Patella, nke a na-akpọkarị kneecap, bụ ọkpụkpụ sesamoid nke e kpụrụ na akaị quadriceps ma bụrụkwa ọkpụkpụ sesamoid kasị ukwuu n'ime ahụ. Ọ dị larịị na ụdị millet, dị n'okpuru akpụkpọ ahụ ma dị mfe mmetụta. Ọkpụkpụ ahụ sara mbara n'elu wee tụọ ya ala, na-enwe ihu siri ike na azụ dị nro. Ọ nwere ike ịkwaga elu na ala, aka ekpe na aka nri, ma na-echebe nkwonkwo ikpere. Azụ nke patella dị nro ma kpuchie ya na cartilage, na-ejikọta na patellar elu nke femur. Ihu ihu siri ike, akwara quadriceps na-agafe na ya.
Patellar chondromalacia bụ ọrịa nkwonkwo ikpere na-ahụkarị. N'oge gara aga, ọrịa a na-adịkarị n'etiti ndị agadi na ndị agadi. Ugbu a, na mgbasawanye nke egwuregwu na ahụike, ọrịa a nwekwara ọnụ ọgụgụ dị elu n'etiti ndị na-eto eto.
I. Gịnị bụ ezi ihe pụtara na ihe kpatara chondromalacia patella?
Chondromalacia patellae (CMP) bụ nkwonkwo nkwonkwo patellofemoral osteoarthritis kpatara site na mmebi na-adịghị ala ala nke patellar cartilage elu, nke na-akpata ọzịza nke cartilage, mgbawa, mgbaji, mbuze, na ịwụfu. N'ikpeazụ, cartilage nke femoral condyle na-enwekwa otu mgbanwe mgbanwe ahụ. Ezi ihe CMP pụtara bụ: enwere mgbanwe mgbanwe pathological nke cartilage patellar dị nro, ma n'otu oge ahụ, enwere mgbaàmà na akara dị ka mgbu patellar, ụda esemokwu patellar, na atrophy quadriceps.
Ebe ọ bụ na cartilage articular enweghị ntinye akwara, usoro mgbu nke chondromalacia kpatara ka amabeghị. CMP bụ nsonaazụ nke ngwakọta nke ọtụtụ ihe. Ihe dị iche iche na-akpata mgbanwe na nrụgide nkwonkwo patellofemoral bụ ihe na-akpata mpụga, ebe mmeghachi omume autoimmune, cartilage dystrophy, na mgbanwe nke nrụgide intraosseous bụ ihe kpatara chondromalacia patellae.
II.Ihe kachasị dị ịrịba ama nke chondromalacia patellae bụ mgbanwe mgbanwe nke pathological. Ya mere, site n'echiche nke mgbanwe ọrịa pathological, kedu ka chondromalacia patellae si na-enweta ọkwa?
Insall kọwara usoro anọ pathological nke CMP: ogbo m bụ cartilage nro nke edema kpatara, ogbo II bụ n'ihi mgbawa na mpaghara dị nro, ogbo III bụ nkewa nke cartilage articular; ogbo IV na-ezo aka na mgbanwe erosive nke osteoarthritis na mkpughe nke ọkpụkpụ subchondral n'elu articular.
Sistemụ grading Outerbridge kacha bara uru maka ịlele ọnya patellar articular cartilage n'okpuru nhụta anya ma ọ bụ arthroscopy. Sistemụ grading Outerbridge bụ nke a:
Ọkwa I: Naanị cartilage dị nro ka a na-eme ka ọ dị nro (imechi cartilage mechiri emechi). Nke a na-achọkarị nzaghachi mmetụ site na iji nyocha ma ọ bụ ngwa ọzọ iji nyochaa.
Ọkwa II: ntụpọ akụkụ-okpukpu na-agaghị agafe 1.3 cm (0.5 in) na dayameta ma ọ bụ rute ọkpụkpụ subchondral.
Ọkwa III: Ihe mgbawa nke cartilage karịrị 1.3 cm (1/2 inch) na dayameta wee gbatịa ruo ọkpụkpụ subchondral.
Ọkwa IV: Mkpughe nke ọkpụkpụ subchondral.
III. Ma pathology na grading na-egosipụta ihe kacha mkpa nke chondromalacia patella. Yabụ kedu ihe ịrịba ama na nyocha kachasị bara uru maka ịchọpụta chondromalacia patella?
Nchoputa a na-adabere na ihe mgbu n'azụ patella, nke a na-eme site na ule ikiri patellar na ule squat otu-ụkwụ. Ekwesịrị ilekwasị anya n'ịmata ma enwere mmerụ ahụ meniscus jikọtara ọnụ na ọrịa ogbu na nkwonkwo. Otú ọ dị, ọ dịghị njikọ n'etiti ịdị njọ nke patellar chondromalacia na mgbaàmà ụlọ ọgwụ nke ọrịa mgbu mgbu ikpere. MRI bụ usoro nyocha nke ziri ezi.
