I-patella, eyaziwa ngokuba yi-kneecap, lithambo le-sesamoid elenziwe kwi-tendon ye-quadriceps kwaye likwalithambo elikhulu le-sesamoid emzimbeni. Lithe tyaba kwaye limile okwe-millet, lifumaneka phantsi kwesikhumba kwaye kulula ukuliva. Ithambo libanzi phezulu kwaye lijonge ezantsi, linecala elirhabaxa kunye nomqolo ogudileyo. Lingahamba phezulu nasezantsi, ekhohlo nasekunene, kwaye likhusela idolo. Umva we-patella uthambile kwaye ugutyungelwe yi-cartilage, uqhagamshela kumphezulu we-patellar we-femur. Umphambili urhabaxa, kwaye i-tendon ye-quadriceps idlula kuyo.
I-Patellar chondromalacia sisifo esiqhelekileyo samalungu edolo. Ngaphambili, esi sifo sasixhaphakile kubantu abakwiminyaka ephakathi kunye nabantu abadala. Ngoku, ngenxa yokwanda kwezemidlalo kunye nokomelela komzimba, esi sifo sikwaxhaphake kakhulu phakathi kwabantu abancinci.
I. Iyintoni intsingiselo yokwenyani kunye nonobangela we-chondromalacia patella?
I-Chondromalacia patellae (CMP) yi-patellofemoral joint osteoarthritis ebangelwa kukonakala okungapheliyo kumphezulu we-patellar cartilage, okubangela ukudumba kwe-cartilage, ukuqhekeka, ukuqhekeka, ukukhukuliseka, kunye nokuphuma. Okokugqibela, i-femoral condyle cartilage echaseneyo nayo idlula kutshintsho olufanayo lwe-pathological. Intsingiselo yokwenyani ye-CMP yile: kukho utshintsho lwe-pathological lwe-patellar cartilage ethambileyo, kwaye kwangaxeshanye, kukho iimpawu kunye neempawu ezifana nentlungu ye-patellar, isandi sokungqubana kwe-patellar, kunye nokuwohloka kwe-quadriceps.
Ekubeni i-articular cartilage ingenalo innervation yemithambo-luvo, indlela eyenzeka ngayo intlungu ebangelwa yi-chondromalacia ayikacaci. I-CMP sisiphumo seziphumo ezidibeneyo zezinto ezininzi. Izinto ezahlukeneyo ezibangela utshintsho kuxinzelelo lwamalungu e-patellofemoral zizizathu zangaphandle, ngelixa iimpendulo ze-autoimmune, i-cartilage dystrophy, kunye notshintsho kuxinzelelo lwangaphakathi zizizathu zangaphakathi ze-chondromalacia patellae.
II. Uphawu olubalulekileyo lwe-chondromalacia patellae lutshintsho oluthile lwe-pathological. Ngoko ke ngokwembono yotshintsho lwe-pathological, i-chondromalacia patellae ihlelwa njani ngokweenqanaba?
I-Insall ichaze amanqanaba amane e-pathological e-CMP: inqanaba I kukuthamba kwe-cartilage okubangelwa kukudumba, inqanaba lesi-2 libangelwa kukuqhekeka kwindawo ethambileyo, inqanaba lesi-3 kukuqhekeka kwe-cartilage ye-articular; inqanaba lesi-IV libhekisa kutshintsho olukhukulisayo lwe-osteoarthritis kunye nokuvezwa kwethambo le-subchondral kumphezulu we-articular.
Inkqubo yokubeka amanqaku e-Outerbridge iluncedo kakhulu ekuvavanyeni izilonda ze-patellar articular cartilage ngokusebenzisa umfanekiso othe ngqo okanye i-arthroscopy. Inkqubo yokubeka amanqaku e-Outerbridge yile ilandelayo:
Ibanga loku-1: Yi-cartilage ye-articular kuphela ethanjiswayo (ukuthamba kwe-cartilage evaliweyo). Oku kudla ngokufuna impendulo echukumisekayo nge-probe okanye esinye isixhobo sokuvavanya.
Ibanga lesiBini: Iziphene zobukhulu obungaphelelanga kwi-1.3 cm (0.5 in) ububanzi okanye ezifikelela kwithambo le-subchondral.
Ibanga lesi-3: I-cartilage fissure inkulu kune-1.3 cm (1/2 intshi) ububanzi kwaye ifikelela kwithambo le-subchondral.
Ibanga lesi-IV: Ukuvezwa kwamathambo e-subchondral.
III. Zombini izifo kunye nokubeka amanqaku kubonisa umongo we-chondromalacia patella. Ngoko ke zeziphi iimpawu kunye novavanyo olubalulekileyo lokufumanisa i-chondromalacia patella?
Ukuxilongwa kusekelwe kakhulu kwiintlungu ezingasemva kwepatella, ezibangelwa luvavanyo lokusila lwepatellar kunye novavanyo lwe-squat lomlenze omnye. Ingqwalasela kufuneka ibe kukwahlula ukuba kukho ukwenzakala kwe-meniscus kunye ne-arthritis ebuhlungu. Nangona kunjalo, akukho nxu lumano phakathi kobunzima be-patellar chondromalacia kunye neempawu zeklinikhi ze-anterior knee pain syndrome. I-MRI yindlela yokuxilonga echanekileyo ngakumbi.
