Lub hauv caug meniscus rupture: cov tsos mob, kuaj mob, kho thiab kho kom rov zoo * Hla ntshav

Cov kev ua si ntaus kis las

1K 0 03/22/2019 (kho dua zaum kawg: 07/01/2019)

Kev tawg ntawm meniscus ntawm lub hauv caug sib koom tes yog qhov kev ua txhaum ntawm kev ncaj ncees ntawm pob txha mos tshwj xeeb sab hauv qhov sib koom ntawm tib lub npe, uas ua zoo li lub ncoo thiab ua kom poob siab.

Cov ntaub ntawv dav dav

Menisci yog cov pob txha mos hauv ib cheeb tsam hauv lub hauv caug txha, ntawm thaj chaw ntawm artur thiab tibia. Tsim los ntawm cov fibers ntawm tshwj xeeb collagen. Los ntawm feem pua:

collagen - 65 ± 5%;
cov txheej txheem ua haujlwm sib ntxiv - 10 ± 3%;
elastin - 0.6 ± 0.05%.

Sab hauv txhua qhov tsim pob txha mos muaj thaj tsam liab - thaj chaw muaj ntshav hlab ntsha.

Caw cov sab nraud thiab sab hauv meniscus. Txhua tus tau cais mus rau hauv lub cev, pem hauv ntej thiab nram qab tshuab raj. Lawv ua raws li lub zog poob siab, faib cov teeb meem tseem ceeb thiab tiv tauj kev ntxhov siab thiab ruaj khov rau kev sib koom ua ke thaum sib hloov. Kev raug mob Meniscus yog ib hom kev sib kis rau cov neeg hnub nyoog 17-42 xyoo uas nquag lossis nquag ua haujlwm. Sab laug thiab sab hauv caug pob qij txha raug puas nyob ntawm tib zaus. Kev sib tsoo ntawm cov meniscus nruab nrab tshwm sim 3 zaug ntau dua li cov leeg tom qab. Kev hloov ntawm ob qho tib si menisci yog tsis tshua muaj. Cov txiv neej raug mob ntau dua li poj niam. Kev kho yog kev txuag lossis kev ua haujlwm.

Etiology

Qhov ua rau kev raug mob yog vim muaj kev ntxhov siab. Tuaj yeem nrog nrog ligamentous ncab lossis kua muag. Feem ntau cov feem ntau lawv yog:

Cov kev sib xyaw ua ke, muaj nyob rau hauv kev sib hloov ntawm lub ntsej muag qis dua:
- sab hauv - ua rau kev hloov ntawm sab nraud meniscus;
- sab nraud - rau kev sib tawg ntawm sab hauv pob txha mos tsim.
Ntau dhau ntawm flexion lossis txuas ntawm qhov sib koom tes, lossis abrupt abduction lossis adduction.
Khiav ntawm qhov tsis ncaj hauv av nrog lub cev nyhav dhau los.
Kev raug mob ncaj qha - lub caij nplooj zeeg nrog lub hauv caug duav ntawm ib kauj ruam.

Kev raug mob ntau zaus ua rau kev txhim kho kev mob mus ntev thiab cov txheej txheem ua rau cov nqaij pob txha mos, uas ua rau muaj kev pheej hmoo rov qab mob.

Cov ua rau pob txha mos degeneration, uas ua rau kom muaj kev puas tsuaj ntxiv, kuj suav nrog:

cov kab mob sib kis - rheumatism, brucellosis;
repetitive microtrauma hauv kev ncaws pob, ntaus pob basketball, ntaus hockey;
mob qaug dab peg nrog benzene, formaldehyde, vinyl chloride;
cov teeb meem metabolic - gout;
malfunctions ntawm endocrine system (tsis txaus ntawm kev loj hlob hormone, estrogen thiab corticosteroids);
txog kev mob plab (hypoplasia ntawm cov pob txha mos, cov menisci, cov hlab ntsha hauv lub hauv caug; cov leeg tsis muaj zog).

Tom qab 40 xyoo, cov txheej txheem tsis sib xws yog cov kev tshwm sim feem ntau ntawm cov npe hu ua pathology (menisci poob lub zog thiab ua rau muaj kev cuam tshuam rau kev mob tshwm sim).

