Amakuru - Amateka yo gusimbuza urutugu

Igitekerezo cyo gusimbuza urutugu rw’ubukorano cyatanzwe bwa mbere na Themistocles Gluck mu 1891. Ingingo z’ubukorano zavuzwe kandi zigashyirwa hamwe zirimo ikibuno, ukuboko, nibindi. Kubaga urutugu kwa mbere kwakorewe umurwayi mu 1893 n’umuganga w’umufaransa Jules Emile Péan muri Hôpital International i Paris ku murwayi w’imyaka 37 urwaye igituntu cy’ingingo n’amagufwa. Ubu buryo bwa mbere bwanditsweho arthroplasty y’urutugu. Ubu buryo bwakozwe n’umuganga w’amenyo J. Porter Michaels wo i Paris, hamwe n’umuganga w’amenyo.igitiYakozwe mu cyuma cya platine, ifatanywa n'icyuma gikozwe muri parafini kugira ngo hakorwe inshinge idafite aho ihuriye. Ibisubizo by'ibanze by'umurwayi byari bishimishije, ariko icyuma cyavuyemo nyuma y'imyaka 2 bitewe n'uko igituntu cyo mu bwoko bwa TB cyakomeje kugaruka kenshi. Iyi ni yo nshuro ya mbere abantu bagerageje gusimbuza urutugu rw'ubukorano.

Mu 1951, Frederick Krueger yavuze ko hakoreshejwe urwego rw'inyuma rw'umugongo rufite agaciro gakomeye rukozwe muri vitamine kandi rukozwe mu gice cy'imbere cy'umurambo. Iyi nyunganizi yakoreshejwe neza mu kuvura umurwayi ukiri muto ufite indwara ya osteonecrosis yo mu mutwe w'umurambo.

Ariko uburyo bwo gusimbuza urutugu bugezweho bwakozwe kandi butegurwa n'umuhanga mu by'urutugu Charles Neer. Mu 1953, kugira ngo bakemure ibisubizo bidashimishije byo kubaga imvune zo mu rutugu, Neer yakoze imiterere y'umubiri we ku mvune zo mu rutugu, yavunitse inshuro nyinshi mu myaka makumyabiri yakurikiyeho. Yakoze imiterere y'urutugu rwa kabiri n'urwa gatatu.

Mu ntangiriro za 1970, kugira ngo hakemurwe ikibazo cyo gusimbuza urutugu ku barwayi bafite ikibazo gikomeye cyo kuvura urutugu, igitekerezo cyo gusimbuza urutugu rw’inyuma (RTA) cyatanzwe bwa mbere na Neer, ariko bitewe n’uko igice cya glenoid cyananiwe gukora, icyo gitekerezo cyaje kwirengagizwa. Mu 1985, Paul Grammont yateye imbere akurikije igitekerezo cyatanzwe na Neer, yimura hagati mu kuzunguruka hagati no kure, ahindura ukuboko n’imbaraga bya deltoid, bityo akemura neza ikibazo cyo kubura imikorere ya rotator cuff.

Amahame y'igishushanyo mbonera cy'insimburangingo ikoreshwa mu gushushanya urwego rw'imbere rw'ingufu

Arthroplasty yo mu rutugu rwo hagati (RTSA) ihindura isano iri hagati y’umubiri w’urutugu rusanzwe kugira ngo igarure ubushobozi bwo kuruhuka. RTSA ikora icyerekezo n’icyerekezo cyo kuzenguruka (CoR) binyuze mu gutuma uruhande rwa glenoid ruhinduka nk’urubingo n’uruhande rw’umutwe w’umugongo bihinduka nk’ibice bito. Akamaro k’ubu buryo bw’umubiri ni ukubuza umutwe w’umugongo kuzamuka iyo imitsi ya deltoid ikora ifata ukuboko ko hejuru. Ikiranga RTSA ni uko hagati y’urutugu rw’ubukorano n’aho umutwe w’umugongo uherereye ugereranije n’urutugu rusanzwe byimurirwa imbere no hasi. Imiterere itandukanye ya RTSA iratandukanye. Umutwe w’umugongo wimurwa hasi na 25 ~ 40mm hanyuma ukimurwa imbere na 5 ~ 20mm.

Ugereranyije n'ingingo karemano y'umubiri w'umuntu, inyungu igaragara yo guhinduranya imbere ya CoR ni uko ukuboko kwa deltoid mu gihe cyo gukuba kwiyongera kuva kuri mm 10 kugera kuri mm 30, ibyo bikaba byongera ubushobozi bwo gukuba kwa deltoid, kandi imbaraga nke z'imitsi zishobora kuboneka. Umuvuduko umwe, hamwe n'iyi miterere, bituma gukuba umutwe wa humeral bitagishingiye ku mikorere yo kwiheba kwa rotator cuff.

