The ngamadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu, oqukethe ithambo lethanga, okanye i-femur, isifuba shin, okanye i-tibia, kunye ne-kneecap, okanye i-patella, phakathi kwezinye iifomthi ezithambileyo. Iintendon zidibanisa amathambo kwiimisipha ngelixa iigaments zidibanisa amathambo emadolo. Iziqwenga zombini ze-cartilage, ezaziwa ngokuba yi-meniscus, zinika ukuzinza emadolweni. Injongo yecandelo elingezantsi kukubonisa kunye nokuxubusha indlela yokuguquka kwamadolo kunye nezicubu ezithambileyo.

Abstract

• Umxholo: Ulwazi malunga nolwakhiwo, ukwakheka, kunye nokusebenza kwamadolo e-menisci kuye kwasasazeka kwimithombo emininzi nakwimimandla. Olu hlalutyo luqulethe inkcazo emfutshane, ecacileyo yamadolo menisci kuquka i-anatomy, i-etymology, i-phylogeny, i-ultrastructure kunye ne-biochemistry, i-vascular anatomy kunye neuroanatomy, umsebenzi we-biomechanical, ukuvuthwa nokuguga, kunye neendlela zokucinga.
• U bungqina: Uphando lwencwadi lwenziwa ngokuhlaziywa kwamaphepha e-PubMed kunye nee-OVID ezipapashwe kwi-1858 ukuya kwi-2011.
• iziphumo: Olu pho nonongo lubonisa iimpawu ezinokwenziwa kwezakhiwo, ezinomxholo, kunye nezixhobo zamadoda, ezinokuthi zilungele ukuboniswa kweklinikhi, ukuxilongwa, kunye nokulungiswa kwezicwangco.
• Izigqibo: Ukuqonda okuqhelekileyo kwe-anatomy kunye ne-biomechanics ye-menisci kuyimfuneko ebalulekileyo ekuqondeni i-pathogenesis yeziphazamiso ezibandakanya idolo.
• Internet: idolo, i-meniscus, i-anatomy, umsebenzi

intshayelelo

Emva kokuchazwa njengentsalela ye-embryonic engasebenziyo, i-162 i-menisci ngoku iyaziwa ukuba ibalulekile ekusebenzeni kwesiqhelo nakwimpilo yexesha elide yamadolo. I-menisci inyusa uzinzo ekuthetheni ngobufazi, isasaze umthwalo we-axial, yenze umothuko, kwaye inike i-lubrication kunye nesondlo emadolweni.4,91,152,153

Ukulimala kumadoda kubonwa njengobangela obuthakathaka obunzima bokusibulala. Isakhiwo esiyingqayizivele nesiyinkimbinkimbi se-menisci senza unyango kunye nokulungiswa komgulane, ugqirha nodokotela. Ukongezelela, umonakalo wangexesha elide unokukhokelela ekutshintsheni okutshatyalaliswayo okunjengeentlobo ze-osteophyte, ukuchithwa kwe-articular cartilage, indawo edibeneyo kunye ne-symptomatic osteoarthritis.36,45,92 Ukulondolozwa kwe-menisci kuxhomekeke ekugcineni ukubunjwa kunye nokuhlelwa kwazo.

Inatomy of Menisci

Meniscal Etymology

Igama elithi meniscus livela kwigama lesiGrike elithi m? Niskos, elithetha crescent, imin ukunciphisa i-m? N ?, Intsingiselo yenyanga.

Meniscal Phylogeny kunye ne-Anatomy yokufanisa

Iimpawu zibonakalisa iimpawu ezifana ne-anatomic kunye nezosebenzayo, kubandakanywa ne-bicondylar distalous ligaments, i-menisci, kunye ne-asymmetrical collateral.40,66 Ezi zibonakaliso ezifanayo ze-morphologic zibonisa umda wofuzo olwabelwanayo onokulandelwa emva kwe-300 yeminyaka .40,66,119

Kwinqanaba le-primate elikhokelela ebantwini, i-hominids yavela kwisimo se-bipedal malunga ne-3 ukuya kwi-4 yezigidi zeminyaka eyadlulayo, kwaye nge-1.3 yezigidi zeminyaka eyadlulayo, indibaniselwano yanamhlanje ye patellofemoral yasekwa (kunye necala elisecaleni le patellar kunye nokuthelekisa i-trochlea yabasetyhini) 164 Tardieu Uphando lotshintsho olusuka kubipedalism ngamanye amaxesha luye kubipedalism ngokusisigxina kwaye waqaphela ukuba ama-primates aqukethe i-meniscus ye-medial kunye ne-lateral fibrocartilaginous meniscus, kunye ne-medial meniscus efana ne-morphologically efanayo kuwo onke ama-primates (i-crescent eyenziwe nge-2 tibial insertions) .163 Ngokwahlukileyo, i-meniscus yangasemva yaqwalaselwa iguquguquke ngakumbi kubume. Into eyahlukileyo eHomo sapiens bubukho bokufakwa kwe-2 tibial 1 ngaphambili kunye ne-1 posterior ebonisa umkhuba oqhelekileyo wokunyusa ngokupheleleyo ukuhlangana kwamadolo ngexesha lokuma kunye nezigaba zokuhamba zebipedal. 20,134,142,163,168

Embryology noPhuhliso

Ubume obunjani be-menisci yangasemva kunye ne-mediexi ephakathi kwe-8th ne-10 yeveki yesigxina.53,60 Zivela kwi-condensation of the layers of mesenchymal tissue ukwakha izinamathiselo kwi-capsule edibeneyo .31,87,110 I-menisci ephuhlisayo ineselula kwaye iisetyhula, kunye nokunikezelwa kwegazi okungena kwimizi-mveliso kunye nokwandisa lonke ububanzi be-menisci.31 Njengoko umntwana eqhubeka ekhula, kukho ukwehla ngokuthe ngcembe kwiseli ye-menisci kunye nokwanda kwenyameko kumxholo we-collagen kwiimeko ezijikelezayo I -30,31 Ukunyakaza okuhlanganyelweyo kunye nokuxinzelela emva kokubeleka kokunyamezela kubaluleke kakhulu ekunqumeni ukuqhelaniswa kwezixhobo ze-collagen. Ngabantu abadala, kuphela i-10% kwi-30% enegazi.12,31

