Lingaliro la kulowa kwa mapewa oyesedwa kale ndi gluskocles gluck mu 1891. Kupikisana ndi zojambulazo Mapewa arthroplasty. Prososthesis adapangidwa ndi mano j. Porter Michaels ochokera ku Paris, ndi kuliranthambiadapangidwa ndi chitsulo chapupom ndikuphatikizidwa ndi mutu wolumikizidwa wa mphira ndi waya kuti apange chopinga. Zotsatira zoyambirira za wodwalayo zinali zokhutiritsa, koma ma prosthelis adachotsedwa pambuyo pa zaka ziwiri chifukwa cha kubwereza kangapo kwa chifuwa chachikulu. Uku ndikuyesa koyamba kwa anthu omwe ali ndi vuto la ult.
Mu 1951, Frederick Kruger adanenanso kugwiritsa ntchito mapewa ofunikira kwambiri opangidwa ndi mavitamini ndikupangidwa kuchokera ku Humesil Humer ya Cadaver. Izi zidagwiritsidwa ntchito bwino kuchitira wodwala wodwala ndi osteones of the Humeral mutu
Koma zodziwikiratu zamapewa zamapewa zomwe zidapangidwa ndikupangidwa ndi phewa Guru Charles. Mu 1953, kuti athetse zotsatira zosakhutiritsa chifukwa cha opaleshoni ya opanga matenda a a opaleshoni, neer adapanga ma prompul a matenda a matenda a Humeral mutu, zomwe zidawasinthira kangapo m'zaka ziwiri zotsatirazi, motsatana. Zopangidwa ndi zipilala zachiwiri ndi zachitatu.
Kumayambiriro kwa m'ma 1970, kuti athetsetsetsetsa kulowa kwa phewa kwa odwala omwe ali ndi rotator croftoction cuerction, koma chifukwa cha kulephera koyambirira kwa glenoid, lingaliro lidasiyidwa. Mu 1985, Paulo galamalamomonit adasintha molingana ndi neer, kusuntha pakati pa kuzungulira kwakanthawi komanso kusinthitsa mkono ndi zovuta za deltoid, motero kuthetsa vuto la vutor Cuff Staff Cuff Caction Staff Cuff Staff Staff Cuff Caction?
Kupanga mfundo za mapewa
Kusintha kwa Arthroplasty (RTSA) kumabweza ubale wa Anatomical kwa phewa lachilengedwe kuti abwezeretse phewa. RTSA imapanga mokwanira ndi kuzungulira (Kor) popanga Glenoid Stvex ndi Humeral mutu. Ntchito ya biomachalchanical ya uphulu uwu ndikupewa mutu wa Humeral mutu kuchokera kumtunda pomwe ma cell a deltoid minofu kuti achotse mkono wapamwamba. Gawo la RTSA ndikuti likulu lazozungulira pamapewa olumikizirana ndi udindo wa a Humeral mutu wa a Humeral kupita ku phewa lachilengedwe limasunthidwa mkati ndi pansi. Zojambula zosiyanasiyana za RTSA Prosthesis ndizosiyana. Mutu wa Humeral umasunthidwa pansi ndi 25 ~ 40mm ndikusunthira mkati mwa 5 ~ 20mm.
Poyerekeza ndi mawonekedwe achilengedwe a thupi la munthu, mwayi wodziwika bwino wa kanjeme kake ndi kamene kalikonse ku Deltoid imachulukitsa kuchokera ku 10mm, yomwe imathandizira mphamvu ya deltoid, ndipo kuchepera kwa minofu kumatha kupangidwa. Torque yomweyo, ndipo izi zimapangitsanso kuperekera kwa mutu wa Humet sikudalira kwathunthu ntchito yakuvutika kwa mbozi yathunthu.
Uku ndi kapangidwe kake ndi biomwenasnanics a RTSA, ndipo mwina kungakhale kotopetsa komanso kovuta kumvetsetsa. Kodi pali njira yosavuta yomvetsetsa? Yankho ndi inde.
Woyamba ndi kapangidwe ka RTSA. Onani mosamala mapangidwe a gawo lililonse la thupi la munthu, titha kupeza malamulo ena. Malumikizidwe a anthu amatha kugawidwa m'magulu awiri. Wina ndi mafupa pafupi ndi mapewa ndi m'chiuno, pofika kumapeto kwenikweni kukhala "chikho" ndi kumapeto kwa nthawi kukhala "mpira".
Mtundu wina ndi zolumikizana mongamadandoNdipo malekezero, ndi kumapeto kwenikweni kukhala "mpira" ndi kumapeto kwenikweni kukhala "chikho".
Dongosolo lomwe latengera apainiya azachipatala popanga masitepe ophatikizika m'masiku oyamba anali kuti abwezeretse dongosolo lachilengedwe momwe angathere, motero mapulani onse adapangidwa ndi gawo la "Mpira" ndi gawo ". Ofufuza ena adapanga mwadala mwadala "chikho" mwadala ndikuzama ndikuzama kuti muwonjezere kukhazikika kwa cholumikizira, ofanana ndi munthum'chiuno cholumikizira, koma pambuyo pake zidatsimikiziridwa kuti zikuwonjezera chidalirocho zinakulitsa chiletso, motero kapangidwe kameneka kanapangidwa mwachangu. taya mtima. Komabe, RTSA, kubwereza pamapewa a chilengedwe, ndikusintha "mpira" ndi "chikho", ndikupanga bondo "lolumikizana". Kusintha kumeneku pomaliza kunathetsa mavuto ambiri komanso kukayikira kwa phewa lamphamvu, ndipo nthawi zambiri, nthawi yayitali ndi yochepa kwambiri yasintha kwambiri.
