Ko te pane o te knee, e mōhiotia whānuitia ana ko te turi, he wheua sesamoid i hangaia i roto i te uaua quadriceps, ā, koia hoki te wheua sesamoid nui rawa atu o te tinana. He papatahi, he āhua millet, kei raro i te kiri, ā, he ngāwari ki te pā atu. He whānui te wheua i te tihi, ā, he anga whakararo ki raro, he taratara te mua, he maeneene te tuara. Ka taea te neke ake, te neke iho, te maui me te matau, ā, ka tiakina te hononga turi. He maeneene te tuara o te pane o te knee, ā, kua kapi i te kiriuhi, e hono ana ki te mata o te hope o te femur. He taratara te mua, ā, ka puta te uaua quadriceps mā roto.
He mate noa te patellar chondromalacia i roto i ngā hononga turi. I mua, he mea noa tēnei mate i waenga i te hunga pakeke me te hunga kaumātua. Ināianei, nā te rongonuitanga o ngā hākinakina me te whakapakari tinana, he nui hoki te auau o te mate i waenga i te hunga rangatahi.
I. He aha te tikanga tuturu me te take o te chondromalacia patella?
Ko te Chondromalacia patellae (CMP) he mate osteoarthritis o te hononga patellofemoral i puta mai i te kino mau tonu ki te mata o te kiriuhi patellar, ka pupuhi, ka pakaru, ka pakaru, ka memeha, ka marere te kiriuhi. Hei whakamutunga, ka pāngia hoki te kiriuhi condyle femoral o tera taha e ngā huringa pathological ōrite. Ko te tikanga tūturu o te CMP ko: he huringa pathological o te ngohengohe o te kiriuhi patellar, ā, i te wa ano, he tohu me ngā tohu pēnei i te mamae o te patellar, te haruru o te waku o te patellar, me te ngoikore o te quadriceps.
Nā te mea kāore he io o roto o te kiriuhi hononga, kāore anō kia mārama te tikanga o te mamae e puta mai ana i te chondromalacia. Ko te CMP te hua o ngā pānga maha o ngā āhuatanga maha. Ko ngā āhuatanga maha e puta ai ngā huringa o te pēhanga o te hononga patellofemoral he take o waho, ko ngā tauhohenga ā-tinana, te ngoikore o te kiriuhi, me ngā huringa o te pēhanga o roto o te uaua he take o roto o te chondromalacia patellae.
II. Ko te āhuatanga tino nui o te chondromalacia patellae ko ngā huringa mate motuhake. Nō reira, mai i te tirohanga o ngā huringa mate, me pēhea te whakarōpūtanga o te chondromalacia patellae?
E whā ngā wāhanga mate pāwera o te CMP i whakaahuahia e Insall: ko te wāhanga I ko te ngohengohe o te kiriuhi i puta mai i te pupuhi, ko te wāhanga II nā ngā kapiti i te wāhi kua ngohengohe, ko te wāhanga III ko te pakaru o te kiriuhi hononga; ko te wāhanga IV e pā ana ki ngā huringa pirau o te osteoarthritis me te kitea o te wheua subchondral i runga i te mata o te hononga.
Ko te pūnaha whakatauranga Outerbridge te mea tino whai hua mō te aromatawai i ngā whara o te kiriuhi hononga o te patellar i raro i te tirohanga tika, i te arthroscopy rānei. Ko te pūnaha whakatauranga Outerbridge e whai ake nei:
Wāhanga I: Ko te kiriuhi hononga anake ka whakangawaritia (te whakangawari o te kiriuhi kua kati). I te nuinga o te wā ka hiahiatia he urupare pā ki te whakamahi i tētahi taputapu tirotiro, i tētahi atu taputapu rānei hei aromatawai.
Wāhanga II: Ko ngā hapa matotoru-wāhanga kāore e neke ake i te 1.3 cm (0.5 inihi) te whānui, kāore rānei e tae atu ki te wheua subchondral.
Wāhanga III: He nui ake i te 1.3 cm (1/2 inihi) te whānui o te pakaru o te kiriuhi, ā, ka toro atu ki te wheua subchondral.
Tau IV: Te pānga ki te wheua subchondral.
III. E whakaata ana te pathology me te grading i te mauri o te chondromalacia patella. Nā, he aha ngā tohu me ngā whakamātautau tino whai tikanga hei tautuhi i te chondromalacia patella?
