Wunim saa? Asiane ahorow ne patellofemoral nkwaa a entumi nnyina pintinn wɔ mmofra mu no ayaresa

Patellofemoral instability (PFI) no bi ne nyarewa ahorow a ɛtoatoa so, efi akisikuru a emu nyɛ den so kosi patella a ɛda adi pefee a ɛtwetwe (LPD) so. LPD abu so kakra, na mmofra 100,000 biara mu 50 na wonya. Mpɛn pii no, nea edi kan a ɛpaapae no ba bere a wadi mfe 15 kosi 19. LPD yɛ yareɛ a ɛma obi yɛ mmerɛw, na sɛnea ɛtwetwe nipadua no fi nipadua no mu wɔ ayaresa a wɔde sa yare anaa nipadua mu ayaresa akyi no dɔɔso te sɛ 70%. Medial patellofemoral ligament a wɔsan yɛ no ne oprehyɛn ayaresa a wɔde di dwuma kɛse. Nanso, ayarefo dodow a ɛboro 16% wɔ nsɛnnennen, a nea ɛka ho ne sɛ wɔsan tu fi wɔn ho. Bio nso, ayarefo no mu nkyem anan mu biako hia oprehyɛn a wodi akyi wɔ kotodwe nkwaa foforo a wɔmfa oprehyɛn nyɛ no ho. Asiane a ɛtra hɔ kyɛ a ɛne sɛ obi bepira ntini a ɛyɛ den kɛse ne OA wɔ LPD akyi no boro nea ɛwɔ hɔ bere a wɔatutu mfiase no akyi mpɛn 6, na ɛma ayarefo nkumaa pii hyia OA asiane wɔ wɔn mfe 30 ne 40 mu. PFI ho ntease a edi mũ a wonni no yɛ akwanside atitiriw a ɛmma patellofemoral nkwaa a ɛteɛ no san yɛ pɛpɛɛpɛ no mu biako.

ASIANE HO NSƐM

Wobetumi akyekyɛ asiane ahorow a ɛwɔ PFI mu no mu abien: nipadua mu nneɛma a ɛnteɛ ne sɛnea ɛne ne ho hyia. Femoral trochlear dysplasia ne nipadua mu ade a ɛnteɛ a ɛho hia sen biara, na alignment a ɛnteɛ no bi ne patellar elevation, patellar roll ne subluxation. Patellofemoral deformity fi biomechanical nsakrae a efi medial stabilizer a opira, Q angle a ɛkɔ soro, anteversion of femur ne lateralization of patellar tendon insertion. Wɔabobɔ asiane a ɛwɔ PFI mu no so wɔ Mfonini 1 mu.

• asen mu ntini a ɛyɛ mmerɛw

• angle a ɛkɔ fam wɔ transverse pulley no mu

• facet asymmetry a ɛwɔ pulley mu

• pulley a emu dɔ

• a ɛne ne ho hyia a ɛnyɛ ne kwan so

• patella a ɛkorɔn

• kwan a ɛda tibia ne trochlear groove (tt-tg) ntam no kɔɔ soro

• nkɔanim q angle

• asen mu anteversion

  
  

SU A ƐFA IMAGING EXAMINATION HO

MRI a wohu wɔ PFI ho no gu ahorow sɛnea yare no mu yɛ den ne sɛnea ɛtra hɔ kyɛ no te. Ebia PFI nsɛm a emu nyɛ den no ne patellar dyskinesia, a ɛyɛ Hoffa srade pad (a wɔsan frɛ no patellofemoral fat impact) no atifi ne akyi afã horow a ɛyɛ kurukuruwa. Patellofemoral fat impact ne asiane afoforo a ɛde PFI ba no wɔ abusuabɔ kɛse, a nea ɛka ho ne femoral condyle dysplasia, patellar height, TT-TG kwan a ɛkɔ soro, lateral patellar tilt ne subluxation. Patellar dyskinesia a ɛtra hɔ kyɛ no ma ntini a ɛwɔ akyi no pira na ɛma akyi berɛmo a ɛwɔ akyi no sɛe ntɛm.

