Ukwakhiwa kwe-ACL yinkqubo yokucwangcisa ukwenza i-ligament entsha kumntu oye waxhasa intlungu ye-ACL . Xa umntu sele anqume ukuhlinzwa, kuya kufuneka ukuba anqume indlela ukuhlinzwa kuyo kwenziwa ngayo. Imibuzo eqhelekileyo yemibuzo ejongene nayo yiyo: yiyiphi i-ACL graft if they choose?
Uluhlu lwe-ACL luhlobo lweethambo ezisetyenziselwa ukwenza i- ligament entsha.
Ukwakhiwa kwe-ACL kunokwenziwa kunye nokukhethwa kweefayile ezahlukeneyo. Ezi zikhetho eziqhelekileyo ziquka i-tendellar tendon, i-tendstring tendon, kunye nezicubu ezixhasayo (allograft). Ngolunye lwezi zikhetho luneenzuzo kunye nezilungelelaniso.
Ukulungisa ngokutsha ngokutsha
Ukuhlinzwa kwe-ACL kuqhelekileyo, kodwa kungabi ngokuchanekileyo, ekubhekiswe kuyo ukulungiswa kwe-ACL. Ukulungiswa kubonisa ukuba unokulungisa into ephukile. Ukuba i-ACL igqityiwe ngokupheleleyo, iziphelo ze-ligament ephuthiweyo ayiyi kubuyiselwa ndawonye, nangona iziphelo eziqhekekileyo zidibene kunye.
Yintoni eyenza kakuhle, ukususa iiphelo eziqhekekileyo ze-ACL kwaye ubeke i-ligament ngesakhiwo esithile-esibizwa ngokuba yi-ACL graft. Ulwahlulo luyisishu ehamba kwindawo enye. Xa umthombo wohlulo luvela kumntu otyunjwa, kuthiwa yi-autograft. Xa umthombo uvela kumnikeli (cadaver), kuthiwa yi-allograft.
Ukukhusela ligament ehlanganisiweyo kwisikhundla se-ACL eqhelekileyo, iitoni zenziwe ngethambo le-shin (tibia) kunye nethambo lesithanga (femur), kwaye i-graft iyadluliselwa kule mijelo ukuze iphinde iphinde ivuselele i-ligament.
Patellar Tendon Autograft
Ithenda ye-patellar isakhiwo esingaphambi kwamadolo akho axhuma i-kneecap (patella) kwisifuba shin (tibia). Umthamo weetellar phakathi kwe-25 ukuya kwe-30 mm ububanzi. Xa i-tendon graft ekhethiweyo ikhethiweyo, i-1/3 ye-tendon patellar isuswe (malunga ne-9 okanye i-10 mm) kunye nebhokisi lesithambo kwiindawo zokunamathisela kwi-kneecap ne-tibia.
- Inzuzo: Amagqirha amaninzi akhetha i-tendellar graft ye-patellar ngenxa yokuba ifana ne-ACL echithwe. Ubude bethenda ye-patellar bufana ne-ACL, kwaye ithambo liphela ekufakeni i-graft linokufakwa kwisithambo apho i-ACL ifake khona. Oku kuvumela ukuba "ithambo ithambo" lokuphilisa, into eninzi abagqirha bajonga ukuba banamandla kuneyiphi indlela yokuphilisa.
- Iingxaki: Xa kuthathwa i-patellar tendon graft, inxalenye yethambo isuswe kwi-kneecap, kwaye malunga ne-1/3 yesithoni isuswe. Kukho umngcipheko wokwephulwa kwe patellar okanye i- patellar tendon ukulila ilandelayo emva kokuhlinzwa. Kwakhona, ingxaki eqhelekileyo emva kwalolu vavanyo yintlungu phambi kwamadolo ( ubuhlungu bentolo yangaphambili ). Enyanisweni, ngamanye amaxesha izigulane zithi zibuhlungu xa ziguqa, nangona emva kokuhlinzwa.
I-Hamstring Tendon Autograft
Imisipha ye-hamstring iqela lezihlunu emva kwethanga lakho. Xa i-tendon ye-hamst isetyenziswe kwi-ACL yokuhlinzwa, ezimbini iintlobo zeethambo ziya kususwa, kwaye "zixubene" ndawonye ukwenza i-ACL entsha. Kule minyaka, iindlela zokulungiswa kwezi ngqungquthela endaweni ziye zaphucula.
