Necrosis we-bone avascular. I-necrosis ye-Avascular yekhanda lesifazane

I-necrosis ye-Avascular yekhanda le-femur ibangelwa ukuphazamiseka kwegazi kuhlelo lwe-vascular olondla leli sayithi. Izenzakalo ezinjalo zivela njengomphumela wokucindezela noma ukuphikisana ngesikhathi sokuzibandakanya nge-artery encane ye-thrombus noma yokuhlukumezeka. Okulandelayo, ake sicabangele ngokuningiliziwe ukuthi yini i-necrosis ye-avascular yenhloko yesifazane.

Izici ezicasulayo

Ukusabalala kwe-vascular eside kanye nokwanda kwe-viscosity yegazi , i- stasis ene-venous kanye nokukhubazeka kokuphuma kukhulu kakhulu ekudleni umsoco wekhanda le-hip bone. Ngokuphathelene nalokhu, ukucindezelwa kwangaphakathi kwanda, ischemia ikhula. Lokhu kubangela ukwephulwa kwezakhiwo zomshini wamathambo amathambo. Ngenxa yalokho, i-voids yenziwa. Ngokuhamba kwesikhathi, ithambo liqala ukubola, i-carticlage ye-articular, ekubhubhiseni, ephuma ngaphandle kwayo.

Izici ze-pathology

I-Necrosis (i-avascular) yethambo itholakala kaningi. Ngokuyinhloko, ukutholakala kwezifo kutholakala emadodeni aneminyaka engu-20 kuya ku-45. I-necrosis ye-Avascular yekhanda lezinsikazi ezinganeni ezineminyaka engu-2 kuya kweyishumi nambili iphinde ihlolwe. Kulokhu, abafana bagula kaningi. Izimpawu ezihambisana nama-avascular necrosis, kwezinye izimo, kunzima ukuhlukanisa. Lokhu kuyinkimbinkimbi ekubunjweni kokuxilongwa okunembile. Ngokuyinhloko, izimpawu ze-necrosis ye-avascular cishe akunakwenzeka ukuhlukanisa nokubonakaliswa kwenqubo ye-pathological in the joint hip.

Ukuqhubeka kombuso

I-necrosis ye-Avascular iqala ngokushesha kakhulu. Kakade ngosuku lwesithathu isiguli sizwa ubuhlungu obungenakubekezelelwa, ukuqina kwalo okwandayo. Uma uzama ukuvuka, ngenkathi uhamba, kukhona ubuhlungu endaweni yokugaya. Ubuye avele engxenyeni ye-lateral futhi yangaphakathi yethanga futhi unikeze emadolweni. Eziguli eziningi, ubuhlungu bungaba nzima futhi buhlala njalo. Ikwazi ukuhlala ebusuku futhi ihlale ngamahora ekuseni. Lapho umthwalo uhamba, ubuhlungu emhlane ongaphansi noma obuthakathaka buyacasuka. Ukunciphisa ukuhamba, ukubonakala komuntu okhubazeka kufanele ngokushesha uqaphele umuntu futhi ube yisizathu sokucela isikhalazo kuqala.

I-necrosis ye-Avascular yenhloko yesifazane: izimbangela

Ngokusho kochwepheshe abaningi, ukuthuthukiswa kwe-pathology kuhlinzekwa ngokuqhubeka nokuphuza utshwala ngobuningi. Futhi, ukwelashwa kwesikhashana nge-corticosteroid hormone emazingeni aphezulu angabangela i-necrosis. Phakathi kwezici ezithandwayo ezihoxisa lesi simo, kufanele futhi kuqashelwe ukulimala: ukuqhuma, ukuhlukanisa, ukulimaza. I-Necrosis (i-avascular) yethambo ingaqala ngenxa yokukhathala, ukucindezeleka, ukucindezeleka ngokomzwelo. Kukhona amacala lapho ukukhubazeka kuthuthukile ngenxa ye-pancreatitis engapheli noma enzima. Njengento ekhangela, ukushisa imisebe emisebeni enkulu kungenza futhi. I-pathology ingahamba ne-antenia ye-earle-cell, i-osteomyelitis. Ezokwelapha kukhona into enjenge-idiopathic necrosis. Isetshenziswe uma kungenakwenzeka ukusungula ukuthi yini eyabangela ukugula.

