Urabizi? Impamvu Zitera Ingaruka no kuvura amasoko ahungabana

Ihungabana rya patellofem (PFI) ririmo urukurikirane rwindwara, kuva kuri malaise yoroheje kugirango utegure patella (LPD). LPD irasanzwe, hamwe na 50 mubana 100.000. Kwiyubaka kwambere mubisanzwe bibaho hagati yimyaka 15 na 19. LPD ni indwara itesha umutwe, hamwe nigipimo cyo kwigomeka nyuma yo kuvura ibituba cyangwa kuvura umubiri ni hejuru nka 70%. Kwiyubaka kwa ligamel ya patelloferal nubuvuzi bukoreshwa cyane bwo kubaga. Ariko, nka 16% byabarwayi bafite ibibazo, harimo kongera kwiba. Byongeye kandi, kimwe cya kane cyabarwayi bakeneye kubagwa kurindi mavi bidafatwa neza. Ingaruka ndende yo gukomeretsa Cartilage igendana na OA nyuma ya LPD inshuro 6 zirenze iyo igabanywa ryambere, rituma abarwayi benshi bakiri bato bahura na OA muri 30 na 40. Kubura imyumvire yuzuye ya PFI nimwe mu mbogamizi nyamukuru zo kugarura ubudahuzagurika ryibipato bisanzwe.

Impamvu Zishobora Guhura

Impamvu ziterwa na PFI zishobora kugabanywamo ibyiciro bibiri: bidasanzwe bidasanzwe no guhuza bidasanzwe. Igituba cya Trochlear Cysplear nigihangano cyingenzi kidasanzwe, kandi guhuza bidasanzwe birimo ubutumburuke bwa patellar, patellar kuzunguruka no kugandukira. Ubumuga bwa patellofemral buterwa nimpinduka zibinyabuzima biterwa no gukomeretsa stabilizer stabilizer, kwiyongera kwa Q, kwiyamba kwa Femur na Femur hamwe na Patellar Tendon Kwinjizamo. Impamvu ziterwa na PFI zikubiye muri make mu gishushanyo cya 1.

• Crochleral Crochlea Dysplasia

• Inguni ya impengamiro ya play

• Facet asimmetrie ya pulley

• Ubujyakuzimu

• Guhuza bidasanzwe

• Patella

• Intera kuva Tibia kugera Trochlear Groove (TT-TG) yiyongereye

• Ongera q inguni

• antelion ya femoral

  
  

Ibiranga Ikizamini cyo Gutekereza

Iboneka ya PFI iratandukanye n'uburemere n'indwara idakira y'indwara. Imanza zoroheje za PFI zirashobora kurangwa na patellar dyskinesia, zirangwa na edema yimpande zo hejuru no kuruhande rwa padi ya Hoffa (uzwi kandi nkingaruka zabyibuha. Ingaruka zabyibuhohomotoya zifitanye isano rya bugufi nibindi bintu bishobora guhura na PFI, harimo uburebure bwa femolplesia, uburebure bwa patellar, byongereye intera ya TT-TG, patellar yihuta. Patellar ihebuje DysKinesia iganisha kuri Cartilage Gukomeretsa no kwangirika hakiri kare hamwe.

Kwirinda gukomeye kwa patella (apld) nuburyo bukomeye bwa PFI. Filime isanzwe ya X-ray yerekana kuvumbura ibikomere bikaze, bishobora kuba birimo efsion ihuriweho, kurenganya patella (ishusho ya patella (ishusho ya supluchochond, ikimenyetso cyinshi cya patella. Imyifatire yihariye ya MRI yo muri AcUTute adudute (igaragara muri 96%), patellar yumuriro cyangwa subluxt, gukomeretsa osteondral hamwe na effusion (Ishusho 2b, c). Mubihe byinshi, patella irasubirwamo nyuma yo kwihindura kwambere.

Abarwayi bagera kuri 70% bazagira imyigaragambyo yisubiramo, kandi imyigaragambyo idahwitse irashobora kubaho. Muri uru rubanza, MRI irashobora kwerekana amarira adakira yaka, ubumuga bwo hagati, gushyira ahagaragara patellar-patellar, gukomeretsa kw'igisasu, igikomere cya karitsiro no kwangirika kw'ipatelloferal (Ishusho 3).

