Nhlanganelo wa Matsolo

01. Xivumbeko xa Xivumbeko xa Marhambu

Ku... nhlonge ya matsolo yina marhambu ya 4: femur, tibia, patella na fibula.

Yi na swiyenge swa 3: xiyenge xa ​​tibiofemoral xa le xikarhi, xiphemu xa tibiofemoral xa le tlhelo, na xiyenge xa ​​patellofemoral, naswona swiyenge swa 3 swi avelana xivandla xa synovial.

02.Xivumbeko xa nhlanganelo

Muxaka: Nhlanganiso wa Xigolonyana

Matsolo yana mahlangano ya 3: nhlonge ya tibiofemoral yale xikarhi, nhlonge ya lateral tibiofemoral na nhlonge ya patellofemoral.

Nhlanganelo wa tibiofemoral wu hlanganisa distal femur na tibia, naswona distal femur tapers ku endla medial femoral condyle na lateral femoral condyle. Tibia yi rhetela nyana, kambe meniscus leyi rhetaka yi yi tisa eka ku hlangana swinene na ti projecting femoral condyles.

Ti femoral condyles ti hambanisiwa hi intercondylar fossa, leyi tlhelaka yitiveka tani hi femoral groove kumbe femoral talus.

Patella i marhambu ya mbewu lawa ya nghenisiweke endzeni ka tendon ya misiha ya quadriceps naswona ya endla nhlangano na trochanteric groove.

Yi tirha ku ndlandlamuxa ku vuyeriwa ka michini ka misiha ya quadriceps. Nhloko ya fibula yi kumeka endzeni ka knee capsule kambe hi ntolovelo ayi tirhi tani hi articular surface leyi rhwalelaka ntiko. Ti femoral condyles na tibial plateau swi endla layini ya nhlangano.

03. Ku tshamiseka ka Nhlangano

Ku tiya ka nhlonge ya matsolo ku hlayisiwa hi ti tissue to hambana hambana to olova leti tlhelaka ti nyika nsirhelelo wa cushioning endzeni ka nhlonge.

Tibia na femur swifunengetiwe hi shock-absorbing hyaline cartilage endzeni ka nhlonge ya matsolo.

-Ti menisci ta xivumbeko xa disc ta lateral na medial tinyika shock absorption yo engetelela naswona titlhela ti hangalasa matimba eka matsolo eka nhlonge hinkwayo.

-Nsinya wa le mahlweni wa xihambano (ACL) na xirhendzevutani xa le ndzhaku xa xihambano (PCL) swi tiyisisa ku fambafamba ka le mahlweni-endzhaku na ku flexion-extension.

-Medil collateral ligament na lateral collateral ligament swi tiyisisa matsolo eka ti plane ta swona.

-Swivumbeko swin’wana leswi tiyisisaka matsolo swikatsa iliotibial bundle na xiphemu xa posterior lateral horn.

04. Swivumbeko swa Bursae na Cystic

Swivumbeko swo hlayanyana swa cystic switala ku kumeka ku rhendzela matsolo, kukatsa na tendon sheath cysts na synovial bursae. Tendon sheath cysts i ku nga tolovelekangi loku nga riki na khombo loku rhendzeriweke hi tinyama to hlanganisa ta fibrous to enta naswona ti na mucus.

Popliteal cyst (i.e., Baker’s cyst) i synovial cyst leyi tolovelekeke swinene emirini. Yisungula kusuka eka bursa exikarhi ka nhloko yale xikarhi ya misiha ya gastrocnemius na semimembranosus tendon. Ti popliteal cysts hi ntolovelo ati na swikombiso kambe titala ku fambelanisiwa na swiphiqo swa intra-articular swa matsolo.

Kuna mune wa ti bursae leti tolovelekeke emahlweni ka matsolo. Suprapatellar bursa yi le kusuhi na knee capsule naswona yitshama exikarhi ka rectus femoris tendon na femur, na ku famba ka yona na knee joint eka vanhu votala lavakulu. Prepatellar bursa yitshama nyana emahlweni ka patella. Bursa yale henhla ya infrapatellar yitshama ehenhla kuya eka xiphemu xale kule xa patellar tendon na tibial tuberosity, kasi deep infrapatellar bursa yitshama swinene exikarhi ka xiphemu xale kule xa patellar tendon na anterior tibial tuberosity. Bursa yale henhla yinga pfimba hiku tirhisiwa ngopfu kumbe ku vaviseka, kufana na ku khinsama nkarhi woleha, kasi kutirhisiwa ngopfu ka swivumbeko swo engetela matsolo swinga endla leswaku ku pfimba ka deep infrapatellar bursa, kufana naku tlula kumbe ku tsutsuma hiku phindha-phindha.

