Patella, inozivikanwa sekneecap, ibhonzo resamoid rakaumbwa mu quadriceps tendon uye ndiro bhonzo guru resamoid mumuviri. Rakati sandara uye rakaita semapundu, riri pasi peganda uye riri nyore kunzwa. Pfupa racho rakafara kumusoro uye rakananga pasi, riine kumberi kwakaomarara uye musana wakatsetseka. Rinogona kufamba kumusoro nekudzika, kuruboshwe nekurudyi, uye rinodzivirira mabvi. Kumashure kwepatella kwakatsetseka uye kwakafukidzwa nekartilage, richibatana nepamusoro pe patellar ye femur. Kumberi kwakaomarara, uye quadriceps tendon inopfuura nepakati paro.
Patellar chondromalacia chirwere chinowanzoonekwa mumabvi. Kare, chirwere ichi chaiwanzoonekwa muvanhu vane makore epakati nepakati nevakwegura. Iye zvino, nekufarirwa kwava kuitwa mumitambo nekugwinya, chirwere ichi chavewo nehuwandu hwakawanda hwezvirwere pakati pevechidiki.
I. Chii chiri revo chaiyo uye chikonzero chechondromalacia patella?
Chondromalacia patellae (CMP) chirwere chemapfupa chemapfupa chepatellofemoral joint osteoarthritis chinokonzerwa nekukuvadzwa kwenguva refu kweganda remajoini, izvo zvinokonzera kuzvimba, kutsemuka, kutyoka, kukurwa, uye kubuda ropa. Pakupedzisira, boka remajoini remajoini repafemoral condyle cartilage rinosanganawo nekuchinja kwakafanana. Zvinorehwa neCMP ndezvekuti: pane kuchinja kwechirwere chekupfava kweganda remajoini, uye panguva imwe chete, pane zviratidzo zvakaita sekurwadziwa kweganda, ruzha rwekukweshana kweganda, uye quadriceps atrophy.
Sezvo tsinga dzemuviri dzisina tsinga dzinoshanda, mashandiro ekurwadziwa anokonzerwa nechondromalacia haasati ajeka. CMP imhedzisiro yemigumisiro yakabatana yezvinhu zvakawanda. Zvinhu zvakasiyana-siyana zvinokonzera shanduko mukumanikidzwa kwejoini repatellofemoral zvinokonzerwa nekunze, nepo autoimmune reactions, cartilage dystrophy, uye shanduko mukumanikidzwa kwemukati memapfupa ndizvo zvinokonzera chondromalacia patellae mukati.
II. Chinhu chinonyanya kukosha pa chondromalacia patellae kuchinja kwechirwere. Saka kubva pakuona kwekuchinja kwechirwere, chondromalacia patellae inoongororwa sei?
Insall akatsanangura matanho mana eCMP: danho rekutanga kupfava kwekatsi kunokonzerwa nekuzvimba, danho rechipiri rinokonzerwa nekutsemuka munzvimbo yakapfava, danho rechitatu kupatsanuka kwekatsi; danho rechina rinoreva kuchinja kwe osteoarthritis uye kuratidzwa kwemapfupa e subchondral pamusoro pekatsi.
Sisitimu yeOuterbridge grading system inonyanya kubatsira pakuongorora maronda e patellar articular cartilage uchishandisa direct visualization kana arthroscopy. Sisitimu yeOuterbridge grading system ndeiyi inotevera:
Giredhi I: Katsi yemukati chete ndiyo inonyoroveswa (kunyoroveswa kwekatsi yakavharwa). Izvi zvinowanzoda mhinduro yekubata neprobe kana chimwe chinhu chekuongorora.
Giredhi Rechipiri: Kukanganisika kwechikamu chekukora kusingapfuure 1.3 cm (0.5 in) mudhayamita kana kusvika kupfupa re subchondral.
Giredhi III: Mutsekwe wekatsi wakakura kupfuura 1.3 cm (1/2 inch) mudhayamita uye unosvika kupfupa re subchondral.
Giredhi IV: Kuonekwa kwemapfupa e subchondral.
III. Zvese pathology uye grading zvinoratidza hunhu hwechondromalacia patella. Saka ndezvipi zviratidzo neongororo zvine musoro pakuongorora chondromalacia patella?
Kuongororwa kwechirwere kunonyanya kubva pakurwadziwa kuseri kwepatella, uko kunokonzerwa nekuyedzwa kwepatellar grinding uye test ye single-gumbo squat. Chinangwa chinofanira kunge chiri pakusiyanisa kana paine kukuvara kwemeniscus pamwe chete netraumatic arthritis. Zvisinei, hapana hukama huripo pakati pekuoma kwepatellar chondromalacia nezviratidzo zve anterior knee pain syndrome. MRI inzira chaiyo yekuongorora.
