Patella, wanda aka fi sani da gwiwa, ƙashi ne na sesamoid da aka samar a cikin jijiyar quadriceps kuma shine mafi girman ƙashin sesamoid a jiki. Yana da faɗi kuma mai siffar gero, yana ƙarƙashin fata kuma yana da sauƙin ji. Ƙashin yana da faɗi a sama kuma yana nuna ƙasa, tare da gaba mai kauri da baya mai santsi. Yana iya motsawa sama da ƙasa, hagu da dama, kuma yana kare haɗin gwiwa. Bayan patella yana da santsi kuma an rufe shi da guringuntsi, yana haɗuwa da saman patellar na femur. Gaban yana da kauri, kuma jijiyar quadriceps tana ratsa ta.
Ciwon gwiwa (Patellar chondromalacia) cuta ce da ta zama ruwan dare gama gari a gidajen gwiwa. A da, wannan cuta ta zama ruwan dare gama gari a tsakanin tsofaffi da tsofaffi. Yanzu, tare da yaɗuwar wasanni da motsa jiki, wannan cutar tana da yawan kamuwa da ita a tsakanin matasa.
I. Menene ainihin ma'anar da kuma dalilin chondromalacia patella?
Chondromalacia patellae (CMP) wani nau'in osteoarthritis ne na haɗin gwiwa na patellofemoral wanda ke faruwa sakamakon lalacewar da ke faruwa a saman guringuntsi na patellar, wanda ke haifar da kumburi, fashewa, karyewa, zaizayar ƙasa, da zubar da jini. A ƙarshe, guringuntsi na femoral condyle shi ma yana fuskantar irin waɗannan canje-canjen na pathological. Ma'anar CMP ta gaskiya ita ce: akwai canjin yanayin pathological na laushin guringuntsi na patellar, kuma a lokaci guda, akwai alamu da alamu kamar ciwon patellar, sautin gogayya na patellar, da kuma atrophy na quadriceps.
Tunda guringuntsi na articular ba shi da wani jijiya a cikin jiki, hanyar da ke haifar da ciwon da chondromalacia ke haifarwa har yanzu ba a fayyace ta ba. CMP sakamakon haɗakar tasirin abubuwa da yawa ne. Abubuwa daban-daban da ke haifar da canje-canje a matsin lamba na haɗin gwiwa na patellofemoral sune dalilai na waje, yayin da halayen autoimmune, dystrophy na guringuntsi, da canje-canje a matsin lamba na ciki sune abubuwan da ke haifar da chondromalacia patellae na ciki.
II. Mafi mahimmancin fasalin chondromalacia patellae shine takamaiman canje-canjen cututtuka. Don haka daga mahangar canje-canjen cututtuka, ta yaya ake tantance chondromalacia patellae?
Insall ya bayyana matakai guda huɗu na cututtukan CMP: mataki na I shine laushin guringuntsi wanda kumburi ke haifarwa, mataki na II yana faruwa ne sakamakon tsagewa a yankin da aka yi wa rauni, mataki na III shine rabuwar guringuntsi na articular; mataki na IV yana nufin canje-canjen da ke lalata osteoarthritis da fallasa ƙashin subchondral akan saman articular.
Tsarin tantancewa na Outerbridge ya fi amfani wajen tantance raunukan da ke tattare da guringuntsi na patellar a ƙarƙashin gani kai tsaye ko arthroscopy. Tsarin tantancewa na Outerbridge kamar haka:
Aji na 1: Gurgunan haɗin gwiwa ne kawai ake tausasawa (rufewar gurgunan). Wannan yawanci yana buƙatar amsawar taɓawa ta amfani da na'urar bincike ko wani kayan aiki don tantancewa.
Aji na II: Lalacewar kauri mai kauri wanda bai wuce santimita 1.3 (inci 0.5) ba ko kuma ya kai ƙashin subchondral.
Aji na Uku: Fashewar guringuntsi ta fi girman inci 1.3 (inci 1/2) a diamita kuma ta miƙe zuwa ƙashin subchondral.
Aji na IV: Bayyanar ƙashi a ƙarƙashin ƙashi.
III. Duka cututtuka da kuma tantancewa suna nuna ainihin cutar chondromalacia patella. To menene alamomi da gwaje-gwaje mafi mahimmanci don gano cutar chondromalacia patella?
