Wadajirka Jilibka

01. Qaab-dhismeedka Lafaha

The Lafaha jilibka ayaa ka kooban 4 lafo: femur, tibia, patella iyo fibula.

Waxay ka kooban tahay 3 qaybood: qaybta dhexe ee tibiofemoral, qaybta dambe ee tibifemoral, iyo qaybta patellofemoral, iyo 3 qaybood waxay wadaagaan godka synovial.

02.Qaabka wadajirka ah

Nooca: Wadajirka Gaariga

Jilibku wuxuu leeyahay 3 kala-goysyo: isku-dhafka tibifemoral ee dhexdhexaadka ah, isku-dhafka tibiofemoral ee lateral iyo patellofemoral-ka.

Isku-dhafka tibiofemoral wuxuu isku xiraa femur fog ilaa tibia, iyo femur femur tapers si ay u sameeyaan kondyle femoral dhexdhexaad ah iyo kondyle femoral lateral. Tibia waa mid siman, laakiin meniscus-ku-jiidhku wuxuu keenaa xiriir dhow oo lala yeesho kondyesyada femoral ee soo baxaya.

Condyles femoral waxaa kala soocay fossa intercondylar, kaas oo sidoo kale loo yaqaan jeexdin femoral ama talus femoral.

Patella waa lafo abuur ku dhex-yaalla seedaha muruqa quadriceps waxayna samaysaa kala-goysyo leh jeexdin trochanteric ah.

Waxay u adeegtaa si kor loogu qaado faa'iidada farsamada ee muruqa quadriceps. Madaxa fibula wuxuu ku yaalaa gudaha kaabsalka jilibka laakiin inta badan uma shaqeeyo sida dusha sare ee culeyska. Condyles femoral iyo plateau tibial waxay sameeyaan xariiqda wadajirka ah.

03. Xasilloonida Wadajirka ah

Xasiloonida wadajirka jilibka waxaa lagu ilaaliyaa unugyo jilicsan oo kala duwan kuwaas oo sidoo kale bixiya ilaalinta barkinta gudaha wadajirka.

Tibia iyo femur waxay ku daboolan yihiin carjawda hyaline ee shoogga nuugaya gudaha wadajirka jilibka.

-Xidhmada lateral iyo medial menisci waxay bixiyaan nuugista shoogga dheeraadka ah waxayna sidoo kale qaybiyaan xoogaga jilibka dhammaan wadajirka.

-Xiddiga hore ee lafdhabarta (ACL) iyo laf-dhabarka lafdhabarta (PCL) waxay dejiyaan dhaqdhaqaaqyada hore-u-socodka iyo dabacsanaanta-fidinta.

-Xiddiga dhexdhexaadka ah ee dhexdhexaadka ah iyo xuubka dammaanadda lateral waxay dejiyaan jilibka diyaaradahooda.

-Qaabka kale ee xasiliya jilibka waxaa ka mid ah xirmada iliotibial iyo qayb ka mid ah geeska dambe ee dambe.

04. Dhismayaasha Bursaae iyo Cystic

Dhowr qaab-dhismeedka cystic ayaa inta badan laga helaa jilibka agtiisa, oo ay ku jiraan fiilooyinka galka seedaha iyo bursiska synovial. Fiixaha galka Tendonku waa cillado aan caadi ahayn oo ay ku dahaaran yihiin unug isku xiran oo fibrous ah oo cufan oo ka kooban xab.

Cyst-ka popliteal (ie, cyst Baker's cyst) waa cystka ugu caansan ee jirka. Waxay ka timaadaa bursa inta u dhaxaysa madaxa dhexe ee muruqa gastrocnemius iyo xuubka semimembranosus. Fiix popliteal caadi ahaan waa asymptomatic laakiin badanaa waxay la xiriiraan xanuunada intra-articular ee jilibka.

Waxaa jira afar bursi oo caadi ah oo ku yaal xagga hore ee jilibka. Bursa suprapatellar waxay u dhowdahay kaabsal jilibka waxayna u dhaxaysaa seedaha femoris femoris iyo femur, iyo taraafikada jilibka ee inta badan dadka waaweyn. Bursa prepatellar waxay ku taalaa dhanka hore ee patella. Bursa infrapatellar dusha sare waxay u jiiftaa qaybta fog ee xuubka patellar iyo tuberosity tibial, halka bursa infrapatellar qoto dheer ay u dhexeyso qaybta fog ee xuubka patellar iyo tuberosity hore ee tibial tuberosity. Bursada sare waxay ku bararsan kartaa isticmaalka xad dhaafka ah ama dhaawac, sida jilba joog dheer, halka isticmaalka xad dhaafka ah ee qaababka fidinta jilibka ay u horseedi karto bararka bursada qoto dheer ee infrapatellar, sida boodboodka ama orodka soo noqnoqda.

