I-Patella, eyaziwa kakhulu ngokuthi i-Kneecap, i-sesamoid bone yakhiwa ku-quadriceps tendon futhi iyithambo elikhulu kakhulu leSesamoid emzimbeni. Kuyinto eyisicaba futhi injwe amabele, itholakala ngaphansi kwesikhumba futhi kulula ukuzizwa. Ithambo libanzi phezulu lalikhomba phansi, linomkhawulo onzima futhi ebushelelezi. Kungashukumisa phezulu naphansi, kwesokunxele nakwesokudla, futhi kuvikele i-knee Joint. Umhlane we-patella ubushelelezi futhi umbozwe nge-cartilage, exhuma ePhathellar ebusweni be-femur. Ingaphambili linokhahlo, futhi i-quadriceps tendon idlula kuyo.
I-Patellar Chondiromacia yisifo esivamile sokuhlangana. Esikhathini esedlule, lesi sifo sasivamile kubantu abaneminyaka ephakathi nabesidala. Manje, ngokuthandwa kwezemidlalo nokuqina, lesi sifo futhi sinesilinganiso esiphezulu phakathi kwabantu abasha.
I. Yini incazelo eyiqiniso nembangela yeChondromalacia Patella?
I-Chondromalacia Patellae (CMP) i-PateloLofemoemooralioralioralialiaralis Osteoarthritis ebangelwa ukulimala okungapheli kobuso be-cartilage ye-patellar, okubangela ukuvuvukala kwe-cartilage, ukuqhekeka, ukwephula, ukuguguleka nokuchithwa, nokuguguleka. Ekugcineni, i-cartilage yabesifazane ephambene ne-condilage ephambene nayo iba nezinguquko ezifanayo ze-pathological. Inchazelo yeqiniso ye-CMP yile: Kukhona ushintsho lwe-pathological lwe-cartilage cartilage luthambisa, futhi ngasikhathi sinye, kunezimpawu nezimpawu ezifana nobuhlungu be-patellar, umsindo we-paudriceps, kanye ne-quadriceps atrophy.
Njengoba i-cartilage ye-articular ayinakho ukulondolozwa kwezinzwa, indlela yobuhlungu obubangelwa i-chondromalacia namanje akucaci. I-CMP ingumphumela wemiphumela ehlanganisiwe yezici eziningi. Izici ezahlukahlukene ezibangela izinguquko ekucindezelweni okuhlangene kwe-patelofemoralioralioralioralioreral izimbangela zangaphandle, ngenkathi ukusabela kwe-autoimmone, noshintsho ekucindezelweni okungalungile kuyizimbangela zangaphakathi ze-chondromalacacia patellae.
Ii.Isici esibaluleke kakhulu se-chondromalacia patellae izinguquko ezithile ze-pathological. Ngakho-ke ngokubona koshintsho lwezinguquko ze-pathological, ihlelwe kanjani i-chondromalalacia?
I-Install ichaze izigaba ezine ze-COPP: Isigaba I kuyinto ethambisayo ye-cartilage ebangelwa i-edema, Isiteji II kungenxa yokuqhekeka endaweni ethambile, Isigaba III ukuhlukaniswa kwe-carticular ye-articular; I-Stage IV isho ushintsho olukhuphelisayo lwe-osteoarthritis nokuvezwa kwethambo le-subchondral endaweni eyingqayizivele.
Uhlelo lwangaphandle lwe-Grading luwusizo kakhulu ekuhlolweni kwezilonda ze-cartellar articular artilicar ngaphansi kokubuka okuqondile noma nge-arthroscopy. Uhlelo lwe-Outerbridge Grading lumi ngokulandelayo:
Ibanga I: Kuphela ukukhala kwe-articular kuthanjiswa (kuvaliwe ukucasha kwe-cartilage). Lokhu kuvame ukudinga impendulo enobuhlakani nge-probe noma elinye ithuluzi ukuhlola.
Ibanga II: Izici ezingxenyena-mbili ezingeqi hhayi ngaphezulu kwe-1,3 cm (0.5 in) ububanzi noma ukufinyelela ithambo elingaphansi kwezepolitiki.
I-Grade III: I-Carrilage Fissure inkulu kune-1.3 cm (1/2 inch) ububanzi futhi ifinyelela ethanjeni elingaphansi.
Ibanga IV: Ukuvezwa kwamathambo subchondral.
III. Womabili womabili ama-pathology kanye nama-grading abonisa umongo we-chondromalacia patella. Ngakho-ke yiziphi izimpawu nezivivinyo ezinengqondo kakhulu zokuthola i-chondromalacia patella?
Ukuxilongwa kusekelwe ikakhulu ebuhlungwini ngemuva kwe-patella, okubangelwa ukuhlolwa kwe-patellar nokuhlolwa kwe-squat eyodwa. Ukugxila kudinga ukwehlukanisa ukuthi ngabe kukhona yini ukulimala okuhlangene kwe-meniscus kanye ne-traumatic arthritis. Kodwa-ke, akukho okuhlobene phakathi kobunzima be-patellar chondiromalacia kanye nezimpawu zomtholampilo ze-anterior knee pain syndrome. I-MRI iyindlela enembile yokuxilonga.
