Ho phatloha ha Achilles Tendon, Patellar Tendon Tear, le Acute Foot Drop Triage¶

Molumo oa tšohanyetso, o lerata kapa o phunyeletsang ka morao ho leoto le ka tlaase kapa ka pel'a lengole nakong ea sprint, qhoma, kapa ho khoptjoa ke letšoao la khale la ho phatloha ho feletseng ** Achilles tendon rupture ** kapa ** extensor mechanism (patellar kapa quadriceps tendon) tabola . Ka mokhoa o ts'oanang, ho se khonehe ka tšohanyetso ho phahamisa karolo e ka pele ea leoto le menoana ho tloha fatše ( ho theoha ha leoto le matla , ho etsa hore menoana e hule kapa e otle fatše ha e tsamaea) ke tsela e potlakileng ea ho hlahloba litsela tse ka bakoang ke ** acute lumbar disc herniation kapa cauda equina compression , ** anterior tibial compartment syndrome ** anterior tibial compartment ho phatloha ha tendon e ka pele **, kapa ** stroke e bohareng ea boko **. Haeba uena kapa motho e mong ea haufi le uena a e-na le ho theoha ha leoto ho tsamaeang le bohloko ba mokokotlo, ho tsieleha ka har'a groin, kapa leoto le batang, letsetsa nomoro ea hau ea tšohanyetso hang-hang ka dinomoro tsa tshohanyetso. Hlahloba maemo a tšohanyetso a amanang le mesifa le methapo ea kutlo ho marapo a robehileng le maqeba, lefu la cauda equina le khatello ea mokokotlo oa mokokotlo, le ho senya kotsi le compartment syndrome.

Etsa sena hona joale¶

1. Tlosa boima BOHLE leotong le lemetseng hang-hang 'me u se ke ua leka ho "tsamaea." Ho tsoela pele ho jara boima ba tendon ea Achilles e robehileng ka ho feletseng, patellar tendon kapa quadriceps tendon e hula mothapo o tabohileng ka lisenthimithara ho arohana, ho pshatla mali a sa tieang a lesela la paratenon le ka mpeng e sebetsang hantle. kaho bocha.
2. Sheba hang-hang bakeng sa "Tshanyetso tsa "Three Limb- and Spine-Threatening Foot Drop" (Letsa 911 / 112/999 hona joale haeba ba teng):
3. Cauda Equina kapa Acute L4/L5 Radiculopathy Red Flags: Ho theoha ha leoto ho tsamaisanang le bohloko bo boholo bo ka tlase ba mokokotlo, ho thunya sciatica ho theosa leoto le le leng kapa ka bobeli, ho ba bohatsu marakong kapa borope ("saddle anesthesia"), kapa bothata ba ho rota kapa ho ts'oara mala (bona lefu la cauda equina).
4. Acute Anterior Compartment Syndrome kapa Popliteal Artery Occlusion (Knee Dislocation): Ho theoha ha leoto ho tsamaeang le ho ruruha ho matla, ho sa khaotseng, ho ruruha ho matla ha majoe le bohloko bo tebileng ka pel'a shin e ntseng e mpefala ha menoana e otlolloa ho ea tlaase, kapa leoto le lerootho, le batang le le sieo ho otla ha leoto ka holim'a leoto * setho sa ischemic se matla).
5. Acute Central Brain Stroke (ACA / Motor Cortex): Ho theoha ha leoto ka tšohanyetso le se nang bohloko ho tsamaisanang le bofokoli lehlakoreng le le leng la serope, noka, letsoho, kapa sefahleho, puo e sa hlakang, kapa pherekano.
6. Beha le ho qhekella leqaqailana le lemetseng kapa lengole sebakeng sa ho phomola ha tendon ha o ntse o hlophisa lipalangoang:
7. Bakeng sa ho Petsoha ha Tendon (Mokokotlo oa Namane/Leqaqailana): Emisa leoto le supang hanyenyane ** TLASE (ka likhato tse 20 ho isa ho tse 30 tsa boemo ba plantarflexion / "tiptoe")** u sebelisa lesela le koetsoeng kapa mesamo. Le ka mohla u se ke ua qobella Achilles leqaqailaneng ho fihla sekhutlong se bataletseng sa 90-degree, hobane ho hula leoto holimo ho arola maqaqailaneng a maqaqailaneng ka lisentimitara tse 3 ho isa ho tse 5.
8. Bakeng sa Patellar e belaelloang kapa Quadriceps Tendon Rupture (Ka Pele ho Lengole): Etsa hore lengole le se ke la sisinyeha ** ka ho feletseng TS'ARAIGHT (0 likhato tse feletseng)** holim'a boto e telele, mosamo, kapa ntho e thibelang lengole. Le ka mohla u se ke ua khumamela lengole, kaha ho khumama ho hula kneecap le tendon e robehileng e fella ka thōko.
9. Etsa tlhahlobo e bonolo ea Thompson Calf-Squeeze haeba ho belaelloa hore ho na le ho phatloha ha Achille. Etsa hore motho ea lemetseng a paqame a shebile fatše betheng kapa sofeng maoto a mabeli a leketlile a iketlile ho tloha moeling (kapa a khumama setulong a lepeletse maoto). Petetsa ka bonolo mpa e nang le nama e bohareng ea mosifa oa namane leotong le letle pele (leoto le tla supa tlase ka bo eona), ebe u petetsa namane ea leoto le lemetseng. Haeba leoto le sa e le theohela tlaase ha namane e petetsoa (Positive Thompson Test), tendon ea Achille e robehile ka ho feletseng.
10. Hamola kapa o arole sekhechana leha e le sefe se thata sa fiberglass, seketsoana se thata sa ski boot, kapa setšepe sa lengole hang-hang haeba bohatsu kapa lerotholi le hlaha. Mothapo oa ** common peroneal (fibular)** o thatela ka ho otloloha holim'a lerapo le ka lehlakoreng le ka ntle la leoto ka tlase ho lengole (molala oa fibula); lerapo le thata, leqhoele la mangole, kapa ho tšela leoto nako e telele ho hatella mothapo ona khahlanong le lesapo, ho baka neurapraxia e fetohang e fetohang ka ho sa feleng haeba khatello e sa fokotsehe ka mor'a lihora tse ngata.
11. *Phahamisa leoto, sebelisa leqhoa le phuthetsoeng ka lesela bakeng sa 15 ho metsotso ea 20 ka nako e le 'ngoe (le ka mohla u se ke ua feta hlooho ea bony e ka ntle ea fibula ka tlas'a lengole),' me u hlophise letsatsi le le leng Lefapha la Tšohanyetso kapa tlhahlobo e potlakileng ea masapo. * Mekhoa ea morao-rao ea Achilles e sa sebetseng le ea ho buoa e hloka ho beha leoto ka har'a thapo ea lihora tse 7 * 2 flex) ea pop e le hore hematoma e ncha e koala lesela le qetellang ka ho toba.

