kotodwe nkwaa .

01. Nnompe nhyehyɛe a wɔahyehyɛ .

No Nkotodwe nkwaa yɛ nnompe 4: asen, tibia, patella ne fibula.

Ɛyɛ 3 compartments: medial tibiofemoral compartment, lateral tibiofemoral compartment, ne patellofemoral compartment, ne 3 compartment no kyɛ synovial cavity.

02.Joint nhyehyɛe .

Type: Teaseɛnam no mu nkwaa .

Nkotodwe no wɔ nkwaa 3: mfinimfini tibiofemoral nkwaa, akyi tibiofemoral nkwaa ne patellofemoral nkwaa.

Tibiofemoral joint no de distal femur no bata tibia no ho, na distal femur tapers no yɛ medial femoral condyle ne lateral femoral condyle no. Tibia no yɛ petee kakra, nanso meniscus a ɛkɔ fam no ma ɛne asen mu ntini a ɛrepue no di nkitaho kɛse.

Asen mu ntini a ɛwɔ asen no mu no, intercondylar fossa a wɔsan frɛ no femoral groove anaa femoral talus no na ɛtetew mu.

Patella no yɛ aba dompe a ɛhyɛ quadriceps ntini no ntini mu na ɛne trochanteric groove no yɛ nkwaa.

Ɛyɛ adwuma ma mfiridwuma mu mfaso a ɛwɔ quadriceps ntini no mu no yɛ kɛse. Fibula no ti wɔ kotodwe no mu nanso ɛntaa nyɛ adwuma sɛ ntini a ɛwɔ mu a ɛyɛ duru. Femoral condyles ne tibial plateau na ɛyɛ nkwaa no.

03. Nkwaa a ɛyɛ den .

Nkotodwe nkwaa no gyina pintinn denam ntini ahorow a ɛyɛ mmerɛw a ɛsan nso ma ahobammɔ a ɛwɔ nkwaa no mu no so.

Wɔde hyaline ntini a ɛtwetwe no akata tibia ne femur no so wɔ kotodwe no mu.

- a ɛte sɛ disc-shaped lateral ne medial menisci no ma shock absorption foforo na ɛsan nso kyekyɛ tumi wɔ kotodwe so wɔ nkwaa no nyinaa mu.

-Aniwa a ɛwɔ anim a ɛyɛ cruciate ligament (ACL) ne akyi cruciate ligament (PCL) no gyina anim-akyi ne anim-trɛw a ɛkɔ so.

- medial collateral ligament ne lateral collateral ligament no ma kotodwe no gyina wɔ wɔn plane ahorow no mu.

-Nhyehyɛe afoforo a ɛma kotodwe no gyina hɔ no bi ne iliotibial bundle ne akyi abɛn no fã.

04. Bursae ne cystic structures .

Wɔtaa hu cystic structures pii wɔ kotodwe no ho, a tendon sheath cysts ne synovial bursae ka ho. Tendon sheath cysts yɛ benign abnormalities a ɛwɔ ntini a ɛyɛ den a ɛka bom a ɛyɛ den a ɛwɔ ntini a ɛyɛ den mu na ɛwɔ mucus.

Popliteal cyst (kyerɛ sɛ, Baker’s Cyst) ne synovial cyst a ɛtaa ba wɔ nipadua no mu. Efi bursa a ɛwɔ gastrocnemius ntini no mfinimfini ti ne semimemranus tendon ntam no mu. Mpɛn pii no, popliteal cysts no nni sɛnkyerɛnne biara nanso mpɛn pii no ɛne nkotodwe no mu ntini mu yare wɔ abusuabɔ.