Chiratidzo chinowanzoonekwa kurwadziwa kusinganyatsooneki kuseri kwepatella uye mukati mebvi, uko kunowedzera mushure mekushanda nesimba kana kukwira kana kudzika masitepisi.
Kuongororwa kwemuviri kunoratidza kurwadza kuri pachena mu patella, peripatella, patellar margin uye posterior patella, izvo zvinogona kuperekedzwa nekurwadziwa kwekutsvedza kwepatellar uye ruzha rwekukweshana kwepatellar. Panogona kunge paine kubuda kwemajoini uye quadriceps atrophy. Muzviitiko zvakakomba, kutenderera kwebvi nekutambanudza kwakaderera uye murwere haakwanise kumira negumbo rimwe chete. Munguva yekuyedzwa kwekumanikidzwa kwepatellar, kune kurwadziwa kwakanyanya kuseri kwepatella, zvichiratidza kukuvara kwekatellar articular cartilage, izvo zvakakosha pakuongorora. Kuyedzwa kwekutya kunowanzo kuve kwakanaka, uye squat test inova yakanaka. Kana ibvi rakatenderedzwa 20° kusvika 30°, kana kufamba kwemukati nekunze kwepatella kuchipfuura 1/4 yedhayamita inochinjika yepatella, zvinoratidza patellar subluxation. Kuyera Q angle yekutenderera kwebvi 90° kunogona kuratidza nzira isina kujairika yekufamba kwepatellar.
Ongororo yekubatsira yakavimbika ndeye MRI, iyo yakatsiva zvishoma nezvishoma arthroscopy uye yava nzira isingapindi uye yakavimbika yeCMP. Ongororo dzekufungidzira dzinonyanya kutarisa pane izvi: patellar height (Caton index, PH), femoral trochlear groove angle (FTA), lateral surface ratio ye femoral trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), pakati padzo PH, PCA, uye PTA ndiwo ma parameter akavimbika emabvi ekuongorora CMP yekutanga.
X-ray neMRI zvakashandiswa kuyera kukwirira kwepatellar (Caton index, PH): a. Axial X-ray iri panzvimbo yakamira ine huremu hwakabatirira ibvi rakatenderedzwa pa30°, b. MRI iri panzvimbo ine ibvi rakatenderedzwa pa30°. L1 ndiyo angle yekutsvedza patellar, inova daro kubva panzvimbo yakaderera yenzvimbo yejoini yepatellofemoral kusvika kune anterior superior angle yetibial plateau contour, L2 ndiyo kureba kwenzvimbo yejoini yepatellofemoral, uye Caton index = L1/L2.
Angle yemugero wefemoral trochlear uye patellar fit angle (PCA) zvakayerwa neX-ray neMRI: a. Axial X-ray ine ibvi rakatenderedzwa pa30° panzvimbo yakamira ine huremu; b. MRI ine ibvi rakatenderedzwa pa30°. Angle yemugero wefemoral trochlear ine mitsara miviri, inoti poindi yakaderera A yemugero wefemoral trochlear, poindi yepamusoro C yenzvimbo yepamusoro yemedial trochlear articular, uye poindi yepamusoro B yenzvimbo yepamusoro ye lateral trochlear articular. ∠BAC ndiyo angle yemugero wefemoral trochlear. Angle yemugero wefemoral trochlear yakadhirowewa pamufananidzo we axial wepatella, uye ipapo bisector AD ye∠BAC yakadhirowewa. Zvadaro mutsetse wakatwasuka AE wakadhirowewa kubva poindi yakaderera A yemugero wefemoral trochlear sekwakabva kuburikidza nepoindi yakaderera E ye patellar crest. Kona iri pakati pemutsetse wakatwasuka AD neAE (∠DAE) ndiyo kona inokwana patellar.
X-ray neMRI zvakashandiswa kuyera angle yekutsvedza kwepatellar (PTA): a. X-ray yeAxial iri panzvimbo yekumira ine huremu nebvi rakatenderedzwa pa30°, b. MRI iri panzvimbo ine ibvi rakatenderedzwa pa30°. Angle yekutsvedza kwepatellar ndiyo kona iri pakati pemutsetse unobatanidza nzvimbo dzakakwirira dze medial ne lateral femoral condyles uye transverse axis yepatella, kureva ∠ABC.
