Arthrosis ntawm lub hauv caug pob qij txha (ICD-10 - M17) yog ib qho kab mob loj zuj zus uas tshwm sim los ntawm kev txhim kho degenerative-dystrophic hloov pauv hauv pob txha mos, pob txha subchondral, tshuaj ntsiav, synovial membrane, cov leeg. Nws tshwm sim nrog mob thiab nyuaj rau kev txav mus los. Kev loj hlob ntawm tus kab mob ua rau muaj kev tsis taus. Osteoarthritis ntawm lub hauv caug pob qij txha cuam tshuam 8-20% ntawm cov neeg. Ntau zaus nce nrog hnub nyoog.
Kev faib tawm ntawm Kosinskaya N. S
Muaj ntau qhov kev faib tawm - vim li cas, rau cov cim hluav taws xob. Nws yooj yim dua hauv kev xyaum siv kev faib tawm ntawm Kosinskaya N. S.
- 1 theem - x-ray duab ntawm me ntsis nqaim ntawm qhov chaw sib koom thiab me me subchondral osteosclerosis. Cov neeg mob yws ntawm qhov mob hauv lub hauv caug pob qij txha thaum taug kev ntev, thaum nce toj lossis nqis ntaiv. Tsis muaj kev ua haujlwm tsis zoo ntawm kev sib koom ua ke.
- 2 theem - articularqhov sib txawv nqaim los ntawm 50% lossis 2/3. Subchondral osteosclerosis yog pronounced. Osteophytes (pob txha loj hlob) tshwm sim. Qhov mob yog me ntsis, muaj lameness, cov leeg ntawm tus ncej puab thiab sab ceg yog hypotrophic.
- 3 theem - qhov chaw sib koom ua ke tsis tuaj yeem ua tiav, muaj kev hais tawm deformation thiab sclerosis ntawm articular nto nrog necrosis ntawm cov pob txha subchondral thiab cov pob txha hauv zos. Tus neeg mob tsis muaj kev txav ntawm qhov sib koom ua ke, qhov mob hnyav heev. Muaj cov leeg nqaij atrophy, lameness, deformity ntawm cov ceg qis (valgus lossis varus).
Kev faib tawm thoob ntiaj teb ntawm Kab Mob ICD-10
Deforming arthrosis ntawm lub hauv caug pob qij txha hauv ICD-10 yog xaiv M17 (gonarthrosis). belongs rau chav kawm 13th - cov kab mob ntawm lub cev musculoskeletal thiab cov ntaub so ntswg sib txuas (M00 - M99). Osteoarthritis ntawm lub hauv caug pob qij txha (ICD-10 code) yog nyob rau hauv pab pawg - arthrosis M15 - M19.
- Yog tias kev puas tsuaj rau ob leeg pob qij txha pib yam tsis muaj kev cuam tshuam sab nraud, ces qhov no yog thawj ob sab arthrosis ntawm lub hauv caug pob qij txha. Hauv ICD-10 - M17.0. Kuj hu ua idiopathic mob caj dab.
- Qhov kev xaiv tom ntej yog lwm qhov kev mob caj dab ntawm lub hauv caug pob qij txha. Hauv ICD-10 - M17.1. Qhov no suav nrog unilateral arthrosis. Piv txwv li, M17.1 - arthrosis ntawm lub hauv caug sab xis hauv ICD-10. Osteoarthritis ntawm lub hauv caug sab laug muaj tib txoj cai.
- Kev mob yog ib qho ua rau muaj mob, tshwj xeeb tshaj yog nyob rau hauv cov tub ntxhais hluas thiab cov neeg ncaws pob. Yog tias ob leeg pob qij txha raug cuam tshuam, tom qab ntawd hauv kev faib tawm nws suab zoo li tom qab kev raug mob ob sab deforming arthrosis ntawm lub hauv caug pob qij txha, ICD-10 code yog M17.2.
- Yog hais tias ib leeg swb, tus lej hloov pauv. Raws li ICD-10unilateral post-traumatic arthrosis ntawm lub hauv caug pob qij txha raug xaiv M17.3.
