Kumayambiriro kwa zaka za m'ma 1990, akatswiri akunja adatsogolera kugwiritsa ntchito zomangira zomangira kuti akonze zinthu monga rotator cuff pogwiritsa ntchito arthroscopy. Chiphunzitsochi chinachokera ku mfundo yothandizira ya "chinthu chomira" pansi pa nthaka ku South Texas, USA, ndiko kuti, pokoka waya wachitsulo pansi pa nthaka pa ngodya ya 45° pansi, nyumba yapansi panthaka imakhazikika mwamphamvu pa "chinthu chomira" kumapeto ena a waya wachitsulo.
Mankhwala amasewera amachokera ku traumatology ya mafupa. Ndi njira yoyambira komanso yodziwika bwino yogwiritsira ntchito mankhwala ndi masewera. Cholinga chake ndikupeza njira yabwino kwambiri yochiritsira popanda kuvulala kwambiri, kuphatikizapo kuvulala kwa meniscus, kuvulala kwa cruciate ligament, kung'ambika kwa rotator cuff, kusakhazikika kwa phewa, kuvulala kwa SLAP, ndi zina zotero. Zonsezi zili mkati mwa chithandizo chamankhwala amasewera.
Anchor ndi chipangizo chachipatala chomwe chimagwiritsidwa ntchito kwambiri mu zamankhwala amasewera ndi opaleshoni ya mafupa. Chimagwiritsidwa ntchito makamaka kumangirira minofu yofewa (monga minyewa, mitsempha, ndi zina zotero) ku mafupa kuti minofu ichiritsidwe ndikuchira. Anchor nthawi zambiri amapangidwa ndi zinthu zogwirizana ndi thupi kuti atsimikizire chitetezo ndi kukhazikika m'thupi.
Malinga ndi magulu a zinthu za anchors, pali magulu awiri akuluakulu: anchors osawonongeka ndi anchors osawonongeka.
Zipangizo zazikulu za ma nangula osawonongeka ndi titaniyamu, nickel-titanium alloy, chitsulo chosapanga dzimbiri, titaniyamu ndi poly-L-lactic acid; ma nangula ambiri omangira omwe amagwiritsidwa ntchito kuchipatala amapangidwa ndi zitsulo, zomwe zili ndi ubwino wokhala ndi mphamvu yogwira bwino, kuyika mosavuta komanso kuwunika mosavuta kwa X-ray.
Zipangizo zazikulu za ma anchor owonongeka ndi poly-D-lactic acid, poly-L-lactic acid, polyglycolic acid, ndi zina zotero. Poyerekeza ndi ma anchor osawonongeka, ma anchor owonongeka ndi osavuta kuwakonzanso, alibe zosokoneza zambiri pazithunzi, ndipo amatha kuyamwa. Angagwiritsidwenso ntchito kwa ana.
Zipangizo zazikulu za anangula
1. Nangula zachitsulo
• Zipangizo: Makamaka zinthu zachitsulo monga titaniyamu.
• Zinthu Zake: Zamphamvu komanso zokhazikika, zomwe zimatha kupereka mphamvu yokhazikika. Komabe, zinthu zojambulira zithunzi zitha kuchitika ndipo pali chiopsezo chogwa.
2. Nangula zotha kunyamulidwa
• Zipangizo: zinthu zomwe zimatha kuyamwa monga polylactic acid (PLLA).
• Zinthu Zake: Pang'onopang'ono thupi likawonongeka, palibe opaleshoni yachiwiri yomwe imafunika kuti lichotsedwe. Komabe, kuchuluka kwa kuwonongeka kungakhale kosakhazikika, ndipo mphamvu yokhazikika imatha kuchepa pakapita nthawi.
3. Zitsulo za Polyetheretherketone (PEEK)
• Zipangizo: ma polima ogwira ntchito kwambiri monga polyetheretherketone.
• Zinthu Zake: Zimapereka mphamvu zambiri pa thupi la misomali ndi mphamvu zake, pomwe zimakhala ndi mgwirizano wabwino ndi thupi lake komanso zotsatira zabwino kwambiri pa kujambula pambuyo pa opaleshoni.
4. Zomangira zomangira zonse
• Kapangidwe kake: Kakakulu kamakhala ndi cholowetsa, chokokera ndi cholumikizira.
• Zinthu Zake: Kakang'ono kwambiri, kapangidwe kofewa, koyenera nthawi zina pamene mafupa enieni atayika kapena malo oyikamo mafupa ndi ochepa.
