Amadolo ethu ahilelekile cishe kuyo yonke intshukumo esiyenzayo nsuku zonke, kusukela ekuthatheni izinyathelo zethu zokuqala kuya ekuzabalazeni ukukhuphuka izitebhisi. Awafani amalungu uma eneminyaka eyi-10, 30, noma engu-70 ubudala , futhi lokhu kubonakala kokubili ezinhlotsheni zokulimala okuvelayo kanye nendlela ekwelashwa ngayo. Kunokuba kube yingxenye nje yokuguga, manje sesiyazi ukuthi ingxenye enkulu yobuhlungu bedolo ingavinjelwa , itholakale kusenesikhathi, futhi iphathwe ngamasu athile kakhulu.
Kuyo yonke impilo, amadolo adlula ezigabeni ezahlukene kakhulu: isigaba sokukhula kobuntwana, iminyaka yokusebenza ngokomzimba okuphezulu, ukuba mdala kanye nokulimala kwezemidlalo okungenzeka ukuthi kuphulukiswe kabi, futhi ekugcineni, isikhathi lapho izinguquko eziwohlokayo ku-cartilage kanye ne-osteoarthritis ziba khona ngokugqamile. Ukuqonda okwenzekayo esigabeni ngasinye, ukuthi kungani zibuhlungu kakhulu eminyakeni ethile, nokuthi yiziphi izinketho zokwelapha ezikhona—kusukela ekuzivocavoceni kanye nokwelashwa ngokomzimba kuya ekuhlinzeni okuthuthukisiwe noma umuthi wokuvuselela—kuyisihluthulelo sokugcina ikhwalithi yokuphila isikhathi eside ngangokunokwenzeka.
Amadolo ashintsha kanjani ngokuya ngeminyaka
Ucwaningo lwamanje olusebenzisa uchungechunge olukhulu lwe-MRI lubonise ukuthi iphethini yokulimala kwamadolo iyahlukahluka kuye ngobudala nobulili . Izifundo ezinezinkulungwane zezivivinyo ezenziwe kubantu ababhekene nobuhlungu bamadolo zikhombe umehluko omkhulu phakathi kwabesilisa nabesifazane, kanye naphakathi kweziguli ezincane nezindala, kuma-menisci, ama-ligaments, kanye ne-cartilage.
Ngesikhathi sobuntwana kanye nentsha, uhlaka lwamathambo luthuthuka ngokushesha, kanti amapuleti okukhula azungeze idolo anegalelo elikhulu ebudeni bokugcina be-femur kanye ne-tibia. Kulesi sigaba, "izinguquko eziningi ezijwayelekile" (imilenze noma amadolo ashayisanayo, ukugoba ezinzwaneni, izinhlungu zokukhula ebusuku) zivame ukubangela ukukhathazeka okukhulu emindenini. Kodwa-ke, lezi zinkinga cishe zihlala zixazululeka zodwa futhi zidinga ukuqapha kanye nolwazi olunembile kuphela.
Lapho befika ebusheni nasebudaleni bokuqala, ikakhulukazi phakathi kwabadlali, ukulimala okubuhlungu kuya ngokuya kwanda: ukudabuka kwe-meniscus, ukuqhekeka noma ukuqhekeka kwemisipha (njenge-ACL) , ukuphuka kwe-osteochondral, i-chondromalacia patellae, noma izinkinga nge-tendon kanye ne-bursa overload. Indlela yokuphila esebenzayo ngokuvamile ivikela ebuhlungwini obungapheli, kodwa eminye imisebenzi enamandla noma engalingani kahle ingaba nomthelela omkhulu uma ukulimala kuqongelela ngaphandle kokwelashwa okufanele.
Cishe eminyakeni engama-40-45, imiphumela yalo mlando wemiphumela, ukulimala okuncane, kanye nokusetshenziswa ngokweqile kuba yinto evamile kakhulu: izinguquko eziwohlokayo ku-cartilage (i-osteoarthritis yasekuqaleni) , i-menisci eyonakele, i-chondromalacia, ukukhubazeka kwe-varus noma i-valgus, ubuthakathaka bemisipha, kanye nesisindo esiningi , konke okwandisa umthwalo emalungeni. Kusukela ngaleso sikhathi kuqhubeke, ingozi ye-osteoarthritis yamadolo iyanda ngokuguga, kanye nenani eliphakeme kulabo abangaphezu kweminyaka engama-70 kanye nokwanda kwabesifazane.
