Ingabe uyakwazi lokho? Izici eziyingozi kanye nokwelashwa kokungazinzi kokuhlanganiswa kwe-patellofemoral ezinganeni

Ukungazinzi kwe-Patellofemoral (PFI) kuhlanganisa uchungechunge lwezifo, kusukela ku-malaise encane kuya ekuhlukaniseni okusobala kwe-patella (LPD). I-LPD ivamile uma kuqhathaniswa, ngamacala angu-50 ezinganeni ezingu-100,000. Ukukhishwa kokuqala ngokuvamile kwenzeka phakathi kweminyaka eyi-15 ne-19 ubudala. I-LPD yisifo esiwohlozayo, futhi izinga lokugudluzwa ngemva kokwelashwa okulondolozayo noma ukwelashwa ngokomzimba liphakeme kakhulu njenge-70%. Ukwakhiwa kabusha kwe-patellofemoral ligament ye-medial iyindlela yokwelapha yokuhlinzwa esetshenziswa kakhulu. Kodwa-ke, iziguli ezifika ku-16% zinezinkinga, ezihlanganisa nokugudluzwa kabusha. Ngaphezu kwalokho, ingxenye yesine yeziguli idinga ukuhlinzwa okulandelwayo kwelinye ilunga ledolo elingalashwa ngokuhlinzwa. Ingozi yesikhathi eside yokulimala kwe-cartilage eqhubekayo kanye ne-OA ngemva kwe-LPD iphakeme ngokuphindwe izikhathi ezingu-6 kunaleyo ngemva kokugudluka kokuqala, okwenza iziguli eziningi ezisencane zibhekane nengozi ye-OA eminyakeni yazo yama-30 nama-40. Ukuntuleka kokuqonda okuphelele kwe-PFI kungenye yezithiyo eziyinhloko zokubuyisela ukuhambisana kwe-patellofemoral joint evamile.

I-RISK FACTOR

Izici zobungozi ze-PFI zingahlukaniswa zibe izigaba ezimbili: ukungavamile kwe-anatomical kanye nokungajwayelekile kokuqondanisa. I-femoral trochlear dysplasia iwukungajwayelekile kwe-anatomical okubaluleke kakhulu, futhi ukungezwani kokuqondanisa kuhlanganisa ukuphakama kwe-patellar, i-patellar roll kanye ne-subluxation. Ukukhubazeka kwe-Patellofemoral kubangelwa izinguquko ze-biomechanical ezibangelwa ukulimala kwe-stabilizer yangaphakathi, ukwanda kwe-Q angle, i-anteversion of femur kanye ne-lateralization yokufakwa kwe-patellar tendon. Izici zobungozi ze-PFI zifingqiwe kuMfanekiso 1.

• i-femoral trochlea dysplasia

• i-angle yokuthambekela kwe-pulley ephambene

• i-facet asymmetry ye-pulley

• ukujula kwe-pulley

• ukuqondanisa okungavamile

• i-patella ephezulu

• ibanga ukusuka ku-tibia kuya ku-trochlear groove (tt-tg) lenyukile

• khulisa i-angle engu-q

• ukuhlukunyezwa kwabesifazane

  
  

IZIMPAWU ZOKUHLOLWA KOMBONISO

Okutholwe yi-MRI ye-PFI kuyahlukahluka ngobukhulu kanye nemvelo engapheli yesifo. Amacala e-PFI athambile angase abonakale nge-patellar dyskinesia, ebonakala nge-edema yezinhlangothi ezingenhla nezingemuva ze-Hoffa fat pad (eyaziwa nangokuthi i-patellofemoral fat impact). Umthelela wamafutha e-Patellofemoral uhlobene eduze nezinye izici eziyingozi ze-PFI, okuhlanganisa i-femoral condyle dysplasia, ukuphakama kwe-patellar, ukukhuphuka kwebanga le-TT-TG, ukutsheka kwe-lateral patellar kanye ne-subluxation. I-patellar dyskinesia ehlala isikhathi eside iholela ekulimaleni kwe-cartilage kanye nokuwohloka kokuqala kwe-lateral patellofemoral joint.

