I te tau 1891 i whakaarohia tuatahitia ai te ariā o te whakakapinga pakihiwi horihori e Themistocles Gluck. Ko ngā hononga horihori i whakahuatia, i hangaia ngātahitia hoki ko te hope, te ringaringa, me ētahi atu. Ko te pokanga whakakapinga pakihiwi tuatahi i mahia ki tētahi tūroro i te tau 1893 e te taote pokanga Wīwī a Jules Emile Péan i te Hôpital International i Parī i runga i tētahi tūroro 37-tau te pakeke e pāngia ana e te mate kohi o ngā hononga me ngā wheua. Ko te tuatahi i tuhia te arthroplasty pakihiwi. Nā te taote niho a J. Porter Michaels o Parī i hanga te prosthesis, ā, ko te humeruskakaui hangaia ki te konganuku konukawata, ā, i whakapirihia ki te pane rapa kua pania ki te parafini mā te waea hei hanga i tētahi whakaurunga here. I pai ngā hua tuatahi a te tūroro, engari i tangohia te prosthesis i muri i ngā tau e 2 nā te maha o ngā hokinga mai o te mate kohi. Koinei te whakamātautau tuatahi a te tangata ki te whakakapinga pakihiwi horihori.
I te tau 1951, i pūrongo a Frederick Krueger mō te whakamahinga o tētahi poroporo pokohiwi he nui ake te hiranga o te tinana, he mea hanga mai i ngā huaora, ā, i hangaia mai i te humerus proximal o tētahi tūpāpaku. I whakamahia angitu tēnei hei rongoā i tētahi tūroro taitamariki e pāngia ana e te osteonecrosis o te pane humeral.
Engari ko te whakakapinga pakihiwi hou rawa atu i hangaia, i whakawhanakehia hoki e te tohunga pakihiwi a Charles Neer. I te tau 1953, hei whakaoti i ngā hua koretake o tana maimoatanga pokanga mō ngā whati o te humerus proximal, i whakawhanakehia e Neer he prosthesis anatomical proximal humeral mō ngā whati o te pane humerus, ā, i whakapaitia i ngā wā maha i roto i ngā tekau tau e rua i muri mai. I hangaia ngā prosthesis o te reanga tuarua me te tuatoru.
I ngā tau tōmua o te tekau tau atu i 1970, hei whakaoti i te raruraru whakakapinga pakihiwi mō ngā tūroro he nui te ngoikore o te hononga o te pokohiwi, i whakaarohia tuatahitia e Neer te ariā o te whakahurihuri pokohiwi (RTSA), engari nā te ngoikore wawe o te wāhanga glenoid, i whakarērea te ariā. I te tau 1985, i whakapai ake a Paul Grammont i runga i te ariā i whakaarohia e Neer, mā te neke i te pokapū o te hurihanga ki waenganui me te taha tawhiti, me te whakarerekē i te ringa nekehanga me te kukū o te deltoid, ā, nā reira i tino whakaotihia ai te raruraru o te ngaronga o te mahi a te hononga o te pokohiwi.
Ngā mātāpono hoahoa o te prosthesis pokohiwi-whakawhiti
Mā te whakahurihuri i te pokohiwi (RTSA) ka hurihia te hononga hanganga o te pakihiwi tūturu hei whakahoki mai i te pumau o te pakihiwi. Ka hangaia e te RTSA he pūtahi me te pokapū hurihuri (CoR) mā te hanga i te taha glenoid kia piko me te taha pane humerus kia piko. Ko te mahi koiora o tēnei pūtahi he ārai i te pane humerus kia neke ake ina kuiti te uaua deltoid ki te tango i te ringa o runga. Ko te āhuatanga o te RTSA ko te nekehanga o te pokapū hurihuri o te hononga pakihiwi horihori me te tūranga o te pane humerus e pā ana ki te pakihiwi tūturu ki roto, ki raro hoki. He rerekē ngā hoahoa prosthesis RTSA rerekē. Ka nekehia te pane humerus ki raro mā te 25~40mm, ā, ka nekehia ki roto mā te 5~20mm.
Ki te whakatauritea ki te hononga pakihiwi tūturu o te tinana tangata, ko tētahi painga kitea o te nekehanga ā-roto o te CoR ko te whakanui ake i te ringa nekehanga o te deltoid mai i te 10mm ki te 30mm, e whakapai ake ana i te whai huatanga o te nekehanga o te deltoid, ā, ka iti ake te kaha o te uaua ka puta. Ko te taipana kotahi, me tēnei āhuatanga hoki, kāore e tino whakawhirinaki te nekehanga o te pane humerus ki te mahi whakaheke o te porowhita hurihuri katoa.
