Pfungwa yekutsiva mapendekete ekugadzira yakatanga kutaurwa naThemistocles Gluck muna 1891. Mapfundo ekugadzira anotaurwa uye akagadzirwa pamwe chete anosanganisira chiuno, ruoko, nezvimwewo. Kuvhiyiwa kwekutanga kwekutsiva mapendekete kwakaitwa pamurwere muna 1893 nachiremba wekuFrance Jules Emile Péan paHôpital International muParis pamurwere ane makore 37 ekuberekwa ane TB yemapfudze nemapfupa. Kuvhiyiwa kwekutanga kwakanyorwa nezve arthroplasty yepfudzi. Kugadzira kwakagadzirwa nachiremba wemazino J. Porter Michaels wekuParis, uye humeral.dzindeYakagadzirwa nesimbi yeplatinum uye yakabatanidzwa newaya pamusoro werabha wakafukidzwa neparafini kuti igadzire chinhu chakaiswa mudumbu. Mhedzisiro yekutanga yemurwere yaigutsa, asi chigadziko chekugadzira chakazobviswa mushure memakore maviri nekuda kwekudzoka kwechirwere cheTB kakawanda. Uku ndiko kuedza kwekutanga kwakaitwa nevanhu pakutsiva mapendekete ekugadzira.
Muna 1951, Frederick Krueger akataura nezvekushandiswa kwechinhu chepfudzi chakakosha zvikuru chakagadzirwa nemavhitamini uye chakaumbwa kubva kunhengo yepedyo yechitunha. Izvi zvakashandiswa zvinobudirira kurapa murwere mudiki ane osteonecrosis yemusoro wenhengo yechipfuva.
Asi nzira yemazuva ano yekutsiva mapendekete yakagadzirwa uye yakagadzirwa nenyanzvi yezvemapendekete Charles Neer. Muna 1953, kuti igadzirise mhedzisiro isingagutsi yekurapa kwayo kupwanyika kwemapfupa eproximal humeral, Neer akagadzira prosthesis yeproximal humeral yemapfupa emusoro wehumeral, iyo yakagadziriswa kakawanda mumakumi maviri emakore akatevera, zvichiteerana. Yakagadzirwa prostheses dzechizvarwa chechipiri nechechitatu.
Mukutanga kwema1970, kuitira kugadzirisa kutsiva mapendekete muvarwere vane dambudziko guru re rotator cuff, pfungwa ye reverse shoulder arthroplasty (RTSA) yakatanga kutaurwa naNeer, asi nekuda kwekukundikana kwekutanga kwechikamu cheglenoid, pfungwa iyi yakazoregwa. Muna 1985, Paul Grammont akavandudzika zvichienderana nepfungwa yakataurwa naNeer, achifambisa pakati pekutenderera pakati nepakati, achichinja ruoko rwenguva uye kusimba kwe deltoid, nokudaro achigadzirisa zvakakwana dambudziko rekurasikirwa kwebasa re rotator cuff.
Nheyo dzekugadzira dze trans-shoulder prosthesis
Kugadziriswa kwemapfupa epafudzi reReverse Shoulder Arthroplasty (RTSA) kunoshandura hukama hwemuviri hwefudzi rechisikigo kuti kudzorere kugadzikana kwefudzi. RTSA inogadzira fulcrum uye centre of rotation (CoR) nekuita kuti divi reglenoid rive convex uye side rehumeral head concave. Basa re biomechanical re fulcrum iyi nderekudzivirira musoro wehumeral kuti usafambe uchikwira kumusoro kana tsandanyama ye deltoid ichidhonza kuti ibvise ruoko rwepamusoro. Chinhu cheRTSA ndechekuti nzvimbo yekutenderera yejointi yefudzi rekugadzira nenzvimbo yemusoro wehumeral zvichienzaniswa nefudzi rechisikigo zvinofambiswa mukati nekudzika. Magadzirirwo akasiyana eRTSA prosthesis akasiyana. Musoro wehumeral unofambiswa pasi ne 25~40mm uye unofambiswa mukati ne 5~20mm.
Zvichienzaniswa nepafudzi rechisikigo remuviri wemunhu, mukana wekuti CoR ishande zvakanaka ndeyekuti ruoko rwe deltoid runowedzerwa kubva pa 10mm kusvika pa 30mm, izvo zvinoita kuti deltoid ishande zvakanaka, uye simba remhasuru risanyanya kugadzirwa. Simba rimwe chete iri, uye chimiro ichi chinoitawo kuti kubatwa kwemusoro we humeral kusashande zvachose pakushanda kwe depression ye rotator cuff.
