Ukwakhiwa kwe-ACL yindlela yokuhlinzwa yokwenza umgudu omusha kumuntu oye wabamba izinyembezi ze-ACL . Uma umuntu esenqume ukuhlinzwa, kuzodingeka anqume ukuthi ukuhlinzwa kuyokwenziwa kanjani. Imibuzo ejwayelekile kunazo zonke iziguli ezibhekene nazo yilona: yiluphi uhlobo lwe-ACL graft okufanele bakhethe?
I-ACL graft yiluhlobo lwamacubu asetshenziselwa ukwenza i- ligament entsha.
Ukwakhiwa kwe-ACL kungenziwa ngezinqumo eziningana zokuhlukunyezwa. Lezi zinketho ezivame kakhulu zihlanganisa i-patellar tendon, i-hamstring tendon, nama-donor tishu (allograft). Ngayinye yalezi zinqumo inezinzuzo nezingozi.
Ukulungisa nokuvuselelwa kabusha
Ukuhlinzwa kwe-ACL kuvamile, kodwa hhayi ngokufanele, okubizwa ngokuthi ukulungiswa kwe-ACL. Ukulungiswa kusho ukuthi ungalungisa into ephukile. Uma i-ACL iqothulwe ngokuphelele, ukuphela kwegamentali eliqhekekile ngeke kuphulukise ndawonye, ngisho noma iziphetho eziboshiwe zihlanganisiwe ndawonye.
Yini esebenza kahle, ukususa iziphetho eziqhekekile ze-ACL bese ushintsha i-ligament ngesakhiwo esihlukile - esibizwa ngokuthi i-ACL graft. I-graft iyisisindo esisuka kwenye indawo iya kwenye. Uma umthombo we-graft uvela kumuntu onokuhlinzwa, ubizwa ngokuthi i-autograft. Lapho umthombo uvela kumnikeli (cadaver), ubizwa ngokuthi i-allograft.
Ukuvikela i-ligament ehlanganisiwe esikhundleni se-ACL evamile, imigudu yenziwe ngamathambo e-shin (tibia) nethambo lethanga (femur), futhi ukufakelwa kwemininingwane kuhanjiswa ngalezi imigudu ukuze kulungiswe i-ligament.
I-Patellar Tendon Autograft
Ithethoni ye-patellar isakhiwo esiphambi kwamadolo akho axhuma i-kneecap (i-patella) emthanjeni we-shin (tibia). Ithenda ye-patellar isilinganiso esiphakathi kwama-25 kuya ku-30 mm ububanzi. Uma i-patellar ithethini yokufakelwa ikhethiwe ikhethiwe, i-1/3 ye-tendon patellar isuswe (cishe ngo-9 noma 10 mm) kanye nebhokisi lesithambo ezindaweni zokunamathiselwe kwi-kneecap ne-tibia.
- Izinzuzo: Odokotela abahlinzayo abaningi bakhetha i-patellar tendon graft ngoba kubonakala sengathi i-ACL ephukile. Ubude bethenda ye-patellar bufana ne-ACL, futhi amathambo ekupheleni kwe-graft angafakwa emthanjeni lapho i-ACL ifaka khona. Lokhu kuvumela "amathambo amathambo" ukuphulukiswa, into eminingi yokuhlinza ibhekwa njengamandla kunanoma iyiphi enye indlela yokuphulukisa.
- Ukungalungi: Uma kuthathwa i-patellar tendon graft, ingxenye yamathambo isusiwe ku-kneecap, futhi cishe ingxenye eyodwa kwe-3 ye-tendon isusiwe. Kunengozi yokuphulwa kwe- patellar noma i- patellar tendon izinyembezi emva kwalokhu kuhlinzwa. Futhi, inkinga ejwayelekile kunazo zonke emva kwalokhu kuhlinzeka ubuhlungu phambi kwamadolo ( ubuhlungu bendondo yangaphambili ). Eqinisweni, ngezinye izikhathi iziguli zithi zizwa ubuhlungu lapho ziguqa, ngisho nangemva kokuhlinzwa.
I-Hamstring Tendon Autograft
Imisipha ye-hamstring yiqembu lezinsipho ngemuva kwethanga lakho. Lapho izintambo zezintambo zisetshenziselwa ukuhlinzekwa kwe-ACL, izintambo ezimbili zalezi zinhlanzi zisuswa, futhi "zihlanganiswe" ndawonye ukuze zenze i-ACL entsha. Kule minyaka edlule, izindlela zokulungisa lezi zingubo endaweni zithuthukisiwe.