Koinei te hoahoa me ngā mahi koiora o te RTSA, ā, tera pea he ahua hoha, he uaua hoki ki te mārama. He ara māmā ake hei mārama? Ko te whakautu he āe.
Ko te tuatahi ko te hoahoa o te RTSA. Mā te āta tirotiro i ngā āhuatanga o ia hononga o te tinana tangata, ka kitea ētahi ture. Ka taea te wehewehe i ngā hononga tangata ki ngā wāhanga e rua. Ko tētahi ko ngā hononga tata-waewae pērā i ngā pakihiwi me ngā hope, ko te pito tata ko te "kapu" me te pito tawhiti ko te "pōro".
Ko tētahi atu momo ko ngā hononga tawhiti pērā i teturime ngā tuke, ko te pito tata ko te "pōro" me te pito tawhiti ko te "kapu".
Ko te mahere i whakamahia e ngā paionia hauora i te wā i hangaia ai ngā hononga pakihiwi horihori i ngā rā o mua ko te whakahoki i te hanganga tinana o te pakihiwi tūturu i te mea ka taea, nō reira i hangaia ngā mahere katoa me te pito tata hei "kapu" me te pito tawhiti hei "pōro". I hangaia e ētahi kairangahau te "kapu" kia nui ake, kia hohonu ake hoki hei whakanui ake i te pumau o te hononga, kia rite ki te hononga tangata.hononga hope, engari i muri mai ka whakamātauhia ko te whakanui ake i te pumau i piki ake ai te tere o te rahunga, nō reira i tere ai te tango i tēnei hoahoa. mutu. Ko te RTSA, i tētahi atu taha, ka hurihia ngā āhuatanga hanganga o te pakihiwi tūturu, ka hurihia te "pōro" me te "kapu", ka rite te hononga "hope" taketake ki te "tuke" me te "turi". Nā tēnei huringa hurihuri i whakatau i ngā uauatanga me ngā feaa maha mō te whakakapinga pakihiwi horihori, ā, i roto i te maha o ngā wā, kua tino pai ake tōna whai huatanga mō te wā roa me te wā poto.
Waihoki, ko te hoahoa o te RTSA e neke ana i te pokapū hurihuri kia taea ai te whakanui ake i te pai o te tango i te uaua deltoid, tera pea he ahua pōuriuri hoki. Ā, ki te whakatauritea tō tātou hononga pakihiwi ki te piupiu, he ngawari ki te mārama. E ai ki te pikitia i raro nei, mā te whakamahi i te taipana kotahi i te ahunga A (te kaha whakaheke o te uaua deltoid), ki te whakarerekētia te tūnga tūnga me te tūranga tīmatanga, he mārama ka taea te whakaputa i te taipana nui ake (te kaha tango o te ringa o runga) i te ahunga B.
He rite tonu te pānga o te panonitanga o te pokapū hurihuri o te RTSA, e āhei ai te pakihiwi kua kore e pumau te tīmata i te tangohanga me te kore e pēhia te porowhita o te ringaringa. E ai ki tā Archimedes: Homai he pūtahi ki ahau, ā, ka taea e au te neke i te whenua katoa!
Ngā Tohu me ngā Āraitanga RTSA
Ko te tohu matua mō te RTSA ko te rotator cuff tear arthropathy (CTA), he haehae nui o te rotator cuff me te osteoarthritis, e tohuhia ana e te nekehanga o te pane humerus ki runga, ka hua ake ko te glenoid, acromion me te pane humerus ka haere tonu ngā huringa pirau. Ko te nekehanga o te pane humerus ki runga ka puta mai i te takirua kaha kore taurite i raro i te mahi a te deltoid i muri i te ngoikore o te rotator cuff. He nui ake te kitea o te CTA i roto i ngā wāhine pakeke, ka puta pea he "pseudoparalysis" tawhito.
Kua tino piki ake te whakamahinga o te pokanga pokohiwi, inā koa te RTSA, i roto i ngā tekau tau e rua kua pahure ake nei. I runga i ngā hua angitu tuatahi o te whakamahinga RTSA, te whanaketanga tonu o te tikanga pokanga, me te whakamahinga matatau o tēnei tikanga, kua whānui ake ngā tohu whaiti tuatahi mō te RTSA, nō reira, ko te nuinga o ngā tikanga pokanga pokohiwi e mahia ana i tēnei wā ko te RTSA.
