Amakuru - Amateka yo Gusimbuza Ibitugu

Igitekerezo cyo gusimbuza ibitugu byakozwe bwa mbere cyatanzwe na Themistocles Gluck mu 1891. Ihuriro ry’ibihimbano ryavuzwe kandi ryateguwe hamwe harimo ikibuno, ukuboko, n’ibindi. Mpuzamahanga i Paris kumurwayi wimyaka 37 urwaye igituntu cyingingo namagufa Icyambere arthroplastique yigitugu.Prothèse yakozwe numuvuzi w amenyo J. Porter Michaels ukomoka i Paris, hamwe na humeralurutiyari ikozwe mu cyuma cya platine kandi ifatanyirizwa hamwe na paraffin isize reberi umutwe ukoresheje insinga kugirango ikorwe.Ibisubizo byambere byumurwayi byari bishimishije, ariko prothèse yaje gukurwaho nyuma yimyaka 2 kubera igituntu cyongeye kugaruka.Nibigeragezo byambere byakozwe nabantu mugusimbuza ibitugu.

Mu 1951, Frederick Krueger yatangaje ko hakoreshejwe prothèse ikomeye cyane yigitugu ikozwe muri vitamine kandi ikabumbabumbwa kuva hafi yigitereko cya cadaver.Ibi byakoreshejwe neza kuvura umurwayi ukiri muto ufite osteonecrosis yumutwe wa humeral

Ariko mubyukuri gusimbuza ibitugu bigezweho byateguwe kandi byatejwe imbere na guru Charles Neer.Mu 1953, kugira ngo gikemure ibisubizo bidashimishije byo kubaga uburyo bwo kubaga ubuvuzi bwavunitse bwa hafi, Neer yashyizeho prothèse anatomical proximal humeral prothèse yo kuvunika umutwe, byatejwe imbere inshuro nyinshi mumyaka 20 yakurikiyeho.Yashizweho prothèse ya kabiri niyagatatu.

Mu ntangiriro ya za 70, mu rwego rwo gukemura ikibazo cyo gusimbuza ibitugu ku barwayi bafite imikorere mibi ya rotateur cuff, igitekerezo cya Neer cyatangijwe bwa mbere na Neer, ariko kubera kunanirwa hakiri kare igice cya glenoide, Igitekerezo cyaje gukurikiraho yatereranye.Mu 1985, Paul Grammont yateye imbere akurikije igitekerezo cyatanzwe na Neer, yimura hagati yo kuzunguruka hagati no hagati, ahindura akanya ukuboko hamwe nuburemere bwa deltoid, bityo bikemura neza ikibazo cyo gutakaza imikorere ya rotate cuff.

Gushushanya amahame ya prostate ya trans-ibitugu

Guhindura ibitugu arthroplasti (RTSA) bihindura umubano udasanzwe wigitugu gisanzwe kugirango ugarure ibitugu.RTSA ikora uruzitiro hamwe na centre yo kuzunguruka (CoR) mugukora uruhande rwa glenoid convex no kuruhande rwumutwe wa humeral.Imikorere ya biomehanike yiyi fulcrum ni ukurinda umutwe wa humeral kuzamuka hejuru mugihe imitsi ya deltoid imeze kugirango ishimuse ukuboko hejuru.Ikiranga RTSA ni uko kuzenguruka hagati yigitugu cya artile hamwe nu mwanya wumutwe wa humeral ugereranije nigitugu gisanzwe cyimurwa imbere no hepfo.Ibishushanyo mbonera bya RTSA bitandukanye biratandukanye.Umutwe wa humeral wimurwa na 25 ~ 40mm hanyuma ukimukira imbere kuri 5 ~ 20mm.

Ugereranije nigitugu gisanzwe cyumubiri wumuntu, inyungu igaragara yo guhinduranya imbere imbere CoR nuko ukuboko kwigihe cyo gushimuta ukuboko kwa deltoid kongerewe kuva kuri 10mm kugera kuri 30mm, bigatuma imikorere ishimutwa ya deltoide, kandi hashobora kubyara imbaraga nke zimitsi. .Umuyoboro umwe, kandi iyi mikorere nayo ituma ishimutwa ryumutwe wa humeral ritagiterwa rwose numurimo wo kwiheba wa rotateur yuzuye.

Nibishushanyo mbonera na biomehanike ya RTSA, kandi birashobora kurambirana gato kandi bigoye kubyumva.Hariho inzira yoroshye yo kubyumva?Igisubizo ni yego.

