Karyewar idon ƙafa ɗaya ce daga cikin nau'ikan karyewar ido da aka fi sani a aikin asibiti. Banda wasu raunukan juyawa na Grade I/II da raunin da aka yi wa garkuwa da su, yawancin karyewar idon ƙafa yawanci suna da alaƙa da malleolus na gefe. Karyewar malleolus na gefe na Weber A/B yawanci yana haifar da rashin kwanciyar hankali na distal tibiofibular syndesmosis kuma yana iya samun kyakkyawan raguwa tare da gani kai tsaye daga distal zuwa proximal. Sabanin haka, karyewar malleolus na gefe na C-type ya ƙunshi rashin kwanciyar hankali a cikin malleolus na gefe a fadin gatari uku saboda raunin tibiofibular na gefe, wanda zai iya haifar da nau'ikan ƙaura guda shida: gajarta/tsawo, faɗaɗa/ragewar sararin tibiofibular na nesa, ƙaura ta gaba/bayan a cikin sagittal plane, karkatar da tsakiya/gefen a cikin coronal plane, juyawar juyawa, da haɗuwa da waɗannan nau'ikan raunuka guda biyar.
Nazarce-nazarce da dama da aka yi a baya sun nuna cewa ana iya tantance gajarta/tsawaita ta hanyar tantance alamar Dime, layin Stenton, da kusurwar tibial-gapping, da sauransu. Ana iya tantance ƙaura a cikin tasoshin coronal da sagittal sosai ta amfani da kallon fluoroscopic na gaba da na gefe; duk da haka, ƙaura ta juyawa ita ce mafi ƙalubale a tantance ta a lokacin tiyata.
Wahalar tantance matsugunin juyawa ta bayyana musamman a cikin rage fibula lokacin saka sukurin tibiofibular na distal. Yawancin wallafe-wallafen sun nuna cewa bayan saka sukurin tibiofibular na distal, akwai raguwar kashi 25%-50% mara kyau, wanda ke haifar da malunion da gyara nakasar fibular. Wasu masana sun ba da shawarar amfani da kimantawar CT na yau da kullun a lokacin tiyata, amma wannan na iya zama ƙalubale a aiwatar da shi a aikace. Don magance wannan batu, a cikin 2019, ƙungiyar Farfesa Zhang Shimin daga Asibitin Yangpu da ke da alaƙa da Jami'ar Tongji ta buga wani labari a cikin mujallar orthopedic ta duniya *Injury*, suna ba da shawarar wata dabara don tantance ko an gyara jujjuyawar malleolus ta gefe ta amfani da X-ray a lokacin tiyata. Littattafan sun ba da rahoton ingantaccen tasirin wannan hanyar a asibiti.
Tushen wannan hanyar ita ce, a cikin yanayin idon sawu, ɓangaren bango na gefe na fossa na malleolar yana nuna inuwa mai haske, a tsaye, mai kauri, daidai da ɓangaren tsakiya da na gefe na malleolus na gefe, kuma yana a tsakiya zuwa waje kashi ɗaya bisa uku na layin da ke haɗa ɓangaren tsakiya da na gefe na malleolus na gefe.
Zane na kallon idon sawu mai kama da ido wanda ke nuna alaƙar matsayi tsakanin cortex na bango na gefe na fossa na gefe (layin b) da kuma cortices na tsakiya da na gefe na malleolus na gefe (layin a da c). Yawanci, layin b yana kan layin waje na ɗaya bisa uku tsakanin layukan a da c.
Matsayin da ake amfani da shi na malleolus na gefe, juyawar waje, da juyawar ciki na iya haifar da bayyanar hoto daban-daban a cikin kallon fluoroscopic:
- Malleolus na gefe yana juyawa a matsayin da ya dace**: Tsarin malleolus na gefe na yau da kullun tare da inuwar cortical a bangon gefe na fossa na gefe, wanda aka sanya a kan layi na waje na kashi ɗaya bisa uku na cortices na tsakiya da na gefe na malleolus na gefe.
-Nakasar juyawar waje ta malleolus ta gefe**: Tsarin malleolus na gefe yana bayyana "mai kaifi mai ganye," inuwar cortical akan fossa na gefe na malleolus ta ɓace, sararin tibiofibular na nesa ya yi ƙunci, layin Shenton ya daina tsayawa kuma ya watse.
-Nakasar juyawar ciki ta malleolus ta gefe**: Tsarin malleolus na gefe yana bayyana "mai siffar cokali," inuwar cortical akan fossa na gefe na malleolus ta ɓace, kuma sararin tibiofibular na nesa yana faɗaɗa.
Ƙungiyar ta haɗa da marasa lafiya 56 da suka samu karyewar lateral malleolar tare da raunin da ya faru a diddige na tibiofibular syndesmosis kuma sun yi amfani da hanyar tantancewa da aka ambata a sama. Sake duba CT bayan tiyata ya nuna cewa marasa lafiya 44 sun sami raguwar yanayin jiki ba tare da wata nakasar juyawa ba, yayin da marasa lafiya 12 suka sami nakasar juyawa mai sauƙi (ƙasa da 5°), tare da shari'o'i 7 na juyawa na ciki da shari'o'i 5 na juyawa na waje. Babu wata shari'ar nakasar juyawa na waje mai matsakaici (5-10°) ko mai tsanani (fiye da 10°) da ta faru.
Nazarin da aka yi a baya sun nuna cewa kimantawar rage karyewar malleolar ta gefe za a iya dogara da shi bisa manyan sigogi uku na Weber: daidaiton daidaito tsakanin saman haɗin tibial da talar, ci gaba da layin Shenton, da kuma alamar Dime.
Rashin rage girman malleolus na gefe abu ne da ya zama ruwan dare a aikin asibiti. Duk da cewa ana ba da kulawa mai kyau ga maido da tsayi, ya kamata a sanya muhimmanci iri ɗaya kan gyaran juyawa. A matsayin haɗin gwiwa mai ɗauke da nauyi, duk wani rauni na idon ƙafa na iya haifar da mummunan tasiri ga aikinsa. An yi imanin cewa dabarar fluoroscopic da Farfesa Zhang Shimin ya gabatar a lokacin tiyata na iya taimakawa wajen cimma daidaitaccen rage karyewar malleolus na gefe na C-type. Wannan dabarar tana aiki a matsayin jagora mai mahimmanci ga likitocin gaba.
Lokacin Saƙo: Mayu-06-2024
