ʻO ka patella, i kapa ʻia ʻo ka kneecap, he iwi sesamoid i hana ʻia i loko o ka tendon quadriceps a ʻo ia hoʻi ka iwi sesamoid nui loa i loko o ke kino. He palahalaha a me ke ʻano millet, aia ma lalo o ka ʻili a maʻalahi ke ʻike. He ākea ka iwi ma luna a kuhikuhi i lalo, he ʻano mua ʻoʻoleʻa a he maʻalahi ke kua. Hiki iā ia ke neʻe i luna a i lalo, hema a ʻākau, a pale i ka hui kuli. He laumania ke kua o ka patella a uhi ʻia me ka cartilage, e pili ana i ka ʻili o ka femur. ʻOʻoleʻa ka mua, a hele ka tendon quadriceps ma ia.
ʻO Patellar chondromalacia kahi maʻi maʻamau o ka hui kuli. I ka wā ma mua, ua maʻamau kēia maʻi i nā poʻe waena a me nā ʻelemakule. I kēia manawa, me ka hoʻolaha ʻana o nā haʻuki a me ka hoʻoikaika kino, ʻoi aku ka nui o kēia maʻi i waena o nā ʻōpio.
I. He aha ke ano maoli a me ke kumu o ka chondromalacia patella?
ʻO Chondromalacia patellae (CMP) he osteoarthritis hui patellofemoral i hana ʻia e ka pōʻino mau i ka ʻili o ka cartilage patellar, ka mea e hoʻoulu ai i ka cartilage, ʻāhaʻi, haki, ʻā, a me ka hoʻokahe. ʻO ka hope, ʻo ka cartilage condyle femoral ʻē aʻe e loaʻa i nā loli pathological like. ʻO ka manaʻo maoli o CMP: aia kahi hoʻololi pathological o ka palupalu ʻana o ka cartilage patellar, a i ka manawa like, aia nā hōʻailona a me nā hōʻailona e like me ka ʻeha patellar, ke kani ʻana o ka patellar friction, a me ka quadriceps atrophy.
No ka loaʻa ʻole o ke aʻalolo o ka cartilage articular, ʻaʻole maopopo ke ʻano o ka ʻeha i hana ʻia e chondromalacia. ʻO CMP ka hopena o nā hopena hui o nā kumu he nui. ʻO nā kumu like ʻole e hoʻololi ai i ke kaomi hui patellofemoral nā kumu o waho, ʻoiai nā hopena autoimmune, cartilage dystrophy, a me nā loli i ke kaomi intraosseous nā kumu o loko o ka chondromalacia patellae.
II. ʻO ka hiʻohiʻona nui loa o ka chondromalacia patellae ʻo ia nā loli pathological kikoʻī. No laila, mai ka hiʻohiʻona o nā loli pathological, pehea ka helu ʻana o ka chondromalacia patellae?
Ua wehewehe ʻo Insall i ʻehā mau ʻāpana pathological o CMP: ʻo ka pae I ka palupalu o ka cartilage ma muli o ka edema, ʻo ka pae II ma muli o nā māwae i loko o ka wahi palupalu, ʻo ka pae III ka ʻāpana o ka cartilage articular; ʻO ka pae IV e pili ana i nā loli erosive o ka osteoarthritis a me ka hōʻike ʻana o ka iwi subchondral ma ka ʻaoʻao articular.
He mea pono loa ka Outerbridge grading system no ka loiloi ʻana i nā ʻeha cartilage articular patellar ma lalo o ka ʻike maka a i ʻole arthroscopy. ʻO ka ʻōnaehana helu Outerbridge penei:
Papa I: ʻO ka cartilage articular wale nō i hoʻopalupalu ʻia (pani ʻia ka cartilage softening). Pono kēia i nā manaʻo maʻalahi me kahi probe a i ʻole mea hana ʻē aʻe e loiloi.