Dhinaca dhexe ee jilibka waxaa xukuma goosefoot bursa, semimembranosus bursa, iyo bursa suprapatellar. Bursa goosefoot waxay ku taallaa inta u dhaxaysa joogsiga tibial ee seedaha dammaanadda tibial lateral iyo seedaha fiyuuska fog ee tolida, femoral dhuuban iyo murqaha semitendinosus. Semimembranosus bursa wuxuu u dhexeeyaa tendonka semimembranosus iyo kondyle tibial medial, iyo bursada suprapatellar waa bursada ugu weyn ee jilibka waxayna ku taal meel ka sarreysa patella iyo dusha qoto dheer ee muruqa quadriceps.

05 Dhaqdhaqaaqa wadajirka ah

Si loo qiimeeyo jilibka jilibka ee firfircoon, bukaanku ha u qaato booska u nugul oo si weyn u jilba jilibka si ciribtu ugu dhowaato gluteal groove intii suurtagal ah; xagasha dabacsanaantu waa qiyaastii 130°.

Si loo qiimeeyo fidinta jilibka, bukaanku ha qaato boos fadhi oo kor u qaad kordhinta jilibka. Kordhinta jilibka ee ka baxsan lugta tooska ah ama booska dhexdhexaadka ah (0°) waa wax caadi u ah bukaannada qaarkood laakiin waxaa loo yaqaan 'hyperextension'. Kordhinta xad dhaafka ah ee aan ka badnayn 3°-5° waa soojeedin caadi ah. Kordhinta ka baxsan xadkan waxaa loo yaqaan dib-u-celinta jilibka waana soo bandhigid aan caadi ahayn.

Tijaabada homas waxay tijaabisaa dabacsanaanta quadriceps iyo miskaha.

Haddii qanjidhada miskaha ee miskaha uu jiro, bawdada cirifka hoose ee jilicsan ayaa u janjeeri doonta saqafka halkii ay ka soo raaci lahayd ama hoos u dhigi lahayd miiska baaritaanka.

Xagasha bowdada ka laadlaadda ee miiska imtixaanku waxay ka tarjumaysaa heerka qanjidhada miskaha.

Haddii cidhiidhi quadriceps uu jiro, lugta hoose ee dahaarka ayaa ka fogaan doona miiska baaritaanka. Xagasha ay samaysay lugta hoose ee daadinaysa oo leh xariiqda tuubada dhulka ayaa ka tarjumaysa heerka xiisadda quadriceps.

06. Qiimaynta xasiloonida wadajirka ah

Tijaabada Drawer-ka dambe - Tijaabada sawir qaade dambe ayaa lagu sameeyaa bukaanka oo ku jira booska dhabarka, sinta ay saamaysay ayaa u leexday 45 °, jilibka ayaa u leexday 90 °, cagtuna waa dhexdhexaad. Baadhiyuhu waxa uu ku qabsanayaa tibia u dhow ee bukaanka labada gacmood si wareeg ah oo xajin ah isaga oo saaraya suulka labada gacmood ee tuberosity tibial. Xoog gadaale ayaa markaa lagu dabaqaa tibia u dhow. Barokaca dambe ee tibia oo ka badan 0.5-1 cm iyo barokaca dambe ee ka weyn kan dhinaca caafimaadka leh ayaa tilmaamaya jeex ama qayb ka mid ah jeexjeexa jilibka dambe ee jilibka.

Quadriceps Test Contraction Firfircoon - Waxay dejisaa cagaha bukaanka (badanaa waxay ku fadhidaa cagta) waxayna leedahay bukaanku isku dayo inuu cagaha hore ugu sii wado miiska baaritaanka (oo ka soo horjeeda caabbinta gacanta baaraha), maneuverkan wuxuu keenaa murqaha quadriceps inuu qandaraas galo, taas oo keeni doonta isbedelka hore ee tibia by ugu yaraan 2mm jilibka dhabarka.

