Ènya nya ma? Afɔku siwo le patellofemoral joint instability me le ɖeviwo ŋu kple wo dada .

Patellofemoral instability (PFI) lɔ dɔléle siwo kplɔ wo nɔewo ɖo ɖe eme, tso dɔléle si mesẽ o dzi va ɖo patella (LPD) ƒe ʋuʋu si dze ƒã la dzi. LPD bɔ ɖe ɖevi 50 me le ɖevi 100,000 ɖesiaɖe me. Zi geɖe la, ʋuʋu gbãtɔ dzɔna tso ƒe 15 va ɖo ƒe 19 dome. LPD nye dɔléle si gblẽa nu le ame ŋu, eye ʋuʋu ƒe agbɔsɔsɔ le atikewɔwɔ si me womezãa atikewo le o alo ŋutilãmedɔdada megbe la lolo abe 70% ene. Medial patellofemoral ligament gbugbɔgatu nye amekoko ƒe atike si wozãna wu. Gake dɔnɔ siwo ade 16% ƒe kuxiwo le wo ŋu, siwo dometɔ aɖewoe nye be woagaɖe wo ɖa ake. Tsɔ kpe ɖe eŋu la, ehiã be woawɔ dɔ na dɔnɔawo ƒe akpa enelia le klo ƒe ƒunukpeƒe bubu si womewɔa dɔ na o la ŋu. Afɔku si nɔa anyi didi si nye abi si woxɔna le ƒunukpeƒetetedɔ me vivivi kple OA le LPD megbe la sɔ gbɔ wu esi le ʋuʋu gbãtɔ megbe zi gbɔ zi 6, si wɔnɛ be sɔhɛ dɔnɔ geɖewo dzea ŋgɔ OA ƒe afɔku le woƒe ƒe 30 kple 40 me. PFI gɔmesese blibo ƒe anyimanɔmanɔ nye mɔxenu vevi siwo ana patellofemoral ƒe ƒunukpeƒe si sɔ la nagaɖo anyi la dometɔ ɖeka.

Afɔku ƒe nusi .

Woate ŋu ama afɔku siwo le PFI me ɖe hatsotso eve me: ŋutilã ƒe wɔwɔme ƒe tɔtrɔ kple eƒe ɖoɖowɔwɔ ɖe ɖoɖo nu. Femoral trochlear dysplasia ye nye ŋutilã ƒe dɔmawɔmawɔ nyuie vevitɔ kekeake, eye alignment abnormality la lɔ patellar kɔkɔ, patellar roll kple subluxation ɖe eme. Patellofemoral deformity tso biomechanical tɔtrɔwo tso abixɔxɔ le medial stabilizer, q angle ƒe dzidziɖedzi, anteversion of femur kple lateralization of patellar tendon insertion gbɔ. Woƒo nu tso afɔku siwo le PFI me ŋu kpuie le Nɔnɔmetata 1 lia me.

• Femoral Trochlea Dysplasia .

• Dzogoe si dzi wotsɔa ʋuƒo si wotsɔna ƒoa ʋuƒoe la ƒe ŋgɔgbedede .

• Facet asymmetry of pulley .

• Pulley ƒe goglome .

• Ðoɖo si mesɔ o .

• Afɔdzideƒe Kɔkɔtɔ .

• Adzɔge tso Tibia yi Trochlear Groove (TT-TG) dzi ɖe edzi .

• Dzi q ƒe dzogoe ɖe edzi .

• Femoral Anteversion .

  
  

Nɔnɔmetatawo me dzodzro ƒe nɔnɔmewo .

Nusiwo ŋu woke ɖo le MRI ŋu le PFI ŋu la toa vovo le dɔlélea ƒe sesẽme kple alesi wònɔna ɖaa nu. PFI ƒe nɔnɔme fafɛwo ate ŋu anye patellar dyskinesia, si ƒe dzesi enye be edema si le Hoffa Fat Pad ƒe akpa si le etame kple axadzi (si woyɔna be patellofemoral fat impact). Patellofemoral ami ƒe ŋusẽkpɔɖeamedzi do ƒome kplikplikpli kple afɔku bubu siwo le PFI me, siwo dometɔ aɖewoe nye femoral condyle dysplasia, patellar height, tt-t-tg distance si dzi ɖe edzi, lateral patellar tilt kple subluxation. Patellar dyskinesia si nɔ anyi ɣeyiɣi didi aɖe la hea ƒunukpeƒetetedɔ kple axadzi patellofemoral ƒunukpeƒea ƒe gbegblẽ kaba vɛ.