Okunye okubalulekile okuvela ezifundweni zakamuva zezithombe ukuthi ukusabalala kokulimala kwe-meniscal kanye ne-ligamentous kuyahluka phakathi kwabesilisa nabesifazane kukho konke ukuphila kwabo. Ukwephuka kwe-meniscal kanye ne-medial collateral ligament kuvame kakhulu kwabesilisa abangaphansi kweminyaka engama-40 , kuyilapho emaqenjini asebekhulile, abesifazane bavame ukuba ne-meniscal tears, i-patellofemoral pathology, kanye nezimpawu ze-osteoarthritis.
Amadolo ezinganeni nasebancane: ukukhula, ezemidlalo nobuhlungu
Ekubonisaneni nezingane, ingxenye enkulu yezizathu zokuvakashela zihlobene nesistimu yemisipha nemisipha. Ebuntwaneni, kubalulekile ukuhlukanisa phakathi kokuvuthwa okuvamile nalokho okubangela isifo ngempela , ngoba amadolo ashintsha ukuma nokuqondana phakathi neminyaka yokuqala yokuphila ngendlela engokomzimba ngokuphelele.
Eminyakeni yokuqala, kuvamile ukubona i-genu varum (imilenze yebhowlegs) ekhula ngokushesha lapho ingane iqala ukuhamba futhi ivame ukuzilungisa ngokuzenzekelayo ngaphambi kokuba ineminyaka emi-3. Bese kuthi, cishe eminyakeni emi-3-4 ubudala, izingane eziningi zibe ne -genu valgum (knock-knees), eba yinto evamile kancane kancane kuze kube yilapho isebusheni, ene-valgus encane ehlala isikhathi eside ebonakala kakhulu kwabesifazane abadala kunakwabesilisa.
Ukukhubazeka okuncane kokugoba (ukujikeleza kwangaphakathi noma kwangaphandle kwe-femur kanye ne-tibia) nakho kuvamile, kubonakala njengokugoba ngaphakathi noma ngaphandle kwezinzwane. Iningi liyazilungisa ngokukhula; indima yokunakekelwa okuyinhloko ukuqapha, ukuqinisekisa umndeni, nokubhekisa kudokotela wamathambo wezingane kuphela uma ukuphambuka kusobala kakhulu, kungalingani, noma kungathuthuki ngokuguga.
Lokho okubizwa ngokuthi " izinhlungu zokukhula " kungenye imbangela evamile yokukhathazeka. Ngokuvamile zivela phakathi kweminyaka engu-3 nengu-10, ekupheleni kosuku noma ebusuku, emathangeni, emhlane ongezansi, noma ematholeni, ngaphandle kokubandakanyeka kwamalunga okuqonda, kanye nokuhlolwa okuvamile nokuhlolwa. Azihlobene ngqo nokukhula okusheshayo, azinabungozi, futhi zisabela ezindleleni ezilula njengokushisa kwendawo, ukubhucungwa, kanye nokuqinisekisa umndeni.
Kwabasubathi abasebasha, isimo siyashintsha: umkhuba owandisiwe webhola likanobhutshuzwayo, i-basketball, i-handball, noma eminye imidlalo yokuthintana kwenza ukulimala kwemisipha, i-ligament, kanye ne-meniscal kuvame kakhulu. Idolo, ngenxa ye-biomechanics yalo eyinkimbinkimbi kanye nokuthembela kwalo ekusekelweni kwemisipha kanye nemisipha, lisengozini enkulu yokunyakaza okusontekile, ukuyeka ngokuzumayo, kanye nokugxuma okuphindaphindiwe.
Ukulimala kwamadolo okujwayelekile ebuntwaneni nasebusheni
Uhlu lwezimo ezingathinta idolo elincane lude, kodwa eziningana zihlukile kakhulu. Ukuzazi kusiza ukugwema ukudida ukungakhululeki okuncane nokulimala okudinga ukuhlolwa okukhethekile (ama-X-ray, i-ultrasound, i-MRI) noma ngisho nokuhlinzwa.
Esinye sezifo ezivame kakhulu yi -patellar pathology . I-patella isebenza njenge-pulley yama-quadriceps futhi ibhekene namandla amakhulu; uma i-vastus medialis (ingxenye yangaphakathi yama-quadriceps) ibuthakathaka, uma kukhona i-Q angle eyandisiwe, noma ushintsho lwe-biomechanical (ukubizwa kwezinyawo, i-external tibial torsion, i-patella alta), ukushelela kwe-patella phezu kwe-femur kuba okungasebenzi kahle, futhi kuvela ukungqubuzana okungavamile nobuhlungu.
