החלפת מפרק – לא מה שחשבתם. מאמר שלישי בסדרת ניתוחים על שולחן הניתוחים

החלפת מפרק – לא מה שחשבתם. מאמר שלישי בסדרת ניתוחים על שולחן הניתוחים

למי משתלם להחליף מפרק?
אנחנו ממשיכים עם סדרת המאמרים על מניעת ניתוחים. הפעם נדבר על החלפת מפרק בירך או בברך.
"שחיקת סחוס" היא אחת האבחנות הנפוצות ביותר בכל הנוגע לכאבי ברכיים וירכיים בעיקר באוכלוסייה מבוגרת. כאשר הכאבים גוברים וטיפול שמרני לא מניב תוצאות משביעות רצון, ההמלצה לרוב תהיה להחליף את המפרק.
להחליף את המפרק?!
אכן. בניתוח המבוצע בהרדמה מלאה, מנסרים את העצמות מעל ומתחת למפרק הברך או הירך, מוציאים את המפרק, ומכניסים שתל מתכתי במקומו המחובר לעצמות על ידי צמנט (מלט).ניתוחים חדשניים מציעים אפשרות לחיבור המפרק ללא צמנט, אך בניתוחים אלה הסיכוי להתפרקות של השתל גבוה מאוד והצורך בניתוח נוסף עולה מאוד ולכן אינם מומלצים (השתל של הניתוחים האלה יקר מאוד ולכן יצרניות השתלים עושות מאמצים גדולים לקדם את הניתוחים הללו..).
ניתוחי החלפת מפרק הופכים להיות נפוצים יותר ויותר עם השנים. בכל שנה מבוצעות בישראל מעל 10,000 החלפות מפרקי ברך וירך אלקטיביות ובעולם נעשות מעל שני מיליון החלפות בשנה. בין 94% ל-97% מההחלפות נעשות בגלל שחיקת סחוס.
נשמע מבטיח, לא?
הנה כמה עובדות העולות ממחקרים רבים וטובים:שחיקת סחוס אינה גורמת לכאבים.
אם ישנם כאבים, ואפילו מאוד חזקים, הם אינם כתוצאה משחיקת הסחוס
שחיקת סחוס אינה מצב פתולוגי, אלא תהליך טבעי ורגיל שמתרחש עם השנים. ממש כשם שמתרחש בגופנו שינוי הורמונלי ב"גיל המעבר" (כן, גם אצל גברים…) הגורם לשערות נושרות או הלבנה שלהן, כך גם הסחוס הולך ונשחק. לכן באופן פשוט, אין שום צורך רפואי "לטפל" בשחיקת סחוס בדיוק כשם שאין טיפול רפואי לשערות לבנות.
אז למה כואב וקשה בהליכה ובמדרגות?
בשורה התחתונה אנחנו לא באמת יודעים את הסיבה המדויקת. המודל המתאים ביותר על מנת להציע הסבר, הוא המודל הביו-נוירו-פסיכולוגי (גוף-מוח-נפש).
גוף – מסיבה לא לגמרי ברורה, מפרק הירך או הברך מתחיל לאבד טווח תנועה ובשל כך נוצרים עומסים גדולים בתוך המפרק. את זה ניתן בע"ה לתקן על ידי תרגול קבוע ופשוט לאורך זמן.
מוח – כאשר אנו בטוחים שהבעיה שלנו היא בגלל הגיל או בגלל הסחוס יהיה לנו מאוד קשה להתרפא. הכרחי להיפטר מאמונות כוזבות כאלה, ולתת אמון מלא ביכולות הריפוי של הגוף על מנת להחלים.
נפש – מחקרים רבים מצביעים על מצב נפשי כאחד הגורמים הבולטים לירידה התפקודית במפרקי הברך או הירך. כמובן שהתייחסות מתאימה לגורם זה עשויה להיות משמעותית מאוד בתהליך הריפוי.לא יותר קל להחליף את המפרק וזהו?
במובן מסוים, התשובה היא חיובית.
נרשמים לניתוח (לרבים יש כיום כיסוי ביטוחי אפילו לשר"פ), הולכים לישון למשך כמה שעות ומתעוררים עם ברך או ירך חדשה. פשוט.
רק שזה לא תמיד המצב…כ40% ממנותחי הברך וקרוב ל 30% ממנותחי ירך עדיין יסבלו מכאב כרוני, אם כי לרוב קל יותר מאשר לפני הניתוח.
אצל חמישית ממנותחי הברך מתעורר כאב ברך קדמי (באזור הפיקה) הנחשב כסיבוך של הניתוח.
אצל מחצית (!) ממנותחי הברך ישנה עלייה בצריכת משככי כאבים אפילו שנה לאחר הניתוח.מעל גיל 70 אחד מכל 20 מנותחים יצטרך לעבור ניתוח נוסף (החלפה חוזרת של השתל) במהלך חייו. ככל שהגיל יורד האחוזים עולם מאוד, בגיל 50-54 כבר אחד מכל 3 (!) יעבור ניתוח נוסף במהלך חייו ולכן ישנה חשיבות עליונה בדחיית הניתוח לגיל מבוגר ככל האפשר.
גם לאחר ניתוח מוצלח במיוחד יהיה צורך בתרגול אינטנסיבי אחריו על מנת לחזור לתפקוד..
ולא דיברנו על סיבוכים אפשריים שיש בכל ניתוח – סיבוכי הרדמה, זיהום וכו'.
אז מה אני מציע?
ובכן, גם אם כבר ניסיתם טיפול שמרני והוא לא הצליח, כדאי לחזור לתחילת המאמר ולקרוא אותו שוב. לא להיחפז לניתוח. מומלץ מאוד לתת דגש לשלושת המרכיבים של הבעיה – גוף-מוח-נפש. ברוב המקרים, אם משקיעים בזה תשומת לב מתאימה, זה עובד בע"ה. 

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