Papa II: ʻAʻole ʻoi aku ka nui o nā pōʻino ʻāpana mānoanoa ma mua o 1.3 knm (0.5 in) ke anawaena a i ʻole hiki i ka iwi subchondral.
Papa III: ʻOi aku ka nui o ka māwae cartilage ma mua o 1.3 knm (1/2 iniha) ke anawaena a hiki i ka iwi subchondral.
Papa IV: Hōʻike iwi subchondral.
III. Hōʻike nā pathology a me ka grading i ke ʻano o ka chondromalacia patella. No laila he aha nā hōʻailona koʻikoʻi a me nā hoʻokolohua no ka ʻike ʻana i ka chondromalacia patella?
Hoʻokumu ʻia ka hōʻailona ma luna o ka ʻeha ma hope o ka patella, ka mea i hana ʻia e ka hoʻāʻo ʻana i ka patellar grinding a me ka hoʻāʻo ʻana i ka wāwae wāwae hoʻokahi. Pono ka manaʻo e hoʻokaʻawale inā loaʻa kahi hōʻeha meniscus i hui pū ʻia a me nā maʻi ʻehaʻeha. Eia nō naʻe, ʻaʻohe pilina ma waena o ke koʻikoʻi o ka patellar chondromalacia a me nā hōʻailona hōʻailona o ka maʻi ʻeha o ke kuli mua. ʻO ka MRI kahi ala diagnostic ʻoi aku ka pololei.
ʻO ka hōʻailona maʻamau ka ʻeha ʻeha ma hope o ka patella a i loko o ke kuli, a ʻoi aku ka nui ma hope o ka hoʻoikaika ʻana a i ʻole ka piʻi ʻana a i ʻole i lalo i ke alapiʻi.
Hōʻike ka nānā ʻana i ke kino i ka ʻoluʻolu ma ka patella, peripatella, patellar margin a me hope patella, hiki ke hui pū ʻia me ka ʻeha patellar sliding a me ke kani patellar friction. Loaʻa paha ka effusion hui a me ka atrophy quadriceps. I nā hihia koʻikoʻi, ua kaupalena ʻia ke kuli a me ka hoʻonui ʻana a ʻaʻole hiki i ka mea maʻi ke kū ma ka wāwae hoʻokahi. I ka wā o ka hoʻāʻo ʻana i ka patellar compression, aia ka ʻeha nui ma hope o ka patella, e hōʻike ana i ka pōʻino o ka cartilage articular patellar, he mea koʻikoʻi ka diagnostic. Maikaʻi pinepine ka hoʻāʻo hopohopo, a maikaʻi ka hoʻāʻo squat. Ke hoʻokuʻu ʻia ke kuli 20 ° a 30 °, inā ʻoi aku ka nui o ka neʻe o loko a me waho o ka patella ma mua o 1/4 o ke anawaena transverse o ka patella, e hōʻike ana i ka subluxation patellar. ʻO ke ana ʻana i ka Q angle o 90° kuli kuli hiki ke hōʻike i ke ʻano o ka neʻe ʻana o ka patellar neʻe.
ʻO ka hoʻokolohua kōkua ʻoi loa ka hilinaʻi ʻo MRI, kahi i hoʻololi mālie i ka arthroscopy a lilo i mea non-invasive a hilinaʻi o CMP. Ke nānā nui nei nā hoʻokolohua kiʻi i kēia mau ʻāpana: ke kiʻekiʻe patellar (Caton index, PH), femoral trochlear groove angle (FTA), lateral surface ratio of femoral trochlear (SLFR), patellar fit angle (PCA), patellar tilt angle (PTA), ma waena o PH, PCA, a me PTA he mau ʻāpana hui kuli pono no ka CMPiliary diagnostics mua.
