Kun san haka? Abubuwan haɗari da kuma maganin rashin lafiyar haɗin gwiwa na patellofemoral a cikin yara

Rashin zaman lafiya na Patellofemoral (PFI) ya haɗa da jerin cututtuka, kama daga rashin lafiya mai laushi zuwa bayyanannun ɓarna na patella (LPD). LPD ya zama ruwan dare gama gari, tare da lokuta 50 a cikin kowane yara 100,000. Ragewar farko yakan faru tsakanin shekaru 15 zuwa 19. LPD cuta ce mai raɗaɗi, kuma yawan raguwa bayan jiyya na ra'ayin mazan jiya ko jiyya ta jiki ya kai 70%. Sake gina ligament na tsakiya na patellofemoral shine mafi yawan amfani da maganin tiyata. Duk da haka, kusan kashi 16% na marasa lafiya suna da rikitarwa, ciki har da sake dawowa. Bugu da ƙari, kashi ɗaya cikin huɗu na marasa lafiya suna buƙatar aikin tiyata na gaba akan ɗayan haɗin gwiwa wanda ba a yi masa tiyata ba. Haɗarin dogon lokaci na raunin guringuntsi na ci gaba da OA bayan LPD shine sau 6 mafi girma fiye da haka bayan an fara raguwa, wanda ya sa yawancin matasa marasa lafiya suna fuskantar haɗarin OA a cikin 30s da 40s. Rashin cikakkiyar fahimtar PFI shine daya daga cikin manyan matsalolin don mayar da daidaituwar haɗin gwiwa na patellofemoral na al'ada.

LABARI MAI HADARI

Abubuwan haɗari na PFI za a iya raba su zuwa kashi biyu: rashin daidaituwa na jiki da rashin daidaituwa. Dysplasia na mata na mata shine mafi mahimmancin rashin lafiyar jiki, kuma rashin daidaituwa ya haɗa da hawan patellar, juyi na patellar da subluxation. Nakasar Patellofemoral yana faruwa ne ta hanyar sauye-sauye na biomechanical wanda ya haifar da rauni na mai daidaitawa na tsakiya, karuwa na Q kwana, antyversion na femur da lateralization na patellar tsokoki. An taƙaita abubuwan haɗari na PFI a cikin Hoto 1.

• femoral trochlea dysplasia

• kwana na karkata na juzu'i

• facet asymmetry na pulley

• zurfin puley

• jeri mara kyau

• high patella

• Nisa daga tibia zuwa trochlear tsagi (tt-tg) ya ƙaru

• karuwa q kwana

• ciwon mata

  
  

HALAYEN JARRABAWAR HOTO

Sakamakon MRI na PFI ya bambanta da tsanani da yanayin cutar. Za a iya kwatanta lokuta masu sauƙi na PFI ta hanyar dyskinesia na patellar, wanda ke da alamar edema na babba da na gefe na Hoffa fat pad (wanda kuma aka sani da tasirin patellofemoral mai). Tasirin kitse na Patellofemoral yana da alaƙa da alaƙa da wasu abubuwan haɗari na PFI, gami da dysplasia condyle na mata, tsayin patellar, haɓaka nisan TT-TG, karkatar patellar ta gefe da subluxation. Dyskinesia na patellar mai tsayi yana haifar da rauni na guringuntsi da farkon lalatawar haɗin gwiwa na patellofemoral na gefe.

Mummunan murkushe patella (APLD) shine mafi girman nau'in PFI. Fim ɗin fili na X-ray yana nuna gano raunin raunin da ya faru, wanda zai iya haɗawa da zubar da jini na haɗin gwiwa, matakin lipid na lokaci-lokaci na fatty arthropathy, karaya na medial patella osteochondral, karkatar da kai / subluxation na patella (Hoto 8A), da alamar sulcus mai zurfi ta gefe wanda ya haifar da tasirin rauni na gungu na mata. Ƙayyadaddun alamun MRI na m LPD sun haɗa da rauni na tsakiya (wanda aka gani a cikin 96%), karkatar da patellar na gefe ko subluxation, raunin osteochondral da haɗin gwiwa (Figure 2B, C). A mafi yawan lokuta, ana sake saita patella ba tare da bata lokaci ba bayan an fara watsewa.

