Ukwandiswa kwemilenze nokunciphisa

Ukwandiswa nokuncishiswa kwemilenze yizinhlobo zokuhlinzwa zokwelapha abanye abantu abanemilenze yobude obungalingani.

Lezi zinqubo zinga:

• Khulisa umlenze omfushane ngokungajwayelekile
• Fushanisa umlenze omude ngokungajwayelekile
• Nciphisa ukukhula komlenze ojwayelekile ukuvumela umlenze omfushane ukuba ukhule ube yinde

UKWANDISA AMATHAMBO

Ngokwesiko, lolu chungechunge lwezokwelapha lubandakanya ukuhlinzwa okuningana, isikhathi eside sokululama, kanye nezingozi eziningi. Kodwa-ke, ingangeza ubude obungamasentimitha ayisithupha (15 cm) ubude emlenzeni.

Ukuhlinzwa kwenziwa ngaphansi kwe-anesthesia ejwayelekile. Lokhu kusho ukuthi umuntu ulele futhi akanazinhlungu ngesikhathi sokuhlinzwa.

• Ithambo elizolulwa liyasikwa.
• Izikhonkwane zensimbi noma izikhonkwane zifakwa esikhunjeni nasethanjeni. Izikhonkwane zifakwa ngenhla nangaphansi kokusikwa kwethambo. Kusetshenziswa umthungo ukuvala isilonda.
• Umshini wensimbi unamathiselwe ezikhonkwaneni ezisethanjeni. Izosetshenziswa kamuva kancane kancane (ngaphezu kwezinyanga) ukudonsa ithambo elisikiwe. Lokhu kudala isikhala phakathi kwemikhawulo yethambo elisikiwe elizogcwalisa ngethambo elisha.

Lapho umlenze usufinyelele kubude obufunwayo futhi selupholile, kwenziwa okunye ukuhlinzwa ukususa izikhonkwane.

Eminyakeni yamuva nje, kuye kwakhiwa amasu amasha amasha ale nqubo. Lokhu kususelwa ekuhlinzweni kokwandiswa kwemilenze kwendabuko, kepha kungahle kube mnandi kakhulu noma kube lula kwabanye abantu. Buza udokotela wakho ohlinzayo ngamasu ahlukene angahle akulungele.

UKUVUSELELWA KAMathambo NOMA UKUSUSWA

Lokhu ukuhlinza okuyinkimbinkimbi okungaveza ushintsho olunembe kakhulu.

Ngenkathi ungaphansi kwe-anesthesia ejwayelekile:

• Ithambo elizofinyezwa liyasikwa. Ingxenye yethambo iyasuswa.
• Imiphetho yethambo elisikiwe lizohlanganiswa. Ipuleti lensimbi elinezikulufo noma isipikili ezansi maphakathi nethambo libekwa ngaphesheya kwethambo ukulibamba lisendaweni lapho liphola.

UKUVinjelwa KOKUKHULA KWAMATHAMBO

Ukukhula kwamathambo kwenzeka emapuletini okukhula (ama-physes) ekugcineni ngakunye kwamathambo amade.

Udokotela ohlinzayo usika phezu kwepuleti lokukhula ekugcineni kwethambo emlenzeni omude.

• Ipuleti lokukhula lingacekeleka phansi ngokuliklwebha noma ngokulibhoboza ukuze limise ukukhula okuqhubekayo kulelo puleti lokukhula.
• Enye indlela ukufaka ukudla okuyisisekelo ohlangothini ngalunye lwepuleti lokukhula kwamathambo. Lezi zingasuswa lapho imilenze yomibili isondele kubude obufanayo.

UKUSUSWA KAMADIVAYI OKUTSHALWA KWEZIMALI

Izikhonkwane zensimbi, izikulufo, ukudla okuyisisekelo, noma amapuleti kungasetshenziswa ukubamba ithambo lisendaweni ngesikhathi sokuphulukiswa. Odokotela abaningi abahlinzayo bamathambo bazolinda izinyanga ezimbalwa kuze kube unyaka ngaphambi kokususa noma yiziphi izimila ezinkulu zensimbi. Kudingeka okunye ukuhlinzwa ukuze kususwe izinto ezifakiwe.

Ukwandiswa kwemilenze kuyabhekwa uma umuntu enomehluko omkhulu ebangeni lomlenze (ngaphezu kwama-5 cm noma ama-intshi ama-2). Inqubo kungenzeka ukuthi inconywe:

• Ezinganeni ezinamathambo asakhula
• Okwabantu abanesimo esifushane
• Ezinganeni ezinokungajwayelekile epuletini lokukhula kwazo

Ukunciphisa noma ukukhawulela umlenze kubhekelwa umehluko omncane kubude bomlenze (imvamisa ungaphansi kwama-5 cm noma ama-intshi amabili). Kunconywa ukunciphisa umlenze omude ezinganeni ezinamathambo azo angasakhuli.

Ukuncishiswa kokukhula kwamathambo kunconyelwa izingane ezinamathambo asakhula. Isetshenziselwa ukukhawulela ukukhula kwethambo elide, kuyilapho ithambo elifushane liqhubeka nokukhula ukufanisa ubude balo. Isikhathi esifanele salokhu kwelashwa kubalulekile ukuze kutholakale imiphumela emihle.

Izimo ezithile zempilo zingaholela ebude obungalingani kakhulu bomlenze. Kubandakanya:

• I-Poliomyelitis
• Ukukhubazeka kobuchopho
• Imisipha emincane, ebuthakathaka noma emifushane, eqinile (spastic), engadala izinkinga futhi ivimbele ukukhula okujwayelekile komlenze
• Izifo ze-Hip ezifana nesifo seLegg-Perthes
• Ukulimala kwangaphambilini noma amathambo aphukile
• Ukukhubazeka kokuzalwa (ukukhubazeka kokuzalwa) kwamathambo, amalunga, imisipha, imisipha, noma imisipha

Izingozi ze-anesthesia nokuhlinzwa ngokujwayelekile zifaka:

• Ukusabela okweqile emithini
• Izinkinga zokuphefumula
• Ukopha, ukunqamuka kwegazi, noma ukutheleleka

Izingozi zalokhu kuhlinzwa zifaka:

• Ukuvinjelwa kokukhula kwamathambo (i-epiphysiodesis), okungadala ukuphakama okufushane
• Ukutheleleka kwamathambo (i-osteomyelitis)
• Ukulimala emithanjeni yegazi
• Ukuphulukiswa kwamathambo kabi
• Ukulimala kwemizwa

Ngemuva komkhawulo wokukhula kwamathambo:

• Kuvamile ukuchitha isikhathi esingangesonto esibhedlela. Kwesinye isikhathi, kufakwa isamente emlenzeni amasonto amathathu kuya kwamane.
• Ukuphulukiswa kuqedile emavikini ayisishiyagalombili kuya kwayi-12. Umuntu angabuyela emisebenzini ejwayelekile ngalesi sikhathi.

Ngemuva kokunciphisa amathambo:

• Kuvamile ukuthi izingane zichithe amaviki amabili kuya kwamathathu esibhedlela. Kwesinye isikhathi, kufakwa isamente emlenzeni amasonto amathathu kuya kwamane.
• Ubuthakathaka bemisipha bujwayelekile, futhi izivivinyo zokuqinisa imisipha ziyaqalwa ngemuva nje kokuhlinzwa.
• Izinduku zisetshenziselwa amasonto ayisithupha kuya kwayisishiyagalombili.
• Abanye abantu bathatha amasonto ayisithupha kuye kwayi-12 ukuthola kabusha ukulawulwa nokusebenza kwamadolo okujwayelekile.
• Induku yensimbi ebekwe ngaphakathi kwethambo iyasuswa ngemuva konyaka ongu-1.

Ngemuva kokululwa kwamathambo:

• Umuntu uzohlala izinsuku ezimbalwa esibhedlela.
• Ukuvakashelwa kaningi kumhlinzeki wezokunakekelwa kwempilo kuyadingeka ukulungisa idivayisi eyandisayo. Isikhathi esetshenziswa yinsiza yokwelula kuncike enanini lokunweba elidingekayo. Ukwelashwa ngokomzimba kuyadingeka ukugcina uhla lokuhamba okujwayelekile.
• Ukunakekelwa okukhethekile kwezikhonkwane noma ngezikulufo ezibambe ucingo kuyadingeka ukuvikela ukutheleleka.
• Isikhathi esithatha ithambo ukuphola sincike enanini lokululwa. Isentimitha ngalinye lokwelula kuthatha izinsuku ezingama-36 zokuphulukiswa.

Ngenxa yokuthi imithambo yegazi, imisipha nesikhumba kuyabandakanyeka, kubalulekile ukuhlola umbala wesikhumba, izinga lokushisa, nokuzwa konyawo nezinzwani njalo. Lokhu kuzosiza ukuthola noma yikuphi ukulimala emithanjeni yegazi, imisipha, noma izinzwa ngokushesha ngangokunokwenzeka.

Ukuvinjelwa kokukhula kwamathambo (i-epiphysiodesis) kuvame ukuphumelela lapho kwenziwa ngesikhathi esifanele esikhathini sokukhula. Noma kunjalo, kungadala ubude obufushane.

Ukunciphisa amathambo kungahle kube ngqo kunokuvinjelwa kwethambo, kepha kudinga isikhathi eside sokululama.

Ukwandiswa kwamathambo kuphumelela ngokuphelele cishe izikhathi ezine kwezingu-10. Inezinga eliphakeme kakhulu lezinkinga kanye nesidingo sokuhlinzwa okuqhubekayo. Izinkontileka ezihlangene kungenzeka.

I-Epiphysiodesis; Ukuboshwa kwe-Epiphyseal; Ukulungiswa kobude obungalingani bamathambo; Ukwandiswa kwamathambo; Ukunciphisa amathambo; Ukwandiswa kwabesifazane; Ukunciphisa abesifazane

• Ukwandiswa kwemilenze - uchungechunge

UDavidson RS. Ukungafani kobude bomlenze. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ama-eds. Incwadi kaNelson Yezingane. Umhla ka-20. IPhiladelphia, PA: Elsevier; 2016: isahluko 676.

UKelly DM. Okuzenzakalelayo kokuzalwa komkhawulo ongezansi. Ku: Azar FM, Beaty JH, Kanale ST, ama-eds. I-Operational Orthopedics yaseCampbell. Umhlaka 13. IPhiladelphia, PA: Elsevier; 2017: isahluko 29.