Kooxda Sawirka & Baadhitaanka ee Rugta dambe. Dr. Alex Jimenez waxa uu la shaqeeyaa dhakhaatiirta qiimaynta sare leh iyo khabiiro sawir-qaadista. Ururkayaga, khabiirada sawir-qaadista waxay bixiyaan natiijooyin degdeg ah, xushmad leh, iyo natiijooyin tayo sare leh. Anagoo la kaashanayna xafisyadayada, waxaan bixinaa tayada adeega waajibaadka bukaankeena oo ay mudan yihiin. Cilad-sheegidda Bukaan-socodka Bukaan-socodka (DOI) waa xarun-Radiology-ga casriga ah ee El Paso, TX. Waa xarunta kaliya ee nooceeda ah ee ku taal El Paso, oo uu leeyahay oo uu maamulo khabiirka Raadiyaha.
Tani waxay ka dhigan tahay marka aad u timaaddo DOI si aad u hesho imtixaan shucaac ah, faahfaahin kasta, laga bilaabo naqshadeynta qolalka, xulashada qalabka, farsamada gacanta lagu doortay, iyo software ka shaqeeya xafiiska, waxaa si taxadar leh u doortay ama naqshadeeyay Raajo-yaqaanka mana aha xisaabiye. Suuqayadu waa hal xarun oo heer sare ah. Qiimahayada la xidhiidha daryeelka bukaanka waa: Waxaan aaminsanahay in loola dhaqmo bukaanada sida aan ula dhaqmi lahayn qoyskayaga, waxaanan ku dadaali doonaa inaan hubinno inaad khibrad fiican u leedahay rugtayada.
Image Dx: Saamaynta fog ee fogaanta/gaabinaysa, xagasha dhabarka ee jajabka fog, si taxadar leh u baadh haddii kordhinta gudaha articular, 50% US Fx
Smith Fx: Goyland ee suugaanta Faransiiska. Loo tixgeliyo inay yihiin Colles rogan, haddii kale ku dhawaad isku mid, Ie, 85% dheeraad ah, 50% US Fx, OSP/haweenka da'da ah, da'da yar ee pts-tamarta tamarta sareeysa. Kala duwanaanshiyaha: farsamayntaFOOSH ee curcurka dabacsanaan m. In ka yar soo noqnoqda.
Tallaabooyinka sawirka: (eeg Colles Fx) C
Dhibaatooyinka: la mid ah Colles Fx
Rad Dx: 85% dheeraad ah oo articular ah oo leh volar( hore) xagal googo'a fog, shucaaca gaabinaya. Si taxadar leh u baar jebinta kortikal ee looga shakisan yahay kordhinta articular-ka ah ee loo magacaabi karo sida Smith type 2 ama Reversed Barton Fx (ku xiga)
Rx: hab la mid ah sida Colles.
Barton fx: FOOSH, saamaynta raadiyaha fog ee la mid ah Colles laakiin xariiqda Fx waxa ay ka fidsan tahay dhinaca radial-ka laf dhabarta una gudubta isgoysyada radiocarpal taas oo ka dhalata silbasho/kala-baxa xubinta taranka.
sawirka: Sebt 1-aad raajo raajo oo badanaa leh CT si ay u baarto fidinta Fx-ka-gaaban iyo qorsheynta hawlgalka
Rad Dx: radius fog Fx oo ka soo bilaabmaya dhabarka ilaa laf-dhabarka shucaaca radiocarpal oo leh heerar kala duwanaansho ah oo barokac ah, silbashada u dhow ee carpus
Haddii khadka Fx uu ka soo baxo dhinaca volar-ka una gudubta wadajirka curcurka ee loo yaqaan Reversed Barton aka Smith nooca 2 (Sawirka hoose ee kore)
Dhibaatooyinka: oo la mid ah dhammaan raadiyaha fog ee Fx
Rx: ku shaqeeya ORIF
Chauffeur's/dabada dhabarka Fx aka Hutchinson Fx: Intra-articular Fx of Radial styloid. Magaca ayaa ka yimid markii gaariga lagu bilaabay a gacanta qallafsanaan kara dib u kicinta curcurka dhabar-jabka iyo leexashada shucaaca.
Sawirka: raajada raajo ayaa ku filan. CT waxaa laga yaabaa inay ku caawiso haddii Fx aan si sahal ah loogu muujin raajo.
Dhibaatooyinka: urur la'aan, malunion, DJD, kala qaybsanaan scapholunate, lunate/burburin
Rx: ku shaqeeya lagscrew percutaneous dhammaan kiisaska d/t gudaha articularnature
Die-Punch Fx: saamayn Fx by lafta Lunate galay articular fog Lunate fossa ee Radius ah. IntraarticularFx. Waxay magaceeda ka soo qaadatay farsamo si ay u qaabayso (soo jiidato) dalool mashiinnada warshadaha "die-punch." Dhaawaca FOOSH.
Sawirka: raajada 1-aad, waxay noqon kartaa mid isku mid ah d/t niyad-jabka daahsoon ee Lunate fossa ka dibna CT scan-ga ayaa ah mid xog badan leh.
Rad Dx: saameeyay lunate fossa gobolka oo leh fidinta Fx-ka-dhex-dhexaad ah. Tani waxay u soo bandhigi kartaa sidii Fxarticular Fx ee Radius Distal ah.
Rx: qalliin d/t gudaha articular Fx
Dhis arcs of Gilula marka la qiimeeyo dhaawacyada carpal. Tallaabo muhiim ah ayaa loo baahan yahay si looga fogaado isbedellada daahsoon ee maqan ee toosinta carpal iyo sii wadida kortical
Scaphoid lafta Fx: m/c Fx lafta carpal. D/tFOOSH curcurka oo fidsan si shucaac ah. Goobta Fx ayaa ugu muhiimsan saadaasha: dhexda-m/c goobta (70%). Waxay yeelan kartaa 70-100% fursad AVN. Cirifka u dhow ee Fx: 20-30% oo leh khatar sare oo aan midow ahayn. Cirifka fog-10% wuxuu muujinayaa saadaal wanaagsan. Cirifka fog ee Fx waa m/c carruurta. Calaamadda bukaan-socodka ee muhiimka ah; xanuunka santuuqa santuuqa.
Sawirka: Talaabada 1aad-x-radiografi laakiin 15-20% seegay d/t occult Fx. Aragtiyo gaar ah ayaa loo baahan yahay. Markaa MRI waa tan ugu xasaasisan uguna gaarka ah hore ee occult Fx. Scintigraphy lafaha ayaa leh 98/100% gaar ah & dareenka esp. 2-3 maalmood ka dib bilawga. Raad fur. Dx: Khadka Fx haddii ay muuqato, barokac iyo madaw ee suufka dufanka leh ee scaphoid (navicular), ka baar kala-baxa scapholunate. Haddii lafta u dhow ay u muuqato sclerotic-AVN ayaa dhacay. MRI: hooseeya T1 & sare T2 / STIR / FSPD d/t bararka lafaha, calaamad hooseFx ayaa la xusi karaa.
Rx: Kabka Spica waa in la mariyaa haddii bukaan-socod ahaan looga shakiyo xitaa natiijooyinka raajooyinka. Loogu talagalay dhexdaFx-kabka ee 3-mo ee prox pole 5-mo immobilization. ORIF ama ku dhejinta maqaarka ee Herbert.
Curcurka SNAC waxa laga yaabaa inuu badanaa keeno DISI
Rx: DJD horumaray waxa ay u horseedi kartaa arthrodesis afar geesood ah
Scapholonate horumarsan burburka ( gacanta SLAC): SLL-ku-xirnaanta horusocod ee isdhexgalka iyo radiocarpal DJD iyo barokaca carpal volar ama dorsal (DISI & VISI). Sababaha: trauma, CPPD, DJD, Kienboch disease (AVN of Lunate), Preiserdisease (AVN of Scaphoid).
Kala qaybsanaanta SLL waxay u horseedi doontaa Dorsal ama VolarIntercarlate aka Intercarpal Segmental Insability (DISIor VISI).
Rad Dx: Dx sababta hoose. Raajooyinku waxay muujinayaan xuubka lunate oo leh xagal scapholunate oo kordhay ama hoos u dhacday oo ku taal aragtida dambe. Dhinaca hore: calaamada Terry Thomas ama ballaadhinta masaafada scapholunate 3-4-mm sida xadka sare ee caadiga ah.
�MRI waxa laga yaabaa inay ka caawiso qiimaynta seedaha iyo qorshaynta qalliinka ka hor
Rx: badiyaa la shaqeeya DJD daahay. arthrodesis afar geesood ah
Triquetrum Fx: 2aad m/c lafta carpal Fx. Dhinaca dhabarka M/C waxa ka gilgilay xuubka radiocarpal ee adag ee Dorsal. Sababta: FOOSH.
Sawirka: taxanaha gacanta ee raajo ayaa ku filan. Sida ugu fiican ayaa lagu muujiyay aragtida dambe sida jajab lafo fidsan oo ku dheggan dorsum ee Triquetrum. CT ayaa laga yaabaa inay ku caawiso haddii shucaac ahaan isu dhigma.
Hook ee Hamate Fx: m/c waxay ku dhacdaa ciyaaraha fiidista (cricket, baseball, hockey, saamaynta ay leedahay naadiga golfka, iwm) 2% ee carpusFx.
Sawirka: raajada waxaa laga yaabaa inay ku guuldareysato in la ogaado Fx ilaa "muuqaalka tunnel-ka carpal" la isticmaalo. CT ayaa laga yaabaa inay ku caawiso haddii raajadu aanay faa'iido lahayn.
Rx: sida caadiga ah kuwa aan qalliin ahayn, laakiin urur la'aan joogto ah ayaa laga yaabaa inay u baahdaan goyn.
DDx: hamate laba geesood ah
Lunate vs. Kala-bax xun: Lunate waa m/c lafta carpal oo kala go'day. Guud ahaan dhaawaca carpal aan soo noqnoqon. Si kastaba ha ahaatee, inta badan waa la waayay!
Waxay ku dhacdaa FOOSH iyo curcurta oo fidsan iyo ul naarada oo leexday. sawirka: raajada 1-aad Abaalmarinta ama waxay u baahan tahay qiimaynta dhaawaca kakan ee CT scan.
Furaha Rad DDx: DDx Lunate oo ka yimid meel-ka-bax halis ah. Meesha Lunate: Lunate waxay lumisay xidhiidhkii ay la lahayd raadiyaha fog ee shaaha daatay ee dhinaca. Kala-bax xun: Lunate waxay sii wadaa xidhiidhka ay la leedahay raadiyaha fog inkastoo Capitatedorsally ay kala guurtay. Kala-baxa Lunate waxa kale oo laga caawiyaa in lagu garto calaamadda �pie
Rx: dhimista degdega ah iyo hagaajinta qalliin ee seedaha jeexan
Metacarpal & Dhaawacyada Phalangeal
Bennett Fx: Intra articular laakiin nooca saamaynta Fx ee saldhigga 1st MC ee suulka. Sawir-qaade ayaa ku filan.
Rad Dx: jajab saddex xagal ah oo sifo ah oo lafta ah oo ku taal dhinaca ulnar ee 1st MCbase, inta badan leh subluxation radial ee dhinaca soo hadhay ee shucaaca ee 1st MC
Dhibaatooyinka: DJD, urur la'aan, iwm.
Rx: waxay u nugushahay degenaansho la'aan/urur la'aan u baahan daryeel qalliin
Rolando Fx: aka comminuted Bennett Y ama T-qaabaynta. Dhaawac aad u adag Waa mid aan degganayn oo u baahan daryeel qalliin
Ciyaartoyga suulka: Dhaqan ahaan waxaa lagu tilmaamaa inay tahay jeex dabadheer oo ah seedaha dammaanadda ah ee 1stMCP ee Ingiriisiga Gamekeepers' kuwaas oo sameeyay qoor leexinta/dilka ugaadh yar. Dhaawac ba'an waxaa sidoo kale loo magacaabi karaa suulka Skier. Dhaawacan wuxuu noqon karaa ligamentous w/oa jab iyo dhaawac avulsion ah ee saldhiga 1aad ee u dhow phalanx.
Cilaaqaadka: Nabarka stener ama barokaca seedaha jeexjeexay ee korka muruqa pollicis Adductor oo aan bogsiin karin hagaajinta qalliinka. MRI Dx ayaa loo baahan yahay.
Ka fogow aragtida diiqada suulka ee keeni karta Stenerlesion
Sawirka: raajo raajo oo ay ku xigto MRI ilaa Dx Stenerlesion. MSK US waa la isticmaali karaa haddii MRI la waayo.
�Nabarka Stener ee MRI & MSUS: Jirrid dammaanad ah oo ulnar ah ayaa aad uga muuqda Adductor policis aponeurosis waxayna u muuqataa sidii kurno cufan oo la mid ah calaamad hoose oo samaysa waxa loogu yeero "yo-yo on the string calaamadda" ayaa laga soo sheegay MRI iyo MSK US.
Rx: badiyaa shaqeeya
Feeryahan Fx: m/c MC Fx. Farsamayn dheeraad ah oo caadi ahaan aan la soo koobin ama yar ayaa la dhammeeyay Fx iyada oo loo marayo m/c 5th iyo mararka qaarkood 4th MCneck-madaxa isku xidhka (mararka qaarkood iyada oo loo marayo shaft) taasoo keentay in madaxa galooto. Farsamaynta: saamayn toos ah sida feedh isku dheggan oo feeray oog adag (tusaale, lafaha wejiga/ feedhaha gidaarka) markaa 95% ragga da'da yar.
sawirka: Taxanaha gacanta ee raajo ayaa ku filan
Rad Dx: Fx line transverse ama oblique iyada oo loo marayo MCneck oo leh xagasha madaxa volar. Qiimee heerka barakaca, oo muhiim u ah warbixinta.
NB Haddii isla farsamadu uu jebiyo 2ndnd 3d MC ee isla aagga anatomic, waxay u baahan kartaa daryeel qalliin.
Gacan Fx: m/c qalfoofka Fx (10% dhammaan Fx). Dhaawacyada isboortiga iyo warshadaha ayaa badan
sawirka: raajada oo leh taxane gacmeed ama PA/aragtida farta dambe ayaa ku filnaan doonta
Rad Dx: Haddii prox phalanx Fx, jajabka fogaana wuxuu u janjeeraa si toos ah oo leh jajab prox ah. Farsamaynta fog waxa laga yaabaa in dhabarka loo leexiyo. U fiirsashada muhiimka ah: dhaawaca sariirta ciddiyaha, kaas oo tixgeliyey Fx furan oo leh khatar caabuqa.
Rx: haddii <10-degree xagal-saalax-saaxiib-ku-duubid dib-u-habayn dhaqdhaqaaq leh. CRPP vs. ORIF waxa loo tixgalin karaa xaalado adag-u-diridda dhakhtarka gacanta ee lafaha
MRI waxaa laga yaabaa inay ku caawiso aqoonsiga hore ee kala-baxa scapholunate, Lunate/Navicular AVN.
Rx: muxaafid vs. hawlwadeen.
Gacanta DJD: Aad ugu badan. OA aasaasiga ah ee runta ah. MCP- waligeed ma saamaysay DIP & PIP
Haddii la go'doomiyay MCP OA la xuso ka fiirsoCPPD & Hemochromatosis (osteophytes-ka u eg osteophytes)
Caafimaad ahaan:
Dumarka da'da dhexe
Caadi ahaan xanuun la'aan marka laga reebo 1st CMC OA
noodhadhka DIPs-Heberden, noodhka PIPs-Bouchard
Erosive OA (mararka qaarkood loo yaqaan �inflammatory OA�)
Spectrum ee OA laakiin soo saarta nabaad-guurka udhaxeeya DIPs iyo PIPs taasoo keentay muuqaal aad u qurux badan. Ma jiro caabuq habaysan (ma jiro CRP, RF, Anti-CCP Ab) sida caadiga ah dumarka da'da dhexe/waayeelka ah, sida Hand OA, oo inta badan lagu arko qoysaska
Arthritis rheumatoid
Rheumatoid Arthritis (RA-Cudurka bararka nidaamka daba-dheeraada ee etiology aan la garanayn, oo lagu beegsanayo kala-goysyada synovial, seedaha leh qaybo badan oo nidaamsan (sambabada, CVS, Ocular, Maqaarka, iwm.) Pathology: Tcell>Macrophage / APC> dhexdhexaadinta habka autoimmune taasoo keentay sameynta pannus iyo burburin tartiib tartiib ah ee ST , carjawda, lafaha, iyo unugyo kale. 3% DumarVS.1% Ragga. Kiciyeyaasha deegaanka: caabuqa, dhaawacyada, sigaarka, iyo kuwa kale ee shakhsi ahaan u nugul. 20-30% ayaa laga yaabaa inay naafo noqdaan 10-sano kadib.
Carruurta: Supracondylar Fx Humerus-ka fog ayaa ah 90% dhaawacyada degdega ah. Had iyo jeer waa d/t dhaawac shil ah oo FOOSH iyo xusul fidsan, dhif <5% oo leh xusul dabacsan. Inta badan Supracondylar Fx waxay ku dhacdaa carruurta <10 yo Males> Dumar. Dhibaatooyinka: malunion in cubitus varus aka Gunstock deformity, dhaawaca xididdada dhiigga iyo xanuunka qaybta ischaemic ee ba'an oo leh qandaraas Volkmann
Sawirka: raajada 1-aad ee raajo ayaa ku filnaan karta. CT mararka qaarkood loo isticmaalo xaaladaha adag.
