Ekyo okimanyi? Ensonga z’akabi n’obujjanjabi bw’obutabeera mu ntebenkevu bw’ennyondo za patellofemoral mu baana

Patellofemoral instability (PFI) mulimu endwadde ezitali zimu, okuva ku buzibu obutono okutuuka ku kuseeseetula okweyoleka okwa patella (LPD). LPD etera okubeerawo, nga buli baana 100,000 bakwatibwa abalwadde 50. Okuseeseetula okusooka kutera kubaawo wakati w’emyaka 15 ne 19. LPD bulwadde bunafuya, era omuwendo gw’okusengulwa oluvannyuma lw’obujjanjabi obw’okukuuma oba okujjanjabibwa mu mubiri guli waggulu nga 70%. Okuddamu okuzimba omusuwa gw’omugongo ogw’omu makkati (medial patellofemoral ligament) gwe bujjanjabi obusinga okukozesebwa mu kulongoosa. Wabula abalwadde abawera 16% balina ebizibu omuli okuddamu okusengulwa. Okugatta ku ekyo, abalwadde kimu kyakuna beetaaga okulongoosebwa okugoberera ekiwanga ekirala eky’okugulu ekitalongoosebwa. Obulabe obw’ekiseera ekiwanvu obw’okulumwa amagumba okugenda mu maaso ne OA oluvannyuma lwa LPD businga emirundi 6 okusinga obwo oluvannyuma lw’okusengulwa mu kusooka, ekireetera abalwadde bangi abato okwolekagana n’akabi ka OA mu myaka gyabwe egy’obukulu 30 ne 40. Obutategeera bulungi PFI kye kimu ku bisinga okulemesa okuzzaawo obutakyukakyuka bw’ekiwanga kya patellofemoral ekya bulijjo.

ENSONGA EY’AKABI

Ensonga z’akabi eza PFI zisobola okwawulwamu ebika bibiri: obutabeera bwa bulijjo mu mubiri n’obutabeera bulungi mu kukwatagana. Obuzibu bw’okusannyalala kw’omugongo (femoral trochlear dysplasia) bwe buzibu obusinga obukulu mu mubiri, era obuzibu mu kukwatagana (alignment abnormality) mulimu okugulumizibwa kw’amagulu (patellar elevation), okuzingulula kw’amagulu (patellar roll) n’okukulukuta (subluxation). Obulema bw’omugongo (patellofemoral deformity) buva ku nkyukakyuka mu by’obutonde (biomechanical changes) ezireetebwa obuvune bwa medial stabilizer, okweyongera kwa Q angle, anteversion of femur ne lateralization of patellar tendon insertion. Ensonga eziyinza okuleeta akabi mu PFI zifunze mu kifaananyi 1.

• obulwadde bw’okuzimba omubiri mu kisambi

• enkoona y’okuserengeta kw’ekiwujjo ekiwanvu (transverse pulley).

• facet asymmetry (obutafaanagana bwa facet) bwa pulley

• obuziba bwa pulley

• okukwatagana okutali kwa bulijjo

• patella empanvu

• ebanga okuva ku tibia okutuuka ku trochlear groove (tt-tg) lyeyongera

• okwongera q angle

• anteversion y’omugongo (femoral anteversion).

  
  

EBINTU EBY’OKUKEBERA EBIFAANANYI

Ebizuuliddwa mu MRI ku PFI byawukana okusinziira ku buzibu n’obutonde bw’obulwadde obutawona. Emisango gya PFI emitono giyinza okumanyibwa n’obulwadde bwa patellar dyskinesia, obumanyiddwa nga okuzimba ku ludda olwa waggulu n’olw’ebbali olwa Hoffa fat pad (era emanyiddwa nga patellofemoral fat impact). Okukosebwa kw’amasavu g’omugongo (patellofemoral fat impact) kukwatagana nnyo n’ebintu ebirala eby’obulabe ebya PFI, omuli okuzimba omubiri (femoral condyle dysplasia), obuwanvu bw’omugongo, okweyongera kw’ebanga lya TT-TG, okulengejja kw’amasavu mu mabbali n’okusereba. Obulwadde bwa patellar dyskinesia obumaze ebbanga buvaako okulumwa eggumba n’okuvunda amangu kw’ekiwanga eky’ebbali (lateral patellofemoral joint).

