Patella, wanda aka fi sani da gwiwa, shine kashi sesamoid da aka kafa a cikin jijiyar quadriceps kuma shine mafi girma na sesamoid a jiki. Yana da lebur da siffar gero, yana ƙarƙashin fata kuma yana da sauƙin ji. Kashin yana da faɗi a sama kuma yana nuni zuwa ƙasa, tare da gaban gaba da 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 haɗawa da patellar surface na femur. Gaban yana da ƙarfi, kuma jijiyar quadriceps ta ratsa ta.
Patellar chondromalacia cuta ce ta haɗin gwiwa ta gwiwa. A da, wannan cuta ta zama ruwan dare ga masu matsakaici da tsofaffi. Yanzu, tare da yaduwar wasanni da motsa jiki, wannan cuta kuma tana da yawan kamuwa da cuta a tsakanin matasa.
I. Menene ma'anar gaskiya da sanadin chondromalacia patella?
Chondromalacia patellae (CMP) wani haɗin gwiwa ne na patellofemoral osteoarthritis wanda ke haifar da lalacewa na yau da kullum ga guringuntsi na patellar, wanda ke haifar da kumburin guringuntsi, fashewa, fashewa, yashewa, da zubarwa. A ƙarshe, akasin guringuntsi na mata na mata shima yana fuskantar canje-canje iri ɗaya. Gaskiyar ma'anar CMP ita ce: akwai canji na pathological na patellar guringuntsi mai laushi, kuma a lokaci guda, akwai alamun bayyanar cututtuka da alamu irin su ciwon patellar, sautin gogayya na patellar, da quadriceps atrophy.
Tun da guringuntsin guringuntsi ba shi da jijiyar jijiya, tsarin jin zafi da chondromalacia ke haifarwa har yanzu ba a san shi ba. CMP shine sakamakon haɗakar tasirin abubuwa masu yawa. Abubuwa daban-daban waɗanda ke haifar da canje-canje a cikin haɗin gwiwa na patellofemoral sune abubuwan waje, yayin da halayen autoimmune, dystrophy na guringuntsi, da kuma canje-canje a cikin matsa lamba na ciki sune abubuwan ciki na chondromalacia patellae.
II.Mafi mahimmancin fasalin chondromalacia patellae shine takamaiman canje-canjen pathological. Don haka daga yanayin sauye-sauyen cututtuka, ta yaya ake ƙididdige chondromalacia patellae?
Insall ya bayyana matakai hudu na cututtukan cututtuka na CMP: mataki na I shine laushi na guringuntsi wanda ya haifar da edema, mataki na II shine saboda raguwa a cikin yanki mai laushi, mataki na III shine raguwa na guringuntsi na articular; mataki na IV yana nufin canje-canje masu banƙyama na osteoarthritis da fallasa ƙasusuwa na subchondral a saman articular.
Tsarin grading na Outerbridge ya fi amfani don kimanta raunin gungu na gungu na patellar a ƙarƙashin gani kai tsaye ko arthroscopy. Tsarin Grading Outerbridge shine kamar haka:
Darasi na I: Ƙunƙarar guringuntsi ne kawai aka yi laushi (rufin guringuntsi mai laushi). Wannan yawanci yana buƙatar amsawa ta hankali tare da bincike ko wani kayan aiki don tantancewa.
Darasi na II: Lalacewar ɓangaren kauri wanda bai wuce 1.3 cm ba (0.5 in) a diamita ko isa ƙashin ƙasa.
Mataki na III: Fissure na guringuntsi ya fi 1.3 cm (1/2 inch) a diamita kuma ya wuce zuwa ƙashin ƙasa.
Darasi na IV: Bayyanar kashi na subchondral.
III. Dukansu ilimin cututtuka da digiri suna nuna ainihin chondromalacia patella. Don haka menene mafi ma'ana alamu da gwaje-gwaje don bincikar chondromalacia patella?
Sakamakon ganewar asali ya dogara ne akan jin zafi a bayan patella, wanda ya faru ta hanyar gwajin niƙa na patellar da gwajin squat kafa ɗaya. Ana buƙatar mayar da hankali kan gano ko akwai haɗin haɗin gwiwa na meniscus da cututtukan cututtuka. Duk da haka, babu wani dangantaka tsakanin tsanani na patellar chondromalacia da kuma alamun asibiti na ciwon ciwon gwiwa na baya. MRI hanya ce mafi daidaitaccen bincike.
