Knee Kopanelo

01. Sebopeho sa Lesapo la Sebopeho

The lenonyeletso la lengole le na le masapo a 4: femur, tibia, patella le fibula.

E na le likarolo tsa 3: karolo ea medial tibiofemoral, lateral tibiofemoral compartment, le patellofemoral compartment, 'me likarolo tsa 3 li arolelana sekoti sa synovial.

02.Mohaho o kopanetsweng

Mofuta: Kopano ea Koloi

Lengole le na le manonyeletso a 3: motsoako oa tibiofemoral oa bohareng, motsoako oa lateral tibiofemoral le motsoako oa patellofemoral.

Lenonyeletso la tibiofemoral le kopanya lesela la distal ho tibia, le li-distal femur tapers ho etsa motsoako o ka hare oa femoral le lateral femoral condyle. Tibia e batla e bataletse, empa meniscus e sekametseng e etsa hore e kopane haufi-ufi le li-condyle tsa botšehali tse hlahisang maikutlo.

Li-condyle tsa botšehali li arohanngoa ke intercondylar fossa, eo hape e tsejoang e le femoral groove kapa femoral talus.

Patella ke lesapo la peo le kentsoeng ka har'a tendon ea mesifa ea quadriceps 'me e etsa motsoako le groove ea trochanteric.

E thusa ho ntlafatsa phaello ea mochini ea mesifa ea quadriceps. Hlooho ea fibula e ka har'a capsule ea lengole empa hangata ha e sebetse e le sebaka se nang le boima ba 'mele. Li-condyle tsa botšehali le sehlaba sa tibial li theha mohala o kopanetsoeng.

03. Botsitso bo Kopanetsoeng

Ho tsitsisa ha lengole la lengole ho bolokoa ke mefuta e fapaneng ea lisele tse bonolo tse fanang ka tšireletso ea cushioning ka har'a motsoako.

Tibia le femur li koahetsoe ke lefufuru la hyaline le monyang ka hare ho lengole.

-Menisci e nang le sebopeho sa disc-shaped lateral le medial e fana ka ts'oaetso e eketsehileng hape e aba matla a mangole ho pholletsa le motsoako.

-The anterior cruciate ligament (ACL) le posterior cruciate ligament (PCL) e tsitsisa metsamao e ka pele-ka morao le ea flexion-extension.

-The medial collateral ligament le lateral collateral ligament li tsitsisa lengole ka lifofane tsa tsona tse fapaneng.

-Mehaho e meng e tsitsang lengole e kenyelletsa lesela la iliotibial le karolo ea lenaka la posterior lateral.

04. Bursae le Cystic Structures

Mehaho e mengata ea cystic e atisa ho fumanoa ho pota-pota lengole, ho akarelletsa le tendon sheath cysts le synovial bursae. Li-tendon sheath cysts ke lintho tse sa tloaelehang tse nang le linama tse teteaneng tse hokahantsoeng le li-mucus.

Popliteal cyst (ke hore, Baker's cyst) ke lesapo la synovial le atileng haholo 'meleng. E tsoa ho bursa pakeng tsa hlooho e bohareng ea mesifa ea gastrocnemius le tendon ea semimembranosus. Hangata li-cysts tsa poplite ha li na matšoao empa hangata li amahanngoa le mathata a intra-articular a lengole.

Ho na le li-bursa tse 'nè tse tloaelehileng ka pele ho lengole. The suprapatellar bursa e proximal ho capsule ea lengole 'me e pakeng tsa rectus femoris tendon le femur, le sephethephethe sa eona se nang le lengole ho batho ba bangata ba baholo. Prepatellar bursa e lutse ka pele ho patella. The superficial infrapatellar bursa e lutse ka holimo ho karolo ea distal ea tendon ea patellar le tibial tuberosity, athe infrapatellar bursa e tebileng e tebile pakeng tsa karolo ea distal ea patellar tendon le anterior tibial tuberosity. Bursa e ka holimo e ka chesoa ke ho sebelisoa ho feteletseng kapa ho sithabela maikutlo, joalo ka ho khumama ka nako e telele, ha tšebeliso e feteletseng ea mehaho ea ho atolosa lengole e ka lebisa ho ruruha ha botebo ba infrapatellar bursa, joalo ka ho qhoma khafetsa kapa ho matha.

