Idolo Joint

01. Ukubunjwa koLwakhiwo lweBone

I idolo elihlangeneyo linamathambo ama-4: i-femur, i-tibia, i-patella kunye ne-fibula.

Iqukethe amacandelo e-3: i-compartment ye-tibiofemoral ye-medial, i-lateral tibiofemoral compartment, kunye ne-patellofemoral compartment, kunye ne-3 compartments ukwabelana nge-synovial cavity.

02.Isakhiwo esidibeneyo

Uhlobo: I-Carriage Joint

Idolo linamalungu e-3: i-medial tibiofemoral joint, i-lateral tibiofemoral joint kunye ne-patellofemoral joint.

I-tibiofemoral joint idibanisa i-distal femur kwi-tibia, kunye ne-distal femur tapers ukuze yenze i-condyle ye-femoral medial kunye ne-lateral femoral condyle. I-tibia ithe tyaba, kodwa i-meniscus ethambekeleyo iyisondeza ngokusondeleyo kunye ne-condyles ye-femal ebonakalayo.

I-condyles ye-femoral yahlulwe yi-intercondylar fossa, eyaziwa ngokuba yi-femoral groove okanye i-femoral talus.

I-patella yithambo lembewu efakwe ngaphakathi kwe-tendon ye-quadriceps muscle kwaye yenza ukudibanisa kunye ne-trochanteric groove.

Isebenza ekuphuculeni inzuzo yomatshini we-quadriceps muscle. Intloko ye-fibula ifumaneka ngaphakathi kwe-knee capsule kodwa ayiqhelekanga ukusebenza njengendawo ene-articular surface. I-condyles ye-femal kunye ne-tibial plateau yenza umgca odibeneyo.

03. Uzinzo oludibeneyo

Ukuzinza kwamadolo ahlangeneyo kugcinwa ngeendlela ezahlukeneyo zezicubu ezithambileyo ezikwabonelela ngokukhuselwa kwe-cushioning ngaphakathi komgudu.

I-tibia kunye ne-femur zigqunywe nge-hyaline cartilage ephazamisayo ngaphakathi kwedolo.

-I-disc-shaped lateral kunye ne-medial menisci ibonelela nge-shock absorption eyongezelelweyo kwaye iphinde isasaze amandla emadolweni kuwo wonke umdibaniso.

-I-anterior cruciate ligament (ACL) kunye ne-posterior cruciate ligament (PCL) izinzile iintshukumo zangaphambili-ngasemva kunye ne-flexion-extension.

-I-ligament ye-collateral ligament kunye ne-lateral collateral ligament iqinisa idolo kwiiplani zabo.

-Ezinye izakhiwo ezizinzisa idolo ziquka i-aliotibial bundle kunye nenxalenye yophondo lwangasemva.

04. I-Bursae kunye ne-Cystic Structures

Izakhiwo ezininzi ze-cystic ziqhele ukufunyanwa ngamadolo, kubandakanya i-tendon sheath cysts kunye ne-synovial bursae. I-Tendon sheath cysts zizenzo ezigwenxa ezifakwe kwi-tissue exineneyo edibeneyo kunye ne-mucus.

I-popliteal cyst (oko kukuthi, i-cyst ka-Baker) yeyona cyst ixhaphakileyo emzimbeni. Ivela kwi-bursa phakathi kwentloko ye-medial ye-gastrocnemius muscle kunye ne-tendon ye-semimembranosus. I-Popliteal cysts idla ngokuba yi-asymptomatic kodwa ihlala ihambelana nokuphazamiseka kwe-intra-articular yamadolo.

Kukho ii-bursae ezine eziqhelekileyo phambi kwedolo. I-suprapatellar bursa isondele kwi-capsule yamadolo kwaye ilele phakathi kwe-rectus femoris tendon kunye ne-femur, kunye ne-traffic yayo kunye nedolo elihlangeneyo kubantu abaninzi abadala. I-prepatellar bursa ilele nje ngaphambili kwipatella. I-superficial infrapatellar bursa ilele phezulu kwi-distal part of patellar tendon kunye ne-tibial tuberosity, kanti i-infrapatellar bursa enzulu ilele phakathi kwendawo ekude ye-tendon ye-patellar kunye ne-tuberosity yangaphambili ye-tibial. I-superficial bursa inokutsha ngokugqithisileyo okanye ukwenzakala, njengokuguqa ixesha elide, ngelixa ukusetyenziswa ngokugqithisileyo kwezakhiwo zokwandisa idolo kunokukhokelela ekudumbeni kwe-infrapatellar bursa enzulu, njengokutsiba ngokuphindaphindiweyo okanye ukubaleka.

