Pfungwa yekutsiviwa kwepfudzi rekugadzira yakatanga kutaurwa naThemistocles Gluck muna 1891. Majoini ekugadzira anotaurwa uye akagadzirwa pamwe chete anosanganisira hip, wrist, nezvimwewo. Kuvhiya kwekutanga kwepfudzi kunoitwa kumurwere muna 1893 nachiremba wekuFrance Jules Emile Péan paHôpital. International muParis pamurwere ane makore makumi matatu nemanomwe ane tuberculosis yemajoini nemapfupa Yekutanga yakanyorwa pamafudzi arthroplasty.Iyo prosthesis yakagadzirwa nachiremba wemazino J. Porter Michaels kubva kuParis, uye humeralstemyakanga yakagadzirwa nesimbi yeplatinum uye yakanamirwa kumusoro werabha wakavharwa neparafini newaya kuti iite chinhu chinosungirirwa.Mhedzisiro yekutanga yemurwere yaigutsa, asi prosthesis yakazobviswa mushure memakore maviri nekuda kwekudzokorora kwakawanda kwechirwere chetachiona.Uku ndiko kuedza kwekutanga kwakaitwa nevanhu mukutsiviwa kwepfudzi.
Muna 1951, Frederick Krueger akashuma kushandiswa kweimwe anatomical yakakosha yepfudzi prosthesis yakagadzirwa nemavhitamini uye yakaumbwa kubva kune proximal humerus yecadaver.Izvi zvakabudirira kushandiswa kurapa murwere wechidiki ane osteonecrosis yehumeral head
Asi iyo chaiyo yemazuva ano inotsiva mafudzi yakagadzirwa uye yakagadziridzwa nemukuru wemafudzi Charles Neer.Muna 1953, kuti igadzirise mhedzisiro isingagutsi yekurapa kwayo kwekuvhiya kweproximal humeral fractures, Neer akagadzira anatomical proximal humeral prosthesis yehumeral head fractures, iyo yakagadziridzwa kakawanda mumakumi maviri emakore akatevera, zvichiteerana.Yakagadzirwa yechipiri neyechitatu chizvarwa prostheses.
Mukutanga 1970s, kuitira kugadzirisa kutsiva kwepfudzi muvarwere vane yakanyanya rotator cuff dysfunction, iyo pfungwa yereverse shoulder arthroplasty (RTSA) yakatanga kutaurwa naNeer, asi nekuda kwekutadza kwekutanga kwechikamu cheglenoid, Pfungwa iyi yakazotevera. kusiiwa.Muna 1985, Paul Grammont akavandudza maererano nemafungiro akakurudzirwa naNeer, achifambisa pakati pekutenderera nepakati uye kure, achishandura nguva yeruoko uye kushushikana kwe deltoid, nokudaro kugadzirisa zvakakwana dambudziko rekurasikirwa kwekushanda kwe rotator cuff.
Dhizaini misimboti ye trans-shoulder prosthesis
Reverse shoulder arthroplasty (RTSA) inodzoreredza hukama hweanatomical hwepafudzi rechisikigo kudzorera kugadzikana kwepfudzi.RTSA inogadzira fulcrum uye yepakati yekutenderera (CoR) nekugadzira iyo glenoid side convex uye humeral musoro padivi concave.Basa rebiomechanical reiyi fulcrum nderokudzivirira musoro wehumeral kuti urege kukwira kumusoro kana deltoid muscle makondirakiti kubvuta ruoko rwepamusoro.Chimiro cheRTSA ndechekuti nzvimbo yekutenderera yejojo repafudzi rekugadzira uye nzvimbo yemusoro wehumera inoenderana nebendekete remusikirwo inofambiswa mukati uye pasi.Yakasiyana RTSA prosthesis magadzirirwo akasiyana.Musoro wehumeral unofambiswa pasi ne25 ~ 40mm uye unofambiswa mukati ne5 ~ 20mm.
Kuenzaniswa neyakajairwa fudzi remuviri wemunhu, mukana uri pachena wekuchinja kwemukati CoR ndeyekuti iyo nguva yekubira ruoko rwe deltoid inowedzerwa kubva pa10mm kusvika 30mm, iyo inovandudza kupamba kweiyo deltoid, uye kushoma mhasuru simba rinogona kugadzirwa. .Iyo torque imwe chete, uye chimiro ichi chinoitawo kuti kubiwa kwehumeral musoro kurege kutsamira zvachose pakuora mwoyo basa reiyo yakazara rotator cuff.
