I-patella, evame ukubizwa ngokuthi i-kneecap, iyithambo le-sesamoid elakhiwe ku-quadriceps tendon futhi futhi iyithambo le-sesamoid elikhulu kunawo wonke emzimbeni. Iyisicaba futhi imise okwe millet, itholakala ngaphansi kwesikhumba futhi kulula ukuyizwa. Ithambo libanzi phezulu futhi libheke phansi, linengaphambili elimaholoholo kanye nengemuva elibushelelezi. Ingakwazi ukuya phezulu naphansi, kwesokunxele nakwesokudla, futhi ivikele ilunga ledolo. Ingemuva le-patella libushelelezi futhi limbozwe i-cartilage, lixhuma endaweni ye-patellar ye-femur. Ingaphambili lilukhuni, futhi i-quadriceps tendon idlula kuyo.
I-Patellar chondromalacia yisifo esivamile samadolo. Esikhathini esidlule, lesi sifo sasivamile kubantu abaneminyaka ephakathi nasebekhulile. Manje, ngokuthandwa kwezemidlalo nokuqina, lesi sifo sibuye sibe nezinga eliphezulu lezigameko phakathi kwabantu abasha.
I. Ithini incazelo yangempela kanye nembangela ye-chondromalacia patella?
I-Chondromalacia patellae (CMP) i-patellofemoral joint osteoarthritis ebangelwa ukulimala okungapheli endaweni ye-patellar cartilage, okubangela ukuvuvukala kwe-cartilage, ukuqhekeka, ukuphuka, ukuguguleka nokuchithwa. Ekugcineni, i-condyle cartilage ephambene nayo ibhekana nezinguquko ezifanayo ze-pathological. Incazelo yangempela ye-CMP ithi: kukhona ushintsho lwe-pathological of patellar cartilage softening, futhi ngesikhathi esifanayo, kunezimpawu nezimpawu ezifana nobuhlungu be-patellar, umsindo we-patellar friction, kanye ne-quadriceps atrophy.
Njengoba i-articular cartilage ingenayo i-nerve innervation, indlela yobuhlungu obubangelwa i-chondromalacia ayikacaci. I-CMP ingumphumela wemiphumela ehlanganisiwe yezinto eziningi. Izici ezihlukahlukene ezibangela izinguquko ekucindezelweni okuhlangene kwe-patellofemoral yizimbangela zangaphandle, kuyilapho ukusabela kwe-autoimmune, i-cartilage dystrophy, nezinguquko ekucindezelweni kwe-intraosseous yizimbangela zangaphakathi ze-chondromalacia patellae.
II.Isici esibaluleke kakhulu se-chondromalacia patellae yizinguquko ezithile ze-pathological. Ngakho-ke ngokombono wezinguquko ze-pathological, i-chondromalacia patellae ihlelwa kanjani?
I-Insall ichaze izigaba ezine ze-pathological ze-CMP: isigaba I ukuthamba kwe-cartilage okubangelwa i-edema, isigaba sesi-II sibangelwa imifantu endaweni ethambile, isigaba III ukuhlukana kwe-articular cartilage; Isigaba IV sisho izinguquko eziguquguqukayo ze-osteoarthritis kanye nokuchayeka kwethambo le-subchondral endaweni ye-articular.
Uhlelo lokugreda lwe-Outerbridge luwusizo kakhulu ekuhloleni izilonda ze-patellar articular cartilage ngaphansi kokubukwa okuqondile noma i-arthroscopy. Uhlelo lokugreda lwe-Outerbridge lumi kanje:
IBanga I: I-articular cartilage kuphela ethambile (ukuthambisa uqwanga oluvaliwe). Lokhu ngokuvamile kudinga impendulo ethintekayo nge-probe noma enye insimbi ukuze ihlolwe.
IBanga II: Amaphutha okujiya ngokwengxenye angeqi ku-1.3 cm (0.5 in) ububanzi noma afinyelele ethanjeni le-subchondral.
Ibanga lesi-III: I-cartilage fissure inkulu kuno-1.3 cm (1/2 intshi) ububanzi futhi idlulela ethanjeni le-subchondral.
Ibanga IV: Ukuchayeka kwamathambo e-Subchondral.
III. Kokubili i-pathology kanye nokugreda kubonisa ingqikithi ye-chondromalacia patella. Ngakho yiziphi izimpawu nokuhlolwa okunenjongo kakhulu kokuxilonga i-chondromalacia patella?
Ukuxilongwa ngokuyinhloko kusekelwe ebuhlungu obungemuva kwe-patella, okubangelwa ukuhlolwa kokugaya kwe-patellar kanye nokuhlolwa kwe-squat yomlenze owodwa. Kudingeka kugxilwe ekuhlukaniseni ukuthi kukhona yini ukulimala kwe-meniscus okuhlangene nesifo samathambo esibuhlungu. Kodwa-ke, akukho ukuhlobana phakathi kobunzima be-patellar chondromalacia kanye nezimpawu zomtholampilo ze-anterior knee pain syndrome. I-MRI iyindlela yokuxilonga enembe kakhudlwana.
Uphawu oluvame kakhulu ubuhlungu obubuhlungu ngemva kwe-patella nangaphakathi kwedolo, okuba kubi kakhulu ngemva kokuzikhandla noma ukukhuphuka noma phansi izitebhisi.
Ukuhlola ngokomzimba kuveza ukuzwela okusobala ku-patella, peripatella, margin patellar kanye ne-patella yangemuva, okungase kuhambisane nobuhlungu be-patellar sliding kanye nomsindo we-patellar friction. Kungase kube nokuphuma kwamalunga kanye ne-quadriceps atrophy. Ezimweni ezimbi kakhulu, ukuguquguquka kwamadolo nokwandiswa kunqunyelwe futhi isiguli asikwazi ukuma emlenzeni owodwa. Ngesikhathi sokuhlolwa kokucindezela kwe-patellar, kukhona ubuhlungu obunzima ngemuva kwe-patella, okubonisa ukulimala kwe-patellar articular cartilage, okubalulekile kokuxilonga. Ukuhlolwa okwethusayo kuvame ukuba kuthiyo, futhi ukuhlolwa kwe-squat kuba positive. Uma idolo liguquguquka ku-20 ° kuya ku-30 °, uma ububanzi bokunyakaza kwangaphakathi nangaphandle kwe-patella kudlula i-1/4 yobubanzi obuguquguqukayo be-patella, kubonisa ukuzithoba kwe-patellar. Ukulinganisa i-engeli ye-Q yokuguquguquka kwedolo engu-90° kungabonisa indlela engavamile yokunyakaza kwe-patellar.
Ukuhlola okusizayo okuthembeke kakhulu yi-MRI, eye yashintsha kancane kancane i-arthroscopy futhi yaba indlela engahlaseli nethembekile ye-CMP. Ukuhlolwa kwesithombe kugxile kakhulu kulawa mapharamitha: ukuphakama kwe-patellar (inkomba ye-Caton, PH), i-femoral trochlear groove angle (FTA), isilinganiso se-lateral surface ye-femoral trochlear (SLFR), i-patellar fit angle (PCA), i-patellar tilt angle (PTA), phakathi kwayo i-PH, i-PCA, ne-PTA kuyipharamitha ethembekile ye-auxi ehlangene ye-CMP.
I-X-ray ne-MRI kwasetshenziswa ukukala ubude be-patellar (inkomba ye-Caton, PH): a. I-X-ray ye-Axial isesimweni sokuma esithwala isisindo nedolo eligotshwe ku-30°, b. I-MRI esesimweni nedolo eligotshwe ku-30°. I-L1 i-angle yokuthambekela kwe-patellar, okuyibanga elisuka endaweni ephansi kakhulu yendawo ehlangene ye-patellofemoral kuya ku-angle ephakeme yangaphambili ye-contour ye-tibial plateau, i-L2 ubude bendawo ehlangene ye-patellofemoral, ne-Caton index = L1 / L2.
I-engeli ye-Femoral trochlear groove kanye ne-patellar fit angle (PCA) kukalwe nge-X-ray kanye ne-MRI: a. I-X-ray ye-axial enedolo eligotshwe ku-30° endaweni yokuma enesisindo; b. I-MRI enedolo eligotshwe ku-30°. I-engeli ye-femoral trochlear groove yakhiwe imigqa emibili, okuyiphoyinti eliphansi kakhulu A le-femoral trochlear groove, indawo ephakeme kakhulu engu-C yendawo ephakathi ye-trochlear articular, kanye nephoyinti eliphakeme kakhulu elingu-B lendawo engemuva ye-trochlear articular. ∠BAC i-engeli ye-femoral trochlear groove. I-engeli ye-femoral trochlear groove yadwetshwa esithombeni se-axial se-patella, kwase zidwetshwa i-bilictor AD ye-∠BAC. Kwabe sekudwetshwa umugqa oqondile we-AE ukusuka endaweni ephansi kakhulu A ye-femoral trochlear groove njengomsuka endaweni ephansi kakhulu engu-E ye-patellar crest. I-engeli ephakathi komugqa oqondile we-AD kanye ne-AE (∠DAE) i-engeli yokulingana kwe-patellar.
I-X-ray ne-MRI kwasetshenziswa ukukala i-patellar tilt angle (PTA): a. I-X-ray ye-Axial isesimweni sokuma esithwala isisindo nedolo eligotshwe ku-30°, b. I-MRI esesimweni nedolo eligotshwe ku-30°. I-engeli etshekile ye-patellar i-engeli ephakathi komugqa oxhuma amaphuzu aphakeme kakhulu wamakhondisi e-female amaphakathi ne-lateral kanye ne-axis ephambanayo ye-patella, okungukuthi ∠ABC.
