Urabizi? Impamvu zishobora kuvurwa no kuvura patellofemorale ihungabana kubana

Ihungabana rya Patellofemorale (PFI) ririmo urukurikirane rw'indwara, uhereye ku kurwara byoroheje kugeza no gutandukana kwa patella (LPD). LPD irasanzwe, hamwe na 50 mubana 100.000. Gutandukana kwambere mubisanzwe bibaho hagati yimyaka 15 na 19. LPD ni indwara itesha umutwe, kandi igipimo cyo gutandukana nyuma yo kuvurwa neza cyangwa kuvura umubiri kiri hejuru ya 70%. Kwiyubaka kwa medell patellofemoral ligament nubuvuzi bukoreshwa cyane. Nyamara, abarwayi bagera kuri 16% bafite ibibazo, harimo no kongera kwimurwa. Byongeye kandi, kimwe cya kane cyabarwayi bakeneye gukurikiranwa kubagwa kurundi rugingo rudafite ubuvuzi butavuwe. Ibyago birebire byo gukomeretsa karitsiye hamwe na OA nyuma ya LPD ikubye inshuro 6 kurenza iyo nyuma yo kwimurwa kwambere, bigatuma abarwayi benshi bakiri bato bahura na OA bafite imyaka 30 na 40. Kudasobanukirwa neza PFI nimwe mu mbogamizi nyamukuru zo kugarura ihame ryimikorere isanzwe ya patellofemoral.

URUGENDO RWA RISK

Impamvu zishobora gutera PFI zishobora kugabanywamo ibyiciro bibiri: kudasanzwe kwa anatomique no guhuza bidasanzwe. Dymplasia ya femorale trochlear nikintu gikomeye cyingenzi kidasanzwe, kandi guhuza bidasanzwe birimo kuzamuka kwa patellar, umuzingo wa patellar na subluxation. Ubumuga bwa Patellofemorale buterwa nimpinduka za biomehanike ziterwa no gukomeretsa kwa stabilisateur yo hagati, kwiyongera kwa Q inguni, anteversion ya femur no kuruhande rwa patellar tendon insertion. Impamvu zishobora gutera PFI zegeranijwe mu gishushanyo 1.

• femorale trochlea dysplasia

• Inguni yo guhinduranya impinduramatwara

• isura idasanzwe ya pulley

• ubujyakuzimu

• guhuza bidasanzwe

• muremure

• intera kuva tibia kugera trochlear groove (tt-tg) yariyongereye

• ongera q inguni

• igitsina gore

  
  

IBIMENYETSO BY'IKIZAMINI

Ubushakashatsi bwa MRI bwa PFI buratandukanye n'uburemere n'imiterere idakira y'indwara. Indwara ya PFI yoroheje irashobora kurangwa na patellar dyskinesia, irangwa no kuribwa mu mpande zo hejuru no kuruhande rwa Hoffa ibinure (bizwi kandi ko ari amavuta ya patellofemorale). Ingaruka yibinure bya patellofemorale bifitanye isano rya bugufi nizindi mpamvu ziterwa na PFI, harimo na dysplasia femorale condyle dysplasia, uburebure bwa patellar, kongera intera ya TT-TG, kuruhande rwa patellar kuruhande no kugabanuka. Indwara ya patellar dyskinesia imaze igihe kinini itera gukomeretsa no kwangirika hakiri kare kuruhande rwa patellofemoral.

Gukuraho cyane patella (APLD) nuburyo bukomeye bwa PFI. Filime ya X-ray yerekana kuvumbura ibikomere bikaze, bishobora kuba birimo gusohora hamwe, urugero rwa lipide rimwe na rimwe rwamavuta ya arthropathie, kuvunika kwa patella osteochondral yo hagati, kuvunika kuruhande / kugabanuka kwa patella (Igicapo 8A), hamwe nikimenyetso cyimbitse cya sulcus cyatewe no gukomeretsa kwangirika kwabagore. Kugaragara kwa MRI kugaragara cyane kwa LPD harimo gukomeretsa kwa medial stabilisateur (bigaragara muri 96%), kuruhande rwa patellar tilt cyangwa subluxation, gukomeretsa osteochondral no gufatana hamwe (Ishusho 2B, C). Mubihe byinshi, patella ihita isubirwamo nyuma yo gutandukana kwambere.

