Umqondo wokufakwa esikhundleni kwehlombe lokwenziwa wahlongozwa okokuqala nguThemistocles Gluck ngo-1891. Amalunga okwenziwa okukhulunywe ngawo futhi aklanywa ndawonye afaka phakathi inqulu, isihlakala, njll. Ukuhlinzwa kokuqala kokufakwa esikhundleni kwehlombe kwenziwa esigulini ngo-1893 ngudokotela ohlinzayo waseFrance uJules Emile Péan eHôpital International eParis esigulini esineminyaka engu-37 ubudala esinesifo sofuba samalunga namathambo. I-arthroplasty yokuqala yamahlombe eqoshiwe. I-prosthesis yenziwe ngudokotela wamazinyo uJ. Porter Michaels waseParis, kanye ne-humeralisiquYenziwe ngensimbi yeplatinum futhi yanamathiselwa ekhanda lerabha elimbozwe ngeparafini ngocingo ukuze kwakheke i-implant evinjiwe. Imiphumela yokuqala yesiguli yayigculisa, kodwa i-prosthesis yagcina isusiwe ngemva kweminyaka emibili ngenxa yokuphindaphinda kaningi kwesifo sofuba. Lona umzamo wokuqala owenziwe ngabantu wokufaka esikhundleni samahlombe okwenziwa.
Ngo-1951, uFrederick Krueger wabika ngokusetshenziswa kwe-prosthesis ebaluleke kakhulu ngokwesimo somzimba eyenziwe ngamavithamini futhi yabunjwa nge-humerus eseduze yesidumbu. Lokhu kwasetshenziswa ngempumelelo ekwelapheni isiguli esincane esine-osteonecrosis yekhanda le-humeral.
Kodwa ukufakwa esikhundleni kwamahlombe kwesimanje ngempela kwaklanywa futhi kwathuthukiswa yisazi samahlombe uCharles Neer. Ngo-1953, ukuze kuxazululwe imiphumela engagculisi yokwelashwa kwayo ngokuhlinzwa kokuphuka kwe-humeral proximal, uNeer wakha i-prosthesis ye-humeral prosthesis yokwakheka kokuphuka kwekhanda le-humeral, eyathuthukiswa izikhathi eziningana eminyakeni engamashumi amabili eyalandela, ngokulandelana. Yaklama i-prostheses yesizukulwane sesibili nesesithathu.
Ngasekuqaleni kwawo-1970, ukuze kuxazululwe ukufakwa esikhundleni sehlombe ezigulini ezinezinkinga ezinkulu ze-rotator cuff, umqondo we-reverse shoulder arthroplasty (RTSA) wahlongozwa okokuqala yiNeer, kodwa ngenxa yokwehluleka kokuqala kwengxenye ye-glenoid, lo mqondo washiywa kamuva. Ngo-1985, uPaul Grammont wathuthuka ngokusho komqondo ohlongozwa yiNeer, ehambisa isikhungo sokujikeleza phakathi nakude, eshintsha ingalo yesikhashana kanye nokucindezeleka kwe-deltoid, ngaleyo ndlela exazulula ngokuphelele inkinga yokulahlekelwa umsebenzi we-rotator cuff.
Izimiso zokuklama ze-trans-shoulder prosthesis
I-arthroplasty yehlombe elingemuva (i-RTSA) iguqula ubudlelwano bokwakheka kwehlombe lemvelo ukuze kubuyiselwe ukuzinza kwehlombe. I-RTSA idala i-fulcrum kanye ne-center of rotation (i-CoR) ngokwenza uhlangothi lwe-glenoid lube yi-convex kanye nohlangothi lwekhanda le-humeral lube yi-concave. Umsebenzi we-biomechanical walesi fulcrum ukuvimbela ikhanda le-humeral ukuthi linganyuki liye phezulu lapho imisipha ye-deltoid ifinyela ukuze ibambe ingalo engenhla. Isici se-RTSA ukuthi isikhungo sokujikeleza se-joint yehlombe lokwenziwa kanye nendawo yekhanda le-humeral maqondana nehlombe lemvelo kushukunyiswa ngaphakathi naphansi. Imiklamo ehlukene ye-prosthesis ye-RTSA ihlukile. Ikhanda le-humeral lishukunyiswa phansi ngo-25 ~ 40mm bese lishukunyiswa ngaphakathi ngo-5 ~ 20mm.
Uma kuqhathaniswa nokuhlangana kwehlombe kwemvelo komzimba womuntu, inzuzo esobala ye-CoR yokushintsha kwangaphakathi ukuthi ingalo yomzuzu wokuthumba ye-deltoid iyanda kusuka ku-10mm kuya ku-30mm, okuthuthukisa ukusebenza kahle kokuthumba kwe-deltoid, futhi kungakhiqizwa amandla amancane emisipha. I-torque efanayo, kanye nalesi sici kwenza nokuthumba ikhanda le-humeral kungasaxhomeki ngokuphelele emsebenzini wokucindezeleka we-rotator cuff ephelele.