Momwemonso, mapangidwe a RTSA amasuntha pakatikati pa kuzungulira kuti alole kuchuluka kwa deltod zoponyera, zomwe zimamvekanso. Ndipo ngati tifanizira phewa lathu lolumikizana ndi Seesaw, ndizosavuta kumvetsetsa. Monga taonera m'chigawo pansipa, kugwiritsa ntchito torque yomweyo kulowera (kovomerezeka)
Kusintha kwa malo ozungulira a RTSA kumachitikanso mofananamo, kuloleza phewa kuti ayambe kuba; Monga mabiradedes adati: Ndipatseni kwathunthu ndipo nditha kusuntha dziko lonse lapansi!
Zisonyezo za RTSA ndi contraindication
Chizindikiro chazachilengedwe cha RTSA ndi Clatotor Cuff Steff Arthropathy (CTA), GTATORTART Cuff Cuff, yomwe nthawi zambiri imayang'aniridwa ndi kusamutsidwa kwa Glenoid. Kusanja kwamtsogolo kwa mutu wa Humeral kumachitika chifukwa cha banja lopanda mphamvu mothandizidwa ndi deltoid pambuyo pa nthoti cutfftion. CTA ikufala kwambiri mu azimayi achikulire, pomwe pseudalysis "imatha kuchitika.
Kugwiritsa ntchito phewa arthroplasty, makamaka RTSA, kwachuluka kwambiri pazaka makumi awiri zapitazi. Kutengera zotsatira zopambana za RTSA Kugwiritsa ntchito, chitukuko chopitilira muyeso, ndi luso lapakati pa njirayi, zisonyezo zowoneka bwino za RTSA zatha, motero, mapewa ambiri a arsasty.
Mwachitsanzo. Pali mbali zotsatirazi. Zifukwa zapangitsa kuti izi zichitike. Choyamba, mpaka 10% ya odwala omwe amalandila kale ali ndi vuto ya rotator misozi. Chachiwiri, nthawi zina, "zovuta" kukhulupirika kwa "ntchito" kwa cutototor syff sikumatha, makamaka kwa odwala okalamba. Pomaliza, ngakhale ngati vatitor cuff ndi yotsimikizika pa nthawi ya opaleshoni, colator cuff staff imachitika ndi zaka za ku Asa, ndipo pali zosatsimikizika zambiri za ntchito ya cuftor cuff. Izi nthawi zambiri zimapezeka mwa okalamba okalamba zaka 70. Chifukwa chake, ochita opaleshoni ambiri adayamba kusankha RTSA akakumana ndi mapewa oyera astearthritis. Izi zadzetsa malingaliro atsopano omwe RTSSA angakhale chisankho choyambirira kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi miyala yokhazikika.
Momwemonso, m'mbuyomu, kwa rotator yosasinthika ya crouftor cuff (mrct) popanda kugweronarthritis, njira zina zimaphatikizapo kugwetsa kocheperako, njira yachinayi, ndi kukonzanso kolumikizana komwe kumamanganso. , kupambana kumasiyana. Kutengera ndi luso komanso kugwiritsa ntchito bwino RTSA pamavuto osiyanasiyana, ogwiritsa ntchito ambiri ayesapo RTSA ngakhale atakumana ndi mrctival, ndi kupulumuka kwa zaka 10.
Mwachidule, kuwonjezera pa CTA, zisonyezo zomwe zatulutsidwa zamakono za RTSA zimaphatikizapo zazikulu za nthoti zopanda pake zopanda pake, zotupa za pachimake, zotupa zopondera kapena mafupa opindika kwambiri. kutupa, komanso mapewa osinthika.
Pali contraindication pang'ono ku RTSA. Kupatula kwa General contraindications ya zojambula zophatikizika monga matenda, osagwira ntchito minofu ya Deltoid ndi chotsutsana ndi rtassa. Kuphatikiza apo, chifukwa cha humsimal humerus fractures, zowonongeka zotsekemera komanso zowonongeka za bralial ziyeneranso kuonedwa ngati zotsutsana, pomwe kuperewera kwa mitsempha ya axillary kuyenera kusokonezedwa ndi contraindication.
Chisamaliro chogwiritsira ntchito ndi kukonzanso
Mfundo Zokonzanso Zosankha:
Sonkhanitsani chidwi cha odwala a odwala pokonzanso ndikukhazikitsa chiyembekezo chokwanira kwa odwala.
Amachepetsa ululu ndi kutupa, ndikuteteza machiritso, koma subscapapularis nthawi zambiri sayenera kutetezedwa.
Kusungunuka kwa phewa kwa phewa kumachitika kumapeto kwa hyperrexinon, mankhwala komanso kusintha kwa mkati, kapena kubzala ndi kuzungulira kwakunja. Chifukwa chake, kusunthira monga ma blaxndes ayenera kupewedwa kwa milungu 4 mpaka 6 opareshoni. Maudindowa ali ndi chiopsezo chofuna kusokonekera.
Pambuyo pa masabata 4 mpaka 6, ndikofunikirabe kulumikizana ndi ndi chilolezo kwa dokotalayo musanayambitse magwero ndi maudindo.
Kuchita masewera olimbitsa thupi kuyenera kuchitidwa koyamba osakhala ndi thupi kenako ndikukhala ndi thupi, choyamba osakana kenako ndikulimbana kenako.
Pakadali pano, palibe muyeso wokhwima komanso wofowoka, ndipo pali kusiyana kwakukulu m'malingaliro osiyanasiyana ofufuza.
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Post Nthawi: Nov-21-2022
