo gusuzuma:
Icyiciro cya I: Nta byangiritse;
Icyiciro cya II: guhuza ligament, gukomeza ubwiza bwimiterere, kubyimba kwa ligaments, hypoechogenicity, edema yimitsi ikikije;
Icyiciro cya III: morfologiya ituzuye, kunanuka cyangwa guhagarika igice cyo gukomeza imiterere, kubyimba imitsi, no kongera ibimenyetso;
Icyiciro cya IV: guhungabanya burundu gukomeza ligamente, bishobora guherekezwa no kuvunika avulion, kubyimba kwa ligaments, hamwe no kongera ibimenyetso byaho cyangwa bikwirakwizwa.
Ibyiza: Gukemura cyane kubice byoroshye, kwitegereza neza ubwoko bwimvune yimitsi; Irashobora kwerekana kwangirika kwa karitsiye, guhuza amagufwa, hamwe nuburyo rusange bwo gukomeretsa.
Ibibi: Ntibishoboka kumenya neza niba kuvunika no kwangirika kwa karitsiye byahagaritswe; Bitewe nuburyo bugoye bwimigeri, imikorere yikizamini ntabwo iri hejuru; Birahenze kandi bitwara igihe.
Ultrasound yumurongo mwinshi
Igishushanyo 1a: Imvune yimbere ya talofibular ligament, amarira igice; Igishushanyo 1b: Ligamenti yimbere ya talofibular yatanyaguwe rwose, igishyitsi kirabyimbye, kandi effusion nini igaragara mumwanya wimbere.
Igishushanyo 2a: Gukomeretsa kwa Calcaneofibular, amarira igice; Igishushanyo 2b: Imvune ya Calcaneofibular ligament, guturika byuzuye
Igishushanyo 3a: Ubusanzwe imbere ya talofibular ligament: ishusho ya ultrasound yerekana imiterere ya mpandeshatu ihindagurika ya hypoechoic; Igishushanyo 3b: Ligamente isanzwe ya calcaneofibular: Mu buryo bushyize mu gaciro kandi imiterere yuzuye ya filimile ishusho ya ultrasound
Igishushanyo 4a: Amarira igice cyimbere ya talofibular ligament kumashusho ya ultrasound; Igishushanyo 4b: Amarira yuzuye ya calcaneofibular ligament kumashusho ya ultrasound
Urwego rwo gusuzuma:
kwitiranya: amashusho ya acoustic yerekana imiterere idahwitse, umubyimba wabyimbye kandi wabyimbye; Amarira igice: Hariho kubyimba muri ligament, habaho guhungabana guhoraho kwa fibre zimwe, cyangwa fibre zinanutse. Isuzuma rya Dynamic ryerekanaga ko impagarara za ligamente zacogoye cyane, kandi ligamente yoroheje kandi yiyongera kandi elastique yagabanutse mugihe cya valgus cyangwa varus.
Amosozi yuzuye: ligamente rwose kandi idahwema guhagarikwa hamwe no gutandukana kure, scan ya dinamike yerekana ko nta mpagarara zomuri ligne cyangwa amarira yiyongereye, kandi muri valgus cyangwa varus, ligamenti yimukira kurundi ruhande, nta elastique kandi ifatanye.
Ibyiza: igiciro gito, cyoroshye gukora, kidatera; Imiterere yoroheje ya buri cyiciro cyimitsi yo munsi yubutaka irerekanwa neza, ifasha mukwitegereza imitsi ya musculoskeletal. Isuzuma ryibice uko bishakiye, ukurikije umukandara wa ligamente kugirango ukurikirane inzira yose yimitsi, aho igikomere cyakomeretse kirasobanutse, kandi impagarara zimpinduka nimpinduka zijyanye na morfologiya ziragaragara.
Ibibi: gukemura byoroshye-tissue ugereranije na MRI; Wishingikirize kubikorwa bya tekiniki yabigize umwuga.
Kugenzura Arthroscopy
Ibyiza: Witegereze neza imiterere ya malleolus yinyuma hamwe ninyuma yinyuma (nka talar yo hasi ya talar, imbere ya talofibular ligament, calcaneofibular ligament, nibindi) kugirango usuzume ubusugire bwimitsi kandi ufashe umuganga kumenya gahunda yo kubaga.
Ibibi: Bitera, birashobora gutera ingorane zimwe na zimwe, nko kwangirika kw'imitsi, kwandura, n'ibindi. Muri rusange bifatwa nk'urwego rwa zahabu mu gusuzuma ibikomere byo mu mitsi kandi kuri ubu bikoreshwa cyane mu kuvura ibikomere.
Igihe cyo kohereza: Nzeri-29-2024
