Knee Joint

01. Bone Structure Kuumbwa

The mabvi akabatanidzwa ane 4 mapfupa: iyo femur, tibia, patella uye fibula.

Inosanganisira 3 compartments: the medial tibiofemoral compartment, the lateral tibiofemoral compartment, uye patellofemoral compartment, uye makamuri e3 anogovera synovial cavity.

02.Joint structure

Type: Carriage Joint

Ibvi rine majoini matatu: iyo medial tibiofemoral joint, the lateral tibiofemoral joint uye patellofemoral joint.

The tibiofemoral joint inobatanidza distal femur kune tibia, uye distal femur tapers kuti iite medial femoral condyle uye lateral femoral condyle. Iyo tibia yakati sandara, asi meniscus yakarerekera inoita kuti ibatane neinofungidzira femoral condyles.

Iyo femoral condyles inoparadzaniswa neiyo intercondylar fossa, iyo inozivikanwawo seye femoral groove kana femoral talus.

Iyo patella ibhonzo rembeu rakaiswa mukati metendon ye quadriceps muscle uye inoumba mubatanidzwa ne trochanteric groove.

Iyo inoshanda kusimudzira iyo mechaniki kuwana kweiyo quadriceps tsandanyama. Musoro wefibula unowanikwa mukati memabvi capsule asi hauwanzoshanda sechinhu chinorema-inotakura articular surface. Iyo femoral condyles uye tibial plateau inoumba mutsara wekubatana.

03. Joint Stability

Kugadzikana kwemabvi akabatanidzwa kunochengetedzwa nemhando dzakasiyana-siyana dzakapfava dzinopawo kudzivirira kwekudzivirira mukati mekubatana.

Iyo tibia nefemur yakafukidzwa nehyaline cartilage inobata kuvhunduka mukati memabvi akabatanidzwa.

-Iyo disc-shaped lateral uye medial menisci inopa kuwedzerwa kushamiswa uye kugovera masimba pamabvi mukati mekubatana.

-Iyo anterior cruciate ligament (ACL) uye posterior cruciate ligament (PCL) inodzikamisa anterior-posterior uye flexion-extension movements.

-Iyo medial collateral ligament uye lateral collateral ligament inodzikamisa mabvi mundege dzavo.

-Zvimwe zvivako zvinogadzirisa mabvi zvinosanganisira iyootibial bundle uye chikamu chemashure anotevera nyanga.

04. Bursae uye Cystic Structures

Zvimiro zvinoverengeka zvecystic zvinowanzowanikwa zvakatenderedza ibvi, kusanganisira tendon sheath cysts uye synovial bursae. Tendon sheath cysts ibhenign abnormalities yakamisikidzwa nedense fibrous connective tissue uye ine mucus.

Iyo popliteal cyst (kureva, Baker's cyst) ndiyo inonyanya kuzivikanwa synovial cyst mumuviri. Inobva ku bursa pakati pemusoro wepakati we gastrocnemius muscle uye semimembranosus tendon. Popliteal cysts kazhinji asymptomatic asi inowanzobatanidzwa ne intra-articular disorders yemabvi.

Kune mana anowanzo bursae pamberi pemabvi. Iyo suprapatellar bursa iri proximal kumabvi capsule uye iri pakati perectus femoris tendon uye femur, uye traffic yayo nemabvi akabatanidzwa muvakuru vazhinji. Iyo prepatellar bursa inongova anterior kune patella. Iyo yepamusoro-soro infrapatellar bursa inorara pamusoro peiyo distal chikamu che patellar tendon uye tibial tuberosity, nepo yakadzika infrapatellar bursa iri pakadzika pakati pe distal chikamu che patellar tendon uye anterior tibial tuberosity. Iyo yepamusoro-soro bursa inogona kupiswa nekushandisa zvakanyanya kana kushungurudzika, sekupfugama kwenguva refu, nepo kunyanya kushandiswa kwemabvi-kuwedzeredza zvimiro kunogona kutungamirira mukuzvimba kweyakadzika infrapatellar bursa, sekuramba kusvetuka kana kumhanya.

Iyo yepakati pemabvi inotongwa negoosefoot bursa, semimembranosus bursa, uye suprapatellar bursa. Iyo goosefoot bursa iri pakati petibial stop ye lateral tibial collateral ligament uye distal fusion tendons ye suture, yakaonda femoral uye semitendinosus muscles. Iyo semimembranosus bursa iri pakati pe semimembranosus tendon uye medial tibial condyle, uye suprapatellar bursa ndiyo yakakura bursa mumabvi akabatanidzwa uye iri pamusoro pe patella uye pakadzika pasi pe quadriceps muscle.

