Izindaba - Umlando Wokubuyiselwa Kwehlombe

Umqondo wokufakwa esikhundleni sehlombe sokufakelwa uhlongozwe okokuqala yiThemistoCles ngo-1891. Amalunga okwenziwa okushiwo futhi aklanywe ngokuhlinzwa kwesiguli ngo-1893 nge-tubercosis enesifo sofuba ehlombe okuqala I-ArthroPlasty. I-prosthesis yenziwa ngudokotela wamazinyo uJ. Porter Michaels waseParis, kanye ne-humelirisiquyenziwe nge-platinam yensimbi futhi yanamathiselwa ekhanda lerabha elihlanganiswe neparaffen ngocingo ukwakha okufakiwe. Imiphumela yokuqala yesiguli yayigculisekile, kepha ekugcineni i-prosthesis yasuswa ngemuva kweminyaka emi-2 ngenxa yokuphindwaphindwa kwezifo eziningi. Lokhu kungumzamo wokuqala owenziwe ngabantu ekubuyiselweni esikhundleni sehlombe se-proficial ehlombe.

Ngo-1951, uFrederick Krueger wabika ukusetshenziswa kwe-prosthesis ebaluleke kakhulu ehlombe ebhekiswe ngamavithamini futhi wabumba kusuka ku-humerus ephezulu ye-cadaver. Lokhu kusetshenziswe ngempumelelo ukwelapha isiguli esincane nge-osteonecrosis yekhanda lezinhlamvu

Kepha ukushintshwa kwanamuhla kwehlombe kwakhiwe futhi kwakhiwa i-Guru Charles Neer. Ngo-1953, ukuze kuxazululwe imiphumela engagculisi ukwelashwa kwayo kokuhlinzwa kwamandla amunyu izimilo, ama-neer athuthuka ama-anatomical proxilal proximal prostheral prostheral for the aumeliral inhloko yokwehla kwamakhanda, kwathuthukiswa amahlandla ambalwa eminyaka, ngokulandelana. Isizukulwane sesibili nelesithathu lesizukulwane esihle.

Ekuqaleni kweminyaka yo-1970, ukuze kuxazululwe okunye esikhundleni sehlombe ezigulini ezinamandla amakhulu we-catator cuff, umqondo we-reverse ehlombe i-arthroplasty (RTSA) wawuhlongozwa okokuqala nge-neer, kepha ngenxa yokwehluleka kokuqala kwesakhi se-gelenoid, umqondo wawushiywe kamuva. Ngo-1985, uPaul Grammont wathuthuka ngokomqondo ohlongozwayo uNeer, ehambisa isikhungo sokujikeleza ngokuzikhethela nangokude, eshintsha izingalo kanye nokungezwani kwe-deltoid, ngaleyo ndlela ukuxazulula inkinga yokulahleka kwe-rotator cuff ukusebenza.

Imigomo yokuqamba ye-trans-ihlombe proskesis

I-Reverse ehlombe i-arthroplasty (RTSA) ibuyela ebudlelwaneni be-anatomical yehlombe lemvelo ukuze ubuyisele ukuqina kwehlombe. I-RTSA idala i-fulcrum kanye nesikhungo sokujikeleza (KOR) ngokwenza i-Glenzeid Side Compani kanye ne-concave yekhanda elithobekile. Umsebenzi we-biomechanical wale fulcrum ukuvikela ikhanda lokutholwa kusuka ekuhambeni phezulu lapho izinkontileka zemisipha ye-deltoid yokuhlamba ingalo engenhla. Isici se-RTSA ukuthi isikhungo sokujikeleza kwehlombe sokufakelwa kanye nesikhundla sekhanda lezinhlokomo esihlobene nehlombe lemvelo lihanjiswa ngaphakathi nakwehlela phansi. Imiklamo ehlukene ye-RTSA prosthesis ihlukile. Inhloko ethobekile ihanjiswa phansi ngo-25 ~ 40mm yathutha ngaphakathi ngo-5 ~ 20mm.

Uma kuqhathaniswa nehlombe lemvelo lomzimba womuntu, inzuzo ebonakalayo yokushintsha kwangaphakathi Kor ukuthi ingalo yokushushuluza okwenziwe nge-deltoid kuya ku-30mm kuya ku-30mm, futhi kukhiqizwa ukusebenza kwe-deltoroid, futhi amandla amancane emisipha. I-torque efanayo, futhi lesi sici futhi senza ukwethulwa kwekhanda elimunyule akusancike ngokuphelele ekusebenzeni komoya kwe-cuff ephelele.

Lona umklamo kanye ne-biomechanics ye-RTSA, futhi kungaba yisidina esincane futhi kunzima ukusiqonda. Ingabe ikhona indlela elula ukuyiqonda? Impendulo inguyebo.

