Yala i b’o dɔn wa? Faratiw ni senkɔni kolotugudaw basigibaliya furakɛli denmisɛnw na

Patellofemoral instability (PFI) bɛ bana caman sɔrɔ, k’a ta bana misɛnninw na ka taa a bila senkɔniw bɔli jɛlen na (LPD). LPD ka ca kosɛbɛ, denmisɛn 100.000 o 100.000 bɛ sɔrɔ a la. A ka ca a la, sɔgɔsɔgɔninjɛ fɔlɔ bɛ kɛ san 15 ni san 19 cɛ. LPD ye bana ye min bɛ mɔgɔ fanga dɔgɔya, wa a bɔli hakɛ furakɛli kɔrɔlen kɔfɛ walima farikoloɲɛnajɛ furakɛli kɔfɛ, o bɛ se 70% ma. Senkɔni cɛmancɛ sɔgɔsɔgɔninjɛ jɔli kokura ye opereli furakɛli ye min bɛ kɛ ka caya. Nka, gɛlɛya bɛ banabagatɔ 16% la, i n’a fɔ u bɛ segin ka bɔ u nɔ na. Ka fara o kan, banabagatɔ tilancɛ kelen mago bɛ opereli kɔfɛ gɛnɛgɛnɛ tɔ kelen na min tɛ furakɛ opereli fɛ. Farati min bɛ sɔrɔ kolotugudaw joginni na min bɛ taa ɲɛ ani ka OA sɔrɔ LPD kɔfɛ, o farati ka bon siɲɛ 6 ka tɛmɛ a daminɛ na, o bɛ kɛ sababu ye ka banabagatɔ fitini caman bila ka OA farati sɔrɔ u si san 30 ni san 40 la. PFI faamuyali dafalen sɔrɔbaliya ye gɛlɛyabaw dɔ ye walasa ka senkɔni kolotuguda cogoya lasegin a cogo kɔrɔ la.

RISK FACTOR (KƆRƆBƆLI ƝƐNABƆLI).

PFI faratiw bɛ se ka tila tila fila ye: farikololabɔbaliya ani ɲɔgɔndanbaliya. Senkɔniw ka sɔgɔsɔgɔninjɛ ye farikololabɔli ye min nafa ka bon kosɛbɛ, wa ɲɔgɔndanbaliya bɛ kɛ ni senkɔniw kɔrɔtacogo, senkɔniw wulicogo ani subluxation ye. Patellofemoral deformité bɛ sɔrɔ biyomekaniki yeli fɛ min bɛ sɔrɔ medial stabilisateur jogin fɛ, Q angle caya, senkɔni ɲɛfɛla ani patellar tendon insertion lateralization. PFI faratiw bɛ lajɛ ja 1 kɔnɔ.

• senkɔniw ka sɔgɔsɔgɔninjɛ

• angle de inclinaison de pulley transversale (angle de inclinaison) min bɛ kɛ ni jirisunba ye

• facet asymétrie de pulley (pulé) ka asimɛtiri

• pulley jugumanba

• ɲɔgɔndan min tɛ bɛn

• patella sanfɛla

• yɔrɔ min bɛ bɔ senkɔni ni senkɔniw cɛ (tt-tg) o cayara

• dɔ fara q angle kan

• senkɔni ɲɛfɛla

  
  

JAABI Sɛgɛsɛgɛli ƝƐNABƆLI ƝƐNABƆLI

PFI ka MRI sɔrɔlenw bɛ danfara ka kɛɲɛ ni bana juguya ni a basigilen ye. PFI banakisɛ nɔgɔmanw bɛ se ka kɛ ni senkɔni diskinɛsi ye, o min bɛ sɔrɔ Hoffa tulumafɛnw sanfɛla ni a kɛrɛfɛla sɔgɔsɔgɔninjɛ fɛ (a bɛ fɔ fana ko patellofemoral fat impact). Patellofemoral fat impact bɛ tali kɛ PFI farati wɛrɛw la, i n’a fɔ senkɔniw sɔgɔsɔgɔninjɛ, senkɔniw janya, TT-TG janya caya, senkɔniw jiginni kɛrɛfɛ ani subluxation. Patellar dyskinesia min bɛ mɛn sen na, o bɛ na ni cartilage jogin ye ani ka patellofemoral joint kɛrɛfɛla tiɲɛni joona.