Uku ndiko dhizaini uye biomechanics yeRTSA, uye inogona kunge iri kufinha uye yakaoma kunzwisisa.Pane imwe nzira iri nyore yekuinzwisisa here?Mhinduro ndihongu.
Yokutanga ndiyo dhizaini yeRTSA.Kunyatsocherechedza maitiro ega rega rega remuviri wemunhu, tinogona kuwana mimwe mitemo.Majoini emunhu anogona kupatsanurwa kuita zvikamu zviviri.Imwe iri padyo-hunde majoini senge mapendekete uye mahudyu, neinoperera magumo iri "mukombe" uye magumo ekupedzisira ari "bhora".
Imwe mhando ndeye distal majoini akadaimabviuye magokora, nemagumo ekupedzisira ari "bhora" uye magumo ari "mukombe".
Urongwa hwakagamuchirwa nemapiyona ezvokurapa pakugadzira mapendekete ejoint prostheses mumazuva ekutanga kwaiva kudzorera anatomical chimiro chepfudzi rezvisikwa zvakanyanya sezvinobvira, saka zvirongwa zvose zvakagadzirirwa nemagumo ekupedzisira se "mukombe" uye kuguma kwekupedzisira se a "bhora".Vamwe vatsvakurudzi vakatogadzira nemaune "mukombe" kuti uve mukuru uye wakadzika kuitira kuti uwedzere kugadzikana kwekubatana, kufanana nemunhu.hip joint, asi gare gare yakaratidza kuti kuwedzera kugadzikana kwakawedzera kukundikana kwehuwandu, saka iyi yakagadzirwa yakakurumidza kugamuchirwa.ramwa.RTSA, kune rumwe rutivi, inodzoreredza hunhu hwemapfudzi echisikigo, kushandura "bhora" uye "mukombe", ichiita iyo yepakutanga "hudyu" yakabatana se "gokora" kana "bvi".Iyi shanduko yekupandukira yakazogadzirisa matambudziko mazhinji uye kusahadzika kwekugadziriswa kwepfudzi, uye kazhinji, kushanda kwayo kwenguva refu uye kwenguva pfupi kwakagadziridzwa zvakanyanya.
Saizvozvowo, dhizaini yeRTSA inoshandura nzvimbo yepakati yekutenderera kuti ibvumidze kuwedzera deltoid abduction kunyatsoita, izvo zvinogona zvakare kunzwika kuvanzika.Uye kana tikaenzanisa majoi edu epafudzi kune seesaw, zviri nyore kunzwisisa.Sezvinoratidzwa mumufananidzo uri pasi apa, kushandisa torque imwechete muA direction (iyo deltoid contraction force), kana fulcrum uye nzvimbo yekutanga yakashandurwa, zviri pachena kuti torque yakakura (iyo yekumusoro ruoko abduction force) inogona kugadzirwa B nhungamiro.
Shanduko yepakati yeRTSA yekutenderera ine mhedzisiro yakafanana, ichibvumira pfudzi risina kugadzikana kuti ritange kupambwa pasina rotator cuff depression.Sezvakataurwa naArchimedes: Ndipei fulcrum uye ndinogona kufambisa pasi rose!
RTSA Zviratidzo uye Contraindications
Chiratidzo chekare cheRTSA ndeye rotator cuff tear arthropathy (CTA), hofori rotator cuff kubvaruka ine osteoarthritis, iyo inowanzo onekwa nekusimuka kwepamusoro kwemusoro wehumeral, zvichikonzera glenoid, acromion uye humeral musoro unoramba uchichinja shanduko.Kusimuka kwepamusoro kwemusoro wehumeral kunokonzerwa nekusagadzikana kwesimba vaviri pasi pechiito che deltoid mushure mekusashanda kwe rotator cuff.CTA inowanzoonekwa muvakadzi vakuru, apo "pseudoparalysis" yekare inogona kuitika.
Kushandiswa kwepfudzi arthroplasty, kunyanya RTSA, kwakawedzera zvakanyanya pamakumi maviri emakore apfuura.Zvichienderana nemigumisiro yekutanga yakabudirira yeRTSA application, kuenderera mberi kwekuvandudzwa kwehunyanzvi hwekuvhiya, uye nehunyanzvi hwekushandisa nzira iyi, yekutanga nhete zviratidzo zveRTSA zvawedzerwa, uye nekudaro, maitiro mazhinji emafudzi arthroplasty anoitwa parizvino iRTSA.