Izifo

I-necrosis ye-Avascular kufanele ibonakale ngokushesha ngangokunokwenzeka. Kulesi simo, kunamathuba aphakeme okugwema ukungenelela kokuhlinzwa. Kodwa-ke, njengomthetho, i-pathology itholakala ukuthi ihambe kancane. Lokhu kungenxa yokuthi ngokubonakala kobuhlungu emthangeni, isiguli sithunyelwa ukuhlolwa kwe-X-ray. Ezithombeni, isigaba sokuqala se-pathology asitholakali. Isiyaluyalu siyabonakala ku-x-ray emva kwezinyanga ezimbalwa. Ukubona i-necrosis (i-avascular) yethambo emagabeni okuqala ingasebenzisa i-MRI noma i-CT. Unganiki umphumela onembile wokuhlolwa kwegazi kanye ne-ultrasound. Njengoba izindlela zokuxilonga, ukuskena nokukala kwe-pressure yangaphakathi yethambo kusetshenziselwa.

Izinyathelo zokuthuthukiswa kwezifo

I-necrosis ye-avascular yekhanda lezinsikazi iqhubeka kanjani? Izigaba ze-pathology zimi kanje:

• Ukuphulwa komsebenzi we-vascular. Kulesi sigaba kubalulekile ukugwema ukugxuma, ukuthwala imithwalo esindayo, ukuma isikhathi eside endaweni eyodwa, egijima. Ukuphumula kokunciphisa nokuphumula. Ukwelashwa kulesi sigaba kumele kuhloswe ukubuyisela ukujikeleza kwegazi ekhanda le-femur, kanye nokuvuselelwa kwezicubu. Isiguli sinconywa ukuvivinya umzimba okukhethekile ukuvimbela ukuthuthukiswa kwe-muscle atrophy. Kulesi sigaba, isazi singancoma ukusetshenziswa kwezidakamizwa ze-vasodilator. Imithi izosiza ekuqedeni izenzakalo eziqhubekayo futhi kubuyiselwe isakhiwo senhloko ngenxa yokumisa ukujikeleza kwegazi kanye nokwehliswa kwezinto ezihamba phambili. Ephumelelayo kulokhu, izidakamizwa ezingekho-steroidal anti-inflammatory, novocain ukuvimbela, hirudotherapy, massage. Ukuhlukunyezwa kwe-trochanter enkulu noma ikhanda lesifuba le-hip lisetshenziswa futhi.
• Ukuguqulwa nokubhujiswa kwento ewonakele. Kulesi sigaba, kuyasiza ukuhamba kancane emaminithini angu-30-50, ukuzivocavoca ngebhayisikili okumilayo, nokubhukuda emanzini olwandle. Kusuka kwizidakamizwa ezinconywayo ezikhuthazwayo ezikhuthaza ukubuyiswa kwethambo nama- vasodilators. I-Hirudotherapy, ukusikhipha imishini, ukuchithwa kwemithi kubuyelelwe.
• I-osteoarthritis yenhlanganisela ye-hip. Kulesi sigaba se-pathology, kunconywa ukuvivinya umzimba nokusikhipha. Kulezi zidakamizwa, isazi singakwazi ukubeka abasebenza nge-chondroprotectors nama- vasodilators.

Ngezinsuku ezedlule, ukuncishiswa kokugqoka nokwehliswa kwesigungu esithintekayo. Ikakhulukazi, lokhu kubonakala lapho isiguli sisesimweni esingezansi. Ngokumelene nesimo se-pathology, i-muscle atrophy iqhubeka: izicubu ziqala ukwehlisa nokunciphisa ivolumu.

I-necrosis ye-Avascular yekhanda lesifazane: ukwelashwa nama-NSAID

Imithi enjalo njenge-Diclofenac, i-Indomethacin, i-Ketoprofen, i-Piroxicam, i-Butadion, i-Meloksikam, i-Nimulide, i-Celebrex kanye ne-derivatives yayo iphakathi kwezidakamizwa eziphakanyisiwe zaleli qembu. Lezi mithi zisiza ukunciphisa ubuhlungu. Kumele kuqashelwe ukuthi i-NSAID ayiphathe i-necrosis (avascular) yethambo. Noma kunjalo, le mithi ingaletha inzuzo ebalulekile isiguli. Ekhethwe ngesikhathi esifanele, lezi zidakamizwa zivimbela i-reflex muscle spasm ebonakala ekuphenduleni ubuhlungu obungenakubekezeleka. Ukuphumula kwamafayili kunomthelela ekubuyiseleni ukujikeleza kwegazi ezindaweni ezithintekayo. Kodwa-ke, ukuthatha ama-NSAID kungaba yingozi kumguli. Iqiniso liwukuthi emva kokusebenzisa imithi umuntu uyeka ukuzwa ubuhlungu futhi alayishe indawo ethintekile ngendlela efanayo enempilo. Lokhu, kunalokho, kunomthelela ekubhujisweni okusheshayo kwekhanda lesithambo. Kule ndaba, isiguli kumele sikhumbule ukuthi, naphezu kokungekho ubuhlungu, indawo emelekile kufanele ivikeleke ekucindezelekeni.

Vasodilators

Lesi sigaba sihlanganisa imithi enjenge- "Trental" ("Pentosifillin", "Agapurin") ne "Theonikol" (i-nicotinate xantinol). Zisebenza kahle nge-necrosis ye-avascular. Lezi zidakamizwa zifaka isandla ekuqedeni ukulimala ekuhambeni. Uma kuthathwa, ukubuyiswa kwezicubu zekhanda zethambo kwashesha. Lokhu kwenziwa ngokuqiniswa kokugeleza kwegazi okuphazamisayo nokuqedwa kwe-spasm emithanjeni encane yegazi. Phakathi kwezinzuzo ezengeziwe zezidakamizwa ze- vasodilator kufanele zibizwe ngokuthi zingenangqondo ngokuphelele. Uma ulandela izincomo zikadokotela futhi uthatha izilinganiso zokwelapha, cishe azikho ukuphikisana nemiphumela emibi. Azinqunyelwe i-infarction eyingozi ye-myocardial, kanye neziguli ezisanda kuhlaselwa isifo esibi kakhulu. Uma uthatha ama-vasodilators, iziguli zivame ukuzwa umuzwa wokushisa, ubuso babo bubomvu. Lokhu kuvamile kakhulu ezimweni ezinjalo. Kungenxa efanelekile ekukhusheni okusebenzayo kwezitsha. Ukwamukelwa kwemithi yalesi sigaba kwenziwa kabili ngonyaka yizifundo ezihlala ezinyangeni ezingu-2-3.

Kusho ukukhuthaza ukukhanda izicubu

Lesi sigaba sibandakanya izidakamizwa ezinjalo njenge- "Calcium D3 Fort", "Alpha D3 TEVA", "Osteomag", "Oxidevit" nabanye. Lezi zindlela ziyasiza kakhulu ekuguleni. Amavithamini eqembu D enza ngcono ukumuncwa kwe-calcium. Ngenxa yalokhu, okuqukethwe kwayo kwanda kakhulu. Lokhu, futhi, kuvimbela ukuphuma okuhlukile kwe-calcium kusuka emathisheni e-bone kuya egazini. Ngenxa yalokhu, uxhumano luqoqa ezakhiweni ze-skeleton. Ikakhulukazi, ukuhlushwa kwalo kukhula emaqenjini ekhanda le-hip bone. Usizo oluphawulekayo nge-pathology kuletha ama-calcitonins. Zihlanganisa, ikakhulukazi, izindlela ezifana neSibakaltsin, Alostin, Miakaltsik nabanye. Lezi zidakamizwa zishukumisa amathambo okwakhiwa futhi ziqede ukukhathazeka. Ngenxa yokusebenzisa kwabo, ukuphuma kwe-calcium kunciphise kakhulu futhi umsebenzi we-osteoblasts ("isakhiwo" amangqamuzana) uqiniswa.

Ulwazi olungeziwe

I-necrosis ye-Avascular yenhloko yesifazane (i-ICD-10: M91.1) inegama elinye. Ibizwa ngokuthi yiLegg-Calve-Perthes isifo. I-pathology evame kakhulu e-England. Kuleli lizwe, 1 icala ngalinye ngabakhile abangu-1800 libhaliswe.