I-Chondromalacia patellae ukuthamba nokuwohloka okuqhubekayo kwe-cartilage ngemuva kwe-kneecap. Kuvame kakhulu entsheni nasebantwini abadala abaqeqesha ezindaweni eziqinile noma abahlanganyela emidlalweni yokugijima nokugxuma. Kubangela ubuhlungu ngaphambili kwedolo obuba bubi kakhulu lapho wehla futhi ukhuphuka izitebhisi, ugijima, noma uhlala isikhathi eside idolo ligobile, futhi kungase kuhambisane nokuchofoza noma umuzwa wokugaya noma wokugxuma.
Esinye isimo esihlobene nalesi yi -Sinding-Larsen-Johansson syndrome , i-apophysitis ye-inferior pole ye-patella kubantu abasha abakhuthele kakhulu (abaneminyaka engu-11-13 ubudala, ikakhulukazi labo abahileleke emidlalweni yokugxuma). Ibonakala ngobuhlungu obutholakala kahle lapho kufakwa i-patellar tendon ngemva kokuzivocavoca, okuthuthuka ngokuphumula. I-X-ray kanye ne-ultrasound kuvumela ukubona ngeso lengqondo izigaba ezahlukene zokuqhekeka kanye ne-calcification kule ndawo.
Ngakolunye uhlangothi lwedolo, isifo esaziwayo se-Osgood-Schlatter sithinta i-tibial tuberosity, lapho i-patellar tendon ingena khona. Sivamile kubadlali abasebasha; ubuhlungu butholakala eqhubu elingaphansi kwe-kneecap, buyanda ngokuzivocavoca, futhi buyancipha ngokuphumula. Kubangelwa yi-microtrauma ephindaphindayo epuletini lokukhula kuleyo ndawo futhi ngokuvamile kuyaphela uma ukukhula sekuqediwe, kodwa nakuba kuqhubeka, kungadinga ukunciphisa noma ukuguqula lo mdlalo.
Ukuqhekeka kwe-patellar noma i-subluxation kuvame kakhulu emantombazaneni asemasha ane-genu valgum ephawulekayo, ubuthakathaka bomsipha we-vastus medialis, futhi ngezinye izikhathi isisindo esiningi. Ukunyakaza okugobile edolweni eligobile kancane kungasusa i-patella ngokuzumayo eceleni, okubangela ubuhlungu obukhulu, ukungakwazi ukuhambisa idolo, kanye nokukhubazeka okubonakalayo. Amacala amaningi ayancipha ngokuzenzekelayo, kodwa kuhlale kudingeka ukuhlola imisipha, ukuba khona kokuphuma kwegazi, kanye nengozi yokuqhekeka okuqhubekayo, kanye nokuqala uhlelo oluthile lokuqinisa imisipha ngokushesha okukhulu.
Okunye ukulimala okungafanele kunganakwa entsheni yi -osteochondritis dissecans ye-femoral condyle, ikakhulukazi i-medial condyle. Lokhu kuhilela indawo yethambo ne-cartilage engaphansi kwe-subchondral elahlekelwa ukuphakelwa kwegazi (ischemia) ngenxa ye-microtrauma ephindaphindwayo futhi ingahlukana kancane noma ngokuphelele, okubangela ukukhiya, ubuhlungu bendawo ku-condyle, kanye nokwandiswa okulinganiselwe. I-magnetic resonance imaging (MRI) ivumela ukuhlukaniswa kobunzima bayo futhi isiza ekunqumeni ukuthi ukuphumula kanye nokwelashwa ngokomzimba kwanele noma ukuthi ukwelashwa kwe-arthroscopic kuyadingeka yini.
I -Baker's cyst ingavela ku-popliteal fossa, ngemuva kwedolo. Lokhu kumane kuyiqoqo loketshezi lwe-synovial olwakha phakathi kwemisipha ne-fascia. Ebusheni, kuvame ukuhlotshaniswa nokungalingani kwemisipha (i-vastus medialis ebuthakathaka, i-patella engasebenzi kahle) okwandisa ukungqubuzana nokukhiqizwa koketshezi. Nakuba isisindo ngokuvamile singenabuhlungu, singazizwa siqinile. Ukwelashwa kugxile ekubhekaneni nembangela eyisisekelo ye-biomechanical kunokuhlinzwa, njengoba izinqubo zokuhlinzwa zinezinga eliphezulu lokuphinda kuvele.
