Uhlelo lwe-Tibial Tuberosity Advancement (TTA): Indlela Yesimanje Yokuhlinza Yokulungisa I-Canine Cruciate Ligament
Isingeniso
I-anterior cruciate ligament (ACL) ingenye yezintambo ezivame ukulimala emlenzeni we-canine wangemuva, okuholela ekungazinzini kwamalungu, ubuhlungu, futhi ekugcineni nesifo esihlangene se-degenerative (DJD). Ukungenelela okuhlinzayo kuvame ukudingeka ukuze kubuyiselwe uzinzo futhi kuvinjwe umonakalo owengeziwe ekuhlanganyeleni. Enye yezindlela zakamuva zokuhlinza zokulungiswa kwe-canine ACL uhlelo lwe-Tibial Tuberosity Advancement (TTA), oluye lwazuza ukuthandwa ngenxa yokuphumelela kwalo ekuthuthukiseni ukusebenza okuhlangene, ukunciphisa ubuhlungu, nokunciphisa izinkinga zangemva kokuhlinzwa. Kulesi sihloko, sizongena sijule ohlelweni lwe-TTA, izimiso zalo, izinhlelo zokusebenza, izinzuzo, kanye nemikhawulo.
I-Anatomy kanye nePhysiology ye-Canine Stifle Joint
Ngaphambi kokuthi sijule ohlelweni lwe-TTA, kubalulekile ukuqonda i-anatomy kanye ne-physiology ye-canine stifle joint. Ilunga le-stifle lilingana nelunga ledolo lomuntu futhi lakhiwe ngamathambo e-femur, tibia, kanye ne-patella. I-ACL inesibopho sokuzinzisa ukujoyina ngokuvimbela i-tibia ukuthi ingasheleli iye phambili ngokuhlobene ne-femur. Ezinjeni, i-ACL itholakala ngaphakathi kwe-capsule ehlangene futhi yakhiwe imicu ye-collagen enamathisela emathanjeni e-femur nase-tibia.
I-Pathogenesis ye-ACL Ukuphuka Ezinja
Ukuphuka kwe-ACL ezinjeni kungase kwenzeke ngenxa yezizathu ezihlukahlukene, kuhlanganise nezakhi zofuzo, ubudala, ukukhuluphala, umsebenzi womzimba, nokuhlukumezeka. Lapho i-ACL iqhuma, ithambo le-tibia liya phambili, libangele ukuthi ilunga lingazinzi, futhi libangele ubuhlungu, ukuvuvukala, futhi ekugcineni i-DJD. Ukuphathwa okulondolozayo, njengokuphumula, imithi, nokwelashwa ngokomzimba, kungasiza ekunciphiseni ubuhlungu, kodwa akuxazululi inkinga eyisisekelo yokungaqini kwamalunga. Ukungenelela okuhlinzayo kuvame ukudingeka ukuze kubuyiselwe uzinzo futhi kuvinjwe umonakalo owengeziwe ekuhlanganyeleni.
Izimiso zohlelo lwe-TTA
Uhlelo lwe-TTA luyindlela yesimanje yokuhlinza yokulungisa i-canine ACL ehlose ukubuyisela ukuzinza kwamalunga ngokushintsha i-engeli yethafa le-tibial. Ithafa le-tibial lingaphezulu kwethambo le-tibia elihambisana nethambo lesifazane ukwenza i-stifle joint. Ezinjeni ezine-ACL rupture, i-tibial plateau yehlela phansi, okwenza ithambo le-tibia lishelele phambili ngokuhlobene nethambo lesifazane. Uhlelo lwe-TTA luhilela ukusika i-tuberosity ye-tibial, ukugqama kwe-bony etholakala ngaphansi kwamadolo ahlangene, futhi kuyiqhubekisele phambili ukwandisa i-angle ye-tibial plateau. Intuthuko iqiniswa kusetshenziswa ikheji ye-titanium nezikulufu, ezikhuthaza ukuphulukiswa kwamathambo nokuhlanganiswa.
Izinzuzo Zohlelo lwe-TTA
Uhlelo lwe-TTA lunikeza izinzuzo ezimbalwa kumasu okukhanda e-ACL endabuko, njenge-tibial plateau leveling osteotomy (TPLO) kanye nokulungisa i-extracapsular. Okokuqala, uhlelo lwe-TTA luzwakala kakhulu nge-biomechanically, njengoba lushintsha i-angle yethafa le-tibial ukuvimbela ukuqhubekela phambili kwe-tibial, okuyimbangela eyinhloko yokuqhuma kwe-ACL. Okwesibili, uhlelo lwe-TTA lugcina i-ACL yomdabu, lunciphisa ingozi yezinkinga ezifana nokutheleleka, ukwehluleka kwe-graft, nokwehluleka kokufakelwa. Okwesithathu, uhlelo lwe-TTA luvumela ukuthwala isisindo sangemva kokuhlinzwa kanye nokuvuselelwa, okuthuthukisa ukusebenza okuhlangene futhi kunciphise isikhathi sokululama. Okwesine, uhlelo lwe-TTA lufanele izinja zabo bonke osayizi nezinhlobo, njengoba lungenziwa ngokwezifiso ngokwezidingo zomuntu ngamunye.
Imikhawulo yoHlelo lwe-TTA
Njenganoma iyiphi indlela yokuhlinzwa, uhlelo lwe-TTA lunemikhawulo yalo kanye nezinkinga ezingaba khona. Inkinga evame kakhulu ukuhluleka kokufakelwa, okungenzeka ngenxa yokucindezeleka kwemishini, ukutheleleka, noma ukuphulukiswa kabi kwamathambo. Ukwehluleka kokufakelwa kungaholela ekungazinzini kwamalunga, ubuhlungu, kanye nesidingo sokuhlinzwa okubukeziwe.
