Nkhani - Mbiri Yosinthira Mapewa

Lingaliro la kusintha kwa mapewa ochita kupanga linaperekedwa koyamba ndi Themistocles Gluck mu 1891. Zolumikizana zopangira zomwe zatchulidwa ndikupangidwira pamodzi zimaphatikizapo chiuno, dzanja, ndi zina zotero. Opaleshoni yoyamba yochotsa mapewa inachitidwa pa wodwala mu 1893 ndi dokotala wa opaleshoni wa ku France Jules Emile Péan ku Hôpital. Mayiko ku Paris pa wodwala 37 wazaka zakubadwa ndi chifuwa chachikulu cha mafupa ndi mafupa Yoyamba yolembedwa phewa arthroplasty.Prosthesis inapangidwa ndi dokotala wamano J. Porter Michaels wochokera ku Paris, ndi humeraltsindeanapangidwa ndi chitsulo cha platinamu ndipo anamangirira kumutu wa raba wokutidwa ndi parafini ndi waya kuti apange impulanti yotsekereza.Zotsatira zoyamba za wodwalayo zinali zokhutiritsa, koma prosthesis potsirizira pake inachotsedwa pambuyo pa zaka 2 chifukwa cha kubwereza mobwerezabwereza kwa chifuwa chachikulu.Uku ndiko kuyesa koyamba kopangidwa ndi anthu posintha mapewa ochita kupanga.

Mu 1951, Frederick Krueger adanena za kugwiritsidwa ntchito kwa prosthesis yofunika kwambiri ya mapewa yopangidwa ndi mavitamini ndipo inapangidwa kuchokera ku proximal humer ya cadaver.Izi zidagwiritsidwa ntchito bwino pochiza wodwala wachinyamata yemwe ali ndi osteonecrosis yamutu wa humeral

Koma kusintha kwamakono kwa mapewa kudapangidwa ndikupangidwa ndi mapewa a Charles Neer.Mu 1953, pofuna kuthana ndi zotsatira zosakhutiritsa za chithandizo chake cha opaleshoni ya proximal humeral fractures, Neer anapanga anatomical proximal humeral prosthesis ya humeral head fractures, yomwe idasinthidwa kangapo m'zaka makumi awiri zotsatira, motsatira.Ma prostheses a m'badwo wachiwiri ndi wachitatu.

Kumayambiriro kwa zaka za m'ma 1970, pofuna kuthetsa kusinthika kwa mapewa kwa 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 gawo la glenoid, Lingalirolo lidayambitsidwa pambuyo pake. kusiyidwa.Mu 1985, Paul Grammont adachita bwino molingana ndi lingaliro lomwe Neer adapereka, kusuntha pakati pa kasinthasintha pakati pawo ndi distally, kusintha kamphindi kamphindi kakang'ono ndi kugwedezeka kwa deltoid, motero kuthetsa mwangwiro vuto la kutaya ntchito kwa rotator cuff.

Mfundo za mapangidwe a trans-shoulder prosthesis

Reverse shoulder arthroplasty (RTSA) imasintha ubale wamapewa achilengedwe kuti ubwezeretse bata.RTSA imapanga fulcrum ndi center of rotation (CoR) popanga mbali ya glenoid convex ndi mutu wa humeral side concave.Ntchito ya biomechanical ya fulcrum iyi ndikuletsa mutu wa humeral kuti usasunthike m'mwamba pamene minofu ya deltoid imagwira ntchito kuti igwire mkono wapamwamba.Mbali ya RTSA ndi yakuti malo ozungulira a mapewa opangira mapewa ndi malo a mutu wa humeral wokhudzana ndi phewa lachilengedwe amasunthidwa mkati ndi pansi.Mapangidwe osiyanasiyana a RTSA prosthesis ndi osiyana.Mutu wa humeral umasunthidwa pansi ndi 25 ~ 40mm ndikusunthira mkati ndi 5 ~ 20mm.

Poyerekeza ndi mapewa achilengedwe a thupi la munthu, mwayi wodziwikiratu wakusintha kwamkati kwa CoR ndikuti mkono wolanda wa deltoid umachulukitsidwa kuchokera pa 10mm mpaka 30mm, zomwe zimapangitsa kuti deltoid igwire bwino, ndipo mphamvu yochepera ya minofu imatha kupangidwa. .Makokedwe omwewo, ndipo mawonekedwewa amapangitsanso kulandidwa kwa mutu wa humeral kusakhalenso kudalira kwathunthu kupsinjika kwamakapu ozungulira.