Semuenzaniso, anatomical total shoulder arthroplasty (ATSA) ndiyo yaisarudzwa sarudzo yepfudzi osteoarthritis isina rotator cuff kubvaruka munguva yakapfuura, asi mumakore achangopfuura, nhamba yevanhu vane maonero aya inoita seiri kuderera zvishoma nezvishoma.Pane zvinhu zvinotevera.Zvikonzero zvakaita kuti pave nemaitiro aya.Kutanga, kusvika gumi muzana yevarwere vanogamuchira ATSA vatove neinotenderera cuff misodzi.Chechipiri, mune dzimwe nguva, kuvimbika kwe "maitiro" e "basa" re rotator cuff haina kukwana, kunyanya kune vamwe varwere vakwegura.Pakupedzisira, kunyange kana iyo rotator cuff yakagadzikana panguva yekuvhiyiwa, rotator cuff degeneration inoitika nezera, kunyanya mushure mekuita kweATSA, uye pane zvechokwadi kusava nechokwadi kwakanyanya pamusoro pebasa re rotator cuff.Ichi chiitiko chinowanzoitika kune vakwegura varwere vanopfuura makore makumi manomwe.Naizvozvo, vavhiyi vakawanda vakatanga kusarudza RTSA pavakatarisana neosteoarthritis yakachena.Mamiriro ezvinhu aya aita kuti pave nemafungiro matsva ekuti RTSA inogonawo kuva sarudzo yekutanga kune varwere vane osteoarthritis ine intact rotator cuff inobva pazera chete.
Saizvozvo, munguva yakapfuura, kune isingagadzirike yakakura rotator cuff misodzi (MRCT) isina osteoarthritis, dzimwe nzira dzinosanganisira subacromial decompression, partial rotator cuff reconstruction, nzira yeChinese, uye yekumusoro joint capsule kuvakazve., mwero wekubudirira unosiyana.Zvichienderana nehunyanzvi uye nekubudirira kwekushandisa kweRTSA mumamiriro akasiyana-siyana, vafambisi vakawanda vachangobva kuedza RTSA pamberi peMRCT iri nyore, uye yakabudirira zvikuru, neiyo 10-gore yekudyara yekupona mwero inopfuura 90%.
Muchidimbu, kuwedzera kuCTA, zviratidzo zvakawedzerwa zveRTSA zvino zvinosanganisira misodzi mikuru isingagadzirike isina kuputika osteoarthropathy, mabundu, kutsemuka kwakanyanya, post-traumatic arthritis, kuremara kwemapfupa kana majoini akaremara zvakanyanya.kuzvimba, uye kudzokororwa kwepfudzi.
Kune mashoma contraindications kune RTSA.Kunze kwezvakajairwa zvipikiso zvekutsiviwa kwemajoini senge hutachiona, kusashanda kweiyo deltoid tsandanyama inopokana zvachose kuRTSA.Pamusoro pezvo, kune proximal humerus fractures, kuvhurika kuputsika uye kukuvara kwebrachial plexus kunofanirwawo kutariswa sezvinopesana, nepo kukuvara kweaxillary nerve kunofanira kutorwa sehukama contraindication.
Post-operative kuchengetedza uye kugadzirisa
Nheyo dze postoperative rehabilitation:
Sanganisa chido chevarwere chekudzorerwa uye gadza zvinotarisirwa zvinotarisirwa kune varwere.
Inoderedza marwadzo uye kuzvimba, uye inodzivirira kuporesa zvimiro, asi subscapularis kazhinji haidi kuchengetedzwa.
Anterior dislocation yejoint shoulder inogona kuitika panzvimbo dzekupedzisira dze hyperextension, adduction uye kutenderera kwemukati, kana kutorwa uye kutenderera kwekunze.Naizvozvo, mafambiro akadai semabackhands anofanirwa kudzivirirwa kwemavhiki mana kusvika matanhatu mushure mekuvhiyiwa.Zvinzvimbo izvi zvine njodzi yekubviswa.
Mushure memavhiki mana kusvika matanhatu, zvichiri kudikanwa kutaurirana uye kuwana mvumo kubva kuna chiremba wekuvhiya usati watanga mafambiro uye zvinzvimbo zviri pamusoro.
Postoperative rehabilitation exercises inofanira kuitwa kutanga pasina huremu uyezve nekutakura uremu, kutanga pasina kupikisa uyezve nekudzivisa, kutanga pasina kutakura uye nekushingaira.
Parizvino, hapana yakasimba uye yunifomu rehabilitation mwero, uye pane misiyano yakakura muzvirongwa zvevaongorori vakasiyana.
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Nguva yekutumira: Nov-21-2022
