ʻO ka patella, i ʻike nui ʻia ʻo ke kneecap, he iwi sesamoid i hana ʻia i loko o ke aʻalolo quadriceps a ʻo ia hoʻi ka iwi sesamoid nui loa i ke kino. He pālahalaha a he ʻano millet, aia ma lalo o ka ʻili a maʻalahi ke hoʻopā. He ākea ka iwi ma luna a kuhikuhi i lalo, me kahi alo ʻino a me ke kua laumania. 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 ke cartilage, e pili ana i ka ʻili patellar o ka femur. He ʻino ke alo, a hele ka aʻalolo quadriceps ma loko.
He maʻi maʻamau ka patellar chondromalacia i nā hui kuli. I ka wā ma mua, he maʻi maʻamau kēia i ka poʻe waena a me ka poʻe ʻelemakule. I kēia manawa, me ka hoʻolaha ʻana o nā haʻuki a me ke kino, he kiʻekiʻe hoʻi ka nui o ka hihia o kēia maʻi i waena o ka poʻe ʻōpio.
I. He aha ke ʻano maoli a me ke kumu o ka chondromalacia patella?
ʻO Chondromalacia patellae (CMP) kahi osteoarthritis hui patellofemoral i hoʻokumu ʻia e ka hōʻino mau ʻana i ka ʻili o ke cartilage patellar, kahi e hoʻoulu ai i ka pehu ʻana o ke cartilage, ka haki ʻana, ka haki ʻana, ka ʻino ʻana, a me ka hoʻokahe ʻana. ʻO ka mea hope loa, ʻo ke cartilage condyle femoral ʻē aʻe e loli pū ana i nā loli pathological like. ʻO ke ʻano maoli o CMP: aia kahi loli pathological o ka palupalu ʻana o ke cartilage patellar, a i ka manawa like, aia nā hōʻailona a me nā hōʻailona e like me ka ʻeha patellar, ke kani friction patellar, a me ka atrophy quadriceps.
ʻOiai ʻaʻohe innervation nerve o ke cartilage articular, ʻaʻole maopopo loa ke ʻano o ka ʻeha i hoʻokumu ʻia e chondromalacia. ʻO CMP ka hopena o nā hopena i hui pū ʻia o nā kumu he nui. ʻO nā kumu like ʻole e hoʻololi ai i ke kaomi hui patellofemoral he mau kumu o waho, ʻoiai ʻo nā hopena autoimmune, ka dystrophy cartilage, a me nā loli i ke kaomi intraosseous he mau kumu kūloko o chondromalacia patellae.
II. ʻO ka hiʻohiʻona koʻikoʻi o ka chondromalacia patellae ʻo ia nā loli pathological kikoʻī. No laila, mai ka manaʻo o nā loli pathological, pehea e hoʻokaʻawale ʻia ai ka chondromalacia patellae?
Ua wehewehe ʻo Insall i ʻehā mau pae pathological o CMP: ʻo ke kahua I ka palupalu ʻana o ke cartilage i hoʻokumu ʻia e ka edema, ʻo ke kahua II ma muli o nā māwae ma kahi i palupalu ʻia, ʻo ke kahua III ka ʻāpana o ke cartilage articular; ʻo ke kahua IV e pili ana i nā loli erosive o ka osteoarthritis a me ka hōʻike ʻana o ka iwi subchondral ma ka ʻili articular.
ʻO ka ʻōnaehana hoʻonohonoho Outerbridge ka mea pono loa no ka loiloi ʻana i nā ʻeha cartilage patellar articular ma lalo o ka nānā pololei ʻana a i ʻole arthroscopy. Penei ka ʻōnaehana hoʻonohonoho Outerbridge:
Papa I: ʻO ke cartilage articular wale nō i palupalu ʻia (palupalu ʻana o ke cartilage pani ʻia). ʻO ka maʻamau, pono kēia i ka manaʻo hoʻopā me kahi probe a i ʻole kekahi mea hana ʻē aʻe e loiloi ai.
Papa II: Nā kīnā mānoanoa hapa ʻaʻole iʻoi aku ma mua o 1.3 cm (0.5 in) ke anawaena a i ʻole e hiki ana i ka iwi subchondral.
Papa III: ʻOi aku ka nui o ka māwae cartilage ma mua o 1.3 cm (1/2 ʻīniha) ke anawaena a hoʻolōʻihi i ka iwi subchondral.
Papa IV: Ka ʻike ʻia ʻana o ka 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?
ʻO ke kumu nui o ka hōʻailona ma muli o ka ʻeha ma hope o ka patella, ka mea i hoʻokumu ʻia e ka hoʻāʻo wili patellar a me ka hoʻāʻo squat wāwae hoʻokahi. Pono ke kālele ʻana ma ka hoʻokaʻawale ʻana inā he hui pū ʻia ka ʻeha meniscus a me ka maʻi ʻeha. Eia nō naʻe, ʻaʻohe pilina ma waena o ke koʻikoʻi o ka chondromalacia patellar a me nā hōʻailona lapaʻau o ka maʻi ʻeha kuli mua. ʻO ka MRI kahi ʻano hōʻailona pololei.
