Ènya esia? Afɔku kple patellofemoral ƒunukpeƒe ƒe malikenyenye dada le ɖeviwo me

Patellofemoral instability (PFI) lɔ dɔléle vovovowo ɖe eme, tso lãmetutudɔ si nu mesẽ o dzi va ɖo patella ƒe ʋuʋu si dze ƒã (LPD) dzi. LPD bɔ vie, eye ɖevi 50 le ɖevi 100,000 ɖesiaɖe me. Zi geɖe la, ʋuʋu gbãtɔ dzɔna le ƒe 15 va ɖo 19 dome. LPD nye dɔléle si nana ame ƒe lãme gbɔdzɔna, eye ʋu ƒe ʋuʋu ƒe agbɔsɔsɔme le atikewɔwɔ si me womezãa atike vɔ̃ɖiwo le o alo kamedede megbe la sɔa gbɔ va ɖoa 70%. Medial patellofemoral ligament gbugbɔgatue nye amekoko ƒe atikewɔwɔ si wozãna wu. Gake kuxiwo le dɔnɔ siwo ade 16% ŋu, siwo dometɔ aɖewoe nye be wogaɖea ʋu le wo ŋu. Tsɔ kpe ɖe eŋu la, ehiã be woawɔ dɔ na dɔnɔwo ƒe akpa enelia le klo ƒe ƒunukpeƒe kemɛ si womewɔa dɔ na o la ŋu. Afɔku si nɔa anyi didi be woaxɔ abi le ƒunukpeƒewo ŋu vivivi kple OA le LPD megbe la lolo wu esi le ƒunukpeƒetetedɔ gbãtɔ ƒe ʋuʋu megbe zi gbɔ zi 6, si wɔnɛ be sɔhɛ dɔnɔ geɖe doa go OA ƒe afɔku le woƒe ƒe 30 kple 40-awo me. PFI gɔmesese blibo ƒe anyimanɔmanɔ nye mɔxenu vevi siwo xea mɔ na patellofemoral joint si sɔ la ƒe ɖekawɔwɔ ake la dometɔ ɖeka.

AFƆKU ƑE NUÐEÐEŊUTI

Woate ŋu ama afɔku siwo le PFI me ɖe hatsotso eve me: ŋutilã ƒe dɔwɔwɔ ƒe masɔmasɔ kple eƒe ɖoɖowɔwɔ ɖe ɖoɖo nu ƒe masɔmasɔ. Femoral trochlear dysplasia nye ŋutilã ƒe nɔnɔme ƒe tɔtrɔ vevitɔ kekeake, eye alignment abnormality lɔ patellar elevation, patellar roll kple subluxation ɖe eme. Patellofemoral deformity tso biomechanical tɔtrɔ siwo 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.

• afɔkpodzi ƒe ʋuka si me ʋu sina tona ƒe dɔmawɔmawɔ nyuie

• dzogoe si dzi wotsɔa ʋuʋudedi si le tsia dzi la ƒonae

• facet asymmetry ƒe ʋuʋudedi

• pulley ƒe goglome

• alesi wowɔa nu ɖe ​​ɖoɖo nu si mesɔ o

• patella si kɔkɔ

• didime si tso tibia gbɔ va ɖo trochlear groove (tt-tg) gbɔ dzi ɖe edzi

• dzi q ƒe dzogoe ɖe edzi

• afɔkpodzi ƒe anteversion

  
  

NƆNƆME SIWO LE NUKPƆKPƆ ƑE DODOKPƆ ME

Nusiwo wokpɔ le MRI me le PFI ŋu la toa vovo le dɔlélea ƒe sesẽme kple eƒe nɔnɔme si nɔa anyi didi nu. PFI ƒe dɔléle siwo mesẽ o ate ŋu anye patellar dyskinesia, si ƒe dzesi enye Hoffa fat pad (si wogayɔna be patellofemoral fat impact) ƒe akpa si le etame kple axadzi ƒe ʋuʋu. Patellofemoral fat impact do ƒome kplikplikpli kple afɔku bubu siwo le PFI me, siwo dometɔ aɖewoe nye femoral condyle dysplasia, patellar height, TT-TG ƒe didime si dzi ɖe edzi, lateral patellar tilt kple subluxation. Patellar dyskinesia si nɔa anyi ɣeyiɣi didi la hea abi le ƒunukpeƒewo ŋu eye wògblẽa axadzi ƒe ƒunukpeƒe ƒe ƒunukpeƒe ƒe gbegblẽ kaba.

