Inkqubo ye-Tibial Tuberosity Advancement (TTA): I-Technique ye-Modern Surgical yokuLungisa i-Canine Cruciate Ligament
Intshayelelo
I-anterior cruciate ligament (ACL) yenye yeentambo eziqhelekileyo zokulimala kwi-canine yangasemva, ekhokelela ekungazinzini kwamalungu, intlungu, kwaye ekugqibeleni isifo esidibeneyo (DJD). Ungenelelo lotyando luhlala lufuneka ukubuyisela ukuzinza kunye nokuthintela umonakalo ongakumbi kwilungu. Enye yeendlela zokugqibela zokuhlinzwa zokulungiswa kwe-canine ACL yinkqubo ye-Tibial Tuberosity Advancement (TTA), eye yafumana udumo ngenxa yokusebenza kwayo ekuphuculeni umsebenzi odibeneyo, ukunciphisa intlungu, kunye nokunciphisa iingxaki emva kokuhlinzwa. Kweli nqaku, siza kungena nzulu kwinkqubo ye-TTA, imigaqo yayo, izicelo, izibonelelo, kunye nemida.
I-Anatomy kunye nePhysiology yeCanine Stifle Joint
Ngaphambi kokuba sihlolisise inkqubo ye-TTA, kubalulekile ukuqonda i-anatomy kunye ne-physiology ye-canine stifle joint. I-stifle joint ilingana nedolo lomntu kwaye yenziwe ngamathambo e-femur, tibia, kunye ne-patella. I-ACL inoxanduva lokuzinzisa i-joint ngokuthintela i-tibia ukuba ihambe phambili ngokumalunga ne-femur. Kwizinja, i-ACL ifumaneka ngaphakathi kwe-capsule edibeneyo kwaye yenziwe nge-collagen fibers enamathele kwi-femur kunye ne-tibia amathambo.
I-Pathogenesis ye-ACL Ukuqhekeka kwiiNja
Ukuqhekeka kwe-ACL kwizinja kunokwenzeka ngenxa yezizathu ezahlukeneyo, kubandakanya imfuza, ubudala, ukutyeba kakhulu, ukusebenza ngokomzimba, kunye nokwenzakala. Xa i-ACL iqhuma, ithambo le-tibia lihamba phambili, libangela ukuba i-joint ingazinzi, kwaye ibangele intlungu, ukuvuvukala, kwaye ekugqibeleni i-DJD. Ulawulo lwe-Conservative, olufana nokuphumla, amayeza, kunye nonyango lomzimba, lunokunceda ukunciphisa intlungu, kodwa ayijongani nengxaki esisiseko yokungazinzi kwamalungu. Ungenelelo lotyando luhlala lufuneka ukubuyisela ukuzinza kunye nokuthintela umonakalo ongakumbi kwilungu.
Imigaqo yeNkqubo yeTTA
Inkqubo ye-TTA yindlela yokuhlinzwa yanamhlanje yokulungiswa kwe-canine ACL ejolise ukubuyisela ukuzinza ngokubambisana ngokutshintsha i-angle ye-plateau ye-tibial. I-tibial plateau yindawo ephezulu yethambo le-tibia elidibanisa nethambo le-femur ukwenza i-stifle joint. Kwizinja ezine-ACL rupture, i-tibial plateau ihla inyuka, ibangela ukuba ithambo le-tibia lityibilikele phambili ngokumalunga nethambo le-femur. Inkqubo ye-TTA ibandakanya ukusika i-tuberosity ye-tibial, i-bony prominence ephantsi kwedolo, kwaye iqhube phambili phambili ukuze ikhulise i-angle ye-tibial plateau. Ukuqhubela phambili kuzinzisiwe kusetyenziswa ikheji ye-titanium kunye nezikrufu, ezikhuthaza ukuphilisa kwamathambo kunye nokudibanisa.
Izinto ezilungileyo zeTTA System
Inkqubo ye-TTA ibonelela ngeenzuzo ezininzi kubuchule bokulungisa be-ACL bendabuko, njenge-tibial plateau leveling osteotomy (TPLO) kunye nokulungiswa kwe-extracapsular. Okokuqala, inkqubo ye-TTA isandi se-biomechanically ngakumbi, njengoko iguqula i-angle ye-plateau ye-tibial ukukhusela phambili i-tibial thrust, eyona nto ibangela ukuphuka kwe-ACL. Okwesibini, inkqubo ye-TTA igcina i-ACL yomthonyama, inciphisa umngcipheko weengxaki ezifana nosulelo, ukusilela kwi-graft, kunye nokusilela kokufakelwa. Okwesithathu, inkqubo ye-TTA ivumela ukuthwala ubunzima bokuqala emva kokusebenza kunye nokuvuselela, okuphucula umsebenzi odibeneyo kunye nokunciphisa ixesha lokubuyisela. Okwesine, inkqubo ye-TTA ifanelekile kwizinja zabo bonke ubukhulu kunye neentlobo, njengoko zinokuthi zenziwe ngokwezifiso kwiimfuno zomntu ngamnye.
Unyino lweNkqubo yeTTA
Njengazo naziphi na iindlela zotyando, inkqubo ye-TTA inemida yayo kunye neengxaki ezinokubakho. Eyona ngxaki ixhaphakileyo kukungaphumeleli kokufakelwa, okunokuthi kwenzeke ngenxa yoxinzelelo lomatshini, usulelo, okanye ukunyangwa kwamathambo. Ukungaphumeleli kokufakelwa kwezinto kunokukhokelela ekungazinzini kwamalungu, intlungu, kunye nesidingo sokuhlinzwa ngokutsha.
