I ngā tau tōmua o te tekau tau atu i 1990, i ārahi ngā tohunga o tāwāhi i te whakamahi i ngā punga tuitui hei whakatika i ngā hanganga pērā i te rotator cuff i raro i te arthroscopy. I ahu mai te ariā i te mātāpono tautoko "mea totohu" i raro i te whenua i South Texas, USA, arā, mā te kukume i te waea rino i raro i te whenua i te koki totohu 45° ki te whenua, ka mau te whare i raro i te whenua ki runga i te "mea totohu" i tērā pito o te waea rino.
I ahu mai te rongoā hākinakina i te traumatology orthopedic. He tono whānui, he tono haumanu hoki mō te rongoā me ngā hākinakina. Ko te whāinga kia tutuki te whakatikatika mahi nui me te iti o te whara, tae atu ki te whara o te meniscus, te whara o te hononga cruciate, te haehae o te rotator cuff, te nekehanga o te pakihiwi, te whara SLAP, me ētahi atu. Kei roto katoa i te whānuitanga o te maimoatanga rongoā hākinakina.
He taputapu hauora te punga e whakamahia whānuitia ana i roto i te rongoā hākinakina me te pokanga wheua. Ko te nuinga o te wā ka whakamahia hei whakapiri i ngā kiko ngohengohe (pērā i ngā uaua, ngā hononga, me ētahi atu) ki ngā wheua hei whakatairanga i te whakaora me te whakaora kiko. He mea hanga ngā punga ki ngā rauemi hototahi ki te koiora hei whakarite i te haumaru me te pumau o te tinana.
E ai ki te whakarōpūtanga rauemi o ngā punga, e rua ngā wāhanga matua: ngā punga kore-pirau me ngā punga pirau-ora.
Ko ngā rauemi matua o ngā punga kore-pirau ko te titanium, te koranu nickel-titanium, te maitai kore waikura, te titanium me te waikawa poly-L-lactic; ko te nuinga o ngā punga tuitui e whakamahia ana i roto i te mahi haumanu he mea hanga ki ngā rauemi whakarewa, he pai te kaha pupuri, he ngāwari te whakauru me te ngāwari ki te aromatawai i te hihi-X.
Ko ngā rauemi matua o ngā punga pirau-koiora ko te waikawa poly-D-lactic, te waikawa poly-L-lactic, te waikawa polyglycolic, me ētahi atu. Ki te whakaritea ki ngā punga kore-pirau-koiora, he ngāwari te whakahou i ngā punga pirau-koiora, he iti noa te whakararuraru ki ngā whakaahua, ā, he ngāwari hoki te mimiti. Ka taea hoki te whakamahi mā ngā tamariki.
Ngā rauemi matua o ngā punga
1. Ngā punga whakarewa
• Ngā Rauemi: Ko te nuinga he mea whakarewa pērā i te koranu titanium.
• Ngā Āhuatanga: He pakari, he roa te mau, ā, ka taea te whakarato i te pānga piri pumau. Heoi anō, tera pea ka puta he āhuatanga whakaahua, ā, tera pea ka taka.
2. Ngā punga mimiti
• Ngā Rauemi: ngā rauemi mimiti pērā i te waikawa polylactic (PLLA).
• Ngā Āhuatanga: Ka memeha haere i roto i te tinana, kāore e hiahiatia he pokanga tuarua hei tango. Heoi anō, kāore pea te tere o te memeha e pumau, ā, ka heke pea te kaha o te piri i roto i te wā.
3. Ngā punga Polyetheretherketone (PEEK)
• Ngā Rauemi: ngā pūhui mahi-teitei pērā i te polyetheretherketone.
• Ngā Āhuatanga: Ka whakarato i te kaha o te tinana whao me ngā āhuatanga hangarau teitei ake, me te pai hoki o te hototahitanga koiora me ngā pānga whakaahua pai i muri i te pokanga.
4. Ngā punga tuitui katoa
• Te Hanganga: Ko te nuinga o te mea he mea whakauru, he punga me he tuitui.
• Ngā Āhuatanga: He iti noa te rahi, he ngawari te kakano, he pai mō ngā āhuatanga e ngaro ai te papatipu wheua taketake, e iti rānei te wāhi i whakatōkia ai.