Inkalo ephakathi kwamadolo ilawulwa yi-goosefoot bursa, i-semimembranosus bursa, kunye ne-suprapatellar bursa. I-goosefoot bursa ifumaneka phakathi kwe-tibial stop ye-lateral tibial collateral ligament kunye ne-distal fusion tendons ye-suture, i-femoral encinci kunye nezihlunu ze-semitendinosus. I-semimembranosus bursa iphakathi kwe-tendon ye-semimembranosus kunye ne-condyle ye-tibial ye-medial, kunye ne-suprapatellar bursa yi-bursa enkulu kunazo zonke emadolweni kwaye ibekwe ngaphezu kwe-patella kunye ne-deep surface ye-quadriceps muscle.

05 Uluhlu oludibeneyo lwentshukumo

Ukuvavanya i-knee flexion esebenzayo, yenza isigulane sithathe isikhundla esiphezulu kwaye siguqe ngokugqithiseleyo idolo ukwenzela ukuba isithende sisondele kwi-gluteal groove ngokusemandleni; i-angle eqhelekileyo yokujika imalunga ne-130 °.

Ukuvavanya ukwandiswa kwamadolo ukuba isigulane sithathe indawo yokuhlala kwaye sandise ukwanda kwamadolo. Ukwandiswa kwedolo ngaphaya komlenze othe tye okanye indawo engathathi hlangothi (0 °) yinto eqhelekileyo kwezinye izigulane kodwa kuthiwa yi-hyperextension. Ulwandiso olungaphaya kwe-3 ° -5 ° yinkcazo eqhelekileyo. I-hyperextension ngaphaya kolu luhlu ibizwa ngokuba yi-knee retroflexion kwaye ibonakaliso engaqhelekanga.

Uvavanyo lwe-homas luvavanya ukuguquguquka kwe-quadriceps kunye ne-hip flexors.

Ukuba ikhontrakthi ye-hip flexion ikhona, ithanga lomgca wecala elisezantsi liya ku-angle ukuya kwisilingi kunokuba ligungxule okanye lihle ngetafile yokuhlola.

I-angle yethanga elijingayo kwitheyibhile yoviwo ibonisa iqondo le-hip flexion contracture.

Ukuba i-quadriceps tightness ikhona, umlenze ophantsi we-drape uya ku-angle kude netafile yoviwo. I-engile eyenziwe ngumlenze osezantsi othontsizayo kunye ne-plumb yasemhlabeni ibonisa iqondo le-quadriceps tension.

06. Uvavanyo lokuzinza ngokubambisana

Uvavanyo lwe-Drawer yangasemva - Uvavanyo lwe-drawer yangasemva lwenziwa kunye nesigulane kwisigxina se-supine, i-hip echaphazelekayo iguqukele kwi-45 °, idolo liguquguquke kwi-90 °, kwaye unyawo lungathathi hlangothi. Umhloli ubamba i-tibia ye-proximal yesigulane ngezandla zombini kwi-circular grip ngelixa ebeka izithupha zezandla zombini kwi-tuberosity ye-tibial. Amandla angasemva asetyenziswa kwi-proximal tibia. Ukufuduka ngasemva kwe-tibia engaphezulu kwe-0.5-1 cm kunye nokufuduka kwangasemva okukhulu kunoko kwecala eliphilileyo kubonisa ukukrazula inxalenye okanye epheleleyo ye-posterior cruciate ligament yamadolo.

Uvavanyo lwe-Quadriceps Active Contraction - Uzinzisa unyawo lwesigulane (ngokuqhelekileyo luhlala ezinyaweni) kwaye unomonde wokuzama ukuslayida unyawo phambili kwitheyibhile yokuhlola (ngokuchasene nokuchasana kwesandla somhloli), lo mgaqo ubangela ukuba i-quadriceps muscle ibe yinkontileka, eya kubangela ukutshintshwa kwangaphambili kwe-tibia nge-knee deficit de le-2mm.

