Ukuhlangana Kwamadolo

01. Ukwakheka Kwethambo

I I-knee joint inamathambo ama-4: i-femur, i-tibia, i-patella ne-fibula.

Iqukethe izingxenye ze-3: i-medial tibiofemoral compartment, i-lateral tibiofemoral compartment, kanye ne-patellofemoral compartment, kanye nezingxenye ze-3 zihlanganyela nge-synovial cavity.

02.Isakhiwo esihlangene

Uhlobo: I-Cariage Joint

Idolo linamalunga angu-3: i-medial tibiofemoral joint, i-lateral tibiofemoral joint kanye ne-patellofemoral joint.

I-tibiofemoral joint ixhuma i-distal femur ne-tibia, kanye ne-distal femur tapers ukuze yenze i-condyle ye-femoral ephakathi kanye ne-lateral femoral condyle. I-tibia iphansi ngokuqhathaniswa, kodwa i-meniscus ethambekele iyisondeza eduze nama-condyles e-femal avelayo.

Ama-condyles wesifazane ahlukaniswa yi-intercondylar fossa, eyaziwa nangokuthi i-femoral groove noma i-femoral talus.

I-patella iyithambo lembewu elifakwe ngaphakathi kwe-tendon ye-quadriceps muscle futhi yakha inhlanganisela ne-trochanteric groove.

Isebenza ukuthuthukisa ukuzuza kwemishini kwemisipha ye-quadriceps. Inhloko ye-fibula itholakala ngaphakathi kwe-capsule yamadolo kodwa ngokuvamile ayisebenzi njengendawo ye-articular enesisindo. Ama-condyles wesifazane kanye ne-tibial plateau akha umugqa ohlangene.

03. Ukuzinza Okuhlangene

Ukuzinza kwamadolo ahlangene kugcinwa yizinhlobonhlobo zezicubu ezithambile ezihlinzeka nokuvikelwa kwe-cushioning ngaphakathi kokuhlangana.

I-tibia ne-femur zimbozwe nge-hyaline cartilage ebamba ukushaqeka ngaphakathi kwejoyinti yamadolo.

-I-disc-shaped lateral ne-medial menisci inikeza ukumuncwa okwengeziwe kokushaqeka futhi iphinde isakaze amandla emadolweni kulo lonke ukujoyina.

-I-anterior cruciate ligament (ACL) kanye ne-posterior cruciate ligament (PCL) iqinisa ukunyakaza kwe-anterior-posterior kanye ne-flexion-extension.

-I-medial collateral ligament kanye ne-lateral collateral ligament iqinisa amadolo ezindizeni zabo.

-Ezinye izakhiwo ezizinzisa idolo zihlanganisa i-aliotibial bundle kanye nengxenye yophondo lwangemuva lwangemuva.

04. Izakhiwo zeBursae kanye neCystic

Izakhiwo eziningana ze-cystic zivame ukutholakala eduze kwedolo, kuhlanganise ne-tendon sheath cysts kanye ne-synovial bursae. Ama-tendon sheath cysts wukungajwayelekile okuhle okuhlanganiswe nezicubu ezixhumeneyo eziminyene futhi aqukethe amafinyila.

I-popliteal cyst (okungukuthi, i-Baker's cyst) iyi-synovial cyst evame kakhulu emzimbeni. Ivela ku-bursa phakathi kwekhanda eliphakathi le-gastrocnemius muscle kanye ne-tendon ye-semimembranosus. Ama-Popliteal cysts ngokuvamile awabonakali kodwa avame ukuhlotshaniswa nokuphazamiseka kwe-intra-articular of the knee.

Kukhona ama-bursae amane ajwayelekile ngaphambili kwedolo. I-suprapatellar bursa iseduze ne-capsule yamadolo futhi iphakathi kwe-rectus femoris tendon kanye ne-femur, kanye nokuhamba kwayo ngedolo elihlangene kubantu abadala abaningi. I-prepatellar bursa ilele ngaphambili nje kwe-patella. I-superficial infrapatellar bursa ilele phezulu engxenyeni ekude yethenda ye-patellar kanye ne-tibial tuberosity, kanti i-infrapatellar bursa ejulile ilele phakathi kwengxenye ekude ye-tendon patellar kanye ne-anterior tibial tuberosity. I-bursa yangaphandle ingavuvuka ngenxa yokusebenzisa ngokweqile noma ukuhlukumezeka, njengokuguqa isikhathi eside, kuyilapho ukusetshenziswa ngokweqile kwezakhiwo ezinwebekayo emadolweni kungaholela ekuvuvukeni kwe-infrapatellar bursa ejulile, njengokugxuma okuphindaphindiwe noma ukugijima.