Uphawu oluqhelekileyo ziintlungu ezibuhlungu emva kwepatella nangaphakathi edolweni, eziba mandundu emva kokuzilolonga okanye ukunyuka okanye ukuhla kwezinyuko.
Uvavanyo lomzimba lubonisa ukuthamba okucacileyo kwi-patella, i-peripatella, umda we-patellar kunye ne-posterior patella, okunokuhambisana nentlungu yokutyibilika kwe-patellar kunye nesandi sokungqubana kwe-patellar. Kunokubakho ukuphuma kwamalungu kunye nokuwohloka kwe-quadriceps. Kwiimeko ezinzima, ukujijeka kwedolo kunye nokwandiswa kuyancitshiswa kwaye isiguli asinakuma ngomlenze omnye. Ngexesha lovavanyo loxinzelelo lwe-patellar, kukho intlungu enzima emva kwe-patella, ebonisa umonakalo we-patellar articular cartilage, nto leyo ebalulekileyo ekuxilongweni. Uvavanyo oluxhalabileyo ludla ngokuba luhle, kwaye uvavanyo lwe-squat luhle. Xa idolo lijijekile ukusuka kuma-20° ukuya kuma-30°, ukuba uluhlu lwentshukumo yangaphakathi nangaphandle ye-patella ludlula i-1/4 yobubanzi obunqamlezileyo be-patella, kubonisa i-patellar subluxation. Ukulinganisa i-Q angle ye-90° knee flexion kunokubonisa indlela engaqhelekanga yokuhamba kwe-patellar.
Uvavanyo oluncedisayo oluthembekileyo yiMRI, eye yathatha indawo ye-arthroscopy kancinci kancinci yaza yaba yindlela engeyiyo ehlaselayo nethembekileyo ye-CMP. Uvavanyo lwe-imaging lugxila kakhulu kwezi parameters: ubude be-patellar (i-Caton index, PH), i-femoral trochlear groove angle (FTA), i-lateral surface ratio ye-femoral trochlear (SLFR), i-patellar fit angle (PCA), i-patellar tilt angle (PTA), apho i-PH, i-PCA, kunye ne-PTA ziiparameter ezithembekileyo zedolo zokuxilongwa kwe-CMP kwangoko.
I-X-reyi kunye ne-MRI zisetyenzisiwe ukulinganisa ubude be-patellar (i-Caton index, PH): a. I-Axial X-reyi kwindawo yokuma enobunzima kunye nedolo eligobileyo kwi-30°, b. I-MRI kwindawo kunye nedolo eligobileyo kwi-30°. I-L1 yi-angle yokuthambekela kwe-patellar, engumda ukusuka kwindawo esezantsi yomphezulu we-patellofemoral ukuya kwi-angle ephezulu yangaphambili ye-tibial plateau contour, i-L2 bubude bomphezulu we-patellofemoral joint, kunye ne-Caton index = L1/L2.
I-angle ye-femoral trochlear groove kunye ne-angle ye-patellar fit (PCA) zilinganiswe nge-X-ray kunye ne-MRI: a. I-X-ray ye-Axial enedolo eligobileyo kwi-30° kwindawo yokuma yobunzima; b. I-MRI enedolo eligobileyo kwi-30°. I-angle ye-femoral trochlear groove yenziwe ngemigca emibini, eyile inqaku eliphantsi u-A le-femoral trochlear groove, inqaku eliphezulu u-C lomphezulu we-medial trochlear articular, kunye nenqaku eliphezulu u-B lomphezulu we-lateral trochlear articular. I-∠BAC yi-angle ye-femoral trochlear groove. I-angle ye-femoral trochlear groove yatsalwa kumfanekiso we-axial we-patella, kwaza kwatsalwa i-bisector AD ye-∠BAC. Emva koko kwatsalwa umgca othe tye u-AE kwinqaku eliphantsi u-A le-femoral trochlear groove njengemvelaphi ngenqaku eliphantsi u-E le-patellar crest. I-engile ephakathi komgca othe tye we-AD kunye ne-AE (∠DAE) yi-engile ye-patellar fit.
I-X-reyi kunye ne-MRI zisetyenzisiwe ukulinganisa i-angle yokuthambeka kwepatellar (PTA): a. I-X-reyi ye-Axial kwindawo yokuma enobunzima kunye nedolo eligobileyo kwi-30°, b. I-MRI kwindawo kunye nedolo eligobileyo kwi-30°. I-angle yokuthambeka kwepatellar yi-engile ephakathi komgca odibanisa amanqaku aphezulu e-medial kunye ne-lateral femoral condyles kunye ne-transverse axis ye-patella, oko kukuthi ∠ABC.
