Labarai - Tarihin Sauya kafadu

Themistocles Gluck ya fara gabatar da manufar maye gurbin kafada ta wucin gadi a shekara ta 1891. Ƙungiyoyin wucin gadi da aka ambata kuma aka tsara su tare sun haɗa da hip, wuyan hannu, da dai sauransu. An yi wa majiyyaci tiyata na farko a kafada a 1893 ta hanyar likitan Faransa Jules Emile Péan a Asibiti. International a Paris a kan wani majiyyaci mai shekaru 37 tare da tarin fuka na gidajen abinci da kasusuwa na farko da aka rubuta arthroplasty na kafada.Likitan hakori J. Porter Michaels daga birnin Paris ne ya yi aikin tiyatar, da humeralkaraan yi shi da ƙarfe na platinum kuma an haɗa shi da kan roba mai lullube da paraffin ta hanyar waya don samar da takurawa.Sakamakon farko na majiyyaci ya gamsar, amma a ƙarshe an cire prosthesis bayan shekaru 2 saboda yawan maimaitawar tarin fuka.Wannan shine ƙoƙari na farko da mutane suka yi don maye gurbin kafada ta wucin gadi.

A shekara ta 1951, Frederick Krueger ya ba da rahoton yin amfani da wata mahimmancin gyaran kafada da aka yi da bitamin kuma an ƙera shi daga kusancin humerus na cadaver.Anyi nasarar amfani da wannan don kula da wani matashi mara lafiya tare da osteonecrosis na humeral head

Amma ainihin maye gurbin kafada na zamani an tsara shi kuma ya haɓaka ta guru Charles Neer.A shekara ta 1953, don magance rashin gamsuwa da sakamakon tiyatar da aka yi masa na raunin raunin da ya faru, Neer ya ɓullo da prosthesis na kusa da humeral don karyewar kai, wanda aka inganta sau da yawa a cikin shekaru ashirin da suka biyo baya.Ƙirƙirar prostheses ƙarni na biyu da na uku.

A farkon 1970s, don magance maye gurbin kafada a cikin marasa lafiya tare da rashin aiki mai tsanani na rotator cuff, Neer ya fara gabatar da manufar reverse kafada arthroplasty (RTSA), amma saboda farkon gazawar bangaren glenoid, manufar ta kasance daga baya. watsi.A cikin 1985, Paul Grammont ya inganta bisa ga ra'ayin da Neer ya gabatar, yana motsa tsakiyar juyawa ta tsakiya da nisa, yana canza lokacin hannu da tashin hankali na deltoid, don haka daidai warware matsalar rashin aikin rotator cuff.

Ka'idodin ƙira na prosthesis trans-kafada

Reverse kafada arthroplasty (RTSA) yana jujjuya dangantakar jikin jikin kafada ta halitta don dawo da kwanciyar hankali na kafada.RTSA yana ƙirƙirar fulcrum da tsakiyar juyawa (CoR) ta hanyar yin madaidaicin gefen glenoid da madaidaicin gefen gefen humeral.Ayyukan biomechanical na wannan fulcrum shine don hana kan humeral motsawa sama lokacin da tsokar deltoid tayi kwangila don sace hannun sama.Siffar RTSA ita ce cibiyar jujjuyawar haɗin gwiwar kafada ta wucin gadi da matsayi na humeral kai dangane da kafada na halitta an motsa zuwa ciki da ƙasa.Daban-daban na RTSA prosthesis ƙira sun bambanta.Shugaban humeral yana saukar da ƙasa da 25 ~ 40mm kuma an motsa shi zuwa ciki ta 5 ~ 20mm.

Idan aka kwatanta da haɗin gwiwa na kafada na jikin ɗan adam, fa'ida ta zahiri na canjin CoR na ciki shine cewa lokacin satar hannu na deltoid yana ƙaruwa daga 10mm zuwa 30mm, wanda ke haɓaka haɓakar satar deltoid, kuma ƙarancin ƙarfin tsoka za a iya haifar da shi. .Irin wannan karfin juyi, wannan siffa kuma ta sa sace kan humeral ya daina dogaro gaba daya ga aikin ɓacin rai na cikakken rotator cuff.

Wannan shi ne ƙira da biomechanics na RTSA, kuma yana iya zama ɗan gundura da wahalar fahimta.Shin akwai hanya mafi sauƙi don fahimtar ta?Amsar ita ce eh.

