Patella, bakunze kwita ivi, ni igufwa rya sesamoide ryakozwe muri tendon ya quadriceps kandi ni naryo magufa manini ya sesamoide mu mubiri. Ireshya kandi ifite ishusho, iri munsi yuruhu kandi byoroshye kubyumva. Amagufwa aragutse hejuru kandi yerekanwe hepfo, hamwe imbere hakeye kandi inyuma. Irashobora kuzamuka hejuru no hepfo, ibumoso n'iburyo, kandi ikarinda ivi. Inyuma ya patella iroroshye kandi itwikiriwe na karitsiye, ihuza hejuru ya patellar ya femur. Imbere irakomeye, kandi quadriceps tendon iranyuramo.
Indwara ya chondromalacia ni indwara isanzwe ifata ivi. Mu bihe byashize, iyi ndwara yari ikunze kugaragara ku bantu bageze mu za bukuru ndetse n'abasaza. Ubu, hamwe no kumenyekanisha siporo no kwinezeza, iyi ndwara nayo ifite umubare munini w’abantu benshi mu rubyiruko.
I. Ni ubuhe busobanuro nyabwo n'impamvu ya chondromalacia patella?
Chondromalacia patellae (CMP) ni osteoarthritis ihuriweho na patellofemorale iterwa no kwangirika karande hejuru ya patellar karitsiye, itera kubyimba, guturika, kumena, isuri, no kumeneka. Hanyuma, ibinyuranye na femorale condyle cartilage nayo ihura nimpinduka zimwe. Igisobanuro nyacyo cya CMP ni: hariho impinduka ziterwa na patellar cartilage yoroshye, kandi mugihe kimwe, hariho ibimenyetso nibimenyetso nkububabare bwa patellar, amajwi yo guterana amagambo, hamwe na quadriceps atrophy.
Kubera ko articular artilage idafite imitekerereze yimbere, uburyo bwububabare buterwa na chondromalacia buracyasobanutse. CMP nigisubizo cyingaruka ziterwa nibintu byinshi. Impamvu zitandukanye zitera impinduka kumuvuduko wa patellofemorale nimpamvu ziva hanze, mugihe reaction ya autoimmune, dystrofi ya karitsiye, hamwe nimpinduka zumuvuduko wimbere nimpamvu zitera chondromalacia patellae.
II. Ikintu cyingenzi kiranga chondromalacia patellae nimpinduka zihariye zindwara. Noneho ukurikije impinduka zindwara, chondromalacia patellae itondekwa gute?
Insall yasobanuye ibyiciro bine byindwara ya CMP: icyiciro cya I ni koroshya karitsiye yatewe no kuribwa, icyiciro cya II giterwa no gucikamo agace koroheje, icyiciro cya III ni ugucamo ibice bya artique; icyiciro cya IV bivuga ihinduka ryangirika rya osteoarthritis no kwerekana amagufwa ya subchondral hejuru yubuso.
Sisitemu yo gutondekanya Outerbridge ningirakamaro cyane mugusuzuma patellar articular cartilage ibikomere munsi ya visualisation cyangwa arthroscopy. Sisitemu yo gutanga amanota ya Outerbridge nuburyo bukurikira:
Icyiciro cya I: Gusa karitsiye ya articular yoroheje (gufunga karitsiye ifunze). Ibi mubisanzwe bisaba ibitekerezo byubusa hamwe nubushakashatsi cyangwa ikindi gikoresho cyo gusuzuma.
Icyiciro cya II: Inenge-yubunini bwigice kitarenze cm 1,3 (0.5 in) ya diametre cyangwa kugera kumagufa ya subchondral.
Icyiciro cya III: Igice cya karitsiye kirenze cm 1,3 (1/2 santimetero) z'umurambararo kandi kigera ku magufa yo munsi.
Icyiciro cya IV: Kugaragara kw'amagufwa ya Subchondral.
III. Byombi patologiya hamwe nu byiciro byerekana ishingiro rya chondromalacia patella. Nibihe bimenyetso bifatika nibizamini byo gusuzuma chondromalacia patella?
Kwipimisha ahanini bishingiye kububabare bwihishe inyuma ya patella, buterwa nikizamini cyo gusya patellar hamwe nikizamini cyo kuguru kamwe. Ibyibandwaho bigomba kuba mukumenya niba hari ibikomere bya menisque hamwe na artite ihahamuka. Nyamara, nta sano riri hagati yuburemere bwa patellar chondromalacia nibimenyetso byamavuriro ya syndrome yububabare bwimbere. MRI nuburyo bwiza bwo gusuzuma.