Isici esimaphakathi samadolo sibuswa i-goosefoot bursa, i-semimembranosus bursa, ne-suprapatellar bursa. I-goosefoot bursa itholakala phakathi kwe-tibial stop ye-lateral tibial collateral ligament kanye ne-distal fusion tendons ye-suture, imisipha emincane ye-femoral kanye ne-semitendinosus. I-semimembranosus bursa iphakathi kwethenda ye-semimembranosus kanye ne-condyle ye-tibial ephakathi, kanti i-suprapatellar bursa iyi-bursa enkulu kunazo zonke emadolweni ahlangene futhi itholakala ngaphezu kwe-patella nangaphezulu kwendawo ejulile ye-quadriceps muscle.

05 Uhla oluhlangene lokunyakaza

Ukuze uhlole ukugoba kwamadolo okusebenzayo, yenza isiguli sithathe isikhundla esivamile futhi siguqe kakhulu idolo ukuze isithende sisondele eduze kwe-gluteal groove ngangokunokwenzeka; i-engeli evamile yokugoba icishe ibe ngu-130°.

Ukuhlola ukunwetshwa kwamadolo yenza isiguli sithathe indawo yokuhlala futhi sikhulise ukunwetshwa kwamadolo. Ukunwetshwa kwedolo ngale komlenze oqondile noma indawo engathathi hlangothi (0°) kuvamile kwezinye iziguli kodwa kubizwa nge-hyperextension. Ukwandiswa okungaphezu kuka-3° -5° isethulo esivamile. I-hyperextension ngale kwalolu bubanzi ibizwa ngokuthi i-knee retroflexion futhi isethulo esingavamile.

Ukuhlolwa kwe-homas kuhlola ukuguquguquka kwe-quadriceps nama-hip flexors.

Uma isivumelwano se-hip flexion sikhona, ithanga lomkhawulo ophansi odonselayo lizobhekela ophahleni kunokuba lishaye phansi noma liye phansi ngetafula lokuhlola.

I-engeli yethanga elilenga etafuleni lokuhlola libonisa izinga lokuvumelana kwe-hip flexion.

Uma ukuqina kwe-quadriceps kukhona, umlenze ongezansi we-drape uzosuka kude netafula lokuhlola. I-engeli eyakhiwe umlenze ongezansi odonsekayo onomugqa womthofu waphansi ubonisa izinga lokungezwani kwe-quadriceps.

06. Ukuhlolwa kokuzinza ngokuhlanganyela

Ukuhlolwa kwe-Drawer yangemuva - Ukuhlolwa kwe-drawer yangemuva kwenziwa nesiguli endaweni ephansi, i-hip ethintekile iguquguquke ku-45 °, idolo liguquguquke ku-90 °, futhi unyawo lungathathi hlangothi. Umhloli ubamba i-proximal tibia yesiguli ngezandla zombili ekubambeni okuyindilinga ngenkathi ebeka izithupha zezandla zombili ku-tuberosity ye-tibial. Amandla abuyela emuva abe esesetshenziswa ku-proximal tibia. Ukususwa kwe-posterior kwe-tibia okungaphezu kuka-0.5-1 cm kanye nokuhamba kwangemuva okukhulu kunohlangothi olunempilo kubonisa ukukhala okuyingxenye noma okuphelele kwe-posterior cruciate ligament yamadolo.

I-Quadriceps Active Contraction Test - Iqinisa unyawo lwesiguli (esivame ukuhlala onyaweni) futhi isiguli sizama ukushelela unyawo luye phambili etafuleni lokuhlola (ngokumelene nokumelana nesandla somhloli), lokhu kuqondisa kubangela ukuthi imisipha ye-quadriceps ifinyeze, okuzoholela ekuguquguqukeni kwangaphambili kwe-tibia nge-posterigament deficie de 2mm okungenani idolo.