Isibonakaliso esivame kakhulu yizinhlungu ezibuthakathaka ngemuva kwe-patella nangaphakathi edolweni, ebibi kakhulu ngemuva kokuzikhandla noma ukukhuphuka noma phansi izitebhisi.
Ukuhlolwa ngokomzimba kwembula ubumnene obubonakalayo ePatella, uPeripatella, uPatellar Margin kanye ne-petellarella yasemuva, engahambisana nobuhlungu be-patellar sliding nomsindo we-patellar. Kungahle kube nokusebenza okuhlangene kanye ne-quadriceps atrophy. Ezimweni ezinzima, ukuguquguquka kwamadolo nokwandiswa kukhawulelwe futhi isiguli asikwazi ukuma emlenzeni owodwa. Ngesikhathi sokuhlolwa kwe-Patellar Compry, kukhona ubuhlungu obukhulu ngemuva kwe-patella, ekhombisa ukulimala kwe-carticular artilicular ukulimala kwe-patellar, okukubaluleka kokuxilonga. Ukuhlolwa okwenziwe ngesikebhe kuvame ukuba neze, futhi ukuhlolwa kwe-squat kuyakuhle. Lapho idolo lishintshana ngama-20 ° kuya ku-30 °, uma uhla lokuhamba kwangaphakathi nangaphandle kwe-patella lidlula i-1/4 yobubanzi be-transverse ye-patella, kukhombisa ukuhanjiswa kwe-petellar. Ukulinganisa i-Q ANLE ye-90 ° KYEE FLEELY FLEENTION ingabonisa ukunyakaza kwe-petallar trajectory.
Ukuhlolwa okunokwethenjelwa okuthembekile kakhulu yi-MRI, okuthatha indawo kancane kancane i-arthroscopy futhi ibe izindlela ezingahlaseli nezinokwethenjelwa ze-CMP. Ukuhlolwa kokucabanga kugxile kakhulu kulezi zinhlaka: I-Patellar Height (i-Caton Index, Ph), i-FETA), i-Patellar Fit Angle amapharamitha ahlanganayo (i-PCA), phakathi kwayo i-PH, PPA, kanye ne-PTA athembekile amapharamitha ahlangene wokuxilongwa kwangaphambi kwe-CMP.
I-X-ray ne-MRI yayisetshenziselwa ukukala i-Patellar Height (Caton Index, PH): a. I-Axial X-RAY ngesikhundla sokumisa isisindo ngedolo eliguqulwe ku-30 °, b. I-MRI isendaweni enedolo eliguqulwe ngo-30 °. I-L1 iyi-angle yokuthambekela ye-patellar, okuyibanga elisuka endaweni ephansi ye-patellofemooralioraling ehlangana elise-anterior ephezulu ye-tibial plateauu a contour, kanye ne-Caton Index = L1 / L2.
I-FlooChar Trochlear Groove Angle ne-Patellar Fit Angle (PCA) yalinganiswa nge-X-ray kanye ne-MRI: a. I-Axial X-ray enedolo eliguqulwe ngo-30 ° ngesimo sokumisa isisindo; b. I-MRI enedolo iguqulwe ngo-30 °. I-angle ye-Floochrol Trochlear Groove angle yakhiwa ngemigqa emibili, okungukuthi indawo ephansi kakhulu i-Feoflear Groochlear groove, iphuzu eliphakeme kakhulu le-C ye-Medial Trochlear articular ebusweni, kanye nephuzu eliphakeme kakhulu B le-lateral articular ebusweni. ∠bac yi-Floony Trochlear Groove Angle. I-angle yowesifazane ye-trochlear groove etholwe esithombeni se-axial se-patella, bese kudonswa isikhangiso se-bisector. Ngemuva kwalokho umugqa oqondile u-AE wadonswa endaweni ephansi kakhulu eqophelweni lowesifazane we-trochlear emthonjeni ngephuzu eliphansi kakhulu elithi e-patellar crest. I-angle phakathi komugqa oqondile isikhangiso ne-AE (∠dae) yi-patellar fit angle.
I-X-ray ne-MRI yayisetshenziselwa ukukala i-angle ye-patellar tult angle (PTA): a. I-Axial X-RAY ngesikhundla sokumisa isisindo ngedolo eliguqulwe ku-30 °, b. I-MRI isendaweni enedolo eliguqulwe ngo-30 °. I-patellar tshet angle yi-angle phakathi komugqa oxhumanisa amaphuzu aphezulu kakhulu we-medial kanye nama-axis we-featal femor
I-radiographs kunzima ukuthola i-CMP ngezigaba zayo zokuqala kuze kube yilapho izigaba ezithuthukile, lapho ulahlekelwe yi-cartilage ebanzi, ukulahleka kwesikhala esihlanganyelwe, kanye nezinguquko ze-cystic zibonakala. I-Arthroscopy ingathola ukuxilongwa okuthembekile ngoba ihlinzeka ngesona ukubonakala okuhle kwe-patellofemoral joition; Kodwa-ke, akukho ukuhlanganiswa okucacile phakathi kobunzima be-patellar chondiromalacia kanye nezinga lezimpawu. Ngakho-ke, lezi zimpawu akufanele zibe yinkomba ye-arthroscopy. Ngaphezu kwalokho, ama-arthrography, njengendlela yokuhlonza okuhlaselayo kanye nokulingana, ngokuvamile kusetshenziswa kuphela ezigabeni ezithuthukile zesifo. I-MRI iyindlela yokuthola isiyalo engekho ethembisa amandla ahlukile okuthola izilonda ze-cartilage kanye nokufakelwa kwangaphakathi kwe-cartilage ngaphambi kokulahleka kwe-cartilage kwe-morphological kubonakala ngamehlo anqunu.
IV. I-Chondromalacia Patellae ingahle ibuyiselwe emuva noma ingathuthuka ku-Patellofemoral arthritis. Ukwelashwa okusebenzayo okusebenzayo kufanele kunikezwe masinyane ezigabeni zokuqala zesifo. Ngakho-ke, kuhlanganisani ukwelashwa okulondoloziwe?
Ngokuvamile kuzwakala ukuthi ekuqaleni kwesigaba (isigaba I to II), i-cartilage ye-patellar isenamandla okulungisa, futhi kufanele kwenziwe ukwelashwa okusebenzayo. Lokhu kufaka phakathi ukukhawulwa komsebenzi noma ukuphumula, kanye nokusetshenziswa kwezidakamizwa ezingezona ezi-anti-inflammatory lapho kunesidingo. Ngaphezu kwalokho, iziguli kufanele zikhuthazwe ukuthi zivivinye umzimba ngaphansi kokugadwa kwe-Therapist ngokomzimba ukuqinisa umsipha we-quadriceps futhi uthuthukise ukuqina kwedolo.
Kuyaqapheleka ukuthi ngesikhathi sokungasebenzi kahle, ama-knee brace noma ama-orthoses edolo ngokuvamile agqokwa, futhi ukulungiswa kocingo kugwenywa ngangokunokwenzeka, ngoba kungaholela kalula ekulimaleni ukulimala kwe-carticular ye-articular; Yize ukwelashwa kweBlockade kungadambisa izimpawu, ama-hormone akufanele asetshenziswe noma asetshenziswe kancane, njengoba avimbela ukuhlanganiswa kwama-glycoproteins kanye ne-collagen futhi athinte ukulungiswa kwe-cartilage; Lapho ukuvuvukala okuhlanganisiwe nobuhlungu kungazelelwe kwanda, kungafakwa ama-ice compress, futhi ukwelashwa ngokomzimba kanye nama-compress afudumele angasebenza ngemuva kwamahora angama-48.
V. Ezigulini zesigaba sesikhathi sekwephuzile, amandla okulungisa ukuqwayisha kwe-articular ampofu, ngakho-ke ukwelashwa okulondoloziwe kuvame ukwelashwa nokuhlinzwa kuyadingeka. Kuhlanganisani Ukwelashwa Ukuhlinzwa?
Izinkomba zokuhlinzwa zifaka: Ngemuva kwezinyanga ezimbalwa zokwelashwa okuqinile, Ubuhlungu bePhatellar busekhona; Uma kunokukhubazeka kokuzalwa noma okutholakele, ukwelashwa kokuhlinzwa kungabhekwa. Uma ukulimala kwe-Outerbridge III-IV Cartilage kwenzeka, isici asisoze sagcwala ukukhala kwangempela kwe-articular. Ngalesi sikhathi, ukumane uphuze i-cartilage ukulimala kwendawo ngokulayishwa ngokweqile okungapheli akukwazi ukuvimba inqubo yokuwohloka komhlaba we-articular.
Izindlela zokuhlinzwa zifaka:
(1) Ukuhlinzwa kwe-arthroscopic kungenye yezindlela ezisebenzayo zokuthola nokwelapha i-chondromalacia patella. Ingabheka ngokuqondile izinguquko ebusweni be-cartilage ngaphansi kwesibonakhulu. Ezimweni zobumnene, izilonda ezincane zokuguguleka kwe-erosion e-patellar articular cartilage zingasondela ukukhuthaza ukulungiswa.
. (3) I-Patellar Cartilage Super Rection. Lokhu kuhlinzwa kwenziwa iziguli ezinomonakalo omncane we-cartilage ukukhuthaza ukulungiswa kwe-cartilage; (4) Ukuhlelwa kwe-Patellar kwenziwa iziguli ezinomonakalo omkhulu endaweni ye-cartilage ye-patellar.
Isikhathi sePosi: Nov-15-2024