Ukulimala kwemisipha kanye ne-meniscal nakho kungenzeka ebuntwaneni, ikakhulukazi kubadlali abangakafiki eminyakeni yobusha kanye nabasebasha. Ukusonteka okungazelelwe ngonyawo olufakwe kungadabula imisipha ehlanganisiwe noma i-anterior cruciate ligament, noma kuqhume i-meniscus. Lokhu kulimala kubonakala njengobuhlungu obubukhali, ukuvuvukala, umuzwa wokungazinzi noma ukukhiya, futhi, uma kwenzeka ukulimala kwe-meniscal, ubuhlungu obuqondile emgqeni wamalunga kanye nemisindo yokuchofoza lapho kwenziwa imisebenzi efana nokuhlolwa kwe-McMurray. Kulezi zinsuku, kubalulekile njalo ukuhlola ukulimala ngokucophelela, ngoba i-meniscectomy ebanzi ihlotshaniswa nengozi ephezulu ye-osteoarthritis kamuva empilweni.
Amadolo kubantu abadala abancane nabaphakathi: ezemidlalo, umsebenzi, nokuhlinzwa
Abantu abaningi bacabanga ukuthi ubuhlungu bedolo "buyinto ethinta abantu abadala kuphela," kodwa iqiniso lihlukile kakhulu: abantu abadala abaningi abasebasha nabaseminyakeni ephakathi beza kudokotela benobuhlungu bedolo obuqhubekayo , obuvame ukuhlotshaniswa nokulimala kwezemidlalo kwangaphambilini, umsebenzi omningi, isisindo esiningi, noma ukungalungi okungazange kucatshangelwe ngesikhathi.
Kuleli qembu leminyaka, izifundo ze-MRI ezinkulu zeqembu ziye zabona ukuvama okuphezulu kokunyenya kwe -anterior cruciate ligament (ACL) okuhlukanisiwe , kanye nokuhlanganiswa kokulimala kwe-ACL nokunyenya kwe-meniscus okuphakathi noma okusemaceleni, ikakhulukazi kwabesilisa abaneminyaka ephakathi kuka-20 no-40 ubudala. Lokhu okutholakele kuphikisa umbono wangaphambilini wokuthi izinyembezi ze-ACL zitholakala kuphela kubadlali besifazane abasebasha: lapho kufundwa lonke inani labantu abanezinhlungu zamadolo (hhayi abadlali kuphela), amadoda abonakala eqoqa okuningi kwalolu hlobo lokulimala.
Ngaphezu kokulimala kwemisipha, ukudabuka kwe-meniscus kuvame kakhulu . Lokhu kungaba yinto ebuhlungu (ngemva kokujika, ukujika, noma ukuwa) noma ukuwohloka (ngenxa yokuguguleka okuqhubekayo), njengoba kunjalo nangezilonda ze-focal chondral kanye nezimpawu zokusetshenziswa ngokweqile njenge- iliotibial band syndrome , i-patellar tendinitis, i-pes anserine bursitis, noma i-patellofemoral pain syndrome. Lokhu kulimala kuvame ukwenzeka kubantu abahlanganyela emidlalweni enomthelela omkhulu (ibhola, ukugijima, i-basketball) noma imisebenzi enzima ngokomzimba ngaphandle kokulungiswa kwemisipha okwanele.
Uma ubuhlungu buqhubeka isikhathi esingaphezu kwezinyanga ezintathu, buhambisana nokuvuvukala okuqhubekayo, ubunzima bokukhuphuka izitebhisi, ukuvuka esihlalweni noma ukuhamba ibanga elingaphezu kwamamitha ambalwa, ukungazinzi noma umuzwa wokuthi idolo "liyayeka" , noma livuka ebusuku, kuyisibonakaliso esicacile sokuthi kungase kube nomonakalo omkhulu wesakhiwo (uqwanga, imisipha noma ithambo) futhi ucwaningo olujulile luyanconywa.
Kulezi zimo, ukufaka idolo esikhundleni salo lonke akuyona inketho yokuqala ngaso sonke isikhathi. Namuhla, uhla lokuhlinzwa lubanzi kakhulu futhi luhambisana nobudala besiguli, uhlobo lomonakalo, kanye nokulindelwe yiso. I-Arthroscopy ivumela ukulungiswa noma ukushelela izinyembezi ze-meniscal, ukususwa kwe-cartilage evulekile noma izingcezu zamathambo, kanye nokwelashwa kwezilonda ezithile ezigxile. I-Osteotomy iqondisa kabusha i-axis ethwala isisindo ezigulini ezisencane ezinokukhubazeka okukhulu kwe-varus noma kwe-valgus, inciphise ingcindezi endaweni eyonakele ye-cartilage. Futhi lapho umonakalo ugxile engxenyeni eyodwa yedolo, ukufaka i-particular noma i-unicompartmental arthroplasty kugcina ingxenye enkulu yelungu lemvelo futhi kukhuthaza ukululama okusheshayo.