Har zuwa kashi 70 cikin dari na marasa lafiya za su fuskanci rikice-rikice na yau da kullum, kuma rashin daidaituwa na yau da kullum na iya faruwa. A wannan yanayin, MRI na iya nuna tsagewar tsagewar tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsakin tsaka-tsaki, nakasa na tsakiya na tsakiya, ossification na patella na tsakiya, tasiri mai tasiri na patellar-femoral, raunin guringuntsi da kuma lalata haɗin gwiwa na patellofemoral na gefe (Figure 3).

MAGANIN

1. Maganin da ba na tiyata ba:

• Yawancin ɓarkewar ɓoyayyen ɓoyayyen ɓoyayyen ɓoyayyen ɓoyayyen ɓoyayyiyar ɗan lokaci ne kuma za a sake saita su nan da nan. Wani lokaci, marasa lafiya, 'yan uwa, abokai, masu horarwa ko masu horarwa za su sake saita patella da hannu akan tabo. Idan majiyyaci ya je sashin gaggawa saboda raunin patellar, za a ba shi jin dadi. Rufe raguwa na patella yana samuwa ta hanyar shimfiɗa ƙafafu a hankali. Da zarar an sake saitawa, a asibiti duba haɗin gwiwa don wasu raunuka.

• Ma'auni na yau da kullum don ƙaddamarwa na farko na patella ba magani ba ne, kuma gajeren lokaci (2-4 makonni) gyare-gyare a cikin splint ko gwiwa haɗin gwiwa mai gyaran kafa zai iya sarrafa ciwo da nama na farko bayan mummunan harin. A wannan lokacin, ana ba da izinin crutches don ɗaukar nauyin. Bayan haka, ana amfani da ɓangarorin stabilizing patella don ayyukan, kuma ana yin aikin jiyya ta jiki don dawo da motsi, ƙarfi da sarrafa hannu.

• Marasa lafiya yawanci suna komawa motsa jiki kamar watanni 3 bayan harin farko. Bayan haka, saka stent ba zaɓi bane.

2. Magani:

• A cikin fiye da 30% na marasa lafiya, ƙaddamarwa na farko na patellar yana da alaƙa da babban adadin haɗin gwiwa na gwiwa. A wannan yanayin, wajibi ne a yi MRI don gano ko akwai raunin osteochondral. Mafi yawan wuraren da aka fi sani da wadannan karaya shine tsakiyar patella ko na gefe na mata, kuma ana ba da shawarar yin aikin tiyata a gaban ɓangarorin ciki.

• A lokacin aikin, ana cire sassan osteochondral ko gyarawa gwargwadon girman karaya da ingancin guringuntsi. Lokacin da girman karayar osteochondral ya kasance ≥ 15 mm, an yi la'akari da gyaran gyare-gyare maimakon cirewa. Ana yin wannan gyare-gyare ta hanyar buɗewa ta amfani da sukurori na ƙarfe, fil ɗin da za a iya ɗauka ko suture.

• A cikin jiyya na karaya, yanayin yanayin kwanciyar hankali na lokaci guda na patella yana samuwa ta hanyar gyara na tsakiya ko sake gina MPFL. Idan an yi amfani da sukulan ƙarfe don gyaran karaya, ƙila a cire su ta wasu hanyoyin tiyata a nan gaba.

• Akwai makarantu biyu na tunani game da mafi kyawun hanyar tabbatar da patellar. Hanya ta farko ita ce sake gina MPFL keɓe. MPFL shine babban mahimmancin mahimmanci na subluxation na gefe na patella, don haka sake gina shi zai samar da kwanciyar hankali da ake bukata don patella. Ana yin gyaran MPFL ta hanyar quadriceps tendon autograft, hamstring tendon autograft ko allograft. Nasarar sake gina MPFL keɓe don maido da kwanciyar hankali ya haura 95%, wanda ba shi da alaƙa da zaɓin dasa. Mafi yawan rikice-rikice na sake gina MPFL shine taurin haɗin gwiwa na gwiwa, raunin patellar da kuma rashin kwanciyar hankali na patellar.

• Hanya na biyu yana warware matsalolin haɗari na rashin zaman lafiya na patellar, da kuma sake gina MPFL. A cikin wannan hanya, an ƙayyade abubuwan haɗari na jiki na rashin zaman lafiyar patellar akan fim din X-ray da CT / MRI, ciki har da dysplasia na trochlear, ƙara girman patellar da nisa na TT-TG. Da zarar an ƙayyade, wasu ko duk abubuwan haɗari za a gyara su ta hanyar tiyata.

