Mabondo Ogwirizana

01. Mapangidwe a Mafupa

The bondo lili ndi mafupa 4: femur, tibia, patella ndi fibula.

Zili ndi zigawo za 3: chipinda chapakati cha tibiofemoral, chigawo cha lateral tibiofemoral, ndi chipinda cha patellofemoral, ndipo zigawo za 3 zimagawana synovial cavity.

02.Mapangidwe ophatikizana

Mtundu: Cholumikizira Chonyamulira

Bondo liri ndi ziwalo za 3: mgwirizano wapakati wa tibiofemoral, lateral tibiofemoral joint ndi patellofemoral joint.

Mgwirizano wa tibiofemoral umagwirizanitsa mbali ya distal femur ku tibia, ndi ma distal femur tapers kuti apange condyle yapakati yachikazi ndi lateral femoral condyle. Tibia ndi yosalala, koma meniscus yotsatiridwa imapangitsa kuti igwirizane kwambiri ndi ma condyles a chikazi.

Ma condyles achikazi amasiyanitsidwa ndi intercondylar fossa, yomwe imadziwikanso kuti femoral groove kapena femoral talus.

The patella ndi fupa la mbewu lomwe lili mkati mwa tendon ya quadriceps minofu ndikupanga mgwirizano ndi trochanteric groove.

Imathandiza kupititsa patsogolo kupindula kwamakina kwa minofu ya quadriceps. Mutu wa fibula uli mkati mwa kapsule ya bondo koma nthawi zambiri samagwira ntchito ngati malo olemera kwambiri. Ma condyles achikazi ndi tibial plateau amapanga mzere wolumikizana.

03. Kukhazikika Pamodzi

Kukhazikika kwa mgwirizano wa mawondo kumasungidwa ndi mitundu yosiyanasiyana yofewa yomwe imaperekanso chitetezo chokhazikika mkati mwa mgwirizano.

Tibia ndi femur zimaphimbidwa ndi hyaline cartilage mkati mwa bondo lolumikizana.

-Menisci yopangidwa ndi diski yozungulira komanso yapakati imaperekanso kugwedezeka kwina komanso kugawa mphamvu pamabondo molumikizana.

-The anterior cruciate ligament (ACL) ndi posterior cruciate ligament (PCL) imakhazikika patsogolo-pambuyo ndi flexion-extension movement.

-Chigwirizano chapakati chapakati ndi lateral collateral ligament chimalimbitsa bondo mu ndege zawo.

-Zinthu zina zomwe zimalimbitsa bondo zimaphatikizapo mtolo wa iliotibial ndi gawo la nyanga yam'mbuyo yam'mbuyo.

04. Bursae ndi Cystic Structures

Mitundu yambiri ya cystic imapezeka mozungulira bondo, kuphatikizapo tendon sheath cysts ndi synovial bursae. Ma tendon sheath cysts ndi matenda osachiritsika omwe amakhala ndi minofu yolumikizana yolumikizana komanso yokhala ndi ntchofu.

Popliteal cyst (ie, Baker's cyst) ndiye chotupa chofala kwambiri cha synovial m'thupi. Amachokera ku bursa pakati pa mutu wapakati wa minofu ya gastrocnemius ndi tendon ya semimembranosus. Popliteal cysts nthawi zambiri imakhala yopanda zizindikiro koma nthawi zambiri imagwirizanitsidwa ndi matenda a intra-articular a bondo.

Pali ma bursae anayi wamba kutsogolo kwa bondo. The suprapatellar bursa ndi proximal kwa bondo kapsule ndipo ali pakati rectus femoris tendon ndi femur, ndi magalimoto ake ndi mawondo olowa mu akuluakulu ambiri. Prepatellar bursa ili kutsogolo kwa patella. The superficial infrapatellar bursa ili pamwamba pa mbali ya distal ya tendon ya patellar ndi tibial tuberosity, pamene deep infrapatellar bursa imakhala pakati pa mbali ya distal ya patellar tendon ndi anterior tibial tuberosity. Bursa yapamwamba imatha kutenthedwa chifukwa chogwiritsidwa ntchito mopitirira muyeso kapena kuvulala, monga kugwada kwa nthawi yaitali, pamene kugwiritsira ntchito mopitirira muyeso kwa mawondo owonjezera mawondo kungayambitse kutupa kwa deep infrapatellar bursa, monga kulumpha mobwerezabwereza kapena kuthamanga.