Karolo e bohareng ea lengole e laoloa ke goosefoot bursa, semimembranosus bursa, le suprapatellar bursa. The goosefoot bursa e teng pakeng tsa setopo sa tibial sa lateral tibial collateral ligament le distal fusion tendons ea suture, mesifa e tšesaane ea botšehali le ea semitendinosus. Semimembranosus bursa e pakeng tsa semimembranosus tendon le medial tibial condyle, 'me suprapatellar bursa ke bursa e kholo ka ho fetisisa ea lengole' me e fumaneha ka holim'a patella le holim'a botebo ba mesifa ea quadriceps.

05 Motsamao o kopaneng oa motsamao

Ho hlahloba ho phunya ha lengole ka mafolofolo, etsa hore mokuli a nke boemo bo tloaelehileng 'me a phunye lengole ka mokhoa o fetisisang e le hore serethe se be haufi le gluteal groove kamoo ho ka khonehang; angle e tloaelehileng ea ho phunya ke hoo e ka bang 130 °.

Ho lekola ho atolosoa ha lengole ho etsa hore mokuli a nke boemo bo lutseng 'me a eketse lengole. Ho atolosoa ha lengole ho feta leoto le otlolohileng kapa boemo ba ho se nke lehlakore (0 °) ke ntho e tloaelehileng ho bakuli ba bang empa e bitsoa hyperextension. Katoloso e fetang 3° -5° ke nehelano e tlwaelehileng. Hyperextension ho feta mefuta ena e bitsoa retroflexion ea lengole 'me ke pontšo e sa tloaelehang.

Teko ea homas e leka ho tenyetseha ha quadriceps le hip flexors.

Haeba konteraka ea hip flexion e le teng, serope sa ntlha e ka tlaase e tla sekamela ho ea siling ho e-na le ho theoha kapa ho theoha ka tafole ea ho hlahloba.

Sebaka sa serope se leketlileng tafoleng ea tlhahlobo se bonahatsa tekanyo ea konteraka ea hip flexion.

Haeba quadriceps tightness e le teng, leoto le ka tlase la drape le tla ema hole le tafole ea tlhahlobo. Sekhutlo se entsoeng ke leoto le ka tlase le nang le pompo ea fatše e bonahatsa tekanyo ea tsitsipano ea quadriceps.

06. Tlhahlobo ea botsitso bo kopanetsoeng

Teko ea Ka morao ea Drawer - Tlhahlobo ea li-drawer e ka morao e etsoa le mokuli ea boemong ba supine, letheka le amehileng le fetohela ho 45 °, lengole le fetohe ho 90 °, 'me leoto le sa nke lehlakore. Mohlahlobi o tšoara li-proximal tibia tsa mokuli ka matsoho a mabeli ka ho tšoara selikalikoe ha a ntse a beha menoana ea matsoho a mabeli holim'a tibial tuberosity. Joale matla a morao a sebelisoa ho proximal tibia. Ho falla ka morao ho tibia ho feta 0.5-1 cm le ho falla ka morao ho feta lehlakoreng le phetseng hantle ho bontša ho lla ha karolo e itseng kapa e feletseng ea mokokotlo oa mokokotlo oa lengole.

Quadriceps Active Contraction Test - E tsitsisa leoto la mokuli (hangata le lutse ka leoto) 'me mokuli a leka ho thellisa leoto ka pele tafoleng ea ho hlahloba (khahlanong le ho hanyetsa ha letsoho la mohlahlobi), mokhoa ona o etsa hore mesifa ea quadriceps e fokotsehe, e leng se tla fella ka ho fetoha ha pele ho tibia ka bonyane 2mm ea lengole la mokokotlo oa lengole.