Patella dislocation acute (APLD) ye PFI suguya jugumanba ye. Filimu jɛlen min bɛ kɛ ni X-ray ye, o bɛ joginda jugumanw sɔrɔli jira, o bɛ se ka kɛ kolotugudaw bɔli ye, tuluma jolilabanaw ka tulumafɛnw hakɛ tuma dɔw la, kolotugudaw cɛmancɛ kari, kolotugudaw kɔrɔtalen/subluxation (ja 8A), ani kɔfɛla sulcus taamasiɲɛ jugumanba min bɛ sɔrɔ senkɔni kɔkanna kolotugudaw joginni fɛ. LPD jugumanba taamasiɲɛ kɛrɛnkɛrɛnnenw ye MRI la, olu ye cɛmancɛ sabatili joginni ye (a bɛ ye 96%), kɛrɛfɛla sɔgɔli walima subluxation, kolotugudaw jogin ani kolotugudaw bɔli (Jaa 2B, C). A ka ca a la, patella bɛ segin a yɛrɛ ma a bɔli fɔlɔ kɔfɛ.

Banabagatɔ 70% bɛna kirinni segin-segin sɔrɔ, wa kirinni segin-segin basigilen bɛ se ka kɛ. O cogo la, MRI bɛ se ka kɛ sababu ye ka cɛmancɛ sabatili ɲɛjibɔ basigilen jira, cɛmancɛla sɔgɔsɔgɔninjɛ, cɛmancɛla koloci, senkɔniw ni senkɔniw tulu bɛ ɲɔgɔn sɔrɔ, kolotugudaw jogin ani senkɔniw kɔkanna joli tiɲɛni (Jaa 3).

FURAKƐLAW

1. Furakɛli min tɛ opereli ye:

• Patellar dislocations acute fanba bɛ kɛ waati dɔɔnin kɔnɔ, wa u bɛna segin u yɛrɛ ma. Tuma dɔw la, banabagatɔw, denbaya kɔnɔmɔgɔw, teriw, degelikɛnɛw walima degelikɛnɛw bɛna patella lasegin u bolo la o yɔrɔ la. Ni banabagatɔ taara kɛnɛyaso la kɔrɔtɔko la ka a sababu kɛ a senkɔniw bɔli ye, u bɛ hakili lafiya fura di a ma. Patella dɔgɔyali datugulen bɛ sɔrɔ ni senw kɔrɔtalen don dɔɔni dɔɔni. Ni a seginna a cogo kɔrɔ la, aw bɛ gɛnɛgɛnɛ joli lajɛ dɔgɔtɔrɔso la ni joginda wɛrɛw tɛ a la.

• Furakɛli min bɛ kɛ ka ɲɛgɛnɛsira bɔ fɔlɔ, o ye furakɛli ye min tɛ opereli ye, wa ni a sirili kuntaala surun (dɔgɔkun 2-4) la sɔgɔsɔgɔninjɛ walima gɛnɛgɛnɛ kolotugudaw la, o bɛ se ka dimi ni farikolo yɔrɔw kɛnɛyali fɔlɔ kunbɛn binkanni juguman kɔfɛ. O waati kɔnɔ, berew bɛ to ka girinya ta. O kɔfɛ, patella stabilisant brackets bɛ kɛ ka baara kɛ, farikoloɲɛnajɛ furakɛli bɛ kɛ walasa ka lamaga, fanga ani bolokɔniw kunbɛnni segin a cogo kɔrɔ la.

• A ka ca a la banabagatɔw bɛ farikoloɲɛnajɛ daminɛ kokura kalo 3 ɲɔgɔn binkanni fɔlɔ kɔfɛ. O tɛmɛnen kɔ, stent donli ye i yɛrɛ sago ye.

2. Opereli furakɛli:

• Banabagatɔ 30% ni kɔ la, senkɔniw bɔli fɔlɔ bɛ tali kɛ gɛnɛgɛnɛ joli bɔli hakɛ caman na. O cogo la, a ka kan ka MRI kɛ walasa ka a dɔn ni kolotugudaw karilen don. Nin kari ninnu bɛ sɔrɔ yɔrɔ min na kosɛbɛ, o ye senkɔni cɛmancɛ walima senkɔni kɔkanna ye, wa a ka ca a la, opereli furakɛli bɛ fɔ ni bolokɔniw kɔnɔna karilen don.

