Ingcamango yokutshintshwa kwamagxa okwenziwa yaqala ukucetyiswa nguThemistocles Gluck ngo-1891. Amalungu okwenziwa akhankanyiweyo kwaye ayilwa kunye aquka isinqe, isandla, njl. Utyando lokuqala lokutshintshwa kwamagxa lwenziwa kwisigulana ngo-1893 ngugqirha waseFransi uJules Emile Péan kwiHôpital International eParis kwisigulana esineminyaka engama-37 ubudala esinesifo sephepha samalungu namathambo. I-arthroplasty yokuqala yamagxa ebhaliweyo. I-prosthesis yenziwe ngugqirha wamazinyo uJ. Porter Michaels waseParis, kunye ne-humeral.isiquyenziwe ngentsimbi yeplatinum yaza yancamathiselwa entlokweni yerabha egqunywe ngeparafini ngocingo ukuze kwenziwe i-implant enomda. Iziphumo zokuqala zesigulana zazanelisa, kodwa i-prosthesis ekugqibeleni yasuswa emva kweminyaka emi-2 ngenxa yokuphinda-phinda kwesifo sephepha. Eli lilinge lokuqala elenziwe ngabantu lokutshintshwa kwamagxa okwenziwa.
Ngo-1951, uFrederick Krueger waxela ngokusetyenziswa kweprosthesis yegxa ebaluleke ngakumbi ngokwendalo eyenziwe ngeevithamini kwaye yabunjwa kwihumerus ekufutshane yesidumbu. Le prosthesis yasetyenziswa ngempumelelo ukunyanga isigulana esiselula esine-osteonecrosis yentloko yehumeral.
Kodwa indawo yokutshintsha igxalaba yanamhlanje yayiyilwe kwaye yaphuhliswa yingcali yegxalaba uCharles Neer. Ngo-1953, ukuze kusonjululwe iziphumo ezingonelisiyo zonyango lwayo lotyando lwezaphuko ze-humeral proximal, uNeer wavelisa i-anatomical proximal humeral prosthesis yokwaphuka kwentloko ye-humeral, eyaphuculwa izihlandlo ezininzi kwiminyaka engamashumi amabini eyalandelayo, ngokulandelelana. Yenzelwe i-prostheses yesizukulwana sesibini nesesithathu.
Ekuqaleni kweminyaka yoo-1970, ukuze kusonjululwe ukutshintshwa kwegxalaba kwizigulana ezineengxaki ezinkulu ze-rotator cuff, ingcamango ye-reverse shoulder arthroplasty (RTSA) yaqala ukucetyiswa yiNeer, kodwa ngenxa yokusilela kwangoko kwecandelo le-glenoid, le ngcamango yashiywa kamva. Ngo-1985, uPaul Grammont waphucuka ngokwengcamango ecetywayo yiNeer, ehambisa iziko lokujikeleza phakathi nakude, etshintsha ingalo yomzuzu kunye noxinzelelo lwe-deltoid, ngaloo ndlela esombulula ngokugqibeleleyo ingxaki yokulahleka komsebenzi we-rotator cuff.
Imigaqo yoyilo lwe-trans-shoulder prosthesis
I-arthroplasty yehlombe elingasemva (i-RTSA) iguqula ubudlelwane be-anatomical begxa lendalo ukuze ibuyisele uzinzo lwegxa. I-RTSA yenza i-fulcrum kunye ne-center of rotation (i-CoR) ngokwenza icala le-glenoid libe yi-convex kunye necala lentloko ye-humeral libe yi-concave. Umsebenzi we-biomechanical wale fulcrum kukuthintela intloko ye-humeral ukuba inganyuki iye phezulu xa umsipha we-deltoid uqina ukuze ubambe ingalo engasentla. Uphawu lwe-RTSA kukuba iziko lokujikeleza le-joint yegxala elenziweyo kunye nendawo yentloko ye-humeral xa kuthelekiswa negxala lendalo zishukunyiswa ngaphakathi nasezantsi. Uyilo olwahlukeneyo lwe-prosthesis ye-RTSA lwahlukile. Intloko ye-humeral ishukunyiswa ezantsi nge-25 ~ 40mm kwaye ishukunyiswa ngaphakathi nge-5 ~ 20mm.
Xa kuthelekiswa nelungu lendalo legxalaba lomzimba womntu, inzuzo ecacileyo ye-CoR yokutshintsha kwangaphakathi kukuba ingalo yomzuzu wokuthathwa kwe-deltoid inyuswa ukusuka kwi-10mm ukuya kwi-30mm, nto leyo ephucula ukusebenza kakuhle kwe-deltoid, kwaye amandla amancinci emisipha anokuveliswa. I-torque efanayo, kunye nolu phawu lwenza ukuba ukuthatyathwa kwentloko ye-humeral kungasaxhomekeki ngokupheleleyo kumsebenzi wokudakumba we-rotator cuff epheleleyo.
