Gupfukama

01. Imiterere yamagufwa

Uwiteka ifi ifatanye igizwe namagufa 4: femur, tibia, patella na fibula.

Igizwe n'ibice 3: igice cya tibiofemorale cyo hagati, igice cya tibiofemorale, hamwe na patellofemorale, naho ibice 3 bisangiye umwobo wa synovial.

02.Imiterere ihuza

Ubwoko: Gutwara abagenzi

Ikivi gifite ingingo 3: ingingo ya tibiofemorale yo hagati, tibiofemoral ihuriweho hamwe na patellofemoral.

Igice cya tibiofemorale gihuza femur ya kure na tibia, hamwe na tapi ya femur ya kure kugirango ikore femorale femorale medial na condyle ya femorale. Tibia irasa neza, ariko menisque ihindagurika irayihuza cyane na prodorale femorale.

Indwara ya femorale itandukanijwe na intercondylar fossa, izwi kandi nka femoral groove cyangwa talus femorale.

Patella ni igufwa ryimbuto ryinjijwe mumitsi yimitsi ya quadriceps kandi ikora ingingo hamwe na trochanteric groove.

Ikora kugirango yongere inyungu zumukanishi wimitsi ya quadriceps. Umutwe wa fibula uherereye muri capsule yivi ariko ntabwo isanzwe ikora nkubuso butwara uburemere. Umugore wigitsina gore hamwe na tibial plateau bigize umurongo uhuriweho.

03. Guhuriza hamwe

Ihungabana ryikivi gikomezwa ningingo zinyuranye zoroheje nazo zitanga uburinzi bwo kuryama imbere.

Tibia na femur bitwikiriwe na karitsiye ya hyaline ikurura imbere imbere yikivi.

-Menisci ya disiki imeze kuruhande no hagati itanga ubundi buryo bwo guhungabana no gukwirakwiza imbaraga kumavi mugice cyose.

-Imbere yimbere (ACL) na ligamenti yimbere (PCL) ihindura imbere-inyuma na flexion-kwaguka.

-Ingingo yo hagati yo hagati hamwe na ligamente ingwate ihindura ivi mu ndege zabo.

-Izindi nyubako zihindura ivi zirimo iliotibial bundle hamwe nigice cyamahembe yinyuma.

04. Bursae nuburyo bwa Cystic

Imiterere myinshi ya cystic ikunze kuboneka hafi yivi, harimo tendon sheath cysts na synovial bursae. Tendon sheath cysts ni ibintu byiza bidasanzwe byometseho fibrous fibrous ihuza kandi irimo urusenda.

Cyst ya popliteal (ni ukuvuga, cyst ya Baker) ni cyst ikunze kugaragara cyane mumubiri. Bikomoka kuri bursa hagati yumutwe wo hagati wimitsi ya gastrocnemius na semimembranosus tendon. Cysts ya popliteal isanzwe idafite ibimenyetso ariko akenshi iba ifitanye isano nindwara zo munda zifata ivi.

Hano hari bursae enye imbere yivi. Suprapatellar bursa yegeranye na capsule yivi kandi iri hagati ya rectus femoris tendon na femur, hamwe numuvuduko wacyo hamwe n ivi hamwe nabakuze benshi. Prepatellar bursa iryamye imbere ya patella. Indwara ya infrapatellar bursa irenze igice cyigice cya kure cya patellar hamwe na tibial tuberosity, mugihe bursa yimbitse ya infrapatellar bursa iri hagati y igice cya kure cyigitereko cyimbere hamwe nigitereko cyimbere. Bursa itagaragara irashobora gutwikwa no gukabya gukabije cyangwa guhahamuka, nko gupfukama igihe kirekire, mugihe gukoresha cyane imiterere yo kwagura ivi bishobora gutera kubyimba infrapatellar bursa, nko gusimbuka inshuro nyinshi cyangwa kwiruka.

Ibice byo hagati byivi byiganjemo ingagi ya burose, semimembranosus bursa, na suprapatellar bursa. Goosefoot bursa iherereye hagati ya tibial ihagarara ya tibial ingwate ya ligament hamwe na fonction intera ya fonction ya suture, imitsi yoroheje ya femorale na semitendinosus. Semimembranosus bursa iri hagati ya semimembranosus tendon na medial tibial condyle, na burrapa ya suprapatellar ni bursa nini mu ivi kandi iherereye hejuru ya patella no hejuru yimbitse yimitsi ya quadriceps.

05 Urwego ruhuriweho

Kugirango usuzume ivi rikora neza, saba umurwayi gufata umwanya ukunda kandi ahindure cyane ivi kuburyo agatsinsino kegereye gluteal groove bishoboka; inguni isanzwe ya flexion igera kuri 130 °.