Ukuhlolwa Kwangaphandle Kwe-Tibial Rotation - Ukuhlolwa kokujikeleza kwangaphandle kwe-tibial kusetshenziselwa ukuthola ukulimala kwekona le-lateral lateral kanye nokuba khona kokulimala kwe-posterior cruciate ligament. I-tibia ijikeleziswa ngaphandle ngaphandle ku-30 ​​° kanye ne-90 ° ye-flexion yamadolo. Ukuhlola kuba nethemba uma uhlangothi oluthintekile luzungeziswe ngaphandle ngaphezu kuka-10°-15° ngaphezu kohlangothi olunempilo. I-positive at 30 ° of knee flexion kanye ne-negative ku-90 ° iphakamisa ukulimala okulula kwe-PLC, futhi okuhle kokubili kwe-30 ° ne-90 ° ye-flexion iphakamisa ukulimala kokubili kwe-posterior cruciate ligament kanye ne-posterolateral complex.

07. Imisipha ye-Periarticular

Imigqa ye-capsule ehlangene

i-patellar ligament, i-patellar ligament ephakathi, i-lateral patellar ligament

I-Intracapsular ligaments

i-anterior cruciate ligament, i-posterior cruciate ligament

Imigqa ye-Extracapsular

umsipha we-medial collateral ligament, lateral collateral ligament, popliteal oblique ligament, fibular collateral ligament

08. Innervation of the joint

Isakhiwo Se-Neurovascular

I-neurovascular bundle equkethe umthambo we-popliteal, i-popliteal vein, ne-tibial nerve (ukuqhubeka kwe-nerve sciatic) ihamba ngemuva nje kokuhlangana kwamadolo.

I-peroneal nerve evamile yigatsha elingemuva le-sciatic nerve.

09. Imisipha Ehlobene

I-Anterior Lateral

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

Uhlangothi lwangemuva

Ama-Hamstrings

kuhlanganisa i-biceps femoris, i-semitendinosus ne-semimembranosus;

I-Gastrocnemius.

I-Antemedial

I-Tibialis yangaphambili.

Imisipha egcina ukuzinza kwamadolo, okuhlanganisa i-quadriceps, imisipha ye-suture, imisipha, imisipha emincane ye-femoral, i-biceps femoris, i-semitendinosus, ne-semimembranosus.

10. Ukuhlolwa ngokomzimba

1. Ukuhlolwa okubukwayo

Bheka ukunyakaza nokulinganisa kwamalunga amadolo ohlangothini oluthintekile nolunye uhlangothi lwesiguli, futhi unake ukuthi kukhona yini ukuvuvukala kwendawo, umbala wesikhumba ongavamile, nokuhamba okungavamile, njll. 3.

2. ukushaya izandla

hlola indawo yobuhlungu nokuvuvukala, ukujula, ububanzi kanye nemvelo, ohlangothini oluthintekile lwesiguli endaweni ekhululekile ngangokunokwenzeka.

3. Ukugqugquzela

Hlola ukuhamba kwedolo elihlangene ngokusebenzisa imisebenzi esebenzayo nengenzi lutho yesiguli.

4. Ukulinganisa

Linganisa ubude bengxenye ngayinye yesitho kanye nobude obuphelele, isiyingi somlenze, ububanzi bokunyakaza kwamalunga, amandla emisipha, ukulahlekelwa indawo yokuzwa, njll., futhi wenze amarekhodi kanye nokumaka.

5. ukuhlolwa okukhethekile

 - Isivivinyo se-patella esintantayo: bheka ukuthi kukhona yini ukufiphala ejoyintini ledolo lesiguli.

Ukuhlola inqubo

Ngemva kokucindezela i-suprapatellar bursa ukuvumela uketshezi ukuba luqoqwe, uma kukhona uketshezi emadolweni, i-patella icindezelwa ngobumnene ngomunwe wenkomba, futhi lapho ukucindezela kukhululwa, i-patella izontanta phezulu ngaphansi kwamandla ashukumisayo oketshezi, futhi lapho ukucindezela kukhululwa, i-patella izoba namandla okuphuma noma okuntantayo.

- Ukuhlolwa kwedrowa: ukubona ukuthi akukho yini umonakalo kumsipha we-cruciate.

