Ukwelashwa kwemilenze yegciwane kungase kube nzima, futhi isinqumo esingcono kakhulu sokwelapha ngokuvamile siyisihloko sempikiswano. Lesi sinqumo sokwelapha singathonywa yizinto eziningi ezihlukene.
Ukwelashwa kungathinteka uhlobo lokulimala, ubuhlungu bokulimala, indlela yokulimala, nokulindela imisebenzi esikhathini esizayo. Akuwona wonke ama-ligament okulimala emadolweni aphathwe ngendlela efanayo, futhi akuwona wonke odokotela abahlinzayo bama-orthopedic abaphatha ukulimala ngendlela efanayo.
Ngenxa yalesi sizathu, abantu abalimala ngamadolo abo bangathola izincomo zokwelapha ezahlukene ezivela odokotela abahlukene. Lokhu akusho ukuthi udokotela oyedwa ulungile kanti okunye okungalungile, kunalokho bahlukene ngemibono mayelana nendlela yokuphatha kangcono lezi zingozi eziyinkimbinkimbi.
Iyini Inyembezi Yomlenze Wokubamba I-Ligament?
I- latal collateral ligament , noma i-LCL, ingenye yezimpawu ezine eziyinhloko ezisekela idolo elihlangene. I-LCL itholakala engxenyeni yangaphandle yamadolo. Izinyembezi ze-LCL zingase zenzeke ngenxa yokulimala okunjalo noma kungase kube umphumela wokushaya ngokuqondile ohlangothini olungaphakathi lwamadolo. I-LCL izinyembezi azikwenzeki ukulimala okwehlukile, futhi zivame ukutholakala ngokuhlangana nomunye umonakalo ngaphakathi kwehlangothini lamadolo. Lapho kwenzeka izinyembezi ze-LCL, abantu bavame ukukhononda ngezinzwa zokungazinzi noma ukujikijela ngamadolo ikakhulukazi ukusika noma ukuhamba ukuhamba noma ukunyakaza okuhambayo.
Ukunakekelwa Kwezingqalasizinda ze-LCL Izinyembezi
Izinyembezi ze-LCL zihanjiswe ngokweqile lobubi. Izinyembezi zeBanga 1 neBanga lesi-2 ze-LCL zifaka umonakalo ku-ligament nokho akukhona ukuphazanyiswa okuphelele kwezingcingo zalo lonke ligament. Ngokuvamile, lokhu kulimala kuphethwe ngemithi yokwelapha.
Ngokufanelekile, abantu abasebenzisa ukulimala kwebanga le-2 ne-2 LCL bangaqala ukuhamba kokuqala kwamadolo. Ukunyakaza okulindelekile kuvame ukuholela ekuqineni kokubambisana.
Ngenkathi izinyembezi zeBL 1 neBakala 2 zingalawulwa ngokungahambi kahle, zingase zenzeke esimweni somunye umonakalo we-ligament okudinga usizo lokuhlinzeka. Nakulokhu, umgomo kufanele ube abantu abahamba ngamadolo ngokushesha ngangokunokwenzeka. Ngakho-ke, ukuhlinzwa kungase kudingeke ukuze kube nokuqiniswa okuhlanganyelwe komunye umonakalo we-ligament, noma ngabe i-LCL ayiqediwe ngokuphelele.
Ukwelashwa Okuhlinzekwayo Izinyembezi ze-LCL
Lapho i-latal collateral ligament igxiliwe ngokuphelele, ukwelashwa okuvamile kuphakanyiswa. Ukwelashwa okuhlinzekwayo kungenziwa ukuze kulungiswe umonakalo we-ligament noma ubuyekeze umthamo we-lateral ligament ngokudala i-ligament entsha usebenzisa i-tissue graft. Ukulungiswa komgogodla we-lateral umlenze ngokuvamile kungenzeka uma i-ligament iqothulwe esitheni ekugcineni komgudu. Lezi zinhlobo zokulimala, okuthiwa i- avulsions ye-ligament , zenzeka lapho i-ligament idwenguliwe kusukela ekunamathiselwe kwayo kuya ethambo. Ezimweni eziningi, i-fragment encane yethambo itholakala ngaphandle kweligament ngesikhathi sokulimala.