Uvavanyo lokujikeleza lwangaphandle lwe-Tibial - Uvavanyo lokujikeleza lwangaphandle lwe-tibial lusetyenziselwa ukufumanisa ukulimala kwekona yangasemva kunye nobukho bokulimala kwe-posterior cruciate ligament. I-tibia i-passively yangaphandle ijikelezwe kwi-30 ° kunye ne-90 ° ye-knee flexion. Uvavanyo lulungile ukuba icala elichaphazelekayo lijikelezwe ngaphandle ngaphezu kwe-10 ° -15 ° ngaphezu kwecala eliphilileyo. I-positive kwi-30 ° ye-knee flexion kunye ne-negative kwi-90 ° ibonisa ukulimala kwe-PLC elula, kwaye i-positive kwi-30 ° kunye ne-90 ° ye-flexion ibonisa ukulimala kwi-ligament ye-posterior cruciate kunye ne-posterolateral complex.

07. Imigqa yePeriarticular

Imigqa ye-capsule edibeneyo

i-patellar ligament, i-medial patellar ligament, i-lateral patellar ligament

I-Intracapsular ligaments

Umphambili weligament, umthambo ongasemva

Imigqa ye-Extracapsular

ithambo eliphakathi elibambiseneyo, umthambo osecaleni osecaleni, umthambo otyebileyo othe tye, umthambo obambeneyo wefibula.

08. Innervation of the joint

Ulwakhiwo lweNeurovascular

I-neurovascular bundle equkethe i-popliteal artery, i-popliteal vein, kunye ne-tibial nerve (ukuqhubela phambili kwe-nerve ye-sciatic) ihamba ngasemva kwi-joint joint.

I-nerve ye-peroneal eqhelekileyo yisebe elisecaleni le-nerve ye-sciatic.

09. Imisipha edibeneyo

Ngaphambili ngasemva

I-Quadriceps iquka i-rectus femoris, i-vastus medialis, i-vastus lateralis, kunye ne-intermedius femoris.

Icala elingasemva

Iintambo zemisipha

kubandakanya i-biceps femoris, i-semitendinosus kunye ne-semimembranosus;

Gastrocnemius.

I-Antemedial

I-Tibialis yangaphambili.

Izihlunu ezigcina ukuzinza kwamadolo, kuquka i-quadriceps, imisipha ye-suture, i-hamstrings, i-femoral muscles, i-biceps femoris, i-semitendinosus, kunye ne-semimembranosus.

10. Uvavanyo lomzimba

1. Uviwo olubonwayo

Qaphela ukuhamba kunye ne-symmetry yamalungu amadolo kwicala elichaphazelekayo kunye necala elichasene nesigulane, kwaye ubeke ingqalelo ukuba kukho ukuvuvukala kwendawo, umbala wesikhumba ongaqhelekanga, kunye ne-gait engavamile, njl.

2. ukubetha izandla

khangela indawo yentlungu kunye nokuvuvukala, ubunzulu, ububanzi kunye nendalo, kunye necala elichaphazelekayo lesigulane kwindawo ekhululekile kangangoko kunokwenzeka.

3. Ukuhlanganisa

Hlola ukuhamba kwedolo elihlangeneyo ngemisebenzi esebenzayo kunye ne-passive yesigulane.

4. Umlinganiselo

Ukulinganisa ubude becandelo ngalinye lomlenze kunye nobude obupheleleyo, umjikelezo wesigxina, uluhlu lwentshukumo yamalungu, amandla emisipha, ukulahleka kwendawo yokuva, njl., kwaye wenze iirekhodi kunye nokumakisha.

5. uviwo olulodwa

 - Uvavanyo lwepatella oludadayo: jonga ukuba kukho ukuxubha kwilungu ledolo lesigulana.

Ukuphonononga inkqubo

Emva kokucofa i-suprapatellar bursa ukuvumela ulwelo ukuba luqokelele, ukuba kukho ulwelo kwi-joint joint, i-patella icinezelwe ngobumnene ngomnwe wesalathisi, kwaye emva kokuba uxinzelelo lukhululiwe, i-patella iya kudada phezulu phantsi kwe-buoyant force ye-fluid, kwaye xa uxinzelelo lukhutshwa, i-patella iya kuba ne-popping okanye i-floating force for buoyant force.

- Uvavanyo lwedrowa: ukubona ukuba kukho umonakalo kwi-cruciate ligament.