Ua hoʻohana ʻia ka X-ray a me MRI e ana i ke kiʻekiʻe o ka patellar (Caton index, PH): a. Axial X-ray ma ke kūlana kū kaumaha me ke kuli i wili ʻia ma 30°, b. ʻO MRI ma ke kūlana me ke kuli i hoʻohuli ʻia ma 30°. ʻO L1 ka huina o ka patellar inclination, ʻo ia ka mamao mai kahi haʻahaʻa o ka ʻili hui patellofemoral a hiki i ka ʻaoʻao kiʻekiʻe o mua o ka contour plateau tibial, ʻo L2 ka lōʻihi o ka ʻili hui patellofemoral, a ʻo Caton index = L1/L2.
Ua ana 'ia ke kihi o ka femoral trochlear groove a me ka patellar fit angle (PCA) e X-ray a me MRI: a. Axial X-ray me ke kuli i hoʻololi ʻia ma 30° ma ke kūlana kū kaumaha; b. ʻO MRI me ke kuli i hoʻohuli ʻia ma 30°. ʻO ka ʻaoʻao o ka ʻaoʻao femoral trochlear he ʻelua laina, ʻo ia ka lae haʻahaʻa A o ka ʻaoʻao trochlear femoral, ka lae C kiʻekiʻe loa o ka ʻili o ka medial trochlear articular, a me ka helu kiʻekiʻe B o ka ʻaoʻao trochlear articular surface. ʻO ∠BAC ka ʻokiʻoki ʻāwīwī trochlear femoral. Ua kaha ʻia ka ʻokiʻoki o ka femoral trochlear groove ma ke kiʻi axial o ka patella, a laila huki ʻia ka bisector AD o ∠BAC. A laila ua kaha ʻia kahi laina pololei AE mai ka lae haʻahaʻa A o ka ʻāwī trochlear femoral e like me ke kumu ma ka lae haʻahaʻa E o ka piko patellar. ʻO ka huina ma waena o ka laina pololei AD a me AE (∠DAE) ʻo ia ka huina kūpono patellar.
Ua hoʻohana ʻia ʻo X-ray a me MRI e ana i ka angle tilt patellar (PTA): a. Axial X-ray ma ke kūlana kū kaumaha me ke kuli i wili ʻia ma 30°, b. ʻO MRI ma ke kūlana me ke kuli i hoʻohuli ʻia ma 30°. ʻO ka angle tilt patellar ka huina ma waena o ka laina e hoʻopili ana i nā wahi kiʻekiʻe loa o ka condyles femoral medial a me ka axis transverse o ka patella, ʻo ia hoʻi ∠ABC.
He paʻakikī ke hoʻopaʻa ʻana i nā radiographs i ka CMP i kona wā mua a hiki i nā pae kiʻekiʻe, ke ʻike ʻia ka nalo ʻana o ka cartilage nui, ka nalowale ʻana o ka wahi hui, a me ka sclerosis iwi subchondral a me nā loli cystic. Hiki i ka Arthroscopy ke hoʻokō i kahi hōʻailona hilinaʻi no ka mea hāʻawi ia i kahi hiʻohiʻona maikaʻi loa o ka hui patellofemoral; akā naʻe,ʻaʻohe pilina maopopo ma waena o ke koʻikoʻi o ka patellar chondromalacia a me ke kiʻekiʻe o nā hōʻailona. No laila, ʻaʻole pono kēia mau hōʻailona he hōʻailona no ka arthroscopy. Eia kekahi, ʻo ka arthrography, ma ke ʻano he ala diagnostic invasive a me kahi modality, hoʻohana wale ʻia i nā pae holomua o ka maʻi. ʻO ka MRI kahi hana diagnostic noninvasive e hoʻohiki i ka hiki ke ʻike i nā ʻeha cartilage a me nā derangements o loko o ka cartilage ma mua o ka ʻike ʻia ʻana o ka nalo cartilage morphological e ka maka ʻōlohelohe.
IV. Hiki ke hoʻohuli ʻia ka Chondromalacia patellae a i ʻole ke holomua i ka maʻi o ka patellofemoral. Pono e hāʻawi koke ʻia ka mālama conservative maikaʻi i ka wā mua o ka maʻi. No laila, he aha ke ʻano o ka mālama conservative?
