kusasa nerve utyando lokudlulisela ukunyanga ukukhubazeka kweengalo nezandla ngenxa yokwenzakala komqolo luncedo ekuphuculeni umsebenzi. Emva kweminyaka emibini yotyando kunye nephysiotherapy, abaguli baphinde basebenza kwiingqiniba kunye nezandla ezikhokelela ekuphuculeni ukuzimela kubomi babo bemihla ngemihla.
Abantu abanayo itetraplegia (ekwabizwa ngokuba yi-quadriplegia) banokukhubazeka kuwo omane amalungu - omabini aphezulu nasezantsi emva kokwenzakala komqolo wesibeleko. Oku kuchaphazela ukuzimela kwesigulane kubomi bemihla ngemihla kunye nemisebenzi yesiqhelo. Ukuphuculwa komsebenzi wezandla kubalulekile kwi-tetraplegic.
Utyando lokudlulisa i-tendon lwenziwa ngokuqhelekileyo ukuze kwakhiwe umsebenzi womlenze ophezulu apho i-tendon ye-muscle esebenzayo ihanjiswe kwindawo entsha yokufakela ukuze kuhlaziywe / kubuyiselwe umsebenzi kwi-muscle ekhubazekile. Ngobunye ubuchule obutsha botyando obubizwa ngokuba nerve ukudluliselwa, isiphelo esinye sempilo nerve igqithiselwa kwindawo yonzakeleyo nerve ngenjongo yokubuyisela umsebenzi. Ngaphezulu kwesihlunu esinye sinokuvuselelwa ngoko ke uninzi nerve ukudluliselwa kunokugqitywa ngaxeshanye. Oku kuchasene nokudluliselwa kwe-tendon efuna i-tendon enye ukuvuselela umsebenzi omnye. Kukwakho nocelomngeni oluncinci kunye nobunzima ekusebenzeni nerve Ugqithiso kwaye banamaxesha amafutshane okuhlanganisa emva kotyando ngelixa bebonelela ngeendlela ezininzi zokwakhiwa kwakhona. Imithambo Udluliselo alukhange lube nampumelelo kakhulu kuninzi ukulimala kwentambo yomgogodla ukude.
Uphononongo olutsha olupapashwe ngoJulayi 4 ngo Lancet ejolise ekuphandeni iziphumo a ukuhanjiswa kwemithambo-luvo utyando kwisakhono salo sokuvuselela ukusebenza kwamalungu aphezulu kwi-tetraplegics. Oogqirha abavela e-Australia abakhokelwa ngu-Natasha van Zyl baqesha abantu abadala abancinci be-16 (umyinge weminyaka eyi-27 yeminyaka) ababenokwenzakala okubuhlungu emva kokuwa, ukuntywila, ezemidlalo okanye iingozi zemoto. Babandezeleka kwangoko (iinyanga ze-18 emva kokulimala) intambo yomlomo wesibeleko yokulimala kwinqanaba le-motor C5 nangaphantsi.
Bonke abathathi-nxaxheba baye bafumana ukuhanjiswa kwe-nerve eyodwa okanye ezininzi kwelinye okanye zombini imilenze yabo ephezulu. Oogqirha botyando bathatha imithambo-luvo esebenzayo egxalabeni kwaye bayihambisa okanye bayibuyisela kwimisipha ekhubazekileyo engalweni, ngaloo ndlela bedlula ukwenzakala. Imithambo-luvo esebenzayo enonxibelelwano olunempilo kwintambo yomgogodla ngaphezu kokulimala ngoku yayidityaniswe nookhubazekileyo neentsholongwane ngaphantsi kokwenzakala kuququzelela ukukhula kwe-nerve. I-10 yabathathi-nxaxheba be-16 babenokudluliselwa kwe-nerve kwingalo enye edibeneyo kunye nokudluliselwa kwe-tendon kwenye. Abathathi-nxaxheba abathathu abakwazanga ukugqiba inkqubo ngenxa yezizathu ezingahambelani nokuhlinzwa. Iyonke, imilenze ye-27 yasetyenzwa kwaye ukuhanjiswa kwe-nerve ye-59 kwagqitywa. Injongo yayikukubuyisela ukwandiswa kwengqiniba, ukubamba, ukupinkisha, ukuvula nokuvala isandla.
Emva kweminyaka emibini nerve utyando lokudlulisa kunye ne-physiotherapy engqongqo, iziphumo eziphambili zilinganiswe ngovavanyo lwengalo (ARAT), uvavanyo lokukhululwa kwe-gresp (GRT) kunye ne-spinal cord independence measure (SCIM). Iziphumo zibonise ukuphucuka okubalulekileyo kokusebenza kwemilenze ephezulu kunye nokusebenza kwesandla kunye nokuphuculwa okunentsingiselo ekwandisweni kwengqiniba. Abathathi-nxaxheba banokolula ingalo yabo, bavule kwaye bavale izandla zabo, babe namandla okubamba izinto. Ngenxa yokubuyiselwa kolwandiso lwengqiniba abathabathi-nxaxheba babekwazi ukuhambisa isitulo sabo esinamavili. Bangenza imisebenzi emininzi yemihla ngemihla ngokuzimeleyo njengokutyisa, ukubrasha, ukubhala, ukusebenzisa izixhobo kunye nezixhobo. Oku kukhokelele kutshintsho olubalulekileyo kubomi babo bemihla ngemihla.
Uphononongo lwangoku luchaza isiphumo sotyando lokudluliselwa kwemithambo-luvo olwenze ukuba i-13 yabantu abadala abakhubazekileyo abakhubazekileyo bakhubazeke ngokupheleleyo ukuba baphinde baphumelele ukunyakaza nokusebenza kwimilenze yabo ephezulu - iingqiniba kunye nezandla. Ukudluliselwa kwe-nerve kudibanisa i-nerve esebenzayo kunye nemithambo-luvo eyenzakeleyo ukubuyisela amandla kwimisipha ekhubazekile. Xa kuthelekiswa nokuhanjiswa kwe-tendon, utyando lokudluliselwa kwemithambo-luvo lubonwa lubuyisela ukunyakaza kwendalo ngakumbi kunye nolawulo olucokisekileyo lwemoto olukhokelela ekuphuculeni umsebenzi kunye nokuzimela kubantu abane-tetraplegia.
***
{Unokufunda iphepha lokuqala lophando ngokunqakraza ikhonkco le-DOI elinikwe ngezantsi kuluhlu lwemithombo ecatshulweyo (s)}
Umthombo (s)
Van Zyl, N. et al. 2019. Ukwandisa ubuchule obusekelwe kwi-tendon-based based transfers kunye ne-nerve transfers yokubuyisela umsebenzi ophezulu we-tetraplegia: i-case series series. ILancet. https://doi.org/10.1016/S0140-6736(19)31143-2