Uvavanyo lwe-drawer yangaphambili: isigulane silala phantsi ebhedini, ukuguqa kwamadolo 90 °, iinyawo zilele ebhedini, zigcine zikhululekile. Umhloli ochasene neenyawo zesigulane ukuze ayenze igxininise, izandla zibambe i-tibial end of the knee joint, ukudonsa ithole ukuya ngaphambili, njenge-tibia anterior displacement kunokuba icala eliphilileyo le-5mm lihle, libonisa ukuba i-anterior cruciate ligament ukulimala (Qaphela: uvavanyo lwe-Lachman luvavanyo lwangaphambili lwe-drawer ye-knee flexion 30 °).

Uvavanyo lwe-drawer yangemva: isigulane silala emhlane, siguqa ngamadolo kwi-90 °, sibeka izandla zombini emva kwedolo elihlangeneyo, sibeka isithupha kwicala le-extensor, sityhala kwaye sikhuphe isiphelo esisondeleyo sethole emva ngokuphindaphindiweyo, kwaye i-tibia ibuyela ngasemva kwi-femur njengento enhle, ebonisa ukuba i-posterior cruise i-partugate i-partigaate ngokupheleleyo.

- Uvavanyo lokugaya: ukucacisa ukuba kukho nawuphi na umonakalo kwi-meniscus yamadolo.

Uvavanyo lwe-Knee Joint Grinding: Indlela yokuhlola umzimba esetyenziselwa ukujonga i-lateral collateral ligament kunye nokulimala kwe-meniscus yamadolo.

Isigulane sisesimweni esifanelekileyo kunye nedolo elichaphazelekayo liguquguquke kwi-90 °.

1. Uvavanyo lokuphakamisa olujikelezayo

Umhloli ucinezela ithole ethangeni lesigulane kwaye ubambe isithende ngezandla zombini ukuphakamisa ithole kunye ne-longitudinal axis yethole, ngelixa wenza ukunyakaza okujikelezayo kwangaphakathi nangaphandle; ukuba intlungu iyenzeka kumacala omabini emadolweni, kurhanelwa ukuba i-lateral collateral ligament ukulimala.

2. Uvavanyo loxinzelelo lweRotary

Umhloli ubamba unyawo lomlenze ochaphazelekayo ngezandla zombini, ukwenzela ukuba idolo elichaphazelekayo liguqulwe kwi-90 ° kwaye ithole likwindawo echanekileyo kunye nonyawo phezulu. Emva koko cinezela idolo ezantsi kwaye ujikelezise ithole ngaphakathi nangaphandle kwangaxeshanye. Ukuba kukho intlungu kwicala langaphakathi nangaphandle ledolo elihlangeneyo, libonisa ukuba i-meniscus yangaphakathi nangaphandle yonakele.

Ukuba idolo ligqithise ngokugqithiseleyo, uphondo lwangasemva lwe-meniscus lukrokreka; ukuba i-90 °, ukugqabhuka okuphakathi kuyakrokrelwa; ukuba intlungu iyenzeka xa isondela kwindawo echanekileyo, ukugqabhuka kophondo lwangaphambili kukrokrelwa.

- Uvavanyo loxinzelelo lwasemva: ukujonga isigulane ngomonakalo kwi-lateral collateral ligament.

Uvavanyo loxinzelelo lwamadolo luvavanyo lomzimba olusetyenziselwa ukujonga i-lateral collateral ligaments of the knee.

Isikhundla: Isigulana silala phezu kwebhedi yoviwo, kwaye ilungu elichaphazelekayo lithatyathwa ngobunono ukuze umlenze ophantsi ochaphazelekayo ubekwe ngaphandle kwebhedi.

Isikhundla esihlangeneyo: idolo libekwe kwindawo eyongeziweyo ngokupheleleyo kunye ne-30 ° indawo eguquguqukayo.

Ukunyanzeliswa kwesicelo: Kwezi zikhundla zingasentla zamadolo, umhloli ubamba umlenze ophantsi wesigulane ngezandla zombini kwaye ufaka uxinzelelo kumacala aphakathi kunye namacaleni ngokulandelanayo, ukwenzela ukuba idolo elihlangeneyo libanjwe okanye lixutywe, oko kukuthi, uvavanyo lwe-valgus kunye ne-valgus lwenziwa kwaye lufaniswa necala eliphilileyo.

