Patella, yemwe amadziwika kuti kneecap, ndi fupa la sesamoid lomwe limapangidwa mu quadriceps tendon komanso ndilo lalikulu kwambiri la sesamoid m'thupi. Ndi lathyathyathya komanso ngati mapira, lomwe lili pansi pa khungu ndipo ndi losavuta kumva. Fupalo ndi lalikulu pamwamba ndi loloza pansi, kutsogolo kwake ndi losalala komanso losalala. Ikhoza kusuntha mmwamba ndi pansi, kumanzere ndi kumanja, ndikuteteza bondo. Kumbuyo kwa patella ndi kosalala ndipo kumakutidwa ndi chichereŵechereŵe, kugwirizanitsa ndi patellar pamwamba pa femur. Kutsogolo kumakhala koyipa, ndipo tendon ya quadriceps imadutsamo.
Patellar chondromalacia ndi matenda ofala a mawondo. Kale, matendawa anali ofala kwa anthu azaka zapakati komanso okalamba. Tsopano, ndi kutchuka kwa masewera ndi kulimbitsa thupi, matendawa amakhalanso ndi chiwerengero chachikulu cha achinyamata.
I. Kodi tanthauzo lenileni komanso chifukwa cha chondromalacia patella ndi chiyani?
Chondromalacia patellae (CMP) ndi matenda a patellofemoral osteoarthritis omwe amayamba chifukwa cha kuwonongeka kosatha kwa patellar cartilage pamwamba, zomwe zimayambitsa kutupa kwa cartilage, kusweka, kusweka, kukokoloka, ndi kukhetsa. Pomaliza, chosiyana cha femoral condyle cartilage chimakhalanso ndi kusintha komweko. Tanthauzo lenileni la CMP ndi: pali kusintha kwa pathological kwa patellar cartilage softening, ndipo panthawi imodzimodziyo, pali zizindikiro ndi zizindikiro monga kupweteka kwa patellar, phokoso la phokoso la patellar, ndi quadriceps atrophy.
Popeza kuti cartilage ya articular ilibe mitsempha yosungiramo mitsempha, njira ya ululu wa chondromalacia sichidziwikabe. CMP ndi zotsatira za kuphatikizika kwa zinthu zingapo. Zinthu zosiyanasiyana zomwe zimayambitsa kusintha kwa kupanikizika kwa patellofemoral ndi zifukwa zakunja, pamene machitidwe a autoimmune, cartilage dystrophy, ndi kusintha kwa intraosseous pressure ndi zifukwa zamkati za chondromalacia patellae.
II.Chofunika kwambiri cha chondromalacia patellae ndi kusintha kwapadera kwa matenda. Kotero kuchokera kumalingaliro a kusintha kwa pathological, kodi chondromalacia patellae imayikidwa bwanji?
Insall anafotokoza magawo anayi pathological CMP: siteji I ndi chichereŵechereŵe kufewetsa chifukwa cha edema, siteji II ndi chifukwa cha ming'alu m`dera anafewetsa, siteji III ndi kugawanika articular chichereŵechereŵe; Gawo IV limatanthawuza kusintha kwa mafupa a osteoarthritis ndi kuwonekera kwa fupa la subchondral pamwamba pa articular.
Dongosolo la grading la Outerbridge ndilothandiza kwambiri pakuwunika zotupa za patellar articular cartilage poyang'ana mwachindunji kapena arthroscopy. Dongosolo la Outerbridge grading ndi motere:
Kalasi Yoyamba: Chiwombankhanga chokhacho chimakhala chofewa (kutsekedwa kwa cartilage kufewetsa). Izi nthawi zambiri zimafuna mayankho okhudzidwa ndi kafukufuku kapena chida china kuti awunike.
Gulu II: Zowonongeka pang'ono zosapitirira 1.3 cm (0.5 mu) m'mimba mwake kapena kufika ku fupa la subchondral.
Gulu lachitatu: Mphuno ya cartilage ndi yaikulu kuposa 1.3 cm (1/2 inchi) m'mimba mwake ndipo imafikira ku fupa la subchondral.
Gulu IV: Kuwonekera kwa mafupa a subchondral.
III. Ma pathology ndi ma grading amawonetsa chiyambi cha chondromalacia patella. Ndiye ndi zizindikiro ziti zomwe zili zofunika kwambiri komanso zowunikira kuti muzindikire chondromalacia patella?
Matendawa makamaka amachokera ku ululu kumbuyo kwa patella, zomwe zimayambitsidwa ndi kuyesa kwa patellar kugaya ndi kuyesa kwa mwendo umodzi wa squat. Cholinga chiyenera kukhala pakusiyanitsa ngati pali kuvulala kwa meniscus ndi nyamakazi yowopsya. Komabe, palibe mgwirizano pakati pa kuuma kwa patellar chondromalacia ndi zizindikiro zachipatala za matenda a anterior mawondo. MRI ndi njira yolondola yodziwira matenda.
