Iqatha arthrodesis: utyando, iziphumo, kwisimo, ukubuyekeza isiguli

Asizizo zonke ezimbi bale nkqubo musculoskeletal lupheliswe ngokuphucula umgangatho isakhiwo. Kwezinye iimeko, umsebenzi ukuvimbela of inxalenye enye okanye ngaphezulu. Arthrodesis welungu amaqatha - kwalo. Injongo yalo iba ukususa izinto nonviable ukulungisa lomzimba axis aphantsi kunye nitrogen ngakumbi izakhiwo zomzimba kule meko nokomzimba. Kuphantsi kwaziphi iimeko apho kwenziwa arthrodesis le iqatha? Yiyiphi imiphumo siseko zongenelelo ngoncedo kunye nokuvuselelwa? Malunga eli - kamva kweli nqaku.

Ubungqina obubonakalayo buxela ukuba ukuhlinza

Arthrodesis - uphazamiseko, apho edibeneyo akasakwazi kwaye zamntu sisigxina endaweni. Imfuneko umsebenzi ngotyando Akunakuphikiswa kwezi meko zilandelayo:

1. Ukubakho alenga ezidibeneyo. Le meko yenzeka ngasemva uhlobo joint interosseous. Kunokuba buso okanye epheleleyo. Isiphumo lunyhasho deformation lomsebenzi komzimba ngaphakathi ilunga (ukukhubazeka elide izihlunu, nemisipha neqwengiweyo, ukwenzakala kokudutyulwa, amalungu ulwandiso kakhulu).
2. Uphuhliso deforming samathambo. Arthrodesis welungu iqatha, ukubuyekeza apho unokufunda ngezantsi, kufuneka kwindawo ubovu, tuberculous kunye nefomu ebuhlungu ngezifo.
3. samathambo sisiba mandundu kunye iingxaki. iimeko yezifo kubandakanya utshintsho epiphysis ithambo.
4. Iingxaki yepoliyo.
5. A ukwa ukuba igqirha engafanelekanga okanye ihlanganiswe ngaphambili.
6. Ukuba kuyimfuneko, umzila lwabafundi abathile okanye lwabafundi bonke welungu, ukuba ezinye iindidi ze ungenelelo ezinokwenzeka.

Izimo

Arthrodesis of amaqatha (neziphumo ngumlinganiswa elibi, kunye nezigulo zinqabile kakhulu emva kotyando) Akuvunyelwe ukuphumeza ngaphandle kwezi meko zilandelayo:

• de elivisayo de inkqubo musculoskeletal na isigaba sokukhula;
• phambi fistula ubhalo tubercular ebangelwe sisenzo mycobacteria engaqhelekanga Nedlac;
• ubukho usulelo kummandla ngoncedo;
• isimo esibi yomguli, ukunqongophala uzinzo ngokuhamba kwexesha.

Emva kweminyaka 60 ukusebenza arthrodesis ye amaqatha nako kunokubangela iingxaki ezinzulu.

iintlobo yokungenelela

Ukwahlula iintlobo ezintlanu eziphambili zotyando kuxhomekeke ngenkqubela yokuntlokothiswa kunye nezixhobo ezisetyenziswayo:

• Intra-articular arthrodesis welungu amaqatha ikhutshwa phandle ukususwa intlala articular.
• inkqubo Extra-articular kwenziwa ekwakheni ingamathambo izinto imifanekiso athatyathwe isigulane efanayo. Mhlawumbi ukusebenzisa lenkohlakalo kubalizi.
• arthrodesis Ludityanisiwe welungu amaqatha idibanisa zombini iindidi imisebenzi. Susa ukusuka ngokudibeneyo intlala kunye sihlume bone nisondelelane lwenziwa yi betyale zonke iipleyiti ezikhethekileyo metal.
• Uhlobo ukwandiswa yokusebenza isekelwe phezu ukuziphatha zaphuka ngumntu. izinto Ezinye ithambo ayinakutshintshwa endaweni ezaxinga nokomzimba nangengalo izixhobo. Ngamanye amazwi, le hlobo longenelelo ngokuba "arthrodesis namaqatha Ilizarov".
• Umsebenzi ucinezelo lwenziwa ngokuthi ukulungisa into kunye nezipeki, iheke, iintonga kunye nezinye izixhobo ezithile ezisetyenziswa traumatology.

Ukubulawa esebenzayo

zomzimba Local kule nkqubo utyando alisetyenziswa ngenxa yokuba ukuphululwa kwenzeka intlala nethambo nezakhiwo enzonzobila. Sebenzisa ezi ndidi zilandelayo Ukubulawa:

• zomzimba endotracheal - isigulane egxile kwi ubuthongo iintlungu imithi ikhethekileyo inhalation, zikhutshwe ngendlela sukube;
• zomzimba spinal - isigulana lisezingqondweni na, akuvayo nakubonayo yonke into, kodwa nemilenze ekumiseni ngokupheleleyo kunye nokungabikho uvakalelo;
• zomzimba zihlangene - analgesia spinal kudityaniswe emanzini ukwimeko esozela isetyenziswa kwizigulana ezibuthathaka kakhulu kwaye ethe kakhulu.

Arthrodesis le iqatha, angqina nomonde abonisa ukuba tyando imide kwaye kuhlala ukusuka iiyure ezi-2 ukuya ku-6. Oku kuxhomekeke kwindlela nzima isimo sokuqala, ungenelelo ubuchule ezikhethiweyo kunye nemfuneko umguli enye sihlume ngayo.

ukulungiselela ogulayo

Arthrodesis le iqatha, angqina nomonde abonisa imfuneko ukulungiselela ipreoperative, ifuna uviwo epheleleyo malunga nesigulane eso. Njengoko phambi naluphi na ungenelelo, operable kufuneka kudlule iimvavanyo lwezonyango igazi, umchamo, ngamachiza ezinto eziphilayo. Bonisa imo coagulation, iqela igazi kunye RH factor. Ingqalelo iimvavanyo zomthetho-HIV, negcushuwa, hepatitis, ephethe x-reyi.

iintsuku ezisi-7 phambi kokuba utyando eziyimfuneko ukuze bashiye amachiza ezichaphazela inkqubo igazi ekunqandeni, kwaye non-steroidal amachiza-ukudumba. Ngosuku lwakhe lokugqibela kuvunyelwa kuphela ukutya eliqhelekileyo. Intsasa ukuba badle, basele amanzi phambi kokuba ungenelelo akuvumelekanga, ukuphepha iingxaki ezinokubakho ngexesha zomzimba.

Qiniseka, njengoko isigulane liya kuba esibhedlele, kufuneka ulungiselele bume obutofotofo endlwini. Ukuze khathalela izinto ezinjalo kufuneka phambili:

• ukususa iikhaphethi, ezinokuthi ukutyibilika;
• njengoko compact kangangoko kunokwenzeka ukubeka oogesi, leyo kulala phantsi, ukuze isigulane na othanda phezu kwabo;
• yangasese ukuthenga emethini kunye iikomityi sokufunxa, ukuze angabi ngaba shift kumgangatho manzi;
• amalungiselelo zonke izibonelelo eziyimfuneko ekuqhubeni iinkqubo yococeko kufutshane kangangoko kunokwenzeka, ukuze kufuneka ukufikelela kuzo.

su

Arthrodesis wokwenzakala amaqatha emva iinkqubo lixesha okanye esosulelayo eziye zakhoke- ukunyhashwa amandla asebenzayo, oluqhutywa kwizigaba ezininzi:

1. Ummandla longenelelo iphathwa kunye ebulala, azigubungela ilinen wawuqalekisa yotyando.
2. Le kwelivi joint uyagawulwa ku-15 cm ubude. Ingaphandle dissected ifascia kunye isihlunu de iindawo articular aziboniswa inxeba.
3. Intlala lolwabo isusiwe, atsalwa non-akhulayo kwaye wonzakala izinto ezidibeneyo.
4. Imiphezulu talus kunye lesiquluba, nto leyo eya uvumelane ngokuqinileyo omnye komnye, abhalwe ngokufanelekileyo. Oku kwenziwa ukuze kuqinisekiswe esqwini oluchanekileyo mlenze asezantsi.
5. Ubume engumphumela imisiwe izixhobo zesinyithi ekhethekileyo fixed ngendlela.
6. Ngokusebenzisa ixesha, thambo liya kukhula kunye izakhi nabanye kwaye ziza kuphinda babe fom yokuqala. imisebenzi yayo iya ngokungaphelelanga kudluliselwa kwezinye izinto.

Yintoni namanye amalungu asebenza

Arthrodesis ayikho njengomlamli, zibalwa amaqatha. Ngokufanayo, oogqirha trauma nga yenze le mimandla yokwakheka zilandelayo:

• hip joint - ukuvelisa Ukusikwa le meniscus ze alungise intloko yifemur isinqe, joint kuhlala yima ngokupheleleyo;
• bony edolweni joint - kuvunyelwa kuphela xa kungekho ezimbi kwenkqubo sentliziyo;
• ligxa - inkqubo ezidla ukusebenzisa sihlume lithambo umguli (ukuba kwenzeke ukulahlwa) okanye ukunikela;
• wengcaciso metatarsophalangeal - injongo ukuphelisa kokuphazamisa okanye valgus deformation ubhontsi iatrogenic ukushukumiseka joint ukugcina emva sokubuyisa ixesha ekuphulukenwe nalo.

Izizathu ezifuna arthrodesis namalungu, bahambelana kuzo zonke ezi zinto zingasentla.

sokubuyisa ixesha ekuphulukenwe

Arthrodesis welungu iqatha, ifoto apho ukuvumela ukuqonda iinkcukacha ngokusebenza, ufuna ukululama elide. Ngosuku lokuqala awukwazi ukufumana ebhedini ukwenzela ukuthintela iingxaki kunokwenzeka ukususela zomzimba (isiyezi, intloko ebuhlungu, ukugabha).

Ugqirha imisela ukusetyenziswa analgesics and non-steroidal amachiza-ukudumba ukuba ntlungu. wasebenzisa arhente antibacterial, xa kukho imfuneko. Oku kuhambisana emngciphekweni omkhulu suppuration kwindawo lwamaqumrhu angaphandle (iinaliti, iipleyiti, iintonga). Of antibiotics kukhethwa leli ubuncinane ukuya isigulane:

1. Cephalosporins - "cefotaxime" "Ceftriaxone".
2. Macrolides - "Erythromycin", "Clarithromycin".
3. Penicillins - "Ampicillin", "Ampioks".

ixesha elithile emva kokuba usebenzo kuyimfuneko ukunxiba umhlabelo udaka, ukubeka up ukuma ezisekupheleni esezantsi uhlala enye apho kubhalwe yincutshe. Ubude gypsum elinokuthatha ukuya kuma kwiinyanga 3-4.

Ugqirha uya kucebisa isigulane xa kunokwenzeka yamanzi kwindawo ukufikelela kwi-intanethi. Own oku makungenziwa ukuthintela indawo usulelo. Emva kokususa ngesamente kuyimfuneko ukuphinda-X-ray iimviwo ukuqinisekisa fusion oluchanekileyo lweziqalelo nokudleka.

Iinyanga zokuqala 2 ukunyathela umlenze esisebenza engaqondanga, ngoko ufuna ukuthenga iintonga ndihambe kuphela nabo. Kwiinyanga ezi-3 emva kokuba X-ray ukusombulula oogqirha trauma angaqala ukuthembela ngeenyawo kwaye usebenzise unyango, ukuyifundisa.

ukuyifundisa

Kwimo emva arthrodesis welungu amaqatha senzelwe ukuba ziquka unyango emzimbeni, yokuthanjiswa, kunye nezinye izinto kwisigaba recovery postoperative. umthambo therapeutic eyona ndlela ibalulekileyo kuba sibamba ngazibini izigulane ukuba iyaluthintela uphuhliso contractures ezidibeneyo.

Of omnye ugqirha therapy ebonakalayo ehambisana:

1. Electrophoresis - kule ndawo amaqatha i kweempembelelo pulses rhoqo zombane. Bangakwazi ufakwe nge amalungiselelo sonyango ihlumelo nangokurhala, bomzimba ukubanjwa, ukuphelisa ukudumba, normalizing ukutya, igazi ukuvula izowuni uqhaqho.
2. UHF - inkqubo apho kukho Impembelelo kagesi UHF entsimini iiseli kunye kwithishyu. UHF kukhuthaza ukusebenza kweenkqubo okungenisa, ukuphiliswa kwizaphuko kunye amanxeba, nokuphelisa ukudumba, nokuphelisa iintlungu, lize igazi yasekuhlaleni.
3. Magnetic - shift keying, esebenzisa yintsimi ngemagnethi. Kuvela ngokupheliswa iintlungu kunye nokudumba, zingenakukwazi kummandla uphazamiseko losulelo, ukwanda luthambe kwemithambo yegazi kunye nokuphucula igazi lokuhamba kummandla ochaphazelekayo.
4. Laser therapy - ukusetyenziswa komhlaba kunye nendlela ofaka ukuphefumla, nto leyo eyinxalenye ye unyango kunye nokufunyanwa kwezifo namalungu kunokwenzeka.