Nangona kukho utshintsho oluneengcambu, inxalenye yecala le-tibial elixutywe ngamadoda e-meniscus lihambelana nokuphuhliswa kwenkqubo yonxibelelwano lomntwana, kunye ne-menisci ephakathi kunye neyoxhomekeke kwi-60% kunye ne-80% yemimandla yomhlaba, ngokulandelanayo.31

I-Anatomy eninzi

Uvavanyo oluninzi lwamadolo e-menisci lubonisa izicubu ezibushelelekileyo, ezinobuthi (umfanekiso we-1). Ziyi-wedges-formed wedges ye-fibrocartilage ekhoyo kwimimandla yecala kunye neyengxowankulu yexolo elihlangeneyo (Umfanekiso 2A). Umda wendawo, umda we-vascular (owaziwa ngokuba ngummandla obomvu) we-meniscus ngayinye unxibe, udibanise, kwaye uqhotyoshelwe kwi-capsule ehlangeneyo. Umda wangaphakathi (owaziwa ngokuba ngummandla omhlophe) uphepha kumgca ongezantsi. Izikhundla eziphezulu zamadoda ziyi-concave, ezenza ukusetyenziswa okusebenzayo kunye neendlela zabo zokuziphatha zentombi. Iindawo ezingezantsi zizocwangcisa ukuba zifake ipulati ye-tibial (Umfanekiso we1) .28,175

 

Meniscus ephakathi. I-meniscus ye-semiicircular mediation ilingana ne-35 mm ububanzi (yangaphambili ukuya phezulu) kwaye ibanzi kakhulu ngokubanzi ngaphaya kwendawo yangaphambili.175 Uphondo oluphambili luqhotyoshelwe kwisiqithi se-tibia kufuphi ne-intercondylar fossa kwangaphambili ukuya kwinqanaba eliphambili le-ACL. Kukho ukuhluka okuphawulekayo kwindawo yokuqhotyoshelweyo yophondo lwangaphambili lwe-meniscus ephakathi. Uphondo olungasemva lufakwe kwi-posterior intercondylar fossa ye-tibia phakathi kwe-meniscus yangaphambili kunye ne-posterior cruciate ligament (i-PCL; Amanani 1 kunye ne -2B) .2B). UJohnson no-al babuye bahlolisisa iindawo zokufakelwa kwe-menisci kunye nobudlelwane babo bezobuqhetseba kwiindawo ezijikelezayo ze-anatomic zamadolo.82 Bafumene ukuba iindawo zokufaka uphondo zangaphambili nangemva kwe-meniscus zazikhulu kunezo ze-meniscus. Ummandla wendawo yokufakelwa kwamaphondo e-intanethi ye-meniscus yangaphakathi yayisona sikhulu kunazo zonke, ukulinganisa i-61.4 mm2, ngelixa uphondo olungaphaya kwe-meniscus olusemva lwalona lincinci, kwi-28.5 mm2.82

Inxalenye ye-tibial ye-capsular attachment yi-coronary ligament. Embindini wayo, i-meniscus yangaphakathi ibambelele ngokuqinileyo kwi-femur ngokusebenzisa i-condensation kwi-capsule edibeneyo eyaziwa ngokuba yi-deep medial collateral ligament. ye-meniscus yangaphakathi ukuya kuphondo lwangaphambili lwe-meniscus yecala (Amanani 175 kunye ne-1A2A).

Meniscus. I-meniscus yesikhokelo isondele malunga nesetyhula, kunye nobubanzi obunjengobunjengobubanzi ukusuka kwangaphambili ukuya kwi-posterior (Amanani 1 kunye neXXUMUMA) .2A). Ihlala inxalenye enkulu (~ 2%) yomhlaba ophezulu ngaphezu kwe-meniscus ephakathi (~ 80%) kwaye ihamba kakhulu.60 Zizibini izimpondo ze-meniscus ezixhasayo zifakwe kwi-tibia. Ukufakwa kocwangco lwangaphambili lwe-meniscus lusempileni lusempilweni kwiindawo eziphambili ze-intercondylar kunye nendawo edibeneyo ye-ACL (umfanekiso we-10,31,165B) .2 Uphondo oluphambili lwendoda elandelelanayo lufaka emva komgca ongaphantsi komgca wecala kwaye ukufakwa kocwangco olungemva komntu we-meniscus (Umzobo we-9,83B) .2 I-meniscus yangaphantsi ixhomekeke kwi-ligs capsular; Nangona kunjalo, le micimbi ayinamathele kwi-ligal colalateral ligament. Uphondo olungasemva lwalo lugqithiso lwama-meniscus ludibanisa nombambano wangaphakathi we-condyle ye-femil ngokusebenzisa i-ligaments yamadoda e-Humphrey ne-Wrisberg, elandelanayo yangaphambili nangemva kwayo, ephuma kwimvelaphi ye-PCL (Amanani 83 kunye neXXUMUMX) .1

Amalungu e-Meniscofemoral ligaments. Uncwadi lubika ukungahambelani okuphawulekayo kubukho kunye nobukhulu be-meniscofemoral ligaments of the lateral meniscus. Isenokungabikho, 1, 2, okanye 4.? Xa zikhoyo, le migqaliselo ye-accessory transverse esuka kwi-posterior horn ye-lateral meniscus ukuya kwicala elisecaleni le-condyle ye-femoral medial. Bafaka ngokukhawuleza kufuphi ne-femoral attachment ye-PCL (Amanani 1 kunye ne-22).