Ihe mgbaàmà a na-ahụkarị bụ ihe mgbu na-adịghị mma n'azụ patella na n'ime ikpere, nke na-akawanye njọ mgbe ọ gbasasịrị ma ọ bụ na-arịgo ma ọ bụ gbadaa steepụ.
Nnyocha anụ ahụ na-ekpughe nro doro anya na patella, peripatella, patellar patellar na posterior patella, nke nwere ike jikọta ya na ihe mgbu na-egbuke egbuke na ụda esemokwu patellar. Enwere ike ịnwe mmịpụta nkwonkwo na atrophy quadriceps. N'ọnọdụ ndị siri ike, mgbatị ikpere na mgbatị dị oke ma onye ọrịa enweghị ike iguzo n'otu ụkwụ. N'oge ule mkpakọ nke patellar, enwere mgbu dị ukwuu n'azụ patella, na-egosi mmebi nke cartilage patellar articular, nke bụ ihe nchọpụta nchọpụta. Nnwale ụjọ na-adịkarị mma, ule squat na-adịkwa mma. Mgbe ikpere na-atụgharị 20 ° ruo 30 °, ma ọ bụrụ na nso nke ime na mpụga ije nke patella gafere 1/4 nke transverse dayameta nke patella, ọ na-egosi patellar subluxation. Ịtụ n'akuku Q nke 90° ngbanwe ikpere nwere ike igosipụta trajectory ije patellar na-adịghị mma.
Nyocha inyeaka kachasị ntụkwasị obi bụ MRI, bụ nke ji nwayọọ nwayọọ dochie arthroscopy ma ghọọ ụzọ na-adịghị emerụ ahụ na nke a pụrụ ịdabere na ya nke CMP. Nnyocha nyocha na-elekwasị anya na paramita ndị a: elu patellar (Caton index, PH), femoral trochlear groove angle (FTA), lateral surface ratio of femoral trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), n'etiti nke PH, PCA, na PTA bụ ndị a pụrụ ịdabere na nkwonkwo ikpere n'oge nchoputa nke C.
A na-eji X-ray na MRI tụọ elu patellar (Caton index, PH): a. Axial X-ray nọ n'ọnọdụ na-ebu ibu na ikpere na-atụgharị na 30º, b. MRI nọ n'ọnọdụ ya na ikpere na-atụgharị na 30 °. L1 bụ ihe nrịbama nke patellar, nke bụ ebe dị anya site na ebe kachasị ala nke patellofemoral nkwonkwo elu ruo n'ihu elu elu nke tibial plateau contour, L2 bụ ogologo nke patellofemoral nkwonkwo elu, na Caton index = L1 / L2.
E ji X-ray na MRI tụọ akụkụ femoral trochlear groove angle na patellar fit angle (PCA): a. Axial X-ray na ikpere na-atụgharị na 30 ° na ọnọdụ na-ebu ibu; b. MRI na ikpere na-atụgharị na 30 °. Akuku femoral trochlear groove nwere ahịrị abụọ, ya bụ ebe kachasị ala A nke trochlear groove femoral, ebe kachasị elu nke C nke medial trochlear articular elu, na ebe kachasị elu B nke mpụta trochlear articular elu. ∠BAC bụ akụkụ femoral trochlear groove. A na-esere akụkụ akụkụ trochlear femoral n'onyinyo axial nke patella, wee see bisector AD nke ∠BAC. Mgbe ahụ, a na-adọta ahịrị kwụ ọtọ AE site na ebe kachasị ala A nke femoral trochlear groove dị ka mmalite site na ebe kacha ala E nke patellar crest. Akụkụ dị n'etiti ahịrị kwụ ọtọ AD na AE (∠DAE) bụ akụkụ dabara adaba patellar.
A na-eji X-ray na MRI tụọ patellar tilt angle (PTA): a. Axial X-ray nọ n'ọnọdụ na-ebu ibu na ikpere na-atụgharị na 30º, b. MRI nọ n'ọnọdụ ya na ikpere na-atụgharị na 30 °. The patellar tilt angle bụ akụkụ dị n'etiti ahịrị na-ejikọta isi ihe kachasị elu nke condyles medial na mpụta femoral na axis transverse nke patella, ntụgharị ∠ABC.
