Unozviziva here? Zvinhu zvine ngozi uye kurapwa kwepatellofemoral joint instability muvana

Patellofemoral instability (PFI) inosanganisira zvirwere zvakasiyana-siyana, zvichibva pakunyorova malaise kusvika pakubuda pachena kwepatella (LPD). LPD yakajairika, ine makumi mashanu ezviitiko mu100,000 ega evana. Kubviswa kwekutanga kunowanzoitika pakati pemakore gumi nemashanu kusvika gumi nemapfumbamwe. LPD chirwere chinopedza simba, uye chiyero chekubvisa mushure mekuchengetedzwa kwekuchengetedza kana kurapwa kwepanyama kwakakwira kusvika 70%. Kuvakwazve kwepakati patellofemoral ligament ndiyo inonyanya kushandiswa kurapwa kwekuvhiya. Zvisinei, vanosvika 16% yevarwere vane matambudziko, kusanganisira kubviswazve. Mukuwedzera, chikamu chechina chevarwere vanoda kuvhiyiwa kwekutevera pane imwe mabvi akabatanidzwa iyo isingarapwe kuvhiyiwa. Njodzi yenguva refu yekufambira mberi kwekukuvara kwecartilage uye OA mushure meLPD yakapetwa ka6 kupfuura iyo mushure mekutanga kubviswa, izvo zvinoita kuti varwere vechidiki vakawanda vatarise njodzi yeOA mumakore avo makumi matatu nemakumi mana. Kushaikwa kwekunzwisisa kwakakwana kwePFI chimwe chezvipingamupinyi zvikuru zvekudzorera kuwirirana kwepatellofemoral joint.

RISK FACTOR

Njodzi zvinhu zvePFI zvinogona kukamurwa kuita mapoka maviri: anatomical abnormality uye alignment abnormality. Iyo femoral trochlear dysplasia ndiyo inonyanya kukosha yeanatomical abnormality, uye kurongeka kwakashata kunosanganisira patellar kukwidziridzwa, patellar roll uye subluxation. Patellofemoral deformity inokonzerwa nekuchinja kwebiomechanical kunokonzerwa nekukuvadzwa kwe medial stabilizer, kuwedzera kweQ angle, anteversion of femur uye lateralization ye patellar tendon kuiswa. Zvinhu zvine njodzi zvePFI zvakapfupikiswa muMufananidzo 1.

• femoral trochlea dysplasia

• kona yekurerekera kweinochinjika pulley

• facet asymmetry ye pulley

• pulley kudzika

• kurongeka kusina kujairika

• high patella

• kureba kubva kune tibia kuenda kutrochlear groove (tt-tg) yakawedzera

• kuwedzera q angle

• kusagadzikana kwechikadzi

  
  

ZVINHU ZVOKUFANIRA EXAMINATION

Izvo MRI zvakawanikwa zvePFI zvinosiyana nekuoma uye kusingaperi kwechirwere. Mild PFI kesi dzinogona kuonekwa ne patellar dyskinesia, iyo inoratidzwa ne edema yekumusoro uye lateral mativi eHoffa mafuta pad (inozivikanwawo se patellofemoral fat impact). Patellofemoral mafuta maitiro anowirirana zvakanyanya nedzimwe njodzi dzePFI, kusanganisira femoral condyle dysplasia, patellar urefu, kuwedzera kweTT-TG kure, lateral patellar tilt uye subluxation. Yakareba-yakamira patellar dyskinesia inotungamirira kukukuvara kwekarati uye kutanga kupera kwe lateral patellofemoral joint.

Acute dislocation yepatella (APLD) ndiyo yakanyanya kuoma fomu yePFI. Iyo X-ray yakajeka firimu inoratidza kuwanikwa kwekukuvadzwa kwakanyanya, izvo zvinogona kusanganisira kubatana kwekubatana, dzimwe nguva lipid level yemafuta arthropathy, fracture ye medial patella osteochondral, lateral tilt / subluxation yepatella (Mufananidzo 8A), uye yakadzika lateral sulcus chiratidzo chinokonzerwa nekukanganiswa kwekukuvara kwe lateral femoral condylar cartilage. Iyo chaiyo MRI inoratidzirwa yeacute LPD inosanganisira kukuvara kwemukati stabilizer (inoonekwa mu96%), lateral patellar tilt kana subluxation, osteochondral kukuvara uye kubatana effusion (Mufananidzo 2B, C). Muzviitiko zvakawanda, patella inongogadziriswa zvakare mushure mekutanga kubviswa.

Kusvika ku70% yevarwere vanozosangana nekudzokororwa, uye kusingaperi kudzokororwa kunodzokororwa kunogona kuitika. Muchiitiko ichi, MRI inogona kuratidza misodzi isingagumi yehutano hwemukati, hutano hwepakati patellar deformity, ossification ye medial patella, patellar-femoral fat impact, cartilage kukuvara uye kupera kwe lateral patellofemoral joint (Mufananidzo 3).

