Kumanga kwa ACL ndi njira yopangira opaleshoni yopangira munthu watsopano amene akuthandiza kugwidwa kwa ACL . Kamodzi munthu atasankha kuchita opaleshoni, ayenera kusankha momwe opaleshoniyo idzachitikire. Odwala ambiri omwe amawafunsa mafunso ndi awa: Ndi mtundu wanji wa ACL womwe umasankha?
Kuphatikiza kwa ACL ndi mtundu wa minofu yomwe imagwiritsidwa ntchito kupanga mzere watsopano.
Ntchito yomanga ACL ikhoza kuchitidwa ndi zisankho zosiyana siyana. Zowonjezereka kwambirizi zimaphatikizirapo patellar tendon, hamstring tendon, ndi minofu yopereka (allograft). Zonsezi mwazikhala ndi ubwino ndi ubwino.
Kukonza ndi Kukonzanso
Opaleshoni ya ACL ndi yofala, koma osati molondola, yotchedwa kukonza ACL. Kukonzekera kumatsimikizira kuti mukhoza kukonza chinthu chomwe chatsweka. Ngati ACL yang'ambika kwathunthu, mapeto a ligament yowonongeka sangachiritse pamodzi, ngakhale ngati mapeto atsekedwa pamodzi.
Chomwe chimagwira ntchito bwino, ndiko kuchotsa zolinga zong'ambika za ACL ndikubwezeretsa ligament ndi dongosolo losiyana - lotchedwa ACL graft. Kuphatikizidwa ndi minofu yomwe imasunthidwa kuchoka ku malo amodzi. Pamene gwero lachitsulo lichokera kwa munthu amene akuchitidwa opaleshoni, limatchedwa autograft. Pamene gwero lachokera kwa wopereka (cadaver), limatchedwa allograft.
Pofuna kuti mgwirizanowo ukhale wodalirika, zimagwiritsidwa ntchito ndi shin fupa (tibia) ndi fupa lafupa (femur), ndipo kuphatikizidwa kumadutsa m'matanthwewa kuti akonzenso mitsempha.
Patellar Tendon Autograft
Thangoni ya patellar ndi kapangidwe ka bondo lanu lomwe limagwirizanitsa mawondo (patella) ndi mafupa (tibia). Mitundu ya patellar pakati pa 25 mpaka 30 mm m'lifupi. Ngati patellar tendon graft yasankhidwa, chapakati 1/3 cha patellar tendel imachotsedwa (pafupi 9 kapena 10 mm) pamodzi ndi chifuwa cha mafupa pa malo a attachment pa kneecap ndi tibia.
- Ubwino: Ambiri opaleshoni amakonda opaleshoni yotchedwa patronlar graft chifukwa amagwirizana kwambiri ndi ACL. Kutalika kwa tendon ya patellar ndi yofanana ndi ACL, ndipo fupa lomaliza la kusindikiza likhoza kuikidwa mu fupa kumene ACL imakhudzira. Izi zimathandiza kuti "mafupa ku fupa" akuchiritsidwe, ena opaleshoni ambiri amawona kuti ali amphamvu kuposa njira ina iliyonse yowononga.
- Zowonongeka: Pamene feteleza ya patellar graft imatengedwa, gawo limodzi la fupa limachotsedwa pa bondo, ndipo pafupifupi 1/3 ya tendon imachotsedwa. Pali chiopsezo chotayika kapena kupweteka kwamtundu wina pambuyo pochita opaleshoniyi. Komanso vuto lalikulu kwambiri pakutsata opaleshoniyi ndi ululu kutsogolo kwa bondo ( kupweteka kwa bondo kumbuyo ). Ndipotu, nthawi zina odwala amamva ululu akamagwada, ngakhale patatha zaka opaleshoni.
Hamstring Tendon Autograft
Minofu yamphongo ndi gulu la minofu kumbuyo kwa ntchafu yanu. Pamene mitsempha yamagetsi imagwiritsidwa ntchito mu opaleshoni ya ACL, mavitoni awiri a minofuwa amachotsedwa, ndipo "amatumidwa" pamodzi kuti apange ACL yatsopano. Kwa zaka zambiri, njira zothetsera ma grafts m'malowa zakhala bwino.
