Kumwendo arthrodesis: opaleshoni, zotsatira, konzanso, mtima ndemanga

Osati pathologies onse a dongosolo minofu ndi mafupa angathe kuthetsedwa ndi kuwongolera zinthu structural. Nthawi zina, ndi kutsekereza ntchito ya zigawo umodzi kapena kuposerapo. Arthrodesis wa bondo olowa - opaleshoni chotero. cholinga chake chimakhala kuchotsa zinthu nonviable kukonza m'munsi nthambi olamulira ndi fixation zina za nyumba anatomic mu zinthu zokhudza thupi. Kodi zinthu imagwiridwa arthrodesis bondo la? Kodi zotsatira za phukusi ndi kukhazikitsa mfundo ziti? Za izi - Patapita nkhaniyi.

Zikuonetsa kwa opaleshoni

Arthrodesis - kuwasokoneza, mmene olowa kuyenda ndi chongopeka anakonza malo. Kufunika kwa ntchito opaleshoni mosalephera milandu zotsatirazi:

1. Pamaso pa dangling olowa. chikhalidwe kumachitika maziko kupsyinjika interosseous olowa. Zimakhala tsankho kapena wathunthu. Chifukwa ndi kuphwanya mapindikidwe a ntchito thupi mwa olowa (yaitali ziwalo minofu, Mitsemphayi ong'ambika, kuvulala gunshot, amaika zimfundo kutambasuka).
2. Development wa deforming nyamakazi. Arthrodesis wa bondo olowa, ndemanga zimene mungathe kuwerenga pansipa, chofunika pa purulent, tuberculous ndi mawonekedwe zoopsa za kudwala.
3. Osachiritsika nyamakazi ndi zosokonezeka. zinthu Pathological zikuphatikizapo kusintha fupa epiphysis.
4. Zovuta za poliyo.
5. A wovulala amene ndimachiza molakwika kapena ophatikizidwa m'mbuyomu.
6. Ngati ndi kotheka, ndi implantation ena kapena onse olowa, ngati zina zikunena zitheka.

contraindications

Arthrodesis za m'miyendo (zotsatira za khalidwe oipa, ndi mavuto n'zochepa kwambiri pambuyo opaleshoni) zoletsedwa kugwira milandu zotsatirazi:

• mpaka akamakula mpaka dongosolo minofu ndi mafupa ndi mu siteji ya kukula;
• pamaso fistula khalidwe chifuwa chachikulu chifukwa cha zochita za nthenda atypical mycobacteria;
• pamaso pa matenda m'dera la alowererepo;
• chikhalidwe kwambiri wodwala, kupanda kukhazikika pa nthawi.

Pambuyo pa zaka 60 za ntchito arthrodesis bondo akhoza kuyambitsa mavuto aakulu.

mitundu ya alowererepo

Kusiyanitsa mitundu ikuluikulu asanu opaleshoni malingana patsogolo mpheto ndi zida ntchito:

• Kwapakati pa-articular arthrodesis wa bondo olowa ikuchitika ndi kuchotsa articular chichereŵechereŵe.
• Ndondomeko owonjezera articular anachita ndi ogwirizana Bony zinthu zithunzi anatengedwa kuchokera wodwala yemweyo. Mwina ntchito kumezanitsa mwiniwake.
• Tikaphatikiza arthrodesis wa bondo olowa Chili mitundu onse a ntchito. Chotsani olowa chichereŵechereŵe ndi fupa kumezanitsa kogwirizana imagwiridwa ndi kuphunzitsa zitsulo mbale wapadera.
• mtundu kutambasuka kwa ntchito zachokera khalidwe la fupa lothyoka yokumba. Komanso zinthu fupa ali anakonza malo ndi kuyenda thupi anatambasula zida. M'mawu ena, mtundu wa alowererepo amatchedwa "arthrodesis kumwendo Ilizarov".
• The psinjika ntchito imagwiridwa ndi kukonza chinthu limodzi ndi masipoko, pivots, ndodo ndi zipangizo zina yeniyeni ntchito traumatology.