Olu luyilo kunye ne-biomechanics ye-RTSA, kwaye isenokuba yinto ekruqulayo kwaye kunzima ukuyiqonda. Ngaba ikho indlela elula yokuyiqonda? Impendulo ngu-ewe.
Eyokuqala luyilo lwe-RTSA. Jonga ngononophelo iimpawu zelungu ngalinye lomzimba womntu, sinokufumana imithetho ethile. Amalungu omntu anokwahlulwahlulwa abe ngamaqela amabini. Elinye lilungu elisondeleyo njengeegxalaba kunye nezinqe, apho isiphelo esikufutshane "yindebe" kwaye isiphelo esikude "yibhola".
Olunye uhlobo zii-distal joints ezifanaamadolokunye neengqiniba, apho isiphelo esikufutshane "yibhola" kwaye isiphelo esikude "yindebe".
Icebo elamkelwe ngoovulindlela bezonyango xa beyila iiprostheses zegxalaba ezenziweyo kwiintsuku zokuqala yayikukubuyisela isakhiwo se-anatomical segxa lendalo kangangoko kunokwenzeka, ngoko ke zonke izicwangciso zayilwa ngesiphelo esikufutshane "njengendebe" kunye nesiphelo esikude "njengebhola". Abanye abaphandi bade bayila ngabom "indebe" ukuba ibe nkulu kwaye ibe nzulu ukuze kwandiswe ukuzinza kwelungu, njengelomntu.isinqe, kodwa kamva kwafunyaniswa ukuba ukwandisa uzinzo ngokwenene kwandisa izinga lokungaphumeleli, ngoko ke olu yilo lwamkelwe ngokukhawuleza. Yeka. I-RTSA, kwelinye icala, iguqula iimpawu zomzimba zegxala lendalo, iguqula "ibhola" kunye "nendebe", okwenza ilungu lokuqala "lesinqe" lifane "nengqiniba" okanye "idolo". Olu tshintsho luguqula ekugqibeleni lisombulule ubunzima obuninzi kunye namathandabuzo okutshintshwa kwegxala elenziweyo, kwaye kwiimeko ezininzi, ukusebenza kwalo ixesha elide kunye nexesha elifutshane kuye kwaphucuka kakhulu.
Ngokufanayo, uyilo lwe-RTSA lutshintsha iziko lokujikeleza ukuze kuvumeleke ukusebenza kakuhle kokususwa kwe-deltoid, okusenokuvakala kungacacanga. Kwaye ukuba sithelekisa i-shoulder joint yethu ne-seesaw, kulula ukuyiqonda. Njengoko kubonisiwe kumfanekiso ongezantsi, ukusebenzisa i-torque efanayo kwicala lika-A (i-deltoid contraction force), ukuba i-fulcrum kunye nendawo yokuqala zitshintshiwe, kuyacaca ukuba i-torque enkulu (i-upper arm abdomination force) inokuveliswa kwicala lika-B.
Utshintsho kwi-center of rotation ye-RTSA lunefuthe elifanayo, oluvumela igxalaba elingazinziyo ukuba liqalise ukubiwa ngaphandle kokuxinezeleka kwe-rotator cuff. Njengoko u-Archimedes watshoyo: Ndinike i-fulcrum kwaye ndingakwazi ukuhambisa umhlaba wonke!
Iimpawu ze-RTSA kunye neZithintelo
Isalathisi esiqhelekileyo se-RTSA yi-rotator cuff tear arthropathy (CTA), ukukrazuka okukhulu kwe-rotator cuff ene-osteoarthritis, edla ngokubonakala ngokufuduka kwentloko ye-humeral phezulu, okubangela utshintsho oluqhubekayo kwi-glenoid, i-acromion kunye nentloko ye-humeral. Ukufuduka kwentloko ye-humeral phezulu kubangelwa liqela elingalinganiyo lamandla phantsi kwesenzo se-deltoid emva kokungasebenzi kakuhle kwe-rotator cuff. I-CTA ixhaphake kakhulu kubafazi abadala, apho i-"pseudoparalysis" eqhelekileyo inokwenzeka.
Ukusetyenziswa kwe-shoulder arthroplasty, ingakumbi i-RTSA, kuye kwanda kakhulu kwiminyaka engamashumi amabini edlulileyo. Ngokusekelwe kwiziphumo zokuqala eziphumeleleyo zokusetyenziswa kwe-RTSA, uphuhliso oluqhubekayo lobuchwephesha botyando, kunye nokusetyenziswa kakuhle kwale ndlela, imiqondiso yokuqala emincinci ye-RTSA yandisiwe, kwaye ke ngoko, uninzi lweenkqubo ze-shoulder arthroplasty ezenziwayo ngoku yi-RTSA.