I-acute dislocation ye-patella (APLD) iwuhlobo olubucayi kakhulu lwe-PFI. Ifilimu ecacile ye-X-ray ibonisa ukutholakala kokulimala okunzima, okungase kuhlanganise ukukhishwa kwamalungu, izinga le-lipid le-fatty arthropathy ngezikhathi ezithile, ukuphuka kwe-medial patella osteochondral, i-lateral tilt/subluxation ye-patella (Umfanekiso 8A), kanye nesibonakaliso esijulile se-sulcus se-lateral esibangelwa ukulimala komthelela we-lateral femoral condylar cartilage. Ukubonakaliswa okuqondile kwe-MRI ye-LPD ebukhali kuhlanganisa ukulimala kwe-stabilizer kwangaphakathi (okubonwe ku-96%), i-lateral patellar tilt noma i-subluxation, ukulimala kwe-osteochondral kanye nokuhlanganiswa kwe-joint (Figure 2B, C). Ezimweni eziningi, i-patella isethwa kabusha ngokuzenzakalelayo ngemva kokukhishwa kokuqala.

Kufika ku-70% weziguli zizothola ukugudluka okuphindelelayo, futhi ukugudluka okungapheli okungamahlalakhona kungase kwenzeke. Kulesi simo, i-MRI ingase ibonise izinyembezi ezingapheli ze-stabilizer medial, i-medial patellar deformity, i-ossification ye-patella ye-medial, umthelela we-patellar-femoral fat, ukulimala kwe-cartilage kanye nokuwohloka kwe-lateral patellofemoral joint (Umfanekiso 3).

UKWELASHWA

1. Ukwelashwa okungahlinzeki:

• Ukususwa okuningi okunamandla kwe-patellar kungokwesikhashana futhi kuzosethwa kabusha ngokuzenzakalelayo. Kwesinye isikhathi, iziguli, amalungu omndeni, abangani, abaqeqeshi noma abaqeqeshi bazosetha kabusha i-patella mathupha khona lapho. Uma isiguli siya emnyangweni wezimo eziphuthumayo ngenxa ye-patellar dislocation, sizonikezwa i-sedation sedation. Ukuncishiswa okuvaliwe kwe-patella kutholakala ngokwelula kancane kancane imilenze. Uma usumisiwe kabusha, hlola ilunga ledolo ngokomtholampilo ukuze uthole okunye ukulimala.

• Ukwelashwa okujwayelekile kokukhishwa kokuqala kwe-patella kuwukwelashwa okungezona ukuhlinzwa, futhi ukulungiswa kwesikhathi esifushane (amaviki angu-2-4) ku-splint noma i-knee joint fixator kungalawula ubuhlungu nokuphulukiswa kwezicubu zokuqala ngemva kokuhlaselwa okunamandla. Ngalesi sikhathi, izinduku zivunyelwe ukuthwala isisindo. Ngemuva kwalokho, amabakaki okuzinza kwe-patella asetshenziselwa imisebenzi, futhi ukwelashwa ngokomzimba kwenziwa ukuze kubuyiselwe ukunyakaza, amandla nokulawulwa kwezitho.

• Iziguli zivame ukuqala kabusha ukuzivocavoca cishe izinyanga ezingu-3 ngemva kokuhlasela kokuqala. Ngaphandle kwalokho, ukugqoka i-stent kuyinketho.

2. Ukwelashwa ngokuhlinzwa:

• Ezigulini ezingaphezu kuka-30%, ukukhishwa kokuqala kwe-patellar kuhlobene nenani elikhulu lokuhlanganiswa kwamadolo. Kulokhu, kuyadingeka ukwenza i-MRI ukukhomba ukuthi kukhona yini ukuphuka kwe-osteochondral. Indawo evame kakhulu yalokhu kuphuka i-patella ephakathi noma i-condyle ye-femoral yangemuva, futhi ukwelashwa kokuhlinzwa kuvame ukutuswa lapho kukhona ukuphuka kwe-intra-articular.

