Gonarthrosis nke nkwonkwo ikpere bụ ihe a na-ahụkarị na ọrịa degenerative-dystrophic, nke a na-eji nwayọọ nwayọọ na-ebibi cartilage na mgbanwe ndị na-esote na elu articular, nke na-esonyere mgbu na mbelata mmegharị.
O yikarịrị ka ọrịa a na-emetụta ụmụ nwanyị karịrị afọ 40, karịsịa ndị nwere oke ibu na varicose veins nke obere nsọtụ.
Njikọ ikpere bụ akụkụ atọ mejupụtara:
- tibifemoral medial;
- tibifemoral n'akụkụ;
- suprapatellar-femoral.
Enwere ike imetụta akụkụ ndị a site na nrụrụ osteoarthritis (DOA) ma n'otu n'otu ma na ngwakọta ọ bụla. 75% nke ọrịa gonarthrosis niile bụ mbibi nke etiti tibifemoral medial (n'oge mmegharị ahụ, ọ na-enweta ibu karịrị ibu ahụ ugboro 2-3).
N'ime ndị ọrịa na-eto eto, ọ bụ naanị otu nkwonkwo na-ebibikarị - aka nri ma ọ bụ aka ekpe (gonarthrosis nke aka nri ma ọ bụ aka ekpe).
Ihe kpatara DOA nke nkwonkwo ikpere
Ọtụtụ ihe nwere ike itinye aka na mmepe nke cartilage degenerative mgbanwe n'otu oge:
- oke ibu nke nkwonkwo ikpere (ụfọdụ ọpụrụiche, egwuregwu) na microtraumatization nke cartilage;
- nsonaazụ nke mmerụ ahụ, ntinye ịwa ahụ (meniscectomy);
- ọrịa ogbu na nkwonkwo nke ikpere (ọrịa ogbu na nkwonkwo);
- anatomical ekwekọghị ekwekọ nke articular elu (dysplasia);
- mmebi nke statics (ụkwụ dị larịị, curvature nke spain);
- hemarthrosis na-adịghị ala ala (mgbakọ ọbara na oghere synovial);
- ọrịa metabolic (gout, hemochromatosis, chondrocalcinosis);
- oke ibu ahu;
- mmebi nke ọbara na-enye ọkpụkpụ;
- osteodystrophy (ọrịa Paget);
- ọrịa akwara ozi, ọnwụ nke mmetụta na akụkụ ahụ;
- ọrịa endocrine (acromegaly, ọrịa shuga mellitus, amenorrhea, hyperparathyroidism);
- mkpụrụ ndụ ihe nketa (ụdị osteoarthritis n'ozuzu);
- mmebi nke njikọ nke collagen ụdị II.
Ma na 40% nke ikpe, ọ gaghị ekwe omume ịmepụta ihe kpatara ọrịa ahụ (isi arthrosis).
pathogenesis nke gonarthrosis
mmalite ogbo
Na mmalite nke ọrịa ahụ, usoro nke cartilage metabolism na-akpaghasị. Ngwakọta na àgwà nke isi ihe nhazi nke anụ ahụ cartilage, proteoglycans, bụ ndị na-ahụ maka nkwụsi ike nke nhazi nke netwọk collagen, na-ebelata.
N'ihi ya, a na-asacha chondroitin sulfate, keratin, hyaluronic acid na ntupu, na proteoglycans nwere nkwarụ enweghị ike idowe mmiri ọzọ. Ọ na-etinye aka na collagen, nke eriri fụrụ akpụ nke na-eduga n'ibelata nguzogide cartilage na nrụgide.
N'ime oghere synovial, ihe ndị na-emepụta ihe na-emepụta ihe na-agbakọta, n'okpuru mmetụta nke cartilage na-ebibi ọbụna ngwa ngwa. Fibrosis nke capsule articular na-etolite. Mgbanwe nke ihe mejupụtara nke mmiri synovial na-eme ka o sie ike ịnye nri na-edozi ahụ na cartilage ma na-emebi ihe na-eme ka ọkpụkpụ na-eme ka ọkpụkpụ dị n'oge mmegharị ahụ.
Ọganihu nke pathology
N'ọdịnihu, cartilage na-eji nwayọọ nwayọọ na-adịwanye njọ, na-esi ike, mgbawa na-etolite n'ogologo ya dum. Epiphyses nke ọkpụkpụ na-enweta ụbara ibu, nke na-akpalite mmepe osteosclerosis na mmụba nke ọkpụkpụ ọkpụkpụ (osteophytes).