Acute dislocation of patella (APLD) ye nye PFI ƒomevi si nu sẽ wu. X-ray gbadzaƒe film la ɖee fia be woke ɖe abi sesẽwo ŋu, si ate ŋu anye ƒunukpeƒewo ƒe ʋuʋu, ami ƒe agbɔsɔsɔ si me ami le ƒe ami ƒe agbɔsɔsɔ ɣeaɖewoɣi, titina patella ƒe ƒumeŋuɖui ƒe gbagbã, patella ƒe akpa si le axadzi si me lãkusi le (Nɔnɔmetata 8A), kple deep lateral condcula ƒe dzesi. MRI ƒe dzesi tɔxɛ siwo le LPD sesẽ la ŋue nye be woxɔ abi le medial stabilizer (si wokpɔ le 96%) me, lateral patellar tilt alo subluxation, osteochondral injury kple joint effusion (Nɔnɔmetata 2B, C). Zi geɖe la, wogbugbɔa patella la ɖona le eɖokui si le ʋuʋu gbãtɔ megbe.

Dɔnɔ siwo ade 70% akpɔ ʋuʋu enuenu, eye ʋuʋu atraɖii ate ŋu adzɔ. Le go sia me la, MRI ate ŋu aɖe medial stabilizer ƒe aɖatsi si nɔa anyi didi, medial patellar deformity, ossification of medial patella, patellar-femoral fat impact, cartilage injury kple lateral patellofemoral joint ƒe gbegblẽ (Nɔnɔmetata 3).

Atikewɔwɔwo .

1. Atikewɔwɔ si menye amekoko o:

• Acute patellar dislocations ƒe akpa gãtɔ nyea ɣeyiɣi kpui aɖe ko eye woagbugbɔ wo aɖo le wo ɖokui si. Ɣeaɖewoɣi la, dɔnɔwo, ƒomea me tɔwo, xɔlɔ̃wo, hehenalawo alo hehenalawo atsɔ asi atrɔ asi le patella la ŋu le teƒea. Ne dɔnɔa yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ le patellar ƒe ʋuʋu ta la, woana atike si naa ame ƒe susu dzea akɔ anyi le susu me. Wokpɔa patella dzi ɖeɖe kpɔtɔ si wotu to afɔawo keke vivivi me. Ne ègaɖoe ɖe ɖoɖo nu ko la, le atikewɔnyawo me la, lé ŋku ɖe klo ƒe ƒunukpeƒea ŋu be abi bubuwo hã le eme hã.

• Atikewɔwɔ si wozãna ɖaa hena patella ƒe ʋuʋu gbãtɔ nye atikewɔwɔ si menye amekoko o, eye ɣeyiɣi kpui aɖe (kwasiɖa 2-4) ƒe fixation le splint alo klo ƒe ƒunukpeƒewo ƒe ƒuƒoƒo me ate ŋu akpɔ vevesese kple lãmenugbagbeviwo ƒe dɔyɔyɔ gbãtɔ dzi le amedzidzedze kpata megbe. Le ɣeyiɣi sia me la, woɖea mɔ na atizɔtiwo be woatsɔ kpekpeme la. Le ema megbe la, wozãa patella stabilizing brackets hena dɔwɔwɔ, eye wowɔa ŋutilãmedɔdada be woatsɔ agbugbɔ ʋuʋu, ŋusẽ kple abɔ kple afɔ dzi akpɔtɔ.

• Zi geɖe la, dɔnɔwo gadzea kamedede gɔme abe ɣleti 3 ene le amedzidzedze gbãtɔ megbe. Gakpe ɖe eŋu la, stent dodo nye tiatia.

2. Amekoko ƒe atikewɔwɔ:

• Le dɔnɔ siwo wu 30% me la, patellar gbãtɔ ƒe ʋuʋu do ƒome kple klo ƒe ƒunukpeƒe ƒe dodo le agbɔsɔsɔ gã aɖe me. Le go sia me la, ehiã be woawɔ MRI atsɔ ade dzesii nenye be ƒumeŋuɖui ƒe gbagbãƒewo li. Afisi ƒuƒu siawo le wue nye medial patella alo lateral femoral condyle, eye zi geɖe la, wokafua amekoko be woawɔ dɔ na ame ne ƒunukpeƒetetedɔ le ƒunukpeƒewo.

• Le dɔwɔwɔa me la, woɖea ƒumeŋuɖui ƒe akpa aɖewo ɖa alo woɖoa wo ɖe teƒe ɖeka le ƒu ƒe gbagbã ƒe akpawo ƒe lolome kple ƒunukpeƒe ƒe nyonyome nu. Ne ƒumeŋuɖui ƒe gbagbã ƒe lolome nye ≥ 15 mm la, wobua gbagbãƒe ƒe fixation ɖe eɖeɖe teƒe ŋu. Wowɔa fixation sia to mɔnu si le ʋuʋu me to ga screws, bioabsorbabs alo sutures zazã me.