Teko ea Tibial External Rotation - Teko ea ho potoloha ka ntle ea tibial e sebelisetsoa ho lemoha likotsi tsa sekhutlo tsa morao-rao le ho ba teng ha likotsi tsa morao-rao tsa li-ligament. Tibia e pota-potiloe ka ntle ho 30 ° le 90 ° ea ho phunya lengole. Tlhahlobo e ntle haeba lehlakore le amehileng le pota-potiloe ka ntle ho feta 10 ° -15 ° ho feta lehlakore le phetseng hantle. E ntle ho 30 ° ea ho phunya lengole le e mpe ho 90 ° e fana ka maikutlo a kotsi e bonolo ea PLC, 'me e ntle ka bobeli 30 ° le 90 ° ea ho phunya e fana ka maikutlo a kotsi ho li-posterior cruciate ligament le posterolateral complex.

07. Periarticular ligaments

Li-capsules tse kopantsoeng

patellar ligament, medial patellar ligament, lateral patellar ligament

Li-Intracapsular ligaments

ka pele cruciate ligament, posterior cruciate ligament

Li-ligaments tsa Extracapsular

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

08. Innervation ea lenonyello

Sebopeho sa Neurovascular

Sehlopha sa methapo ea methapo e nang le methapo ea popliteal, popliteal vein, le tibial nerve (tsoelopele ea methapo ea sciatic) e tsamaea ka morao ho lenonyeletso la lengole.

Methapo e tloaelehileng ea peroneal ke lekala la lateral la methapo ea sciatic.

09. Mesifa e Amanang

Anterior Lateral

Quadriceps e na le rectus femoris, vastus medialis, vastus lateralis, le intermedius femoris.

Lehlakore le ka morao

Li-hamstrings

ho kenyelletsa biceps femoris, semitendinosus le semimembranosus;

Gastrocnemius.

Li-anteromedial

Tibialis anterior.

Mesifa e bolokang botsitso ba lenonyeletso la lengole, ho kenyelletsa le quadriceps, mesifa ea suture, hamstrings, mesifa e tšesaane ea botšehali, biceps femoris, semitendinosus, le semimembranosus.

10. Tlhahlobo ea ’mele

1. Tlhahlobo ea pono

Ela hloko ho sisinyeha le ho lekana ha manonyeletso a lengole lehlakoreng le amehileng le lehlakoreng le fapaneng la mokuli, 'me u ele hloko hore na ho na le ho ruruha ha sebaka,' mala o sa tloaelehang oa letlalo, le ho tsamaea ho sa tloaelehang, joalo-joalo.

2. palpation

hlahloba sebaka sa bohloko le ho ruruha, botebo, bophara le tlhaho, ka lehlakore le amehileng la mokuli le le boemong bo phutholohileng ka hohle kamoo ho ka khonehang.

3. Ho bokella

Hlahloba ho sisinyeha ha lengole la lengole ka mesebetsi e sebetsang le e sa sebetseng ea mokuli.

4. Tekanyo

Lekanya bolelele ba karolo e 'ngoe le e' ngoe ea leoto hammoho le bolelele ba kakaretso, selikalikoe sa leoto, mefuta e mengata ea ho sisinyeha ha manonyeletso, matla a mesifa, ho lahleheloa ke sebaka sa kutlo, joalo-joalo, 'me u etse litlaleho le matšoao.

5. tlhahlobo e khethehileng

 - floating patella test: hlokomela hore na ho na le effusion lenonyellong la lengole la mokuli.

Ho hlahloba mokhoa

Ka mor'a ho penya suprapatellar bursa ho lumella mokelikeli hore o bokelle, haeba ho na le mokelikeli mokokotlong oa lengole, patella e hatelloa ka bonolo ka monoana oa index, 'me hang ha khatello e lokolloa, patella e tla phalla holimo tlas'a matla a matla a mokelikeli,' me ha khatello e lokolloa, patella e tla ba le matla a ho phalla kapa a phaphametseng.

- Teko ea li-drawer: ho bona hore na ho na le tšenyo ho ligament ea cruciate.

Teko ea li-anterior drawer: mokuli o robala betheng, lengole le 90 °, maoto a bataletse betheng, a lule a phutholohile. Mohlahlobi khahlanong le maoto a mokuli ho etsa hore e be e tsitsitseng, matsoho a tšoereng karolo ea tibial ea lengole la lengole, a hule namane ka pele, joalo ka tibia anterior displacement ho feta lehlakoreng le phetseng hantle la 5mm e ntle, e ntle e fana ka maikutlo a hore kotsi ea anterior cruciate ligament (Hlokomela: teko ea Lachman ke teko ea pele ea li-drawer ea lengole flexion 30 °).

