Ingqikelelo yokutshintshwa kwegxalaba elingelokwenziwa lacetywa kuqala nguThemistocles Gluck ngo-1891. Amalungu okwenziwa akhankanywe kwaye ayilwe kunye aquka ihip, isihlahla, njl njl. Utyando lokuqala lokutshintshwa kwegxalaba lwenziwa kwisigulana ngo-1893 ngugqirha wotyando ongumFrentshi uJules Emile Péan eHôpital. Ngamazwe ngamazwe eParis kwisigulane esineminyaka engama-37 ubudala esinesifo sephepha samalungu kunye namathambo I-arthroplasty yokuqala ebhaliweyo.Iprosthesis yenziwa ngugqirha wamazinyo uJ. Porter Michaels waseParis, kunye ne-humeralisiquyayenziwe ngentsimbi yeplatinam yaza yancanyathiselwa kwintloko yerabha eqatywe ngeparafini ngocingo ukuze yenze into yofakelo oluthintelweyo.Iziphumo zokuqala zesigulane zanelisekile, kodwa i-prosthesis ekugqibeleni yasuswa emva kweminyaka eyi-2 ngenxa yokuphindaphinda kwesifo sofuba.Eli linyathelo lokuqala elenziwa ngabantu ekutshintsheni igxalaba elenziweyo.
Ngo-1951, uFrederick Krueger wachaza ukusetyenziswa kweprosthesis ye-anatomically ebalulekileyo ye-anatomically eyenziwe ngeevithamini kwaye ibunjwe ukusuka kwi-humerus ejikelezayo ye-cadaver.Oku kusetyenziswe ngempumelelo ukunyanga isigulane esincinci nge-osteonecrosis yentloko ye-humeral
Kodwa ukutshintshwa kwamagxa anamhlanje kuyilwe kwaye kwaphuhliswa nguCharles Neer.Ngo-1953, ukuze kusonjululwe iziphumo ezingonelisiyo zonyango lwayo lotyando lokuqhekeka kwe-humeral, u-Neer wavelisa i-anatomical proximal humeral prosthesis ye-humeral head fractures, eyaphuculwa izihlandlo ezininzi kule minyaka ingamashumi amabini ilandelayo, ngokulandelelanayo.Iiprostheses eziyilwe kwisizukulwana sesibini nesesithathu.
Ekuqaleni kweminyaka yoo-1970, ukuze kusonjululwe ukutshintshwa kwegxalaba kwizigulana ezinokungasebenzi kakuhle kwecufu ye-rotator, ingqikelelo ye-reverse shoulder arthroplasty (RTSA) yacetywa kuqala nguNeer, kodwa ngenxa yokungaphumeleli kwangaphambili kwecandelo le-glenoid, le ngcamango yalandelwa emva koko. ilahliwe.Kwi-1985, uPaul Grammont waphucula ngokwembono ecetywayo nguNeer, ehambisa iziko lokujikeleza phakathi kunye ne-distally, ukutshintsha ingalo yomzuzwana kunye noxinzelelo lwe-deltoid, ngaloo ndlela isombulula ngokugqibeleleyo ingxaki yokulahleka komsebenzi we-rotator cuff.
Imigaqo yoyilo yeprosthesis ye-trans-shoulder
I-reverse shoulder arthroplasty (RTSA) ibuyisela umva ubudlelwane be-anatomical yegxalaba lendalo ukubuyisela ukuzinza kwamagxa.I-RTSA yenza i-fulcrum kunye neziko lokujikeleza (CoR) ngokwenza i-glenoid side convex kunye ne-humeral head side concave.Umsebenzi we-biomechanical wale fulcrum kukuthintela intloko ye-humeral ukuba ihambe phezulu xa i-deltoid muscle contracts ukuba ibambe ingalo ephezulu.Isici se-RTSA kukuba iziko lokujikeleza legxalaba elenziweyo kunye nendawo yentloko ye-humeral enxulumene negxalaba lendalo ishukunyiswa ngaphakathi nangaphantsi.Uyilo olwahlukileyo lwe-RTSA prosthesis yahlukile.Intloko enesithunzi ihanjiswa phantsi nge-25 ~ 40mm kwaye ihanjiswe ngaphakathi nge-5 ~ 20mm.
Xa kuthelekiswa negxalaba lendalo elihlangeneyo lomzimba womntu, inzuzo ecacileyo yokutshintsha kwangaphakathi kwe-CoR kukuba ingalo yomzuzu wokuxhwila we-deltoid inyuswe ukusuka kwi-10mm ukuya kwi-30mm, ephucula ukusebenza kakuhle kwe-deltoid, kwaye kunokwenziwa amandla angaphantsi kwezihlunu. .I-torque efanayo, kwaye olu phawu lwenza ukuba ukuthunjwa kwentloko ye-humeral kungasaxhomekeki ngokupheleleyo kumsebenzi wokudakumba we-cuff ejikelezayo epheleleyo.
Olu luyilo kunye ne-biomechanics ye-RTSA, kwaye inokuba yinto ekruqulayo kwaye kunzima ukuyiqonda.Ngaba ikho indlela elula yokuyiqonda?Impendulo nguewe.