Ngezilonda ze-focal chondral ezigulini ezingaphansi kweminyaka engama-40, amasu okubuyisela i-cartilage njenge-microfracture, i-autologous chondrocyte implantation, kanye ne-osteochondral grafts athuthukiswe ukuze kuphinde kuvuseleleke izicubu ezonakele. Ngaphandle kwezwe labo abahlala kulo, kube nesithakazelo esikhulayo kwezokuvakasha kwezokwelapha ezindaweni ezihlanganisa amanani angabizi kakhulu, izikhathi zokulinda ezimfushane, kanye nobuchwepheshe bokuhlinzwa obuthuthukisiwe, njengezikhungo ezithile ezikhethekile eTurkey.
I-osteoarthritis yedolo kanye nokuguga kwamalunga
Kusukela eminyakeni eyishumi yempilo kuqhubeke, ikakhulukazi uma kunezici ezihambisana nobungozi, izimpawu ze- knee osteoarthritis ziqala ukubonakala , isifo esiwohlokayo lapho i-articular cartilage incipha futhi ilahlekelwa yikhwalithi, kancane kancane ishiya ukuvikeleka okuncane phakathi kwe-femur, i-tibia kanye ne-patella.
Idolo liyilungu elithwala isisindo : lisekela isisindo somzimba nanoma yini esiyiphathayo lapho simi, sihamba, sigijima, noma sikhuphuka izitebhisi. Yingakho i-knee osteoarthritis ingenye yezifo ezivame kakhulu emzimbeni. Ekuqaleni, inqubo yokuwohloka ayithuli ngoba i-cartilage ayinazo iziphetho zemizwa; ubuhlungu buvela lapho ithambo le-subchondral, ulwelwesi lwe-synovial, i-ligaments, kanye ne-capsule kuthinteka.
Kunezinhlobo ezimbili eziyinhloko ze-osteoarthritis yamadolo. I-osteoarthritis eyinhloko noma engavamile iyona evame kakhulu, ehlobene nobudala kanye nenhlanganisela yezici zofuzo kanye nendlela yokuphila (ubulili besifazane, ukukhuluphala ngokweqile, umsebenzi womzimba onamandla kakhulu, ubuthakathaka bemisipha, ukukhubazeka kwe-biomechanical). Ngokuvamile iqala cishe eminyakeni engama-40-50 futhi iqhubeka kancane, ngezikhathi ezingaba khona zokusheshisa noma ukuzinza okulinganiselwe.
I-osteoarthritis yesibili ivela ngenxa yezinye izinqubo: ukuvaleka kwe-meniscectomies ebanzi, ukuqhekeka kwe-anterior cruciate ligament okungakhiwa kabusha noma okungalungiswa kahle, ukuqhekeka kwe-intra-articular, ukukhubazeka kwe-varus noma kwe-valgus okubonakalayo, izifo ze-metabolic ezifana ne-gout noma i-pseudogout, isifo sikashukela, noma izifo ezinzima zamalunga (i-septic arthritis). Kulezi zimo, ukuguguleka kungabonakala ngisho nakubantu abasebasha.
Izifundo ze-Epidemiological zibonisa ukuthi phakathi kuka-10 no-15% wabantu abadala bahlushwa yi-knee osteoarthritis ngezinga elithile, kanti amazinga okusabalala akhula ngokusobala njengoba iminyaka ikhula futhi aphezulu kwabesifazane. ESpain, idatha efana naleyo evela ocwaningweni lwe-EPISER ibeka ukusabalala kwe-knee osteoarthritis cishe ku-13-14% kubantu abangaphezu kweminyaka engu-40, okunomthelela omkhulu kwabesifazane, abantu abakhuluphele, kanye nabantu asebekhulile.
