Ibikomere byo ku kaguru ni imvune ikunze kugaragara mu mikino ikunze kugaragara ku bantu bagera kuri 25% by'imvune zo mu mitsi n'amagufwa, aho imvune zo ku kaguru (LCL) ari zo zikunze kugaragara cyane. Iyo indwara ikomeye idavuwe ku gihe, biroroshye gutuma habaho gucika intege kenshi, kandi indwara zikomeye zizagira ingaruka ku mikorere y'ingingo y'akaguru. Kubwibyo, ni ingenzi cyane gusuzuma no kuvura imvune z'abarwayi hakiri kare. Iyi nkuru izibanda ku buhanga bwo gusuzuma imvune zo ku kaguru mu gice cy'akaguru kugira ngo ifashe abaganga kunoza uburyo bwo gusuzuma.
I. Imiterere y'umubiri
Imbere y'umugongo wa talofibula (ATFL): irambitse, ifatanye n'agapfukamunwa ko ku ruhande, itangirira imbere y'agapfukamunwa hanyuma irangirira imbere y'umubiri wa talus.
Ishinya rya Calcaneofibular (CFL): rifite ishusho nk'umugozi, ritangirira ku mupaka w'imbere wa malleolus yo ku ruhande rwa kure rikarangira kuri calcaneus.
Umutsi w'inyuma wa talofibular (PTFL): Uturuka ku buso bwo hagati bwa malleolus yo ku ruhande hanyuma ukagera inyuma kuri talus yo hagati.
ATFL yonyine yagize imvune zigera kuri 80%, mu gihe ATFL hamwe n'imvune za CFL zari zigera kuri 20%.
Imbonerahamwe y'icyitegererezo n'imbonerahamwe y'imiterere y'umubiri w'ingingo y'akaguru
II. Uburyo bw'imvune
Ibikomere byo mu gituza: umugozi w'imbere wa talofibula
imvune ya varus y'umugozi wa calcaneofibula: umugozi wa calcaneofibula
III. Gupima imvune
Icyiciro cya mbere: gucika intege kw'imitsi, kudacika kw'imitsi kugaragara, kubyimba cyangwa kubabara gake, kandi nta bimenyetso byo kubura imikorere;
Icyiciro cya kabiri: gucika kw'imitsi igice kimwe, ububabare buri hagati, kubyimba no kubabara, hamwe no kudakora neza kw'ingingo;
Icyiciro cya gatatu: umutsi uracika burundu ugatakaza ubuziranenge bwawo, bigaherekezwa no kubyimba gukomeye, kuva amaraso no kubabara, bigaherekezwa no gutakaza imikorere myiza no kugaragaza ko ingingo zidakora neza.
IV. Isuzuma ry'ubuvuzi Ikizamini cyo ku kabati k'imbere
Umurwayi yicaye ivi rye rizungurutse kandi impera y'inyana iramanitse, maze umusuzumyi afashe igituza cy'ikirenge n'ukuboko kumwe hanyuma agasunika ikirenge imbere inyuma y'agatsinsino n'ukundi.
Ubundi buryo, umurwayi aba yicaye aryamye cyangwa yicaye ivi ripfukamye kuri dogere 60 kugeza kuri 90, agatsinsino gahagaze hasi, naho umusuzumyi agashyira igitutu cy'inyuma ku gice cyo hagati cy'umugongo.
Isuzuma ryiza rigaragaza ko umugozi w'imbere wa talofibular uzacika.
Ikizamini cy'umuvuduko wo guhindura ibintu
Akaguru k'imbere kari karahagaze, maze imbaraga za varus zishyirwa ku kaguru k'inyuma kugira ngo harebwe inguni y'aho talus ihengamiye.
Ugereranyije n'uruhande rw'inyuma, >5° ni nziza mu buryo buteye amakenga, naho >10° ni nziza; cyangwa unilateral >15° ni nziza.
Igipimo cyiza cy'uko imitsi ya calcaneofibular yacitse.
Ibizamini byo gushushanya
Imirasire ya X y'imvune zisanzwe zo mu kaguru
Imirasire ya X-rays ntabwo ari myiza, ariko MRI igaragaza ko imitsi ya talofibular y'imbere na calcaneofibular yacitse.
Ibyiza: Gupima X-ray ni byo bya mbere mu gusuzuma, bikaba bihendutse kandi byoroshye; Ingano y'imvune igaragazwa hashingiwe ku rugero rw'aho talus ihagaze. Ingaruka mbi: Kugaragara nabi kw'ingingo zoroshye, cyane cyane imiterere y'imitsi ari ingenzi mu kubungabunga ituze ry'ingingo.
MRI
Ishusho ya 1. Ahantu ho gushyira umugongo wa talofibulari imbere ha 20° hagaragaje umugongo mwiza cyane w’imbere (ATFL); Ishusho ya 2. Umurongo wa Azimuth wo gupima ATFL
Amashusho ya MRI agaragaza ibikomere bitandukanye by'imitsi ya talofibula y'imbere yagaragaje ko: (A) imitsi ya talofibula y'imbere irushaho gukomera no kubyimba; (B) imitsi ya talofibula y'imbere icika; (C) guturika kw'imitsi ya talofibula y'imbere; (D) Gukomereka kw'imitsi ya talofibula y'imbere hamwe no kuvunika kw'inyuma.