Iya mbere ni igishushanyo cya RTSA.Witondere witonze ibiranga buri ngingo yumubiri wumuntu, dushobora kubona amategeko amwe.Ihuriro ryabantu rishobora kugabanywamo ibice bibiri.Imwe ni hafi-ihuza ingingo nkibitugu nigituba, impera yegeranye ikaba "igikombe" naho impera ya kure ikaba "umupira".

Ubundi bwoko ni ingingo ya kure nkaamavin'inkokora, hamwe nimpera yegeranye ni "umupira" naho impera ya kure ikaba "igikombe".

Gahunda yemejwe nabapayiniya mubuvuzi mugihe bashushanyaga prothèse yintugu yubukorikori muminsi yambere kwari ukugarura imiterere ya anatomique yigitugu karemano bishoboka, bityo gahunda zose zateguwe hamwe nimpera yegeranye nk "igikombe" nimpera ya kure nkuko "umupira".Bamwe mu bashakashatsi banashizeho nkana "igikombe" kugira ngo kibe kinini kandi cyimbitse mu rwego rwo kongera ituze ry’ingingo, bisa n’umuntuikibuno, ariko nyuma byaje kugaragara ko kongera umutekano mubyukuri byongereye igipimo cyo gutsindwa, bityo iki gishushanyo cyafashwe vuba.kureka.Ku rundi ruhande, RTSA ihindura ibiranga anatomique iranga urutugu rusanzwe, ihindura "umupira" n "" igikombe ", bigatuma" ikibuno "cy'umwimerere gisa nk '" inkokora "cyangwa" ivi ".Ihinduka ryo gukuraho amaherezo ryakemuye ibibazo byinshi no gushidikanya byo gusimbuza ibitugu byakozwe, kandi mubihe byinshi, imikorere yigihe kirekire nigihe gito yarahinduwe neza.

Mu buryo nk'ubwo, igishushanyo cya RTSA gihindura hagati yo kuzunguruka kugira ngo hongerwe imbaraga zo gushimuta deltoid, zishobora no kumvikana neza.Niba kandi tugereranije ibitugu byacu hamwe nigitereko, biroroshye kubyumva.Nkuko bigaragara ku gishushanyo gikurikira, ushyireho urumuri rumwe mu cyerekezo (imbaraga zo kugabanya deltoid), niba fulcrum nu mwanya wo gutangira byahinduwe, biragaragara ko urumuri runini (imbaraga zo gushimuta ukuboko hejuru) rushobora kubyara muri Icyerekezo B.

Guhindura ikigo cya RTSA cyo kuzunguruka bigira ingaruka nkizo, bituma igitugu kidahungabana gutangira gushimuta nta kwiheba kwa rotator.Nkuko Archimedes yabivuze: Mpa fulcrum ndashobora kwimura isi yose!

Ibimenyetso bya RTSA

Ikimenyetso cyerekana kuri RTSA ni rotator cuff amarira arthropathie (CTA), amarira manini ya rotate cuff amarira hamwe na osteoarthritis, ubusanzwe arangwa no kwimuka hejuru kumutwe wa humeral, bikavamo glenoid, acromion hamwe numutwe wa humeral bikomeza guhinduka.Kwimura hejuru yumutwe wa humeral biterwa numugabo utaringaniza imbaraga zakozwe na deltoid nyuma ya rotator cuff idakora neza.CTA ikunze kugaragara mubagore bakuze, aho hashobora kubaho "pseudoparalysis".

Ikoreshwa rya arthroplasti yigitugu, cyane cyane RTSA, ryiyongereye cyane mumyaka 20 ishize.Ukurikije ibisubizo byambere byagezweho mubikorwa bya RTSA, iterambere rihoraho ryubuhanga bwo kubaga, hamwe no gukoresha neza ubwo buhanga, ibimenyetso byambere byerekana ibimenyetso bya RTSA byaraguwe, bityo rero, inzira nyinshi zo mu bitugu arthroplastique kuri ubu zikorwa ni RTSA.

Kurugero, anatomical total ibitugu arthroplasty (ATSA) niyo yahisemo guhitamo ibitugu osteoarthritis idafite amarira ya rotator cuff amarira, ariko mumyaka yashize, umubare wabantu bafite iki gitekerezo usa nkigenda ugabanuka buhoro buhoro.Hariho ibintu bikurikira.Impamvu zatumye iyi nzira.Ubwa mbere, abarwayi bagera kuri 10% bakira ATSA basanzwe bafite amarira ya rotator.Icya kabiri, mubihe bimwe na bimwe, "imiterere" ubunyangamugayo bwa "imikorere" ya rotate cuff ntabwo yuzuye, cyane cyane mubarwayi bamwe bageze mu zabukuru.Hanyuma, niyo rotate cuff idahwitse mugihe cyo kubagwa, rotate cuff degeneration ibaho hamwe nimyaka, cyane cyane nyuma yuburyo bwa ATSA, kandi mubyukuri haribintu byinshi bidashidikanywaho kumikorere ya rotateur.Iyi phenomenon ikunze kugaragara kubarwayi bageze mu zabukuru barengeje imyaka 70.Kubwibyo, abantu benshi kandi babaga batangiye guhitamo RTSA mugihe bahuye nigitugu cyiza cya osteoarthritis.Iki kibazo cyatumye abantu batekereza ko RTSA ishobora kandi kuba ihitamo ryambere kubarwayi barwaye osteoarthritis bafite rotateur ya rotateur idashingiye kumyaka gusa.

Mu buryo nk'ubwo, mu bihe byashize, kubera amarira manini adasubirwaho (MRCT) adafite osteoarthritis, ubundi buryo burimo decompression subacromial decompression, igice cya rotator cuff kwiyubaka, inzira yubushinwa, hamwe no kwiyubaka kwa capsule yo hejuru.igipimo cyo gutsinda kiratandukanye.Ukurikije ubuhanga no gukoresha neza RTSA mubihe bitandukanye, abashoramari benshi kandi baherutse kugerageza RTSA imbere ya MRCT yoroshye, kandi byaragenze neza cyane, hamwe nimyaka 10 yo kubaho kwatewe hejuru ya 90%.

Muri make, usibye CTA, ibimenyetso byagutse kuri RTSA birimo amarira manini adasubirwaho ya rotate cuff amarira adafite osteoarthropathie inflammatory, ibibyimba, kuvunika gukabije, arthrite nyuma yo guhahamuka, inenge zamagufwa cyangwa ingingo zamagufwa zahindutse cyane.gutwika, hamwe no gutandukana ibitugu.

Hano hari bike bivuguruza RTSA.Usibye kwanduza muri rusange gusimburanya ibihimbano nko kwandura, kudakora kwimitsi ya deltoid ni ukurwanya rwose RTSA.Byongeye kandi, kubijyanye no kuvunika kwimyanya ndangagitsina, kuvunika gukinguye no gukomeretsa kwa brachial plexus na byo bigomba gufatwa nk’indwara zanduza, mu gihe ibikomere by’imitsi by’imitsi byitaruye bigomba gufatwa nkaho bivuguruzanya.

Kwitaho nyuma yubuvuzi no gusubiza mu buzima busanzwe

Amahame yo gusubiza mu buzima busanzwe nyuma yo kubagwa:

Gukangurira ishyaka abarwayi bafite bwo gusubiza mu buzima busanzwe no gushyiraho ibyifuzo bifatika ku barwayi.

Kugabanya ububabare no gutwikwa, kandi bikarinda ibyubaka, ariko subcapularis mubisanzwe ntabwo ikeneye kurindwa.

Gutandukana imbere yigitugu gishobora kuba kumwanya wanyuma wa hyperextension, kwiyongera no kuzunguruka imbere, cyangwa gushimuta no kuzunguruka hanze.Kubwibyo, kugenda nka backhands bigomba kwirindwa ibyumweru 4 kugeza kuri 6 nyuma yo kubagwa.Iyi myanya ifite ibyago byo gutandukana.

Nyuma yibyumweru 4 kugeza kuri 6, biracyakenewe gushyikirana no kubona uruhushya kubaga mbere yo gutangira ingendo n'imyanya yavuzwe haruguru.

Imyitozo ngororamubiri nyuma yo kubagwa igomba gukorwa mbere idafite uburemere hanyuma ikabyara ibiro, ubanza nta kurwanywa hanyuma ikabirwanya, ikabanza guhita hanyuma ikabikora.

Kugeza ubu, nta buryo bukomeye kandi bumwe bwo gusubiza mu buzima busanzwe, kandi hariho itandukaniro rikomeye muri gahunda z’abashakashatsi batandukanye.

Ibikorwa byabarwayi mubuzima bwa buri munsi (ADLs) (ibyumweru 0-6):