Kino kye kikuviirako okulumwa amagulu? Ka tuyige ku bulwadde bwa Popliteal Artery Entrapment Syndrome (PAES)!

Era owulira obulumi, okunyiga oba okuzitowa mu magulu naddala mu kitundu ky’ennyana, ng’okola dduyiro, ng’odduka oba ng’otambula amangu? Buvaawo oluvannyuma lw’akaseera, naye bukomawo ng’ozzeemu okutandika okukola dduyiro? Olwo kikulu nnyo gy’oli okumanya embeera eno eyitibwa popliteal artery entrapment syndrome. Tofaayo, ka tukyogereko mu ngeri ennyangu.

Obulwadde bw’okusiba emisuwa gy’omugongo (PAES) kye ki?

Mu ngeri ennyangu, obulwadde bwa Popliteal Artery Entrapment Syndrome (PAES) bulwadde bwa misuwa obutatera kulabika. Businga kukwata bavubuka, abanyiikivu naddala abo abazannya emizannyo. Omusuwa gwa popliteal gwe musuwa omukulu ogukulukuta okuva mu kisambi okutuuka mu kisambi emabega w’amaviivi gaffe. Omusuwa guno gunyigirizibwa ekinywa ekiri emabega w’okugulu, nga kino kye kibaawo mu mbeera eno.

Kilowoozeeko nga payipu y’amazzi. Kiwa omusaayi mu kigere ekya wansi. Kati, omusuwa guno guyinza okuzibikira olw’enkyukakyuka mu ngeri ebinywa byaffe eby’omu lubuto gye byekwata ku ggumba ly’ekisambi. Naddala bwe tufukamira ekigere kyaffe wansi (kino kiyitibwa ``plantar flexion'' mu ngeri y'obusawo), ekinywa kino ekya gastrocnemius kikonziba. Olwo omusuwa ogwo ne gweyongera okuzibikira.

Bw’okola dduyiro, omusuwa guba gusika buli kiseera ekiguviirako okusannyalala. Kiki ekibaawo olwo? Omuwendo gw’omusaayi ogugenda mu kigere gukendeera. Kino kireetera ebintu nga lactic acid ne carbon dioxide okuzimba mu binywa n’obusimu. Eno y’ensonga lwaki owulira ng’ozitowa, obulumi, ng’okooye oluusi n’okuziyira mu magulu n’ebigere.

Amawulire amalungi gali nti obubonero buno butera okukka mu ddakiika ssatu oba ttaano ng’omaze okulekera awo okukola dduyiro. Kyokka singa tebujjanjabwa, ekiseera bwe kigenda kiyitawo, obubonero buno busobola okweyongera ne buwangaala. Kino kitegeeza nti ojja kutandika okuwulira obulumi ne bw’oba ​​odduse olugendo olutono, era kijja kutwala ekiseera kiwanvu okudda engulu.

Ani asinga okukosebwa embeera eno eya PAES?

Embeera eno eyitibwa PAES, etera okukwata abazannyi abato abali wakati w’emyaka 15 ne 25. Obulabe buno bungi nnyo naddala eri abo abeetabye mu mizannyo egy’okudduka. Okugeza nga:

• Empaka z'emmotoka z'empaka (Track) .
• Emisinde gya cross country
• Omupiira
• Empaka za Lacrosse
• Hockey y’omu nnimiro

Lowooza ku mwana eyeetaba mu mpaka z’amasomero, oba omuvubuka azannya omupiira. Batera okufuna embeera eno kubanga bakozesa amagulu buli kiseera.

PAES ya bulijjo etya?

PAES mu butuufu mbeera ya bbula nnyo . Kiteeberezebwa nti abantu abatakka wansi wa 1% be balina. Kale kizibu okwogera ddala abantu bameka ababulina.

Waliwo embeera endala eziraga obubonero obufaananako ne PAES?

Yee, waliwo. Obulwadde bwa Chronic Exertional Compartment Syndrome (CECS) mbeera ya binywa n’obusimu esinga PAES, era era eva ku dduyiro. Era kiyinza okuleeta obulumi n’okuzimba mu binywa by’amagulu (n’oluusi n’emikono). Wadde nga CECS esobola okukosa omuntu yenna, esinga kubeera mu baddusi abato n’abo abazannya emizannyo egy’okukwatagana ennyo.

Oluusi, omuntu alina PAES naye asobola okuba ne CECS. Kizuuliddwa nti abantu nga 5% abatannawonyezebwa PAES nabo balina CECS. Kale kikulu okujjukira nti embeera zombi zisobola okubaawo mu kiseera kye kimu.