• Ngesikhathi sokusebenza, izingcezu ze-osteochondral fracture ziyasuswa noma zilungiswe ngokuya ngosayizi wezingcezu zokuphuka kanye nekhwalithi yoqwanga. Uma usayizi wokuphuka kwe-osteochondral ingu-≥ 15 mm, ukulungiswa kokuphuka esikhundleni sokusikwa kuyacatshangelwa. Lokhu kulungiswa kwenziwa ngendlela evulekile kusetshenziswa izikulufu zensimbi, izikhonkwane ezitholakala nge-bioabsorbable noma ama-sutures.

• Ekwelapheni ukuphuka, ukuthambekela kokuqiniswa kokuhlinzwa ngesikhathi esisodwa kwe-patella kufinyelelwa ngokulungisa okuphakathi noma ukwakhiwa kabusha kwe-MPFL. Uma izikulufu zensimbi zisetshenziselwa ukulungisa ukuphuka, kungase kudingeke zisuswe ngezinye izinqubo zokuhlinzwa esikhathini esizayo.

• Kunezikole ezimbili zokucabanga mayelana nendlela engcono kakhulu yokuqiniswa kwe-patellar. Indlela yokuqala ukwenza kabusha i-MPFL eyodwa. I-MPFL iyisici esiyisivimbelo esiyinhloko se-lateral subluxation ye-patella, ngakho ukwakhiwa kabusha kwayo kuzohlinzeka ukuzinza okudingekayo kwe-patella. Ukwakhiwa kabusha kwe-MPFL kuvame ukwenziwa yi-quadriceps tendon autograft, i-hamstring tendon autograft noma i-allograft. Izinga lempumelelo yokwakhiwa kabusha kwe-MPFL ehlukanisiwe ukuze kubuyiselwe ukuzinza kwe-patellar kungaphezu kwama-95%, okungahlangene nokukhetha kokuxhunyelelwa. Izinkinga ezivame kakhulu zokwakhiwa kabusha kwe-MPFL ukuqina kwamadolo, ukuphuka kwe-patellar kanye nokungaqini okuphindaphindiwe kwe-patellar.

• Indlela yesibili ixazulula izici zobungozi zokungazinzi kwe-patellar, kanye nokwakhiwa kabusha kwe-MPFL. Kule ndlela, izici zengozi ye-anatomical yokungazinzi kwe-patellar zinqunywa ifilimu ye-X-ray kanye ne-CT / MRI, okuhlanganisa i-trochlear dysplasia, ukuphakama kwe-patellar okwandisiwe kanye nebanga le-TT-TG. Uma sekunqunyiwe, ezinye noma zonke izici eziyingozi zizolungiswa ngokuhlinzwa.

• I-trochlear dysplasia ixazululwa yi-trochleoplasty, lapho i-trochlear groove ijula ​​(Umfanekiso 12A). I-Trochlear plasty ayidumile kakhulu e-United States ngoba ihilela ukuhlasela kwe-articular cartilage, futhi kucatshangwa ukuthi kunengozi ye-ischemic necrosis noma isifo samathambo.

• Ukuphakama kwe-Patella noma ukwanda kobude be-patella kuxazululwa yi-distal tibial tubercle. Ukuze ukwandise ibanga le-TT-TG, i-tubercle ye-tibial medial noma i-anteromedial yenziwa (Umfanekiso we-12B). Izinkinga ze-tibial tuberosity osteotomy zihlanganisa ukungahambi kahle, ubuhlungu be-hardware, ukulahlekelwa ukuncishiswa kwe-tuberosity kanye nokuphuka.

• Ngokucindezela kwe-retina yangemuva, ukukhululwa kwe-retina yangemuva kwenziwa, okubonisa ukwanda kokutsheka kwe-patella. Izinkinga zokukhululwa kwe-lateral zihlanganisa ukuvuvukala okuqhubekayo kanye nokungazinzi kwe-iatrogenic medial ye-patella.