Madaxa shucaaca (RH) Fx: Kala soocida Mason waxay caawisaa in la go'aamiyo heerka kakanaanta iyo qaabka daaweynta
Nooca 1- aan la guurin waa m/c oo xasilloon oo ay ku jiraan seedaha. Shucaacyada shucaaca waxay noqon karaan kuwo aad u khiyaano leh oo qiimeynta suufka aan caadiga ahayn ee dufanka suxulka ayaa muhiim ah oo badiyaa calaamada kaliya ee ogaanshaha
Nooca 2- lagu barokiciyey 2-mm ama > leh block wareeg ah
Nooca 3- comminuted> 2-3 jajab iyo
Nooca 4 waxaa lagu soo bandhigaa RH fx, leexashada suxulka dambe iyo mararka qaarkood habka Coronoid dilaac inta badan d/t Brachialis M avulsion
Rx: Nooca 1 waxaa lagu maareeyaa si aan hawl-gal ahayn iyada oo la adeegsanayo dhaqdhaqaaq la'aan iyo dhaqan celin dhaqdhaqaaq. Nooca 2- ORIF haddii xannibaad wareeg ah. Nooca 3 iyo 4, ORIF iyo resection RH ama RH arthroplasty
Ogsoonow suufka hore ee aan caadiga ahayn ee barokacay ( falaarta orange) iyo soo bixitaanka suufka dambe ee baruurta ( falaarta cagaaran) ee sida caadiga ah qoto dheer ee fossa olecranon oo aan la arkin ilaa hemarthrosis ba'an ama dhiigbax kale ayaa horumariya calaamadaha suufka fat ayaa ah kuwa ugu kalsoonida badan ee tilmaamayaasha gudaha articular. suxulka Fx
Mason nooca 1 RH Fx waxay noqon kartaa v. khiyaano iyo seegay. Raadinta shucaaca waa in ay ku lug yeelato qiimeyn dhow ee calaamadaha suufka dufanka leh. Ogow barokaca baruurta hore ee aka calaamada Sail iyo joogitaanka suufka dufanka dambe d/t dhiigbax degdeg ah
Raajooyinku waxay si sahal ah u muujinayaan ulnar Fx, laakiin leexashada madaxa shucaaca ayaa laga yaabaa inay noqoto mid khiyaano leh oo mararka qaarkood la waayo. Kani waa dhaawac halis ah oo u horseedaya itaaldarrida xusulka haddii Dx ay dib u dhigto 2-3 toddobaad ama laga tago iyada oo aan la daweyn. Raajooyinku caadi ahaan waa ku filan yihiin:Rx: tuurista vs. operative.
Supracondylar Fx: kani waa xusulka M/C ee carruurta.
Gaar ahaan, noocyada aan la barakicin ee 1 (midig sare) way ku adagtahay Dx. Caadi ahaan aan caadi ahayn ee "suunka dufanka leh" iyo xariiqda hore ee xumeralka iyo khad qaska radiocapitella ayaa inta badan la isku halleyn karaa.
Nooca 3 wuxuu si gaar ah khatar ugu yahay qandaraaska Volkmann (vascular ischemic-necrosis ee qaybta murqaha hore ee cududda hore).
Cabashooyinka xusulka ee ciyaaryahan dhalinyaro ah
Epicondyle Fx: Dhaawaca carruurta ee caadiga ah, qiyaastii 10%.Asal ahaan avulsion Fx iyo jeexjeex MUCL ah. Econdyle dhexdhexaad ah waa m/c Fx. FOOSH waa habka m/c.M>F. Haddii ugu yar ee la barokiciyo ama aan la barakicin waxaa lagu daweyn karaa kabka esp. cudud aan xukun lahayn. Haddii loo barakacay sida kiiskan oo kale, u baahan ORIF.
Dhexdhexaad epicondyle avulsive Fx oo ku dhex jira kubbadda koleyga da'da yar waxaa loo sameeyay xusul yar 60kii, hadda waa in laga fogaadaa si looga fogaado jahawareer.
OCD ee Capitellum waa dhaawac cayaareed oo caadi ah oo ay keento cadaadis/ dabacsanaan soo noqnoqda. OCD waa inay noqotaa DDx oo ka timid cudurka Panner's ama osteochondritis sida caadiga ah lagu soo bandhigo bukaannada yaryar
Dhibaatada cudurka waxaa laga yaabaa inay ka timaado multipleapophysis oo ku saabsan xusulka (eeg CRitoE)
Sawirka: Tallaabada 1aad: Raajooyin ay ku xigto MRI iyo MRarthrogramme haddii la tilmaamo.
CT waxa laga yaabaa inay ku caawiso qiimaynta dhaawaca kakan. MRI iyo MSKUS ayaa laga yaabaa inay kaa caawiyaan dhaawaca seedaha.
Xanuunka lafaha ee xusulka
DJD ee xusulka waa wax aan caadi ahayn oo caadi ahaan 2-aad ilaa dhaawacyada, shaqada, CPPD, OCD ee TheCapitellum ama pathology kale. Kiliinik ahaan: xanuun, ROM esp oo yaraada. gacanta ugu weyn, ka sii daridda ADL. Luminta dabacsanaanta terminalka iyo kordhinta. 50% waxay yeeshaan xanuunka 'Ulnarcompressive neuropathy'. Rx: konserfatif, arthroscopic debridement/saarista osteophytes, siidaynta kaabsal. Bukaannada da'da weyn ee aan firfircoonayn Wadarta suxulka arthroplasty (TEA) waa la isticmaali karaa
Sawirka: raajada ayaa ku filan, CT waxay ka caawisaa qorshaynta qalliinka ka hor
Arthritis bararka: RA ee suxulka waa mid soo noqnoqda (20-50%) iyo d/t synovitis, pannus, lafo/carjawda, iyo burburka seedaha. Kiliinik ahaan: waxay bilaabataa ka dib bilawga gacmaha calaamadaha, bararka sumaysan, xanuunka, ROM-ka oo yaraada, qandho dabacsanaan. Joogitaanka nodules rheumatoid waxaa lagu ogaan karaa iyada oo la raacayo olecranon iyo cududda dambe. Rx: DMARD, hagaajinta seedaha qalliinka.
Sawirka: raajo raajo oo leh dheecaan hore oo aan gaar ahayn (caleemaha dufanka leh), ka dib: nabaad-guurka, summadda JSL, osteopenia. MSK US waxay caawisaa hore Dx. MRI waxay muujinaysaa synovitis; bararka lafuhu waxay la xidhiidhaan natiijooyinkii hore ee raajada, kobcinta synovial ee FS T1+C.
Gouty Arthritis: waxa laga yaabaa inay saamayso xusulka laakiin in ka yar xagga cidhifka hoose. Bursitis-ka 'Olecranon Bursitis' oo ku keenaya calaamad qorrax soo bax ah oo raajadu wadata ama lafaha nabaad-guurka. Hamiga iyo mikroskoobyada kala-baxsan oo muujinaya kiristaalo monosodium urate si xun u qaabaysan irbad. Rx: colchicine, daawooyin kale.
Septic Arthritis: ka fiirso dadka qaba sonkorowga, isticmaalayaasha IV-ga ee daroogada, RA-da, bukaanada qaba TB firfircoon, gonococcal dhalinyarada. Kiliinik ahaan wuxuu u soo bandhigaa sida monoarthritis oo leh ama leh calaamado dastuuri ah. Raajo: ogaansho liidata marxaladaha hore. Waxa laga yaabaa in Maraykanku muujiyo shuban iyo Doppler sare.MRI: dhiigbax, barar lafaha. Baaritaanka lafaha ayaa sidoo kale ku caawin kara. Shaybaarada: CBC, ESR, CRP. Ogaanshaha arthrocentesis ee leh midabaynta garaam iyo dhaqan ayaa muhiim ah. Rx: Antibiyootik IV degdeg ah
Arthritis-ka dhallaanka ee idiopathic (JIA) loo tixgeliyey M/C cudur daba-dheeraada ee caruurnimada iyo ka hor inta aan la gaarin IBD. Dx waa bukaan-socod iyo sawir-qaadis: Shuruudaha: Xanuunka wadajirka ah iyo bararka ilmaha 0-16-sano 6-usbuuc ama ka badan. Noocyo badan ayaa jira�M/C pauciarticular(oligoarticular) 40%, F>M, oo la xidhiidha ku lug lahaanshaha indhaha (iridocyclitis) iyo indho la'aan suurtagal ah. Foomamka polyarticular iyo habaysan.
Suxulka waxaa si joogta ah u saameeya jilibka, curcurka, iyo gacmaha, gaar ahaan polyarticular dz.
Shaybaarada: ESR/CRP RF-VE inta badan
Sawirka: Astaamaha raajada hore waa kuwo aan gaar ahayn. Later: nabaad-guurka lafaha, burburinta carjawda wadajirka ah, kor u kaca epiphyses articular, xiritaanka hore ee physis. Astaamaha dib u dhaca: 2nd DJD, ankyloses wadajir ah.DDx: hemophilic arthropathy. Shucaaca afka ilmagaleenka ayaa muhiim ah.
Rx: DMARD, daryeelka konserfatifka
Cudurrada kala duwan
Habka Supracondylar: 2% dadweynaha. Waxa qeexay Sir JohnStruthers sannadkii 1854. Xadhkaha fiyuuska ah (Ligament of Struthers) waxa laga yaabaa inay horseeddo isku-duubnida Dhexdhexaadiyaha N. DDx ee Osteochondroma oo sida caadiga ah farta ka durugsan wadajirka
Cudurka loo yaqaan 'chondrometaplasia' ee asaasiga ah(Reichel Syndrome): cillad aan caadi ahayn oo unugyada synovial ah oo daadinaya carjawda isku-goysyada taasoo keeni karta DJD, nabaad-guurka lafaha dibadda, synovitis, cadaadis dareemayaasha iwm. Si qalliin looga saaray. Sawirka: maydhyo dabacsan oo badan oo osseocartilaginous ah oo qiyaas ahaan le'eg oo ku jira daloolka wadajirka ahDx oo leh DJD iyo 2ndosteochondromatosis. Calaamadaha MRI-hooseeya ee T1 iyo T2 oo leh dheecaan wadajir ah oo suurtagal ah. Kala-goysyada adag ee sida xusulka ayaa laga yaabaa inay la yimaadaan kalagoyn weyn oo wadajir ah
Cudurka Panner: osteochondrosis of theCapitellum sida caadiga ah 5-10 yo da'da yar ee DDX ee OCD of Capitellum (laga hadlay) oo ku dhaca dhalinyarada. Soo kabashada waxay ku dhacdaa xaaladaha badankood iyadoo bogsasho lama filaan ah. Sawirka: raajooyinku waxay muujinayaan sclerosis iyo qayb yar oo ka mid ah Capitellum w/o jidh dabacsan. MRI: T1 hoose iyo calaamad T2 sare ee Capitellum oo dhan.
Myositis Ossificance:
Unug Jilicsan & Neoplasms Lafaha oo ku saabsan xusulka
Lipoma: intramuscular, subcutaneous. Neoplasms unug jilicsan ee ugu caansan. Ka kooban baruur laakiin tiro la taaban karo ayaa laga yaabaa in uu ku dhaco dufan necrosis-calcification-fibrosis. Caadi ahaan waxa ay ahaanaysaa mid wanaagsan. Mararka qaarkood way ku adag tahay DDx liposarcoma oo si fiican u kala duwan. Sawirka: x raajo: nabar radiolucent si fiican loogu wareegay ama w/o calcification. US iyo MRI waa muhiim. On MRIT1high, T2 SI hoose.
Hemangioma: dhaawaca xididdada dhiigga aan fiicnayn, oo inta badan ka kooban kanaalada xididdada dhiigga badan. Capillary vs. godad. Aad ugu badan carruurta, laakiin laga helo da 'kasta. Waxaa laga yaabaa inay badanaa sameeyaan phleboliths (calcification). Sawirka: Raajooyinka ayaa muujinaya cufnaanta unug jilicsan oo ay ku jiraan phleboliths. MRI: T1-sare ama calaamad doorsooma. Calaamadaha T2-sare ee meelaha qulqulka qunyar socodka ah. � boorsada Gooryaanka. Biopsiga sida ugu wanaagsan ayaa looga fogaadaa. Rx: adag: goynta maxalliga ah vs. embolization vs. fiirsashada. Soo noqnoqoshada sare.
Burada galka neerfaha ee ku wareegsan (PNST)benign vs.malignant. Dhacdooyin ka sii weyn NF1 oo leh khatar sare oo PNST xun ah. PNST Benign: Schwannoma vs.Neurofibroma Laf-dhabarka vs. dareemayaasha durugsan. Histology: Unugyada Schwann waxay ku dhexjireen fibroblast iyo maraakiibta.Clin ahaan: pts ee 20s iyo 30s, mass la dareemi karo oo leh ama w / o cadaadis maxalli ah. Sawirka: MRI: T1: calaamad dufan leh, T2: calaamad bartilmaameed. Kordhinta T1+C
Sarcomas jilicsan: MFH, Sarcoma Synovial, (laga hadlay), Liposarcoma (inta badan ee retroperitoneum) Dx: MRI. Caafimaad ahaan: Dx waa la daahiyay d/t tiro balaadhan oo aan xanuun lahayn oo inta badan la iska indho tiro. Baaxadda caafimaad ahaan la dareemi karo waxay u qalantaa baaritaanka MRI, Mareykanka ayaa laga yaabaa inuu ku caawiyo. Biopsy waxay xaqiijisaa Dx.
Humeral Fx waxay ku xisaabtamaysaa 4-6% dhammaan Fxs. Lafo-jileeca (OSP) Fx in>60 yo oo la xidhiidha dhaawaca ugu yar ee F: M 2:1 saamiga. Bukaannada da'da yar, dhaawaca tamarta sare ee degdega ah ayaa u badan.
Dhibaatooyinka: AVN madaxa xumeral, Axillary N curyaan.
Kala-soocidda Neer: waxay tixgelisaa jabka ay la socdaan 4-xariiqo anatomical ah oo leh ama baro-kac> 1-cm & xagasha 45-degree
Hal qayb Neer Fx- ma jiraan baro-kac ama aad ugu yar <1-cm/45-degree. Waxay saameyn kartaa 1-4 xariiqo iyo M/C marka loo eego tuberosity weyn. 80% ee xumeral Fx u dhow waa hal qayb Neer.
Laba qaybood oo Fx: 1-qayb ayaa la barakiciyey>1-cm/45-degrees. m/c waxay ku lug leedahay qoorta qaliinka
Saddex qaybood oo Fx: 2-qaybood ayaa la barakiciyey>1-cm/45-degrees.
Afar-qaybood Fx: dhammaan 4-qaybood waa la barakici karaa. Wax aan caadi ahayn <1%
sawirka: Talaabada 1-aad-radiography, CT waxaa loo isticmaali karaa xaalado aad u adag. gudbinta lafaha
Maamulka: Neer-hal-qayb Fx waxaa lagu daaweeyaa Dhaqdhaqaaq la'aanta Sling iyo baxnaanin horusocod ah
Inta badan Fx ee dadka da'da ah waxaa loola dhaqmaa si aan qaliin ahayn
Bukaannada da'da yar (40-65) ayaa laga yaabaa inay marmar u baahdaan hemiarthroplasty haddii 3 ama 4-qayb Neer Fx ay joogaan. Khatar weyn oo AVN ah
Jabka Humerus Proximal
Fiiro gaar ah: Sawirka bidix: Fx ku lug leh qoorta anatomical iyo tuberosity weyn oo leh barokaca ugu yar <1-cm/45-degree markaa Dx sida hal qayb Fx. Sawirka saxda ah: Fx yar yar oo tuberosity weyn leh oo leh barokac weyn (> 45-degrees & 1-cm) sidaas darteed Dx oo ah laba qaybood Fx
Fiiro gaar ah: Saddex qaybood oo Neer Fx (bidix) ah iyo afar qaybood Neer Fx (midig)> Maareynta: hawlwadeennada xaaladaha badankood ee bukaannada da'da yar (40-65)
GHJD danbe (4%) gaar ahaan la xidhiidha suuxdinta suuxdinta, korantada oo waxay ku dhici kartaa b/l
Inferior GHJD aka Laxatio Erecta (<1%) oo la xidhiidha jug daran
Caafimaad ahaan: AGHJD waxay soo bandhigtaa xanuun aad u daran, cududku waa mid dibadda ah oo wareeg ah oo soo jiidanaya, xaddidaad daran oo dhaqdhaqaaqa. GHJD waxa laga yaabaa inay u sii jirto sida kala-bax joogto ah.