Ganewar cutar ta dogara ne akan ciwon da ke bayan patella, wanda gwajin niƙa patellar da gwajin squat na ƙafa ɗaya ke haifarwa. Ya kamata a mai da hankali kan gano ko akwai haɗin raunin meniscus da ciwon amosanin gabbai. Duk da haka, babu wata alaƙa tsakanin tsananin patellar chondromalacia da alamun cutar ciwon gwiwa ta gaba. MRI hanya ce ta ganewar asali mafi inganci.
Alamar da aka fi sani ita ce ciwo mai raɗaɗi a bayan patella da kuma cikin gwiwa, wanda ke ƙara ta'azzara bayan aiki ko hawa ko sauka daga matakala.
Binciken jiki yana nuna taushi a fili a cikin patella, peripatella, gefen patellar da kuma bayan patella, wanda zai iya kasancewa tare da ciwon zamiya na patellar da sautin gogayya na patellar. Akwai iya samun fitar da iskar gaɓoɓi da kuma atrophy na quadriceps. A cikin mawuyacin hali, lanƙwasa gwiwa da tsawaitawa ba su da iyaka kuma mara lafiya ba zai iya tsayawa a kan ƙafa ɗaya ba. A lokacin gwajin matsewar patellar, akwai ciwo mai tsanani a bayan patella, wanda ke nuna lalacewar cartilage na articular patellar, wanda ke da mahimmanci ga ganewar asali. Gwajin tsoro sau da yawa yana da kyau, kuma gwajin squat yana da kyau. Lokacin da gwiwa ta lanƙwasa daga 20° zuwa 30°, idan kewayon motsi na ciki da waje na patella ya wuce 1/4 na diamita mai wucewa na patella, yana nuna subluxation na patellar. Auna kusurwar Q na lanƙwasa gwiwa 90° na iya nuna yanayin motsi na patellar mara kyau.
Gwajin taimako mafi inganci shine MRI, wanda a hankali ya maye gurbin arthroscopy kuma ya zama hanyar CMP mara haɗari kuma mai inganci. Gwaje-gwajen hoto galibi suna mai da hankali kan waɗannan sigogi: tsayin patellar (Caton index, PH), kusurwar trochlear groove ta femoral (FTA), rabon saman lateral na femoral trochlear (SLFR), kusurwar fit patellar (PCA), kusurwar karkatar da patellar (PTA), daga cikinsu PH, PCA, da PTA sune ma'aunin haɗin gwiwa na gwiwa masu aminci don ganewar asali na farkon CMP.
An yi amfani da X-ray da MRI don auna tsayin patellar (Caton index, PH): a. Axial X-ray a matsayin tsaye mai ɗauke da nauyi tare da gwiwa a lankwasa a 30°, b. MRI a matsayin tare da gwiwa a lankwasa a 30°. L1 shine kusurwar karkata patellar, wanda shine nisan daga mafi ƙasƙanci wurin haɗin patellofemoral zuwa kusurwar gaba ta sama ta tibial plateau, L2 shine tsawon saman haɗin patellofemoral, da Caton index = L1/L2.
An auna kusurwar ramin trochlear na femoral da kusurwar dacewa da patellar (PCA) ta hanyar X-ray da MRI: a. X-ray na axial tare da gwiwa a lankwasa a 30° a matsayin tsaye mai ɗaukar nauyi; b. MRI tare da gwiwa a lankwasa a 30°. Kusurwar ramin trochlear na femoral ta ƙunshi layuka biyu, wato mafi ƙasƙanci maki A na ramin trochlear na femoral, mafi girman maki C na saman trochlear na medial, da kuma mafi girman maki B na saman trochlear na gefe. ∠BAC shine kusurwar ramin trochlear na femoral. An zana kusurwar ramin trochlear na femoral akan hoton axial na patella, sannan aka zana bisector AD na ∠BAC. Sannan aka zana layi madaidaiciya AE daga mafi ƙasƙanci maki A na ramin trochlear na femoral a matsayin asalin ta hanyar mafi ƙasƙanci maki E na gefen patellar. Kusurwar da ke tsakanin layin madaidaiciya AD da AE (∠DAE) ita ce kusurwar dacewa da patellar.
An yi amfani da X-ray da MRI don auna kusurwar karkatar da patellar (PTA): a. X-ray na Axial a matsayin tsaye mai ɗauke da nauyi tare da gwiwa a lankwasa a 30°, b. MRI a matsayin tare da gwiwa a lankwasa a 30°. Kusurwar karkatar da patellar ita ce kusurwar da ke tsakanin layin da ke haɗa mafi girman wuraren haɗin gwiwa na femoral na tsakiya da na gefe da kuma axis mai wucewa na patella, watau ∠ABC.
