7 Chithandizo cha Chithandizo kwa Dupuytren's Contracture

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Kusamala

Dupuytren akugwirizanitsa ndi zala zomwe zimapezeka chifukwa cha matenda a Dupuytren, vuto la mapangidwe osagwirizana ndi collagen pa dzanja lala ndi zala. Mapangidwe owonjezereka a collagen amachititsa zokolola zamphamvu, zotchedwa nodules, ndi magulu onga chingwe, otchedwa zingwe. Ndizo zingwezi zomwe zimakhomerera zala kumtambo ndikuletsa kuwongola kwathunthu kwa zala.

Malangizowo a "chithandizo" kwa anthu omwe ali ndi vutoli ndi kuyembekezera mgwirizano wa Dupuytren pokhapokha ngati wolekerera ndipo pokhapokha akuchipatala. Izi ndi zomwe madokotala amachitcha "kudikirira kuyembekezera." Chifukwa chodikirira kuchipatala chinali chakuti Dupuytren sanachiritsidwe ndi kubwereza kuchipatala kunali kofunikira panthawi ina. Ndipo, podikirira kuti athetse vutoli, chiwerengero cha mankhwala ofunikira m'moyo wonse wa wodwalayo chinali chosachepera.

Monga mankhwala ena atsopano athandizira njira yothetsera vuto la Dupuytren, pali madotolo omwe tsopano amalimbikitsa chithandizo cham'mawa. Ndi majekeseni a collagenase ndi a singano aponeurotomy, kuchiza mobwerezabwereza sikumangoganizira kwambiri. Choncho, chithandizo cham'mawa pamene matendawa sakhala otchuka. Ndipo, posadikirira, mwayi wokonzera bwino mgwirizano ndi wabwino kwambiri umene umapangitsa kuyembekezera kuchipatala mochepa kwambiri.

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Kutambasula & Injections

Kunalipo nthawi imene madokotala analimbikitsa kutambasula, kupukuta, ndi kupyolera cortisone mu minofu ya Dupuytren. Kawirikawiri, mankhwalawa ndi abwino, amathandiza kanthawi kochepa ndipo, poipitsitsa, amatha kuchititsa kuti vutoli lifulumire mwamsanga.

Zilangizi za Cortisone nthawi zina zimagwiritsidwa ntchito poyesa mtundu wa nodupu wa Dupuytren (osati zingwe) ndipo ungathandize kuchepa. Chokhumudwitsa ndi chakuti minofuyi imabwereranso nthawi yayitali kukula kwake, koma mankhwalawa sachitika kawirikawiri. Kuonjezera apo, pali zotsatira zina zomwe zingayambitse zida za cortisone zomwe zingayambitse mavuto kwa anthu ena.

Kutambasulira ndi kugwedeza kunkagwiritsidwa ntchito kawirikawiri m'mbuyomo. Vuto ndiloti mankhwalawa akuwoneka kuti ndi ovuta kwambiri kuwononga vutoli m'malo mowathandiza. Anthu ambiri amayesera kutambasula chala chogwiritsidwa ntchito, koma kawirikawiri chizoloŵezi chimenechi chiyenera kukhumudwa.

Nthawi zina kugwiritsidwa ntchito ndi kutambasula kumagwiritsidwa ntchito pokhapokha ngati mankhwala akuthandizira kuti pakhale mgwirizano wothandizira komanso kupewa kulembetsa mgwirizano. Koma, izi zimakhala zogwira ntchito ngati chithandizo chotsatira pambuyo pake. Panthawiyo, kutambasula ndi kutambasula kungapangidwe kawirikawiri. Kutambasula monga mankhwala ogwiritsidwa ntchito paokha sikungathandize.

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Collagenase Injections

Collagenase ndi puloteni yomwe imachokera ku mabakiteriya. Enzyme iyi imayikidwa mwachindunji mu chingwe cha minofu ya Dupuytren ndipo kenako imaloledwa kuthetsa mitsempha yolimba, yogwirizana. Anthu omwe amalandira katemerawa nthawi zambiri amabwereranso ku ofesi yawo ya dokotala tsiku lotsatira, atatha kukhala ndi mwayi wochotsa minofu yolimba. Panthawi imeneyi, dokotala wanu adzagwiritsira ntchito chala chake mwamphamvu kuti athetse mitsempha yonseyo.

Majekeseni a Collagenase, ogulitsidwa pansi pa dzina la malonda a Xiaflex, adziwika kuti ndi losavuta kuchita ndipo motero mitundu yambiri ya madokotala imapereka. Ndondomekoyi ingathe kuchitidwa mu ofesi ya dokotala, ngakhale kuti imafuna kuti munthu adzidwe kuti abwerere tsiku lotsatizana.