- Zowonjezera: Vuto lalikulu kwambiri pakutsata opaleshoni ya ACL pogwiritsira ntchito tendon patellar ndi ululu kutsogolo kwa bondo. Zina mwa ululu uwu zimadziwika kuti ndi chifukwa cha kuphatikiza ndi fupa lomwe limachotsedwa. Izi sizomwe zimakhala zovuta mukamagwiritsa ntchito tchutchutchu. Kutengeka kuti apeze kuphatikizira ndi kochepetsetsa, ndipo ululu womwe umakhalapo nthawi yomweyo pambuyo pake ndi pansi pa msewu, umaganiziridwa kukhala wochepa.
- Zowonongeka: Vuto lalikulu la grafts awa ndi kukonzekera kuphatikizidwa m'matanthwe a fupa. Pamene thambo la patellar likugwiritsidwa ntchito, fupa limatha kumachiritsa mafupa a mafupa ("fupa mpaka fupa" machiritso). Ndi hamstring grafts, nthawi yochuluka ndi yofunika kuti kuphatikiza kukhale kolimba. Choncho, anthu okhala ndi hamstring grafts nthawi zambiri amatetezedwa kwa nthawi yayitali pamene kuphatikiza kumachiza.
Allograft (Zopereka Zopereka)
Allograft nthawi zambiri amagwiritsa ntchito masewera osangalatsa (osati ochita maseĊµera othamanga), kapena odwala omwe akuchitidwa opaleshoni ya ACL (pamene kukonzanso ACL kumalephera).
Kafukufuku wasonyeza kuti allograft (minofu yopereka chithandizo kuchokera ku cadaver) sali yolimba ngati mthupi la wodwala (autograft). Kwa odwala ambiri, komabe mphamvu ya ACL yokonzanso pogwiritsira ntchito allograft ndi yokwanira pazofuna zawo. Choncho izi zikhoza kukhala njira yabwino kwambiri kwa odwala omwe sakukonzekera kuchita nawo masewera apamwamba (monga mpira, basketball, etc.).
- Ubwino: Kuchita opaleshoni ya ACL pogwiritsira ntchito allograft kumapangitsa nthawi yothandizira kuchepa, osasowa kuchotsa minofu ina yogwiritsira ntchito kuphatikizidwa, zovuta zochepa, komanso kupweteka kwapambuyo kwapambuyo. Kuwonjezera apo, ngati kuphatikizidwa kukanatha, kukonzanso kukonzanso ntchito kungakhoze kuchitidwa pogwiritsa ntchito tendon patellar kapena hamstring grafts.
- Zowonongeka: Zakale, ma graft awa anali osauka ndipo anali ndi chiopsezo chachikulu cha matenda opatsirana. Posachedwapa, njira za allograft zokonzekera zakhala zikudabwitsa kwambiri, ndipo nkhawazi ndizovuta. Komabe, ndondomeko ya kukonzekera kumtengowo (kumangiriza-kuyanika), imapha maselo amoyo ndi kuchepetsa mphamvu ya minofu. Palinso vuto lofalitsa matenda . Ngakhale kukonzekera kubereka ndi kukonzekera ma graft kuchepetsa vutoli, sililichotseratu.
Mmene Mungasankhire A ACL Graft
Madokotala ambiri opaleshoni ali ndi zida zosiyana siyana. Mphamvu ya patellar tendon ndi hamstring grafts ndizofanana. Palibe yankho lolondola pa zomwe ziri zabwino, osakhala chimodzi chomwe chavomerezedwa mu maphunziro a sayansi.
Mphamvu ya allograft minofu ndi yochepa kuposa ya graft ina, koma mphamvu ya patellar tendon ndi nyundo ya tendon grafts imaposa mphamvu ya ACL yachibadwa. Chofunika kwambiri ndi odwala 85% mpaka 95% omwe ali ndi mawondo olimbitsa thupi pambuyo pa opaleshoni ya ACL yokonzanso.
Chitsime:
Kuvulaza kwa ACL: Kodi Kufunikira Opaleshoni? Ophunzira a American Academy of Orthopedic, September 2009