Yala i b o dn wa? Farati minnu bɛ denmisɛnw na ani u furakɛli patellofemorali la denmisɛnw na .

Patellofemoral instability (PFI) bɛ bana dɔw la minnu bɛ tugu ɲɔgɔn na, k’a ta farigan nɔgɔman na ka se patella (LPD) bɔli jɛlen ma. LPD ka ca, a bɛ sɔrɔ 50 la denmisɛn 100 000 o 100.000 la. A ka c’a la, a bɔli fɔlɔ bɛ kɛ san 15 ni san 19 cɛ. LPD ye bana ye min bɛ mɔgɔ fanga dɔgɔya, wa a jiginni hakɛ furakɛli kuntaalajan walima farikoloɲɛnajɛ furakɛli kɔfɛ, o bɛ se 70% ma. Patellofemoral ligament cɛmancɛ jɔli ye opereli ye min bɛ kɛ ka caya. Nka, banabagatɔ 16% bɛ se ka gɛlɛya sɔrɔ, hali ni u bɛ segin u cogo kɔrɔ la. Ka fara o kan, banabagatɔ tilancɛ mako bɛ opereli kɔfɛ gɛnɛgɛnɛ joli tɔ la min tɛ furakɛ opereli fɛ. Joginni min bɛ taa ɲɛ ka taa a fɛ ani OA kɔfɛ LPD kɔfɛ, o farati ka bon siɲɛ 6 ka tɛmɛ a daminɛni kɔfɛ, o bɛ banabagatɔ fitinin caman bila ka OA farati sɔrɔ u si san 30 ni 40 la. PFI faamuyali dafalen sɔrɔbaliya ye gɛlɛyaba dɔ ye min bɛ se ka kɛ sababu ye ka patellofemoral joint normale (patellofemoral joint) ka bɛnkan segin a cogo kɔrɔ la.

Farati min bɛ a la .

PFI ka faratiw bɛ se ka tila kulu fila ye: farikololabɔli kɛcogo jugu ani a ɲɔgɔnnabɔli. Senkɔniw ka sɔgɔsɔgɔninjɛ ye farikololabɔli ye min nafa ka bon kosɛbɛ, wa a sinsinni ɲɔgɔn tɛ, o ye patellar elevation, patellar roll ani subluxation ye. Patellofemoral deformité bɛ sɔrɔ biomechanical changes fɛ minnu bɛ sɔrɔ medial stabilisateur joginni fɛ, q angle caya, senkɔniw sɔgɔli ani patellar senkɔni doncogo lateralize. PFI ka faratiw bɛ lajɛ ja 1 kɔnɔ.

• trochlea de femoral .

• Angle de inclination de pulley transversale .

• facet asymétrie de pulley .

• Pulley ka juguya .

• Alignment abnormal .

• Patella sanfɛla .

• Tibia ni Trochlear Groove (TT-TG) cɛ janya cayara .

• Dɔ fara Q angle kan .

• Femoral anteversion .

  
  

Ja lajɛcogo jogo .

PFI ka MRI sɔrɔlenw bɛ danfara don bana juguya ni a cogoya basigilen na. PFI misɛnniw bɛ se ka sɔrɔ ɲɛda la, o bɛ sɔrɔ Hoffa Fat Pad sanfɛla ni a kɛrɛfɛla kirinni fɛ (a bɛ fɔ fana ko patellofemoral fat impact). Patellofemoral fatɔya bɛ tali kɛ PFI farati wɛrɛw la kosɛbɛ, i n’a fɔ senkɔniw ka ɲɛgɛnɛsiralabanaw, patellar janya, TT-TG yɔrɔjan caya, patellar lateral tilt ani subluxation. Patellar diskinesia min bɛ kɛ kabini tuma jan, o bɛ kɛ sababu ye ka kolotugudaw jogin ani ka patellofemoral joint latérale (patellofemoral latérale) tiɲɛ joona.

