Achilles Tendon Rupture, Patellar Tendon Tear, ndi Acute Foot Drop Triage¶

Kuwombera mwadzidzidzi, mokweza kapena kumveka phokoso kumbuyo kwa mwendo wapansi kapena kutsogolo kwa bondo panthawi yothamanga, kudumpha, kapena kupunthwa ndi chizindikiro chodziwika bwino cha ** Achilles tendon rupture ** kapena ** extensor mechanism (patellar kapena quadriceps tendon) misozi . Mofananamo, kulephera mwadzidzidzi kukweza kutsogolo kwa phazi ndi zala pansi ( kutsika kwa phazi lopweteka **, kuchititsa zala zala zala kukokera kapena kugunda pansi pamene akuyenda) ndi njira yofulumira yodziwira matenda yomwe ingachokere ku ** acute lumbar disc herniation kapena cauda equina compression , ** anterior tibial compartment * * entratibia syndrome * * * anterior tibial compartment * * entratibia syndrome * * kuphulika kwa tendon, kapena pakati paubongo. Ngati inu kapena munthu wina wapafupi nanu akumva kupweteka kwambiri kwa phazi limodzi ndi ululu wammbuyo, dzanzi m'chiuno, kapena phazi lopanda kuzizira, imbani nambala yanu yadzidzidzi nthawi yomweyo. manambala angozi. Onaninso zochitika zadzidzidzi za musculoskeletal ndi neurovascular mu mafupa osweka ndi sprains, cauda equina syndrome ndi kupsinjika kwa msana,ndi kuphwanya kuwonongeka ndi compartment syndrome.

Chitani izi tsopano¶

1. Chotsani zolemetsa ZONSE pa mwendo wovulala nthawi yomweyo ndipo musayese "kuchokapo." Kupitiliza kulemera pa tendon yosweka ya Achilles, tendon ya patellar, kapena quadriceps tendon imakoka tendon yomwe yang'ambikayo imalekanitsa centimita, kuphwanya magazi osalimba a paratenon sheath yomwe imagwira ntchito bwino, ndipo imatha kupangitsa kuti misozi ikhale yovuta. kumanganso.
2. ** Onerani nthawi yomweyo "Zowopsa Zitatu za Miyendo ndi Msana" (Imbani 911 / 112 / 999 pompano ngati alipo):**
3. Cauda Equina kapena Acute L4/L5 Radiculopathy Red Flags: Kutsika kwa phazi limodzi ndi ululu wopweteka kwambiri wa msana, kuwombera sciatica pansi pa mwendo umodzi kapena onse awiri, dzanzi m'matako kapena m'mimba ("chishalo choletsa kupweteka"), kapena vuto loyambitsa kukodza kapena kugwira matumbo (onani cauda equina syndrome).
4. Acute Anterior Compartment Syndrome kapena Popliteal Artery Occlusion (Knee Dislocation): Kutsika kwa phazi limodzi ndi kutupa koopsa, kosalekeza, kutupa kwamwala ndi kupweteka kwambiri kutsogolo kwa ntchafu zomwe zimakula kwambiri pamene zala zala zala zimatambasulidwa pansi, kapena phazi lotumbululuka, lozizira lopanda kugunda pamwamba pa phazi kapena phazi * pachimake ischemic nthambi).
5. Acute Central Brain Stroke (ACA/Motor Cortex): Kutsika kwa phazi kosapweteka mwadzidzidzi komwe kumatsagana ndi kufooka mbali imodzi ya ntchafu, ntchafu, mkono, kapena nkhope, mawu osamveka bwino, kapena chisokonezo.
6. Ikani ndi kuphatikizira bondo kapena bondo lomwe lavulala mumayendedwe enieni opumula pamene mukukonzekera zoyendera:
7. Pa Kuphulika Kwa Mifupa Ya Mifupa Yoganiziridwa (Kumbuyo kwa Ng'ombe/Gulu): Sanizani phazi lolozera pang'ono PASI (mu 20 mpaka 30 madigiri a plantarflexion / "tiptoe" malo) pogwiritsa ntchito pilo kapena pilo. MUSAkakamize bondo loduka la Achilles kuti lifike pamtunda wa digirii 90, chifukwa kukokera phazi m'mwamba kumalekanitsa mbali zong'ambika za Achilles ndi 3 mpaka 5 centimita.
8. Kwa Kukayikiridwa Kwa Patellar kapena Quadriceps Tendon Rupture (Kutsogolo kwa Bondo): Sanizani bondo KULUMBIKITSA KWAMBIRI (madigiri 0 otambasula) pa bolodi lalitali, pilo, kapena cholepheretsa mawondo. Osagwada bondo, monga kugwada kumakoka bondo ndipo tendon yong'ambika imalekanitsa.
9. Yezerani mayeso a Thompson Calf-Squeeze ngati akuganiziridwa kuti anaphulika. Muuzeni wovulalayo kuti agone chafufumimba pabedi kapena pabedi mapazi onse alendewende m'mphepete (kapena gwadirani pampando mapazi akulendewera). Finyani pang'onopang'ono mimba yapakati ya mwana wa ng'ombe pa mwendo wabwino poyamba (phazi lidzaloza pansi), kenaka finyani mwana wa ng'ombe wa mwendo wovulalayo. Ngati phazi lilibe ** osasunthira pansi pamene mwana wa ng'ombe akuphwanyidwa (** Positive Thompson Test **), tendon ya Achilles imasweka kwathunthu.
10. Masulani kapena kugawani magalasi olimba a fiberglass, nsapato zolimba za ski, kapena zingwe zamabondo nthawi yomweyo ngati dzanzi kapena kugwa kwa phazi kwayamba. Mitsempha ya common peroneal (fibular) imakulunga molunjika pa bampu ya fupa lakunja kwa mwendo kunsi kwa bondo (**khosi la ulusi **); Mphepete mwachitsulo, chingwe cha mawondo, kapena kuwoloka mwendo wautali kumapondereza minyewa iyi motsutsana ndi fupa, zomwe zimapangitsa kuti neurapraxia yosinthika yomwe imakhala yosatha ngati kupanikizika sikutha maola angapo.
11. ** Kwezani mwendo, ikani paketi ya ayezi yokulungidwa ndi nsalu kwa mphindi 15 mpaka 20 nthawi imodzi (osati pamwamba pa fupa lakunja kwa mutu wa ulusi pansi pa bondo), ndipo konzani tsiku lomwelo Dipatimenti Yadzidzidzi kapena kuwunika mwachangu kwa mafupa.* * Ma protocol a Achilles amakono osagwira ntchito komanso opangira opaleshoni amafunikira kuyika phazi mkati mwa maola 7 * equinus * 2 flexed * a pop kotero kuti milatho yatsopano ya hematoma ya tendon imatha kulumikizana mwachindunji.

