I-Avascular Necrosis (i-Osteonecrosis)

I-Avascular necrosis ithinta izinkulungwane zabantu unyaka ngamunye. Kwenzeka lapho ukugeleza kwegazi okuncishisiwe kuya ethanjeni kuholela ekuwohlokeni kancane kancane kanye nokuwa kwezicubu zethambo. Ngokungafani nokulimala okungazelelwe, lesi simo esibuhlungu sikhula kancane kancane phakathi nezinyanga neminyaka. Ngokuvamile kuthinta abantu abaneminyaka engu-30 no-50.

Isimo, esibizwa nangokuthi i-osteonecrosis, siqondise izingxenye ezithile zomzimba ngokungaguquki. Izimo eziningi zenzeka ekhanda lesifazane (i-hip), idolo, i-talus, nenhloko ye-humeral (ehlombe). Nakuba izimpawu nezimbangela kungase kuhluke, ukunganeli kwegazi emathanjeni kuseyindaba eyinhloko.

Ake sihlole uhlobo lwe-avascular necrosis, ukuxilongwa kwayo, izinketho zokwelapha, nezimpawu ezibonisa ukuthi udinga usizo lwezokwelapha. Lesi sihloko sinikeza izimpendulo ezicacile ezikusiza ukuthi uqonde isimo kangcono, kungakhathaliseki ukuthi uthole ukuxilongwa kwakho kamuva noma ufuna ukufunda okwengeziwe ngakho.

Iyini i-Avascular Necrosis (Osteonecrosis)?

Amaseli amathambo ayafa lapho igazi lawo linqamuka esimweni esibizwa ngokuthi i-avascular necrosis. Izicubu zethambo azikwazi ukuthola umoya-mpilo kanye nezakhamzimba ngaphandle kokugeleza kwegazi okufanele, okuholela ekuwohlokeni kwamathambo. Lesi simo sithinta iziphetho zamathambo amade kaningi, ikakhulukazi ikhanda lesifazane (inqulu), i-humerus (ingalo engenhla), idolo, neqakala. Lesi simo singakhula kunoma yiliphi ithambo futhi singase sithinte ithambo elilodwa noma amaningi ngesikhathi esisodwa.

Izigaba ze-Avascular Necrosis

Ukuqhubekela phambili kwe-avascular necrosis kwenzeka ngezigaba ezine ezihlukene:

• Isiteji 1: I-MRI ingakwazi ukubona isimo, kodwa ama-X-ray awabonisi umonakalo obonakalayo. Iziguli zingase zizwe ubuhlungu be-hip.
• Isiteji sesi-2: Ama-X-ray aveza ukulimala kwamathambo nge-lucency noma i-sclerosis, kodwa ikhanda lesifazane lihlala linjalo.
• Isiteji sesi-3: "Uphawu lwe-crescent" luvela kuma-X-ray - lubonisa ukuphuka kwe-subchondral kanye nokuwa kwethambo.
• Isigaba 4: Ikhanda lesifazane liwa ngokuphelele nge-osteoarthritis enzima.

Izimpawu ze-Avascular Necrosis

Abantu bangase bangaboni noma yiziphi izimpawu ze-avascular necrosis ekuqaleni. Isimo siyaqhubeka, futhi iziguli zivame ukuzwa:

• ubuhlungu Joint lokho kuba kubi kakhulu, ikakhulukazi phakathi nemisebenzi yokuthwala isisindo
• Ubuhlungu obusuka okhalweni kuya e-groin, ethangeni, noma esinqeni
• Ukunyakaza kuba nomkhawulo
• Amalunga aqina
• Ukuhamba kuba nzima ngokuxhuga okubonakalayo

Izinkinga ze-Avascular Necrosis

Ukuphazamiseka kokunikezwa kwegazi emathanjeni kubangela i-avascular necrosis. Lokhu kuphazamiseka kungenzeka kusuka:

• Ukuphuka noma ukuhlukaniswa ngenxa yokuhlukumezeka
• Imithambo yegazi ivinjwe amahlule egazi noma ama-fatty deposits
• Ukuphuza kakhulu utshwala
• Imithi ye-Corticosteroid esetshenziswa isikhathi eside
• Ukwelashwa ngemisebe yomdlavuza

Izingozi Zezingozi

Amathuba okuthuthukisa i-avascular necrosis anda ngalezi zici:

• Abantu abaphakathi kweminyaka engama-30-50 ubudala
• Amadoda ngaphezu kwabesifazane
• Ukulimala kwamalunga kusukela esikhathini esidlule
• Izimo zezokwelapha ezifana nesifo se-sickle cell, i-lupus, noma isifo sikaGaucher
• Isifo sokucindezeleka kusukela ekujuleni
• Ukusetshenziswa kwe-steroid isikhathi eside