Acute dislocation of patella (APLD) ne PFI a ɛyɛ hu sen biara. X-ray sini a ɛnyɛ den no kyerɛ sɛnea wɔahu apirakuru a emu yɛ den, a ebia nea ɛka ho ne nkwaa a ɛtwetwe, srade dodow a ɛtɔ mmere bi a ɛyɛ srade a ɛwɔ ntini mu, ntini a ɛwɔ mfinimfini no a ɛpaapae, akyi a ɛdannan/subluxation of patella (Mfonini 8A), ne akyi sulcus sɛnkyerɛnne a emu dɔ a ɛnam impaction opira a ɛba akyi asen mu ntini a ɛwɔ akyi no so. MRI a ɛda adi pɔtee a ɛkyerɛ LPD a emu yɛ den no bi ne medial stabilizer opira (wohu wɔ 96%), lateral patellar tilt anaa subluxation, osteochondral opira ne nkwaa mu effusion (Mfonini 2B, C). Mpɛn pii no, wɔsan de patella no si hɔ ankasa bere a wɔatutu nea edi kan no akyi.

Ayarefo no mu bɛyɛ 70% benya akisikuru a ɛsan ba bio, na akisikuru a ɛsan ba a enni sabea betumi aba. Wɔ saa tebea yi mu no, MRI betumi akyerɛ sɛ medial stabilizer no tetew bere tenten, medial patellar deformity, ossification of medial patella, patellar-femoral fat impact, cartilage opira ne lateral patellofemoral joint a asɛe (Mfonini 3).

AYARESA A WƆYƐ

1. Ayaresa a ɛnyɛ oprehyɛn:

• Patellar dislocations a emu yɛ den dodow no ara yɛ bere tiaa mu de na ɛbɛsan ayɛ no ara kwa. Ɛtɔ da bi a, ayarefoɔ, abusua mufoɔ, nnamfo, akyerɛkyerɛfoɔ anaa nteteefoɔ de wɔn nsa bɛsan de patella no asi hɔ wɔ hɔ ara. Sɛ ɔyarefo no kɔ baabi a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ esiane patellar dislocation nti a, wɔbɛma no aduru a ɛma n’adwene mu da hɔ. Wɔnam nan no a wɔtrɛw mu nkakrankakra so na ɛma patella so tew a wɔatoto mu. Sɛ wɔsan de si hɔ wie a, hwɛ kotodwe nkwaa no mu wɔ ayaresabea sɛ ebia apirakuru afoforo bi wɔ hɔ anaa.

• Ayaresa a wɔtaa de di dwuma ma patella a edi kan a ɛpue ne ayaresa a ɛnyɛ oprehyɛn, na bere tiaa (adapɛn 2-4) a wɔde si hɔ wɔ splint anaa kotodwe nkwaa fixator mu no betumi adi ɛyaw ne ntini a edi kan a ɛsa wɔ ntua a emu yɛ den akyi no so. Wɔ saa bere yi mu no, wɔma poma kwan ma ɛsoa emu duru no. Ɛno akyi no, wɔde patella stabilizing brackets di dwuma de yɛ dwumadi ahorow, na wɔyɛ apɔw-mu-teɛteɛ de san ma kankyee, ahoɔden ne akwaa a wɔde di dwuma no san ba.

• Mpɛn pii no, ayarefo san fi ase teɛteɛ wɔn apɔw mu bɛyɛ asram 3 wɔ ntua a edi kan no akyi. Ɛno da nkyɛn a, stent a wɔbɛhyɛ no yɛ nea obiara betumi apaw.

2. Oprehyɛn a wɔde sa yare:

• Wɔ ayarefo bɛboro 30% mu no, patellar dislocation a edi kan no ne kotodwe nkwaa a ɛtwetwe kɛse no wɔ abusuabɔ. Wɔ eyi mu no, ɛho hia sɛ wɔyɛ MRI de hu sɛ ebia nnompe mu akisikuru bi wɔ hɔ anaa. Beae a ɛtaa si saa akisikuru yi ne medial patella anaa lateral femoral condyle, na wɔtaa kamfo oprehyɛn a wɔde sa yare kyerɛ bere a ntini no mu abubu wɔ hɔ no.