Acute dislocation of patella (APLD) ye nye PFI ƒe ƒomevi si nu sẽ wu. X-ray film si le gbadzaa la ɖe abi sesẽ siwo ŋu woke ɖo fia, siwo ate ŋu anye ƒunukpeƒetetedɔ, ami ƒe agbɔsɔsɔ si me ami le ɣeaɖewoɣi, ƒunukpeƒetetedɔ si le titina ƒe ƒunukpeƒewo ƒe gbagbã, ƒunukpeƒetetedɔ ƒe axadzi ƒe ʋuʋu/subluxation (Nɔnɔmetata 8A), kple axadzi sulcus ƒe dzesi goglo si tso abi si le axadzi ƒe ƒunukpeƒe ƒe ƒunukpeƒe ƒe impaction gbɔ. MRI ƒe LPD sesẽ ƒe dzesi tɔxɛwo dometɔ aɖewoe nye medial stabilizer injury (wokpɔe le 96%), lateral patellar tilt alo subluxation, osteochondral injury kple joint effusion (Nɔnɔmetata 2B, C). Zi geɖe la, wogbugbɔa patella la ɖoa eɖokui si le eƒe ʋuʋu gbãtɔ megbe.

Dɔnɔ siwo ade 70% akpɔ ʋu ƒe ʋuʋu ake, eye ʋu ƒe ʋuʋu atraɖii ate ŋu adzɔ. Le nɔnɔme sia me la, MRI ate ŋu aɖe medial stabilizer ƒe aɖatsi si nɔa anyi didi, medial patellar deformity, medial patella ƒe ƒu ƒe tsitsi, patellar-femoral fat impact, cartilage ƒe abixɔxɔ kple lateral patellofemoral joint ƒe gbegblẽ afia (Nɔnɔmetata 3).

ATIKƆMEŊUTINYAWO

1. Atikewɔwɔ si menye amekoko o:

• Patellar dislocations sesẽ akpa gãtɔ nyea ɣeyiɣi kpui aɖe ko eye woagbugbɔ aɖoe le wo ɖokui si. Ɣeaɖewoɣi la, dɔnɔwo, ƒometɔwo, xɔlɔ̃wo, hehenalawo alo hehenalawo atsɔ asi agbugbɔ patella la aɖo teƒea. Ne dɔnɔa yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ le eƒe afɔkpodzi ƒe ʋuʋu ta la, woana atike si naa ame ƒe susu dzea akɔ anyi. Wokpɔa patella dzi ɖeɖe kpɔtɔ si wotu to afɔawo keke vivivi me. Ne ènya gbugbɔ ɖoe ko la, lé ŋku ɖe klo ƒe ƒunukpeƒea ŋu le atikewɔnyawo me be abi bubuwo hã le eŋu hã.

• Atikewɔwɔ si wozãna ɖaa na patella ƒe ʋuʋu gbãtɔe nye atikewɔwɔ si menye amekoko o, eye ɣeyiɣi kpui aɖe (kwasiɖa 2-4) ƒe tsɔtsɔ ɖe splint alo klo ƒe ƒunukpeƒe ƒe fixator me ate ŋu aɖu vevesese kple lãmekawo ƒe dɔyɔyɔ gbãtɔ dzi le amedzidzedze kpata megbe. Le ɣeyiɣi sia me la, woɖea mɔ na atizɔtiwo be woatsɔ kpekpemea. Le ema megbe la, wozãa patella stabilizing brackets hena dɔwɔnawo, eye wowɔa kamedede be woagaʋuʋu, ŋusẽ kple abɔ kple afɔwo dzi ɖuɖu ake.

• Zi geɖe la, dɔnɔwo gadzea kamedede gɔme abe ɣleti 3 ene le amedzidzedze gbãtɔ megbe. Gakpe ɖe eŋu la, stent dodo nye nusi woate ŋu awɔ le wo ɖokui si.