Ko te mate e ahu mai ana i te mamae i muri i te hope o te kōpū, i puta mai i te whakamātautau huri o te hope me te whakamātautau piko waewae kotahi. Me arotahi ki te wehewehe mēnā he whara meniscus me te mate rumatiki whara. Heoi, kāore he hononga i waenga i te kaha o te chondromalacia hope me ngā tohu haumanu o te mamae o te turi o mua. He tikanga tātaritanga tika ake te MRI.
Ko te tohu tino kitea ko te mamae puhoi i muri i te hope me roto o te turi, ka kino ake i muri i te whakakaha tinana, i te piki rānei, i te heke iho rānei i ngā arawhata.
Mā te whakamātautau tinana ka kitea te ngawari o te patella, te peripatella, te taha patellar me te patella o muri, ka haere tahi pea me te mamae paheke o te patella me te haruru o te waku o te patella. Tērā pea ka puta he rerenga hononga me te ngoikore o te quadriceps. I ngā wā tino kino, ka iti te piko me te toronga o te turi, ā, kāore e taea e te tūroro te tū ki runga i te waewae kotahi. I te wā o te whakamātautau pēhi patella, ka kitea te mamae nui i muri i te patella, e tohu ana i te kino o te kiriuhi hononga o te patella, he mea nui ki te tātaritanga. He pai te whakamātautau mataku, ā, he pai te whakamātautau piko. Ina piko te turi mai i te 20° ki te 30°, ki te neke atu te whānuitanga o te nekehanga o roto me waho o te patella i te 1/4 o te diameter whakawhiti o te patella, e tohu ana i te subluxation o te patella. Mā te ine i te koki Q o te piko turi 90° ka taea te whakaatu i te ara nekehanga patella rerekē.
Ko te whakamātautau āwhina tino pono ko te MRI, kua whakakapia haeretia e tēnei te arthroscopy, ā, kua noho hei huarahi pono, kore-whakaekenga hoki mō te CMP. Ko te aro nui o ngā whakamātautau whakaahua ki ēnei tawhā: te teitei o te patellar (Caton index, PH), te koki awaawa o te trochlear femoral (FTA), te ōwehenga mata taha o te trochlear femoral (SLFR), te koki taunga o te patellar (PCA), te koki tilt patellar (PTA), i roto i ēnei ko te PH, te PCA, me te PTA he tawhā pono mō te hononga turi hei āwhina i te tautuhi i te CMP wawe.
I whakamahia te hihi-X me te MRI hei ine i te teitei o te hope (Caton index, PH): a. Hiko-X tuaka i te tūnga tū me te turi piko i te 30°, b. MRI i te tūnga me te turi piko i te 30°. Ko L1 te koki pikinga o te hope, ko te tawhiti mai i te pūwāhi raro rawa o te mata o te hononga patellofemoral ki te koki o mua o runga o te āhua o te tibial plateau, ko L2 te roa o te mata o te hononga patellofemoral, me te tohu Caton = L1/L2.
I inehia te koki awaawa trochlear femoral me te koki taunga patellar (PCA) mā te hihi-X me te MRI: a. Hiko-X axial me te turi piko i te 30° i te tūnga tū-waewae; b. MRI me te turi piko i te 30°. E rua ngā rārangi o te koki awaawa trochlear femoral, arā, ko te pūwāhi raro A o te awaawa trochlear femoral, te pūwāhi teitei C o te mata hononga trochlear medial, me te pūwāhi teitei B o te mata hononga trochlear lateral. Ko te ∠BAC te koki awaawa trochlear femoral. I tuhia te koki awaawa trochlear femoral ki te ahua axial o te patella, kātahi ka tuhia te wehenga AD o ∠BAC. Kātahi ka tuhia he rārangi tika AE mai i te pūwāhi raro A o te awaawa trochlear femoral hei pūtake mā te pūwāhi raro E o te tihi patellar. Ko te koki i waenganui i te rārangi tika AD me te AE (∠DAE) ko te koki taunga patellar.
I whakamahia te hihi-X me te MRI hei ine i te koki whakarara o te hope (PTA): a. Hiri-X tuaka i te tūnga tū e amo ana i te taumaha me te turi e piko ana i te 30°, b. MRI i te tūnga me te turi e piko ana i te 30°. Ko te koki whakarara o te hope ko te koki i waenganui i te rārangi e hono ana i ngā pūwāhi teitei rawa o ngā condyles femur medial me lateral me te tuaka whakawhiti o te hope, arā, ∠ABC.