Kuluhlu lwesifundo, iHarner kunye nokulinganisa indawo yesigxina segigaments kwaye yafumanisa ukuba i-meniscofemoral ligament i-20% yobungakanani be-PCL (ububanzi, i-7% -35%) .69,70 Noko ke, ubukhulu becala indawo yokungeniswa yodwa ngaphandle kolwazi lwe-angle yokugxininisa okanye ubuninzi be-collagen abubonakalisi amandla abo.115 Umsebenzi wale migqa awukwazi; banokukrazula uphondo olungaphaya kwe-meniscus esecaleni kwinqanaba elingaphambili ukwenzela ukwandisa i-meniscotibial fossa kunye ne-condyle femoral.75

Ultrastructure kunye ne-Biochemistry

I-Extracellular Matrix

I-meniscus yimatrix ye-extracellular matrix (ECM) eyakhiwe ikakhulu ngamanzi (72%) kunye ne-collagen (22%), idityaniswe neeseli.9,55,56,77 Iiproteoglycans, iiprotein ezingezizo ezomeleleyo, kunye neakhawunti ye-glycoproteins yesisindo esisele esomileyo. Iiseli zeMeniscal zihlanganisa kwaye zigcine i-ECM, emisela iipropathi ezibonakalayo zenyama.

Iiseli zamadoda zibizwa ngokuba yi-fibrochondrocytes kuba zibonakala zingumxube we-fibroblasts kunye ne-chondrocytes.111,177 Iiseli ezingqongqeleko ezingaphezulu kwamadoda ziyi-fusiform okanye i-spindle shape (ngaphezulu kwe-fibroblastic), ngelixa iiseli ziphantsi ngakumbi i-meniscus i-ovoid okanye i-polygonal (i-chondrocytic engaphezulu) .55,56,178 I-morphology yeselula ayifani phakathi kwendawo yendawo kunye neendawo eziphambili kwi-menisci.56

Ezi zombini iintlobo ziqulethe i-endoplasmic reticulum kunye neGolgi. I-Mitochondria zibonwa ngezihlandlo kuphela, zibonisa ukuba indlela enkulu yokuveliswa kwamandla kwe-fibrochondrocytes kwimvelo yabo ye-avascular mhlawumbi i-anaerobic glycolysis.112

amanzi

Ngokwesiqhelo, i-menisci enempilo, i-tissue fluid ibonisa i-65% ukuya kwi-70% yesisindo sonke. Ubuninzi bamanzi bugcinwa ngaphakathi kwezicubu kwiindawo eziselululeni zeproteoglycans. Umxholo wamanzi wamathambo e-meniscal uphezulu kwimimandla engasemva kuneendawo eziphakathi okanye ezingaphakathi; iisampuli zamathambo ukusuka kwiindawo eziphezulu kunye neendawo ezinzulu ziqulethe okufanayo.135

Ukunyanzeliswa kwamanzi amakhulu kunyanzelekile ukuba unqobe ukuxhatshazwa kokuxhatshazwa kokunyanzelisa ukuhamba kwamanzi ngamathambo. Ngaloo ndlela, ukusebenzisana phakathi kwamanzi kunye nesakhelo se-matrix macromolecular inomthelela omkhulu kwiimpawu ze-viscoelastic zezicubu.

ICollagens

I-Collagens ngokuyinhloko ixanduva lokuxhaswa kwamandla omsebenzi we-menisci; zinegalelo kwi75% yobunzima obomileyo be-ECM.77 I-ECM ibhalwe ngokuyinhloko ngohlobo I-collagen (90% isisindo esomileyo) kunye nemilinganiselo eguqukileyo yeentlobo II, III, V, kunye ne-VI.43,44,80,112,181 I-predominance of type I i-collagen ihlukanisa i-fibrocartilage ye-menisci esuka kwi-articular (hyaline). I-collagens inqamana kakhulu ne-hydroxylpyridinium aldehydes.44

Ilungiselelo lefiber ye-collagen ilungele ukuhambisa umthwalo ocinezelayo othe nkqo kwi-circumferential �hoop) yoxinzelelo (Umfanekiso 3) .57 Uhlobo lwe-collagen fibers lujoliswe kwi-circumferentially kwiingqimba ezinzulu ze-meniscus, ezihambelana nomda we-peripheral. Ezi ntambo zidibanisa i-ligamentous connections of the meniscal horns to the tibial articular surface (Umfanekiso 3) .10,27,49,156 Kwindawo ephakamileyo kakhulu ye-menisci, uhlobo lwe-Fibers lujoliswe kwi-radial direction. Iifiber ze-Radially oriented �tie� zikhona kwindawo enzulu kwaye zixutywe okanye ziboshwe phakathi kweefayili ezijikelezayo ukubonelela ngentembeko yesakhiwo (Umfanekiso 3). ziqulethe iikristale ezinde, ezincinci ze-phosphorus, i-calcium, kunye ne-magnesium kwi-electron-probe roentgenographic analysis.54 Umsebenzi wale kristale awuqondwanga ngokupheleleyo, kodwa kukholelwa ukuba banokudlala indima yokuvuvukala ngokubambisana kunye ne-arthropathies eyonakalisayo.