05 Joint range yekufamba

Kuti uongorore kushanduka kwemabvi anoshingaira, ita kuti murwere atore nzvimbo yakagadzikana uye awedzere kushanduka kwebvi kuitira kuti chitsitsinho chive pedyo ne gluteal groove sezvinobvira; iyo yakajairika kona yekuchinjika inenge 130°.

Kuti uongorore kuwedzera kwemabvi ita kuti murwere atore nzvimbo yekugara uye awedzere kuwedzera kwemabvi. Kuwedzerwa kwemabvi kunze kwegumbo rakarurama kana nzvimbo isina kwaakarerekera (0 °) inowanzoitika kune vamwe varwere asi inonzi hyperextension. Kuwedzeredza kusingapfuuri 3 ° -5 ° iratidziro yakajairika. Hyperextension mhiri kwerudzi urwu inonzi ibvi retroflexion uye iratidziro isina kujairika.

Iyo homas bvunzo inoedza kuchinjika kweiyo quadriceps uye hip flexors.

Kana hip flexion contracture iripo, chidya chekudonha chepasi chekupedzisira chichakona chakananga padenga pane kudonha kana kudzika netafura yekuongorora.

Kona yechidya chakarembera patafura yebvunzo inoratidza dhigirii rehudyu flexion contracture.

Kana quadriceps tightness iripo, gumbo rezasi redrape richakona kure netafura yekuongororwa. Kona yakaumbwa negumbo rezasi rinodonhedza netambo yepasi rinotaridza dhigirii rekumanikidzana kwequadriceps.

06. Kuongororwa kwekugadzikana kwekubatana

Posterior Drawer Test - The posterior drawer test inoitwa nemurwere ari panzvimbo yepamusoro, hudyu yakakanganiswa inoshanduka kusvika ku45 °, ibvi rinoshandura kusvika 90 °, uye tsoka isingaiti. Muongorori anobata proximal tibia yemurwere nemaoko ese ari mudenderedzwa akabata achiisa zvigunwe zvemaoko ese pane tibial tuberosity. Simba rekudzokera shure rinobva rashandiswa kune proximal tibia. A posterior displacement yetibia yeanopfuura 0.5-1 cm uye posterior displacement yakakura kudarika iyo yehutano hwehutano hunoratidza kusara kwechidimbu kana kuzara kwemashure emakumbo emabvi.

Quadriceps Active Contraction Test - Inodzikamisa tsoka yemurwere (inowanzogara patsoka) uye ane murwere anoedza kutsveta rutsoka mberi patafura yekuongorora (kupikisa kushorwa kweruoko rwemuongorori), kufambisa uku kunoita kuti tsandanyama ye quadriceps iite chibvumirano, izvo zvichaita kuti anterior shifting of the tibia by at least 2mm ibvi or knee.

Tibial External Rotation Test - Iyo tibial yekunze kutenderera bvunzo inoshandiswa kuona posterior lateral kukuvara kwekona uye kuvapo kwekukuvadzwa kwemashure ekupedzisira ligament. Iyo tibia inotenderedzwa kunze ichitenderedzwa pa30 ° uye 90 ° yemabvi kuchinjika. Muedzo wakanaka kana rutivi rwakakanganisika rwakatenderedzwa kunze kupfuura 10 ° -15 ° kupfuura rutivi rune utano. Yakanaka pa 30 ° yemabvi kushanduka uye yakaipa pa 90 ° inoratidza kukuvara kwePLC iri nyore, uye yakanaka pane zvose 30 ° uye 90 ° yekuputika inoratidza kukuvadzwa kune zvose zviri shure kwemashure uye posterolateral complex.

07. Periarticular ligaments

Joint capsule ligaments

patellar ligament, medial patellar ligament, lateral patellar ligament

Intracapsular ligaments

anterior cruciate ligament, posterior cruciate ligament

Extracapsular ligaments

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

08. Innervation yekubatana

Neurovascular Structure

A neurovascular bundle ine popliteal artery, popliteal vein, uye tibial nerve (kuenderera kweiyo sciatic nerve) inofamba ichingoenda kumashure kumabvi akabatanidzwa.

Iyo inowanikwa peroneal nerve ndiyo lateral branch ye sciatic nerve.

09. Misumbu Yakabatana

Anterior Lateral

Quadriceps ine rectus femoris, vastus medialis, vastus lateralis, uye intermedius femoris.

Posterior side

Hamstrings

inosanganisira biceps femoris, semitendinosus uye semimembranosus;

Gastrocnemius.

Anteromedial

Tibialis anterior.

Tsandanyama dzinochengetedza kugadzikana kwemabvi akabatanidzwa, kusanganisira quadriceps, suture muscles, hamstrings, nhete dzevakadzi, biceps femoris, semitendinosus, uye semimembranosus.

10. Kuongorora muviri

1. Kuongorora kwemaziso

Cherechedza kufamba uye kuenzana kwemajoini emabvi kune rumwe rutivi rwakakanganiswa uye kune rumwe rutivi rwomurwere, uye teerera kuti pane kuzvimba kwenzvimbo, ruvara rweganda risina kujairika, uye kufamba kusina kujairika, nezvimwewo.

2. palpation

tarisa marwadzo uye nzvimbo yekuzvimba, kudzika, chiyero uye zvisikwa, nerutivi rwakakanganiswa rwemurwere munzvimbo yakasununguka zvakanyanya sezvinobvira.

3. Kuunganidza

Tarisa kufamba kwemabvi akabatanidzwa kuburikidza nekushanda uye kungoita zvinhu zvemurwere.

4. Kuyera

Edza kureba kwechikamu chimwe nechimwe chechikamu pamwe chete nehurefu hwakazara, denderedzwa remakumbo, mararamiro ekufamba kwemajoini, simba remhasuru, kurasikirwa kwekunzwa nzvimbo, nezvimwewo, uye ita zvinyorwa uye zviratidzo.

5. kuongororwa kwakakosha

 - inoyangarara patella bvunzo: tarisa kana paine effusion mumabvi emurwere.

Kuongorora maitiro

Mushure mokusvina suprapatellar bursa kubvumira mvura kuti iunganidze, kana pane mvura mumabvi akabatanidzwa, patella inotsikirirwa zvinyoronyoro nemunwe wechiratidzo, uye kana kumanikidzwa kusunungurwa, patella ichayangarara kumusoro pasi pesimba rinoputika remvura, uye kana kumanikidzwa kuchibudiswa, patella ichava nekuputika kana kutenderera kwesimba rinoputika.

-Dhirowa bvunzo: kuona kana paine kukuvara kune iyo cruciate ligament.

Anterior drawer test: murwere anorara pamubhedha, mabvi anoputika 90 °, tsoka dzakadzika pamubhedha, ramba wakasununguka. Muongorori anopikisana netsoka dzemurwere kuti aite kuti zvigadziriswe, maoko akabata mugumo wetibial wemabvi akabatanidzwa, dhonza mhuru kumberi, zvakadai setibia anterior displacement kupfuura rutivi rwakanaka rwe5mm rwakanaka, zvakanaka zvinoratidza kuti anterior cruciate ligament kukuvadzwa (Cherechedza: muedzo weLachman ndeye anterior drawer test yebvi flexion 30 °).

Kuongorora kwedhirowa yepashure: murwere anorara pamusana wake, anokotama mabvi pa90 °, anoisa maoko ose kumusana wemabvi akabatanidzwa, anoisa chigunwe padivi rekuwedzera, anosundira uye anokwevera kuguma kwemhuru kumashure kakawanda, uye tibia inofamba ichidzokera kumashure kune femur seyakanaka, iyo inoratidza kuti posterior crumb inoputika zvachose partigaate.

-Kukuya bvunzo: kujekesa kana paine kukuvadza kune meniscus yemabvi.

Knee Joint Grinding Test: Nzira yekuongorora yepanyama inoshandiswa kutarisa lateral collateral ligament uye meniscus kukuvara kwemabvi akabatanidzwa.

Murwere ari panzvimbo yakagadzikana uye ibvi rakakanganiswa rinoputika pa 90 °.

1. Rotational kusimudza bvunzo

Muongorori anodzvanya mhuru pachidya chemurwere uye anobata chitsitsinho nemaoko maviri kuti asimudze mhuru pamwe chete neakisi yelongitudinal yemhuru, ichiita mukati nekunze kutenderera kutenderera; kana kurwadziwa kuchiitika kumativi ose emabvi, inofungidzirwa kuva lateral collateral ligament injury.

2. Rotary compression test

Muongorori anobata tsoka yegumbo rakabatwa nemaoko maviri, kuitira kuti ibvi rakakanganiswa rishandurwe pa 90 ° uye mhuru iri panzvimbo yakarurama netsoka kumusoro. Wosvina mabvi akabatana pasi wotenderedza mhuru mukati nekunze panguva imwe chete. Kana pane marwadzo mukati nekunze kwechikamu chebvi, zvinoratidza kuti mukati nekunze meniscus yakakuvadzwa.

Kana mabvi ari mukuputika kwakanyanya, posterior horn meniscus rupture inofungidzirwa; kana iri pa90 °, kuputika kwepakati kunofungidzirwa; kana kurwadziwa kuchiitika pakuswedera panzvimbo yakarurama, kuputika kwenyanga ye anterior kunofungidzirwa.

-Lateral stress test: kutarisa murwere kune kukuvara kune lateral collateral ligament.

Iro lateral knee stress test ndeyekuongorora kwepanyama kunoshandiswa kutarisa lateral collateral ligaments yemabvi.