2. Amekoko ƒe atikewɔwɔ:

• Le dɔnɔ siwo wu 30% me la, afɔti ƒe ʋuʋu gbãtɔ do ƒome kple klo ƒe ƒunukpeƒe ƒe ʋuʋu gbogbo aɖe. Le go sia me la, ehiã be woawɔ MRI atsɔ ade dzesii ne ƒumeŋuɖui ƒe gbagbãwo li. Afisi ƒunukpeƒetetedɔ siawo bɔ ɖo wue nye titina ƒe akɔta alo afɔkpodzi ƒe axadzi, eye zi geɖe la, wokafua amekoko be woawɔ dɔ na ame ne ƒunukpeƒetetedɔ le ame ŋu.

• Le dɔwɔwɔ na amea me la, woɖea ƒumeŋuɖui ƒe akpa siwo gbã alo woɖɔa wo ɖo le ƒumeŋuɖui ƒe lolome kple ƒunukpeƒe ƒe nyonyome nu. Ne ƒumeŋuɖui ƒe gbagbã ƒe lolome nye ≥ 15 mm la, wobua ƒu ƒe gbagbã ƒe fixation ŋu le esi teƒe be woaɖee ɖa. Wowɔa fixation sia to mɔnu si le ʋuʋu ɖi dzi to ga screws, bioabsorbable pins alo sutures zazã me.

• Le gbagbãƒewo dada me la, wokpɔa nɔnɔme si nye be amekoko nana patella nali ke le ɣeyiɣi ɖeka me to titina dzadzraɖo alo MPFL gbugbɔgatu me. Ne wozãa gaviwo tsɔ léa gbagbãƒewo ɖe te la, ɖewohĩ ahiã be woaɖe wo ɖa to amekoko bubuwo dzi le etsɔme.

• Suku eve li ku ɖe mɔnu nyuitɔ kekeake si dzi woato ana afɔtiwo nali ke 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 patella nali ke si hiã. Zi geɖe la, wowɔa MPFL gbugbɔgatu to quadriceps tendon autograft, hamstring tendon autograft alo allograft dzi. Dzidzedzekpɔkpɔ ƒe agbɔsɔsɔme si le MPFL gbugbɔgatu si woɖe ɖe aga me be woagbugbɔ patellar ƒe liƒo aɖo te la wu 95%, si meku ɖe graft tiatia ŋu o. Kuxi siwo bɔ wu le MPFL gbugbɔgatu me enye klo ƒe ƒunukpeƒe ƒe sesẽ, akɔta ƒe gbagbã kple afɔti ƒe malike si gbugbɔna.

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

• Wokpɔa trochlear dysplasia gbɔ to trochleoplasty me, si me trochlear groove la de to ɖe edzi (Nɔnɔmetata 12A). Trochlear plasty mexɔ ŋkɔ boo le United States o elabena elɔ ƒunukpeƒe ƒe ƒunukpeƒetetedɔ ƒe amedzidzedze ɖe eme, eye le nukpɔsusu nu la, afɔku li be ʋuka me ʋu ƒe sisi alo ƒunukpeƒetetedɔ ate ŋu adze ame dzi le etsɔme.

• Patella ƒe kɔkɔme alo patella ƒe kɔkɔme ƒe dzidziɖedzi kpɔa egbɔ to distal tibial tubercle me. Be woadzi TT-TG ƒe didime ɖe edzi la, wowɔa titina alo ŋgɔgbe titina tibial tubercle (Nɔnɔmetata 12B). Kuxi siwo dona tso tibial tuberosity osteotomy me dometɔ aɖewoe nye nonunion, hardware pain, tuberosity dzi ɖeɖe kpɔtɔ ƒe bu kple fracture.

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

• Le dɔnɔ siwo ƒe ƒuwo metsi o gome la, womeɖe mɔ ɖe dɔwɔwɔ aɖewo ŋu o alo wotrɔa asi le wo ŋu le esi ƒuwo ƒe lãkusiwo me mekɔ o ta.

• MFPL ƒe afɔkpodzi ƒe teƒe si wòléna ɖe eŋu la le afɔkpodzi si le didiƒe ƒe epiphysis te tututu. Eyata ele be woawɔ MPFL gbugbɔgatu na dɔnɔ siwo ƒe ƒuwo metsi o le fluoroscopy ƒe mɔfiame sesẽ te be woakpɔ egbɔ be woku afɔkpodzi ƒe mɔ̃ dedie.