Ubuvuzi

1. Kutivuririra:

• Gutandukanya gate PATELARBE PATELARBE ni ngombwa kandi bizasubirwamo. Rimwe na rimwe, abarwayi, abagize umuryango, inshuti, abatoza cyangwa abatoza bazasubiramo intoki putella ku mwanya. Niba umurwayi yagiye mu ishami ryihutirwa kubera kwihitiramo patellar, azahabwa amacakubiri. Kugabanya patella bigerwaho na buhoro buhoro kurambura amaguru. Bimaze gusubiramo, kugenzura neza ivi ryibindi bikomere.

• Ubuvuzi busanzwe bwo kugabanuka bwa mbere bwa patella ntabwo ari ubuvuzi bwo kubaga, kandi bwibyumweru 2-4) gukosorwa cyangwa gusohora guhuza hamwe no gusohora amavi mbere gato. Muri iki gihe, inkoni zemerewe kwihanganira uburemere. Nyuma yibyo, ibice bya patella birakoreshwa mubikorwa, kandi kuvura kumubiri bikorwa kugirango ugarure kugenda, imbaraga nigitsina gabo.

• Ubusanzwe abarwayi bakomeza bamezi 3 nyuma yigitero cya mbere. Uretse ibyo, kwambara stent birashoboka.

2. Kuvura ubwiti:

• Mu barwayi barenga 30%, imyigaragambyo ya mbere ya patellar ifitanye isano ninini cyane ya diffision. Muri iki gihe, birakenewe gukora MRI kumenya niba hariho ibirangagurika. Ahantu hakunze kugaragara kuri ibi bice ni patella yo hagati cyangwa kuruhande, kandi ubuvuzi bwo kubaga burasabwa imbere yububiko bwa instra-Arcticular.

• Mugihe cyibikorwa, ibice bya ostechondral bikurwaho cyangwa byashyizweho hakurikijwe ingano yibice byo kuvunika hamwe nubwiza bwa karitsiye. Iyo ubunini bwa ostecHandral buvunika ari ≥ 15 mm, kuvunika bikosorwa aho gusuzumwa. Ikosora ikorwa nuburyo bufunguye ukoresheje amacunga yicyuma, pinobsorbable pin cyangwa suture.

• Mu kuvura ibivunika, icyerekezo cya icyarimwe cyo kubaga Patella kigerwaho no gusana imitako cyangwa mpfl. Niba imigozi yicyuma ikoreshwa mugukosora gukosorwa, barashobora gukurwaho nubundi buryo bwo kubaga mugihe kizaza.

• Hano hari amashuri abiri yo gutekereza kubyerekeranye nuburyo bwiza bwo gutuza patellar. Uburyo bwa mbere ni ugukora imyitozo ya MPFL. MPFL nicyo kintu nyamukuru kibuza gutandukana kwa patella, bityo kwiyubakira bizatanga igihangano gikenewe kuri Patella. Kwiyubaka kwa MPFL mubisanzwe bikorwa na Quadrices Tenden Auton Autow, hamstring tendon autograft cyangwa allograft. Ikigereranyo cyo kwiyubaka kwa MPFL cyo kwiyubaka kwa MPFL kugirango ugarure patellar hasigaye 95%, ntaho bihuriye no guhitamo graft. Ingorabahizi zikunze kwiyubaka kwa MPFL ni ivi rikomeye, kuvunika patellar na patellar ihungabana.

• Uburyo bwa kabiri bukemura ibibazo byingaruka bya patellar guhungabana, no kwiyubaka kwa MPFL. Muri ubu buryo, ibyago bya Anatolical bahura na Patellar bashinzwe i Patellar bagenwa kuri X-Ray Filime na CT / MRI, harimo Trochlear Dysplasia, yongereye uburebure bwa patellar na TT. Bimaze kwiyemeza, bimwe cyangwa ibintu byose bishobora gukosorwa no kubaga.