Iyi ni imiterere n'ubuhanga bwa RTSA, kandi ishobora kugorana gato kandi ikagorana kubyumva. Ese hari uburyo bworoshye bwo kubyumva? Igisubizo ni yego.

Icya mbere ni imiterere ya RTSA. Reba witonze imiterere ya buri ngingo y'umubiri w'umuntu, dushobora kubona amategeko amwe. Ingingo z'umuntu zishobora kugabanywamo ibice bibiri. Kimwe ni ingingo zegeranye n'umubyimba nk'amatugu n'ikibuno, aho impera y'imbere ari "igikombe" naho impera y'imbere ikaba "umupira".

Ubundi bwoko ni ingingo za kure nkaamavin'inkokora, aho impera y'imbere ari "umupira" naho impera y'inyuma ikaba "igikombe".

Gahunda yafashwe n'abaganga batangije ubwo bakoraga poroteyine z'urutugu mu minsi ya mbere yari iyo kugarura imiterere y'umubiri w'urutugu karemano uko bishoboka kose, bityo gahunda zose zakozwe zifite impera y'imbere nk' "igikombe" n'iy'inyuma nk' "umupira". Abashakashatsi bamwe banakoze nkana "igikombe" kugira ngo kibe kinini kandi cyimbitse kugira ngo cyongere ubushobozi bwo kugumana ingingo, nk'uko umuntu abigenza.ingingo y'ikibuno, ariko nyuma byagaragaye ko kongera ubushobozi bwo guhagarara byongereye igipimo cyo gutsindwa, bityo iyi miterere yahise yemezwa. Ku rundi ruhande, RTSA ihindura imiterere y'umubiri w'urutugu karemano, ihindura "umupira" n' "igikombe", bigatuma ingingo y'umwimerere "y'ikibuno" isa n' "inkokora" cyangwa "ivi". Iyi mpinduka ikomeye yarangije gukemura ibibazo byinshi n'amakenga ku birebana no gusimbuza urutugu rw'ubukorano, kandi mu bihe byinshi, imikorere yarwo y'igihe kirekire n'igihe gito yarushijeho kunozwa cyane.

Mu buryo nk'ubwo, imiterere ya RTSA ihindura urwego rwo hagati mu kuzunguruka kugira ngo yemererwe kongera ubushobozi bwo gukurura deltoid, bishobora no kumvikana nk'ibidasobanutse. Kandi iyo tugereranije urutugu rwacu n'icyuma gikonjesha, biroroshye kubyumva. Nk'uko bigaragara ku ishusho iri hepfo, gukoresha torque imwe mu cyerekezo cya A (ingufu zo gukonjesha deltoid), niba fulcrum n'aho umuntu atangira bihindutse, biragaragara ko torque nini (ingufu zo hejuru zo gukurura ukuboko) ishobora gukorwa mu cyerekezo cya B.

Impinduka mu mikorere ya RTSA yo hagati igira ingaruka nk'izo, ituma urutugu rudakora neza rutangira gushimuta umuntu nta ruhu rw'inyuma. Nk'uko Archimedes yabivuze: Mpa umwanya wo kuzunguruka maze nshobore kwimura isi yose!

Ibipimo bya RTSA n'ibidakwiye

Ibimenyetso bya RTSA bizwi cyane ni rotator cuff tear arthropathy (CTA), rotator cuff tear rinini riterwa na osteoarthritis, rikunze kurangwa no kwimuka k'umutwe w'umugongo, bigatuma glenoid, acromion n'umutwe w'umugongo bikomeza kwangirika. Kwimuka k'umutwe w'umugongo guterwa n'imbaraga zidahuje neza bitewe n'imikorere ya deltoid nyuma yo kudakora neza kwa rotator cuff. CTA ikunze kugaragara cyane ku bagore bakuze, aho "pseudoparalysis" isanzwe ishobora kubaho.

Gukoresha uburyo bwo kuvura indwara zo mu rutugu, cyane cyane RTSA, byariyongereye cyane mu myaka makumyabiri ishize. Hashingiwe ku musaruro wa mbere wavuye mu gukoresha uburyo bwa RTSA, iterambere rihoraho ry’ubuhanga bwo kubaga, ndetse no gukoresha neza ubu buryo, ibimenyetso bya mbere bya RTSA byongerewe, bityo, uburyo bwinshi bwo kuvura indwara zo mu rutugu bukorwa ubu ni RTSA.