Patella (APLD) jiginni jugumanba ye PFI suguya ye min ka jugu kosɛbɛ. Filimu kɛnɛ min bɛ kɛ ni X-ray ye, o bɛ joginni jugumanw sɔrɔli jira, o bɛ se ka kɛ joli-sira-funu ye, joli-sira-funu-banakisɛ-fagalanw bɛ sɔrɔ tuma dɔw la, patella osteochondral cɛmancɛ kari, lateral tilt/subluxation of patella (Ja 8A), ani sulcus lateral deep lateral femoral condylar catilage. LPD jugumanba MRI kɛrɛnkɛrɛnnenw ye joli-sira-funu-kɔnɔ-joginni ye (a bɛ ye 96%), lateral patellar tilt walima subluxation, osteochondral injury ani joint effusion (Ja 2B, C). A ka c’a la, patella bɛ segin a yɛrɛ ma a daminɛ fɔlɔ kɔfɛ.

Banabagatɔ 70% bɛna se ka u yɛrɛ bɔ u la, wa u bɛ se ka kɛ ko u bɛ segin ka kɛ u la. Nin ko in na, MRI bɛ se ka ɲɛji basigilenw jira minnu bɛ kɛ ka fɛnw mara, patellar medial deformity, ossisification of medial patella, patellar-femoral fat impact, cartilage injury ani lateral patellofemoral joint (Jaa 3).

Furakɛliw .

1. Furakɛli min tɛ opereli ye:

• Patellar dislocations acute fanba bɛ kɛ waati dɔɔni dɔrɔn de la, wa u bɛna segin u yɛrɛ ma. Tuma dɔw la, banabagatɔw, denbaya kɔnɔmɔgɔw, teriw, lakɔlidenw walima degelikɛnɛw bɛna patella min bɛ segin a cogo kɔrɔ la o yɔrɔ la. Ni banabagatɔ taara kɛnɛyaso kɔrɔtɔlen na k’a sababu kɛ patellar dislocation ye, a bɛna lafiya di a ma ni hakili ye. Patella dɔgɔyali dasirilen bɛ sɔrɔ ni senw bɛ wuli dɔɔni dɔɔni. Ni a seginna, aw bɛ gɛnɛgɛnɛ kolotuguda lajɛ kɛnɛyaso la ni joginda wɛrɛw tɛ a la.

• Furakɛli sariyalen min bɛ kɛ ka patella dila fɔlɔ, o ye furakɛli ye min tɛ opereli ye, wa a sirili waati kunkuruni (dɔgɔkun 2-4) bɛ se ka kɛ sɔgɔsɔgɔninjɛ walima gɛnɛgɛnɛ kolotugudaw la, o bɛ se ka dimi ni farikolo yɔrɔ fɔlɔ kɛnɛyali kunbɛn bana jugumanba kɔfɛ. O waati kɔnɔ, berew bɛ to ka girinya muɲu. O kɔfɛ, patella sabatili brackets bɛ kɛ ka baara kɛ, wa farikoloɲɛnajɛ bɛ kɛ walasa ka lamaga, fanga ani senkɔniw kunbɛn.

• A ka ca a la banabagatɔw bɛ farikoloɲɛnajɛ daminɛ kokura kalo 3 ɲɔgɔn binkanni fɔlɔ kɔfɛ. O tɛmɛnen 'kɔ, stendi donli ye 'fɛn ye min bɛ Se ka Kɛ.

2. Opereli furakɛli:

• Banabagatɔ minnu ka ca ni 30% ye, olu la, patellar dislocation fɔlɔ bɛ tali kɛ gɛnɛgɛnɛ kolotuguda caman bɔli la. O cogo la, a ka kan ka MRI kɛ walasa ka a dɔn ni kolotugudaw karilen don. Nin kariw bɛ kɛ yɔrɔ min na kosɛbɛ, o ye patella cɛmancɛ walima senkɔniw lamini na, wa a ka ca a la, opereli furakɛli ka ɲi ni kolotugudaw kɔnɔ karilenw ye.

• Opereli senfɛ, kolotugudaw karilen yɔrɔw bɛ bɔ walima ka u siri ka kɛɲɛ ni kariyɔrɔw bonya ye ani kolotugudaw cogoya. Ni kolotugudaw karilen hakɛ ye ≥ 15 mm ye, kari jɔli bɛ jateminɛ. Nin fiɲɛ in bɛ kɛ ni fɛɛrɛ dafalen ye ni nɛgɛberew ye, ni bioabsorbable pinɛw walima suturaw ye.