Yana da wuya a gano CMP a farkon matakansa har sai an sami ci gaba, lokacin da asarar guringuntsi mai yawa, asarar sararin haɗin gwiwa, da kuma sclerosis na ƙashi na subchondral da canje-canjen cystic suka bayyana. Arthroscopy na iya cimma ingantaccen ganewar asali saboda yana ba da kyakkyawan hangen nesa na haɗin patellofemoral; duk da haka, babu wata alaƙa bayyananniyar alaƙa tsakanin tsananin chondromalacia na patellar da matakin alamun. Saboda haka, waɗannan alamun bai kamata su zama alamar arthroscopy ba. Bugu da ƙari, arthrography, a matsayin hanyar bincike mai mamayewa da kuma hanyar magani, galibi ana amfani da shi ne kawai a cikin matakai na ci gaba na cutar. MRI hanya ce ta ganewar cutar ba tare da cutarwa ba wacce ke alƙawarin ikon musamman na gano raunukan guringuntsi da kuma lalacewar cikin guringuntsi kafin a ga asarar guringuntsi a ido tsirara.
IV. Chondromalacia patellae na iya zama mai jurewa ko kuma yana iya ci gaba zuwa ciwon haɗin gwiwa na patellofemoral. Ya kamata a ba da ingantaccen magani mai ra'ayin mazan jiya da sauri a farkon matakan cutar. To, menene maganin mai ra'ayin mazan jiya ya ƙunsa?
Gabaɗaya ana kyautata zaton cewa a matakin farko (mataki na I zuwa na II), guringuntsi na patellar har yanzu yana da ikon gyarawa, kuma ya kamata a yi maganin da ba na tiyata ba. Wannan ya haɗa da takaita aiki ko hutawa, da kuma amfani da magungunan hana kumburi marasa steroid idan ya zama dole. Bugu da ƙari, ya kamata a ƙarfafa marasa lafiya su yi motsa jiki a ƙarƙashin kulawar likitan motsa jiki don ƙarfafa tsokar quadriceps da kuma inganta kwanciyar hankali a haɗin gwiwa.
Ya kamata a lura cewa a lokacin hana motsi, galibi ana sa kayan haɗin gwiwa ko na gwiwa, kuma ana guje wa gyaran filasta gwargwadon iko, domin yana iya haifar da rashin amfani da guringuntsi na haɗin gwiwa cikin sauƙi; kodayake maganin toshewa na iya rage alamun, bai kamata a yi amfani da hormones ko amfani da su kaɗan ba, saboda suna hana haɗakar glycoproteins da collagen kuma suna shafar gyaran guringuntsi; idan kumburin haɗin gwiwa da ciwo suka tsananta ba zato ba tsammani, ana iya amfani da matse kankara, kuma ana iya amfani da magani na jiki da matse mai ɗumi bayan awanni 48.
V. A cikin marasa lafiya da ke fama da ciwon gwiwa, ƙarfin gyaran guringuntsi na ƙashi ba shi da kyau, don haka magani mai kyau ba shi da tasiri kuma ana buƙatar maganin tiyata. Me ya haɗa da maganin tiyata?
Alamomin tiyata sun haɗa da: bayan watanni da yawa na magani mai tsauri, ciwon patellar har yanzu yana nan; idan akwai nakasar haihuwa ko ta samu, ana iya la'akari da maganin tiyata. Idan lalacewar guringuntsi ta Outerbridge III-IV ta faru, ba za a taɓa cika lahani da ainihin guringuntsi na articular ba. A wannan lokacin, kawai aske yankin lalacewar guringuntsi da yawan wuce gona da iri ba zai iya hana tsarin lalacewar saman articular ba.
Hanyoyin tiyata sun haɗa da:
(1) Tiyatar arthroscopic tana ɗaya daga cikin hanyoyin da suka fi tasiri wajen gano da kuma magance cutar chondromalacia patella. Tana iya lura da canje-canje kai tsaye a saman guringuntsi a ƙarƙashin na'urar hangen nesa. A cikin yanayi masu sauƙi, ana iya goge ƙananan raunukan yashewa a kan guringuntsi na patellar don inganta gyara.
(2) ɗagawar lateral femoral condyle; (3) cirewar saman cartilage na patellar. Ana yin wannan tiyatar ga marasa lafiya da ke da ƙananan lalacewar cartilage don haɓaka gyaran cartilage; (4) ana yin tiyatar patellar ga marasa lafiya da ke da mummunan lalacewa ga saman cartilage na patellar.
Lokacin Saƙo: Nuwamba-15-2024