- Yog tias tus neeg mob muaj keeb kwm ntawm qhov ua rau muaj kev puas tsuaj rau cov qauv ntawm cov pob qij txha, piv txwv li, mob hnyav lossis ntev dhau, mob caj dab, mob caj dab ntawm ntau yam etiologies, kab mob somatic nrog kev puas tsuaj, ces qhov no yog qhov thib ob ob sab. arthrosis. Kev mob caj dab ntawm lub hauv caug hauv ICD-10 muaj ntau txoj haujlwm nyob ntawm qhov ua rau.
- M17.5 - lwm qhov kev mob caj dab thib ob ntawm lub hauv caug pob qij txha, raws li ICD-10 - M17.5. Qhov no yog ib qho unilateral lesion.
- Unspecified arthrosis ntawm lub hauv caug hauv ICD-10 - M17.9.
qauv ntawm lub hauv caug sib koom
Lub hauv caug sib koom ua ke peb cov pob txha: femur, tibia thiab patella, npog cov pob qij txha nyob rau hauv pem hauv ntej. Cov chaw sib txuas ntawm femur thiab tibia yog qhov tsis sib xws, yog li ntawm lawv muaj cov pob txha mos hyaline ntom ntom kom nqus tau cov load (meniscus). Cov pob txha nto hauv qhov sib koom ua ke kuj tseem npog nrog pob txha mos. Tag nrho cov khoom ntawm kev sib koom ua ke tuav cov ligaments: lateral medial thiab lateral, cruciate anterior thiab posterior. Sab nraud, tag nrho cov no yog them nrog lub zog sib koom ua ke capsule. Sab hauv ntawm lub capsule yog lined nrog ib tug synovial membrane, uas yog densely nkag nrog cov ntshav thiab cov ntaub ntawv synovial kua. Nws txhawb nqa tag nrho cov qauv ntawm kev sib koom ua ke los ntawm kev sib kis, vim tias tsis muaj cov hlab ntsha hauv pob txha mos. Nws muaj chondrocytes (txog li 10%), thiab cov tshuaj intercellular (matrix), uas muaj collagen fibers, proteoglycans (lawv yog tsim los ntawm chondrocytes) thiab dej (txog 80%).glycosaminoglycans thiab chondroitin sulfate, khi dej thiab fiber.
Etiopathogenesis
Ua rau pob txha mos puas tuaj yeem yog keeb kwm ntawm kev kis kab mob lossis kab mob pob txha (rheumatoid, mob caj dab reactive, gout, psoriatic arthropathies), mob hnyav lossis ntev dhau ntawm kev sib koom ua ke (kev ua si, qhov hnyav), kev raug mob, lub cev tsis muaj zog hauv cov neeg mob laus. Tag nrho cov no ua rau muaj teeb meem metabolic, txo qis hauv qib ntawm proteoglycans, thiab dej poob. Cov pob txha mos loosens, dries tawm, tawg, ua thinner. Nws qhov kev puas tsuaj tshwm sim, tom qab ntawd rov tsim dua tshiab nrog kev tsis sib haum xeeb, cov pob txha pob txha pib nthuav tawm thiab loj hlob. Thaum tsis muaj kev kho mob, qhov chaw sib koom ua ke ploj mus, cov pob txha sib cuag. Qhov no ua rau mob hnyav thiab mob, deformity, necrosis ntawm pob txha.
Clinic
thawj qhov tshwm sim ntawm tus kab mob yog mob hauv caug pob qij txha thaum lub cev tawm dag zog, tom qab taug kev ntev, thaum txias, huab cua txias, thaum nce thiab nqis ntaiv, nqa qhov hnyav. Tus neeg mob saib xyuas nws txhais ceg. Lameness tshwm sim. Raws li tus kab mob tshwm sim, crunching, crepitus, nyuaj rau kev txav, thiab sib koom deformity tau sau tseg. Synovitis tshwm sim ib ntus. Hauv kev kuaj xyuas, thaj chaw sib koom ua ke tuaj yeem yog edematous, hyperemic, mob ntawm palpation. Muaj peev xwm deformation ntawm kev sib koom tes lossis tag nrho limb.
Diagnosis
txhawm rau nrhiav qhov ua rau tus kab mob thiab txiav txim siab qib ntawm nws qhov hnyav, nws yog qhov tsim nyogassign:
- Tau suav suav.
- Ua tiav urinalysis.
- Biochemical tsom xam: CRP, RF, lub siab ua haujlwm enzyme (AST, ALT), tag nrho cov protein, creatinine, uric acid, qabzib.