• Le gbagbãwo dada me la, wokpɔa alesi wowɔa dɔ na ame le amekoko me le ɣeyiɣi ɖeka me ƒe nɔnɔme to medial repair alo mpfl gbugbɔgatu me. Ne wozã ga si wotsɔ ƒoa gaviwoe be woatsɔ axe mɔ ɖe wo nu la, ɖewohĩ ahiã be woaɖe wo ɖa to amekokomɔnu bubuwo dzi le etsɔme.

• Suku eve li siwo susu le patellar stabilization ƒe mɔnu nyuitɔ kekeake ŋu. Mɔnu gbãtɔe nye be woawɔ MPFL gbugbɔgatu si woɖe ɖe aga. MPFL ye nye nu vevitɔ si xea mɔ na patella ƒe axadzi subluxation, eyata eƒe gbugbɔgatu ana liƒo si hiã na patella. Zi geɖe la, MPFL gbugbɔgawɔ nyea quadriceps tendon autograft, hamstring tendon autograft alo allograft. MPFL gbugbɔgatu si woɖe ɖe aga ƒe dzidzedzekpɔkpɔ ƒe agbɔsɔsɔme be woagbugbɔ patellar ƒe liƒo aɖo anyi wu 95%, si meku ɖe graft tiatia ŋu o. Kuxi siwo bɔ wu le MPFL gbugbɔgatu me enye klo ƒe ƒunukpeƒe ƒe sesẽ, patellar fracture kple patellar malike si gbugbɔna.

• Mɔnu evelia kpɔa afɔku siwo le patellar ƒe malikenyenye me gbɔ, kple MPFL gbugbɔgatu. Le mɔnu sia me la, wokpɔa ŋutilã ƒe afɔku ƒe nusiwo le patellar malikenyenye me le X-ray film kple CT/MRI dzi, siwo dometɔ aɖewoe nye trochlear dysplasia, patellar ƒe kɔkɔme si dzi ɖe edzi kple TT-TG ƒe didime. Ne wonya nyae ko la, woaɖɔ afɔku aɖewo alo wo katã ɖo to amekoko me.

• Wokpɔa trochlear dysplasia gbɔ to trochleoplasty, si me trochlear groove la me goglo (Nɔnɔmetata 12a). Trochlear plasty mexɔa ŋkɔ boo le United States o elabena elɔ articular cartilage ƒe amedzidzedze ɖe eme, eye le nukpɔsusu nu la, afɔku le etsɔme ischemic necrosis alo arthritis me.

• Wokpɔa patella ƒe kɔkɔme alo patella ƒe kɔkɔme ƒe dzidziɖedzi gbɔ to distal tibial tubercle me. Be woadzi TT-TG ƒe didime ɖe edzi la, wowɔa tibial tubercle si le titina alo anteromedial (Nɔnɔmetata 12b). Kuxi siwo le tibial tuberosity osteotomy me dometɔ aɖewoe nye nounion, hardware pain, buberosity dzi ɖeɖe kpɔtɔ kple gbagbã.

• Le axadzi ƒe ŋku ƒe ŋkume ƒe tete gome la, woɖea ŋku ƒe ŋkume ƒe ʋuʋu le axadzi, si ɖea patella ƒe ʋuʋu ƒe dzidziɖedzi fiana. Kuxi siwo dona tso axadzi ƒe asiɖeɖe le eŋu me dometɔ aɖewoe nye ʋuʋudedi si nɔa anyi ɖaa kple iatrogenic medial instability of patella.

• Le dɔnɔ siwo ƒe ƒuwo metsi o gome la, womeɖea mɔ ɖe dɔ aɖewo wɔwɔ ŋu alo wotrɔa asi le wo ŋu le epiphysis la ta o.

• MFPL ƒe afɔkpodzi ƒe nutrenu ƒe teƒe si wotsɔ kpe ɖe eŋu la le akɔta ƒe akpa si le didiƒe la te tututu. Eyata ele be woawɔ MPFL gbugbɔgatu dɔnɔ siwo ƒe ƒuwo metsi o la le fluoroscopy ƒe mɔfiame sesẽwo te be woakpɔ egbɔ be wodo afɔkpodzi ƒe mɔ̃ si le dedie.

• Aɖuɖɔtoe si le didiƒe ate ŋu ana ame nazu nuwɔametɔ, si ate ŋu abia be woaɖɔ amekoko ɖo alo mahiã be woawɔ dɔ le eŋu o. Nenema ke abi si woxɔna le lãkusi si te ɖe eŋu me ate ŋu ahe nɔnɔme gbegblẽ vɛ, vevietɔ le klo si le titina la me. Eyata woxe mɔ ɖe tibial tuberosity ƒe ƒugɔmeɖeɖe nu na dɔnɔ siwo ƒe tibial protrusion si le ʋuʋu ɖi si le ʋuʋu ɖi.