Bursae anan a wɔtaa de di dwuma wɔ kotodwe anim. Suprapatellar bursa no bɛn kotodwe no ho na ɛda rectus femoris tendon ne femur no ntam, ne ne kar a ɛwɔ nkotodwe nkwaa mu wɔ mpanyimfo dodow no ara mu. Prepatellar bursa no da patella no anim pɛɛ. Infrapatellar bursa a ɛwɔ soro no da patellar ntini no fã a ɛwɔ akyirikyiri ne tibial tuberosity no so, bere a infrapatellar bursa a emu dɔ no da patellar ntini no fã a ɛwɔ akyirikyiri ne anim tibial tuberosity no ntam. Bursa a ɛwɔ soro no betumi ayɛ hyew esiane sɛ wɔde di dwuma boro so anaasɛ ɛyɛ ahodwiriw nti, te sɛ nkotodwe a wɔde di dwuma bere tenten, bere a nkotodwe a wɔde di dwuma boro so no betumi ama infrapatellar bursa a emu dɔ no ahon, te sɛ nea wohuruw mpɛn pii anaasɛ wotu mmirika no.

Nkotodwe no fã a ɛwɔ mfinimfini no yɛ nea goosefoot bursa, semimembranosus bursa, ne suprapatellar bursa na ɛwɔ mu. Goosefoot bursa no wɔ tibial stop a ɛwɔ lateral tibial collateral ligament no ne distal fusion tendons a ɛwɔ suture, asen a ɛyɛ tratraa ne semitendinosus ntini no ntam. Semimembranosus bursa no wɔ semimembranosus tendon ne medial tibial condyle ntam, na suprapatellar bursa no yɛ bursa a ɛsõ sen biara wɔ kotodwe nkwaa no mu na ɛwɔ patella no atifi ne quadriceps ntini no ani a emu dɔ no.

05 Nkyɛmu a ɛkɔ so wɔ nipadua no mu .

Sɛnea ɛbɛyɛ na wɔasusuw kotodwe a ɛyɛ nnam a ɛbɔ no ho no, ma ɔyarefo no nsusuw sɛ ne gyinabea yɛ nea ɛkɔ so no na ɔmmɔ ne kotodwe no kɛse sɛnea ɛbɛyɛ a ne nan ase no bɛbɛn gluteal groove no sɛnea obetumi; Flexion no anim a ɛyɛ daa no bɛyɛ 130°.

Sɛnea ɛbɛyɛ na wɔasusuw kotodwe ntrɛwmu ho no ma ɔyarefo no nsusuw sɛ ɔte ne kotodwe ntrɛwmu kɛse. Nkotodwe no a wɔbɛtrɛw mu akɔ akyiri sen nan a ɛyɛ tẽẽ anaasɛ ne gyinabea a ɛnyɛ nea ɛwɔ afã biara (0°) no yɛ ade a ɛfata ma ayarefo binom nanso wɔfrɛ no hyperextension. Overextension a ɛnyɛ nea ɛboro 3°-5° yɛ ade a wɔde kyerɛ sɛnea ɛsɛ. Wɔfrɛ hyperextension a ɛboro saa kwan yi so no kotodwe retroflexion na ɛyɛ nkyerɛkyerɛmu a ɛnyɛ ne kwan so.

HOMAS sɔhwɛ no sɔ sɛnea quadriceps ne hip flexors no tumi yɛ nsakrae no hwɛ.

Sɛ hip flexion contracture bi wɔ hɔ a, draping draping lower extremity no asen no bɛyɛ anim akɔ soro sen sɛ ɛbɛ flush anaasɛ ɛbɛkɔ fam wɔ nhwehwɛmu pon no so.

Angle a ɛsensɛn asen no mu kɔ sɔhwɛ pon no so no kyerɛ sɛnea hip flexion contracture no te.

Sɛ quadriceps tightness wɔ hɔ a, drape no nan ase no bɛyɛ angle afi sɔhwɛ pon no so. Angle a ɛnam draping ase nan ase ne fam plumb line no da quadriceps nhyɛso no adi.