Awa ndiye mapangidwe ndi biomechanics a RTSA, ndipo zitha kukhala zotopetsa komanso zovuta kuzimvetsetsa.Kodi pali njira yosavuta yomvetsetsa?Yankho ndi lakuti inde.

Choyamba ndi kapangidwe ka RTSA.Kusamala makhalidwe a aliyense olowa thupi la munthu, tikhoza kupeza malamulo.Mafupa a anthu akhoza kugawidwa pafupifupi m'magulu awiri.Mmodzi ali pafupi ndi thunthu lolumikizira ngati mapewa ndi m'chiuno, ndipo kumapeto kwake kumakhala "chikho" ndipo kumapeto kwake kumakhala "mpira".

Mtundu wina ndi ma distal olowa mongamawondondi zigongono, ndi mathero oyandikira kukhala "mpira" ndipo mathero akutali kukhala "chikho".

Dongosolo lotengedwa ndi apainiya azachipatala popanga ma prostheses ophatikizika pamapewa m'masiku oyambilira anali kubwezeretsa mawonekedwe amtundu wa phewa lachilengedwe momwe angathere, kotero mapulani onse adapangidwa ndi mapeto oyandikira ngati "chikho" ndi malekezero akutali ngati ndi "mpira".Ofufuza ena adapanga dala kuti "chikho" chikhale chachikulu komanso chozama kuti chiwonjezere kukhazikika kwa mgwirizano, mofanana ndi munthu.mgwirizano wa chiuno, koma pambuyo pake zinatsimikiziridwa kuti kuonjezera kukhazikika kwenikweni kunawonjezera chiwerengero cha kulephera, kotero kuti mapangidwe awa adalandiridwa mwamsanga.taya mtima.RTSA, kumbali ina, imasintha mawonekedwe a mapewa achilengedwe, kutembenuza "mpira" ndi "chikho", kupanga "chiuno" choyambirira kukhala ngati "chigongono" kapena "bondo".Kusintha kwachigawenga kumeneku kunathetsa mavuto ambiri ndi kukayikira za kusintha kwa mapewa opangira, ndipo nthawi zambiri, mphamvu yake ya nthawi yayitali komanso yaifupi yakhala yabwino kwambiri.

Momwemonso, mapangidwe a RTSA amasintha pakati pa kasinthasintha kuti alole kuwonjezeka kwa deltoid kulanda, komwe kungamvekenso kosamveka.Ndipo tikayerekeza mfundo yathu ya paphewa ndi nsabwe, n’zosavuta kuzimvetsa.Monga momwe tawonetsera m'chithunzichi, kugwiritsa ntchito torque yomweyi ku A direction (chiwopsezo cha deltoid contraction force), ngati fulcrum ndi malo oyambira asinthidwa, n'zoonekeratu kuti torque yaikulu (mphamvu yakumtunda kwa mkono) ikhoza kupangidwa mu B malangizo.

Kusintha kwa malo ozungulira a RTSA kumakhala ndi zotsatira zofananira, kulola phewa lokhazikika kuti liyambitse kubedwa popanda kupsinjika kwa rotator cuff.Monga Archimedes adanena: Ndipatseni fulcrum ndipo ndikhoza kusuntha dziko lonse lapansi!

RTSA Zizindikiro ndi Contraindications

Chizindikiro chodziwika bwino cha RTSA ndi rotator cuff tear arthropathy (CTA), chimphona chachikulu chozungulira chomwe chimang'ambika ndi nyamakazi, yomwe imadziwika ndi kusuntha kwamutu kwamutu, zomwe zimapangitsa kuti glenoid, acromion ndi humeral mutu apitirire kusintha.Kusamuka kwapamwamba kwa mutu wa humeral kumachitika chifukwa cha kusagwirizana pakati pa deltoid pambuyo pa kukanika kwa rotator cuff.CTA imapezeka kwambiri mwa amayi achikulire, pomwe "pseudoparalysis" yachikale imatha kuchitika.

Kugwiritsa ntchito mapewa arthroplasty, makamaka RTSA, kwakula kwambiri pazaka makumi awiri zapitazi.Kutengera zotsatira zoyamba zopambana za ntchito ya RTSA, kupititsa patsogolo njira ya opaleshoni, komanso kugwiritsa ntchito mwaluso njira imeneyi, zizindikiro zocheperako za RTSA zakulitsidwa, motero, njira zambiri zamapewa arthroplasty zomwe zikuchitika pano ndi RTSA.