Kugirango usuzume kwagura ivi saba umurwayi gufata umwanya wo kwicara no kwagura ivi. Kwagura ivi kurenza ukuguru kugororotse cyangwa kutagira aho bibogamiye (0 °) nibisanzwe kubarwayi bamwe ariko byitwa hyperextension. Gukabya kurenza 3 ° -5 ° ni ibintu bisanzwe. Hyperextension irenze iyi ntera yitwa ivi retroflexion kandi ni uburyo budasanzwe.

Ikizamini cya homas kigerageza guhinduka kwa quadriceps na hip flexors.

Niba amasezerano ya hip flexion ahari, ikibero cyumutwe wo hasi ugana hejuru kurisenge aho gutembera cyangwa kumanuka hamwe nameza yo gusuzuma.

Inguni yibibero bimanikwa kumeza yikizamini byerekana urwego rwamasezerano ya hip flexion.

Niba kwadriceps gukomera bihari, ukuguru kwa hepfo ya drape kuzenguruka kumeza yikizamini. Inguni ikozwe no kuguru kumaguru yo hepfo hamwe numurongo wubutaka wubutaka byerekana urwego rwa quadriceps.

06. Isuzuma rihamye

Ikizamini cya Posterior Drawer - Ikizamini cyo gukurura inyuma gikorerwa hamwe nu murwayi mu mwanya wa supine, ikibuno cyanduye cyahindutse kuri 45 °, ivi ryerekeje kuri 90 °, naho ikirenge kidafite aho kibogamiye. Umugenzuzi afata tibia yegeranye yumurwayi n'amaboko yombi mu muzingi mugihe ashyira igikumwe cyamaboko yombi kuri tibial tuberosity. Imbaraga zisubira inyuma noneho zikoreshwa kuri tibia yegeranye. Kwimura inyuma ya tibia ya cm zirenga 0.5-1 hamwe no kwimura inyuma kurenza iy'uruhande rwiza byerekana amarira igice cyangwa yuzuye amarira yinyuma yimbere yimbere.

Quadriceps Active Contraction Test - Ihindura ikirenge cyumurwayi (ubusanzwe yicaye kumaguru) kandi ifite umurwayi ugerageza kunyerera ikirenge imbere kumeza yisuzumabumenyi (kurwanya ukuboko kwabashinzwe ibizamini), iyi myitozo itera imitsi ya quadriceps kwandura, bikazaviramo guhinduranya imbere ya tibia byibuze 2mm mumyanya yimbere.

Ikizamini cya Tibial External Rotation Test - Ikizamini cyo kuzunguruka cyo hanze gikoreshwa mugutahura ibikomere byinyuma byuruhande no kuba hari ibikomere byimbere. Tibia irazunguruka hanze kuri 30 ° na 90 ° yo guhindagurika kw'ivi. Ikizamini ni cyiza niba uruhande rwanduye ruzunguruka hanze hejuru ya 10 ° -15 ° kurenza uruhande rwiza. Ibyiza kuri 30 ° byo guhindukirira ivi nibibi kuri 90 ° byerekana imvune yoroshye ya PLC, kandi nziza kuri 30 ° na 90 ° ya flexion yerekana gukomeretsa kumitsi yinyuma yinyuma hamwe ninyuma yinyuma.

77. Indimi zidasanzwe

Guhuza capsule ligaments

ligellar patament, medial patellar ligament, kuruhande rwa patellar ligament

Indangururamajwi

ligamenti yimbere, ligamenti yimbere

Indanganturo zidasanzwe

Hagati yingwate yo hagati, impande zombi zegeranye, popliteal oblique ligament, fibular ingwate

08. Kwinjiza ingingo

Imiterere ya Neurovasculaire

Indwara ya neurovasculaire irimo imiyoboro ya popliteal, imitsi ya popliteal, hamwe na tibial nervice (gukomeza imitsi ya sciatic) igenda inyuma yinyuma yivi.

Imyakura isanzwe ya peroneal nishami ryuruhande rwimyanya myakura.

09. Imitsi ifitanye isano

Imbere

Quadriceps igizwe na rectus femoris, vastus medialis, vastus lateralis, na intermedius femoris.

Uruhande rwinyuma

Hamstrings

ikubiyemo biceps femoris, semitendinosus na semimembranosus;

Gastrocnemius.

Anteromedial

Tibialis imbere.

Imitsi ikomeza guhagarara neza kumavi, harimo quadriceps, imitsi ya suture, hamstrings, imitsi yoroheje yumugore, biceps femoris, semitendinosus, na semimembranosus.

