Patella, izwi cyane nka kneecap, ni igufwa rya sesamoid ryakozwe mu mutsi w’amaguru, kandi ni na ryo gukurura igufwa rya sesamoid mu mubiri. Rifite ishusho y’umuhondo, riri munsi y’uruhu kandi ryoroshye kumva. Igufwa ni rinini hejuru kandi ryerekeza hasi, rifite imbere hagoye n’umugongo woroshye. Rishobora kuzamuka no hasi, ibumoso n’iburyo, kandi ririnda ingingo y’ivi. Inyuma ya patella ni nziza kandi itwikiriwe n’udusimba, duhuza n’ubuso bwa patellar bw’inyuma. Imbere ni hagoye, kandi umutsi w’amaguru unyuramo.
Patellar chondromalacia ni indwara ikunze kugaragara mu ngingo z'amavi. Mu bihe byashize, iyi ndwara yakunze kugaragara mu bantu bari mu kigero cyo hagati n'abageze mu za bukuru. Ubu, kubera ko siporo n'imyitozo ngororamubiri byamamaye, iyi ndwara inagaragara cyane mu rubyiruko.
I. Ni iyihe mpamvu nyayo ya chondromalacia patella n'igisobanuro cyayo?
Chondromalacia patellae (CMP) ni indwara ya osteoarthritis iterwa n’ubwandu buhoraho ku gice cy’inyuma cy’inyuma cy’inyuma, bigatuma ingirangingo zibyimba, zicika, zicika, zisenyuka, kandi zigacika. Amaherezo, ingirangingo y’inyuma y’inyuma nayo ihura n’impinduka zimwe mu ndwara. Igisobanuro nyacyo cya CMP ni iki: hari impinduka mu buryo ingirangingo ziterwa no koroshya ingirangingo, kandi icyarimwe, hari ibimenyetso nk’ububabare, ijwi ry’ingirangingo, no kugabanuka kw’ingirangingo.
Kubera ko cartilage y'imitsi itagira uburyo bwo kuvura imitsi, uburyo ububabare buterwa na chondromalacia butera ntabwo busobanutse neza. CMP ni ingaruka z'ingaruka zihuriweho z'ibintu byinshi. Ibintu bitandukanye bitera impinduka mu gitutu cy'ingingo za patellofemoral ni impamvu zo hanze, mu gihe ingaruka z'ubwiyongere bw'umubiri, indwara ya cartilage, n'impinduka mu gitutu cy'imbere mu maraso ari byo bintu bitera chondromalacia patellae.
II. Ikintu cy'ingenzi cyane cya chondromalacia patellae ni impinduka zihariye z’uburwayi. None se ukurikije impinduka z’uburwayi, chondromalacia patellae ishyirwa mu byiciro ite?
Insall yavuze ibyiciro bine by’uburwayi bwa CMP: icyiciro cya mbere ni ugukorora kwa cartilage guterwa no kubyimba, icyiciro cya kabiri giterwa n’imitumba mu gace koroshye, icyiciro cya gatatu ni ukwigabanya kwa cartilage y’imitsi; icyiciro cya kane kivuga ku mpinduka za osteoarthritis no kugaragara kw’igufwa rya subchondral ku buso bw’imitsi.
Sisitemu yo gupima Outerbridge ni ingirakamaro cyane mu gusuzuma ibikomere bya patellar articular cartilage hakoreshejwe uburyo bwo kureba neza cyangwa arthroscopy. Sisitemu yo gupima Outerbridge ni iyi ikurikira:
Icyiciro cya I: Agatsima k'imitsi gusa ni ko koroshya (gufunga agatsima). Ibi akenshi bisaba gusubiza ibintu mu buryo bufatika hakoreshejwe icyuma gipima cyangwa ikindi gikoresho kugira ngo gipimwe.
Icyiciro cya II: Ubusembwa bw'igice cy'ubugari butarengeje santimetero 1.3 (0.5 in) z'umurambararo cyangwa bugera ku igufwa rya subchondral.
Icyiciro cya gatatu: Umuyoboro w'inyama urenza santimetero 1.3 (1/2 santimetero) z'umurambararo kandi ugera ku igufwa rya subchondral.
Icyiciro cya kane: Kugaragara kw'amagufwa ya subchondral.
III. Indwara z'indwara n'amanota byombi bigaragaza imiterere ya chondromalacia patella. None se ni ibihe bimenyetso n'ibizamini bifite akamaro cyane mu gusuzuma chondromalacia patella?
Isuzuma rishingiye ahanini ku bubabare buri inyuma ya patella, buterwa no gupima patellar grinding test n'ikizamini cyo gukaraba amaguru rimwe. Icyibandwaho ni ukumenya niba hari imvune ya meniscus hamwe na rubagimpande iteye ubwoba. Ariko, nta sano riri hagati y'ubukana bwa patellar chondromalacia n'ibimenyetso by'indwara y'ububabare bw'ivi imbere. MRI ni uburyo bwo gusuzuma bunoze kurushaho.
