Zisonyezero za kuponyedwa kwa nthambi. Mbali za ntchito ndi kukonzanso

amputation wa miyendo ndi chimodzi mwa zinthu zakale mbiri ya mankhwala. Zimene woyamba madeti zana la 4 BC. e. Komabe, kulephera kuchepetsa kutaya mwazi wambiri, komanso kusowa kudziwa za ligation mtima kawirikawiri amapha. The dokotala analimbikitsa truncate nthambi mkati zimakhala anakhudzidwa, izo kumatha magazi oopsa, koma sanali kufala kwa chilonda.

M'zaka za m'ma AD choyamba, Aulus Korneliyo Celsus adafotokoza chosiyana nthawi njira zake kayendetsedwe ka ntchito ngati amayi, ayamikira kuti:

- kuti agwire truncation la mlingo wa minofu yotheka;

- ligation wa akutali mtima chitsa kupewa magazi;

- akumeta ubweya kubwerera m'pang'ono pomwe minofu kuphimba chitsa popanda mavuto pathological.

Yofunika kwambiri kusintha kwa njira amputation wa miyendo ankaimba ndi kukhazikitsa njira yopanda magazi opaleshoni pamene Esmarch Kulengedwa ntchito kufikira tsopano gulu mphira.

Mu dziko kutsogolera malo lero pakati pa zikuonetsa kuti amputation zatenga shuga ndi matenda a mtima.

Amputation - truncation wa miyendo ndi, kapena m'malo mbali wapotalikira, mafupa, koma izo zikanakhala ndalakwitsa kwambiri kuwaona monga kuchotsa yosavuta ya gawo akhudzidwa. Mawu amenewa akusonyeza pulasitiki opaleshoni reconstructive, umalimbana anapitiriza mofulumira ndi ogwira mtima konzanso.

Pali ena adziwe mtundu wa opaleshoni. Taganizirani kuwerenga deta mwatsatanetsatane.

Zikuonetsa kuti amputation

- chilonda.

- Kupezeka kwa cholinga lolemera matenda, kuopseza wodwalayo moyo (anaerobic matenda).

- sizingasinthe ischemia minofu contracture.

- tulo syndrome.

- udzaphwanya Ngozi Mantha choipa kwa miyendo ziwiya chachikulu ndi mitsempha, anachititsa wotchedwa zoopsa amputation.

- occlusive matenda ndi zotsatira za chilonda.

- tourniquet, woyikidwa maola oposa atatu.

- Common, osati amenable kuti zilonda mankhwala neurotrophic.

- Osteomyelitis ndi kuopseza okhudzidwa mkati limba.

- The wamba chifuwa chachikulu chotupa minofu fupa okalamba.

- Yapakhungu fupa zotupa popanda kuthekera kwa kuchotsa chipinda lakutali.

Kuona mlingo wa resection

Kusankha mlingo wa amputation zimadalira mlingo wa matenda magazi m'dera opareshoni, pamaso pa chilonda, matenda trophic, mayiko a zimakhala moyandikana ndi kukula kwa matenda ndi ululu.

ana amayesetsa kutsatira disarticulation (kudzipatula mbali zinkakhala pa mlingo olowa), popanda kuphwanya zina kukula fupa.

Malinga ndi kufunika kwa opaleshoni olekanitsidwa nthambi amputation:

- mwamsanga amputation anachita kupereka opaleshoni thandizo kuchotsa sanali yotheka, zimakhala kuonongeka;

- mwadzidzidzi ntchito ndi truncation moto kuledzera ndi inefficiency njira ndiwofatsa;

- anakonza amputation, amachitika zotupa zilonda za fupa osteomyelitis.

- reamputatsiya kukonza maganizo otsutsana chitsa.

Kuonetsetsa zozungulira, elliptical ndi patchwork amputation. Tiyeni tikambirane mitundu izi pansipa.

zozungulira amputation

The zikuonetsa chachikulu ablation, ndicho guillotine (munthawi yomweyo zozungulira) amadulidwa chiwalo ndi mpweya chilonda ndi nthambi resection atapachikidwa pa m'pang'ono pomwe musculocutaneous. kusokonezedwa ndi ikuchitika yekha kuchipatala chopulumutsa moyo. A drawback chapadera cha njira imeneyi ndi kupereka kufa sanali zinchito ndi wotsatira reamputatsiya kumangako atengere nthambi prosthesis zina kukhazikitsidwa.

The ntchito mwayi umenewu ndi kupanda amputation kusintha necrotic kuti shreds, ngakhale pa maola okwanira magazi.

Pamene guillotine amputation anaona pa fupa pa mlingo mofanana ndi minofu zofewa.

