Option Non-Surgical for Iminwe Eboshwe
Isivumelwano sikaDupuytren yisimiso esibangela ukuba iminwe ihanjiswe ibe yindawo ehlanganisiwe. Isivumelwano sikaDupuytren senziwa ngamakhulu ezinkulungwane zamaMelika kanye nezigidi zabantu emhlabeni wonke. Lesi simo sivimbela labo abathintekile ukuba bakwazi ukuqondisa ngokugcwele iminwe yabo, futhi ukuqina kungabuka kusukela emnene kakhulu ngokunyuka komunwe okujwayelekile kumacala aqinile lapho iminwe ifaka khona entendeni yesandla.
Isivumelwano sikaDupuytren siwukubonakaliswa kwesifo sikaDupuytren, isifo esingase sibangele nezivumelwano zethambo ezincane (Lederhose isifo) noma, emadodeni, e-penis ( isifo sikaPeyronie ). Ayikho ikhambi elaziwa ngesifo sikaDupuytren, futhi okuncane kuqondwa ngesizathu salesi simo. Kuze kube yamuva, kwakukhona nezinketho ezimbalwa kakhulu zokwelapha iziguli ezibhekana nalezi zimo.
I-Collagenase Injections
I-Collagenase ivele njengokwelashwa okuwusizo kwezinye iziguli ezinezinkontileka zikaDupuytren. Uhlobo lwezincuba ezivumelanwe entendeni yesandla nangeminwe lenziwe ngu-collagen. Isivumelwano sakha ama-nodules nezintambo ezidonsa iminwe esendeni yesundu. I-Collagenase iyi-enzyme ekhishwa amabhaktheriya okuthiwa i-Clostridium histolyticum, futhi le-enzyme idla ku-collagen, okwenza ukuthi isakhiwo sibe buthakathaka. I-Collagenase isuswa kuma-bacteria, futhi igxilwe emathangeni kaDupuytren ngudokotela wakho.
Ngolunye usuku ngemuva kokujova, emva kokuba i-enzyme yenze umsebenzi, ubuyela kudokotela ukuze ube nomunwe owenziwe ukuze uqede izicubu eziqinisiwe, futhi ubuyekeze ukuhamba komunwe.
Umjovo we-collagenase uthengiswa ngaphansi kwegama lohwebo Xiaflex. Iza kuqala e-syringe ethunyelwa ngqo kudokotela wakho wokuphatha.
Noma yikuphi udokotela angakwazi ukuqinisekiswa ukuthi ahlinzeke izijovo ze-Xiaflex, kodwa lokhu kuvame ukuwenziwa ngabahlinzayo bama-orthopedic, odokotela bokuhlinza ngesandla, kanye nama-rheumatologists.
Ukwelashwa kwe-Contracture kaDupuytren
Kuze kube yamuva, okukhethwa kukho kuphela kokwelashwa kwesivumelwano sikaDupuytren kwaba ukubonwa noma ukuhlinzwa. Ngenxa yokuthi ukuhlinzwa kuhlasela kakhulu, futhi kungabandakanya ukuvuselelwa okwesikhashana, odokotela abaningi bancoma ukulinda isikhathi eside ngangokunokwenzeka, bese behlinzwa lapho kudingeka khona. Izinto ziye zashintsha, futhi njengoba ukwelashwa okuncane okungenasisindo sekuye kwatholakala, odokotela abaningi bazama ukuphatha isivumelwano sikaDupuytren ezinyathelweni zangaphambili, ukuvimbela ukuqhubeka kokukhubazeka okunzima kakhulu okulula ukulungisa.
Ngokuvamile, kunezinketho ezine zokwelapha ezivumelwaneni zikaDupuytren:
- Ukuqaphela: Ukuqaphela ukuphathwa kokuqala okujwayelekile kwe-Dupuytren's. Iningi labantu abanezivumelwano ezincane azikhathazeki ngalesi simo, futhi uma kunokuqhubeka kancane, ukwelashwa kungase kungadingeki. Lezi ziguli zingaba nesimo sabo njalo sihlolwe ukuhlola ukuqhubekela phambili.
- I-Needle Aponeurotomy : I- needle aponeurotomy yenzeke eYurophu iminyaka eminengi, futhi isiye saziwa kakhulu e-US eminyakeni eyishumi edlule. Kule nqubo, udokotela wakho usebenzisa insipho yenaliti ukuze aphule ngokucophelela izintambo zezicubu ukuze avunywe ngomunwe. Ukucubungula okukhulu akudingeki. Abanye odokotela kanye neziguli bakhetha le nqubo ngoba kungcono kakhulu kunazo zonke zokwelashwa (ngaphandle kokubona), futhi kungenziwa njalo ngokuvakashelwa okukodwa kuphela, ngokunciphisa okuncane.
