Themistocles Gluck ne ya fara gabatar da manufar maye gurbin kafada ta wucin gadi a shekarar 1891. Gabobin roba da aka ambata kuma aka tsara tare sun haɗa da kugu, wuyan hannu, da sauransu. An yi tiyatar maye gurbin kafada ta farko ga wani majiyyaci a shekarar 1893 ta likitan fida na Faransa Jules Emile Péan a Hôpital International da ke Paris a kan wani majiyyaci mai shekaru 37 da ke fama da tarin fuka na gidajen abinci da ƙasusuwa. An yi tiyatar farko ta kafada ta wucin gadi ta likitan haƙori J. Porter Michaels daga Paris, da kuma humeral.tusheAn yi shi ne da ƙarfe na platinum kuma an haɗa shi da kan roba mai rufi da paraffin ta hanyar waya don samar da dashen da ya dace. Sakamakon farko na majiyyacin ya gamsar, amma daga ƙarshe an cire robar bayan shekaru 2 saboda sake kamuwa da cutar tarin fuka sau da yawa. Wannan shine yunƙurin farko da mutane suka yi don maye gurbin kafadar roba.
A shekarar 1951, Frederick Krueger ya ba da rahoton amfani da wani sinadari mai ƙarfi na kafada wanda aka yi da bitamin kuma aka ƙera shi daga ƙashin ƙugu na gawar. An yi amfani da wannan da kyau wajen magance wani matashi mai fama da ciwon ƙashi na ƙashin ƙugu.
Amma ƙwararren masanin kafada Charles Neer ne ya tsara kuma ya ƙirƙiro madadin kafada ta zamani. A shekarar 1953, domin magance rashin gamsuwar sakamakon tiyatar da aka yi masa na karyewar ƙashin ƙugu, Neer ya ƙirƙiro wani aikin tiyata na musamman na ƙashin ƙugu don karyewar kai na ƙashin ƙugu, wanda aka inganta sau da yawa a cikin shekaru ashirin da suka biyo baya. An ƙera kayan tiyata na ƙarni na biyu da na uku.
A farkon shekarun 1970, domin magance matsalar maye gurbin kafada ga marasa lafiya da ke fama da matsalar aikin gyaran kafada mai tsanani, Neer ne ya fara gabatar da manufar gyaran kafada mai juyawa (RTSA), amma saboda gazawar da aka samu a farkon bangaren glenoid, daga baya aka yi watsi da manufar. A shekarar 1985, Paul Grammont ya inganta bisa ga manufar da Neer ya gabatar, yana motsa tsakiyar juyawa a tsakiya da kuma nesa, yana canza hannun motsi da tashin hankali na deltoid, ta haka ne ya magance matsalar asarar aikin gyaran kafada mai juyawa.
Ka'idojin ƙira na roba mai trans-shoulder
Gyaran kafada na baya (RTSA) yana mayar da dangantakar jikin kafada ta halitta don dawo da daidaiton kafada. RTSA yana ƙirƙirar fulcrum da tsakiyar juyawa (CoR) ta hanyar yin gefen glenoid convex da gefen kai na humeral concave. Aikin biomechanical na wannan fulcrum shine hana kan humeral motsawa sama lokacin da tsokar deltoid ta yi ƙunci don janye hannun sama. Siffar RTSA ita ce cibiyar juyawa ta haɗin kafada ta wucin gadi da matsayin kan humeral dangane da kafada ta halitta ana motsa su ciki da ƙasa. Tsarin prosthesis na RTSA daban-daban sun bambanta. Kan humeral yana motsawa ƙasa da 25 ~ 40mm kuma yana motsawa ciki da 5 ~ 20mm.
Idan aka kwatanta da haɗin kafadar jikin ɗan adam na halitta, wata fa'ida ta musamman ta CoR mai canzawa ta ciki ita ce cewa hannun da aka ɗaga na deltoid yana ƙaruwa daga 10mm zuwa 30mm, wanda ke inganta ingancin ɗaga na deltoid, kuma ana iya samun ƙarancin ƙarfin tsoka. Ƙarfin juyi iri ɗaya, kuma wannan fasalin yana sa ɗaga kan humeral ba ya dogara gaba ɗaya akan aikin ɓacin rai na cikakken rotator cuff.
Wannan shine ƙira da kuma tsarin biomechanics na RTSA, kuma yana iya zama ɗan gundura da wahalar fahimta. Akwai wata hanya mafi sauƙi ta fahimtar ta? Amsar ita ce eh.