Chokhumudwitsa ndi chakuti collagenase ili ndi zizindikiro zenizeni, kutanthauza kuti sizothandiza aliyense amene ali ndi Dupuytren. Madokotala ena amamva kuti amatha kuthandiza odwala ena pogwiritsa ntchito singano kapena opaleshoni, zomwe nthawi zambiri zimakhala zovuta kwambiri. Kuwonjezera apo, pali mtengo wapatali wa collagenase ndi mapulani ambiri a inshuwaransi sangaphimbe mankhwalawo.

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Needle Aponeurotomy

Thandizo la aponeurotomy ndi njira yowonongeka yochepa yomwe m'malo mochotsa minofu ya Dupuytren yomwe imagwiritsidwa ntchito, imagwiritsa ntchito mfundo ya singano kuti iwononge zingwe ndi kuthetsa mgwirizano. Dokotala wanu amapanga punctures zing'onozing'ono pakhungu, popanda kugwiritsidwa ntchito, komanso pogwiritsa ntchito nsonga ya singano, amadula m'magawo angapo.

Otsatira pa ndondomekoyi amapeza madalitso angapo:

• Ndizotetezeka kwambiri. Zovuta zingatheke, koma mavuto aakulu ndi achilendo.
• Ndi yotchipa. Poyerekeza ndi njira zina zothandizira, nthendayi imakhala yochepa kuposa collagenase kapena opaleshoni.
• Ndi zophweka. Izi ndizofananitsa, kutanthauza kuti sizingakhale zophweka kwa aliyense, koma zimatha kuchitidwa osachepera ora limodzi ndikutsatiridwa sikofunikira.

Pali zotheka kugwiritsira ntchito sing'onoting'ono la singano. Sikuti aliyense ali ndi mtundu wa Dupuytren womwe udzasamalidwe bwino ndi ndondomeko ya singano. Komanso, chizoloŵezichi chikhoza kukhala chofala. Ndipo pamene kubwereza ndondomekoyi sikuli vuto, kubwereza kumachitika mofulumira pambuyo pa njira ya singano poyerekeza ndi chithandizo cha opaleshoni.

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Opaleshoni

Kuyambira kale, opaleshoni ndiyo njira yodziwika kwambiri yothandizira Dupuytren. Pali kusiyana kwakukulu kwa momwe opaleshoni ingathere ndi momwe zikuyenera kukhalira. Pamene opaleshoni imachitidwa, kafukufuku amachitidwa molunjika pamwamba pa dupuytren's, minofu yosasintha imachotsedwa, ndipo zomwe zimagwedezeka zimagwedezeka.

Ubwino wopaleshoni ndi wakuti, ngakhale m'magulu apamwamba kwambiri a Dupuytren, kawirikawiri amatha kuchita chinachake kuchokera kuchipatala. Zambiri za Dupuytren zingafunikire opaleshoni yowonjezereka, koma nthawi zambiri imatha kuthandizidwa kupyolera mu chombo.

Kuonjezerapo, pamene njira zonsezi zimagwirizanitsa ndi mankhwala a Dupuytren, palibe amene amachiza matenda omwe ali ndi matenda a Dupuyren. Choncho, kugwirizanitsa ntchito nthawi zonse ndi kotheka, ziribe kanthu mankhwala omwe akuchitidwa. Nthawi yayitali pakati pa mankhwala ndi kubwereza ndi yaitali kwambiri (kutanthauza kuti anthu safunikira kubwereza mankhwala kwa nthawi yambiri) ndi opaleshoni poyerekeza ndi jekeseni kapena ndondomeko ya singano.

Chovuta kwambiri cha opaleshoni ndichoti kuchira kwa njirayi kungakhale kovuta ndipo kungakhale yaitali. Anthu akhoza kukhala ndi matanthwe kwa masabata ndi kugawidwa kwa miyezi. Nthawi zambiri mankhwala amathandizira kuchipatala. Poyerekeza ndi ndondomeko ya collagenase kapena singano, kupulumuka kwa opaleshoni kumakhudzidwa kwambiri. Ntchitoyi ndi yoti dokotala wanu angathe kuchitidwa opaleshoni yambiri kusiyana ndi njira zochepetsera.

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Kukonzanso Opaleshoni

Monga tanenera kale, chimodzi mwa mavuto akuluakulu ochiza Dupuytren ndi chakuti vuto lalikulu silinasinthe. Matenda a Dupuytren ndi omwe amachititsa kuti collagen mu thupi lanu lisamalamulidwe bwino. Anthu omwe ali ndi vutoli amapanga collagen kwambiri ndipo samaphwanya collagen akale bwino. Mankhwala omwe atchulidwa pano onse amachiza chizindikiro cha vutoli-samathetsa vutoli.