MIRAPI

1. Non-kuvhiya kurapwa:

• Mazhinji acute patellar dislocations anogara kwenguva pfupi uye anozongogadzikwa patsva. Dzimwe nguva, varwere, nhengo dzemhuri, shamwari, varairidzi kana varairidzi vanozogadzirisa patella ipapo ipapo. Kana murwere akaenda kudhipatimendi rekukurumidzira nekuda kwekubviswa patellar, anopihwa conscious sedation. Yakavharwa kuderedzwa kwepatella inowanikwa nekutambanudza zvishoma nezvishoma makumbo. Kana uchinge wagadziriswa, chengetedza kliniki yejojo ​​yebvi kune mamwe kukuvara.

• Chimiro chekurapa kwekutanga kubviswa kwepatella hakusi kurapwa kwekuvhiyiwa, uye kwenguva pfupi (2-4 mavhiki) kugadzirisa mune splint kana mabvi akabatanidzwa fixator inogona kudzora marwadzo uye kutanga kuporesa kwenyama mushure mekurwisa kwakanyanya. Munguva iyi, madondoro anobvumirwa kutakura uremu. Mushure meizvozvo, patella kudzikamisa mabhureki anoshandiswa kumabasa, uye kurapwa kwemuviri kunoitwa kudzoreredza kufamba, simba uye kudzora mitezo.

• Varwere vanowanzotangazve maekisesaizi anenge mwedzi mitatu mushure mekurwisa kwekutanga. Kunze kwezvo, kupfeka stent isarudzo.

2. Kuvhiya kurapwa:

• Mune vanopfuura 30% yevarwere, yekutanga patellar dislocation inobatana nehuwandu hwemabvi akabatanidzwa effusion. Muchiitiko ichi, zvakakosha kuita MRI kuti uone kana pane osteochondral fractures. Nzvimbo inonyanyozivikanwa yezvimedu izvi ndeye medial patella kana lateral femoral condyle, uye kurapwa kwekuvhiya kunowanzo kukurudzirwa pamberi pe-intra-articular fractures.

• Munguva yekushanda, osteochondral fracture zvidimbu zvinobviswa kana kugadziriswa maererano nehukuru hwezvimedu zvekuputsika uye kunaka kwecartilage. Kana ukuru hwe osteochondral fracture iri ≥ 15 mm, kugadziriswa kwekuputsika panzvimbo yekucheka kunofungidzirwa. Kugadziriswa uku kunoitwa nenzira yakazaruka uchishandisa simbi screws, bioabsorbable pini kana sutures.

• Mukurapa kwekuputsika, maitiro ekugadzirisa panguva imwechete yekuvhiya kwepatella inowanikwa nekugadziriswa kwepakati kana MPFL kuvakazve. Kana simbi dzesimbi dzakashandiswa kugadzirisa kuputsika, dzinogona kubviswa nedzimwe nzira dzekuvhiya mune ramangwana.

• Kune zvikoro zviviri zvekufunga nezve yakanakisa nzira yekudzikamisa patellar. Nzira yekutanga ndeyekuita yega MPFL kuvakazve. MPFL ndiyo inonyanya kumanikidza chinhu che lateral subluxation yepatella, saka kuvakazve kwayo kunopa kugadzikana kunodiwa kwepatella. MPFL kuvakazve kunowanzoitwa ne quadriceps tendon autograft, hamstring tendon autograft kana allograft. Kubudirira kweiyo yega MPFL kuvakazve kudzoreredza patellar kugadzikana inopfuura 95%, iyo isina chekuita nesarudzo yegraft. Matambudziko akajairika ekuvakwazve kweMPFL ibvi kuoma kwakabatana, patellar fracture uye kudzokororwa patellar kusagadzikana.

• Nzira yechipiri inogadzirisa zvinhu zvinokanganisa patellar kusagadzikana, uye MPFL kuvakazve. Munzira iyi, iyo anatomical ngozi inokonzera kusagadzikana kwepatellar inotarirwa pa X-ray firimu uye CT / MRI, kusanganisira trochlear dysplasia, yakawedzera patellar urefu uye TT-TG kure. Kana yangotemwa, zvimwe kana zvese zvine njodzi zvinogadziriswa nekuvhiyiwa.

• Iyo trochlear dysplasia inogadziriswa ne trochleoplasty, umo iyo trochlear groove yakadzika (Mufananidzo 12A). Trochlear plasty haina kufarirwa zvakanyanya muUnited States nekuti inosanganisira kupinda kwearticular cartilage, uye nedzidziso kune njodzi yeramangwana ischemic necrosis kana arthritis.

• Patella kureba kana kuwedzera kwe patella kureba kunogadziriswa ne distal tibial tubercle. Kuti uwedzere TT-TG kure, medial kana anteromedial tibial tubercle inoitwa (Mufananidzo 12B). Zvinetso zvetibial tuberosity osteotomy zvinosanganisira kusabatana, kurwadziwa kwehardware, kurasikirwa kwekudzikisa tuberosity uye kuputsika.