Sefate sa ho etsa qeto: Teko e fapaneng ea namane ea pop, ho taboha ha lengole, le ho theoha ho hoholo ha leoto¶

flowchart TD
    Start["Acute Lower Extremity Mechanical Pop KAPA Ho se khone ho Phahamisa / Ho Supa Leoto ka tšohanyetso"] --> DirectionCheck{"Ke Motsamao Ofe o Lahlehileng Kapa o bohloko?"}

    DirectionCheck -->|"HA KE KA SUPIA LEOTO FATSHE / Push Off Ground ('Pop' e utlwahalang ka morao ho Namane/Leqaqailane)"| AchillesBranch["HO HLOMELA HO HLAHALA TENDON ACHILLES: 1. Etsa Tlhahlobo ea Thompson Namane ea Namane (Leoto le hlōleha ho plantarflex = Positive). 2. Ikutloe bakeng sa lekhalo le hlakileng la 2-6 cm ka holim'a lesapo la serethe. 3. Leqaqailana le supang KA TLASE (20-30 deg equinus); ZERO boima ba 'mele; Tlhokomelo ea Emergency / Orthopedic nakong ea 24-48h."]

    DirectionCheck -->|"HA E KANE HO OTA LE LENGOLE Kgahlanong le Matla"| KneeExtensorBranch{"Sekoli se Palpable se Hokae & Ke Tsela Efe eo Kneecap (Patella) e ileng ea Shift ka eona?"}

    KneeExtensorBranch -->|"Lekhalo TLAS'A Kneecap + Kneecap E Hulutsoeng HIGH Holimo Serope (Patella Alta), Ka tloaelo lilemo tse <40"| PatellarTear["PATELLAR TENDON RUPTURE: 1. Senya lengole 100% STRAIGHT (0 deg extension). 2. Opereishene e potlakileng ea Orthopedic e hlokahalang ka mor'a matsatsi a seng makae ho tsosolosa tendon ho tibial tubercle."]

    KneeExtensorBranch -->|"Lekhalo KA HOLIMO LE Kneecap + Kneecap le Lerohile LOW (Patella Baja), Ka tloaelo lilemo > 40"| QuadTear["QUADRICEPS TENDON RUPTURE: 1. Senya lengole 100% STRAIGHT (0 deg extension). 2. Tokiso e Potlakileng ea Opereishene ea Meriana e hlokahalang hang-hang ho thibela ho lieha ho sa feleng hoa extensor."]