Mmeghachi omume a nke anụ ahụ na-achọ ịbawanye ebe nke articular na-ebupụta ma na-ekesa ibu ahụ. Ma ọnụnọ nke osteophytes na-abawanye ahụ erughị ala, nrụrụ ma na-egbochi mmegharị nke akụkụ ahụ.
A na-emepụta microfractures na ọkpụkpụ ọkpụkpụ, nke na-emerụ arịa ndị ahụ ma na-eduga n'ọbara mgbali elu intraosseous. N'oge ikpeazụ nke ọrịa ogbu na nkwonkwo, a na-ekpughe ihe ndị dị n'elu articular kpamkpam, nkwarụ, mmegharị aka na-adịchaghị mma.
Mgbaàmà nke gonarthrosis nke nkwonkwo ikpere
A na-eji arthrosis nke nkwonkwo ikpere eme ihe na-adịghị ala ala, na-eji nwayọọ nwayọọ na-aga n'ihu (ọnwa, afọ). Ụlọ ọgwụ ahụ na-eto nke nta nke nta, na-enweghị mkpasu iwe. Onye ọrịa enweghị ike icheta kpọmkwem mgbe mgbaàmà mbụ pụtara.
Ngosipụta ụlọ ọgwụ nke gonarthrosis:
- mgbu. Na mbụ, gbasaa, mkpụmkpụ (na ogologo ogologo oge, na-eje ije na steepụ), na ka ọrịa ogbu na nkwonkwo na-aga n'ihu, ihe mgbu na-aghọ mpaghara (n'ihu na n'ime elu nke ikpere), ike ha na-abawanye;
- mmetụta mpaghara na palpation. Ọtụtụ n'ime n'ime ikpere n'akụkụ ọnụ nke oghere nkwonkwo;
- crunch. N'ọkwa nke m, ọ nwere ike bụrụ ihe a na-anụghị, na ọkwa II-III ọ na-eso mmegharị niile;
- mmụba nke olu, nrụrụ ikpere. N'ihi ike ọgwụgwụ nke akwara ndị dị n'akụkụ, mmadụ na-emepụta nhazi nke ọdịdị O nke akụkụ ahụ (ọ na-ahụ nke ọma ọbụna na foto);
- mmachi nke ngagharị. Na mbụ, enwere ihe isi ike na ikpere ikpere, mgbe e mesịrị - na mgbatị.
Ihe kpatara mgbu na DOA:
- esemokwu n'ibu nke akụkụ articular mebiri emebi;
- ụba intraosseous mgbali, venous mkpọchi;
- ọgwụgwọ nke synovitis;
- mgbanwe na anụ ahụ periarticular (mgbatị nke capsule, ligaments, tendon);
- ibu nke periosteum;
- phenomena nke dystrophy na akwara dị n'akụkụ;
- fibromyalgia;
- mkpakọ nke njedebe akwara.
N'adịghị ka coxarthrosis, DOA nke ikpere nwere ike igosi nlọghachi azụ nke mgbaàmà ozugbo.
Ngosipụta ụlọ ọgwụ nke gonarthrosis dabere na ogbo:
| Njirimara | m ogbo | II ogbo | III ogbo |
|---|---|---|---|
| Mgbu | Mkpirisi, na-emekarị mgbe ikpere na-agbatị (ogologo ogologo, na-arịgo steepụ) | Na-agafeghị oke, na-apụ n'anya mgbe izu ike abalị gasịrị | Akpọrọ, na-akpaghasị ọbụna n'abalị |
| Mmachi ngagharị | A naghị ahụ anya | Enwere mmachi nke ndọtị, ngwụrọ dị nro | Nkwekọrịta mgbanwe mgbanwe na-adịgide adịgide, ngwụrọ |
| crunching | Ọ bụghị | A na-enwe mmetụta na palpation n'oge mmegharị | nke dịpụrụ adịpụ crunch |
| Nrụrụ | Na-efu efu | Ntugharị ntakịrị nke axis nke akụkụ ahụ n'ihu, uru ahụ na-efunahụ ya | Valgus ma ọ bụ varus nrụrụ. Njikọ ahụ anaghị akwụsi ike, atrophy nke akwara apata ụkwụ |
| Foto X-ray | Obere mbelata nke oghere nkwonkwo, akara mmalite nke osteosclerosis subchondral | A na-ebelata oghere nkwonkwo site na 50% ma ọ bụ karịa, osteophytes pụtara | Ihe fọrọ nke nta ka ọ bụrụ enweghị ohere nkwonkwo zuru oke, nrụrụ dị ịrịba ama na sclerosis nke elu articular, mpaghara subchondral necrosis ọkpụkpụ, osteoporosis. |
Mgbagwoju anya nke arthrosis nke nkwonkwo ikpere na-emekarị bụ synovitis reactive nke abụọ, nke e ji mgbaàmà ndị a mara:
- na-eto eto mgbu;
- ọfụfụ;
- mmịpụta n'ime oghere synovial;
- mmụba na okpomọkụ akpụkpọ.