Alamar da aka fi sani da ita ita ce rashin jin daɗi a bayan patella da kuma cikin gwiwa, wanda ke daɗa muni bayan yin aiki ko hawan sama ko ƙasa.
Binciken jiki yana nuna alamar tausayi a cikin patella, peripatella, patellar gefe da patella na baya, wanda zai iya kasancewa tare da ciwon zamewar patellar da sautin gogayya na patellar. Ana iya samun zubar da jini na haɗin gwiwa da atrophy quadriceps. A lokuta masu tsanani, ƙwanƙwasa gwiwa da tsawo suna iyakance kuma mai haƙuri ba zai iya tsayawa a kan ƙafa ɗaya ba. A lokacin gwajin matsawa na patellar, akwai ciwo mai tsanani a bayan patella, yana nuna lalacewar guringuntsi na patellar, wanda ke da mahimmancin bincike. Gwajin tsoro sau da yawa yana da kyau, kuma gwajin squat yana da kyau. Lokacin da gwiwa yana jujjuya 20 ° zuwa 30 °, idan kewayon motsi na ciki da na waje na patella ya wuce 1/4 na diamita mai jujjuyawa na patella, yana nuna subluxation patellar. Auna madaidaicin Q na 90° ƙwanƙwasa gwiwa na iya nuna yanayin motsi mara kyau.
Jarabawar ƙarin abin dogara shine MRI, wanda a hankali ya maye gurbin arthroscopy kuma ya zama hanyar da ba ta da haɗari kuma abin dogara na CMP. Imaging jarrabawa yafi mayar da hankali a kan wadannan sigogi: patellar tsawo (Caton index, PH), femoral trochlear tsagi kusurwa (FTA), a kaikaice surface rabo na femoral trochlear (SLFR), patellar fit angle (PCA), patellar karkatar kwana (PTA), daga cikinsu PH, PCA, da kuma PTA ne dogara ga gwiwa hadin gwiwa farkon ganewar asali.
An yi amfani da X-ray da MRI don auna tsayin patellar (Caton index, PH): a. Axial X-ray a tsaye mai ɗaukar nauyi tare da jujjuya gwiwa a 30°, b. MRI a matsayi tare da ƙwanƙwasa gwiwa a 30 °. L1 shine madaidaicin kusurwa na patellar, wanda shine nisa daga mafi ƙasƙanci na haɗin haɗin gwiwa na patellofemoral zuwa kusurwar maɗaukaki na gaba na tibial plateau contour, L2 shine tsawon tsayin haɗin gwiwa na patellofemoral, da Caton index = L1 / L2.
An auna kusurwar trochlear na mata da kusurwa mai dacewa ta patellar (PCA) ta X-ray da MRI: a. Axial X-ray tare da gwiwa gwiwa a 30 ° a matsayin matsayi mai nauyi; b. MRI tare da ƙwanƙwasa gwiwa a 30 °. Ƙaƙwalwar ƙwanƙwasa na mata yana kunshe da layi biyu, wato mafi ƙasƙanci A na ƙwanƙwasa trochlear na mata, mafi girman ma'auni C na tsaka-tsakin tsaka-tsaki na tsakiya, da kuma mafi girma B na gefen trochlear articular surface. ∠BAC ita ce kusurwar trochlear na mata. An zana kusurwar tsagi na femoral trochlear a kan hoton axial na patella, sannan aka zana bisector AD na ∠BAC. Sa'an nan kuma an zana madaidaiciyar layi AE daga mafi ƙasƙanci A na femoral trochlear groove a matsayin asali ta hanyar mafi ƙasƙanci E na patellar crest. Kusurwar da ke tsakanin madaidaiciyar layin AD da AE (∠DAE) ita ce kusurwar dacewa ta patellar.
An yi amfani da X-ray da MRI don auna kusurwar patellar tilt (PTA): a. Axial X-ray a tsaye mai ɗaukar nauyi tare da jujjuya gwiwa a 30°, b. MRI a matsayi tare da ƙwanƙwasa gwiwa a 30 °. Matsakaicin karkatarwar patellar ita ce kwana tsakanin layin da ke haɗa mafi girman maki na tsaka-tsakin tsaka-tsaki da na gefe na femoral condyles da madaidaicin axis na patella, watau ∠ABC.