Mbali yapakati pa bondo imayang'aniridwa ndi goosefoot bursa, semimembranosus bursa, ndi suprapatellar bursa. Goosefoot bursa ili pakati pa tibial stop of the lateral tibial collateral ligament ndi distal fusion tendons za suture, zowonda zachikazi ndi semitendinosus minofu. The semimembranosus bursa ili pakati pa semimembranosus tendon ndi medial tibial condyle, ndipo suprapatellar bursa ndi bursa yaikulu kwambiri pa mawondo a mawondo ndipo ili pamwamba pa patella ndi pamwamba pa quadriceps minofu.

05 Kusuntha kophatikizana

Kuti muwone kugwedezeka kwa mawondo, perekani wodwalayo kuti atenge malo ozungulira ndikugwedeza kwambiri bondo kuti chidendene chikhale pafupi ndi gluteal groove momwe zingathere; ngodya yabwinobwino yopindika ndi pafupifupi 130 °.

Kuti muwunikire kufalikira kwa mawondo, wodwalayo ayenera kukhala pansi ndikuwonjezera mawondo awo. Kukula kwa bondo kupitirira mwendo wowongoka kapena kusalowerera ndale (0 °) ndikwachilendo kwa odwala ena koma amatchedwa hyperextension. Kuchulukira kosapitilira 3 ° -5 ° ndikuwonetsa kwabwinobwino. Hyperextension kupitilira izi imatchedwa retroflexion ya bondo ndipo ndikuwonetsa kwachilendo.

Mayeso a homas amayesa kusinthasintha kwa ma quadriceps ndi ma flexor a m'chiuno.

Ngati ntchafu ya m'chiuno imakhalapo, ntchafu ya m'munsi mwake idzayang'ana padenga osati kutsika kapena kutsika ndi tebulo lowunika.

Ngodya ya ntchafu yolendewera patebulo loyeserera ikuwonetsa kuchuluka kwa kusinthasintha kwa ntchafu.

Ngati kulimba kwa quadriceps kulipo, mwendo wakumunsi wa drape udzatalikirana ndi tebulo loyeserera. Ngodya yopangidwa ndi mwendo wakumunsi wotsetsereka wokhala ndi chingwe chowongolera pansi amawonetsa kulimba kwa quadriceps.

06. Kuwunika kukhazikika kwa mgwirizano

Mayesero Ojambula Pambuyo - Kuyesedwa kwapambuyo kwa kabati kumachitidwa ndi wodwalayo pamalo omwe ali pamwamba, chiuno chokhudzidwa chimasintha mpaka 45 °, bondo limasintha ku 90 °, ndi phazi losalowerera ndale. Woyesayo amagwiritsira ntchito proximal tibia ya wodwalayo ndi manja onse awiri muzitsulo zozungulira pamene akuyika zala zazikulu za manja onse pa tibial tuberosity. Mphamvu yakumbuyo imayikidwa ku proximal tibia. Kusamuka kwapambuyo kwa tibia kupitirira 0.5-1 masentimita ndi kusamuka kwapambuyo kwakukulu kusiyana ndi mbali yathanzi kumasonyeza kung'ambika pang'ono kapena kwathunthu kwa bondo la bondo.

Mayeso a Quadriceps Active Contraction Test - Amakhazikitsa phazi la wodwalayo (kawirikawiri amakhala pa phazi) ndipo wodwalayo amayesa kusuntha phazi patsogolo pa tebulo lofufuzira (motsutsana ndi kukana kwa dzanja la woyesa), kuyendetsa uku kumapangitsa kuti minofu ya quadriceps igwirizane, zomwe zidzachititsa kuti kutsogolo kusuntha kwa tibia ndi bondo la 2mm deficient.

