Nkhani - Mbiri ya Kulowa M'malo mwa Mapewa

Lingaliro la kusintha mapewa opangidwa linayambitsidwa koyamba ndi Themistocles Gluck mu 1891. Mafupa opangidwa omwe atchulidwa ndi kupangidwa pamodzi akuphatikizapo chiuno, dzanja, ndi zina zotero. Opaleshoni yoyamba yosintha mapewa inachitidwa pa wodwala mu 1893 ndi dokotala wa opaleshoni wa ku France Jules Emile Péan ku Hôpital International ku Paris pa wodwala wazaka 37 yemwe ali ndi chifuwa chachikulu cha mafupa ndi mafupa. Cholembedwa choyamba cha arthroplasty ya mapewa. Chojambulacho chinapangidwa ndi dokotala wa mano J. Porter Michaels wochokera ku Paris, ndipo chotupacho chinapangidwa ndi humeral.tsindelinapangidwa ndi chitsulo cha platinamu ndipo linalumikizidwa ku mutu wa rabara wophimbidwa ndi paraffin ndi waya kuti lipange cholumikizira cholimba. Zotsatira zoyambirira za wodwalayo zinali zokhutiritsa, koma cholumikiziracho chinachotsedwa patatha zaka ziwiri chifukwa cha kubwereranso kwa chifuwa chachikulu. Uku ndi kuyesa koyamba komwe anthu adachita posintha mapewa awo.

Mu 1951, Frederick Krueger adanena kuti anagwiritsa ntchito njira yopangira mapewa yofunika kwambiri yopangidwa ndi mavitamini ndipo inapangidwa kuchokera ku humerus yapafupi ya mtembo. Njira imeneyi inagwiritsidwa ntchito bwino pochiza wodwala wachinyamata yemwe ali ndi osteonecrosis ya mutu wa humeral.

Koma njira yatsopano yosinthira mapewa inapangidwa ndi katswiri wa mapewa Charles Neer. Mu 1953, pofuna kuthetsa zotsatira zosakhutiritsa za chithandizo chake cha opaleshoni ya kusweka kwa fupa la proximal humeral, Neer anapanga prosthesis ya proximal humeral prosthesis ya kusweka kwa mutu wa fupa la humeral, yomwe inakonzedwa kangapo m'zaka makumi awiri zotsatira, motsatana. Anapanga prostheses ya m'badwo wachiwiri ndi wachitatu.

Kumayambiriro kwa zaka za m'ma 1970, pofuna kuthetsa vuto la kusintha kwa mapewa mwa odwala omwe ali ndi vuto lalikulu la rotator cuff, lingaliro la reverse shoulder arthroplasty (RTSA) linaperekedwa koyamba ndi Neer, koma chifukwa cha kulephera koyambirira kwa glenoid component, lingaliroli linasiyidwa pambuyo pake. Mu 1985, Paul Grammont adasintha malinga ndi lingaliro lomwe Neer adapereka, akusuntha pakati pa kuzungulira pakati ndi kutali, kusintha mkono wa nthawi ndi kupsinjika kwa deltoid, motero kuthetsa bwino vuto la kutayika kwa ntchito ya rotator cuff.

Mfundo zopangira opaleshoni ya trans-shoulder prosthesis

Kubwezeretsa mafupa a mafupa (RTSA) kumathetsa ubale wa thupi la phewa lachilengedwe kuti libwezeretse kukhazikika kwa phewa. RTSA imapanga fulcrum ndi center of rotation (CoR) mwa kupanga glenoid side convex ndi humeral head side concave. Ntchito ya biomechanical ya fulcrum iyi ndikuletsa mutu wa humeral kuti usasunthire mmwamba pamene minofu ya deltoid ikugunda kuti igwire mkono wapamwamba. Mbali ya RTSA ndi yakuti pakati pa phewa lopangidwa ndi malo ndi malo a mutu wa humeral poyerekeza ndi phewa lachilengedwe zimasunthidwa mkati ndi pansi. Mapangidwe osiyanasiyana a RTSA prosthesis ndi osiyana. Mutu wa humeral umasunthidwa pansi ndi 25~40mm ndikusunthidwa mkati ndi 5~20mm.

Poyerekeza ndi cholumikizira chachilengedwe cha phewa la thupi la munthu, ubwino woonekeratu wa CoR yosuntha mkati ndikuti mkono wa deltoid wothamanga pang'onopang'ono umawonjezeka kuchoka pa 10mm mpaka 30mm, zomwe zimapangitsa kuti deltoid igwire bwino ntchito, ndipo mphamvu zochepa za minofu zimatha kupangidwa. Mphamvu yomweyo, komanso mawonekedwe awa, zimapangitsanso kuti kugundana kwa mutu wa humeral kusadalirenso ntchito yochepetsa mphamvu ya rotator cuff yonse.

