Puncture wa phewa olowa: Patsogolo njira

Puncture wa olowa phewa ndi opaleshoni, imene adokotala zolowetsa singano mu kapisozi olowa. A ndondomeko ofanana imagwiridwa zolinga matenda kapena chikhalidwe mankhwala alipo. Cholinga cha amenewa ndondomeko ndi - kuchepa kwa chiwerengero cha olowa synovial madzimadzi.

Awiri mitundu puncture

Madokotala puncture ogaŵikana mitundu iwiri:

• Machiritso.
• Matenda.

olowa thunthu

Pa puncture wa olowa phewa n'kofunika kuganizira zinthu khalidwe la thunthu lake. The synovium - ndi casing imene pa matabwa ake ndi chiyambi wosiyana nembanemba serous (monga nembanemba wa pleura, peritoneum, pericardium). Chachikulu kusiyana kwagona kuti mbali mkati moyang'ana pamwamba pa M'mimbamo ndi, lilibe epithelium ndi za indofeliyamu akalowa. Nembanemba makulidwe zimasiyanasiyana. Komanso, ali ndi tilinazo kuchuluka kwa ikukhudzana zoopsa, matenda, ndi mankhwala kukana.

Ndi hypersensitivity synovium matenda osiyanasiyana amafuna potsatira kwambiri aseptic isanafike ndondomeko puncture, ndi pamaso kutsegula articular patsekeke. Komanso pamafunika kuvomerezedwa kusindikiza. M'mimbamo olowa lili pang'ono madzimadzi synovial pafupifupi Botolo anayi. Madzimadzi synovial phindu, ali chikasu udzu mtundu ndipo Kudaonekeratu poyera mwamtheradi. Iwo amakhala ndi kukhuthala kwambiri, iwo lili ndi maselo phagocytic ndi maselo oyera, koma katundu wake antibacterial ang'ono kwambiri. Chifukwa chakuti zimalimbikitsa mucopolysaccharides madzimadzi synovial kulemera mkulu zimenezi, amasonkhana olowa osati akakufunsani mwa M'mimbamo ake.

Njira ya puncture wa olowa phewa ayankhidwa pansipa.

Za madzimadzi olowa

Pezani madzimadzi olowa ndi sayambitsa ndondomeko matenda ndi zovuta chifukwa cha kuchuluka kwake ka makhalidwe oipa ndi mkulu kukhuthala. zimfundo wathanzi ndi makhalidwe oipa:

• Kumwendo: 270-210 mamilimita madzi yachiwiri.
• Kukuletsani: 75-90 millimeters pa danga madzi.

Pamaso pa makhalidwe oipa amachititsa madzimadzi osmosis mbale subchondral ndi synovial, kumene olowa chichereŵechereŵe amapezeka chakudya.

Puncture wa olowa phewa anthu athanzi ali osowa.

Ntchito za madzimadzi synovial

Ntchito yaikulu anachita ndi madzimadzi synovial, ingakhale monga iyi:

• Locomotor ntchito. Synovial madzimadzi mu tandem ndi chichereŵechereŵe articular amapereka ufulu kayendedwe wa linanena pamalo fupa.
• Kagayidwe kachakudya ntchito. madzimadzi Synovial kumatanthauza njira kagayidwe kachakudya zikuchitika pakati pa mabedi mtima ndi articular madzimadzi.
• Trophic ntchito. Avascular synovial madzimadzi chakudya zigawo chichereŵechereŵe.

Ngati pali yotupa ndondomeko mu malo, ndi synovial madzimadzi ukuwonjezeka mwa mapuloteni okhutira. Ichi ndi chifukwa kuchuluka permeability mtima. The madzi amakhala turbid, izo kumawonjezera zili neutrophils chifukwa mu pachimake zoopsa synovitis.

Puncture wa olowa phewa: neno

• Khama la nkhani za zikuchokera (pamaso la mafinya exudate kapena magazi). Ngati zimfundo kuonongeka munali magazi, chifukwa angayambitse synovitis, chichereŵechereŵe kuwonongeka osachiritsika chikhalidwe, kwapakati pa-articular adhesions. Pankhani ya zoopsa haemarthrosis stiffness ndi kutupa zomatira khalidwe amayamba kwakukulukulu kuonongeka chichereŵechereŵe makulidwe osati extravasated zotsatira magazi. Kusinthika kwa chichereŵechereŵe amapezeka ndi kusintha mu proliferative zikuluzikulu za minofu connective. Mu nkhani ya kuwonongeka kwa chipolopolo kumachitika coagulation mokwanira mofulumira ndi kuundana ndiye anapanga, tingayambe ndi kuchuluka kwambiri kwa nembanemba minofu. Chifukwa cha zimenezi, iwo amayamba kufafaniza wa M'mimbamo olowa.
• Kukhazikitsa meniscus kuwonongeka mu bondo olowa ntchito pnevmoartrografii kapena radiography.
• Kukhazikitsa kukhalapo mu M'mimbamo olowa "matupi mpunga" kapena "mbewa olowa."

Mapeto ino matenda puncture wa olowa phewa.