• Abi si woxɔ le afɔkpodzi si le didiƒe ate ŋu ana ame nazu nuwɔametɔ, si ate ŋu ahiã be woawɔ dɔ nɛ be wòaɖɔe ɖo alo mahiã o. Nenema ke abi si woxɔna le proximal tibial protrusion me ate ŋu ana ame nazu nuwɔametɔ, vevietɔ le klo si le titina me. Eyata wode se ɖe ƒunukpeƒetetedɔ ƒe ɖeɖeɖa nu na dɔnɔ siwo ƒe ƒunukpeƒetetedɔ le ʋuʋu ɖi.

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

• Ele be woada dɔnɔ siwo katã wole dɔ wɔm na la akpɔ be woƒe afɔtiwo meli ke le dzitodzito me abɔwo kple abɔ kple afɔ siwo le tɔtrɔm ƒe ɖoɖo me hã. Genu valgus ƒe dzidziɖedzi, femoral anteversion si gbɔ eme kple gotagome tibial torsion ƒe dzidziɖedzi nye afɔku siwo na patellar instability.

• Le dɔnɔ siwo ƒe ƒuwo metsi o gome la, ele be woabu mɔfiafia tsitsi ŋu ne wole nu wɔm kple genu valgus. Epiphyseal screws alo tension band plates ate ŋu akeke afɔkpodzi ƒe akpa si le didiƒe ƒe titina gome hena ɖɔɖɔɖo vivivi. Ehiã be woaɖe ƒuwo ɖa be woatsɔ aɖɔ dɔnɔ siwo ƒe ƒuwo tsi tsitsi ɖo ɖe dzitodzito me dɔléle alo ʋu ƒe tɔtrɔ ƒe dɔmawɔmawɔ nyuie ta. Genu valgus ƒe ɖɔɖɔɖo ƒe dzesi nye > 10 degree, eye ɖɔɖɔɖo ƒe dzesi si nye rotational dislocation wu 20 degree.

• Ðeviwo (< ƒe 10 viwo) ado go afɔkpodzi ƒe malikenyenye ƒe nɔnɔme sesẽwo, siwo dometɔ aɖewoe nye afɔkpodzi ƒe ʋuʋu si nɔa anyi ɖaa alo esi nye numame. Dɔléle geɖewo 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 mesɔ gbɔ be wòakpɔ nɔnɔme sesẽ siawo gbɔ o, elabena dɔléle gbãtɔa le axadzi, eye ɣeaɖewoɣi la, woɖea quadriceps femoris ƒe mɔnu dzi kpɔtɔna, si bia be woaɖe asi le axadzi gbadzaa eye woawɔ quadriceps femoris plasty be woakpɔ kuxi siawo gbɔ.

• Le quadriceps femoris plasty me la, wogbugbɔa quadriceps femoris ƒe mɔ̃a ɖoa teƒe bubu eye/alo wòdidina. Le ɖekematsɔleme alo atikewɔwɔ megbe la, woate ŋu ado go nɔnɔme sesẽ siawo siwo meli ke o le eƒe tsitsime.

Ale Si Nàƒle Ƒumeŋuɖuiwo Kple Ƒumeŋuɖui Dɔwɔnuwo?

Elabena CZMEDITECH , míekpɔa adzɔnuwo ƒe hatsotso si de blibo ŋutɔ si me ƒumeŋuɖui ƒe amekoko ƒe nusiwo wotsɔ dea ame me kple dɔwɔnu siwo sɔ kplii, nusiwo dometɔ aɖewoe nye akɔta ƒe akpa siwo wotsɔ dea ame me, ɖa siwo le lãkusi me, trauma plate, ʋuƒo si wotsɔ xea mɔ na nu, cranial-maxillofacial ƒe tagbɔ, ametia ƒe ŋutilã ƒe akpa aɖe, elektrikdɔwɔnuwo, gotagome fixators, ƒunukpeƒetetedɔ (arthroscopy)., lãwo ƒe dɔlélewo gbɔ kpɔkpɔ kple woƒe kpeɖeŋutɔ dɔwɔnuwo.

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

Míeɖoa nu ɖe ​​xexeame katã, eyata àte ŋui te ɖe mía ŋu le email adrɛs song@orthopedic-china.com hena nyayɔyɔ femaxee, alo ɖo gbedasi ɖe WhatsApp hena ŋuɖoɖo kaba +86- 18112515727 .

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