Chisangalalo cha Mgwirizano Wopweteka Wophatikiza Pamodzi
Mphepete mwa mapepala ndi ophatikizana omwe amalumikizana pamodzi mafupa atatu. Anthu ambiri amaganiza za mzere wa mpira ndi mthunzi umene pamwamba pake ya mfupa imakumana ndi phasu (chomwe chimatchedwa glenohumeral joint). Komabe, palinso mafupa awiri ophatikizana omwe amaphatikizidwa pamapapu, mbali ya collarbone ndi mapewa (acromioclavicular joint).
Mgwirizano wa acromioclavicular, womwe umasindikizidwanso monga mgwirizano wa AC, ndiye kuti mapeto a collarbone (clavicle) ndi mbali ya mapewa (otchedwa acromion). Mgwirizano wa AC ukhoza kuonongeka mofanana ndi ziwalo zina, ndipo zingafunike chithandizo. Mankhwala omwe amagwiritsidwa ntchito pa mavuto a mgwirizano wa AC ndi kuchotsa mapeto a chifuwachi kuti mafupa asakanikizane. Njirayi imatchedwa distal clavicle resection ndipo nthawi zambiri imatchedwa njira ya Mumford.
Mavuto Ophatikiza Awiri
Pali zifukwa zitatu zazikulu zomwe zimachititsa kuti anthu azikhala ndi mavuto aakulu, omwe amakhalapo kwa nthawi yayitali ndi mgwirizano wa AC:
- Matenda a nyamakazi (osteoarthritis)
- Matenda othamanga pambuyo pake
- Mafupa otupa
Palinso nthawi yomwe mgwirizano wa AC ungakhale wovuta pa nthawi yovuta (kuvulaza mwadzidzidzi), koma pokambirana za kuchotsa mapeto a collarbone, kawirikawiri izi ndi opaleshoni yokhazikitsidwa kwa anthu omwe ali ndi mavuto ochuluka kwambiri ndi mgwirizano wa AC.
Izi zimati, kuvulala koopsa kumakhala ngati nyamakazi yowopsya, chimodzi mwa zifukwa zomwe zimakhalira ndi amayi a Mford.
Nyamakazi yowonongeka imachitika pamene pang'onopang'ono ikuyamba kuwonongeka kwa khungu la mgwirizano wa AC. Patapita nthawi, ngati phokoso lasalala limatha kutalika, zimawoneka kuti mafupa ndi mafupa angapangidwe kumbali ya AC.
Ngakhale kuti mgwirizano sukusunthira kwambiri, ndi njira zambiri zamagulu, ngakhale kuyenda kosavuta kumagwiridwe ka nyamakazi kungachititse ululu.
Matenda othamanga pambuyo pake amatanthauza kuti kuvulala kwina kunachitika kuti pakhale chitukuko chofulumira kwambiri chokhalitsa. Zizindikiro za poyera mafupa ndi mafupa angakhale ofanana ndi osteoarthritis, koma kukula kwa chovulalacho ndi chosiyana. Matenda othamanga pambuyo pake amatha kuchitika pambuyo pa ma fractures omwe amatha kufotokozera.
Mankhwala osokoneza bongo ndi odwala kwambiri , omwe amawoneka olemera kwambiri. Zomwe zimapangitsa kuti mafupa azifooka kumapeto kwa chinyama sichidziwikiratu, koma izi zimapezeka nthawi zambiri pochita masewera olimbitsa thupi. Nthawi zina mpumulo ndi mankhwala ochiritsira amatha kuwathandiza kuchepetsa zizindikiro, koma vutoli lingapangitse ululu waukulu wa mgwirizano wa AC.
Zizindikiro za Mavuto a Jo Joint
Chizindikiro chodziwika kwambiri cha vuto ndi mgwirizano wa AC ndi ululu womwe umapezeka mwachindunji kumapeto kwa collarbone ndi pamwamba pa mapewa. Nthawi zina kupweteka kumatha kumapeto kwa khosi kapena pansi. Kupweteka kwa mitsempha mu trapezius ndi minofu ya deltoid ndi zizindikiro zofala za vuto la mgwirizano wa AC.
Zizindikiro za ululu zimakhala zovuta kwambiri ndi kuyenda kwa mapewa. Kusuntha kophweka komwe kumapangitsa kuti mavuto a mgwirizano wa AC ayambe kudutsa thupi lonse, monga kusamba paphewa kapena pakani. Kufikira kumbuyo kukamanga chovala kapena kuika bra kumathandizanso zizindikiro zowawa.