Chizindikiro chofala kwambiri ndi ululu wopweteka kumbuyo kwa patella ndi mkati mwa bondo, zomwe zimapweteka pambuyo pochita khama kapena kukwera kapena kutsika masitepe.
Kuwunika kwakuthupi kumawonetsa chikondi chodziwikiratu mu patella, peripatella, patellar margin ndi posterior patella, zomwe zimatha kutsagana ndi kupweteka kwa patellar sliding ndi phokoso la phokoso la patellar. Pakhoza kukhala mgwirizano wa effusion ndi quadriceps atrophy. Pazovuta kwambiri, kupindika kwa mawondo ndi kutambasula kumakhala kochepa ndipo wodwalayo sangathe kuyima pa mwendo umodzi. Panthawi yoyezetsa kupanikizika kwa patellar, pali ululu waukulu kumbuyo kwa patella, kusonyeza kuwonongeka kwa patellar articular cartilage, komwe kuli kofunika kwambiri. Mayeso owopsa nthawi zambiri amakhala abwino, ndipo mayeso a squat amakhala abwino. Pamene bondo likugwedezeka 20 ° mpaka 30 °, ngati kayendetsedwe ka mkati ndi kunja kwa patella kumaposa 1/4 ya m'mimba mwake ya patella, zimasonyeza patellar subluxation. Kuyeza mbali ya Q ya 90 ° kupindika kwa bondo kumatha kuwonetsa njira yachilendo ya patellar.
Kufufuza kothandiza kodalirika kwambiri ndi MRI, yomwe yasintha pang'onopang'ono m'malo mwa arthroscopy ndikukhala njira yosasokoneza komanso yodalirika ya CMP. Mayeso oyerekeza amayang'ana kwambiri pazigawo izi: kutalika kwa patellar (Caton index, PH), femoral trochlear groove angle (FTA), lateral surface ratio of femoral trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), yomwe PH, PCA, ndi PTA ndizodalirika zodziwika bwino za mawondo a CMP.
X-ray ndi MRI zinagwiritsidwa ntchito poyeza kutalika kwa patellar (Caton index, PH): a. Axial X-ray poyima ponyamula kulemera ndi bondo lopindika pa 30°, b. MRI pa malo ndi bondo kusinthasintha pa 30 °. L1 ndi mbali ya patellar inclination angle, yomwe ndi mtunda wochokera kumalo otsika kwambiri a patellofemoral joint surface kupita kumtunda wapamwamba kwambiri wa tibial plateau contour, L2 ndi kutalika kwa patellofemoral joint surface, ndi Caton index = L1 / L2.
Femoral trochlear groove angle ndi patellar fit angle (PCA) adayesedwa ndi X-ray ndi MRI: a. Axial X-ray yokhala ndi bondo lopindika pa 30 ° poyima molemera; b. MRI yokhala ndi bondo lopindika pa 30 °. Femoral trochlear groove angle ili ndi mizere iwiri, yomwe ndi malo otsika kwambiri A a femoral trochlear groove, malo okwera kwambiri C apakati apakati a trochlear articular surface, ndi malo apamwamba kwambiri B a lateral trochlear articular surface. ∠BAC ndi femoral trochlear groove angle. Femoral trochlear groove angle idajambulidwa pa chithunzi cha axial cha patella, kenako bisector AD ya ∠BAC idajambulidwa. Kenako mzere wowongoka wa AE udakokedwa kuchokera kumunsi kwambiri A wa femoral trochlear groove monga chiyambi kudzera pamunsi kwambiri E wa patellar crest. Ngodya yomwe ili pakati pa mzere wowongoka wa AD ndi AE (∠DAE) ndi ngodya yokwanira ya patellar.
X-ray ndi MRI anagwiritsidwa ntchito kuyeza patellar tilt angle (PTA): a. Axial X-ray poyima ponyamula kulemera ndi bondo lopindika pa 30°, b. MRI pa malo ndi bondo kusinthasintha pa 30 °. Kupendekeka kwa patellar ndi kolowera pakati pa mzere wolumikiza nsonga zapamwamba kwambiri za ma condyle apakati ndi am'mbali mwachikazi ndi axis yopingasa ya patella, mwachitsanzo ∠ABC.