• Bere a wɔreyɛ oprehyɛn no, woyi nnompe mu asinasin a abubu no anaasɛ wosiesie sɛnea nnompe no kɛse ne sɛnea nnompe no te te. Sɛ osteochondral fracture kɛse yɛ ≥ 15 mm a, wosusuw fracture fixation a wɔde besi hɔ mmom sen sɛ wobetwa ho. Wɔnam ɔkwan a wɔabue so na ɛyɛ saa fixation yi denam dade screws, bioabsorbable pins anaa sutures so.

• Wɔ akisikuru a wɔsa mu no, su a ɛne sɛ wɔyɛ oprehyɛn ma patella no gyina bere koro mu no nam mfinimfini a wosiesie anaasɛ MPFL a wɔsan yɛ so na ɛba. Sɛ wɔde dade nkɔnsɔnkɔnsɔn di dwuma de siw akisikuru no ano a, ebia ɛho behia sɛ wɔde oprehyɛn afoforo yi fi hɔ daakye.

• Sukuu abien na ɛwɔ hɔ a ɛfa ɔkwan a eye sen biara a wɔfa so ma patellar gyina hɔ pintinn ho. Ɔkwan a edi kan ne sɛ wɔbɛyɛ MPFL san a atew ne ho. MPFL ne anohyeto titiriw a ɛma patella subluxation wɔ akyi, enti ne san a wɔbɛsan ayɛ no bɛma patella no agyina pintinn a ɛho hia. Wɔtaa de quadriceps tendon autograft, hamstring tendon autograft anaa allograft na ɛyɛ MPFL sanba. Nkonimdie dodoɔ a ɛwɔ MPFL a wɔsan yɛ a wɔatew wɔn ho mu de san de patellar stability ba no boro 95%, a ɛne graft a wɔpaw no nni hwee yɛ. Nsɛnnennen a ɛtaa ba wɔ MPFL a wɔsan yɛ no mu ne kotodwe nkwaa a ɛyɛ den, nkotodwe a ɛpaapae ne akyi a ɛsan gyina pintinn.

• Ɔkwan a ɛto so abien no di asiane ahorow a ɛwɔ patellar a entumi nnyina pintinn, ne MPFL a wɔsan yɛ no ho dwuma. Wɔ saa kwan yi so no, wɔde X-ray film ne CT/MRI na ɛkyerɛ nipadua mu asiane ahorow a ɛde patellar a entumi nnyina pintinn ba, a trochlear dysplasia, patellar tenten a ɛkɔ soro ne TT-TG kwan ka ho. Sɛ wohu wie a, wɔde oprehyɛn besiesie asiane ahorow no bi anaa ne nyinaa.

• Wɔnam trochleoplasty so di trochlear dysplasia no ho dwuma, a ɛma trochlear groove no mu dɔ (Mfonini 12A). Trochlear plasty nyɛ nea nkurɔfo ani gye ho kɛse wɔ United States efisɛ ɛfa articular cartilage a wɔtow hyɛ so ho, na wɔ nsusuwii mu no, asiane wɔ hɔ sɛ daakye ischemic necrosis anaa ntini mu yare bɛba.

• Patella tenten anaa patella sorokɔ a ɛkɔ soro no nam distal tibial tubercle so siesie. Sɛnea ɛbɛyɛ a TT-TG kwan no bɛkɔ soro no, wɔyɛ medial anaa anteromedial tibial tubercle (Mfonini 12B). Nsɛnnennen a ɛba wɔ tibial tuberosity osteotomy mu no bi ne nonunion, hardware pain, tuberosity a ɛso tew a ɛyera ne fracture.

• Wɔ lateral retina no nhyɛso ho no, wɔyɛ lateral retina release, a ɛkyerɛ sɛ patella tilt no kɔ soro. Nsɛnnennen a ɛba bere a wɔayi afi akyi no bi ne ɔfe a ɛkɔ so tra hɔ ne iatrogenic medial instability of patella.

• Wɔ ayarefo a wɔn nnompe nnyinii mu no, wɔbara oprehyɛn ahorow bi anaasɛ wɔsakra mu esiane epiphysis nti.