Na farko shine ƙirar RTSA.A hankali kula da halaye na kowane haɗin gwiwa na jikin mutum, zamu iya samun wasu dokoki.Za a iya raba mahaɗin ɗan adam kusan kashi biyu.Ɗayan yana kusa da gangar jikin jiki kamar kafadu da kwatangwalo, tare da ƙarshen kusa shine "kofin" kuma ƙarshen nesa shine "ball".

Sauran nau'in shine haɗin gwiwa mai nisa kamargwiwoyida gwiwar hannu, tare da ƙarshen kusanci shine "ball" kuma ƙarshen nesa shine "kofin".

Shirin da majagaba na likitanci suka yi amfani da shi lokacin zayyana kayan aikin haɗin gwiwar kafada na wucin gadi a farkon kwanakin shine don dawo da tsarin jikin jikin kafada ta halitta gwargwadon yadda zai yiwu, don haka duk tsare-tsaren an tsara su tare da ƙarshen kusanci a matsayin "kofin" da ƙarshen nesa. da "ball".Wasu masu bincike ma sun tsara "kofin" da gangan don ya zama mafi girma da zurfi don ƙara ƙarfin haɗin gwiwa, kama da ɗan adam.hip hadin gwiwa, amma daga baya an tabbatar da cewa haɓaka kwanciyar hankali a zahiri yana haɓaka ƙimar gazawar, don haka an karɓi wannan ƙirar da sauri.bari.RTSA, a gefe guda, tana jujjuya dabi'un halittar jikin kafada ta halitta, tana jujjuya "ball" da "kofin", yin haɗin gwiwa na "hip" na asali kamar "gwiwoyi" ko "gwiwoyi".Wannan sauye-sauyen juyin juya hali a ƙarshe ya warware matsaloli da yawa da shakku na maye gurbin kafada na wucin gadi, kuma a yawancin lokuta, an inganta ingancinsa na dogon lokaci da na ɗan gajeren lokaci.

Hakazalika, ƙirar RTSA tana canza tsakiyar juyawa don ba da damar haɓaka haɓakar satar deltoid, wanda kuma yana iya zama mara duhu.Kuma idan muka kwatanta hadin gwiwar kafadar mu da abin gani, abu ne mai saukin fahimta.Kamar yadda aka nuna a cikin hoton da ke ƙasa, yin amfani da juzu'i iri ɗaya a cikin hanyar A (ƙarfin ƙanƙara na deltoid), idan an canza fulcrum da matsayi na farawa, a bayyane yake cewa za a iya haifar da ƙarfin da ya fi girma (ƙarfin satar hannu na sama) a cikin B hanyar.

Canji a tsakiyar juyawa na RTSA yana da irin wannan tasiri, yana barin kafada mai rauni ta fara sacewa ba tare da baƙin ciki na rotator cuff ba.Kamar yadda Archimedes ya ce: Ka ba ni fulcrum kuma zan iya motsa dukan duniya!

Alamar RTSA da Contraindications

Alamar al'ada ga RTSA ita ce rotator cuff tear arthropathy (CTA), wani katuwar rotator cuff hawaye tare da osteoarthritis, wanda yawanci ana nuna shi ta hanyar motsawa sama na shugaban humeral, wanda ya haifar da glenoid, acromion da humeral kai ya ci gaba da sauye-sauye na lalacewa.Matsar da kan humeral zuwa sama yana faruwa ne ta hanyar ma'aurata marasa daidaituwa a ƙarƙashin aikin deltoid bayan rashin aiki na rotator cuff.CTA ya fi kowa a cikin tsofaffin mata, inda "pseudoparalysis" na al'ada zai iya faruwa.

Amfani da gyaran kafada, musamman RTSA, ya karu sosai a cikin shekaru ashirin da suka gabata.Dangane da sakamakon nasarar farko na aikace-aikacen RTSA, ci gaba da haɓaka fasahar tiyata, da ƙwararrun aikace-aikacen wannan fasaha, an faɗaɗa alamun farko na kunkuntar don RTSA, sabili da haka, mafi yawan hanyoyin arthroplasty na kafada a halin yanzu ana yin RTSA.