Mtengo wachigamulo: Kusiyanasiyana kwamtundu wa ng'ombe, kung'ambika kwa bondo, ndi kutsika kwa phazi¶

flowchart TD
    Start["Acute Lower Extremity Mechanical Pop OR Mwadzidzidzi Kulephera Kukweza/Kuloza Phazi"] --> DirectionCheck{"Ndi Kuyenda Iti Kotayika Kapena Kowawa?"}

    DirectionCheck -->|"SUNGALOBE PHAZI PASI / Push Off Ground (Zomveka 'Pop' Kumbuyo kwa Ng'ombe/Gulu)"| AchillesBranch["SUSPECT ACHILLES TENDON RUPTURE: 1. Chitani Mayeso a Thompson Ng'ombe-Squeeze (Phazi likulephera plantarflex = Positive). 2. Muzimva kusiyana kwa 2-6 masentimita pamwamba pa chidendene fupa. 3. Bondo lopindika lolozera KUPSI (20-30 deg equinus); ZERO zolemera; Chisamaliro chadzidzidzi/Mafupa mkati mwa 24-48h."]

    DirectionCheck -->|"SUNGAWONGOLE MABOGO Olimbana ndi Mphamvu yokoka (Pop kutsogolo kwa bondo pambuyo pa Kulumpha/Kupunthwa)"| KneeExtensorBranch{"Kodi Chilema Chotha Kutha Chili Pati & Kodi Kneecap (Patella) Inasinthira Njira Iti?"}

    KneeExtensorBranch -->|"Mpata Pansi pa Kneecap + Kneecap Yokokera Mmwamba ntchafu (Patella Alta), Zaka <40"| PatellarTear["PATELLAR TENDON UPTURE: 1. Sungani bondo 100% STRAIGHT (0 deg extension). 2. Opaleshoni Yofulumira ya Orthopaedic yofunikira mkati mwa masiku kuti agwirizanenso ndi tendon ku tibial tubercle."]

    KneeExtensorBranch -->|"Mpata PAM'MBUYO YOTSATIRA Kneecap + Kneecap Watsitsidwa PAMENE (Patella Baja), Zaka nthawi zambiri > 40"| QuadTear["QUADRICEPS TENDON RUPTURE: 1. Sungani bondo 100% STRAIGHT (0 deg extension). 2. Kukonzekera Kwachangu kwa Opaleshoni Yamafupa kumafunika mwachangu kuti tipewe kuchedwa kwachikale."]