Maamulka: hoos u dhigista degdega ah ee ED marka la suuxiyo ama suuxdin culus oo leh Kocher farsamada sawirka sare (aan la isticmaalin), Habka wareegga dibadda (dhexe) ama farsamada caanaha (waxaa loo isticmaali karaa suuxinta) iyo dhowr habab oo kale. Dib u dhigista dhimista waxay la xiriirtaa khatarta weyn ee dhibaatooyinka degdegga ah iyo kuwa mustaqbalka fog
Habka Sawirka ogaanshaha
Raajo-raajada garabka ee taxanaha ah ayaa ku filan. Sawir dheeraad ah oo leh CT scan iyo MRI ayaa laga yaabaa inay ku caawiyaan Dx osseous, carjawda, shaybaarka / seedaha.
GHJD hore (95%). Booska Subcoracoid (midig sare) ee humerus waa m/c
GHJD hore waxa kale oo laga yaabaa inuu u dhaco sida subglenoid (bidix hoose) iyo marar dhif ah sida subclavicular
Furaha raadinta shucaaca waa in la qiimeeyo dhaawacyada Bankart iyo Hill-Sachs ee la xiriira
Dhaawaca Bankart
Waxay dhacdaa inta lagu jiro hore ee GHJD d/t saamaynta madaxa ee hore-inferior glenoid. Kala duwanaansho ayaa jirta (eeg bogga soo socda). BonyBankart waxa lagu arki karaa raajada. Waxa loogu yeero unug jilicsan Bankart wuxuu u baahan yahay MRI. Carjawda (jilicsan) Bangigu waa m/c.
Hill-Sachs aka Hatchet deformity (dhib-dhis fallaadho) dhaca inta lagu guda jiro habka la mid ah sida Bankart, ie, cadaadis iyo saamaynta dhinaca dambe ee madaxa ee ka dhanka ah glenoid soo saara qaab jeexan Fx. Dhaawaca Hill-Sachs waxa laga yaabaa inuu u saadaaliyo GHJD soo noqnoqota/soo noqnoqota.
Dhaawaca bankiga ayaa laga yaabaa inuu bogsado, laakiin barroosinnada tolitaanka qalliin ayaa loo baahan yahay mararka qaarkood
CT arthrogram iyo MRI ayaa laga yaabaa inay ku caawiyaan
Noocyada Dhaawaca Bankart
Ogow noocyada kala duwan ee dhaawaca Bankart. Onlyosseous Bankart waxa lagu arki karaa shucaac ahaan. Unug jilicsan Bankart wuxuu u baahan yahay MRI oo leh iyo la'aanteed gadolinium-ka-goysyada (arthrogram).
Kala-baxa dambe
Fiiro gaar ah: GHJD danbe oo leh calamadaha lagu garto:
Calaamada Trough aka reverse Hill-Sachs. Waxay dhacdaa d/t saamaynta madaxa geesaha ee Fx
Calaamadda cirifka: kaliya waxay ku dhacdaa PGHJD d/t booska dambe ee madaxa iyo glenoid-ka hore ee madaxa masaafada 6-mm ama ka weyn
RCM tendinopathy: Hoosudhaca kolajka ee RCM gaar ahaan Supraspinatus M. tendon(SSMT) d/t si xad dhaaf ah u isticmaal/waxyeelo-yar oo jeexjeexaya beddelka kolajka. Impingement syndrome waa sababta 2aad ee dibadda ka ah. Waxaa loo soo bandhigay bukaan ahaan xanuun iyo ROM xaddidan
Sawirka Dx: MSK US waxa ay noqon kartaa mid sax ah sida MRI oo kale oo ka fiican xaaladaha qaarkood d/t qiimayn firfircoon v. kharash waxtar leh
Natiijooyinka MSKUS: dhumucnaanta walxaha SSMT oo leh isbeddel ku yimaadda echogenicity caadiga ah.MSKUS waxay u fiican tahay DDx iyadoo SSMT ay la ilmayso. Faa'iidooyinka Maraykanku waa in ay ogolaato qiimeyn firfircoon ee qaababka xanuunka leh
Jeexitaanka qayb ka mid ah SSMT: Jeexitaanka qayb (aan dhammaystirnayn) ee SSMT waxa laga yaabaa inay ka dhacdo bursalka iyo dusha sare ee articular ama interstitial, ie, walaxda gudaha/aan la isgaadhsiin. Etiology: is-hortaag hoose, cadaadis ba'an, iyo tendinosis microtrauma raaga
Sawirka Dx: MSKUS waxay u fiican tahay MRI (Daraasadaha NB qaar ayaa tilmaamaya in MSKUS uu aad uga sarreeyo MRI). Natiijooyinka muhiimka ah ee MRI: farqiga / ilmada aan dhamaystirnayn ee SSMT oo ay ka buuxaan dareeraha wadajirka ah +/- nudaha granulation
MSKUS: hoos u dhaca echogenicity ee SSMT, khafiifinta iyo jeexjeexa qayb ka mid ah oo ay ka buuxaan dareere Isku-xidhnaanta lumay ee bursal seedaha ama is-dhexgalka articular.
Dhumucda buuxda Jeexitaanka SSMT jeexjeexid/jeexid katiinad qudhuntay. 2nd si ay u hor istaagto Hooked acromion, isticmaalka xad dhaafka ah ama dhaawac ba'an. 7-25% xanuunka garabka ee dadweynaha guud. Caafimaad ahaan: xanuun ku dhaca shaybaarada xannibaadda.
Sawirka Dx: MSKUS waxay u fiican tahay MRI. Xaddidaad: Dx liidata ee cudurada shaybaarka. USDx furaha ah: kala goysyada xudunta u ah, kala goysyada anechoic (dareere ayaa buuxsamay), tendon hypoechoic, seedaha dib u gurashada, calaamad carjawda oo aan daboolin (bidix hoose, A: US B: MRI)
MRI: furaha Dx: Jeexitaanka jeexjeexa oo ku fidsan dhammaan bisha SSMT, dib u gurasho leh hoos u dhac dufan ah oo SSMT ah iyo muruqa. Haddii dib-u-celinta ay tahay 12 saac ama ka weyn (sawirrada sare), waxa laga yaabaa inaan si hawl-gal ah loogu xidhin.
Rotator Cuff (RTC) Tendinitis Calcific: badiyaa d/t kalsiyum HADD crystals. Dumarka da'da dhexe ayaa ugu badan ee ay dhibaatadu saameysey. Waxay u dhexeysaa helitaan sawir asymptomatic ah ilaa arthropathy burbur daran ama garabka Milwaukee (aan dhif ah)
Dhammaan 4-ta nooc ee shaybaarka sare ayaa saameeya ama w/oLHBMT jeexjeexa (fiiri sawirada). Caafimaad ahaan: xanuunka, xaddidaadda AROM ee leh tijaabooyinka cadaadiska firfircoon, sida caadiga ah natiijooyin aan gaar ahayn oo ku dayanaya RTCpathology
Sawirku waa muhiim: sawirka ugu fiican waa MRI arthrography. Calaamadaha furaha: calaamada dareeraha toosan ee hyperintense ee gudaha labrum sare +/- ku fidaya LHBT sawir-qaadista dareeraha xasaasiga ah ee dufanka leh iyo FS T1 arthrogram. Sida ugu wanagsan ee loo arko jeexjeexyada wadnaha
Rx: ilmo yar ayaa laga yaabaa inay bogsato, laakiin ilmada aan degganayn waxay u baahan tahay daryeel qalliin.
Furaha DDx: kala duwanaanshiyaha anatomical sida Buford complex iyo shaybaar-hoosaadka
jeexjeexa SLAP oo leh cyst is barbar socda (midig hoose)
Kala duwanaanshiyaha caadiga ah DDx: shaybaar hoosaadka (bidix hoose) note: MR arthrography oo leh isbarbardhig hoos u dhigaya shaybaarka laakiin w/o ku sii fidaya xagga dambe ee LHBT
Arthritis garabka
GHJ DJD: Caadi ahaan waxay la xiriirtaa sababta 2aad: dhaawac, xasillooni darro, AVN, CPPD, iwm Cudurka RTC ee la xidhiidha ayaa laga yaabaa inuu jiro. Sawirka; raajada raajada ayaa ku filan oo bixisa darajaynta/qorshaynta daryeelka. Natiijooyinka ugu waaweyn: cidhiidhi wadajir ah, osteophytosis esp. madaxa hoose ee dhexe ( falaarta orange), subchondral sclerosis/cysts. Inta badan waxaa la xusay guuritaanka madaxa sare d/t cudurka RTC.
ACJ OA: caadiga ah iyo sida caadiga ah aasaasiga ah ee gabowga. Waxay soo bandhigtaa lumis ACJ iyo osteophytes. Osteophytes oo ku yaal dusha sare ee ACJ �keel osteophytes Bursitis-goboleedku waa sifo kale oo caafimaad oo ACJ arthrosis ah.
Maareynta: inta badan waa muxaafid iyadoo ku xiran calaamadaha/calaamadaha bukaan socodka
Rheumatoid Arthritis GHJ: RA waa cudur bararka nidaamka badan oo saameeya kala-goysyada badan ee ay ku daboolan yihiin synovium. GHJ RA waa caadi (m/c kala goysyada waaweyn ee jilbaha/garbaha RA). Kiliinik ahaan: xanuun, ROM xaddidan iyo xasillooni darro, muruq daciifnimo / lumis. Gacmaha, cagaha, iyo curcurada ayaa saameeya m/c. Sawirka: raajo-raajo ayaa daaha ka qaadaysa nabaad-guurka periarticular, luminta booska wadajirka ah ee wadajirka ah, lafo-jileeca-articular osteoporosis, subluxations, iyo bararka unugyada jilicsan. MRI waxay kaa caawin kartaa in la ogaado jeexjeexa RTC-da ee sida caadiga ah la xidhiidha iyo xasilloonida. Isbeddelada hore waxa lagu ogaan karaa MSKUS esp. Isticmaalka awoodda Doppler ee muujinaysa hyperemia/barar.
Fiiro gaar ah: raajada garabka L oo muujinaysa burburka carjawda iyo luminta wadajirka summeedka, nabaad guurka badan, iyo luminta taageerada RTCM ee socdaalka madaxa sare, ST effusion ayaa jooga.
Fiiro gaar ah: PDFS coronal iyo axial MRI jeexjeexyada GHJ RA oo tilmaamaya dheecaan wadajir ah oo barar ah, nabaad-guur/ barar, samaynta pannus synovial iyo jeexjeexa ay u badan tahay RTC m. Maareynta: Gudbinta Rheumatological iyo daawaynta farmashiyaha ee DMARD. Daryeelka hawlgalka asRTCM dayactirka. 10% bukaanada waa naafo d/t RA
Neuropathic Osteoarthropathy aka Charcot garabka: d/t dhaawaca xididdada dhiigga iyo xididdada dhiigga. Sababo badan ayaa jira.M/c wuxuu ku soo baxaa dadka sokorowga lugaha dhexe. Garabka Charcot waa m/c gudaha Syringomyelia (25%), curyaannimada dhaawacyada, MS, iwm. Dx: bukaan-socod (50% xanuun / barar 50% burbur aan xanuun lahayn). Sawirku waa muhiim. Raajo-raajo ayaa ku filan kiisas si wanaagsan loo aasaasay, laakiin Dx hore waa mid adag. MRI waxaa laga yaabaa inay ku caawiso hore Dx iyo dhibaatooyinka dib u dhaca. Rad Dx: Garabka Charcot waa m/c loo soo bandhigay sida atrophic nooca arthropathy burburiyaha leh madaxa xumeral u muuqda sida haddii qaliin la gooyey oo ay la socdaan qashinka intra-articular, cufnaanta, kala-baxa, kala-baxa, iyo sifooyinka kale ee muhiimka ah
Garabka Septic: garabku waa jilibka 3aad m/c jilibka soo socda. Bukaanada halista ugu jira: kuwa macaanka qaba, RA pts, immunocompromised, IV dadka isticmaala daroogada, kateetarka guryaha, iwm Staph. Aureus (> 50%) m/c.
Caafimaad ahaan: kalagoysyada xanuunka iyo Dec. ROM, qandho 60% kaliya, toxemia, inc. ESR/CRP Dx: sawirka iyo hamiga/dhaqanka wadajirka ah. RadDx: raajo hore ayaa inta badan aan la arki karin marka laga reebo ST effusion/diyaaradaha dufanka leh oo mugdi ku jira, ballaarinta wadajirka ah. Ka dib 7-12 maalmood osteopenia oo bararsan, aboor-cunida/lafaha lafo-soo-baxa, burbur articular, cidhiidhi wadajir ah. Waxaa laga yaabaa inay u gudubto burbur daran oo wadajir ah iyo ankyloses. Dawooyinka hore ee Dx & IV waa muhiim xitaa dhaqanka ka hor. Waraabka shaqada iyo dheecaanka wadajirka ah xaaladaha qaarkood. Dhibaatooyinka waa suurtagal esp. haddii Rx dib loo dhigo. MSKUS oo leh rabitaan irbad ayaa laga yaabaa inay ku caawiso. Fiiro gaar ah: (sawirka sare) kala-goysyada aan dhaawac ahayn oo balaadhinta madaxa ka-soo-baxa d/t septic A dx: irbada hamiga Staph. Aures
Osteonecrosis ischemic
Osteonecrosis ischemic ee madaxa xumeral waxaa laga yaabaa inay ku dhacdo d/t trauma (Neer four-part Fx), Steroids, Lupus, Sickle cell, Alcoholism, Sonkorowga, iyo xaalado kale oo badan. Sawirku waa muhiim: MRI waxay ogaataa isbeddelada ugu horreeya sida bararka gudaha gudaha. Astaamaha raajada ayaa soo daahay, oo loo soo bandhigay sida burburka lafta-hoosaadka oo leh sclerosis �snow cap� calaamad, jajab, iyo DJD daran oo sii socda.
Maareynta: gudbinta lafaha, niyad-jabka asaasiga ah ee kiisaska hore, hemiarthroplasty ee dhexdhexaad ah iyo wadarta arthroplasty ee xaaladaha daran.
Neoplasms garabka
Dadka qaangaarka ah> 40, lafaha Mets d/t sambabada, naaska, unugyada kelyaha, tayroodh CA & prostate waa sababaha m/c. Kiliinik ahaan: waxa laga yaabaa in ay ku ekaato xanuunka u eg RTC/isbeddellada wadajirka ah. Waa in si taxadar leh loo qiimeeyaa. Furaha Dx: Hx, PE iyo Imaging esp.in pts oo leh aasaas la yaqaan
sawirka: Raajooyinka 1st, MRI waxay ku caawin kartaa, Tc99 scintigraphy lafaha waxay caawisaa in la ogaado cudurka gobolka iyo kan fog. Astaamaha raajada: isbeddellada lytic ee wax burburiya sida caadiga ah prox humerus(dhuuxa cas) oo leh ama w/o jidka Fx. DDx: Mets, MM, lymphoma
Kiliinik ahaan: xanuunka habeenkii, xanuunka nasashada, iwm. Tijaabada shaybaadhka: aan faa'iido lahayn, xaaladaha daran hypercalcemia ayaa laga yaabaa in la ogaado.
Neoplasms lafaha aasaasiga ah ee malignantiga ah (garabka) Dadka waaweyn: M. Myeloma ama Plasmacytoma Keli ah, Chondrosarcoma waxa laga yaabaa inay isu beddesho enchondroma iyo qaar kale. Carruurta/Dhalinyarada: OSA vs. Ewing�s
Neoplasms lafaha aasaasiga ah ee aan fiicneyn (garabka). Dadka waaweyn: Enchondroma (bukaanada 20-30s) GCT. Carruurta: Cyst lafo fudud (Unicameral Cyst), Osteochondroma, Aneurysmal Bone Cyst, Chondroblastoma (naadir)
Sawirka: raajada 1-aad
MRI waxay lagama maarmaan u tahay Dx. Gaar ahaan xaaladaha neoplasms malignant aasaasiga ah Qiimee xadka, soo galitaanka unugyada jilicsan, qorshaynta ka hor qalliinka, diyaarinta, iwm.