    DirectionCheck -->|"HA E KANE LE HO PHAHAMA LEOTO / MENOANA HO HOLIMO Ho leba Shin (Acute Foot Drop / Mohato oa Leqephe)"| FootDropRedFlags{"Lekola Boemo ba Tšohanyetso ba Neurosurgical & Vascular Emergency Pele: Ho opeloa ke mokokotlo / leoto, boshoa ba sale, bothata ba ho ntša metsi, KAPA shin e bohloko e thata-thata / leoto le se nang pulseless?"}

    FootDropRedFlags -->|"EE: Bohloko bo ka morao, Sciatica, kapa Matšoao a Bladder / Saddle"| SpineEmergency["ACUTE L5 RADICULOPATHY KAPA CAUDA EQUINA SYNDROME: Bitsa 911 / 112 / 999 bakeng sa Stat Lumbar Spine MRI & Emergency Neurosurgical Decompression."]

    FootDropRedFlags -->|"EE: Bohloko bo Bohloko ba Shin ka Passive Toe Flexion KAPA Cold Pulseless Foot"| VascularCompartment["ANTERIOR COMPARTMENT SYNDROME OR POPLITEAL ATERY OCLUSION: Bitsa 911 / 112 / 999 bakeng sa Emergency Fasciotomy / Vascular Surgery."]

    FootDropRedFlags -->|"HA HO Mokokotlo kapa Lifolakha tse Khubelu tsa Vascular: Test Ankle Inversion (Ho Fetolela Sole ka hare)"| InversionTest{"Na Mokuli a ka Fetola Sole ea Leoto KA HARE (Ankle Inversion = Tibialis Posterior, L5)?"}

    InversionTest -->|"Ankle Inversion e STRONG (E tiile), Eversion e fokola, ho ba bohatsu ka holim'a leoto / 1st Webspace"| PeronealOrTendon["TLOAELEHILE PERONEAL NERVE PALSY (ho Fibular Neck) KAPA TIBIALIS ANTERIOR TENDON RUPTURE: Tlosa li-casts tse thata / likhoele ka lengole; hlahloba hore na ho na le khoele e bulehang ka pel'a leqaqailaneng; Urgent Neurology/Orthopedic consultation."]

    InversionTest -->|"KA BOBELI Ankle Inversion LE Eversion li Fokola + Hip Capduction e Fokotse"| L5RootOrSciatic["L5 NERVE ROOT LESION, SCIATIC NERVE PALSY, KAPA STROKE E KAROLO: Lefapha le potlakileng la Emergency Neurological & MRI Workup."]

Boemo ba 1: Acute Achilles Tendon Rupture¶

Tlhahiso ea "Ho Raha kapa ho Thunngoa ka Morao ho Leqaqailaneng".¶

The ** Achilles tendon (calcaneal tendon) ** ke tendon e kholo ka ho fetisisa le e matla ka ho fetisisa 'meleng oa motho, e entsoeng ka ho kopanngoa ha mesifa ea ** gastrocnemius ** le **soleus ** le ho kenya ka morao ho lesapo la serethe (**calcaneal tuberosity **). Ho sa tsotellehe ho mamella meroalo e boima ho isa ho makhetlo a 8 ho isa ho a 12 boima ba 'mele nakong ea ho matha, tendon e na le sebaka se tummeng se tummeng sa metsi sa phepelo e mpe ea mali se fumanehang 2 ho 6 centimeters (0.8 ho 2.4 inches) ka holim'a ho kenngoa ha serethe **.

Ha moatlelete kapa "mohlabani oa mafelo-beke" (ea atisang ho ba lilemo li 30 ho isa ho tse 55 nakong ea tennis, pickleball, basketball, bolo ea maoto, badminton, kapa sprinting) a sutumetsa ka pele ka pele ha lengole le ntse le phahama, kapa mehato e sa lebelloang ka mokoting: 1. The Sensation: Ho feta karolo ea 70 lekholong ea bakuli ba reteleha ka khalefo ho bona hore na ba rahile ka morao ho leqaqailaneng kapa ba ba otla ka bolo ea tenese kapa racket, hobane mothapo o phatlohang o ikutloa o ts'oana le ho otla ka kotloloho ho tsoa ka morao. 2. Mongolo o Utloahalang: Ho phatloha ho kang ho thunya kapa molumo o matla hangata o utloahala ke batho ba emeng bohole ba limithara tse 'maloa. 3. Tahlehelo ea Ts'ebetso ea Tšohanyetso: Motho ha a khone ho sututsa menoana ea hae kapa ho phahamisa leoto le le leng ka lehlakoreng le lemetseng, a tsamaea ka leoto le sephara. Hangata bohloko bo kokobela ho fihlela ho opa habohloko ka mor'a metsotso e 15, e leng se qhekellang bahlaseluoa ba bangata hore ba liehe ho fumana tlhokomelo ea meriana.