    DirectionCheck -->|"SINGAKWEZE KUWEZA Phazi / Zala Zam'mwamba Kulowera Ku Shin (Acute Foot Drop / Step-Page Gait)"| FootDropRedFlags{"Yang'anani Zadzidzidzi Zam'mitsempha ndi Mitsempha Yoyamba: Kupweteka kwa msana/myendo, dzanzi lachishalo, vuto la mkodzo, KAPENA SHIN YOWAWA KWAMBIRI / phazi lopanda pulseless?"}

    FootDropRedFlags -->|"INDE: Ululu Wobwerera, Sciatica, kapena Zizindikiro za Chikhodzodzo / Saddle"| SpineEmergency["ACUTE L5 RADICULOPATHY OR CAUDA EQUINA SYNDROME: Imbani 911 / 112 / 999 kwa Stat Lumbar Spine MRI & Emergency Neurosurgical Decompression."]

    FootDropRedFlags -->|"INDE: Kupweteka Kwambiri kwa Shin pa Passive Toe Flexion OR Cold Pulseless Phazi"| VascularCompartment["ANTERIOR COMPARTMENT SYNDROME KAPENA POPLITEAL ATERY OCCLUSION: Imbani 911 / 112 / 999 pa Emergency Fasciotomy / Vascular Surgery."]

    FootDropRedFlags -->|"PALIBE Msana kapena Mitsempha Yofiira Mbendera: Yesani Ankle Inversion (Kutembenuza Kokha Mkati)"| InversionTest{"Kodi Wodwala Angatembenuzire Phazi Mkati (Ankle Inversion = Tibialis Posterior, L5)?"}

    InversionTest -->|"Ankle Inversion NDI YAM'MBUYO (Yosasinthika), Eversion Ndi Yofooka, Kufooka Pamwamba Pamapazi / 1st Webspace"| PeronealOrTendon["COMMON PERONEAL NERVE PALSY (pa Fibular Neck) KAPENA TIBIALIS ANTERIOR TENDON UPTURE: Chotsani zomangira / zomangira pa bondo; yang'anani chingwe chosavuta kutsogolo kwa bondo; Kufunsira kwa Neurology / Orthopedic mwachangu."]

    InversionTest -->|"ONSE Ankle Inversion NDI Eversion Ndi Ofooka + Kubedwa Kwa Hip Ofooka"| L5RootOrSciatic["L5 NERVE ROOT LESON, SCIATIC NERVE PALSY, KAPENA CENTRAL STROKE: Immediate Emergency Department Neurological & MRI Workup."]

Chikhalidwe 1: Kuphulika Kwambiri kwa Achilles Tendon¶

Chiwonetsero cha "Kumenyedwa kapena Kuwomberedwa Kuseri kwa Ankle".¶

** Achilles tendon (calcaneal tendon) ** ndi tendon yaikulu kwambiri komanso yamphamvu kwambiri m'thupi la munthu, yomwe imapangidwa ndi kuphatikiza kwa ** gastrocnemius ** ndi ** soleus ** minofu ya ng'ombe ndikuyika kumbuyo kwa chidendene fupa (**calcaneal tuberosity **). Ngakhale kupirira kuchulukirachulukira mpaka 8 mpaka 12 kulemera kwa thupi pakuthamanga, tendon ili ndi malo odziwika bwino ** othira madzi opanda magazi omwe ali ndi 2 mpaka 6 centimita (0.8 mpaka 2.4 mainchesi) pamwamba pa kuyika chidendene **.

Pamene wothamanga kapena "wankhondo wakumapeto kwa sabata" (kawirikawiri wazaka 30 mpaka 55 pa nthawi ya tenisi, pickleball, basketball, mpira, badminton, kapena sprinting) akukankhira mwamphamvu ndi phazi lakutsogolo pamene bondo likutambasula, kapena kuponda mwadzidzidzi mu dzenje: 1. Kumva: Oposa 70 peresenti ya odwala amatembenuka mokwiya kuti awone yemwe ** adawaponyera kumbuyo kwa bondo ** kapena kuwamenya ndi mpira wa tenisi kapena racket, chifukwa tendon yowombera imamveka yofanana ndi kugunda kwachindunji kumbuyo. 2. Nyimbo Yomveka: Mng'oma ngati kulira kwamfuti kapena phokoso lamphamvu limamveka nthawi zambiri ndi anthu omwe atayima kutali. 3. Kuthamanga Mwadzidzidzi: Munthuyo sangathe kukankha zala zake kapena kukweza mwendo umodzi kumbali yovulalayo, akuyenda ndi phazi lathyathyathya. Ululu nthawi zambiri umachepa pakangotha ​​mphindi 15, zomwe zimanyengerera anthu ambiri kuti achedwetse chithandizo chamankhwala.