MaX-rayography akaoma kuona CMP muzvikamu zvayo zvekutanga kusvika padanho repamusoro, apo kurasikirwa kukuru kwecartilage, kurasikirwa nenzvimbo yemajoini, uye subchondral bone sclerosis pamwe nekuchinja kwecystic zvinoonekwa. Arthroscopy inogona kuwana kuongororwa kwakavimbika nekuti inopa kuona kwakanaka kwejoini repatellofemoral; zvisinei, hapana hukama hwakajeka pakati pekuoma kwepatellar chondromalacia uye huwandu hwezviratidzo. Nokudaro, zviratidzo izvi hazvifanirwe kuva chiratidzo che arthroscopy. Pamusoro pezvo, arthrography, senzira yekuongorora inopindira uye nzira, inowanzo shandiswa chete muzvikamu zvepamusoro zvechirwere. MRI inzira yekuongorora isingapindi inovimbisa kugona kwakasiyana kwekuona maronda ecartilage pamwe nekukanganisika kwemukati mecartilage usati waona kurasikirwa kwecartilage nemaziso asina kupfeka.
IV. Chondromalacia patellae inogona kugadziriswa kana kuti inogona kufambira mberi kuita patellofemoral arthritis. Kurapa kunoshanda kwekuchengetedza kunofanira kuitwa nekukurumidza pakutanga kwechirwere. Saka, kurapwa kwekuchengetedza kunosanganisira chii?
Zvinotendwa kuti pakutanga (danho rekutanga kusvika rechipiri), patellar cartilage ichiri kugona kugadzirisa, uye kurapwa kunoshanda pasina kuvhiyiwa kunofanira kuitwa. Izvi zvinosanganisira kudzikamisa mashandiro kana kuzorora, uye kushandisa mishonga isingashandisi steroidal inorwisa kuzvimba kana zvichidikanwa. Pamusoro pezvo, varwere vanofanira kukurudzirwa kurovedza muviri vachitarisirwa nachiremba wezvemuviri kuti vasimbise tsandanyama dzemakumbo uye vawedzere kugadzikana kwemajoini emabvi.
Zvakakosha kucherechedza kuti panguva yekusagona kufamba, mabraces emabvi kana mabvi anowanzo shandiswa, uye plaster fixing inodziviswa zvakanyanya sezvinobvira, sezvo inogona kutungamira nyore nyore kukuvara kwe articular cartilage; kunyangwe kurapwa kwe blockade kuchigona kuderedza zviratidzo, mahormone haafanirwe kushandiswa kana kushandiswa zvishoma, sezvo anodzivirira kugadzirwa kweglycoproteins ne collagen uye anokanganisa kugadziriswa kwe cartilage; kana kuzvimba nekurwadziwa zvikawedzera, ice compresses zvinogona kuiswa, uye physiotherapy uye inodziya compresses zvinogona kuiswa mushure memaawa makumi mana nemasere.
V. Muvarwere vanenge vasvika padanho rekupedzisira, kugona kwekugadzirisa shwashwa ye articular cartilage hakuna kunaka, saka kurapwa kwakarongeka kazhinji hakushande uye kurapwa kwekuvhiya kunodiwa. Kurapa kwekuvhiya kunosanganisirei?
Zviratidzo zvekuvhiyiwa zvinosanganisira: mushure memwedzi yakati wandei yekurapwa kwakasimba kwekuchengetedza, kurwadziwa kwepatellar kuchiripo; kana paine kuremara kwekuzvarwa nako kana kwakawanikwa, kurapwa kwekuvhiya kunogona kufungwa nezvako. Kana kukuvara kwecartilage yeOuterbridge III-IV kukaitika, kukanganisa hakugone kuzadzwa necartilage chaiyo yearticular. Panguva ino, kungoveura nzvimbo yekukuvara kwecartilage nekuwedzera kwenguva refu hakugone kudzivirira kuora kwemusoro wearticular.
Nzira dzekuvhiya dzinosanganisira:
(1) Kuvhiyiwa kweArthroscopy ndeimwe yenzira dzinoshanda dzekuongorora nekurapa chondromalacia patella. Kunogona kuona zvakananga shanduko dziri pamusoro pekartilage pasi pemaikorosikopu. Muzviitiko zvisina kuoma, maronda madiki ekukukurwa kwekartilage yepatellar articular anogona kukwenywa kuti zvikubatsire kugadzirisa.
(2) kukwidziridzwa kweganda remudumbu reparutivi; (3) kubviswa kweganda remudumbu reparutivi. Kuvhiyiwa uku kunoitwa kune varwere vane kukuvara kudiki kweganda kuti vagadzirise ganda remudumbu; (4) kubviswa kweganda remudumbu kunoitwa kune varwere vane kukuvara kwakanyanya kweganda remudumbu reparutivi.
Nguva yekutumira: Mbudzi-15-2024