Meriana ea Meriana le Mekhoa ea Kotsi ea Ts'ebetso e Fokotsang Tendone ea Achilles le Quadriceps¶

Kamehla hlahloba hore na mokuli ea itlhahisitseng ka ho robeha ha tendon ka tšohanyetso kapa ka matla a tlase o pepesehetse meriana kapa maemo a theolang mofuta oa I collagen: - Lithibela-mafu tsa Fluoroquinolone (Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin): E-ba le FDA le EMA Boxed Temoso bakeng sa tendinitis le ho robeha ha tendon (e amang tendon ea Achille maemong a 90 lekholong, le linaha tse peli ho isa ho karolo ea boraro). Fluoroquinolones e laola matrix metalloproteinase (collagenase) e silang li-tendon fibrils. Latency: Ho phatloha ho ka etsahala **pele ho lihora tse 48 tsa pilisi ea pele ea lithibela-mafu KAPA ho fihla likhoeling tse 6 ka mor'a ho qeta mokhoa oa lithibela-mafu **, 'me kotsi e eketseha haholo ho bakuli ba lilemo tse fetang 60 kapa ba noang nako e le 'ngoe corticosteroids. - Maente a Sisteme kapa a Lehae a Corticosteroid: Liente tsa steroid tse tobileng kapa tse haufi le Achilles, patellar, kapa quadriceps tendon li fokolisa collagen cross-linking le ho phatloha ho hoholo. - Statins, Boloetse bo sa Feleng ba Liphio (Dialysis / Hyperparathyroidism), Gout, Lefu la Lefu la tsoekere, le Ramatiki ea Ramatiki / Lupus.

Litlhahlobo tse 4 tsa Tlhahlobo ea Libethe tsa Achilles Tendon Rupture¶

Lefapheng la Tšohanyetso, tlhahlobo ea bongaka e sebelisang American Academy of Orthopedic Surgeons (AAOS) Quartet of Tests ha e le hantle e ** e hlokolosi ho feta MRI**: 1. Tlhahlobo ea Thompson (Teko ea Simmonds-Thompson Calf-Squeeze, 96% Sensitivity): Ha mokuli a robetse a sekametse (a shebile fatše) tafoleng ea tlhahlobo 'me maoto a mabeli a leketlile ka bolokolohi qetellong ea tafole, mohlahlobi o pepeta mpa e nang le nama e bohareng ba namane. Ka tloaelo, ho petetsa namane ho hulela tendon ea Achilles holimo ebe ho etsa hore leoto la plantarflex (le supe fatše). Ka ho phatloha ho feletseng ha Achilles, ** leoto le lula le tsitsitse ka ho feletseng ** ha le bapisoa le lehlakore le phetseng hantle. 2. Teko ea Matles (Tlhahlobo ea Knee Flexion Resting Angle, 88% Sensitivity): Ha mokuli a robetse a shebile fatše betheng, ba kōpe hore ba khumame mangole ka bobeli ho ** 90-degree angle ** e le hore likhahla tsa bona li lebe holimo ho ea siling, ha ba ntse ba boloka maqaqailana a bona a phutholohile ka ho feletseng. - Leoto le Tloaelehileng: Mathata a tlhaho a ho phomola ha mothapo oa Achilles o ntse o tiile o tšoara leoto le lebisitsoe holim'a siling (ka \(20\text{ho }30\text{ degrees}\) of plantarflexion). - Ruptured Achilles Leg: Hobane matla a khoheli a hulela leoto le sa tšehetsoeng fatše ntle le tether ea Achilles e tsitsitseng, leoto le lehlakoreng le phatlohileng ** le oela fatše ka sephara (e sa nke lehlakore \(0\text{ degrees}\)) kapa dorsiflexed position** (Positive Matles Sign). 3. Palpation of Tendon Gap (Sekoli): Ho matha menoana e 'meli ka bonolo ka har'a mohala oa Achilles 2 ho 6 centimeters ka holim'a lesapo la serethe ho senola **divot e fapaneng e sa bonahaleng kapa lekhalo ** moo tendon e ileng ea phunyeha (e ile ea utloahala hantle nakong ea lihora tsa pele tsa 24 pele ho ruruha ha hematoma ho tlatsa lekhalo). 4. Ho Fokotseha Molumo oa Leqaqailana la Plantarflexion le ho se khone ho phahamisa serethe sa leoto le le leng.