Qiyaastii 1.5 milyan oo qof oo ku nool Mareykanka ayaa qaba rheumatoid arthritis-ka. rheumatoid arthritis, ama RA, waa cudur daba-dheeraaday, difaaca jirka oo lagu garto xanuunka iyo bararka xubnaha. Iyadoo RA, habka difaaca jirka, kaas oo ilaaliya fayoqabkayaga isagoo weeraraya walxaha shisheeye sida bakteeriyada iyo fayrasyada, si qalad ah u weeraraya kala-goysyada. Rheumatoid arthritis-ku wuxuu inta badan saameeyaa kala-goysyada gacmaha, cagaha, curcurada, xusullada, jilbaha iyo anqawyada. Xirfadlayaal badan oo daryeelka caafimaadku waxay ku talinayaan ogaanshaha hore iyo daaweynta RA.
aan la taaban karin
Rheumatoid arthritis-ku waa kan ugu badan ee la ogaado xanuunka bararka habdhiska. Haweenka, kuwa sigaarka cabba, iyo kuwa taariikhda qoyska ee cudurka ayaa inta badan saameeya. Shuruudaha lagu ogaanayo waxaa ka mid ah in la yeesho ugu yaraan hal laf dhabar oo leh barar qeexan oo aan lagu sharraxin cudur kale. Suurtagalnimada ogaanshaha cudurka rheumatoid arthritis-ku wuxuu kordhiyaa tirada xubnaha yar yar ee ku lug leh. Bukaanka qaba arthritis-ka bararka, joogitaanka qodobka rheumatoid ama borotiinka anti-citrullinated antibody, ama heerka borotiinka C-reactive oo sarreeya ama heerka sedimentation erythrocyte ayaa soo jeedinaya ogaanshaha rheumatoid arthritis-ka. Qiimaynta hore ee shaybaadhka waa in lagu daraa tirinta dhiiga oo dhammays tiran oo kala duwan iyo qiimaynta shaqada kelyaha iyo beerka. Bukaan-socodka qaadanaya walxaha bayoloji waa in laga baadho cagaarshow B, cagaarshow C, iyo qaaxada. Baaritaanka hore ee rheumatoid arthritis-ku wuxuu u oggolaanayaa daaweyn hore oo leh cudur-wax ka beddelka wakiilada antirheumatic. Isku darka daawooyinka ayaa inta badan loo isticmaalaa si loo xakameeyo cudurka. Methotrexate caadi ahaan waa dawada safka kowaad ee rheumatoid arthritis-ka. Waxyaalaha bayoolojiga ah, sida inhibitors factor necrosis tumor, ayaa guud ahaan loo arkaa wakiilada safka labaad ama waxaa lagu dari karaa labada daawaynta. Hadafka daawaynta waxaa ka mid ah in la yareeyo xanuunka kala goysyada iyo bararka, ka hortagga dhaawaca shucaaca iyo qallooca muuqda, iyo sii wadida shaqada iyo hawlaha gaarka ah. Beddelka wadajirka ah waxaa loo tilmaamaa bukaanada leh dhaawac daran oo wadajir ah kuwaas oo astaamahooda ay si xun u xakameynayaan maamulka caafimaadka. (Am Fam Physician. 2011;84(11):1245-1252. Xuquuqda daabacaadda � 2011 Akademiyada Maraykanka ee Dhakhaatiirta Qoyska.
Rheumatoid arthritis-ka (RA) waa xanuunka bararka ee ugu caansan, oo leh faafitaan nololeed oo dhan ilaa 1 boqolkiiba adduunka oo dhan. Koox weyn oo Maraykan ah, 1 boqolkiiba bukaanada qaba RA waxay lahaayeen naafo shaqo 30 sano kadib.50
Etiology iyo Pathophysiology
Sida cudurro badan oo difaaca jirka ah, etiology ee RA waa arrimo badan. U nuglaanshaha hidde-sidaha ayaa ka muuqda isku-dhafka qoyska iyo daraasadaha mataanaha monozygotic, oo leh 50 boqolkiiba khatarta RA ee loo aanaynayo arrimaha hidde-sideyaasha. 4 Cilmi-baadhisyada ururka genome-ballaaran ayaa aqoonsaday saxeexyo hidde-siyeedyo dheeraad ah oo kordhinaya halista RA iyo cudurrada kale ee difaaca jirka, oo ay ku jiraan STAT45 hidda-wadaha iyo CD1 locus.6,7 Sigaar cabbiddu waa kicinta ugu weyn ee deegaanka ee RA, gaar ahaan kuwa leh saadaalin hidde-side.4 Inkastoo infekshannada. waxaa laga yaabaa in ay daaha ka qaaddo jawaab-celinta difaaca jirka, ma jiro cudur-gaare gaar ah oo la xaqiijiyay in uu keeno RA.40 RA waxaa lagu gartaa waddooyinka bararka ee keena bararka unugyada synovial ee kala-goysyada. Samaynta pannus ee danbe waxay u horseedi kartaa burburka carjawda hoose iyo nabaad-guurka lafaha. Soo saarista xad-dhaafka ah ee cytokines pro-inflammatory, oo ay ku jiraan factor necrosis tumor (TNF) iyo interleukin-5, ayaa dhaqaajiya habka burburka.8
Waxyaabaha Halista ah
Da'da da'da weyn, taariikhda qoyska ee cudurka, iyo jinsiga dheddigga ayaa lala xiriiriyaa khatarta sii kordheysa ee RA, inkasta oo kala duwanaanshaha jinsiga uu ku yar yahay bukaanka da'da weyn. = 1, ilaa 1.4 in ka badan 2.2-sano sigaarka cabba. RA aad ayey ugu yar tahay in lagu baaro dumarka faqiirka ah marka loo eego dumarka nulliparous (RR = 40).11 Naasnuujintu waxay hoos u dhigtaa halista RA = 12 kuwa qaba xanuunka caadada ee da'doodu tahay 0.61 sano ama ka yar) iyo caadada aan caadiga ahayn (RR = 13,14) waxay kordhisaa khatarta.
Cilad-
Soo Bandhigida Caadiga Ah
Bukaanka qaba RA waxay caadi ahaan la kulmaan xanuun iyo qallafsanaan kalagoysyo badan. Curcurada, kala-goysyada interphalangeal ee u dhow, iyo kala-goysyada metacarpophalangeal ayaa inta badan ku lug leh. Adkaanshaha subaxda ee soconaya wax ka badan hal saac ayaa soo jeedinaya etiology bararka. Barar barar ah oo ay sababto synovitis-ka ayaa laga yaabaa in la arki karo (Jaantuska 1), ama dhumuc weyn oo synovial ah ayaa laga yaabaa in laga dareemo baaritaanka wadajirka ah. Bukaan-socodka ayaa sidoo kale laga yaabaa inay soo bandhigaan arthralgias badan oo aan fiicnayn ka hor inta uusan bilaaban bararka wadajirka ah ee muuqda. Calaamadaha habaysan ee daalka, miisaanka oo yaraada, iyo qandho-hooseeya ayaa laga yaabaa inay ku dhacaan cudur firfircoon.
Shuruudaha Aqoonsiga
2010, Kulliyada American College of Rheumatology iyo European League Against Rheumatism ayaa iska kaashaday inay abuurto shuruudo cusub oo kala soocida RA (Shaxda 1) . shuruudaha. Shuruudaha 16 kuma jiraan joogitaanka qanjidhada rheumatoidka ama isbeddellada shucaaca ee shucaaca, kuwaas oo labaduba ay aad ugu yar yihiin horraanta RA. Cudurka 'Symmetric Arthritis' sidoo kale loogama baahna shuruudaha 1987, taasoo u oggolaanaysa soo bandhigid asymmetric hore ah. Intaa waxaa dheer, cilmi-baarayaasha Dutch-ka waxay soo saareen oo ay ansixiyeen qaanuunka saadaasha kiliinikada ee RA (Shaxda 2010) .2010 Ujeedada xeerkani waa in lagu caawiyo aqoonsiga bukaanka qaba arthritis-ka aan kala sooc lahayn oo ay u badan tahay inay u gudbaan RA, iyo inay hagaan raac-raaca- kor iyo tixraac.
Tijaabooyinka Diinta
Cudurada difaaca jirka sida RA waxaa badanaa lagu gartaa joogitaanka unugyada difaaca jirka. Cunsurka Rheumatoidku maaha mid gaar u ah RA waxaana laga yaabaa inuu ku jiro bukaannada qaba cudurrada kale, sida cagaarshow C, iyo dadka waayeelka ah ee caafimaadka qaba. Protein anti-citrullinated antibody ayaa si gaar ah u gaar ah RA waxaana laga yaabaa inay door ka ciyaaraan pathogenesis cudurada.6 Qiyaastii 50 ilaa 80 boqolkiiba dadka qaba RA waxay leeyihiin factor rheumatoid, anti-citrullinated protein antibody, ama labadaba. Natiijooyinka baaritaanka antinuclear-ka ee togan, imtixaankuna waa muhiimadda saadaalinta ee qaababka da'yarta ee cudurkan. Shuruudaha kala-saarista RA.10 Heerarka borotiinka C-reactive iyo heerka sedimentation erythrocyte ayaa sidoo kale loo isticmaali karaa in lagu raaco dhaqdhaqaaqa cudurka iyo jawaabta daawada. Asal ahaan tirada dhiigga oo dhamaystiran oo leh kala duwanaansho iyo qiimaynta shaqada kelyaha iyo beeryarada ayaa waxtar leh sababtoo ah natiijadu waxay saamayn kartaa fursadaha daawaynta (tusaale, bukaanka qaba kelyo-yaraanta ama trombocytopenia oo weyn waxay u badan tahay inaan loo qori doonin dawo aan isteeroydh lahayn oo ka hortagga caabuqa [NSAID]). Dhiig-yarida khafiifka ah ee cudurrada daba-dheeraada waxay ku dhacdaa 19 ilaa 16 boqolkiiba dhammaan bukaannada qaba RA,33 inkastoo dhiig-baxa caloosha iyo mindhicirka sidoo kale lagu tixgeliyo bukaanada qaadanaya corticosteroids ama NSAIDs. Methotrexate waa ka mamnuuc bukaanka qaba cudurrada beerka, sida cagaarshow C, iyo bukaanada qaba naafo weyn oo kelyaha ah.60 Daaweynta bayoolojiga, sida TNF inhibitor, waxay u baahan tahay baaritaanka qaaxada ee taban ama daaweynta qaaxada qarsoon. Dib u kicinta cagaarshowga B waxa kale oo ay ku dhici kartaa isticmaalka TNF inhibitor.20 Shucaaca gacmaha iyo cagaha waa in la sameeyaa si loo qiimeeyo isbeddelada nabarrada periarticular ee dabeecadda ah, taas oo laga yaabo inay muujiso nooc-hoosaad RA ah oo gardarro badan.21
Ogaanshaha Kala Duwanaanshaha
Natiijooyinka maqaarku waxay soo jeedinayaan lupus erythematosus systemic, sclerosis systemic, ama psoriatic arthritis. Polymyalgia rheumatica waa in lagu tixgeliyo bukaan da' weyn oo leh calaamadaha ugu horreeya ee garabka iyo sinta, bukaankana waa in la weydiiyo su'aalo la xiriira arteritis ku meel gaar ah. Shucaaca xabadka ayaa waxtar leh si loo qiimeeyo sarcoidosis sida etiology ee arthritis-ka Dadka leh wax ka yar lix toddobaad oo calaamado ah ayaa laga yaabaa inay yeeshaan habka fayras, sida parvovirus. Dhacdooyinka is-xakamaynta ee soo noqnoqda ee bararka wadajirka ah ee ba'an waxay soo jeedinayaan arthropathy crystal, iyo arthrocentesis waa in la sameeyaa si loo qiimeeyo monosodium urate monohydrate ama crystals pyrophosphate dihydrate crystals. Joogitaanka dhibco badan oo kiciya myofascial iyo calaamadaha somatic waxay soo jeedin karaan fibromyalgia, kaas oo la noolaan kara RA. Si loo caawiyo hagaha ogaanshaha iyo go'aaminta istaraatiijiyad daawaynta, bukaanada qaba xinjirowga bararka waa in si degdeg ah loogu gudbiyaa takhtar ku takhasusay rheumatology.16,17
Rheumatoid arthritis-ka, ama RA, waa nooca ugu badan ee arthritis-ka. RA waa cudur difaaca jirka ah, oo keena marka habka difaaca jirka, habka difaaca jirka bini'aadamka, uu weeraro unugyadiisa iyo unugyadiisa, gaar ahaan kala-goysyada. Rheumatoid arthritis-ka waxaa inta badan lagu gartaa calaamadaha xanuunka iyo bararka, oo inta badan saameeya kala-goysyada yaryar ee gacmaha, cududaha iyo cagaha. Marka loo eego xirfadlayaal badan oo daryeelka caafimaadka ah, ogaanshaha hore iyo daawaynta RA waa lama huraan si looga hortago dhaawac dheeraad ah oo wadajir ah oo la yareeyo calaamadaha xanuunka leh. Dr. Alex Jimenez DC, CCST Insight
Daaweynta
Ka dib markii RA la ogaado oo qiimeyn hore la sameeyo, daaweyntu waa inay bilaabataa. Tilmaamaha ugu dambeeyay ayaa wax ka qabtay maamulka RA,21,22 laakiin doorbidida bukaan-socodka ayaa sidoo kale door muhiim ah ka ciyaara. Waxaa jira tixgelin gaar ah oo loogu talagalay haweenka da'da dhalmada sababtoo ah daawooyin badan ayaa saameyn xun ku leh uurka. Hadafka daawaynta waxaa ka mid ah in la yareeyo xanuunka kala goysyada iyo bararka, ka hortagga qallafsanaanta (sida leexashada ulnar) iyo dhaawaca shucaaca (sida nabaad-guurka), ilaalinta tayada nolosha (shaqsiyeed iyo shaqo), iyo xakamaynta muuqaalada dheeraadka ah. Daawooyinka wax ka beddelka cudurrada ka hortagga laabotooyinka (DMARDs) ayaa ah tiirarka ugu muhiimsan ee daawaynta RA.
DMARDs
DMARD-yadu waxay noqon karaan bayooloji ama kuwa aan noolayn (Shaxda 3) .23 Walaxaha bayoolojiga waxaa ka mid ah unugyada difaaca jirka ee monoclonal iyo recombinant recombinant reseptors si ay u xannibaan cytokines kuwaas oo kor u qaadaya cascade bararka ka masuulka ah calaamadaha RA. Methotrexate ayaa lagula talinayaa inay noqoto daawaynta safka koowaad ee bukaanada qaba RA firfircoon, ilaa aan la xakameynin ama aan loo dulqaadan karin.21 Leflunomide (Arava) ayaa laga yaabaa in loo isticmaalo beddelka methotrexate, inkastoo saameynta xun ee caloosha ay aad u badan tahay. Sulfasalazine (Azulfidine) ama hydroxychloroquine (Plaquenil) pro-inflammatory sida monotherapy ee bukaanada qaba hawlo yar oo jirro ah ama aan lahayn astaamo saadaal xumo (tusaale, seronegative, non-erosive RA) . ka badan monotherapy; si kastaba ha ahaatee, saameynaha xun ayaa sidoo kale laga yaabaa inay ka weynaadaan.21,22 Haddii RA aan si fiican loo koontaroolin DMARD aan nooleyn, waa in la bilaabo DMARD bayooloji ah. Haddii horjoogayaasha TNF ay yihiin kuwo aan waxtar lahayn, daaweyn bayooloji oo dheeraad ah ayaa la tixgelin karaa. Isticmaalka isku mar ee wax ka badan hal daawaynta bayooloji (tusaale, adalimumab [Humira] with abatacept [Orencia]) laguma talinayo sababtoo ah xad aan la aqbali karin oo saameyn xun leh.24
NSAIDs iyo Corticosteroids
Daawaynta maandooriyaha ee RA waxay ku lug yeelan kartaa NSAID-yada iyo corticosteroids-ka afka, murqaha, ama intra articular si loo xakameeyo xanuunka iyo bararka. Fikrad ahaan, NSAIDs iyo corticosteroids waxaa loo isticmaalaa oo kaliya maaraynta muddada gaaban. DMARD waa daawaynta la door bidayo.21,22
Daawooyinka Kaabayaasha ah
Waxqabadyada cuntada, oo ay ku jiraan cuntooyinka khudradda iyo Mediterranean-ka, ayaa lagu bartay daaweynta RA iyada oo aan caddayn caddayn faa'iido leh. oo leh RA.25,26 Intaa waxaa dheer, ku daaweynta kulaylka iyo ultrasound-ka daaweynta ee RA si fiican looma baranin. wilfordii (thunder god vine) waxay leedahay faa'iidooyin suurtagal ah.27,28 Waa muhiim in la ogeysiiyo bukaanada in waxyeellooyin halis ah laga soo sheegay isticmaalka daaweynta dhirta.29,30
Jimicsiga iyo Daaweynta Jirka
Natiijooyinka tijaabooyinka la kantaroolay ee la kala soocay waxay taageeraan jimicsiga jirka si loo hagaajiyo tayada nolosha iyo xoogga muruqa ee bukaanada qaba RA.32,33 Barnaamijyada jimicsiga jimicsiga laguma muujin inay saameyn xun ku yeelanayaan dhaqdhaqaaqa cudurka RA, dhibcaha xanuunka, ama dhaawaca wadajirka shucaaca. 34 Tai chi ayaa lagu muujiyay in ay wanaajiso dhaqdhaqaaqa canqowga ee dadka qaba RA, inkastoo tijaabooyinka la kala soocay ay xadidan yihiin.
Muddada Daaweynta
Remission waxaa lagu heli karaa 10 ilaa 50 boqolkiiba bukaanada qaba RA, taas oo ku xidhan sida cafiska loo qeexay iyo xoojinta daaweynta. Bukaanka ka weyn 10 sano), oo leh muddo gaaban oo cudur ah, oo leh hawlo fudud oo cudur ah, iyada oo aan lahayn falcelin heer sare ah oo degdeg ah, iyo iyada oo aan lahayn rheumatoid factor togan ama natiijooyinka anti-citrullinated borotiinka antibody. ilaa inta ugu yar ee loo baahan yahay. Bukaan-socodka waxay u baahan doonaan kormeer joogto ah si loo hubiyo in calaamaduhu deggan yihiin, waxaana lagu talinayaa in si degdeg ah loo kordhiyo daawada marka ay cudurku dillaacaan.40
Beddelka wadajirka
Beddelka wadajirka ah ayaa la tilmaamayaa marka uu jiro dhaawac daran oo wadajir ah iyo xakameyn aan ku qanacsanayn calaamadaha maamulka caafimaadka. Natiijooyinka muddada dheer waa taageero, kaliya 4 ilaa 13 boqolkiiba beddelka wadajirka ah ee u baahan dib u eegis 10 sano gudahood.38 Sinta iyo jilibka ayaa ah kuwa ugu badan ee la beddelo.
