D gyaran kafa na lakaran yana faruwa a lokacin da aka cire gwiwoyi daga cikin tsagi a ƙarshen cinya. Kullum an cire gwiwa a gwiwa a waje na tsagi. Da zarar fashewar fasalin ya faru, zai yiwu ya sake faruwa a nan gaba.
Fahimtar dalilin da yasa rikice-rikice na gwiwa ya kasance mahimmanci don ƙayyade magani mai dacewa.
A wasu mutane, haɓakar kashi ko jiki zai iya zama fitowar, a wasu, akwai ƙuƙwalwar haɗi. Idan an yanke shawarar cewa tiyata shi ne mafi kyawun magani, to, ƙayyade takamaiman aikin aiki shi ne hanya mafi muhimmanci don hana haɓatawa a nan gaba.
Ƙaramar Miki-Miki
A al'ada, bayan da aka fara fashewa, an ba da shawarar likita marasa magani. Magungunan marasa magani yakan kunshi aikin jiki don ƙarfafa tsokoki a gwiwa gwiwa tare da yin amfani da takalmin gyaran kafa don taimakawa riƙe gwiwa a matsayin da ya dace. Yadda magungunan marasa magani ba zai yiwu ba don hana rigakafin da ake zuwa yanzu, amma yawancin likitoci suna jin cewa yana da muhimmanci a tantance idan wannan abu ne na daya lokaci, ko kuma idan yana da wata matsala. Ba a tabbatar da jimawa ba tukuna ba bayan da aka yi watsi da farko ba.
Yawancin likitoci sun yarda, idan gwibecap ya ɓace sau da yawa, to sai a yi aikin tiyata.
Lokacin da kneecap ya rushe, zai yiwu ya lalata guringuntsi a cikin gwiwa, wanda zai haifar da ƙananan ciwon gwiwoyi . Lokacin da nakasassun abubuwa suka faru, tilas ne a yi la'akari da tiyata.
Saki na karshe
Saki a waje shine mafi sauki kuma mafi yawan tiyata don magance matsalar rashin lafiyar mutum .
Saboda ana jawo gwiwa zuwa gindin gwiwa, saki na gefe yana yanke murfin gwiwa ta gwiwa (retinaculum) a waje na haɗin gwiwa . Manufar ita ce ta cire shinge zuwa waje kuma da fatan mafi alhẽri daga tsakiya a cikin tsagi a ƙarshen cinya cinya. Za a iya saki saki a waje don yin amfani da digi na tsakiya ko MPFL sake ginawa (duba ƙasa).
Asibiti na Imbrication / Reefing
Gidajen aikin likita shine hanya don ƙarfafa nama a gefen gwiwa. Kamar yadda saki a waje ya sassauta sassan da ke jawo gwiwa zuwa ga waje, haɗin daji na tsakiya yana ƙarfafa sassa a gefen gwiwa. Hanyar da ta fi dacewa ta ƙara ƙarfafa gefen tsakiya na gwiwoyi yana ci gaba da haɗin ƙananan ƙwayoyin quadriceps a kan gwiwa a kan gefen gwiwa.
MPFL gyara / haɓaka
Hanyar mafiya zamani da aka yi don raguwa ta katako ya shafi wani muhimmin ligament da ake kira lijital patellofemoral medial, ko MPFL. MPFL shine tayi tsakanin iyakar cinyar cinyar (femur) da kuma gefen gwiwoyi (patella). Lokacin da kneecap ya rushe, MPFL an tsage shi kullum.
A cikin raunin da ya faru , zai yiwu a gyara MPFL.
Wannan shi ne gaskiya kawai a farkon lokacin da aka magance shi da gaggawa. Sabili da haka, wasu likitoci sunyi umurni da yin aikin tiyata a lokacin da aka fara motsa jiki don sake gyara MPFL, duk da cewa ba a nuna wannan ba don rage yawan fashewa.
Bayan maimaita sakewa, don gyara MPFL, dole ne ayi sabon ligament. Ana iya yin wannan ta amfani da ligament ko tendon daga wasu wurare a jikinka, ko daga mai bayarwa (cadaver). An kirkiro sabon liyarar MPFL da kuma haɗe zuwa thighbone da kneecap. Wannan MPFL ne wanda aka sake ginawa kuma yana riƙe da kneecap a matsayi mai kyau.
Gyara Gyara / Fulkerson Shirin
A wasu marasa lafiya, nakasar su na da mawuyaci kuma suna taimakawa gwiwa don saukowa. Matsalar na iya zama wani tsagi mai zurfi a ƙarshen cinyar cinya ko rashin daidaituwa na ƙananan ƙananan .
A cikin waɗannan yanayi, aikin tiyata na yau da kullum shi ne daidaitawa da matsananciyar ta hanyar sakawa a cikin ƙuƙwalwar ƙuƙwalwa. Tudun tibial tubercle, ƙugiya a saman kashin ƙashi, yana rataye dogon kafa . Ta wurin sakawa na tarin tubal, an cire patella zuwa gefen gwiwa.
Akwai hanyoyi masu yawa na tiyata da ke cika wannan aiki. Hanyar Fulkerson ita ce mafi yawan al'ada kuma an labafta shi bayan likita wanda ya bayyana wannan fasaha. Akwai wasu hanyoyi masu kama da haka waɗanda suke sanya gurbin tubal din.
Rehab Bayan Yin Hoto
Rehab bayan tiyata don tabbatar da patella mai sauƙi ne. Rikicin tsawon lokaci yana tare da saki mai laushi, kuma mafi tsawo na hawaye yana da hanyar ƙaddamar da kashi. Ko da wane irin aikin da ake gudanarwa, aikin da yafi dacewa bayan tiyata shi ne girman gwiwa . Samun ƙarfin hali da motsa jiki da aka gano bayan tiyata iya ɗaukar watanni ko tsawo.
Kamar yadda aka ambata a farkon wannan labarin, matakin mafi muhimmanci shi ne tabbatar da mafi kyawun tiyata don yin la'akari da kowane hali. Ba dukkanin rushewa na gwiwa ba na faruwa ne saboda wannan dalili, sabili da haka ba dukkanin jiyya ba ne. Ganin likitan likita wanda ya saba da haddasawa da kuma maganin jiyya na katako ya zama mahimmanci.
Duk da yake lalacewa na patella zai iya faruwa bayan an tilasta su, ba su da yawa. Yawancin marasa lafiya zasu iya ci gaba da aikin ci gaba da raunin su ba tare da hadarin haɗuwa da gwiwa ba.
Sources:
Hing CB, et al. "Masiyoyin da ba tare da haɗari ba don magance farfadowa da ɓarna" Cochrane Database Syst Rev 2011 Nov 9; 11: CD008106.
Andrish J. "Gudanar da lalacewa na yau da kullum" Orthop Clin North Am. 2008 Yuli; 39 (3): 313-27.