Tsiku lina, tikuyembekeza kuti tidzatha kupereka mankhwala kwa anthu omwe ali ndi Dupuytren kuti athetse kupititsa patsogolo kapena kubwereza mgwirizano. Komabe, mpaka nthawi imeneyo, timakhala ndi mankhwala ochizira matenda a Dupuytren okha. Pa chifukwa chimenechi, Dupuytren angathe, ndipo nthawizonse adzatero, potsirizira pake adzabweranso. Pazochitikazi, chithandizo chamtsogolo chikhoza kuganiziridwa.

Kubwereza opaleshoni ikhoza kukhala yonyenga ndipo ndithudi sizowoneka ngati opaleshoni yoyamba ya Dupuytren. Chifukwa cha minofu yofiira , mapuloteni omwe amatha kukhala osokonezeka, amatha kupotoza (kubwereza) opaleshoni kwambiri. Ndipotu, kafukufuku wina wasonyeza chiwerengero cha zopweteka mobwerezabwereza katatu pazochitika zochitidwa opaleshoni.

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Salvage Treatments

Pali nthawi zina pamene mankhwala osamalidwa samagwira ntchito komanso kuyembekezera kapena kupita patsogolo kwa Dupuytren ngakhale akuchiritsidwa. Kwa anthu ena, kugwirana kwa zala kwapita patsogolo kwambiri moti sizingatheke, ngakhale ndi mankhwala oopsa. Muzochitika izi, njira ya salvage ikhoza kukhala yofunikira.

Njira ya salvage ndi mankhwala omwe sagwiritsidwe ntchito kuthetsa vuto, koma kuti athe kupirira mosavuta. Zina mwa njira za salvage zomwe sizinkachitidwe pochiza mgwirizano wa Dupuytren ndi izi:

• Kusakaniza kophatikizana : Kugwirizanitsa pamodzi ndi kuchitidwa opaleshoni yokhazikika palimodzi mu malo ndipo mafupa amakula kudutsa kuti asaphonye kachiwiri. Pamene mgwirizanowu ukuphatikizidwa, sichidzagwirizananso, ngakhale kuti Dupuytren ikupita patsogolo.
• Kukonzekera kunja : Wowonetsera kunja ndi chipangizo chophatikizidwa ku fupa chomwe chingathe kutambasula matenda ofewa palimodzi pa nthawi yaitali. Kwa anthu okhala ndi tizirombo tomwe timagwira ntchito, kutambasula kwa milungu kapena miyezi kungathandize.
• Kuchotsa : Kuchotsa chala sikupezeka kawirikawiri mu Dupuytren, koma kungakhale kothandiza pazovuta kwambiri. Makamaka pa zala zazing'onoting'ono-ndipo mwa anthu omwe ali ndi zofooka zazikulu pa ntchito za kuchotsa kwa chiwerengero cha chiwerengero zingakhale zothandiza nthawi zina.

Kachilinso, mankhwala ochiritsira amatha kusungirako zovuta kwambiri zomwe zakhala zikulepheretsanso mankhwala ambiri. Komabe, pali njira zothetsera vutoli.

> Zotsatira:

> Becker GW, Davis TR: Zotsatira za mankhwala opaleshoni ya matenda a Dupuytren oyambirira: Kuwongolera mwatsatanetsatane. J Hand Surgery Eur Vol 2010; 35 (8): 623-626.

> Black EM, Blazar PE. "Matenda a Dupuytren: kumvetsa kosavuta kwa matenda akale" J Am Acad Orthop Surg. 2011 Dec; 19 (12): 746-57.

> Denkler K: Zovuta za opaleshoni zomwe zimagwirizanitsidwa ndi fasciectomy kwa matenda a Dupuytren: Kuwerenga kwa zaka 20 za Chingelezi. Eplasty 2010; 10: e15.

> Hindocha S, Stanley JK, Watson S, Bayat A: Dupuytren a diathesis adakambirananso: Kuwonetsa zizindikiro zowonetsera za chiopsezo cha matenda obwereza. J Kupatulira Mankhwala Am 2006; 31 (10): 1626-1634.

> Hurst LC, Badalamente MA, Hentz VR, et al: CORD I Gulu Lophunzira: Chojambulidwa collagenase Clostridium histolyticum kwa mgwirizano wa Dupuytren. N Engl J Med 2009; 361 (10): 968-979.

> Van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM: Kuyerekezera zotsatira zenizeni za sing'anga za fasciotomy ndi zochepa zochepa za matenda a Dupuytren: Kuphunzira kwa milungu isanu ndi umodzi. J Kupaleshoni Mankhwala Am 2006; 31 (5): 717-725.