• Opereli senfɛ, kolotugudaw karilenw bɛ bɔ walima ka u jɔ ka kɛɲɛ ni kolotugudaw bonya ye ani kolotugudaw cogoya. Ni kolotugudaw karilen bonya ye ≥ milimɛtɛrɛ 15 ye, kolotugudaw jɔli bɛ jateminɛ sanni ka a tigɛ. O sirili bɛ kɛ ni fɛɛrɛ dafalen ye ni nɛgɛberew ye, ni piniw ye minnu bɛ se ka fɛnw minɛ biyobɔrɔsi walima ni suturaw ye.

• Kariw furakɛli la, opereli kɛcogo min bɛ kɛ ka patella sabati waati kelen na, o bɛ sɔrɔ ni cɛmancɛ dilan ye walima ni MPFL jɔli ye kokura. Ni nɛgɛberew bɛ kɛ ka kariw siri, a bɛ se ka kɛ ko u ka kan ka bɔ opereli wɛrɛw fɛ don nataw la.

• Hakilila-kalanso fila bɛ yen patellar stabilisation fɛɛrɛ ɲuman kan. Fɛɛrɛ fɔlɔ ye ka MPFL jɔli seginni kɛ yɔrɔ kelen na. MPFL ye patella ka subluxation laterale balilanba ye, o la a jɔcogo kura bɛna sabatili wajibiyalen di patella ma. A ka ca a la MPFL seginni bɛ kɛ ni kɔkolo naani sɔgɔsɔgɔninjɛ otografu ye, senkɔniw sɔgɔsɔgɔninjɛ otograft walima allograft. MPFL seginni yɔrɔ kelen na walasa ka patellar sabatili segin a cogo kɔrɔ la, o ɲɛtaa hakɛ bɛ tɛmɛ 95% kan, o min ni jiribolo sugandili tɛ ɲɔgɔn ta. MPFL seginni gɛlɛya minnu ka teli ka sɔrɔ, olu ye gɛnɛgɛnɛw gɛlɛyali ye, senkɔniw kari ani senkɔniw basigibaliya segin-segin.

• Fɛɛrɛ filanan bɛ faratiw ɲɛnabɔ patellar basigibaliya la, ani MPFL jɔli kokura. Nin fɛɛrɛ in na, senkɔniw basigibaliya farati minnu bɛ farikolo la, olu bɛ dɔn X-ray film ni CT/MRI fɛ, i n’a fɔ trochléaire dysplasia, patellar janya caya ani TT-TG yɔrɔjan. Ni a dɔnna, farati dɔw walima u bɛɛ bɛna latilen opereli fɛ.

• Trochléaire dysplasia bɛ ɲɛnabɔ ni trochléoplastie ye, o la, trochléaire groove bɛ juguya (Jaa 12A). Trochléaire plastie man di kosɛbɛ Ameriki jamana na barisa a bɛ tali kɛ joli-sira-funu-kɔnɔ-fɛnw binkanni na, wa hakilinata la, farati bɛ a la ka kɛ ischemic necrosis walima arthritis nataw la.

• Patella janya walima patella janya bonya bɛ ɲɛnabɔ ni distal tibial tubercle ye. Walasa ka dɔ fara TT-TG janya kan, senkɔni tubercle medial walima anteromedial bɛ kɛ (Jaa 12B). Gɛlɛya minnu bɛ sɔrɔ tibial tuberosity osteotomy la, olu ye nonunion, hardware dimi, tuberosity dɔgɔyali bɔnɛni ani kari.

• Walasa ka ɲɛda kɛrɛfɛla tansiyɔn, ɲɛda kɔkanna bɔli bɛ kɛ, o bɛ ɲɛda ɲɛkisɛw jiginni caya jira. Kɛrɛfɛla bɔli gɛlɛyaw ye funu basigilen ye ani patella cɛmancɛ basigibaliya iatrogenic.

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

• MFPL senkɔni nɔrɔyɔrɔ bɛ senkɔni yɔrɔjan epiphyse jukɔrɔ dɔrɔn. O la, MPFL seginni ka kan ka kɛ banabagatɔw la minnu kolo ma kɔgɔ, o ka kan ka kɛ ni fluoroscopie bilasirali gɛlɛn ye walasa ka senkɔniw sɔgɔli kɛ cogo la min tɛ mɔgɔ tɔɔrɔ.