Radiographs siri ike ịchọpụta CMP n'oge mmalite ya ruo mgbe ọkwa dị elu, mgbe nnukwu cartilage mfu, nkwụsị nke oghere nkwonkwo, na sclerosis subchondral ọkpụkpụ jikọtara na mgbanwe cystic pụtara ìhè. Arthroscopy nwere ike nweta nchoputa a pụrụ ịdabere na ya n'ihi na ọ na-enye ọhụụ magburu onwe ya nke nkwonkwo patellofemoral; Otú ọ dị, enweghi njikọ doro anya n'etiti oke nke patellar chondromalacia na ogo mgbaàmà. Ya mere, mgbaàmà ndị a ekwesịghị ịbụ ihe ngosi maka arthroscopy. Tụkwasị na nke ahụ, arthrography, dị ka usoro nchọpụta nke na-emerụ ahụ na usoro ihe omume, na-ejikarị eme ihe naanị na ọkwa dị elu nke ọrịa ahụ. MRI bụ usoro nchọpụta nke na-adịghị ahụ anya nke na-ekwe nkwa ikike pụrụ iche iji chọpụta ọnya cartilage yana nhụsianya dị n'ime nke cartilage tupu mfu cartilage morphological na anya gba ọtọ.
IV. Chondromalacia patellae nwere ike gbanwee ma ọ bụ nwee ike ịga n'ihu na ọrịa ogbu na nkwonkwo patellofemoral. Ekwesịrị inye ọgwụgwọ nchekwa nchekwa dị mma ozugbo na mmalite nke ọrịa ahụ. Yabụ, kedu ihe ọgwụgwọ mgbanwe na-agụnye?
A na-ekwenyekarị na n'oge mmalite (ogbo I ruo II), cartilage patellar ka nwere ikike ịrụzi, na ọgwụgwọ na-abụghị nke ịwa ahụ kwesịrị ịrụ ọrụ nke ọma. Nke a na-agụnyekarị mmachi ọrụ ma ọ bụ izu ike, yana iji ọgwụ mgbochi mkpali na-abụghị steroidal mgbe ọ dị mkpa. Tụkwasị na nke ahụ, a ga-agba ndị ọrịa ume ka ha na-emega ahụ n'okpuru nlekọta nke onye na-ahụ maka ọgwụgwọ anụ ahụ iji mee ka akwara quadriceps sikwuo ike ma mee ka nkwonkwo ikpere dịkwuo elu.
Ọ dị mma ịmara na n'oge a na-emegharị ahụ, a na-eyikarị ihe nkwado ikpere ma ọ bụ orthoses ikpere, a na-ezere nhazi nke plasta dị ka o kwere mee, n'ihi na ọ nwere ike iduga n'ụzọ dị mfe na-emerụ ahụ nke cartilage articular; ọ bụ ezie na ọgwụgwọ mgbochi nwere ike belata mgbaàmà, e kwesịghị iji hormones mee ihe ma ọ bụ jiri nwayọọ mee ihe, n'ihi na ha na-egbochi njikọ nke glycoproteins na collagen ma na-emetụta nrụzi nke cartilage; mgbe ọzịza nkwonkwo na mgbu na-akawanye njọ na mberede, a na-etinye ihe mkpuchi ice, a pụkwara itinye ọgwụgwọ anụ ahụ na mkpakọ ọkụ mgbe awa 48 gachara.
V. N'ime ndị ọrịa na-emepe emepe, ike nrụzi nke cartilage articular adịghị mma, n'ihi ya, ọgwụgwọ na-adịghị mma na-adịkarịghị irè na ọgwụgwọ ịwa ahụ chọrọ. Kedu ihe ọgwụgwọ ịwa ahụ gụnyere?
Ihe ngosi maka ịwa ahụ gụnyere: mgbe ọtụtụ ọnwa nke ọgwụgwọ nlezianya siri ike, ihe mgbu patellar ka dị; ọ bụrụ na enwere nkwarụ ma ọ bụ enwetara, enwere ike ịtụle ọgwụgwọ ịwa ahụ. Ọ bụrụ na mmebi cartilage Outerbridge III-IV mere, ntụpọ enweghị ike ijupụta na ezigbo cartilage. N'oge a, naanị ịkpụcha ebe mmebi cartilage na oke ibu na-adịghị ala ala enweghị ike igbochi usoro mmebi elu articular.
Ụzọ ịwa ahụ gụnyere:
(1) Ịwa ahụ arthroscopic bụ otu n'ime ụzọ dị irè isi chọpụta na ọgwụgwọ chondromalacia patella. Ọ nwere ike ịhụ mgbanwe na elu cartilage n'okpuru microscope ozugbo. N'ọnọdụ ndị dị nro, obere ọnya mbuze na cartilage patellar articular nwere ike ihichapụ iji kwalite nrụzi.
(2) elu condyle femoral n'akụkụ; (3) ntughari elu nke cartilage patellar. A na-arụ ọrụ ịwa ahụ a maka ndị ọrịa nwere obere mmebi nke cartilage iji kwalite mmezi nke cartilage; (4) A na-emezigharị patellar maka ndị ọrịa nwere nnukwu mmebi nke elu cartilage patellar.
Oge nzipu: Nov-15-2024