Kulezi zimo, ukwaziswa okunamandla, okunamandla okushubile kungasetshenziselwa ukufaka i-ligament esitokisini lapho kuqothulwe khona.
Uma umonakalo kwenzeka engxenyeni eyinhloko yomgogodla we-lateral, ngokuvamile i-ligament izofuna ukuvuselelwa nokusetshenziswa kwezinto zokufakelwa. Izinhlobo ezahlukene ze-tissue graft zingasetshenziselwa ukuvuselela umgogodla wokulimaza owenziwe kamuva. Izinketho zihlanganisa ukuthola izicubu emzimbeni wesiguli (autograft) noma ukuthola izicubu kumnikezi (allograft). Inzuzo ye-allograft impahla akufanele ibangele noma yimuphi omunye umonakalo kumuntu olimele ofuna ukuvuselelwa.
Kodwa-ke, kukhona ukukhathazeka mayelana nokuthi kungenzeka yini ukudluliselwa kwesifo, kanye nokukhathazeka mayelana namandla esithombeni se-graft, ngakho-ke abanye abantu bakhetha ukusebenzisa izicubu zabo. Ngokuvamile, ukufakelwa kwe-donor kusetshenziselwa ukuvuselela i-ligal lateral yokubambisana.
Ukuze wenze kabusha kukhona izindlela eziningi zokuhlinzeka. Ngokuvame ukufakwa kwesigxobo se-lateral isakhiwe kabusha ngokuhlanganisa ukufakelwa kwesibani kuze kube sekupheleni kwethanga lesenzeni (femur), ukufaka uhlaka ngokuphezulu kwe-fibula (ithambo elincane ngaphandle kwegceke elihlangene) bese uphinde uqale ukuphela ukuxhunyelelwa emuva ku-femur. Lokhu kuvuselelwa kuvumela ukubuyiswa kwe-anatomy evamile ye-ligal lateral.
Imiphumela Yokuhlinzwa
Ucwaningo oluningi luye lwaphenya imiphumela ye-latal reconstruction lateral. Nakuba lezi zingozi zingavamile, ngakho-ke lezi zifundo zincane uma ziqhathaniswa nokuhlaziywa kwezinye izinhlobo zokulimala kwamagciwane emadolweni, ngokuvamile zibonisa ukuthi imiphumela yokuhlinzwa iyinto enhle kakhulu. Abantu abahlinzwayo baye baphuthukisa ukusebenza, ukuhamba, nobuhlungu obuncane uma kuqhathaniswa nabantu abanemithi yokwelapha (izinyembezi ze-grade 3) ze-lateral collateral ligament. Ngaphezu kwalokho, lapho abantu belimale, njengama-ACL izinyembezi noma ukulimala kwamakhonsela, imiphumela yokuthola ukwelashwa kwe-ligal lateral ibambezela imiphumela.
Lokho kusho ukuthi kunezinsizakalo ezingase zibe khona. Kwenye ucwaningo olwalubheka abadlali bebhola bezobuchwepheshe, bathola ukuthi abagijimi ababephathwa ngokungenasisindo babengase bakwazi ukubuyela emidlalweni yezemidlalo, futhi bavuselele ngokushesha kunabo abaphethwe ngokuhlinzwa. Ngaphezu kwalokho, laba badlali abazange bavelele ezingozini kanye nezinkinga ezingase zibe khona zokuhlinzwa. Kukhona njalo isilingo sokuzama ukubuyisela imishini evamile nokuzinza emadolweni, kodwa ekugcineni umgomo kufanele kube ukubuyisela abantu emisebenzini abafuna ukuyenza. Uma ukuhlinzwa kungaphuthuli noma i-short term noma umsebenzi wesikhathi eside wokujoyina, kufanele siphendule izinzuzo zokungenelela kokuhlinzwa.