 

Iiprotheni ze-matrix ezingenayo i-noncollagenous, ezifana ne-fibronectin, ifake i-8% ukuya ku-13% yobunzima obumileyo obunzima. I-Fibronectin ibandakanyeka kwiinkqubo ezininzi zamaseli, kuquka ukulungiswa kwezicubu, i-embryogenesis, i-clotting yegazi kunye nokufuduka kweeseli / ukunamathela. I-Elastin iquka ngaphantsi kwe-0.6% yesisindo somzimba esisomileyo; iindawo zalo zendawo azicacanga. Kusenokwenzeka ukuba idibana ngqo kunye ne-collagen ukubonelela ngokuqinisekileyo kwiisishu. **

Proteoglycans

Zifakwe kwi-meshwork emihle ye-collagen fibrils, i-proteoglycans inkulu, ihlawulisa iamoleksi yama-hydrophilic, igalela i-1% ukuya kwi-2% yobunzima obomileyo.58 Ziyilwe ngeprotheyini eyinhloko kunye ne-1 okanye idibanti ye-glycosaminoglycan idibeneyo (Figure 4) .122 Ubungakanani bala malekyuli buya kwandiswa ngokubambisana ngokuthe ngqo kunye ne-hyaluronic acid.67,72 Inani leproteoglycans kwi-meniscus linye yeyesibhozo se-carticlage ye-articular, i-2,3 kwaye kunokukho ukuhlukahluka ngokuxhomekeka kwisayithi yesampuli kunye nobudala isiguli.49

 

Ngenxa yolwakhiwo lwabo olukhethekileyo, uxinizelelo oluphezulu olusisigxina, kunye nemikhosi ehlawulisa ukubuyisa, iiproteoglycans kwi-ECM inoxanduva lokuhambisa amanzi kunye nokubonelela ngezicubu ngomthamo omkhulu wokumelana nemithwalo yoxinzelelo. Iphrofayili yeglycosaminoglycan yomntu omdala oqhelekileyo I-meniscus iqukethe i-chondroitin-6-sulfate (40%), i-chondroitin-4-sulfate (10% ukuya kwi-20%), i-dermatan sulfate (20% ukuya kwi-30%), kunye ne-keratin sulfate (15%; Umzobo 4) .65,77,99,159 , 58,77 Iindawo eziphezulu ze-glycosaminoglycan zifumaneka kwiimpondo ze-meniscal kunye nesiqingatha sangaphakathi se-menisci kwiindawo eziphambili zokuthwala.XNUMX

I-Aggrecan yiyona proteoglycan enkulu efunyenwe kumadoda abantu kwaye ixanduva elikhulu kwiimpawu ze-viscoelastic (compact 5). I-proteoglycans encinci, njenge-decorin, i-biglycan, ne-fibromodulin, ifumaneka kumanani amancinci.XXUMUMX Hexosamine inika i-124,151% kwisisindo esomileyo se-ECM.1 Imisebenzi echanekileyo yale nxalenye yeeproteoglycans ezincinci kwi-meniscus ayinakucaciswa ngokupheleleyo.

 

IMatrix Glycoproteins

I-Meniscal cartilage iqulethe uluhlu lwe-matrix glycoprotein, iimpawu kunye nemisebenzi engekagqitywa. I-Electrophoresis kunye ne-staining elandelayo yeegels ze-polyacrylamide ityhila iibhendi ezinobunzima be-molecular obuhluka ukusuka kwiikilodaltons ezimbalwa ukuya ngaphezu kwe-200 kDa.112 Ezi molekyuli ze-matrix ziquka iiprotheni zekhonkco ezizinzisa i-proteoglycan�hyaluronic acid aggregates kunye ne-protein ye-116-k46 engaziwayo ye-46-kDa engaziwayo. Le proteni ihlala kwi-matrix ngendlela ye-disulfide-bonded complex of high molecular weight.47 Izifundo ze-Immunolocalization zibonisa ukuba ibekwe ngokubanzi malunga ne-collagen bundles in the interterritorial matrix.XNUMX

I-glycoprotein yokunamathela yakha iqela elincinci le-gricoprotein. Ezi zi-macromolecules zixanduva lokubopha nezinye iimleksile ze-matrix kunye / okanye iiseli. Ezi zinxalenye ze-molecular adhesion ziyimpawu ezibalulekileyo kwintlangano ye-supramolecular ye-molecules i-extracellular ye-meniscus.150 Iimamolekyu ezintathu ziye zachongwa ngaphakathi kwe-meniscus: uhlobo lwama-collagen, uhlobo lwe-fibronectin kunye ne-thrombospondin.112,118,181

I-Vascular Anatomy

I-meniscus isakhiwo se-avascular esinegazi elingaphantsi kwegazi. I-articular articulator (egxininisa umthambo we-popliteal) inikezela i-vascularization enkulu kwiindawo eziphantsi kunye eziphezulu kwi-meniscus nganye. (5-9,12,33. i-oblique popliteal ligament kwikona ye-posteromedial yendibano ye-tibiofemoral. Inethiwekhi yecillary premeniscal evela kumasebe ala mithwayilo ivela ngaphakathi kwimizimba ye-synovial kunye ne-capsular yamadolo ejikelezileyo ye-menisci. I-35,148% ukuya kwi-10% yomda we-meniscus umda kunye ne-30% ukuya kwi-10% ye-meniscus elandelelanayo ixhaswa kakuhle, eneempembelelo ezibalulekileyo zokuphulukisa i-meniscus (Umfanekiso we25) .Iinqanawa ze-6 ezingapheliyo zivela kwiimpondo zangaphambili nangaphezulu zihamba Umgama omfutshane kwizinto ezisisigxina se-menisci kunye nefom ye-end loops, ukubonelela ngendlela efanelekileyo yokutya.12,33,68 Inxalenye eseleyo ye-meniscus nganye (i-33% ukuya ku-65%) ithola ukutya kwimizi e-synovial ngokusebenzisa i-diffusion okanye ukupompoza kumatshini (okt, ukuhamba ngokubambisana) .75

 

I-Bird and Sweet ihlolisise i-menisci yezilwanyana kunye nabantu ngokusebenzisa i-electron ukuskena kunye ne-microscopy elula.23,24 Babona izakhiwo ezinjenge-canal zivula ngaphakathi kwi-menisci. Le mijelo inokudlala indima ekuthuthweni komngcipheko ngaphakathi kwe-meniscus kwaye ikwazi ukuthwala izondlo kwi-synovial fluid kunye nemithambo yegazi kwizigaba ze-avascular ze-meniscus.23,24 Nangona kunjalo, kufuneka kuqhutywe phambili ukufundwa ukuze kucaciswe indlela efanelekileyo yokuhambisa Isondlo kwisabelo se-avascular se-menisci.