Misali, anatomical total kafada arthroplasty (ATSA) shine zabin da aka fi so don ciwon osteoarthritis na kafada ba tare da rotator cuff hawaye a baya ba, amma a cikin 'yan shekarun nan, adadin mutanen da ke da wannan ra'ayi yana raguwa a hankali.Akwai abubuwa masu zuwa.Dalilai sun haifar da wannan yanayin.Na farko, har zuwa 10% na marasa lafiya da suka karɓi ATSA sun riga sun sami rotator cuff hawaye.Na biyu, a wasu lokuta, amincin "tsarin" na "aiki" na rotator cuff bai cika ba, musamman a wasu tsofaffi marasa lafiya.A ƙarshe, ko da rotator cuff ba shi da kyau a lokacin aikin tiyata, ƙwayar rotator cuff degeneration yana faruwa tare da shekaru, musamman bayan hanyoyin ATSA, kuma hakika akwai rashin tabbas game da aikin rotator cuff.Wannan al'amari yakan faru ne a cikin tsofaffi marasa lafiya da suka girmi shekaru 70.Saboda haka, ƙarin likitocin fiɗa sun fara zaɓar RTSA lokacin da suke fuskantar tsantsar ciwon osteoarthritis na kafada.Wannan yanayin ya haifar da sabon tunani cewa RTSA na iya zama zaɓi na farko ga marasa lafiya da ciwon osteoarthritis tare da ingantaccen rotator cuff dangane da shekaru kawai.

Hakazalika, a baya, ga massive rotator cuff hawaye (MRCT) ba tare da ciwon osteoarthritis ba, wasu hanyoyin da za a iya gyarawa sun haɗa da ɓarkewar ƙwayar cuta, sake gina wani ɓangaren rotator cuff, hanyar Sinanci, da kuma sake gina capsule na haɗin gwiwa na sama., Yawan nasara ya bambanta.Dangane da ƙwarewa da nasarar aikace-aikacen RTSA a yanayi daban-daban, ƙarin masu aiki kwanan nan sun gwada RTSA ta fuskar MRCT mai sauƙi, kuma ya sami nasara sosai, tare da ƙimar tsira na shekaru 10 sama da 90%.

A taƙaice, ban da CTA, alamun faɗaɗa na yanzu don RTSA sun haɗa da manyan juzu'i mai jujjuyawar hawaye ba tare da kumburin osteoarthropathy ba, ciwace-ciwacen daji, karaya mai ƙarfi, cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan da kuma ƙasusuwa.kumburi, da raguwar kafada akai-akai.

Akwai 'yan contraindications ga RTSA.Sai dai gabaɗayan contraindications na maye gurbin haɗin gwiwa na wucin gadi kamar kamuwa da cuta, rashin aikin tsokar deltoid shine cikakken hani ga RTSA.Bugu da ƙari, don raunin humerus na kusa, raunin budewa da raunuka na brachial plexus ya kamata a yi la'akari da contraindications, yayin da raunin jijiya axillary ya kamata a yi la'akari da contraindications.

Kulawar bayan tiyata da gyarawa

Ka'idodin gyaran bayan tiyata:

Tattara sha'awar marasa lafiya don gyarawa da kuma kafa kyakkyawan fata ga marasa lafiya.

Yana rage zafi da kumburi, kuma yana kare tsarin warkaswa, amma subscapularis yawanci baya buƙatar kariya.

Ƙunƙarar gaba na haɗin gwiwa na kafada zai iya faruwa a ƙarshen matsayi na hyperextension, ƙaddamarwa da juyawa na ciki, ko ƙaddamarwa da juyawa na waje.Don haka, ya kamata a guji motsi irin su na baya na tsawon makonni 4 zuwa 6 bayan aikin.Waɗannan matsayi suna da haɗarin tarwatsewa.

Bayan makonni 4 zuwa 6, har yanzu yana da mahimmanci don sadarwa tare da samun izini daga likitan tiyata kafin fara motsi da matsayi na sama.

Dole ne a fara gudanar da atisayen gyaran gyare-gyaren bayan tiyata da farko ba tare da ɗaukar nauyi ba sannan kuma tare da ɗaukar nauyi, da farko ba tare da juriya ba sannan kuma tare da juriya, da farko ba da ƙarfi sannan kuma cikin raɗaɗi.

A halin yanzu, babu ƙaƙƙarfan ƙayyadaddun ƙayyadaddun gyare-gyare, kuma akwai babban bambance-bambance a cikin tsare-tsaren masu bincike daban-daban.

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