Ukuba intlungu iyenzeka kwi-joint joint ngexesha lenkqubo yesicelo soxinzelelo, okanye ukuba i-inversion kunye ne-angle ye-eversion ifunyenwe ngaphandle koluhlu oluqhelekileyo kwaye kukho ukuvakala kwe-popping, kubonisa ukuba kukho i-sprain okanye i-rupture ye-lateral collateral ligament. Xa uvavanyo loxinzelelo lokujikeleza kwangaphandle lulungile, lubonisa ukuba ulwalathiso oluthe tye lwangaphakathi aluzinzile, kwaye kunokubakho izilonda ze-ligament ye-collateral ligament, i-meniscus ephakathi kunye ne-capsule edibeneyo; xa uvavanyo loxinzelelo lokujikeleza lwangaphakathi lulungile, lubonisa ukuba i-lateral straight direction ayizinzile, kwaye kunokubakho ukulimala kwi-meniscus yecala okanye i-articular surface cartilage.

11. Ukucinga ngedolo

1. Ukuhlolwa kwe-X-ray

isetyenziselwa ukujonga iifractures kunye ne-osteoarthropathy ewohlokayo. Ukuthwala ubunzima (ukuma) indawo yedolo edibeneyo ngaphambili kunye nefilimu yecala lokujonga ifilimu inokuqwalasela ithambo, i-gap joint gap njalo njalo.

2. I-Computed tomography (CT)

I-CT scans inokunceda ukuxilonga iingxaki zethambo kunye nokuqhekeka okufihlakeleyo. Uhlobo olukhethekileyo lwe-CT scan lunokuchonga ngokuchanekileyo i-gout, nokuba i-joint ayivuthi.

3. Ultrasound

Isebenzisa amaza omsindo ukuvelisa imifanekiso yexesha langempela yezakhiwo zezicubu ezithambileyo ngaphakathi nangaphandle kwedolo. I-Ultrasound inokubona utshintsho lwe-pathologic efana ne-bony mastoids kwimida edibeneyo, ukubola kwe-cartilage, i-synovitis, i-joint effusionª, ukudumba kwe-popliteal fossa, kunye ne-meniscal bulging.

4. Umfanekiso wemagnetic resonance imaging (MRI)

Olu vavanyo lunceda ukuxilonga ukulimala kwezicubu ezithambileyo, ezifana nemigqa, i-tendon, i-cartilage kunye nezihlunu.

Uvavanyo lwebhubhoratri: Ukuba ugqirha ukrokrela ukusuleleka okanye ukuvuvukala, uvavanyo lwegazi kwaye ngamanye amaxesha i-arthrocentesis °, inkqubo ekhupha ulwelo oluncinci olusuka edolweni ukuze kuhlalutywe kwi-laboratory, kunokufuneka.

12. Izizathu eziqhelekileyo zentlungu edibeneyo

1. Okunxulumene nokwenzakala

ukulimala kwe-ligament njenge-anterior and posterior cruciate ligament kunye ne-lateral collateral ligament strains kunye neenyembezi; ukwenzakala kwe-meniscus; i-patellar tendonitis kunye neenyembezi; ukwaphuka kwamathambo njalo njalo.

2. Enxulumene nesifo samathambo

i-osteoarthritis ebangelwa ukuguga kunye nokukrazula kwe-cartilage edibeneyo; isifo samathambo sibangelwa amajoni omzimba ahlasela amalungu; igawuthi ibangelwa kukwakheka kweekristale ezivela kwi-uric acid ephezulu echaphazela amalungu.

3. Abanye oonobangela

i-synovitis ebangela intlungu kunye nokuvuvukala; iingxaki zepatellar ezifana nokuchithwa kunye nokunxiba kwe-cartilage; amathumba ahlasela umdibaniso; i-edema ebangelwa ukuvuvukala, njl.; ixesha elide lokuma kakubi; iliotibial fascia syndrome ebangelwa ukukhuhlana okuphindaphindiweyo okukhokelela kwiintlungu ngaphandle kwedolo.

13. Iindlela zonyango ezisetyenziswa ngokuqhelekileyo

1.Unyango loLondolozo

-Ukuphumla kunye ne-braking

-Uxinzelelo olubandayo kunye nobushushu

-Unyango lweziyobisi

-Ulungiso lwenyama

-Unyango lokuzilolonga

-Ukusetyenziswa kwezixhobo ezincedisayo

2.Utyando

-Utyando lweArthroscopic

-I-Arthroplasty

3.Olunye unyango

-Amayeza esintu aseTshayina (TCM)

-Unyango lokutofa