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UkuqaphelaIsivumelwano sikaDupuytren ukukhishwa kweminwe eyenzeka ngenxa yesifo sikaDupuytren, inkinga yokwakheka kwe-collagen engalawulwa entendeni yesandla neminwe. Ukwakheka kwe-collagen ngokweqile kubangela ukuqoqwa okuqinile, okuthiwa ama-nodules, namaqoqo afana nezintambo, okuthiwa izintambo. Yilezi zingcingo ezidonsa iminwe phansi kwesundu futhi zivimbele ukuqondisa okuphelele kweminwe.
Isiphakamiso sendabuko "yokwelapha" kubantu abanesimo salesi simo kwakuwukulinda isivumelwano sikaDupuytren uma nje sikhathazeka futhi sinezokwelapha kuphela. Yilokho odokotela ababiza ngokuthi "ukulinda okuqaphileyo." Isizathu sokulinda ukwelashwa okuhlinzekwa ukuthi uDupuytren akazange aphuluke futhi aphinde ukwelashwa cishe kwakudingeka esikhathini esizayo. Futhi, ngokulinda ukuphatha lesi simo, inani lezokwelapha ezidingekayo kulo lonke isikhathi sokuphila kwesiguli ligcinwe okungenani.
Njengoba ezinye izindlela zokwelashwa ezintsha zinikeze indlela encane yokulawula ukuvumelanisa kukaDupuytren, kunabanye odokotela abancoma manje ukwelashwa kwasekuqaleni. Ngamajojo e-collagenase kanye ne-needle aponeurotomy, ukwelashwa okuphindaphindiwe akukona okukhathazayo okuningi. Ngakho-ke, ukwelashwa kwasekuseni lapho isimo sinzima kakhulu sithandwa. Futhi, ngokungalindeli, amathuba okulungisa ngokugcwele izivumelwano zingcono nakakhulu okwenza ukulinda ukwelashwa kungathandwa kakhulu.
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Ukwehlisa & IzifoKwakukhona isikhathi lapho odokotela batusa ukunweba, ukukhazimula, nokujova i-cortisone zibe izicubu zikaDupuytren. Ngokuvamile, lezi zokwelapha zihle kakhulu, zisiza kuphela okwesikhashana futhi, nakakhulu, zingenza isimo sithuthuke ngokushesha.
I-Cortisone injection isetshenziswa ngezikhathi ezithile ukuze ijobe uhlobo lwe-nodular lwe-Dupuytren (hhayi izintambo) futhi lingasiza ukunciphisa ama-nodules. Ukukhathazeka ukuthi lezi zinyosi zibuyele ngokuhamba kwesikhathi kuze kube yilapho isisindo sangaphambi kokujova, ngakho-ke le ndlela yokwelashwa ayitholakali eyenziwa. Ngaphezu kwalokho, kunemiphumela emibi ye-cortisone shots engabangela izinkinga kwabanye abantu.
Ukudambisa nokukhazimula kwakusetshenziswa kaningi esikhathini esidlule. Inkinga ukuthi lezi zindlela zokwelapha kubonakala sengathi zivame ukwandisa isimo kunokuba sisize. Abantu abaningi bazama ukwelula ngomunwe okwenziwe, kodwa ngokujwayelekile lo mkhuba kufanele udangele.
Ngezinye izikhathi kusetshenziselwa ukugqama nokukhazimula ngemuva kokwelashwa ukwandisa ukuhamba okuhambisanayo nokuvimbela ukuphindaphinda kwesivumelwano. Kodwa, lokhu kusebenza ngempela njengendlela yokwelapha emva kokuhlinzwa noma kokuphuma. Ngaleso sikhathi, ngokuvamile ukuphakama nokukhazimula kunganconywa. Ukwehlisa njengokwelashwa okwenziwe ngokwakho ngokuvamile akusizi.
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I-Collagenase InjectionsI-Collagenase iyi-enzyme ekhishwa kuma-bacteria. Le- enzyme ijojowe ngqo emthonjeni wezicubu zikaDupuytren bese ivumelekile ukudiliza izicubu eziqinile, ezinesivumelwano. Abantu abathola lezi zijovo bavame ukubuyela ehhovisi labodokotela ngosuku olulandelayo, ngemuva kokuba i-enzyme inethuba lokudiliza izicubu eziqinile. Ngaleso sikhathi, udokotela wakho uzosebenzisa umunwe ngamandla ukuze aphule ngokuphelele izicubu ezihlanganisiwe.
I-Collagenase injection, edayiswa ngaphansi kwegama lokuhweba lika-Xiaflex, seliye lathandwa njengoba lilula ukwenza futhi ngakho-ke izinhlobo eziningi zodokotela zinikeza. Inqubo ingenziwa ngokuphelele ehhovisi likadokotela, nakuba lidinga umuntu ojojelwe ukuba abuyele ezinsukwini ezilandelanayo.