Position: Murwere akarara pamubhedha wekuongorora, uye nhengo inobatwa inotorwa zvinyoronyoro kuitira kuti gumbo rezasi rinobatwa riiswe kunze kwemubhedha.

Joint chinzvimbo: ibvi rinoiswa munzvimbo yakawedzerwa yakazara uye iyo 30 ° yakachinjika chinzvimbo.

Simba rekushandisa: Mumabvi maviri ari pamusoro apa, muongorori anobata gumbo rezasi remurwere nemaoko maviri uye anoshandisa kushushikana kumucheto wepakati uye wepamusoro zvakateerana, kuitira kuti mabvi akabatanidzwa arege kutorwa kana kutorwa, kureva kuti, kuongororwa kwevalgus uye valgus kunoitwa uye kuenzaniswa nerutivi rwakanaka.

Kana kurwadziwa kuchiitika mumabvi akabatanidzwa panguva yekushandiswa kwekushungurudzika kwekuita, kana kana inversion uye eversion angle inowanikwa kunze kwehutano hwemazuva ose uye kune manzwiro ekuputika, zvinoratidza kuti kune kuputika kana kuputika kwe lateral collateral ligament. Kana iyo yekunze kutenderera kushushikana bvunzo yakanaka, inoratidza kuti iyo yepakati yakatwasuka kutungamira haina kugadzikana, uye panogona kunge paine maronda eiyo medial collateral ligament, medial meniscus uye joint capsule; apo kuongorora kwemukati kutenderera kwekunetseka kwakanaka, kunoratidza kuti lateral straight direction haina kugadzikana, uye panogona kuva nekukuvadzwa kune lateral meniscus kana articular surface cartilage.

11. Kufananidzira Kwemabvi

1. X-ray kuongorora

inoshandiswa kutarisa kutyoka uye degenerative osteoarthropathy. Weight-bearing (kumira) chinzvimbo ibvi akabatana mberi uye divi kuona firimu anogona kuona pfupa, ibvi akabatana gap uye zvichingodaro.

2. Computed tomography (CT)

CT scans inogona kubatsira kuongorora matambudziko emapfupa uye kuputsika kwakajeka. Rudzi rwakakosha rweCT scan runogona kunyatso ziva gout, kunyangwe mubatanidzwa hauna kupisa.

3. Ultrasound

Inoshandisa masaisai eruzha kugadzira mifananidzo chaiyo-yenguva yezvimiro zvakapfava mukati nekutenderedza ibvi. Ultrasound inogona kuona kuchinja kwepathologic senge bony mastoid pajoint margins, cartilage degeneration, synovitis, joint effusionª, popliteal fossa kuzvimba, uye meniscal bulging.

4. Magnetic resonance imaging (MRI)

Muedzo uyu unobatsira kuona kukuvara kwenyama yakapfava, senge ligaments, tendon, cartilage nemamhasuru.

Kuongororwa kwerabhoritari: Kana chiremba achifungidzira utachiona kana kuzvimba, kuongororwa ropa uye dzimwe nguva arthrocentesis °, nzira inobvisa mvura shoma kubva pamabvi akabatanidzwa kuti iongorore laboratory, inogona kudiwa.

12. Zvinowanzokonzera kurwadziwa kwemajoini

1. Kukuvadza-kwakabatana

kukuvadzwa kwemakumbo akadai seanterior uye posterior cruciate ligament uye lateral collateral ligament strains uye misodzi; meniscus kukuvara; patellar tendonitis uye misodzi; kuputika kwemapfupa uye zvichingodaro.

2. Chirwere cheArthritis

osteoarthritis inokonzerwa nokusakara uye kubvaruka kwejoint cartilage; rheumatoid arthritis inokonzerwa nehutachiona hunorwisa majoini; gout inokonzerwa nekuumbwa kwemakristasi kubva kune high uric acid inobata majoini.

3. Zvimwe zvikonzero

synovitis inokonzera kurwadziwa kwemajoini uye kuzvimba; matambudziko patellar akadai dislocation uye cartilage kupfeka; mapundu anopinda mujoini; edema inokonzerwa nekuputika, nezvimwewo; kureba kusina kunaka chimiro; iliotibial fascia syndrome inokonzerwa nekudzokorora kupesana kunotungamirira kumarwadzo kunze kwebvi.

13. Inowanzoshandiswa nzira dzokurapa

1.Conservative Treatment

- Zorora uye braking

- Inotonhora uye inopisa compresses

-Drug therapy

-Physical therapy

-Kuita kurapa

-Kushandisa zvishandiso zvinobatsira

2.Kuvhiya

-Arthroscopic kuvhiyiwa

-Arthroplasty

3.Kumwe Kurapa

-Traditional Chinese Medicine (TCM)

-Jekiseni kurapwa