Iyo patella, inowanzozivikanwa sekneecap, ibhonzo sesamoid rakagadzirwa mu quadriceps tendon uye zvakare ndiro hombe sesamoid bhonzo mumuviri. Iyo yakati sandara uye yakaita semhunga, iri pasi peganda uye iri nyore kunzwa. Bhonzo rakafara kumusoro uye rakanongedza pasi, riine rough kumberi uye kumashure kwakatsetseka. Inogona kufamba kumusoro uye pasi, kuruboshwe uye kurudyi, uye inodzivirira mabvi akabatanidzwa. Kumashure kwepatella kunotsvedzerera uye kwakafukidzwa neshwashwa, ichibatanidza kune patellar pamusoro pechikadzi. Kumberi kwakashata, uye quadriceps tendon inopfuura nayo.
Patellar chondromalacia chirwere chinowanzoitika mumabvi. Munguva yakapfuura, chirwere ichi chaive chakajairika muzera repakati uye vanhu vakura. Iye zvino, nekuzivikanwa kwemitambo uye kusimba, chirwere ichi chinewo chiitiko chepamusoro pakati pevechidiki.
I. Chii chinoreva chokwadi uye chikonzero chechondromalacia patella?
Chondromalacia patellae (CMP) inonzi patellofemoral joint osteoarthritis inokonzerwa nekukuvara kusingaperi kune patellar cartilage pamusoro, iyo inokonzera cartilage kuzvimba, kuputika, kuputsika, kukukurwa, uye kudurura. Pakupedzisira, iyo yakatarisana nefemoral condyle cartilage zvakare inoenda kune imwechete pathological shanduko. Chirevo chechokwadi cheCMP ndechekuti: kune pathological shanduko ye patellar cartilage softening, uye panguva imwe chete, pane zviratidzo nezviratidzo zvakadai sekurwadziwa kwe patellar, patellar friction sound, uye quadriceps atrophy.
Sezvo articular cartilage isina nerve innervation, nzira yekurwadziwa kunokonzerwa nechondromalacia haisati yanyatsojeka. CMP mhedzisiro yezvakasanganiswa mhedzisiro yezvinhu zvakawanda. Zvinhu zvakasiyana-siyana zvinokonzera kuchinja patellofemoral joint pressure ndezvikonzero zvekunze, nepo autoimmune reactions, cartilage dystrophy, uye kuchinja kwe intraosseous pressure ndezvikonzero zvemukati zvechondromalacia patellae.
II.Chinonyanya kukosha chechondromalacia patellae ndiyo chaiyo yekuchinja kwehutano. Saka kubva pakuona kwekuchinja kwechirwere, chondromalacia patellae inogadziriswa sei?
Insall yakatsanangura nhanho ina dzepathological dzeCMP: nhanho I is cartilage softening inokonzerwa ne edema, nhanho II inokonzerwa nekutsemuka munzvimbo yakanyoroveswa, nhanho III kupatsanurwa kwearticular cartilage; Nhanho IV inoreva kushanduka kweosteoarthritis uye kuratidzwa kwe subchondral bone pane articular surface.
Iyo Outerbridge grading system inonyanya kubatsira pakuongorora patellar articular cartilage maronda pasi pekuona kwakananga kana arthroscopy. Iyo Outerbridge grading system yakaita seiyi:
Giredhi I: Chete articular cartilage inopfaviswa (yakavharwa cartilage softening). Izvi zvinowanzoda tactile mhinduro ine probe kana chimwe chiridzwa chekuongorora.
Giredhi II: Kuremara kwechikamu-kurema kusingapfuure 1.3 cm (0.5 mu) mudhayamita kana kusvika kune subchondral bone.
Giredhi III: Iyo cartilage fissure yakakura kupfuura 1.3 cm (1/2 inch) muhupamhi uye inoenda kune subchondral bone.
Giredhi IV: Subchondral bone exposure.
III. Ose ari maviri pathology uye magiredhi anoratidza hunhu hwechondromalacia patella. Saka ndezvipi zvinonyanya kukosha zviratidzo uye bvunzo dzekuongorora chondromalacia patella?
Kuongororwa kunonyanya kuenderana nekurwadziwa kuseri kwepatella, iyo inokonzerwa ne patellar grinding test uye imwe-leg squat test. Chinangwa chinoda kuve pakusiyanisa kana paine kukuvara kwemeniscus uye traumatic arthritis. Zvisinei, hapana kuwirirana pakati pekuoma kwepatellar chondromalacia uye zviratidzo zvechipatara zveanterior knee pain syndrome. MRI ndiyo nzira yakarurama yekuongorora.