Acute dislocation of patella (APLD) y’engeri esinga okuba ey’amaanyi eya PFI. Firimu ya X-ray plain eraga okuzuula obuvune obw’amaanyi, ekiyinza okuli okukulukuta kw’amasavu oluusi n’oluusi, omutindo gw’amasavu ogw’amasavu oluusi n’oluusi, okumenya amagumba g’amagumba ag’omu makkati, okulengejja/okukulukuta okw’ebbali (lateral tilt/subluxation of patella) (Figure 8A), n’akabonero ka deep lateral sulcus akava ku impaction injury of lateral femoral condylar cartilage. Ebiraga ebitongole ebya MRI ebya LPD ey’amangu mulimu obuvune bwa medial stabilizer (obulabibwa mu 96%), lateral patellar tilt oba subluxation, osteochondral injury n’okufuluma kw’ennyondo (Figure 2B, C). Ebiseera ebisinga, ekitundu ky’omubiri ekiyitibwa patella kiddamu okuteekebwawo mu ngeri eyeetongodde oluvannyuma lw’okusengulwa okusooka.

Abalwadde okutuuka ku bitundu 70% bajja kufuna okuseeseetula okuddamu, era okuseeseetula okuddamu okutambula obutasalako kuyinza okubaawo. Mu mbeera eno, MRI eyinza okulaga okukutuka okutambula obutasalako okw’ekirungo ekinyweza eky’omu makkati, okulema kw’amagumba ag’omu makkati, okufuuka amagumba g’omugongo ogw’omu makkati, okukosebwa kw’amasavu g’omugongo n’ekisambi, okulumwa eggumba n’okuvunda kw’ekiwanga eky’ebbali eky’omugongo (Figure 3).

OBUSAANYIZIBWA

1. Obujjanjabi obutali bwa kulongoosa:

• Acute patellar dislocations ezisinga ziba za kaseera buseera era zijja kuddamu okuteekebwawo mu ngeri ey’okwekolako. Oluusi, abalwadde, ab’omu maka, mikwano gyabwe, abatendesi oba abatendesi bajja kuzzaawo patella mu ngalo mu kifo ekyo. Singa omulwadde agenda mu kitongole ky’abalwadde ab’amangu olw’okusannyalala kw’omugongo, ajja kuweebwa eddagala erikkakkanya ng’ategeera. Okukendeeza ku patella okuggaddwa kutuukibwako nga ogolola amagulu mpolampola. Bw’omala okuddamu okugiteeka, kebera mu bujjanjabi ekinywa ky’okugulu oba tekirina buvune bulala.

• Obujjanjabi obw’omutindo ku kuseeseetula okusooka kw’ekitundu ky’omubiri ekiyitibwa patella bujjanjabi obutali bwa kulongoosa, era okunyweza okw’ekiseera ekitono (wiiki 2-4) mu splint oba knee joint fixator kuyinza okufuga obulumi n’okuwona kw’ebitundu ebisooka oluvannyuma lw’okulumbibwa okw’amaanyi. Mu kiseera kino, emiggo gikkirizibwa okwetikka obuzito. Oluvannyuma lw’ekyo, patella stabilizing brackets zikozesebwa mu mirimu, era obujjanjabi bw’omubiri bukolebwa okuzzaawo entambula, amaanyi n’okufuga ebitundu by’omubiri.

• Abalwadde batera okuddamu okukola dduyiro nga wayise emyezi nga 3 oluvannyuma lw’okulumbibwa okusooka. Ng’oggyeeko ekyo, okwambala stent kya kwesalirawo.

2. Obujjanjabi obw’okulongoosa:

• Mu balwadde abasukka mu 30%, okuseeseetula kw’amagulu okusooka kwekuusa ku bungi bw’okufuluma kw’ekinywa ky’okugulu. Mu mbeera eno, kyetaagisa okukola MRI okuzuula oba waliwo okumenya amagumba. Ekifo ekisinga okubeera n’okumenya kuno kwe kitundu ky’omugongo ekiyitibwa medial patella oba lateral femoral condyle, era obujjanjabi obulongoosebwa butera okusemba nga waliwo okumenya mu bitundu by’omubiri (intra-articular fractures).

• Mu kiseera ky’okulongoosebwa, ebitundu ebimenya amagumba biggyibwawo oba ne binyweza okusinziira ku bunene bw’ebitundu ebimenyese n’omutindo gw’amagumba. Obunene bw’okumenya amagumba bwe buba ≥ mm 15, okunyweza okumenya mu kifo ky’okusalako kulowoozebwako. Okunyweza kuno kukolebwa mu nkola enzigule nga tukozesa sikulaapu z’ebyuma, ppini ezinyweza obulamu oba emisono.