Owokuqala ukwakheka kwe-RTSA. Bheka ngokucophelela izici zokuhlanganiswa ngakunye komzimba womuntu, singathola imithetho ethile. Amalunga abantu angahlukaniswa ngezigaba ezimbili. Eyodwa izokuhlangene okusondelene namahlombe anjengamahlombe kanye okhalweni, ngokuphela kweProximal Ukuba "yindebe" kanye nokuphela kwe-distal kube "yibhola".

Olunye uhlobo ukuhlanganiswa okude okufana nakhoamadolokanye ne-elbows, ngokuphela kweProximal Ukuba "yibhola" kanye nokuphela kwe-distal kube yi- "Cup".

Uhlelo olwamukelwe amaphayona wezokwelapha lapho liklama ama-proficial ehlombe amahlombe ezinsukwini zokuqala kwakuwukubuyisela isakhiwo se-anatomical sehlombe semvelo ngangokunokwenzeka, ngakho-ke zonke izinhlelo zadalwe ngokuphela kwe- "Cup" kanye ne-dist ". Abanye abacwaningi baklame ngamabomu "inkomishi" ukuba ibe nkulu futhi ijule ukuze bandise ukuqina kokuhlangana, okufana nomuntui-hip ngokuhlangene, kepha kamuva kwabonakala ukuthi ukukhulisa ukuqina empeleni kwandise izinga lokuhluleka, ngakho-ke lo mklamo wamukelwa ngokushesha. Yeka. Ngakolunye uhlangothi, i-RTSA, ibuyisa izici ze-anatomical zehlombe lemvelo, ingenela "ibhola" nelithi "i-hip" yasekuqaleni "noma" idolo ". Lokhu kuguqulwa okuguquguqukayo kwagcina kuxazululwe ubunzima obuningi nokungabaza kokubuyiselwa kwehlombe lokufakelwa, futhi ezimweni eziningi, ukusebenza kwayo kwesikhathi eside kanye nesikhashana kube ngcono kakhulu.

Ngokufanayo, ukwakheka kwe-RTSA kushiya isikhungo sokujikeleza ukuvumela ukunyuselwa ukukhiqizwa kahle kwe-deltoroid, okungazwakala nokufihla. Futhi uma siqhathanisa ihlombe lethu elihlangene ne-seesaw, kulula ukuyiqonda. Njengoba kukhonjisiwe kwisibalo esingezansi, sisebenzisa i-torque efanayo endaweni (amabutho we-deltoIngi kanye ne-delcrum nesiqalo ashintshiwe, kusobala ukuthi i-torque enkulu (ibutho eliphakeme le-ingalo) lingakhiqizwa endaweni ye-B.

Ushintsho esikhungweni se-RTSA sokujikeleza lunomphumela ofanayo, okuvumela ihlombe elimiswe endaweni ukuze lisungule ukuthwala ngaphandle kokucindezelwa kwe-rotator cuff. Njengoba ama-arbimedes athi: Nginike i-fulcrum futhi ngikwazi ukuhambisa umhlaba wonke!

Izinkomba ze-RTSA kanye ne-Contraindication

Inkomba yakudala ye-RTSA i-rotator cuff izixubekisa i-arthropathy (CTA), i-cattator enkulu ye-cuff yama-osteoarthritis, okuvame ukuvezwa ukufudumalo okuphezulu kwekhanda elithobelayo, okuholela ekushintsheni kwekhanda okuhlangene. Ukufudumala okuphezulu kwekhanda elimilaweni kubangelwa umbhangqwana wamandla angalinganiselwe ngaphansi kwesenzo se-deltoid ngemuva kokungasebenzi kahle kwe-rotator. I-CTA ivame kakhulu kwabesifazane asebekhulile, lapho kungenzeka khona "i-pseudoparalysis" yakudala.

Ukusetshenziswa kwehlombe arthroplasty, ikakhulukazi i-RTSA, ikhuphuke kakhulu kule minyaka engamashumi amabili edlule. Ngokusekelwe kwimiphumela yokuqala ephumelelayo yohlelo lwe-RTSA, ukuthuthukiswa okuqhubekayo kwenqubo yokuhlinza, kanye nokusetshenziswa kahle kwale ndlela, ngakho-ke izinkomba zezinqubo zokuqala ze-RTSA zandisiwe, ngakho-ke, izinqubo eziningi zehlombe zehlombe zinwetshiwe,