Mwachitsanzo, anatomical total shoulder arthroplasty (ATSA) inali njira yabwino kwambiri yopangira nyamakazi pamapewa popanda kung'ambika m'mbuyomo, koma m'zaka zaposachedwa, chiwerengero cha anthu omwe ali ndi lingaliro ili chikuwoneka chikuchepa pang'onopang'ono.Pali mbali zotsatirazi.Zifukwa zachititsa zimenezi.Choyamba, mpaka 10% ya odwala omwe amalandira ATSA ali kale ndi misozi yozungulira.Chachiwiri, nthawi zina, kukhulupirika kwa "structural" kwa "ntchito" ya rotator cuff sikukwanira, makamaka kwa odwala ena okalamba.Potsirizira pake, ngakhale chikhoto cha rotator chitakhala chokhazikika panthawi ya opaleshoni, kuwonongeka kwa rotator cuff kumachitika ndi msinkhu, makamaka pambuyo pa njira za ATSA, ndipo palidi kukayikira kwakukulu pa ntchito ya rotator cuff.Chodabwitsa ichi nthawi zambiri chimapezeka mwa odwala okalamba opitilira zaka 70.Chifukwa chake, maopaleshoni ambiri adayamba kusankha RTSA akakumana ndi nyamakazi yoyera pamapewa.Izi zadzetsa kuganiza kwatsopano kuti RTSA ingakhalenso chisankho choyamba kwa odwala osteoarthritis omwe ali ndi chikhomo chozungulira chokhazikika malinga ndi msinkhu.

Momwemonso, m'mbuyomu, misozi yayikulu yosasinthika ya rotator cuff (MRCT) yopanda nyamakazi, njira zina zimaphatikizapo decompression subacromial, kumanganso makapu a rotator, njira yaku China, komanso kumanganso kapisozi wapamwamba., mlingo wopambana umasiyanasiyana.Kutengera luso ndi kugwiritsa ntchito bwino kwa RTSA muzochitika zosiyanasiyana, ochita ntchito ochulukira ayesa RTSA posachedwa pamaso pa MRCT yosavuta, ndipo yakhala yopambana kwambiri, ndikukhala ndi moyo kwazaka 10 kupitilira 90%.

Mwachidule, kuwonjezera pa CTA, zomwe zikuchulukirachulukira za RTSA zikuphatikizapo misozi yayikulu yosasinthika yopanda mafupa osteoarthropathy, zotupa, kusweka kwambiri, nyamakazi yowopsa, kupunduka kwa mafupa kapena mafupa opunduka kwambiri.kutupa, ndi kusuntha kwa mapewa mobwerezabwereza.

Pali zochepa zotsutsana ndi RTSA.Pokhapokha zotsutsana ndi zopinga zopangira zolowa m'malo monga matenda, kusagwira ntchito kwa minofu ya deltoid ndikotsutsana kwambiri ndi RTSA.Kuonjezera apo, chifukwa cha kuphulika kwa humerus, fractures yotseguka ndi kuvulala kwa brachial plexus kuyeneranso kuonedwa ngati zotsutsana, pamene kuvulala kwapadera kwa mitsempha ya axillary kuyenera kuganiziridwa ngati zotsutsana.

Kusamalira pambuyo pa opaleshoni ndi kukonzanso

Mfundo za postoperative rehabilitation:

Limbikitsani chidwi cha odwala pakuchira ndikukhazikitsa ziyembekezo zoyenera kwa odwala.

Amachepetsa ululu ndi kutupa, ndipo amateteza machiritso, koma subscapularis nthawi zambiri safunikira kutetezedwa.

Kusunthika kwapambuyo kwa mgwirizano wa mapewa kumatha kuchitika kumapeto kwa hyperextension, adduction ndi kuzungulira kwamkati, kapena kubedwa ndi kuzungulira kwakunja.Choncho, mayendedwe monga backhands ayenera kupewa kwa masabata 4 mpaka 6 pambuyo opaleshoni.Maudindowa ali ndi chiopsezo chosokonezeka.

Pambuyo pa masabata 4 mpaka 6, ndikofunikabe kulankhulana ndi kupeza chilolezo kuchokera kwa dokotala wa opaleshoni musanayambe kusuntha ndi malo omwe ali pamwambawa.

Zochita zolimbitsa thupi pambuyo pa opaleshoni ziyenera kuchitidwa poyamba popanda kunyamula zolemera, poyamba popanda kukana, kenako ndi kukana, poyamba mosasamala kenako mwachangu.

Pakali pano, palibe okhwima ndi yunifolomu kukonzanso muyezo, ndipo pali kusiyana kwakukulu mu mapulani osiyana ofufuza '.

Zochita za Odwala za tsiku ndi tsiku (ADLs) njira (masabata 0-6):