Patella, yomwe imadziwika kuti kneecap, ndi fupa la sesamoid lomwe limapangidwa mu tendon ya quadriceps ndipo ndi fupa lalikulu kwambiri la sesamoid m'thupi. Ndi lathyathyathya komanso looneka ngati mapira, lomwe lili pansi pa khungu ndipo ndi losavuta kumva. Fupalo ndi lalikulu pamwamba ndipo limayang'ana pansi, ndi kutsogolo kolimba komanso kumbuyo kosalala. Limatha kuyenda mmwamba ndi pansi, kumanzere ndi kumanja, ndipo limateteza bondo. Kumbuyo kwa patella ndi kosalala ndipo kuli ndi cartilage, yolumikizana ndi pamwamba pa patellar ya femur. Kutsogolo ndi kolimba, ndipo tendon ya quadriceps imadutsamo.
Patellar chondromalacia ndi matenda ofala kwambiri a bondo. Kale, matendawa anali ofala kwambiri kwa anthu azaka zapakati komanso okalamba. Tsopano, chifukwa cha kufalikira kwa masewera ndi masewera olimbitsa thupi, matendawa alinso ndi chiwerengero chachikulu cha achinyamata.
I. Kodi tanthauzo lenileni ndi chifukwa cha chondromalacia patella ndi chiyani?
Chondromalacia patellae (CMP) ndi matenda a mafupa a patellofemoral omwe amayamba chifukwa cha kuwonongeka kosatha kwa pamwamba pa cartilage ya patellar, zomwe zimapangitsa kuti cartilage itukuke, isweke, isweke, ikukokoloka, ndi kutuluka. Pomaliza, cartilage yotsutsana ndi femoral condyle cartilage imakumananso ndi kusintha komweko kwa matendawa. Tanthauzo lenileni la CMP ndi: pali kusintha kwa pathological kwa patellar cartilage yofewa, ndipo nthawi yomweyo, pali zizindikiro monga kupweteka kwa patellar, phokoso la patellar friction, ndi quadriceps atrophy.
Popeza kuti cartilage ya articular ilibe mitsempha yosungiramo mitsempha, njira ya ululu yomwe imachitika chifukwa cha chondromalacia siikudziwikabe. CMP ndi zotsatira za zotsatira za zinthu zosiyanasiyana. Zinthu zosiyanasiyana zomwe zimayambitsa kusintha kwa kuthamanga kwa magazi a patellofemoral ndi zomwe zimayambitsa zakunja, pomwe zochita za autoimmune, cartilage dystrophy, ndi kusintha kwa kuthamanga kwa magazi ndi zomwe zimayambitsa chondromalacia patellae mkati.
II. Chinthu chofunika kwambiri pa chondromalacia patellae ndi kusintha kwa matenda. Chifukwa chake, potengera kusintha kwa matenda, kodi chondromalacia patellae imawerengedwa bwanji?
Insall anafotokoza magawo anayi a matenda a CMP: gawo loyamba ndi kufewetsa kwa cartilage komwe kumachitika chifukwa cha kutupa, gawo lachiwiri ndi chifukwa cha ming'alu m'dera lofewa, gawo lachitatu ndi kugawikana kwa cartilage ya articular; gawo lachinayi limatanthauza kusintha kowononga kwa osteoarthritis ndi kupezeka kwa fupa la subchondral pamwamba pa articular.
Dongosolo lowunikira la Outerbridge ndilothandiza kwambiri poyesa zilonda za patellar articular cartilage pogwiritsa ntchito mawonekedwe owonekera kapena arthroscopy. Dongosolo lowunikira la Outerbridge ndi ili:
Giredi I: Kanyama ka articular cartilage kokha ndi komwe kamafewa (kufewetsa kanyama ka articular cartilage). Izi nthawi zambiri zimafuna kuyankha kogwira mtima pogwiritsa ntchito probe kapena chida china chowunikira.
Giredi II: Zofooka zokhuthala pang'ono zosapitirira 1.3 cm (0.5 in) m'mimba mwake kapena kufika pa fupa la subchondral.
Giredi III: Mng'alu wa cartilage ndi waukulu kuposa 1.3 cm (1/2 inchi) m'mimba mwake ndipo umafikira ku fupa la subchondral.
Kalasi IV: Kupezeka kwa mafupa a subchondral.
III. Matenda ndi kusanthula zonse zimasonyeza kufunika kwa chondromalacia patella. Ndiye zizindikiro ndi mayeso ofunika kwambiri odziwira chondromalacia patella ndi ziti?
Matendawa amachokera makamaka pa ululu womwe umabwera chifukwa cha patella, womwe umayamba chifukwa cha mayeso opukutira patellar ndi mayeso opukutira mwendo umodzi. Cholinga chachikulu chiyenera kukhala kudziwa ngati pali kuvulala kwa meniscus ndi nyamakazi yoopsa. Komabe, palibe mgwirizano pakati pa kuopsa kwa patellar chondromalacia ndi zizindikiro zachipatala za matenda a ululu wa bondo la anterior. MRI ndi njira yolondola kwambiri yodziwira matenda.
