Inkcazo ye-epicondylitis esecaleni ye-humerus
Ikwaziwa nangokuthi yi-tennis elbow, i-tendon strain ye-extensor carpi radialis muscle, okanye ukukruneka kwendawo yokuncamathelisa ye-extensor carpi tendon, i-brachioradial bursitis, ekwaziwa nangokuthi yi-lateral epicondyle syndrome. Ukudumba okubangelwa kukwenzakala okungapheliyo kwezicubu ezithambileyo ezijikeleze i-lateral epicondyle ye-humerus ngenxa yokwenzakala okungapheliyo..
I-Pathogenesis
Inxulumene kakhulu nomsebenzi, ingakumbi kubasebenzi abadla ngokujikelezisa ingalo yabo baze bolule baze bagobe ingqiniba kunye namalungu esihlathi. Uninzi lwabo ngabafazi basekhaya, abachweli, abakhi bezitena, abalungisi beemibhobho, abalungisi beepayipi, kunye nabadlali bezemidlalo.
Dizinambuzane
Izinto ezibalaseleyo kumacala omabini esiphelo esisezantsi se-humerus zii-epicondyles eziphakathi kunye nezisecaleni, i-epicondyle ephakathi yindawo yokuncamathelisa i-tendon eqhelekileyo yemisipha ye-flexor yengalo, kwaye i-epicondyle esecaleni yindawo yokuncamathelisa i-tendon eqhelekileyo yemisipha ye-extensor yengalo. Indawo yokuqala yemisipha ye-brachioradialis, jika ingalo kwaye ubhale kancinci. Indawo yokuqala ye-extensor carpi radialis longus, i-extensor carpi radialis brevis muscle, i-extensor digitorum majoris, i-extensor digitorum propria yomunwe omncinci, i-extensor carpi ulnaris, i-supinator muscle.
Pi-athogen
Ukuqala kwe-condyle kubangelwa kukukruneka okukhulu nokuzolula, kodwa uninzi lwezigulane luqala kancinci kwaye ngokubanzi alunambali icacileyo yokwenzakala, kwaye kuqheleke kakhulu kubantu abadala abafuna ukujikeleza ingalo ngokuphindaphindiweyo nokwandisa isandla ngamandla. Ingaxhuzulwa okanye ikruzulwe ngenxa yokwandiswa okuphindaphindiweyo kwelungu lesandla kunye nokwelulwa okugqithisileyo kwe-tendon yesandla ekuncamathiselweni kwe-epicondyle esecaleni ye-humerus xa ingalo ikwindawo yokuma.
Pi-atology
1.Ngenxa yokwenzakala okuphindaphindiweyo, i-lateral epicondyle ye-muscle fiber iyakrazulwa kwaye yopha, yenze i-subperiosteal hematoma, ize ihleleke kwaye iqokelele, nto leyo ebangela i-periosteitis kunye ne-bone hyperplasia ye-lateral epicondyle ye-humerus (ikakhulukazi ngohlobo lwe-nodule ebukhali). Uvavanyo lwe-pathological tissue biopsy yi-hyaline degeneration ischemia, ngoko ke ikwabizwa ngokuba yi-ischemic inflammation. Ngamanye amaxesha ihamba nokukrazuka kwe-joint sac, kwaye i-synovial membrane ye-joint iyakhula kwaye iqine ngenxa yokukhuthazwa ixesha elide yimisipha.
2.Krazula kwindawo yokuncamathisela i-extensor tendon.
3.ukudumba okubuhlungu okanye i-fibrohistolitis ye-annular ligament.
4. i-bursitis ye-brachioradial joint kunye ne-extensor common tendon.
5.Ukudumba kwe-synovium ye-humerus kunye ne-radial joint okubangelwa kukudibana kwe-humerus kunye nentloko encinci ye-radius.