Ukuhlolwa kwekhabethe langaphambili: isiguli silala phansi embhedeni, ukugoba kwamadolo 90 °, izinyawo ziphansi embhedeni, zihlale zikhululekile. Umhloli ngokumelene nezinyawo zesiguli ukuze akwenze kulungiswe, izandla ezibambe ukuphela kwe-tibial yedolo elihlangene, donsa ithole ngaphambili, njenge-tibia anterior displacement kunohlangothi olunempilo lwe-5mm luhle, luhle lusikisela ukuthi ukulimala kwe-anterior cruciate ligament (Qaphela: ukuhlolwa kwe-Lachman ukuhlolwa kwe-drawer yangaphambili ye-knee flexion 30 °).

Ukuhlolwa kwe-drawer yangemuva: isiguli silala emhlane, siguqa idolo ku-90 °, sibeka izandla zombili ngemuva kwedolo elihlangene, sibeka isithupha ohlangothini lwe-extensor, siphushe futhi sidonse ukuphela okuseduze kwethole emuva ngokuphindaphindiwe, futhi i-tibia ihlehla emuva ku-femur njenge-positive, okusikisela ukuthi i-posterior crush i-partigate i-partigate ngokuphelele.

- Ukuhlolwa kokugaya: ukucacisa ukuthi kukhona yini umonakalo ku-meniscus yamadolo.

Ukuhlolwa Kokugaya Okuhlangene Kwamadolo: Indlela yokuhlola ngokomzimba esetshenziselwa ukuhlola i-lateral collateral ligament kanye nokulimala kwe-meniscus kwamadolo ahlangene.

Isiguli sisesimweni esivamile nedolo elithintekile ligobe ku-90 °.

1. Ukuhlolwa kokuphakamisa okujikelezayo

Umhloli ucindezela ithole ethangeni lesiguli futhi ubambe isithende ngezandla zombili ukuze aphakamise ithole eduze kwe-axis longitudinal yethole, ngenkathi enza ukunyakaza kwangaphakathi nokujikeleza kwangaphandle; uma ubuhlungu buvela ezinhlangothini zombili zamadolo, kusolwa ukuthi ukulimala kwe-lateral ligament.

2. Ukuhlolwa kokucindezelwa okujikelezayo

Umhloli ubamba unyawo lwesitho esithintekile ngezandla zombili, ukuze idolo elithintekile ligobe ku-90 ° futhi ithole lisendaweni eqondile unyawo lubheke phezulu. Bese ucindezela idolo elihlangene liye phansi bese uzungezisa ithole ngaphakathi nangaphandle ngesikhathi esifanayo. Uma kukhona ubuhlungu ohlangothini lwangaphakathi nangaphandle lwejoyinti yamadolo, kubonisa ukuthi i-meniscus yangaphakathi nangaphandle yonakele.

Uma idolo liguquguquka ngokwedlulele, uphondo lwangemuva lwe-meniscus lusolwa ngokuphuka; uma ku-90 °, ukuphuka okuphakathi kusolwa; uma ubuhlungu buvela lapho usondela endaweni eqondile, ukuphuka kophondo lwangaphambili kusolwa.

- Ukuhlolwa kokucindezeleka kwe-lateral: ukubheka isiguli ngokulimala kwe-lateral collateral ligament.

Ukuhlolwa kokucindezeleka kwamadolo e-lateral ukuhlolwa ngokomzimba okusetshenziselwa ukuhlola imigqa ye-lateral collateral yamadolo.

Isikhundla: Isiguli silala silale embhedeni wokuhlolwa, futhi isitho esithintekile sithunjwa kahle ukuze umlenze ongezansi othintekile ubekwe ngaphandle kombhede.

Ukuma okuhlangene: idolo libekwe endaweni enwetshiwe ngokugcwele futhi indawo eguquguqukayo engu-30 °.

Isicelo sokuphoqelela: Ezikhundleni ezimbili ezingenhla zamadolo, umhloli ubamba umlenze ophansi wesiguli ngezandla zombili futhi usebenzise ukucindezeleka emaceleni aphakathi nendawo ngokulandelana ngokulandelana, ukuze idolo elihlangene lithunjwe ngokuzenzakalelayo noma lidonswe, okungukuthi, ukuhlolwa kwe-valgus ne-valgus kwenziwa futhi kuqhathaniswa nohlangothi olunempilo.