Zochita zowonjezereka zamasewero monga makina a bench kapena apamwamba pa chipinda cholemera zimatha kuwonjezera mavuto a mgwirizano wa AC. Ululu usiku (wotchedwa kupweteka kwa usiku) ndibvuto, makamaka pamene anthu amapitiliza kumbali yawo. Kupweteka kumeneku kumatha kuwalitsa anthu ku tulo ngati kupweteka kwa mapewa.
Matenda omwe ali ndi vutoli amatha kupangika polemba mbiri ya wodwalayo komanso kumayang'anitsitsa. Ululu umakhala wotchuka kwambiri pa mgwirizano wa AC. Kuyesedwa kwapachikidwa pamtanda kumachitidwa pothyola dzanja lokhazikika pamtunda ndikukankhira kumbali. Mayeso abwino amayambiranso zizindikiro za ululu mwachindunji pa mgwirizano wa AC. Anthu ambiri omwe ali ndi mavuto ovomerezeka a AC ali ndi zizindikilo zofanana ndi zokopa katemera , monga momwe zinthu zimayendera.
Mayesero omwe amachitidwa kuti adziwe mavuto a mgwirizano wa AC amayamba ndi x-ray. X-rays akhoza kusonyeza kuvala kwa mgwirizano wa AC ndi malo ochepa pakati pa mapeto a collarbone pamapewa. Kuphulika kwa mafupa kungakhalenso kuwoneka pa chithunzi cha x-ray. Ngati x-ray sichisonyezeratu vutoli, kapena ngati pali vuto linalake (monga chikhoto cha rotator ), mayesero a MRI akhoza kuchitidwa. MRI ingasonyeze tsatanetsatane wa mkhalidwe wa mafupa, mafupa, mitsempha, ndi tendon kuzungulira phewa. Ngati pangakhale funso ngati mgwirizano wa AC uli magwero a zopweteka, jekeseni yowonongeka mumagulu a AC ayenera kuthetsa zizindikiro. Ngati mgwirizanowo uli ndi mankhwala osokoneza bongo, ndipo ululu umatonthozedwa mwazomwe timayesedwa ndikuyendetsa, ndiye mgwirizano wa AC ndiwo womwe umayambitsa vuto.
Osati Opaleshoni Chithandizo Cha Njira
A distal clavicle resection nthawi zonse amakhala otsiriza mu chithandizo cha mankhwala osapsa. Mankhwala ochiritsira a kupweteka kwa mapiritsi a AC ndi awa:
- Kupumula: kulola nkhawa za mgwirizano kuti zitheke, makamaka anthu omwe akugwira ntchito mwakhama omwe mwina akuwonjezera vutoli. Mpumulo sikutanthauza kuti muyenera kukhala osasunthika, koma nthawi zambiri amatanthauza kupewa zinthu zina zomwe zimawoneka kuti zimapangitsa zizindikiro zowawa kwambiri.
- Mankhwala Opatsirana Opaka Mafupa: Mankhwala oletsa kupweteka, omwe amatchedwa NSAIDs , amathandiza kuchepetsa kutupa ndi kuchepetsa ululu wochokera ku mgwirizano wa AC. Ngakhale nthawi zambiri si njira yothetsera nthawi yaitali, mankhwalawa nthawi zambiri amathandiza kuthetsa kutupa komanso kutsegula zizindikiro.
- Thandizo lachilengedwe: Mankhwala amathandizira kukonza makina a pamapewa ndi kupanikizika ku mgwirizano wa AC. Monga tanenera kale, mbali imodzi ya mgwirizano wa AC ndi mapewa, ndipo osauka magetsi kapena kuyenda kwa mapewa angapangitse zizindikiro za vuto la mgwirizano wa AC.
- Cortisone Injections: Cortisone ndi mankhwala amphamvu kwambiri othana ndi kutupa , kuti pamene jekeseni mwachindunji mu mgwirizano wa AC akhoza kuthetsa zizindikiro za kutupa mwamsanga. Ngakhale zotsatira za jekeseni imodzi zimatha mkati mwa masabata kapena miyezi, kawirikawiri ululu ukhoza kulamulidwa kwa nthawi yaitali.
Ngati mankhwala onsewa sapereka mpumulo wosatha, ndipo zizindikiro zikukulepheretsani kuchita ntchito zomwe mukufuna ndikuzichita, ndiye opaleshoni ingaganizidwe. Njira imodzi ndiyo kuchotsa mapeto a collarbone, opaleshoni yotchedwa Mumford ndondomeko. Mumford anali dokotala wa opaleshoni yemwe poyamba adalongosola chithandizochi kuti athetse mavuto a mapeto a collarbone.