Hobaneng ha Equinus hang-hang (Plantarflexion) e arohana ka lihora tse 48 tsa pele e fetola ntho e ngoe le e ngoe.¶

Liteko tsa kliniki tse sa tloaelehang (tse kang liteko tsa SMART le UKSTAR) li fetotse tlhokomelo ea Achilles rupture: tsokoloso e sa sebetseng e sa sebetseng ka har'a mochini o ikhethileng oa wedge boot o fihlella litheko tse tlase ka mokhoa o ts'oanang (liperesente tse 2 ho isa ho tse 4) joalo ka opereishene e bulehileng, HO FIHLA leoto le sa sisinyeheng ka botlalo, ho ea ho \(20\) toes-down) hang-hang nakong ea lihora tse 24 ho isa ho tse 72. - Ha leoto le lebisitsoe ho ea tlaase ka equinus hang ka mor'a kotsi, lipheletsong tse peli tse tabohileng tsa tendon ea Achilles li ama tse ling ka har'a letsoho le tsitsitseng la paratenon, ho lumella lesela le lecha la mali (le ruileng ka liplatelete le li-fibroblasts) ho kopanya tendon hammoho ka bolelele ba eona bo tloaelehileng ba ho phomola. - Haeba mokuli a tsamaea ka seeta se bataletseng kapa a behoa setulong se bataletseng sa 90-degree bakeng sa beke pele a bona setsebi, Achilles folisa ** e telele (e otlolloa ka 2 ho 3 centimeters) **, e siea motho ea nang le bofokoli bo sa feleng ba namane le ho qhoaela bophelo bohle bo hlokang ho buuoa ka mokhoa o rarahaneng oa ho fetisa tendon. - Tlhokomeliso ea Kotsi e Phahameng ea DVT: Hobane ho se sebetse ha leoto le tlase ka har'a equinus cast kapa boot ka mor'a ho phatloha ha Achilles ho emisa pompo ea mesifa ea namane, Ho phatloha ha tendon ea Achilles ho jara e 'ngoe ea litekanyetso tse phahameng ka ho fetisisa tsa deep vein thrombosis (DVT) le pulmonary embolism ho lingaka tsa masapo (ho fihlela ho karolo ea 5 ho isa ho 30 lekholong ka ultrasound); Lingaka li lula li hlahloba pharmacologic DVT prophylaxis (e kang heparin e tlaase-molek'hule kapa li-anticoagulants tsa molomo tse tobileng) nakong ea ho se sebetse.

Maemo a 2: Patellar Tendon Tear le Quadriceps Tendon Rupture (The Knee Extensor Mechanism)¶

Mokhoa oa ** extensor oa lengole ** ke ketane e tsoelang pele e nang le ** quadriceps mesifa -> quadriceps tendon -> patella (kneecap) -> patellar tendon (ligament) -> tibial tubercle ** ka holim'a lesela la lesapo. Haeba lehokelo leha e le lefe la ketane ena le robeha ka ho feletseng, motho ha a khone ho otlolla lengole la hae khahlanong le matla a khoheli 'me lengole la hae le hohla hang ha a leka ho ema holim'a lona.

Phapang pakeng tsa Quadriceps Tendon vs. Patellar Tendon Rupture¶

*(Clinical Pitfall: Feela joalokaha mesifa ea lisebelisoa e ka thetsa baoki ka ho phatloha ha Achilles, mokhoa o tsitsitseng oa medial le lateral *patellar retinaculum ** ka mahlakoreng a lengole a ka lumella mokuli ea nang le lehare le bohareng hore a fokotse leoto la bona hang ha ngaka e ba phahamisetsa eona, le hoja ba e-na le 20-degree * ho ea ho 30 ka bobona. leka katoloso e sebetsang ea lengole ho tloha boemong bo kobehileng ba likhato tse 45 khahlano le matla a khoheli).

Boemo ba 3: Acute Foot Drop Triage (Mokokotlo vs. Nerve vs. Compartment vs. Tendon)¶

Lerotholi la leoto ke ho se khone ho phahamisetsa leoto le ka pele ho leoto le menoana holimo ho leba shin (tahlehelo ea maqaqailaneng dorsiflexion ). Hobane menoana e leketla fatše nakong ea ho tsamaea, mokuli o tlameha ho hula menoana ea hae fatše kapa a phahamise lengole la hae holimo ka mokhoa o sa tloaelehang joaloka litepisi tsa ho hloa ("steppage gait") ebe o otla leoto la hae fatše ka lentsoe le phahameng mohatong ka mong.

**Ho theoha ha leoto ho hoholo ke bothata bo phahameng ba ho hlahloba ** hobane maemo a tšohanyetso a mahlano a fapaneng ka ho feletseng ho pholletsa le boko, mokokotlo, methapo ea maoto, methapo ea peripheral, le maqaqailaneng a ka baka. Sebelisa tafole ena ea papiso ea tleliniki le tlhahlobo ea 'mele e haufi le bethe ho fumana sesosa se nepahetseng:

Papiso e kholo ea kliniki ea lisosa tse 5 tsa ho theoha ha leoto le matla¶

Senotlolo sa bethe ea 10-Metsotsoana: Ho Lekola Phetoho ea Maqaqailaneng ho Arohanya Mokokotlo ho tloha Knee Nerve¶

