Amakuru - Amateka yo gusimbuza ibitugu

Igitekerezo cyo gusimbuza ibitugu bya artificiene byasabwe bwa mbere na Theluck muri 1891. Ingingo ya ahinera arthroplasy. Prostèse Yakozwe n'Umuganga w amenyo J. Porter Michaels kuva Paris, hamwe nabanyamategekourutiyari ikozwe mucyuma cya platine hanyuma ifatanye na reberi yafashwe ya paraffin umutwe ku mutwe kugirango ikore ingufu. Ibisubizo byambere byabarwayi byari bishimishije, ariko prostèse yaje gukurwaho nyuma yimyaka 2 kubera ibisubizo byinshi byo kwisubiraho igituntu. Ubu ni bwo buryo bwa mbere bwatanzwe n'abantu mu gusimbuza ibitugu.

Mu 1951, Frederick Kruseger yatangaje ko ikoreshwa ry'igitugu gikomeye anatosike gikozwe muri vitamine no kubumbwa na humer ya proximal ya cadaver. Ibi byakoreshwaga neza mugufata umurwayi ukiri muto hamwe na OsteoneCrosis yumutwe wubuhinzi

Ariko gusimburwa ibitugu bigezweho byateguwe kandi byatejwe imbere numutugu Guru Charles Neer Neer. Mu 1953, kugira ngo bikemuke ibisubizo bidashimishije byo kubaga byo kubaga byo kuvurika kw'ubuhinzi bw'amakorikori, Neer yateje imbere prosal ya Anatosique yo kuvura umutwe w'abafite ubuhinzi, yateje imbere inshuro nyinshi mu myaka 20 yakurikiyeho. Yashizeho igisekuru cya kabiri na gatatu protates.

Mu ntangiriro ya za 70, kugirango ukemure urutugu mu barwayi bazengurutse mu buryo bukabije, igitekerezo cy'uruhu rw'ibitugu cyashize. Mu 1985, Paul Grammt yazamuye akurikije igitekerezo cyasabwe na Neer, kwimura hagati yo kuzunguruka no gupfobya ikiganza, bityo bikemurwa neza ikibazo, bityo bikemuke neza ikibazo cya Rotator Cuff.

Igishushanyo cyo gushushanya prothèse

Hindura ibitugu arthroplasty (rTSA) bihindura umubano wa anatomical yigitugu rusanzwe rwo kugarura urutugu. RTSSA ikora kuzuye kandi ihuriro ryo kuzunguruka (COR) mugukora uruhande rwa Glenoid convex hamwe numugereka wuruhande rwubuhinzi. Imikorere ya biomenical yiyi juvercrum ni ukubuza umutwe wubuhinzi kuva kugenda hejuru mugihe amasezerano yimitsi ya Deltoid yashimuta ukuboko hejuru. Ikiranga cya RTSA nuko ikigo cyo kuzunguruka kigizwe nigitugu cyubukoriko hamwe numwanya wumutwe wubuhinzi ugereranije nigitugu kamere kimuwe imbere no hepfo. Ibishushanyo bya RTSA bitandukanye biratandukanye. Umutwe w'ubuto mu buvumo wimuwe na 25 ~ 40mm wimukira imbere na 5 ~ 20m.

Ugereranije nurutugu rusanzwe rwumubiri wumuntu, inyungu zigaragara yimbere cor nuko hakurya umwanya wa deltoid wiyongereye kuva 10mm kuri 30mm, kandi imbaraga zidashobora kubyara. Torque imwe, kandi iyi mikorere nayo ituma umutwe wubuhinzi utagishingiye rwose kumikorere yo kwiheba ya rotator yuzuye cuff.

Nibishushanyo na biomenics bya RTSA, kandi birashobora kuba birarambiranye kandi biragoye kubyumva. Hariho uburyo bworoshye bwo kubyumva? Igisubizo ni yego.