Eyokuqala luyilo lwe-RTSA.Ukuqwalasela ngokucophelela iimpawu zelungu ngalinye lomzimba womntu, sinokufumana imigaqo ethile.Amalungu omntu anokwahlulwa ngokweendidi ezimbini.Enye inamalungu akufutshane-e-trunk njengamagxa kunye nesinqe, kunye nesiphelo esisondeleyo "yindebe" kwaye isiphelo esikude sibe "yibhola".
Olunye uhlobo ludityanisiweyo olukude njengengamadolokunye neengqiniba, kunye nesiphelo esisondeleyo ibe "yibhola" kwaye isiphelo esikude sibe "yindebe".
Isicwangciso esamkelwa ngoovulindlela bezonyango xa kusenziwa iiprostheses zegxalaba ezenziweyo kwimihla yangaphambili yayikukubuyisela ulwakhiwo lwe-anatomical yegxalaba lendalo kangangoko kunokwenzeka, ngoko ke zonke izicwangciso zaziyilwe kunye nesiphelo esisondeleyo njenge "ndebe" kunye nesiphelo esikude njengoko. a "ibhola".Abanye abaphandi bade baqulunqa ngamabom "indebe" ukuba ibe nkulu kwaye ibe nzulu ukuze kwandiswe ukuzinza komdibaniso, kufana nomntu.i-hip joint, kodwa kamva kwangqinwa ukuba ukwandisa uzinzo ngokwenene kwandisa izinga lokungaphumeleli, ngoko olu yilo lwamkelwa ngokukhawuleza.ncama.I-RTSA, kwelinye icala, ibuyisela umva iimpawu ze-anatomical zegxalaba lendalo, ukuguqula "ibhola" kunye ne "cup", okwenza i-original "hip" edibeneyo ifana ne "elbow" okanye "idolo".Olu tshintsho lokubhukuqa ekugqibeleni lwasombulula ubunzima obuninzi kunye namathandabuzo okutshintshwa kwamagxa okwenziwa, kwaye kwiimeko ezininzi, ukusebenza kwayo kwexesha elide kunye nexesha elifutshane kuye kwaphuculwa kakhulu.
Ngokunjalo, uyilo lwe-RTSA lutshintsha iziko lokujikeleza ukuze kuvumeleke ukonyuka kokubanjwa kwe-deltoid, enokuthi ivakale ingacacanga.Kwaye ukuba sithelekisa igxalaba lethu kunye ne-seesaw, kulula ukuyiqonda.Njengoko kubonisiwe kumzobo ongezantsi, ukusebenzisa i-torque efanayo kwi-A direction (i-deltoid contraction force), ukuba i-fulcrum kunye nendawo yokuqala zitshintshiwe, kuyacaca ukuba i-torque enkulu (i-abduction force force) inokuveliswa kwi B ulwalathiso.
Utshintsho kwiziko le-RTSA lokujikeleza linesiphumo esifanayo, esivumela igxalaba elizinzileyo ukuba liqalise ukuxhwilwa ngaphandle kokudakumba kwe-rotator cuff.Njengoko u-Archimedes wathi: Ndinike i-fulcrum kwaye ndikwazi ukuwuhambisa wonke umhlaba!
RTSA Iimpawu kunye Contraindications
Isalathiso sakudala se-RTSA yi-rotator cuff tear arthropathy (CTA), i-giant rotator cuff tear kunye ne-osteoarthritis, ebonakala ngokufuduswa phezulu kwentloko ye-humeral, ekhokelela ekubeni i-glenoid, i-acromion kunye nentloko ye-humeral iqhubekile notshintsho oluwohlokayo.Ukufuduka okuphezulu kwentloko ye-humeral kubangelwa isibini samandla angalinganiyo phantsi kwesenzo se-deltoid emva kokungasebenzi kwe-rotator cuff.I-CTA ixhaphake kakhulu kubasetyhini abadala, apho i-classic "pseudoparalysis" inokuthi yenzeke.
Ukusetyenziswa kwe-arthroplasty yamagxa, ngakumbi i-RTSA, inyuke kakhulu kule minyaka ingamashumi amabini idlulileyo.Ngokusekwe kwiziphumo zokuqala eziyimpumelelo zesicelo se-RTSA, uphuhliso oluqhubekayo lobuchule botyando, kunye nokusetyenziswa ngobunono kobu buchwephesha, izikhombisi zokuqala ezimxinwa ze-RTSA zandisiwe, kwaye ke, iinkqubo ezininzi ze-arthroplasty ezenziweyo ngoku ziyi-RTSA.