Xav txog qhov hais los saum toj no, ib tug xov tooj ntawm sau phau ntawv faib lub kua muag meniscus rau hauv:

kev poob plig;
degenerative (nthuav tawm thaum ua tus cwj pwm tsis tu ncua lossis thauj khoom tsawg kawg, cov duab hauv chaw kuaj yog lwv).

Cov ចំណាត់ថ្នាក់ ntawm alterations thiab lawv cov degrees

Kev puas tsuaj yog ua tiav lossis ib nrab, nrog lossis tsis muaj kev tshem tawm, hauv lub cev, lossis hauv lub plhaw sab xub ntiag lossis tom qab. Ua rau hauv tus account lub duab, cov so tau faib ua:

kav ntev;
kab rov tav;
radial;
los ntawm hom ntawm "dej tuaj yeem kov";
thaj ua haujlwm;
thaj ua haujlwm kab rov tav.

Conventionally, raws li MRI cov ntaub ntawv, plaub qib kev hloov tau pom qhov txawv:

Lub Zog	Cov yam ntxwv ntawm meniscus kev puas tsuaj
0	Tsis muaj kev hloov pauv.
1	Sab hauv qhov sib koom tes sib xyaw ua ke, muaj kua muag ntawm cov nqaij mos pob txha mos tsis cuam tshuam rau lub plhaub sab nraud thiab txiav txim siab ntawm MRI. Tsis muaj cov tsos mob tshwm sim.
2	Cov kev hloov pauv txuas ntxiv mus tob rau ntawm meniscus yam tsis cuam tshuam rau lub plhaub sab nraud.
3	Kev ua tiav los yog ib nrab ntawm cov khauj khaum sab nraud ntawm sab hauv yog txiav txim siab. Puffiness tiv thaiv keeb kwm yav dhau los ntawm qhov mob hnyav ua kom yooj yim rau kev txheeb xyuas.

Cov tsos mob

Cov cim ntawm pathology txawv raws li nws lub sijhawm, ntxiv rau ntawm qhov loj ntawm kev puas tsuaj.

Lub sijhawm raug mob	Soj ntsuam duab
Mob mob	Cov tsos mob tsis tseem ceeb ntawm qhov mob tshwm sim (hais tawm ntawm lub cev; mob hauv zos thiab tsis muaj zog txav, tshwj xeeb txuas ntxiv). Hemarthrosis yog muaj peev xwm (nrog kev raug mob rau thaj chaw liab).
Subacute	Nws pib 2-3 lub lis piam tom qab raug mob. Qhov tsis tshua muaj mob hnyav zuj zus lawm. Kev mob hauv zos, sib txuas tshuaj ntsiav induration thiab kev txwv ntawm kev txav mus los. Nrog kev hloov pauv ntawm cov meniscus medial, kev hloov pauv yooj yim dua, nyuaj dua qub - txuas ntxiv. Txoj kev mob yuav ua rau muaj qee yam, piv txwv, thaum nce toj ntaiv (thaum nqis los, tej zaum nws yuav tsis tuaj). Vim tias kev txiav tawm ntawm ib qho ntawm ib qho ntawm meniscus, qhov sib koom tes yuav txiav. Feem ntau, kev tawg ntawm cov posterior tom qab ua rau kev txwv ntawm lub cev, thiab lub cev thiab lub zog sab xub ntiag txuas ntxiv.
Mob sib kho	Qhov mob me ntsis thiab qhov kev txwv ntawm kev txav mus los yog ib txwm muaj.

Tus kws tshaj lij twg yuav tiv toj

Koj yuav tsum sab laj ib tus kws phais neeg los yog kev phais neeg mob caj dab.

Kev kuaj mob

Kev kuaj mob yog txiav txim siab ntawm tus mob anamnesis (qhov tseeb ntawm kev raug mob), cov ntaub ntawv kuaj (nrog rau kev ntsuas mob phais), kev tsis txaus siab ntawm tus neeg mob thiab cov txiaj ntsig ntawm cov khoom siv tshawb nrhiav.