Mankhwala & Zowopsa Zowopsa Zomwe Zimafooketsa Ma Achilles ndi Quadriceps Tendons¶

Nthawi zonse fufuzani ngati wodwala yemwe akutuluka mwangozi kapena kutsika kwa tendon wakumana ndi mankhwala kapena zinthu zomwe zimawononga mtundu wa collagen wa mtundu woyamba: - Maantibayotiki a Fluoroquinolone (Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin): Nyamulani FDA ndi EMA Boxed Chenjezo pa chifuwa chachikulu cha tendinitis ndi kuphulika kwa tendon (zokhudza Achilles tendon mu 90 peresenti ya milandu, ndi mayiko awiri mpaka gawo limodzi mwamagawo atatu). Fluoroquinolones imathandizira matrix metalloproteinase (collagenase) yomwe imagaya ma tendon fibrils. Kuchedwa: Kusweka kumatha kuchitika pasanathe maola 48 kuchokera pamapiritsi oyamba a maantibayotiki KAPENA mpaka miyezi 6 mutamaliza kumwa mankhwala opha maantibayotiki, chiopsezo chikuchulukirachulukira mwa odwala opitilira zaka 60 kapena omwe akumwa nthawi imodzicorticosteroids. - Majekeseni a Corticosteroid kapena Local Corticosteroid: Majekeseni a steroid mwachindunji mkati kapena mozungulira tendon ya Achilles, patellar, kapena quadriceps amafooketsa kolajeni yolumikizana ndi kuphulika. - Ma Statin, Matenda a Impso Osatha (Dialysis / Hyperparathyroidism), Gout, Diabetes, ndi Rheumatoid Arthritis / Lupus.

Mayesero a 4 Odziwika Pa Bedside of Achilles Tendon Rupture¶

Mu dipatimenti ya Zadzidzidzi, matenda opatsirana pogwiritsa ntchito **American Academy of Orthopedic Surgeons (AAOS) Quartet of Tests ** ndizovuta kwambiri kuposa MRI : 1. Mayeso a Thompson (Simmonds-Thompson Calf-Squeeze Test, 96% Sensitivity): Wodwalayo atagona molunjika (choyang'ana pansi) pa tebulo la mayeso ndipo mapazi onse akulendewera momasuka kumapeto kwa tebulo, woyesayo amafinya minofu yapakati pa ng'ombe. Kawirikawiri, kufinya mwana wa ng'ombe kumakoka tendon ya Achilles m'mwamba ndikupanga phazi plantarflex (kulozera pansi). Pakuphulika kwathunthu kwa Achilles, phazi limakhalabe kthunthu poyerekeza ndi mbali yathanzi. 2. Mayeso a Matles (Knee Flexion Resting Angle Test, 88% Sensitivity): Wodwala atagona chafufumimba pabedi, afunseni kuti apinde mawondo onse a 90-degree angle kotero kuti zipilala zawo ziloze molunjika pamwamba pa denga, ndikusunga akakolo awo momasuka. - Nyendo Wabwinobwino: Kupumira kwachilengedwe kwa tendon ya Achilles yomwe ili yosasunthika kumagwira phazi loloza pang'ono kudenga (mu \(20\text{mpaka }30\text{degree}\) of plantarflexion). - Myendo Wosweka Wa Achilles: Chifukwa mphamvu yokoka imakokera phazi losachirikizidwa pansi popanda cholumikizira cha Achilles, phazi lomwe lili kumbali yong'ambika ** limagwera pansi (osalowerera \(0\text{ degrees}\)) kapena malo opindika (Positive Matles Sign). 3. Palpation of a Tendon Gap (Chilema): Kuthamanga zala ziwiri pang'onopang'ono pa chingwe cha Achilles 2 mpaka 6 centimita pamwamba pa fupa la chidendene kumavumbula divot yosiyana kapena kusiyana kosiyana ** kumene tendon inadumpha (kumveka bwino mkati mwa maola oyambirira kutupa kwa hematoma kusanadzaze). 4. Kuchepetsa Kupumula kwa Ankle Plantarflexion Tone & Kulephera Kukweza Chidendene Cha Mwendo Umodzi.