Igishushanyo cya 3. Ahantu ha -15° hagaragazaga ligament nziza ya calcaneofibular (CFI);
Igishushanyo cya 4. Azimuth yo gupima CFL
Gucika burundu kw'umugozi wa calcaneofibular
Ishusho ya 5: Ishusho ya Koronali igaragaza umugozi mwiza cyane wo mu gice cy'inyuma cya talofibula (PTFL);
Igishushanyo cya 6: Azimuth yo gupima PTFL
Gucika igice cy'umugozi w'inyuma wa talofibula
Isuzuma ry'indwara:
Icyiciro cya mbere: Nta byangiritse;
Icyiciro cya II: kuvunika kw'imitsi, imiterere myiza, kwiyongera kw'imitsi, ubushyuhe bw'uturemangingo, kubyimba kw'ingingo zikikije;
Icyiciro cya gatatu: imiterere y'imitsi idahagije, kugabanuka cyangwa guhungabana kw'imiterere y'imitsi, kwiyongera kw'imitsi, no kwiyongera kw'ikimenyetso;
Icyiciro cya kane: guhungabana burundu kw'imitsi ikomeza gukora, bishobora guherekezwa no kuvunika kw'imitsi, kwiyongera kw'imitsi, no kwiyongera kw'ibimenyetso byo mu gace cyangwa bikwirakwira.
Ibyiza: Ifite ubushobozi bwo kureba neza imiterere y'ingingo zoroshye, isuzuma neza ubwoko bw'imvune z'imitsi; Ishobora kugaragaza kwangirika kw'agatsi, gucika kw'amagufwa, ndetse n'imiterere rusange y'imvune.
Ingaruka mbi: Ntibishoboka kumenya neza niba imvune n'ibyangiritse ku mitsi yo mu kaguru bihagarara; Bitewe n'ubukana bw'imitsi yo ku kaguru, ubushobozi bwo gusuzuma ntabwo buri hejuru; Birahenze kandi bifata igihe.
Ultrasound ikoresha inshuro nyinshi
Ishusho ya 1a: Gukomereka kw'imitsi ya talofibula y'imbere, gucika igice; Ishusho ya 1b: Imitsi ya talofibula y'imbere yacitse burundu, igituza kirabyimba, kandi hagaragara urujya n'uruza runini mu gice cy'imbere cy'uruhande.
Ishusho ya 2a: Gukomereka kw'imitsi ya Calcaneofibula, gucika igice; Ishusho ya 2b: Gukomereka kw'imitsi ya Calcaneofibula, gucika burundu
Ishusho ya 3a: Ishusho isanzwe ya talofibular ligament: ishusho ya ultrasound igaragaza imiterere ya mpandeshatu ihindukiye isa n'iya hypoechoic; Ishusho ya 3b: Ishusho isanzwe ya calcaneofibular ligament: Imiterere iri hagati ya echojeni n'ubucucike ku ishusho ya ultrasound
Ishusho ya 4a: Gucika igice cy'umutsi w'imbere wa talofibula ku ishusho ya ultrasound; Ishusho ya 4b: Gucika burundu kw'umutsi w'imbere wa calcaneofibula ku ishusho ya ultrasound
Isuzuma ry'indwara:
Gucikamo ibice: amashusho agaragaza imiterere idahinduka, imitsi ikomeye kandi yabyimbye; Gucika igice: Hari kubyimba mu mitsi, hari ukuvunika guhoraho kwa fibre zimwe na zimwe, cyangwa fibre zagabanutse mu gace runaka. Gupima mu buryo bwa Dynamic byagaragaje ko umuvuduko w'imitsi wagabanutse cyane, kandi imitsi yagabanutse kandi yiyongera ndetse no gucika intege mu gihe cya valgus cyangwa varus.
Gucika burundu: umugozi uhora uhagarara burundu kandi uhoraho hamwe no gutandukana kwa distal, scan ihindagurika igaragaza ko nta gucika intege kw'imigozi cyangwa gucika kwiyongera, kandi muri valgus cyangwa varus, umugozi wimukira ku rundi ruhande, nta bunararibonye cyangwa ingingo irekuye.
Ibyiza: bihendutse, byoroshye gukoresha, ntibitera indwara; Imiterere yoroheje ya buri gice cy'ingingo zo munsi y'umubiri igaragara neza, ibyo bikaba byorohereza kureba ibisebe by'imitsi n'amagufwa. Gusuzuma igice gisanzwe, hakurikijwe umukandara w'imitsi kugira ngo harebwe inzira yose y'imitsi, aho imitsi yakomeretse hasobanuka neza, kandi imitsi n'impinduka mu miterere y'umubiri bigaragarira mu buryo buhamye.
Ingaruka mbi: kudakora neza kw'uturemangingo tworoshye ugereranije na MRI; Kwishingikiriza ku bikorwa bya tekiniki by'umwuga.
Isuzuma rya Arthroscopy
Ibyiza: Reba neza imiterere ya malleolus yo ku ruhande n'ikirenge cy'inyuma (nk'urugingo rwa talar ruri munsi, umugozi wa talofibular w'imbere, umugozi wa calcaneofibular, nibindi) kugira ngo usuzume ubuziranenge bw'imigozi no gufasha umuganga kubaga kumenya gahunda yo kubaga.
Ingaruka mbi: Itera indwara, ishobora gutera ingorane zimwe na zimwe, nko kwangirika kw'imitsi, kwandura indwara, nibindi. Muri rusange ifatwa nk'icyitegererezo cyiza cyo gusuzuma imvune z'imitsi kandi ubu ikoreshwa cyane mu kuvura imvune z'imitsi.
Igihe cyo kohereza ubutumwa: 29 Nzeri 2024