Na farko shine tsarin RTSA. A hankali a lura da halayen kowace haɗin gwiwa na jikin ɗan adam, za mu iya samun wasu ƙa'idodi. Haɗin gwiwar ɗan adam za a iya raba shi kashi biyu. Ɗaya shine haɗin gwiwa na kusa da gangar jiki kamar kafadu da kwatangwalo, ƙarshen kusanci shine "ƙoƙon" kuma ƙarshen nesa shine "ƙwallo".
Wani nau'in kuma shine haɗin nesa kamargwiwoyida gwiwar hannu, inda ƙarshen kusanci shine "ƙwallo" kuma ƙarshen nesa shine "ƙoƙon".
Shirin da majagaba na likitanci suka ɗauka lokacin da suke tsara kayan haɗin gwiwa na kafada na wucin gadi a farkon zamanin shine a dawo da tsarin jikin kafadar halitta gwargwadon iko, don haka an tsara dukkan tsare-tsare tare da ƙarshen kusanci a matsayin "ƙoƙo" da ƙarshen nesa a matsayin "ƙwallo". Wasu masu bincike ma sun tsara "ƙoƙon" da gangan don ƙara kwanciyar hankali na haɗin gwiwa, kama da na ɗan adam.haɗin hip, amma daga baya an tabbatar da cewa ƙara kwanciyar hankali ya ƙara yawan gazawar, don haka aka ɗauki wannan ƙira cikin sauri. daina. RTSA, a gefe guda, yana juya halayen jikin kafadar halitta, yana juya "ƙwallo" da "ƙoƙo", yana mai da haɗin "ƙugu" na asali kamar "gwiwoyi" ko "gwiwa". Wannan canjin da ke haifar da rikici a ƙarshe ya magance matsaloli da shakku da yawa na maye gurbin kafadar wucin gadi, kuma a lokuta da yawa, ingancinsa na dogon lokaci da na ɗan gajeren lokaci ya inganta sosai.
Haka kuma, ƙirar RTSA tana canza tsakiyar juyawa don ba da damar ƙara ingancin satar deltoid, wanda kuma zai iya yin kama da ba a san shi ba. Kuma idan muka kwatanta haɗin kafadarmu da na'urar aunawa, yana da sauƙin fahimta. Kamar yadda aka nuna a cikin hoton da ke ƙasa, ana amfani da ƙarfin juyawa iri ɗaya a cikin alkiblar A (ƙarfin matsewar deltoid), idan an canza fulcrum da matsayin farawa, a bayyane yake cewa ana iya samar da babban ƙarfin juyawa (ƙarfin satar hannu na sama) a alkiblar B.
Sauyin da aka samu a tsakiyar juyawar RTSA yana da irin wannan tasiri, yana ba da damar kafada mai rauni ta fara satar jiki ba tare da rage girman da ke kan na'urar juyawa ba. Kamar yadda Archimedes ya ce: Ba ni wani abu mai ƙarfi kuma zan iya motsa duniya gaba ɗaya!
Alamomi da Hana Amfani da RTSA
Alamun da ake samu a RTSA shine ciwon jijiyoyi na rotator cuff tear arthropathy (CTA), wani babban tsagewar rotator cuff tare da osteoarthritis, wanda yawanci ana siffanta shi da canjin kan humeral sama, wanda ke haifar da canje-canje masu lalacewa a kan glenoid, acromion da humeral. Canjin kan humeral sama yana faruwa ne sakamakon rashin daidaiton ƙarfi tsakanin ma'aurata a ƙarƙashin aikin deltoid bayan rashin aikin rotator cuff. CTA ya fi yawa a cikin tsofaffi mata, inda "pseudoparalysis" na gargajiya na iya faruwa.
Amfani da tiyatar gyaran kafada, musamman RTSA, ya ƙaru sosai a cikin shekaru ashirin da suka gabata. Dangane da sakamakon farko na aikace-aikacen RTSA, ci gaba da haɓaka dabarun tiyata, da kuma ƙwarewar amfani da wannan dabarar, an faɗaɗa alamun farko na RTSA, saboda haka, yawancin hanyoyin tiyatar gyaran kafada da ake yi a halin yanzu sune RTSA.
Misali, tiyatar gyaran kafada ta jiki (ATSA) ita ce zaɓin da aka fi so ga osteoarthritis na kafada ba tare da tsagewar cuff ba a baya, amma a cikin 'yan shekarun nan, adadin mutanen da ke da wannan ra'ayi yana raguwa a hankali. Akwai waɗannan fannoni. Dalilai sun haifar da wannan yanayin. Na farko, har zuwa kashi 10% na marasa lafiya da suka karɓi ATSA sun riga sun sami tsagewar cuff ta rotator. Na biyu, a wasu lokuta, "tsarin" ingancin "aikin" rotator cuff bai cika ba, musamman a wasu tsofaffi marasa lafiya. A ƙarshe, ko da rotator cuff ɗin yana nan lafiya a lokacin tiyata, lalacewar rotator cuff yana faruwa da shekaru, musamman bayan hanyoyin ATSA, kuma hakika akwai rashin tabbas sosai game da aikin rotator cuff. Wannan lamari yawanci yana faruwa ne a cikin tsofaffi marasa lafiya sama da shekaru 70. Saboda haka, ƙarin likitocin tiyata sun fara zaɓar RTSA lokacin da suke fuskantar osteoarthritis na kafada mai tsabta. Wannan yanayin ya haifar da sabon tunani cewa RTSA na iya zama zaɓi na farko ga marasa lafiya da ke da osteoarthritis tare da rotator cuff mai tsabta bisa ga shekaru kawai.
Hakazalika, a baya, ga masu fama da ciwon da ba za a iya gyarawa ba (MRCT) ba tare da osteoarthritis ba, wasu hanyoyin sun haɗa da rage matsin lamba na subacromial, sake gina rotator cuff, hanyar Sinanci, da sake gina kapsul na sama. , ƙimar nasarar ta bambanta. Dangane da ƙwarewa da nasarar amfani da RTSA a cikin yanayi daban-daban, ƙarin masu aiki sun gwada RTSA kwanan nan a gaban MRCT mai sauƙi, kuma ya yi nasara sosai, tare da tsawon shekaru 10 na dasawa sama da kashi 90%.
A taƙaice, ban da CTA, alamun da aka faɗaɗa a yanzu na RTSA sun haɗa da manyan raunukan da ba za a iya gyarawa ba tare da kumburin osteoarthritis ba, ciwace-ciwacen daji, karyewar ƙashi mai tsanani, ciwon gwiwa bayan rauni, lahani na ƙashi ko kuma gurɓataccen haɗin ƙashi mai tsanani. kumburi, da kuma sake dawowar karyewar kafada.
Akwai ƙananan abubuwan da ke hana RTSA. Banda ga abubuwan da ke hana maye gurbin gaɓoɓin roba kamar kamuwa da cuta, rashin aikin tsokar deltoid babban abin da ke hana RTSA ne. Bugu da ƙari, ga karaya ta proximal humerus, karyewar buɗaɗɗiya da raunin brachial plexus suma ya kamata a ɗauke su a matsayin abubuwan da ke hana, yayin da raunin jijiya na axillary da aka ware ya kamata a ɗauke su a matsayin abubuwan da ke hana faruwar ...
Kulawa da gyaran jiki bayan tiyata
Ka'idojin gyaran jiki bayan tiyata:
Ka tattaro sha'awar marasa lafiya don gyarawa da kuma kafa tsammanin da ya dace ga marasa lafiya.
Yana rage ciwo da kumburi, kuma yana kare tsarin warkarwa, amma yawanci ba sai an kare subscapularis ba.
Rushewar haɗin gwiwa na gaba yana iya faruwa a ƙarshen matsayi na tsawaitawa, juyawa da juyawar ciki, ko juyawar ɗagawa da juyawar waje. Saboda haka, ya kamata a guji motsi kamar na baya na tsawon makonni 4 zuwa 6 bayan tiyata. Waɗannan wurare suna da haɗarin karyewa.
Bayan makonni 4 zuwa 6, har yanzu yana da mahimmanci a yi magana da likitan tiyata kafin a fara motsi da matsayi a sama.
Ya kamata a fara yin atisayen gyaran jiki bayan tiyata ba tare da ɗaukar nauyi ba sannan a yi amfani da ɗaukar nauyi, da farko ba tare da juriya ba sannan a yi amfani da juriya, da farko ba tare da amfani da hankali ba sannan a yi aiki da hankali.
A halin yanzu, babu wani tsari mai tsauri da daidaito na gyaran jiki, kuma akwai manyan bambance-bambance a cikin shirye-shiryen masu bincike daban-daban.
Tsarin Ayyukan Rayuwa ta Yau da Kullum (ADLs) (makonni 0-6):
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Lokacin Saƙo: Nuwamba-21-2022