Neuroanatomy

Ixolo elihlangeneyo lilungelelwa yilebe yangaphambili ehamba phambili yentsholongwane engaphantsi komzimba kunye namagatsha okuphela kwesigqeba kunye neentsholongwane zesifazane. Isabelo esilandelayo se-capsule ayinakulungiswa yilebe ephindaphindiweyo ye-peroneal ye-neroneal nerveal. Ezi zikhuni ze-nerve zingena kwi-capsule kwaye zilandele i-vascular supply kwingxenye yendawo yomda yee-menisci kunye neempondo zangaphambili neziphambili, apho ininzi yezibilini ze-nerve zigxininisekile.52,90 Ingxenye yesithathu yomzimba we-meniscus ininzi kakhulu Umgangatho wesithathu.183,184 Ngexesha lokugqithisa ngokugqithiseleyo kunye nokwandiswa kwamadolo, izimpondo ze-meniscal zigxininiswe, kunye negalelo elichaphazelekayo likhulu kakhulu kulezi zikhundla eziphezulu.183,184

I-mechanoreceptors ngaphakathi kwimisebenzi ye-menisci njengabatshintshi, ukuguqula ukukhuthazwa komzimba kunye nokunyanzeliswa kwimbane ethile yombane. Izifundo ze-menisci yabantu zichonge i-3 ye-morphologically ehlukile ye-mechanoreceptors: Ukuphela kweRuffini, ii-Pacinian corpuscle, kunye nezitho zetoni ze-Golgi. Uhlobo I (Ruffini) oomatshini bokubamba baphantsi kwaye bahlengahlengisa kancinci kutshintsho kuhlanganiso kunye noxinzelelo. Uhlobo lwe-II (Pacinian) lwee-mechanoreceptors lusezantsi kwaye luguqulwa ngokukhawuleza kutshintsho lweengxaki. Uhlobo III (Golgi) zii-high-threshold mechanoreceptors, ezithi zibonakalise xa idolo lihlangene lisondela kuluhlu lokuhamba kwaye linxulunyaniswa ne-neuromuscular inhibition. Ezi zinto ze-neural zafunyanwa kugxininiso olukhulu kwiimpondo ze-meniscal, ngakumbi uphondo lwasemva.

Izinto ezingalinganiyo zamadolo zisebenza ekhonsathini njengohlobo losasazo lwendalo olwamkelayo, olugqithisayo, nolusasaza imithwalo ecaleni kwe-femur, tibia, patella, kunye ne-femur.41 Imigudu isebenza njengonxibelelaniso olwenziwayo, kunye ne-menisci emele iibheringi ezihambayo. Izifundo ezininzi ziye zaxela ukuba izinto ezahlukeneyo zangaphakathi kwamadolo zivakalelwa, ziyakwazi ukuvelisa imiqondiso ye-neurosensory efikelela kumqolo, kwi-cerebellar, nakumanqanaba aphezulu enkqubo ye-nervous. Kukholelwa ukuba ezi zimpawu ze-neurosensory zikhokelela ekuboneni kwengqondo kwaye zibalulekile ekusebenzeni kwesiqhelo kwamadolo kunye nokugcinwa kwethishu ye-homeostasis.42

I-meniscus i-cartilage enika ingqibelelo esekweni kwaye isebenzayo emadolweni. I-menisci yimizi emibini yeengxube ze-fibrocartilaginous ezisasaza ukuxubana emadolweni xa zixhatshazwa kunye nokugqithisa phakathi kwethambo lesifuba, okanye i-tibia, kunye nethambo lesithambo, okanye i-femur. Ukuqonda kwe-anatomy kunye ne-biomechanics yodolo oludityanisiweyo kubalulekile ekuqondeni ukulimala kwamadolo kunye / okanye iimeko. UDkt Alex Jimenez DC, i-CCST Insight

Umsebenzi weBiomchanical

Umsebenzi we-biomechanical we-meniscus ubonakalisa i-anatomy enkulu kunye nolwakhiwo kunye nobudlelwane bayo nakwizinto ezingqonge i-intra-articular and extra-articular structures. I-menisci isebenza imisebenzi emininzi ebalulekileyo ye-biomechanical. Banegalelo ekulayisheni ukuhanjiswa, ukufunxa ukothuka, i-10,49,94,96,170 yozinzo, i-51,100,101,109,155 yesondlo, i-23,24,84,141 yokuthanjiswa ngokudibeneyo, i-102-104,141 kunye ne-proprioception.5,15,81,88,115,147 Bakwanceda ukunciphisa unxibelelwano. Uxinzelelo kunye nokwandisa indawo yokunxibelelana kunye nokudibana kwamadolo.91,172