La socodka muddada-dheer
Inkasta oo RA loo tixgeliyo cudur ku dhaca kala-goysyada, sidoo kale waa cudur nidaamsan oo awood u leh inuu ku lug yeesho hababka xubnaha badan. Calaamadaha dheeraadka ah ee RA waxay ku jiraan Shaxda 4.1,2,10 Bukaanka qaba RA waxay leeyihiin labanlaab khatarta ah ee lymphoma, taas oo loo maleynayo in ay keento habka bararka ee hoose, oo aan ahayn natiijada daaweynta.39 Bukaanka qaba RA sidoo kale waxay halis dheeraad ah ugu jiraan cudurrada halbowlaha wadnaha, dhakhaatiirtuna waa inay la shaqeeyaan bukaannada si ay wax uga beddelaan arrimaha khatarta ah, sida sigaarka, dhiig karka, iyo kolestaroolka sare.40,41 Class III ama IV congestive heart failure (CHF) waa diidmada isticmaalka TNF inhibitors, taas oo ka sii dari karta natiijooyinka CHF.21 Bukaanka qaba RA iyo malignant, taxadar ayaa loo baahan yahay isticmaalka joogtada ah ee DMARDs, gaar ahaan TNF inhibitors. DMARD bayooloji, methotrexate, iyo leflunomide waa in aan lagu bilaabin bukaanada leh herpes zoster firfircoon, caabuq fangas oo muhiim ah, ama caabuqa bakteeriyada u baahan antibiyootik.21 Dhibaatooyinka RA iyo daawaynta ayaa ku taxan Shaxda 5.1,2,10
Sadaalin
Bukaanka qaba RA waxay ku nool yihiin saddex ilaa 12 sano in ka yar dadka guud ahaan.40 Kordhinta dhimashada bukaannadan ayaa inta badan sabab u ah cudurrada wadnaha iyo xididada oo la dedejiyey, gaar ahaan kuwa leh dhaqdhaqaaqa sare ee cudurrada iyo caabuqa joogtada ah. Dawaynta bayoolojiga ee cusub ayaa laga yaabaa inay dib u dhigto horumarka atherosclerosis oo ay kordhiso nolosha kuwa qaba RA.41
Data Sources: Raadinta PubMed ayaa lagu dhammeeyey Weydiimaha Kiliinikada iyadoo la adeegsanayo ereyada muhiimka ah ee rheumatoid arthritis-ka, muujinta articular-ka ka baxsan, iyo cudurrada wax ka beddelaya wakiilada ka hortagga laabotooyinka. Raadinta waxaa ka mid ah falanqaynta-meta-falanqaynta, tijaabooyinka la kantaroolay ee la kala soocay, tijaabooyin caafimaad, iyo dib u eegis. Waxa kale oo la baadhay Wakaaladda Cilmi-baadhista Daryeelka Caafimaadka iyo warbixinnada caddaynta tayada, Caddaynta Kiliinikada, xogta Cochrane, caddaynta muhiimka ah, iyo UpToDate. Taariikhda raadinta: Sebtembar 20, 2010.
Shaacinta qoraaga: Ma jiro xiriir dhaqaale oo khuseeya oo la shaaciyo. Gebagebadii, rheumatoid arthritis-ku waa cudur daba-dheeraaday, oo difaaca jidhka ah kaas oo keena calaamado xanuun badan, sida xanuunka iyo raaxo-darrada, bararka iyo bararka xubnaha iyo kuwa kale. Burburka wadajirka ah ee lagu garto sida RA waa mid siman, taasoo la micno ah inay guud ahaan saameyso labada dhinac ee jirka. Ogaanshaha hore ayaa muhiim u ah daaweynta RA. Baaxadda macluumaadkayadu waxay ku kooban tahay xanuunka loo yaqaan 'chiropractic' iyo arrimaha caafimaadka laf dhabarta. Si aad ugala hadasho mawduuca, fadlan xor u noqo inaad waydiiso Dr. Jimenez ama nagala soo xidhiidh at�915-850-0900� Waxaa soo saaray Dr. Alex Jimenez
Xanuunka jilibka waa calaamad caan ah oo ku dhici karta dhaawacyo jilibka ah iyo/ama xaalado kala duwan, oo ay ku jiraandhaawacyada isboortiga. Jilibku waa mid ka mid ah kala-goysyada ugu adag ee jidhka bini'aadamka maadaama uu ka kooban yahay isgoysyada afar lafo, afar seediyo, seedooyin kala duwan, laba menisci, iyo carjawda. Sida laga soo xigtay Akademiyada Maraykanka ee Dhakhaatiirta Qoyska, sababaha ugu badan ee xanuunka jilibka waxaa ka mid ah subluxation patellar, patellar tendinitis ama jilibka jumper, iyo cudurka Osgood-Schlatter. Inkasta oo xanuunka jilibka ay u badan tahay inuu ku dhaco dadka ka weyn 60 sano, xanuunka jilibka wuxuu sidoo kale ku dhici karaa carruurta iyo dhalinyarada. Xanuunka jilibka waxaa lagu daweyn karaa guriga iyadoo la raacayo hababka RICE, si kastaba ha ahaatee, dhaawacyada daran ee jilibka ayaa laga yaabaa inay u baahdaan daryeel caafimaad oo degdeg ah, oo ay ku jiraan daryeelka xanuunka loo yaqaan 'chiropractic care'.
M/C oo ka go'a cagta ee articulation tarsal-metatarsal articulation (Lisfranc joint). Saamayn toos ah ama degitaan iyo dhirbaaxo ama laablaabasho cagta ah. Lisfranc ligament haysta saldhigga 2aad ee MT iyo 1aad Cu waa dillaacay. Waxay ka muuqataa jab-jabka ama jabka.
Sawirka: tillaabada 1aad: shucaaca cagta xaaladaha badankooda waa ku filan Dx. MSK US ayaa laga yaabaa inay ku caawiso: tuso Cu1-Cu2 khalkhalka galay. ligament iyo bannaanka la ballaadhiyey> 2.5mm. MRI ayaa laga yaabaa inay ku caawiso laakiin lama huraan. Kaalmada aragtida miisaanka Dx.
Jones Fx: dheeraad ah-articular Fx ee metaphysis u dhow ee 5th MT. U nugul urur la'aanta. Inta badan waxay u go'an tahay qaliin.
Been abuur-Jones: Avulsion intra articular avulsion of 5th MT styloid/saldhig by foosha eccentric ee Peroneus Brevis M. Loo maareeyay muxaafid: kicinta boot-cast. Jones iyo Pseudo-Jones Dx labadaba raadiyaha taxanaha cagta.
Cadaadiska Fx. Calcaneus, 2nd, 3rd, 5th MTs. Soo-celinta soo noqnoqda (orodeysa) ama "Cagta Maarso" 2nd/3rd MT. Kiliinik ahaan: xanuunka ku dhaca dhaqdhaqaaqa, hoos u dhaca nasashada. Dx: Raajooyinku inta badan abaal-marin hore uma laha. MRI ama MSK US ayaa laga yaabaa inay ku caawiyaan. Maareeyey: Muxaafid ahaan. Dhibaatooyinka; Horumarka oo dhammaystiran Fx
Suufka cawska: hyperextension caadiga ah ciyaaraha fudud ee 1st MTP-sesamoid/plantar dhismaha saxanku waa jeexjeexayaa. 1st MTP aan degganayn/ dabacsan Si hawlkar ah loo maareeyey.
Arthritis-ka cagta & anqawga
DJD ee canqowga: aan caadi ahayn OA aasaasiga ah. Caadi ahaan waxay u koraan sida 2nd ilaa trauma/AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis, iwm
Arthritis bararka: RA waxaa laga yaabaa inay ku horumarto anqawga ama xubin kasta oo synovial ah. Waxay caadi ahaan soo bandhigaysaa Gacmaha/cagaha smmetrical RA marka hore (2aad, 3aad MCP, curcurka, MTP-yada cagaha) badiyaa leh nabaad guurka, lebbiska JSL, osteopenia juxta-articular, iyo subluxations daahday.
Gouty Arthritis: caan ku ah cirifka hoose. Anqawga, cag-dhexe-cagta 1st MTPs. Bilawga ugu horreeya: xanuunka gouty arthritis-ka oo ba'an oo leh ST effusion oo aan lahayn nabaad-guur/tophi. Gout-ka sare ee daba-dheeraada: Peri-articular, intra-osseous feer-ka baxay nabaad-guurka oo leh cidhifyo aad u-laad-laadsan, aan lahayn bilowga JSL/osteopenia, ST. Tophi waa la arki karaa.
Arthropathy kala duwan: PVNS. Aan caadi ahayn. Waxay saamaysaa 3-4aad ee nolosha. Natiijada kororka synovial oo leh Macrophages iyo unugyo badan oo Nuclear ah oo Giant ah oo ay ka buuxaan hemosiderin iyo dufanka dufanka leh waxay u horseedi kartaa barar, burburka carjawda, nabaad-guurka lafaha dibadda. Dx: Raajooyinku waa dareen la'aan, qaabka MRI ee doorashada. Biopsi synovial. Maareynta: qalliin, waxay noqon kartaa mid adag.
Neuropathic Osteoarthropathy
(Wadajirka Charcot) Caadiyan iyo kor u kaca cudurka d/t ee nooca 2 DM. Waxaa laga yaabaa inuu la kulmo xanuunka marka hore (50% kiisaska) iyo arthropathy aan xanuun lahayn oo burburaya sida muujin soo daahday. Horey Dx: daahday. Sawirku waa muhiim: raajooyin: bilawga abaal-marin, dheecaan SF ah ayaa la arkay. MRI waxay ka caawisaa hore ee Dx iyo xajinta off-loading. Late Dx: Kala-bax aan la soo celin karin, burbur, naafo. Xusuusin: Kala-baxa Lisfrance ee wadajirka Charcot
Arthritis waxaa lagu gartaa sida bararka hal ama dhowr kala goysyo. Calaamadaha ugu caansan ee arthritis-ka waxaa ka mid ah xanuun iyo raaxo la'aan, barar, barar, iyo qallafsanaan, iyo kuwo kale. Arthritis-ku waxa uu saameeyaa kala-goysyada jidhka bini'aadamka, si kastaba ha ahaatee, waxa uu caadi ahaan ka soo baxa jilibka. arthritis-ka jilibka wuxuu ka dhigi karaa hawl maalmeed adag. Noocyada ugu badan ee arthritis-ku waa osteoarthritis iyo rheumatoid arthritis-ka, inkastoo ay jiraan in ka badan 100 nooc oo arthritis ah, oo saameeya carruurta iyo dadka waaweyn si isku mid ah. Iyadoo aan dawo loo lahayn arthritis-ku, habab badan oo daaweyn ah ayaa kaa caawin kara daaweynta calaamadaha arthritis-ka jilibka.
Anatomy ee Jilibka
� Jilibku waa laf-dhabarta ugu weyn uguna xoogga badan ee jidhka bini'aadamka. Waxay ka kooban tahay cidhifka hoose ee lafta bowdada, ama femur, cidhifka sare ee lafta shinka, ama tibia, iyo jilbaha, ama patella. Cidhifyada saddexda lafood waxaa lagu daboolay carjawda articular, qaab siman oo simbiriirixan leh kaas oo ilaaliya oo barkinta lafaha marka la foorarsado oo toosiyo jilibka.
� Laba qaybood oo u eg carjawda, oo loo yaqaan meniscus, waxay u shaqeeyaan sida shoogga shoogga inta u dhaxaysa lafaha jilibka si ay u caawiyaan barkinta wadajirka oo ay u helaan xasillooni. Labbada jilibka sidoo kale waxaa ku wareegsan maro khafiif ah oo loo yaqaan xuubka synovial. Xuubkani waxa uu soo daayaa dareere ka soo saara carjawda waxa kale oo uu ka caawiyaa yaraynta is jiid jiidka jilibka. Noocyada muhiimka ah ee arthritis-ka ee saameeya jilibka waxaa ka mid ah osteoarthritis, rheumatoid arthritis-ka, iyo arthritis-ka post-traumatic.
Osteoarthritis
� Lafo-jileecu waa nooca ugu badan ee arthritis-ka kaas oo saameeya lafaha jilibka. Noocan ah arthritis-ku waa arrin caafimaad xumo, xirasho-iyo-jeexjeexa kaas oo inta badan ku dhaca dadka da'doodu tahay 50 sano iyo ka weyn, si kastaba ha ahaatee, waxay sidoo kale ku dhici kartaa dadka da'da yar.
� Lafo-jileecu, carjawda ku jirta lafta jilibka ayaa si tartiib tartiib ah u daata. Marka carjawgu sii dabargo'o, masaafada u dhaxaysa lafaha ayaa hoos u dhacda. Tani waxay keeni kartaa xoqid lafo waxayna abuuri kartaa xanuujiyo lafo xanuun leh. Osteoarthritis guud ahaan si tartiib tartiib ah ayuu u korayaa laakiin xanuunku wuu ka sii dari karaa muddo ka dib.
Arthritis rheumatoid
Rheumatoid arthritis-ku waa arrin caafimaad oo daba-dheeraatay kaasoo saameeya kala-goysyada badan ee jirka oo dhan, gaar ahaan lafaha jilibka. RA sidoo kale waa summetrical, taasoo la micno ah in ay inta badan saameyso isku-dhafka dhinac kasta ee jirka bini'aadamka.
� rheumatoid arthritis-ka, xuubka synovial ee daboolaya laabta jilibka ayaa barara oo barara, taasoo keenta xanuun jilibka ah, raaxo la'aan, iyo qallafsanaan. RA waa cudur difaaca jirka, taas oo macnaheedu yahay in habka difaaca jirka uu weeraro unugyadiisa jilicsan. Nidaamka difaaca jirka waxa uu weeraraa unug caafimaad qaba, oo ay ku jiraan seedaha, seedaha iyo carjawda, sidoo kale waxa uu jilciyaa lafaha.
Xanuunka Arthritis-ka kadib
� Posttraumatic Arthritis waa nooc ka mid ah arthritis-ku ka soo baxa ka dib dhaawac ama dhaawac jilibka ah. Tusaale ahaan, laf-dhabarta jilibka waxaa laga yaabaa inay waxyeelo ka soo gaarto lafo jaban, ama jab, oo ay keento arthritis-ka daba-galka ah sannado ka dib dhaawaca hore. Ilmada Meniscal iyo dhaawacyada seedaha waxay sababi karaan daal-iyo-jeexid dheeraad ah oo ku dhaca wadajirka jilibka, taas oo waqti ka dib u horseedi karta arthritis iyo dhibaatooyin kale.
Calaamadaha Arthritis Jilibka
Calaamadaha ugu caansan ee arthritis-ka jilibka waxaa ka mid ah xanuun iyo raaxo la'aan, barar, barar, iyo qallafsanaan. In kasta oo ay suurtogal tahay in si degdeg ah u bilaabmo, calaamadaha xanuunka badan si tartiib tartiib ah ayey u korayaan muddo ka dib. Calaamadaha dheeraadka ah ee arthritis-ka jilibka ayaa loo aqoonsan karaa sida soo socota:
Kala-goysyadu waxay noqon karaan kuwo qallafsan oo barara, taas oo adkeynaysa in la leexiyo oo toosiyo jilibka.
Bararka iyo bararka ayaa laga yaabaa inay ka sii daraan subaxda, ama markaad fadhido ama nasato.
Dhaqdhaqaaqa xooggan ayaa laga yaabaa inuu keeno xanuunka inuu soo baxo.
Qaybaha dabacsan ee carjawda iyo unugyo kale oo jilicsan ayaa laga yaabaa inay farageliyaan dhaqdhaqaaqa siman ee kala-goysyada, taasoo keenta in jilibku uu xidho ama ku dhego dhaqdhaqaaqa. Waxay kaloo kicin kartaa, gujin kartaa, dhufan kartaa ama samayn kartaa dhawaaq shiidi, oo loo yaqaan crepitus.
Xanuunku wuxuu keeni karaa dareen daal ama jilibka oo ka soo booda.
Shakhsiyaad badan oo qaba arthritis-ku waxay sidoo kale qeexi karaan xanuunka wadajirka ah ee sii kordhaya ee cimilada roobka iyo isbeddelka cimilada.