Ezinye iingxaki ezinokuthi zenzeke kwinkqubo ye-TTA ziquka i-tibial crest fracture, i-patellar tendonitis, kunye ne-joint effusion. Ukongeza, inkqubo ye-TTA bubuchule botyando obuntsonkothileyo obufuna uqeqesho olukhethekileyo kunye nobuchule, obunokuthi buthintele ukufumaneka kwayo kwezinye iikliniki zonyango lwezilwanyana. Ngaphezu koko, inkqubo ye-TTA ibiza kakhulu kunezinye iindlela zokulungisa i-ACL, ezinokuthi zingenzeki kwabanye abanini bezilwanyana zasekhaya.
Abaviwa beNkqubo yeTTA
Inkqubo ye-TTA ifanelekile kwizinja ezine-ACL eziqhekezayo kunye nokungazinzi ngokubambisana, kunye nezo zineenyembezi ze-meniscal okanye i-DJD. Umgqatswa ofanelekileyo kwinkqubo ye-TTA yinja enobunzima bomzimba obungaphezulu kwe-15 kg, njengoko izinja ezincinci zisenokungabi namathambo aneleyo okuxhasa ikheji ye-titanium. Ngaphezu koko, inkqubo ye-TTA ayikhuthazwa kwizinja ezine-patellar luxation enzima, i-cranial cruciate ligament (CCL) degeneration, okanye i-medial patellar luxation.
UVavanyo lwangaphambili kunye noCwangciso
Ngaphambi kokwenza inkqubo ye-TTA, inja kufuneka ihlolwe ngokucokisekileyo kwangaphambili, kubandakanywa uviwo olupheleleyo lomzimba, i-radiographic imaging, kunye novavanyo lwebhubhoratri. I-radiographic imaging kufuneka ibandakanye zombini iimbono ezidibeneyo kunye nemibono ye-hip ukulawula i-hip dysplasia okanye isifo samathambo. Ngaphezu koko, ugqirha kufuneka acwangcise ngononophelo utyando, kubandakanywa ubungakanani kunye nendawo ye-titanium cage, ubungakanani be-tibial tuberosity progression, kunye nohlobo lwe-anesthesia kunye nokulawulwa kweentlungu.
UbuCwangciso bokuSebenza
Inkqubo ye-TTA bubuchule obufuna utyando obufuna uqeqesho olukhethekileyo kunye nobuchule. Utyando lwenziwa phantsi kwe-anesthesia jikelele, kwaye inja ibekwe kwi-dorsal recumbency. Ugqirha wenza i-incision phezu kwe-tuberosity ye-tibial kwaye ikhupha i-tendon ye-patellar kwi-tuberosity. I-tuberosity isikwa kusetyenziswa isarha ekhethekileyo, kuze kubekwe ikheji ye-titanium phezu kwesi sikiweyo. I-cage ikhuselekile ngokusebenzisa izikhonkwane, kwaye i-tendon ye-patellar iphinda ifakwe kwi-tuberosity. I-joint ke ihlolwe ukuzinza, kwaye i-incision ivaliwe ngokusebenzisa i-sutures okanye i-staples.
Ukhathalelo lwasemva kotyando kunye noBuyiselo kwimo yesiqhelo
Emva kotyando, inja ifakwa kumayeza eentlungu kunye namayeza okubulala iintsholongwane, kwaye umdibaniso ujongwa ukudumba, intlungu, okanye usulelo. Inja ivumelekile ukuba ithwale ubunzima kwilungu elichaphazelekayo ngokukhawuleza emva kokuhlinzwa, kodwa umsebenzi othintelweyo unconywa kwiiveki ezimbalwa zokuqala. Inja kufuneka igcinwe kwintambo kwaye ithintelwe ekuxhumeni, ukubaleka, okanye ukunyuka izinyuko. Unyango lomzimba, olubandakanya ulwahlulo lweendlela zokuzivocavoca kunye nokuzivocavoca okulawulwayo, kufuneka kuqale kwiintsuku ezimbalwa emva kotyando ukuphucula umsebenzi odibeneyo kunye nokuthintela i-atrophy ye-muscle. Ukutyelelwa rhoqo ngokulandelelana kunye nogqirha wotyando kuyimfuneko ukubeka iliso kwinkqubo yokuphulukisa kunye nokufumanisa iingxaki ezinokuthi zibe khona.
Ukuqukumbela
Inkqubo ye-Tibial Tuberosity Advancement (TTA) yindlela yanamhlanje yokuhlinzwa yokulungiswa kwe-canine ACL ejolise ukubuyisela ukuzinza ngokubambisana ngokutshintsha i-angle ye-tibial plateau. Inkqubo ye-TTA ibonelela ngeenzuzo ezininzi kubuchule bokulungisa be-ACL bemveli, kubandakanywa isandi se-biomechanical, ukugcinwa kwe-ACL yomthonyama, kunye nokuvuselelwa kwangethuba emva kotyando. Nangona kunjalo, inkqubo ye-TTA inemida yayo kunye neengxaki ezinokubakho, kwaye ifuna uqeqesho olukhethekileyo kunye nobuchule. Ngoko ke, isigqibo sokwenza inkqubo ye-TTA kufuneka senziwe emva kovavanyo olucokisekileyo lwangaphambili kunye nokubonisana nogqirha wezilwanyana oqeqeshiweyo.