Nsogbu ndị na-adịchaghị adịkarị ma dị ize ndụ gụnyere: mgbochi nke nkwonkwo, osteonecrosis nke condyle femoral, subluxation nke patella, hemarthrosis na-apụtaghị ìhè.
Nchọpụta nke DOA nke nkwonkwo ikpere
Nchọpụta nke gonarthrosis dabere na mkpesa njirimara onye ọrịa, mgbanwe achọpụtara n'oge nyocha na nsonaazụ ule ndị ọzọ.
Iji kwado ọrịa ogbu na nkwonkwo, a na-enye ya:
- redio nke nkwonkwo ikpere na ntule abụọ (anteroposterior na mpụta): ụzọ kachasị mfe iji kwado nchoputa na ọkwa dị elu nke pathology;
- Ultrasound: mkpebi siri ike nke ọnụnọ nke effusion na nkwonkwo, nha nke ọkpụkpụ cartilage;
- nyocha nke mmiri synovial;
- diagnostic arthroscopy (nyocha anya nke cartilage) na biopsy;
- gbakọọ na magnetik resonance imaging (CT, MRI): usoro kachasị mma maka ịchọpụta DOA n'oge mmalite.
Ọ bụrụ na dọkịta nwere obi abụọ banyere nchoputa ahụ, enwere ike ịnye ya:
- scintigraphy: nyocha nke nkwonkwo mgbe iwebata isotope redioaktivu;
- thermography: ọmụmụ nke ike nke infrared radieshon (ike ya bụ kpọmkwem ike nke mbufụt).
Ọgwụgwọ nke gonarthrosis nke nkwonkwo ikpere
Usoro ọgwụgwọ maka ọrịa ogbu na nkwonkwo na-ejikọta ọtụtụ ụzọ: ụzọ ndị na-abụghị ọgwụ ọjọọ, pharmacotherapy na mgbazi ịwa ahụ. A na-ekpebi oke nke usoro ọ bụla n'otu n'otu maka onye ọrịa ọ bụla.
Ọgwụgwọ na-abụghị ọgwụ
N'ime usoro ESCEO kachasị ọhụrụ (European Society for the Clinical Aspects of Osteoporosis and Osteoarthritis) ntuziaka maka otu esi agwọ ọrịa ogbu na nkwonkwo nke ikpere, ndị ọkachamara na-etinye aka na agụmakwụkwọ onye ọrịa na mgbanwe ndụ.
Onye ọrịa chọrọ:
- kọwaa ihe bụ isi nke ọrịa ahụ, nke edoziri maka ọgwụgwọ ogologo oge;
- kụzie ka esi eji ngwaọrụ enyemaka (okpete, orthoses);
- nye iwu nri (maka ndị ọrịa nwere ọnụọgụ ahụ karịa 30);
- nye usoro mmega ahụ iji mee ka akwara apata ụkwụ sikwuo ike ma budata nkwonkwo ikpere;
- kọwaa mkpa ọ dị ịbawanye mgbatị ahụ.
Na mmalite nke arthrosis ikpere, usoro ọgwụgwọ physiotherapy na-enye nsonaazụ dị mma:
- ịhịa aka n'ahụ;
- magnetotherapy;
- ọgwụgwọ UHF;
- electrophoresis;
- hydrogen sulfide bath;
- ngwa paraffin;
- acupuncture.
Pharmacotherapy nke gonarthrosis
Iji ọgwụ eme ihe na DOA bụ iji belata ihe mgbu, ibelata mbufụt, na ibelata ọnụego mbibi cartilage.
