Ukuzibheka Kwe-AC Joint Ebuhlungu Ehlombe
Ihlangothini lehlombe lihlangene eliyinkimbinkimbi elihlanganisa ndawonye amathambo amathathu. Iningi labantu bacabanga nge-ball-and-socket joint lapho phezulu kwethambo lesandla lihlangana ne-shoulder blade (okubizwa ngokuthi i-glenohumeral joint). Kodwa-ke, kukhona okunye okubalulekile okujoyina amathambo amabili ehlombe, ukuhlangana kwe-collarbone kanye ne-shoulder shoulder (i-acromioclavicular joint).
Ukuhlanganiswa kwe-acromioclavicular, futhi okufingqiwe njenge-AC ngokuhlanganyela, kungumphumela wokuphela kwe-collarbone (i-clavicle) ngecala le-shoulder blade (elibizwa nge-acromion). Ukuhlanganyela kwe-AC kungalimala kakhulu njengamanye amalunga, futhi kungadinga ukwelashwa. Ukwelashwa okulodwa okusetshenziselwa izinkinga ezihlangene ze-AC ukukhipha ukuphela kwe-clavicle ukuze amathambo ahlukumezane. Le nqubo ibizwa ngokuthi i-distal clavicle resection futhi ngokuvamile ibizwa ngokuthi yiNqubo yeMamford.
Izinkinga ezihlangene ze-AC
Kunezizathu ezintathu eziyinhloko zokuthi kungani abantu banezinkinga ezingapheli, ezinesikhathi eside ngokuhlanganyela kwe-AC:
- I-arthritis eguqukayo (i-osteoarthritis)
- I-arthritis yokuthuthumela
- I-distal clavicle i-osteolysis
Kukhona izikhathi zokuhlangana kwe-AC ezingabangela inkinga ngokumangalisa (ukulimala okungazelelwe), kodwa uma ukhuluma ngokususa ekupheleni kwe-collarbone, ngokuvamile lokhu kungukuhlinzwa okugcinwe kubantu abanezinkinga ezide isikhathi eside ngokuhlanganyela kwe-AC.
Lokho kuthiwa, ukulimala okuvame ukuvame ukuba isifo samathambo esiphuthumayo, esinye sezizathu zokuthi kungani inqubo kaMamford ingacatshangwa.
I-arthritis ehlukumezayo yenzeka lapho ikhula kancane kancane ihlakulela umonakalo we-cartilage we-AC ehlangene. Ngokuhamba kwesikhathi, njengoba ubuso obushelelezi obuqhekekile buhamba, ukukhanya kwethambo nethambo kungase kuthuthuke ngokubambisana kwe-AC.
Ngisho noma ukujoyina akuhambisani kakhulu, ngezinye izinhlangothi zehlombe, ngisho nokunyakaza okucashile ekuhlanganyeleni kwe-arthritic kungabangela ubuhlungu.
I-arthritis ehamba phambili isho ukuthi ukulimala okwenzeke okwenzekile ekuthuthukiseni inkinga yokuqhafaza ngokushesha neyodwa. Izimpawu zethambo nethambo spurs zingase zifane ne-osteoarthritis, kodwa ukuthuthukiswa kokulimala kuhlukile. I-arthritis ephazamisekile yangemva kokuhlangana kwe-AC ingenzeka ngemva kokuhlukanisa i- distal clavicle kanye nokuhlukaniswa kwehlombe .
I-distal clavicle i-osteolysis i-overuse syndrome, evame ukubonwa ekukhuleni komzimba. Ngokuqondile okuholela ekuthuthukiseni kwethambo elibuthakathaka ekupheleni kwe-clavicle akucaci, kodwa lokhu kuvame kubonakala kuma-weightlifters enza okweqa phezulu. Ngezinye izikhathi ukuphumula nokwelashwa okunamandla kungavumela ukukhululeka kwezimpawu, kodwa lesi simo singabangela ubuhlungu obungapheliko bokuhlangana kwe-AC.
Izimpawu zezinkinga ezihlangene ze-AC
Isibonakaliso esivame kakhulu senkinga ngokuhlanganyela kwe-AC ubuhlungu bubekwe ngqo ekuhlanganiseni kokuphela kwe-collarbone kanye nekhasi eliphezulu lehlombe. Ngezinye izikhathi ubuhlungu bungabonakala phansi entanyeni noma phansi kwengalo. Ubuhlungu be-muscular emithanjeni ye-trapezius ne-deltoid yizimpawu ezivamile zenkinga ehlangene ye-AC.
Izimpawu zobuhlungu zivame ukwedlula ukuhamba kwehlombe. Ukunyakaza okulula okuvame ukwandisa izinkinga ezihlangene ze-AC zifinyelela kuwo wonke umzimba, njengokugeza ihlombe lakho elihlukile noma umgodi wengalo. Ukufika ngemuva ukubopha isihlalo sobukhosi noma ukubambelela ibhu kungenza futhi izimpawu ezibuhlungu.