Tlhahlobo ea li-drawer e ka morao: mokuli o robala ka mokokotlo oa hae, o khumama ka lengole ka 90 °, o beha matsoho ka bobeli ka morao ho lenonyeletso la lengole, o beha monoana o motona ka lehlakoreng la extensor, o sutumetsa le ho hula pheletsong e haufi ea namane ka morao ka makhetlo a mangata, 'me tibia e khutlela morao holim'a femur e le ntle, e leng se bontšang hore karolo ea posterior crumb e arotsoe ka ho feletseng kapa e arotsoe ka ho feletseng.

- Tlhahlobo ea ho sila: ho hlakisa hore na ho na le tšenyo leha e le efe ho meniscus ea lengole.

Teko e Kopanetsoeng ea Knee: Mokhoa oa ho hlahloba 'mele o sebelisetsoang ho hlahloba lateral collateral ligament le meniscus likotsi tsa lengole.

Mokuli o le boemong bo tloaelehileng le lengole le amehileng le tsitsitse ho 90 °.

1. Teko ea ho phahamisa e potolohang

Mohlahlobi o hatella namane holim'a serope sa mokuli 'me o tšoara serethe ka matsoho a mabeli ho phahamisa namane ho latela axis ea longitudinal ea namane, ha a ntse a etsa mekhoa ea ho potoloha ka hare le ka ntle; haeba bohloko bo hlaha mahlakoreng ka bobeli a lengole, ho belaelloa hore ke kotsi ea lateral collateral ligament.

2. Teko ea khatello ea rotary

Mohlahlobi o tšoara leoto la leoto le amehileng ka matsoho a mabeli, e le hore lengole le amehileng le fetohe ho 90 ° 'me namane e be sebakeng se otlolohileng le leoto le holimo. Ebe u petetsa lenonyeletso la lengole ho ea tlase 'me u fetole namane ka hare le ka ntle ka nako e le' ngoe. Haeba ho na le bohloko karolong e ka hare le ka ntle ea lengole, e bontša hore meniscus e ka hare le ka ntle e senyehile.

Haeba lengole le le boemong bo feteletseng, ho belaelloa hore lenaka la posterior meniscus le phunyeha; haeba e le ka 90 °, ho belaelloa ho phunyeha ha bohareng; haeba bohloko bo etsahala ha o atamela sebakeng se otlolohileng, ho belaelloa hore ho na le lenaka le ka pele la lenaka.

- Tlhahlobo ea khatello ea kelello ea morao-rao: ho shebella mokuli bakeng sa tšenyo ea lateral collateral ligament.

Tlhahlobo ea khatello ea kelello ea lengole ke tlhahlobo ea 'mele e sebelisetsoang ho hlahloba li-lateral collateral ligaments tsa lengole.

Boemo: Mokuli o robala betheng ea tlhahlobo, 'me leoto le amehileng le nkoa ka bonolo e le hore leoto le ka tlaase le amehileng le behoe ka ntle ho bethe.

Boemo bo kopanetsoeng: lengole le behiloe sebakeng se atolositsoeng ka ho feletseng le boemo ba 30 ° bo tsitsitseng.

Tšebeliso ea matla: Libakeng tse peli tse ka holimo tsa lengole, mohlahlobi o tšoara leoto le ka tlaase la mokuli ka matsoho a mabeli 'me o sebelisa khatello ea maikutlo mahlakoreng a bohareng le a mahlakoreng ka ho latellana, e le hore lenonyeletso la lengole le nkiloe ka mokhoa o sa reroang kapa le kenngoe, ke hore, liteko tsa valgus le valgus li etsoa le ho bapisoa le lehlakore le phetseng hantle.