Xiphemu xa le xikarhi xa matsolo xi lawuriwa hi goosefoot bursa, semimembranosus bursa na suprapatellar bursa. Goosefoot bursa yi kumeka exikarhi ka tibial stop ya lateral tibial collateral ligament na distal fusion tendons ya suture, misiha yo olova ya femoral na semitendinosus. Semimembranosus bursa yile xikarhi ka semimembranosus tendon na medial tibial condyle, naswona suprapatellar bursa i bursa leyikulu swinene eka nhlonge ya matsolo naswona yi kumeka ehenhla ka patella nale ka vuandlalo byo enta bya misiha ya quadriceps.

05 Nhlayo ya ku famba ka nhlangano

Ku kambela ku olovisiwa ka matsolo loku tirhaka, endla leswaku muvabyi a teka xiyimo xo olova naswona a gombonyokisa matsolo hi xitalo leswaku xirhendze xi va ekusuhi na gluteal groove hilaha swi nga kotekaka hakona; angle ya ntolovelo ya flexion yi kwalomu ka 130°.

Ku kambela ku andzisiwa ka matsolo endla leswaku muvabyi a teka xiyimo xo tshama na ku kurisa ku andzisiwa ka matsolo. Ku engeteriwa ka matsolo ku tlula nenge wo kongoma kumbe xiyimo xa neutral (0°) swi tolovelekile eka vavabyi van’wana kambe swi vuriwa hyperextension. Ku andzisiwa ngopfu lokunga hundziki 3°-5° i nkombiso lowu tolovelekeke. Hyperextension ku tlula mpimo lowu yi vuriwa knee retroflexion naswona i presentation leyi nga tolovelekangiki.

Xikambelo xa homas xi kambela ku olova ka ti quadriceps na ti hip flexors.

Loko ku ri na hip flexion contracture, thigh ya draping lower extremity yita angle kuya e silingi ematshan’wini yo flush kumbe kuya ehansi na tafula ro kambela.

Angle ya xirhendze lexi lengalengaka eka tafula ro kambela yi kombisa mpimo wa hip flexion contracture.

Loko ku tsana ka quadriceps ku ri kona, nenge wa le hansi wa drape wu ta angle ekule na tafula ra xikambelo. Angle leyi vumbiwaka hi draping lower leg na ground plumb line yikombisa degree ya quadriceps tension.

06. Ku kamberiwa ka ku tshamiseka ka nhlanganelo

Xikambelo xa Drawer ya le Ndzhaku - Xikambelo xa drowara ya le ndzhaku xi endliwa na muvabyi a ri eka xiyimo xo tshama ehansi, xirhendze lexi khumbekaka xi govekile ku ya eka 45°, matsolo ya goveka ku ya eka 90°, naswona nenge wu ri eka neutral . Mukamberi u khoma tibia ya le kusuhi ya muvabyi hi mavoko hamambirhi hi ku khoma ka xirhendzevutana loko a ri karhi a veka swikunwana swa mavoko hamambirhi eka tibial tuberosity. Kutani ku tirhisiwa matimba yo tlhelela endzhaku eka tibia ya le kusuhi. Ku rhurha ka le ndzhaku ka tibia kutlula 0.5-1 cm na ku rhurha ka le ndzhaku lokukulu kutlula ka tlhelo leri hanyeke kahle swikomba ku handzuka ka xiphemu kumbe hiku hetiseka ka posterior cruciate ligament ya matsolo.

Quadriceps Active Contraction Test - Yi tiyisisa nenge wa muvabyi (hi ntolovelo wu tshamile emilengeni) naswona wu endla leswaku muvabyi a ringeta ku rhetela nenge emahlweni eka tafula ro kambela (ku lwisana na ku lwisana ka voko ra muhlahluvi), maneuver leyi yi endla leswaku misiha ya quadriceps yi hlangana, leswi nga ta endla leswaku ku cinca ka le mahlweni ka tibia hi kwalomu ka 2mm eka ku pfumaleka ka ligament ya le ndzhaku ya cruciate matsolo.

Tibial External Rotation Test - Xikambelo xa tibial external rotation test xitirhisiwa ku kuma ku vaviseka ka posterior lateral corner xikan’we na vukona bya posterior cruciate ligament injuries. Tibia yi rhendzeleka ehandle hi ndlela yo ka yi nga tirhi eka 30° na 90° ya ku olovisiwa ka matsolo. Xikambelo xiva xiri positive loko tlhelo leri khumbekaka ri rhendzeleka ehandle kutlula 10°-15° kutlula tlhelo leri hanyeke kahle. Positive eka 30° ya knee flexion na negative eka 90° yi ringanyeta ku vaviseka ko olova ka PLC, naswona positive eka 30° na 90° ya flexion swi ringanyeta ku vaviseka eka havumbirhi bya posterior cruciate ligament na posterolateral complex.