Umzekelo, i-anatomical total shoulder arthroplasty (ATSA) yayiyeyona ndlela ikhethwayo kwi-shoulder osteoarthritis ngaphandle kwe-rotator cuff tear kwixesha elidlulileyo, kodwa kwiminyaka yakutshanje, inani labantu abanale mbono libonakala lincipha kancinci kancinci. Kukho ezi zinto zilandelayo. Izizathu zikhokelele kule ndlela. Okokuqala, ukuya kuthi ga kwi-10% yezigulana ezifumana i-ATSA sele zine-rotator cuff tear. Okwesibini, kwezinye iimeko, "ulwakhiwo" "lomsebenzi" we-rotator cuff aluphelelanga, ngakumbi kwezinye izigulana ezikhulileyo. Okokugqibela, nokuba i-rotator cuff ayiphelelanga ngexesha lotyando, i-rotator cuff degeneration iyenzeka ngokukhula, ngakumbi emva kweenkqubo ze-ATSA, kwaye kukho ukungaqiniseki okukhulu malunga nomsebenzi we-rotator cuff. Le nto idla ngokuvela kwizigulana ezikhulileyo ezingaphezulu kweminyaka engama-70. Ke ngoko, oogqirha abaninzi baqala ukukhetha i-RTSA xa bejongene ne-osteoarthritis yamahlombe acocekileyo. Le meko ikhokelele kwingcinga entsha yokuba i-RTSA isenokuba lolona khetho lokuqala kwizigulana ezine-osteoarthritis ezine-rotator cuff engapheliyo ngokusekelwe kuphela kubudala.
Ngokufanayo, kwixesha elidlulileyo, kwiinyembezi ze-massive rotator cuff tears (MRCT) ezingenakulungiswa ngaphandle kwe-osteoarthritis, ezinye iindlela ziquka i-subacromial decompression, i-partial rotator cuff reconstruction, i-Chinese way, kunye ne-upper joint capsule reconstruction. , izinga lempumelelo liyahluka. Ngokusekelwe kubuchule kunye nokusetyenziswa ngempumelelo kwe-RTSA kwiimeko ezahlukeneyo, abaqhubi abaninzi baye bazame i-RTSA kutshanje xa bejamelene ne-MRCT elula, kwaye ibe yimpumelelo kakhulu, kunye nezinga lokusinda kweminyaka eli-10 lokufakelwa kwe-implantation elingaphezulu kwama-90%.
Ngamafutshane, ukongeza kwi-CTA, izibonakaliso ezandisiweyo zangoku ze-RTSA ziquka ukukrazula okukhulu kwe-rotator cuff okungenakulungiswa ngaphandle kwe-osteoarthropathy evuthayo, iithumba, ukwaphuka okukhawulezileyo, isifo samathambo emva kwengozi, iziphene zamathambo okanye amalungu amathambo abuthathaka kakhulu, ukudumba, kunye nokuqhekeka kwamagxa okuphindaphindiweyo.
Zimbalwa izinto ezingavumelekanga kwi-RTSA. Ngaphandle kwezinto ezingavumelekanga xa kutshintshwa amalungu angengowokwenziwa njengosulelo, ukungasebenzi kakuhle kwemisipha ye-deltoid kukungavumeleki ngokupheleleyo kwi-RTSA. Ukongeza, kwiingxaki zokuqhekeka kwe-humerus ekufutshane, ukwaphuka okuvulekileyo kunye nokwenzakala kwe-brachial plexus nazo kufuneka zithathwe njengezingavumelekanga, ngelixa ukwenzakala kwemithambo-luvo ye-axillary kufanele kuthathwe njengezingavumelekanga.
Ukhathalelo emva kotyando kunye nokuvuselelwa
Imigaqo yokuvuselelwa emva kotyando:
Ukukhuthaza umdla wezigulane wokubuyisela impilo yazo kwimeko yazo kwaye umisele ulindelo olufanelekileyo kwizigulane.
Iyanciphisa iintlungu kunye nokudumba, kwaye ikhusela izakhiwo zokuphilisa, kodwa i-subscapularis ayisoloko ifuna ukukhuselwa.
Ukukhubeka kwangaphambili kwegxalaba kunokwenzeka kwiindawo zokugqibela ze-hyperextension, i-adduction kunye ne-internal rotation, okanye i-abdomination kunye ne-external rotation. Ke ngoko, iintshukumo ezifana ne-backhands kufuneka ziphetshwe iiveki ezi-4 ukuya kwezi-6 emva kotyando. Ezi ndawo zinomngcipheko wokukhubeka.
Emva kweeveki ezi-4 ukuya kwezi-6, kusafuneka unxibelelane nogqirha kwaye ufumane imvume ngaphambi kokuba uqale ezi ntshukumo kunye neendlela ezichazwe apha ngasentla.
Ukuzilolonga emva kotyando kufuneka kwenziwe kuqala ngaphandle kokuthwala ubunzima, kuze kulandele ukuthwala ubunzima, kuqala ngaphandle kokumelana, kuze kulandele ukumelana, kuqala ngaphandle kokungenelela, kuze kulandele ukungenelela.
Okwangoku, akukho mgangatho ungqongqo nofanayo wokuvuselelwa, kwaye kukho umahluko omkhulu kwizicwangciso zabaphandi abahlukeneyo.
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Ixesha lokuthumela: Novemba-21-2022