Ngokomzekelo, i-anatomical total shoulder arthroplasty (ATSA) yayilukhetho olukhethiweyo lwe-osteoarthritis ngaphandle kokukrazula i-rotator cuff kwixa elidlulileyo, kodwa kwiminyaka yakutshanje, inani labantu ababambe lo mbono libonakala liyancipha ngokuthe ngcembe.Kukho le miba ilandelayo.Izizathu ezikhokelele kulo mkhwa.Okokuqala, ukuya kuthi ga kwi-10% yezigulane ezifumana i-ATSA sele zine-rotator cuff tear.Okwesibini, kwezinye iimeko, ingqibelelo "yesakhiwo" ye "umsebenzi" we-rotator cuff ayiphelelanga, ngakumbi kwezinye izigulane ezisebekhulile.Ekugqibeleni, nokuba i-rotator cuff ilungile ngexesha lotyando, i-rotator cuff degeneration iyenzeka ngokukhula, ngakumbi emva kweenkqubo ze-ATSA, kwaye ngokwenene kukho ukungaqiniseki okukhulu malunga nomsebenzi we-rotator cuff.Le nto idla ngokuvela kwizigulane ezisele zikhulile kuneminyaka engama-70.Ke ngoko, ngakumbi nangakumbi oogqirha botyando baqala ukukhetha i-RTSA xa bejongene ne-osteoarthritis ecocekileyo.Le meko iye yakhokelela ekucingeni okutsha ukuba i-RTSA inokuba yinto yokuqala yokukhetha izigulane ezine-osteoarthritis kunye ne-rotator cuff engaguqukiyo esekelwe kuphela kwiminyaka yobudala.
Ngokufanayo, kwixesha elidlulileyo, kwiinyembezi ezingenakulungiseka ze-rotator cuff (MRCT) ngaphandle kwe-osteoarthritis, ezinye iindlela ziquka ukuthotywa kwe-subacromial, ukwakhiwa kwakhona kwekhafu ye-rotator, indlela yaseTshayina, kunye nokwakhiwa ngokutsha kwe-capsule edibeneyo., izinga lempumelelo liyahluka.Ngokusekwe kubuchule kunye nempumelelo yokusetyenziswa kwe-RTSA kwiimeko ezahlukeneyo, ngakumbi nangakumbi abaqhubi baye bazama i-RTSA kutshanje ebusweni be-MRCT elula, kwaye ibe yimpumelelo enkulu, kunye ne-10-year-implantation rate of survival over 90%.
Isishwankathelo, ukongeza kwi-CTA, izalathisi ezandisiweyo zangoku ze-RTSA ziquka iinyembezi ezinkulu ezingenakulungiseka ngaphandle kwe-osteoarthropathy evuthayo, amathumba, ukwaphuka okubukhali, isifo samathambo sasemva kokwenzakala, iziphene zamathambo okanye amathambo awonakele kakhulu.ukuvuvukala, kunye nokuchithwa kwamagxa okuphindaphindiweyo.
Kukho izithintelo ezimbalwa kwi-RTSA.Ngaphandle kokuchasana ngokubanzi kokutshintshwa kwejoyinti eyenziweyo njengosulelo, ukungasebenzi kwe-deltoid muscle kuchasene ngokupheleleyo ne-RTSA.Ukongeza, kwi-proximal humerus fractures, i-fractures evulekileyo kunye nokulimala kwe-plexus ye-brachial kufuneka kuthathelwe ingqalelo njengezinto ezichaseneyo, ngelixa ukwenzakala okukodwa kwe-axillary nerve kufuneka kuthathelwe ingqalelo njengokuchasana.
Ukhathalelo lwasemva kotyando kunye nokubuyisela kwisimo sangaphambili
Imigaqo yokuvuselelwa emva kotyando:
Hlanganisa umdla wezigulane wokubuyisela kwisimo sangaphambili kwaye umisele ulindelo olufanelekileyo kwizigulane.
Iyanciphisa intlungu kunye nokuvuvukala, kwaye ikhusela izakhiwo zokuphilisa, kodwa i-subscapularis ngokuqhelekileyo ayifuni ukukhuselwa.
Ukutshatyalaliswa kwangaphambili kwegxala elihlangeneyo kunokwenzeka ukuba kwenzeke kwizikhundla zokugqibela ze-hyperextension, i-adduction kunye nokujikeleza kwangaphakathi, okanye ukuthunjwa kunye nokujikeleza kwangaphandle.Ngoko ke, iintshukumo ezifana ne-backhands kufuneka zigwenywe kwiiveki ezi-4 ukuya kwezi-6 emva kokuhlinzwa.Ezi zikhundla zinomngcipheko wokukhutshwa.
Emva kweeveki ezi-4 ukuya kwezi-6, kusafuneka ukuba unxibelelane kwaye ufumane imvume kugqirha wotyando ngaphambi kokuba uqale ukunyakaza kunye nezikhundla ezingentla.
Ukuzivocavoca emva kokuhlinzwa kufuneka kwenziwe kuqala ngaphandle kokuthwala ubunzima kwaye emva koko ngokuthwala ubunzima, okokuqala ngaphandle kokuxhathisa kwaye emva koko ngokuxhathisa, kuqala ngokungahambiyo kwaye ngokusebenzayo.
Okwangoku, akukho mgangatho ungqongqo nofanayo wokubuyisela kwisimo sangaphambili, kwaye kukho umahluko omkhulu kwizicwangciso zabaphandi abahlukeneyo.
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Ixesha lokuposa: Nov-21-2022