mankhwala ochititsa dzanzi applicable

mankhwala oletsa ululu pamalopo mu njirayi opaleshoni si ntchito chifukwa chakuti mpheto amatenga malo akuya chichereŵechereŵe ndi fupa nyumba. Ikani mitundu zotsatirazi wa mankhwala oletsa ululu:

• endotracheal ochititsa dzanzi - wodwala kumizidwa mu tulo mankhwala ochititsa medicaments wapadera ndi inhalation, ndi anagawira mu mawonekedwe gaseous;
• msana ochititsa dzanzi - wodwala amadziwa, amaona ndi kumva zonse, koma miyendo m'munsi kwathunthu kuyenda ndi kupanda tilinazo;
• ophatikizana ochititsa dzanzi - msana analgesia pamodzi ndi kumiza mu theka-tulo boma, ntchito odwala tcheru kwambiri ndi tcheru kwambiri.

Arthrodesis bondo la, pamene umboni uperekedwa mtima umene akusonyeza kuti opaleshoni m'malo yaitali ndipo ukhoza kwa maola 2 mpaka 6. Izo zimatengera nkobvuta boma koyamba, osankhidwa njira phukusi ndi kufunika wodwala yomweyo kumezanitsa.

kukonzekera mtima

Arthrodesis bondo la, pamene umboni uperekedwa mtima amene amasonyeza kufunika kukonzekera preoperative, amafuna kufufuza lathunthu la mtima. Monga pamaso alowererepo aliyense, operable ayenera mayesero matenda a magazi, mkodzo, sayansi. Kudziwa boma la coagulation, gulu magazi ndi RH china. Akuti mayesero kuvomerezedwa kwa HIV, chindoko, matenda a chiwindi, atagwira x-ray.

masiku 7 pamaso pa opaleshoni m'pofunika kusiya mankhwala bwanji magazi dongosolo clotting, ndipo sanali steroidal odana ndi yotupa mankhwala. Pa tsiku lake lomaliza analolera oti amanenedwa pa chilichonse chakudya. M'mawa kudya ndi kumwa madzi alowererepo ndikoletsedwa, kupewa mavuto kuthekera pa ochititsa dzanzi.

Onetsetsani, monga wodwala adzakhala kuchipatala, muyenera kukonzekera m'mlengalenga omasuka m'nyumba. Kusamalira zinthu zotere ayenera patsogolo:

• kuchotsa makalipeti, kumene amalowetsa;
• monga yaying'ono ngati n'kotheka kuika mawaya, amene kugona pansi, kuti wodwalayo si anazolowera pa iwo;
• bafa kugula machila zida zomatira, kotero kuti iye safuna kuloza pansi yonyowa;
• kukonza nyumba zonse zofunikira pogwira njira ukhondo pafupi zotheka, kuti ndi kuzikwaniritsa.

njira ya

Arthrodesis za kuvulala bondo pambuyo njira lotha kapena matenda zimene zinachititsa kuti kuyan'anila za ubongo zinchito, ikuchitika mu magawo angapo:

1. M'dera la alowererepo amaliona ndi antiseptics, wokutidwa ndi nsalu wosabala opaleshoni.
2. The ziyerekezo olowa Kadulidwa cm 15 m'litali. Zigawo kuligaŵa fascia ndi minofu mpaka pamalo articular si kuwonetsedwa chilonda.
3. Chichereŵechereŵe minofu chikutha yotengedwa sanali yotheka ndipo anavulala zinthu olowa.
4. Kali talus ndi tibia, amene adzayenerera mwamphamvu kwa wina ndi mzake, anapanga moyenera. Izi zachitika pofuna kusonyeza olamulira olondola a nthambi m'munsi.
5. Kapangidwe chifukwa chili ndi zovekera wapadera zitsulo atathana unsembe.
6. Nthawi, fupa chidzakula limodzi zinthu ndi mzake ndi olowa sadzakhalanso ndi mawonekedwe pachiyambi. ntchito zake pang'ono tinatengera kwa zinthu zina.