Imtixaanka Wareegga Dibeda ee Tibial - Imtixaanka wareegga dibadda ee tibial waxaa loo isticmaalaa in lagu ogaado dhaawacyada geesaha dambe ee dambe iyo joogitaanka dhaawacyada lafdhabarta ee dambe. Tibia ayaa si dadban dibadda ugu wareegta 30° iyo 90° ee laablaabashada jilibka. Tijaabadu waa togan haddii dhinaca ay saamaysay dibadda loo rogo in ka badan 10°-15° in ka badan dhinaca caafimaadka qaba. Fiican ee 30 ° ee jilibka jilibka iyo diidmada 90 ° waxay soo jeedinaysaa dhaawaca fudud ee PLC, iyo labadaba 30 ° iyo 90 ° ee dabacsanaantu waxay soo jeedinayaan dhaawaca labadaba lafdhabarta dambe iyo iskudhafka dambe.

07. Seediyaha xuubka

Seedyaha kaabsulka wadajirka ah

xuubka patellar, seedaha patellar medial, ligament patellar lateral

seedaha intracapsular

xiniinyaha hore ee lafdhabarta, lafdhabarta dambe

Seedyaha ka baxsan

Xubinta damiinashada dhexdhexaadka ah, seedaha damiinashada lateral, ligament oblique ah ee popliteal, ligament dammaanad fibular

08. Innervation ee wadajirka ah

Qaab-dhismeedka Neerfaha

Xirmado neerfaha oo ay ku jiraan halbowlaha popliteal, xididka popliteal, iyo dareemaha tibial (sii wadida dareemaha sciatic) waxay u socotaa gadaal xagga laf dhabarta.

Dareemaha peroneal-ka caadiga ah waa laanta dambe ee neerfaha sciatic.

09. Murqaha isku xidhan

Dambe hore

Quadriceps waxay ka kooban tahay femoris malawadka, vastus medialis, vastus lateralis, iyo femoris intermedius.

Dhinaca dambe

Muruqyada

waxaa ku jira biceps femoris, semitendinosus iyo semimembranosus;

Gastrocnemius.

Anteromedial

Tibialis hore.

Muruqyada ilaaliya xasiloonida wadajirka jilibka, oo ay ku jiraan quadriceps, murqaha suture, murqaha murqaha, muruqyada femoris dhuuban, biceps femoris, semitendinosus, iyo semimembranosus.

10. Baaritaanka jirka

1. Baaritaan muuqaal ah

3

2. garaacid

hubi goobta xanuunka iyo bararka, qoto dheer, baaxadda iyo dabeecadda, iyada oo dhinaca bukaanku saameeyeen ee ku jira meel dabacsan intii suurtagal ah.

3. Abaabulka

Hubi dhaqdhaqaaqa wadajirka jilibka iyada oo loo marayo waxqabadyada firfircoon ee bukaanka.

4. Cabbirka

Cabbir dhererka qayb kasta oo addinka ah iyo sidoo kale wadarta dhererka, wareegga addinka, kala duwanaanshaha dhaqdhaqaaqa kala-goysyada, xoogga muruqa, luminta aagga dareenka, iwm, oo samee diiwaanno iyo calaamado.

5. imtixaan gaar ah

 - Baadhitaanka patella sabbaynaya: u fiirso haddii uu jiro dareere ku jira lafaha jilibka ee bukaanka.

Baaritaanka habka

Ka dib marka la tuujiyo bursaha suprapatellar si ay u oggolaato dareeraha inuu ku ururo, haddii uu jiro dareere ku jira wadajirka jilibka, patella si tartiib ah ayaa loogu riixaa farta murqaha, iyo marka cadaadiska la sii daayo, patella ayaa kor u sabeyn doonta xoogga qulqulka ee dareeraha, iyo marka cadaadiska la sii daayo, patella waxay yeelan doontaa dareen soo jiidasho leh ama sabayn sababtoo ah buoyanka.

- Tijaabada khaanadaha: si loo eego haddii ay jirto dhaawac soo gaadhay seedaha cruciate.