Icya mbere nigishushanyo cya RTSA. Witondere witonze ibiranga buri huriro ryumubiri wumuntu, dushobora kubona amategeko amwe. Ingingo zingingo zirashobora kugabanywa hafi mu byiciro bibiri. Imwe ni hafi-hubake hamwe nkibitugu hamwe nigituba, hamwe no kurangiza kwambere kuba "igikombe" nindabyo "ni" umupira ".

Ubundi bwoko ni ingingo ya kure nkaamavin'inkokora, hamwe no kurangiza kwangirika kuba "umupira" n'iherezo rya kure ni "igikombe".

Gahunda yemejwe nabapayiniya bashinzwe ubuvuzi mugihe ushushanya uruhu rw'ubukorikori mu minsi ya mbere kwari ukugarura imiterere y'ibitugu bishoboka, bityo gahunda zose zashizweho hamwe na "igikombe" n '"umupira". Abashakashatsi bamwe bakorewe nkana "igikombe" kiba kinini kandi cyimbitse kugirango bongere umutekano wingingo, bisa numuntuhip, ariko byaje kugaragara ko byongera umutekano mu byukuri byongereye igipimo cyo kunanirwa, bityo iki gishushanyo cyakiriwe vuba. kureka. RTSA, on the other hand, reverses the anatomical characteristics of the natural shoulder, inverting the "ball" and "cup", making the original "hip" joint more like an "elbow" or "knee". Iyi mpinduka nyinshi yarangije yakemuye ingorane nyinshi no gushidikanya kubisimburangingo, kandi akenshi, ingaruka zigihe kirekire kandi igihe gito cyateye imbere cyane.

Mu buryo nk'ubwo, igishushanyo cya RTSA kimuhindura hagati yo kuzenguruka kugirango wemererwe kwiyongera kwa deltoid, bishobora no kumvikana. Niba kandi tugereranije ibitugu byacu hamwe na reseaw, biroroshye kubyumva. Nkuko bigaragara ku gishushanyo gikurikira, shyiramo torque imwe mu cyerekezo (ingufu za deltoid), niba umwanya wa Veltoid ugahinduka, biragaragara ko ari Torque nini (ishimuta ku maboko yo hejuru) ishobora gutangwa mu cyerekezo B.

Impinduka mu kigo cya RTSA cyo kuzunguruka gifite ingaruka nk'izo, zituma igitugu n'ihungangura ryangiza igabanuka ritagira depression. Nkuko Archibedes yabivuze: Mpa juvercrum kandi nshobora kwimura isi yose!

RTSA yerekana kandi itumanaho

Ikimenyetso cya kera kuri RTSA ni Rotator cuff amarira ya arthropathy (CTA), ubusanzwe irangwa no kwimura imisoro, bikaba bikaba byaranzwe na glenoid, bikaba umutwe wa acroion, bahinduye impinduka zidahwitse. Kwimura hejuru yumutwe wubuhinzi biterwa nimbaraga zitaringaniye hamwe nigikorwa cya Deltoid nyuma ya Rotator Cuff. CTA irasanzwe mubagore bakuze, aho "pseudoparalysis" ishobora kubaho.

Gukoresha mutuguhe mu rutugu, cyane cyane RTSA, byiyongereye cyane mu myaka 20 ishize. Ukurikije ibisubizo byambere byateganijwe bya Massa, iterambere rihoraho rya tekinike yo kubaga, hamwe nubuhanga bwa mbere kuri RTSA byaguwe, bityo, inzira y'ibitugu yakozwe muri iki gihe irakorwa ni Тр.