ʻO ka hōʻailona maʻamau ka ʻeha ʻeha ma hope o ka patella a ma loko o ke kuli, kahi e ʻoi aku ka ʻino ma hope o ka hoʻoikaika kino a i ʻole ka piʻi ʻana i luna a i ʻole ka iho ʻana i ke alapiʻi.
Hōʻike ka hoʻokolohua kino i ka palupalu maopopo i loko o ka patella, peripatella, patellar margin a me ka posterior patella, hiki ke hele pū me ka ʻeha patellar sliding a me ke kani friction patellar. Loaʻa paha ka effusion joint a me ka quadriceps atrophy. I nā hihia koʻikoʻi, ua kaupalena ʻia ka flexion kuli a me ka extension a ʻaʻole hiki i ka mea maʻi ke kū ma kekahi wāwae. I ka wā o ka hoʻāʻo patellar compression, aia ka ʻeha nui ma hope o ka patella, e hōʻike ana i ka hōʻino ʻia o ka cartilage articular patellar, he mea koʻikoʻi ka diagnostic. Hoʻomaʻamaʻa pinepine ka hoʻāʻo hopohopo, a hoʻomaʻamaʻa squat. Ke flexed ke kuli 20° a 30°, inā ʻoi aku ka laulā o ka neʻe ʻana o loko a me waho o ka patella ma mua o 1/4 o ke anawaena transverse o ka patella, hōʻike ia i ka patellar subluxation. ʻO ke ana ʻana i ka kihi Q o ka flexion kuli 90° hiki ke hōʻike i ke alahele neʻe patellar maʻamau.
ʻO ka hoʻokolokolo kōkua hilinaʻi loa ʻo MRI, ka mea i pani mālie i ka arthroscopy a lilo i ala ʻole invasive a hilinaʻi hoʻi o CMP. ʻO ka hoʻokolokolo kiʻi ʻana e kālele nui ana i kēia mau palena: ke kiʻekiʻe patellar (Caton index, PH), ke kihi groove trochlear femoral (FTA), ka lakio ʻili lateral o ka femoral trochlear (SLFR), ke kihi kūpono patellar (PCA), ke kihi tilt patellar (PTA), ma waena o ia mau mea ʻo PH, PCA, a me PTA he mau palena hilinaʻi no ka hōʻoia kōkua o ka CMP mua.
Ua hoʻohana ʻia ke kiʻi X-ray a me ka 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 pelu ʻia ma 30°, b. MRI ma ke kūlana me ke kuli i pelu ʻia ma 30°. ʻO L1 ke kihi inclination patellar, ʻo ia ka mamao mai ke kiko haʻahaʻa loa o ka ʻili hui patellofemoral a i ke kihi luna mua o ke kiko o ka tibial plateau, ʻo L2 ka lōʻihi o ka ʻili hui patellofemoral, a ʻo Caton index = L1/L2.
Ua ana ʻia ke kihi ʻauwaha trochlear femoral a me ke kihi kūpono patellar (PCA) e ka X-ray a me ka MRI: a. Axial X-ray me ke kuli i pelu ʻia ma 30° ma ke kūlana kū kaumaha; b. MRI me ke kuli i pelu ʻia ma 30°. Ua haku ʻia ke kihi ʻauwaha trochlear femoral i ʻelua laina, ʻo ia hoʻi ke kiko haʻahaʻa A o ke ʻauwaha trochlear femoral, ke kiko kiʻekiʻe loa C o ka ʻili articular trochlear medial, a me ke kiko kiʻekiʻe loa B o ka ʻili articular trochlear lateral. ʻO ∠BAC ke kihi ʻauwaha trochlear femoral. Ua kahakiʻi ʻia ke kihi ʻauwaha trochlear femoral ma ke kiʻi axial o ka patella, a laila ua kahakiʻi ʻia ka bisector AD o ∠BAC. A laila ua kahakiʻi ʻia kahi laina pololei AE mai ke kiko haʻahaʻa A o ke ʻauwaha trochlear femoral ma ke ʻano he kumu ma o ke kiko haʻahaʻa E o ka piko patellar. ʻO ke kihi ma waena o ka laina pololei AD a me AE (∠DAE) ʻo ia ke kihi kūpono patellar.
Ua hoʻohana ʻia ke kiʻi X-ray a me ka MRI e ana i ke kihi tilt patellar (PTA): a. Kiʻi X-ray Axial ma ke kūlana kū kaumaha me ke kuli i pelu ʻia ma 30°, b. MRI ma ke kūlana me ke kuli i pelu ʻia ma 30°. ʻO ke kihi tilt patellar ke kihi ma waena o ka laina e hoʻopili ana i nā wahi kiʻekiʻe loa o nā condyles femoral medial a me lateral a me ke axis transverse o ka patella, ie ∠ABC.