He uaua te tautuhi i te CMP mā te whakamahi i ngā whakaahua X-ray tae noa ki ngā wāhanga matatau, ina kitea te ngaronga nui o te kiriuhi, te ngaronga o te wāhi hononga, me te sclerosis wheua subchondral me ngā huringa cystic. Ka taea e te arthroscopy te whakatutuki i tētahi tautuhi pono nā te mea ka taea te whakaatu pai i te hononga patellofemoral; heoi, kāore he hononga mārama i waenga i te kaha o te chondromalacia patellar me te nui o ngā tohu. Nō reira, kaua ēnei tohu e waiho hei tohu mō te arthroscopy. Hei tāpiri, ko te arthrography, hei tikanga tautuhi whakaeke me te momo, ka whakamahia noa i ngā wāhanga matatau o te mate. Ko te MRI he tikanga tautuhi kore whakaeke e oati ana i te kaha ahurei ki te kite i ngā whara kiriuhi me ngā raruraru o roto o te kiriuhi i mua i te kitenga o te ngaronga kiriuhi morphological ki te kanohi tahanga.
IV. Tērā pea ka taea te whakakore i te chondromalacia patellae, ka taea rānei te whanake hei mate rumatiki patellofemoral. Me tuku wawe tonu te maimoatanga whai hua ā-pūmau i ngā wāhanga tōmua o te mate. Nā, he aha ngā mea kei roto i te maimoatanga ā-pūmau?
E whakaponohia whānuitia ana i te wā tōmua (wāhanga I ki te II), kei te kaha tonu te kiriuhi o te hope ki te whakatika, ā, me mahi he maimoatanga whai hua kore-pokanga. Ko te nuinga o tēnei ko te whakawhāiti i ngā mahi, te okioki rānei, me te whakamahi i ngā rongoā anti-inflammatory kore-steroidal ina hiahiatia. Hei tāpiri, me akiaki i ngā tūroro ki te whakakorikori tinana i raro i te tirotiro a te kaiwhakaora tinana hei whakapakari i te uaua quadriceps me te whakarei ake i te pumau o te hononga turi.
He mea tika kia mōhiotia i te wā e whakaūngia ana te nekehanga, ka mauhia ngā tautoko turi, ngā hononga turi rānei, ā, me karo te whakapiri i te pāreti i ngā wā katoa e taea ana, nā te mea ka taea e tēnei te arahi ngāwari ki te whara o te kiriuhi hononga kāore e whakamahia; ahakoa ka taea e te rongoā aukati te whakamamae i ngā tohu, kaua e whakamahia, kaua hoki e whakamahia he homoni, nā te mea ka aukati i te hanganga o ngā glycoprotein me te collagen, ā, ka pā ki te whakatikatika o te kiriuhi; ina ka kino haere te pupuhi me te mamae o ngā hononga, ka taea te whakamahi i ngā kōpeke hukapapa, ā, ka taea te whakamahi i te whakaora tinana me ngā kōpeke mahana i muri i te 48 hāora.
V. Mō ngā tūroro o te wāhanga whakamutunga, he ngoikore te kaha ki te whakatika i te kiriuhi hononga, nō reira he maha ngā wā kāore e whai hua te maimoatanga ā-pūmau, ā, me mahi pokanga. He aha ngā mea kei roto i te maimoatanga pokanga?
Ko ngā tohu mō te pokanga ko: i muri i ētahi marama o te maimoatanga tino āta, kei te mamae tonu te hope; ki te mea he āhua whānau mai, he āhua whiwhi rānei, ka taea te whakaaro ki te pokanga. Ki te pakaru te kiriuhi Outerbridge III-IV, e kore rawa e taea te whakakī i te hapa ki te kiriuhi hononga tūturu. I tēnei wā, ko te heu noa i te wāhi kua pakaru te kiriuhi me te taumaha roa e kore e taea te aukati i te tukanga o te pirau o te mata hononga.
Ko ngā tikanga pokanga ko:
(1) Ko te pokanga arthroscopic tētahi o ngā huarahi whai hua mō te tautuhi me te rongoā i te chondromalacia patella. Ka taea te tirotiro tika i ngā huringa o te mata o te kiriuhi i raro i te karuārai. I ngā take ngawari, ka taea te waru i ngā whara iti o te kiriuhi hononga o te patellar hei whakatairanga i te whakatikatika.
(2) te whakaara ake i te taha o te condyle femur; (3) te tango i te mata o te kiriuhi patellar. Ka mahia tēnei pokanga mō ngā tūroro he iti noa te pakaru o te kiriuhi hei whakatairanga i te whakatikatika o te kiriuhi; (4) ka mahia te tangohanga o te kiriuhi patellar mō ngā tūroro he nui te pakaru o te mata o te kiriuhi patellar.
Wā tuku: Whiringa-ā-rangi 15-2024