Mumford Procedure
Mchitidwe wa Mumford ndi chimodzimodzi kunena kuti wina ali ndi chisankho cha distal clavicle. Mumford ndiye dokotala woyamba opaleshoni kuti afotokoze njirayi kumayambiriro kwa zaka za m'ma 1940, choncho dzina lake linagwirizana ndi ndondomekoyi. Kuwuza wina kuti ali ndi njira ya Mumford kumangotanthauza kuti ali ndi mapeto a opaleshoni yawo. Kuchita opaleshoniyi kungachitenso chimodzimodzi ndi njira zina zopaleshoni za pamapewa kuphatikizapo kukonzanso katemera kapena kusokoneza maganizo .
Mchitidwe wa Mumford ukhoza kuchitidwa kudzera pang'onopang'ono kapena ngati gawo la opaleshoni ya m'mapapo . Pa opaleshoni, mapeto a collarbone achotsedwa. Pafupifupi 1 masentimita a clavicle amachotsedwa ngati kumwa mochuluka kapena zochepa kwambiri zingathe kubweretsa mavuto. Kupindula kwa opaleshoni yamakono ndi njira yochepa yopaleshoni ya opaleshoni, pamene chovuta ndi chakuti zingakhale zovuta kuweruza ngati kuchuluka kwa fupa kumachotsedwa.
Kukonzekera motsatira njira ya Mumford kungakhale kosiyana, makamaka ngati pali njira zina (monga kukonza kabokosi ka rotator) zomwe zimagwira ntchito yomweyo; monga nthawi zonse, funsani dokotala wanu opaleshoni pazomwe mukufuna kuti muzitsatire. Pambuyo pa opaleshoni yokhayokha ya Mumford, rehab ikhoza kuyamba mofulumira. Pambuyo panthawi yochepa yosungiramo thumba (kawirikawiri masiku kapena sabata), kusunthika bwino kwa mapewa kungayambe. Ndikofunika kuyesa mapewa mwamsanga mutatha opaleshoni kuti muteteze chisawawa ndi kuuma. Pomwe kayendetsedwe kamene kamalandiranso, pulogalamu yowonjezera ikhoza kuyamba. Kawirikawiri, ntchito zowonjezereka zimayambiranso pafupi masabata asanu ndi limodzi ndi asanu ndi limodzi pambuyo pa opaleshoni, ngakhale ntchito zolemetsa zolemetsa zingatenge nthawi yaitali kuti abwerere.
Ngozi za Opaleshoni
Ngozi za opaleshoni zomwe zimagwiritsidwa ntchito pamtunduwu zimakhudzana kwambiri ndi kuchotsedwa kwa mnofu kapena pang'onopang'ono kwambiri. Ngati zowonjezereka zimachotsedwa, mitsempha yazitsulo ya phokoso ikhoza kusokonezeka, ndipo izi zingapangitse kusasinthasintha kwa collarbone. Ngati pang'onopang'ono mafupa amachotsedwa, chotsegulira chophatikizira chikhoza kuchitikabe, zomwe zimachititsa kuti zizindikiro zowonongeka zikhalepobe. Zovutazi ndizofala makamaka pamene opaleshoni yamakono amatha kupweteka pamene mapeto onse a collarbone angakhale ovuta kuwona, kotero kuchotsa kwathunthu.
Kalekale, kuwonongeka kwa chiyanjano cha minofu ya deltoid pa scapula ndi collarbone chinali chachikulu. Chifukwa chakuti opaleshoni yophatikizira mgwirizano wa AC amagwiritsa ntchito kachetechete kamodzi kake, kupuma kwabwino kumatenga nthawi yaitali. Ndi njira zamakono, zopangira minofu sizingasokonezedwe, ndipo vutoli ndilovuta kwambiri. Kuwonjezera pa zoopsazi, mavuto ena omwe angakhalepo ndi monga matenda, kuuma kwa mapewa, kapena kupweteka kosalekeza. Kugwirizana ndi malangizo enieni ochokera kwa dokotala wanu opaleshoni, makamaka momwe mungayambire mapewa anu, kungathandize kuti mutha kukhala ndi mwayi wopeza bwino.
> Zotsatira:
> Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. "Kuvulala kwagwirizanaku: Kugwiritsidwa ntchito ndi kasamaliro" J Am Acad Orthop Surg. 2009 Apr; 17 (4): 207-19.