• Kariw furakɛli la, patella ka opereli sabatili cogoya bɛ sɔrɔ waati cɛmancɛ la ni dilan cɛmancɛ ye walima MPFL labɛnni kokura. Ni nɛgɛberew bɛ kɛ ka kari siri, u bɛ se ka bɔ opereli wɛrɛw fɛ don nataw la.

• Hakilila-jɔ-kalanso fila bɛ yen minnu bɛ patellar sabatili fɛɛrɛ ɲuman kan. Fɛɛrɛ fɔlɔ ye ka MPFL jɔli kɛ yɔrɔ kelen na. MPFL ye patella ka lateral subluxation (kɔrɔbɔli) gɛlɛya sababuba ye, o la a jɔli kura bɛna kɛ sababu ye ka sabatili magoɲɛta di patella ma. A ka c’a la, MPFL ka segin-ka-bɔnye bɛ kɛ ni senkɔniw ye minnu bɛ wele ko tendon autograft, hamstring tendon autograft walima allograft. MPFL ka segin-ka-bɔ-ɲɔgɔn na, o ka ɲɛtaa hakɛ min bɛ kɛ ka patellar sabatili segin a cogo kɔrɔ la, o bɛ tɛmɛ 95% kan, o min ni jirituru sugandili tɛ ɲɔgɔn ta. MPFL jɔli gɛlɛya minnu ka teli ka sɔrɔ, olu ye gɛnɛgɛnɛ kolotugudaw gɛlɛyali ye, patelli kari ani patellar basigilen basigilenbaliya.

• Fɛɛrɛ filanan bɛ patellar basigibaliya faratiw ɲɛnabɔ, ani MPFL seginni. Nin fɛɛrɛ in na, patellar basigibaliya farikololabɔli faratiw bɛ latigɛ X-ray filimu ni CT/MRI kan, i n’a fɔ trochlear dysplasia, patellar janya caya ani TT-TG yɔrɔjan. Ni a latigɛra, farati dɔw walima u bɛɛ bɛna latilen opereli fɛ.

• trochlear dysplasia bɛ ɲɛnabɔ ni trochleoplastie ye, o min na trochlear groove bɛ juguya (Jaa 12A). Trochlear plasty tɛ diya kosɛbɛ Ameriki jamana na bawo a bɛ kɛ ni joli-sira-funu-bana ye, wa hakilila-taama siratigɛ la, farati bɛ a la ka joli-sira-funu walima jolidɛsɛ sɔrɔ sini.

• Patella janya walima patella janya caya bɛ ɲɛnabɔ ni tibial tibial tubercle ye. Walasa ka TT-TG yɔrɔjan caya, tibial tubercle cɛmancɛ walima a ɲɛfɛla bɛ kɛ (Jaa 12B). Tibial tuberosity osteotomy gɛlɛyaw ye dimi tɛ min na, dimimadafura, tuberosité dɔgɔyali ani a karili.

• Walasa ka ɲɛda laminiw gɛlɛya, ɲɛda kɔkanna bɔli bɛ kɛ, o bɛ patella tilt caya jira. Kɔnɔnatumuw bɔli gɛlɛyaw ye funu basigilen ye ani patella ka basigibaliya ye iatrogénique ye.

• Banabagatɔ minnu kolo ma kɔrɔbaya, opereli dɔw man ɲi walima u bɛ se ka fɛn caman sɛmɛntiya ka a sababu kɛ epifisi ye.

• MFPL ka senkɔniw siriyɔrɔ bɛ sɔrɔ senkɔni yɔrɔjan epifisisi jukɔrɔ dɔrɔn. O la, MPFL bɛ banabagatɔ minnu na, ni kolo ma kɔgɔ, olu jɔli ka kan ka kɛ ni fluoroskopi ye kosɛbɛ walasa ka senkɔniw ka ɲɛgɛnɛsiralabanaw sɛgɛsɛgɛli kɛ cogo la min tɛ mɔgɔ tɔɔrɔ.