Lona umklamo kanye ne-biomechanics ye-RTSA, futhi kungase kube yinto eyisicefe futhi kube nzima ukuyiqonda. Ingabe ikhona indlela elula yokuyiqonda? Impendulo inguyebo.
Okokuqala ukwakheka kwe-RTSA. Qaphela ngokucophelela izici zelungu ngalinye lomzimba womuntu, singathola imithetho ethile. Amalunga omuntu angahlukaniswa ngezigaba ezimbili. Elinye limalunga aseduze nesiqu njengamahlombe nezinqe, kanti ukuphela okuseduze "kuyindebe" kanti ukuphela okukude "kuyibhola".
Olunye uhlobo ngamajoyinti akude njengeamadolokanye nezindololwane, lapho ingxenye eseduze iyibhola kanti ingxenye ekude iyindebe.
Uhlelo olwamukelwa ochwepheshe bezokwelapha lapho beklama izitho zokufakelwa zamahlombe ezenziwe ngesikhumba ezinsukwini zokuqala kwakuwukubuyisela isakhiwo somzimba sehlombe lemvelo ngangokunokwenzeka, ngakho-ke wonke amapulani aklanywa ngesiphetho esiseduze "njengendebe" kanye nesiphetho esikude "njengebhola". Abanye abacwaningi baze baklama ngamabomu "indebe" ukuba ibe nkulu futhi ijule ukuze kwandiswe ukuzinza kwelungu, okufana nokwabantu.ilunga lesinqe, kodwa kamuva kwafakazelwa ukuthi ukwandisa ukuzinza empeleni kwandise izinga lokuhluleka, ngakho-ke lo mklamo wamukelwa ngokushesha. Yeka. Ngakolunye uhlangothi, i-RTSA iguqula izici zomzimba zehlombe lemvelo, iguqula "ibhola" kanye "nendebe", okwenza ilunga lokuqala "le-hip" libe njenge-"elbow" noma "idolo". Lolu shintsho olugumbuqela ekugcineni luxazulule ubunzima obuningi kanye nokungabaza kokufakwa esikhundleni kwehlombe lokwenziwa, futhi ezimweni eziningi, ukusebenza kwalo kwesikhathi eside nesikhathi esifushane kuye kwathuthukiswa kakhulu.
Ngokufanayo, ukwakheka kwe-RTSA kushintsha indawo ephakathi yokujikeleza ukuze kuvunyelwe ukusebenza kahle kokuthumba i-deltoid, okungase kuzwakale kungacacile. Futhi uma siqhathanisa ihlombe lethu ne-seesaw, kulula ukuyiqonda. Njengoba kuboniswe esithombeni esingezansi, ukusebenzisa i-torque efanayo ohlangothini lwe-A (amandla okugoba i-deltoid), uma i-fulcrum kanye nendawo yokuqala kushintshwa, kusobala ukuthi i-torque enkulu (amandla okuthumba ingalo ephezulu) ingadalwa ohlangothini lwe-B.
Ushintsho endaweni ephakathi nendawo ye-RTSA lunomphumela ofanayo, okuvumela ihlombe elingazinzile ukuthi liqale ukuthunjwa ngaphandle kokucindezeleka kwe-rotator cuff. Njengoba u-Archimedes eshilo: Nginike i-fulcrum futhi ngingakwazi ukuhambisa wonke umhlaba!
Izinkomba ze-RTSA kanye ne-Contraindications
Isibonakaliso esivamile se-RTSA yi-rotator cuff tear arthropathy (CTA), ukudabuka okukhulu kwe-rotator cuff okune-osteoarthritis, okuvame ukubonakala ngokusuka phezulu kwekhanda le-humeral, okuholela ekutheni i-glenoid, i-acromion kanye nekhanda le-humeral ziqhubeke nokushintshashintsha. Ukusuka 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 kungenzeka khona "i-pseudoparalysis" yakudala.
Ukusetshenziswa kwe-shoulder arthroplasty, ikakhulukazi i-RTSA, kuye kwanda kakhulu eminyakeni engamashumi amabili edlule. Ngokusekelwe emiphumeleni yokuqala ephumelelayo yokusetshenziswa kwe-RTSA, ukuthuthukiswa okuqhubekayo kobuchwepheshe bokuhlinzwa, kanye nokusetshenziswa kahle kwale ndlela, izinkomba zokuqala ezincane ze-RTSA zandisiwe, ngakho-ke, izinqubo eziningi ze-shoulder arthroplasty ezenziwayo njengamanje yi-RTSA.