Ukukhathazeka ukuthi i-collagenase inezinkomba eziqondile, okusho ukuthi akuyona ukwelashwa okuwusizo kuwo wonke umuntu one-Dupuytren's. Abanye odokotela bazizwa ukuthi bangasiza iziguli eziningi nge-alex aponeurotomy noma ukuhlinzwa, okuyizinqubo eziningi ezihlukahlukene. Ngaphezu kwalokho, kunezindleko eziphezulu ze-collagenase futhi izinhlelo eziningi zomshuwalense ngeke zimboze imithi.
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Needle AponeurotomyI-needle aponeurotomy iyinkqubo encane yokuhlasela ukuthi esikhundleni sokususa izicubu zedivaysi eD contractytren, isebenzisa iphuzu lensiza ekuqedeni izintambo nokukhulula izinkontileka. Udokotela wakho wenza ama-punctures amancane esikhumbeni, akukho ukucubungula, nangokusebenzisa iphoyinti lenaliti, ukusika ngezicubu ezihlanganisiwe ezindaweni eziningana.
Abagqugquzeli bale nqubo zonke izinzuzo eziningana:
- Kuphephile kakhulu. Izinkinga zingenzeka, kodwa izinkinga ezinkulu zingavamile.
- Kuyabizi. Uma kuqhathaniswa nezinye izifo, i-alex aponeurotomy ngokuvamile ibiza kakhulu kune-collagenase noma ukuhlinzwa.
- Kulula. Lokhu kuqhathanisa, okusho ukuthi kungase kungabi lula kuwo wonke umuntu, kodwa ngokuvamile kungenziwa ngaphansi kwehora futhi ukulandelelwa akudingekile.
Kunezinsizakalo ezingase zenzeke ekudleni kwe-needle aponeurotomy. Akuwona wonke umuntu onolwazi lwe-Dupuytren oluzophathwa ngendlela efanele ngenqubo yenaliti. Ngaphezu kwalokho, ukuphindaphinda kwalesi simo kungavamile. Futhi ngenkathi ukuphindaphinda inqubo ngokuvamile akuyona inkinga, ukuphindaphinda kubonakala kwenzeka ngokushesha ngemva kwenqubo yenaliti uma kuqhathaniswa nokwelashwa okuhlinzekwayo.
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UkuhlinzwaSekuyisikhathi eside ukwelashwa kuwuhlobo oluvame kakhulu ukwelashwa kwesivumelwano sikaDupuytren. Kunezinhlobonhlobo eziningi zokuthi ukuhlinzwa kungenziwa kanjani nokuthi kudinga kangakanani. Uma ukuhlinzeka kwenziwa, ukuqhuma ngokuvamile kwenziwa ngokuqondile endaweni ye-Dupuytren's, izicubu ezingavamile zisuswe, futhi okushiwo yi-sutured kuvaliwe.
Inzuzo yokwelapha ukwelapha ukuthi, ngisho nasezigabeni eziphambili kakhulu ze-Dupuytren, ngokuvamile kukhona into engenziwa ngombono wokuhlinzwa. Ama-Dupuytren amaningi angadinga ukuhlinzwa okubanzi, kodwa cishe cishe sonke singadluliselwa ngokusebenzisa ukungcola.
Ngaphezu kwalokho, kuyilapho zonke lezi zinqubo zibhekene nezicubu ezinesivumelwano se-Dupuytren, akekho kubo ophulukisa isimo esibizwa ngokuthi i-Dupuyren's disease. Ngakho-ke, ukuphindaphindiwe kwesivumelwano kungenzeka njalo, kungakhathaliseki ukuthi ukwelashwa kwenziwa kanjani. Isikhathi esiphezulu esiphakathi kokwelashwa nokuphindaphinda yisikhathi eside kunazo zonke (okusho ukuthi abantu abadingi ukwelashwa okuphindaphindiwe isikhathi esiningi) ngokuhlinzwa ngokuqhathaniswa namajojo noma inqubo yenaliti.
Okuyinhloko yokwelapha ukuthi ukubuyiswa kwenqubo kungabandakanya ukungakhululeki futhi kungenziwa isikhathi eside. Abantu bangase babe nama-bandages amaviki namagqabha izinyanga. Kukhona ngokuvamile ukwelapha ngokomzimba okuhilelekile ekwelapheni. Uma kuqhathaniswa nenqubo ye-collagenase noma inaliti, ukutakula kusuka ekuhlinzekeni kuhileleke kakhulu. Ukuhweba ukuthi udokotela wakho ohlinzayo angakwazi ukubhekana nokuhlinzwa okungaphezu kwalokho ngokusebenzisa lezo zindlela ezincane ezingavamile.
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Ukubuyekeza UkuhlinzwaNjengoba kushiwo ngaphambili, enye yezinkinga ezinkulu ekwelapheni kwesivumelwano sikaDupuytren yukuthi inkinga ebalulekile ingaguquki. Isifo sikaDupuytren yisimo esibangela ukuba i-collagen emzimbeni wakho ilawulwe kahle. Abantu abanalesi simo benza i-collagen eningi kakhulu futhi abaphuli kahle kakhulu i-collagen endala. Imithi yokwelapha echazwe lapha yikho konke ukwelashwa kwesibonakaliso sale nkinga-abayikubhekana nesimo esiyinkimbinkimbi.