Kodi mfundo zina ntchito

Arthrodesis si alowererepo zimenezi, ndi kuchita masamu pa bondo la. Mofananamo, zoopsa madokotala angathe kuchitapo kanthu zotsatirazi zigawo anatomical:

• ncafu olowa - kubala excision wa meniscus ndi kukonza mutu wa femur kwa mafupa a chiuno, ndi olowa amakhalabe ima kwathunthu;
• Bony bondo olowa - amaloledwa yekha, pakalibe pathologies a dongosolo mtima;
• phewa olowa - ndondomeko zimene kawirikawiri ntchito fupa kumezanitsa wodwalayo (osati kuchitika kukanidwa) kapena mwiniwake;
• metatarsophalangeal articulation - cholinga kuchotsa n'kusokoneza kapena valgus mapindikidwe iatrogenic chala olowa sayenda kusunga pambuyo nthawi kuchira.

The zifukwa zimene zimafuna arthrodesis zimfundo ndi, zizigwirizana zonsezi pamwambapa.

nthawi kuchira

Arthrodesis wa bondo olowa, chithunzi cha moti kumvetsa mwatsatanetsatane za opaleshoni, pamafunika nthawi yaitali. Tsiku loyamba simungathe kudzuka pabedi pofuna kupewa mavuto zotheka kwa mankhwala ochititsa dzanzi (chizungulire, kupweteka kwa mutu, kusanza).

dokotala n'kukulemberani ntchito analgesics ndipo sanali steroidal odana ndi yotupa mankhwala mpumulo ululu. wothandizila antibacterial ntchito ngati n'koyenera. Izi amagwirizana ndi chiopsezo suppuration pa malo matupi yachilendo (masingano, mbale, ndodo). Antibayotiki zokonda zapatsidwa kwa osachepera angaononge wodwalayo:

1. Cephalosporins - "cefotaxime" "Ceftriaxone".
2. Macrolides - "mankhwalawa", "Clarithromycin".
3. Penicillin - "Ampicillin", "Ampioks".

Patapita nthawi opaleshoni m'pofunika kuvala pulasitala bandeji, kupirira udindo wa malekezero m'munsi mpaka pano imene analemba katswiri. Nthawi gypsum ukhoza kwa miyezi 3-4.

adokotala kulangiza wodwalayo zotheka kuthirira malo Intaneti mwayi. Eni zimenezi sizingatheke kuti apewe malo matenda. Pambuyo kuchotsa pulasitala m'pofunika kuti adzathe X-ray muone kutsimikizira maphatikizidwe olondola a zinthu Bony.

Woyamba 2 miyezi pakupita pa mwendo opareshoni zoletsedwa, kotero muyenera kugula ndodo amayenda nawo. Pa miyezi 3 pambuyo X-ray kuthetsa kupwetekedwa madokotala angayambe kudalira phazi ndi ntchito physiotherapy mankhwala.

physiotherapy

Konzanso pambuyo arthrodesis wa bondo olowa cholinga monga mankhwala thupi, kutikita, ndi zinthu zina mu postoperative gawo kuchira. zolimbitsa thupi achire ndi njira yofunika kwambiri chifukwa ndi uyamiko kwa odwala ake kupewa chitukuko cha contractures olowa.

Wa mankhwala ena thupi dokotala n'kukulemberani:

1. Electrophoresis - m'dera kumwendo ndi chikoka cha nyemba zonse magetsi. Iwo angathe kuperekedwa kudzera kukonzekera mankhwala mphukira kutupa, kumangidwa soreness, kuthetsa kutupa, normalizing kagayidwe kuwonjezera magazi kuti yambitsa woyendera nthambi opaleshoni.
2. UHF - ndondomeko imene pali mphamvu ya mu atomu munda UHF pa maselo ndi minofu. UHF amalimbikitsa kutsegula njira regenerative, machiritso a fractures ndi mabala, relieves kutupa, relieves ululu, kumapangitsa m'dera magazi.
3. Maginito - kosangalatsa keying, lomwe lili ndi maginito. Kumachitika Kupha ululu ndi edema, zizipita ku dera kusokonezedwa matenda, kuchuluka elasticity Mitsempha ndi kuwongolera magazi mu zinkakhala m'dera.
4. Laser mankhwala - zotheka kugwiritsa ntchito pamwamba ndi njira intraosseous kukhudzana, zomwe zili mbali ya mankhwala ndi kuchira matenda zimfundo ndi.

