Te Maimoatanga Tohunga mō te Roimata o te Pakihiwi Labral
Ina pāngia ō mahi o ia rā me ō mahi hākinakina e te mamae, te pāorooro, te kore pumau rānei o te pakihiwi, tera pea he pakaru labral te take. Kua whanake te maimoatanga mō te pakaru labral o te pakihiwi ki te whakarato i ngā hua pai rawa atu mō te nuinga o ngā tūroro, ahakoa mā te whakaora ā-pūmau, mā te pokanga iti rawa rānei. Mā te mārama ki tēnei āhuatanga pakihiwi noa ka āwhina i a koe ki te whai wāhi kaha ki ngā whakataunga maimoatanga me te arotau i tō whakaoranga.
I Madison Medical, ka whakaratohia e ā mātou tohunga pakihiwi he maimoatanga whānui mō te haehae o te pokohiwi e hāngai ana ki tō momo whara, taumata mahi, me ngā whāinga. Mai i te tautuhi tika tae atu ki te whakaora katoa, ka ārahi mātou i ngā tūroro ki te hoki ki te mahi kore mamae me te whakamahi pakihiwi māia.
Te Mārama ki te Labrum Pakihiwi
Ko te whitiki pokohiwi he mowhiti kiriuhi e karapoti ana i te kōpuku (glenoid) o te hononga pokohiwi, e whakahōhonu ake ana i tēnei kōpuku papaku, e whakapai ake ana hoki i te pumau. Ka mahi anō hoki tēnei kiko kiriuhi uaua hei pūwāhi piri mō ngā hononga me te uaua biceps. Ina pakaru te whitiki pokohiwi, ka heke te pumau o te pokohiwi, ā, ka whai ake te mamae.
He maha ngā momo haehae labral, e whakarōpūtia ana e te wāhi me ngā hanganga e pā ana. Ka pāngia te tihi o te labrum e piri ana te uaua biceps e ngā haehae SLAP (Superior Labrum Anterior to Posterior). Ka pāngia te wāhanga o mua-raro o te labrum e ngā whara bankart, ā, he maha ngā wā ka haere tahi me ngā nekehanga pakihiwi. Ka pāngia te tuara o te pona e ngā roimata labral o muri. Mā te mārama ki te momo haehae e tika ana māu ka ārahi i te maimoatanga tika.
Te Mōhio ki ngā Tohu o te Roimata Labral o te Pakihiwi
Ka puta ngā tohu rerekē i ngā pakaru o te pakihiwi i runga i te wāhi me te kaha o te pakaru. He mea noa te mamae hohonu o te pakihiwi, he mamae rawa, kāore i te kitea i roto i te hononga. Ka kino ake te mamae i ngā mahi o runga, i te toro atu ki muri o te tuara, i ngā nekehanga motuhake rānei e whakararuraru ana i te wāhi pakaru. He maha ngā tūroro e kī ana he nui ake te mamae i te pō, inā koa ka takoto ki runga i te pakihiwi e pāngia ana.
He maha ngā tohu ā-ringa e haere tahi ana me ngā roimata o te hononga o te ringa. Ko te pāwhiri, te pakū, te hopu, te raka rānei i te nekehanga o te pakihiwi e tohu ana i te wetekina, te neke rānei o te kiko o te hononga e whakararuraru ana i ngā mahi noa o te hononga. Tērā pea ka puta anō ēnei tohu mā te whakamahi i ngā tūranga motuhake o te ringa.
Ko te kore pumau, te ahua rānei kei te paheke te pakihiwi i tōna tūranga, te tohu o ngā whara me ngā haehae o Bankart e pā ana ki ngā nekehanga o mua. He maha ngā wā ka puta te mamae i ngā haehae SLAP i te wā e whiua ana, e hikitia ana rānei te pokohiwi. Ka kite ētahi tūroro i te ngoikore o te kaha o te pakihiwi, i te ahua pōuri rānei kāore te pakihiwi e mahi tika ana.
Ngā momo roimata o te pakihiwi
- Haehae PAPAKU: He pakaru nui o te labrum e pā ana ki te piri o te uaua biceps; he mea noa i roto i ngā kaitākaro o runga
- Te whara o te Bankart: He maha ngā wā ka pakaru te pokohiwi o mua-o raro i te taha o te pokohiwi; ka puta te kore pumau
- Te haehae o muri o te puku: Tua o te labrum; ka mamae pea i te pēhi, i te pēhi pae rānei
- Ngā roimata whakakotahi: He maha ngā wāhi e pā ana; me nui ake te maimoatanga
Ngā Take Noa o ngā Roimata Labral
He maha ngā wā ka pakaru te whitiki o te pokohiwi i ngā whara whara. He maha ngā wā ka pakaru te whitiki o te pokohiwi i te wā e panaia ana te pōro ki waho o te pona. Ka taea e te taka ki runga i te ringa kua totorohia, te whiu tika ki te pokohiwi, me ngā whara tōia ohorere te haehae i te kiko o te pokohiwi. I ētahi wā ka puta he whara o te pokohiwi i ngā aituā motuka me ētahi atu whara o te pokohiwi.