Ngolunye usuku, silindele ukuthi sizokwazi ukunikeza imithi kubantu abane-Dupuytren ukuvimbela ukuqhubeka noma ukuphindaphinda kwezivumelwano. Kodwa-ke, kuze kube yilapho, sinezinkinga zokwelapha izimpawu zesifo sikaDupuytren kuphela. Ngenxa yalesi sizathu, uDupuytren angakwazi, futhi cishe njalo uzokwenza, ekugcineni abuyele. Kulezo zimo, ukwelashwa okuqhubekayo kungacatshangwa.
Ukuphinda ukuhlinzeka kungaba yinto ekhohlisayo futhi nakanjani hhayi njengoba iqonde phambili njengoba ukuhlinzwa kokuqala for Dupuytren's. Ngenxa yokwakheka kwezicubu , izindiza ezijwayelekile zokuzivikela kanye nezicubu ngaphakathi kwesandla zihlanekezela, ukwenza ukuhlinzwa (ukuphindaphinda) ukuhlinzwa kungcono kakhulu. Eqinisweni, ezinye izifundo zibonise izinga lokucindezela izikhathi eziphindwe izikhathi ezingu-10 ezibukweni zokuvuselelwa kabusha.
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Salvage TreatmentsKunezikhathi lapho ukwelashwa kungasebenzi futhi kuthemba noma lapho intuthuko kaDupuytren naphezu kokwelashwa. Kwamanye abantu, isivumelwano sokuthi iminwe iqhubekele ngezinga elingeke lilungiswe, ngisho nangezokwelapha ezinonya. Kulezi zimo, inqubo ye-salvage ingadingeka.
Inqubo ye-salvage yindlela yokwelapha engasetshenziselwa ukulungisa inkinga, kodwa kunalokho ukwenza isimo sibekezeleleke ngangokunokwenzeka. Ezinye izinqubo zokunakekelwa kwe-salvage ezingavamile ukwenza ukwelashwa kwesivumelwano sikaDupuytren zihlanganisa:
- I-fusion ehlangene : Ukuhlanganiswa okuhlangene kuyindlela yokuhlinzekela unomphela ukujoyina endaweni futhi ithambo lingakhula kulo ukuze lingalokothi ligobe. Lapho ukuhlanganiswa kufakwa, ngeke kusayinkontileka, ngisho noma i-Dupuytren iqhubeka.
- Ukulungiswa kwangaphandle : I- fixator yangaphandle idivayisi ehlanganiswe nasetheni engakwazi ukwelula izicubu ezithambile ezungeze ukujoyina isikhathi eside. Kubantu abanezicubu ezinenkontileka kakhulu, ukwelula amasonto noma izinyanga kungasiza.
- Ukuqothulwa : Ukukhishwa komunwe akuvamile ukwenza ku-Dupuytren, kodwa kungasiza ezinkingeni ezinzima kakhulu. Ikakhulukazi iminwe encane-futhi kubantu abanemikhawulo emikhulu emisebenzini yokukhishwa ngesandla kwedijithali ingaba usizo kwezinye izimo ezingavamile.
Okunye futhi, ukwelashwa kwe-salvage kugcinwe izimo ezinzima kunazo zonke eziye zahluleka kakhulu ukwelashwa okungokwenkolo. Noma kunjalo, kunezinyathelo ezingenzeka zokuthatha lezi zimo ezinzima.
> Imithombo:
> Becker GW, Davis TR: Umphumela wezokwelapha zokwelashwa kwesifo esiyinhloko se-Dupuytren: Ukubuyekezwa okuhlelekile. J Hand Surg Eur Vol 2010; 35 (8): 623-626.
> Black EM, i-Blazar PE. "Isifo se-Dupuytren: ukuqonda okuguqukayo kwesifo esineminyaka yobudala" J Am Acad Orthop Surg. 2011 Dec; 19 (12): 746-57.
> Denkler K: Izinkinga zokuhlinzwa ezihlobene ne-fasciectomy ye-Dupuytren's disease: Ukubuyekezwa kweminyaka engu-20 yezincwadi zesiNgisi. Eplasty 2010; 10: e15.
> Hindocha S, Stanley JK, Watson S, Bayat A: Datheyt's diathesis ubuyekezwa: Ukuhlola izinkomba zokubikezela ngenhlekelele yokuphindaphinda kwesifo. J Hand Surg Am 2006; 31 (10): 1626-1634.
> Hurst LC, Badalamente MA, Hentz VR, et al: CORD I Study Group: Injectable collagenase Clostridium histolyticum yesivumelwano sikaDupuytren. N Engl J Med 2009; 361 (10): 968-979.
> Van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM: Ukuqhathaniswa kwemiphumela eqondile ye-fasciectomy ye-sidecotomy kanye ne-fasciectomy elinganiselwe yesifo sikaDupuytren: Isifundo sokulandela ukulandela isonto eli-6. J Hand Surg Am 2006; 31 (5): 717-725.