Njawulo ki eri wakati wa PAES ne CECS?

Omusawo wo ajja kukola ebigezo eby’enjawulo okusobola okwawula embeera zino ebbiri.

• Ku PAES: Puleesa epimibwa mu kigere ng’owummudde n’oluvannyuma n’ekeberebwa okulaba oba ekendeera oluvannyuma lw’okukola dduyiro.
• Ku CECS: Puleesa mu bitundu ebina eby’ebinywa mu kigere epimibwa nga tebannaba kukola dduyiro n’oluvannyuma lw’okukola dduyiro. Mu CECS, puleesa mu bisenge bino yeeyongera mu ngeri etaali ya bulijjo.

Owulira otya ng’olina PAES?

Bw’oba ​​okola dduyiro, oyinza okufuna obubonero nga buno mu kitundu ky’ekisambi kyo ne/oba amagulu go:

• Obulumi ng’okuzimba
• Nkooye
• Enneewulira enzito
• Okuzimba ebinywa
• Okuzirika
• Ekibobe

Obubonero buno butera okuggwaawo oluvannyuma lw’okuwummula eddakiika ssatu oba ttaano. Kyokka nga bwe twagambye emabegako, singa tebujjanjabwa, obubonero buno busobola okuddamu okumala ekiseera ne butwala ekiseera ekiwanvu okuwona.

Biki ebivaako PAES?

Okusinga waliwo engeri bbiri okusika kuno kwe kuyinza okubaawo:

1. Anatomic compression: Kino kirabibwa mu bitundu nga 10%. Kirabika kisingako katono mu basajja. Mu bitundu nga 70%, kibeera mu kigere kimu kyokka.

2. Non-anatomic compression, functional oba physiologic compression: Kino kitera kubaawo mu bakyala. Mu bitundu ebisukka mu 90%, kiyinza okubeera mu magulu gombi.

Okunyigirizibwa kw’omubiri (anatomic compression).

Kino kibaawo kubanga ekitundu ky’ekinywa kyo eky’omu lubuto kibeera waggulu oba wansi w’omusuwa gw’omu lubuto. Mpozzi ekitundu ekiyitibwa tendinous band mu kinywa kiyinza okwonoona omusuwa. Kino kiri bwe kityo kubanga:

• Amabwa oba ekiwundu kiyinza okuvaamu.
• Ekizimba ky’omusaayi kiyinza okutondebwawo.
• Ekiseera bwe kigenda kiyitawo, omusuwa guyinza okuzibikira ddala (okuzibikira) oba emisuwa wansi waagwo giyinza okuzibikira.

Mu ngeri eno, waliwo engeri nnya ez’enjawulo ekinywa gye kiteekebwamu okusinziira ku musuwa.

Okunyigirizibwa okw’emirimu oba okw’omubiri

Mu mbeera eno, ebinywa byo byonna bibeera mu kifo kya bulijjo. Wabula ekinywa kino kitera okwekwata waggulu ddala w’eggumba ly’ekisambi, oba mu kisenge ekiri munda mu kugulu. Kale bw’ofukamira ekigere wansi (plantar flexion), ekinywa kisika munda ne kinyigiriza omusuwa.

Oluusi puleesa eno era eyinza okuva ku kinywa ekirala (popliteus muscle) ekisangibwa wansi w’omusuwa. Abanoonyereza bagamba nti puleesa eno ekola tezuuliddwa nti eyonoona omusuwa.

PAES ezuulibwa etya?

Omukugu mu by’emisuwa asobola okuzuula embeera eno. Ajja kukukebera era akebere oba waliwo ettondo mu kigere n’omukka gw’ennyindo (popliteal pulse). Era bayinza okukebera oba waliwo enkyukakyuka mu pulse yo ng’otambuza okugulu kwo waggulu ne wansi ku kintu.

Bw’oba ​​olina PAES, omusawo wo ayinza:

• Osobola okuwulira omukka gwo ng’owummudde.
• Naye bw’okola dduyiro, omukka gwo guyinza okukendeera ng’ofukamidde oba ng’ogolodde ekigere.

Bikebere ki ebikolebwa okukebera PAES?

Ebigezo bino bipima omusaayi oguyita mu kugulu, okugulu n’ekigere. Ebigezo bino eby’okukuba ebifaananyi bisobola okulaga bino wammanga:

• Omusuwa gwa bulijjo?
• Oba obuvune bw’emisuwa bujja kubaawo.
• Waliwo ebizimba omusaayi?
• Omusuwa guzimba (aneurysm - omusuwa omunene ebitundu 50% okusinga ogwa bulijjo).
• Ekinywa kinyigiriza omusuwa?