Ogaanshaha Arthritis Jilibka
� Inta lagu jiro ballanta bukaan-socodka ee ogaanshaha arthritis-ka jilibka, xirfad-yaqaanka daryeelka caafimaadku waxa uu ka hadli doonaa calaamadaha iyo taariikhda caafimaadka, iyo sidoo kale in uu sameeyo baaritaan jireed. Dhakhtarku waxa kale oo laga yaabaa inuu dalbado baadhitaanada ogaanshaha sawir-qaadista, sida raajada, MRI ama baadhista dhiigga si loo sii ogaado cudurka. Inta lagu jiro baaritaanka jirka, dhakhtarku wuxuu raadin doonaa:
Caabuqa wadajirka, barar, diirimaad, ama casaan
Dareenka agagaarka wadajirka jilibka
Kala duwanaanshaha dhaqdhaqaaqa firfircoon iyo dhaqdhaqaaqa
Degenaansho la'aanta wadajirka jilibka
Crepitus, dareenka xiiqsan ee gudaha wadajirka, oo leh dhaqdhaqaaq
Xanuun marka miisaanka la saaro jilibka
Arrimaha socodka, ama habka socodka
Calaamad kasta oo dhaawac ama dhaawac ah oo ku yimaada murqaha, seedaha, iyo seedaha ku hareeraysan wadajirka jilibka
Raajooyin. Tijaabooyinkan ogaanshaha sawir-qaadista waxay soo saaraan sawirro qaab-dhismeedyo is haysta, sida lafaha. Waxay kaa caawin karaan inay kala soocaan noocyada kala duwan ee arthritis-ka. Raajooyinka loogu talagalay arthritis-ka jilibka ayaa laga yaabaa inay muujiyaan qayb ka mid ah masaafada wadajirka ah, isbeddelka lafaha iyo sidoo kale samaynta lafaha lafaha, oo loo yaqaan 'osteophytes'.
Imtixaan dheeraad ah. Mararka qaarkood, sawir-qaadista magnetic, ama MRI, scans, tomografi la xisaabiyay, ama CT, scans, ama baarista lafaha ayaa loo baahan yahay si loo xaqiijiyo xaalada lafaha iyo unugyada jilicsan ee jilibka.
Baaritaanka Dhiiga
� Waxa kale oo laga yaabaa in dhakhtarkaagu kugula taliyo baadhitaano dhiig si loo go'aamiyo nooca arthritis-ka ee aad qabto. Noocyada qaarkood ee arthritis-ka, sida rheumatoid arthritis-ka, baaritaanka dhiigga ayaa kaa caawin kara aqoonsiga saxda ah ee cudurka.
Inkasta oo laf-dhabarta jilibka ay tahay mid ka mid ah kuwa ugu xoogga badan uguna weyn ee jidhka bini'aadamka, waxay inta badan u nugul yihiin inay soo gaarto dhaawac ama dhaawac, taasoo keenta xaalado kala duwan. Intaa waxaa dheer, si kastaba ha ahaatee, arrimaha kale ee caafimaadka, sida arthritis-ka, waxay saameyn kartaa wadajirka jilibka. Shabakadda inta badan caymiska El Paso, TX, daryeelka xanuunka loo yaqaan 'chiropractic care' ayaa kaa caawin kara fududaynta calaamadaha xanuunka leh ee la xidhiidha arthritis-ka jilibka, iyo arrimaha kale ee caafimaadka. Dr. Alex Jimenez DC, CCST Insight
Daaweynta Arthritis Jilibka
Daaweynta aan qaliinka ahayn
� Hababka daawaynta aan qaliinka ahayn ayaa inta badan lagu taliyaa ka hor inta aan la tixgelin daawaynta qaliinka ee arthritis-ka jilibka. Xirfadlayaasha daryeelka caafimaadku waxay kugula talinayaan xulashooyin daaweyn oo kala duwan, oo ay ku jiraan daryeelka xanuunka loo yaqaan 'chiropractic care', daaweynta jireed, iyo wax ka beddelka qaab nololeedka, iyo kuwo kale.
Waxka bedelka qaab nololeedka Qaar ka mid ah wax ka beddelka hab-nololeedka ayaa kaa caawin kara ilaalinta wadajirka jilibka waxayna carqaladeeyaan horumarka arthritis-ka. Yaraynta dhaqdhaqaaqyada jireed ee sii xumeynaya xaaladda, waxay saaraysaa cadaadis yar oo jilibka ah. Miisaanka oo lumiya waxa kale oo laga yaabaa inay kaa caawiso yaraynta cadaadiska iyo cadaadiska jilibka, taasoo keentay calaamado xanuun yar iyo kor u kaca shaqada.
Daryeelka lafdhabarta iyo daaweynta jireed.Daryeelka lafdhabarta ayaa isticmaala hagaajinta xanuunka loo yaqaan 'chiropractic' si ay si taxadar leh u soo celiyaan wixii qallafsanaanta laf dhabarta, ama subluxations, taas oo keeni karta calaamadaha, oo ay ku jiraan arthritis. Dhakhtarku waxa kale oo laga yaabaa inuu kugula taliyo daaweynta jireed si loo abuuro jimicsi shakhsi ahaaneed iyo barnaamij jimicsi oo loogu talagalay baahida bukaan kasta.
Qalabka gargaarka. Isticmaalka aaladaha caawinta, sida bakooradda, kabaha shoogga nuugaya ama wax la geliyo, ama gacan-gashiga ama gacmaha jilibka, waxay yarayn karaan calaamadaha xanuunka leh. Qalabku wuxuu caawiyaa shaqada iyo xasilloonida, waxaana laga yaabaa inay si gaar ah faa'iido u leedahay haddii arthritis-ku ku saleysan yahay hal dhinac oo jilibka ah. Waxaa jira laba nooc oo ka mid ah xargaha oo inta badan loo isticmaalo arthritis-ka jilibka: "dejinta" dhejinta waxay ka beddeshaa miisaanka qaybta jilibka ee ay saameysey, halka "taageerada" ay ka caawiso taageerada dhammaan culeyska jilibka.
Daawooyinka iyo/ama daawooyinka. Noocyo dhowr ah oo daawooyin ah ayaa faa'iido u leh daaweynta arthritis-ka jilibka. Maadaama ay shakhsiyaadku si kala duwan uga jawaabaan daawooyinka, dhakhtarkaagu si dhow ayuu kula shaqayn doonaa si loo go'aamiyo daawooyinka iyo qiyaasta kuwaas oo badbaado leh oo waxtar kuu leh.
Daaweynta Qalitaanka
Xirfadlaha daryeelka caafimaadku waxa uu kugula talin karaa daawaynta qaliinka haddii jilibka arthritis-ka ee bukaanka uu keeno naafonimo daran oo kaliya haddii dhibaatadu aan lagu nafisin daawaynta aan qaliinka ahayn. Sida qalliinnada oo dhan, waxaa jira khataro iyo dhibaatooyin dhowr ah oo leh daawaynta qaliinka ee arthritis-ka jilibka. Dhakhtarku waxa uu bukaanka kala hadli doonaa dhibaatooyinka suurtogalka ah.
Arthroscopy. Inta lagu jiro arthroscopy, takhaatiirtu waxay isticmaalaan qalabyo iyo jeexjeexyo yaryar si ay u baaraan oo ay u daaweeyaan dhibaatooyinka wadajirka ah ee jilibka. Qalliinka arthroscopic inta badan looma isticmaalo daawaynta arthritis-ka ee jilibka. Kiisaska ay osteoarthritis la socoto jeexan meniscal ah, qalliinka arthroscopic ayaa laga yaabaa inuu caqli yeesho in lagu daweeyo meniscus jeexan.
Ku-tallaalidda carjawda. Unugyada carjawda caadiga ah waxaa laga soo qaadi karaa bangi unug ama qayb kale oo jilibka ah si loo buuxiyo daloolka carjawda articular. Habkan waxaa caadi ahaan loo tixgaliyaa bukaanada da'da yar.
Synovectomy Dahaarka ay waxyeeleeyeen rheumatoid arthritis-ku waa la tirtiraa si loo yareeyo bararka iyo xanuunka.
Lafo-beelka. Jilibka osteotomy-ka, mid ka mid ah tibia (shinlafta) ama femur (lafaha bowdada) ayaa la gooyaa ka dibna dib ayaa loo qaabeeyaa si loo yareeyo cadaadiska iyo cadaadiska wadajirka jilibka. Jilibka osteotomy waxaa la isticmaalaa marka marxaladda hore ee osteoarthritis ay dhaawacday hal weji oo ka mid ah wadajirka jilibka. Beddelidda qaybinta miisaanka, tani waxay yareyn kartaa oo kor u qaadi kartaa shaqada jilibka.
Wadarta ama qayb ka mid ah beddelka jilibka (arthroplasty).�Dhakhtarku waxa uu ka saarayaa lafaha dhaawacantay iyo carjawda, ka dib waxa uu dhigayaa baco ama sagxad cusub oo bir ah si uu u soo celiyo shaqadii jilibka iyo dhismooyinkiisa ku xeeran.
� Ka dib nooc kasta oo qalliin ah oo loogu talagalay arthritis jilibka waxay ku lug yeelan doontaa muddo soo kabasho. Waqtiga soo kabashada iyo baxnaanintu waxay ku xirnaan doontaa nooca qaliinka la sameeyay. Waa lagama maarmaan inaad la hadasho xirfadlahaaga daryeelka caafimaadka si loo go'aamiyo doorashada daawaynta ugu fiican ee arthritis-kaaga jilibka. Baaxadda macluumaadkayadu waxay ku kooban tahay xanuunka loo yaqaan 'chiropractic' iyo arrimaha caafimaadka laf dhabarta. Si aad ugala hadasho mawduuca, fadlan xor u noqo inaad waydiiso Dr. Jimenez ama nagala soo xidhiidh at�915-850-0900 .
Xanuunka jilibka waa calaamad caan ah oo ku dhici karta dhaawacyo iyo/ama xaalado kala duwan oo jilibka ah, oo ay ku jiraandhaawacyada isboortiga. Jilibku waa mid ka mid ah kala-goysyada ugu adag ee jidhka bini'aadamka maadaama uu ka kooban yahay isgoysyada afar lafo, afar seediyo, seedooyin kala duwan, laba menisci, iyo carjawda. Sida laga soo xigtay Akademiyada Maraykanka ee Dhakhaatiirta Qoyska, sababaha ugu badan ee xanuunka jilibka waxaa ka mid ah subluxation patellar, patellar tendinitis ama jilibka jumper, iyo cudurka Osgood-Schlatter. Inkasta oo xanuunka jilibka ay u badan tahay inuu ku dhaco dadka ka weyn 60 sano, xanuunka jilibka wuxuu sidoo kale ku dhici karaa carruurta iyo dhalinyarada. Xanuunka jilibka waxaa lagu daweyn karaa guriga iyadoo la raacayo hababka RICE, si kastaba ha ahaatee, dhaawacyada daran ee jilibka ayaa laga yaabaa inay u baahdaan daryeel caafimaad oo degdeg ah, oo ay ku jiraan daryeelka xanuunka loo yaqaan 'chiropractic care'.
The jilibka waa mid ka mid ah kala-goysyada ugu adag ee jidhka bini'aadamka, oo ka kooban lafta bowdada, ama femur, lafta shin, ama tibia, iyo jilibka, ama patella, oo ka mid ah unugyo kale oo jilicsan. Tendons waxay ku xiraan lafaha murqaha halka seedaha ay isku xiraan lafaha wadajirka jilibka. Laba qaybood oo u eg carjawda, oo loo yaqaan meniscus, ayaa siinaya xasilloonida wadajirka jilibka. Ujeedada maqaalka hoose waa in la muujiyo iyo sidoo kale ka doodista anatomy ee wadajirka jilibka iyo unugyada jilicsan ee ku hareeraysan.
aan la taaban karin
Macnaha guud: Macluumaadka ku saabsan qaabka, ka kooban, iyo shaqada menisci jilibka ayaa ku kala firirsan ilo iyo goobo badan. Dib-u-eegiddu waxay ka kooban tahay sharraxaad kooban, faahfaahsan oo ku saabsan menisci jilibka oo ay ku jiraan anatomy, etymology, phylogeny, ultrastructure iyo biochemistry, vascular anatomy iyo neuroanatomy, shaqada biomechanical, korriinka iyo gabowga, iyo qaababka sawirka.
Helitaanka caddaynta: Raadinta suugaanta ayaa lagu sameeyay dib u eegis lagu sameeyay PubMed iyo OVID maqaallada oo la daabacay 1858 ilaa 2011.
Gabagabo: Fahamka anatomy caadiga ah iyo biomechanics ee menisci waa shardi lagama maarmaan ah si loo fahmo cudur-sidaha jirrooyinka ku lug leh jilibka.
Keywords:jilibka, meniscus, anatomy, function
Hordhac
Marka lagu tilmaamo hadhaaga uurjiifka ee aan shaqaynayn,162 menisci ayaa hadda la og yahay inay muhiim u yihiin shaqada caadiga ah iyo caafimaadka muddada dheer ee wadajirka jilibka. iyo nafaqaynta lafaha jilibka.4,91,152,153
Dhaawacyada menisci waxaa loo aqoonsan yahay inay sabab u tahay xanuunada murqaha ee muhiimka ah. Qaab dhismeedka gaarka ah ee kakan ee menisci wuxuu ka dhigayaa daaweynta iyo dayactirka caqabad ku ah bukaanka, dhakhtarka qalliinka, iyo daaweeyaha jireed. Intaa waxaa dheer, dhaawaca muddada dheer wuxuu keeni karaa isbeddellada wadajirka ah ee is-beddelka ah sida samaynta osteophyte, carjawda articular articular, cidhiidhiga booska wadajirka ah, iyo osteoarthritis calaamad.
Hominids waxay soo bandhigaan sifooyin isku mid ah anatomic iyo functional, oo ay ku jiraan femur distal distal ah, intra-articular cruciate ligaments, menisci, iyo asymmetrical . ,40,66
In lineage primate ee u horseedaya bini'aadamka, hominids waxay u kobceen mawqifka laba-geesoodka ah qiyaastii 3 ilaa 4 milyan oo sano ka hor, iyo 1.3 milyan sano ka hor, isku-dhafka casriga ah ee patellofemoral ayaa la aasaasay (oo leh weji dheer oo patellar ah oo u dhigma trochlea femoral lateral).164 Tardieu baaris ku sameeyay kala-guurka laga soo bilaabo bipedalism-ka marmar ilaa laba-cirifoodka joogtada ah waxaana la arkay in primates ay ku jiraan meniscus dhexdhexaad ah iyo lateral fibrocartilaginous meniscus, iyada oo meniscus dhexdhexaad ah uu la mid yahay morphologically dhammaan primates (bilaha loo qaabeeyey 2 tibial galinta).163 Taas bedelkeeda, meniscus lateral ayaa la arkay qaab ahaan u doorsooma. Gaarka ah ee Homo sapiens waa joogitaanka 2 gelinta tibial�1 hore iyo 1 danbe� taas oo muujinaysa dhaqanka caadiga ah ee dhaqdhaqaaqa fidinta buuxda ee wadajirka jilibka inta lagu jiro marxaladaha taagan iyo lulida ee socodka laba-geesoodka ah.20,134,142,163,168
Embryology iyo Kobcinta
Qaabka dabeecadda ah ee menisci lateral iyo medial menisci waxaa lagu gaaraa inta u dhaxaysa usbuuca 8th iyo 10th ee uurka.53,60 Waxay ka soo jeedaan lakabka dhexe ee unugyada mesenchymal si ay u sameeyaan lifaaqyo ku wareegsan kaabsoosha wadajirka ah.31,87,110 Menisci soo koraya waa unugyo unugyo iyo xididdo sare leh, iyadoo sahayda dhiiggu ka soo galayo xayndaabka oo ku fidsan dhammaan ballaca menisci-ga. 31 Dhaqdhaqaaqa wadajirka ah iyo walbahaarka dhalmada ka dib ee miisaan-qaadista ayaa ah arrimo muhiim ah oo lagu go'aaminayo jihada fiilooyinka kolajka. Marka la gaaro qaangaarnimada, kaliya 30,31% ilaa 10% hareeraha ayaa helaya dhiig.30
Inkasta oo isbeddelladan taariikhiga ah ay jiraan, saamiga tibial plateau ee uu daboolay meniscus u dhigma waa mid joogto ah inta lagu jiro koritaanka uurjiifka, iyada oo menisci dhexdhexaad ah iyo lateral uu daboolayo qiyaastii 60% iyo 80% meelaha dusha sare, siday u kala horreeyaan.31
Wadajirka Dhexe
Baadhitaanka guud ee menisci jilibka ayaa muujinaya unug siman, dufan leh (Jaantus 1). Waxay yihiin xayndaab-qaabeeya fibrocartilage oo ku yaal dhinacyada dhexe iyo kuwa dambe ee wadajirka jilibka (Jaantuska 2A). Xuddunta, xudduudaha xididdada dhiigga (sidoo kale loo yaqaan aagga cas) ee meniscus kasta waa dhumuc weyn, qallafsan, oo ku dheggan kaabsoosha wadajirka ah. Soohdinta ugu hooseysa (sidoo kale loo yaqaan aagga cad) waxay ku dhufanaysaa gees dhuuban oo xor ah. Sagxadaha sare ee menisci waa concag, oo awood u siinaya artication wax ku ool ah oo leh kondylesyada femoral convex . Sagxadaha hoose waa fidsan si ay u dajiyaan dhulalka tibial (Jaantuska 1).28,175
Meniscus dhexdhexaad ah. Meniscus-ka dhexdhexaadka ah ee dhexdhexaadka ah wuxuu cabbiraa qiyaastii 35 mm dhexroorka (hore ilaa dambe) wuxuuna si weyn uga sii ballaadhan yahay xagga dambe marka loo eego xagga hore. Waxaa jira kala duwanaansho la taaban karo oo ku saabsan meesha ku lifaaqan ee geeska hore ee meniscus medial. Geeska dambe wuxuu ku xiran yahay fossa intercondylar dambe ee tibia ee u dhexeeya meniscus lateral iyo ligament cruciate (PCL; Sawirada 175 iyo iyo1B) .2B). Johnson et al ayaa dib u eegay goobaha galinta tibial ee menisci iyo cilaaqaadkooda muuqaalka ah ee ku hareeraysan calaamadaha anatomic ee jilibka.2 Waxay ogaadeen in meelaha hore iyo kuwa dambe ee geesaha galinta ee meniscus medial ay ka weyn yihiin kuwa meniscus lateral. Aagga galinta geeska hore ee meniscus medial wuxuu ahaa midka ugu weyn, oo cabbiraya 82 mm61.4, halka geeska dambe ee meniscus lateral uu ahaa kan ugu yar, 2 mm28.5
Qaybta tibial ee ku-xidhka kaabsoosha waa seedaha halbowlaha. Barta dhexe, meniscus medial wuxuu si adag ugu dheggan yahay femur iyada oo loo marayo uumi ku jira kaabsulka wadajirka ah ee loo yaqaan ligament dhexdhexaad ah oo qoto dheer. ee meniscus-ka dhexdhexaadka ah ee geeska hore ee meniscus lateral (Jaantusyada 175 iyo 1A2A).