Isibonelo, i-Anatomical Total Arthroplasty (ATSA) yayiyindlela ekhethwayo yokukhethwa kwamahlombe amahlombe ngaphandle kwe-rotator cuff, kodwa eminyakeni yamuva, inani labantu ababambe lo mbono libonakala lincipha kancane kancane. Kukhona izici ezilandelayo. Izizathu ziholele kulo mkhuba. Okokuqala, kuze kufike ku-10% weziguli ezithola i-ATSA sezivele zine-culf cuff. Okwesibili, kwezinye izikhathi, "ukuthembeka" kwesakhiwo "komsebenzi" umsebenzi "we-rotator cuff akuphelele, ikakhulukazi kwezinye iziguli ezindala. Ekugcineni, noma ngabe i-rotator cuff ihlala ngesikhathi sokuhlinzwa, i-rotator cuff conegeration yenzeka ngeminyaka, ikakhulukazi ngemuva kwezinqubo ze-ATSA, futhi empeleni kunokungaqiniseki okukhulu mayelana nomsebenzi we-rotator cuff. Le nto ivame ukwenzeka ezigulini ezikhulile ngaphezulu kweminyaka engama-70. Ngakho-ke, odokotela abahlinza ngokwengeziwe baqala ukukhetha i-RTSA lapho bebhekene nehlombe elihlanzekile le-osteoarthritis. Lesi simo siholele ekucabangeni okusha okwenziwa yi-RTSA nakho kube ngukukhetha okokuqala kweziguli ezine-osteoarthritis nge-catator cuff esekelwe kuphela eminyakeni yobudala.

Ngokufanayo, esikhathini esedlule, sokungenakufinyeleleka kwe-cattator cuff izinyembezi (MRCT) ngaphandle kwe-osteoarthritis, ezinye izindlela zifaka ukuwohloka komphakathi, ukwakhiwa kabusha kwe-cuff ehlanganayo, indlela yesiShayina, kanye nokwakhiwa kabusha kwe-capsule ephezulu. , Izinga lempumelelo liyahlukahluka. Ngokuya ngobungcweti kanye nokusebenza okuphumelelayo kwe-RTSA ezimweni ezahlukahlukene, opharetha abaningi basanda kuzama i-RTSA ebusweni be-MRCT elula, futhi iye yaphumelela kakhulu, ngezinga lokusinda kweminyaka eyi-10.

Ngamafuphi, ngaphezu kwe-CTA, izinkomba ezinwetshiwe zamanje ze-RTSA zifaka izinyembezi ezinkulu ze-rotator cuffrovager ngaphandle kokuvuvukala kwe-osteoaarthropathy, amathumbu, ukuphazamiseka okukhulu, ama-arthritis angemuva, alimaze kakhulu amathango. ukuvuvukala, kanye nokuphamba kwehlombe.

Kukhona okumbalwa okuphikisana ne-RTSA. Ngaphandle kwe-General Contraimpication yokubuyiselwa okuhlangene okuhlangene njengokutheleleka, ukungasebenzi komsipha we-deltoid kuyinto ephikisana ngokuphelele ne-RTSA. Ngaphezu kwalokho, ngokuba ama-aumerus angu-auterus aqhekezwa, ukulimala okuvulekile kanye nokulimala kwe-plexus ye-brachial kufanele kubhekwe njengokulimala kwe-axillical nerve kufanele kubhekwe njengempikiswano ehlobene.

Ukunakekelwa kwangemva kokusebenza kanye nokuvuselelwa kabusha

Izimiso zokuvuselelwa kwe-postoperative:

Hlanganisa intshiseko yeziguli zokuvuselela kabusha futhi isungule okulindelwe okulindelekile ezigulini.

Yehlisa ubuhlungu nokuvuvukala, futhi kuvikele izinhlaka zokupholisa, kepha i-subscaluris imvamisa ayidingi ukuvikeleka.

Ukudilizwa kwe-anterior of the wagger ehlanganisiwe kungenzeka kwenzeke ezikhundleni zokugcina ze-hyperextension, ukungeza ukujikeleza kwangaphakathi, noma ukuthumba nokujikeleza kwangaphandle nokujikeleza kwangaphandle. Ngakho-ke, ukunyakaza okufana ne-backhands kufanele kugwenywe amasonto amane kuya kwayi-6 ngemuva kokuhlinzwa. Lezi zikhundla zinobungozi bokususwa.

Ngemuva kwamaviki ama-4 kuye kwayi-6, kusadingekile ukuxhumana nokuthola imvume nodokotela ohlinzayo ngaphambi kokuqala ukunyakaza nezikhundla ezingenhla.

Ukuzivocavoca okuvuselelwa kwe-postoperative kufanele kwenziwe kuqala ngaphandle kokuthwala isisindo bese kuzala isisindo, okokuqala ngaphandle kokumelana bese kuthi ngokumelana, kuqala bese kuthi, kuqala bese ngentshiseko.

Njengamanje, akukho okujwayelekile nokuvuselelwa okuvuselelayo futhi okufanayo, futhi kunomehluko omkhulu ezinhlelweni zabacwaningi ezahlukene.

Imisebenzi Yesineke Yecebo Lokuphila Kwansuku zonke (ADLS) (amaviki angu-0-6):