Haeba bohloko bo hlaha mokokotlong oa lengole nakong ea ts'ebetso ea ts'ebetso ea khatello ea kelello, kapa haeba ho kheloha le ho pota-pota ho fumanoa ho tsoa ka ntle ho mokhoa o tloaelehileng 'me ho na le maikutlo a hlahang, ho fana ka maikutlo a hore ho na le ho senyeha kapa ho phatloha ha lateral collateral ligament. Ha tlhahlobo ea khatello ea ho potoloha ka ntle e le ntle, e bontša hore tataiso e otlolohileng ea bohareng ha e tsitsa, 'me ho ka' na ha e-ba le liso tsa mokokotlo oa mokokotlo oa mokokotlo, meniscus ea bohareng le capsule e kopanetsoeng; ha tlhahlobo ea khatello ea ho potoloha ka hare e le ntle, e bontša hore tataiso e otlolohileng ea lateral ha e tsitsa, 'me ho ka' na ha e-ba le likotsi ho lateral meniscus kapa articular surface cartilage.

11. Knee Imaging

1. Tlhahlobo ea X-ray

e sebelisetsoang ho hlahloba ho robeha le ho senyeha ha masapo a masapo. Boima (ho ema) boemo ba lengole kopanetsweng ka pele le lehlakoreng pono filimi ka hlokomela lesapo, lengole lenonye lekhalo joalo-joalo.

2. Computed tomography (CT)

CT scans e ka thusa ho hlahloba mathata a masapo le ho robeha ho poteletseng. Mofuta o khethehileng oa CT scan o ka khetholla gout ka nepo, le haeba lenonyeletso le sa chese.

3. Ultrasound

E sebelisa maqhubu a molumo ho hlahisa litšoantšo tsa nako ea sebele tsa lisele tse bonolo tse ka hare le ho pota-pota lengole. Ultrasound e ka bona ka mahlo a kelello liphetoho tsa pathologic tse kang bony mastoid ka mahlakoreng a kopantsoeng, ho senyeha ha lefufuru, synovitis, effusion e kopantsoengª, popliteal fossa ho ruruha le meniscal bulging.

4. Litšoantšo tsa Magnetic resonance (MRI)

Tlhahlobo ena e thusa ho hlahloba likotsi tsa lisele tse bonolo, tse kang li-ligaments, tendon, lefufuru le mesifa.

Liteko tsa laboratori: Haeba ngaka e belaella tšoaetso kapa ho ruruha, liteko tsa mali 'me ka linako tse ling arthrocentesis°, mokhoa oa ho ntša mokelikeli o monyenyane lenonyeletsong la lengole bakeng sa tlhahlobo ea laboratori, o ka hlokahala.

12. Lisosa tse tloaelehileng tsa bohloko ba manonyeletso

1. E amanang le kotsi

likotsi tsa ligament tse kang anterior le posterior cruciate ligament le lateral collateral ligament strains le meokho; likotsi tsa meniscus; patellar tendonitis le meokho; ho robeha ha masapo joalo-joalo.

2. E amanang le Ramatiki

osteoarthritis e bakoang ke ho senyeha ha lefufuru le manonyeletso; ramatiki ea ramatiki e bakoa ke sesole sa 'mele se hlaselang manonyeletso; gout e bakoa ke ho thehoa ha likristale tse tsoang ho uric acid e ngata e amang manonyeletso.

3. Lisosa tse ling

synovitis e bakang bohloko ba manonyeletso le ho ruruha; mathata a patellar a kang ho kheloha le ho roala ha lefufuru; lihlahala tse hlaselang lenonyeletso; edema e bakoang ke ho ruruha, joalo-joalo; boemo bo bobe ba nako e telele; iliotibial fascia syndrome e bakoang ke ho ferekana ho pheta-pheta ho lebisang ho bohloko ka ntle ho lengole.

13. Mekhoa ea phekolo e sebelisoang ka tloaelo

1.Kalafo ea Conservative

- Phomolo le braking

- Li-compress tse batang le tse chesang

-Kalafo ea lithethefatsi

-Kalafo ya mmele

-Kalafo ea boikoetliso

- Tšebeliso ea lisebelisoa tse thusang

2.Ho buoa

- Opereishene ea Arthroscopic

- Arthroplasty

3.Liphekolo Tse Ling

-Meriana ea Tloaelo ea Sechaena (TCM)

-Kalafo ea ente