Malinga ndi kapangidwe ka ma nangula, amatha kugawidwa m'magulu awiri: anangula omangiriridwa ndi opanda mfundo (monga anangula athunthu):
1. Anangula opindika
Ma nangula opindika ndi mitundu yachikhalidwe ya nangula, yomwe imadziwika ndi gawo la nangula yolumikizidwa kumchira wa nangula. Dokotala ayenera kulowetsa nangulayo kudzera mu minofu yofewa ndi singano ndikumanga mfundo kuti amange minofu yofewa ku nangula, kutanthauza pamwamba pa fupa.
• Zipangizo: Ma nangula opindika nthawi zambiri amapangidwa ndi zinthu zosayamwa (monga titaniyamu alloy) kapena zinthu zoyamwa (monga polylactic acid).
• Njira yogwirira ntchito: Nangula imakhazikika mu fupa kudzera mu ulusi kapena mapiko okulitsa, pomwe suture imagwiritsidwa ntchito kulumikiza minofu yofewa ndi nangula, ndipo mphamvu yokhazikika imapangidwa mutamanga mfundo.
• Ubwino ndi kuipa: Ubwino wa ma nangula omangiriridwa ndi mfundo ndi wakuti mphamvu yake yomangira ndi yodalirika komanso yoyenera kuvulala kosiyanasiyana kwa minofu yofewa. Komabe, njira yomangira mfundo ingawonjezere zovuta ndi nthawi yogwirira ntchito, ndipo kupezeka kwa mfundo kungayambitse kupsinjika kwapafupi, zomwe zimawonjezera chiopsezo cha kusweka kwa suture kapena kumasuka kwa nangula.
2. Zonamira zopanda mfundo
Ma anchor opanda mfundo, makamaka ma anchor odzaza ndi suture, ndi mtundu watsopano wa nangula womwe wapangidwa m'zaka zaposachedwa. Khalidwe lake ndilakuti nangula yonse imapangidwa ndi ma suture, ndipo kukhazikika kwa minofu yofewa kumatha kuchitika popanda kumangirira mfundo.
• Zipangizo: Ma anchor athunthu nthawi zambiri amagwiritsa ntchito zinthu zofewa komanso zolimba, monga ulusi wa ultra-high molecular weight polyethylene (UHMWPE).
• Njira Yogwirira Ntchito: Ma anchor athunthu a suture amatha kulowetsedwa mwachindunji mu minofu ya mafupa kudzera mu kapangidwe kake kapadera ka suture ndi njira yoyikiramo, pomwe akugwiritsa ntchito mphamvu ya suture kuti amange minofu yofewa pamwamba pa fupa. Popeza palibe chifukwa chomangira mfundo, zovuta ndi nthawi ya opaleshoni zimachepa, ndipo chiopsezo cha suture kusweka ndi kumasuka kwa anchor chimachepanso.
• Ubwino ndi kuipa: Ubwino wa zomangira zonse za suture ndi ntchito yosavuta ya opaleshoni, mphamvu yokhazikika yokhazikika komanso kuwonongeka kochepa kwa minofu yofewa. Komabe, chifukwa cha kapangidwe kake kapadera, ili ndi zofunikira zambiri pa njira zopangira opaleshoni ndi malo oikiramo. Kuphatikiza apo, mtengo wa zomangira zonse za suture ukhoza kukhala wokwera pang'ono, zomwe zimawonjezera mavuto azachuma kwa odwala.
Ma anangula amagwiritsidwa ntchito kwambiri pa opaleshoni zosiyanasiyana zamankhwala amasewera, monga kukonza ma rotator cuff, kukonza tendon, kumanganso ligament, ndi zina zotero. Chitsanzo cha izi ndi chiyambi cha kugwiritsa ntchito ma anangula opaleshoni pogwiritsa ntchito rotator cuff repair:
• Njira zochitira opaleshoni: Choyamba, dokotala adzayeretsa ndikukonza malo ovulala a rotator cuff; kenako, ikani nangula pamalo oyenera; kenako, gwiritsani ntchito ma shoti kuti mumange minofu ya rotator cuff ku nangula; pomaliza, suture ndi bandeji.
• Zotsatira za opaleshoni: Kudzera mu kukhazikika kwa nangula, kukhazikika ndi kugwira ntchito kwa minofu ya rotator cuff kumatha kubwezeretsedwa, zomwe zimathandiza wodwalayo kuchira.
Ubwino, Zoyipa ndi Machenjezo a Anangula
Ubwino
• Amapereka kukhazikika kokhazikika.
• Imagwiritsidwa ntchito pa kuvulala kosiyanasiyana kwa minofu yofewa.
• Ma nangula ena amatha kuyamwa ndipo safunikira opaleshoni yachiwiri kuti achotsedwe.
Zoyipa
• Zomangira zitsulo zimatha kupanga zinthu zojambulira zithunzi.
• Kuchuluka kwa kuwonongeka kwa ma nangula omwe amatha kuyamwa kungakhale kosakhazikika.
• Pali chiopsezo chakuti nangula ang'ambe kapena suture isweke.
