I-patella, eyaziwa ngokuba yi-kneecap, lithambo le-sesamoid elenziwe kwi-quadriceps tendon kwaye ikwalelona thambo le-sesamoid likhulu emzimbeni. Ithe tyaba kwaye imile okwe millet, ibekwe phantsi kwesikhumba kwaye kulula ukuyiva. Ithambo libanzi phezulu kwaye lijonge ezantsi, lirhabaxa ngaphambili kunye nomqolo ogudileyo. Iyakwazi ukunyuka phezulu nasezantsi, ekhohlo nasekunene, kwaye ikhusela idolo elihlangeneyo. Umva we-patella ugudile kwaye ugqunywe nge-cartilage, edibanisa kwi-patellar surface ye-femur. Umphambili unzima, kwaye i-tendon ye-quadriceps idlula kuyo.
I-Patellar chondromalacia sisifo esiqhelekileyo samadolo. Ngaphambili, esi sifo sasixhaphakile kubantu abaneminyaka ephakathi kunye nabantu abadala. Ngoku, ngokuthandwa kwezemidlalo kunye nokuqina, esi sifo sinezinga eliphezulu lezehlo phakathi kwabantu abatsha.
I. Iyintoni intsingiselo yokwenene kunye nembangela ye-chondromalacia patella?
I-Chondromalacia patellae (CMP) yi-patellofemoral joint osteoarthritis ebangelwa ngumonakalo ongapheliyo kwi-patellar cartilage surface, ebangela ukuvuvukala kwe-cartilage, ukuqhekeka, ukuphuka, ukuguguleka kunye nokuchithwa. Ekugqibeleni, i-condyle cartilage echasene ne-femoral nayo iphinda iphinde iphinde iphinde iphinde iphinde iphinde iguquke. Intsingiselo yangempela ye-CMP yile: kukho utshintsho lwe-pathological of patellar cartilage softening, kwaye ngelo xesha, kukho iimpawu kunye neempawu ezifana nentlungu ye-patellar, i-patellar friction sound, kunye ne-quadriceps atrophy.
Ekubeni i-articular cartilage ayinayo i-nerve innervation, indlela yeentlungu ezibangelwa yi-chondromalacia ayikacaci. I-CMP sisiphumo semiphumo edibeneyo yezinto ezininzi. Izinto ezahlukahlukeneyo ezibangela ukuba utshintsho kwixinzelelo lwe-patellofemoral luyimbangela yangaphandle, ngelixa ukuphendulwa kwe-autoimmune, i-cartilage dystrophy, kunye nokutshintsha kwengcinezelo ye-intraosseous yizizathu zangaphakathi ze-chondromalacia patellae.
II.Into ebaluleke kakhulu ye-chondromalacia patellae yinguqu ethile ye-pathological. Ngoko kwimbono yotshintsho lwe-pathological, i-chondromalacia patellae ihlelwa njani?
I-Insall ichaze izigaba ezine ze-pathological ze-CMP: inqanaba I ukuthamba kwe-cartilage okubangelwa yi-edema, isigaba se-II sibangelwa kukuqhekeka kwendawo ethambileyo, isigaba se-III kukuqhekeka kwe-articular cartilage; Inqanaba IV libhekiselele kutshintsho olwenzekayo lwe-osteoarthritis kunye nokuvezwa kwethambo le-subchondral kumphezulu we-articular.
Inkqubo yokuhlelwa kwe-Outerbridge yeyona nto iluncedo ekuvavanyeni izilonda ze-patellar articular cartilage phantsi kokubonwa ngokuthe ngqo okanye i-arthroscopy. Inkqubo yokuhlela ye-Outerbridge imi ngolu hlobo lulandelayo:
IBakala I: Kuphela i-articular cartilage ethambileyo (i-closed cartilage softening). Oku kudla ngokufuna impendulo ebambekayo kunye neprobe okanye esinye isixhobo sokuvavanya.
IBakala II: Iziphene ezinobunzima obungadluli kwi-1.3 cm (0.5 in) ububanzi okanye ukufikelela kwithambo le-subchondral.
IBakala III: I-cartilage fissure inkulu kune-1.3 cm (1/2 intshi) ububanzi kwaye idlulela kwithambo le-subchondral.
IBakala IV: I-Subchondral bone exposure.
III. Zombini i-pathology kunye nokuhlelwa kubonakalisa undoqo we-chondromalacia patella. Ngoko ke zeziphi iimpawu ezinentsingiselo kunye neemviwo zokuxilonga i-chondromalacia patella?
Ukuxilongwa ngokuyinhloko kusekelwe kwintlungu emva kwepatella, ebangelwa uvavanyo lokugaya i-patellar kunye novavanyo lwe-squat yomlenze omnye. Ugxininiso kufuneka lube kukwahlula ukuba kukho ukulimala kwe-meniscus edibeneyo kunye nesifo samathambo. Nangona kunjalo, akukho kulungelelaniswa phakathi kobunzima be-patellar chondromalacia kunye neempawu zekliniki ze-syndrome ye-knee yangaphambili. I-MRI yindlela echanekileyo yokuxilonga.