Hei tauira, ko te pokanga pokohiwi katoa (ATSA) te whiringa pai mō te osteoarthritis pakihiwi me te kore he pakaru o te rotator cuff i mua, engari i ngā tau tata nei, ko te tokomaha o te hunga e pupuri ana i tēnei tirohanga te ahua nei kei te heke haere. Anei ngā āhuatanga e whai ake nei. Ko ngā take i arahi ai tēnei ia. Tuatahi, tae atu ki te 10% o ngā tūroro e whiwhi ana i te ATSA kua pakaru kē te rotator cuff. Tuarua, i ētahi wā, kāore i te tino oti te "hanganga" o te "mahi" o te rotator cuff, inā koa i roto i ētahi tūroro kaumātua. Hei whakamutunga, ahakoa kei te ora tonu te rotator cuff i te wā o te pokanga, ka puta te pirau o te rotator cuff me te pakeketanga, inā koa i muri i ngā tikanga ATSA, ā, he nui te koretake mō te mahi a te rotator cuff. Ko tēnei āhuatanga ka puta i ngā tūroro kaumātua neke atu i te 70 tau te pakeke. Nō reira, he maha ake ngā taote pokanga i tīmata ki te whiriwhiri i te RTSA i te wā e pāngia ana e te osteoarthritis pakihiwi parakore. Nā tēnei āhuatanga i arahi ai ki tētahi whakaaro hou ko te RTSA pea te whiringa tuatahi mō ngā tūroro e pangia ana e te osteoarthritis me te rotator cuff ora tonu i runga i te tau anake.
Waihoki, i ngā wā o mua, mō ngā haehae nui o te hononga porotaka kore e taea te whakatika (MRCT) me te kore he osteoarthritis, ko ngā tikanga kē atu ko te decompression subacromial, te hanga anō i te hononga porotaka wāhanga, te tikanga Hainamana, me te hanga anō i te capsule hononga o runga. , he rerekē te reiti angitu. I runga i te matatau me te angitu o te whakamahinga o te RTSA i roto i ngā āhuatanga rerekē, he maha ake ngā kaiwhakahaere kua whakamātau i te RTSA i mua tata nei i te MRCT māmā, ā, he tino angitu, me te reiti oranga 10-tau neke atu i te 90%.
Hei whakarāpopototanga, hei tāpiri atu ki te CTA, ko ngā tohu whānui mō te RTSA ko ngā haehae nui o te rotator cuff kāore e taea te whakatika, kāore he osteoarthropathy mumura, ngā pukupuku, ngā whatiwhatinga whakapeka, te rumatiki muri i te whara, ngā hapa wheua, ngā hononga wheua tino hē rānei, te mumura, me ngā nekehanga pakihiwi auau.
He iti noa ngā ārai ki te RTSA. Haunga ngā ārai whānui mō te whakakapinga hononga horihori pēnei i te mate, ko te kore mahi a te uaua deltoid he ārai tino ki te RTSA. Hei tāpiri, mō ngā whati humerus proximal, ngā whati tuwhera me ngā whara brachial plexus me whakaaro hoki he ārai, ko ngā whara o te io axillary takitahi me whakaaro he ārai whanaunga.
Te tiaki me te whakaora i muri i te pokanga
Ngā mātāpono o te whakaora i muri i te pokanga:
Whakaohokia te hihiri o ngā tūroro ki te whakaora, me te whakatū i ngā tumanakohanga whaitake mō rātou.
Ka whakaiti i te mamae me te mumura, ā, ka tiaki i ngā hanganga whakaora, engari kāore e hiahiatia he tiaki i ngā subscapularis.
Tērā pea ka puta te nekehanga o mua o te hononga pakihiwi i ngā tūranga mutunga o te hyperextension, te adduction me te rotation o roto, te abduction me te rotation o waho rānei. Nō reira, me karohia ngā nekehanga pēnei i ngā ringa whakamuri mō ngā wiki e 4 ki te 6 i muri i te pokanga. He tūponotanga kei roto i ēnei tūranga te nekehanga o te hononga.
I muri i ngā wiki e 4 ki te 6, me kōrero tonu koe ki te taote pokanga, me te tiki whakaaetanga hoki i mua i te tīmatanga o ngā nekehanga me ngā tūranga o runga ake nei.
Me mahi ngā mahi whakapakari tinana i muri i te pokanga i te tuatahi, kaua e amo i te taumaha, kātahi me amo i te taumaha, kaua e ātete i te tuatahi, kātahi me ātete, i te tuatahi mā te ngākau mārire, kātahi ka kaha te mahi.
I tēnei wā, kāore he paerewa whakaora tino pakari, he ōrite hoki, ā, he nui ngā rerekētanga i roto i ngā mahere a ngā kairangahau rerekē.
Rautaki mō ngā mahi o ia rā (ADL) a te tūroro (0-6 wiki):
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Rautaki whakakori tinana o ia rā (0-6 wiki):
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Wā tuku: Whiringa-ā-rangi 21-2022