Ka memeha haere te labrum i ngā mahi o runga ake i te tinana i te roanga o te wā. Ka nui ake te tūponotanga o te haehae SLAP ki ngā kaitākaro whiu, ngā kauhoe, ngā kaitākaro poipapa, me ngā kaitākaro tēnehi. Ko te hiki taumaha, inā koa ngā nekehanga pēnei i te pēhi pae me te pēhi hōia, ka whakakaha i te labrum. Ahakoa ngā mahi o runga ake kāore i te hākinakina, ka taea e rātou te whai wāhi ki ngā huringa labrum e heke ana.
Ka ngoikore te hope o te pokohiwi i te ngoikore haere o te koroheketanga, ka ngawari ake te haehae i te ahotea iti. I muri i te 40 tau, ka iti ake te pakari o te kiko hope, ā, ka pakaru pea me te kore he whara motuhake. Ko te kore pumau o te pakihiwi i raro i ngā hononga ngoikore ka nui ake te ahotea hope me te mōrearea o te haehae.
Aromatawai Tātaritanga
Mā te whakamātautau tinana ka kitea ngā tohu nui mō te pakari o te taha o te pokohiwi. Ka aromatawaihia e tō kaiwhakarato te whānuitanga o te nekehanga o te pakihiwi, te pumau, me te kaha, me te tautuhi i ngā nekehanga e whakaputa anō i ō tohu. Ka aro nui ngā whakamātautau whakamātautau motuhake ki ngā rohe rerekē o te taha o te pokohiwi—ka aromatawaihia e te whakamātautau a O'Brien me te whakamātautau a Speed ngā roimata SLAP, ko te whakamātautau hopu ka aromatawaihia e te pakari o te taha o mua.
Mā te MRI me te arthrography ka kitea te āhua tino tika o te labrum pakihiwi. Mā te rauemi rerekē i werohia ki roto i te hononga ka kitea ngā pakaru e kore e kitea i runga i te MRI paerewa. Mā te wāhi, te rahi, me ngā āhuatanga o te pakaru ka ārahi i te whakamahere maimoatanga.
Mā te werohanga tātaritanga o te rongoā whakamoe ki te pakihiwi ka taea te whakaū ko te hononga te pūtake o te mamae ina kore e taea te whakatau tika i te whakaahua, ina rānei he maha ngā momo mamae ka puta. Ko te whakamamae mamae wā poto i muri i te werohanga e tohu ana i te mate o roto o te hononga pērā i te haehae o te uaua o te tari.
Ngā Kōwhiringa Maimoatanga Tūpato
He maha ngā roimata o te uaua o te uaua o te uaua o te uaua, inā koa ko ngā roimata SLAP iti ake i roto i te hunga ehara i te kaitākaro, ka pai te urupare ki te maimoatanga ā-pūmau. Mā te whakarerekētanga o ngā mahi—te karo i ngā nekehanga e whakararuraru ana i te wāhi kua pakaru—ka taea te noho o te mumura me te whakapai ake i ngā tohu. Ehara tēnei i te tikanga o te okiokinga katoa engari he karo mohio i ngā mahi whakapataritari.
Ka aro te whakaora tinana ki ngā uaua kāore i te taurite, ka whakapai ake i ngā mahi a te pakihiwi, ka whakapakari hoki i te porowhita me ngā mea whakaū i te hope. Ka taea e ngā uaua kaha e karapoti ana te whakakapi i te ngoikore o te uaua i roto i ētahi tūroro. Ka whakahokia mai anō hoki e te whakaora te whānuitanga o te nekehanga me te ako i ngā tauira nekehanga e tiaki ana i te kiko kua pakaru.
Ka whakaitihia te mamae me te mumura e ngā rongoā ārai-mumura. Ka taea e ngā werohanga corticosteroid ki te pakihiwi te whakarato i te oranga nui, ā, ka āwhina hoki ki te whakatau mēnā he pai te pokanga mōu—ko te whakapainga i muri i te werohanga e tohu ana i te pai o te pokanga.