Izingozi Zokuhlinzwa
Ukuhlinzwa kwe-ligament sekujwayelekile kakhulu, futhi izingozi ezihlobene nokwelapha ukwelashwa ngokuvamile akunakwenzeka. Abantu abaguqulwe ngamadolo, kufaka phakathi ukwelashwa kwe-LCL, kungenzeka ukuthi bangabhekana nezinkinga ezibandakanya ukuqina, ukwehla kokuqiniswa kokubambisana, nokungahambi kahle kwamadolo. Ngaphezu kwalokho, abantu abasebenzisa ukulimala kwamagciwane kunamathuba amaningi okuthuthukisa isifo samathambo esihlangene kamuva ekuphileni. Lezi zingozi kanye nezinkinga zikhona kungakhathaliseki ukuthi ukuhlinzwa noma ukwelashwa kungukuthi ukwelashwa okhethiwe, kanti izingozi zinganciphisa ukwelashwa okuhlinzekwayo. Uma i-arthritis iqhutshwa emadolweni ngemva kwesikhathi ekuphileni, izinqubo ezengeziwe zokuhlinzekwa, okubandakanya ukuhlinzwa ngokuguqula amadolo , zingase zidingeke ekugcineni.
Izingozi ezihlotshaniswa nokuhlinzekwa zifaka ukutheleleka kanye nokulimala kwenzwa. Kukhona inzwa enkulu ebizwa ngokuthi i-peroneal nererve eseduze kakhulu nokunamathiselwe kwe-fibula ye-ligal lateral collateral. Ngesikhathi sokuhlinzwa, qaphela ngokucophelela ukuvikela leyo nerve kudingeka iyenze. I-nerve peroneal ibalulekile ekusizeni ukulawula ukuhamba kwezinyawo. Le nerve ilawula imisipha ehamba ngezinyawo ezinyaweni. Ibuye ihlinzeke ukuzwa phezulu kwonyawo. Abantu abanomonakalo ku-nerve peroneal banesimo esibizwa ngokuthi " ukwehla kwamanyawo " okungaphazamisa ikhono labo lokuhamba ngendlela evamile futhi kuholele ekuguleni kwamanzi.
Izwi elivela
Ukulimala komgogodla yizinkinga ezivamile ezithinta ezemidlalo ezenzeka kubadlali. Enye yama-knee ligaments amakhulu yi-ligal lateral, noma i-LCL. Uma ukulimala kwenzeka kwi-ligal lateral, imithi yokwelashwa incike ezintweni eziningana ezihlanganisa ubunzima bezinyembezi. Kulimala kwebanga lesi-1 no-grade 2, ukwelashwa okungenasidingo ngokuvamile kuyindlela yokwelashwa efanelekile. Kulimala kwebanga lesi-3, lapho i-ligament iqothulwe ngokuphelele, ukuhlinzwa kungase kuphakanyiswe. Ukwelashwa kokulimala komgogodla wesikhombisi se-ligal ngokuvamile kuhilela ukwakha kabusha usebenzisa i-tissue graft ukwenza i-ligament entsha ukuthatha indawo yegamentali elimele.
> Imithombo:
> Grawe B, Schroeder AJ, Kakazu R, Messer MS. "I-Ligament Yokubambisana Kwamacala Okulimala Ngokwe-Knee: Anatomy, Assessment, and Management" J Am Acad Orthop Surg. 2018 Mar 15; 26 (6): e120-e127.
> Geeslin AG, iLaPrade RF. "Imiphumela yokwelashwa kwama-grade acute-III ahlukumezekile futhi ahlangene ukulimala kwamadolo: I-cape ochungechunge lwezochungechunge nezinqubo zokuhlinza" I-Bone Bone Surgery Am 2011; 93 (18): 1672-1683.