Ha mokuli a fihla ka lerotholi le matla la leoto, lingaka tsa tšohanyetso li bolela joang hang-hang hore na bothata ke tšohanyetso ea neurosurgical ka ** mokokotlo o ka tlaase (L5 methapo ea methapo) ** khahlanong le benign peripheral nerve pinch ho ** lengole le ka ntle (common peroneal nerve) ? - Ba leka ANKLE INVERSION (ho kopa mokuli hore a fetole bohato ba leoto la bona le lemetseng ka hare ho leoto le leng khahlanong le letsoho la mohlahlobi) le HIP ABDUCTION (ho sutumelletsa serope ka ntle): 1. Ka bobeli ** Tibialis Anterior ** (e phahamisang leoto holimo) le ** Tibialis Posterior ** (e fetolang bohato ba leoto ka hare) e fumana methapo ea methapo ho tloha ** L5 mokokotlo oa methapo ea mokokotlo ** mokokotlong o ka tlaase. 2. Leha ho le joalo, holimo seropeng, likhoele tseo tsa methapo ea L5 li arotsoe ka litsela tse peli tse fapaneng: likhoele tse phahamisang leoto holimo li tsamaea ho theosa le ** Common Peroneal Nerve ** (ho phuthela molala o ka ntle oa fibula ka lengole), athe likhoele tse fetolang leoto ka hare ( inversion **) li tsamaea ho theosa le sirelelitsoeng ** Tibial Nerve ea mokokotlo oa lesapo. 3. Molao oa bongaka: - Haeba mokuli a e-na le **Foot Drop + WEAK Ankle Inversion (e ke keng ea retelehela feela ka hare) + WEAK Hip Abduction **, leqeba ke ** PHAHAMA ho L5 Nerve Root ho Lumbar Spine (kapa Sciatic Nerve) ** -> E hloka MRI e potlakileng ea lumbar spine. - Haeba mokuli a e-na le **Foot Drop + STRONG Ankle Inversion (e fetohela ka hare feela ka hare ka matla) + Weak Ankle Eversion **, leqeba ke ** TLASE HO TLOHA ho Common Peroneal Nerve ho Fibular Neck ** -> Sheba hang-hang bakeng sa ho lla ka thata, ho qhoqhoa ha lengole, ho robeha ha hlooho ea fibula, cyst Baker's crossing, kapa tloaelo ea leg leg.

Mokhoa oa ho Lemoha Tibialis Anterior Tendon Rupture (The Mechanical Foot Drop Mimic)¶

Ho batho ba baholo ba lilemo li 50 ho isa ho tse 75 (kapa ka mor'a ho khaola ka bohale ka pel'a leqaqailaneng ho tloha khalase kapa moeling oa ski boot), ** tibialis anterior tendon ** e ka phunyeha hantle moo e tšelang karolo e ka pele ea maqaqailana: - Sheba ka Pele ho Leqaqailaneng Ha U Phahamisa Menoana: Ka tloaelo, ha u hula leoto le menoana ea hao holimo ho ea nko ea hao khahlanong le khanyetso, khoele e teteaneng ea boholo ba pentšele (**the tibialis anterior tendon **) e hlahella ka ho hlahella karolong e ka hare-ka pele ea leqaqailaneng la hao. - Ka ** Tibialis Anterior Tendon Rupture **, thapo eo e ka hare e hlaheletseng e haella **, e nkeloa sebaka ke lesela le bonolo la lepa ("pseudotumor") la tendon e khutliselitsoeng 3 ho ea ho 5 centimeters holimo ho shin, ha *extensor hallucis longus (EHLw) e leka ho sebetsa ka nako e telele (EHLw) ho hula leoto lohle hodimo (clawing/hyperextension of the big finger). Ho utloahala ha letlalo ho tloaelehile ka karolo ea 100 lekholong.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