Izinto eziyingozi: ubudala, isisindo, ubulili, isisindo semisipha, nokusebenza komzimba
Ubudala ngokusobala buyisici esibalulekile: lapho siqoqana iminyaka eminingi, kulapho amathuba okuwohloka kwe-cartilage ekhula khona . Kodwa akuyona yodwa, futhi okubaluleke kakhulu, ayinakuguqulwa. Ngakolunye uhlangothi, ezinye izici zingaxazululwa futhi zenze umehluko omkhulu engcupheni yokuthola i-osteoarthritis ebuhlungu.
Ukuba ngowesifazane kwandisa ingozi ye-osteoarthritis yamadolo, ikakhulukazi ngemva kokunqamuka kokuya esikhathini, mhlawumbe ngenxa yezinguquko zamahomoni, umehluko ku-biomechanics, kanye nokwehluka kokusatshalaliswa kwemisipha namafutha. Eqinisweni, ubuhlungu bamadolo obubangelwa ukuguguleka buvame ngokuphindwe kathathu kwabesifazane kunabesilisa abaneminyaka efanayo.
Ukukhuluphala ngokweqile kanye nokukhuluphala kuphakathi kwezinto ezibaluleke kakhulu futhi, ngenhlanhla, ezingashintshwa zibe yizici eziyingozi. Ngokwemishini, ikhilogremu ngayinye eyengeziwe ihumushela kumakhilogremu amaningana engeziwe omthwalo edolweni ngesinyathelo ngasinye (iphindaphindwe ngo-2-4 uma uhamba). Ngokwe-metabolism, ukukhuluphala kuhlotshaniswa nesimo sokuvuvukala okungapheli esisezingeni eliphansi esithinta namalunga, okuchaza, isibonelo, ukwanda okukhulu kwe-osteoarthritis ezandleni zabantu abakhuluphele, yize izandla zingezona izitho ezithwala isisindo.
Ubuthakathaka bemisipha , ikakhulukazi kuma-quadriceps kanye nama-hamstrings, kwandisa ukucindezeleka ku-cartilage ngoba imisipha ayikwazi ukuvikela noma ukuzinzisa kahle imiphumela. Lokhu kushintsha ukuhamba kwe-biomechanics, kukhuthaza ukungazinzi kwamalunga, futhi kudala umjikelezo omubi: ukunyakaza okuncane ngenxa yobuhlungu, imisipha eminingi iyalahleka, idolo liya ngokuya lingazinzile, futhi ubuhlungu buba bubi kakhulu.
Ngokuphathelene nomsebenzi womzimba , isihluthulelo ukulinganisela. Umsebenzi olula noma omaphakathi, ongenamthelela omkhulu (ukuhamba endaweni eqondile, ukugibela ibhayisikili, ukubhukuda, i-aerobics yamanzi) uthuthukisa ukudla okunomsoco we-cartilage, ugcina ukunyakaza kwamalunga, futhi uqinisa imisipha nemisipha. Kodwa-ke, eminye imisebenzi enomthelela omkhulu noma ukuqeqeshwa kobungcweti (ibhola, i-basketball, i-volleyball) okuphindaphindiwe iminyaka eminingi ngaphandle kokuvimbela okwanele kuhlotshaniswa nengozi eyengeziwe ye-osteoarthritis ngemva kokuthatha umhlalaphansi, ngokwengxenye ngenxa yokulimala kwe-meniscus nemisipha eqongelelekile.
Okokugcina, izinguquko ze-biomechanical (njengokugoba kakhulu kwemilenze ku-varus noma ku-valgus, ukuphinyiselwa kwezinyawo okuphawulekayo, amadolo angalingani kahle, kanye nokungafani kobude bemilenze) kusabalalisa kabusha umthwalo ngokungalingani futhi kugxilise ukucindezeleka ezindaweni ezithile ze-cartilage, kusheshise ukuguguleka kwayo. Ama-insoles enziwe ngokwezifiso, ama-orthotics, ama-braces amadolo, futhi, ezimweni ezikhethiwe, ama-osteotomies okulungisa angadlala indima ebalulekile kulezi ziguli.
Izimpawu ze-osteoarthritis kanye nokuhlolwa kwedolo
I-knee osteoarthritis ingaqala ngokunganaki, ngobuhlungu obuvela kuphela ngokuzikhandla (ukwehla entabeni, ukuthwala izinto ezisindayo, ukuhamba amabanga amade) kanye nokuqina okuncane kwasekuseni okuhlala imizuzu embalwa kuphela. Ngokuhamba kwesikhathi, ubuhlungu buba buhlala njalo, buvela ngemisebenzi emincane, bukhawulela ukuhamba, futhi budinga ukusetshenziswa kwezinduku noma izinduku zokuhamba.