Olona phawu luxhaphakileyo ziintlungu ezibuhlungu emva kwepatella nangaphakathi edolweni, ezithi zibe mandundu emva kokuzibhokoxa okanye ukunyuka okanye ukuhla ngezinyuko.
Uvavanyo lomzimba lubonisa ububele obucacileyo kwi-patella, i-peripatella, i-patellar margin kunye ne-patella yangasemva, enokuthi ihambe kunye neentlungu ze-patellar sliding kunye nesandi se-patellar friction. Kusenokubakho ukudityaniswa ngokudibeneyo kunye ne-quadriceps atrophy. Kwiimeko ezinzima, ukuguqa kwamadolo kunye nokwandiswa kulinganiselwe kwaye isigulane asikwazi ukuma emlenzeni omnye. Ngethuba lovavanyo lokunyanzeliswa kwe-patellar, kukho intlungu ebuhlungu emva kwe-patella, ebonisa umonakalo we-patellar articular cartilage, okubaluleka kokuxilonga. Uvavanyo loloyiko luhlala lubonisa ukuba unayo, kwaye uvavanyo lwe-squat lubonisa ukuba unayo. Xa idolo liguquguquka kwi-20 ° ukuya kwi-30 °, ukuba uluhlu lwentshukumo yangaphakathi nangaphandle ye-patella idlula i-1/4 yobubanzi obunqamlekileyo be-patella, ibonisa i-patellar subluxation. Ukulinganisa i-angle ye-Q ye-90 ° ukuguqa kwamadolo kunokubonisa indlela engaqhelekanga ye-patellar movement trajectory.
Olona vavanyo lokuncedisa oluthembekileyo yi-MRI, ethe ngokuthe ngcembe yathatha indawo ye-arthroscopy kwaye yaba yindlela engabonakaliyo kwaye ethembekileyo ye-CMP. Iimviwo zokucinga zijolise ikakhulu kwezi parameters: ukuphakama kwepatellar (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), phakathi kwayo i-PH, i-PCA, kunye ne-PTA yiparamitha ye-knee ethembekileyo ye-CMP ethembekileyo.
I-X-ray kunye ne-MRI yayisetyenziselwa ukulinganisa ubude bepatellar (i-Caton index, PH): a. I-Axial X-reyi kwindawo yokuma ethwele ubunzima kunye nedolo eligobileyo kwi-30 °, b. I-MRI kwindawo enedolo eguquguqukayo kwi-30 °. I-L1 yi-angle ye-patellar inclination angle, engumgama ukusuka kwindawo ephantsi ye-patellofemoral surface joint kwi-angle yangaphambili ye-angle ephezulu ye-tibial plateau contour, i-L2 ubude bendawo edibeneyo ye-patellofemoral, kunye ne-Caton index = L1 / L2.
I-Femoral trochlear groove angle kunye ne-patellar fit angle (PCA) yalinganiswa nge-X-ray kunye ne-MRI: a. I-Axial X-ray enedolo eliguquguqukayo kwi-30 ° kwindawo yokuma ethwele ubunzima; b. I-MRI enamadolo aguquguqukayo kwi-30 °. I-engile ye-femoral trochlear groove yenziwe yimigca emibini, eyileyona ndawo isezantsi A ye-femoral trochlear groove, eyona ndawo iphakamileyo ye-C ye-medial trochlear surface articular, kunye neyona ndawo iphakamileyo ye-B ye-lateral trochlear surface articular. ∠BAC yi-engile ye-femoral trochlear groove. I-engile ye-femoral trochlear groove izotywa kumfanekiso we-axial wepatella, kwaye emva koko i-bisector AD ye-∠BAC izotywa. Emva koko umgca othe ngqo we-AE wazotywa ukusuka kwindawo ephantsi A ye-femoral trochlear groove njengemvelaphi ngeyona ndawo isezantsi E ye-patellar crest. I-engile phakathi komgca othe ngqo we-AD kunye ne-AE (∠DAE) yi-angle yokungena kwi-patellar.
I-X-ray kunye ne-MRI zazisetyenziselwa ukulinganisa i-patellar tilt angle (PTA): a. I-Axial X-reyi kwindawo yokuma ethwele ubunzima kunye nedolo eligobileyo kwi-30 °, b. I-MRI kwindawo enedolo eguquguqukayo kwi-30 °. I-patellar tilt angle yi-engile ephakathi komgca odibanisa iindawo eziphezulu ze-medial kunye ne-lateral femoral condyles kunye ne-axis enqamlezayo ye-patella, okt ∠ABC.