Arthrodesis wa bondo olowa, kenako konzanso ukhoza kwa miyezi 8, wodwalayo amafuna ntchito zonse pa wekha. Only mu nkhani iyi n'zotheka kupewa chitukuko cha matenda oyamba ndi kubwezeretsa ntchito za m'dera ntchito.

zosokonezeka zotheka

Mofanana ndi opaleshoni iliyonse, arthrodesis wa bondo olowa akhoza kukhala ndi chiwerengero cha mavuto:

• matenda olowa ndi pofuna kukwaniritsa osteomyelitis;
• magazi, hematoma mapangidwe;
• paresthesia - kuphwanya tilinazo chifukwa cha kung'ambika ochepa mitsempha plexus;
• kusowa mpata kukonza olowa;
• kupunduka ndi zina pathological gait;
• kufunika kwa njira zina opaleshoni;
• thrombosing mitsempha zakuya za nthambi m'munsi;
• thromboembolism waukulu mitsempha.

Sindilephera Mkuluyo zizindikiro zotsatirazi:

• malungo;
• kupweteka kwambiri pa malo mwayi opaleshoni;
• kulimbitsa kutupa;
• pamaso pa dzanzi kapena kumva kulasalasa;
• nthambi kapena blueness maonekedwe a bulauni mawanga;
• maonekedwe a kufupika kwa mpweya, nseru, kusanza.

kulumala

Arthrodesis wa bondo olowa, amene amati wolemala pambuyo chikhalidwe osowa imafuna kuti kumatheka maphunziro mwendo oipa mtima. Pakuti nthawi yaing'ono pambuyo phukusi la kulumala n'zotheka, koma mpaka kubwezeretsa chikhalidwe zinchito za olowa.

Malinga ndi malamulo, wobvomerezedwayo mwa Order kwa Utumiki wa Labor unachitika ntchito ndi kukakamizidwa immobilization za m'miyendo zinthu olowa nthawi zambiri kumayambitsa kuyan'anila zazing'ono silikula zazikulu makhalidwe zinchito, kutanthauza kuti kulumala si okhazikika.

Mwa dongosolo la kulumala anatsimikizira chiwerengero cha chikhalidwe matenda ndi chiŵerengero cha kudwala yeniyeni mndandanda pamwamba matenda. Pamene mlingo wa kudwala kwa 30% (amanenera akatswiri MSEC Commission) chilema sipakhala, 40-60% - gulu lachitatu la 70-80% - gulu lina, 90-100% - gulu loyamba. mwana A amalandira chilema pa mitengo kuchokera 40 mpaka 100%.

kusintha Minor mu umene munthu kutumikira okha, si za magulu awa. Pankhani ya contractures ndi matenda a minofu ndi mafupa ntchito malo amodzi amene aitanidwa arthrodesis wa bondo olowa, zotsatira - olumala, amalephera paokha kudzisamalira ndi zosoŵa za chitukuko maziko awa mavuto a m'maganizo.

umboni

Anthu amene anapulumuka ntchito immobilization limodzi ndi kobvuta yaitali opaleshoni yofuna luso mkulu wa opaleshoni ya. Nthawi konzanso ndi fundo yofunika kwambiri ndi odwala kuyamba kudzimvera chisoni ndi underperforming mawu kuphedwa zolimbitsa thupi tsiku ndi tsiku. Ndi zolakwa awa akhale mfundo za chitukuko cha contractures olowa ndi kuwona ntchito galimoto.

No ululu, ngakhale mu mkhalidwe katundu wolemera, kuchira bwino za gait, kusowa kusapeza m'dera alowererepo, wabwino zodzikongoletsera maonekedwe - zizindikiro za ntchito bwino.