Ngaphezu kobuhlungu, ezinye izimpawu eziphawulekayo zifaka phakathi ukwehla kokuhamba (ubunzima bokugoba noma ukwelula idolo), ukuqina ngemva kwezinkathi zokuphumula, umuzwa wokungazinzi, i-crepitus (imisindo yokuqhekeka noma yokuqhekeka), kanye nokuvela kokuphuma kwamalunga (ukuqongelela koketshezi ngaphakathi kwedolo) okuholela ekuvuvukeni, ikakhulukazi esifundeni se-suprapatellar. Ezigabeni ezithuthukile, izinguquko ezibonakalayo zokwakheka komzimba zingabonakala: amadolo e-varus noma e-valgus acacile, ivolumu ekhuphukile, ukukhubazeka, kanye nokulahlekelwa amandla nokusebenza okucacile.
Ngesikhathi sokuhlolwa kwezokwelapha, udokotela uhlola ukuhambisana kwemilenze, ukuba khona kwe-quadriceps atrophy, ukuzinza kwe-ligamentous esebenzisa izindlela ezithile (ukuhlolwa kwe-anterior kanye ne-posterior drawer, ukuhlolwa kwe-Lachman, ukuhlolwa kwe-valgus-varus okuphoqelelwe), ububele obukhethiwe emgqeni wamalunga (okubonisa ukulimala kwe-meniscus), kanye nobubanzi bokunyakaza. Umlando wezokwelapha ophelele kanye nokuhlolwa okuhlelekile okwenziwe kahle kuvumela ukuxilongwa okuvamile ngisho nangaphambi kokusebenzisa izivivinyo zezithombe.
Ama-X-ray athwala isisindo yiwona vivinyo lokuqala lokuqinisekisa i-osteoarthritis, njengoba ebonisa ukuncishiswa kwesikhala samalunga (ukulahlekelwa yi-cartilage), ukwakheka kwe-osteophyte, i-subchondral bone sclerosis, kanye nokukhubazeka okungenzeka. I-magnetic resonance imaging (MRI) kanye ne-CT scans zigcinelwe ukuhlolwa okuningiliziwe kwezilonda ze-menisci, i-ligaments, kanye ne-focal chondral, noma lapho kusolwa olunye uhlobo lwesifo oluhambisanayo.
Ukwelashwa: kusukela ekushintsheni kwendlela yokuphila kuya ekufakweni kwamadolo
Indlela yokwelapha i-osteoarthritis kanye nobuhlungu bamadolo ngokuvamile ilandela izinyathelo futhi ihlanganisa imikhakha eminingi. Akuzona zonke iziguli ezidinga ukwelashwa okufanayo noma ngesikhathi esifanayo , futhi ukuhlinzwa kufanele kubhekwe njengendlela yokugcina ngemuva kokusebenzisa izindlela ezinengqondo zokulondoloza impilo, ngaphandle kokukuhlehlisa isikhathi eside kuze kuphuce iziguli iminyaka eminingi yokuphila okuhle.
Ezigabeni zokuqala, izinyathelo ezingezona ezemithi ziyitshe lesisekelo: ukunciphisa isisindo ezimweni zokukhuluphala, uhlelo lokuzivocavoca umzimba oluguquliwe (ukuhamba, ukugibela ibhayisikili, ukubhukuda, ukuzivocavoca ngamandla okuqhubekayo) , i-physiotherapy yokuthuthukisa ukuhamba kanye nokulawula imisipha, imfundo yesimo somzimba, kanye nokusetshenziswa kwezinsiza zobuchwepheshe (izinduku, ama-knee pad, ama-insoles) uma kuboniswe.
Ngokombono wezokwelapha, ukwelashwa kuvame ukuqala ngemithi yokunciphisa ubuhlungu elula njenge-paracetamol ngemithamo elungisiwe, yize ukusebenza kwayo kwesikhathi eside kunqunyelwe. Imithi yomlomo engeyona i-steroidal yokulwa nokuvuvukala (ama-NSAID) ingaba usizo ngesikhathi sokuvuvukala okukhulu kobuhlungu, kucatshangelwa njalo izingozi zenhliziyo, ukugaya ukudla kanye nezinso. Ama-NSAID asetshenziswayo (okhilimu, amajeli) nawo ayasetshenziswa, anemiphumela embalwa yomzimba.