Meniscal Kinematics

Kuphononongo malunga nomsebenzi we-ligamentous, i-Brantigan kunye neVoshell babika ukuba i-meniscus yangaphakathi ihambisa i-avareji ye-2 mm, ngelixa i-meniscus esecaleni yayiphawuleka ngakumbi i-mobile kunye ne-10 mm ye-anterior-posterior displacement ngexesha lokuhamba.25 Ngokufanayo, i-DePalma ibike ukuba i-meniscus ephakathi ihamba nge-3 mm ye-anterior-posterior displacement, ngelixa i-meniscus yecala ihamba nge-9 mm ngexesha lokuhamba.37 Kuphononongo olusebenzisa amadolo e-cadaveric e-5, u-Thompson et al wabika ukuba uhambo oluphakathi lube yi-5.1 mm (umyinge weempondo zangaphambili kunye nezingasemva) kunye I-excursion ye-lateral excursion, i-11.2 mm, kunye ne-tibial articular surface (Umfanekiso 7) .165 Iziphumo ezivela kwezi zifundo ziqinisekisa umehluko omkhulu kwintshukumo yecandelo phakathi kwe-menisci ephakathi kunye ne-lateral. I-meniscus yangaphambili kunye nophondo lwangasemva luncinci kwaye lubonisa ukuba i-meniscus ihamba ngakumbi njengeyunithi enye.165 Ngaphandle koko, i-meniscus ephakathi (ngokupheleleyo) ihamba ngaphantsi kwe-meniscus yecala, ibonisa i-excursion enkulu yangaphambili ukuya kwi-posterior horn differential excursion. U-Thompson et al wafumanisa ukuba indawo encinci ye-meniscal motion yikona yangasemva ye-medial, apho i-meniscus inqandelwa ngokuqhotyoshelweyo kwi-plateau ye-tibial ngenxalenye ye-meniscotibial ye-posterior oblique ligament, ekuye kwabikwa ukuba ixhomekeke kukulimala. I-143,165 Ukunciphisa ukunyakaza kophondo lwangasemva lwe-meniscus ye-medial yindlela enokubakho yeenyembezi ze-meniscal, kunye nesiphumo 'sokubambisa' i-fibrocartilage phakathi kwe-condyle ye-femoral kunye ne-tibial plateau ngexesha lokujikeleza okupheleleyo. Ukwahlula okukhulu phakathi kwe-excursion yophondo lwangaphambili kunye nolwemva kunokubeka i-meniscus ephakathi kumngcipheko omkhulu wokulimala.165

 

Ukwahlukahlula kocwangco lwangaphambili ukuya kwintsika yokumisa ukuvota kuvumela ukuba amadoda ayenze i-radius eyanciphayo, ehambelana nokunciphisa umda we-curve of posterior femels.165 Olu tshintsho lomzila luvumela ukuba i-meniscus ihlale iqhagamshelana nobunzulu bomhlaba zombini i-femur kunye ne-tibia kuyo yonke indawo.

Ukulayishwa kweMpahla

Umsebenzi we-menisci uye wenziwa ngonyango ngokutshintshwa kwezinto eziguqukayo ezihamba kunye nokususwa kwawo. I-Fairbank ichaze ukunyuka kweemeko kunye nokuguqulwa kokutshintsha kwezinto ezixubileyo kwiindawo ezixubileyo emadolweni .45 Ukususela kulo msebenzi wokuqala, uphando oluninzi luqinisekisile ezi ziphumo kwaye luye lwalubeka phambili indima ebalulekileyo ye-meniscus njengendlela yokukhusela, isithwala imithwalo.

Ukuthwala ubunzima kuvelisa amandla e-axial emadolweni, acinezela i-menisci, ekhokelela kuxinzelelo lwe- hoop (circumferential ).170 Uxinzelelo lwe-Hoop lwenziwa njengemikhosi ye-axial kwaye iguqulwe ibe luxinzelelo lwe-tensile ecaleni kwe-collagen fibers ye-meniscus (Umzobo 8). Iziqhotyoshelweyo eziqinileyo ezenziwa ngaphambili kunye nasemva kokufakwa kwemithambo zithintela i-meniscus ekukhutsheni ngokungaphaya ngexesha lokuthwala umthwalo. 94 Izifundo ezenziwe ngeMbewu kunye neHargreaves zixele ukuba i-70% yomthwalo kwigumbi elisecaleni kunye ne-50% yomthwalo kwigumbi eliphakathi lihanjiswa menisci.153 I-menisci ihambisa i-50% yomthwalo wokucinezelwa ngeempondo zangasemva ezandisiweyo, nge-85% yokuhambisa kwi-90 flexion.172 Radin et al ibonise ukuba le mithwalo ihanjiswa kakuhle xa i-menisci ihambile.137 Nangona kunjalo, ukususwa kwe Iziphumo ze-meniscus eziphakathi kwi-50% ukuya kwi-70% yokuncipha kwendawo yoqhakamshelwano yabasetyhini kunye ne-100% yokunyuka koxinzelelo koqhakamshelwano. 4,50,91 Iyonke i-lateral meniscectomy ibangela ukuhla kwe-40% ukuya kwi-50% kwindawo yoqhakamshelwano kunye nokwandisa uxinzelelo koqhakamshelwano Icandelo elisecaleni ukuya kwi-200% ukuya kwi-300% yesiqhelo. 18,50,76,91 Oku kwandisa kakhulu umthwalo kwiyunithi nganye kwaye kunokuba negalelo ekukhawuleziseni ukonakala kwe-articular cartilage kunye nokonakala.45,85

 

Ukutshatyalaliswa kwamanzi

Ama-menisci adlala indima ebalulekileyo ekuncediseni amajelo okutshitshiswa okuphakathi okuveliswa ngophazamiseko yokulayishwa kwamadolo ngohlobo oluqhelekileyo.XXUMUMX Voloshin kunye neWosk ibonise ukuba idolo eliqhelekileyo linamandla okutyhawula nge-94,96,153% ephezulu kuneendolo eziye zafumana i-meniscectomy.20 Njengoko ukungakwazi kwe-joint joint system to absorb a shock has been involved in the development of osteoarthritis, i-meniscus ibonakala ibambe indima ebalulekileyo ekugcineni impilo yemadolo .170