Radiyon radiyo yana da wuya a gano CMP a farkon matakansa har zuwa matakan ci gaba, lokacin da asarar guringuntsi mai yawa, asarar sararin haɗin gwiwa, da alaƙar sclerosis na ƙashi na subchondral da canje-canjen cystic sun bayyana. Arthroscopy na iya samun ingantaccen ganewar asali saboda yana ba da kyakkyawan gani na haɗin gwiwa na patellofemoral; duk da haka, babu wata ma'ana mai ma'ana tsakanin tsananin cutar patellar chondromalacia da kuma matakin bayyanar cututtuka. Sabili da haka, waɗannan alamun bazai zama nuni ga arthroscopy ba. Bugu da ƙari, arthrography, a matsayin hanyar bincike mai banƙyama da tsari, ana amfani da shi ne kawai a cikin ci gaba na cutar. MRI wata hanya ce ta bincike marar haɗari wanda ke yin alƙawarin iyawa na musamman don gano raunuka na guringuntsi da kuma ɓarna na ciki na guringuntsi kafin asarar guringuntsi ya bayyana ga ido tsirara.
IV. Chondromalacia patellae na iya zama mai jujjuyawa ko zai iya ci gaba zuwa cututtuka na patellofemoral. Ya kamata a ba da ingantaccen magani na mazan jiya da sauri a farkon cutar. Don haka, menene maganin ra'ayin mazan jiya ya haɗa?
An yi imani da cewa a farkon mataki (mataki na I zuwa II), gungumen na patellar har yanzu yana da ikon gyarawa, kuma ya kamata a yi maganin da ba a yi ba. Wannan ya haɗa da ƙuntatawa ko hutawa, da kuma amfani da magungunan da ba na steroidal anti-inflammatory idan ya cancanta. Bugu da ƙari, ya kamata a ƙarfafa marasa lafiya don yin motsa jiki a karkashin kulawar mai ilimin motsa jiki don ƙarfafa tsokar quadriceps da haɓaka kwanciyar hankali na gwiwa.
Yana da kyau a lura cewa a lokacin da ba a iya motsi ba, ana amfani da takalmin gyare-gyare na gwiwa ko gwiwa, kuma an kauce wa gyaran filastar kamar yadda zai yiwu, kamar yadda zai iya haifar da rashin amfani da ƙananan ƙwayoyin cuta; ko da yake maganin toshewa zai iya sauƙaƙa alamun bayyanar cututtuka, bai kamata a yi amfani da hormones ko amfani da shi ba, saboda suna hana haɗin glycoproteins da collagen kuma suna shafar gyaran guringuntsi; lokacin da kumburin haɗin gwiwa da zafi ke ƙaruwa ba zato ba tsammani, ana iya amfani da damfara na kankara, kuma ana iya amfani da jiyya na jiki da damfara mai dumi bayan sa'o'i 48.
V. A cikin marasa lafiya na ƙarshen zamani, ƙarfin gyaran gyare-gyare na guringuntsi yana da kyau, don haka maganin ra'ayin mazan jiya sau da yawa ba shi da amfani kuma ana buƙatar magani na tiyata. Menene maganin fiɗa ya haɗa?
Alamomi don tiyata sun haɗa da: bayan watanni da yawa na kulawa mai mahimmanci, ciwon patellar har yanzu yana wanzu; idan akwai nakasar haihuwa ko samu, ana iya yin la'akari da aikin tiyata. Idan Outerbridge III-IV lalacewar guringuntsi ya faru, lahanin ba zai taɓa cika da guringuntsi na zahiri ba. A wannan lokacin, kawai aske wurin lalacewa na guringuntsi tare da nauyi mai yawa ba zai iya hana aiwatar da lalatawar saman articular ba.
Hanyoyin tiyata sun haɗa da:
(1) tiyatar arthroscopic daya ne daga cikin ingantattun hanyoyin ganowa da magance chondromalacia patella. Yana iya kallon canje-canje kai tsaye a cikin farfajiyar guringuntsi a ƙarƙashin na'urar hangen nesa. A cikin ƙananan yanayi, ƙananan raunuka na yashwa a kan guringuntsi na patellar articular za a iya goge su don inganta gyarawa.
(2) Ƙwararren ƙwanƙolin mata na gefe; (3) Gyaran guringuntsin guringuntsi. Ana yin wannan tiyata ga marasa lafiya tare da ƙananan lalacewar guringuntsi don inganta gyaran guringuntsi; (4) Ana yin gyaran gyare-gyare na patellar ga marasa lafiya tare da mummunar lalacewa ga guringuntsi na patellar.
Lokacin aikawa: Nuwamba-15-2024