Koj tuaj yeem lees paub qhov kev kuaj mob nrog:

Xoo hluav taws xob, tso cai los txheeb xyuas qhov kev puas tsuaj (txoj kev kawm tuaj yeem nqa tawm nrog kev sib piv); tus nqi ntawm txoj kev kawm hauv kev suav nrog qhov ua tsis tau ntawm pob txha txhim kho;
MRI, uas yog tus cwj pwm los ntawm cov neeg siab dua qub piv rau cov duab hluav taws xob;
CT, tsis tshua paub txog MRI, yog siv thaum tom kawg tsis yooj yim sua;
Ultrasound, uas ua rau nws tuaj yeem txheeb xyuas thiab ntsuas qhov ntau ntawm kev puas tsuaj rau cov ntaub so ntswg sib txuas;
arthroscopy, muab lub sijhawm:
- pom kev poob plig;
- tshem cov khoom tawg ntawm pob txha mos;
- qhia tshuaj kho mob.

Kev Kho Mob

Nws muaj ntau theem. Nws yog xaiv ib tus zuj zus.

Hauv lub sijhawm mob yog qhia:

puncture ntawm lub hnab ntim articular thiab nqus ntshav, yog tias muaj;
so thiab immobilization ntawm ceg nrog hloov tseem ceeb nyob rau kev pom zoo ntawm tus kws kho mob mus kawm (plaster nrum tuaj yeem siv); nrog lub ntsej muag me ntsis lossis sab nruab nrab ntawm lub tshuab raj, ua kom tiav immobilization tsis qhia vim muaj kev pheej hmoo ntawm kev cog lus (ib daim ntaub qhwv lub zog los ntawm daim ntaub qhwv elastic siv);
noj cov tshuaj pleev qhov ncauj (Ibuprofen, Ketanol, Diclofenac);
txav nrog cov ntoo hla kom thiaj li txo qis ntawm lub ntsaws rau ntawm qhov sib koom ua ke;
nyob rau hnub ntawm kev raug mob - hauv zos txias, muab txhais ceg sawv qhov chaw siab.

Koomhaum ntxiv:

Kev tawm dag zog ib ce;
zaws;
kev siv lub cev ua haujlwm (UHF txoj kev kho, kev kho microwave, laser, kev kho hluav taws xob, kho mob hydrotherapy, electromyostimulation, raug ultrasound, hirudotherapy, electrophoresis);
chondroprotectors (glucosamine, chondroitin sulfate).

Kev phais mob yog muab rau yog tias kuaj mob:

detachment ntawm lub cev thiab tshuab raj ntawm cov meniscus (ntau ntau muaj ib qho kev sib tawg ntawm lub posterior pos ntawm meniscus medial, nrog los ntawm khoom thaum lub caij zaum npuag);
rupture ntawm tus meniscus nrog nws tawm mus tom ntej;
crushing lub meniscus;
tsis muaj txiaj ntsig los ntawm kev saib xyuas txoj kev kho.

Qhov loj tshaj plaws yog kev kho mob meniscectomy thiab meniscus-khaws cia phais los ntawm suture thiab cov qauv tshwj xeeb. Kev nkag mus rau cov ntaub so ntswg raug mob yog nqa tawm los ntawm txoj kev qhib lossis siv duab arthroscope.

Kev phais yas yog ua tau yog tias muaj kev sib cais los ntawm qhov sib koom los yog qhov ntev thiab qhov loj thiab qhov sib npaug. Txoj kev pheej hmoo ntawm txoj kev vam meej yog siab dua nrog kev raug mob tshiab thiab tus neeg mob hnub nyoog qis dua 40 xyoo.

Meniscus hloov dua siab tshiab yog siv rau kev rhuav tshem cov pob txha mos. Cov xaum yog lyophilized lossis irradiated menisci. Muaj cov ntaub ntawv ntawm cov ntawv sau ntawm kev txhim kho ntawm cov khoom siv dag.

Qhov nruab nrab ntawm lub sijhawm ua haujlwm yog kwv yees li 2 teev.

Tus mob txhawm zuj zus thaum tawg ntau dua los sis pob txha mos lawm pib - cov cim qhia meej rau cov meniscus extrusion.

Kev kho ua kom tawm dag zog

Txhawm rau tiv thaiv hypotrophy ntawm cov leeg ceg, ntxiv dag zog rau ligamentous apparatus thiab ruaj khov ntawm menisci, kev qoj ib ce yog qhia. Them yuav tsum tau ua ob peb zaug ib hnub. Lub sijhawm ntawm kev qoj ib ce tuaj yeem yog 20-30 feeb.

Kev tawm dag zog	Kev piav qhia	Daim duab ce
Tuav lub pob	Koj yuav tsum sawv ntawm sab nraub qaum rau phab ntsa, tuav pob ntawm koj lub hauv caug. Koj yuav tsum zaum maj mam, khoov koj lub hauv caug.
Kauj ruam	Ib txhais taw raug muab tso rau ntawm lub sam thiaj, lwm tus tseem nyob hauv pem teb. Txoj haujlwm ntawm lub taw yuav tsum hloov ib qho los ntawm ib qho.
Ncab	Cov raug mob ceg yog khoov ntawm lub hauv caug, txhais taw yog mob tom qab nraub qaum, thiab tom qab ntawd nws ncaj ncaj rau hauv pem teb.
Ua viav vias nrog tiv	Tuav rau kev txhawb nqa nrog koj ob txhais tes, tus ceg raug mob pib ntawm kev noj qab nyob zoo ib qho los ntawm lwm sab.

Cov lus pom zoo ntawm S.M. Bubnovsky

Cov kev tawm dag zog uas tau pom zoo muab faib ua qhov yooj yim thiab nyuaj:

Yooj Yim. Cov dej khov zuaj yog qhwv hauv daim ntaub uas qhwv ntawm hauv caug. Koj yuav tsum txav ntawm koj lub hauv caug, maj mam nce tus naj npawb ntawm cov kauj ruam mus rau 15. Tom qab tshem cov dej khov, txhos caug thiab sim qis koj lub pob tw mus rau koj lub luj taws, maj mam nce lub sijhawm zaum mus rau 5 feeb (thaum pib, koj tuaj yeem tso lub lev nyob hauv qab pob tw). Tom qab ntawd ncab koj ob txhais ceg mus tom ntej, txhuam ib txhais taw nrog koj ob txhais tes thiab rub nws.

Complex:
- Zaum-sawv. Txhos caug ntawm 90 ° kaum sab xis. Sab nraub qaum yog ncaj. Tsis txhob khoov dhau. Nws raug tso cai siv kev txhawb nqa. Dr. Bubnovsky pom zoo kom ua 20 squats hauv ib txoj kev. Yuav tsum muaj tsawg kawg 5 txoj hauv kev ib hnub.

Cia li txhos caug, xyab npab ob sab pem hauv ntej. Txo qis dua, kov hauv pem teb nrog lub pob tw.

Dag koj lub plab, npuaj koj qij taws, rub koj ob txhais taw mus rau ntawm koj lub pob tw, kov lawv nrog koj luj taws.

Pw ntawm koj sab nraub qaum, ncab koj ob txhais caj npab raws koj lub npog tas ib ce thiab khoov koj lub hauv caug tig. Tsis tas thawb koj lub luj taws mus rau hauv av, rub lawv mus rau ntawm koj lub pob tw, pab koj tus kheej ntawm koj txhais tes.

Kev kho kom rov zoo thiab ua tub rog

Nyob rau theem ntawm kev rov kho dua tom qab kev phais mob, nws raug nquahu kom txwv tsis pub lub nra ntawm lub hauv caug ob peb lub hlis. Nyob ntawm cov yam ntxwv ntawm kev ua haujlwm tau ua, sib txawv ntawm cov txheej txheem ntawm kev tawm dag zog, ERT thiab zaws tuaj yeem siv. Ntawm cov tshuaj, NSAIDs thiab chondroprotectors tau sau tseg.

Yog tias tus kws sau ntawv tau raug mob meniscus ua ntej sau ntawv, ncua rau-lub hlis ncua sijhawm rau kho mob. Kev tsis xwm yeem ua rau muaj kev zam ntawm kev ua tub rog: