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UkuqwalaselwaIsivumelwano seDupuytren kukukhawulelana kweminwe eyenzeka ngenxa yesifo sikaDupuytren, ingxaki yokuqulunqwa kwemigaqo ye-collagen esesandleni sesandla kunye neminwe. Ukuqulunqwa kweglajeni eyongezelelekileyo kubangela ukuqokelela okuqinileyo, okubizwa ngokuba ngama-nodules, kunye neqoqo efana neetambo, ezibizwa ngokuthi iintambo. Zizo zibambo ezidonsa iminwe ukuya entendeni kwaye zikhusele ukulungiswa okupheleleyo kweminwe.
Inkcazo "yonyango" yenkcubeko kubantu abanalo mqathango kwakufuneka balinde isivumelwano sikaDupuytren xa nje sinyamezela kwaye sinoo unyango otyando. Yilokho oogqirha ababiza ngokuba "balindile." Isizathu sokulinda unyango olugqithisileyo kukuba uDupuytren akazange aphiliswe kwaye aphinda unyango lwaluya kuba luyimfuneko kamva. Kwaye, ngokulinda ukunyanga le mqathango, inani lezonyango ezifunekayo kulo lonke ixesha lokuphila kwiguli ligcinwe ubuncinci.
Njengoko ezinye iindlela ezintsha zonyango ziye zanikela ngendlela encinci yokulawula isivumelwano sikaDupuytren, kukho oogqirha abacebisa ngoku unyango lokuqala. Nge-injenjini ye-collagenase kunye ne-alexone aponeurotomy, ukuphinda unyango akuyona nkxalabo eninzi. Ngoko ke, unyango lokuqala xa imeko leyo ingabonakali kakhulu. Kwaye, ngokungalindelanga, ukulungiswa ngokupheleleyo kwezivumelwano kungcono ngakumbi, okwenza ukuba ulinde unyango olungathandwa kakhulu.
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UkuThatyathwa kunye nokuHlanywaKwakukho ixesha apho oogqirha bancoma ukunweba, ukudibanisa kunye nokufaka i-cortisone kwiiyunithi zikaDupuytren. Ngokuqhelekileyo, ezi zonyango zibhetele, zona zikunceda okwethutyana kwaye, ngokugqithiseleyo, zinokwenza ukuba imeko iqhubele phambili ngokukhawuleza.
Izilwanyana zeCortisone zivame ukusetyenziswa ukuba zijobe uhlobo lwe-Duntyytren (kungekhona iintambo) kwaye lunokunceda ukuhlahlela iigununu. Ingcipheko kukuba la maqhuqhuva abuyele ngokukhawuleza ngexesha lokuya kweso sikwere sokujova, ngoko ke le nyeza ayifumanekanga. Ukongezelela, kukho imiphumo yecala le-cortisone engabangela iingxaki kwabanye abantu.
Ukubethelwa kunye nokuqhaqhaqhashe kwakusetyenziswa ngokuqhelekileyo kwixesha elidlulileyo. Ingxaki kukuba ezi zonyango zibonakala zinokubangela ukonakalisa imeko ngakumbi kunokunceda. Abantu abaninzi baya kuzama ukusabalalisa umnwe, kodwa ngokuqhelekileyo lo mkhuba kufuneka udikibala.
Ukusetyenziswa kunye nokukhawulelana ngamanye amaxesha kusetyenziswa emva kokuba unyango lukhulise ukuhamba ngokubambisana kunye nokukhusela ukuphindaphinda kwesivumelwano. Kodwa, oku kusebenza ngokusemthethweni njengophulo olusemva kokugqitywa okanye emva kokukhululwa. Ngelo xesha, ukulula kunye nokuqhaqhaqhekeza kuya kuphakanyiswa ngokuqhelekileyo. Ukuchonga njengonyango esisetyenzisiweyo ngokwabo ngokuqhelekileyo akunakunceda.
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I-Collagenase InjectionsI-Collagenase yi-enzyme ekhishwe kwiibhaktheriya. Le enzyme ijojowe ngqo kwintambo yeethambo zikaDupuytren ize ivumeleke ukuba idibanise iisisiti eziqinile, ezinesivumelwano. Abantu abafumana ezi ngxube bavame ukubuyela kwiofisi yabo ngogqirha ngosuku olulandelayo, emva kokuba i-enzyme iye yafumana ithuba lokuphula izicubu ezinzima. Ngelo xesha, ugqirha wakho uya kusebenzisa umlenze ngamandla ukuba aphule ngokupheleleyo iishubhu ezinesivumelwano.
Iilenjini ze-Collagenase, ezithengiswa phantsi kwegama lezorhwebo likaXiaflex, liye laziwa njengento elula ukwenza kwaye ngoko ezininzi iintlobo zamagqirha zinikezela ngoku. Inqubo inokwenziwa ngokupheleleyo kwiofisi yegqirha, nangona ifuna ukuba umntu ajojowe abuyele kwiintsuku ezilandelelanayo.
Ingcipheko kukuba i-collagenase inezibonakaliso ezicacileyo, nto leyo ithetha ukuba ayiyilwaphulo eluncedo kubo bonke abaneDupuytren. Abanye oogqirha baziva ukuba banokunceda izigulane ezininzi nge-alexone aponeurotomy okanye utyando, eziqhelekileyo iinkqubo ezinxulumeneyo. Ukongezelela, kukho iindleko eziphezulu ze-collagenase kwaye ezininzi izicwangciso ze-inshorensi aziyi kugubungela amayeza.
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I-Needle AponeurotomyI-needle aponeurotomy yinkqubo encinci ye-invasive yenkqubo yokuba esikhundleni sokususa izicubu zeDupuytren ezithengiweyo, isebenzisa inqaku leenaliti ukukhupha iintambo kunye nokunciphisa izivumelwano. Ugqirha wakho wenza ama-punctures amancinci ekliniki, akukho nto eyenziwe ngayo, kwaye ngokuxhaphaza isalathisi senaliti, ukucoca ngeetyhubhu ezivumelwano.
Abaxhasi bale nkqubo bafumana izibonelelo ezininzi:
- Kukhuselekile kakhulu. Iingxaki ziyakwenzeka, kodwa iingxaki ezinzima aziqhelekanga.
- Akubizi. Xa kuthelekiswa nezinye iindlela zonyango, i-alex aponeurotomy ngokubanzi ixabisa kakhulu ngaphantsi kwe-collagenase okanye utyando.
- Kulula. Oku kuthelekiswayo, oku kuthetha ukuba akumele kube lula kuwo wonke umntu, kodwa ngokuqhelekileyo kuyenziwa ngaphantsi kweyure kwaye ukulandelelana akusoloko kuyimfuneko.
Kunokwenzeka ukuba kunokwenzeka ukuba phantsi kwe-needle aponeurotomy. Hhayi wonke umntu unomhlobo we-Dupuytren oya kuphathwa ngokufanelekileyo ngenkqubo yensiza. Ukongezelela, ukuphindaphinda kwimeko kuya kuqheleka. Yaye ngelixa ukuphinda le nkqubo ngokuqhelekileyo ayiyiyo ingxaki, ukuphindaphinda kubonakala ukuba kwenzeke ngokukhawuleza emva kokuba inkqubo yenaliti ilinganiswe nonyango.
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UkuhlinzwaUtyando luye lwaba luhlobo oluqhelekileyo kunyango lwesivumelwano sikaDupuytren. Kukho iintlobo ezininzi kwiindlela zokuhlinzwa ezinokuthi zenziwe ngayo kwaye kufuneka zifunwe kangakanani. Xa utyando lwenziwa, i-incision isenziwa ngokuthe ngqo kwi-Dupuytren's, izicubu ezingavumelekanga zisuswe, kwaye ukuboniswa kwe-sutured kuvaliwe.
Inzuzo yokunyangwa ngonyango kukuba, nakwizona zigaba eziphambili zeDupuytren, ngokuqhelekileyo kukho into enokuyenza kwindlela yokuhlinzwa. I-Dupuytren eyongezelelekileyo ingadinga utyando olunzulu, kodwa phantse njalo inokuqwalaselwa ngokubakho.
Ukongeza, ngelixa zonke ezi nkqubo zijongana nezicubu ezinesivumelwano seDupuytren, akukho namnye kubo ophilisa imeko ebizwa ngokuba yi-Dupuyren's disease. Ngoko ke, ukuphindaphinda kwesivumelwano kuya kuhlala kunokwenzeka, kungakhathaliseki ukuba yintoni unyango olwenziwa. Ixesha eliphakathi kwonyango kunye nokuphindaphinda lona lude kunabo bonke (abantu abathethayo abayidingi unyango lokuphindaphinda ixesha elininzi) kunye nokuhlinzwa ngokuthelekiswa neenjini okanye inkqubo yenaliti.
Ingxaki engundoqo yokuhlinzwa kukuba ukubuyiswa kwenkqubo kungabandakanya ukungaphumeleli kwaye kunokuthi kubekho ixesha elide. Abantu banokuba nezibhanki kwiiveki kunye neengcambu zeenyanga. Kukho unyango olusenyakatho olubandakanyeka kunyango. Xa kuthelekiswa ne-collagenase okanye inkqubo yenaliti, ukubuyiselwa kwindlela yokuhlinzwa kubandakanyeka ngakumbi. I-trade off is ukuba ugqirha wakho angakwazi ukujongana ngokugqithiseleyo ngaphezu kwezo zikhetho ezingaphantsi.
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Ukuhlaziya uphandoNjengoko kuchazwe ngasentla, enye yeengxaki eziphambili zonyango lwesivumelwano sikaDupuytren kukuba le ngxaki isingatshintshi. Isifo sikaDupuytren yisimo esenza ukuba i-collagen emzimbeni wakho ilawulwe kakubi. Abantu abaneli meko benza i-collagen eninzi kwaye abawaphuli kakuhle i-collagen endala. Ionyango ezichazwe apha zizonke unyango lweempawu zale nkinga-abayikujongana nesimo esiyiyo.
