I-patella, eyaziwa kakhulu ngokuthi i-kneecap, iyithambo le-sesamoid elakhiwe ku-tendon ye-quadriceps futhi futhi iyithambo elikhulu kunawo wonke le-sesamoid emzimbeni. Liyisicaba futhi liyisimo se-millet, litholakala ngaphansi kwesikhumba futhi kulula ukulizwa. Ithambo libanzi phezulu futhi libheke phansi, linengaphambili eliqinile kanye nomhlane obushelelezi. Lingahamba phezulu naphansi, kwesobunxele nakwesokudla, futhi livikela idolo. Ingemuva le-patella libushelelezi futhi limbozwe yi-cartilage, lixhuma ebusweni be-patellar ye-femur. Ingaphambili liqinile, futhi i-tendon ye-quadriceps idlula kulo.
I-Patellar chondromalacia yisifo esivamile samalunga edolo. Esikhathini esidlule, lesi sifo sasivame kubantu asebekhulile nabaneminyaka ephakathi nendawo. Manje, njengoba ezemidlalo nokuqina komzimba sekuthandwa kakhulu, lesi sifo sinezinga eliphezulu lokusabalala kwaso phakathi kwentsha.
I. Iyini incazelo yangempela kanye nembangela ye-chondromalacia patella?
I-Chondromalacia patellae (CMP) iyi-osteoarthritis yamalunga e-patellofemoral ebangelwa umonakalo ongapheli ebusweni be-cartilage ye-patellar, okubangela ukuvuvukala kwe-cartilage, ukuqhekeka, ukuphuka, ukuguguleka, nokuphuma. Okokugcina, i-cartilage ye-condyle ye-femoral ehlukile nayo idlula ezinguqukweni ezifanayo ze-pathological. Incazelo yangempela ye-CMP yile: kukhona ushintsho lwe-pathological lokuthamba kwe-cartilage ye-patellar, futhi ngesikhathi esifanayo, kunezimpawu nezimpawu ezifana nobuhlungu be-patellar, umsindo wokungqubuzana kwe-patellar, kanye nokuwohloka kwe-quadriceps.
Njengoba i-articular cartilage ingenayo i-nerve innervation, indlela yobuhlungu obubangelwa yi-chondromalacia ayikacaci. I-CMP ingumphumela wemiphumela ehlangene yezinto eziningi. Izici ezahlukahlukene ezibangela izinguquko ekucindezelweni kwamalunga e-patellofemoral ziyizimbangela zangaphandle, kuyilapho ukusabela kwe-autoimmune, i-cartilage dystrophy, kanye nezinguquko ekucindezelweni kwangaphakathi kwe-osseous kuyizimbangela zangaphakathi ze-chondromalacia patellae.
II. Isici esibaluleke kakhulu se-chondromalacia patellae izinguquko ezithile ze-pathological. Ngakho-ke ngokombono wezinguquko ze-pathological, i-chondromalacia patellae ihlelwa kanjani?
I-Insall ichaze izigaba ezine ze-CMP: isigaba I ukuthamba kwe-cartilage okubangelwa ukuvuvukala, isigaba II sibangelwa imifantu endaweni ethambile, isigaba III ukuhlukana kwe-cartilage ye-articular; isigaba IV sibhekisela ezinguqukweni ezigugulekayo ze-osteoarthritis kanye nokuvezwa kwethambo le-subchondral ebusweni be-articular.
Uhlelo lokuhlola i-Outerbridge luwusizo kakhulu ekuhloleni izilonda ze-patellar articular cartilage ngaphansi kokubona ngqo noma i-arthroscopy. Uhlelo lokuhlola i-Outerbridge lumi kanje:
Ibanga I: I-cartilage ye-articular kuphela ethanjiswayo (ukuthamba kwe-cartilage evaliwe). Lokhu ngokuvamile kudinga impendulo ethintekayo nge-probe noma enye ithuluzi lokuhlola.
Ibanga II: Ukukhubazeka kokujiya okuyingxenye okungadluli ububanzi obuyi-1.3 cm (0.5 in) noma okufinyelela ethanjeni le-subchondral.
Ibanga lesi-3: Uqhekeko lwe-cartilage lukhulu kuno-1.3 cm (1/2 intshi) ububanzi futhi ludlulela ethanjeni le-subchondral.
Ibanga IV: Ukuvezwa kwamathambo e-subchondral.
III. Kokubili i-pathology kanye nokuhlolwa kwe-grade kubonisa umongo we-chondromalacia patella. Ngakho-ke yiziphi izimpawu nezivivinyo ezibaluleke kakhulu zokuxilonga i-chondromalacia patella?
Ukuxilongwa kusekelwe kakhulu ebuhlungwini obungemuva kwe-patella, obubangelwa ukuhlolwa kokugaya i-patellar kanye nokuhlolwa kwe-squat ngomlenze owodwa. Kudingeka kugxilwe ekuhlukaniseni ukuthi kukhona yini ukulimala kwe-meniscus okuhlangene kanye ne-arthritis ebuhlungu. 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 obungacacile ngemuva kwe-patella nangaphakathi kwedolo, obuba bubi kakhulu ngemva kokuzikhandla noma ukukhuphuka noma ukwehla izitebhisi.