Ma Radiographs ndi ovuta kuzindikira CMP kumayambiriro kwake mpaka kupititsa patsogolo, pamene kutayika kwakukulu kwa cartilage, kutaya malo olowa, ndi subchondral bone sclerosis ndi kusintha kwa cystic kumaonekera. Arthroscopy imatha kupeza chidziwitso chodalirika chifukwa imapereka chithunzithunzi chabwino kwambiri cha mgwirizano wa patellofemoral; komabe, palibe mgwirizano womveka bwino pakati pa kuopsa kwa patellar chondromalacia ndi mlingo wa zizindikiro. Choncho, zizindikirozi siziyenera kukhala chizindikiro cha arthroscopy. Kuphatikiza apo, arthrography, monga njira yodziwira matenda komanso njira yodziwira, nthawi zambiri imagwiritsidwa ntchito m'magawo apamwamba a matendawa. MRI ndi njira yodziwira matenda omwe amalonjeza kuti ali ndi luso lapadera lozindikira zilonda za cartilage komanso kuwonongeka kwa mkati mwa cartilage pamaso pa morphological cartilage imfa ikuwonekera ndi maso.
IV. Chondromalacia patellae ikhoza kusinthidwa kapena ikhoza kupita ku nyamakazi ya patellofemoral. Thandizo lothandiza lokhazikika liyenera kuperekedwa mwamsanga kumayambiriro kwa matendawa. Ndiye, kodi chithandizo chanthawi zonse chimaphatikizapo chiyani?
Ambiri amakhulupirira kuti kumayambiriro (siteji I mpaka II), patellar cartilage ikadali ndi mphamvu yokonzanso, ndipo chithandizo chopanda opaleshoni chiyenera kuchitidwa. Izi makamaka zikuphatikizapo kuletsa zochita kapena kupuma, komanso kugwiritsa ntchito mankhwala osagwiritsa ntchito steroidal odana ndi kutupa pakafunika. Kuonjezera apo, odwala ayenera kulimbikitsidwa kuchita masewera olimbitsa thupi moyang'aniridwa ndi dokotala kuti alimbitse minofu ya quadriceps ndikulimbikitsa kukhazikika kwa mawondo.
Ndikoyenera kudziwa kuti panthawi yopumula, mawondo a mawondo kapena mawondo a mawondo nthawi zambiri amavala, ndipo kukonza pulasitala kumapewedwa momwe zingathere, chifukwa kungayambitse kuvulaza kwa cartilage; ngakhale mankhwala oletsa blockade amatha kuthetsa zizindikiro, mahomoni sayenera kugwiritsidwa ntchito kapena kugwiritsidwa ntchito mochepa, chifukwa amalepheretsa kaphatikizidwe ka glycoproteins ndi collagen ndipo amakhudza kukonzanso kwa cartilage; pamene kutupa kwa mafupa ndi kupweteka kwadzidzidzi kumawonjezereka, ma compresses a ayezi amatha kuikidwa, ndipo chithandizo chamankhwala ndi kukakamiza kutentha kungagwiritsidwe ntchito patatha maola 48.
V. Odwala ochedwa, mphamvu yokonzanso ya cartilage ya articular imakhala yochepa, choncho chithandizo chodziletsa nthawi zambiri sichigwira ntchito ndipo chithandizo cha opaleshoni chimafunika. Kodi chithandizo cha opaleshoni chimaphatikizapo chiyani?
Zizindikiro za opaleshoni zikuphatikizapo: pambuyo pa miyezi ingapo ya chithandizo chokhazikika, kupweteka kwa patellar kudakalipo; ngati pali congenital kapena kupeza chilema, chithandizo cha opaleshoni chingaganizidwe. Ngati kuwonongeka kwa cartilage ya Outerbridge III-IV kumachitika, chilemacho sichingadzazidwe ndi cartilage yeniyeni yeniyeni. Panthawiyi, kungometa malo owonongeka a cartilage ndi kulemetsa kosatha sikungalepheretse njira yowonongeka kwa articular.
Njira za opaleshoni zikuphatikizapo:
(1)Opaleshoni ya Arthroscopic ndi imodzi mwa njira zothandiza zodziwira ndi kuchiza chondromalacia patella. Ikhoza kuona mwachindunji kusintha kwa chichereŵechereŵe pansi pa microscope. Munthawi yochepa, zotupa zazing'ono zakukokoloka kwa patellar articular cartilage zimatha kukwapulidwa kuti zithandizire kukonza.
(2) lateral femoral condyle kukwera; (3) patellar cartilage pamwamba resection. Opaleshoniyi imachitidwa kwa odwala omwe ali ndi vuto laling'ono la cartilage kuti alimbikitse kukonza kwa cartilage; (4) patellar resection imachitidwa kwa odwala omwe ali ndi kuwonongeka kwakukulu kwa patellar cartilage pamwamba.
Nthawi yotumiza: Nov-15-2024