• Senkɔni yɔrɔjan joginni bɛ se ka kɛ sababu ye ka farikolo tiɲɛ, o bɛ se ka kɛ opereli ye walima a tɛ se ka kɛ sababu ye ka opereli latilen. O cogo kelen na, proximal tibial protrusion joginni bɛ se ka kɛ sababu ye ka farikolo tiɲɛ, kɛrɛnkɛrɛnnenya la gɛnɛgɛnɛ cɛmancɛ la. O la, senkɔniw koloci dagalen don banabagatɔw la minnu ka senkɔniw dabɔlen don.

• O kɔfɛ, patellar tendon bɛ se ka wuli pewu walima a yɔrɔ dɔ la cɛmancɛ la. Ni senkɔni kɛnɛma tilancɛ jiginna cɛmancɛ fan fɛ, o opereli bɛ wele ko Roux-Goldthwait opereli (Jaa 12C).

• Banabagatɔ minnu bɛ opereli kɛ, olu bɛɛ ka kan ka jateminɛ kɛ ni u senw tɛ basigi koronawirisi ni senkɔniw labɛncogo la minnu bɛ wuli. Genu valgus caya, senkɔni ɲɛfɛla jiginni kojugu ani senkɔniw kɔkanna jiginni caya ye faratiw ye minnu bɛ se ka kɛ sababu ye ka senkɔni basigibaliya.

• Banabagatɔ minnu kolo ma kɔgɔ, olu ka kan ka jateminɛ kɛ ka bonya ɲɛminɛ ni u bɛ ka genu valgus furakɛ. Epiphyseal screws walima tension band plates bɛ se ka senkɔni epiphyse yɔrɔ jan cɛmancɛ fan fɛ walasa ka a latilen dɔɔni dɔɔni. Koloci ka kan ka kɛ walasa ka banabagatɔw latilen minnu kolo kɔgɔlen don, ni u ka koronawirisi walima u ka wulicogo tɛ u la. Genu valgus ka latilenni jiralan ye > degere 10 ye, ani jiginni jiracogo latilenni bɛ tɛmɛ degere 20 kan.

• Denmisɛnw (< san 10) bɛna ɲɔgɔn sɔrɔ ni senkɔniw basigibaliya cogoya gɛlɛnw ye, minnu ye senkɔniw jiginni jɔlen walima u delila ka kɛ. Sindrom caman i n’a fɔ Down syndrome, nail-patellar syndrome, Kabuki syndrome ani Rubinstein Taybi syndrome, olu bɛ sɔrɔ patellar basigibaliya fɛ.

• A nafa ka bon k’a dɔn ko MPFL ka segin-ka-bɔnye kelen-kelen tɛ se ka nin cogoya gɛlɛn ninnu ɲɛnabɔ, barisa bana fɔlɔ bɛ sɔrɔ kɛrɛfɛ, wa tuma dɔw la, senkɔni naani fɛɛrɛ bɛ surunya, o min bɛ kɛ sababu ye ka kɔkanna bɔli caman kɛ ani ka senkɔni naani plastiki kɛ walasa ka nin gɛlɛya ninnu ɲɛnabɔ.

• Ni senkɔni naani (quadriverseps femoris plasty) bɛ kɛ, senkɔni naani-kɔnɔna fɛɛrɛ bɛ wuli ka segin a kan ani/walima a bɛ mɛn. Ni a ma kɛ ni ɲɛmajɔbaliya ye walima ni furakɛli kɛra kɔfɛ, o cogoya gɛlɛnw sabatibaliw bɛ se ka sɔrɔ kɔfɛ ɲɛnamaya kɔnɔ.

Cogo min na i bɛ se ka kolotugudaw ni kolotugudaw sancogo?

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Ka fara o kan, an cɛsirilen don ka to ka fura kuraw labɛn ani ka fɛn dilannenw caya, walasa ka dɔgɔtɔrɔw ni banabagatɔ caman ka opereli magow ɲɛ, ani fana k’an ka tɔn kɛ ɲɔgɔndanba ye diɲɛ kolotugudaw ni minɛnw baara bɛɛ la.

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