06. Nhwehwɛmu a ɛfa nkwaa a ɛgyina pintinn ho .

Akyi drawer sɔhwɛ - Wɔyɛ akyi drawer sɔhwɛ no a ɔyarefo no wɔ supine gyinabea, asen a ɛka no no bɔ kɔ 45°, kotodwe no bɔ kɔ 90°, na nan no yɛ neutral . Ɔsɔhwɛfo no de ne nsa abien nyinaa kura ɔyarefo no tibia a ɛbɛn no mu bere a ɔde ne nsa abien no nsateaa no hyɛ tibial tuberosity no so no. Afei wɔde tumi bi a ɛkɔ akyi di dwuma wɔ proximal tibia no so. Akyi a ɛkɔ akyi a ɛboro 0.5-1 cm ne akyi a ɛkɔ akyiri sen ɔfã a ɛte apɔw no kyerɛ sɛ akyi abon no mu ntini a ɛwɔ kotodwe no mu no atetew fã bi anaa ne nyinaa.

Quadriceps Active Contraction Test - Ɛma ɔyarefo no nan ho yɛ den (mpɛn pii no, ɔte nan ase) na ɛma ɔyarefo no bɔ mmɔden sɛ ɔbɛtwe ne nan akɔ n’anim wɔ nhwehwɛmu pon no so (ɛne nea ɔreyɛ nhwehwɛmu no nsa no gyina ano), saa ɔkwan yi ma quadripeps ntini no twetwe, a ɛbɛma Tibia a ɛwɔ anim no ayɛ kɛse wɔ anim a ɛyɛ mmerɛw.

Tibial external rotation test - Wɔde tibial external rotation test no di dwuma de hu akyi apirakuru a ɛwɔ akyi ne akyi cruciate ligament apirakuru a ɛwɔ hɔ. Tibia no yɛ passively akyi dannan wɔ 30° ne 90° kotodwe flexion. Sɔhwɛ no yɛ papa sɛ ɔfã a ɛka ho no dannan akyi bɛboro 10°-15° sen ɔfã a ɛwɔ apɔwmuden no a. Positive wɔ 30° kotodwe flexion ne negative wɔ 90° kyerɛ sɛ ɛyɛ mmerɛw PLC opira, na positive wɔ 30° ne 90° nyinaa flexion kyerɛ sɛ opira nyinaa akyi cruciate ligament ne akyi akyi complex.

07. Ntini a ɛwɔ akyi .

Ntini a ɛwɔ nkwaa mu a ɛwɔ nkwaa mu .

Patellar Ligament, Mfinimfini Ntini a ɛwɔ soro, akyi berɛmo no akyi ntini .

Ntini a ɛwɔ intracapsular mu .

Ntini a ɛwɔ anim a ɛwɔ akyi, akyi berɛmo no akyi berɛmo .

Extracapsular ligaments .

mfinimfini fã a ɛwɔ akyi, akyi fã a ɛwɔ akyi, popliteal oblique ligament, fibular collateral ligament .

08. Ntini a ɛwɔ nkwaa mu .

Ntini mu ntini nhyehyɛe .

Ntini mu ntini a ɛwɔ popliteal ntini, popliteal vein, ne tibial nerve (sciatic nerve a ɛtoa so) no fa akyi kɛkɛ kɔ kotodwe nkwaa no mu.

Peroneal nerve a ɛtaa ba no ne sciatic nerve no akyi nkorabata.

09. Ntini a ɛbata ho .

Anterior lateral .

Quadriceps yɛ rectus femoris, vastus medialis, vastus lateralis, ne intermedius femoris.

akyi fã .

Nhama a wɔde yɛ apɔw-mu-teɛteɛ .

Nea ɛka ho ne biceps femoris, semitendinosus ne semimembranosus;

Gastrocnemius a ɛwɔ nipadua no mu.

anteromedial .

Tibialis anim.

Ntini a ɛma kotodwe nkwaa no gyina pintinn, a nea ɛka ho ne quadriceps, ntini a wɔde twitwiw nipadua, akyi berɛmo, asen mu ntini a ɛyɛ tratraa, biceps femoris, semitendinosus, ne semimembranosus.

10. Nipadua mu nhwehwɛmu .

1. Nhwehwɛmu a wɔde aniwa hu .

Hwɛ sɛnea nkotodwe nkwaa a ɛwɔ ɔfã a ayɛ mmerɛw no ne ɔyarefo no fã a ɛka ho no tumi kɔ baabiara na ɛyɛ pɛ, na hwɛ yiye sɛ ebia baabi a ɛho ahon, honam ani kɔla a ɛnteɛ, ne nantew a ɛnyɛ ne kwan so wɔ hɔ, ne nea ɛkeka ho 3.

