Gonarthrosis na haɗin gwiwa gwiwa shine mafi yawan bayyanar cututtuka na cututtukan degenerative-dystrophic, wanda ke da lalacewa a hankali na guringuntsi tare da canje-canje masu zuwa a cikin sassan articular, wanda ke tare da ciwo da rage motsi.
Cutar ta fi shafar matan da suka haura shekaru 40, musamman ma masu kiba da varicose veins na kasa da kasa.
Ƙungiyar gwiwa ta ƙunshi sassa uku:
- tibifemoral na tsakiya;
- tibifemoral na gefe;
- suprapatellar-femoral.
Ana iya shafar waɗannan ɓangarori ta hanyar naƙasa osteoarthritis (DOA) duka ɗaya ɗaya kuma a kowace haɗuwa. 75% na duk lokuta na gonarthrosis shine lalata sashin tibifemoral na tsakiya (a lokacin motsi, yana fuskantar nauyin da ya wuce nauyin jiki ta sau 2-3).
A cikin matasa marasa lafiya, haɗin gwiwa ɗaya kawai ya fi lalacewa - dama ko hagu (gonarthrosis na gefen dama ko hagu).
Dalilan DOA na haɗin gwiwa gwiwa
Abubuwa da yawa na iya shiga cikin haɓakar sauye-sauye na guringuntsi na degenerative lokaci guda:
- nauyin inji na haɗin gwiwa na gwiwa (wasu ƙwarewa, wasanni) tare da microtraumatization na guringuntsi;
- sakamakon raunin da ya faru, aikin tiyata (meniscectomy);
- cututtuka masu kumburi na gwiwa (arthritis);
- rashin daidaituwa na anatomical na sassan articular (dysplasia);
- cin zarafi na statics (lebur ƙafa, curvature na kashin baya);
- na kullum hemarthrosis (tarin jini a cikin kogon synovial);
- pathology na rayuwa (gout, hemochromatosis, chondrocalcinosis);
- wuce haddi nauyi na jiki;
- cin zarafi na samar da jini zuwa kashi;
- osteodystrophy (cutar Paget);
- cututtuka na jijiyoyin jini, asarar jin dadi a cikin gabobin;
- cututtuka na endocrine (acromegaly, ciwon sukari mellitus, amenorrhea, hyperparathyroidism);
- kwayoyin halitta predisposition (gaba ɗaya siffofin osteoarthritis);
- take hakkin kira na collagen type II.
Amma a cikin 40% na lokuta, ba shi yiwuwa a kafa tushen tushen cutar (primary arthrosis).
Pathogenesis na gonarthrosis
matakin farko
A cikin mataki na farko na cutar, hanyoyin tafiyar da ƙwayar guringuntsi suna damuwa. Ƙaddamarwa da ingancin babban tsarin tsarin nama na guringuntsi, proteoglycans, wanda ke da alhakin zaman lafiyar tsarin cibiyar sadarwar collagen, an rage.
A sakamakon haka, ana wanke chondroitin sulfate, keratin, hyaluronic acid daga raga, kuma gurɓataccen tsari na proteoglycans ba zai iya riƙe ruwa ba. Yana shiga cikin collagen, kumburin zaruruwa wanda ke haifar da raguwar juriya na guringuntsi zuwa damuwa.
A cikin rami na synovial, abubuwa masu kumburi suna tarawa, a ƙarƙashin rinjayar abin da guringuntsi ya lalace har ma da sauri. Fibrosis na capsule articular yana tasowa. Canji a cikin abun da ke ciki na ruwan synovial yana da wuya a sadar da kayan abinci mai gina jiki zuwa guringuntsi kuma yana ɓata zamewar sassan articular yayin motsi.
Ci gaban pathology
A nan gaba, guringuntsi a hankali ya zama bakin ciki, ya zama m, fasa yana samuwa a cikin dukan kauri. Epiphyses na kasusuwa suna samun ƙarin nauyi, wanda ke haifar da haɓakar osteosclerosis da haɓakar ramuwa na kyallen kasusuwa (osteophytes).
Wannan dauki na jiki yana da nufin kara yawan yanki na articular saman da kuma sake rarraba kaya. Amma kasancewar osteophytes yana ƙara rashin jin daɗi, nakasa kuma yana ƙara iyakance motsi na hannu.
An kafa microfractures a cikin kauri na kashi, wanda ke cutar da tasoshin kuma ya haifar da hauhawar jini na intraosseous. A cikin mataki na ƙarshe na osteoarthritis, sassan articular sun bayyana gaba daya, sun lalace, ƙungiyoyin hannu suna da iyakacin iyaka.
Alamun gonarthrosis na gwiwa gwiwa
Arthrosis na gwiwa gwiwa yana da halin da ake ciki na yau da kullum, sannu a hankali ci gaba (watanni, shekaru). Asibitin yana girma sannu a hankali, ba tare da fayyace tashin hankali ba. Mai haƙuri ba zai iya tunawa daidai lokacin da alamun farko suka bayyana ba.
Bayyanar cututtuka na gonarthrosis:
- zafi. Da farko, yadawa, gajere (tare da tsayi mai tsayi, tafiya sama da matakala), kuma yayin da osteoarthritis ke ci gaba, zafi ya zama na gida (gaba da ciki na gwiwa), ƙarfin su yana ƙaruwa;
- hankalin gida ga palpation. Mafi yawa a cikin gwiwa tare da gefen sararin haɗin gwiwa;
- kumbura. A mataki na I yana iya zama ba a ji, a mataki na II-III yana tare da duk motsi;
- karuwa a girma, nakasar gwiwa. A sakamakon rauni na ligaments na gefe, mutum yana samar da tsari na O-dimbin yawa na gabobin (yana bayyane a fili ko da a cikin hoto);
- ƙuntata motsi. Da farko, akwai matsaloli tare da durƙusa gwiwa, daga baya - tare da tsawo.
Dalilan ciwo a DOA:
- juzu'i na inji na lalacewa articular saman;
- karuwa a cikin intraosseous matsa lamba, venous cunkoso;
- bayyanar cututtuka na synovitis;
- canje-canje a cikin kyallen takarda na periarticular (mikewar capsule, ligaments, tendons);
- thickening na periosteum;
- abubuwan mamaki na dystrophy a cikin tsokoki da ke kusa;
- fibromyalgia;
- matsawa ƙarshen jijiya.
Ya bambanta da coxarthrosis, DOA na gwiwa na iya nuna alamun bayyanar cututtuka na gaggawa.
Bayyanar cututtuka na gonarthrosis dangane da mataki:
| Halaye | Ina mataki | II mataki | Mataki na III |
|---|---|---|---|
| Ciwo | Short, yana faruwa sau da yawa lokacin da aka mika gwiwa (tsawon tsayi, tafiya sama da matakala) | Matsakaici, yana ɓacewa bayan hutun dare | Furta, damuwa har da dare |
| Ƙuntataccen motsi | Ba a bayyane | Akwai ƙuntatawa na tsawo, gurgu mai laushi | Kwangila na jujjuyawar jujjuyawa-extensor, gurgu |
| murƙushewa | Ba | Yana jin kan palpation yayin motsi | m crunch |
| Nakasa | Bace | Kadan karkatar da axis na gaɓa a gaba, ɓarna tsoka | Valgus ko nakasar varus. A haɗin gwiwa ne m, atrophy na cinya tsokoki |
| Hoton X-ray | Ƙananan ƙunshewar sararin haɗin gwiwa, alamun farko na subchondral osteosclerosis | An rage sararin haɗin gwiwa da 50% ko fiye, osteophytes sun bayyana | Kusan cikakken rashi na sararin haɗin gwiwa, gagarumin nakasar da sclerosis na articular saman, yankunan subchondral kashi necrosis, osteoporosis. |
Sau da yawa rikitarwa na arthrosis na gwiwa gwiwa shine synovitis reactive na biyu, wanda ke da alamun bayyanar cututtuka:
- girma zafi;
- kumburi;
- zubar da jini a cikin rami na synovial;
- ƙara yawan zafin jiki na fata.
Ƙananan rikitarwa kuma mafi haɗari sun haɗa da: toshewar haɗin gwiwa, osteonecrosis na condyle femoral, subluxation na patella, hemarthrosis na lokaci-lokaci.
Binciken DOA na haɗin gwiwa gwiwa
Binciken gonarthrosis ya dogara ne akan gunaguni na halayen haƙuri, canje-canjen da aka gano yayin jarrabawa da sakamakon ƙarin gwaje-gwaje.
Don tabbatar da osteoarthritis, an wajabta:
- rediyo na haɗin gwiwa gwiwa a cikin tsinkaya guda biyu (anteroposterior da na gefe): hanya mafi dacewa don tabbatar da ganewar asali a cikin ci gaba na ilimin cututtuka;
- Duban dan tayi: ƙaddarar kasancewar zubar da jini a cikin haɗin gwiwa, ma'auni na kaurin guringuntsi;
- nazarin ruwan synovial;
- arthroscopy na bincike (kimanin gani na guringuntsi) tare da biopsy;
- Ƙididdigar ƙididdiga da Maganar Magana (CT, MRI): hanya mafi kyau don bincikar DOA a farkon matakai.
Idan likita yana da shakku game da ganewar asali, ana iya rubuta shi:
- scintigraphy: duban haɗin gwiwa bayan gabatarwar isotope na rediyoaktif;
- thermography: nazarin ƙarfin infrared radiation (ƙarfinsa yana daidai da ƙarfin kumburi).
Jiyya na gonarthrosis na gwiwa gwiwa
Tsarin jiyya don osteoarthritis ya haɗu da hanyoyi da yawa: hanyoyin da ba na ƙwayoyi ba, magungunan magani da gyaran tiyata. An ƙayyade rabon kowace hanya a ɗaiɗaiku ga kowane mai haƙuri.
Maganin marasa magani
A cikin sabuwar ESCEO (Ƙungiyar Tarayyar Turai don Abubuwan Lafiya na Osteoporosis da Osteoarthritis) jagororin kan yadda ake bi da osteoarthritis na gwiwa, masana sun ba da fifiko na musamman kan ilimin haƙuri da gyare-gyaren salon rayuwa.
Mai haƙuri yana buƙatar:
- bayyana mene ne ainihin cutar, wanda aka kafa don magani na dogon lokaci;
- koyar da yadda ake amfani da na'urori masu taimako (kanes, orthoses);
- rubuta abinci (ga marasa lafiya tare da ma'auni na jiki fiye da 30);
- ba da tsarin motsa jiki don ƙarfafa tsokoki na cinya da sauke haɗin gwiwa;
- bayyana mahimmancin ƙara yawan aikin jiki.
A farkon matakan arthrosis na gwiwa, hanyoyin physiotherapy na jiyya suna ba da sakamako mai kyau:
- tausa;
- magnetotherapy;
- UHF far;
- electrophoresis;
- hydrogen sulfide baho;
- aikace-aikacen paraffin;
- acupuncture.
Pharmacotherapy na gonarthrosis
Yin amfani da kwayoyi a cikin DOA yana nufin kawar da ciwo, rage kumburi, da rage yawan lalacewar guringuntsi.
Maganin bayyanar cututtuka:
- analgesics;
- abubuwan da ba steroidal anti-mai kumburi abubuwa (NSAIDs) na rukuni na COX-2 inhibitors a cikin nau'i na allunan ko suppositories;
- marasa narcotic analgesics (tare da resistant ciwo ciwo).
Magunguna masu gyara tsari (chondroprotectors):
- Chondroitin sulfate;
- Glucosamine sulfate.
Ana iya ɗaukar waɗannan magungunan a cikin nau'i na capsules a cikin darussa sau da yawa a shekara, allura ta ciki ko kai tsaye zuwa cikin rami na synovial.
Jiyya na gida ya haɗa da alluran kusa-da kuma intra-articular na glucocorticosteroids, shirye-shiryen hyaluronic acid.
A matakai I-II na DOA, wani muhimmin wuri a cikin hadaddun magani shine amfani da man shafawa, gels da creams dangane da NSAIDs. Suna taimakawa wajen rage buƙatar majiyyaci na shan NSAIDs a baki, ta yadda za a rage haɗarin lalacewa ga tsarin narkewa.
Maganin jama'a
Yin amfani da tinctures, decoctions, ruwan 'ya'yan itace, aikace-aikacen gida na tsire-tsire masu magani ya kamata a yi la'akari da su azaman hanyoyin taimako don maganin DOA, magungunan jama'a ba zai iya maye gurbin maganin da likita ya tsara ba.
Tsire-tsire da ake amfani da su a cikin osteoarthritis: Dandelion, Ginger, Jerusalem artichoke, burdock, tafarnuwa, buckthorn na teku.
Tiyata
Ana iya buƙatar shiga tsakani na tiyata a kowane mataki na gonarthrosis tare da rashin isasshen tasirin matakan likita. Mafi na kowa shine hanyoyin endoscopic, a cikin mafi tsanani lokuta ana nuna maye gurbin endoprosthesis.
Nau'o'in shiga tsakani na endoscopic:
- bita da gyaran haɗin gwiwa: cirewar abubuwan da ke cikin kumburi daga cikin rami na synovial, gutsuttsura na guringuntsi;
- Plasma ko Laser ablation: kawar da toshewar injiniya a cikin rami na synovial;
- chondroplasty.
Ana nuna osteotomy na periarticular gyara ga marasa lafiya da alamun farko na nakasar axial (ba fiye da 15-20%) ba.
Manufar aikin shine don mayar da daidaitattun daidaituwa na haɗin gwiwa, daidai da rarraba kaya a kan farfajiyar articular, da kuma cire wuraren da aka lalace. Wannan hanya tana ba ku damar jinkirta arthroplasty.
Alamu don maye gurbin yankin da abin ya shafa (ko duka haɗin gwiwa) tare da na wucin gadi:
- DOA II-III digiri;
- nakasar axial mai tsanani na sashin jiki;
- aseptic necrosis na subchondral kashi Layer;
- ciwo mai ci gaba.
Contraindications ga gwiwa arthroplasty:
- duka lalacewa ga haɗin gwiwa;
- na'urar ligamentous mara ƙarfi;
- DOA a sakamakon ciwon kumburi mai kumburi;
- ƙwanƙwasawa mai jujjuyawa, raunin tsoka mai tsanani.
A wannan yanayin, mai haƙuri yana fama da arthrodesis - kwatancen haɗin gwiwa na gwiwa a cikin matsayi na ilimin lissafi tare da kawar da sassan articular. Wannan yana rage zafi amma yana rage ƙafar ƙafa, yana haifar da raunuka na biyu a cikin gwiwa, hip, da kashin baya.
Rigakafi
Rigakafin lalacewar guringuntsi da bai kai ba ya kamata a fara tun yana ƙuruciya.
Matakan kariya:
- rigakafin scoliosis;
- gyaran ƙafar ƙafa (takalma tare da goyan bayan baka);
- ilimin motsa jiki na yau da kullum (iyakance wasanni masu nauyi);
- keɓance ƙayyadaddun matsayi yayin aiki.