Ama-Radiographs anzima ukuxilonga i-CMP ezinyathelweni zayo zakuqala kuze kube yizigaba ezithuthukisiwe, lapho ukulahleka okukhulu kwe-cartilage, ukulahlekelwa kwesikhala esihlangene, kanye ne-subchondral bone sclerosis ehambisanayo nezinguquko ze-cystic zibonakala. I-arthroscopy ingakwazi ukufeza ukuxilongwa okuthembekile ngoba inikeza ukubonwa okuhle kakhulu kwe-patellofemoral joint; Nokho, akukho ukuhlobana okucacile phakathi kobukhulu be-patellar chondromalacia kanye nezinga lezimpawu. Ngakho-ke, lezi zimpawu akufanele zibe inkomba ye-arthroscopy. Ngaphezu kwalokho, i-arthrography, njengendlela yokuxilonga ehlaselayo kanye nendlela, ngokuvamile isetshenziswa kuphela ezigabeni eziphambili zesifo. I-MRI iyindlela yokuxilonga engavamile ethembisa ikhono eliyingqayizivele lokubona izilonda ze-cartilage kanye nokuphazamiseka kwangaphakathi kwe-cartilage ngaphambi kokulahlekelwa kwe-morphological cartilage kubonakala ngeso lenyama.
IV. I-Chondromalacia patellae ingase iguquke noma iqhubekele ku-patellofemoral arthritis. Ukwelashwa okuphumelelayo kwe-conservative kufanele kunikezwe ngokushesha ezigabeni zokuqala zesifo. Ngakho-ke, kuhlanganisani ukwelashwa okuvamile?
Ngokuvamile kukholelwa ukuthi esigabeni sokuqala (isigaba I kuya ku-II), i-patellar cartilage isenamandla okulungisa, futhi ukwelashwa okuphumelelayo okungahlinzeki kufanele kwenziwe. Lokhu ikakhulukazi kuhlanganisa ukuvinjelwa komsebenzi noma ukuphumula, kanye nokusetshenziswa kwezidakamizwa ezingezona ukuvuvukala uma kunesidingo. Ngaphezu kwalokho, iziguli kufanele zikhuthazwe ukuba zivivinye ngaphansi kokuqondisa komelaphi womzimba ukuze ziqinise imisipha ye-quadriceps futhi zithuthukise ukuzinza kwamadolo.
Kuyaphawuleka ukuthi ngesikhathi sokunganyakazi, ama-knee braces noma ama-knee orthoses ngokuvamile agqokwa, futhi ukulungiswa kwe-plaster kugwenywa ngangokunokwenzeka, njengoba kungabangela kalula ukungasebenzisi ukulimala kwe-articular cartilage; nakuba ukwelashwa kwe-blockade kunganciphisa izimpawu, ama-hormone akufanele asetshenziswe noma asetshenziswe kancane, njengoba evimbela ukuhlanganiswa kwe-glycoprotein ne-collagen futhi athinte ukulungiswa kwe-cartilage; lapho ukuvuvukala kwamalunga kanye nobuhlungu bukhula ngokuzumayo, ukuminyanisa kweqhwa kungasetshenziswa, futhi ukwelashwa ngokomzimba nokucindezelwa okufudumele kungasetshenziswa ngemva kwamahora angu-48.
V. Ezigulini ezifika sekwephuzile, ikhono lokulungisa i-articular cartilage liphansi, ngakho ukwelashwa okuvamile ngokuvamile kungasebenzi futhi ukwelashwa kokuhlinzwa kuyadingeka. Kuhlanganisani ukwelapha ngokuhlinzwa?
Izinkomba zokuhlinzwa zihlanganisa: ngemva kwezinyanga ezimbalwa zokwelashwa okuqinile, ubuhlungu be-patellar busekhona; uma kukhona ukukhubazeka kokuzalwa noma okutholiwe, ukwelashwa kokuhlinzwa kungacatshangwa. Uma kwenzeka ukulimala kwe-cartilage ye-Outerbridge III-IV, isici asikwazi ukugcwaliswa nge-articular cartilage yangempela. Ngalesi sikhathi, ukumane ukushefa indawo yokulimala kwe-cartilage ngokugcwala okungapheli akukwazi ukuvimbela inqubo yokuwohloka kwe-articular surface.
Izindlela zokuhlinza zihlanganisa:
(1)Ukuhlinzwa kwe-arthroscopic kungenye yezindlela ezisebenzayo zokuxilonga nokwelapha i-chondromalacia patella. Ingakwazi ukubona ngokuqondile izinguquko endaweni yoqwanga ngaphansi kwesibonakhulu. Ezimweni ezibucayi, izilonda ezincane zokuguguleka ku-patellar articular cartilage zingaklwejwa ukuze kuthuthukiswe ukulungiswa.
(2) ukuphakama kwe-condyle ye-femoral; (3) i-patellar cartilage surface resection. Lokhu kuhlinzwa kwenziwa ezigulini ezinomonakalo omncane we-cartilage ukukhuthaza ukulungiswa kwe-cartilage; (4) ukukhishwa kwe-patellar kwenziwa ezigulini ezinomonakalo omkhulu endaweni ye-patellar cartilage.
Isikhathi sokuthumela: Nov-15-2024