2. Palpation .

Hwɛ ɛyaw ne baabi a ɛho ahon, emu dɔ, ne kɛse ne ne su, a ɔyarefo no fã a ɛka ho no wɔ baabi a ɛhɔ yɛ komm sɛnea ɛbɛyɛ yiye biara.

3. Nnipa a wɔboaboa wɔn ano .

Hwɛ sɛnea kotodwe no ntumi nkɔ baabiara denam ɔyarefo no dwumadi ahorow a ɛyɛ nnam ne nea ɛnyɛ adwuma so.

4. Nsusuwii .

Susuw akwaa no fã biara tenten ho ne saa ara nso na ne nsa ne ne nan no nyinaa tenten, ne nsa ne ne ho twa ho hyia, nkwaa no kwan a ɛkɔ so, ntini ahoɔden, baabi a ɛte nka a ɛyera, ne nea ɛkeka ho, na yɛ kyerɛwtohɔ ne agyiraehyɛde ahorow.

5. Sɔhwɛ Titiriw .

 - Floating Patella Test: Hwɛ sɛ ebia effusion wɔ ɔyarefo no kotodwe nkwaa mu anaa.

Nhwehwɛmu a wɔyɛ wɔ ɔkwan a wɔfa so yɛ adwuma no mu .

Bere a wɔapia suprapatellar bursa no awie na ama nsu aboaboa ano, sɛ nsu wɔ kotodwe no nkwaa mu a, wɔde nsateaa a wɔde kyerɛ ade no mia patella no so brɛoo, na sɛ wɔde nhyɛso no fi hɔ wie a, patella no bɛsen akɔ soro wɔ tumi a ɛwɔ nsu no mu no ase, na sɛ wɔde nhyɛso no fi hɔ a, patella no benya popping anaa floating sensation dueting sensation dueting sensation dueting sensation dueting sensation dueting sensation dueting sensation dueting an

- Drawer Test: Sɛ wobɛhwɛ sɛ ebia cruciate ligament no asɛe anaa.

Anterior drawer test: Ɔyarefo no da mpa no so petee, ne kotodwe bɔ 90 °, ne nan yɛ petee wɔ mpa no so, kɔ so gye n’ahome. Nhwehwɛmufo a ɔde ne ho bɔɔ ɔyarefo no nan ho sɛ ɔbɛma ayɛ yiye, nsa a ɛkura kotodwe nkwaa no ano a ɛyɛ tibial no, twe nantwi ba no kɔ anim, te sɛ tibia anim a ɛkɔ anim sen 5mm no fã a ɛte apɔw no yɛ papa, positive kyerɛ sɛ anterior cruciate ligament injury (hyɛ no nsow: Lachman test of the anterior drawer of the knee flexion 30 10 °O fam°O°O fam°o fam°o fam°o fam°o fam°o fam°o fam°o fam°o fam°o fam°o fam°o°ion 1000 mu.

Posterior drawer test: the patient lies on his back, bends the knee at 90°, puts both hands on the back of the knee joint, puts the thumb on the extensor side, pushes and pulls the proximal end of the calf backward repeatedly, and the tibia moves backward on the femur as positive, which suggests that the posterior cruciate ligament is partially or completely ruptured.

- Grinding Test: Sεdeε εbεyε na εbεma emu ada hɔ sε ebia sεdeε εbεyε na εbεyε biribi a εbεyε sεdeε εbεyε na εbεtumi aba sεdeε εbεyε a, εbεma meniscus a εwכ kotodwe mu no aba.

Nkotodwe nkwaa a wɔde yɛ nhwehwɛmu: Nipadua mu nhwehwɛmu kwan a wɔfa so hwɛ sɛ ɛwɔ akyi collateral ligament ne meniscus apirakuru a ɛwɔ kotodwe nkwaa no mu anaa.

Ɔyarefo no wɔ tebea pa mu a ne kotodwe a ayɛ mmerɛw no abɔ 90°.