Ikimenyetso gikunze kugaragara ni ububabare budakomeye inyuma ya patella no mu ivi, burushaho kwiyongera nyuma yo gukora imyitozo ngororamubiri cyangwa kuzamuka cyangwa kumanuka ingazi.
Isuzuma ry’umubiri rigaragaza ububabare bugaragara muri patella, peripatella, patellar na posterior patella, bishobora guherekezwa n’ububabare bwo kunyerera no gukururana kwa patellar. Hashobora kubaho gusohoka kw’ingingo no gucika intege kwa quadriceps. Mu bihe bikomeye, guhindagurika kw’ivi no kwaguka kwaryo biba bike kandi umurwayi ntashobora guhagarara ku kaguru kamwe. Mu gihe cyo gupima patellar, hari ububabare bukomeye inyuma ya patella, bigaragaza ko patellar articular cartilage yangiritse, ibyo bikaba bifite akamaro mu gusuzuma. Ikizamini giteye ubwoba akenshi kiba ari cyiza, kandi ikizamini cyo guhagarara kiba ari cyiza. Iyo ivi rizungurutse hagati ya 20° na 30°, niba intera y’imbere n’inyuma ya patella irenga 1/4 cy’umurambararo wa patella, bigaragaza patellar subluxation. Gupima inguni ya Q ya 90° yo guhindagurika kw’ivi bishobora kugaragaza uburyo budasanzwe bwo kugenda kwa patellar.
Isuzuma ryizewe cyane ni MRI, ryagiye risimbura arthroscopy buhoro buhoro, rihinduka uburyo bwo kwirinda indwara ya CMP. Isuzuma ryibanda cyane kuri ibi bipimo: uburebure bwa patellar (Caton index, PH), inguni ya femoral trochlear groove (FTA), igipimo cy’ubuso bwa femoral trochlear (SLFR), inguni ya patellar fit (PCA), inguni ya patellar tilt (PTA), muri byo PH, PCA, na PTA ni ibipimo byizewe byo gusuzuma CMP hakiri kare.
X-ray na MRI byakoreshejwe mu gupima uburebure bwa patellar (Caton index, PH): a. Axial X-ray mu mwanya uhagaze uhagaze ufite uburemere hamwe n'ivi rizungurutse kuri 30°, b. MRI mu mwanya wayo hamwe n'ivi rizungurutse kuri 30°. L1 ni inguni yo kuzenguruka, ikaba ari intera iri hagati y'igice cyo hasi cy'ubuso bw'ingingo ya patellofemoral n'inguni isumba izindi z'imbere z'ikibaya cya tibial, L2 ni uburebure bw'ubuso bw'ingingo ya patellofemoral, naho Caton index = L1/L2.
Inguni ya trochlear groove y'abagore n'inguni ya patellar fit (PCA) byapimwe hakoreshejwe X-ray na MRI: a. X-ray yo mu mutwe hamwe n'ivi rizunguruka kuri 30° mu mwanya wo guhagarara uremereye; b. MRI hamwe n'ivi rizunguruka kuri 30°. Inguni ya trochlear groove y'abagore igizwe n'imirongo ibiri, ari yo ingingo yo hasi A y'umuyoboro wa trochlear w'abagore, ingingo yo hejuru C y'ubuso bwa trochlear bw'imbere, n'ingingo yo hejuru B y'ubuso bwa trochlear bw'iruhande. ∠BAC ni inguni ya trochlear groove y'abagore. Inguni ya trochlear groove y'abagore yashushanyijwe ku ishusho ya patella, hanyuma hagafatwa bisector AD ya ∠BAC. Hanyuma hafatwa umurongo ugororotse AE uhereye ku ngingo yo hasi A y'umuyoboro wa trochlear w'abagore nk'inkomoko binyuze ku ngingo yo hasi E y'inyuma ya patellar. Inguni iri hagati y'umurongo ugororotse AD na AE (∠DAE) ni inguni ifata patellar.
X-ray na MRI byakoreshejwe mu gupima inguni yo kuzunguruka ya patellar (PTA): a. X-ray yo mu mutwe ihagaze ihagaze ifite uburemere, ivi rizunguruka kuri 30°, b. MRI ihagaze ivi rizunguruka kuri 30°. Inguni yo kuzunguruka ya patellar ni inguni iri hagati y'umurongo uhuza ingingo zo hejuru z'imitsi yo hagati n'iy'inyuma y'umugongo n'umurongo unyuranamo wa patella, ni ukuvuga ∠ABC.