• Nokuda kwekutambudzika kwe lateral retina, lateral retinal release inoitwa, iyo inoratidza kuwedzera kwe patella tilt. Matambudziko ekusunungurwa kwemashure anosanganisira kuramba kupfugama uye iatrogenic medial kusagadzikana kwepatella.

• Mune varwere vane mapfupa asina kukura, mamwe maoparesheni anopikiswa kana kuchinjwa nekuda kweiyo epiphysis.

• Iyo femoral attachment point yeMFPL iri pazasi peepiphysis ye distal femur. Nokudaro, kuvakwazve kweMPFL kwevarwere vane mapfupa asina kukura kunofanira kuitwa pasi pehutungamiri hwefluoroscopy kuti ive nechokwadi chekuchera kwakachengeteka kwemugero wevakadzi.

• Distal femur kukuvara kunogona kutungamirira kukuremara, izvo zvingave kana zvisingadi kururamiswa kwekuvhiya. Saizvozvowo, kukuvadzwa kweproximal tibial protrusion kunogona kutungamirira kukuremara, kunyanya mumabvi epakati. Naizvozvo, osteotomy yetibial tuberosity inorambidzwa kune varwere vane yakazaruka proximal tibial protrusion.

• Pane zvinopesana, iyo patellar tendon inogona kubviswa zvachose kana kuti chikamu pakati. Kana hafu yekunze ye patellar tendon ichiendeswa kudivi remukati, oparesheni iyi inonzi Roux-Goldthwait operation (Mufananidzo 12C).

• Vose varwere vari kuvhiyiwa vanofanira kuongororwa kuti patellar kusagadzikana mukurongwa kwemakumbo emakumbo uye makumbo anotenderera. Kuwedzera genu valgus, kunyanyisa kwechikadzi anteversion uye kuwedzera kunze kwetibial torsion ndiyo inokonzera kusagadzikana kwepatellar.

• Kune varwere vane mapfupa asina kukura, kutungamira kukura kunofanirwa kutariswa kana uchibata genu valgus. Epiphyseal screws kana tension bhendi mahwendefa anogona kutenderedza divi repakati pekupedzisira kwechikadzi epiphysis kuti zvishoma nezvishoma kugadzirisa. Osteotomy inodiwa kururamisa varwere vane mapfupa akakura nekuda kwekuremara kana kutenderera. Chiratidzo chekugadzirisa genu valgus ndeye> 10 madhigirii, uye chiratidzo chekugadzirisa chekutenderera kwekutenderera kunodarika madhigirii makumi maviri.

• Vana (< 10 yemakore) vachasangana nemaitiro akaoma e patellar kusagadzikana, izvo zvinosanganisira zvakagadziriswa kana tsika patellar dislocation. Zvirwere zvakawanda zvakadai seDown syndrome, nail-patellar syndrome, Kabuki syndrome uye Rubinstein Taybi syndrome inoumbwa nekusagadzikana kwepatellar.

• Zvakakosha kuziva kuti kuvakwazve kwega kweMPFL hakuna kukwana kugadzirisa aya akaomeswa mapatani, nekuti yekutanga pathology inowanikwa nechemberi, uye dzimwe nguva nzira ye quadriceps femoris inopfupiswa, iyo inoda yakafara lateral kuburitswa uye quadriceps femoris plasty kugadzirisa matambudziko aya.

• Mu quadriceps femoris plasty, quadriceps femoris mechanism inotungamirwa uye / kana kurebesa. Munyaya yekuregeredzwa kana kunonoka kurapwa, aya akaomarara asina kugadzikana maitiro anogona kusangana gare gare muhupenyu.

Nzira yeKutenga Orthopedic Implants uye Orthopedic Instruments?

For CZMEDITECH , isu tine yakazara yakazara chigadzirwa mutsara we orthopedic oparesheni yekuvhiya uye inowirirana zviridzwa, zvigadzirwa zvinosanganisira ma implants emusana, intramedullary misumari, trauma plate, kukiya ndiro, cranial-maxillofacial, prosthesis, zvishandiso zvemagetsi, vagadziri vekunze, arthroscopy, veterinary care uye yavo inotsigira chiridzwa seti.

Pamusoro pezvo, takazvipira kuenderera mberi nekugadzira zvigadzirwa zvitsva uye kuwedzera mitsara yechigadzirwa, kuitira kuti tisangane nekuvhiyiwa kwevamwe vanachiremba nevarwere, uye zvakare kuita kuti kambani yedu iwedzere kukwikwidza muindasitiri yepasi rose yemapfupa emapfupa uye zviridzwa.

Isu tinotumira kunze kwenyika pasi rose, saka iwe unogona taura nesu pa email kero song@orthopedic-china.com yemahara quote, kana kutumira meseji paWhatsApp kuti upindure nekukurumidza +86- 18112515727 .

Kana uchida kuziva rumwe ruzivo, tinya CZMEDITECH kuti uwane mamwe mashoko.