Ukwandiswa kwemilenze kunye nokunciphisa

Ukwandiswa kwemilenze kunye nokunciphisa ziindidi zoqhaqho ukunyanga abantu abathile abanemilenze yobude obungalinganiyo.

Ezi nkqubo zinokuthi:

• Yandisa umlenze omfutshane ngokungaqhelekanga
• Mfutshane umlenze omde ngokungaqhelekanga
• Nciphisa ukukhula komlenze oqhelekileyo ukuvumela umlenze omfutshane ukuba ukhule ubude obufanayo

UKWANDISWA kwamathambo

Ngokwesiko, olu ngcelele lonyango lubandakanya utyando oluninzi, ixesha lokufumana kwakhona, kunye nenani lomngcipheko. Nangona kunjalo, inokudibanisa ukuya kwii-intshi ezi-6 (iisentimitha ezili-15) ubude emlenzeni.

Olu tyando lwenziwa phantsi kweanesthesia ngokubanzi. Oku kuthetha ukuba umntu ulele kwaye akabi nazintlungu ngexesha lotyando.

• Ithambo elandisiweyo lisikwa.
• Izikhonkwane zentsimbi okanye izikrufu zibekwa kulusu nakwithambo. Izikhonkwane zibekwe ngaphezulu nangaphantsi kokunqunyulwa kwethambo. Ukuthunga kusetyenziselwa ukuvala inxeba.
• Isixhobo sesinyithi siqhotyoshelwe kwizikhonkwane ezisethanjeni. Iya kusetyenziswa kamva kancinci kancinci (ngaphezulu kweenyanga) ukutsala ithambo elisikiweyo ngaphandle. Oku kudala indawo phakathi kweziphelo zethambo elisikiweyo eliya kuthi ligcwalise ngethambo elitsha.

Xa umlenze ufikelele kubude obufunwayo kwaye uphilile, kwenziwa olunye utyando ukususa izikhonkwane.

Kwiminyaka yakutshanje, kuye kwenziwa iindlela ezininzi ezintsha zokwenza le nkqubo. Oku kusekwe kutyando lokwandiswa kwemilenze yesiqhelo, kodwa kunokuba kukhululeke ngakumbi okanye kulunge kwabanye abantu. Buza ugqirha wakho malunga neendlela ezahlukeneyo ezinokuthi zikulungele.

UKUTSHISWA KAMATSHA OKANYE UKUSUSWA

Olu lutyando oluntsonkothileyo olunokuvelisa utshintsho oluchanekileyo.

Ngelixa uphantsi kweanesthesia ngokubanzi:

• Ithambo elifutshane liya kunqunyulwa. Icandelo lethambo liyasuswa.
• Iiphelo zethambo elisikiweyo ziya kudityaniswa. Isitya sensimbi esinezikrufu okanye isikhonkwane ezantsi embindini wethambo sibekwe ngaphaya kwethambo ukuze silibambe endaweni ngexesha lokuphilisa.

UKUTHINTELWA KOKUKHULA KWAMathambo

Ukukhula kwethambo kwenzeka kumacwecwe okukhula (i-physes) kwisiphelo ngasinye samathambo amade.

Ugqirha usika ngaphezulu kwepleyiti yokukhula ekupheleni kwethambo kumlenze omde.

• Isitya sokukhula singatshatyalaliswa ngokusihluza okanye ngokusiba ukuze siyeke ukukhula kwesi sitya sokukhula.
• Enye indlela kukufaka ukutya okwexeshana kwicala ngalinye lesitya sokukhula kwamathambo. Ezi zinokususwa xa imilenze yomibini isondele kubude obufanayo.

UKUSUSWA KWEZIXHOBO ZETYHALA

Izikhonkwane zensimbi, izikrufu, ukutya, okanye iipleyiti zinokusetyenziselwa ukubamba ithambo endaweni yokuphilisa. Uninzi lwamayeza ogqirha alinda iinyanga ezininzi ukuya kunyaka ngaphambi kokuba asuse naziphi na izinto ezifakwe kwisinyithi. Olunye utyando luyafuneka ukususa izixhobo ezifakiweyo.

Ukwandiswa kwemilenze kuthathelwa ingqalelo ukuba umntu unomahluko omkhulu kubude bemilenze (ngaphezulu kwe-5 cm okanye ii-intshi ezimbini). Inkqubo kunokwenzeka ukuba icetyiswe:

• Kubantwana abasenamathambo asakhulayo
• Kubantu abafutshane
• Kubantwana abanokungaqhelekanga kwipleyiti yokukhula kwabo

Ukunciphisa umlenze okanye ukuthintela kuthathelwa ingqalelo yomehluko omncinci kubude bomlenze (uhlala ungaphantsi kwe-5 cm okanye 2 intshi). Ukunciphisa umlenze omde kunokucetyiswa kubantwana abanamathambo abo angakhuli.

Ukuthintelwa kokukhula kwethambo kuyacetyiswa kubantwana abanamathambo abo asakhulayo. Isetyenziselwa ukuthintela ukukhula kwethambo elide, ngelixa ithambo elifutshane liqhubeka nokukhula ukuze lihambelane nobude balo. Ixesha elifanelekileyo lolu nyango lubalulekile kwiziphumo ezilungileyo.