Uzinzo oluhlangeneyo

Isakhiwo sejometri ye-menisci sinika indima ebalulekileyo ekugcineni inhlanganisela kunye nokuzinza okuhlangeneyo. ## Ubungakanani obuphezulu bomntu ngamnye we-meniscus bubunxibelelwano, obangela ukusetyenziswa ngokucacileyo phakathi kweempawu zentombi kunye ne-flat tibial plateau. Xa i-meniscus ihambelana, ukulayishwa kwe-axial yamadolo kunomsebenzi ozinzileyo wokuzinza, ukunciphisa ukunyuka okugqithiseleyo kuzo zonke iinqununu.9

UMarkolf kunye noogxa bakhe bathethe ngesiphumo se-meniscectomy kwi-anterior-posterior and rotational laxity. I-medial meniscectomy kwi-ACL-intact knee ayinampembelelo incinci kwi-posterior-posterior motion, kodwa kwi-ACL-defeed knee, kubangela ukwanda kwangaphakathi-posterior tibial translation up to 58% at 90o of flexion. 109 Shoemaker and Markolf ibonakalise ukuba uphondo lwangasemva lwe-meniscus yangaphakathi lolona lwakhiwo lubaluleke kakhulu oluchasene namandla angaphandle e-ACL-idolo eline-ACL.155 U-Allen et al ubonise ukuba amandla akhokelayo kwi-meniscus ye-medial ye-ACL-defeed knee inyuswe nge-52% kwi ukwandiswa ngokupheleleyo kunye ne-197% kwi-60 yokuhamba phantsi komthwalo we-134-N wangaphambili we-tibial.7 Utshintsho olukhulu kwii-kinematics ngenxa ye-medial meniscectomy kwi-ACL-defeed knee eqinisekisa indima ebalulekileyo ye-meniscus medial kuqiniso lwamadolo. Kutshanje, uMusahl et al uxele ukuba i-meniscus esecaleni idlala indima kutoliko lwangaphambili lwe-tibial ngexesha lokuhamba-pivot-maneuver.123

Ukutya okudibeneyo kunye noLubrication

I-menisci inokudlala indima kwisondlo kunye ne-lubrication yamadolo. I-mechanics yale lubrication ayisaziwa; i-menisci inokunyanzelisa i-synovial fluid kwi-cartilage ye-articular, eyanciphisa amandla okuxhatshazwa ngexesha lokunyamezela.13

Kukho inkqubo ye-microcanals ngaphakathi kwe-meniscus esondele kwimithambo yegazi, edibanisa ne-synovial cavity; ezi zinokubonelela ngezothutho olusetyenziswayo ngokutya kunye nokubambisana ngokubambisana.23,24

Ukufumana

Umbono wokuhamba kunye kunye nesimo (ukufumanisa i-propriecception) lixhaswa ngabaxhasi bamashishini abahambisa i-deformation mechanical into signs signals. Iimpawu ze-Mechanoreceptors ziye zafunyanwa kwiimpondo zangaphambili nangemva kwe-menisci. *** I-Quick-adapting mechanoreceptors, njengePalinian corpuscles, kucatshangelwa ukuba idibanise ukuvakalelwa kwe-joint joint, njenge-Reffor e-slow-adapting, njenge-Ruffini yokuphela kunye ne-Golgi tendon izitho, zikholelwa ukuba zidibanisa ukuvakalelwa kwendawo yokubambisana.140 Ukuchongwa kwezi zixhobo ze-neural (ikakhulukazi kwindawo yesithathu kunye nangaphandle kwe-meniscus) kubonisa ukuba i-menisci iyakwazi ukufumana ulwazi oluyimfihlo kwi-knee joint, ngaloo ndlela idlala indima ebalulekileyo ebandakanyekayo kwindlela yokwenza ingxelo ngeengcambu zamadolo.61,88,90,158,169

Ukukhula kunye nokuguga kweMeniscus

I-microanatomy ye-meniscus iyinkimbinkimbi yaye ngokuqinisekileyo ibonisa utshintsho olusisiseko. Ngokweminyaka yobudala, i-meniscus iyaba nzima, ilahleke i-elasticity, ibe yilephu. I-78,95 Encinci, kukho ukulahlekelwa ngokuthe ngcembe kwezixhobo zamaselula ezineendawo ezingenanto kunye nokwanda kwezicubu ezinobumba xa kuthelekiswa nezicubu ezinamanzi.74 Le mimandla ye-cystic ingaqalisa , kunye ne-torsional force nge-condyle ye-femil, iziqendu ezingaphezulu komntu we-meniscus zingase zikhange zisuka kwiindawo ezingqongileyo zenguqu kwi-interface ye-cystic deeneral change, ekhiqize iinyembezi ezinqamlekileyo. Ingqungquthela phakathi kwale miqolo ingabangela intlungu. I-meniscus eqhekekileyo ingalimaza ngqo ngqo i-articular cartilage.74,95

UGhosh noTaylor bafumanise ukuba uxinzelelo lwe-collagen lonyuka ukusuka ekuzalweni ukuya kwiminyaka eyi-30 kwaye luhlala lukhona de kube li-80 yeminyaka ubudala, emva koko ukwehla kwenzekile.58 Iiprotein ze-matrix ezingezizo ezobungqina zibonisa olona tshintsho lukhulu, lwehla ukusuka kwi-21.9% ukuya kwi-1.0% (ubunzima obomileyo) kuma-neonates ukuya ku-8.1% 0.8% phakathi kweminyaka engama-30 ukuya kuma-70 iminyaka. 80 Emva kweminyaka engama-70 ubudala, amanqanaba eeprotein angaqhelekanga ayanda ukuya kwi-11.6% 1.3%. UPeter noSmillie babone ukwanda kwe-hexosamine kunye ne-uronic acid kunye nobudala.131

UMicNicol noRoughley bafunde ukuhluka kweentlobo ze-meniscal proteoglycans kwi-aging113; Ulwahlulo oluncinci ekukhutshweni kunye nobukhulu be-hydrodynamic bhengezwa. Ubungakanani be-keratin sulphate ehlobene ne-chondroitin-i-6-sulfate yanda ngokuguga.146