Ọgwụgwọ Symptomatic:
- analgesics;
- ihe na-abụghị steroidal mgbochi mkpali (NSAIDs) nke otu COX-2 inhibitors n'ụdị mbadamba nkume ma ọ bụ suppositories;
- ndị na-abụghị narcotic analgesics (na-eguzogide ọgwụ mgbu syndrome).
Ọgwụ na-emezi ihe owuwu (chondroprotectors):
- Chondroitin sulfate;
- Glucosamine sulfate.
Enwere ike were ọgwụ ndị a n'ụdị capsules na nkuzi ọtụtụ oge n'afọ, gbanye intramuscularly ma ọ bụ ozugbo n'ime oghere synovial.
Usoro ọgwụgwọ mpaghara na-agụnye injections nso na intraarticular nke glucocorticosteroids, nkwadebe hyaluronic acid.
N'oge I-II nke DOA, ebe dị mkpa na ọgwụgwọ mgbagwoju anya bụ iji ọgwụ mgbochi mkpali, gels na creams dabeere na NSAIDs. Ha na-enyere aka belata mkpa onye ọrịa nwere iji ọnụ NSAIDs, si otú ahụ belata ohere nke mmebi nke tract digestive.
Ngwọta ndị mmadụ
Ojiji tinctures, decoctions, extracts, ngwa mpaghara nke osisi ọgwụ kwesịrị ka e were ya dị ka ụzọ inyeaka maka ọgwụgwọ DOA, ọgwụgwọ ndị mmadụ enweghị ike dochie ọgwụgwọ dọkịta nyere.
Osisi eji agwọ ọrịa ogbu na nkwonkwo: dandelion, ginger, Jerusalem artichoke, burdock, galik, oké osimiri buckthorn.
Ịwa ahụ
Enwere ike ịchọrọ enyemaka ịwa ahụ n'oge ọ bụla nke gonarthrosis na-enweghị mmetụta zuru oke nke usoro ahụike. Ihe na-emekarị bụ usoro endoscopic, n'ọnọdụ ndị kachasị njọ, a na-egosipụta nnọchi endoprosthesis.
Ụdị enyemaka endoscopic:
- ntughari na nhazigharị nke nkwonkwo: mmịpụta nke ihe na-egbuke egbuke site na oghere synovial, iberibe cartilage;
- plasma ma ọ bụ ablation laser: mwepụ nke ihe mgbochi n'ibu na oghere synovial;
- chondroplasty.
A na-egosi osteotomy periarticular mgbazi maka ndị ọrịa nwere ngosipụta mbụ nke nrụrụ axial (ọ dịghị ihe karịrị 15-20%).
Ebumnuche nke ọrụ ahụ bụ iji weghachite nhazi nkịtị nke nkwonkwo ahụ, kesaa ibu ahụ n'elu elu articular, ma wepụ ebe ndị mebiri emebi. Usoro a na-enye gị ohere igbu oge arthroplasty.
Ngosipụta maka iji ihe arụrụ arụ dochie mpaghara emetụtara (ma ọ bụ nkwonkwo dum):
- DOA II-III ogo;
- nnukwu nrụrụ axial nke akụkụ ahụ;
- aseptic necrosis nke subchondral ọkpụkpụ oyi akwa;
- ọrịa mgbu na-adịgide adịgide.
Contraindications maka ikpere arthroplasty:
- ngụkọta mmebi nke nkwonkwo;
- ngwa ligamentous na-adịghị akwụsi ike;
- DOA n'ihi ọrịa ogbu na nkwonkwo;
- nkwekọrịta mgbanwe mgbanwe na-adịgide adịgide, adịghị ike anụ ahụ siri ike.
N'okwu a, onye ọrịa ahụ na-enweta arthrodesis - ntụnyere nke nkwonkwo ikpere na ọnọdụ physiological na mwepụ nke elu articular. Nke a na-ebelata ihe mgbu ma na-ebelata ụkwụ, na-ebute ọnya nke abụọ na ikpere, hip, na ọkpụkpụ azụ.
Mgbochi
Mgbochi nke mmebi cartilage na-akaghị aka kwesịrị ịmalite na nwata.
Usoro ịkpachara anya:
- mgbochi scoliosis;
- mgbazi ụkwụ dị larịị (akpụkpọ ụkwụ nwere nkwado ndabere);
- ọzụzụ anụ ahụ mgbe nile (na-egbochi egwuregwu dị arọ);
- mwepu nke ọnọdụ a kapịrị ọnụ n'oge ọrụ.