10. Isuzuma ry'umubiri

1. Ikizamini cyo kureba

Itegereze urujya n'uruza rw'amavi ku ruhande rwanduye no ku rundi ruhande rw'umurwayi, kandi witondere niba hari kubyimba kwaho, ibara ry'uruhu rudasanzwe, no kugenda bidasanzwe, n'ibindi 3.

2

reba ububabare no kubyimba, ubujyakuzimu, ingano na kamere, hamwe nuruhande rwanduye rwumurwayi ahantu hatuje bishoboka.

3. Gukangurira

Reba kugendagenda kumavi ukoresheje ibikorwa bikora kandi byoroshye byumurwayi.

4. Igipimo

Gupima uburebure bwa buri gice cyigihimba kimwe nuburebure bwuzuye, umuzenguruko wurugingo, urwego rwimikorere yingingo, imbaraga zimitsi, gutakaza aho wumva, nibindi, hanyuma ukore inyandiko nibimenyetso.

5. Ikizamini kidasanzwe

 - ikizamini kireremba patella: reba niba hari effusion mu ivi ryumurwayi.

Gusuzuma inzira

Nyuma yo gukanda burrapa ya suprapatellar kugirango yemere ko amazi yegeranya, niba hari amazi mumyanya y'amavi, patella ikanda buhoro buhoro nurutoki rwerekana, hanyuma igitutu nikimara kurekurwa, patella izareremba hejuru munsi yingufu za fluide ya fluide, kandi mugihe igitutu kirekuwe, patella izaba ifite ibyuka cyangwa bireremba kubera imbaraga za buoyant.

- Ikizamini cyo gushushanya: kureba niba hari ibyangiritse kuri ligamenti.

Ikizamini cyo gukuramo imbere: umurwayi aryamye ku buriri, guhindagurika kw'ivi 90 °, ibirenge biringaniye ku buriri, komeza uruhuke. Isuzuma ku birenge by’umurwayi kugirango bikosorwe, amaboko afashe impera ya tibial yumutwe wivi, gukurura inyana imbere, nko kwimura tibia imbere yimbere kurenza uruhande rwiza rwa 5mm nibyiza, nibyiza byerekana ko igikomere cyimbere cyimbere (Icyitonderwa: Ikizamini cya Lachman nikizamini cyimbere cyikizamini cyikivi cya 30 °).

Ikizamini cyo gukurura inyuma: umurwayi aryamye ku mugongo, yunama ivi kuri 90 °, ashyira amaboko yombi ku mugongo w’ivi, ashyira igikumwe ku ruhande rwagutse, asunika kandi akurura impera y’inyana asubira inyuma inshuro nyinshi, kandi tibia igenda isubira inyuma ku gitsina gore nk'icyiza, ibyo bikaba byerekana ko igice cy'imbere cyacitse.

- Gusya gusya: gusobanura niba hari ibyangiritse kuri menisque y'amavi.

Ikizamini cyo Gupfukama Gufata Amavi: Uburyo bwo kwisuzumisha kumubiri bukoreshwa mugusuzuma ingwate zomugongo hamwe nibikomere bya menisque yo mu ivi.

Umurwayi ari mumwanya ufite ivi ryanduye ryahindutse kuri 90 °.

1. Ikizamini cyo guterura kizunguruka

Usuzuma akanda inyana ku itako ry'umurwayi agafata agatsinsino n'amaboko yombi kugira ngo azamure inyana ku murongo muremure w'inyana, mu gihe akora ingendo zo mu nda no hanze; niba ububabare bubaye kumpande zombi zivi, birakekwa ko ari igikomere cyuruhande.

2. Ikizamini cyo kwikuramo ibizunguruka

Isuzuma rifata ikirenge cy'ingingo zanduye n'amaboko yombi, ku buryo ivi ryanduye ryahinduwe kuri 90 ° kandi inyana ikaba ihagaze neza kandi ikirenge hejuru. Noneho kanda ivi hepfo hanyuma uzenguruke inyana imbere n'inyuma icyarimwe. Niba hari ububabare kuruhande rwimbere ninyuma rwikivi, byerekana ko menisque yimbere ninyuma yangiritse.

Niba ivi riri guhindagurika cyane, harakekwa amahembe yinyuma ya meniscus; niba ari kuri 90 °, hakekwa guturika hagati; niba ububabare bubaye iyo wegereye umwanya ugororotse, harakekwa gucika amahembe yimbere.

- Ikizamini cyo guhangayika: kwitegereza umurwayi kugirango yangiritse ku mpande zombi.

Ikizamini cyo guhangayikisha ivi ni isuzuma ryumubiri rikoreshwa mugusuzuma ingwate zifatika zivi.