Monga opaleshoni imagwiridwa? Amputation wa gawo loyamba tichipeza mu khungu ang'ambe thupilo, subcutaneous mafuta ndi fascia. M'mphepete kusesa khungu ndi chikhomo kupitirirabe m'mphepete. Kachiwiri siteji kung'ambika minofu ku fupa ndiponso kudula fupa. fupa mapeto chivundikirocho ndi chifukwa khungu ndi fascia.

Mtundu akulimbikitsidwa mabungwe a nthambi ndi minofu misa ochepa.

Pakuti m'madipatimenti ndi lalikulu minofu misa trohmomentnaya analimbikitsa amputation (phirilo losavuta, ndi ablation zozungulira ndi Pirogov).

Woyamba magawo awiri a opaleshoni ofanana dvuhmomentnoy amputation. Komanso, pambuyo kutsetsereka minofu ndi minofu chongodziwa motsogozedwa proximal, ndi mpando odulidwa minofu kukopedwa padziko m'mphepete mwa khungu. Kudzera mwa tadulidwa minofu zigawo kwambiri ndipo zimenezi zimathandiza kuti mapangidwe aŵa chitsa conical.

njira Patchwork kugawana:

• pa odnoloskutnye (kutalika khumudwitsidwa chimodzi chofanana ndi awiri a chitsa cha);

• dvuloskutnye (awiri chiguduli zamitundu yosiyanasiyana pa Uwerenge zotalika ndi kupanga awiri amputiruemoy miyendo).

Mu kupanga chitsa ayenera adzanyamula kukumbukira kuti chilonda sayenera padziko ntchito. Nyenyeswa ayenera kupangidwa kutenga nkhani luso kunyamula katundu.

osteoplastic amputation

Kodi amputation wa malekezero a m'munsi? Chinthu chapadera ndi kukhalapo makombo fupa yokutidwa ndi periosteum mu zikuchokera yamawangamawanga.

osteoplastic amputation wa mwendo m'munsi mwa njira Pirogov wabweza kuzindikira lonse chifukwa bwino kwambiri anatomical mapeto thandizo konzanso wa mwendo ntchito.

Ubwino wa njira:

- Zochepa soreness chitsa.

- Kukhala ndi thandizo la chimaliziro chitsa.

- Sungani proprioceptive tilinazo minofu ndi tendons.

masitepe Procedural

Pamene kuchotsa tibia, amacheka awiri anapangidwa pa Pirogov. Chifukwa chaichi, amputation mpeni. Choyamba kutulutsa mtanda kagawo ka zimakhala zofewa, kuvumbula bondo olowa zina ntchito gawo arcuate anakafika pamodzi dorsum phazi. Ataoloka Mitsemphayi lateral kupanga kudzipatula kwa talus, tibia fupa kumaliza. A-gawo mtanda anatseka yamawangamawanga. Kupanga chitsa.

Ntchito Sharpe

Pali njira inanso imene anachita amputation wa miyendo m'munsi.

Pamene inu kuchotsa phazi minofu zofewa kung'ambika ikuchitika ndi masentimita angapo wapotalikira phalanges wa woyamba metatarsal fupa. Pambuyo periosteum otpreparovyvaniya imagwiridwa kumaliza metatarsals ndi kuwongola cutters onse anaona kudula. Dulani chivundikiro plantar yamawangamawanga.

Taganizirani zimene zimayambitsa waukulu amputation.

ashuga microangiopathy

Zochita dokotala zimadalira kukula kwa vutolo. Pa kuchuluka kwa zotupa purulent necrotic magawo asanu:

- Zikundiyendera necrosis popanda tendons kugonja.

- chilonda chala zokhudza phalanx woyamba ndi tendon.

- The ambiri chilonda cha zala, pamodzi ndi chilonda phazi.

- gangrenous chotupa lonse wapansi.

- NAWO m'kati tibia lapansi.

Pa chikuonetseratu wodwala ndi ischemia necrotic unachitikira konzanso pangozi ya moto, chomwe potsegula abscess, ngalande za abscesses, kochepa resection a mbali akhudzidwa mafupa ndi kuchotsa minofu akufa. Pambuyo excision minofu nonviable opaleshoni kubwezeretsa chokwanira magazi kuonongeka nthambi.

Ischemia:

- mlingo woyamba imagwiridwa yekha ukhondo moto;

- mphamvu chachiwiri zikutanthauza amputation zala akhudzidwa ndi ndondomeko excision nawo tendons ndi;

- pamene mlingo lachitatu ikuchitika amadulidwa chiwalo pa Sharpe ntchito yapadera mpeni amputation;

- mankhwala a pamlingo wachinayi ndi resection pa tibia ya;

- pa mlingo wachisanu wa amputation wa amachitidwa pa mlingo wa m'chiuno.