Ikimenyetso gikunze kugaragara ni ububabare butagaragara inyuma ya patella no imbere y'amavi, bikarushaho gukomera nyuma yo gukora cyane cyangwa kuzamuka hejuru cyangwa kumanuka.
Isuzuma ryumubiri ryerekana ubwuzu bugaragara muri patella, peripatella, marge marge na patella inyuma, bishobora guherekezwa nububabare bwa patellar kunyerera hamwe nijwi ryo guterana amagambo. Hashobora kubaho effusion hamwe na quadriceps atrophy. Mubihe bikomeye, guhindagurika kw'ivi no kwaguka bigarukira kandi umurwayi ntashobora guhagarara kumaguru kamwe. Mugihe cyo kwipimisha patellar, hari ububabare bukabije inyuma ya patella, byerekana kwangirika kwa patellar articular artilage, bifite akamaro ko gusuzuma. Ikizamini giteye ubwoba akenshi ni cyiza, kandi ikizamini cya squat ni cyiza. Iyo ivi rihindagurika 20 ° kugeza 30 °, niba intera yimbere yimbere ninyuma ya patella irenze 1/4 cya diameter ihindagurika ya patella, byerekana subellarxation. Gupima Q inguni ya 90 ° ivi irashobora kwerekana inzira idasanzwe ya patellar.
Ikizamini cyabafasha cyizewe cyane ni MRI, yagiye isimbuza buhoro buhoro arthroscopie ihinduka uburyo budatera kandi bwizewe bwa CMP. Ibizamini byerekana amashusho byibanda cyane kuri ibi bipimo: uburebure bwa patellar (indangagaciro ya Caton, PH), inguni ya femorale trochlear groove angle (FTA), igipimo cyo hejuru cyuruhande rwa femorale trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), muri byo harimo PH, PCA, na PTA ni ibipimo byizewe byamavi bya CMP hakiri kare.
X-ray na MRI byakoreshejwe mugupima uburebure bwa patellar (Indangagaciro ya Caton, PH): a. X-ray ya Axial muburyo bwo kwihagararaho ihagaze ivi ihindagurika kuri 30 °, b. MRI mu mwanya ufite ivi ryahindutse kuri 30 °. L1 ni impagarike ya patellar, niyo ntera kuva hasi cyane yubuso bwa patellofemorale kugera hejuru yimbere yimbere yimbere ya tibial plateau kontour, L2 nuburebure bwubuso bwa patellofemorale, hamwe na Caton index = L1 / L2.
Femoral trochlear groove angle na patellar fit angle (PCA) byapimwe na X-ray na MRI: a. Axial X-ray ifite ivi ihindagurika kuri 30 ° mumwanya uhagaze ufite uburemere; b. MRI ifite ivi ryahindutse kuri 30 °. Inguni ya femorale trochlear groove igizwe n'imirongo ibiri, aribwo ingingo yo hasi ya A ya femorale trochlear groove, ingingo yo hejuru C yubuso bwa medial trochlear articular articular, hamwe na point B yo hejuru ya troclear arctular. ACBAC ni inguni ya femorale trochlear groove inguni. Inguni ya femorale trochlear groove yashushanijwe ku ishusho ya axe ya patella, hanyuma bisiteri AD ya ∠BAC yashushanijwe. Noneho umurongo ugororotse AE wakuwe kumurongo wo hasi A ya femorale trochlear groove nkinkomoko inyuze kumurongo wo hasi wa E wa patellar. Inguni iri hagati yumurongo ugororotse AD na AE (∠DAE) ni patellar ikwiye.
X-ray na MRI byakoreshejwe mugupima impande zose (PTA): a. X-ray ya Axial muburyo bwo kwihagararaho ihagaze ivi ihindagurika kuri 30 °, b. MRI mu mwanya ufite ivi ryahindutse kuri 30 °. Inguni ya patellar ihanamye ni inguni iri hagati yumurongo uhuza ingingo ndende za condyles ya medial na lateral femoral condyles hamwe na axe ihindagurika ya patella, ni ukuvuga ∠ABC.