Isibonelo, i-anatomical total shoulder arthroplasty (i-ATSA) kwakuyindlela ekhethwayo ye-shoulder osteoarthritis ngaphandle kwe-rotator cuff tear esikhathini esidlule, kodwa eminyakeni yamuva nje, inani labantu abanalo mbono libonakala lincipha kancane kancane. Kunezici ezilandelayo. Izizathu ziholele kulokhu kuthambekela. Okokuqala, kufika ku-10% weziguli ezithola i-ATSA sezivele zine-rotator cuff tear. Okwesibili, kwezinye izimo, ubuqotho "besakhiwo" "bomsebenzi" we-rotator cuff abuphelele, ikakhulukazi kwezinye iziguli esezikhulile. Okokugcina, noma ngabe i-rotator cuff iphelele ngesikhathi sokuhlinzwa, ukuwohloka kwe-rotator cuff kwenzeka ngokuguga, ikakhulukazi ngemva kwezinqubo ze-ATSA, futhi empeleni kukhona ukungaqiniseki okukhulu mayelana nomsebenzi we-rotator cuff. Lesi simo sivame ukwenzeka ezigulini esezikhulile ezineminyaka engaphezu kwengu-70. Ngakho-ke, odokotela abaningi abahlinzayo baqala ukukhetha i-RTSA lapho bebhekene ne-osteoarthritis yamahlombe ahlanzekile. Lesi simo siholele ekucabangeni okusha kokuthi i-RTSA ingaba yisinqumo sokuqala seziguli ezine-osteoarthritis ezine-rotator cuff engaguquki ngokusekelwe kuphela eminyakeni yobudala.
Ngokufanayo, esikhathini esidlule, ngezehlo ze-mass rotator cuff tears (MRCT) ezingenakulungiswa ngaphandle kwe-osteoarthritis, ezinye izindlela zifaka phakathi i-subacromial decompression, i-partial rotator cuff reconstruction, i-Chinese way, kanye ne-upper joint capsule reconstruction. , izinga lempumelelo liyahlukahluka. Ngokusekelwe kubuchwepheshe kanye nokusetshenziswa ngempumelelo kwe-RTSA ezimweni ezahlukahlukene, opharetha abaningi basanda kuzama i-RTSA lapho bebhekene ne-MRCT elula, futhi iphumelele kakhulu, ngesilinganiso sokusinda seminyaka eyi-10 sokufakelwa esingaphezu kwama-90%.
Ngamafuphi, ngaphezu kwe-CTA, izinkomba zamanje ezandisiwe ze-RTSA zifaka phakathi ukudabuka okukhulu kwe-rotator cuff okungenakulungiswa ngaphandle kwe-osteoarthropathy yokuvuvukala, amathumba, ukuphuka okukhulu, i-arthritis yangemva kwenhlekelele, amaphutha ethambo noma amalunga amathambo akhubazeke kakhulu, ukuvuvukala, kanye nokuhlukana kwamahlombe okuphindaphindiwe.
Zimbalwa izinto ezingavumelani ne-RTSA. Ngaphandle kwezinto eziphikisanayo ezijwayelekile zokufakwa esikhundleni kwamalunga okwenziwa njengokutheleleka, ukungasebenzi kahle kwemisipha ye-deltoid kuyizinto eziphikisanayo ngokuphelele ne-RTSA. Ngaphezu kwalokho, ngokuqhekeka kwe-proximal humerus, ukuqhekeka okuvulekile kanye nokulimala kwe-brachial plexus kufanele futhi kubhekwe njengezingavumelani, kuyilapho ukulimala kwe-axillary nerve okuhlukile kufanele kubhekwe njengezingavumelani.
Ukunakekelwa kanye nokuvuselelwa ngemva kokuhlinzwa
Izimiso zokuvuselelwa ngemva kokuhlinzwa:
Vuselela intshiseko yeziguli yokuvuselelwa futhi uhlele amathemba afanele ezigulini.
Kunciphisa ubuhlungu nokuvuvukala, futhi kuvikela izakhiwo zokuphulukisa, kodwa ngokuvamile ama-subscapularis awadingi ukuvikelwa.
Ukuhlukana kwangaphambi kwehlombe kungenzeka ezindaweni zokugcina ze-hyperextension, adduction kanye nokujikeleza kwangaphakathi, noma ukuthunjwa kanye nokujikeleza kwangaphandle. Ngakho-ke, ukunyakaza okufana ne-backhands kufanele kugwenywe amasonto amane kuya kwayisithupha ngemva kokuhlinzwa. Lezi zikhundla zinobungozi bokuhlukana.
Ngemva kwamasonto amane kuya kwayisithupha, kusadingeka ukuxhumana nodokotela ohlinzayo nokuthola imvume ngaphambi kokuqala ukunyakaza nezikhundla ezingenhla.
Ukuzivocavoca kokuvuselelwa ngemva kokuhlinzwa kufanele kwenziwe kuqala ngaphandle kokuthwala isisindo bese kuba nokuthwala isisindo, kuqala ngaphandle kokumelana bese kuba nokumelana, kuqala ngaphandle kokungenelela bese kuba ngokusebenza.
Okwamanje, akukho simiso sokuvuselela esiqinile nesifanayo, futhi kunomehluko omkhulu ezinhlelweni zabacwaningi abahlukene.
Isu lemisebenzi yesiguli yokuphila kwansuku zonke (ama-ADL) (amasonto angu-0-6):
Ukugqoka izingubo
Ukulala
Isu lokuzivocavoca nsuku zonke (amasonto angu-0-6):
Ukugoba kwendololwane okusebenzayo
Ukugoba kwehlombe okungenamsebenzi
I-Sichuan Chenanhui Techonology Co., Ltd.
I-Whatsapp:+8618227212857
Isikhathi sokuthunyelwe: Novemba-21-2022