meniscus lateral. Meniscus-ka dambe wuxuu ku dhow yahay wareeg, oo leh qiyaas lebis ballac ah oo hore ilaa dambe (Jaantus 1 iyo 2A).2A). Waxay ku jirtaa qayb weyn (~ 80%) ee dusha sare ee articular marka loo eego meniscus medial (~ 60%) waana mobile badan.10,31,165 Labada gees ee meniscus lateral waxay ku xiran yihiin tibia. Gelida geesaha hore ee meniscus lateral waxay ku taalaa hore ee cirifka intercondylar iyo ku dheggan goobta ballaaran ee lifaaqa ee ACL (Jaantus 2B) xagga hore ee gelinta geeska dambe ee meniscus medial (Jaantus 9,83B) .2 Meniscus lateral ayaa si dabacsan ugu xiran seedaha kaabsal; si kastaba ha ahaatee, fiilooyinkani kuma xirna seedaha dammaanadda dambe. Geeska dambe ee meniscus lateral wuxuu ku xiran yahay dhinaca gudaha ee kondyle femoral dhexdhexaad ah iyada oo loo marayo xudunta hore iyo dambe ee meniscofemoral ee Humphrey iyo Wrisberg, siday u kala horreeyaan, kuwaas oo asal ahaan ka soo jeeda asalka PCL (Jaantus 83 iyo 1).22
seedaha meniscofemoral. Suugaanta ayaa ka warbixisa is-maandhaafka weyn ee joogitaanka iyo xajmiga seedaha meniscofemoral ee meniscus lateral. Waxaa laga yaabaa inaysan jirin, 1, 2, ama 4.? Marka la joogo, seedahan dheeriga ah waxay ka soo wareegaan geeska dambe ee meniscus lateral ilaa dhinaca dambe ee kondhile femoral dhexdhexaad ah. Waxay isla markiiba geliyaan ku dheggan xubinta taranka ee PCL (Jaantus 1 iyo iyo 22).
Daraasado taxane ah, Harner et al waxay qiyaaseen aagga isugeynta ee seedaha waxayna ogaadeen in ligament meniscofemoral celcelis ahaan 20% cabbirka PCL (qiyaas ahaan, 7% -35%) .69,70 Si kastaba ha ahaatee, cabbirka aagga la geliyo oo keliya iyada oo aan la aqoon xagasha la geliyo ama cufnaanta kolajku ma muujinayso xooggooda.115 Shaqada seedahani waa mid aan la garanayn; waxaa laga yaabaa inay u soo jiidaan geeska dambe ee meniscus-ka dambe ee jihada hore si ay u kordhiyaan isku-dhafka fossa meniscotibial iyo kondyle femoral lateral.75
Ultrastructure iyo Biochemistry
Matrix ka baxsan unugga
Meniscus waa matrix ka baxsan unugyada cufan (ECM) oo ka kooban ugu horrayn biyaha (72%) iyo kolajka (22%), oo dhexda u ah unugyada.9,55,56,77 Proteoglycans, borotiinno aan collagenous ahayn, iyo glycoproteins ayaa xisaabiya miisaanka qallalan ee soo hadhay. Unugyada Meniscal waxay farsameeyaan oo ay ilaaliyaan ECM, taas oo go'aamisa sifooyinka walxaha unugyada.
Unugyada menisci waxaa loo yaqaan fibrochondrocytes sababtoo ah waxay u muuqdaan inay yihiin isku-dhafka fibroblasts iyo chondrocytes.111,177 Unugyada ku jira lakabka sare ee menisci waa fusiform ama spindle qaabeeya (fibroblastic ka badan), halka unugyadu ay ku yaalaan qoto dheer meniscus waa ovoid ama geeso badan (chondrocytic ka badan)
Labada nooc ee unuggu waxay ka kooban yihiin reticulum endoplasmic oo aad u badan iyo iskudhafka Golgi. Mitochondria ayaa mararka qaarkood la arkaa, taas oo soo jeedinaysa in dariiqa ugu weyn ee wax soo saarka tamarta fibrochondrocytes ee milieu xididada xididada ay u badan tahay anaerobic glycolysis.112
Biyaha
Caadi ahaan, menisci caafimaad qaba, dareeraha unuggu wuxuu u taagan yahay 65% ilaa 70% miisaanka guud. Inta badan biyaha waxa lagu hayaa unugyada dareeraha ee proteoglycans. Maaddada biyaha ee unugyada meniscal waxay ka sarreeyaan aagagga dambe marka loo eego meelaha dhexe ama hore; Tijaabooyin unugyo laga soo qaaday oogada iyo lakabyada qoto-dheer waxay lahaayeen waxyaabo isku mid ah.135
Cadaadiska haydarooliga weyn ayaa loo baahan yahay si looga gudbo jiidashada iska caabbinta jahwareerka ee ku qasbeysa qulqulka dareeraha iyada oo loo marayo unugyada meniscal. Sidaa darteed, isdhexgalka ka dhexeeya biyaha iyo qaabka macromolecular matrix waxay si weyn u saameeyaan sifooyinka viskoelastic ee unugyada.
Collagens
Collagens ayaa ugu horreyn mas'uul ka ah xoogga xajinta ee menisci; Waxay ka qaybqaataan ilaa 75% miisaanka qallalan ee ECM.77 ECM wuxuu ka kooban yahay ugu horrayn nooca I kolajka (90% miisaanka qalalan) oo leh qiyaaso kala duwan oo ah noocyada II, III, V, iyo VI.43,44,80,112,181 Inta badan nooca I kolajka ayaa kala sooca fibrocartilage ee menisci iyo carjawda articular (hyaline). Collagens-yadu waxay si aad ah isugu gudbeen hydroxylpyridinium aldehydes.44
Habaynta fiber-ka kolajku waxa ay ku habboon tahay in culayska cadaadiska toosan loo wareejiyo culayska wareegga wareegga (Jaantuska 3) . Fiilooyinkani waxay isku daraan xidhiidhada ligamentous ee geesaha meniscal ee dusha sare ee tibial articular (Jaantus 57) Fiilooyinka shucaaca u janjeera ayaa sidoo kale ku jira aagga qoto dheer waxaana la isku dhex daray ama lagu toleeyey inta u dhaxaysa fiilooyinka wareegyada si ay u bixiyaan qaabdhismeed ahaan (Jaantus 3). waxaa ku jira crystals dheer, caato ah oo fosfooraska, calcium, iyo magnesium on electron-probe roentgenographic analysis.
Borotiinnada matrixka aan collagenous ahayn, sida fibronectin, waxay gacan ka geystaan 8% ilaa 13% miisaanka engegan ee dabiiciga ah. Fibronectin wuxuu ku lug leeyahay habab badan oo gacanta ah, oo ay ku jiraan hagaajinta unugyada, embryogenesis, xinjirowga dhiigga, iyo guuritaanka/adhejinta unugga. Elastin wuxuu sameeyaa wax ka yar 0.6% miisaanka meniscus ee qallalan; meelayntiisa ultrastructural ma cadda. Waxay u badan tahay inay si toos ah ula falgasho kolajka si ay u bixiso adkeysiga nudaha.**
Proteoglycans
Waxay ku yaalaan gudaha meshwork wanaagsan ee fibrillada kolajka, proteoglycans waa waaweyn, molecules hydrophilic si xun u dallacay, oo gacan ka geysanaya 1% ilaa 2% miisaanka qalalan.58 Waxay ku sameysteen borotiinka asaasiga ah oo leh 1 ama in ka badan oo si isku mid ah ugu xiran silsiladaha glycosaminoglycan (Jaantus 4).122 Baaxadda molecules-ka waxaa sii kordhaya isdhexgalka gaarka ah ee hyaluronic acid.67,72 Qadarka proteoglycans ee meniscus waa siddeed-meelood meel ka mid ah carjawda articular,2,3 waxaana laga yaabaa inay jiraan kala duwanaansho badan oo ku xiran goobta saamiga. iyo da'da bukaanka.49
Iyada oo loo eegayo qaab-dhismeedkooda gaarka ah, cufnaanta xad-dhaafka ah ee sarreeya, iyo xoogagga dib-u-celinta, proteoglycans ee ECM ayaa mas'uul ka ah fuuq-celinta waxayna siiyan nudaha awood sare oo ay iskaga caabiyaan culeysyada cadaadiska ah. meniscus wuxuu ka kooban yahay chondroitin-6-sulfate (40%), chondroitin-4-sulfate (10% ilaa 20%), dermatan sulfate (20% ilaa 30%), iyo keratin sulfate (15%; Jaantus 4).65,77,99,159 ,58,77 Heerarka ugu sarreeya ee glycosaminoglycan waxaa laga helaa geesaha meniscal iyo qeybta hoose ee menisci ee meelaha miisaanka aasaasiga ah.XNUMX
Aggrecan waa proteoglycan-ka weyn ee laga helo menisci bini'aadamka wuxuuna inta badan mas'uul ka yahay sifooyinkooda isku-buuqa ee viscoelastic (Jaantuska 5). Proteoglycans yaryar, sida decorin, biglycan, iyo fibromodulin, ayaa laga helaa qadar yar.124,151 Hexosamine waxay ku biirtaa 1% miisaanka qalalan ee ECM.57,74 Shaqooyinka saxda ah ee mid kasta oo ka mid ah proteoglycans yar yar ee meniscus ayaa weli si buuxda u noqon. la caddeeyey.
Matrix Glycoproteins
Carjawda Meniscal waxay ka kooban tahay noocyo kala duwan oo ah glycoproteins matrix, aqoonsiyada iyo hawlahooda aan weli la go'aamin. Electrophoresis iyo midabaynta xiga ee jel polyacrylamide waxay muujinaysaa xadhig leh miisaan kelli ah oo ku kala duwan dhowr kilodaltons ilaa in ka badan 200 kDa.112 Unugyada matrixkan waxaa ka mid ah borotiinnada isku xirka ee xasiliya isku-darka proteoglycan hyaluronic acid iyo borotiinka aan la garanayn ee 116-k. Barootiinkani waxa uu ku dhex jiraa matrixka qaab ka kooban isku xidhan oo isku xidhan oo miisaankiisu sarreeyo.46 Cilmi-baadhista difaaca jirka waxa ay soo jeedinaysaa in ay inta badan ku taal agagaarka xidhmooyinka kolajka ee matrix interterritorial.46
Glycoproteins-ku-dheejisku wuxuu ka kooban yahay koox-hoosaadyada glycoproteins-ka matrixka. Makromolecules-yadan ayaa qayb ahaan mas'uul ka ah ku-xidhka molecules kale ee matrixka iyo/ama unugyada. Unugyada isku dhejinta intermolecular ee noocan oo kale ah ayaa sidaas darteed qaybo muhiim ah ka ah ururka supramolecular ee unugyada unugyada ka baxsan ee meniscus.
Anatomy Vascular
Meniscus-ku waa qaab-dhismeed xididdada dhiigga ah oo leh qayb xaddidan oo dhiigga ah. Xididdada dhexdhexaadka ah, lateral, iyo dhexe ee geniculate (oo laan ka ah halbowlaha popliteal) ayaa bixiya xididdada ugu weyn ee dhinacyada hoose iyo kuwa sare ee meniscus kasta (Jaantus 5) laanta ka daloosha ligamenti popliteal oblique ee geesta dambe ee isgoysyada tibiofemoral. Shabakad xidid premeniscal ah oo ka soo baxa laamaha halbowlayaashan waxay ka soo jeedaan unugyada synovial iyo capsular ee jilibka oo ku teedsan durugsan ee menisci. 9,12,33% ilaa 35,148% ee xudduudaha meniscus ee dhexdhexaadka ah iyo 10% ilaa 30% ee meniscus lateral ayaa si fiican u wanaajiya, taas oo saameyn muhiim ah u leh bogsashada meniscus (Jaantus 10) .25 Endoligamentous maraakiibta hore iyo geesaha danbe ayaa masaafo gaaban u socdaa walaxda menisci waxayna sameeyaan siddooyinkooda terminal, iyagoo siinaya dariiq toos ah oo nafaqo ah. , mooshin wadajir ah).6
Shimbiraha iyo macaanku waxay baareen menisci ee xayawaanka iyo bini-aadmiga iyagoo isticmaalaya sawir-qaadista elektarooniga iyo microscopy-ka iftiinka.23,24 Waxay arkeen dhismayaal u eg kanaalka oo si qoto dheer u furaya dusha sare ee menisci. Kanaalkani waxaa laga yaabaa inay door ka ciyaaraan qaadista dareeraha gudaha meniscus waxayna qaadi karaan nafaqooyinka dheecaanka synovial iyo xididdada dhiigga ee qaybaha avascular ee meniscus.23,24 Si kastaba ha ahaatee, daraasad dheeraad ah ayaa loo baahan yahay si loo caddeeyo habka saxda ah ee farsamada Dhaqdhaqaaqa ayaa nafaqo siiya qaybta xididdada dhiigga ee menisci.
Neuroanatomy
Isku-dhafka jilibka waxaa soo jiitay laanta articular ee dambe ee dareemaha tibial-ka dambe iyo laamaha dhamaadka ee dareemayaasha obturator iyo femoral. Qaybta dambe ee kaabsoosha waxaa gelisa laanta peroneal ee soo noqnoqda ee dareemaha peroneal-ka caadiga ah. Xiidmooyinkan dareemayaasha waxay galaan kaabsalka waxayna raacaan sahayda xididada qaybta durugsan ee menisci iyo geesaha hore iyo kan dambe, halkaas oo inta badan fiilooyinka dareemayaasha ay ku urursan yihiin. marka loo eego sadexda dhexe ee dhexe.52,90 Inta lagu jiro darafyada dabacsanaan iyo fidinta jilibka, geesaha meniscal waa cadaadis, gelinta afferent waxay u badan tahay inay ugu weyn tahay meelahan xad dhaafka ah.183,184
Mechanoreceptors ee ku dhex jira menisci waxay u shaqeeyaan sidii kuwa wax beddela, iyagoo u beddelaya kicinta jireed ee kacsanaanta iyo isku-buufinta dareen dareen koronto oo gaar ah. Daraasadaha menisci bini'aadamka ayaa aqoonsaday 3 morphologically mechanoreceptors kala duwan: Ruffini endings, Pacinian corpuscles, iyo Golgi tendon xubnaha. Mechanoreceptors Nooca II (Pacinian) waa heer hoose oo si degdeg ah ula qabsanaya isbeddelada xiisadda. Cunsuradan neerfaha ayaa laga helay xooga weyn ee geesaha meniscal, gaar ahaan geesaha dambe.