Uku ndiko kugadzirwa uye biomechanics yeRTSA, uye inogona kunge isina kufadza uye yakaoma kunzwisisa. Pane nzira iri nyore yekuinzwisisa here? Mhinduro ndeyekuti hongu.
Chekutanga igadzirirwo yeRTSA. Nyatsocherechedza hunhu hwejoini rega rega remuviri wemunhu, tinogona kuwana mimwe mitemo. Majoini evanhu anogona kukamurwa kuita zvikamu zviviri. Rimwe majoini ari pedyo nedumbu akaita semapendekete nechiuno, mugumo wepedyo uri "kapu" uye mugumo wekure uri "bhora".
Rumwe rudzi irworwo majoini ekure akadai semabvinemagokora, mugumo wepedyo uri "bhora" uye mugumo wekure uri "kapu".
Chirongwa chakatorwa nevaya vaitanga zvekurapa pakugadzira maprostheses epafudzi ekugadzira mumazuva ekutanga chaive chekugadzirisa chimiro chemuviri wepafudzi rechisikigo zvakanyanya sezvinobvira, saka mapurani ese akagadzirwa nemucheto wepazasi se "kapu" uye mugumo wekure se "bhora". Vamwe vaongorori vakatogadzira nemaune "kapu" kuti ive yakakura uye yakadzika kuitira kuti iwedzere kugadzikana kwejoini, yakafanana neyavanhu.joini yehudyu, asi zvakazoratidzwa gare gare kuti kuwedzera kugadzikana kwakawedzera mwero wekukundikana, saka dhizaini iyi yakakurumidza kugamuchirwa. Rega. RTSA, kune rumwe rutivi, inoshandura hunhu hwemafudzi echisikigo, ichichinja "bhora" uye "kapu", zvichiita kuti "chiuno" chepakutanga chiite se "gokora" kana "bvi". Kuchinja uku kwakagadzirisa matambudziko mazhinji nekusava nechokwadi kwekutsiva mafudzi ekugadzira, uye muzviitiko zvakawanda, kushanda kwayo kwenguva refu uye kwenguva pfupi kwakagadziridzwa zvakanyanya.
Saizvozvowo, dhizaini yeRTSA inochinja nzvimbo yekutenderera kuti ibvumire kuwedzera kushanda kwekubvisa deltoid, izvo zvinogonawo kunzwika zvisina kujeka. Uye kana tikaenzanisa pfudzi redu neseesaw, zviri nyore kunzwisisa. Sezvakaratidzwa mumufananidzo uri pazasi, kushandisa torque imwechete munzira yeA (simba rekudzikisa deltoid), kana fulcrum nenzvimbo yekutanga zvikachinjwa, zviri pachena kuti torque yakakura (simba rekudzikisa ruoko repamusoro) inogona kugadzirwa munzira yeB.
Kuchinja kwepakati pekutenderera kweRTSA kune mhedzisiro yakafanana, zvichibvumira fudzi risina kugadzikana kuti ritange kubatwa pasina kushushikana kwe rotator cuff. Sezvakataurwa naArchimedes: Ndipeiwo fulcrum uye ndinogona kufambisa pasi rese!
Zviratidzo zveRTSA uye Contraindications
Chiratidzo chekare cheRTSA irotator cuff tear arthropathy (CTA), kuputika kukuru kwerotator cuff kune osteoarthritis, iyo inowanzoonekwa nekusuduruka kwemusoro wehumeral kumusoro, zvichikonzera shanduko dzinoramba dzichiita kuti glenoid, acromion uye musoro wehumeral zvirambe zvichiora. Kusuduruka kwemusoro wehumeral kumusoro kunokonzerwa nekusagadzikana kwesimba remuviri mushure mekushanda kwedeltoid mushure mekusashanda zvakanaka kwerotator cuff. CTA inowanzoonekwa muvakadzi vakuru, uko "pseudoparalysis" inogona kuitika.
Kushandiswa kwekurapa mafudzi, kunyanya RTSA, kwakawedzera zvakanyanya mumakore makumi maviri apfuura. Zvichibva pakubudirira kwekutanga kwekushandisa RTSA, kufambira mberi kwekugadzirwa kwenzira yekuvhiya, uye kushandiswa kwakanaka kwenzira iyi, zviratidzo zvekutanga zvakaderera zveRTSA zvakawedzerwa, uye nekudaro, nzira zhinji dzekurapa mafudzi dziri kuitwa pari zvino iRTSA.