1. Rotational Lifting Test .

Ɔsɔhwɛfo no mia nantwi ba no so wɔ ɔyarefo no asen so na ɔde ne nsa abien nyinaa kura ne nan ase ma ɛma nantwi ba no so wɔ nantwi ba no kwan tenten no so, bere a ɔreyɛ ne ho ne akyi a ɛkyinkyini no; Sɛ ɛyaw ba wɔ kotodwe no afã abien no nyinaa a, wosusuw sɛ ɛyɛ akyi berɛmo mu ntini a ɛwɔ akyi.

2. Rotary compression sɔhwɛ .

Ɔsɔhwɛfoɔ no de ne nsa mmienu nyinaa kura ne nsa mmienu no nan ase, sɛdeɛ ɛbɛyɛ a ne kotodwe a ɛka no bɛbɔ wɔ 90° na nantwi ba no wɔ gyinabea a ɛteɛ a ne nan no kɔ soro. Afei pia kotodwe no nkwaa no kɔ fam na dannan nantwi ba no kɔ mu ne akyi bere koro mu. Sɛ ɛyaw wɔ kotodwe no mu ne akyi fã a ɛwɔ mu no so a, ɛkyerɛ sɛ meniscus a ɛwɔ mu ne akyi no asɛe.

Sɛ kotodwe no bɔ kɛse a, wosusuw sɛ akyi abɛn meniscus rupture; Sɛ ɛwɔ 90° a, wosusuw sɛ mfinimfini mpaapaemu; Sɛ ɛyaw ba bere a ɛrebɛn gyinabea a ɛteɛ no a, wosusuw sɛ abɛn anim a ɛpaapae no.

- lateral stress test: Sεdeε εbεyε na εbεhwε ɔyarefo no sε εbεsɛe wכ lateral collateral ligament no ho.

Nkotodwe mu nhyɛso sɔhwɛ no yɛ nipadua mu nhwehwɛmu a wɔde hwɛ nkotodwe no akyi ntini a ɛwɔ akyi no.

Gyinabea: Ɔyarefo no da hɔ a ɔda fam wɔ nhwehwɛmu mpa no so, na wɔkyere ne nan no bɔkɔɔ ma ɛkyere ne nan ase a ɛho ayɛ fĩ no wɔ mpa no akyi.

Nkyɛmu gyinabea: Wɔde kotodwe no si gyinabea a ɛtrɛw koraa ne 30° gyinabea a wɔabɔ no mu.

Ahoɔden a wɔde di dwuma: Wɔ atifi hɔ kotodwe gyinabea abien no mu no, nea ɔreyɛ nhwehwɛmu no de ne nsa abien nyinaa kura ɔyarefo no nan ase na ɔde adwennwen di dwuma wɔ mfinimfini ne akyi afã horow no, sɛnea ɛbɛyɛ a wɔbɛkyere nkotodwe nkwaa no anaasɛ wɔakyere no, kyerɛ sɛ, wɔyɛ valgus ne valgus sɔhwɛ ahorow no na wɔde toto afã a ɛwɔ apɔwmuden no ho.

Sɛ ɛyaw ba wɔ kotodwe nkwaa mu wɔ adwennwen a wɔde di dwuma no mu, anaasɛ sɛ wohu sɛ inversion ne eversion angle no fi nea ɛfata no mu na popping sensation wɔ hɔ a, ɛkyerɛ sɛ ɛwɔ hɔ a ɛyɛ mmerɛw anaasɛ ɛpaapae wɔ akyi collateral ligament no mu. Sɛ abɔnten so rotation stress sɔhwɛ no yɛ papa a, ɛkyerɛ sɛ medial tẽẽ kwan no ntumi nnyina, na ebia akuru a ɛwɔ medial collateral ligament, medial meniscus ne joint capsule; Sɛ emu rotation stress test no yɛ papa a, ɛkyerɛ sɛ lateral tẽẽ kwan no ntumi nnyina, na ebia apirakuru wɔ akyi meniscus anaa articular surface cartilage.