Arthrodesis welungu iqatha, emva koko yesiqhelo elinokuthatha ukuya kuma kwiinyanga 8, isigulana kufuna umsebenzi rhoqo phezu wedwa. Kuphela Kule meko kungenzeka ukuba siphephe uphuhliso iingxaki abuyisele umsebenzi kwindawo owawusebenza.

iingxaki kunokwenzeka

Njengayo nayiphi utyando, arthrodesis welungu amaqatha unokuba eziliqela iingxaki:

• usuleleko kunye uphuhliso olungaphezulu osteomyelitis;
• ukopha, hematoma ukwakhiwa;
• paresthesia - yaphula uvakalelo ngenxa asike of plexus luvo amancinci;
• ukungabikho ithuba ukulungisa joint;
• ekuqhwaleleni kunye nezinye iqinelwa zophendlo lwezifo;
• imfuno iinkqubo ezongezelelweyo zotyando;
• thrombosing ngemithambo ezinzulu mlenze asezantsi;
• thromboembolism main imithambo.

Qiniseka ukuba uxelele ingcali kwezi mpawu zilandelayo:

• umkhuhlane;
• ubuhlungu obukhulu kwindawo yokufikelela steel;
• nokuqiniswa ukudumba;
• phambi ndindisholo okanye ukuntlontlozela;
• konyawo okanye imbonakalo Imivumbo amabala brown;
• ukubonakala ukuphelelwa umoya, isicaphucaphu, ukugabha.

ukukhubazeka

Arthrodesis welungu iqatha, nto leyo ithathwa njengokuba zikhubaziwe emva kokuba imeko enqabileyo kudinga ngakumbi uqeqesho umlenze embi evela isigulane. Kuba ixesha elincinane emva kokuba ungenelelo lokukhubazeka kunokwenzeka, kodwa kuphela ukuba nokubuyiselwa zikwimeko esebenzayo entlanganweni.

Ngokutsho imithetho, evunywe Order of kwiSebe lezeMisebenzi, ebanjwe naMazwe immobilization ngenkani amaqatha izinto ezidibeneyo kwiimeko ezininzi ikhokelela ephule ezincinane lweempawu ezisebenzayo emile-onamandla, nto leyo ithetha ukuba ukukhubazeka akukho lusekiwe.

Ngokomyalelo ukukhubazeka waqinisekisa Ipesenti imeko izifo umlinganiselo ngezifo ezithile kuluhlu ngasentla izifo. Xa umgangatho leengxaki kwi-30% (kuqikelelwa ziingcali MSEC Commission) lokukhubazeka lingakulungele, 40-60% - iqela lesithathu 70-80% - iqela lesibini, 90-100% - iqela lokuqala. Umntwana ufumana nokukhubazeka ngamaxabiso ukusuka-40 ukuya kwi-100%.

utshintsho Minor apho umntu unako ukukhonza bona, bengengabo kwezi ndidi. Kwimeko contractures kunye ukuphazamiseka musculoskeletal kwemisebenzi ezingashukumiyo ekuthiwa arthrodesis welungu iqatha, imiphumo - ukukhubazeka, ukungakwazi ngokuzimeleyo ukuzinakekela kwaye ukukhawulelana neemfuno zophuhliso kule imvelaphi iingxaki zengqondo.

baqinisekiswa

Ngokutsho kwabo abasindayo ukusebenza immobilization ngokudibeneyo, oko etyandwa elide nzima ukuba kufuna ubuchule ophezulu ngugqirha. Ithuba novuselelo ingongoma ebalulekileyo kukuba izigulane siqalise ukuzisizela wena kakuhle ngokwemiqathango yokwenza umthambo ngemihla. Kuyinto ezi ntsilelo kuba yinkalo engundoqo ekuphuhlisweni contractures ngokudibeneyo kunye nemisebenzi ngeemoto kakuhle.

Akukho buhlungu, nkqu kwimo imithwalo enzima, bachache ngokupheleleyo of iqinelwa, ukungabikho kabi kwindawo ngoncedo, nenkangeleko entle izithambiso - izalathi si zokunikwa umsebenzi ngempumelelo.