Chifukwa chiyani Equinus (Plantarflexion) Kugawanika mu Maola 48 Oyamba Kumasintha Chilichonse¶

Mayesero achipatala odziwika bwino (monga SMART ndi UKSTAR) asintha chisamaliro cha rupture ya Achilles: kukonzanso kosagwira ntchito mu wedge boot kumapindula mofanana ndi maopaleshoni otsegula (2 mpaka 4 peresenti) monga opaleshoni yotsegula, NGATI phazi silingayende bwino{100}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{101}{10111 $20} (plantarflex). zala-pansi) nthawi yomweyo mkati mwa maola 24 mpaka 72. - Phazi likalozera pansi mu equinus mwamsanga pambuyo povulazidwa, mbali ziwiri zong'ambika za tendon Achilles zimagwirana wina ndi mzake mkati mwa manja a paratenon, kulola magazi atsopano (olemera mu mapulateleti ndi fibroblasts) kuti agwirizane ndi tendon pamodzi nthawi yake yopuma. - Ngati wodwala akuyenda mozungulira nsapato yophwanyika kapena kuikidwa mu nsapato ya 90-degree kuyenda kwa sabata asanaone katswiri, Achilles amachiritsa ** kutalika (kutambasulidwa ndi 2 mpaka 3 centimita) **, kusiya munthuyo kukhala ndi kufooka kwa ng'ombe kosatha ndi kufooka kwa moyo wonse komwe kumafuna opaleshoni yovuta yopititsa tendon. - Chenjezo Lachiwopsezo Chachiwopsezo Chachikulu cha DVT: Chifukwa kusasunthika kwa mwendo wakumunsi mu equinus cast kapena boot pambuyo pa kuphulika kwa Achilles kumayimitsa pampu ya minofu ya ng'ombe, Kuphulika kwa tendon ya Achilles kumakhala ndi imodzi mwazokwera kwambiri. deep vein thrombosis (DVT) ndi pulmonary embolism mu mafupa (mpaka 5 mpaka 30 peresenti pa ultrasound); Madokotala nthawi zonse amawunika za pharmacologic DVT prophylaxis (monga heparin yolemera kwambiri ya molekyulu kapena anticoagulants yapakamwa mwachindunji) panthawi yakusayenda.

Chikhalidwe 2: Misozi ya Patellar Tendon ndi Kuphulika kwa Tendon ya Quadriceps (Njira Yowonjezera Bondo)¶

** njira yowonjezera ya bondo ** ndi unyolo wopitirira womwe uli ndi ** quadriceps minofu -> quadriceps tendon -> patella (kneecap) -> patellar tendon (ligament) -> tibial tubercle ** pamwamba pa shinbone. Ngati ulalo uliwonse wa unyolowu uduka kwathunthu, munthuyo satha kuwongola bondo lake motsutsana ndi mphamvu yokoka ndipo mawondo ake amamangirira nthawi yomweyo akafuna kuyimirira.

Kusiyanitsa Quadriceps Tendon vs. Patellar Tendon Kuphulika¶

(Clinical Pitfall: Monga momwe minofu yowonjezera imatha kupusitsa asing'anga pakuphulika kwa Achilles, kukhazikika kwapakati komanso kumbuyo patellar retinaculum kumbali ya bondo kumatha kulola wodwala yemwe ali ndi misozi yapakati kuti agwire mwendo wake mowongoka pomwe adokotala amawakweza, ngakhale ali ndi 20-degree * mpaka 30 kuyesera kuti adzikweze. yesani kukulitsa bondo logwira ntchito kuchokera pamalo opindika ma degree 45 motsutsana ndi mphamvu yokoka).

Chikhalidwe 3: Kuthamanga Kwambiri Pansi Pansi (Spine vs. Nerve vs. Compartment vs. Tendon)¶

** Dontho la phazi ** ndiko kulephera kukweza kutsogolo kwa phazi ndi zala kumtunda kupita ku shin (kutayika kwa ankle dorsiflexion ). Chifukwa chakuti zala zimagwera pansi panthawi yogwedezeka, wodwalayo ayenera kukoka zala zake pansi kapena kukweza bondo lake mopanda mtunda ngati kukwera masitepe ("steppage gait") ndikumenya phazi mokweza pa sitepe iliyonse.