Umwanya: Umurwayi aryamye hejuru yigitanda cyo kwisuzumisha, kandi ingingo yanduye irashimuswe yitonze kuburyo ukuguru kwanduye kwashyizwe hanze yigitanda.

Umwanya uhuriweho: ivi rishyirwa mumwanya wagutse rwose hamwe na 30 ° ihindagurika.

Gukoresha imbaraga: Mu myanya ibiri yavuzwe haruguru, umugenzuzi afata ukuguru kw’umurwayi ukoresheje amaboko yombi kandi agashyira impungenge ku mpande zo hagati no ku mpande zombi, ku buryo ingingo yo mu ivi ishimutwa cyangwa ikongerwaho, ni ukuvuga ibizamini bya valgus na valgus bikorwa kandi ugereranije n’uruhande rwiza.

Niba ububabare bubaye mu ivi mugihe cyo gusaba guhangayika, cyangwa niba inguni ihindagurika na eversion isanze itari murwego rusanzwe kandi hakaba hari ibyiyumvo byerekana, byerekana ko hariho sprain cyangwa guturika kwingingo zegeranye. Iyo ibizamini byo kuzenguruka hanze ari byiza, byerekana ko icyerekezo kigororotse cyo hagati kidahungabana, kandi hashobora kubaho ibikomere byo hagati yingwate yo hagati, menisque yo hagati hamwe na capsule ihuriweho; mugihe ikizamini cyo kuzenguruka imbere ari cyiza, cyerekana ko icyerekezo kigororotse kidahagaze neza, kandi hashobora kubaho ibikomere kuri menisque yinyuma cyangwa hejuru ya karitsiye.

11. Kwerekana amavi

1. Ikizamini cya X-ray

ikoreshwa mugusuzuma kuvunika hamwe na osteoarthropathie igabanuka. Ibiro biremereye (bihagaze) ikivi gifatanye imbere hamwe no kureba firime irashobora kureba igufwa, icyuho cyamavi nibindi.

2. Kubara tomografiya (CT)

CT scan irashobora gufasha gusuzuma ibibazo byamagufwa no kuvunika kworoshye. Ubwoko bwihariye bwa CT scan burashobora kumenya neza gout, nubwo ingingo idacanwa.

3. Ultrasound

Koresha amajwi yumvikana kugirango ubyare amashusho nyayo yuburyo bworoshye bwimiterere yimyenda no mumavi. Ultrasound irashobora kwiyumvisha impinduka zindwara nka mastoide yamagufwa kumpande zombi, kwangirika kwa karitsiye, synovitis, gufatira hamwe, kubyimba fossa, no kubyimba kwa menici.

4. Ishusho ya Magnetic resonance imaging (MRI)

Iki kizamini gifasha gusuzuma ibikomere byoroheje, nka ligaments, tendons, karitsiye n'imitsi.

Ibizamini bya laboratoire: Niba umuganga akeka ko yanduye cyangwa yaka umuriro, gupima amaraso ndetse rimwe na rimwe arthrocentezi °, inzira ikuraho amazi make ava mu ivi kugirango isesengure laboratoire, irashobora gukenerwa.

12. Impamvu zisanzwe zitera ububabare

1. Gukomeretsa

ibikomere byo mu mitsi nka ligamenti y'imbere n'inyuma hamwe na ligamente ingwate hamwe n'amarira; ibikomere bya menisque; patellar tendonitis n'amarira; kuvunika amagufwa n'ibindi.

2. Indwara ya rubagimpande

osteoarthritis iterwa no kwambara no kurira bya karitsiye; rubagimpande ya rubagimpande iterwa na sisitemu yumubiri yibasira ingingo; goutte iterwa no gukora kristu ziva kuri acide nyinshi ya uric ifata ingingo.

3. Izindi mpamvu

synovitis itera ububabare hamwe no kubyimba; ibibazo bya patellar nka dislocation no kwambara karitsiye; ibibyimba byibasira ingingo; kuribwa biterwa no gutwikwa, nibindi.; kumara igihe kirekire; syndrome ya iliotibial fascia iterwa no guterana inshuro nyinshi biganisha kubabara hanze yivi.

13. Uburyo bukoreshwa muburyo bwo kuvura

1.Ubuvuzi

-Gusubiramo no gufata feri

-Ubukonje bukonje kandi bushyushye

-Kuvura ibiyobyabwenge

-Ubuvuzi bwa fiziki

-Kora imyitozo

-Koresha ibikoresho bifasha

2.Kubaga

-Kubaga Arthroscopique

-Arthroplasty

3.Ubundi buvuzi

-Ubuvuzi gakondo bw'Abashinwa (TCM)

-Ubuvuzi bwo gutera inshinge