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Sayniska Aasaasiga ah ee Qaab-dhismeedka Menisci Jilibka Jilibka, Halabuurka, iyo Shaqada

by | Cirrhaafka, Baaritaanka Daaweynta Duumada, Xanuun Chronic, Caafimaadka, Sawirka & Cilad-sheegista, Daryeelka Dhaawaca, Daraasaadka Cilmi-baarista, Tijaabada Baaritaanka, Dhaawacyada Isboortiga, Daaweyn, Wellness

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.
  • Natiijooyinka: Daraasadani waxay muujinaysaa qaab-dhismeedka, isku-dhafka, iyo sifooyinka shaqada ee menisci, kuwaas oo laga yaabo inay khuseeyaan bandhigyada kiliinikada, ogaanshaha, iyo hagaajinta qalliinka.
  • 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.

 

Anatomy ee Menisci

 

Meniscal Etymology

 

Erayga meniscus wuxuu ka yimid ereyga Giriigga m?niskos, oo macneheedu yahay �bisha,

 

Meniscal Phylogeny iyo Anatomy Isbarbardhigga

 

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

 

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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

Dr Jimenez White Coat

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.

 

Dhinaca MRI-da isgoysyada ah, meniscus-ka caadiga ah wuxuu u muuqdaa qaab-dhismeed hoose oo calaamad hoose ah (madow) (Jaantus 9). Jeexitaanka meniscal waxaa lagu gartaa joogitaanka calaamadda intrameniscal oo kordhaysa oo ku fidsan oogada dhismahan.

 

 

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.

 

Mahadnaq

 

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

 

Qoraalada

 

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

 

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 .

 

Waxaa soo saaray Dr. Alex Jimenez

 

Badhanka Wicista Cagaaran H .png

 

Mawduuc Dheeraad ah oo Wadahadal ah: Nasinta Jilibka Xanuunka Qalliin la'aan

 

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'.

 

sawirka blog ee wiil warqad kartoon ah

 

DHEERAAD AH | Mawduuca MUHIIMKA AH: El Paso, TX Chiropractor ayaa lagu taliyay

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