Iimeko ezithile zempilo zingakhokelela kubude obungalinganiyo bomlenze. Ziquka:

• Ipoliomyelitis
• Umvakalelo yokitazo
• Izihlunu ezincinci, ezibuthathaka okanye ezimfutshane, eziqinileyo (spastic), ezinokubangela iingxaki kwaye zithintele ukukhula okuqhelekileyo komlenze
• Izifo ze-Hip ezifana nesifo seLegg-Perthes
• Ukulimala kwangaphambili okanye amathambo aphukileyo
• Iziphene zokuzalwa (ukukhubazeka kokuzalwa) kwamathambo, amalungu, izihlunu, imisipha, okanye iigaments

Umngcipheko we-anesthesia kunye notyando ngokubanzi kubandakanya:

• Ukunyanga kwamayeza
• Iingxaki zokuphefumla
• Ukopha, ihlwili legazi, okanye usulelo

Iingozi zolu tyando zibandakanya:

• Isithintelo sokukhula kwethambo (i-epiphysiodesis), enokubangela ukuphakama okufutshane
• Usulelo lwe-Bone (osteomyelitis)
• Ukwenzakala kwimithambo yegazi
• Ukuphilisa amathambo kakubi
• Umonakalo wemithambo

Emva kokuthintelwa kokukhula kwethambo:

• Kuqhelekile ukuchitha ixesha elingangeveki esibhedlele. Ngamanye amaxesha, isamente ibekwa emlenzeni iiveki ezi-3 ukuya kwezi-4.
• Ukuphilisa kugqityiwe kwiiveki ezi-8 ukuya kwezi-12. Umntu unokubuyela kwimisebenzi yesiqhelo ngeli xesha.

Emva kokunciphisa ithambo:

• Kuqhelekile ukuba abantwana bachithe iiveki ezimbini ukuya kwezintathu esibhedlele. Ngamanye amaxesha, isamente ibekwa emlenzeni iiveki ezi-3 ukuya kwezi-4.
• Ubuthathaka bemisipha buqhelekile, kwaye imithambo yokuqinisa imisipha iqalwa kwakamsinya emva kotyando.
• Iintonga zisetyenziselwa iiveki ezi-6 ukuya kwezi-8.
• Abanye abantu bathatha iiveki ezi-6 ukuya kwezi-12 ukubuyisa ulawulo kunye nokusebenza kwamadolo okuqhelekileyo.
• Intonga yentsimbi ebekwe ngaphakathi kwethambo isuswe emva konyaka omnye.

Emva kokwandiswa kwethambo:

• Umntu uza kuchitha iintsuku ezimbalwa esibhedlele.
• Ukutyelela rhoqo kumboneleli wezempilo kuyafuneka ukulungelelanisa isixhobo esandisayo. Ubungakanani bexesha isixhobo esisolulayo esisetyenzisiweyo sixhomekeke kubungakanani bokwandiswa okufunekayo. Unyango lomzimba luyafuneka ukugcina uluhlu oluqhelekileyo lokuhamba.
• Unonophelo olukhethekileyo lwezikhonkwane okanye izikhonkwane ezibambe isixhobo ziyafuneka ukukhusela usulelo.
• Ixesha elithathayo ukuthatha ithambo ukuphilisa lixhomekeke kubungakanani bokwandiswa. Isentimitha nganye yokwandisa ithatha iintsuku ezingama-36 zokuphilisa.

Ngenxa yokuba imithambo yegazi, izihlunu, kunye nolusu ziyabandakanyeka, kubalulekile ukukhangela umbala wolusu, ubushushu, kunye nokuziva konyawo neenzwane rhoqo. Oku kuya kunceda ukufumana nawuphi na umonakalo kwimithambo yegazi, izihlunu, okanye imithambo-luvo kwangoko.

Isithintelo sokukhula kwamathambo (i-epiphysiodesis) sihlala siphumelela xa sisenziwa ngexesha elifanelekileyo ngexesha lokukhula. Nangona kunjalo, kunokubangela ubude obufutshane.

Ukunciphisa amathambo kunokuchaneka ngakumbi kunothintelo lwethambo, kodwa kufuna ixesha elide lokufumana kwakhona.

Ukwandiswa kwamathambo kuphumelele ngokupheleleyo malunga namaxesha ama-4 kwali-10. Inenqanaba eliphezulu kakhulu leengxaki kunye nemfuno yokuqhubeka kotyando. Izivumelwano ezidibeneyo zinokwenzeka.

Epiphysiodesis; Ukubanjwa kwe-Epiphyseal; Ukulungiswa kobude obungalinganiyo bethambo; Ukwandiswa kwamathambo; Ukunciphisa amathambo; Ukwandiswa kwabafazi; Ukunciphisa abafazi

• Ukwandiswa kwemilenze - uthotho

UDavidson RS. Umahluko kubude bomlenze. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla we-20. IPhiladelphia, PA: Elsevier; Ngo-2016: isahluko 676.

UKelly DM. Ukungaqheleki kokubeleka komda osezantsi. Ku: Azar FM, Beaty JH, Kanale ST, ii-eds. Umsebenzi weCampbell's Orthopedics. Umhla we-13. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 29.