I-Radiographs inzima ukuxilonga i-CMP kumanqanaba ayo okuqala kude kube yizigaba eziphambili, xa ukulahleka kwe-cartilage ebanzi, ukulahlekelwa kwendawo edibeneyo, kunye ne-subchondral bone sclerosis kunye noshintsho lwe-cystic lubonakala. I-arthroscopy inokufezekisa ukuxilongwa okuthembekileyo kuba ibonelela ngokubonakalayo okugqwesileyo kwe-patellofemoral joint; nangona kunjalo, akukho kulungelelaniswa okucacileyo phakathi kobunzima be-patellar chondromalacia kunye neqondo leempawu. Ngoko ke, ezi zibonakaliso akufanele zibe ngumqondiso we-arthroscopy. Ukongezelela, i-arthrography, njengendlela yokuxilongwa kwe-invasive kunye ne-modality, ngokuqhelekileyo isetyenziswa kuphela kwizigaba eziphambili zesifo. I-MRI yindlela yokuxilonga engabonakaliyo ethembisa amandla ayingqayizivele okubona izilonda ze-cartilage kunye nokuphazamiseka kwangaphakathi kwe-cartilage ngaphambi kokuba ukulahleka kwe-cartilage ye-morphological kubonakala kwiso lenyama.
IV. I-Chondromalacia patellae inokuguqulwa okanye iqhubele phambili kwi-patellofemoral arthritis. Unyango olusebenzayo olulondolozayo kufuneka lunikezwe ngokukhawuleza kwizigaba zokuqala zesifo. Ngoko ke, unyango olulondolozayo lubandakanya ntoni?
Ngokuqhelekileyo kukholelwa ukuba kwinqanaba lokuqala (inqanaba I ukuya ku-II), i-patellar cartilage isenamandla okulungisa, kwaye unyango olusebenzayo olungasebenziyo kufuneka lwenziwe. Oku kubandakanya ikakhulu uthintelo lomsebenzi okanye ukuphumla, kunye nokusetyenziswa kweziyobisi ezingekho-steroidal ezichasayo xa kuyimfuneko. Ukongezelela, izigulane kufuneka zikhuthazwe ukuba zisebenzise phantsi kweliso lonyango lomzimba ukuqinisa i-quadriceps muscle kunye nokuphucula ukuzinza kwamadolo.
Kuyafaneleka ukuba uqaphele ukuba ngexesha lokunyanzeliswa kwe-immobilization, i-knee braces okanye i-knee orthoses ngokuqhelekileyo igqitywe, kwaye ukulungiswa kwe-plaster kugwenywe kangangoko kunokwenzeka, njengoko kunokukhokelela ngokulula ekusebenziseni ukulimala kwe-articular cartilage; nangona unyango lwe-blockade lunokunciphisa iimpawu, i-hormone akufanele isetyenziswe okanye isetyenziswe ngokukhawuleza, njengoko inqanda ukuhlanganiswa kwe-glycoproteins kunye ne-collagen kwaye ichaphazela ukulungiswa kwe-cartilage; xa ukudumba kwamalungu kunye neentlungu zisiba mbi ngesiquphe, ukucinezelwa komkhenkce kunokufakwa, kwaye unyango lomzimba kunye noxinzelelo olufudumeleyo lunokusetyenziswa emva kweeyure ezingama-48.
V. Kwizigulane zasemva kwexesha, amandla okulungisa i-articular cartilage ayimbi, ngoko ke unyango olulondolozayo luhlala lungasebenzi kwaye unyango lotyando luyafuneka. Lubandakanya ntoni unyango lotyando?
Izibonakaliso zotyando ziquka: emva kweenyanga eziliqela zonyango olungqongqo, intlungu ye-patellar isekhona; ukuba kukho ukukhubazeka kokuzalwa okanye okufunyenweyo, unyango lotyando lunokuqwalaselwa. Ukuba i-Outerbridge III-IV umonakalo we-cartilage uyenzeka, i-defect ayinakuze izaliswe yi-articular cartilage yangempela. Ngeli xesha, ukucheba nje indawo yomonakalo we-cartilage kunye nokugqithiswa okungapheliyo akukwazi ukuthintela inkqubo ye-articular surface degeneration.
Iindlela zotyando ziquka:
(1) Utyando lweArthroscopic yenye yeendlela ezisebenzayo zokuxilonga kunye nokunyanga i-chondromalacia patella. Iyakwazi ukujonga ngokuthe ngqo utshintsho kwi-cartilage surface phantsi kwe-microscope. Kwiimeko ezincinci, izilonda ezincinci zokhukuliseko kwi-patellar articular cartilage zinokukhutshelwa ukukhuthaza ukulungiswa.
(2) ukuphakama kwe-condyle ye-femoral esecaleni; (3) ipatellar cartilage surface resection. Olu tyando lwenziwa kwizigulane ezinomonakalo omncinci we-cartilage ukukhuthaza ukulungiswa kwe-cartilage; (4) i-patellar resection yenziwa kwizigulane ezinomonakalo omkhulu kwi-patellar cartilage surface.
Ixesha lokuposa: Nov-15-2024