He paʻakikī ke ʻike ʻana i ka CMP ma nā Radiographs i kona mau wā mua a hiki i nā pae holomua, i ka wā e ʻike ʻia ai ka nalowale nui o ke cartilage, ka nalowale o ka hakahaka hui, a me ka sclerosis iwi subchondral e pili ana a me nā loli cystic. Hiki i ka Arthroscopy ke hoʻokō i kahi hōʻailona hilinaʻi no ka mea hāʻawi ia i kahi ʻike 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 ʻano diagnostic invasive a me ke ʻano, hoʻohana pinepine ʻia i nā pae holomua o ka maʻi. ʻO MRI kahi ʻano diagnostic noninvasive e hoʻohiki ana i ka hiki kū hoʻokahi e ʻike i nā lesions cartilage a me nā derangements kūloko o ke cartilage ma mua o ka ʻike ʻia ʻana o ka nalowale o ke cartilage morphological i ka maka ʻōlohelohe.
IV. Hiki ke hoʻohuli ʻia ka Chondromalacia patellae a i ʻole e holomua i ka patellofemoral arthritis. Pono e hāʻawi koke ʻia ka lāʻau lapaʻau conservative kūpono i nā pae mua o ka maʻi. No laila, he aha nā mea e komo pū ana me ka lāʻau conservative?
Manaʻo nui ʻia i ka wā mua (pae I a II), loaʻa nō i ka cartilage patellar ka hiki ke hoʻoponopono, a pono e hana ʻia ka lāʻau lapaʻau kūpono ʻole me ke ʻoki ʻana. ʻO kēia ka mea nui e pili ana i ka palena hana a i ʻole ka hoʻomaha, a me ka hoʻohana ʻana i nā lāʻau anti-inflammatory non-steroidal inā pono. Eia kekahi, pono e paipai ʻia nā maʻi e hoʻoikaika kino ma lalo o ka nānā ʻana o kahi mea hoʻōla kino e hoʻoikaika i ka ʻiʻo quadriceps a hoʻonui i ke kūpaʻa o nā hui kuli.
He mea kūpono ke hoʻomaopopo ʻana i ka wā o ka hoʻopaʻa ʻana, e hoʻokomo pinepine ʻia nā mea pale kuli a i ʻole nā orthoses kuli, a pale ʻia ka hoʻopaʻa ʻana o ka plaster i ka hiki, no ka mea hiki ke alakaʻi maʻalahi i ka hōʻeha ʻana o ke cartilage articular; ʻoiai hiki i ka blockade therapy ke hōʻoluʻolu i nā hōʻailona, ʻaʻole pono e hoʻohana iki ʻia nā hormones, no ka mea, ke kāohi nei lākou i ka synthesis o glycoproteins a me collagen a hoʻopilikia i ka hoʻoponopono ʻana o ke cartilage; i ka wā e ʻoi koke ai ka pehu a me ka ʻeha o nā hono, hiki ke hoʻopili ʻia nā compresses hau, a hiki ke hoʻopili ʻia ka lāʻau kino a me nā compresses mahana ma hope o 48 mau hola.
V. I nā poʻe maʻi ma ke kahua hope loa, ʻaʻole maikaʻi ka hiki ke hoʻoponopono i ke cartilage articular, no laila ʻaʻole maikaʻi pinepine ka mālama conservative a pono ke ʻoki kino. He aha nā mea e komo pū ana me ka mālama ʻoki kino?
ʻO nā hōʻailona no ke ʻoki ʻana: ma hope o kekahi mau mahina o ka mālama koʻikoʻi, ke mau nei ka ʻeha o ka patellar; inā he deformity congenital a i loaʻa paha, hiki ke noʻonoʻo ʻia ke ʻoki ʻana. Inā loaʻa ka hōʻino ʻana o ke cartilage Outerbridge III-IV, ʻaʻole hiki ke hoʻopiha ʻia ke kīnā me ke cartilage articular maoli. I kēia manawa, ʻo ka ʻoki wale ʻana i ka wahi i hōʻino ʻia ai ke cartilage me ka overload mau loa ʻaʻole hiki ke pale i ke kaʻina hana o ka degeneration o ka ʻili articular.
ʻO nā ʻano hana ʻoki kino:
(1) ʻO ke ʻoki ʻana o Arthroscopic kekahi o nā ala kūpono no ka ʻike ʻana a me ka mālama ʻana i ka chondromalacia patella. Hiki iā ia ke nānā pololei i nā loli i ka ʻili o ke cartilage ma lalo o ka microscope. I nā hihia palupalu, hiki ke ʻoki ʻia nā ʻeha liʻiliʻi o ka erosion ma ke cartilage articular patellar e hoʻolaha i ka hoʻoponopono ʻana.
(2) ka hoʻokiʻekiʻe ʻana o ka condyle femoral lateral; (3) ka ʻoki ʻana i ka ʻili o ke cartilage patellar. Hana ʻia kēia ʻoki no nā poʻe maʻi me ka hōʻino ʻana o ke cartilage liʻiliʻi e hoʻolaha i ka hoʻoponopono ʻana o ke cartilage; (4) hana ʻia ka ʻoki ʻana o ka patellar no nā poʻe maʻi me ka hōʻino nui ʻana i ka ʻili o ke cartilage patellar.
Ka manawa hoʻouna: Nov-15-2024