• Mu kujjanjaba okumenya, omuze gw’okulongoosa okutebenkeza ekitundu ky’omubiri ekiyitibwa patella mu kiseera kye kimu gutuukibwako nga baddaabiriza wakati oba okuddamu okuzimba MPFL. Singa sikulaapu z’ebyuma zikozesebwa okunyweza okumenya, kiyinza okuggyibwawo mu biseera eby’omu maaso n’okulongoosa okulala.

• Waliwo amasomero abiri ag’endowooza ku nkola esinga obulungi ey’okutebenkeza ebitundu by’omubiri (patellar stabilization). Enkola esooka kwe kukola okuzimba obuggya MPFL okwawuddwamu. MPFL ye nsonga enkulu eziyiza okusumululwa okw’ebbali (lateral subluxation of patella), kale okuddamu okuzimba kwayo kujja kuwa obutebenkevu obwetaagisa eri patella. Okuddamu okuzimba MPFL kutera kukolebwa nga tuyita mu kulongoosa omusuwa gwa quadriceps tendon autograft, hamstring tendon autograft oba allograft. Obuwanguzi bw’okuzimba obuggya MPFL eyawuddwamu okuzzaawo obutebenkevu bwa patellar busukka mu 95%, ekitaliiko kakwate na kulonda graft. Ebizibu ebisinga okuva mu kuddamu okuzimba MPFL kwe kukaluba kw’ennyondo z’okugulu, okumenya amagulu n’obutabeera mu ntebenkevu okuddamu.

• Enkola eyokubiri egonjoola ensonga z’akabi ez’obutabeera mu ntebenkevu bwa patellar, n’okuddamu okuzimba MPFL. Mu nkola eno, ensonga z’akabi mu mubiri (anatomical risk factors of patellar instability) zisalibwawo ku firimu ya X-ray ne CT/MRI, omuli trochlear dysplasia, okweyongera kw’obuwanvu bw’enkizi n’obuwanvu bwa TT-TG. Bwe kinaaba kizuuliddwa, ebimu oba byonna ebiyinza okuleeta akabi bijja kulongoosebwa nga balongooseddwa.

• Obulwadde bwa trochlear dysplasia bugonjoolwa mu nkola ya trochleoplasty, nga mu kino ekitundu ky’omubiri ekiyitibwa trochlear groove kifunda (Figure 12A). Trochlear plasty si yettanirwa nnyo mu Amerika kubanga ezingiramu okulumba eggumba ly’omubiri, era mu ndowooza waliwo akabi k’obulwadde bwa ischemic necrosis oba endwadde z’enkizi mu biseera eby’omu maaso.

• Obugulumivu bwa patella oba okweyongera kw’obuwanvu bwa patella kugonjoolwa distal tibial tubercle. Okusobola okwongera ku TT-TG distance, medial oba anteromedial tibial tubercle ekolebwa (Figure 12B). Ebizibu ebiva mu kulongoosa amagumba mu tibial tuberosity mulimu obutakwatagana, obulumi mu hardware, okufiirwa okukendeeza ku tuberosity n’okumenya.

• Ku kunyigirizibwa kw’amaaso ag’ebbali, okufulumya amaaso ag’ebbali kukolebwa, ekiraga okweyongera kw’okulengejja kw’amaaso. Ebizibu ebiva mu kusumululwa okw’ebbali mulimu okuzimba okutambula obutasalako n’obutabeera mu ntebenkevu mu makkati (iatrogenic medial instability of patella).

• Mu balwadde abalina amagumba agatakuze, okulongoosebwa okumu kuziyiza oba kukyusibwa olw’obulwadde bwa epiphysis.

• Ekifo ekikwatagana n’ekisambi ekya MFPL kisangibwa wansi ddala w’epiphysis y’ekisambi eky’ewala. N’olwekyo, okuddamu okuzimba MPFL kw’abalwadde abalina amagumba agatakuze kulina okukolebwa wansi w’obulagirizi obukakafu obw’okukebera fluoroscopy okulaba ng’okusima omukutu gw’ekisambi mu ngeri ey’obukuumi.