Chizindikiro chofala kwambiri ndi ululu wosawoneka bwino kumbuyo kwa patella ndi mkati mwa bondo, womwe umakula kwambiri mukachita masewera olimbitsa thupi kapena kukwera kapena kutsika masitepe.
Kuwunika thupi kumasonyeza kuuma koonekera bwino kwa patella, peripatella, patellar m'mphepete ndi posterior patella, komwe kungaphatikizepo kupweteka kwa patellar sliding ndi phokoso la patellar friction. Pakhoza kukhala effusion ya mafupa ndi quadriceps atrophy. Pazochitika zazikulu, kupindika kwa bondo ndi kutambasuka kumakhala kochepa ndipo wodwalayo sangathe kuyimirira pa mwendo umodzi. Pa mayeso a patellar compression, pamakhala ululu waukulu kumbuyo kwa patella, kusonyeza kuwonongeka kwa cartilage ya patellar articular, komwe ndikofunikira kwambiri pozindikira. Mayeso owopsa nthawi zambiri amakhala abwino, ndipo mayeso a squat amakhala abwino. Bondo likapindika 20° mpaka 30°, ngati kuyenda kwamkati ndi kunja kwa patella kukuposa 1/4 ya m'mimba mwake wopingasa wa patella, kumasonyeza kuti patellar subluxation ndi yolakwika. Kuyeza ngodya ya Q ya kupindika kwa bondo la 90° kungasonyeze njira yosazolowereka yoyendera patellar.
Kuyezetsa kodalirika kwambiri ndi MRI, komwe pang'onopang'ono kwalowa m'malo mwa arthroscopy ndipo kwakhala njira yosavulaza komanso yodalirika ya CMP. Kuyezetsa zithunzi kumayang'ana kwambiri magawo awa: kutalika kwa patellar (Caton index, PH), ngodya ya femoral trochlear groove (FTA), chiŵerengero cha pamwamba cha femoral trochlear (SLFR), ngodya ya patellar fit (PCA), ngodya ya patellar tilt (PTA), yomwe PH, PCA, ndi PTA ndi magawo odalirika a bondo kuti azindikire CMP yoyambirira.
X-ray ndi MRI zinagwiritsidwa ntchito poyesa kutalika kwa patellar (Caton index, PH): a. Axial X-ray poyimirira ndi bondo lopindika pa 30°, b. MRI poyimirira ndi bondo lopindika pa 30°. L1 ndi ngodya ya patellar intensity, yomwe ndi mtunda wochokera pa malo otsika kwambiri a patellofemoral joint surface kupita ku anterior superior angle ya tibial plateau contour, L2 ndi kutalika kwa malo a patellofemoral joint surface, ndipo Caton index = L1/L2.
Ngodya ya trochlear groove ndi ngodya ya patellar fit (PCA) zinayesedwa ndi X-ray ndi MRI: a. X-ray ya axial yokhala ndi bondo lopindika pa 30° pamalo oyimirira olemera; b. MRI yokhala ndi bondo lopindika pa 30°. Ngodya ya trochlear groove ya femoral imapangidwa ndi mizere iwiri, yomwe ndi mfundo yotsika kwambiri A ya trochlear groove ya femoral, mfundo yayikulu kwambiri C ya pamwamba pa trochlear articular, ndi mfundo yayikulu kwambiri B ya pamwamba pa trochlear articular. ∠BAC ndi ngodya ya trochlear groove ya femoral. Ngodya ya trochlear groove ya femoral inajambulidwa pachithunzi cha axial cha patella, kenako bisector AD ya ∠BAC inajambulidwa. Kenako mzere wolunjika AE unatengedwa kuchokera ku mfundo yotsika kwambiri A ya trochlear groove ya femoral monga chiyambi kudzera mu mfundo yotsika kwambiri E ya patellar crest. Ngodya pakati pa mzere wolunjika AD ndi AE (∠DAE) ndi ngodya yoyenerera ya patellar.
X-ray ndi MRI zinagwiritsidwa ntchito poyesa ngodya yozungulira ya patellar tilt (PTA): a. X-ray ya axial mu malo oyimirira olemera ndi bondo lopindika pa 30°, b. MRI mu malo ndi bondo lopindika pa 30°. Ngodya yozungulira ya patellar ndi ngodya pakati pa mzere wolumikiza mfundo zapamwamba kwambiri za medial ndi lateral femoral condyles ndi transverse axis ya patella, mwachitsanzo ∠ABC.