UPeteren noTillmann immunohistochemically baphando nge-menisci yabantu (ukusukela kwiiveki ezingama-22 zokukhulelwa ukuya kwiminyaka engama-80), bejonga umohluko wemithambo yegazi kunye nee-lymphatics kwii-20 cadavers zabantu. Ngexesha lokuzalwa, phantse yonke i-meniscus yayinemisipha. Kunyaka wesibini wobomi, indawo ye-avascular ephuhliswe kwisangqa sangaphakathi. Kwiminyaka elishumi yesibini, imithambo yegazi yayikho kwi-peripheral yesithathu. Emva kweminyaka engama-50 ubudala, kuphela ikota yomda wesiseko se-meniscal isascularized. Izicubu ezixineneyo zonxibelelwano zazifakelwe imithambo kodwa hayi ifibrocartilage yofako. Imithambo yegazi yayihamba nee-lymphatics kuzo zonke iindawo

UArnoczky wacebisa ukuba ubunzima bomzimba kunye nokunyakaza kwamadolo kunokuphelisa imithwalo yegazi kwimimandla engaphakathi nephakathi kweminisci.9 Isondlo samathambo angamazinyo senziwa nge-perfusion evela emithanjeni yegazi kunye nokusabalalisa kwi-synovial fluid. Imfuno yesondlo ngokusasazeka yilapho ilayishwa ngokukhawuleza kwaye ikhutshwe kwiindawo ezixubileyo, igxininiswe ngumzimba womzimba kunye nemisipha ye-muscle .130 Le ndlela ifaniswa nokutya komzimba we-articular carticlage.22

Ukubonakaliswa kweMagnetic Resonance ye-Meniscus

I-IMRI) isicatshulwa esingenakuvakalayo sokuxilonga esisetyenziselwa ukuvavanya, ukuxilongwa kunye nokubeka esweni i-menisci. I-MRI iyamkelwa ngokubanzi njengendlela yokujonga imifanekiso efanelekileyo ngenxa yeendlela eziphambili ezibonakalayo.

Kwi-MRI yesigaba esinqamlekileyo, i-meniscus eqhelekileyo ibonakala njengesakhiwo esisigxina (simnyama) esinesigxina (isibonakaliso 9). Ingqungquthela yokuzilalisa ibonakala ngokubonakala kwimiqondiso engena kwi-intrameniscal engaphezulu kweso sakhiwo.

 

Uphando oluthile luye lwavavanya ukusetyenziswa kweekliniki ze-MRI ngenxa yezinyembezi ezingahambiyo. Ngokuqhelekileyo, i-MRI ibuhlungu kakhulu kwaye ikhethe iinyembezi ze-meniscus. Uvakalelo lwe-MRI ekufumaneni iindawo zezinyembezi ezivela kwi-70% ukuya ku-98%, kunye neenkcukacha, ukusuka kwi-74% ukuya ku-98% .48,62,105,107,117 I-MRI yezigulane ze-1014 phambi kokuhlolwa kwe-arthroscopic inechanekileyo ye-89% yokugula kwe-meniscus ephakathi. I-88% ye-meniscus ye-lateral.48 Uhlalutyo lwe-meta lwezigulane ze-2000 ezine-MRI kunye nokuhlolwa kwe-arthroscopic zifumene ukuqonda kwe-88% kunye ne-94% ngokuchaneka kweezinyembezi.I-105,107

Kubekho ukungangqinelani phakathi kokuchongwa kwe-MRI kunye ne-pathology echongiweyo ngexesha lovavanyo lwe-arthroscopic. Ubulungisa kunye noQuinn baxele ukungangqinelani ekuchongeni izigulana ezingama-66 ze-561 (12%). Ukuxilongwa kwe-arthroscopic kwaqatshelwa kwi-86 yamatyala e-92 (22%) .349 UMiller uqhube isifundo esingaboniyo xa kuthelekiswa iimviwo zeklinikhi kunye neMRI kwiimviwo ezingama-6 zamadolo. % kunye ne-106%, ngokwahlukeneyo). U-Shepard okqhubekayo wavavanya ukuchaneka kwe-MRI ekufumaneni izilonda ezibonakalayo zophondo lwangaphambili lwe-meniscus kwi-57 idolo elandelelanayo le-MRI117 kwaye yafumana i-80.7% yenqanaba lobuxoki. Ukonyuka kokuqina komqondiso kuphondo lwangaphandle akuthethi ukuba kukho ulusu olubalulekileyo eklinikhi.73.7

izigqibo

I-menisci yamadolo adibeneyo i-wedges-shaped wedges ye-fibrocartilage eyenza ukuzinyuka okuzinzileyo kwi-femorotibial, ukusabalalisa i-axial load, ukuthatha ukutshatyalaliswa, kunye nokubonelela i-lubrication kwi-knee joint. Ukulimala kumadoda kubonwa njengobangela obuthakathaka obunzima bokusibulala. Ukulondolozwa kwe-menisci kuxhomekeka kakhulu ekugcineni ukubunjwa kwayo kunye nentlangano.

Imibulelo

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

Imihlathi

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

Ukuququmbela, idolo lelona lidibeneyo likhulu nelintsokothileyo emzimbeni womntu. Nangona kunjalo, ngenxa yokuba idolo linokonakala ngokuxhaphakileyo ngenxa yokwenzakala kunye / okanye imeko, kubalulekile ukuqonda ukwakheka kwamadolo ukuze izigulana zifumane unyango olufanelekileyo. Ubungakanani bolwazi lwethu bukhawulelwe kwi-chiropractic kunye Imiba yezempilo yomqolo. Ukuxoxa ngomxholo, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

 

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

Intlungu yedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yeengozi zamadolo kunye / okanye iimeko, kubandakanya ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.

 

I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe