Mengapa Lutut Saya Sakit?
Sendi lutut anda adalah diperbuat daripada tiga tulang. Tulang paha (femur) anda berada di atas tulang kering (tibia) anda. Apabila anda membongkok atau meluruskan lutut anda, hujung bulat tulang paha anda bergolek dan meluncur merentasi permukaan di atas yang agak rata bagi tulang kering anda. Tulang ketiga kerap dipanggil tempurung lutut (patela), yang tersangkut pada otot-otot yang membenarkan anda untuk meluruskan lutut anda. Tempurung lutut anda menyediakan sistem tuas untuk mengurangkan ketegangan pada otot-otot ini.
Dalam keadaan normal, lutut yang sihat mempunyai permukaan tulang yang bersama adalah licin dan keras. Satu pengkusyenan lapisan tisu yang dipanggil rawan, mencegah hubungan langsung di antara tulang-tulang ini. Ketahanan lapisan tisu ini membenarkan tiga tulang tersebut untuk bergerak tanpa mencipta geseran atau permukaan tulang menjadi haus.
Walaubagaimanapun, apabila rawan ini menjadi rosak, tulang-tulang anda bergeser bersama-sama menyebabkan geseran, sakit dan, akhirnya, kemerosotan permukaan tulang. Punca-punca lazim kerosakan kepada rawan anda adalah daripada pelbagai jenis artritis. Tiada ubat atau rawatan yang akan membuatkan rawan yang rosak membesar kembali.
Apakah Penggantian Total Sendi Lutut?
Di dalam pembedahan penggantian total sendi lutut, bahagian daripada tulang-tulang yang bergeser akan diletakkan dengan implan logam dan plastik. Dengan menggunakan peralatan yang khas dan tepat, pakar bedah anda akan membuang permukaan tulang yang rosak. Kemudian penggantian permukaan akan dibetulkan di tempat yang asal.
Permukaan atas tulang akan digantikan dengan satu komponen logam yang bulat yang menyerupai permukaan lengkung tulang anda. Permukaan tulang yang lebih rendah akan digantikan dengan satu komponen logam yang leper bersama satu kepingan ultra-tinggi-molekul-berat plastik polyethylene yang tebal untuk dijadikan sebagai rawan. Di bawah permukaan tempurung lutut juga digantikan dengan satu cakera yang bulat yang diperbuat daripada plastik polyethylene yang sama.
Bagaimana Saya Mengetahui Jika Saya Memerlukan Penggantian Sendi Lutut?
Pakar bedah ortopedik anda akan menjalankan pemeriksaan yang lengkap mengenai lutut anda. Ini akan termasuk satu ujian jarak di mana sejauh mana anda dapat membengkok dan meluruskan lutut anda. Pakar bedah anda juga akan melihat kecacatan yang ada pada kaki anda yang boleh menunjukkan sebagai keadaan yang biasanya dipanggil pengkar atau lutut yang melengkung ke dalam. Anda akan diminta untuk berjalan, duduk dan kemungkinan mendaki dan jatuh beberapa langkah.
Pakar bedah anda juga akan bertanya soalan untuk menentukan sejarah perubatan anda. Anda akan ditanya tentang kecederaan-kecederaan, jangkitan-jangkitan dan kekacauan lain yang anda telah alami dalam kehidupan anda. Pakar bedah anda bertanya untuk mengetahui pengambilan ubat apa yang anda ambil. Dan, sudah tentu, anda akan diminta untuk menjelaskan sakit dalam lutut anda.
Akhirnya, pakar bedah anda akan mengambil x-ray yang akan digunakan untuk penilaian berterusan mengenai keadaan sendi lutut anda. Jika anda membuat keputusan untuk menjalani pembedahan total sendi lutut, x-ray ini juga akan digunakan untuk membantu pakar bedah anda memilih jenis dan saiz yang terbaik buatan lutut.
Berdasarkan ujian ini, pakar bedah anda akan menentukan sama ada anda adalah seorang calon yang sesuai untuk penggantian total sendi lutut. Walaupun dengan meluas dipraktikkan, penggantian total sendi lutut adalah satu prosedur pembedahan yang utama dan hanya akan dipertimbangkan apabila semua rawatan lain gagal. Terdapat banyak alternatif yang konservatif yang pakar bedah anda dan anda mungkin mahu pertimbangkan. Ini termasuk pengambilan ubat atau suntikan untuk kesakitan dan keradangan, terapi fizikal, atau jenis pembedahan yang lain.
Anda akan membuat keputusan mengenai jika atau tidak untuk menjalani pembedahan total sendi lutut, supaya anda akan mahu memahami risiko-risiko yang akan terjadi. Terdapat komplikasi yang berpotensi akan terjadi semasa dan selepas pembedahan. Umumnya, termasuk jangkitan, darah pekat, pneumonia, prosthesis yang longgar, dan kerosakan saraf. Pakar bedah anda dapat menjawab anda soalan-soalan mengenai risiko-risiko tersebut.
Bagaimanakah Rasanya Menjalani Pembedahan Penggantian Sendi Lutut?
Sebelum Pembedahan
Jika anda dan pakar bedah anda membuat keputusan bahawa penggantian total lutut adalah sesuai untuk anda, satu tarikh akan dijadualkan untuk pembedahan anda. Beberapa perkara mungkin diperlukan sebagai persediaan untuk pembedahan. Contoh, pakar bedah anda mungkin menyuruh anda membuat pemeriksaan fizikal oleh pakar perubatan atau doktor anda.
Oleh kerana proses pemindahan darah berkemungkinan menjadi keperluan semasa pembedahan anda, anda mungkin perlu menderma satu unit darah, atau dua unit jika pakar bedah anda rasa ia diperlukan. Anda boleh menderma satu unit seminggu sebelum pembedahan anda.
Semasa Pembedahan
Pada hari pembedahan, satu tiub kecil (tiub intravena) akan dimasukkan ke dalam tangan anda. Tiub ini akan digunakan untuk mengawal antibiotik dan ubat lain semasa pembedahan anda. Anda akan dibawa ke bilik pembedahan dan diberi anestesia. Selepas anestesia berkesan, lutut anda akan digosok dan disteril dengan satu rawatan khas.
Pembedahan akan dimulakan dengan satu pemotongan atas lutut yang akan mendedahkan sendi. Apabila tulang-tulang dapat dilihat sepenuhnya oleh pakar bedah, peralatan yang khas dan tepat digunakan untuk membuang permukaan-permukaan dan bentuk tulang yang rosak untuk digantikan dengan implan
Kemudian, implan selamat diletakkan pada tulang. Kemungkinan juga menjadi keperluan untuk menyesuaikan ligamen yang menyelubungi lutut supaya fungsi lutut yang terbaik dapat dicapai. Apabila pakar bedah berpuas hati dengan fungsi implan, pemotongan itu akan ditutup.
Satu salur keluar yang khas akan dimasukkan ke dalam luka untuk mengeluarkan cecair-cecair yang ada semasa pembedahan berlaku. Kemudian, satu pembalut yang disteril dibalut, dan anda akan dibawa ke bilik pemulihan, di mana anda akan dipantau. Pembedahan anda mungkin mengambil di antara satu hingga tiga jam, bergantung kepada keadaan anda.
Selepas Pembedahan
Selepas kesan anestesia berkurang, anda akan mulai sedar. Seorang jururawat akan bersama anda, dan akan menggalakkan anda untuk batuk atau bernafas dengan mendalam untuk membantu membersihkan paru-paru anda. Anda juga akan diberi ubat. Apabila anda sudah sedar sepenuhnya, anda akan dibawa ke bilik hospital anda. Lutut anda akan kekal bengkak dan tidak kuat untuk beberapa hari.
Apakah Yang Saya Harapkan Selepas Pembedahan?
Apabila anda berada di dalam bilik hospital anda, anda akan memulakan program pemulihan yang akan membantu anda mendapatkan semula kekuatan, penyeimbangan, dan pelbagai pergerakan lutut anda. Program ini akan direkabentuk khususnya untuk anda. Ia termasuk sebuah mesin, yang dipanggil mesin gerakan sedar pasif, yang secara automatik menggerakkan kaki anda bagi membantu mengurangkan kekakuan.
Ahli terapi fizikal anda akan membantu anda menjalani senaman yang sesuai. Dalam 24 jam selepas pembedahan, anda akan berkemungkinan diminta untuk berdiri. Selepas 24 jam, anda akan mula untuk berjalan beberapa langkah dengan bantuan tongkat.
Anda akan dibenarkan keluar sebaik sahaja pakar bedah anda menentukan yang anda telah pulih secukupnya. Anda boleh menjangkakan untuk berada di hospital untuk lebih kurang tiga hari selepas pembedahan anda. Anda kemungkinan akan dipindahkan untuk sebuah kemudahan kejururawatan untuk beberapa hari, seperti yang ditentukan oleh pakar bedah anda. Pembalut dan jahitan akan dibuka sebelum anda keluar hospital.
Di rumah, anda perlulah meneruskan senaman anda. Ahli terapi fizikal anda akan mengarahkan anda mengenai penjagan yang sesuai di rumah.
Dalam tempoh enam minggu selepas pembedahan, kebanyakan pesakit boleh berjalan dengan menggunakan tongkat. Anda akan mungkin berasa sihat sepenuhnya untuk memandu kereta dalam masa tujuh ke lapan minggu selepas pembedahan.
Dalam kebanyakan kes, kejayaan penggantian total sendi lutut akan melegakan kesakitan dan kekakuan kaki anda, dan membenarkan anda untuk melakukan aktiviti harian anda. Tetapi, walaupun selepas anda telah pulih sepenuhnya daripada pembedahan anda, anda masih tidak boleh melakukan beberapa perkara. Aktiviti-aktiviti harian yang normal tidak termasuk sukan atau aktiviti yang melibatkan ketegangan yang berlebihan pada lutut anda. Walaupun lutut buatan anda boleh diganti, ianya tidak akan sebaik yang pertama.
Untuk maklumat lanjut, sila berjumpa atau hubungi:
DR. SUHAIL SURESH ABDULLAH
M.D (UKM), M.S Orth (UKM)
Senior Lecturer / Consultant Orthopaedic & Arthroplasty Surgeon
Knee and Hip Joint Replacement
(Special Interest in Minimal Access & Computer Aided Joint Replacement)
Tel : 019 - 3795765
Tel :03 - 9170 3700 / 6700
Fax : 03 - 91712837
Email: drsuhail69@yahoo.com
http://www.ukmsc.com.my/lutut1.html
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