Ngolunye usuku, silindele ukuba siyakwazi ukunikezela ngamachiza kubantu abaneDupuytren ukuthintela ukuqhubela phambili okanye ukuphindaphinda kwezivumelwano. Nangona kunjalo, kwada kweso sihlandlo, sinamathela kunyango lweempawu zesifo sikaDupuytren kuphela. Ngenxa yoko, i-Dupuytren inako, kwaye phantse njalo, iya kugcina ibuye. Kuloo meko, unyango olungaphezulu lunokuqwalaselwa.
Ukuphinda uphenywe kunokuba lukhohlisayo kwaye ngokuqinisekileyo kungekhona nje ngokugqithisileyo njengokuhlinzwa kuqala kuDupuytren. Ngenxa yokubunjwa kwamathambo , izixhobo eziqhelekileyo ze-anatomy kunye nezicubu zenyama ziphendukile, ukwenza ukuhlaziywa (ukuphinda) ukuhlinzwa ngokugqithiseleyo. Enyanisweni, ezinye izifundo zibonise isantya senkathazo ukuya kumaxesha angama-10 aphakamileyo kwiimeko zokuhlaziywa kwakhona.
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LweSalvage TreatmentsKukho amaxesha apho unyango alusebenzi kunye nethemba okanye xa uhambo lukaDupuytren luqhubeka nangona unyango. Kwabanye abantu, isivumelwano sokunweba kweminwe siye saqhubela phambili kwinqanaba elingazilungiseleli, nangona unyango olunonya. Kule meko, inkqubo yokunceda i-salvage ingafuneka.
Inkqubo yokunyusela yinkqubo engasetyenziswanga ukulungisa ingxaki, kodwa kunokuba wenze imeko ibe yinyamezelo kunokwenzeka. Ezinye iinkqubo zokuncedisa i-salvage ezingavumelekanga zonyango ekwenzeni isivumelwano sikaDupuytren ziquka:
- Ukuhlanganiswa okuhlangeneyo : Ukuhlanganiswa okuhlangeneyo kukutyunjwa ukubeka ngokusisigxina ukudibanisa kwisikhundla kwaye ithambo likhule kulo kulo ukuze lingaphinde ligobe. Xa idibeneyo ixutywanga, ayiyi kuphinda ivumelwano, nokuba i-Dupuytren iyaqhubeka.
- Ukulungiswa kwangaphandle : Isilungiso sangaphandle sisisitya esanyathiselwe kwithambo esinokuyolulela iithambo ezinotsholongwane malunga nexesha elide kwixesha elide. Kubantu abanamaqhina amankontileka kakhulu, ukunweba iiveki okanye iinyanga kunokunceda.
- Ukuxothwa : Ukukhutshwa komnwe akufaneki kwenziwe kwiDupuytren, kodwa kunokuba luncedo kwiimeko ezinzima kakhulu. Ngokukodwa kwiminwe emincinci-kwaye kubantu abanemiqobo emikhulu kwimisebenzi yokukhutshwa kwesandla kwedijithi kunokuba luncedo kwezinye iimeko ezinqabileyo.
Kwakhona, unyango lwe-salvage lugcinwe kwiimeko ezinzima kakhulu eziye zahluleka ukwelashwa kwamasiko emveli. Nangona kunjalo, kukho amanyathelo anokuthatha ukuthatha kwiimeko ezilukhuni.
> Imithombo:
> Becker GW, Davis TR: Isiphumo sonyango lwe-Dwaliytren yesifo esiphambili: Uhlolo oluhlelekile. J Hand Surg Eur Vol 2010; 35 (8): 623-626.
> EM emnyama, uBlazar PE. "Isifo se-Dupuytren: ukuqonda okuguqukayo kwesifo esikudala" J Am Acad Orthop Surg. NgoDisemba ka-2011; 19 (12): 746-57.
> UDenkler K: Iingxaki zokuphaphazela ezinxulumene ne-fasciectomy yesifo sikaDupuytren: Ukuhlolwa kwengxelo yamaNgesi iminyaka engama-20. Eplasty 2010; 10: e15.
> Hindocha S, uStanley JK, Watson S, Bayat A: Datheytren's diathesis ubuyekezwa: Ukuphononongwa kwezibonakaliso zokuchazwa kwengozi yokuphindaphinda kwesifo. UJ Hand Surg Ngo- 2006; 31 (10): 1626-1634.
> I-Lst i-LC, i-Badalamente MA, i-Hentz VR, ne-al: I-CORD Iqela lokuFunda: I-collagenase engenayo Clostridium histolyticum kwisivumelwano sikaDupuytren. N Engl J Med 2009; 361 (10): 968-979.
> UVan Rijssen AL, uGerbrandy FS, uTer Linden H, Klip H, Werker PM: Ukuthelekiswa kweziphumo ezichanekileyo zesalathonomyomy kunye ne-fasciectomy esincinci kwisifo sikaDupuytren: Ukufunda okulandelelweyo kweveki ezintandathu. I-J Hand Surg Ngo- 2006; 31 (5): 717-725.