Chiratidzo chinonyanyozivikanwa marwadzo asinganzwisisi kuseri kwepatella uye mukati mebvi, izvo zvinowedzera mushure mekuedza kana kukwira kana kudzika masitepisi.
Kuongorora kwepanyama kunoratidza hunyoro huri pachena mupatella, peripatella, patellar margin uye posterior patella, iyo inogona kuperekedzwa nekurwadziwa kwepatellar sliding uye patellar friction sound. Panogona kuva nekubatana kwekubatana uye quadriceps atrophy. Muzviitiko zvakakomba, kuputika kwemabvi uye kuwedzerwa kunogumira uye murwere haagoni kumira pagumbo rimwe chete. Panguva yekuedza kwepa patellar compression, kune kurwadziwa kwakanyanya kuseri kwepatella, zvichiratidza patellar articular cartilage kukuvadzwa, iyo inokosha yekuongorora. Muedzo wekutya unowanzo kuve wakanaka, uye bvunzo yesquat yakanaka. Apo ibvi rinogadziriswa 20 ° kusvika ku30 °, kana huwandu hwekufamba kwemukati nekunze kwepatella hunopfuura 1/4 yehupamhi hwepakati pe patella, inoratidza patellar subluxation. Kuyera iyo Q angle ye90 ° kuchinjika kwebvi kunogona kuratidza zvisirizvo patellar kufamba trajectory.
Kuongororwa kwebetsero kwakavimbika zvikuru iMRI, iyo zvishoma nezvishoma yakatsiva arthroscopy uye ikava nzira isina-invasive uye yakavimbika yeCMP. Kufungidzira bvunzo dzinonyanya kutarisisa pane aya maparamendi: patellar urefu (Caton index, PH), femoral trochlear groove angle (FTA), lateral surface ratio yefemoral trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), pakati payo PH, PCA, uye PTA inovimbika kana CMP yemabvi akabatanidzwa parameters.
X-ray uye MRI zvakashandiswa kuyera patellar urefu (Caton index, PH): a. Axial X-ray iri pahuremu-inotakura kumira panzvimbo ine ibvi rakachinjika pa30°, b. MRI pachinzvimbo nemabvi akachinjika pa30 °. L1 ndiyo patellar inclination angle, iyo iri kureba kubva kumucheto wakaderera wepatellofemoral joint surface kusvika kune anterior superior angle ye tibial plateau contour, L2 ndiyo urefu hwepatellofemoral joint surface, uye Caton index = L1 / L2.
Femoral trochlear groove angle uye patellar fit angle (PCA) yakayerwa neX-ray uye MRI: a. Axial X-ray ine ibvi rakanyunguduka pa 30 ° munzvimbo inorema-inotakura kumira; b. MRI ine ibvi rakachinjika pa30 °. Iyo femoral trochlear groove angle inoumbwa nemitsara miviri, inova nzvimbo yakaderera A yefemoral trochlear groove, nzvimbo yepamusoro-soro C yepakati pepakati trochlear articular surface, uye yepamusoro-soro B ye lateral trochlear articular surface. ∠BAC ndiyo femoral trochlear groove angle. Iyo femoral trochlear groove angle yakadhirowewa paaxial mufananidzo wepatella, uyezve bisector AD ye∠BAC yakadhirowewa. Ipapo mutsara wakatwasuka AE wakadhirowewa kubva pazasi penzvimbo A yefemoral trochlear groove semabviro kuburikidza nenzvimbo yakaderera E ye patellar crest. Iko kona iri pakati pemutsara wakatwasuka AD neAE (∠DAE) ndiyo patellar fit angle.
X-ray uye MRI zvakashandiswa kuyera patellar tilt angle (PTA): a. Axial X-ray iri pahuremu-inotakura kumira panzvimbo ine ibvi rakachinjika pa30°, b. MRI pachinzvimbo nemabvi akachinjika pa30 °. Iyo patellar tilt angle ndiyo kona iri pakati pemutsara unobatanidza nzvimbo dzepamusoro-soro dzepakati uye lateral femoral condyles uye inochinjika axis yepatella, kureva ∠ABC.