Ma anangula a mankhwala amasewera angagwiritsidwe ntchito pa opaleshoni zotsatirazi:
1. Epicondylitis yobwerezabwereza (tennis elbow) yomwe sinachiritsidwe bwino kwa nthawi zambiri: Ngati chithandizo chokhazikika sichikugwira ntchito, chithandizo cha opaleshoni chingasankhidwe, ndipo nangula ingagwiritsidwe ntchito kulumikizanso malo olowera a radial extensor carpi brevis ku lateral epicondyle ya humerus.
2. Kung'ambika kwa tendon ya biceps yakutali: Misozi yomwe imayambitsidwa ndi kuyenda kosazolowereka, kukoka, kugwedezeka, ndi zina zotero imatha kuchiritsidwa ndi ma waya. Ma waya awiri amakwiriridwa mu radial tuberosity, ndipo waya wammbuyo umakokedwa ku tsinde la biceps tendon.
3. Kuphulika kwa ligament ya chigongono: Kusweka kwa chigongono cha kumbuyo nthawi zambiri kumayenderana ndi kuvulala kwa ligament ya ulnar collateral, makamaka kuvulala kwa anterior bundle. Pa kuvulala kwa ligament ya chigongono cha collateral, akatswiri ambiri amakonda chithandizo cha opaleshoni yoyambirira. Njira ya waya imagwiritsidwa ntchito kukanda pamwamba pa fupa pomwe ligament imalumikizidwa. Pambuyo potuluka magazi atsopano, nangulayo imakulungidwa pamwamba pa fupa pomwe ligament imalumikizidwa, ndipo waya wolukidwa kumapeto kwa msomali umagwiritsidwa ntchito kuluka chitsa cha ligament ndikuchilimbitsa kapena kukonza ligament ndi singano.
4. Kusweka kwa malo olumikizirana otsika a ligament ya cruciate: Kusweka kwa malo olumikizirana a tibial anterior cruciate ligament (ACL) tibial attachment point avulsion ndi mtundu wapadera wa kuvulala kwa ACL ndipo kuyenera kukonzedwa msanga. Kugwiritsa ntchito njira ya waya yolumikizira kuli ndi zizindikiro zambiri ndipo sikungodalira kukula kwa chidutswa chosweka. Sikufuna fluoroscopy mkati mwa opaleshoni kuti musinthe komwe screw ikupita. Opaleshoniyo ndi yosavuta ndipo nthawi yogwirira ntchito imafupikitsidwa mofananamo.
5. Kusakhazikika kwa mafupa: komwe kumachitika chifukwa cha kusakhazikika kwa mafupa komanso kulephera kwa minofu yofewa. Akatswiri ambiri amalimbikitsa chithandizo cha opaleshoni pogwiritsa ntchito zingwe zolumikizira.
6. Kusweka kwa pole ya pansi pa Patellar: Ukadaulo wa waya wolumikizira ungagwiritsidwe ntchito pochiza kusweka kwa pole ya pansi pa patellar. Mwa kukonza kusweka kwa pole ya pansi pa patellar ndi kuluka ndi kusoka ligament ya patellar, umphumphu wa njira yotulutsira bondo ukhoza kubwezeretsedwa ndipo kutalika kogwira mtima kwa njira yotulutsira bondo kumatha kusungidwa.
7. Yoyenera kulumikiza ndi kukhazikika kwa mafupa ndi minofu yofewa m'maopaleshoni a bondo, msana, phewa, chigongono, akakolo, phazi, dzanja ndi manja: Nangula ili ndi kapangidwe ka ulusi wozungulira, womwe ndi wosavuta kuuyika ndipo umapereka mphamvu yolimba yotulutsa, ndipo ndi yoyenera opaleshoni m'malo osiyanasiyana.
Kusamalitsa
• Mkhalidwe wa mafupa a wodwalayo komanso kapangidwe ka thupi la malo ochitira opaleshoni ziyenera kufufuzidwa bwino musanachite opaleshoni.
• Sankhani mtundu woyenera wa nangula ndi zofunikira kuti muwonetsetse kuti opaleshoniyo ikugwira ntchito.
• Maseŵero oyenera obwezeretsa thupi ayenera kuchitika pambuyo pa opaleshoni kuti minofu ichiritsidwe ndikubwezeretsa ntchito yake.
Mwachidule, ma nangula amagwira ntchito yofunika kwambiri pa zamankhwala amasewera. Mwa kusankha mtundu woyenera wa nangula ndi zofunikira zake komanso kutsatira njira zoyenera zochitira opaleshoni ndi njira zodzitetezera, zotsatira za opaleshoniyo zitha kutsimikizika ndipo wodwalayo akhoza kuchira.
Nthawi yotumizira: Disembala-17-2024