Tibial External Rotation Test - Kuyesa kwa tibial kunja kwa kuzungulira kumagwiritsidwa ntchito kuti azindikire kuvulala kwapambuyo kwapambuyo pakona ndi kukhalapo kwa kuvulala kwapambuyo kwa cruciate ligament. Tibia imazungulira kunja kwa 30 ° ndi 90 ° ya mawondo. Mayesowa ndi abwino ngati mbali yokhudzidwayo ikuzungulira kunja kuposa 10 ° -15 ° kuposa mbali yathanzi. Zabwino pa 30 ° za kupindika kwa bondo ndi zoipa pa 90 ° zimasonyeza kuvulala kosavuta kwa PLC, ndipo zabwino pa 30 ° ndi 90 ° zopindika zimasonyeza kuvulazidwa kwa mitsempha ya posterior cruciate ligament ndi posterolateral complex.

07. Mitsempha ya Periarticular

Magulu a capsule ligaments

patellar ligament, medial patellar ligament, lateral patellar ligament

Intracapsular ligaments

minyewa yam'mbuyo ya cruciate ligament, posterior cruciate ligament

Mitsempha ya Extracapsular

medial collateral ligament, lateral collateral ligament, popliteal oblique ligament, fibular collateral ligament

08. Kulowa m'malo olowa

Mapangidwe a Neurovascular

Mtolo wa neurovascular womwe uli ndi mitsempha ya popliteal, popliteal vein, ndi mitsempha ya tibial (kupitiriza kwa mitsempha ya sciatic) imayenda kumbuyo kwa bondo.

Mitsempha wamba ya peroneal ndi nthambi yotsatizana ya sciatic nerve.

09. Minofu Yogwirizana

Anterior Lateral

Quadriceps imakhala ndi rectus femoris, vastus medialis, vastus lateralis, ndi intermedius femoris.

Mbali yakumbuyo

Hamstrings

kumaphatikizapo biceps femoris, semitendinosus ndi semimembranosus;

Matenda a Gastrocnemius.

Anteromedial

Tibialis anterior.

Minofu yomwe imasunga kukhazikika kwa mawondo a bondo, kuphatikizapo quadriceps, suture minofu, hamstrings, minofu yopyapyala yachikazi, biceps femoris, semitendinosus, ndi semimembranosus.

10. Kuyeza thupi

1. Kupenda m'maso

Yang'anani kusuntha ndi kufanana kwa mawondo a mawondo kumbali yomwe yakhudzidwa ndi mbali ina ya wodwalayo, ndipo samalani ngati pali kutupa komweko, khungu lachilendo, ndi kuyenda kwachilendo, ndi zina zotero.

2. palpation

yang'anani ululu ndi kutupa malo, kuya, kukula ndi chilengedwe, ndi mbali yokhudzidwa ya wodwalayo mu malo omasuka momwe mungathere.

3. Kulimbikitsa anthu

Yang'anani kuyenda kwa bondo lolumikizana kudzera muzochita zolimbitsa thupi komanso zopanda pake za wodwalayo.

4. Kuyeza

Yezerani kutalika kwa gawo lililonse la chiwalocho komanso kutalika kwake, kuzungulira kwa chiwombankhanga, kusuntha kwamagulu, mphamvu ya minofu, kutayika kwa malo okhudzidwa, ndi zina zotero, ndikupanga zolemba ndi zizindikiro.

5. kufufuza kwapadera

 - Mayeso oyandama a patella: onani ngati bondo la wodwalayo latuluka.

Kuwunika ndondomekoyi

Pambuyo pa kufinya suprapatellar bursa kuti madzi asungunuke, ngati pali madzi mu mgwirizano wa bondo, patella imakanikizidwa pang'onopang'ono ndi chala cholozera, ndipo pamene kukakamizidwa kumasulidwa, patella idzayandama m'mwamba pansi pa mphamvu yamadzimadzi, ndipo pamene kukakamizidwa kumasulidwa, patella idzakhala ndi kuphulika kapena kuyandama chifukwa cha kuphulika.

- Mayeso otengera: kuti muwone ngati pali kuwonongeka kwa cruciate ligament.