Uma ukulawula ubuhlungu kunganele, kungacatshangwa ngokujova ama-corticosteroids ngaphakathi kwe-articular (kokuvuvukala okuthile, okulinganiselwe ngenani ngonyaka) noma i-hyaluronic acid (i-viscosupplementation). I-Hyaluronic acid isebenza njenge-lubricant kanye ne-shock absorber futhi inganikeza impumuzo izinyanga eziningana ezigulini ezithile. Ama-SYSADOA abizwa ngokuthi ama-SYSADOA (i-glucosamine, i-chondroitin, i-diacerein) ayimithi esebenza kancane enemiphumela ehlukahlukene ngokusho kwezifundo, kodwa abekezelelwa kahle futhi asetshenziswa ezinhlotsheni zesikhathi eside.
Eminyakeni yamuva nje, umuthi wokuvuselela osetshenziswa edolweni uye waduma, ngokusetshenziswa kwe-plasma ecebile ngama-platelet (PRP) kanye, kwezinye izimo, namaseli e-mesenchymal stem. Lezi zindlela zokwelapha zihlose ukulawula ukuvuvukala nokukhuthaza ukulungiswa kwezicubu; zingabambezela isidingo sokufakwa esikhundleni sedolo kwezinye iziguli, yize ucwaningo lusalungiswa ukuze kutholakale ukuthi yimaphi amaphrofayili asabela kahle nokuthi yiziphi izindlela zokwenza.
Uma ubuhlungu bukhulu, bunciphisa kakhulu impilo yansuku zonke naphezu kokwelashwa nge-physiotherapy, imithi, imijovo, kanye nezinguquko zendlela yokuphila, futhi ukuguga okuthuthukile kuqinisekiswa ngezithombe, ukuhlinzwa kuba yindlela efanelekile kakhulu , kungakhathaliseki ubudala. Ngezinye izikhathi, ukuhlehlisa i-prosthesis kuyacatshangelwa kubantu "abasebancane kakhulu," kodwa lokhu kusho ukwamukela iminyaka yokuphila okulinganiselwe, njengoba kuboniswe amacala eziguli ezineminyaka engu-50 ubudala ezitshelwa ukuthi zilinde eminye iminyaka eyishumi kuyilapho ubuhlungu buzivimbela ekudanseni, ekuhambeni, noma ekusebenzeni ngokujwayelekile.
Ukufakelwa kwamadolo kwesimanje okuphelele kuvame ukuba nokuphila okungaphezu kweminyaka engama-20 uma kukhethwa imodeli efanele futhi kwenziwa inqubo eqondile yokuhlinzwa, eklanyelwe uhlobo lokukhubazeka, ukuqina kwemisipha, kanye nesimo semisipha. Kunezinhlobo ezahlukene zemiklamo (ukugcinwa okubalulekile, ukuqina kwangemuva, ukufakelwa okuvinjelwe, njll.) ezitholakalayo, ezikhethwa udokotela ohlinzayo ukuze athuthukise ukuqina nokuphila isikhathi eside. Futhi lapho ukufakelwa kwamadolo kuguga noma kwehluleka, ukushintshwa kwamadolo kungenzeka.
Ngemva kokufakelwa idolo, umgomo akukhona ukuthi isiguli sibuyele emncintiswaneni osezingeni eliphezulu noma sixhumane nemidlalo efana nebhola, kodwa kunalokho sikwazi ukuhamba ngaphandle kobuhlungu, sikhuphuke izitebhisi, siphile ngokuzimela, futhi sihlanganyele emisebenzini yokuzijabulisa ephakathi nendawo . Futhi, ukuvuselelwa kanye nokuzibophezela kwesiguli ekuqeqeshweni kwamandla nokuhambahamba kubaluleke njengokuhlinzwa uqobo.
Impilo yedolo kuyo yonke impilo incike ezicini eziningi, kusukela ku-genetics kanye nesimo somzimba kuya esisindweni, isisindo semisipha, umsebenzi womzimba, kanye nendlela ukulimala okuphathwa ngayo uma kwenzeka. Ngolwazi oluhle, ukuvimbela okunengqondo, ukutholakala kusenesikhathi komonakalo wesakhiwo, kanye nokusetshenziswa ngobuhlakani kwamathuluzi okwelapha atholakalayo (kufaka phakathi ukuhlinzwa uma kudingeka, hhayi eminyakeni kamuva), kungenzeka ngokuphelele ukufinyelela ebudaleni obukhulile ngamadolo, yize engaphelele, akuvumela ukuthi uqhubeke uhamba ngokukhululeka futhi ulondoloze impilo enhle.