11. Knee ho mfoniniyɛ .

1. X-ray nhwehwɛmu .

Wɔde hwɛ sɛ ebia abubu ne nnompe mu ntini a ɛyɛ mmerɛw anaa. Mu duru-soa (gyina) gyinabea kotodwe nkwaa anim ne afã hwɛ film betumi ahu dompe, kotodwe nkwaa mu nsonsonoe ne nea ɛkeka ho.

2. Kɔmputa so tomography (CT) .

CT mfonini ahorow no betumi aboa ma wɔahu nnompe mu haw ne akisikuru a ɛnyɛ anifere. CT scan soronko bi betumi ahu gout no pɛpɛɛpɛ, sɛ mpo nkwaa no mu nyɛ hyew a.

3. Ultrasound .

de nnyigyei asorɔkye di dwuma de yɛ bere ankasa mu mfonini ahorow a ɛkyerɛ ntini a ɛyɛ mmerɛw a ɛwɔ kotodwe no mu ne nea atwa ho ahyia no. Ultrasound betumi ayɛ nsakrae a ɛba ɔyare no mu te sɛ nnompe mu mastoids wɔ nkwaa no anoano, ntini a ɛyɛ mmerɛw, synovitis, nkwaa a ɛwɔ nipadua no mu, po so ntini a ɛma nipadua no ho ahon, ne meniscal a ɛreyɛ ayɛ kɛse no ho mfonini wɔ w’adwenem.

4. Magnetic resonance mfoniniyɛ (MRI) .

Saa nhwehwɛmu yi boa ma wohu ntini a ɛyɛ mmerɛw a apira, te sɛ ntini, ntini, ntini a ɛyɛ mmerɛw ne ntini.

Nhwehwɛmu a wɔyɛ wɔ aduruyɛdan mu: Sɛ oduruyɛfo no susuw sɛ ɔyare mmoawa anaa ɔyare, mogya mu nhwehwɛmu ne ɛtɔ mmere bi a, arthrocentesis°, adeyɛ a woyi nsu kakraa bi fi kotodwe no nkwaa mu ma wɔyɛ nhwehwɛmu wɔ aduruyɛdan mu a, ɛho behia.

12. Nneɛma a ɛtaa de nkwaa mu yaw ba .

1. Opira a ɛfa ho .

ligament opira te sɛ anim ne akyi cruciate ligament ne akyi collateral ligament ahorow ne nusu; Meniscus apirakuru; patellar tendonitis ne nusu; Nnompe mu akisikuru ne nea ɛkeka ho.

2. Ntini mu yare a ɛfa ho .

nnompe mu yare a efi nkwaa mu ntini a ɛyɛ mmerɛw mu ba; Ntini mu yare a ɛma obi ho yɛ hyew no fi nipadua no mu tumi a ɛko tia nyarewa no; Gout fi ahwehwɛ a efi uric acid a ɛdɔɔso a ɛka nkwaa no mu ba no mu.

3. Nneɛma afoforo a ɛde ba .

synovitis a ɛma nkwaa yɛ yaw na ɛhoa; patellar haw ahorow te sɛ dislocation ne cartilage wear; akisikuru a ɛba nkwaa no so; edema a efi ɔfe, ne nea ɛkeka ho mu ba; gyinabea a enye a ɛkyɛ; Iliotibial fascia syndrome a ɛnam akasakasa a ɛtaa ba a ɛde ɛyaw ba wɔ kotodwe akyi no so na ɛba.

13. Akwan a wɔtaa fa so yɛ ayaresa .

1.Conservative ayaresa .

- ahomegye ne breki .

-Awɔw ne ɔhyew a ɛyɛ hyew .

-Nnuru ho ayaresa .

-Aduru a wode sa yare .

-Apɔw-mu-teɛteɛ ayaresa .

- a wode di dwuma wo mfiri a ewo ho so .

2.Opɔw mu oprehyɛn .

-Arthroscopic oprehyɛn .

-Akode a woasesa no .

3.Ayaresa afoforo .

-Atetesɛm mu Chinafoɔ Aduruyɛ (TCM) .

-injection ayaresa .