**Kutsika kwambiri kwa phazi ndi chithunzithunzi chodziwikiratu ** chifukwa chadzidzidzi zisanu zosiyanasiyana muubongo, msana, mitsempha ya m'miyendo, zotumphukira zamitsempha, ndi minyewa ya akakolo. Gwiritsani ntchito tebulo lofanizira lachipatalali komanso kuyezetsa thupi kwa bedi kuti muwone chomwe chimayambitsa:

Kuyerekeza kwachipatala kwa 5 zomwe zimayambitsa kugwa kwa phazi¶

Chinsinsi cha Bedi Lachiwiri la 10: Kuyesa Kutembenuka kwa Ankle Kuti Musiyanitse Msana ndi Knee Nerve¶

Wodwala akafika ndi kutsika kwa phazi, kodi madokotala odzidzimutsa amadziŵa bwanji mwamsanga ngati vutoli ndilo vuto la neurosurgical mu ** msana wapansi (L5 nerve root) ** motsutsana ndi benign peripheral nerve pinch pa ** bondo lakunja (common peroneal nerve) *? - Amayesa ANKLE INVERSION (kufunsa wodwalayo kuti atembenuzire phazi lake lovulala MKATI ku phazi lina motsutsana ndi dzanja la woyesa) ndi HIP ABDUCTION (kukankhira ntchafu kunja): 1. Onse a ** Tibialis Anterior ** (omwe amakweza phazi mmwamba) ndi ** Tibialis Posterior ** (yomwe imatembenuza phazi mkati) imapeza mitsempha yawo ya mitsempha kuchokera ku ** L5 mitsempha ya msana wa msana ** kumunsi kumbuyo. 2. Komabe, pamwamba pa ntchafu, mitsempha ya mitsempha ya L5 imagawanika kukhala misewu iwiri yosiyana: ulusi womwe umakweza phazi kupita ku Common Peroneal Nerve ** (kuzungulira khosi lakunja la khosi pa bondo), pamene ulusi womwe umatembenuza phazi mkati ( inversion **) umayenda pansi pa chitetezo ** Tibial Nerve kumbuyo kwa ng'ombe mkati mwa ng'ombe. 3. Lamulo la Zachipatala: - Ngati wodwalayo ali ndi ** Foot Drop + WEAK Ankle Inversion (sangathe kutembenukira mkati) + KUSAVUTA KWA M'chiuno **, chotupacho ndi ** ZOTHANDIZA pa L5 Nerve Root mu Lumbar Spine (kapena Sciatic Nerve) ** -> Amafuna mwamsanga MRI ya msana. - Ngati wodwalayo ali ndi ** Foot Drop + STRONG Ankle Inversion (kutembenukira mkati mkati mwamphamvu) + Kufooka kwa Ankle Eversion **, chotupacho ndi ** POSANI PANSI pa Common Peroneal Nerve pa Fibular Neck ** -> Yang'anani nthawi yomweyo kuti mukhale olimba, mawondo a mawondo, kuphulika kwa mutu wa fibular, cyst ya Baker, kapena chizolowezi chodutsa leg.

Momwe Mungadziwire Kuphulika kwa Tibialis Anterior Tendon (Mechanical Foot Drop Mimic)¶

Kwa akuluakulu azaka zapakati pa 50 mpaka 75 (kapena mutadula kutsogolo kwa bondo kuchokera pagalasi kapena pamphepete mwa ski boot), ** tibialis anterior tendon ** ikhoza kuphulika pomwe imadutsa kutsogolo kwa phazi: - ** Yang'anani Kutsogolo kwa Bondo Pamene Mukukweza Zala Zapampando: ** Nthawi zambiri, mukamakoka phazi lanu ndi zala zanu kumphuno yanu kuti musamatsutse, chingwe chamtundu wa pensulo (**the tibialis anterior tendon **) chimatuluka kwambiri mkati mwa m'chiuno mwako. - Mu ** Tibialis Anterior Tendon Rupture **, chingwe chodziwika chamkati chikusowa **, m'malo mwake ndi mtanda wofewa wa mtedza ("pseudotumor") wa tendon yobwerera 3 mpaka 5 centimita pamwamba pa shin, pamene extensor hallucis longus (EHLw) ikugwi ntchito nthawi yayitali * kukokera phazi lonse mmwamba (clawing/hyperextension of the big chala). Khungu limamveka bwino 100 peresenti.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 kuti phazi litsike kwambiri ndi mbendera zofiira za msana (cauda equina), zizindikiro za sitiroko, kapena zizindikiro za vascular/compartment syndrome. Tsatirani American Academy of Orthopedic Surgeons (AAOS) Malangizo Othandizira Achipatala a Acute Achilles Tendon Rupture (kuthamangitsidwa koyambirira mkati mwa maola 48 ndi stratification ya DVT).
• United Kingdom: Imbani 999 (kapena 112) ya cauda equina, stroke, kapena ischemia ya miyendo. Pakuphulika kwa tendon ya Achilles, pitani ku A & E kapena NHS Minor Injuries Unit / Virtual Fracture Clinic tsiku lomwelo kuti bondo liziikidwa mu equinus boot/plaster cast ndikuwunikiridwa chifukwa cha venous thromboembolism (VTE) prophylaxis pansi NICE Guideline NG89 British Orthodic Associations (British Orthodic Association) ndi Trauma
• European Union: Imbani 112. Tsatirani ESSKA (European Society of Sports Traumatology, Knee Surgery & Arthroscopy) malangizo ogwirizana pa Achilles pachimake ndi kuvulala kwa mawondo a mawondo.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Tsatirani Malangizo a Bungwe la Australian Orthopedic Association (AOA) ndi ANZCOR okhudza kusasunthika kwa minofu ndi mafupa ndi macheke a neurovascular.
• India ndi Asia-Pacific: Imbani 112 ku India, 119 ku Japan ndi South Korea, kapena 995 ku Singapore. M'madera omwe mabala otseguka a squat-toilet (amalowa mu poto ya ceramic) nthawi zambiri amadula tendon ya Achilles ngati ** kutsegula kotseguka **, kuwongolera kutuluka kwa magazi ndi kupanikizika kwachindunji, kusunga phazi, ndikuyendetsa nthawi yomweyo kuti awononge chipinda, tetanasi prophylaxis, maantibayotiki a IV, ndi kukonza tendon yoyamba.

