Koj puas paub qhov ntawd? Kev pheej hmoo thiab kev kho mob ntawm patellofemoral kev sib koom ua ke tsis ruaj khov hauv cov menyuam yaus

Patellofemoral instability (PFI) suav nrog ntau cov kab mob, xws li mob me me mus rau qhov pom tseeb ntawm qhov tsis pom kev ntawm patella (LPD). LPD feem ntau tshwm sim, nrog 50 tus neeg mob hauv txhua 100,000 tus menyuam yaus. Thawj qhov dislocation feem ntau tshwm sim ntawm 15 thiab 19 xyoo. LPD yog ib qho kab mob debilitating, thiab tus nqi dislocation tom qab kev kho mob los yog kev kho lub cev yog siab li 70%. Reconstruction ntawm medial patellofemoral ligament yog qhov kev kho mob uas siv ntau tshaj plaws. Txawm li cas los xij, ntau li 16% ntawm cov neeg mob muaj teeb meem, suav nrog kev rov ua dua tshiab. Tsis tas li ntawd, ib feem peb ntawm cov neeg mob xav tau kev phais tom qab ntawm lwm lub hauv caug sib koom ua ke uas tsis kho phais. Qhov kev pheej hmoo mus sij hawm ntev ntawm kev mob pob txha mos thiab OA tom qab LPD yog 6 npaug ntau dua li tom qab pib qhov kev hloov pauv, uas ua rau ntau tus neeg mob hluas ntsib kev pheej hmoo OA hauv lawv 30s thiab 40s. Tsis muaj kev nkag siab zoo ntawm PFI yog ib qho teeb meem tseem ceeb los kho qhov sib xws ntawm kev sib koom ua ke ntawm patellofemoral.

RISK FACTOR

Kev pheej hmoo ntawm PFI tuaj yeem muab faib ua ob pawg: anatomical abnormality thiab alignment abnormality. Lub femoral trochlear dysplasia yog qhov tseem ceeb tshaj plaws ntawm qhov txawv txav ntawm lub cev, thiab qhov sib txawv ntawm qhov sib txawv xws li patellar nce, patellar yob thiab subluxation. Patellofemoral deformity yog tshwm sim los ntawm kev hloov pauv biomechanical los ntawm kev raug mob ntawm medial stabilizer, nce ntawm Q lub kaum sab xis, anteversion ntawm femur thiab lateralization ntawm patellar tendon insertion. Cov kev pheej hmoo ntawm PFI tau sau tseg hauv daim duab 1.

• femoral trochlea dysplasia

• lub kaum sab xis ntawm inclination ntawm transverse pulley

• lub ntsej muag asymmetry ntawm pulley

• pulley qhov tob

• kev sib txawv txawv

• siab patella

• qhov kev ncua deb ntawm tibia mus rau trochlear groove (tt-tg) nce

• nce q

• femoral anteversion

  
  

CHAW UA HAUJ LWM ntawm IMAGING EXAMINATION

Qhov kev tshawb pom MRI ntawm PFI sib txawv nrog qhov mob hnyav thiab mob ntev ntawm tus kab mob. Cov mob PFI me me tuaj yeem yog tus cwj pwm los ntawm patellar dyskinesia, uas yog tus cwj pwm los ntawm edema ntawm sab sauv thiab sab sab ntawm Hoffa fat pad (tseem hu ua patellofemoral fat impact). Patellofemoral rog cuam tshuam yog ze rau lwm yam kev pheej hmoo ntawm PFI, suav nrog femoral condyle dysplasia, patellar qhov siab, nce TT-TG nrug, lateral patellar qaij thiab subluxation. Ntev-sawv patellar dyskinesia ua rau pob txha raug mob thiab ntxov degeneration ntawm lateral patellofemoral sib koom.