Iyi ndi njira yopangira ndi kupanga makina a RTSA, ndipo ikhoza kukhala yosasangalatsa komanso yovuta kumvetsetsa. Kodi pali njira yosavuta yoimvetsetsera? Yankho ndi inde.

Choyamba ndi kapangidwe ka RTSA. Yang'anirani mosamala mawonekedwe a chiwalo chilichonse cha thupi la munthu, titha kupeza malamulo ena. Ziwalo za anthu zitha kugawidwa m'magulu awiri. Chimodzi ndi ziwalo zomwe zili pafupi ndi thunthu monga mapewa ndi chiuno, pomwe kumapeto kwake kuli "chikho" ndipo kumapeto kwake kuli "mpira".

Mtundu wina ndi malo olumikizirana akutali mongamawondondi zigongono, pomwe mbali yapafupi ndi "mpira" ndipo mbali yakutali ndi "chikho".

Ndondomeko yomwe akatswiri azachipatala adagwiritsa ntchito popanga ma prostheses opangira mapewa m'masiku oyambirira inali yobwezeretsa kapangidwe ka thupi la phewa lachilengedwe momwe zingathere, kotero mapulani onse adapangidwa ndi kumapeto kwa proximal ngati "chikho" ndi kumapeto kwakutali ngati "mpira". Ofufuza ena adapanga dala "chikho"cho kuti chikhale chachikulu komanso chakuya kuti chikhale cholimba, chofanana ndi cha munthu.cholumikizira cha m'chiunoKoma pambuyo pake zinatsimikiziridwa kuti kuwonjezera kukhazikika kwenikweni kunawonjezera kuchuluka kwa kulephera, kotero kapangidwe kameneka kanagwiritsidwa ntchito mwachangu. Kumbali ina, RTSA imasinthira mawonekedwe a phewa lachilengedwe, kutembenuza "mpira" ndi "chikho", zomwe zimapangitsa kuti cholumikizira choyambirira cha "chiuno" chikhale ngati "chigongono" kapena "bondo". Kusintha kumeneku kosokoneza pamapeto pake kunathetsa mavuto ambiri ndi kukayikira za kusintha kwa phewa lochita kupanga, ndipo nthawi zambiri, mphamvu yake yayitali komanso yaifupi yakhala ikuwonjezeka kwambiri.

Momwemonso, kapangidwe ka RTSA kamasinthasintha pakati pa kuzungulira kuti zithandize kuti deltoid abdomination igwire bwino ntchito, zomwe zingamvekenso zosamveka bwino. Ndipo ngati tiyerekeza phewa lathu ndi seesaw, n'zosavuta kumvetsetsa. Monga momwe chithunzi chili pansipa chikusonyezera, kugwiritsa ntchito torque yomweyo mu A direction (deltoid contraction force), ngati fulcrum ndi starting position zasinthidwa, n'zoonekeratu kuti torque yayikulu (upper arm abdomination force) ikhoza kupangidwa mu B direction.

Kusintha kwa malo ozungulira a RTSA kuli ndi zotsatira zofanana, zomwe zimapangitsa kuti phewa losakhazikika liyambe kuba popanda kupsinjika kwa rotator cuff. Monga momwe Archimedes adanenera: Ndipatseni gawo lofunikira ndipo nditha kusuntha dziko lonse lapansi!

Zizindikiro ndi Zotsutsana za RTSA

Chizindikiro cha RTSA ndi rotator cuff tear arthropathy (CTA), yomwe ndi rotator cuff tear fracture yomwe imadziwika ndi osteoarthritis, yomwe nthawi zambiri imadziwika ndi kusuntha kwa mutu wa humeral mmwamba, zomwe zimapangitsa kuti glenoid, acromion ndi mutu wa humeral zipitirire kusintha. Kusuntha kwa mutu wa humeral mmwamba kumachitika chifukwa cha mphamvu zosakwanira zomwe zimachitika chifukwa cha deltoid pambuyo pa rotator cuff yosagwira ntchito bwino. CTA imapezeka kwambiri mwa akazi okalamba, komwe "pseudoparalysis" yachikhalidwe ingachitike.

Kugwiritsa ntchito njira yopangira opaleshoni ya paphewa, makamaka RTSA, kwawonjezeka kwambiri m'zaka makumi awiri zapitazi. Kutengera zotsatira zabwino zoyambirira za kugwiritsa ntchito njira ya RTSA, kupita patsogolo kosalekeza kwa njira yopangira opaleshoni, komanso kugwiritsa ntchito bwino njira imeneyi, zizindikiro zoyamba zochepa za RTSA zawonjezeka, ndipo chifukwa chake, njira zambiri zopangira opaleshoni ya paphewa zomwe zikuchitika pano ndi RTSA.