- Izinzuzo: Inkinga ejwayelekile kunazo zonke kulandela ukuhlinzwa kwe-ACL usebenzisa ithethoni ye-patellar ubuhlungu ngaphezu kwamadolo. Ezinye zalezi zibuhlungu ziyaziwa ngenxa ye-graft kanye nethambo elisusiwe. Lokhu akuyona inkinga uma usebenzisa ithethoni yokugwedla. Ukuhlaselwa kokuthola ukufakelwa kwamancane kuncane, futhi ubuhlungu kokubili esikhathini esilandelayo ngemuva komgwaqo kanye nomgwaqo, kucatshangwa ukuthi buncane.
- Izinkinga: Inkinga eyinhloko yalezi zingubo zokufaka ukufakwa kwe-graft emathanjeni amathambo. Uma ithethoni ye-patellar isetshenziselwa, ithambo liphela ukuphulukisa emathanjeni amathambo ("amathambo amathambo" ukuphulukisa). Ngama-graft we-hamstring, isikhathi esidele siyadingeka ukuze uhlaka lube lukhuni. Ngakho-ke, abantu abanamatherafrikhthi bavame ukuvikelwa isikhathi eside ngenkathi i-graft ipholisa endaweni.
I-Allograft (I-Donor Tissue)
I-Allograft ivame ukusetshenziselwa abadlali bezokuzilibazisa (ngokuphambene nabagijimi bezokuncintisana), noma iziguli ezibuzwa ukuhlinzwa kwe-ACL (uma ukuvuselelwa kwe-ACL kwehluleka).
Ucwaningo luye lwabonisa ngokucacile ukuthi i-allograft (izicubu ezinikela nge-cadaver) ayinamandla njengezicubu zesiguli (autograft). Nokho, iziguli eziningi, amandla e-ACL avuselelwe esebenzisa i-allograft yanele izidingo zabo. Ngakho-ke lokhu kungaba yindlela enhle kakhulu yeziguli ezingahle zihlele ukuhlanganyela emidlalweni ephezulu yokudinga (isib. Ibhola, basketball, njll).
- Izinzuzo: Ukwenza ukuhlinzwa kwe- ACL usebenzisa i-allograft kuvumela isikhathi sokusebenza esinciphile, asikho isidingo sokususa ezinye izicubu ezisetshenziselwa ukuhlanganiswa, ukucubungula okuncane, nobuhlungu obuncane bokuthunyelwe. Ngaphezu kwalokho, uma ukuhlanganiswa kungaphumeleli, ukubuyekezwa kokuhlinzwa kungenziwa ngokusebenzisa i-tendon patellar noma i-hamstring grafts.
- Ukungalungi: Ngokomlando, lezi zinhlaka zaziyizinga elibi futhi zenzeke ingozi enkulu yokudluliswa kwezifo. Muva nje, amasu okulungiswa kwe-allograft athuthukisiwe kakhulu, futhi lokhu okukhathazayo akuyona inkinga enkulu. Kodwa-ke, inqubo yokulungiswa kwamagrafu (i-frozen-drying), ibulala amangqamuzana aphilayo futhi inciphisa amandla amathishu. Kukhona nokukhathazeka kokudluliswa kwezifo . Ngenkathi inzalo nokulungiswa kwe-graft kunciphisa lo mngcipheko, awuqedi ngokuphelele.
Indlela Yokukhetha i-ACL Graft
Abahlinzayo abaningi banezinhlobo ezihlukahlukene zokufakelwa kwezinhlamvu ngezizathu ezahlukene. Amandla we-patellar tendon kanye ne-hamstring grafts ayalingana ngokulinganayo. Ayikho impendulo efanele mayelana nokuthi yikuphi okungcono kakhulu, okungenani akukho okuye kwafakazelwa ezikoleni zesayensi.
Amandla ama-allograft izicubu angaphansi kwamanye ama-grafts, kodwa amandla we-tendon ye-patellar kanye ne-hamstring amathrekhi we-tendon adlula amandla we-ACL evamile. Okubalulekile ukuthi iziguli ezingu-85% kuya ku-95% ziyoba namadolo azinzile emitholampilo elandela ukuhlinzwa kwe-ACL.
Umthombo:
Ukulimala kwe-ACL: Ingabe Kudinga Ukuhlinzwa? I-American Academy yezigulane ezingama-Orthopedic, ngo-September 2009