关节炎早期髌骨软化症ppt课件

1、.,1,髌骨软化症,Doctor wang,2,.,髌骨软化症是髌软骨面及与其相对的股骨髌面的关节软骨由于损伤而引起的退行性变。,3,.,【病因病机】,本病多发生于运动员，常由慢性或急性损伤引起，如膝的长期猛烈屈伸活动，使髌股之间发生长期猛烈的摩擦。,4,.,Definition,Chondromalacia patella, Softening and degenerative changes in the posterior surface of the patella.,5,.,Pathology,First used by Aleman in 1917, chondromalacia

2、patella was the name given to a degeneration of the patellar articular cartilage (Kipnis and Scuderi, 1995). True chondromalacia patella involves the degeneration of the articular facets of the patella, with resulting ragged fronded edges, (Welsh and Hutton, 1990), and is a very common injury amongs

3、t both men and women of our sporting population (Williams, 1990).,6,.,Along with osteoarthritis, chondromalacia patella is a type of cartilage damage resulting in anterior knee pain. It is also named as a cause of the symptoms of patellofemoral pain syndrome (Reid, 1992). When compared to the number

4、 of patients who are seen with patellofemoral pain, and those with actual changes to the articular cartilage of the patella, chondromalacia patella is a rare condition though (Nofthall, 1990).,7,.,Cartilage changes occur due to excess compression which disrupts the intermediate and deep layers of ca

5、rtilage of the patellas articular surface (Reid, 1992). Kulund, 1988, also describes changes which occur to the subchondral bone microfractures and sclerosis both of which make the bone less resilient and lead to greater shock to the cartilage. Most chondromalacic changes are seen along the median r

6、idge of the patella, and here cartilage is thickest (Kulund, 1988).,Patella trauma A fracture involving the full thickness of the patella in a child is extremely rare. However fractures of the patellar articular facets are less uncommon.,PATELLA: Medial contact of femur in extreme flexion (rose) Fac

7、et for medial femoral condyle Facet for lateral femoral condyle Attachment of patellar ligament,Lateral release,4 xs body weight with knee flexed 70-80 degrees of flexion,14,.,15,.,Patella Pathologies,Patellofemoral Stress Syndrome Mechanism S/S History Inspection Palpation AROM PROM RROM Special Te

8、sts,16,.,Anatomy,Patellar Retinaculum Longitudinal tendinous fibers Patellofemoral ligaments Blood Supply Primarily derived from geniculate arteries,17,.,Biomechanics,The patella undergoes approximately 7 cm of translation from full flexion to extension Only 13-38% of the patellar surface is in cont

9、act with the femur throughout its range of motion,18,.,Biomechanics,The patella increases the moment arm about the knee Contributes up to 30% increase in force with extension Patella withstands compressive forces greater than 7X body weight with squatting,19,.,Biomechanics,Twice as much torque is ne

10、eded to extend the knee the final 15 degrees than to extend from a fully flexed position to 15 degrees of flexion,20,.,Modified Tension Band Wiring,Transverse, noncomminuted fractures After reduction, fracture is fixed with two parallel, 1.6mm Kirschner wires placed perpendicular to the fracture 18

11、gauge wire passed behind proximally and distally,21,.,Modified Tension Band Wiring,Wire converts anterior distractive forces to compressive forces at the articular surface Two twists are placed on opposite sides of the wire Tighten simultaneously to achieve symmetric tension Repair any retinacular t

12、ears,22,.,分级,23,.,Outerbridge Chondral Defect Classification:,24,.,Outerbridge Chondral Defect Classification:,Grade 0: normal cartilage Grade I: cartilage with softening and swelling;,25,.,Outerbridge Chondral Defect Classification:,Grade II: a partial-thickness defect with fissures on the surface

13、that do not reach subchondral bone or exceed 1.5 cm in diameter;,26,.,Outerbridge Chondral Defect Classification:,Grade III: fissuring to the level of subchondral bone in an area with a diameter more than 1.5 cm;,27,.,Outerbridge Chondral Defect Classification:,Grade IV, exposed subchondral bone.,28

14、,.,【 诊断】,（一）临床表现 患者初为膝部不适，继而有髌骨后方疼痛，膝内侧隐痛，活动时或活动后疼痛加重，上、下楼梯尤为明显。 自觉髌股之间有摩擦感，压迫髌骨有疼痛，尤以膝外侧压痛明显，膝关节活动度正常，但有细小摩擦音。,29,.,（二）检查,1髌骨压磨试验 2 单腿下蹲试验患肢单腿站立,30,.,（三）X 线检查,31,.,Radiographic Appearance,Plain radiography of the knee is of limited use, on a skyline axial projection the small fissures may be visible and in the final grade 4 stages osteoarthritic-sclerotic changes take place and osteophytes are visibleMR is able to provide sagittal a