Radiografi iragoye gusuzuma CMP mubyiciro byayo byambere kugeza ibyiciro byateye imbere, mugihe igihombo kinini cya karitsiye, gutakaza umwanya uhuriweho, hamwe na sklerose yo mu magufwa ya sklerose hamwe nimpinduka za cystic biragaragara. Arthroscopy irashobora kugera ku isuzuma ryizewe kuko itanga ishusho nziza yimikorere ya patellofemoral; icyakora, nta sano isobanutse iri hagati yuburemere bwa patellar chondromalacia nurwego rwibimenyetso. Kubwibyo, ibi bimenyetso ntibigomba kuba ikimenyetso cya arthroscopie. Byongeye kandi, arthrography, nkuburyo bwo kwisuzumisha butagaragara hamwe nuburyo busanzwe, bukoreshwa gusa mubyiciro byindwara. MRI nuburyo bwo kwisuzumisha budasobanutse busezeranya ubushobozi budasanzwe bwo kumenya ibikomere bya karitsiye ndetse no gutandukana kwimbere muri karitsiye mbere yuko igihombo cya morfologiya kigaragara mumaso.
IV. Chondromalacia patellae irashobora guhinduka cyangwa irashobora gutera imbere kurwara rubagimpande. Uburyo bwiza bwo kuvura indwara zigomba gutangwa vuba mugihe cyambere cyindwara. None, kuvura konservateur bikubiyemo iki?
Muri rusange abantu bemeza ko mugihe cyambere (icyiciro cya mbere kugeza ku cya II), karitsiye ya patellar iracyafite ubushobozi bwo gusana, kandi hagomba gukorwa uburyo bwiza bwo kubaga atari kubaga. Ibi bikubiyemo cyane cyane guhagarika ibikorwa cyangwa kuruhuka, no gukoresha imiti itari steroidal anti-inflammatory igihe bibaye ngombwa. Byongeye kandi, abarwayi bagomba gushishikarizwa gukora siporo bayobowe numuvuzi wumubiri kugirango bakomeze imitsi ya quadriceps no kuzamura ivi.
Birakwiye ko tumenya ko mugihe cya immobilisation, imivi yivi cyangwa ivi ya orthose muri rusange byambarwa, kandi gukosora plaster biririndwa bishoboka, kuko bishobora gukurura byoroshye gukomeretsa imitsi ya artique; nubwo kuvura gukumira bishobora kugabanya ibimenyetso, imisemburo ntigomba gukoreshwa cyangwa gukoreshwa gake, kuko ibuza synthèse ya glycoproteine na kolagen kandi bikagira ingaruka ku gusana karitsiye; mugihe kubyimba hamwe no kubabara bikabije, compresses zirashobora gukoreshwa, hamwe nubuvuzi bwumubiri hamwe na compresses zishyushye birashobora gukoreshwa nyuma yamasaha 48.
V. Mu barwayi batinze, ubushobozi bwo gusana karitsiye ya artique ni bubi, bityo rero kuvura indwara zidahwitse akenshi nta cyo bivuze kandi birasabwa kuvurwa. Ubuvuzi bwo kubaga bukubiyemo iki?
Ibimenyetso byo kubaga birimo: nyuma y'amezi menshi yo kuvura byimazeyo, ububabare bwa patellar buracyahari; niba hari ubumuga bwavutse cyangwa bwabonye, ubuvuzi bwo kubaga bushobora gutekerezwa. Niba Outerbridge III-IV yangiritse yibasiwe, inenge ntishobora kuzuzwa na karitsiye nyayo. Muri iki gihe, kwiyogoshesha kwangirika kwa karitsiye hamwe nuburemere burenze urugero ntibishobora kubuza inzira yo kwangirika kwinyuma.
Uburyo bwo kubaga burimo:
(1) Kubaga Arthroscopique ni bumwe mu buryo bwiza bwo gusuzuma no kuvura chondromalacia patella. Irashobora kwitegereza mu buryo butaziguye impinduka ziri hejuru ya karitsiye munsi ya microscope. Mugihe cyoroheje, isuri ntoya yisuri kuri patellar articular cartilage irashobora gukurwaho kugirango iteze imbere.
(2) ubutumburuke bwa femorale condyle; (3) patellar cartilage hejuru yububiko. Ubu bubaga bukorerwa abarwayi bafite ibyangiritse bito kugirango bateze imbere gusana; (4) patellar resection ikorerwa kubarwayi bafite ibyangiritse bikabije kubutaka bwa patellar.
Igihe cyo kohereza: Ugushyingo-15-2024