• Joginni min bɛ se ka kɛ sababu ye ka mɔgɔ fari faga, o bɛ se ka kɛ sababu ye ka opereli latilen walima ka a kɛ a tɛ se ka kɛ. O cogo kelen na, tibial protrusion proximale joginni bɛ se ka kɛ sababu ye ka fɛn dɔw tiɲɛ, kɛrɛnkɛrɛnnenya la gɛnɛgɛnɛ cɛmancɛ la. O la, kolotugudaw ka kolotugudaw koloci dagalen don banabagatɔw la minnu ka tibial protrusion da wulilen don.

• O kɔ fɛ, patellar tendon bɛ Se ka Bɔ a nɔ na pewu walima a yɔrɔ dɔ la. Ni ɲɛgɛnɛsira kɔkanna tilancɛ bɛ wuli ka taa cɛmancɛ fan fɛ, o baara bɛ wele ko Roux-Goldthwait baarakɛcogo (Ja 12C).

• Banabagatɔ minnu bɛɛ bɛ opereli kɛ, olu bɛɛ ka kan ka jateminɛ kɛ ka ɲɛsin ɲɛgɛnɛsiraw basigibaliya ma koronawirisi ni senkɔniw lamagacogo la. genu valgus caya, senkɔniw ka sɔgɔsɔgɔ kojugu ani kɔnɔbara basigilen girinya caya ye farati ye patellar basigibaliya la.

• Banabagatɔ minnu kolo ma kɔgɔ, ɲɛminɛni bonya ka kan ka jateminɛ ni u bɛ baara kɛ ni genu valgus ye. Epiphyseal screws walima tension band plates bɛ se ka span kɛ senkɔniw ka epifizisi laban cɛmancɛ fan fɛ walasa ka u latilen dɔɔni dɔɔni. Kolotugudaw ka kan ka kɛ walasa ka banabagatɔw latilen minnu kolo kɔgɔlen don ka ɲɛsin koronawirisi walima jiginni ma. Genu valgus jiracogo latilenni ye > 10 degere ye, wa jiginni jiginni jiracogo bɛ tɛmɛ degere 20 kan.

• Denmisɛnw (< san 10) bɛna patellar basigibaliya cogoya gɛlɛnw sɔrɔ, minnu bɛ kɛ ni patellar dislocation fixe ou habituels ye. Sindrom caman i n’a fɔ Syndrome Down, Nail-Patellar Syndrome, Kabuki Syndrome ani Rubinstein Taybi Syndrome bɛ kɛ ni patellar basigibaliya ye.

• A nafa ka bon k’a dɔn ko MPFL ka segin-ka-bɔ-ɲɔgɔn na, o tɛ se ka nin cogoya gɛlɛnw ɲɛnabɔ, bawo bana fɔlɔ bɛ sɔrɔ kɛrɛfɛ, wa tuma dɔw la, a bɛ se ka kɛ ko a bɛ se ka kɛ sababu ye ka den naani bɔ kɛnɛ kan, o bɛ kɛ sababu ye ka musomanninw bila ka taa yɔrɔ jan na ani ka kɛ ni naani ye walasa ka nin gɛlɛyaw ɲɛnabɔ.

• Quadriceps femoris plasty kɔnɔ, quadriceps femoris mechanism bɛ ɲɛsin kokura ani/walima ka mɛn. Ni furakɛli kɛra kɔfɛ walima furakɛli kɔfɛ, o cogoya gɛlɛn gɛlɛnw bɛ se ka sɔrɔ kɔfɛ ɲɛnamaya kɔnɔ.

Orthopedic Implants ani Orthopedic Instruments (Fɛn minnu bɛ se ka kɛ ka ɲɛgɛnɛ kɛ) san cogo min na, o ye .

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Ka fara o kan, an b’an jija ka fɛn kuraw dilan tuma bɛɛ ani ka fɛn dilannenw caya, walasa ka dɔgɔtɔrɔw ni banabagatɔ caman ka opereli magow ɲɛ, ani fana k’an ka tɔn kɛ ɲɔgɔndan ye diɲɛ kɔnɔ kolotugudaw ni minɛnw dilanni bɛɛ la.

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