• Ezigulini ezinamathambo angakavuthwa, okunye ukuhlinzwa kuyaphikiswa noma kushintshwe ngenxa ye-epiphysis.

• Iphoyinti lokunamathisela lesifazane le-MFPL litholakala ngezansi nje kwe-epiphysis ye-distal femur. Ngakho-ke, ukwakhiwa kabusha kwe-MPFL kweziguli ezinamathambo angakavuthwa kufanele kwenziwe ngaphansi kokuqondisa okuqinile kwe-fluoroscopy ukuze kuqinisekiswe ukubhola okuphephile komhubhe wezinsikazi.

• Ukulimala kwe-distal femur kungaholela ekukhubazekeni, okungenzeka noma kungadingi ukulungiswa kokuhlinzwa. Ngokufanayo, ukulimala kwe-proximal tibial protrusion kungabangela ukukhubazeka, ikakhulukazi emadolweni aphakathi. Ngakho-ke, i-osteotomy ye-tibial tuberosity ayivunyelwe ezigulini ezine-proximal proximal protrusion protrusion.

• Ngokuphambene nalokho, i-patellar tendon ingasuswa ngokuphelele noma ingxenye ethile phakathi. Lapho ingxenye engaphandle yethenda ye-patellar idluliselwa ohlangothini oluphakathi, lokhu kusebenza kubizwa ngokuthi i-Roux-Goldthwait operation (Umfanekiso 12C).

• Zonke iziguli ezihlinzwa kufanele zihlolwe ukungazinzi kwe-patellar ekuhleleni izitho ze-coronary kanye nezitho ezijikelezayo. Ukwenyuka kwe-valgus ye-genu, i-anteversion ye-femal ngokweqile kanye nokwanda kwe-tibial torsion yangaphandle yizici eziyingozi zokungazinzi kwe-patellar.

• Ezigulini ezinamathambo angavuthiwe, ukukhula okuqondisayo kufanele kucatshangelwe lapho kubhekwana ne-valgus yohlobo. Izikulufu ze-Epiphyseal noma amapuleti ebhendi ye-tension angadonsa uhlangothi olumaphakathi lwe-distal end ye-femoral epiphysis ukuze kulungiswe kancane kancane. I-osteotomy iyadingeka ukuze kulungiswe iziguli ezinamathambo avuthiwe ngenxa yokukhubazeka kwe-coronary noma ukujikeleza. Inkomba yokulungiswa kwe-valgus yohlobo i> 10 degrees, futhi inkomba yokulungisa yokugudluka okujikelezayo idlula ama-degree angu-20.

• Izingane (ezineminyaka engaphansi kwe-10) zizohlangabezana namaphethini ayinkimbinkimbi okungazinzi kwe-patellar, okuhlanganisa ukugudluka okugxilile noma okuvamile. Ama-syndromes amaningana afana ne-Down syndrome, i-nail-patellar syndrome, i-Kabuki syndrome kanye ne-Rubinstein Taybi syndrome akhiwe ukungazinzi kwe-patellar.

• Kubalulekile ukuqaphela ukuthi ukwakhiwa kabusha okukodwa kwe-MPFL akwanele ukuxazulula la maphethini ayinkimbinkimbi, ngoba i-pathology eyinhloko itholakala eceleni, futhi ngezinye izikhathi indlela ye-quadriceps femoris iyafinyezwa, okudinga ukukhululwa okubanzi kwe-lateral kanye ne-quadriceps femoris plasty ukuxazulula lezi zinkinga.

• Ku-quadriceps femoris plasty, indlela ye-quadriceps femoris iqondiswa kabusha futhi/noma inwetshiwe. Esimeni sokunganakwa noma ukwelashwa sekwephuzile, lawa maphethini anzima angazinzile angase ahlangabezane nawo kamuva ekuphileni.

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