Mob patella (APLD) yog qhov mob hnyav tshaj plaws ntawm PFI. X-ray dawb zaj duab xis qhia txog kev tshawb pom ntawm kev raug mob hnyav, uas yuav suav nrog kev sib koom ua ke, qee zaus lipid qib ntawm fatty arthropathy, tawg ntawm medial patella osteochondral, lateral qaij / subluxation ntawm patella (Daim duab 8A), thiab sib sib zog nqus sulcus kos npe tshwm sim los ntawm kev raug mob ntawm larvae cartilage. Qhov tshwj xeeb MRI tshwm sim ntawm mob LPD suav nrog kev raug mob nruab nrab ntawm qhov chaw ruaj khov (pom hauv 96%), lateral patellar qaij lossis subluxation, kev raug mob osteochondral thiab sib koom ua ke effusion (Daim duab 2B, C). Feem ntau, patella yog spontaneously pib dua tom qab thawj dislocation.

Txog li 70% ntawm cov neeg mob yuav hnov ​​​​mob rov tshwm sim, thiab qhov mob tsis zoo tuaj yeem tshwm sim. Nyob rau hauv cov ntaub ntawv no, MRI tej zaum yuav qhia cov kua muag mob ntawm lub plawv stabilizer, medial patellar deformity, ossification ntawm medial patella, patellar-femoral rog cuam tshuam, pob txha raug mob thiab degeneration ntawm lateral patellofemoral joint (Daim duab 3).

Kev kho mob

1. Kev kho tsis yog phais:

• Feem ntau mob patellar dislocations yog ib ntus thiab yuav rov pib dua tshiab. Qee lub sij hawm, cov neeg mob, cov neeg hauv tsev neeg, cov phooj ywg, cov kws qhia lossis cov kws qhia yuav rov pib kho tus mob patella ntawm qhov chaw. Yog hais tias tus neeg mob mus rau lub chaw kho mob xwm txheej ceev vim yog patellar dislocation, nws yuav tau txais kev nco qab sedation. Kaw txo ntawm patella yog ua tiav los ntawm maj mam ncab ob txhais ceg. Thaum rov pib dua, kuaj xyuas lub hauv caug sib koom ua ke rau lwm qhov kev raug mob.

• Txoj kev kho tus qauv rau thawj qhov kev tshem tawm ntawm patella yog kev kho mob tsis yog phais, thiab lub sij hawm luv luv (2-4 lub lis piam) kho nyob rau hauv splint lossis lub hauv caug fixator tuaj yeem tswj qhov mob thiab pib cov ntaub so ntswg kho tom qab mob hnyav. Thaum lub sij hawm no, crutches raug tso cai rau dais qhov hnyav. Tom qab ntawd, patella stabilizing brackets yog siv rau kev ua ub no, thiab kev kho lub cev yog ua kom rov qab txav mus los, lub zog thiab kev tswj ntawm ceg.

• Cov neeg mob feem ntau rov ua haujlwm li 3 lub hlis tom qab thawj qhov kev tawm tsam. Tsis tas li ntawd, hnav stent yog xaiv tau.

2. Kev kho mob phais:

• Hauv ntau dua 30% ntawm cov neeg mob, thawj qhov kev cuam tshuam ntawm patellar yog cuam tshuam nrog ntau lub hauv caug sib koom ua ke effusion. Hauv qhov no, nws yuav tsum tau ua MRI txhawm rau txheeb xyuas seb puas muaj pob txha osteochondral. Qhov chaw feem ntau ntawm cov pob txha no yog qhov nruab nrab patella lossis lateral femoral condyle, thiab kev kho mob phais feem ntau pom zoo nyob rau hauv muaj cov pob txha pob txha.

• Thaum lub sijhawm ua haujlwm, cov pob txha pob txha osteochondral raug tshem tawm lossis kho raws li qhov loj ntawm pob txha pob txha thiab qhov zoo ntawm pob txha mos. Thaum qhov luaj li cas ntawm osteochondral puas yog ≥ 15 hli, pob txha fixation es tsis txhob excision. Qhov kev kho no yog ua los ntawm txoj kev qhib siv hlau ntsia hlau, bioabsorbable pins lossis sutures.