• United States le Canada: Letsetsa 911 bakeng sa ho theoha ho hoholo ha leoto ka lifolakha tse khubelu tsa mokokotlo (cauda equina), matšoao a stroke, kapa matšoao a vascular/compartment syndrome. Latela American Academy of Orthopedic Surgeons (AAOS) Litaelo tsa Kliniki tsa Boikoetliso bakeng sa Acute Achilles Tendon Rupture (equinus immobilization ea pele nakong ea lihora tse 48 le stratification ea kotsi ea DVT).
• United Kingdom: Letsetsa 999 (kapa 112) bakeng sa cauda equina, stroke, kapa ischemia ea maoto le matsoho. Bakeng sa ho phatloha ha tendon ea Achilles e ka thōko, e-ea A & E kapa NHS Minor Injuries Unit / Virtual Fracture Clinic ka letsatsi le le leng e le hore leqaqail le behoe ka **equinus boot/plaster cast ' me le hlahlojoe bakeng sa venous thromboembolism (VTE) prophylaxis tlas'a NICE Guideline NG89 (British Guideline NG89) Protocol Orthopedic Orthope (Tlaelo ea Brithani) le Trauma
• European Union: Letsetsa 112. Latela ESSKA (European Society of Sports Traumatology, Knee Surgery & Arthroscopy) tataiso ea tumellano mabapi le likotsi tse matla tsa Achilles le maqeba a mochine oa lengole.
• Australia le New Zealand: Letsetsa 000 Australia kapa 111 New Zealand. Latela Mokhatlo oa Orthopedic oa Australia (AOA) le ANZCOR tataiso bakeng sa ho thibela mesifa le ho hlahloba methapo ea kutlo.
• India le Asia-Pacific: Letsetsa 112 India, 119 Japane le Korea Boroa, kapa 995 Singapore. Libakeng moo maqeba a squat-toilet a bulehileng (a thellang ka paneng ea ceramic) hangata a khaola tendon ea Achilles e le ** leqeba le bulehileng **, ho laola ho tsoa mali ka khatello e tobileng e sa hloekang, ho boloka maqaqailana a maqaqailana, 'me a tsamaise hang-hang bakeng sa ho senya kamoreng ea ho sebetsa, tetanus prophylaxis, lithibela-mafu tsa IV, le tokiso ea tendon e ka sehloohong.

Bona dinomoro tsa tshohanyetso bakeng sa linomoro tsohle tsa machaba tsa thomello.

Lipotso tse botsoang khafetsa¶

Ke joang mothapo oaka oa Achilles o ka robehang ka ho feletseng haeba ke ntse ke khona ho supa leoto la ka le ho tsoka menoana ea ka betheng?¶

The Achilles tendon (gastrocnemius le mesifa ea soleus) e fana ka hoo e ka bang karolo ea 80 ea matla a hao a ho sutumelletsa boima ba 'mele oa hao holim'a menoana ea hau, empa mesifa e meraro e nyenyane ea bobeli e tebileng ka hare ho namane ea hau (** flexor hallucis longus, flexor digitorum longus, le tibialis posterior **) e feta ka mor'a lesapo la hau le ka hare la Achille ka thōko. Mesifa eo e meraro e menyenyane e ntse e u lumella hore u sisinye menoana ea hau 'me u fokotse maoto a hao moeeng ha u ntse u robetse, ke ka lebaka leo lingaka li itšetlehileng ka tlhahlobo ea ** Thompson calf-squeeze** le ho phahamisa serethe se le seng ho e-na le leoto le sebetsang le supang moeeng.

Na ke tlameha ho buuoa bakeng sa tendon ea Achilles e robehileng ka ho feletseng, kapa na e ka fola ka booting?¶

Liteko tsa morao-rao tsa meriana (tse kang UKSTAR le liteko tsa SMART) li paka hore haeba tendon ea Achilles e phatlohileng e kenngoa ka har'a "equinus" (menoana-e lebisitsoeng-tlaase) kapa boot boot ka nako ea pele ea 24 ho lihora tsa 72 ** ea kotsi 'me e lateloa ke mokhoa o hlophisitsoeng oa ho tsosolosa boima ba' mele, lebelo la tendon le fola ka mokhoa o ts'oanang le 4% ho ea ho opereishene. ho qoba tšoaetso ea maqeba a ho buuoa le maqeba a methapo. Hangata, opereishene e etsoa bakeng sa tlhahiso ea morao-rao (moo lekhalo le seng le bulehile), baatlelete ba phahameng ba qhoma-qhomang, kapa ho phunya lesapo la serethe.

Hobaneng ha ngaka ea tlhokomelo e potlakileng e ile ea arola leqaqailana la ka le shebile tlase joalo ka ballerina ho fapana le ho bata ka likhato tse 90?¶

Ha tendon ea hau ea Achille e robeha, mesifa ea namane ea hau e hula ntlha e ka holimo ea tendon holimo ha matla a khoheli a hulela leoto la hau tlase. Haeba motho e mong a arola leqaqailaneng ka lehlakoreng la 90-degree, lipheletso tse peli tse tabohileng tsa tendon ea Achilles li huloa ka lisenthimithara tse 3 ho isa ho tse 5 'me ha li khone ho tšoarana ho folisa. Ho supa leoto ho ea tlase ho likhato tse 20 ho isa ho tse 30 (**plantarflexion / equinus**) ho tlisa ntlha e ka tlase ea serethe ho khutlela holimo ho suna ntlha e ka holimo ea namane e le hore 'mele o ka li kopanya hammoho ka tsitsipano e tloaelehileng.

