Izindaba - Umlando Wokushintshwa Kwamahlombe

Umqondo wokushintshwa kwehlombe okuzenzela wahlongozwa okokuqala ngu-Themistocles Gluck ngo-1891. Amalunga okwenziwa okukhulunywe ngawo futhi aklanywa ndawonye ahlanganisa inqulu, isihlakala, njll. Ukuhlinzwa kokuqala esikhundleni sehlombe kwenziwa esigulini ngo-1893 udokotela ohlinzayo ongumFulentshi uJules Emile Péan e-Hôpital International eParis ngethambo lesiguli esineminyaka engu-37 ubudala esine-tuber-old document. i-arthroplasty. I-prosthesis yenziwa udokotela wamazinyo u-J. Porter Michaels waseParis, kanye ne-humeralisiquyayenziwe ngensimbi ye-platinum futhi yaxhunywa ekhanda lenjoloba elimbozwe upharafini ngocingo ukuze kwakheke into egxilile. Imiphumela yokuqala yesiguli yayigculisa, kodwa i-prosthesis yagcina isusiwe ngemva kweminyaka engu-2 ngenxa yokuphindaphinda kaningi kwesifo sofuba. Lona umzamo wokuqala owenziwa abantu ekushintsheni amahlombe okwenziwa.

Ngo-1951, uFrederick Krueger wabika ukusetshenziswa kwe-prosthesis yehlombe ebaluleke kakhulu eyenziwe ngamavithamini futhi yabunjwa kusukela ku-humerus ye-cadaver. Lokhu kusetshenziswe ngempumelelo ekwelapheni isiguli esincane esine-osteonecrosis yekhanda le-humeral

Kodwa ukushintshwa kwehlombe kwesimanje ngempela kwaklanywa futhi kwathuthukiswa yi-shoulder guru uCharles Neer. Ngo-1953, ukuze kuxazululwe imiphumela engagculisi yokwelashwa kwayo kokuhlinzwa kwe-proximal humeral fractures, u-Neer wenza i-anatomical proximal prosthesis ye-humeral ye-humeral head fractures, eyathuthukiswa izikhathi eziningana emashumini amabili eminyaka alandelayo, ngokulandelana. Ama-prostheses esizukulwane sesibili nesesithathu aklanyelwe.

Ekuqaleni kwawo-1970, ukuze kuxazululwe ukushintshwa kwehlombe ezigulini ezinokungasebenzi kahle kwe-cuff ye-rotator, umqondo we-reverse shoulder arthroplasty (RTSA) wahlongozwa okokuqala nguNeer, kodwa ngenxa yokungaphumeleli kokuqala kwengxenye ye-glenoid, Lo mqondo wabuye washiywa. Ngo-1985, u-Paul Grammont wathuthuka ngokomqondo ohlongozwe u-Neer, ehambisa isikhungo sokujikeleza phakathi nendawo kanye ne-distally, eshintsha ingalo yesikhashana kanye nokungezwani kwe-deltoid, ngaleyo ndlela ixazulule ngokuphelele inkinga yokulahlekelwa komsebenzi we-rotator cuff.

Izimiso zokuklama ze-trans-shoulder prosthesis

I-reverse shoulder arthroplasty (RTSA) ihlehlisa ubudlelwano be-anatomical behlombe lemvelo ukuze kubuyiselwe ukuzinza kwehlombe. I-RTSA idala i-fulcrum kanye nesikhungo sokujikeleza (CoR) ngokwenza i-glenoid side convex kanye ne-humeral head side concave. Umsebenzi we-biomechanical wale fulcrum ukuvimbela ikhanda le-humeral ukuthi likhuphukele phezulu lapho i-deltoid muscle inkontileka ukuze ithumbe ingalo engenhla. Isici se-RTSA siwukuthi isikhungo sokuzungezisa sejoyinti lehlombe lokwenziwa kanye nendawo yekhanda elinomvumo ngokuhlobene nehlombe lemvelo ihanjiswa ngaphakathi naphansi. Imiklamo ehlukene ye-RTSA prosthesis ihlukile. Ikhanda le-humeral lihanjiswa phansi ngo-25~40mm futhi lihanjiswe ngaphakathi ngo-5~20mm.

Uma kuqhathaniswa nokuhlangana kwehlombe kwemvelo komzimba womuntu, inzuzo esobala yokuguquguquka kwangaphakathi kwe-CoR ukuthi ingalo yomzuzu wokuthumba ye-deltoid iyanda isuka ku-10mm iye ku-30mm, okuthuthukisa ukusebenza kahle kokuthunjwa kwe-deltoid, futhi kungenziwa amandla amancane emisipha. I-torque efanayo, futhi lesi sici senza futhi ukuthunjwa kwekhanda le-humeral kungabe kusancika ngokuphelele emsebenzini wokucindezeleka we-cuff ejikelezayo ephelele.

Lona umklamo kanye ne-biomechanics ye-RTSA, futhi kungase kube yisicefe futhi kube nzima ukukuqonda. Ingabe ikhona indlela elula yokuyiqonda? Impendulo ithi yebo.