Ii-X-raygrafi kunzima ukuzifumanisa i-CMP kumanqanaba ayo okuqala de kube kumanqanaba aphezulu, xa ukulahleka okukhulu kwe-cartilage, ukulahleka kwendawo yamalungu, kunye ne-subchondral bone sclerosis kunye notshintsho lwe-cystic lubonakala. I-Arthroscopy inokufikelela ekuxilongweni okuthembekileyo kuba ibonelela ngembonakalo entle ye-patellofemoral joint; nangona kunjalo, akukho nxibelelwano lucacileyo phakathi kobunzima be-patellar chondromalacia kunye nobungakanani beempawu. Ke ngoko, ezi mpawu akufuneki zibe luphawu lwe-arthroscopy. Ukongeza, i-arthrography, njengendlela yokuxilonga ehlaselayo kunye nendlela yokwenza izinto, isetyenziswa kuphela kumanqanaba aphezulu esi sifo. I-MRI yindlela yokuxilonga engahlaseliyo ethembisa amandla akhethekileyo okubona izilonda ze-cartilage kunye nokuphazamiseka kwangaphakathi kwe-cartilage ngaphambi kokuba ukulahleka kwe-cartilage ye-morphological kubonakale emehlweni.
IV. I-Chondromalacia patellae inokuguqulwa okanye iqhubekele kwi-patellofemoral arthritis. Unyango olusebenzayo olugcina ixesha elide kufuneka lunikwe ngokukhawuleza kwizigaba zokuqala zesifo. Ngoko ke, unyango olugcina ixesha elide luquka ntoni?
Ngokwesiqhelo kukholelwa ukuba kwinqanaba lokuqala (inqanaba loku-1 ukuya kwelesi-2), i-patellar cartilage isenako ukulungisa, kwaye unyango olusebenzayo olungenalo utyando kufuneka lwenziwe. Oku kubandakanya ikakhulu ukunciphisa umsebenzi okanye ukuphumla, kunye nokusetyenziswa kwamayeza okulwa nokuvuvukala angengo-steroidal xa kuyimfuneko. Ukongeza, izigulana kufuneka zikhuthazwe ukuba zenze umthambo phantsi kweliso logqirha wezonyango ukuze kuqiniswe izihlunu ze-quadriceps kwaye kuphuculwe uzinzo lwamalungu edolo.
Kubalulekile ukuqaphela ukuba ngexesha lokungasebenzi kakuhle, ii-braces zamadolo okanye ii-orthoses zamadolo zihlala zinxitywa, kwaye ukufakwa kweplasta kuyathintelwa kangangoko kunokwenzeka, njengoko kunokukhokelela ekulimaleni kwe-articular cartilage; nangona unyango lokuvimba lunokuphelisa iimpawu, ii-hormone akufanele zisetyenziswe okanye zisetyenziswe kancinci, njengoko zithintela ukwenziwa kwee-glycoproteins kunye ne-collagen kwaye zichaphazela ukulungiswa kwe-cartilage; xa ukudumba kwamalungu kunye nentlungu zisiba mandundu ngequbuliso, kunokusetyenziswa ii-ice compresses, kwaye unyango lomzimba kunye nee-compresses ezifudumeleyo zinokusetyenziswa emva kweeyure ezingama-48.
V. Kwizigulane ezikwinqanaba lokugqibela, amandla okulungisa i-articular cartilage ayancipha, ngoko ke unyango oluhlala lusetyenziswa alusebenzi kwaye kufuneka unyango lotyando. Luquka ntoni unyango lotyando?
Iimpawu zotyando ziquka: emva kweenyanga ezininzi zonyango olungqongqo olugcina imizimba, iintlungu zepatellar zisekhona; ukuba kukho ukukhubazeka kokuzalwa okanye okufunyenweyo, unyango lotyando lunokuqwalaselwa. Ukuba kwenzeka umonakalo we-cartilage e-Outerbridge III-IV, isiphene asinakuze sizaliswe yi-cartilage yokwenyani. Okwangoku, ukucheba nje indawo yomonakalo we-cartilage ngokugqithisa okungapheliyo akunakuthintela inkqubo yokuwohloka komphezulu we-articular.
Iindlela zotyando ziquka:
(1) Utyando lwe-arthroscopic yenye yeendlela ezisebenzayo zokuxilonga nokunyanga i-chondromalacia patella. Lunokubona ngokuthe ngqo utshintsho kumphezulu we-cartilage phantsi kwe-microscope. Kwiimeko ezincinci, izilonda ezincinci zokukhukuliseka kwi-cartilage ye-patellar articular zinokukrwelwa ukuze kuphuculwe ukulungiswa.
(2) ukuphakama kwe-lateral femoral condyle; (3) ukususwa komphezulu we-patellar cartilage. Olu tyando lwenziwa kwizigulana ezinomonakalo omncinci we-cartilage ukukhuthaza ukulungiswa kwe-cartilage; (4) ukususwa kwe-patellar patellar kwenziwa kwizigulana ezinomonakalo omkhulu kumphezulu we-cartilage ye-patellar.
Ixesha leposi: Novemba-15-2024