Ke hobane'ng ha ho nka ciprofloxacin kapa levofloxacin bakeng sa tšoaetso ea sinus kapa ea moroto ho ka etsa hore tendon ea ka ea Achille e phatlohe likhoeli hamorao?¶

Lithibela-mafu tsa Fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) li kenella ka har'a lisele tsa tendon ebe li kenya tšebetsong **matrix metalloproteinase (MMP) li-enzyme** ha li ntse li hatella tlhahiso ea collagen ea fibroblast, e fokolisang ka microscopic likhoele tsa collagen tsa tendon ea Achilles. Hobane collagen ea tendon e fetoha butle haholo, bofokoli boo ba sebopeho bo tsoela pele ho ** ho fihlela likhoeling tse 6 ka mor'a hore u koete pilisi ea hao ea ho qetela ea lithibela-mafu **; haeba u hlaolela serethe kapa namane leha e le efe ha u ntse u nka kapa ka mor'a ho qeta fluoroquinolone, khaotsa ho ikoetlisa hang-hang 'me u ikopanye le ngaka ea hau.

Haeba ke tsoha ke e-na le "leoto le shoeleng" (lerotholi la leoto) ka mor'a hore ke robale ke kentse leoto kapa ke roetse maqiti a thata a mangole, na e tla khutla?¶

Ha ho theoha ha leoto ho bakoa ke ho hatelloa ka ntle ho ** tloaelehileng peroneal nerve ** khahlanong le lesapo la ka ntle la molala le ka tlas'a lengole (ho tloha ho tšela leoto, lesela le thata, kapa ho itšetleha ka lengole le ka ntle khahlanong le bohale bo thata), hangata methapo e na le "conduction block" ea nakoana ea sheath ea myelin (**neurapraxia **) ho e-na le methapo e khaohileng. Hafeela u tlosa khatello hang-hang, qoba ho tšela maoto a hao, 'me u sebelise sesepa sa **Ankle-Foot Orthosis (AFO)** ho thibela ho khoptjoa le ho tiisa ha Achilles, ho feta karolo ea 80 ho isa ho 90 lekholong ea khatello ea kelello ea peroneal palsies e hlaphoheloa ka ho feletseng ka libeke tse 2 ho isa ho tse 12 **.

Ke hobane'ng ha meokho ea patellar tendon le quadriceps tendon hangata e hloka ho buuoa ha Achilles meokho hangata e sa e hloke?¶

Ha ho phunyeha ha Achilles, ho supa leoto ho ea tlase ka har'a boot ho sutumetsa lithapo tse peli tse tabohileng hammoho le ho li sireletsa matla a khoheli. Ka mokhoa o feletseng oa ** patellar tendon kapa quadriceps tendon e tabohang ** ka pele ho lengole, mesifa e matla ea quadriceps seropeng e lula e hula lesela la kneecap kapa lesela le ka holimo la li-tendon lisenthimithara tse 'maloa ho tloha moo ho tabohang,' me lengole le leng le le leng le lenyenyane le ba hulela ka thōko; ntle le ho roka ka potlako ka lithapo tsa masapo matsatsing a seng makae ka mor'a kotsi, lekhalo le tlala lisele tse fokolang tsa lebali 'me motho o lahleheloa ke matla a ho otlolla lengole.

Litataiso tse amanang¶

• Ho robeha ha masapo, ho robeha le ho robeha
• Ho kheloha mahetla, k'hepe ea lengole, le ho se tsitse ha manonyeletso
• Cauda equina syndrome le lifolakha tse khubelu tsa khatello ea mokokotlo oa mokokotlo
• Kotsi ea ho senya le lefu la compartment

Mehloli le tataiso ea semmuso¶

• American Academy of Orthopedic Surgeons (AAOS, United States): Tlhahiso ea Boits'oaro ba Kliniki mabapi le Tlhahlobo le Kalafo ea Acute Achilles Tendon Rupture (Teko ea Thompson, tlhahlobo ea Matles, tsosoloso ea pele ea ts'ebetso ea equinus vs. tokiso ea ho buuoa, le tlhahlobo ea VTE).
• Setsi sa Sechaba sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE, United Kingdom) le British Orthopedic Association (BOAST): Venous Thromboembolism in Over 16s: Ho Fokotsa Kotsi ea ho Fumana Metsing e Tebileng ea Sepetlele kapa Pulmonary Embolism in Lower Limb Immobilisation (NG89) le UKSTARto Functional
• ** European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA):** * Lipolelo tsa Tumellano ka Tsamaiso ea Likotsi tse Acute Achilles Tendon le Mechanism ea Knee Extensor (Quadriceps le Patellar Tendon) *.
• United States Food and Drug Administration (FDA) le European Medicines Agency (EMA): Likhokahano tsa Tšireletseho ea Lithethefatsi le Litemoso tse Boxed ka Fluoroquinolone-Associated Tendinopathy le Tendon Rupture.
• Mokhatlo oa Amerika oa Neuromuscular & Electrodiagnostic Medicine (AANEM): Practice Parameter for Electrodiagnostic Evaluation of Acute Foot Drop (Common Peroneal Neuropathy vs. L5 Radiculopathy).