Mwaona manambala angozi kwa manambala onse otumizira mayiko.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi tendon yanga ya Achilles ingaphwanyike bwanji ngati ndingathe kuloza phazi langa ndikugwedeza zala zanga pabedi?¶

Minofu ya Achilles (gastrocnemius ndi minofu yokhayokha) imapereka pafupifupi 80 peresenti ya mphamvu zanu kuti musunthire kulemera kwa thupi lanu ku nsonga zanu, koma minyewa itatu yaying'ono yachiwiri mkati mwa ng'ombe yanu (** flexor hallucis longus, flexor digitorum longus, ndi tibialis posterior **) imadutsa kumbuyo kwa fupa lanu lamkati la Achille mosiyana. Minofu itatu yaing'onoyo imakulolani kuti mugwedeze zala zanu ndikuloza mofooka phazi lanu mumlengalenga mutagona, chifukwa chake madokotala amadalira * Thompson ng'ombe-kufinya mayeso ** ndi kukweza chidendene cha mwendo umodzi m'malo mochita phazi logwira ntchito mlengalenga.

Kodi ndiyenera kuchitidwa opaleshoni chifukwa cha tendon yosweka ya Achilles, kapena ikhoza kuchira mu boot?¶

Mayesero amakono amakono (monga UKSTAR ndi mayesero a SMART) amatsimikizira kuti ngati tendon yosweka ya Achilles imayikidwa mu *equinus (zala zoloza-pansi) zoponyedwa kapena zida zowonongeka mkati mwa 24 oyambirira mpaka maola 72 ** akuvulazidwa ndikutsatiridwa ndi ndondomeko yokonzanso yolemetsa yolemetsa, tendon imachiritsa mofanana (2 peresenti ya kukonzanso) kupewa matenda a mabala opangira opaleshoni ndi zipsera za mitsempha. Maopaleshoni nthawi zambiri amasungidwa kuti awonetsedwe mochedwa (pomwe kusiyana kwayamba kale kutseguka), othamanga odumpha osankhika, kapena kuphulika kwa chidendene.

Chifukwa chiyani dotolo wondisamalira mwachangu adang'amba bondo langa ndikuloza pansi ngati ballerina m'malo mopanda fulati pa madigiri 90?¶

Pamene tendon yanu ya Achilles ikudumpha, minofu yanu ya ng'ombe imakoka kumapeto kwa tendon mmwamba pamene mphamvu yokoka imakokera phazi lanu pansi. Ngati wina akupambanitsa bondo lanu pamtunda wa digirii 90, nsonga ziwiri zong'ambika za tendon ya Achilles zimakokedwa 3 mpaka 5 centimita motalikirana ndipo sizingakhudze wina ndi mnzake kuti muchiritse. Kuloza phazi pansi pa madigiri 20 mpaka 30 (**plantarflexion / equinus**) kumabweretsa kumapeto kwa chidendene cham'mwamba kupsompsona kumtunda kwa ng'ombe kuti thupi liziwotcherera pamodzi pakavuta.