Isuzuma rya CMP riragoye gusuzuma mu ntambwe zaryo za mbere kugeza igihe rigeze ku ntambwe za nyuma, aho gutakaza cyane kwa cartilage, gutakaza umwanya w'ingingo, hamwe n'indwara ya sclerosis y'amagufwa ya subchondral hamwe n'impinduka za cystice bigaragara. Arthroscopy ishobora gutanga isuzuma ryizewe kuko itanga ishusho nziza y'urugingo rwa patellofemoral; icyakora, nta sano igaragara hagati y'ubukana bwa patellar chondromalacia n'urugero rw'ibimenyetso. Kubwibyo, ibi bimenyetso ntibikwiye kuba ikimenyetso cya arthroscopy. Byongeye kandi, arthrography, nk'uburyo bwo gusuzuma indwara bukoreshwa mu buryo butunguranye kandi bukoreshwa mu ntambwe za nyuma z'indwara, muri rusange ikoreshwa gusa mu ntambwe za nyuma z'indwara. MRI ni uburyo bwo gusuzuma budakoreshejwe mu buryo butunguranye busezeranya ubushobozi bwihariye bwo kumenya ibisebe bya cartilage ndetse n'ibibazo by'imbere bya cartilage mbere yuko gutakaza cartilage bigaragara ku maso.
IV. Chondromalacia patellae ishobora gusubizwa mu buzima cyangwa igatera rubagimpande ya patellofemoral. Ubuvuzi bwiza bugomba gutangwa vuba mu ntangiriro z'indwara. None se, ubuvuzi busanzwe burimo iki?
Muri rusange abantu bizera ko mu ntangiriro (icyiciro cya mbere kugeza icya kabiri), patellar cartilage iracyafite ubushobozi bwo gusana, kandi hagomba gukorwa ubuvuzi bwiza butarimo kubaga. Ibi bikubiyemo cyane cyane kugabanya ibikorwa cyangwa kuruhuka, no gukoresha imiti idakoresha steroide igabanya ububabare iyo bibaye ngombwa. Byongeye kandi, abarwayi bagomba gushishikarizwa gukora imyitozo ngororamubiri bayobowe n'umuganga w'imitsi kugira ngo bakomeze imitsi ya quadriceps kandi bongere ubushobozi bwo kugumana neza kw'ingingo z'amavi.
Ni ngombwa kumenya ko mu gihe cyo guhagarika kugenda, imishumi y'amavi cyangwa imishumi y'amavi muri rusange irambarwa, kandi kwirindwa gufunga plaster uko bishoboka kose, kuko bishobora gutuma habaho gukomereka k'umuvuduko w'ingingo; nubwo uburyo bwo kuvura bushobora kugabanya ibimenyetso, imisemburo ntigomba gukoreshwa cyangwa ngo ikoreshwe gake, kuko ibuza imikorere ya glycoproteine na collagen kandi bigira ingaruka ku gusana k'umuvuduko; iyo ingingo zibyimba kandi ububabare bukabije, hashobora gushyirwaho imishumi y'urubura, kandi hagashyirwaho imishumi y'imyitozo ngororamubiri n'imishumi y'imyitozo ngororamubiri ishyushye nyuma y'amasaha 48.
V. Ku barwayi barangije mu cyiciro cya nyuma, ubushobozi bwo gusana cartilage y'imitsi iba ari buke, bityo ubuvuzi busanzwe akenshi ntibugira icyo bugeraho kandi ubuvuzi bwo kubaga burakenewe. Ubuvuzi bwo kubaga bukubiyemo iki?
Ibimenyetso byerekana ko umuntu abagwa birimo: nyuma y'amezi menshi yo kuvurwa mu buryo burambye, ububabare bwa patellar buracyahari; niba hari ubumuga bw'umubiri buvukanwa cyangwa bumaze kuvuka, ubuvuzi bwo kubagwa bushobora kwitabwaho. Iyo habayeho kwangirika kwa cartilage ya Outerbridge III-IV, ikibazo ntigishobora kuzuzwa na cartilage nyayo y'imitsi. Muri iki gihe, kogosha agace ka cartilage gafite umuvuduko ukabije ntibishobora gukumira inzira yo kwangirika k'ubuso bw'imitsi.
Uburyo bwo kubaga burimo:
(1) Kubaga arthroscopic ni bumwe mu buryo bwiza bwo gusuzuma no kuvura chondromalacia patella. Bushobora kureba mu buryo butaziguye impinduka mu buso bw'agatsiko k'imitsi hifashishijwe mikorosikopi. Mu bihe byoroheje, udusebe duto two kwangirika ku gatsiko k'imitsi gashobora gukurwaho kugira ngo birusheho gusanwa.
(2) kuzamura urwego rw'imitsi yo mu kibuno; (3) gukata ubuso bw'imitsi yo mu kibuno. Ubu buryo bwo kubaga bukorerwa abarwayi bafite imitsi mito kugira ngo bakomeze gusana imitsi yo mu kibuno; (4) gukata imitsi yo mu kibuno bikorerwa abarwayi bafite imitsi ikomeye yo mu kibuno.
Igihe cyo kohereza: Ugushyingo-15-2024