Frostbite zala ziwalo zina

kusiyanitsa:

• okwana yozizira koopsa (kusintha pathological ziwalo ndipo zimakhala, kuyamba chifukwa cha matenda magazi ndi ischemia zina ubongo chifukwa otsika kutentha kuleza akuchita);

• perfrigeration (akuwonetseredwa aakulu yotupa anachita khungu mu mawonekedwe a bluish-wofiirira wazikang'a yamawangamawanga ndi kuyabwa kwambiri.

Pali madigiri anayi:

Mlingo woyamba limodzi ndi kusintha kusintha kwa khungu: erythema, kutupa, kuyabwa, kupweteka ndi tcheru kuchepa asanawonetseredwebe. Patapita masiku ochepa zinkakhala m'dera ndi exfoliated.

Kwa mlingo wachiwiri yodziwika ndi maonekedwe a thovu ndi zili kuwala, chimaonetsera kuchepa tilinazo, mwina chifukwa matenda kujowina matenda trophic.

Mbali yachitatu kukuonetsedwa kusintha necrotic mu minofu zofewa chifukwa iwo kufa, kupanga mzere wa demarcation (delimitation akufa minofu kuchokera wathanzi granulation Mzere), malo owonongeka ya nthambi mummified, ndi zomera inalowa tating'onoting'ono angathe yonyowa chilonda.

Pamene digiri chachinayi minofu necrosis chimafikira kwa fupa, madzimadzi mu thovu pa khungu amakhala turbid wakuda, khungu bluish, ululu tilinazo Mwamsanga kwathunthu, ndipo blackens nthambi akhudzidwa mummified.

chithandizo

• 1 digiri. Rewarming wodwala, UHF-mankhwala darsonval, frostbitten nthambi mapaundi boric mowa.
• 2 digiri. Processing ikuchitika thovu. Pambuyo kutsegula khungu lawo zowonongeka chikutha bala kuvala umagwiritsidwa mowa. Zokhudza zonse mankhwala mankhwala tikulimbikitsidwa.
• Chachitatu digiri. Amachotsa thovu excised necrotic minofu bandeji ndi saline hypertonic. Maantibayotiki akagwiritsidwa ntchito kwa matenda sekondale.
• 4-TH digiri. Necrectomy (kuchotsa minofu devitalized) ikuchitika pa 1 cm pamwamba pa mzere necrosis. Amputation imagwiridwa pambuyo mapangidwe kutumphuka youma.

chilonda

Youma chilonda ndi chifukwa cha wosakwiya mwapang'onopang'ono matenda a kapezedwe magazi zimakhala ndi khalidwe la odwala atherosclerosis ndi kuwononga endarteritis.

Yodziwika ndi kusapezeka kwa kuledzera a chamoyo, ndi pamaso pa demarcation bwino m'dzenjewo. Mankhwalawa akhoza kugwiritsa ntchito kasamalidwe woyembekezera.

Ikani: mankhwala kuti kusintha minofu trophism, zokhudza zonse mankhwala mankhwala. opaleshoni ikuchitika pambuyo kupanga mzere bwino demarcation.

M'madzi chilonda kumachitika monga chotsatira cha pachimake kutha kwa makope (frostbite zala thrombosis, mtima psinjika). Iwo amakhala ndi kuledzera kwambiri, palibe mzere demarcation ndipo anawapatsa edema. Amputation ndi chilonda unachitikira mwachangu, kasamalidwe oyembekezera ndi zosayenela. ntchito imagwiridwa pambuyo mankhwala detoxification. amputation mzere ayenera kukhala chilonda kwambiri apamwamba (ndi zotupa analimbikitsa amputation wa kugwira phazi pa mlingo m'chiuno).

Gasi chilonda kumasonyeza mtheradi kwa amputation guillotine. Zizindikiro khalidwe: kutchulidwa, mofulumira mwapang'onopang'ono kutupa, pamaso mpweya mu zimakhala ndi minofu necrosis ndi abscess ndi kusungunuka minofu zofewa. Zowoneka minofu grayish, wosasamala, zosavuta crumple pa palpation. Khungu wofiirira-bluish, pamene mbamuikha anamva crunching ndi creaking. Wodwala anadandaula za mumamva, akuphulikira ndi ululu.

I kwa solvency wa chitsa ndi wokonzeka ake yopanga zina

Pakuti uziyenda wabwinobwino wa prosthesis ndi m'litali yotsalira ya olowa ayenera kukhala woposa awiri ake. Chofunikanso ndi mawonekedwe ake thupi (pang'ono tapered kuchokera pamwamba mpaka pansi) ndipo sabweretsa chisoni. Kupulumutsa Akuti sayenda zimfundo ndi khungu chilonda (sayenda wake ndi kusowa cohesion ndi maziko fupa).

Zizindikiro mwankhanza chitsa

- Kufalitsa wa pachilondacho wayamba kuoneka padziko ntchito.