Manaʻo maʻamau i ka wā mua (ʻo ka pae I a i ka II), hiki i ka cartilage patellar ke hoʻoponopono hou, a pono e hana ʻia ka lāʻau lapaʻau kūpono ʻole. Hoʻopili ʻia kēia i ka hoʻomaha ʻana a i ʻole ka hoʻomaha ʻana, a me ka hoʻohana ʻana i nā lāʻau anti-inflammatory non-steroidal inā pono. Eia kekahi, pono e paipai ʻia nā poʻe maʻi e hoʻomaʻamaʻa ma lalo o ka mākaʻikaʻi ʻana o ka mea hoʻoponopono kino e hoʻoikaika i ka ʻiʻo quadriceps a hoʻonui i ka paʻa o ka hui kuli.
He mea pono e hoʻomaopopo i ka wā o ka immobilization, hoʻohana pinepine ʻia nā kuli kuli a i ʻole nā kuli orthoses, a pale ʻia ka hoʻopaʻa ʻana i ka plaster i ka mea hiki, no ka mea hiki ke alakaʻi i ka hōʻeha ʻole o ka cartilage articular; ʻOiai hiki i ka blockade therapy ke hōʻoluʻolu i nā hōʻailona, ʻaʻole pono e hoʻohana a hoʻohana liʻiliʻi i nā hormones, no ka mea, ke kāohi nei lākou i ka synthesis o glycoproteins a me ka collagen a pili i ka hoʻoponopono ʻana o ka cartilage; i ka wā e piʻi koke ai ka pehu a me ka ʻeha, hiki ke hoʻohana ʻia ka hau hau, a hiki ke hoʻohana ʻia ka lāʻau lapaʻau kino a me nā compresses mahana ma hope o 48 mau hola.
V. I nā poʻe maʻi hope loa, ʻilihune ka hiki ke hoʻoponopono i ka cartilage articular, no laila ʻaʻole pono ka mālama conservative a koi ʻia ka lāʻau lapaʻau. He aha ke ʻano o ka lāʻau lapaʻau?
ʻO nā hōʻailona no ka ʻokiʻoki ʻana: ma hope o kekahi mau mahina o ka mālama ʻana i ka conservative koʻikoʻi, e mau ana ka ʻeha patellar; inā he congenital a loaʻa paha ka deformity, hiki ke noʻonoʻo ʻia ka lāʻau lapaʻau. Inā loaʻa ka pōʻino o ka cartilage o Outerbridge III-IV, ʻaʻole hiki ke hoʻopiha ʻia ka hemahema me ka cartilage articular maoli. I kēia manawa, ʻaʻole hiki ke amu wale i ka wahi i hōʻino ʻia i ka cartilage me ka haʻahaʻa mau loa ʻaʻole hiki ke pale i ke kaʻina o ka degeneration o ka ʻili.
Loaʻa nā ʻano hana ʻokiʻoki:
(1) ʻO ka ʻoki ʻana ʻo Arthroscopic kekahi o nā ala maikaʻi o ka ʻike a me ka mālama ʻana i ka chondromalacia patella. Hiki iā ia ke nānā pono i nā loli o ka ʻili cartilage ma lalo o ka microscope. I nā hihia haʻahaʻa, hiki ke ʻoki ʻia nā ʻeha liʻiliʻi liʻiliʻi ma ka cartilage articular patellar e paipai i ka hoʻoponopono.
(2) ke kiʻekiʻe o ka condyle femoral; (3) ka wehe ʻana i ka ʻili o ka ʻili o ka ʻili. Hana ʻia kēia ʻokiʻoki no nā poʻe maʻi me nā pōʻino o ka cartilage liʻiliʻi e hāpai i ka hoʻoponopono ʻana i ka cartilage; (4) hana ʻia ka ʻoki ʻana o ka patellar no nā poʻe maʻi me ka pōʻino nui i ka ʻili o ka cartilage patellar.
Ka manawa hoʻouna: Nov-15-2024