Chifukwa chiyani kumwa ciprofloxacin kapena levofloxacin chifukwa cha matenda am'mapapo kapena mkodzo kungapangitse tendon yanga ya Achilles kudumpha patapita miyezi ingapo?¶

Maantibayotiki a Fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) amalowa m'minyewa ya tendon ndikuyambitsa **matrix metalloproteinase (MMP) michere** kwinaku akupondereza kupanga kolajeni kwa fibroblast, komwe kumafooketsa ulusi wa collagen wa tendon Achilles. Chifukwa collagen ya tendon imatembenuka pang'onopang'ono, kufooka kwapangidweko kumapitilira kwa **mpaka miyezi isanu ndi umodzi mutameza mapiritsi omaliza opha maantibayotiki **; ngati mukumva kupweteka kwa chidendene kapena mwana wa ng'ombe mukamamwa kapena mukamaliza fluoroquinolone, siyani kuchita masewera olimbitsa thupi nthawi yomweyo ndipo funsani dokotala.

Ngati ndidzuka ndi "phazi lakufa" (dontho la phazi) nditagona ndi mwendo wanga wopingasa kapena kuvala chingwe cholimba cha bondo, kodi chidzabwereranso?¶

Pamene kutsika kwa phazi kumayambitsidwa ndi kupanikizana kwakunja kwa *common peroneal nerve** motsutsana ndi fupa lakunja la khosi la khosi lomwe lili pansi pa bondo (kuchokera kuwoloka mwendo, kuponyedwa kolimba, kapena kutsamira bondo lakunja pamphepete molimba), mitsempha nthawi zambiri imakhala ndi vuto lakanthawi kochepa la myelin sheath (**neurapraxia **) m'malo modula mitsempha. Ngati mutachotsa kupanikizika nthawi yomweyo, pewani kuwoloka miyendo yanu, ndikugwiritsanso ntchito **Ankle-Foot Orthosis (AFO) brace** kuti muteteze kugwedezeka ndi kulimbitsa kwa Achilles, kupitirira 80 mpaka 90 peresenti ya matenda a peroneal palsies amachira pakadutsa ** 2 mpaka masabata 12 **.

Chifukwa chiyani misozi ya patellar tendon ndi quadriceps tendon nthawi zambiri imafunikira opaleshoni pomwe Achilles misozi nthawi zambiri satero?¶

Pakuphulika kwa Achilles, kuloza phazi pansi mkati mwa boot mosasunthika kumakankhira minyewa iwiri yong'ambika pamodzi ndikuyiteteza ku mphamvu yokoka. Pamphuno yathunthu ya ** patellar tendon kapena quadriceps tendon** kutsogolo kwa bondo, minofu yamphamvu ya quadriceps mu ntchafu nthawi zonse imakoka bondo kapena chitsa chapamwamba cha tendon centimita angapo kutali ndi malo ong'ambika, ndipo mawondo ang'onoang'ono amawakokera kutali; popanda kulumikiza mwachangu m'mitsempha ya mafupa pasanathe masiku ovulalawo, kusiyana kwake kumadzaza ndi minofu yofooka ndipo munthuyo amalephera kuwongola bondo lake.

Maupangiri ogwirizana¶

• Mafupa osweka, fractures, ndi sprains
• Mapewa osokonekera, chipewa cha bondo, ndi kusasunthika kwa mafupa
• Cauda equina syndrome ndi mbendera zofiira za msana
• Crush injury and compartment syndrome

Magwero ndi malangizo ovomerezeka¶

• American Academy of Orthopedic Surgeons (AAOS, United States): Clinical Practice Guideline on the Diagnosis and Treatment of Acute Achilles Tendon Rupture (Thompson test, Matles test, early functional equinus rehabilitation vs. kukonzanso opaleshoni, ndi kuyesa kwa VTE).
• National Institute for Health and Care Excellence (NICE, United Kingdom) ndi British Orthopedic Association (BOAST): Venous Thromboembolism mu Oposa 16s: Kuchepetsa Chiwopsezo cha Chipatala Chopezeka Pachipatala Chachikulu Chotchedwa Deep Vein Thrombosis kapena Pulmonary Embolism mu Lower Limb Immobilisation (NG89) ndi UKSTARto Functional Functional
• European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA): * Ndemanga Zogwirizana pa Utsogoleri wa Acute Achilles Tendon Ruptures ndi Knee Extensor Mechanism (Quadriceps ndi Patellar Tendon) Kuvulala *.
• United States Food and Drug Administration (FDA) ndi European Medicines Agency (EMA): Drug Safety Communications and Boxed Warnings on Fluoroquinolone-Associated Tendinopathy and Tendon Rupture.
• ** American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM): ** * Practice Parameter for Electrodiagnostic Evaluation of Acute Foot Drop (Common Peroneal Neuropathy vs. L5 Radiculopathy) *.