Ezinye izinkinga ezingase zibe khona zesistimu ye-TTA zihlanganisa ukuhlukana kwe-tibial crest, i-patellar tendonitis, nokuhlanganiswa okuhlangene. Ukwengeza, uhlelo lwe-TTA luwusu lokuhlinzwa oluyinkimbinkimbi oludinga ukuqeqeshwa okukhethekile kanye nobuchwepheshe, olungakhawulela ukutholakala kwalo kweminye imitholampilo yezilwane. Ngaphezu kwalokho, uhlelo lwe-TTA lubiza kakhulu kunezinye izindlela zokulungisa i-ACL, okungenzeka zingenzeki kwabanye abanikazi bezilwane ezifuywayo.
Abazongenela Uhlelo lwe-TTA
Uhlelo lwe-TTA lufanele izinja ezinokuqhekeka kwe-ACL nokungaqini kwamalunga, kanye nalezo ezinezinyembezi ze-meniscal ngesikhathi esisodwa noma i-DJD. Ikhandidethi elifanele lesistimu ye-TTA yinja enesisindo somzimba esingaphezu kuka-15 kg, njengoba izinja ezincane zingase zingabi nesisindo samathambo esanele ukusekela ikheji ye-titanium. Ngaphezu kwalokho, uhlelo lwe-TTA alunconyelwe izinja ezine-patellar luxation okunzima, ukonakala okukhulu kwe-cranial cruciate ligament (CCL), noma i-medial patellar luxation.
Ukuhlola Nokuhlela Kwangaphambi Kokusebenza
Ngaphambi kokwenza uhlelo lwe-TTA, inja kufanele ihlolwe ngokuphelele ngaphambi kokuhlinzwa, okuhlanganisa ukuhlolwa okuphelele komzimba, i-radiographic imaging, nokuhlolwa kwelebhu. I-imaging ye-radiographic kufanele ifake kokubili ukubukwa okuhlanganyelwe nokubuka kwe-hip ukuze kukhishwe i-hip dysplasia noma isifo samathambo. Ngaphezu kwalokho, udokotela ohlinzayo kufanele ahlele ngokucophelela ukuhlinzwa, okuhlanganisa ubukhulu nendawo yekheji ye-titanium, inani lokuthuthuka kwe-tibial tuberosity, kanye nohlobo lwe-anesthesia nokulawulwa kobuhlungu.
I-Surgery Technique
Uhlelo lwe-TTA luyisu lokuhlinza elidinga ngobuchwepheshe elidinga ukuqeqeshwa okukhethekile nobungcweti. Ukuhlinzwa kwenziwa ngaphansi kwe-anesthesia ejwayelekile, futhi inja ibekwe endaweni yomgogodla. Udokotela ohlinzayo wenza i-incision phezu kwe-tuberosity ye-tibial futhi ususa i-tendon patellar kusuka ku-tuberosity. I-tuberosity ibe isisikwa kusetshenziswa isaha elikhethekile, bese kubekwa ikheji le-titanium phezu kwesisikiwe. Ikheji ivikelwe kusetshenziswa izikulufu, futhi i-patellar tendon ixhunywe kabusha ku-tuberosity. Ijoyinti libe selihlolwa ukuthi alizinzi yini, bese imbobo ivalwa kusetshenziswa ama-sutures noma ama-staples.
Ukunakekelwa Kwangemva Kokuhlinzwa Nokuvuselelwa
Ngemva kokuhlinzwa, inja ifakwa emithini yezinhlungu nama-antibiotics, futhi ilunga libhekwa ukuvuvukala, ubuhlungu, noma ukutheleleka. Inja ivunyelwe ukuthwala isisindo esithweni esithintekile ngokushesha ngemva kokuhlinzwa, kodwa umsebenzi okhawulelwe uyatuswa emasontweni ambalwa okuqala. Inja kufanele igcinwe entanjeni futhi ivinjwe ekugxumeni, ekugijimeni, noma ekukhuphukeni izitebhisi. Ukwelapha ngokomzimba, okuhlanganisa uhla lwezivivinyo lokunyakaza nokuzivocavoca okulawulwayo, kufanele kuqale phakathi nezinsuku ezimbalwa ngemva kokuhlinzwa ukuze kuthuthukiswe ukusebenza kwamalunga futhi kuvimbele ukuwohloka kwemisipha. Ukuvakasha okulandelwa njalo nodokotela ohlinzayo kuyadingeka ukuze kuqashwe inqubo yokuphulukisa kanye nokubona izinkinga ezingase zibe khona.
Isiphetho
Uhlelo lwe-Tibial Tuberosity Advancement (TTA) luyindlela yesimanje yokuhlinza yokulungisa i-canine ACL ehlose ukubuyisela ukuzinza okuhlangene ngokushintsha i-angle ye-tibial plateau. Uhlelo lwe-TTA lunikeza izinzuzo ezimbalwa kumasu okulungisa i-ACL endabuko, okuhlanganisa nokuzwakala kwe-biomechanical, ukulondolozwa kwe-ACL yomdabu, kanye nokuvuselelwa kwangaphambi kokuhlinzwa. Nokho, uhlelo lwe-TTA lunemikhawulo yalo kanye nezinkinga ezingaba khona, futhi ludinga ukuqeqeshwa okukhethekile kanye nobuchwepheshe. Ngakho-ke, isinqumo sokwenza uhlelo lwe-TTA kufanele senziwe ngemva kokuhlolwa okuphelele ngaphambi kokuhlinzwa kanye nokubonisana nodokotela ohlinzayo wezilwane oqeqeshiwe.