Okokuqala ukwakhiwa kwe-RTSA. Qaphela ngokucophelela izici zelunga ngalinye lomzimba womuntu, singathola imithetho ethile. Amalunga omuntu angahlukaniswa cishe abe izigaba ezimbili. Elinye lingamajoyinti asondelene nesiqu njengamahlombe nezinqulu, isiphetho esiseduze sibe "indebe" futhi isiphetho esikude sibe "ibhola".

Olunye uhlobo amalunga distal ezifanaamadolonezindololwane, isiphetho esiseduze sibe "ibhola" futhi isiphetho esikude sibe "indebe".

Uhlelo olwamukelwa amaphayona ezokwelapha lapho kuklanywa izitho zokwenziwa ezihlangene ehlombe ezinsukwini zakuqala kwakuwukubuyisela isakhiwo se-anatomical sehlombe lemvelo ngangokunokwenzeka, ngakho-ke zonke izinhlelo zenzelwe ukuphela okuseduze njenge "ndebe" kanye nokuphela kwe-distal "njengebhola". Abanye abacwaningi baze baklama ngamabomu "indebe" ukuthi ibe nkulu futhi ijule ukuze kwandiswe ukuzinza kwelunga elifana nelomuntu.i-hip joint, kodwa kamuva kwafakazelwa ukuthi ukwandisa ukuzinza empeleni kwandisa izinga lokuhluleka, ngakho lo mklamo wamukelwa ngokushesha. Yeka. I-RTSA, ngakolunye uhlangothi, ihlehlisa izici ze-anatomical zehlombe lemvelo, iguqule "ibhola" kanye "nenkomishi", okwenza ilunga le-"hip" langempela lifane "nendololwane" noma "idolo". Lolu shintsho lokuketula ekugcineni luxazulule ubunzima obuningi nokungabaza kokushintshwa kwamahlombe okwenziwa, futhi ezimweni eziningi, ukusebenza kahle kwawo kwesikhathi eside kanye nesikhathi esifushane kuye kwathuthukiswa kakhulu.

Ngokunjalo, idizayini ye-RTSA ishintsha isikhungo sokuzungezisa ukuze ivumele ukwanda kokuthunjwa kwe-deltoid, okungase kuzwakale kungacacile. Futhi uma siqhathanisa ihlombe lethu lehlombe nesaha, kulula ukuliqonda. Njengoba kuboniswe emfanekisweni ongezansi, ukusebenzisa i-torque efanayo ku-A direction (i-deltoid contraction force), uma i-fulcrum nendawo yokuqala kuguqulwa, kusobala ukuthi i-torque enkulu (amandla okuthumba izingalo) ingakhiqizwa ohlangothini luka-B.

Ushintsho esikhungweni sokuzungezisa se-RTSA sinomphumela ofanayo, ovumela ihlombe elingasebenzi kahle ukuthi liqalise ukuthumba ngaphandle kokucindezeleka kwe-cuff ejikelezayo. Njengoba u-Archimedes esho: Nginike i-fulcrum futhi ngingakwazi ukuhambisa wonke umhlaba!

RTSA Izinkomba kanye Contraindications

Inkomba yakudala ye-RTSA i-rotator cuff tear arthropathy (CTA), ukudabula kwe-rotator cuff enkulu ene-osteoarthritis, ebonakala ngokugudlukela phezulu kwekhanda elithambile, okuholela ekutheni i-glenoid, i-acromion kanye nekhanda elithambile liqhubeke nezinguquko eziwohlokayo. Ukuthuthela phezulu kwekhanda le-humeral kubangelwa umbhangqwana wamandla ongalingani ngaphansi kwesenzo se-deltoid ngemva kokungasebenzi kahle kwe-rotator cuff. I-CTA ivame kakhulu kwabesifazane asebekhulile, lapho "pseudoparalysis" yakudala ingase yenzeke.

Ukusetshenziswa kwe-shoulder arthroplasty, ikakhulukazi i-RTSA, kukhule kakhulu kule minyaka engamashumi amabili edlule. Ngokusekelwe emiphumeleni yokuqala eyimpumelelo yohlelo lokusebenza lwe-RTSA, ukuthuthukiswa okuqhubekayo kwendlela yokuhlinza, kanye nokusebenzisa kahle le ndlela yokwenza, izinkomba zokuqala ezincane ze-RTSA zandisiwe, ngakho-ke, izinqubo eziningi ze-arthroplasty ehlombe ezenziwa manje yi-RTSA.