Abagera kuri 70% by'abarwayi bazahura na dislokisiyo, kandi birashobora kubaho igihe kirekire. Muri iki gihe, MRI irashobora kwerekana amarira adakira ya stabilisateur medial, ubumuga bwa patellar medial, ossification ya patella medial, ingaruka zamavuta ya patellar-femorale, gukomeretsa kwa karitsiye no kwangirika kwingingo ya patellofemorale (Ishusho 3).

IMVUGO

1. Kuvura kutabagwa:

• Ibyinshi bikabije bya patellar dislocations nigihe gito kandi bizahita bisubirwamo. Rimwe na rimwe, abarwayi, abagize umuryango, inshuti, abatoza cyangwa abahugura bazajya basubiramo patella aho hantu. Niba umurwayi yagiye mu ishami ryihutirwa kubera gutandukana kwa patellar, azahabwa umutuzo. Kugabanya gufunga patella bigerwaho no kurambura amaguru buhoro buhoro. Umaze gusubiramo, kora ivuriro rivure ivi kubindi bikomere.

• Ubuvuzi busanzwe bwo kwimura bwa mbere patella nubuvuzi budasanzwe bwo kubaga, kandi gukosora igihe gito (ibyumweru 2-4) gukosora ibice cyangwa ivi birashobora gukiza ububabare no gukira kwambere nyuma yo kwibasirwa bikabije. Muri iki gihe, inkoni zemerewe kwihanganira uburemere. Nyuma yibyo, patella ituza imitwe ikoreshwa mubikorwa, kandi kuvura kumubiri bikorwa kugirango ugarure ingendo, imbaraga no kugenzura ingingo.

• Ubusanzwe abarwayi bakomeza imyitozo nyuma y'amezi 3 nyuma yigitero cya mbere. Uretse ibyo, kwambara stent birashoboka.

2. Ubuvuzi bwo kubaga:

• Mu barwayi barenga 30%, diselokisiyo ya mbere ya patellar ifitanye isano ninshi ryinshi ryamavi. Muri iki kibazo, birakenewe gukora MRI kugirango tumenye niba hari imvune za osteochondral. Ahantu henshi havunitse ni patella yo hagati cyangwa kuruhande rwa femorale condyle, kandi kubagwa mubisanzwe birasabwa mugihe habaye kuvunika imbere.

• Mugihe cyo kubaga, ibice byavunitse osteochondral bivanwaho cyangwa bigashyirwaho ukurikije ubunini bwibice byavunitse hamwe nubwiza bwa karitsiye. Iyo ubunini bwa osteochondral bwavunitse ari mm 15 mm, gukosora kuvunika aho gutekerezwa birasuzumwa. Uku gukosorwa bikorwa nuburyo bufunguye ukoresheje ibyuma, bioabsorbable pin cyangwa suture.

• Mu kuvura imvune, inzira yo kubaga icyarimwe kubaga patella igerwaho no gusana hagati cyangwa kwiyubaka kwa MPFL. Niba imigozi yicyuma ikoreshwa mugukosora kuvunika, birashobora gukurwaho nubundi buryo bwo kubaga mugihe kizaza.

• Hano hari amashuri abiri yibitekerezo kuburyo bwiza bwo gutuza patellar. Uburyo bwa mbere nugukora MPFL yihariye. MPFL nimpamvu nyamukuru itera inzitizi ya patella, bityo kuyubaka bizatanga umutekano ukenewe kuri patella. Kwiyubaka kwa MPFL mubisanzwe bikorwa na quadriceps tendon autograft, hamstring tendon autograft cyangwa allograft. Intsinzi yo kwiyubaka kwa MPFL yitaruye kugirango igarure umutekano wa patellar irenze 95%, idafite aho ihuriye no guhitamo ibihingwa. Ingorane zikunze kugaragara mu kwiyubaka kwa MPFL ni ugukomera kw'ivi, kuvunika patellar hamwe no guhungabana kwa patellar.

• Uburyo bwa kabiri bukemura ingaruka ziterwa na patellar ihungabana, no kwiyubaka kwa MPFL. Muri ubu buryo, ibintu bitera ingaruka ziterwa no guhungabana kwa patellar bigenwa kuri firime X-ray na CT / MRI, harimo na troclear dysplasia, kongera uburebure bwa patellar hamwe nintera ya TT-TG. Bimaze kugenwa, ibintu bimwe cyangwa byose bishobora gukosorwa no kubagwa.