Imisebenzi yezemidlalo enzima kakhulu njengomshini wokunyathelisa noma ibhethri ephezulu ekamelweni lesisindo ingabangela ikakhulukazi izinkinga ze-AC ezihlangene. Ubuhlungu ebusuku (okuthiwa ubuhlungu obubusuku busuku) buyinkinga, ikakhulu uma abantu beqhubekela ohlangothini lwabo oluthintekile. Lobuhlungu buvame ukuvusa abantu ekulele njengesiyaluyela ehlombe elibuhlungu.
Ukuxilongwa kwenkinga ehlangene ye-AC kungenziwa ngokuthatha umlando ngokucophelela wezibonakaliso zesiguli nokuhlola ihlombe elithintekayo. Ubuhlungu buvelele kakhulu ngokuhlanganyela kwe-AC. 'Ukuhlolwa kokukhishwa kwengalo ye-cross' kwenziwa ngokuthatha ingalo ethintekile ngqo kuwo wonke umzimba futhi ucindezela ukuya ehlombe elibhekene nalo. Isivivinyo esihle siphumelela izimpawu zobuhlungu ngqo ekuhlanganyeleni kwe-AC. Abantu abaningi abanezinkinga ezihlangene ze-AC nabo banezibonakaliso ezijwayelekile zokufaka ukungena kwe-rotator , njengoba lezi zimiso zihamba ngesandla.
Izivivinyo ezenzelwe ukukhomba izinkinga ezihlangene ze-AC zivame ukuqala ngama-x-ray. I-X-ray ingabonisa ukugqokisa ukuhlanganiswa kwe-AC nokunciphisa isikhala phakathi kokuphela kwe-collarbone emgqeni wehlombe. I-bone spurs ingase ibonakale emfanekisweni we-x-ray. Uma i-x-ray ingabonisi ngokucacile inkinga, noma uma kukhona umbuzo womunye umonakalo (njenge- coat rotator yezinyembezi ), ukuhlolwa kwe-MRI kungenziwa. I-MRI ingabonisa imininingwane eminingi yesimo se-bone, i-cartilage, i-ligaments, ne-tendon emhlabeni wonke. Uma kusekhona umbuzo uma ukujoyina i-AC kungumthombo wobuhlungu, umjovo olula we-anesthetic ekuhlanganyeleni kwe-AC kufanele uqede ngokuphelele izimpawu. Uma okuhlanganyelwe kunesisindo esiphundu, futhi ubuhlungu bukhululekile ngokuphelele ekuhlolweni okukhulunywe ngenhla nokuqondisa, khona-ke ukubambisana kwe-AC cishe kuyimbangela yenkinga.
Izinketho ezingelapheki zokwelapha
I-distal clavicle resection isivele isigcina esiphezulu esinyathelweni esingahambi kahle. Izindlela zokwelashwa ezivamile zobuhlungu obuhlangene be-AC zihlanganisa:
- Ukuphumula: Ukuvumela ukucindezeleka kwesibambisene ukuxoshwa, ikakhulukazi kubantu abakhuthele kakhulu okungenzeka babekhuphula inkinga. Ukuphumula akusho ukuthi kufanele uhlale uhlala phansi, kodwa ngokuvamile kusho ukugwema imisebenzi ethize ebonakala ibangela izimpawu ezibuhlungu kakhulu.
- Imithi Yokuvimbela Umlomo Ngamlomo: Imithi yokwelapha yomlomo ebizwa ngokuthi i- NSAID , iyasiza ukuthulisa ukuvuvukala nokunciphisa ubuhlungu obuvela ekuhlanganyeleni kwe-AC. Nakuba ngokuvamile kungeyona isisombululo esikhulu sesikhathi eside, le mithi ingase ibe usizo ekuxazululeni ukuvuvukala nokugubha izimpawu.
- Ukwelashwa Kwemvelo: Ukwelapha kungasiza ekuthuthukiseni umshini wehlombe futhi uthathe ukucindezeleka ekuhlanganyeleni kwe-AC. Njengoba kukhulunywe ngaphambili, ingxenye ye-AC ehlangene iyinhlama yehlombe, futhi imishini engakalungi noma ukuhamba kwekhasi lamahlombe kungadala izimpawu zenkinga ehlangene ye-AC.
- I-Cortisone Injections: I- Cortisone imithi enamandla yokulwa nokuvuvukala , ukuthi uma isilwane ngqo kwi-AC yokuhlanganyela ingaxazulula izimpawu zokuvuvukala ngokushesha kakhulu. Ngenkathi imiphumela yomjovo oyedwa iphela phakathi kwamasonto noma izinyanga, ngokuvamile ubuhlungu bungalawula ngaphansi kwesikhathi eside.
Uma zonke lezi zonyango zihluleka ukunikeza ukuphumula okuhlala njalo, futhi izimpawu zikuvimbela ukwenza imisebenzi oyifunayo futhi udinga ukukwazi ukwenza, khona-ke ukuhlinzwa kungacatshangwa. Enye indlela ukukhipha ukuphela kwe-collarbone, ukuhlinzwa okuthiwa yi-Mumford inqubo. UMamford wayengudokotela ohlinzayo owaqale uchaza lokhu ukwelashwa okwelashwa ngezinkinga zokuphela kwe-collarbone.