E ai ki ngā āhuatanga hoahoa o ngā punga, ka taea te wehewehe kia rua ngā wāhanga: ngā punga here me ngā punga kore here (pērā i te tuitui katoa):
1. Ngā punga here
Ko ngā punga here he momo punga tuku iho, ko te āhua o tēnei he wāhanga tuitui e hono ana ki te hiku o te punga. Me tuku e te tākuta te tuitui mā roto i te kiko ngohengohe mā te ngira, ka herea he pona hei whakapiri i te kiko ngohengohe ki te punga, arā, te mata o te wheua.
• Rauemi: Ko ngā punga here he mea hanga i ngā rauemi kore-mimiti (pērā i te koranu titanium) i ngā rauemi rānei ka mimiti (pērā i te waikawa polylactic).
• Tikanga mahi: Ka mau te punga ki roto i te wheua mā roto i ngā miro, i ngā parirau whānui rānei, ko te tuitui ia ka whakamahia hei hono i te kiko ngohengohe ki te punga, ā, ka puta he pānga mau tonu i muri i te herenga o te pona.
• Ngā Painga me ngā Huakore: Ko te painga o ngā punga here ko te pono o te pānga whakapiri, ā, he pai hoki mō ngā whara kiko ngohengohe. Heoi anō, ka piki ake pea te uauatanga me te roa o te mahi i te tukanga here, ā, ko te noho mai o te here ka arahi pea ki te kukū o te taumahatanga ā-rohe, ka piki ake te mōrearea o te whati o te tuitui, te wetekina rānei o te punga.
2. Ngā punga kore-hono
Ko ngā punga kore-pona, inā koa ko ngā punga tuitui katoa, he momo punga hou i whakawhanakehia i ngā tau tata nei. Ko tōna āhuatanga ko te punga katoa he mea tito mai i ngā tuitui, ā, ka taea te whakau i ngā kiko ngohengohe me te kore e herea ngā pona.
• Ngā Rauemi: Ko ngā punga tuitui katoa he mea whakamahi i ngā rauemi tuitui ngohengohe, kaha hoki, pērā i ngā muka polyethylene taumaha ngota tino teitei (UHMWPE).
• Tikanga mahi: Ka taea te whakauru tika i ngā punga tuitui katoa ki roto i te kiko wheua mā roto i tō rātou hanganga tuitui motuhake me te tikanga whakato, me te whakamahi i te kukū o te tuitui hei whakapiri pūmau i te kiko ngohengohe ki te mata o te wheua. Nā te mea kāore he take ki te here i ngā pona, ka whakaitihia te uauatanga me te roa o te mahi, ā, ka whakaitihia hoki te mōrearea o te whati tuitui me te wetekina o te punga.
• Ngā Painga me ngā Huakore: Ko ngā painga o ngā punga tuitui katoa ko te mahi pokanga ngāwari, te pānga whakapiri pono, me te iti o te kino ki ngā kiko ngohengohe. Heoi, nā tōna hanganga motuhake, he nui ngā whakaritenga mō ngā tikanga pokanga me te wāhi whakato. Hei tāpiri, tera pea he nui te utu o ngā punga tuitui katoa, ka nui ake te taumahatanga pūtea ki ngā tūroro.
E whakamahia whānuitia ana ngā punga i roto i ngā momo pokanga rongoā hākinakina, pērā i te whakatika i te poroporo ringa, te whakau i ngā uaua, te hanga anō i ngā hononga, me ētahi atu. E whai ake nei he kupu whakataki ki te whakamahinga pokanga o ngā punga mā te whakamahi i te whakatika poroporo ringa hei tauira:
• Ngā mahi pokanga: Tuatahi, ka horoia e te tākuta te wāhi i whara ai te poroporo ringa; kātahi ka whakatōkia te punga ki te tūranga tika; kātahi ka whakamahia he tuitui hei whakapiri i te kiko poroporo ringa ki te punga; hei whakamutunga, ka tuituia, ka takai.
• Ngā hua o te pokanga: Mā te whakapiri i te punga, ka taea te whakahoki mai i te pumau me te mahi o te kiko o te poroporo, ka whakatairanga i te oranga o te tūroro.
Ngā Painga, Ngā Huakore me Ngā Whakatūpato o ngā Punga
Ngā Painga
• E whakarato ana i te pumau pumau.
• E pā ana ki ngā momo whara kiko ngohengohe.
• Ka mimitia ētahi punga, ā, kāore e hiahiatia he pokanga tuarua hei tango.
Ngā ngoikoretanga
• Tērā pea ka puta he whakaahua o ngā punga whakarewa.