• Dysplasia ya trochlear ikemurwa na trochleoplasty, aho umwobo wa trochlear wimbitse (Ishusho 12A). Plastike ya Trochlear ntabwo ikunzwe cyane muri Reta zunzubumwe zamerika kuko irimo no gutera karitsiye ya articular, kandi mubyukuri hariho ibyago byo kurwara ischemic necrosis cyangwa arthritis.

• Uburebure bwa Patella cyangwa ubwiyongere bwa patella bukemurwa nigituntu cya kure. Kugirango wongere intera ya TT-TG, hakorwa igituntu cyo hagati ya tibial medial cyangwa anteromedial (Ishusho 12B). Ingorane za tibial tuberosity osteotomy zirimo kudahuza, kubabara ibyuma, gutakaza igituntu no kuvunika.

• Kubijyanye no guhagarika retina, kuruhande rwa retina irekurwa, byerekana kwiyongera kwa patella. Ingorane zo kurekura kuruhande zirimo kubyimba guhoraho hamwe na iatrogenic medial instabilite ya patella.

• Ku barwayi bafite amagufwa adakuze, ibikorwa bimwe na bimwe birabujijwe cyangwa byahinduwe kubera epiphysis.

• Umugereka wumugore wa MFPL uherereye munsi ya epiphysis ya femur ya kure. Niyo mpamvu, MPFL yongeye kubaka abarwayi bafite amagufwa adakuze igomba gukorwa hifashishijwe ubuyobozi bwa fluoroscopi kugira ngo hacukurwe neza umuyoboro w’umugore.

• Gukomeretsa kure kw'igitsina gore birashobora gutera ubumuga, bushobora cyangwa budakeneye gukosorwa kubagwa. Mu buryo nk'ubwo, gukomeretsa hafi ya tibial protrusion bishobora gutera ubumuga, cyane cyane mu ivi ryo hagati. Kubwibyo, osteotomy ya tibial tuberosity irabujijwe kubarwayi bafite tibial primaxime ifunguye.

• Ibinyuranye, imitekerereze ya patellar irashobora kwimurwa burundu cyangwa igice. Iyo igice cyinyuma cya patellar tendon yimuriwe kuruhande rwagati, iki gikorwa cyitwa Roux-Goldthwait (Ishusho 12C).

• Abarwayi bose barimo kubagwa bagomba gusuzumwa kubera ihungabana rya patellar mugutunganya ingingo zumutima hamwe ningingo zizunguruka. Kwiyongera kwukuri kwa valgus, anteversion ikabije yumugore no kwiyongera kwa tibial torsion yo hanze ni ibintu bishobora guteza umutekano muke.

• Ku barwayi bafite amagufa adakuze, kuyobora gukura bigomba kwitabwaho mugihe ukorana na valgus. Epiphyseal screw cyangwa plaque bande irashobora kuzenguruka uruhande rwo hagati rwimpera ya epiphysis femorale kugirango ikosorwe buhoro buhoro. Osteotomy irakenewe kugirango ikosore abarwayi bafite amagufwa akuze kugirango bahindurwe neza. Ikosora ryerekana genu valgus ni> dogere 10, naho ikosora ryerekana ko izunguruka irenze dogere 20.

• Abana (<imyaka 10) bazahura nuburyo bugoye bwo guhungabana kwa patellar, burimo gutandukana kwimikorere cyangwa bisanzwe. Indwara nyinshi nka syndrome ya Down, syndrome de nail-patellar, syndrome ya Kabuki na syndrome ya Rubinstein Taybi igizwe no guhungabana kwa patellar.

• Ni ngombwa kumenya ko kwiyubaka kwa MPFL byitaruye bidahagije kugira ngo bikemure ubwo buryo bugoye, kubera ko indwara y’ibanze ibanza iherekejwe, kandi rimwe na rimwe uburyo bwa quadriceps femoris buragufi, busaba kurekura impande zose hamwe na quadriceps femoris plasty kugirango bikemure ibyo bibazo.

• Muri quadriceps femoris plasty, uburyo bwa quadriceps femoris bwimikorere kandi / cyangwa igihe kirekire. Mugihe cyo kwirengagiza cyangwa gutinda kuvurwa, ubwo buryo bugoye butajegajega bushobora guhura nyuma mubuzima.

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