07. Swirhendzevutana swa le matlhelo ya swirho

Ti ligaments ta ti capsule ta nhlonge

patellar ligament, xirho xa le xikarhi xa patellar, xirho xa le tlhelo xa patellar

Ti ligaments ta le ndzeni ka xirho xa le ndzeni

anterior cruciate ligament, xirho xa le ndzhaku xa xihambano

Ti ligaments ta le handle ka ti-capsular

xirho xa le xikarhi xa xisirhelelo, xirho xa le tlhelo xa xisirhelelo, xirho xa popliteal oblique, xirho xa xisirhelelo xa fibular

08. Ku nghenisiwa ka misiha ya nhlonge

Xivumbeko xa misiha ya misiha

Ntlawa wa misiha ya misiha lowu nga na popliteal artery, popliteal vein na tibial nerve (ku ya emahlweni ka sciatic nerve) wu famba endzhakunyana ka nhlonge ya matsolo.

Nsinya lowu tolovelekeke wa peroneal i rhavi ra le tlhelo ra misiha ya sciatic.

09. Misiha leyi Fambelanaka

Xiphemu xa le mahlweni xa Lateral

Quadriceps yi vumbiwa hi rectus femoris, vastus medialis, vastus lateralis na intermedius femoris.

Xiphemu xa le ndzhaku

Swirhendzevutana swa le ndzhaku

swi katsa biceps femoris, semitendinosus na semimembranosus;

Xitsongwatsongwana xa Gastrocnemius.

Anteromedial ya le mahlweni

Tibialis ya le mahlweni.

Misiha leyi hlayisaka ku tshamiseka ka nhlonge ya matsolo, ku katsa na quadriceps, misiha ya suture, hamstrings, misiha yo olova ya femoral, biceps femoris, semitendinosus na semimembranosus.

10. Ku kamberiwa ka miri

1. Ku kamberiwa hi mahlo

Languta ku famba-famba na ku ringana ka mahlangano ya matsolo eka tlhelo leri khumbekeke na tlhelo leri hambaneke ra muvabyi, naswona u nyikela nyingiso eka loko ku ri na ku pfimba ka ndhawu, muvala wa nhlonge lowu nga tolovelekangiki, na ku famba loku nga tolovelekangiki, na swin’wana 3.

2. ku khoma-khoma hi voko

kambela ndzhawu ya switlhavi na ku pfimba, vuenti, vukulu na ntumbuluko, laha tlhelo leri khumbekaka ra muvabyi riri eka xiyimo xo ntshunxeka hilaha swinga kotekaka hakona.

3. Ku hlengeletiwa ka vanhu

Languta ku fambafamba ka nhlonge ya matsolo hi ku tirhisa migingiriko leyi tirhaka na leyi nga tirhiki ya muvabyi.

4. Ku pima

Pima ku leha ka xiphemu xin’wana na xin’wana xa xirho xikan’we na ku leha hinkwako, ku rhendzeleka ka xirho, ku famba ka mahlangano, matimba ya misiha, ku lahlekeriwa hi ndhawu yo twa, na swin’wana, naswona u endla tirhekhodo na swikoweto.

5. xikambelo xo hlawuleka

 - floating patella test: languta loko ku ri na effusion eka nhlonge ya matsolo ya muvabyi.

Ku kambisisa endlelo

Endzhaku ko tsindziyela suprapatellar bursa leswaku kuta pfumelela mati kuva ya hlengeletana, loko kuri na mati eka nhlonge ya matsolo, patella yi tshikileriwa hiku olova hi index finger, naswona loko ntshikelelo wu humesiwile, patella yita papamala kuya e henhla ehansi ka buoyant force ya fluid, naswona loko ntshikelelo wu humesiwa, patella yitava na popping kumbe floating sensation hikokwalaho ka buoyant force

- Drawer test: ku vona loko kuri na ku onhaka eka cruciate ligament.

Anterior drawer test: muvabyi u etlela a flat ehenhla ka mubedo, knee flexion 90 °, milenge yi flat ehenhla ka mubedo, tshama a ntshunxekile. Mukamberi ku lwisana na milenge ya muvabyi ku endla leswaku yi tshamiseka, mavoko ya khoma makumu ya tibial ya nhlangano wa matsolo, ku koka rhole kuya emahlweni, kufana na tibia anterior displacement kutlula tlhelo leri hanyeke kahle ra 5mm i positive, positive yi ringanyeta leswaku anterior cruciate ligament injury (Xiya: xikambelo xa Lachman i anterior drawer test ya knee flexion 30 °).