Isibonelo, i-anatomical total shoulder arthroplasty (ATSA) kwakuyinketho ekhethwayo ye-osteoarthritis yehlombe ngaphandle kokudabula kwe-rotator cuff esikhathini esidlule, kodwa eminyakeni yamuva nje, inani labantu abanalo mbono libonakala lincipha kancane kancane. Kukhona izici ezilandelayo. Izizathu ziholele kulo mkhuba. Okokuqala, kufika ku-10% weziguli ezithola i-ATSA sezivele zinezinyembezi ze-rotator cuff. Okwesibili, kwezinye izimo, ubuqotho "besakhiwo" "somsebenzi" we-rotator cuff awuphelele, ikakhulukazi kwezinye iziguli esezikhulile. Okokugcina, ngisho noma i-rotator cuff ingashintshile ngesikhathi sokuhlinzwa, ukuwohloka kwe-rotator cuff kwenzeka ngokukhula, ikakhulukazi ngemva kwezinqubo ze-ATSA, futhi kukhona ngempela ukungaqiniseki okukhulu mayelana nomsebenzi we-rotator cuff. Lesi simo ngokuvamile sivela ezigulini esezikhulile ezingaphezu kweminyaka engama-70. Ngakho-ke, odokotela abaningi abahlinzayo baqala ukukhetha i-RTSA lapho bebhekene ne-osteoarthritis yehlombe ehlanzekile. Lesi simo siholele ekucabangeni okusha kokuthi i-RTSA ingase futhi ibe yinketho yokuqala ezigulini ezine-osteoarthritis ezine-cuff ejikelezayo engaguquki ngokusekelwe eminyakeni yobudala kuphela.

Ngokufanayo, esikhathini esidlule, ngezinyembezi ezingenakulungiseka ze-rotator massive rotator (MRCT) ngaphandle kwe-osteoarthritis, ezinye izindlela zifaka ukuwohloka kwe-subacromial, ukwakhiwa kabusha kwekhafu elijikelezayo ngokwengxenye, indlela yaseShayina, nokwakhiwa kabusha kwe-capsule ehlangene ephezulu. , izinga lempumelelo liyahlukahluka. Ngokusekelwe ekwazini nasekusetshenzisweni ngempumelelo kwe-RTSA ezimeni ezahlukahlukene, bayanda opharetha abasanda kuzama i-RTSA lapho bebhekene ne-MRCT elula, futhi ibe yimpumelelo enkulu, ngezinga lokusinda leminyaka eyi-10 lokufakelwa elingaphezu kwama-90%.

Kafushane, ngaphezu kwe-CTA, izinkomba zamanje ezandisiwe ze-RTSA zihlanganisa izinyembezi ezinkulu ezingenakulungiseka ze-rotator cuff ngaphandle kwe-osteoarthropathy evuvukalayo, izimila, ukuphuka okukhulu, isifo samathambo sangemuva kokuhlukumezeka, ukukhubazeka kwamathambo noma amalunga amathambo akhubazekile kakhulu. ukuvuvukala, kanye nokuhlukana kwamahlombe okuphindaphindiwe.

Kukhona ama-contraindication ambalwa ku-RTSA. Ngaphandle kokungqubuzana okuvamile kokushintshwa kwamalunga okwenziwa njengokutheleleka, ukungasebenzi komsipha we-deltoid kuwukungqubuzana ngokuphelele ne-RTSA. Ngaphezu kwalokho, ngokuphuka kwe-humerus eseduze, ukuphuka okuvulekile kanye nokulimala kwe-plexus ye-brachial kufanele futhi kubhekwe njengezinto eziphikisanayo, kuyilapho ukulimala kwe-axillary nerve ehlukanisiwe kufanele kubhekwe njengokuphikisana okuhlobene.

Ukunakekelwa kwangemva kokuhlinzwa kanye nokuvuselelwa

Izimiso zokuvuselelwa kwangemva kokuhlinzwa:

Hlanganisa umdlandla weziguli wokuvuselelwa kanye nokusungula okulindelekile ezigulini.

Yehlisa ubuhlungu nokuvuvukala, futhi ivikela izakhiwo zokuphulukisa, kodwa i-subscapularis ngokuvamile ayidingi ukuvikelwa.

Ukukhishwa kwangaphakathi kwe-joint joint ehlombe kungenzeka ukuthi kwenzeke ezindaweni zokugcina ze-hyperextension, i-adduction kanye nokujikeleza kwangaphakathi, noma ukuthunjwa nokujikeleza kwangaphandle. Ngakho-ke, ukunyakaza okufana nama-backhands kufanele kugwenywe amaviki angu-4 kuya kwangu-6 ngemva kokuhlinzwa. Lezi zikhundla zinengozi yokugudluka.

Ngemuva kwamaviki ama-4 kuya kwayi-6, kusadingeka ukuxhumana nokuthola imvume kudokotela ohlinzayo ngaphambi kokuqala ukunyakaza okungenhla kanye nezikhundla.

Ukuzivocavoca kwangemuva kokuhlinzwa kufanele kwenziwe kuqala ngaphandle kokuthwala isisindo bese kuba ngesisindo, okokuqala ngaphandle kokumelana bese kuba ngokumelana, okokuqala ngqa bese kuthi ngenkuthalo.

Njengamanje, alikho izinga eliqinile nelifanayo lokuhlunyeleliswa kwezimilo, futhi kunomehluko omkhulu ezinhlelweni zabacwaningi abahlukene.

Imisebenzi yesiguli yokuphila kwansuku zonke (ADLs) isu (amaviki angu-0-6):