- X-ray ntawm lub hauv caug pob qij txha.
- Ultrasound (yog tias muaj Becker cyst, effusion hauv qhov sib koom ua ke).
- Thaum pw hauv tsev kho mob, ntxiv rau cov kev tshawb fawb saum toj no, MRI thiab densitometry kuj tau ua raws li cov lus qhia.
X-ray ntawm lub hauv caug pob qij txha yog ua tiav nyob rau hauv lateral thiab frontal projections. Cov cim hluav taws xob ntawm arthrosis muaj xws li: qhov txo qis hauv qhov siab ntawm qhov sib koom ua ke, pob txha loj hlob, osteophytes, subchondral osteosclerosis, cysts hauv epiphyses, deformity.
Nyob rau theem pib ntawm kev loj hlob ntawm tus kab mob, thaum tseem tsis tau muaj cov cim hluav taws xob, kev sib nqus resonance imaging (MRI) yuav yog ib txoj kev tshawb fawb ntau dua. Txoj kev no tso cai rau koj kom pom cov kev hloov pauv hauv pob txha mos, nws cov thinning, tawg, txhawm rau txheeb xyuas qhov mob ntawm cov kab mob synovial. Ntawm cov txheej txheem invasive, arthroscopy yog qhia. Nws tso cai rau koj pom qhov muag tshuaj xyuas tag nrho cov khoom sab hauv ntawm kev sib koom ua ke.
Differential Diagnosis
Kev kuaj mob sib txawv yog ua tiav nyob rau hauv thawj theem ntawm arthrosis, thaum lub chaw kho mob thiab cov duab hluav taws xob tseem tsis tau qhia. Nws yog ib qho tsim nyog yuav tsum tsis suav nrog kev mob caj dab ntawm ntau yam etiologies: rheumatoid, psoriatic, kis kab mob, rov ua haujlwm, nrog rau kev mob gout, kev sib koom ua ke hauv cov kab mob ulcerative colitis (NUC), Crohn tus kab mob. Nrog kev mob caj dab, yuav muaj cov tsos mob dav dav thiab hauv zos ntawm qhov mob,hloov pauv hauv daim duab ntawm cov ntshav thiab x-rays. Yuav tsum teem sij hawm nrog kws kho mob rheumatologist.
kev kho tsis yog tshuaj
Kev kho cov neeg mob gonarthrosis yog phais thiab tsis phais, thiab nws nyob ntawm theem ntawm tus kabmob. Nyob rau hauv thawj thiab thib ob theem, kev kho mob tsis muaj kev phais yog ua tau. Hauv qhov thib ob, yog tias tsis muaj txiaj ntsig los ntawm kev saib xyuas kev noj qab haus huv, nrog rau qhov thib peb, kev kho phais tau qhia.
Kev kho tsis yog phais yog tsis siv tshuaj thiab tshuaj. Kev kho tsis yog tshuaj muaj xws li:
- poob phaus.
- Kev kho mob kom ntxiv dag zog rau cov leeg ntawm sab ceg thiab ncej puab.
- Kev tshem tawm ntawm yam uas ua rau kom cov axial load ntawm qhov sib koom ua ke (khiav, dhia, taug kev ntev, nqa hnyav).
- Siv tus pas nrig ntawm sab nraud ntawm kev sib koom ua ke.
- Nkauj orthoses kom txo tau kev sib koom tes.
- Massage ntawm ceg thiab ncej puab cov leeg, hydromassage.
- Kho kho lub cev kho mob: SMT, electrophoresis nrog dimexide, analgin, novocaine, ultrasound lossis phonophoresis nrog hydrocortisone, chondroxide gel, magnetotherapy, laser. Tsis tas li ntawd, nrog rau qhov zoo dynamic, paraffin-ozocerite, av nkos daim ntawv thov. Radon, hydrogen sulfide, da dej bischofite, hydrorehabilitation muaj txiaj ntsig zoo.
kev kho mob
Raws li European cov lus qhia (ESCEO) 2014 rau kev kho mob ntawm cov neeg mob osteoarthritis, 4-kauj ruam algorithm rau kev kho mob osteoarthritis tau pom zoo:
- Thawj theemKev siv cov tshuaj paracetamol ntawm qhov kev thov rau cov nyhuv analgesic ceev yog qhia. Yog tias tus neeg mob muaj kab mob hauv plab, nws raug nquahu kom muab cov NSAIDs nrog rau cov tshuaj gastroprotectors. Kev txais tos ntawm cov qauv-hloov tshuaj ntawm kev ua haujlwm qeeb yog qhia. Cov no suav nrog glucosamine sulfate thiab chondroitin sulfate. Outwardly ntawm qhov sib koom - NSAID tshuaj pleev. Cov txheej txheem ntawm kev kho tsis yog tshuaj yeeb kuj tau qhia. Txhua kauj ruam tom ntej no tsis thim qhov dhau los.
- Ntawm theem ob, cov neeg mob uas muaj cov tsos mob hnyav (mob mob) lossis nquag synovitis yog cov kev kawm ntawm NSAIDs (xaiv lossis tsis xaiv, nyob ntawm qhov sib txawv). Nyob rau hauv cov ntaub ntawv ntawm inefficiency - intra-articular txhaj ntawm glucocorticoids (nrog effusion nyob rau hauv lub sib koom tes, cov nyhuv yog ceev, ntev mus txog rau peb lub lis piam, betamethasone 1-2 ml los yog methylprednisolone acetate 20-60 mg yog txhaj) los yog hyaluronic acid (nrog contraindications). rau NSAIDs, lub zog ntawm qhov mob nyem zoo ib yam, cov nyhuv yog 6 lub hlis, txhaj li 2 ml 3-5 zaug ib lub lim tiam).
- Kauj ruam thib peb yog qhov kev sim zaum kawg ntawm kev kho tshuaj ua ntej npaj rau kev phais. Cov tshuaj me me opioids thiab tshuaj tiv thaiv kev nyuaj siab tau sau tseg ntawm no.
- theem plaub yog kev kho mob phais. Pom ib nrab lossis tag nrho arthroplasty, kho osteotomy, arthroscopy.
kev kho mob phais
Nrog arthroscopy, cov hauv qab no tuaj yeem ua tau: kev tshuaj xyuas pom hauv qhov sib koom ua ke, tshem tawm cov seem ntawm pob txha mos, cov kab mob inflammatory, resection ntawm qhov chaw puas, leveling ntawm pob txha mos uas tau ua filamentous, tshem tawm ntawm osteophytes. Tab sis lub hom phiaj tseem ceeb ntawm arthroscopy yog teemKev kuaj mob txhawm rau npaj ua haujlwm ntxiv.
Kho osteotomy ntawm lub femur lossis tibia yog ua los kho cov axis ntawm sab ceg qis kom txo tau lub nra ntawm thaj chaw cuam tshuam. Qhov taw qhia rau kev ua haujlwm no yog gonarthrosis theem 1-2 nrog valgus lossis varus deformity ntawm qis qis.
Arthroplasty yog tag nrho thiab ib nrab. Feem ntau ua rau cov neeg mob hnub nyoog tshaj 50 xyoo. Cov lus qhia yog:
- arthrosis ntawm theem thib ob lossis thib peb;
- kev puas tsuaj rau thaj chaw ntawm kev sib koom tes nrog valgus lossis varus deformities ntawm qis extremities;
- pob txha necrosis;
- kev cog lus.
Kev phais arthroplasty yog ua nyob rau hauv cov neeg mob tom qab arthroplasty, yog tias muaj kev rov ua dua ntawm kev phais mob. Tom qab ua haujlwm no, koj yuav tsum taug kev hauv orthosis lossis nrog kev txhawb nqa.
Nyob rau hauv lub davhlau ya nyob twg ntawm arthrosis, thaum qhov sib koom ua ke tsis ruaj khov (dangling), nrog rau qhov deformity loj, cov tsos mob hnyav, yog tias nws tsis tuaj yeem ua qhov hloov pauv endoprosthesis vim muaj kev pheej hmoo siab lossis tsis lees txais cov endoprosthesis, kev ua haujlwm tau ua. - arthrosis. Txoj kev no tso cai rau koj kom tshem tau qhov mob thiab txuag cov ceg li kev txhawb nqa. Shortening ntawm limb nyob rau hauv lub neej yav tom ntej ua rau kev loj hlob ntawm degenerative-dystrophic txheej txheem nyob rau hauv tus txha nraub qaum.