Posterior drawer test: muvabyi u etlela hi nhloko, a gombonyokisa matsolo hi 90°, a veka mavoko hamambirhi endzhaku ka nhlangano wa matsolo, a veka xikunwana eka tlhelo ra extensor, a susumeta no koka makumu ya proximal ya rhole endzhaku hiku phindha-phindha, naswona tibia yi tlhelela endzhaku eka femur tani hi positive, leswi kombaka leswaku posterior cruciate ligament yi pandzekile hi xiphemu kumbe hiku hetiseka.

- Xikambelo xo sila: ku hlamusela loko kuri na ku onhaka eka meniscus ya matsolo.

Knee Joint Grinding Test: Ndlela yo kambela miri leyi tirhisiwaka ku kambela ku vaviseka ka lateral collateral ligament na meniscus ya nhlonge ya matsolo.

Muvabyi u le ka xiyimo xo olova laha matsolo lama khumbekeke ma govekeke hi 90°.

1. Xikambelo xa ku tlakusa hi ku rhendzeleka

Mukamberi u tshikilela rhole eka xirhendze xa muvabyi kutani a khoma xirhendze hi mavoko hamambirhi ku tlakusa rhole hi longitudinal axis ya rhole, loko a ri karhi a endla ku rhendzeleka ka le ndzeni na le handle; loko ku vava ku humelela eka matlhelo hamambirhi ya matsolo, ku ehleketeleriwa leswaku i ku vaviseka ka lateral collateral ligament.

2. Xikambelo xa ntshikelelo wa ku rhendzeleka

Mukamberi u khoma nenge wa xirho lexi khumbekaka hi mavoko hamambirhi, leswaku matsolo lawa ya khumbekaka ya gombonyoka eka 90° naswona rhole riva eka xiyimo xo yima laha nenge wunga e henhla. Kutani tsindziyela nhlonge ya matsolo kuya ehansi kutani u rhendzeleka na rhole endzeni nale handle hi nkarhi wun’we. Loko ku ri ni ku vava eka tlhelo ra le ndzeni ni ra le handle ra nhlonge ya matsolo, swi kombisa leswaku meniscus ya le ndzeni ni ya le handle yi onhakile.

Loko matsolo ya ri eka ku olovisiwa lokukulu, ku ehleketeleriwa leswaku ku pandzeka ka meniscus ya rimhondzo ra le ndzhaku; loko yiri eka 90°, ku ehleketeleriwa ku pandzeka ka le xikarhi; loko ku vava ku humelela loko u tshinela eka xiyimo xo kongoma, ku ehleketeleriwa leswaku ku pandzeka ka rimhondzo ra le mahlweni.

- Xikambelo xa ntshikelelo wa le tlhelo: ku languta muvabyi ku vona loko a onhakile eka ligament ya le tlhelo ya collateral.

Xikambelo xa ntshikelelo wa matsolo ya le tlhelo i ku kamberiwa ka miri loku tirhisiwaka ku kambela ti lateral collateral ligaments ta matsolo.

Xiyimo: Muvabyi u etlela a tshamile ehenhla ka mubedo wo kambela, naswona xirho lexi khumbekaka xi tekeriwa hi vukheta leswaku nenge wa le hansi lowu khumbekaka wu vekiwa ehandle ka mubedo.

Xiyimo xa nhlangano: matsolo ya vekiwa eka xiyimo lexi andlariweke hiku hetiseka na xiyimo xa 30° flexed.

Ku tirhisiwa ka matimba: Eka swiyimo swimbirhi leswi nga laha henhla swa matsolo, muhlahluvi u khoma nenge wa le hansi wa muvabyi hi mavoko hamambirhi kutani a tirhisa ntshikelelo eka matlhelo ya le xikarhi na ya le tlhelo hi ku landzelelana, leswaku nhlonge ya matsolo yi tekeriwa kumbe ku nghenisiwa hi ndlela yo ka yi nga tirhi, i.e., swikambelo swa valgus na valgus swa endliwa no pimanisiwa na tlhelo leri hanyeke kahle.