Tijaabada khaanadaha hore: bukaanku sariirta ayuu si siman ugu seexdaa, jilibka 90 °, cagaha sariirta si siman, isdeji. Baadhaha ka soo horjeeda cagaha bukaanka si loo hagaajiyo, gacmaha oo haya cidhifka tibial ee jilibka jilibka, u jiid kubka xagga hore, sida barokaca hore ee tibia marka loo eego dhinaca caafimaadka leh ee 5mm waa mid togan, si fiican ayaa u soo jeedinaysa in dhaawaca xididdada hore ee lafdhabarta (Fiiro gaar ah: Imtixaanka Lachman waa tijaabada sawirka hore ee jilibka 30 °).

Tijaabada khaanadaha dambe: bukaanku wuxuu u jiifaa dhabarka, jilibka ayuu ku foorariyaa 90 °, wuxuu labada gacmood saarayaa dhabarka jilibka, wuxuu suulka saarayaa dhinaca fidinta, riixaya oo soo jiidaya dhamaadka kubka kubka si isdaba joog ah, iyo tibia waxay dib ugu socotaa femur si fiican, taas oo soo jeedinaysa in qaybta dambe ay si buuxda u jajaban tahay.

- Tijaabada shiida: si loo caddeeyo haddii ay jiraan wax dhaawac ah oo soo gaadhay meniscus ee jilibka.

Tijaabada Burinta Jilibka ee Wadajirka ah: Habka baaritaanka jirka ee loo isticmaalo in lagu hubiyo seedaha dammaanadda ah iyo dhaawacyada meniscus ee wadajirka jilibka.

Bukaanku wuxuu ku sugan yahay meel u nugul jilibka ay saameysay oo la leexiyay 90 °.

1. Imtixaan qaadis wareeg ah

Baaraha ayaa ku riixaya kubka bowdada bukaanka wuxuuna ku hayaa ciribta labada gacmood si uu u qaado kubka dhinaca dhidibka dheer ee kubka, isagoo sameynaya dhaqdhaqaaqyo wareeg ah oo gudaha iyo dibadda ah; haddii xanuun uu ka dhaco labada dhinac ee jilibka, waxaa la tuhunsan yahay inuu yahay dhaawaca seedaha dammaanadda ah.

2. Tijaabada cadaadiska wareega ah

Baaruhu wuxuu ku hayaa cagta addinka ay saameysay labada gacmood, si jilibka ay saameysay uu u leexiyo 90° kubkana wuxuu ku yaal meel toosan oo cagtu kor u kaceyso. Ka dib isku dhufashada jilibka hoos oo u wareeji kubka gudaha iyo dibadda isku mar. Haddii uu jiro xanuun dhinaca gudaha iyo dibadda ah ee wadajirka jilibka, waxay muujinaysaa in meniscus gudaha iyo dibaddaba uu dhaawacmay.

Haddii jilibka uu ku jiro dabacsanaan daran, geesta dambe ee meniscus-ka ayaa la tuhunsan yahay; haddii ay tahay 90 °, dillaac dhexdhexaad ah ayaa la tuhunsan yahay; haddii xanuunku dhaco marka loo soo dhawaado booska toosan, geesaha hore ee dillaaca ayaa la tuhunsan yahay.

- Tijaabada walbahaarka dambe: si loo eego bukaanka dhaawaca soo gaadhay seedaha dammaanadda.

Baaritaanka cadaadiska jilibka ee dambe waa baaritaan jireed oo loo isticmaalo in lagu hubiyo seedaha dammaanadda ee jilibka.

Booska: Bukaanku wuxuu ku seexdaa sariirta baaritaanka, oo qaybta ay saameysay si tartiib ah ayaa loo afduubaa si lugta hoose ee ay saameysay la dhigo sariirta ka baxsan.

Booska wadajirka ah: jilibka ayaa la dhigayaa booska si buuxda loo fidiyay iyo 30 ° booska dabacsan.

Codsiga xoogga ah: Labada meelood ee sare ee jilibka, baaraha ayaa ku haya lugta hoose ee bukaanka labada gacmood oo ku dhejinaya walbahaarka dhinacyada dhexdhexaadka ah iyo kuwa dambe, si wadajirka jilibka loo afduubo ama la isku dhejiyo, ie, baaritaanka valgus iyo valgus ayaa la sameeyaa oo la barbar dhigo dhinaca caafimaadka qaba.