- I-Collagenase: I-Collagenase injection iye yathandwa kakhulu kusukela ngo-2010 lapho i-FDA ivuma imithi yokuqala yalokhu ukusetshenziswa e-United States. I-Collagenase ithengiswa ngaphansi kwegama lokuhweba i-Xiaflex, futhi kufanele ijojowe udokotela oqinisekisiwe oqeqeshiwe ekusebenziseni imithi. Ama-injection ye-Collagenase ayabiza (ngaphezulu kuka-$ 3000 nge-vial), futhi angadinga izikhumba ezingaphezu kweyodwa zemithi ngezivumelwano eziningi kakhulu. Lokho kusho ukuthi le ndlela yokwelapha cishe ibiza kakhulu kunokuhlinzwa.
- Ukuhlinzwa: Njengoba kushiwo, kuze kube yamuva, ukuhlinzwa kwakuwukuphela kokwelashwa okutholakala ekuvumelaneni kukaDupuytren. Nakuba ukuhlinzwa ngokuvamile kuvame ukwelashwa okungcono kakhulu kunezivumelwano ezinzima kakhulu, kunamaphutha amaningi. Ukwelashwa kuyingozi kakhulu, kubuhlungu kakhulu, futhi kuhilela ukuvuselelwa isikhathi eside kunokukhetha okuncane. Lokho kusho ukuthi izinketho ezingenasidingo zivame ukwenza kahle kakhulu kwiziguli ezinezinkontileka ezincane kuya ezilinganisweni kanti imiphumela emva kokukhubazeka okukhulu kakhulu kuvame ukwelashwa kangcono ngokuhlinzwa. Ngaphezu kwalokho, ukuhlinzekwa kuye kwaboniswa ukuhlinzeka ukukhululeka okuhlala isikhathi eside, isikhathi eside kuze kube yilapho kuqhubeka nokukhubazeka.
Yikuphi Okuhle Kakhulu?
Akukho ngempela 'ukwelashwa okungcono kakhulu,' njengoba zonke lezi zinketho zinezinzuzo nezingozi. Ngokuqinisekile, uma inketho encane ingavamile, iziguli eziningi zizokhetha izinketho ezinjalo. Ngeshwa, ezinye iziguli zidinga ukwelashwa okubanzi, futhi kulawo mahlakalo, ukuhlinzwa kungase kube yisinqumo esingcono kakhulu. Noma ngabe iyiphi inketho oyikhethayo, kubalulekile ukukhomba udokotela osebenzisa ukwelashwa njalo, futhi unezikhathi ezivamile ngenqubo ekhethiwe. Abanye odokotela banamakhono ezinkambisweni ezingaphezu kweyodwa, kodwa ngokuvamile uma ufuna ukuqhathanisa izinketho, kuzodingeka ubone odokotela abangaphezu kweyodwa.
Ngihlale ngitshela iziguli zami, ukuthi kungakhathaliseki ukuthi ukhethwe ukwelashwa, iziguli kudingeka ziqonde ukuthi okwamanje akakho ukwelashwa kwesifo sikaDupuytren, kuphela ukwelashwa kokubonakaliswa kwesimo (isivumelwano). Ngakho-ke, kungakhathaliseki ukuthi yimuphi ukwelashwa okwenziwa, ukuphindaphinda kwesivumelwano kungenzeka. Ukuphindaphinda ngemuva kwe-alexone aponeurotomy kuyinto isilinganiso seminyaka emithathu, ngemuva kokuhlinzwa isilinganiso seminyaka emihlanu. Ayikho idatha okwanele ngalesi sikhathi ukwazi ukuthi imithi yokwelapha i-collagenase iyakwenza kanjani ngokuya kwesilinganiso sokuphindaphindiwe.
Imithombo:
Omnyama EM no-Blazar PE. "I-Dupuytren Disease: Ukuguquka Ukuqonda Ukugula Okudala" J Am Acad Orthop Surg December 2011; 19: 746-757.
U-Murphy K, "Ukuguqulwa Kwama-Bent Fingers, Akukho Ukuhlinzwa Okudingekayo" I-New York Times July 24, 2007.