Ukuhlolwa ngokomzimba kwembula ububele obusobala ku-patella, i-peripatella, i-patellar margin kanye ne-posterior patella, okungase kuhambisane nobuhlungu obushelelayo be-patellar kanye nomsindo wokungqubuzana kwe-patellar. Kungase kube nokuqhuma kwamalunga kanye nokuncipha kwe-quadriceps. Ezimweni ezimbi kakhulu, ukugoba kwamadolo kanye nokwelulwa kwawo kulinganiselwe futhi isiguli asikwazi ukuma ngomlenze owodwa. Ngesikhathi sokuhlolwa kokucindezela kwe-patellar, kukhona ubuhlungu obukhulu ngemuva kwe-patella, okubonisa umonakalo we-cartilage ye-patellar articular, okubaluleke kakhulu ekuxilongweni. Ukuhlolwa okwethusayo kuvame ukuba yikho, kanti ukuhlolwa kwe-squat kuba yikho. Uma idolo ligoba kusuka ku-20° kuya ku-30°, uma ububanzi bokunyakaza kwangaphakathi nangaphandle kwe-patella budlula i-1/4 yobubanzi obuphambene be-patella, kubonisa i-patellar subluxation. Ukulinganisa i-Q angle yokugoba kwamadolo okungu-90° kungabonisa indlela engavamile yokunyakaza kwe-patellar.
Ukuhlolwa okusizayo okunokwethenjelwa kakhulu yi-MRI, eye yathatha indawo ye-arthroscopy kancane kancane futhi yaba yindlela engangenisi futhi ethembekile ye-CMP. Ukuhlolwa kwezithombe kugxila kakhulu kulezi zinhlaka: ukuphakama kwe-patellar (inkomba ye-Caton, i-PH), i-femoral trochlear groove angle (i-FTA), isilinganiso sobuso be-lateral se-femoral trochlear (i-SLFR), i-patellar fit angle (i-PCA), i-patellar tilt angle (i-PTA), phakathi kwazo i-PH, i-PCA, kanye ne-PTA kuyizinhlaka zejoyinti lamadolo ezithembekile zokuxilongwa okusizayo kwe-CMP yokuqala.
I-X-ray kanye ne-MRI kwasetshenziswa ukukala ukuphakama kwe-patellar (i-Caton index, PH): a. I-Axial X-ray esimweni sokuma esithwala isisindo kanye nedolo eligobile ku-30°, b. I-MRI esimweni kanye nedolo eligobile ku-30°. I-L1 yi-angle yokuthambekela kwe-patellar, okuyibanga elisuka endaweni ephansi kakhulu ebusweni be-patellofemoral joint surface kuya e-anterior superior angle ye-tibial plateau contour, i-L2 ubude bendawo ye-patellofemoral joint, kanye ne-Caton index = L1/L2.
I-angle ye-femoral trochlear groove kanye ne-angle ye-patellar fit (PCA) zalinganiswa nge-X-ray kanye ne-MRI: a. I-X-ray ye-axial enedolo eligobile ku-30° endaweni yokuma ethwele isisindo; b. I-MRI enedolo eligobile ku-30°. I-angle ye-femoral trochlear groove yakhiwe imigqa emibili, okuyiphuzu eliphansi kakhulu A lomsele we-femoral trochlear, iphuzu eliphakeme kakhulu C lomphezulu we-medial trochlear articular, kanye nephuzu eliphakeme kakhulu B lomphezulu we-lateral trochlear articular. I-∠BAC yi-angle ye-femoral trochlear groove. I-angle ye-femoral trochlear groove yadwetshwa esithombeni se-axial se-patella, kwabe sekudweba i-bisector AD ye-∠BAC. Kwabe sekudweba umugqa oqondile i-AE kusukela komsele we-femoral trochlear groove ophansi kakhulu njengesiqalo ngephuzu eliphansi kakhulu E lomsele we-patellar crest. I-engeli ephakathi komugqa oqondile AD kanye ne-AE (∠DAE) yi-engeli yokulingana kwe-patellar.
I-X-ray kanye ne-MRI kwasetshenziswa ukukala i-patellar tilt angle (PTA): a. I-Axial X-ray endaweni yokuma ethwele isisindo kanye nedolo eligobile ku-30°, b. I-MRI endaweni kanye nedolo eligobile ku-30°. I-patellar tilt angle yi-angle ephakathi komugqa oxhumanisa amaphuzu aphezulu kakhulu e-medial kanye ne-lateral femoral condyles kanye ne-transverse axis ye-patella, okungukuthi ∠ABC.