Kurugero, Anatolast Ansthuke Yose (ATSA) yahisemo guhitamo ibitugu adafite rowita mu bihe byashize, ariko mu myaka yashize, umubare wabantu bafite iki gitekerezo basa nkaho bagabanuka buhoro buhoro. Hariho ibintu bikurikira. Impamvu zatumye iyi nzira. Ubwa mbere, kugeza 10% byabarwayi bakira ATSA basanzwe bafite rotator cuff amarira. Icya kabiri, mubihe bimwe, "imiterere" yubunyangamugayo bwikirere "imikorere" ya rotator cuff ntabwo yuzuye, cyane cyane mubarwayi bageze mu zabukuru. Hanyuma, nubwo wataze cuff mugihe cyo kubagwa, Rotatombyi Cuff, cyane cyane inzira ya ATSA, kandi mubyukuri nyuma yuburyo bwa ATSA, kandi mubyukuri haribintu byinshi bidashidikanywaho kubikorwa bya Rotator Cuff. Ubusanzwe iyi ngingo iboneka mubarwayi bageze mu zabukuru barengeje imyaka 70. Kubwibyo, benshi kandi benshi batangiye guhitamo RTSA mugihe bahuye nibitugu byera osteoarthritis. Ibi bintu byatumye ibitekerezo bishya biteyeho RTSA nanone kuba amahitamo yambere kubarwayi bafite osteoarthritis hamwe na rotator idasanzwe cuff gusa kumyaka.

Mu buryo nk'ubwo, mu bihe byashize, ku buryo bidahuye na rotator ya rotatorho (MRCT) idafite osteoRortrite, ubundi buryo bwo kuzenguruka. , intsinzi igipimo kiratandukanye. Ukurikije ubumenyi no gukoresha neza RTSA mubihe bitandukanye, abakora benshi kandi barenze muri RTSA imbere ya MRCT yoroshye, kandi byagenze neza cyane, bimaze imyaka 10 yo kubahiriza imyaka 10%.

Muri make, usibye CTA, ikimenyetso cyagutse kuri RTSA kirimo Rotator ya Rotamit idahwitse nta nkomyi osteumaartropatory osteumatique, amagufwa yahinduwe cyane. gutwikwa, no gutandukana kw'urutugu.

Hano hari imiturire nke kuri RTSA. Usibye ibyerekeye rusange yo gusimburwa hamwe nkubwandu, infection, ntabwo ikorwa mumitsi ya deltoid nigikorwa cyuzuye kuri RTSA. Byongeye kandi, kuri humerus ya humerus ya proximi, ibikomere bya plexus plexus na plexus nabyo bigomba gufatwa nkibikomere, mugihe ibikomere byiterambere byahinduwe, mugihe ibikomere byihariye byahinduwe, mugihe imitsi yiterambere yitaruye igomba gufatwa nkaho ihuriweho.

Kwitaho nyuma yo gutangaza no gusubiza mu buzima busanzwe

Amahame yo gusubiza mu buzima busanzwe:

Gukangurira ishyaka ry'abarwayi mu gusubiza mu buzima busanzwe no gushyiraho ibyifuzo byumvikana kubarwayi.

Kugabanya ububabare, no kurengera inzego zikiza, ariko subkapuke zidakenewe kurindwa.

Kwirinda imbere ku rutugu birashoboka ko bizabera ku myanya ya hyperexTension, kwiyegurira no kuzunguruka imbere, cyangwa gushimuta no kuzunguruka hanze. Kubwibyo, ingendo nkinyuma zigomba kwirindwa ibyumweru 4 kugeza 6 nyuma yo kubagwa. Iyi myanya ifite ibyago byo kwimyambaga.

Nyuma yibyumweru 4 kugeza 6, biracyakenewe kugirango tuvugane kandi tubone uruhushya rwo kubaga mbere yo gutangira ingendo n'imyanya.

Imyitozo yo gusarura nyuma yo gusubiza mu buzima busubirwamo igomba kubanza kwitwaza ibiro hanyuma hamwe no kubyara, ubanza utarwanya hanyuma ukaba urwanya, ubanza uhanganye hanyuma ukinisha.

Kugeza ubu, nta rwego rukomeye kandi rwo gusubiza mu buzima busanzwe kandi mu rwego rwo gusana, kandi hari itandukaniro rikomeye muri gahunda zitandukanye z'abashakashatsi batandukanye.

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