Loko ku vava ku humelela eka nhlonge ya matsolo hi nkarhi wa endlelo ro chela ntshikelelo, kumbe loko inversion na eversion angle yi kumeka yi ri ehandle ka mpimo wa ntolovelo naswona ku ri na popping sensation, swi ringanyeta leswaku ku na ku pfimba kumbe ku pandzeka ka lateral collateral ligament. Loko xikambelo xa ntshikelelo wa ku rhendzeleka ehandle xi ri kahle, swi kombisa leswaku tlhelo ro kongoma ra le xikarhi a ri tshamisekanga, naswona ku nga va na swirhumbana swa ligament ya le xikarhi ya collateral, meniscus ya le xikarhi na capsule ya nhlangano; loko xikambelo xa ntshikelelo wa ku rhendzeleka ka le ndzeni xi ri kahle, swi kombisa leswaku tlhelo ro kongoma ra le tlhelo a ri tshamisekanga, naswona ku nga ha va na ku vaviseka eka meniscus ya le tlhelo kumbe articular surface cartilage.

11. Ku Endla Swifaniso swa Matsolo

1. Ku kamberiwa hi X-rheyi

yi tirhisiwa ku kambela ku tshoveka ka marhambu na degenerative osteoarthropathy. Weight-bearing (yima) position knee joint front na side view film yinga languta marhambu, knee joint gap na swin’wana.

2. Ku endliwa ka tomography hi khompyuta (CT) .

Ti- CT scan ti nga pfuna ku kambela swiphiqo swa marhambu ni ku tshoveka loku nga vonakiki. Muxaka wo hlawuleka wa CT scan wu nga vona kahle gout, hambiloko nhlonge yi nga pfimbi.

3. Ku tirhisa ultrasound

U tirhisa magandlati ya mpfumawulo ku humesa swifaniso swa nkarhi wa xiviri swa swivumbeko swa tinyama to olova leswi nga endzeni ni le kusuhi na matsolo. Ultrasound yinga vona hi mahlo ya mianakanyo ku cinca ka pathologic kufana na mastoids ya marhambu eka margins ya mahlangano, cartilage degeneration, synovitis, joint effusiona, popliteal fossa swelling, na meniscal bulging.

4. Ku endliwa ka swifaniso hi magnetic resonance (MRI) .

Xikambelo lexi xi pfuneta ku kambela ku vaviseka ka tinyama to olova, kufana na ti ligaments, ti tendons, cartilage na misiha.

Swikambelo swa le laboratori: Loko dokodela a sola ku tluleriwa kumbe ku pfimba, ku kamberiwa ka ngati naswona minkarhi yin’wana arthrocentesis°, endlelo leri susaka nhlayo yitsongo ya mati eka nhlonge ya matsolo ku ya kamberiwa hi laboratory, swi nga ha laveka.

12. Swivangelo leswi tolovelekeke swa ku vava ka mahlangano

1. Leswi fambelanaka na ku vaviseka

ku vaviseka ka ligament kufana na anterior na posterior cruciate ligament na lateral collateral ligament ku tsana na ku handzuka; ku vaviseka ka meniscus; patellar tendonitis na mihloti; ku tshoveka ka marhambu na swin’wana.

2. Leswi fambisanaka ni vuvabyi bya marhambu

vuvabyi bya marhambu lebyi vangiwaka hi ku onhaka ka marhambu ya mahlangano; vuvabyi bya marhambu byi vangiwa hi masocha ya miri lama hlaselaka mahlangano; gout yi vangiwa hi ku endliwa ka ti crystals kusuka eka uric acid yale henhla leyi khumbhaka mahlangano.

3. Swivangelo swin’wana

synovitis leyi vangaka ku vava ka mahlangano na ku pfimba; swiphiqo swa patellar swofana na ku tshukatshuka na ku onhaka ka marhambu; swirhumbana leswi hlaselaka nhlonge; edema leyi vangiwaka hi ku pfimba, na swin’wana; ku yima hi ndlela yo biha nkarhi wo leha; iliotibial fascia syndrome leyi vangiwaka hi ku hlangana loku phindha-phindhiweke loku yisaka eka ku vava ehandle ka matsolo.

13. Maendlelo ya vutshunguri lama tirhisiwaka ngopfu

1.Vutshunguri byo Hlayisa

-Ku wisa na ku braka

-Ti compress to titimela na to hisa

-Vutshunguri bya swidzidziharisi

-Vutshunguri bya miri

-Vutshunguri bya ku endla vutiolori

-Ku tirhisiwa ka switirhisiwa swo pfuneta

2.Vuhandzuri

-Vuhandzuri bya arthroscopic

-Ku endliwa ka arthroplasty

3.Vutshunguri byin’wana

-Vutshunguri bya Ndhavuko bya Xichayina (TCM) .

-Vutshunguri bya ku tlhaviwa