Anterior drawer test: wodwalayo akugona pansi pa bedi, bondo flexion 90 °, mapazi pansi pa kama, kukhala omasuka. Wofufuza pamapazi a wodwalayo kuti akhazikike, manja akugwira kumapeto kwa tibial pa bondo, kukoka mwana wa ng'ombe kutsogolo, monga tibia anterior displacement kusiyana ndi mbali yathanzi ya 5mm ndi yabwino, zabwino zimasonyeza kuti kuvulala kwapambuyo kwa mitsempha ya mitsempha (Zindikirani: mayeso a Lachman ndi mayeso a anterior drawer of the knee flexion 30 °).

Kuyeza kwa kabati kumbuyo: wodwalayo akugona kumbuyo kwake, amapinda bondo pa 90 °, amaika manja onse kumbuyo kwa bondo, amaika chala chachikulu pambali ya extensor, amakankhira ndi kukokera kumapeto kwa ng'ombe kumbuyo mobwerezabwereza, ndipo tibia imayenda cham'mbuyo pa femur ngati zabwino, zomwe zimasonyeza kuti posterior cruciate ndi partigate partigate.

- Mayeso akupera: kuti afotokoze ngati pali kuwonongeka kwa meniscus ya bondo.

Kuyesa Kugaya Pamabondo: Njira yowunikira thupi yomwe imagwiritsidwa ntchito poyang'ana lateral collateral ligament ndi meniscus kuvulala kwa bondo.

Wodwalayo ali pachiwopsezo chokhala ndi bondo lomwe lakhudzidwa ndi 90 °.

1. Mayeso okweza mozungulira

Woyesayo amakankhira mwana wa ng'ombe pa ntchafu ya wodwalayo ndipo akugwira chidendene ndi manja onse awiri kuti akweze mwana wa ng'ombeyo motsatira njira yotalikirapo ya ng'ombeyo, pamene akuyenda mkati ndi kunja; ngati ululu umapezeka kumbali zonse za bondo, amaganiziridwa kuti ndi lateral collateral ligament kuvulala.

2. Mayeso a rotary compression

Woyesayo akugwira phazi la chiwalo chokhudzidwa ndi manja onse awiri, kotero kuti bondo lomwe lakhudzidwa lisunthike pa 90 ° ndipo mwana wa ng'ombe ali pamalo oongoka ndi phazi mmwamba. Kenako finyani bondo pansi ndi kuzungulira mwana wa ng'ombe mkati ndi kunja nthawi yomweyo. Ngati pali ululu kumbali ya mkati ndi kunja kwa bondo, zimasonyeza kuti meniscus yamkati ndi yakunja yawonongeka.

Ngati bondo likugwedezeka kwambiri, nyanga yam'mbuyo ya meniscus ikukayikira; ngati ili pa 90 °, kuphulika kwapakati kumaganiziridwa; ngati ululu umapezeka pamene ukuyandikira malo owongoka, nyanga ya kutsogolo ikukayikira.

- Kuyesa kwapambuyo kwapakatikati: kuyang'ana wodwalayo kuwonongeka kwa lateral collateral ligament.

Kuyesa kwa mawondo amtundu wa lateral ndi kuyesa kwa thupi komwe kumagwiritsidwa ntchito kuti ayang'ane mitsempha yowonongeka ya bondo.

Udindo: Wodwalayo amagona cham'munsi pa bedi lomuyezera, ndipo mwendo womwe wakhudzidwawo amatengedwa pang'onopang'ono kotero kuti mwendo wapansi womwe wakhudzidwawo uikidwe kunja kwa bedi.

Malo olowa: bondo limayikidwa pamalo otalikirapo ndipo 30 ° imasinthasintha.

Kugwiritsa ntchito mphamvu: Pazigawo ziwiri zapamwamba za mawondo, woyesayo akugwira mwendo wapansi wa wodwalayo ndi manja onse awiri ndikugwiritsa ntchito kupanikizika kumbali yapakati ndi yapakatikati motsatira, kotero kuti mawondo a mawondo amatengedwa mopanda kanthu kapena kulowetsedwa, mwachitsanzo, kuyesa kwa valgus ndi valgus kumachitika ndikuyerekeza ndi mbali yathanzi.