Ebimu ku bigezo ebikolebwa ku kino bye bino:

• Ankle-brachial index nga olina dduyiro: Kino kipima puleesa mu mikono gyo n’amagulu nga tonnaba kukola dduyiro n’oluvannyuma lw’okukola dduyiro. Mu budde obwabulijjo, puleesa mu mikono n’amagulu y’emu era byombi byeyongera ng’okola dduyiro. Wabula singa emisuwa gyo gisannyalala ng’odduka, puleesa yo mu magulu go oluvannyuma lw’okukola dduyiro esobola okukka ebitundu ebisukka mu 90% ku puleesa yo mu mikono gyo.
• Duplex ultrasound of the popliteal artery with plantar flexion: Kino kikozesa amaloboozi okukola ekifaananyi ky’omusuwa n’okupima entambula y’omusaayi. Kino kisobozesa omusawo okulaba engeri emisuwa mu kigere gyo gye giwuliramu ng’ekigere kifukamidde era nga kiwummudde, n’okulaba oba waliwo okusannyalala kw’ebinywa.
• Computed tomographic angiography (CTA) nga erimu okufukamira kw’amagulu: Kino nakyo kika kya CT scan. Langi ey’enjawulo ekozesebwa okutunuulira embeera y’emisuwa mu kigere n’okulaba oba waliwo okusannyalala kw’ebinywa ng’ekigere kifukamidde era nga kiwummudde.
• Magnetic resonance angiography (MRA) with plantar flexion: Okukebera kuno kukozesa magnetic field ne radio waves okutunuulira embeera y’emisuwa mu kigere n’okulaba oba waliwo okusannyalala kwonna mu binywa ng’ekigere kifukamidde era nga kiwummudde.

PAES ejjanjabwa etya?

Omusawo ayinza okukulongoosa.Oluvannyuma, ggyawo akatundu akatono ku binywa bya gastrocnemius ne popliteus. Kino kijja kumalawo puleesa ku musuwa era kisobozese omusaayi okutambula obulungi okutuuka ku kigere.

Okulongoosa kuno kutera okutwala essaawa nga emu. Kikolebwa mu bujjanjabi obw’okubudamya.

Oluusi, mu mbeera ez’amaanyi ng’omusuwa gwonoonese era ne guzibikira olw’okukwatibwa kw’omubiri (anatomical popliteal entrapment), omusawo alongoosa ayinza okwetaaga okuyonja omusuwa, okugusiba oba okukola ekkubo eppya okwetoloola omusuwa (bypass).

Okulongoosa bwe bujjanjabi obusinga okukola obulungi ku PAES, kuba nkola ekola bulungi nnyo eri abantu abasinga obungi. Abantu abasoba mu 90% abalongoosebwa bafuna okulongoosa okw’amaanyi mu bubonero bwabwe.

Ku abo abalina PAES ezikola, obujjanjabi obutali bwa kulongoosa ye Botulinum toxin A. Wansi w’obulagirizi bwa CT oba ultrasound, omusawo akuba empiso oba `Botox®` oba `Dysport®` mu kinywa ekivaako okunyiganyiga. Kino kisannyalaza ekinywa okumala akaseera. Essuubi liri nti olwo ekinywa ekyo kijja kukonziba enkalakkalira.

Naye kino kimala emyezi esatu oba mukaaga gyokka. Singa ekinywa tekikendeera, obubonero buno busobola okuddamu. Obujjanjabi buno bubadde buwanguzi mu bantu abatakka wansi wa 60% oluvannyuma lw’omwaka mulamba nga bajjanjabwa.

Kitwala bbanga ki okuwona oluvannyuma lw’obujjanjabi buno?

Kiyinza okutwala emyezi ena oba mukaaga okuwona mu bujjuvu oluvannyuma lw’okulongoosebwa.

Oluvannyuma lw’okulongoosebwa, ojja kwetaaga okumala ekiro mu ddwaaliro. Olwo, ojja kwetaaga okukola obujjanjabi bw’omubiri (nga dduyiro w’okugolola) okumala wiiki bbiri ezisooka. Oluvannyuma lwa wiiki bbiri, ojja kwetaaga okukola dduyiro ow’amaanyi n’okulongoosa okutuusa lw’owona ddala.

Kiki ekituuka ku muntu alina PAES?