Maimoatanga Toi
He tino pai ngā hua o te pokanga arthroscopic mō ngā pakaru o te pokohiwi kāore e aro ki te maimoatanga pūmau, e kore rānei e tino pumau. Mā roto i ngā tapahi iti, ka kitea e te taote pokanga te hononga pakihiwi katoa, ā, ka aro atu ki te kino o te pokohiwi me ngā raruraru e pā ana.
Mā te whakatikatika labral ka hono anō i te kiko pakaru ki te awhi o te pūtu mā te whakamahi i ngā punga iti. Mā te whakatikatika SLAP ka mau te punga labrum o runga me te punga biceps. Mā te whakatikatika Bankart ka whakatika i ngā pakaru o mua-o raro, mā te whakamahi i ētahi punga hei whakaora i te parenga labrum me te whakau i te kiko capsular kua totoro. Ko te whāinga he whakaora i ngā mahi hiri me te pumau o te labrum.
I ētahi wā, inā koa mō ngā tūroro kaumātua, mō te hunga rānei he pakaru SLAP kua heke te kounga, he pai ake ngā hua o te biceps tenodesis—te tango i te biceps mai i te labrum me te hono anō ki tētahi atu wāhi—i te whakatikatika. Ka tūtohu tō taote pokanga i te huarahi e tino tutuki ai ō whāinga mahi.
Te Whakaora me te Hoki ki te Mahi
Ko te whakaoranga i muri i te pokanga ka whai i tētahi whanaketanga āta whakaritea. Ko ngā wiki tuatahi ka arotahi ki te tiaki i te whakatikatika, te whakahaere i te mumura, me te tīmata i te nekehanga ngawari. Ka tīmata te whakapakari tinana ina oti te whakaora tika, i te nuinga o te wā i roto i te 6-8 wiki. Mā te whakangungu hākinakina motuhake ka whakarite i ngā kaitākaro mō te hokinga ki te whakataetae.
Ka āta haere ngā kaupapa hoki-ki-te-whiu mō ngā kaitākaro pēihipora me ngā kaitākaro whutupōro i roto i ētahi marama. Ko te tikanga, e 4-6 marama te roa o te hokinga ki ngā hākinakina pā, i runga i te whakatikatika motuhake me te whakaora takitahi. Ko te whakaoranga katoa mō ngā kaitākaro whutupōro taumata teitei ka roa pea e 9-12 marama.
He aha i whiriwhiria ai a Madison Medical mō te maimoatanga o te haehae pakihiwi?
He nui te wheako o ā mātou tohunga pakihiwi ki te rongoā i ngā roimata o te waha i roto i ngā tūroro, mai i ngā toa o te mutunga wiki ki ngā kaitākaro whakataetae. Neke atu i te 1,200 ngā tūroro e toro atu ana ki Madison Medical ia wiki, e whakarato ana i te tohungatanga e hiahiatia ana mō te tātaritanga tika me te whiriwhiri maimoatanga tino pai. Ka tukuna e mātou he tiaki whānui mai i te aromatawai tae noa ki te whakaora katoa.
Mā tā mātou tīma whakauru e whakarite te whakaora tinana, ngā maimoatanga werohanga, me ngā whiringa pokanga kia pai ai te tiaki. Ka whai wā mātou ki te whakamārama i tō mate, ki te matapaki i ō whāinga, me te whakauru i a koe ki ngā whakataunga maimoatanga. Ko te nuinga o ngā mahere inihua nui e whakaaetia ana i ō mātou wāhi watea i New Jersey.
Mātakihia kia nui ake ai te mōhio
Whakahokia anō tō pakihiwi ki te mahi
Kāore te pakaru o te pokohiwi e mutu ai tō mahi hākinakina, e whakawhāiti rānei i ō mahi o ia rā. Mā te tātaritanga tika me te maimoatanga tika, ka eke te nuinga o ngā tūroro ki ngā hua pai rawa atu, ā, ka hoki anō ki ngā taumata mahi e hiahiatia ana. Ko te mea nui ko te mahi tahi me ngā tohunga e mārama ana ki ngā āhuatanga motuhake o te mate pukupuku me te maimoatanga.
Whakapā atu ki a Madison Medical hei whakarite i tō aromatawai pakihiwi. Ka aromatawaihia e ā mātou tohunga tō āhua, ka whakamārama i ngā kitenga whakaahua, ā, ka tūtohu i te huarahi maimoatanga e tika ana mō tō whara me ō whāinga. Ahakoa e hiahia ana koe ki te whakahaere ā-pūmau, ki te whakatikatika pokanga rānei, kei a mātou te tohungatanga hei ārahi i tō whakaoranga.