Ama-X-raygraph kunzima ukuwaxilonga i-CMP ezigabeni zayo zokuqala kuze kube yilapho sekudlule isikhathi eside, lapho ukulahlekelwa okukhulu kwe-cartilage, ukulahlekelwa isikhala samalunga, kanye ne-subchondral bone sclerosis ehambisanayo kanye nezinguquko ze-cystic kubonakala. I-Arthroscopy ingafeza ukuxilongwa okuthembekile ngoba inikeza umbono omuhle kakhulu we-patellofemoral joint; noma kunjalo, akukho ukuhlobana okucacile phakathi kobunzima be-patellar chondromalacia kanye nezinga lezimpawu. Ngakho-ke, lezi zimpawu akufanele zibe yinkomba ye-arthroscopy. Ngaphezu kwalokho, i-arthrography, njengendlela yokuxilonga ehlaselayo kanye nendlela, ngokuvamile isetshenziswa kuphela ezigabeni eziphambili zesifo. I-MRI iyindlela yokuxilonga engahlaseli ethembisa ikhono eliyingqayizivele lokubona izilonda ze-cartilage kanye nokuphazamiseka kwangaphakathi kwe-cartilage ngaphambi kokuba ukulahlekelwa kwe-cartilage yesimo kubonakale emehlweni enyama.
IV. I-Chondromalacia patellae ingase iguqulwe noma ingase iqhubekele ekubeni yi-patellofemoral arthritis. Ukwelashwa okusebenzayo kokulondoloza kufanele kunikezwe ngokushesha ezigabeni zokuqala zesifo. Ngakho-ke, ukwelashwa kokulondoloza kuhlanganisani?
Ngokuvamile kukholelwa ukuthi esigabeni sokuqala (isigaba sokuqala kuya kwesesibili), i-cartilage ye-patellar isenamandla okulungisa, futhi ukwelashwa okuphumelelayo okungadingi ukuhlinzwa kufanele kwenziwe. Lokhu kufaka phakathi ukuvinjelwa kokusebenza noma ukuphumula, kanye nokusetshenziswa kwemithi yokulwa nokuvuvukala engeyona i-steroidal uma kudingeka. Ngaphezu kwalokho, iziguli kufanele zikhuthazwe ukuthi zivocavoce ngaphansi kokuqondisa kochwepheshe bezokwelapha ngokomzimba ukuze kuqiniswe imisipha ye-quadriceps futhi kuthuthukiswe ukuqina kwamalunga edolo.
Kubalulekile ukuqaphela ukuthi ngesikhathi sokuvaleka, izinsimbi zokubopha amadolo noma izintambo zokubopha amadolo zivame ukugqokwa, futhi ukufakwa kweplasta kuyagwenywa ngangokunokwenzeka, njengoba kungaholela kalula ekulimaleni kwe-cartilage ye-articular; yize ukwelashwa kokuvinjelwa kunganciphisa izimpawu, ama-hormone akufanele asetshenziswe noma asetshenziswe kancane, njengoba evimbela ukwakheka kwama-glycoprotein kanye ne-collagen futhi athinte ukulungiswa kwe-cartilage; lapho ukuvuvukala kwamalunga nobuhlungu kuba kubi ngokuzumayo, kungasetshenziswa izingcindezi zeqhwa, futhi ukwelashwa ngokomzimba kanye nezingcindezi ezifudumele kungasetshenziswa ngemva kwamahora angu-48.
V. Ezigulini ezisemaphethelweni esigaba sokugcina, ikhono lokulungisa i-articular cartilage libi, ngakho-ke ukwelashwa okulondolozayo ngokuvamile akuphumelelanga futhi kudingeka ukwelashwa ngokuhlinzwa. Kuhlanganisani ukwelashwa ngokuhlinzwa?
Izinkomba zokuhlinzwa zifaka: ngemva kwezinyanga eziningana zokwelashwa okuqinile okulondolozayo, ubuhlungu be-patellar busekhona; uma kukhona ukukhubazeka kokuzalwa noma okutholiwe, ukwelashwa kokuhlinzwa kungacatshangelwa. Uma kwenzeka umonakalo we-cartilage e-Outerbridge III-IV, iphutha alisoze lagcwaliswa yi-cartilage yangempela ye-articular. Ngalesi sikhathi, ukushefa nje indawo yomonakalo we-cartilage ngokugcwala ngokweqile okungapheli akukwazi ukuvimbela inqubo yokuwohloka kobuso be-articular.
Izindlela zokuhlinzwa zifaka:
(1) Ukuhlinzwa kwe-arthroscopic kungenye yezindlela eziphumelelayo zokuxilonga nokwelapha i-chondromalacia patella. Kungabona ngqo izinguquko ebusweni be-cartilage ngaphansi kwe-microscope. Ezimweni ezincane, izilonda ezincane zokuguguleka kwe-cartilage ye-patellar articular zingaklwejwa ukuze kukhuthazwe ukulungiswa.
(2) ukuphakama kwe-lateral femoral condyle; (3) ukususwa kwe-patellar cartilage surface resection. Lokhu kuhlinzwa kwenziwa ezigulini ezinomonakalo omncane we-cartilage ukuze kukhuthazwe ukulungiswa kwe-cartilage; (4) ukususwa kwe-patellar resection kwenziwa ezigulini ezinomonakalo omkhulu ebusweni be-cartilage ye-patellar.
Isikhathi sokuthunyelwe: Novemba-15-2024
