Ðe wò ŋutilã ƒe akpa aɖewo li siwo sena le ɖokuiwò me be yebla ɖe ye ŋu hetsia? Esia ate ŋu anye kontraktɔ!

Ðe nèsena le ɖokuiwò me ɣeaɖewoɣi be yeƒe ŋutilã ƒe akpa aɖewo, ɖewohĩ ŋutigbalẽ, lãmekawo, alo ƒunukpeƒe aɖe gɔ̃ hã, le sesẽm hele xa? Ðe nèkpɔnɛ be yemate ŋu abɔbɔ alo akeke ye ɖokui bɔbɔe abe tsã ene oa? Nɔnɔme sia ate ŋu anye nɔnɔme si woyɔna be ‘nubabla’ abe alesi ɖɔktawo yɔnɛ ene. Mègatsi dzi o, mina míaƒo nu tso esia ŋu bɔbɔe.

Nukae nye ‘nubabla’ sia?

Kpuie ko la, contracture nye nuwo ƒe wɔwɔme ƒe tɔtrɔ si dzɔna le míaƒe ŋutilã ƒe lãkusi falɛfalɛwo kple kadodoŋusẽwo me. Esia wɔnɛ be lãkusi siawo sesẽna, wosẽna, eye womegate ŋu nɔa te sesĩe abe rababa ene o . Kpɔe ɖa le susu me be wò ŋutigbalẽ, lãmekawo, alo lãmenugbagbevi siwo ƒo xlã wò ƒunukpeƒewo le sesẽm hele sesẽm, abe kpewo ene. Esia xea mɔ na akpa mawo ƒe ʋuʋu ƒe didime.

Esia le abe abi ƒomevi aɖe si le míaƒe ŋutilã me ene. Ɣeaɖewoɣi la, àte ŋu akpɔe nyuie le ŋutigbalẽa ŋu. Le kpɔɖeŋu me, ne ame aɖe xɔ dzo gã aɖe, ne abi la haya vɔ la, ɖewohĩ èkpɔe be ŋutigbalẽ si le teƒe ma la xɔ abi eye wòsesẽ. Emae nye nusi nye esia. Ne abi sia ƒomevi dzɔ le lãkusi bubuwo me, si nye le lãmekawo me, le lãkusiwo me la, míeyɔnae hã be `fibrosis`. Nusi dzɔnae nye be vivivi la, lãkusi ƒomevi aɖe si le ʋeʋẽm, sesẽ, si me ka le, si metrɔna o la va ɖɔlia lãkusi siawo ƒe akpa aɖewo.

Eyata, vevesesea doa mo ɖa elabena lãkusi siawo siwo le sesẽm la mete ŋu kekena alo ʋãna nyuie o. Ɣeaɖewoɣi la, lãkusi siawo ate ŋu aɖiɖi eye woanɔ kpuie. Ne edzɔ alea la, woate ŋu akeke lãmeka bubu siwo ƒo xlã ‘contracture’ la hã, si ana ŋutilãa nazu nuwɔametɔ.

Nukawoe nye kontraktɔ ƒomevi veviwo?

Nutete ate ŋu akpɔ ŋusẽ ɖe míaƒe ŋutilã ƒe lãkusi vovovowo kple eƒe akpa aɖewo dzi le mɔ vovovowo nu. Ðɔktawo zãa ŋkɔ vovovowo tsɔ ɖɔa wo. Mina míalé ŋku ɖe ƒomevi vevi aɖewo ŋu:

• Abi ƒe ʋuʋu: Esiawo tsoa abi siwo dona ne wò ŋutigbalẽ xɔ abi eye wòhaya vɔ megbe. Ne abi ƒe ƒoƒo xe mɔ na lãkusi alo ƒunukpeƒe bubuwo be woagaʋuʋu nyuie o la, ate ŋu ana abi ƒomevi bubuwo nadze ame dzi.
• Lãmetsiwo ƒe tete: Esiawo ate ŋu akpɔ ŋusẽ ɖe lãmeka ɖeka alo lãmeka siwo do ƒome kple wo nɔewo ƒe ƒuƒoƒo aɖe dzi. Lãmetsi siawo ƒe tete ate ŋu ana lãmeka bubuwo hã nate ŋu, abe alesi womate ŋu aʋuʋu nuwo abe ƒunukpeƒewo ene nyuie o ene.
• Ƒunukpeƒetete alo ƒunukpeƒetetedɔ: Esia gblẽa nu le kadodoŋusẽ si ƒo xlã ƒunukpeƒe ƒe ƒuwo, si woyɔna be ƒunukpeƒetetedɔ. Ne atikekui sia va le sesẽm la, ƒu siwo le ƒunukpeƒea mete ŋu ʋãna o.
• Ƒunukpeƒetetedɔ:Esia hã nye ƒunukpeƒetetedɔ si dzɔna le ƒunukpeƒea ƒe lãkusi me. Gake esia dzɔna le ƒunukpeƒea ŋutɔ me. Abe alesi lãmeka ƒe ʋuʋu gblẽa nu le ƒunukpeƒe ŋu ene la, ƒunukpeƒe ƒe ʋuʋu le ƒunukpeƒea ate ŋu akpɔ ŋusẽ ɖe lãmeka siwo do ƒome kplii dzi bɔbɔe.

Ðe ‘nubabla’ ƒomevi aɖewo koŋ li siwo ŋu míesea nu tsoe zi geɖea?

Ẽ, ‘nubabla’ ƒomevi aɖewo koŋ li, wotsɔ ŋkɔ vovovowo na wo gɔ̃ hã. Na míalé ŋku ɖe wo dometɔ ʋɛ aɖewo ŋu:

• Amyoplasia: Esia nye dɔléle si wodzina. Le nɔnɔme sia me la, àte ŋu akpɔ viwòa ƒe abɔwo kple afɔwo ƒe ʋuʋu zi geɖe.
• Arthrogryposis: Esia nye nya si bɔ. Wozãa ŋkɔ sia ne wodzi ɖevi si ƒe lãme ʋuʋu zi geɖe. Woate ŋu akpɔe kple domenyiŋusẽfianu ƒe nɔnɔmewo abe Muscular Dystrophy kple Edwards Syndrome ene.
• Afɔkpodzi: Esia hã nye dɔléle si wodzina. Egblẽa nu le ɖevia ƒe afɔ alo afɔ ƒe lãkusiwo ŋu, si wɔnɛ be afɔa trɔna yia eme, ɖoa ta ŋutilãa gbɔ. Ɣeaɖewoɣi la, ate ŋu akpɔ ŋusẽ ɖe nyitsu ƒe lãmekawo hã dzi.
• Dupuytren ƒe ʋuʋu: Esia nye domenyiŋusẽfianu ƒe nɔnɔme. Enaa asibidɛ falɛfalɛwo ƒoa ƒu, si wɔnɛ be asibidɛ ɖeka alo esi wu nenema bɔbɔna ɖe eme yia asibidɛa gbɔ.
• Abɔta ƒe ʋuʋu alo abɔta si sesẽ: Esia nye abɔta ƒe ʋuʋu si dzɔna le abɔta ƒe ƒunukpeƒe ƒe lãkusi me.
• Equinus contracture: Esia nye afɔkpodzi ƒe ƒunukpeƒe alo lãmeka siwo ƒo xlãe ƒe ƒoƒo, si wɔnɛ be womegatsɔa afɔa vaa nɔnɔme si sɔ, si mewɔa akpa aɖeke o me (le dzogoe si nye dzidzenu 90 me kple afɔa o).
• Flexion contracture: Esia nye ƒunukpeƒetetedɔ ƒomevi aɖe. Le esia me la, ƒunukpeƒea sesẽna ne wobɔbɔ eye womate ŋu aɖɔe ake o. Ekpɔa ŋusẽ ɖe abɔ kple afɔwo dzi wu.
• Frozen shoulder or adhesive capsulitis: Esia nye abɔta ƒe ƒunukpeƒetetedɔ ƒe ʋuʋu. Ame geɖe se nya sia.
• Volkmann contracture: Esia nye contracture ƒomevi bubu si dzɔna le asi me. Le esia me la, asibidɛawo kple asibidɛwo bɔbɔna ɖe eme, si wɔnɛ be asi la dzena abe asike ene.

Nukae nye dzesi siwo dzena le dɔléle si nye contracture ŋu?

Ne dɔdzẽ le ŋuwò la, àte ŋu akpɔ dzesiwo abe:

• Abi ƒe lãkusi si dzena nyuie, si le ʋeʋẽm, eye wòsesẽ.
• Lãmetsiwo, ƒunukpeƒewo, alo lãkusi falɛfalɛ bubuwo ƒe sesẽ alo woƒe tete.
• Lãmetsiŋusẽ ƒe vevesese.
• Ʋuʋu ƒe didime kple ʋuʋu bliboa dzi ɖeɖe kpɔtɔ.
• Muscle atrophy (lãmekawo ƒe lolome dzi ɖeɖe kpɔtɔ).
• Azɔlizɔzɔ ƒe kuxiwo.
• Flexion deformities (nɔnɔme si wobɔbɔna ɖaa), vevietɔ le abɔwo kple afɔwo me.

Nukatae ‘nubabla’ sia dzɔna?

Contracture, abe alesi míeƒo nu tso eŋu va yi ene, nye nɔnɔme aɖe si woyɔna be abi alo fibrosis le wò lãmenugbagbeviwo me. Zi geɖe la , esia dzɔna ne lãmekawo le agbagba dzem be yewoagbugbɔ awɔ yeye le abixɔxɔ vɔ megbe , alo ne lãkusiwo vuvu le esi womegazãe o ta . Ɣeaɖewoɣi la, ate ŋu anye nusi wodzina.

Susu vevi aɖewoe nye esi:

• Abi: Ne lãmeka gbogbo aɖewo bu le wò ŋutilã me le nuwo abe dzobibi, abi siwo me dɔlékuiwo le, alo amekoko ta la, abi ate ŋu adzɔ le ŋutigbalẽa alo lãkusi falɛfalɛwo me.
• Ischemia: Ʋu ƒe sisi yi lãmekawo me nyuie nana abi nɔa ame ŋu atraɖii, eye emegbe wòhea abi vɛ. Ischemia ate ŋu adzɔ kpata alo vivivi. Ʋuʋu ƒe anyimanɔmanɔ nye nusi gbɔ esia tso dometɔ ɖeka.
• Mɔmaɖemaɖeɖenuŋu: Nusi koŋ gbɔ lãmeka falɛfalɛwo ƒe ʋuʋu tsonae nye ʋuʋu ƒe anyimanɔmanɔ. Wò ŋutilã ƒe akpa aɖewo ate ŋu atɔtɔ le abi si nèxɔ, ŋutilã ƒe nuwɔametɔnyenye, alo ahɔhɔ̃mekawo ƒe dɔléle ta. Bu eŋu kpɔ, ne ègbã alɔ alo afɔ eye wòhiã be nàdo aŋe kwasiɖa geɖe la, akpa ma sesẽna, alo? Ele nenema.
• Ahɔhɔ̃mekawo ƒe dɔmawɔmawɔ nyuie: Nɔnɔmewo abe ʋusɔgbɔdɔ kple ahɔhɔ̃mekawo ƒe ʋuʋu ene gblẽa kadodo si le ahɔhɔ̃a kple lãmekawo dome me, si wɔnɛ be womegate ŋu ʋãna o alo wotsia lãme na ame akpa (hypertonia).
• Dɔléle siwo tso domenyinyi me: Dɔléle siwo gblẽa nu le alesi wò kadodoŋusẽwo tsinae ŋu, abe lãmekawo ƒe dɔléle si wodzina ene, ate ŋu ana lãmekawo nasẽ akpa alo woaɖe asi le wo ŋu akpa (hypotonia).
• Vidzidzi ƒe gbɔdzɔgbɔdzɔ: Wodzia vidzĩ aɖewo kple ʋuka siwo me ʋu sina tona. Esiawo ate ŋu adzɔ dɔléle alo nusi gbɔ wòtso si dze ƒã manɔmee. Woate ŋu atso domenyiŋusẽfianu ƒe tɔtrɔ alo ʋuʋu si mesɔ o le vidzidɔa me gbɔ.

Kuxi kawoe ate ŋu ado mo ɖa le ‘nubabla’ sia ta?

Dɔléle si nɔa anyi ɖaa ate ŋu akpɔ ŋusẽ gã aɖe ɖe wò agbenɔnɔ ƒe nyonyome dzi . Ate ŋu akpɔ ŋusẽ ɖe wò ʋuʋu kple ɖokuisinɔnɔ dzi. Ate ŋu ana wòasesẽ hã be woawɔ gbesiagbedɔwo kpekpeɖeŋu manɔmee.

Azɔ hã, ƒunukpeƒetetedɔ ate ŋu ana ame nase veve atraɖii eye ate ŋu agblẽ nu le lãmeka kple ƒunukpeƒe bubu siwo ŋu wòku ɖo ŋu, si ana nɔnɔmea nagagblẽ ɖe edzi. Bu eŋu kpɔ, ne mègate ŋu ʋãna boo o la, wò lãmekawo tea ɖeɖeɖa geɖe wu.

Aleke woawɔ ade dzesi ‘nubabla’?

Ne abi alo nɔnɔme aɖe le ŋuwò xoxo si ate ŋu ana nàxɔ ʋu ƒe sisi la, wò ɖɔkta anyae. Ate ŋu alé ŋku ɖe wò ʋuʋu ƒe didime ŋu eye wòakpɔe to ŋutilãmedɔdada me .

Ɣeaɖewoɣi la, wò ɖɔkta adi be yeaɖe wò kadodoŋusẽwo kple lãmeka falɛfalɛwo ƒe nɔnɔmetatawo atsɔ aku nu me geɖe wu le nusi gbɔ wòtso be ʋua ƒe ʋuʋu tso ŋu. Esia ate ŋu anye X-ray, ultrasound scan, alo MRI scan.

Nukawoe nye atike nyuitɔwo kekeake na kontraktɔ?

Atike nyuitɔ kekeake si woatsɔ ada dɔlékuiwutikewoe nye mɔxexe ɖe enu . Zi geɖe la, woate ŋu axe mɔ ɖe enu. Ne mèle ʋuʋum fifia o alo dɔléle aɖe le ŋuwò si ate ŋu ana nàtsi la, kamedede ate ŋu akpe ɖe ŋuwò nàxe mɔ ɖe enu le mɔ geɖe nu.

Ne dɔdzẽ dze dziwò la, anyo wu be nàdae kaba . Zi geɖe la, ʋuka yeyewo mesẽna nenema gbegbe o eye woate ŋu adae bɔbɔe amekoko manɔmee. Gake ɖewohĩ dɔlékuiwutike deŋgɔwo mawɔ nu ɖe ​​atikewɔwɔ siwo menye amekoko o ŋu o.

Atikewɔwɔ siwo woate ŋu azã na kontraktɔ dometɔ aɖewoe nye ƒumeŋuɖui ƒe atikewɔwɔ si wozãna ɖaa, kple amekoko. Ele vevie hã be nàda nɔnɔme si gbɔ wòtso si le wò ʋu ƒe sisi hem vɛ.

Atikewɔwɔ si menye amekoko o

Dɔdamɔnu siwo dze le hatsotso sia me enye:

• Keke si nɔa teƒe ɖeka kple esi me ŋusẽ le: Ðɔktawo zãa akɔtaɖonu, aŋenu, kple aŋe ƒomevi vovovowo tsɔ kekea lãkusi si te ɖe wo nɔewo ŋu vivivi eye wòyia edzi ɖaa.
• Dzoxɔxɔ ƒe atikewɔwɔ: Ne ètsɔ dzoxɔxɔ si wozãna tsɔ daa dɔe de wò lãmeka falɛfalɛwo me la, ate ŋu akpe ɖe wo ŋu woaɖe dzi ɖi ahakeke wo ɖokui. Esia kpena ɖe ŋuwò vevietɔ ne ʋusɔgbɔdɔ si nɔa anyi didi (lãmekawo ƒe dɔwɔwɔ fũ akpa) alo spasticity (lãmekawo ƒe sesẽ akpa) le ŋuwò. Dzoxɔxɔ hã nana ʋu ƒe sisi nyona ɖe edzi.
• Lãmesẽfefe: Kamedede si me womewɔa naneke le o kple esi mewɔa dɔ o ate ŋu ana lãmeka kple ƒunukpeƒe siwo le sesẽm la nate ŋu atrɔ ɖe nɔnɔmewo ŋu nyuie wu eye woate ŋu aʋã wo. Esia ate ŋu akpe ɖe ame ŋu hã be woaxe mɔ ɖe lãmekawo ƒe vuvu le ʋuʋu ƒe anyimanɔmanɔ ta nu.
• Myofascial release ƒe atikewɔwɔ:Esia nye asisisi ƒe mɔnu si léa fɔ ɖe wò fascia, si nye kadodoŋusẽ si le wò lãmekawo te ŋu. Ate ŋu akpe ɖe ame ŋu be woaxe mɔ ɖe ʋu ƒe sisi nu ahadae.
• Atikewo dodo: Le go aɖewo me la, atike siwo wodona ɖe ƒunukpeƒewo kple lãkusi falɛfalɛwo me ate ŋu akpe ɖe ame ŋu wòaɖe ʋuka siwo me ʋu sina tona la dzi akpɔtɔ. Botox® dodo ate ŋu akpe ɖe lãmekaa ŋu wòaɖe dzi ɖi, eye collagenase dodo ate ŋu akpe ɖe ame ŋu wòagbã fibrosis.
• Atike siwo tsia dɔdzẽ nu: Atike siwo tsia dɔdzẽ nu kple atikewɔwɔ abe laser-dɔdamɔnu si mebɔ o (infrared light) ene ate ŋu akpe ɖe ame ŋu be dɔdzẽ dzi naɖe akpɔtɔ eye wòaxe mɔ ɖe fibrosis nu le eƒe ʋuʋu vɔ megbe.

Amekoko siwo wowɔna le nubabla me

Amekoko ƒe atikewɔwɔ na kontraktɔ dometɔ aɖewoe nye:

• Tenotomy (tendon didi): Amekoko sia bia be nàtso alo ado do suesuesuewo le wò lãkusi me be wòagasẽ o. Ne lãkusia le tsitsim ake la, woate ŋu adidie.
• Lãmetsiwo ƒe ʋuʋu: Le dɔ sia wɔwɔ me la, woɖea lãkusi si te ɖe eŋu la ɖa eye wodoa lãkusi bubu, si tso ame si tsɔe na wò alo tso wò ŋutilã ƒe akpa bubu me, yia teƒe si ʋua ƒo ɖo.
• Ƒunukpeƒetetedɔ: Le ƒunukpeƒetetedɔ gome la, ahiã be woawɔ dɔ na wò be wòaɖe wò ƒunukpeƒetetedɔa ƒe akpa aɖewo ɖa, aɖɔlii, alo ɣeaɖewoɣi aɖɔli ƒunukpeƒe bliboa.
• Fasciotomy: Nusiwo gblẽa nu le wò fascia ŋu, abe Dupuytren ƒe contracture ene, ate ŋu aɖe vi tso fasciotomy me. Amekolawo tsoa dowo ɖe fascia la me be woaɖe asi le eŋu, alo ɖea abi ƒe kakɛwo ɖa.
• Z-plasty: Mɔ ɖeka si dzi woato agbã ʋuʋudedi siwo le ŋutigbalẽa kple lãkusia me enye be woaɖe lãmenugbagbevi siwo le abe Z ene le lãkusia me be wòaɖe eƒe tete dzi akpɔtɔ. Z-nɔnɔme sia dea dzi ƒo na lãkusia be wòagatsi ake tsɔ wu be wòatsi.
• Amekoko: Le abi ƒe ƒoƒo gome la, ahiã be amekola naɖe abi ƒe lãkusia ɖa eye wòatsɔ ŋutigbalẽ si wodo alo ŋutigbalẽ ƒe akpa si woɖe tso amesi na wò alo wò ŋutilã ƒe akpa bubu aɖe aɖɔlii.

Nukae nye dɔléle ƒe ŋgɔdonya ƒe ŋgɔdonya?

Dɔlékuiwutikewo wɔa dɔ nyuie wu ne wowɔ atike na wo hafi wosẽna eye wosẽna ɖe edzi . Ðɔktawo ate ŋu aɖe afɔ aɖewo atsɔ axe mɔ ɖe ʋu ƒe sisi le amesiwo le afɔku me ŋu alo aɖe wo dzi akpɔtɔ.

Zi geɖe la, kontraktɔ yeye siwo wowɔ la wɔa nu ɖe ​​atikewɔwɔ siwo me womezãa nu geɖe le o ŋu. Woate ŋu awɔ dɔ na lãkusi siwo de ŋgɔ wu to amekoko me. Gake ɖewohĩ atike aɖewo mawɔ nu ɖe ​​dɔlékuiwutike aɖewo ŋu o alo womate ŋu ada wo keŋkeŋ to amekoko me o.