• MFPL no asen a ɛbata ho no wɔ asen a ɛwɔ akyirikyiri no epiphysis no ase pɛɛ. Enti, ɛsɛ sɛ wɔyɛ MPFL a wɔsan yɛ ayarefo a wɔn nnompe nnyinii no wɔ fluoroscopy akwankyerɛ a emu yɛ den ase na ama wɔahwɛ ahu sɛ wɔatu asen mu kwan a ahobammɔ wom.

• Distal femur opira betumi ama obi adi dɛm, na ebia ɛho behia sɛ wɔyɛ oprehyɛn teɛteɛ anaasɛ ɛrenhia. Saa ara nso na opira a ɛba wɔ proximal tibial protrusion mu no betumi ama obi adi dɛm, titiriw wɔ kotodwe a ɛwɔ mfinimfini no mu. Enti, wɔabara osteotomy of tibial tuberosity mma ayarefo a open proximal tibial protrusion.

• Nea ɛne eyi bɔ abira no, patellar tendon no betumi atu koraa anaa ne fã bi akɔ mfinimfini. Sɛ wɔde patellar tendon no akyi fã no kɔ mfinimfini fã a, wɔfrɛ saa oprehyɛn yi Roux-Goldthwait oprehyɛn (Mfonini 12C).

• Ɛsɛ sɛ wɔhwehwɛ ayarefo a wɔreyɛ wɔn oprehyɛn nyinaa mu hwɛ sɛ ebia patellar instability wɔ nhyehyɛe a ɛwɔ coronary akwaa ne akwaa a ɛkyinkyini no mu anaa. Genu valgus a ɛkɔ soro, femoral anteversion a ɛboro so ne abɔnten tibial torsion a ɛkɔ soro ne asiane ahorow a ɛma patellar ntumi nnyina.

• Wɔ ayarefo a wɔn nnompe nnyinii fam no, ɛsɛ sɛ wosusuw sɛnea wɔbɛkyerɛ wɔn nyin kwan bere a wɔredi genu valgus ho dwuma no. Epiphyseal screws anaa tension band plates betumi atrɛw akɔ femoral epiphysis no awiei a ɛwɔ akyirikyiri no mfinimfini fã ma wɔateɛteɛ mu nkakrankakra. Ɛho hia sɛ wotwa nnompe de teɛteɛ ayarefo a wɔn nnompe a ɛho akokwaw no wɔ ahurututu mu ntini anaasɛ ntini a ɛkyinkyini no ho. Nteɛsoɔ a ɛkyerɛ sɛ genu valgus wɔ no yɛ > digrii 10, na nteɛsoɔ a ɛkyerɛ sɛ ɛyɛ rotational dislocation boro digrii 20.

• Mmofra (< mfe 10) behyia akwan a ɛyɛ den a ɛma wɔn akyi berɛmo no ntumi nnyina pintinn, a nea ɛka ho ne akyi berɛmo a ɛtwetwe a ɛyɛ pintinn anaasɛ ɛyɛ ne su. Nyarewa pii te sɛ Down syndrome, nail-patellar syndrome, Kabuki syndrome ne Rubinstein Taybi syndrome yɛ patellar a entumi nnyina pintinn.

• Ɛho hia sɛ yehu sɛ MPFL a wɔsan yɛ no foforo a atew ne ho no nnɔɔso sɛ wobedi saa nhwɛso ahorow a ɛyɛ den yi ho dwuma, efisɛ ɔyare titiriw no wɔ nkyɛnkyɛn, na ɛtɔ mmere bi a quadriceps femoris no kwan a wɔfa so yɛ no yɛ tiaa, a ɛhwehwɛ sɛ wogyae afã horow a ɛtrɛw na wɔde quadriceps femoris plasty di ɔhaw ahorow yi ho dwuma.

• Wɔ quadriceps femoris plasty mu no, wɔsan dan quadriceps femoris adwinnade no kwan na/anaasɛ ɛkyɛ. Wɔ anibiannaso anaa ayaresa a wɔka akyiri ho no, wobetumi ahyia saa nneɛma a entumi nnyina a ɛyɛ den yi akyiri yi wɔ asetra mu.

Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!

Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.

Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.

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