• Hauv kev kho cov pob txha, cov qauv ntawm kev phais ib txhij stabilization ntawm patella yog ua tiav los ntawm kev kho nruab nrab lossis MPFL rov tsim kho. Yog tias cov ntsia hlau hlau siv rau kev txhim kho pob txha, lawv yuav tsum raug tshem tawm los ntawm lwm cov txheej txheem phais yav tom ntej.

• Muaj ob lub tsev kawm ntawm kev xav txog txoj kev zoo tshaj plaws ntawm patellar stabilization. Thawj txoj hauv kev yog ua kom rov tsim kho MPFL cais. MPFL yog qhov kev txwv tseem ceeb ntawm lateral subluxation ntawm patella, yog li nws txoj kev tsim kho yuav muab qhov kev xav tau ruaj khov rau patella. MPFL reconstruction feem ntau yog ua los ntawm quadriceps tendon autograft, hamstring tendon autograft los yog allograft. Qhov kev vam meej ntawm kev sib cais MPFL rov tsim kho kom rov qab muaj kev ruaj ntseg patellar yog tshaj 95%, uas tsis muaj dab tsi cuam tshuam nrog kev xaiv ntawm graft. Cov teeb meem tshwm sim feem ntau ntawm MPFL rov tsim kho yog lub hauv caug sib koom ua ke nruj, patellar puas thiab rov muaj dua patellar instability.

• Qhov thib ob txoj kev daws cov kev pheej hmoo ntawm patellar instability, thiab MPFL reconstruction. Nyob rau hauv txoj kev no, qhov kev pheej hmoo ntawm anatomical ntawm patellar instability yog txiav txim siab ntawm X-ray zaj duab xis thiab CT / MRI, nrog rau trochlear dysplasia, nce patellar qhov siab thiab TT-TG nrug. Thaum txiav txim siab, qee qhov lossis tag nrho cov kev pheej hmoo yuav raug kho los ntawm kev phais.

• Lub trochlear dysplasia yog daws los ntawm trochleoplasty, nyob rau hauv uas lub trochlear zawj yog tob (Daim duab 12A). Trochlear plasty tsis nrov heev hauv Tebchaws Meskas vim tias nws cuam tshuam txog kev cuam tshuam ntawm cov pob txha mos, thiab txoj kev xav muaj kev pheej hmoo ntawm ischemic necrosis lossis mob caj dab yav tom ntej.

• Patella qhov siab los yog nce ntawm patella qhov siab yog daws los ntawm distal tibial tubercle. Yuav kom nce TT-TG nrug, medial lossis anteromedial tibial tubercle yog ua (Daim duab 12B). Cov teeb meem ntawm tibial tuberosity osteotomy muaj xws li nonunion, kho vajtse mob, poob ntawm tuberosity txo thiab pob txha.

• Rau qhov nro ntawm lateral retina, lateral retinal tso tawm yog ua, uas qhia qhov nce ntawm patella qaij. Cov teeb meem ntawm kev tso tawm sab nraud suav nrog qhov mob tsis tu ncua thiab iatrogenic medial instability ntawm patella.

• Hauv cov neeg mob uas cov pob txha tsis paub qab hau, qee qhov kev ua haujlwm yog contraindicated lossis hloov kho vim yog epiphysis.

• Lub femoral attachment point ntawm MFPL yog nyob rau hauv qab ntawm lub epiphysis ntawm lub distal femur. Yog li ntawd, MPFL reconstruction ntawm cov neeg mob uas tsis paub tab cov pob txha yuav tsum tau ua raws li nruj me ntsis fluoroscopy kev taw qhia los xyuas kom meej qhov zoo drilling ntawm femoral qhov.

• Distal femur raug mob tuaj yeem ua rau deformity, uas tej zaum yuav lossis tsis xav tau kev kho phais. Ib yam li ntawd, kev raug mob ntawm tibial protrusion tuaj yeem ua rau deformity, tshwj xeeb tshaj yog nyob rau hauv nruab nrab lub hauv caug. Yog li ntawd, osteotomy ntawm tibial tuberosity yog txwv tsis pub rau cov neeg mob uas qhib proximal tibial protrusion.