6. Ukukhululeka kwe-humerioradial ligament kunye nokwahlukana okuncinci kwejoyinti ye-proximal radial-ulnar nako kunokwenzeka, okubangela ukukhubeka kwentloko ye-radial cephalic. Olu tshintsho lwe-pathological lunokubangela ukuqaqamba kwemisipha, iintlungu zasekuhlaleni, iintlungu ezivela kwimisipha yesandla esoluliweyo ukuya kwingalo.
Inkcazo yeklinikhi
1. Intlungu engaphandle kwelungu lengqiniba iyakhula xa kusenziwa i-pronation, ingakumbi xa kujikeleziswa ulwandiso lomqolo, kuphakanyiswa, kutsalwa, kupheliswa, kutyhalwa nakwezinye izenzo, kwaye kuphuma isandi esisezantsi kwisihlunu se-extensor esihlathini. Ekuqaleni, ndihlala ndisiva iintlungu kunye nobuthathaka kwilungu elonzakeleyo, kwaye kancinci kancinci ndiba neentlungu ngaphandle kwengqiniba, ezikhula kakhulu kukwanda kokuzilolonga. (Uhlobo lwentlungu kukuqaqamba okanye ukurhawuzelelwa)
2. Iyaqina emva kokuzibhokoxa kwaye ikhululeke emva kokuphumla.
3.Ukujikeleza kwengalo kunye nobuthathaka ekubambeni izinto, kwanokuwela nezinto.
Iimpawu
1. I-epicondyle ye-humeral esecaleni I-posterolateral aspect ye-lateral epicondyle ye-humerus, indawo ye-humeral-radial joint, i-cephalic cephalic kunye nomphetho osecaleni we-radial neck condyle inokuchukunyiswa, kwaye i-musculosis kunye ne-fast tissue kwicala le-radial le-forearm engaphezulu nayo inokuchukunyiswa ngokudumba okuncinci, ukuthamba okanye ukuqina. Ngamanye amaxesha imiphetho ebukhali ye-hyperostosis inokuvakala kwi-lateral epicondyle ye-humerus, kwaye ithambile kakhulu.
2. Uvavanyo lweMills lubonisa ukuba lulungile. Goba ingalo yakho kancinci uze wenze isiqingatha senqindi, ugobe ingalo yakho kangangoko unako, uze uphakamise ingalo yakho ngokupheleleyo uze ulungise ingqiniba yakho. Ukuba intlungu ivela kwicala elingasecaleni le-brachioradial joint xa ingqiniba ilungisiwe, iba ntle.
3. Uvavanyo lokuxhathisa oluvela ngaphandle: isigulane sibambe inqindi saza sagoba isandla saso, kwaye umvavanyi ucinezele umva wesandla sesigulana ngesandla sakhe ukuze isigulane sixhathise ukuxhathisa aze andise isandla, njengokuba intlungu engaphandle kwengqiniba ilungile.
4. Uvavanyo lwe-X-ray lunokubonisa ukungaqheleki kwe-periosteum ngamanye amaxesha, okanye inani elincinci lamanqaku e-calcification ngaphandle kwe-periosteum.
Unyango
Unyango olugcina indalo:
1. Yeka uqeqesho lwasekuhlaleni lokukhuthaza kwangethuba, kwaye ezinye izigulana zinokukhululeka ngokuphumla okanye i-condyle yokuthintela ukungasebenzi kakuhle kweplasta.
2. Unyango lokumasaja, sebenzisa iindlela zokutyhala nokuxovula ukuze unciphise ukuqaqamba kunye nokunciphisa iintlungu kwimisipha yengalo, uze usebenzise iindlela zoxinzelelo lwenqaku kunye neendlela zokuxovula kwi-epicondyle esecaleni ye-humerus kunye neendawo zentlungu ezikufutshane.