Aleke mawɔ axe mɔ ɖe ‘nubabla’ sia nu?

Nusi hea kontraktɔ vɛ wue nye be womegate ŋu ʋãna o . Ne woxɔ wò ɖe kɔdzi le abi gã aɖe si nèxɔ, amekoko, dɔléle, alo wòhiã be nàdo aŋetu kwasiɖa geɖe la, ke àte ŋu axɔ ʋuka si me ʋu sina tona.

Ðɔktawo awɔ woƒe ŋutete ɖesiaɖe be woaxe mɔ ɖe ʋu ƒe sisi nu esime nèle be lém na wò. Gake woahiã wò kpekpeɖeŋu hã . Ele vevie ŋutɔ be nàwɔ wò kamededewo nyuie le wò hayahayaɣi.

Kamedede ate ŋu asesẽ alo asesẽ ne dɔléle, nuwɔametɔ, alo abi aɖe le ŋuwò. Ɣeaɖewoɣi la, àte ŋu ahiã kpekpeɖeŋu le wò kamedede ƒe ɖoɖoa me, alo ame aɖe si aɖo ŋku edzi na wò ahaʋã wò.

Ne dɔléle aɖe si nɔa anyi didi si ate ŋu ana wò lãme nasẽ la le ŋuwò alo ame aɖe si dzi nèle be lém na la, ahiã be nàyi edzi awɔ kamedede be nàxe mɔ ɖe enu. Le nɔnɔme siawo me la, ele vevie be woakpɔ beléle nyuitɔ le woƒe agbemeŋkekewo katã me .

Nubabla ate ŋu adzɔ bɔbɔe ne wole hayahayam tso nɔnɔme bubu me. Woate ŋu axɔ ɣeyiɣi didi hã hafi woada gbe le wo ŋu. Be nàtrɔ nusiwo gblẽ la, ele be nàwɔ dɔ veviedodotɔe kple kutrikuku kple kamedede .

Nɔnɔme aɖewo siwo nɔa anyi didi kple esiwo wodzina ate ŋu axe mɔ na ʋu ƒe sisi vaseɖe afi aɖe. Gake nudede nyawo me kaba ate ŋu ana vovototo gã aɖe nanɔ alesi gbegbe wògblẽa nu le ŋuwòe kple alesi gbegbe wòhea nuwɔametɔnyenye vɛ me.

Mlɔeba la, ɖo ŋku esia dzi (Take-Home Message) .

Contracture nye nɔnɔme si me míaƒe ŋutilã ƒe lãkusi falɛfalɛwo va nɔa sesẽm, wosẽna, eye wòsesẽna be woaʋuʋu. Ele abe abi si tso ememe ene. Nɔnɔme sia ate ŋu atso nusiwo le abe dzobibi, abixɔxɔ, amekoko, ʋuʋumanɔamesi ɣeyiɣi didi, ahɔhɔ̃medɔ aɖewo, kple vidzidzi ƒe gbɔdzɔgbɔdzɔ gbɔ. Nu vevitɔ kekeakee nye be nàdze agbagba axe mɔ ɖe enu. Vevietɔ ne mègate ŋu ʋãna o ɣeyiɣi didi aɖe le susu aɖe ta la, wɔ kamededewo abe alesi wò ɖɔkta gblɔe ene pɛpɛpɛ. Elabena, ne kontraktɔ aɖe va do la, ate ŋu abia ɣeyiɣi kple agbagbadzedze geɖe hafi wòahaya.

Ne dzesi siawo dometɔ aɖe le ŋuwò alo ɖikeke aɖe le ŋuwò la, kpɔ egbɔ be yeyi ɖɔkta gbɔ hena aɖaŋuɖoɖo . Ne èkpɔ dɔlélea kaba eye nèdae la, ate ŋu akpe ɖe ŋuwò nàxe mɔ ɖe dɔlélea nu be wòagagblẽ ɖe edzi o eye wòana wò agbenɔnɔ nanyo ɖe edzi.

`contracture, lãmekawo ƒe sesẽ, ƒunukpeƒewo ƒe sesẽ, abi ƒe lãkusi, ʋuʋu si seɖoƒe li na, fibrosis, kamedede