Inqubo ye-Mumford
Inqubo ye-Mumford yinto efanayo ngokuthi omunye umuntu une-excal clavicle. UMamford ungumane ohlinzayo wokuqala ukuchaza le nqubo ekuqaleni kwawo-1940, ngakho-ke igama lakhe linamathele enkambisweni. Ukusho ukuthi umuntu owenza inqubo kaMamford ngokuvamile kusho ukuthi banomphela wokukhishwa kwe-collarbone. Lokhu kuhlinzekwa kungenziwa futhi ngokuhambisana nezinye izinqubo zokuhlinza zehlombe kufaka phakathi ukulungiswa kwamakhokhethi we-Rotator noma ukuchithwa okungahambi kahle .
Inqubo ye-Mumford ingenziwa nge-incision encane noma njengengxenye yokuhlinzwa kwe-shoulder arthroscopic . Phakathi nokuhlinzwa, ukuphela kwe-collarbone kususiwe. Cishe u-1 cm we-clavicle ngokuvamile ususwe njengokuthatha okuningi noma okuncane kakhulu kungabangela izinkinga zombili. Inzuzo yocwaningo lwe-arthroscopic yilona uhlobo oluthile olwenziwe ngokuhlinzwa, kuyilapho ukungabi nengozi ukuthi kungaba nzima kakhulu ukwahlulela uma inani elifanele lesithambo lisusiwe.
Ukuvuselelwa ngokulandela inqubo kaMamford kungahlukahluka, ikakhulukazi uma kunezinye izinqubo (ezifana nokukhanda kwe-cuffator rotation) eyenziwa ngesikhathi sokusebenza okufanayo; njengoba njalo, hlola nodokotela wakho ohlinzayo ku-protocol ethize ye-rehab yena ofuna ukuba ulandele. Ngemuva kokuhlinzwa okusemkhawulweni waseMyford, i-rehab ingaqala ngokushesha. Ukulandela isikhathi esincane sokungasebenzi kahle kwesibhakela (ngokuvamile izinsuku noma ngesonto), ukunyakaza okuncane kwehlombe kungaqala. Kubalulekile ukuzama ukuhambisa ihlombe ngokushesha emva kokuhlinzwa ukuze kuvinjelwe ukuthuthukiswa kwehlombe eliqhwaqwe kanye nokuqina. Uma ngabe uhambo olubanzi luyatholakala, uhlelo oluqinisayo luyaqala. Ngokujwayelekile, imisebenzi egcwele iphinda iqale ngamasonto ayisithupha kuya kwangu-8 emva kokuhlinzwa, nakuba imisebenzi eqinile yokuphakamisa isisindo ingathatha isikhathi eside ukubuyela.
Izingozi Zokuhlinzwa
Izingozi zokuhlinzwa eziqondene nale nqubo zihlobene ngokuyinhloko nokususwa kwethambo elikhulu kakhulu noma elincanyana kakhulu. Uma kususwe kakhulu, izigxobo zokuzinzisa ze-clavicle zingaphazanyiswa, futhi lokhu kungaholela ekungazinzekeni kwe-collarbone. Uma kususwe ithambo elincanyana kakhulu, ukufakelwa okuhlangene kusengenzeka, okuholela ekuboniseni izinhlungu eziqhubekayo. Lezi zinkinga zivame kakhulu ngesikhathi sokuhlinzwa kwe-arthroscopic lapho konke ukuphela kwe-collarbone kungaba nzima ukubona, ngakho-ke ususe ngokuphelele.
Ngokomlando, ukulimala kokunamathiselwe komzimba we-deltoid ku-scapula ne-collarbone kwakukhathazeka okukhulu. Ngenxa yokuthi indlela yokuhlinzekela ekuhlanganyeleni kwe-AC idinga ukuthunjwa okuncane okungenasici kwe-muscle, ukubuyiswa komsebenzi we-shoulder evamile kungathatha isikhathi eside. Ngezici ze-arthroscopic, okunamathiselwe kwe-muscle akuphazanyiswa, futhi lokhu kunzima kakhulu ukukhathazeka. Ngaphandle kwalezi zingozi ezithile, ezinye izinkinga zingase zibandakanye ukutheleleka, ukuqina kohlombe, noma ubuhlungu obuqhubekayo. Ukuhambisana nemilayezo ethize evela kudokotela wakho ohlinzayo, ngokuqondene nokuthi uzoqala nini ukuhambisa ihlombe lakho, kungasiza ukuqinisekisa ukuthi kunethuba elihle lokuthola ngokugcwele.
> Imithombo:
> Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. "Ukulimala okuhlanganyelwe kwe-Acromioclavicular: ukuxilongwa nokuphathwa" J Am Acad Orthop Surg. 2009 Ngo-Apr; 17 (4): 207-19.