Qaybaha asymmetrical ee jilibka waxay u dhaqmaan si wada jir ah sida nooc ka mid ah gudbinta bayooloji ee aqbala, wareejiya, oo kala daadiya culeysyada femur, tibia, patella, iyo femur. Daraasado dhowr ah ayaa soo sheegay in qaybaha kala duwan ee intra-articular ee jilibka ay yihiin dareen, awood u leh inay soo saaraan calaamadaha neurosensory ee gaadha laf-dhabarka, cerebellar, iyo heerarka sare ee habka dhexe ee dareenka. Waxaa la rumeysan yahay in calaamadahan dareemayaasha dareemayaasha ay keenaan aragtida miyir-qabka ah waxayna muhiim u yihiin shaqada wadajirka ah ee jilibka iyo dayactirka homeostasis nudaha.41
Meniscus waa carjawda kaas oo siinaya qaabdhismeed iyo daacadnimo shaqaynaysa jilibka. Menisci waa laba suuf oo ah unugyo fibrocartilaginous ah kuwaas oo ku kala fidiya kala-goysyada jilibka marka ay ku dhacdo xiisad iyo jeexjeexa u dhexeeya lafaha shin, ama tibia, iyo lafta bowdada, ama femur. Fahamka anatomy iyo biomechanics ee wadajirka jilibka ayaa lagama maarmaan u ah fahamka dhaawacyada jilibka iyo/ama xaaladaha. Dr. Alex Jimenez DC, CCST Insight
Shaqada biomechanical
Shaqada biomechanical ee meniscus waa mid ka tarjumaysa anatomy-ga guud iyo ultrastructural iyo xiriirka ay la leedahay dhismayaasha ku hareeraysan intra-articular iyo ka baxsan-articular. Menisci-gu wuxuu u adeegaa hawlo badan oo biomechanical muhiim ah. Waxay gacan ka geystaan gudbinta culeyska, nuugista naxdinta leh, 10,49,94,96,170 xasilloonida,51,100,101,109,155 nafaqada,23,24,84,141 saliid wadajir ah,102-104,141 iyo proprioception.5,15,81,88,115,147 culayska iyo korodhka goobta xidhiidhka iyo congruity ee jilibka.91,172
Meniscal Kinematics
Daraasad ku saabsan shaqada ligamentous, Brantigan iyo Voshell ayaa sheegay in meniscus-ka dhexdhexaadka ah uu u guuro celcelis ahaan 2 mm, halka meniscus lateral uu ahaa mid aad u badan oo mobile ah oo leh qiyaastii 10 mm ee barokaca hore ee gadaal inta lagu jiro dabacsanaanta .25 Sidoo kale, DePalma ayaa sheegay in meniscus dhexdhexaad ah. wuxuu maraa 3 mm ee barokaca hore-daba-dambe, halka meniscus lateral uu dhaqaaqo 9 mm inta lagu jiro dabacsanaanta.37 Daraasad la adeegsanayo 5 jilbaha cad, Thompson et al ayaa sheegay in celceliska dalxiiska dhexdhexaadka ah uu yahay 5.1 mm (celcelis ahaan geesaha hore iyo gadaal) iyo celceliska dalxiiska lateral, 11.2 mm, oo ay weheliyaan dusha sare ee tibial articular (Jaantus 7) .165 Natiijooyinka daraasaddan ayaa xaqiijinaya farqi weyn oo u dhexeeya dhaqdhaqaaqa qaybta u dhexeeya menisci dhexdhexaad ah iyo lateral. Saamiga hore iyo kan dambe ee geesaha geesaha ee meniscus waa ka yar yahay wuxuuna tilmaamayaa in meniscus uu u dhaqaaqo in ka badan hal unug. Thompson et al waxay ogaatay in aagga ugu yar ee dhaqdhaqaaqa meniscal uu yahay geeska dambe ee dhexdhexaadka ah, halkaasoo meniscus uu ku xaddidan yahay ku dhejinta taagga tibial ee qaybta meniscotibial ee lafdhabarta dhabarka, kaas oo lagu soo warramey inuu aad ugu nugul yahay dhaawaca. 165 Hoos u dhigista dhaqdhaqaaqa geeska dambe ee meniscus medial waa habab suurtagal ah oo loogu talagalay ilmada meniscal, oo leh natiijada � dabinka fibrocartilage ee u dhexeeya condyle femoral iyo taagga tibial inta lagu jiro dabacsanaan buuxda. Farqiga weyn ee u dhexeeya dalxiiska geesaha hore iyo kan dambe wuxuu gelin karaa meniscus dhexdhexaad ah khatar weyn oo dhaawac ah.143,165
Kala duwanaanta geesaha hore iyo dhaqdhaqaaqa geesaha dambe waxay u ogolaataa menisci in ay u qaataan raajo hoos u dhacaya oo leh dabacsanaan, taas oo u dhiganta hoos u dhaca qalooca ee kondyles femoral ee dambe. labadda femur iyo tibia inta lagu jiro laablaabashada.
Soo gudbinta culeyska
Shaqada menisci waxaa lagu qiimeeyay kiliinikada isbeddelada xumaaday ee la socda ka saariddeeda. Fairbank waxay ku qeexday korodhka korodhka iyo isbeddelada hoos u dhaca ee la saadaalin karo ee sagxadaha articular ee jilbaha gebi ahaanba meniscectomized.45 Tan iyo shaqadan hore, daraasado badan ayaa xaqiijiyay natiijooyinkan waxayna sii kordhiyeen doorka muhiimka ah ee meniscus sida ilaalinta, qaabdhismeedka culeyska.
Miisaanka ayaa soo saara xoogag axial ah oo dhan jilibka, kuwaas oo cadaadiya menisci, taasoo keentay cadaadis �hoop� (wareeg ah) stress. Lifaaqa adag ee seedaha la geliyo ee hore iyo kan dambe ayaa ka hortagaya meniscus inuu ka soo baxo hareeraha inta lagu jiro culeyska. menisci.170 Menisci-ku wuxuu u gudbiyaa 8% culeyska culeyska iyada oo loo marayo geesaha dambe ee kordhinta, iyadoo 94% gudbinta 70� flexion.50 Radin et al ay muujiyeen in culeysyadan si fiican loo qaybiyey marka menisci ay wada jiraan.153 Si kastaba ha ahaatee, ka saarida meniscus medial meniscus wuxuu keenayaa 50% ilaa 85% hoos u dhaca aagga xidhiidhka kondyle ee femoral iyo 90% korodhka cadaadiska xidhiidhka. qaybta dambe ee 172% ilaa 137% ee caadiga ah.50 Tani waxay si weyn u kordhinaysaa culeyska halkii unug waxayna ka qayb qaadan kartaa dardargelinta burburka carjawda articular iyo hoos u dhaca.70
Abuuritaanka Shoogga
Menisci wuxuu door muhiim ah ka ciyaaraa hoos u dhigista mowjadaha shoogga ee isdaba-joogga ah ee ka yimaada culeyska jilibka ee socodka caadiga ah. .94,96,153 Sida awood la'aanta nidaamka wadajirka ah si uu u nuugo shoogga ayaa lagu lug yeeshay horumarinta osteoarthritis, meniscus wuxuu u muuqan doonaa inuu door muhiim ah ka ciyaaro ilaalinta caafimaadka wadajirka jilibka.20
Xasilloonida Wadajirka ah
Qaab dhismeedka joomatari ee menisci wuxuu bixiyaa door muhiim ah si loo ilaaliyo wadajirka wadajirka ah iyo xasilloonida. Marka meniscus uu yahay mid sugan, culeyska axial ee jilibka wuxuu leeyahay hawl dejin jiho badan, xaddidaysa dhaqdhaqaaqa xad-dhaafka ah ee dhammaan jihooyinka.9
Markolf iyo asxaabtiisuba waxay wax ka qabteen saamaynta meniscectomy ee jilibka hore iyo gadaal-wareegga. Meniscectomy dhexdhexaad ah oo ku jira jilibka ACL-jilibka ah ayaa saameyn yar ku leh dhaqdhaqaaqa hore ee dambe, laakiin jilibka ACL-yarida, waxay keentaa kororka tarjumaadda hore ee tibial-ka dambe ilaa 58% at 90o of flexion.109 Shoemaker iyo Markolf waxay muujisay in geeska dambe ee meniscus medial uu yahay qaabka ugu muhiimsan ee ka hortagaya xoogga tibial ee hore ee jilibka ACL-yar. Kordhinta buuxda iyo 155% at 52 � ee dabacsanaanta ka hooseeya culeyska hore ee tibial 197-N.60 Isbeddelka weyn ee kinematics sababtoo ah meniscectomy dhexdhexaad ah ee jilibka-yaraanta ACL waxay xaqiijineysaa doorka muhiimka ah ee meniscus dhexdhexaadka ah ee xasiloonida jilibka. Dhowaan, Musahl et al ayaa sheegay in meniscus lateral uu door ka ciyaaro tarjumaada tibial hore inta lagu jiro dhaqdhaqaaqa pivot-shift.134
Nafaqada iyo Saliidda Wadajirka ah
Menisci ayaa sidoo kale laga yaabaa inuu door ka ciyaaro nafaqada iyo saliidda wadajirka jilibka. Farsamoyaqaanka saliiddan ayaan weli la garanayn; menisci waxaa laga yaabaa inuu ku cadaadiyo dareeraha synovial ee carjawda articular, kaas oo yareynaya xoogaga is jiid-jiidka inta lagu jiro culeyska.13
Waxaa jira nidaam microcanals gudaha meniscus oo ku yaal meel u dhow xididdada dhiigga, kaas oo la xidhiidha godka synovial; kuwaani waxa laga yaabaa inay bixiyaan gaadiidka dareeraha ah ee nafaqada iyo saliidda wadajirka ah.23,24
Lahaanshaha gaarka ah
Aragtida dhaqdhaqaaqa wadajirka ah iyo booska (proprioception) waxaa dhexdhexaadiya mechanoreceptors kuwaas oo beddela cillad farsamo oo u beddela calaamadaha neerfaha korantada. Mechanoreceptors ayaa lagu aqoonsaday geesaha hore iyo kan dambe ee menisci.*** Mechanoreceptors-dhakhso leh, sida Pacinian corpuscles, ayaa loo maleynayaa inay dhexdhexaadiyaan dareenka dhaqdhaqaaqa wadajirka ah, iyo soo-dhoweynta tartiib-tartiib ah, sida Ruffini endings iyo Golgi tendon xubnaha, ayaa la aaminsan yahay in ay dhexdhexaadiyaan dareenka booska wadajirka ah.140 Aqoonsiga walxahan neerfaha (oo inta badan ku yaal saddex meelood meel dhexe iyo dibadda ee meniscus) waxay muujinaysaa in menisci ay awood u leeyihiin inay ogaadaan macluumaadka la-qabsiga ee wadajirka jilibka, sidaas darteedna ciyaaro doorka afferent ee muhiimka ah ee habka falcelinta dareenka ee jilibka.61,88,90,158,169
Qaangaarka iyo gabowga ee Meniscus
Microanatomy ee meniscus waa mid adag waxaana hubaal ah inay muujiso isbeddellada dareenka. Marka da'da kor u kacdo, meniscus wuxuu noqdaa mid qallafsan, luminaya barti, wuxuuna noqdaa huruud.78,95 Microscopically, waxaa si tartiib tartiib ah u luminaya xubno unugyo ah oo leh meelo madhan iyo kororka unugyada fibre ee marka la barbardhigo unugyada laastikada.74 Meelahan cystic waxay bilaabi karaan jeex, oo leh xoog torsional by kondyle femoral, lakabyada kore ee meniscus ayaa laga yaabaa inay ka xiiraan lakabka qoto dheer ee isdhexgalka isbeddelka cystic, oo soo saara jeexjeex toosan. Goynta lakabyadan dhexdooda waxay keeni kartaa xanuun. Meniscus-ka dillaacay waxa laga yaabaa inuu si toos ah u dhaawaco carjawda articular ee kor-dhaafka ah.74,95
Ghosh iyo Taylor waxay ogaadeen in xoojinta kolajku ay kor u kacday dhalashada ilaa 30 sano oo ay joogto ilaa 80 sano jir, ka dib hoos u dhac ayaa dhacay. Dhallaanka cusub ilaa 58% � 21.9% inta u dhaxaysa da'da 1.0 ilaa 8.1 sano.0.8 Kadib 30 sano jir, heerarka borotiinka matrix-ka ee aan collagenous kor u kacay ilaa 70% - 80%. Peters iyo Smillie waxay arkeen kororka hexosamine iyo uronic acid da'da.70
McNicol iyo Roughley waxay barteen kala duwanaanshaha proteoglycans meniscal ee gabowga113; kala duwanaansho yar oo saarista iyo cabbirka hydrodynamic ayaa la arkay. Heerarka keratin sulfate marka loo eego chondroitin-6-sulfate ayaa kordhay da'da.146
Petersen iyo Tillmann immunohistochemically waxay baareen menisci bini'aadamka (laga bilaabo 22 toddobaad ee uurka ilaa 80 sano), iyagoo eegaya kala duwanaanta xididdada dhiigga iyo lymphatics ee 20 ka mid ah dadka. Waqtiga dhalmada, ku dhawaad dhammaan meniscus-ka ayaa xididdada dhiigga loo geliyay. Sannadka labaad ee nolosha, aagga xididada ayaa ka soo baxay wareegga gudaha. Tobankii sano ee labaad, xididdada dhiigga ayaa ku jiray saddex geesoodka. Ka dib 50 sano jir, kaliya rubuci durugsan ee saldhigga meniscal ayaa la sameeyay. Unugyada isku xiran ee cufan ee gelinta ayaa la sameeyay laakiin maaha fibrocartilage ee gelinta. Xididdada dhiigga waxaa weheliyay lymfatics dhammaan aagagga.��
Arnoczky wuxuu soo jeediyay in miisaanka jidhka iyo dhaqdhaqaaqa wadajirka jilibka ay baabi'in karaan xididdada dhiigga ee gudaha iyo dhexe ee menisci.9 Nafaqada nudaha meniscal waxay ku dhacdaa iyada oo loo marayo dhiig-karka xididdada dhiigga iyo iyada oo loo marayo faafinta dheecaanka synovial. Baahida loo qabo nafaqeynta iyadoo la adeegsanayo faafintu waa rarista iyo sii daynta joogtada ah ee sagxadaha articular, culayska jidhka iyo xoogga muruqa.130 Habkani wuxuu la mid yahay nafaqada carjawda articular
Sawirka Resonance Magnetic ee Meniscus
Sawir-qaadista resonance magnetic (MRI) waa qalab ogaanshaha oo aan fiicneyn oo loo isticmaalo qiimeynta, ogaanshaha, iyo la socodka menisci. MRI si ballaaran ayaa loo aqbalaa qaabka sawirka ugu fiican sababtoo ah kala duwanaanshaha jilicsan ee jilicsan.
Daraasado dhowr ah ayaa qiimeeyay isticmaalka kiliinikada ee MRI ee ilmada meniscal. Guud ahaan, MRI waa mid aad xasaasi u ah oo gaar u ah ilmada meniscus. Dareenka MRI ee lagu ogaanayo ilmada meniscal waxay u dhexeysaa 70% ilaa 98%, iyo gaar ahaan, laga bilaabo 74% ilaa 98%. meniscus iyo 48,62,105,107,117% ee meniscus lateral.1014 Falanqaynta maadada ee bukaanada 89 ee MRI iyo baaritaanka arthroscopic ayaa helay 88% dareenka iyo 48% saxnaanta ilmada meniscal.2000
Waxaa jiray farqi u dhexeeya baaritaanka MRI iyo pathology-ga lagu aqoonsaday inta lagu jiro baaritaanka arthroscopic. . . Baaritaannada arthroscopic ayaa lagu xusay 66 ka mid ah 561 (12%). -86% siday u kala horreeyaan). Shepard et al waxay qiimeeyeen saxnaanta MRI ee lagu ogaanayo nabarrada kiliinikada ee muhiimka ah ee geeska hore ee meniscus ee 92 jilibka MRI22 oo isku xigta waxayna heleen 349% heerka been-abuurka ah. Kordhinta xoogga isha hore ee geeska hore maahan inay tilmaamayso nabar caafimaad ahaan muhiim ah.6
Gabagabada
Menisci ee wadajirka jilibka ayaa ah xayndaab-qaabaysan oo ah fibrocartilage kuwaas oo siinaya xasilloonida sii kordheysa ee articulation femorotibial, qaybinta culeyska axial, nuugaya shoogga, oo siiya saliidda wadajirka jilibka. Dhaawacyada menisci waxaa loo aqoonsan yahay inay sabab u tahay xanuunada murqaha ee muhiimka ah. Ilaalinta menisci waxay si aad ah ugu tiirsan tahay ilaalinta hal-abuurkeeda gaarka ah iyo abaabulkeeda.
Gabagabadii, jilibku waa isku-xidhka ugu wayn uguna adag ee jidhka bini'aadamka. Si kastaba ha ahaatee, sababtoo ah jilibka ayaa si caadi ah u dhaawacmi kara dhaawac iyo/ama xaalad awgeed, waxaa lagama maarmaan ah in la fahmo anatomy ee wadajirka jilibka si bukaanku u helo daaweyn habboon. arrimaha caafimaadka laf dhabarta. Si aad ugala hadasho mawduuca, fadlan xor u noqo inaad waydiiso Dr. Jimenez ama nagala soo xidhiidh at�915-850-0900 .
Xanuunka jilibka waa calaamad caan ah oo ku dhici karta dhaawacyo jilibka ah iyo/ama xaalado kala duwan, oo ay ku jiraandhaawacyada isboortiga. Jilibku waa mid ka mid ah kala-goysyada ugu adag ee jidhka bini'aadamka maadaama uu ka kooban yahay isgoysyada afar lafo, afar seediyo, seedooyin kala duwan, laba menisci, iyo carjawda. Sida laga soo xigtay Akademiyada Maraykanka ee Dhakhaatiirta Qoyska, sababaha ugu badan ee xanuunka jilibka waxaa ka mid ah subluxation patellar, patellar tendinitis ama jilibka jumper, iyo cudurka Osgood-Schlatter. Inkasta oo xanuunka jilibka ay u badan tahay inuu ku dhaco dadka ka weyn 60 sano, xanuunka jilibka wuxuu sidoo kale ku dhici karaa carruurta iyo dhalinyarada. Xanuunka jilibka waxaa lagu daweyn karaa guriga iyadoo la raacayo hababka RICE, si kastaba ha ahaatee, dhaawacyada daran ee jilibka ayaa laga yaabaa inay u baahdaan daryeel caafimaad oo degdeg ah, oo ay ku jiraan daryeelka xanuunka loo yaqaan 'chiropractic care'.
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