Ma X-ray ndi ovuta kuzindikira CMP kumayambiriro kwake mpaka magawo apamwamba, pomwe kutayika kwakukulu kwa cartilage, kutayika kwa malo olumikizirana mafupa, ndi subchondral bone sclerosis ndi kusintha kwa cystic kumaonekera. Arthroscopy imatha kupeza matenda odalirika chifukwa imapereka chithunzi chabwino kwambiri cha patellofemoral joint; komabe, palibe mgwirizano womveka bwino pakati pa kuopsa kwa patellar chondromalacia ndi kuchuluka kwa zizindikiro. Chifukwa chake, zizindikirozi siziyenera kukhala chizindikiro cha arthroscopy. Kuphatikiza apo, arthrography, monga njira yodziwira matenda komanso njira yodziwira matenda, nthawi zambiri imagwiritsidwa ntchito pokhapokha magawo apamwamba a matendawa. MRI ndi njira yodziwira matenda yosalowerera yomwe imalonjeza kuthekera kwapadera kozindikira zilonda za cartilage komanso kusokonekera kwa mkati mwa cartilage isanawonekere ndi maso.
IV. Chondromalacia patellae ikhoza kuchiritsidwa kapena ikhoza kupitirira kukhala patellofemoral arthritis. Chithandizo chogwira mtima chosamalira chiyenera kuperekedwa mwachangu kumayambiriro kwa matendawa. Ndiye, kodi chithandizo chosamalira chimaphatikizapo chiyani?
Kawirikawiri amakhulupirira kuti kumayambiriro (gawo loyamba mpaka lachiwiri), cartilage ya patellar imakhalabe ndi mphamvu yokonzanso, ndipo chithandizo chogwira ntchito chopanda opaleshoni chiyenera kuchitidwa. Izi zikuphatikizapo kuchepetsa zochita kapena kupuma, komanso kugwiritsa ntchito mankhwala oletsa kutupa osagwiritsa ntchito steroidal ngati pakufunika kutero. Kuphatikiza apo, odwala ayenera kulimbikitsidwa kuchita masewera olimbitsa thupi moyang'aniridwa ndi katswiri wothandiza thupi kuti alimbikitse minofu ya quadriceps ndikuwonjezera kukhazikika kwa bondo.
Ndikofunika kudziwa kuti panthawi yoletsa kuyenda, zomangira mawondo kapena zomangira mawondo nthawi zambiri zimavalidwa, ndipo kuyika pulasitala kumapewedwa momwe zingathere, chifukwa kungayambitse kuvulala kwa cartilage ya articular; ngakhale kuti mankhwala oletsa amatha kuchepetsa zizindikiro, mahomoni sayenera kugwiritsidwa ntchito kapena kugwiritsidwa ntchito pang'ono, chifukwa amaletsa kupanga ma glycoprotein ndi collagen ndikukhudza kukonzanso cartilage; pamene kutupa ndi ululu wa mafupa zikuipiraipira mwadzidzidzi, kukanikiza ayezi kungagwiritsidwe ntchito, ndipo chithandizo chamankhwala ndi zomangira zofunda zitha kugwiritsidwa ntchito patatha maola 48.
V. Kwa odwala omwe ali mu gawo lomaliza la matendawa, mphamvu yokonzanso cartilage ya articular imakhala yofooka, kotero chithandizo chokhazikika nthawi zambiri sichigwira ntchito ndipo chithandizo cha opaleshoni chimafunika. Kodi chithandizo cha opaleshoni chimaphatikizapo chiyani?
Zizindikiro za opaleshoni ndi izi: patatha miyezi ingapo ya chithandizo chokhwima, ululu wa patellar umakhalapobe; ngati pali chilema chobadwa nacho kapena chopezeka, chithandizo cha opaleshoni chingaganizidwe. Ngati kuwonongeka kwa cartilage ya Outerbridge III-IV kukuchitika, chilemacho sichingadzazidwe ndi cartilage yeniyeni ya articular. Pakadali pano, kungometa malo owonongeka a cartilage ndi overload yosatha sikungalepheretse kuwonongeka kwa articular surface.
Njira zopangira opaleshoni zikuphatikizapo:
(1) Opaleshoni ya Arthroscopic ndi njira imodzi yothandiza yodziwira ndi kuchiza chondromalacia patella. Imatha kuwona mwachindunji kusintha kwa pamwamba pa cartilage pansi pa maikulosikopu. Muzochitika zofatsa, zilonda zazing'ono zomwe zimakokoloka pa cartilage ya patellar articular zimatha kukanda kuti zikonzedwe.
(2) kukwezedwa kwa lateral femoral condyle; (3) kuchotsedwa kwa patellar cartilage pamwamba. Opaleshoni iyi imachitika kwa odwala omwe ali ndi vuto laling'ono la cartilage kuti akonzenso cartilage; (4) kuchotsedwa kwa patellar patellar patellar patellar cartilage kumachitika kwa odwala omwe ali ndi vuto lalikulu la cartilage pamwamba.
Nthawi yotumizira: Novembala-15-2024