Bw’oba ​​olina functional popliteal entrapment ate ng’obulumi bw’amagulu ng’okola dduyiro si bwa maanyi, oyinza okwagala okussa ekkomo ku dduyiro wo. Omusawo asobola okulondoola embeera yo.

Wabula nga bwe twagambye emabegako, okulongoosa kugenda bulungi ebitundu ebisukka mu 90%, era akabi k’okuddamu okuddamu okulongoosebwa katono. Abazannyi abasinga badda mu mirimu gyabwe egya bulijjo oluvannyuma lw’okulongoosebwa.

Singa wabaawo okukwatibwa kw’omubiri (anatomic entrapment), abasawo bagamba nti okulongoosa okuggyamu ebinywa ebitali bya bulijjo. Kino kiri bwe kityo kubanga, singa tekikolebwa, omusuwa guyinza okwonooneka okumala ekiseera. Singa olwawo obujjanjabi n’ofuna structural PAES eyonoonye omusuwa gw’omugongo, oyinza okulumwa amagulu buli kiseera ng’otambula. Mu mbeera ezitali nnyingi, ekigere kiyinza okwetaagisa okutemebwako. Naye ekyo tekitera kubaawo nnyo .

Ddi lwe nnina okuddamu okulaba omusawo?

Oluvannyuma lw’okulongoosebwa, ojja kwetaaga okulaba omusawo:

• Mu mwezi gumu.
• Mu myezi mukaaga.
• Mu myezi kkumi n’ebiri.

Mu nkiiko zino:

• Okukebera omusuwa gwo ogwaddaabiriziddwa mu ngeri ya ultrasound kujja kukolebwa.
• Bali mu kukebera puleesa mu magulu go.

Singa omusuwa gwo gukomyewo mu mbeera eya bulijjo, tewajja kwetaagisa kugenda mu maaso okuggyako ng’obubonero buzzeemu oba nga weetaaga okulongoosebwa omusuwa.

Bibuuzo ki bye nnina okubuuza omusawo wange?

• Nnina PAES ez’omubiri oba PAES ezikola?
• Oteesa okulongoosebwa ku mbeera yange?

Bw’oba ​​okyali muto ate ng’amagulu gakuluma, kakasa nti ogenda ew’omusawo. Wayinza okubaawo ebintu ebiwerako ebivaako obulumi buno. Gy’okoma okuzuulibwa amangu, gy’okoma okutandika amangu obujjanjabi. Bw’oba ​​olina obulwadde bwa popliteal artery entrapment syndrome, yogerako n’omusawo wo oba okulongoosebwa kirungi gy’oli. Buno bubadde bujjanjabi bulungi mu mbeera nnyingi.

Ebintu ebikulu by'olina okujjukira (Take-Home Message)

Okay, kale ka tufunze ebimu ku bintu by'olina okujjukira okuva mu bye twogeddeko:

• PAES mbeera ng’omusuwa omukulu emabega w’okugulu, ekinywa, guzibikira, ne gukendeeza ku kutambula kw’omusaayi okutuuka ku kigere.
• Kino kisinga kukosa bannabyamizannyo abato , naddala abadduka.
• Bw’ofuna obubonero ng’obulumi , okuzitowa oba okuwunya mu kitundu ky’ekisambi ng’okola dduyiro, naye nga bukendeera ng’owummudde, oyinza okuba n’obulwadde bwa PAES.
• Waliwo n’embeera eyitibwa CECS ng’erina obubonero obufaanagana, n’olwekyo okuzuula obulungi obulwadde buno kikulu.
• Obulwadde buno busobola okukakasibwa nga omukugu akukebera (nga `Ankle-brachial index`, `Duplex ultrasound`, `CTA`, `MRA`).
• Okulongoosa emirundi mingi kye kisinga okukola obulungi . Abantu abamu baweebwa empiso za `(Botulinum toxin A)`.
• Singa tebajjanjabwa, ekiseera bwe kigenda kiyitawo, omusuwa guyinza okwonooneka era embeera n’eyongera okwonooneka.
• N’olwekyo, bw’oba ​​olina obubonero buno, kikulu nnyo okunoonya amagezi g’abasawo awatali kulwa.

Teweeraliikiriranga, bw’otegeera embeera eno, waliwo obujjanjabi obulungi. Ekikulu kwe kulaba omusawo mu bwangu, nga tobuusa maaso bubonero. Olwo osobola okuddamu okuba omulamu obulungi n’okukola ennyo!

` popliteal artery entrapment syndrome, PAES, okulumwa amagulu, okulumwa ekisambi, okukola dduyiro, abazannyi abato, emisuwa, popliteal artery