• Trochlear Dysplasia ikemuwe na Trochleooooky, aho igikona cya Trochlear cyimbitse (Ishusho 12a). Trochlear Plasty ntabwo ikunzwe cyane muri Amerika kuko irimo gutera akamenyetso kabuto, kandi mubyukuri hari ibyago byo gusohora ischemic necrosic cyangwa arthritis.

• Uburebure bwa patella cyangwa kwiyongera k'uburebure bwa patella byakemuwe na tubercle ya kure. Kugirango wongere intera ya TT-TG, hagati cyangwa anteromedial tubercle ikorwa (ishusho ya 12b). Ingorabahizi za Tubeotomy Osteotomy irimo ubusa, ububabare bwamahirwe, gutakaza isuku no kuvunika.

• Ku mpagarara za retina kuruhande, irekurwa ryibumba ryakozwe, ryerekana ubwiyongere bwa patella. Ingorabahizi yo kurekurwa kuruhande harimo ubudahangarwa bwahagaritswe na ITatrogen ihungabana rya patella.

• Mu barwayi bafite amagufwa adakuze, ibikorwa bimwe byandujwe cyangwa byahinduwe kubera epiphysis.

• Umugereka wa Mfpl uherereye munsi ya epiphysis ya femur ya kure. Kubwibyo, kongera kubaka abarwayi bafite amagufwa adakuze bidakwiye gukorwa mubuyobozi bwa flueroscopy kugirango abone imiyoboro myiza yumuyoboro wumunya femore.

• Gukomeretsa kwa femur bishobora kuganisha ku guhindura, bishobora cyangwa bidashobora gukurikiza ubugororangingo bwo kubaga. Mu buryo nk'ubwo, gukomeretsa ibimenyetso byambere byerekana uburyo burashobora kuganisha ku guhindura, cyane cyane mumavi. Kubwibyo, Osteotomy ya Tuberosiyani irabujijwe kubarwayi bafite umuvuduko ukabije wo muri Tibial.

• Ibinyuranye, patellar Tendon irashobora kwimurwa rwose cyangwa igice cyimuwe. Iyo kimwe cya kabiri cya patellar cyimuriwe kuruhande rwumugabo, iki gikorwa cyitwa Roux-zahabu Igikorwa (Ishusho 12c).

• Abarwayi bose barimo kubagwa bagomba gusuzumwa patellar guhungabana muri gahunda yamaguru yinjira no kuzunguruka. Kwiyongera kwa Runu Valgus, induru ya femoral irenze urugero kandi yongereye torsion yo hanze niyo mpamvu ziterwa nitsinda rya patellar.

• Ku barwayi bafite amagufwa adakuze, hagomba gukururwa no gukurungura bigomba gutekerezwa mugihe cyo gukorana na genu valgus. Epiphyseal screw cyangwa impamyabumenyi ya punsino irashobora kuzenguruka uruhande rwo hagati yinyuma ya epiphysis ya femoral epiphysis yo gukosora buhoro buhoro. Osteotomy irakenewe kugirango ikosore abarwayi n'amagufa akuze kuri corurity cyangwa iboneza. Ikimenyetso cyo gukosora Genu Valgus ni> dogere 10, hamwe no gukosora kwerekana ko imyigaragambyo izunguruka irenga dogere 20.

• Abana (<imyaka 10) bazahura nuburyo bugoye bwihungabana rya patellar, birimo kwigana patellar. Syndromes nyinshi nka Syndrome ya Down, Syndrome ya Sundrome, Syndrome, Kabuki Syndrome na Rubinstein taybi bagizwe na patellar ihungabana.

• Ni ngombwa kumenya ko kwiyubaka kwa MPFL bitarahagije kugirango bikemure ibishushanyo mbonera, kuko rimwe na rimwe uburyo bwa Quadriceps bwagabanijwe, busaba kurekurwa kwa Quadriceps na Quadriceps FLOST kugirango ikemure ibyo bibazo.

• Muri quadriceps femoris plasty, quadriceps guhagarika umutima Mugihe cyo kwirengagiza cyangwa gutinda kwivuza, ibi bitoroshye birashobora guhura nyuma mubuzima.

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