Semuenzaniso, anatomical total shoulder arthroplasty (ATSA) ndiyo yaive sarudzo yaifarirwa ye shoulder osteoarthritis isina rotator cuff tear munguva yakapfuura, asi mumakore achangopfuura, huwandu hwevanhu vane maonero aya hunoita sehuri kudzikira zvishoma nezvishoma. Pane zvinhu zvinotevera. Zvikonzero zvakakonzera izvi. Chekutanga, kusvika ku10% yevarwere vanowana ATSA vatova ne rotator cuff tear. Chechipiri, mune dzimwe nguva, "chimiro" che "basa" re rotator cuff hachina kukwana, kunyanya kune vamwe varwere vakwegura. Chekupedzisira, kunyangwe kana rotator cuff isina kubatwa panguva yekuvhiyiwa, rotator cuff degeneration inoitika nekukura, kunyanya mushure mekuvhiyiwa kweATSA, uye zvechokwadi pane kusava nechokwadi kukuru nezvekushanda kwe rotator cuff. Chiitiko ichi chinowanzoitika muvarwere vakwegura vane makore anopfuura 70. Nokudaro, vanachiremba vakawanda vakatanga kusarudza RTSA pavanotarisana ne pure shoulder osteoarthritis. Mamiriro aya akaita kuti pave nepfungwa itsva yekuti RTSA inogonawo kuva sarudzo yekutanga kune varwere vane osteoarthritis vane intact rotator cuff zvichibva pazera chete.
Saizvozvowo, kare, kune irreparable massive rotator cuff tears (MRCT) isina osteoarthritis, dzimwe nzira dzinosanganisira subacromial decompression, partial rotator cuff reconstruction, Chinese way, uye upper joint capsule reconstruction. , mwero wekubudirira unosiyana. Zvichienderana nehunyanzvi uye kushandiswa kwakabudirira kweRTSA mumamiriro akasiyana-siyana, vashandi vakawanda vakaedza RTSA munguva pfupi yapfuura vachitarisana neMRCT iri nyore, uye yakabudirira zvikuru, nechikamu chekurarama kwemakore gumi chekuisirwa kwemasero chinodarika 90%.
Muchidimbu, pamusoro peCTA, zviratidzo zvakawedzerwa zveRTSA zvinosanganisira misodzi mikuru isingagadzirisiki ye rotator cuff isina kuzvimba kwe osteoarthropathy, bundu, kutyoka kwakanyanya, arthritis mushure mekutambudzika, kukuvara kwemapfupa kana majoini emapfupa akaremara zvakanyanya, kuzvimba, uye kudzokororwa kwemafudzi.
Kune zvinhu zvishoma zvisingabvumidzwe kuRTSA. Kunze kwezvisingabvumidzwe zvekutsiva majoini ekugadzira zvakaita sehutachiona, kusashanda kwemhasuru yedeltoid kunopesana zvachose neRTSA. Pamusoro pezvo, pakutyoka kweproximal humerus, kutyoka kwakavhurika uye kukuvara kwebrachial plexus kunofanirawo kuonekwa sekupesana, nepo kukuvara kwetsinga dzemuhudyu kuchifanira kuonekwa sekupesana.
Kutarisirwa uye kugadziriswa mushure mekuvhiyiwa
Nheyo dzekugadzirisa mushure mekuvhiyiwa:
Kurudzirai shungu dzevarwere dzekurapwa uye gadzirai zvinotarisirwa nevarwere.
Inoderedza marwadzo nekuzvimba, uye inodzivirira masero anoporesa, asi subscapularis kazhinji haidi kudzivirirwa.
Kubuda kwepafudzi pamberi kunogona kuitika panzvimbo dzekupedzisira dzekuwedzera simba, kuwedzera simba uye kutenderera kwemukati, kana kubviswa kwemapfupa nekutenderera kwekunze. Saka, mafambiro akaita sekubata maoko kumashure anofanira kudzivirirwa kwemavhiki mana kusvika matanhatu mushure mekuvhiyiwa. Nzvimbo idzi dzine njodzi yekubuda kwemapfupa.
Mushure memavhiki mana kusvika matanhatu, zvichiri kudiwa kutaurirana nachiremba wezvekuvhiya uye kuwana mvumo usati watanga kufamba uye kumira zvataurwa pamusoro apa.
Maekisesaizi ekugadzirisa mushure mekuvhiyiwa anofanira kutanga aitwa pasina kurema uye ozotanga nekutakura uremu, kutanga pasina kuramba uye ozotanga nekuramba, kutanga pasina kusimba uye ozotanga nekushanda nesimba.
Parizvino, hapana mwero wakasimba uye wakafanana wekugadzirisa, uye kune misiyano mikuru muzvirongwa zvevaongorori vakasiyana.
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