Haddii xanuunku ku dhaco jilibka jilibka inta lagu jiro habka codsiga cadaadiska, ama haddii leexashada iyo xagasha da'da ah la ogaado in ay ka baxsan tahay heerka caadiga ah oo uu jiro dareen soo jiidasho leh, waxay soo jeedinaysaa in uu jiro murgacasho ama dillaaca lafdhabarta dammaanadda. Marka baaritaanka cadaadiska wareegga dibadda uu yahay mid togan, waxay muujineysaa in jihada tooska ah ee dhexdhexaadka ah ay tahay mid aan degganeyn, waxaana laga yaabaa inay jiraan dhaawacyo ka mid ah xuubka dammaanadda dhexdhexaadka ah, meniscus medial iyo kaabsal wadajir ah; marka baaritaanka cadaadiska wareegga gudaha uu yahay mid togan, waxay muujineysaa in jihada tooska ah ee tooska ah ay tahay mid aan degganeyn, waxaana laga yaabaa inay jiraan dhaawacyo soo gaara meniscus lateral ama carjawda dusha articular.

11. Sawirka Jilibka

1. Baaritaanka raajada

loo isticmaalo in lagu hubiyo jabka iyo osteoarthropathy xumaaday. Miisaan-qaadista (taagista) booska wadajirka jilibka ee hore iyo filimka muuqaalku wuxuu arki karaa lafta, faraqa wadajirka jilibka iyo wixii la mid ah.

2. Sawir qaade la sameeyay (CT)

Baaritaannada CT-ga ayaa kaa caawin kara in la ogaado dhibaatooyinka lafaha iyo jabka daahsoon. Nooc gaar ah oo CT-ga ah ayaa si sax ah u aqoonsan kara gout, xitaa haddii kala-goysyadu aanu bararin.

3. Ultrasound

Wuxuu adeegsadaa mowjadaha dhawaaqa si uu u soo saaro sawirada wakhtiga dhabta ah ee qaab dhismeedka unugyada jilicsan ee jilibka iyo hareerihiisa. Ultrasound wuxuu arki karaa isbeddellada cudurrada sida mastoids-ka lafaha ee xudduudaha wadajirka ah, carjawda carjawda, synovitis, dheecaan wadajir ah, barar fossa popliteal, iyo barar meniscal ah.

4. Sawir-qaadista resonance magnetic (MRI)

Tijaabadani waxay caawisaa in la ogaado dhaawacyada unugyada jilicsan, sida seedaha, seedaha, carjawda iyo murqaha.

Tijaabada shaybaadhka: Haddii dhakhtarku ka shakiyo caabuq ama caabuq, baadhitaano dhiig iyo mararka qaarkood arthrocentesis °, nidaam ka saaraya qadar yar oo dareere ah wadajirka jilibka si loo baaro shaybaarka, ayaa loo baahan karaa.

12. Sababaha caadiga ah ee xanuunka kala goysyada

1. Dhaawac la xiriira

Dhaawacyada seedaha sida ligament hore iyo dambe iyo xiniinyaha dammaanadda lateral iyo jeexjeexyada; dhaawacyada meniscus; tendonitis patellar iyo ilmada; jabka lafaha iyo wixii la mid ah.

2. Arthritis la xidhiidha

osteoarthritis oo ay keento jeexjeexa iyo dillaaca carjawda wadajirka ah; rheumatoid arthritis-ka waxaa keena habka difaaca jirka oo weerara xubnaha; gout waxa sababa samaynta kiristaalo oo ka yimi aashitada uric acid oo saraysa oo saamaynaysa kala goysyada.

3. Sababaha kale

synovitis oo keena xanuun wadajir ah iyo barar; dhibaatooyinka patellar sida kala-baxa iyo xirashada carjawda; burooyinka soo weeraray wadajirka; barar uu keeno barar, iwm; qaab xumo dabadheeraad ah; iliotibial fascia syndrome oo ay sababtay is-jiidh soo noqnoqda oo keenaya xanuun ka baxsan jilibka.

13. Hababka daawaynta ee sida caadiga ah loo isticmaalo

1.Daawaynta Conservative

-Nasasho iyo bareegga

- Cadaadis qabow iyo kulul

-Daawaynta dawada

-Daawaynta jidhka

-Daawaynta jimicsiga

-Isticmaalka aaladaha caawinta

2.Qaliin

-Qaliinka arthroscopic

-Arthroplasty

3.Daawaynta Kale

-Daawaynta Shiineeska dhaqameed (TCM)

-Daawaynta duritaanka