• Kura o, patellar tendon ate ŋu aʋuʋu keŋkeŋ alo eƒe akpa aɖe le titina. Ne wotsɔ patellar tendon ƒe gota afã yi titina ƒe akpa dzi la, woyɔa dɔwɔwɔ sia be Roux-Goldthwait dɔwɔwɔ (Nɔnɔmetata 12C).

• Ele be woada dɔnɔ siwo katã wowɔ dɔ na la kpɔ le patellar instability le coronary limbs kple rotating limbs ƒe ɖoɖowɔwɔ me hã. Genu valgus ƒe dzidziɖedzi, afɔkpodzi ƒe ŋgɔgbedede fũ kple gotagome tibial torsion ƒe dzidziɖedzi nye afɔku siwo le patellar ƒe malikenyenye me.

• Le dɔnɔ siwo ƒe ƒuwo metsi o gome la, ele be woabu mɔfiafia ƒe tsitsi ŋu ne wole nu wɔm kple genu valgus. Epiphyseal screws alo tension band plates ate ŋu akeke ɖe enu le titina ƒe akpa si le afɔkpodzi ƒe epiphysis ƒe nuwuwu si le didiƒe hena ɖɔɖɔɖo vivivi. Ƒumeŋuɖui hiã be woatsɔ aɖɔ dɔnɔ siwo ƒe ƒuwo tsi ɖo la ɖo na ʋuka siwo me ʋu sina tona alo esiwo trɔna le wo nɔewo ŋu. Genu valgus ƒe ɖɔɖɔɖo ƒe dzesi nye > 10 degree, eye ɖɔɖɔɖo ƒe dzesi si nye rotational dislocation wu degree 20.

• Ðeviwo (< 10 ƒe) ado go patellar instability ƒe ɖoɖo sesẽwo, siwo dometɔ aɖewoe nye patellar dislocation si woɖo ɖi alo esi nye numame. Dɔléle geɖe abe Down Syndrome, Nail-Patellar Syndrome, Kabuki Syndrome kple Rubinstein Taybi Syndrome nye patellar ƒe malikenyenye.

• Ele vevie be míanya be MPFL ƒe gbugbɔgatu si woɖe ɖe aga la mesɔ gbɔ be woatsɔ akpɔ nɔnɔme sesẽ siawo gbɔ o, elabena dɔléle gbãtɔa le axadzi, eye ɣeaɖewoɣi la, woɖea afɔ ene ƒe afɔtiwo ƒe dɔwɔwɔ ƒe mɔnu la dzi kpɔtɔna, si bia be woaɖe asi le eŋu le axadzi eye Quadriceps Femoris Plasty be woatsɔ akpɔ kuxi siawo gbɔe.

• Le quadriceps femoris plasty me la, wogbugbɔa afɔ eneawo ƒe femoris mɔ̃a ƒe susu ɖo eye/alo wodidia wo ɖe edzi. Le ɖekematsɔleme alo atikewɔwɔ megbe la, woate ŋu ado go nɔnɔme siawo siwo me li ke o siwo sesẽ la emegbe le woƒe agbe me.

Ale Si Nàƒle Ƒumeŋutinunya Kple Ƒumeŋuɖuiwo ƒe Dɔwɔnuwo)

na . czmediTech , míekpɔa atike ƒomevi aɖe si de blibo ŋutɔ le ƒumeŋutinunya ƒe dɔwɔwɔ na ame ƒe ŋutilã kple dɔwɔnu siwo sɔ kplii me, atikeawo dometɔ aɖewoe nye . Akɔta ƒe nusiwo wotsɔ dea akɔtae ., Intramedullary ƒe ɖawo ., nuveviwɔame ƒe agbalẽvi ., Locking Plate ., Tagbɔ-maxillofacial ., Ametia ƒe akpa aɖe ., Ŋusẽ Dɔwɔnuwo ., External fixators ., Arthroscopy ., Lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe dɔwɔnu siwo kpena ɖe wo ŋu.

Tsɔ kpe ɖe eŋu la, míeɖoe kplikpaa be míayi edzi ato atike yeyewo vɛ eye míakeke atikewo ɖe enu, ale be míakpɔ ɖɔkta kple dɔnɔ geɖe ƒe amekoko ƒe nuhiahiãwo gbɔ, eye míana míaƒe dɔwɔƒea hã nate ŋu aʋli ho le xexeame katã ƒe ƒumeŋutinunya kple dɔwɔnuwo ƒe dɔwɔƒe bliboa me.

Míeɖoa wo ɖe xexeame katã, ale be nàte ŋu awɔ . Ka ɖe mía dzi le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .

Ne èdi be yeanya nyatakaka bubuwo la,zi edzi CzmediTech be nàkpɔ nyatakaka bubuwo.