Izinkinga

I-Avascular necrosis iba yimbi kakhulu uma ingelashwa. Nakhu okushiwo konke:

• Amathambo agoqeka unomphela
• Amalunga alimala kakhulu futhi abe nesifo samathambo
• Amalunga angalashiwe angabhujiswa phakathi neminyaka emihlanu
• Ukunyakaza kuba nomkhawulo ngobuhlungu obungapheli
• Ukuhlinzwa ngokuhlanganyela esikhundleni iba kudingekile

Ukuxilongwa kwe-Avascular Necrosis

Ukuhlolwa okuphelele komzimba kuqala inqubo yokuxilonga. Udokotela wakho uzohlola ukuthamba okuhlangene futhi ahlole ukuthi unganyakaza kanjani. Ukuhlolwa kwezithombe eziningana kusiza ukuthola umthombo wobuhlungu:

• I-X-rays - Imifanekiso eyisisekelo ibonisa izinguquko zamathambo ezigabeni ezithuthukisiwe kodwa zigeje izifo zakuqala
• I-MRI - Indlela enokwethenjelwa kakhulu eveza izinguquko ezinemininingwane yamathambo ngaphambi kokuba kubonakale izimpawu
• Ama-CT scans - Izithombe ezinemininingwane yethambo nezamalunga zisiza ukuhlela ukuhlinzwa
• I-Bone scans - I-Nuclear imaging ibonisa ukugeleza kwegazi nokusebenza kwamangqamuzana amathambo
• I-Biopsy - Ukuhlaziywa kwelebhu yamasampula ezicubu ngaphansi kwesibonakhulu

I-MRI igqama njengethuluzi elithembeke kakhulu elibamba i-avascular necrosis ngaphambi kokuba i-X ray ikwazi ukuyibona.

Ukwelashwa kwe-Avascular Necrosis

Ukwelashwa okufanele kusiza ukugcina ukusebenza kwamalunga futhi kunqande ukulimala kwamathambo ukuba kungabi kubi kakhulu. Udokotela wakho uzokhetha izinketho ngokusekelwe esigabeni sesifo, ubudala, nendawo yamathambo ethintekile:

• Izindlela ezingahlinzeki:
  • Imithi yobuhlungu (NSAIDs)
  • Izinduku noma izinduku zokunciphisa isisindo
  • Ukwelapha ngokomzimba igcina ukunyakaza kwamalunga
  • Ukugqugquzelwa kukagesi kukhuthaza ukukhula kwamathambo
  • Ama-bisphosphonates anciphisa ukulahleka kwamathambo
• Izinketho zokuhlinzwa:
  • I-Core decompression - Ukubhoboza amathambo kuthuthukisa ukugeleza kwegazi futhi kunciphisa ingcindezi
  • Ukufakwa kwamathambo - Ukufakelwa kwethambo okunempilo kusekela izindawo ezilimele
  • Osteotomy - Ukwakheka kabusha kwamathambo kunciphisa ukucindezeleka ezingxenyeni ezithintekile
  • Ukushintshwa okuhlangene - Inketho engcono kakhulu ezimweni ezinzima ngokugoqeka kwethambo

Ukwelashwa kwe-stem cell kubonisa imiphumela ethembisayo evimbela ukuwa kwekhanda lesifazane futhi ithuthukise ububanzi bokunyakaza.

Uzoyibona Nini Udokotela

Isimo sakho sizoba sibi ngaphandle kokwelashwa. Kufanele ubone udokotela wakho ngokushesha uma ubona:

• Ubuhlungu obuhlangene obuphumulayo abuthuthuki
• Ubuhlungu oba bubi kakhulu ngomsebenzi
• Ukunyakaza kuba nomkhawulo 
• Uqala ukuxhuga
• Kungenzeka ukuthi uphukile noma ukhiphe okuthile

Ukunakekelwa ngokushesha kwezokwelapha kukhulisa amathuba akho okwelashwa okuphumelelayo futhi kuvimbele ukulimala okuhlala njalo kwamalunga.

Isiphetho

I-Avascular necrosis yisimo esibucayi samathambo esidinga ukunakwa ngokushesha. Ngaphandle kokwelashwa, lesi sifo sihamba kancane kancane ezigabeni ezine futhi siholela ekugoqekeni okuphelele kwamathambo nokulimala okukhulu kwamalunga. Ukutholwa kusenesikhathi kwezimpawu eziyisixwayiso kwenza umehluko omkhulu endleleni ukwelashwa okusebenza kahle ngayo.

I-Avascular necrosis ingabangela ubuhlungu obuningi kanye nezinkinga zokuhamba. Intuthuko yezokwelapha yenze izindlela zokwelapha zaba ngcono kakhulu manje. Ukwelashwa okusha njengokwelashwa kwe-stem cell kubonisa isithembiso phakathi kwezinye izindlela zokuhlinza. Ngaphezu kwalokho, izinguquko ezilula njengokuphuza utshwala obuncane nokuhlala kude nemisebenzi enomthelela omkhulu kusiza ukulawula izimpawu.

Iziguli ezinobuhlungu obuhlangene obuqhubekayo, ikakhulukazi phakathi nemisebenzi yokuthwala isisindo, kufanele zithole usizo lwezokwelapha ngokushesha. Isenzo esisheshayo sithuthukisa amathuba akho okusindisa ukwakheka kwamathambo nokugcina amalunga esebenza kahle. Luselude ukhalo okufanele siluhambe, kodwa singakhela phezu kwale nqubekelaphambili njengoba ukunakekelwa okufanele kwezokwelapha kusiza iziguli eziningi zigcine izinga lempilo yazo futhi zigweme izinkinga ezinkulu zalesi sifo samathambo.

Imibuzo Evame Ukubuzwa

1. Ingabe ukushintshwa kwe-hip kuyayelapha i-avascular necrosis?

Ukushintshwa kwe-Hip empeleni "akulaphi" i-avascular necrosis, kodwa kusiza ukubhekana nemiphumela yako. Inqubo:

• Ikhipha ithambo elilimele futhi esikhundleni salo ifake amalunga okwenziwa 
• Inikeza ukukhululeka okuhle kakhulu kobuhlungu obuhlala iminyaka eminingi 
• Ibuyisela ukusebenza kwe-hip evamile ezimweni ezithuthukile 

Ubude ukuphinda esikhundleni ihlala iyindlela yokwelapha enokwethenjelwa kakhulu uma ugoqe amakhanda ezinsikazi kanye nobuhlungu obukhulu. Inqubo iletha ukukhululeka kobuhlungu okungaguquki kanye nemiphumela emihle yokusebenza, nakuba iziguli zingase zidinge ukuhlinzwa okubukeziwe kamuva.

2. I-avascular necrosis ithuthuka ngokushesha kangakanani?

Umuntu ngamunye uhlangabezana ne-avascular necrosis ngendlela ehlukile, kodwa ihamba ngokushesha kunezinye izimo ezihlangene:

• Ngokungafani osteoarthritis, ekhula kancane ngokuhamba kweminyaka, izigaba ze-AVN zihamba ngokushesha 
• Lesi sifo sithatha izinyanga eziyi-12-18 ukuze sithuthuke ngokugcwele, nakuba ezinye izimo ziqala ezinyangeni ezimbalwa nje 
• I-AVN ehlobene nokuhlukumezeka ihamba ngokushesha kunezinye izinhlobo 

3. Ingabe i-avascular necrosis ingalapheka?

Alikho ikhambi eliphelele le-avascular necrosis okwamanje, kodwa ukwelashwa kungasiza ukuphatha lesi simo:

• Ukutholwa kusenesikhathi ngama-X-ray noma i-MRI kuvumela ukwelashwa okungahlinzeki okungase kubambezele isifo 
• Izindlela zokwelapha eziyisisekelo zihlanganisa ukushintsha imisebenzi, ukuphuza imithi elwa nokuvuvukala, nokwenza ukwelapha ngokomzimba
• I-Core decompression isiza ukuvimbela ukuqhubeka phakathi nezigaba zokuqala ngaphambi kokuwa kwethambo 
• Iziguli ezisabela kahle ekuwohlokeni komgogodla zingahamba ngaphandle kosizo cishe izinyanga ezi-3 
• Ukuhlinzwa kuba ukuphela kwendlela esebenza ngemva kokuwa kwamathambo 

Odokotela abakwazi ukwelapha i-avascular necrosis ngaphandle kokuhlinzwa, futhi ukwelapha okungahlinzeki kusiza kuphela izimpawu okwesikhashana. Iziguli eziningi ezinesifo esithuthukisiwe (isigaba III nangaphezulu) zidinga ukushintshwa okuhlangene okuphelele, okusebenza kahle ekunciphiseni ubuhlungu nokusebenza okuthuthukisiwe.

UDkt. Ajay Kumar Paruchuri

I-MBBS, i-MS (i-Orthopaedics), i-MCh (i-Orthopaedics, e-UK), Ukuhlanganyela ku-Athroscopy Yamahlombe (UK)
I-CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad, CARE Hospitals, Banjara Hills, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529