- Iingenelo: Ingxaki eqhelekileyo emva kokuhlinzwa kwe-ACL esebenzisa ithenda ye patellar yintlungu phambi kwegolo. Ezinye zeentlungu ziyaziwa ngenxa ye-graft kunye nethambo elisuswe. Oku akusiyo ingxaki xa usebenzisa ithethoni. Isicatshulwa ekufumaneni i-graft isincinci, kwaye intlungu emibini kwithuba elide emva kwexesha kunye nehla kwendlela, kucatshangelwa ukuba lingaphantsi.
- Iintsilelo: Ingxaki ephambili yale mibutho i-graft i-graft in the tunnels. Xa ithenda ye-patellar isetyenziswe, ithambo liphela ukuphulukisa kwiitoni zamathambo ("ithambo ithambo" lokuphilisa). Ngama-graft hamstring, ixesha elide liyimfuneko ukuba ulungelelwano lube lukhuni. Ngako oko, abantu abanamathengisa amaqhina bavame ukukhuselwa ixesha elide ngelixa i-graft iphilisa endaweni.
Allograft (i-Donor Tissue)
I-Allograft isetyenziswa ngokuqhelekileyo kubadlali bemidlalo yokuzonwabisa (ngokuchasene nabagijimi bezokhuphiswano), okanye izigulane eziye zahlolwa ngokutsha ukuhlinzwa kwe-ACL (xa ukulungiswa kwe-ACL kuphelelwa).
Izifundo zibonise ngokucacileyo ukuba i-allograft (izixhobo ezixhasayo kwi-cadaver) ayinamandla njengesiguli sesiguli (autograft). Kwizigulane ezininzi, nangona kunjalo, amandla e-ACL aphinda asebenzise i-allograft yanele ngokwabo iimfuno zabo. Ngako oko oku kunokuba yinto enhle kakhulu kwizigulane ezingenaso ukuthabatha inxaxheba kwimidlalo edinga kakhulu (umz. Ibhola, ibhaskball, njl).
- Inzuzo: Ukwenza uphando lwe- ACL usebenzisa i-allograft ivumela ixesha lokusebenza elinciphileyo, akukho mfuneko yokususa ezinye izicubu ezisetyenziselwa ukufakelwa, ukuboniswa okuncinci kunye nentlungu engaphantsi kokuhamba. Ukongezelela, ukuba ulwahlulo lwaluhluleka ukuhlaziywa, ukuhlaziywa kwenzelwa ukusetyenziswa ngokusetyenziswa kwethenda ye-patellar okanye i-hamstring grafts.
- Iingxaki: Ngokomlando, ezi ngqungquthela zazingekho mgangatho ophantsi kwaye zithatha ingozi enkulu yokudlulisa izifo. Ngoku kutshanje, iindlela zokulungiswa kwe-allograft ziye zaphucula ngokuphawulekayo, kwaye ezi nkxalabo aziyiyo ingxaki. Nangona kunjalo, inkqubo yokulungiswa kwe-graft (i-frozen-drying), iyabulala iiseli eziphilayo kwaye iyancipha amandla eethambo. Kukho ukuxhalabisa ngesifo . Nangona ukucwangcisa kunye nokulungiswa kwegraft kuyancipha le mngcipheko, akuyikukuphelisa ngokupheleleyo.
Indlela yokukhetha i-ACL Graft
Amagqirha amaninzi analo uhlobo oluthile lokufakelwa kweefayile ngezizathu ezahlukeneyo. Amandla wethenda ye-patellar kunye ne-hamstring grafts iyalingana ngokulinganayo. Akukho mpendulo efanelekileyo malunga nokuba yiyiphi enye into engcono, ubuncinane akukho nanye eye yaboniswa kwizifundo zesayensi.
Amandla e-allograft tissue aphantsi kwamanye ama-grafts, kodwa amandla othenda we-patellar kunye ne-hamstring bandon grafts kudlula amandla e-ACL evamile. Umgca we-85% ukuya kuma-95% wezigulane uya kuba namadolo azinzileyo ezinokliniki emva kokuhlinzwa okwakhiwa kwe-ACL.
Umthombo:
Ukulimala kwe-ACL: Ngaba ifuna ukuba unyango? I-American Academy ye-Orthopedic Surgeons, ngoSeptemba 2009