Radiographs yakaoma kuongorora CMP mumatanho ayo ekutanga kusvika padanho repamusoro, apo yakakura kurasikirwa kwecartilage, kurasikirwa kwepajoin space, uye yakabatana subchondral bone sclerosis uye cystic shanduko inoonekwa. Arthroscopy inogona kuwana kuongororwa kwakavimbika nokuti inopa kuonekwa kwakanakisisa kwekubatana kwepatellofemoral; zvisinei, hapana kuwirirana kwakajeka pakati pekuoma kwepatellar chondromalacia uye chiyero chezviratidzo. Nokudaro, zviratidzo izvi hazvifaniri kuva chiratidzo che arthroscopy. Mukuwedzera, arthrography, senzira inoparadza yekuongorora uye maitiro, inowanzoshandiswa chete mumatanho epamusoro echirwere. MRI inzira isingasviki yekuongorora iyo inovimbisa kukwanisa kwakasiyana-siyana kuona maronda e-cartilage pamwe chete nekuputika kwemukati kwekatekete pamberi pe morphological cartilage kurasikirwa kunoonekwa kune ziso rakashama.
IV. Chondromalacia patellae inogona kuchinjwa kana inogona kufambira mberi kusvika patellofemoral arthritis. Kubudirira kwekuchengetedza kurapwa kunofanira kupiwa nekukurumidza mukutanga kwechirwere. Saka, kurapa kwekuchengetedza kunosanganisira chii?
Zvinowanzotendwa kuti padanho rekutanga (danho I kusvika II), iyo patellar cartilage ichiri kugona kugadzirisa, uye inoshanda isiri-yekuvhiya kurapwa kunofanira kuitwa. Izvi zvinonyanya kusanganisira kurambidzwa kuita basa kana kuzorora, uye kushandiswa kweasiri-steroidal anti-inflammatory drugs kana zvichidikanwa. Mukuwedzera, varwere vanofanira kukurudzirwa kurovedza muviri pasi pekutariswa kwechiremba wepanyama kusimbisa mutsara we quadriceps uye kuwedzera kugadzikana kwemabvi.
Zvakakosha kucherechedza kuti panguva yekusagadzikana, mabheti emabvi kana mabvi orthoses anowanzo kupfekwa, uye kugadzirisa plaster kunodziviswa zvakanyanya sezvinobvira, sezvo zvinogona kutungamirira nyore kusashandisa kukuvara kwearticular cartilage; kunyange zvazvo blockade therapy inogona kuderedza zviratidzo, mahomoni haafaniri kushandiswa kana kushandiswa zvishoma, sezvo anodzivisa kuumbwa kweglycoproteins uye collagen uye anokanganisa kugadziriswa kwekatekete; apo kuzvimba kwemajoini uye kurwadziwa kwakangoerekana kwawedzera, mazaya echando anogona kuiswa, uye kurapwa kwemuviri uye kudziya kwekumanikidza kunogona kuiswa mushure memaawa makumi mana nemasere.
V. Mukunonoka kwevarwere, kukwanisa kugadzirisa kwe articular cartilage kwakashata, saka kurapa kwekuchengetedza kunowanzoita kusashanda uye kurapa kwekuvhiya kunodiwa. Kuvhiya kunosanganisira chii?
Zviratidzo zvekuvhiyiwa zvinosanganisira: mushure memwedzi yakawanda yekurapa kwakasimba kwekuchengetedza, kurwadziwa kwepatellar kuripo; kana pane kuberekwa kana kuwanikwa kuremara, kurapwa kwekuvhiya kunogona kufungwa. Kana Outerbridge III-IV cartilage kukuvara kukaitika, chirema hachingambozadzwa nechaiyo articular cartilage. Panguva ino, kungoveura nzvimbo yekukuvara kwecartilage nekuremerwa kusingaperi hakugone kudzivirira nzira yekuderera kwearticular surface.
Nzira dzekuvhiya dzinosanganisira:
(1) Kuvhiyiwa kweArthroscopic ndiyo imwe yenzira dzinoshanda dzekuongorora nekurapa chondromalacia patella. Inogona kuona zvakananga kuchinja kwecartilage pasi pasi pe microscope. Muzviitiko zvinyoro, maronda madiki ekukurwa pamatellar articular cartilage anogona kukweshwa kukurudzira kugadziriswa.
(2) lateral femoral condyle elevation; (3) patellar cartilage surface resection. Kuvhiyiwa uku kunoitwa kune varwere vane kukuvadzwa kwecartilage diki kukurudzira kugadziriswa kwegorofu; (4) patellar resection inoitwa kune varwere vane kukanganisa kwakanyanya kune patellar cartilage pamusoro.
Nguva yekutumira: Nov-15-2024