• Ana magance dysplasia na trochlear ta hanyar trochleoplasty, wanda aka zurfafa tsagi na trochlear (Hoto 12A). Plasty na Trochlear ba ya shahara sosai a cikin Amurka saboda ya haɗa da mamayewar guringuntsi, kuma a ka'idar akwai haɗarin ischemic necrosis ko arthritis na gaba.

• Tsayin Patella ko karuwar tsayin patella ana warware shi ta hanyar distal tibial tubercle. Don ƙara nisa na TT-TG, ana yin matsakaici ko kuma anteromedial tibial tubercle (Hoto 12B). Matsalolin tibial tuberosity osteotomy sun haɗa da rashin haɗuwa, zafi na hardware, asarar raguwar tuberosity da karaya.

• Don tashin hankali na ƙwayar ido na gefe, ana yin sakin layi na gefe, wanda ke nuna karuwar patella. Abubuwan da ke haifar da sakin layi sun haɗa da kumburi mai tsayi da kuma iatrogenic medial rashin zaman lafiyar patella.

• A cikin marasa lafiya da ƙasusuwan da ba su da girma, wasu ayyuka sun hana ko an gyara su saboda epiphysis.

• Wurin haɗe-haɗe na mata na MFPL yana ƙarƙashin epiphysis na femur mai nisa. Saboda haka, MPFL sake gina marasa lafiya tare da ƙasusuwan da ba su da girma ya kamata a gudanar da su a karkashin ingantacciyar jagorar fluoroscopy don tabbatar da hakowa mai aminci na ramin femoral.

• Raunin femur mai nisa zai iya haifar da nakasu, wanda maiyuwa ko bazai buƙatar gyaran tiyata ba. Hakazalika, rauni na protrusion tibial na kusa zai iya haifar da nakasa, musamman ma a cikin gwiwa na tsakiya. Saboda haka, an haramta osteotomy na tibial tuberosity ga marasa lafiya tare da buɗaɗɗen tibial protrusion.

• Akasin haka, tendon patellar na iya zama gaba ɗaya ko wani ɗan gudun hijira ta tsakiya. Lokacin da aka mayar da rabin gefen hagu na patellar zuwa gefen tsakiya, ana kiran wannan aikin Roux-Goldthwait aiki (Hoto 12C).

• Dole ne a kimanta duk marasa lafiya da ke yin aikin tiyata don rashin kwanciyar hankali na patellar a cikin tsari na jijiyoyin jini da jujjuyawa. Ƙarfafa genu valgus, wuce haddi na femoral anterversion da ƙãra ƙwanƙwasa tibial na waje sune abubuwan haɗari ga rashin kwanciyar hankali na patellar.

• Ga marasa lafiya da ƙasusuwan da ba su da girma, ya kamata a yi la'akari da jagorancin girma lokacin da ake hulɗa da genu valgus. Epiphyseal screws ko kuma faranti na bandeji na tashin hankali na iya mamaye tsakiyar tsakiyar ƙarshen epiphysis na mata don gyara a hankali. Ana buƙatar osteotomy don gyara marasa lafiya da ƙasusuwa balagagge don nakasar jijiyoyin jini ko juyawa. Alamar gyaran genu valgus shine> digiri 10, kuma alamar gyaran jujjuyawar juyawa ta wuce digiri 20.

• Yara (< 10 shekaru) za su fuskanci hadaddun alamu na rashin zaman lafiya na patellar, wanda ya haɗa da ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙwayar cuta. Cututtuka da yawa irin su Down syndrome, ƙusa-patellar ciwo, Kabuki ciwo da Rubinstein Taybi ciwo sun hada da rashin kwanciyar hankali na patellar.

• Yana da mahimmanci a gane cewa keɓantaccen sake ginawa na MPFL bai isa ya magance waɗannan alamu masu rikitarwa ba, saboda ilimin farko yana samuwa a gefe, kuma wani lokaci ana rage tsarin quadriceps femoris, wanda ke buƙatar sakin layi mai faɗi da quadriceps femoris plasty don magance waɗannan matsalolin.

• A cikin plasty femoris quadriceps, tsarin femoris quadriceps yana sake daidaitawa da/ko tsawaitawa. Game da rashin kulawa ko jinkirin jinya, waɗannan rikitattun tsarin rashin kwanciyar hankali na iya fuskantar daga baya a rayuwa.

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