• Obuvune bw’omugongo ogw’ewala buyinza okuvaako okulema, ekiyinza okwetaagisa oba tekiyinza kwetaagisa kulongoosebwa. Mu ngeri y’emu, obuvune bw’okufuluma kw’omugongo ogw’okumpi (proximal tibial protrusion) buyinza okuvaako okulema naddala mu kugulu okw’omu makkati. N’olwekyo, osteotomy of tibial tuberosity kigaaniddwa eri abalwadde abalina open proximal tibial protrusion.

• Okwawukana ku ekyo, omusuwa gwa patellar guyinza okusengulwa ddala oba ekitundu mu makkati. Ekitundu eky’ebweru eky’omusuwa gw’omugongo bwe kikyusibwa okudda ku ludda olw’omu makkati, okulongoosebwa kuno kuyitibwa Roux-Goldthwait operation (Figure 12C).

• Abalwadde bonna abalongoosebwa balina okwekebejjebwa okulaba oba tebali mu ntebenkevu mu bitundu by’omubiri (patellar instability) mu nteekateeka y’ebitundu by’omubiri ebiyitibwa coronary limbs n’ebitundu ebikyukakyuka. Okwongera ku genu valgus, femoral anteversion esukkiridde n’okweyongera kw’okukyukakyuka kw’ekisambi okw’ebweru bye biyinza okuleeta obutabeera mu ntebenkevu mu bitundu by’omubiri (patellar instability).

• Ku balwadde abalina amagumba agatakuze, okulungamya okukula kulina okulowoozebwako nga bakola ku genu valgus. Epiphyseal screws oba tension band plates zisobola okubuna oludda olw’omu makkati olw’enkomerero ey’ewala eya femoral epiphysis okusobola okutereeza mpolampola. Osteotomy yeetaagibwa okutereeza abalwadde abalina amagumba amakuze olw’obulema mu coronary oba rotational deformity. Ekiraga okutereeza genu valgus kiri > diguli 10, ate ekiraga okutereeza eky’okusengulwa kw’enzitowerera kusukka diguli 20.

• Abaana (< emyaka 10) bajja kusanga enkola enzibu ez’obutabeera mu ntebenkevu mu bitundu by’omubiri (patellar instability), nga muno mulimu okusereba kw’ennyindo okutambula oba okwa bulijjo. Obulwadde obuwerako nga Down syndrome, nail-patellar syndrome, Kabuki syndrome ne Rubinstein Taybi syndrome bukolebwa obutabeera mu ntebenkevu bwa patellar.

• Kikulu okukimanya nti okuddamu okuzimba okwawuddwamu okwa MPFL tekimala kugonjoola nkola zino enzibu, kubanga endwadde ezisookerwako zisangibwa mu mabbali, era oluusi enkola ya quadriceps femoris efunzibwa, ekyetaagisa okufulumya mu mabbali okugazi ne quadriceps femoris plasty okugonjoola ebizibu bino.

• Mu quadriceps femoris plasty, enkola ya quadriceps femoris eddamu okutunuulirwa era/oba ewangaala. Mu mbeera y’okulagajjalirwa oba okulwawo okujjanjabibwa, enkola zino enzibu ezitanywevu ziyinza okusangibwa mu bulamu obw’oluvannyuma.

Engeri y'okugulamu ebyuma ebiteekebwa mu magumba n'ebikozesebwa mu kulongoosa amagumba?

A CZMEDITECH , tulina layini y’ebintu ebijjuvu ennyo eby’ebiteekebwa mu kulongoosa amagumba n’ebikozesebwa ebikwatagana, ebintu omuli okuteekebwamu omugongo, emisumaali egy’omu lubuto (intramedullary nails)., essuuka y’okulumwa, ebbakuli y’okusiba, cranial-maxillofacial mu maaso, okuzimba omubiri (prosthesis)., ebikozesebwa eby’amasannyalaze, ebinyweza eby’ebweru, okukebera ebinywa, okulabirira ebisolo n’ebikozesebwa byabwe ebibiwagira.

Okugatta ku ekyo, twewaddeyo okugenda mu maaso n’okukola ebintu ebipya n’okugaziya layini z’ebintu, tusobole okutuukiriza ebyetaago by’okulongoosa eby’abasawo n’abalwadde bangi, era n’okufuula kkampuni yaffe okuvuganya ennyo mu mulimu gwonna ogw’ensi yonna ogw’okussaamu amagumba n’ebikozesebwa.

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