• Ntawm qhov tsis sib xws, cov leeg patellar tuaj yeem ua tiav lossis ib nrab hloov chaw nruab nrab. Thaum sab nrauv ib nrab ntawm lub patellar tendon hloov mus rau sab nruab nrab, qhov kev ua haujlwm no hu ua Roux-Goldthwait operation (Daim duab 12C).

• Txhua tus neeg mob uas raug phais yuav tsum raug soj ntsuam rau qhov tsis muaj zog ntawm patellar nyob rau hauv kev npaj ntawm coronary libs thiab rotating nqua. Nce genu valgus, ntau dhau femoral anteversion thiab nce sab nraud tibial torsion yog qhov muaj feem cuam tshuam rau patellar instability.

• Rau cov neeg mob uas cov pob txha tsis paub qab hau, kev coj noj coj ua yuav tsum tau txiav txim siab thaum cuam tshuam nrog genu valgus. Epiphyseal screws los yog nro band daim hlau tuaj yeem hla qhov nruab nrab ntawm qhov kawg ntawm qhov kawg ntawm femoral epiphysis rau kev kho me ntsis. Osteotomy yog xav tau los kho cov neeg mob nrog cov pob txha paub tab rau coronary lossis rotational deformity. Kev kho qhov taw qhia ntawm genu valgus yog> 10 degrees, thiab qhov kho qhov taw qhia ntawm kev hloov pauv hloov siab tshaj 20 degrees.

• Cov menyuam yaus (< 10 xyoo) yuav ntsib cov qauv nyuaj ntawm patellar instability, uas suav nrog kev hloov pauv tsis tu ncua lossis ib txwm nyob. Ntau tus mob xws li Down syndrome, ntsia thawv-patellar syndrome, Kabuki syndrome thiab Rubinstein Taybi syndrome yog tsim los ntawm patellar instability.

• Nws yog ib qho tseem ceeb kom paub tias qhov kev sib cais ntawm MPFL tsis txaus los daws cov teeb meem nyuaj no, vim tias cov kab mob tseem ceeb nyob tom qab, thiab qee zaum cov txheej txheem ntawm quadriceps femoris luv luv, uas yuav tsum tau nthuav dav rau sab nraud thiab quadriceps femoris plasty los daws cov teeb meem no.

• Hauv quadriceps femoris plasty, quadriceps femoris mechanism yog reoriented thiab / lossis ntev. Nyob rau hauv rooj plaub ntawm kev tsis saib xyuas los yog kev kho mob lig, cov qauv tsis ruaj khov no yuav raug ntsib tom qab hauv lub neej.

Yuav Ua Li Cas Orthopedic Implants thiab Orthopedic Instruments?

Rau CZMEDITECH , peb muaj cov khoom lag luam ua tiav ntawm orthopedic phais implants thiab cov cuab yeej siv, cov khoom suav nrog txha caj qaum, intramedullary rau tes, kev raug mob phaj, xauv phaj, cranial-maxillofacial cov, prosthesis, cov cuab yeej siv zog, sab nraud fixators, arthroscopy, Veterinary saib xyuas thiab lawv cov cuab yeej txhawb nqa.

Tsis tas li ntawd, peb tau cog lus los tsim cov khoom tshiab thiab nthuav dav cov khoom lag luam, txhawm rau ua kom tau raws li kev xav tau ntawm kev phais ntawm ntau tus kws kho mob thiab cov neeg mob, thiab tseem ua rau peb lub tuam txhab muaj kev sib tw ntau dua nyob rau hauv tag nrho lub ntiaj teb orthopedic implants thiab instruments kev lag luam.

Peb xa tawm thoob ntiaj teb, yog li koj tuaj yeem ua tau tiv tauj peb ntawm email chaw nyob song@orthopedic-china.com rau ib qho kev tsocai pub dawb, lossis xa lus ntawm WhatsApp rau cov lus teb ceev +86- 18112515727 .

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