Zikuonetsa kuti chamankhwala monga puncture

• Kuchotsa magazi pa chitukuko hemarthrosis.
• Kuchotsa exudate, mafinya kuchokera articular M'mimbamo, kumayambiriro njira mankhwala.
• Chiyambi novocaine yankho pa kuchepetsa dislocation.
• Chiyambi cha corticosteroids osakaniza Lydasum pamaso pa deformans arthrosis.
• Chiyambi cha mpweya kapena mpweya chifukwa cha njira wofatsa wovulala anapanga zinachitikira adhesions fibrous articular adhesions. Chiyambi cha mpweya n'zothekanso kuti abwezeretse galimoto ntchito kapena chikhomo redressatsii.

Kuti zimenezi zitheke, puncture angathe kuchitidwa phewa ndi bondo mafupa.

ndondomeko

Chifukwa tilinazo muyeso wa madzimadzi synovial matenda, pa puncture olowa ayenera akupitirizabe kutsatira malamulo onse a asepsis ndi antisepsis.

Musanayambe ntchito ndi puncture, ndi puncture malo ayenera bwinobwino decontaminated. Iwo m'pofunika kumwa mowa semidesyatiprotsentnogo. Pamene khungu pa puncture malo wakhala kudzoza peresenti asanu ayodini yothetsera, zotsala ake ayenera kuchotsedwa pochotsa ndi mowa kawiri. Kuchotsa ayodini yotsalira, makamaka kondomu zambiri chofunika chifukwa chakuti ayodini pamodzi ndi singano zingathe kulowa mu M'mimbamo anawa ndipo zimenezi zimachititsa kuyabwa ndi aakulu synovial anachita lamoto. Komanso, ayodini akhoza kuyamwa X-ray, kumene kungakhudze yolondola chithunzi - izo angasonyeze mithunzi zina molakwika fano.

Ntchito m'dera kusalola ochititsa dzanzi.

Kodi kupanga puncture?

Kutalika kwa puncture singano kwa 5-6 masentimita. Ngati kumayambiriro mpweya ikuchitika, ndiye singano ayenera kugwiritsidwa ntchito ndi wochepa thupi, mpaka millimeter wina awiri. Apo ayi, mafuta akhoza kulowa mu minofu zofewa ozungulira olowa. Ndiyeno, hule ndi subcutaneous, periarticular minofu kapena ndiko kumayambitsa.

Khungu puncture pa olowa phewa zimafunika kusunthidwa pambali. Zimenezi zimathandiza kukhotetsa bala njira anatsala singano, ndi pakhungu pambuyo ndondomeko amagwanso danga. njira amenewa amapewa malowedwe matenda padziko thupi kuti patsekeke olowa.

The singano ayenera kusunthidwa pang'onopang'ono, kuyesera kuti adziwe nthawi imene mapeto a izo udzachitike mu kapisozi olowa. Ngati M'mimbamo glenoid ali magazi, kudzakhala novocaine kudetsa yothetsera mu syringe kapena ngati mafinya - njira amakhala mitambo.

Za mozama pa zimene puncture, pali maganizo osiyanasiyana ayenera akuyendera. Ena mabuku limanena kuti singano ayenera kudutsa mpaka centimeter wina, ndi zina - pa masentimita 2-3.

Phula puncture ayenera akuyamwitsa ndi syringe ndi buku la magalamu 10 20. Ngati chofunika - kutumikiridwa mankhwala. Pambuyo kuchotsa singano khungu nkani adzamasulidwa, potero kupinda bala njira, malo puncture ndiye ankachitira ndi mowa ndi bandeji wosabala ntchito.

Technology puncture phewa olowa

Puncture wa olowa ayenera idzachitika pa mbali, kutsogolo kapena kumbuyo. Ngati ndondomeko ikuchitika kutsogolo, ndiye wodwalayo ayenera kuvala kumbuyo. Kenako, dokotala ayenera kupeza njira coracoid wa masamba phewa, lomwe ndi masentimita atatu poyerekeza mapeto wapotalikira wa clavicle lapansi. The singano ayenera kuperekedwa pansi pake ndi kutsogolera pakati pa mafupa a mapewa a mutu ndi mphukira zake malangizo ochokera kutsogolo kumbuyo. singano ndi anaikapo kuti akuya masentimita 4.

Ngati puncture ndi imagwiridwa ndi dokotala wa phewa olowa mbali, wodwala ayenera kuikidwa pa mbali ina, pamene dzanja lake linayikidwa pamodzi thunthu. M'lifupi chala ndi pang'ono m'munsi ku tuberosity wamkulu wa humerus mutu ndi mutu wake. ndodo singano ndi gawo pansi ndondomeko acromion, ndilo kwambiri yotundumukira kunja kwa mpanda, kenako patsogolo icho mu minofu deltoid mu ndege mazunzo.

Pogwira kumbuyo njira puncture mtima chofunika kugona mimba yake. Kenako, dokotalayo akuona kuti minofu deltoid ndi m'mphepete ake m'munsi. Pa nthawi imeneyi, pali dzenje, ili pang'ono poyerekeza m'mphepete kumbuyo kwa ndondomeko acromion. Mu malo awa m'pofunika jekeseni singano nachiyika kuti akuya masentimita 5 malangizo a scapula coracoid.