3. Unyango lweTuina, isigulane sihlala phantsi. Ugqirha usebenzisa ukugoqa nokuxova kancinci ukuze asebenze emqolo nangaphandle kwengqiniba aze aphinde abuyele kwicala langasemva lengalo. Ugqirha usebenzisa incam kabhontsi ukuze acinezele aze ahlikihle i-Ah Shi (i-lateral epicondyle), i-Qi Ze, i-Quchi, i-Hand Sanli, i-Waiguan, i-Hegu acupoint, njl. Isigulane sihleli phantsi, aze ugqirha akhuphe indawo yokuqala yesigulane ye-extensor carpi kunye ne-extensor carpi longus kunye ne-brevis radialis. Tsala kwaye wolule, iingqiniba eziphilayo. Okokugqibela, sebenzisa indlela yokuhlikihla i-thenar ukuze uhlikihle i-lateral epicondyle yengqiniba kunye nemisipha ye-extensor yengalo, kwaye ubushushu bendawo busetyenziswa ukuya kwinqanaba.
4. Unyango ngamayeza, amayeza okulwa nokuvuvukala angengo-steroidal asetyenziswa ngomlomo kwinqanaba elikhawulezileyo.
5. Unyango olufihlakeleyo: ii-glucocorticoids (ezifana ne-compound betamethasone injection) zifakwa kwindawo ethambileyo kwaye zifakwe kwindawo yokufakwa kwe-tendon kunye nendawo ye-subaponeurosis (ngaphantsi okanye ilingana nezihlandlo ezi-3), ezinokudlala isiphumo sokulwa nokuvuvukala kunye ne-analgesic, kwaye i-compound betamethasone kunye ne-ropivacaine okanye ukuhambelana ne-levobupivacaine okwangoku zibonwa njenge-fast-acting, long-acting, high anti-inflammatory titer, kunye ne-fast, long-long blocking time, response encinci kunye ne-low pain rebound drug ukuhambelana ne-local occlusion.
6. Unyango lwe-acupuncture, ukusika kukufutshane nomphezulu wethambo ukuze kususwe izicubu ezithambileyo ezinamatheleyo ezijikeleze inkqubo yethambo, kukhutshwe umsipha wesandla se-extensor, umsipha weminwe ye-extensor kunye ne-supinator tendon, kwaye kukhutshwe imela ngemvakalelo yokungakhululeki. Unyango lotyando: lufanelekile kwizigulana ezingasabeliyo kunyango oluhlala ixesha elide.
1. Indlela yeBody & Meleod, olu tyando lubandakanya phantse zonke izicubu zesilonda, kubandakanya ukususwa kwe-epicondyle esecaleni eyi-2mm, ukukhululwa kwendawo yokuqala ye-extensor common tendon, ukususwa kwenxalenye yesiphelo esikufutshane se-annular ligament, ukufakwa kwe-humeroradial joint kwi-synovium, kunye nokususwa kwe-granulation tissue okanye i-bursa kwindawo engaphantsi kwe-tendinous.
2. Indlela yeNischl, i-common extensor tendon kunye ne-extensor carpi longus radialis tendon zahlulwe ngobude, i-deep extensor carpi radialis brevis tendon iyabonakala, indawo yokufaka ixotyulwe embindini we-lateral epicondyle, izicubu ze-tendon ezonakeleyo ziyasuswa, inxalenye ye-bone cortex engaphambili iyasuswa, kwaye i-residual tendon kunye ne-fascia ejikelezileyo ziyathungwa okanye zakhiwe kwakhona kwithambo. Ukubandakanyeka ngaphakathi kwe-articular akukhuthazwa.
Pi-rognosis
Ixesha lesi sifo lide kwaye lidla ngokubuyela umva.
Ni-ote
1. Nika ingqalelo ukuze uhlale ushushu kwaye uphephe ukubanda;
2.Nciphisa izinto ezibangela izifo;
3. Ukuzilolonga okusebenzayo;
4. Kwinqanaba elibukhali, le ndlela kufuneka ibe thambileyo, kwaye indlela yokunyanga kufuneka iqhubeke kancinci kancinci kwabo bebegula ixesha elide, oko kukuthi, le ndlela kufuneka ithambe ngokuqina, ukuqina ngokuthambileyo, kwaye ukuqina nokuthamba kufuneka kudityaniswe.
Ixesha leposi: Februwari-19-2025