Mwachitsanzo, anatomical total shoulder arthroplasty (ATSA) inali njira yabwino kwambiri yochizira matenda a osteoarthritis a paphewa popanda rotator cuff tear m'mbuyomu, koma m'zaka zaposachedwapa, chiwerengero cha anthu omwe ali ndi lingaliro limeneli chikuoneka kuti chikuchepa pang'onopang'ono. Pali zinthu zotsatirazi. Zifukwa zomwe zapangitsa kuti izi zichitike. Choyamba, mpaka 10% ya odwala omwe amalandira ATSA ali kale ndi rotator cuff tear. Chachiwiri, nthawi zina, "kapangidwe" ka "ntchito" ya rotator cuff sikukwanira, makamaka kwa odwala ena okalamba. Pomaliza, ngakhale rotator cuff ili bwino panthawi ya opaleshoni, rotator cuff degeneration imachitika ndi ukalamba, makamaka pambuyo pa opaleshoni ya ATSA, ndipo pali kusatsimikizika kwakukulu pa ntchito ya rotator cuff. Izi nthawi zambiri zimachitika kwa odwala okalamba opitirira zaka 70. Chifukwa chake, madokotala ambiri ochita opaleshoni anayamba kusankha RTSA akakumana ndi osteoarthritis ya paphewa. Izi zapangitsa kuti anthu aganize kuti RTSA ikhozanso kukhala chisankho choyamba kwa odwala omwe ali ndi osteoarthritis omwe ali ndi rotator cuff yosatha kutengera zaka zawo.

Mofananamo, kale, pa misozi ya massive rotator cuff tears (MRCT) yosakonzedwanso popanda osteoarthritis, njira zina zimaphatikizapo subacromial decompression, partial rotator cuff reconstruction, Chinese way, ndi upper joint capsule reconstruction. , kuchuluka kwa kupambana kumasiyana. Kutengera luso ndi kugwiritsa ntchito bwino kwa RTSA m'mikhalidwe yosiyanasiyana, ogwiritsa ntchito ambiri ayesa RTSA posachedwapa polimbana ndi MRCT yosavuta, ndipo yakhala yopambana kwambiri, ndi chiŵerengero cha moyo wa zaka 10 choposa 90%.

Mwachidule, kuwonjezera pa CTA, zizindikiro zomwe zikuwonjezeka pakali pano za RTSA zikuphatikizapo misozi ikuluikulu yosasinthika ya rotator cuff yopanda kutupa kwa mafupa, zotupa, kusweka kwadzidzidzi, nyamakazi yodwala pambuyo pa zoopsa, zolakwika za mafupa kapena mafupa ofooka kwambiri, kutupa, ndi kusokonekera kwa mapewa mobwerezabwereza.

Pali zinthu zochepa zotsutsana ndi RTSA. Kupatulapo zinthu zambiri zotsutsana ndi kusintha kwa mafupa opangidwa monga matenda, kusagwira ntchito kwa minofu ya deltoid ndi chinthu chotsutsana ndi RTSA. Kuphatikiza apo, pa kusweka kwa humerus yoyandikana nayo, kusweka kwa mafupa otseguka ndi kuvulala kwa brachial plexus kuyeneranso kuonedwa ngati zinthu zotsutsana, pomwe kuvulala kwa mitsempha ya m'khwapa kuyenera kuonedwa ngati zinthu zotsutsana.

Chisamaliro ndi kukonzanso pambuyo pa opaleshoni

Mfundo zofunika pakubwezeretsa munthu pambuyo pa opaleshoni:

Limbikitsani chidwi cha odwala kuti alandire chithandizo choyenera komanso kukhazikitsa ziyembekezo zoyenera kwa odwala.

Amachepetsa ululu ndi kutupa, ndipo amateteza ziwalo zochiritsira, koma nthawi zambiri subscapularis sifunikira kutetezedwa.

Kusuntha kwa phewa kutsogolo kungachitike kumapeto kwa hyperextension, adduction ndi internal rotation, kapena abdomination ndi external rotation. Chifukwa chake, mayendedwe monga backhands ayenera kupewedwa kwa milungu 4 mpaka 6 pambuyo pa opaleshoni. Malo awa ali ndi chiopsezo chosuntha.

Pambuyo pa masabata 4 mpaka 6, ndikofunikirabe kulankhulana ndi kupeza chilolezo kuchokera kwa dokotala wa opaleshoni musanayambe mayendedwe ndi malo omwe ali pamwambapa.

Maseŵero olimbitsa thupi pambuyo pa opaleshoni ayenera kuchitidwa poyamba popanda kunyamula zolemera kenako ndi kunyamula zolemera, choyamba popanda kukana kenako ndi kukana, choyamba mopanda kuchitapo kanthu kenako mwachangu.

Pakadali pano, palibe muyezo wokhwima komanso wofanana wokonzanso, ndipo pali kusiyana kwakukulu m'mapulani osiyanasiyana a ofufuza.

Ndondomeko ya zochita za odwala za tsiku ndi tsiku (ADLs) (masabata 0-6):