Urugero, uburyo bwo kuvura indwara ya arthroplasty y’urutugu (ATSA) bwari bwo bwakunze gukoreshwa mu kuvura osteoarthritis yo mu rutugu idafite rotator cuff tear mu bihe byashize, ariko mu myaka ya vuba aha, umubare w’abantu bafite iki gitekerezo usa n’aho ugenda ugabanuka buhoro buhoro. Hari ibintu bikurikira. Impamvu zatumye habaho iyi gahunda. Ubwa mbere, kugeza kuri 10% by’abarwayi bahabwa ATSA basanzwe bafite rotator cuff tear. Icya kabiri, rimwe na rimwe, "imiterere" y’"imikorere" ya rotator cuff ntabwo yuzuye, cyane cyane ku barwayi bamwe na bamwe bageze mu za bukuru. Amaherezo, nubwo rotator cuff yaba yuzuye mu gihe cyo kubagwa, rotator cuff degeneration ibaho uko imyaka igenda ishira, cyane cyane nyuma yo kuvurwa na ATSA, kandi koko hari byinshi bitazwi ku mikorere ya rotator cuff. Iki kintu gikunze kubaho ku barwayi bageze mu za bukuru barengeje imyaka 70. Kubwibyo, abaganga benshi batangiye guhitamo RTSA iyo bahuye na osteoarthritis yo mu rutugu. Iki kibazo cyatumye habaho igitekerezo gishya cy’uko RTSA ishobora kuba amahitamo ya mbere ku barwayi bafite osteoarthritis bafite rotator cuff idafite rotator cuff hashingiwe gusa ku myaka.

Mu buryo nk'ubwo, mu bihe byashize, ku marira ya rotator cuff tears (MRCT) adasubirwamo nta osteoarthritis, ubundi buryo burimo gusukura subacromial decompression, kongera kubaka igice cya rotator cuff, uburyo bw'Abashinwa, no kongera kubaka capsule y'ingingo. , igipimo cy'intsinzi kiratandukanye. Hashingiwe ku buhanga n'ikoreshwa ryiza rya RTSA mu bihe bitandukanye, abakora benshi baherutse kugerageza RTSA mu gihe cy'ikoreshwa rya MRCT ryoroshye, kandi ryagenze neza cyane, aho igipimo cyo kubaho cy'imyaka 10 cyo gutera implantation kirenga 90%.

Muri make, uretse CTA, ibimenyetso byagutse bya RTSA birimo amarira manini adakira ya rotator cuff adafite ububabare bw'amagufwa, ibibyimba, kuvunika gukabije, rubagimpande nyuma y'ihungabana, inenge z'amagufwa cyangwa ingingo z'amagufwa zangiritse cyane, kubyimba no gucika kw'amagufwa mu buryo butunguranye.

Hari ibintu bike bibuza RTSA. Uretse ibintu rusange bibuza ingingo zisimburana nk'ubwandu, kudakora neza kw'imitsi ya deltoid ni ikintu kibuza RTSA. Byongeye kandi, ku mvune zo mu gice cya hafi cy'umugongo, imvune zifunguye n'imvune zo mu gice cya brachial plexus nabyo bigomba gufatwa nk'ibibuza, mu gihe imvune zo mu mitsi yo mu gituza zigomba gufatwa nk'ibibuza.

Kwita ku buzima nyuma yo kubagwa no kugororwa

Amahame yo kuvugurura ubuzima nyuma yo kubagwa:

Gushishikariza abarwayi gushishikarira gusana no gushyiraho ibyo bategereje ku barwayi.

Igabanya ububabare n'ububyimbirwe, kandi ikarinda ingingo zivura, ariko subscapularis ubusanzwe ntikenera kurindwa.

Gucika kw'ingingo y'urutugu imbere bishobora kubaho ku mpera z'umubiri, nko gukurura no kuzunguruka imbere, cyangwa gukurura no kuzunguruka inyuma. Kubwibyo, gukora ingendo nko gukoresha amaboko inyuma bigomba kwirindwa mu byumweru 4 kugeza kuri 6 nyuma yo kubagwa. Iyi myanya ifite ibyago byo kuva mu mwanya wayo.

Nyuma y'ibyumweru 4 kugeza kuri 6, biba ngombwa kuvugana n'umuganga ubaga no gusaba uburenganzira mbere yo gutangira ingendo n'imyanya byavuzwe haruguru.

Imyitozo yo kuvura indwara nyuma yo kubagwa igomba gukorwa mbere na mbere nta gupima ibiro hanyuma hagakurikiraho gupima ibiro, hagakurikiraho kudapima, hanyuma hagakurikiraho kudapima, hagakurikiraho kudapima, hanyuma hagakurikiraho gukora imyitozo ngororamubiri.

Kuri ubu, nta gipimo gihamye kandi kimwe cyo gusana gihari, kandi hari itandukaniro rikomeye mu migambi y'abashakashatsi batandukanye.

Ingamba z'ibikorwa by'abarwayi bya buri munsi (ADLs) (ibyumweru 0-6):