Uma ubuhlungu buvela ekuhlanganyeleni kwamadolo ngesikhathi senqubo yokufaka isicelo sokucindezeleka, noma uma i-inversion kanye ne-eversion angle itholakala ingekho ebangeni elivamile futhi kukhona ukuzwa okuphumayo, kuphakamisa ukuthi kukhona ukugoqa noma ukuphuka kwe-lateral collateral ligament. Uma ukuhlolwa kokucindezeleka kokujikeleza kwangaphandle kuhle, kubonisa ukuthi isiqondiso esiqondile esiphakathi asizinzile, futhi kungase kube nezilonda ze-ligament ye-collateral ligament, i-meniscus yangaphakathi kanye ne-capsule ehlangene; lapho ukuhlolwa kokucindezeleka kokujikeleza kwangaphakathi kuhle, kubonisa ukuthi isiqondiso se-lateral esiqondile asizinzile, futhi kungase kube nokulimala ku-meniscus ehlangene noma i-articular surface cartilage.

11. Ukufanekisa Amadolo

1. Ukuhlolwa kwe-X-ray

esetshenziselwa ukuhlola ukuphuka kanye ne-osteoarthropathy ewohlokayo. I-Beight-bearing (emile) isikhundla sedolo elihlangene ngaphambili kanye nefilimu yokubuka eseceleni ingakwazi ukubona ithambo, igebe elihlangene lamadolo nokunye.

2. I-Computed tomography (CT)

Ama-CT scan angasiza ekuhlonzeni izinkinga zamathambo kanye nokuphuka okucashile. Uhlobo olukhethekile lwe-CT scan lungakwazi ukubona ngokunembile i-gout, ngisho noma ilunga lingavuvukalanga.

3. I-Ultrasound

Isebenzisa amaza omsindo ukukhiqiza izithombe zesikhathi sangempela zezakhiwo zezicubu ezithambile ngaphakathi naseduze kwedolo. I-Ultrasound ingabona ngeso lengqondo izinguquko ze-pathologic ezifana nama-mastoid amathambo emaphethelweni ahlangene, ukonakala kwe-cartilage, i-synovitis, i-joint effusionª, ukuvuvukala kwe-popliteal fossa, nokuqhuma kwe-meniscal.

4. I-Magnetic resonance imaging (MRI)

Lokhu kuhlola kusiza ukuhlonza ukulimala kwezicubu ezithambile, njengemigqa, imisipha, uqwanga kanye nemisipha.

Ukuhlolwa kwaselabhorethri: Uma udokotela esola ukutheleleka noma ukuvuvukala, ukuhlolwa kwegazi futhi ngezinye izikhathi i-arthrocentesis°, inqubo ekhipha uketshezi oluncane ejoyintini ledolo ukuze kuhlaziywe elabhorethri, kungase kudingeke.

12. Izimbangela ezivamile zobuhlungu obuhlangene

1. Okuhlobene nokulimala

ukulimala kwe-ligament njenge-anterior and posterior cruciate ligament kanye ne-lateral collateral ligament strains nezinyembezi; ukulimala kwe-meniscus; i-patellar tendonitis nezinyembezi; ukuphuka kwamathambo nokunye.

2. Okuhlobene nesifo samathambo

i-osteoarthritis ebangelwa ukuguga nokuqhekeka kwe-cartilage ehlangene; i-rheumatoid arthritis ibangelwa amasosha omzimba ahlasela amalunga; i-gout ibangelwa ukwakheka kwamakristalu e-uric acid ephezulu ethinta amalunga.

3. Ezinye izimbangela

i-synovitis ebangela ubuhlungu obuhlangene nokuvuvukala; izinkinga ze-patellar ezifana nokugudluka nokuguga kwe-cartilage; amathumba ahlasela ilunga; i-edema ebangelwa ukuvuvukala, njll.; ukungahambi kahle isikhathi eside; i-aliotibial fascia syndrome ebangelwa ukungqubuzana okuphindaphindiwe okuholela ebuhlungu ngaphandle kwedolo.

13. Izindlela zokwelapha ezivame ukusetshenziswa

1.I-Conservative Treatment

- Ukuphumula kanye braking

-Ukucindezela okubandayo nokushisayo

-Ukwelashwa kwezidakamizwa

-Ukwelashwa ngokomzimba

-Ukwelashwa kokuzivocavoca

-Ukusetshenziswa kwezinto ezisizayo

2.Ukuhlinzwa

- Ukuhlinzwa kwe-arthroscopic

- I-Arthroplasty

3.Okunye Ukwelashwa

-Imithi Yendabuko YamaShayina (TCM)

-Ukwelashwa ngomjovo