Ngati ululu umapezeka pamagulu a mawondo panthawi yogwiritsira ntchito kupanikizika, kapena ngati inversion ndi eversion angle ikupezeka kuti ili kunja kwamtundu wamba ndipo pali kumverera kwapang'onopang'ono, kumasonyeza kuti pali sprain kapena kupasuka kwa lateral collateral ligament. Pamene kuyesedwa kwa kupanikizika kwa kunja kuli koyenera, kumasonyeza kuti njira yowongoka yapakati imakhala yosasunthika, ndipo pangakhale zotupa za mitsempha yapakati, meniscus yapakati ndi capsule yolumikizana; pamene kuyesa kupanikizika kwapakati mkati kuli bwino, kumasonyeza kuti njira yowongoka yowonjezereka imakhala yosasunthika, ndipo pangakhale kuvulala kwa lateral meniscus kapena articular surface cartilage.

11. Kujambula mawondo

1. Kuwunika kwa X-ray

amagwiritsidwa ntchito poyang'ana fractures ndi degenerative osteoarthropathy. Kulemera (kuimirira) malo bondo olowa kutsogolo ndi mbali view filimu akhoza kuona fupa, bondo olowa kusiyana ndi zina zotero.

2. Computed tomography (CT)

Ma scans a CT angathandize kuzindikira mavuto a mafupa ndi fractures zobisika. Mtundu wapadera wa CT scan ukhoza kuzindikira molondola gout, ngakhale kuti cholumikizira sichikuwotcha.

3. Ultrasound

Amagwiritsa ntchito mafunde omveka kuti apange zithunzi zenizeni za minofu yofewa mkati ndi kuzungulira bondo. Ultrasound imatha kuwona kusintha kwa matenda monga ma bony mastoid m'mphepete mwa mafupa, kuwonongeka kwa cartilage, synovitis, joint effusionª, popliteal fossa kutupa, ndi meniscal bulging.

4. Kujambula kwa maginito (MRI)

Mayesowa amathandiza kuzindikira kuvulala kwa minofu yofewa, monga mitsempha, tendon, cartilage ndi minofu.

Kuyeza kwa ma laboratory: Ngati dokotala akukayikira kuti ali ndi matenda kapena kutupa, kuyezetsa magazi komanso nthawi zina arthrocentesis °, njira yomwe imachotsa madzi pang'ono pamphuno ya bondo kuti afufuze ma laboratory, ingafunike.

12. Zomwe zimayambitsa kupweteka kwamagulu

1. Zokhudzana ndi kuvulala

kuvulala kwa ligament monga anterior and posterior cruciate ligament ndi lateral collateral ligament misozi ndi misozi; kuvulala kwa meniscus; patellar tendonitis ndi misozi; mafupa othyoka ndi zina zotero.

2. Zokhudzana ndi nyamakazi

osteoarthritis chifukwa cha kuwonongeka ndi kung'ambika kwa mafupa a mafupa; nyamakazi imayamba chifukwa cha chitetezo chamthupi cholimbana ndi mafupa; gout amayamba chifukwa cha kupanga makhiristo kuchokera ku uric acid wambiri womwe umakhudza mafupa.

3. Zifukwa zina

synovitis kuchititsa kupweteka pamodzi ndi kutupa; mavuto a patellar monga dislocation ndi cartilage kuvala; zotupa zowononga olowa; edema chifukwa cha kutupa, etc.; yaitali osauka kaimidwe; iliotibial fascia syndrome chifukwa cha kukangana kobwerezabwereza komwe kumabweretsa kupweteka kunja kwa bondo.

13. Njira zochiritsira zomwe zimagwiritsidwa ntchito kawirikawiri

1.Conservative Chithandizo

-Kupumula ndikuchita braking

- Zozizira komanso zotentha

- Chithandizo chamankhwala

- Chithandizo chamankhwala

-Kulimbitsa thupi

- Kugwiritsa ntchito zida zothandizira

2.Opaleshoni

- Opaleshoni ya Arthroscopic

- Arthroplasty

3.Zithandizo Zina

-Traditional Chinese Medicine (TCM)

-Kumwa jakisoni