• Kāore pea i te pumau te tere o te pirau o ngā punga mimiti.
• Tērā pea ka motu te punga, ka whati rānei te tuitui.
Ka taea te whakamahi i ngā punga rongoā hākinakina mō ngā pokanga e whai ake nei:
1. Te epicondylitis taha (tīke tēnehi) e hokihoki ana kāore anō kia rongoatia pai mō ngā wā maha: Mēnā kāore e whai hua te maimoatanga pūmau, ka taea te whiriwhiri i te maimoatanga pokanga, ā, ka taea te whakamahi i te punga hei hono anō i te pūwāhi whakauru o te radial extensor carpi brevis ki te epicondyle taha o te humerus.
2. Te haehae o te uaua o te biceps distal: Ko ngā haehae i puta mai i te whānuitanga o te nekehanga rerekē, te kume, te pānga, me ētahi atu, ka taea te rongoā mā te whakamahi i ngā punga waea. E rua ngā punga e tanumia ana ki te ngongo radial, ā, ka tuia te waea hiku ki te pūtake o te uaua o te biceps.
3. Te pakaru o te hononga o te tuke: He maha ngā wā ka haere tahi te nekehanga o muri o te tuke me te whara o te hononga o te ulnar collateral, inā koa te whara o te paihere o mua. Mō te whara o te hononga o te tuke, he maha ngā tohunga e pai ake ana ki te maimoatanga pokanga wawe. Ka whakamahia te tikanga punga waea hei whakakorikori i te mata o te wheua kei reira te hononga. I muri i te toto hou, ka whiria te punga ki te mata o te wheua kei reira te hononga, ā, ka whakamahia te waea whiri i te pito o te whao hei whiri i te pūtake o te hononga me te whakau, te whakatika rānei i te hononga ki te ngira.
4. Te whati o te pūwāhi piri o raro o te hononga cruciate: Ko te whati o te hononga cruciate o mua (ACL) o te hononga tibial attachment point avulsion he momo whara ACL motuhake, me whakatika wawe. He whānuitia ngā tohu o te whakamahinga o te tikanga punga waea, ā, kāore e herea e te rahi o te kongakonga whati. Kāore e hiahiatia he fluoroscopy i te wā e pokanga ana hei whakatika i te ahunga o te tīwiri. He māmā noa te mahi, ā, kua poto ake te wā mahi.
5. Te kore pumau o te pane o te waewae: nā ngā āhuatanga rerekē o te tinana me te kore e ranea o ngā kiko ngohengohe. He maha ngā tohunga e tautoko ana i te maimoatanga pokanga kaha mā te whakamahi i ngā punga waea.
6. Te whati o te pou raro o te patellar: Ka taea te whakamahi i te hangarau punga waea hei rongoā i te whati o te pou raro o te patellar. Mā te whakatika i te whati o te pou raro o te patellar me te whatu me te tuitui i te hononga o te patellar, ka taea te whakahoki mai i te pono o te pūnaha toronga turi, ā, ka taea te pupuri i te roa ā-tinana o te pūnaha toronga turi.
7. He pai mō te hono me te whakau i ngā wheua me ngā kiko ngohengohe i roto i ngā pokanga turi, tuaiwi, pakihiwi, tuke, pona waewae, ringaringa me te ringa: He hoahoa miro kōpikopiko te punga, he ngāwari ki te whakatō, ā, he kaha ake te ātete ki te kume, ā, he pai mō ngā pokanga i ngā wāhanga rerekē.
Ngā Whakatūpato
• Me arotake katoa te āhua o te wheua o te tūroro me te hanganga tinana o te wāhi i pokaina ai i mua i te pokanga.
• Kōwhiria te momo punga me ngā whakaritenga e tika ana kia pai ai te mahi pokanga.
• Me mahi ngā mahi whakaora tika i muri i te pokanga hei whakatairanga i te whakaora kiko me te whakahoki mai i te mahi a te tinana.
Hei whakarāpopototanga, he mea nui te mahi a ngā punga i roto i te rongoā hākinakina. Mā te whiriwhiri i te momo punga me ngā whakaritenga e tika ana, me te whai i ngā mahi pokanga me ngā mahi ārai tika, ka taea te whakarite i te hua o te pokanga, ā, ka taea hoki te whakatairanga i te whakaoranga o te tūroro.
Wā tuku: Hakihea-17-2024