- Owonjezera zofewa minofu.

- Kusowa kwa tapering chitsa.

- Zisudzo ndi minofu yovulazidwa, kunja kuli zii ake.

- Kwambiri mkulu dongosolo la minofu.

- Kugwiritsa mavuto a utuchi khungu fupa.

- Akukana zigawo fupa ndi amputation wophatikizidwa mafupa.

- kwambiri conical mawonekedwe a chitsa cha.

kupanga kulumala

Amputation wa miyendo ndi chilema anatomical imene inachititsa chilema gulu anatumizidwa kalekale. Ngati panali mwendo amputation, kulumala gulu anatumizidwa yomweyo.

Chiwerengero cha mlingo wa imfa ya ntchito zinchito, olumala ndi Kupunduka, komanso ntchito zina za olumala ndi chinkhoswe mu komiti zachipatala-konzanso Katswiri.

Pokhazikitsa mlingo wa kulemala ndi imawunikidwa:

- The luso kudzimvera utumiki.

- Kudziŵa kuyenda palokha.

- The adequacy ya lathu mu mlengalenga ndipo nthawi pakalibe kudwala ntchito maganizo (anayeza kumva ndi masomphenya).

- ntchito Communication, luso anazionera, kulemba, kuwerenga, etc ...

- The mlingo wa ulamuliro wa khalidwe chawo (zoletsedwa ndi malamulo malamulo, makhalidwe abwino ndi za chikumbumtima cha anthu a).

- kuphunzira luso, mwayi kuphunzira luso latsopano, chitukuko cha kudzinenera ena.

- Luso kuchita ntchito.

- Luso kupitiriza kugwira ntchito mu chimango cha zochita zawo akatswiri pambuyo konzanso ndi chilengedwe cha zinthu zapadera.

- The magwiridwe ndi digiri ya chitukuko cha prosthesis lapansi.

Gulu loyamba

Zikuonetsa kwa mphoto ya gulu loyamba:

- Amputation wa miyendo onse pa mlingo m'chiuno.

- Popeza zala zinayi (kuphatikizapo phalanx choyamba) pa manja onse.

- Amputation manja.

Gulu lachiwiri

- Amputation zala zitatu (ndi phalanges choyamba) manja onse.

- Posachedwapa 1 ndi 2 zala.

- No zala 4 pokhalabe ndi phalanges choyamba.

- Amputation chala pa dzanja limodzi ndi chitsa mkulu wa dzanja chachiwiri.

- Opaleshoni ya Chopart ndi Pirogov.

- High resection wa mwendo umodzi, pamodzi ndi kusapezeka kwa zala za dzanja limodzi kapena diso.

- amputation wa dzanja limodzi ndi diso.

- disarticulation m'chiuno kapena paphewa.

Gulu lachitatu

- Unilateral amputation wa zala popanda kuchotsa phalanx choyamba.

- kawiri amaganiza amputation chala.

- High amputation wa mwendo kapena mkono.

- Chotsani mapazi pa Sharpe.

- The kusiyana mwendo kutalika 10 cm.

Konzanso pambuyo amputation

Kuwonjezera anatomical chilema nthambi amputation kumayambitsa kwambiri zoopsa maganizo mtima. Wodwala atseka pa malingaliro onyozeka pamaso pa anthu, iye amakhulupirira kuti moyo wake pa.

The bwino apulasitiki tsogolo anatsimikiza osati mwa Timeliness ntchito, mlingo wa amputation ndi chisamaliro wotsatira oyenera pa chitsa cha.

masiku 3-4 pambuyo kupewa amputation akuyamba flexion contractures, kuchita kayendedwe chitsa. Pambuyo kuchotsa sutures yogwira zolimbitsa minofu chitsa analimbikitsa. Patatha mwezi umodzi, anayamba kuyesa prosthesis choyamba.

Chofunika kwambiri konzanso ndi ziziyenda wodwalayo boma maganizo ndi mapangidwe mankhwala ake chokwanira cha yopanga.

ntchito Komanso monga:

- Maphunzilo ku ntchito prosthesis ya;

- akonzedwa zokambirana kuti yambitsa ndi prosthesis ndi kulolerana wake wonse galimoto stereotype;

- normalization wa mugwirizano, ntchito yophunzitsa zachipatala ndi apulasitiki.

- umoyo-konzanso ntchito, anatengera moyo wa wodwala ndi prosthesis ndi;

- kuchepetsa kukula kwa mapulogalamu munthu, retraining ndi ntchito zina (magulu 2 ndi 3).

Ngati inu kubva malodza mu nthambi udulidwe amalangiza kuti novocaine anatseka misewu, kutsirikidwa ndi misala. Ngati palibe kusintha zotheka kuchita opaleshoni ndi resection ya mitsempha akhudzidwa.