Iqakala arthrodesis: ukuhlinzwa, imiphumela, ukuvuselelwa, ukubuyekezwa nesineke

Akuwona wonke pathologies of the system zemisipha luqedwe ngu lube lwenta ncono lizinga timphawu tesakhiwo. Kwezinye izimo, umsebenzi Ukuvinjwa of eyodwa noma ngaphezulu izingxenye. Arthrodesis we ngokuhlanganyela iqakala - ukuhlinzwa okunjalo. Umgomo wayo iba ekususeni izakhi nonviable silungise aphansi esitho ahlangene nenkanuko edlulele obengeziwe izakhiwo ezicacile zomzimba e isimo bokuphila. Kungaphansi kwaziphi izimo wenziwa arthrodesis we iqakala? Iyini imiphumela yokungenela nokuhlunyeleliswa izimiso? Mayelana nalesi - kamuva esihlokweni.

Izinkomba ukuhlinzwa

Arthrodesis - ukuphazamiseka, lapho ilunga yisimo kanye eyayenziwe ilungiswe isikhundla. Isidingo operation kuhlinzwa akunakugwenywa kulezi zimo ezilandelayo:

1. Ukuba khona ensimbi alenga ngokuhlanganyela. Lesi simo kwenzeka ngemuva umthwalo ngokuhlanganyela interosseous. Kungaba esinqunyiwe noma ephelele. Umphumela kungukuphula ukusonteka yomsebenzi bokuphila ngaphakathi ngokuhlanganyela (ukukhubazeka nokunwetshiwe imisipha, nemisipha ziklebhukile, ukulimala kokudutshulwa, ngokweqile isandiso amalunga omzimba).
2. Kutfutfukiswa deforming Arthritis. Arthrodesis we ngokuhlanganyela iqakala, ukubuyekezwa mayelana nokuthi iziphi izinhlelo ungafunda ngezansi, iyadingeka ngesikhathi ubovu, tuberculous futhi ifomu ebuhlungu egunjini lokuhlolwa kwezifo.
3. sokuqaqamba kwamalunga esiwohlozayo nge ukuxakeka. izimo zokucabanga okubangelwa isifo kuhilelani izinguquko ithambo epiphysis.
4. Izinkinga uvendle.
5. A ukwa aphulukisayo engafanele noma ahlanganisiwe esikhathini esidlule.
6. Uma kudingekile, zokwakha umzila ka embalwa noma yiyo yonke joint, uma ezinye izinhlobo ukungenelela zingenzeka.

Izimo

Arthrodesis we iqakala (ngemiphumela uhlamvu negative, kanye nezinkinga ezingajwayelekile kakhulu emva kokuhlinzwa) asivunyelwe lokufeza kulezi zimo ezilandelayo:

• kuze usakhula kuze zemisipha uhlelo in a sigaba sokukhula;
• khona fistula uhlamvu tubercular kubangelwa isenzo esiphambene mycobacteria atypical;
• khona ukutheleleka endaweni yokungenela;
• usesimweni esibucayi isiguli, ukuntuleka ukuzinza ngokuhamba kwesikhathi.

Ngemva kweminyaka engu-60 yokusebenza arthrodesis we iqakala ingabagulisa eziyingozi.

izinhlobo kokungenela

Hlukanisa izinhlobo ezinhlanu eyinhloko ukuhlinzwa kuncike intuthuko zokukhwabanisa kanye nemishini esetshenziswa:

• Naphakathi-articular arthrodesis we ngokuhlanganyela iqakala Kwenziwa ukususwa uqwanga articular.
• inqubo-Extra articular kwenziwa ukusondelana bony izakhi izithombe othathwe isiguli esifanayo. Mhlawumbe ukusetshenziswa xhumelela abanikelayo.
• arthrodesis angumfelandawonye ngokuhlanganyela iqakala ihlanganisa zombili izinhlobo imisebenzi. Susa kusukela ngokuhlanganyela uqwanga bone milisa kunenze nisondelane wenziwa ukugxilisa ekhethekile izingcwecwe zensimbi ezilula.
• Uhlobo isandiso wokusebenza kusekelwe ngokuziphatha ukwa yokufakelwa. Ngaphezu kwalokho ithambo izakhi awashintsheki endaweni futhi akasakwazi bokuphila apharathasi sisalokhu. Ngamanye amazwi, lolu hlobo kokungenela ibizwa ngokuthi "arthrodesis iqakala Ilizarov".
• Ukusebenza kokucindezelwa wenziwa ukulungisa isici ezikanye spokes, pivots, izinduku kanye namanye amadivayisi ethize esetshenziswa traumatology.

izinzwa esebenzayo

izinzwa wendawo kule eyohlinzwa alisetshenziswa ngenxa yokuthi manipulation yenzeka uqwanga bone izakhiwo ezijulile. Sebenzisa lezi zinhlobo ezilandelayo izinzwa:

• izinzwa endotracheal - isiguli bacwiliswa ubuthongo izinzwa ukuthaka imithi ngendlela ekhethekile lapho ephefumula, kwasakazwa ifomu gaseous;
• izinzwa emgogodleni - isiguli bayazi, akubonayo nakuzwayo konke, kodwa izingalo nemilenze aphansi yisimo ngokuphelele kanye nokuntuleka lokutfutfukako;
• izinzwa kuhlanganiswe - analgesia umgogodla kuhlangene ukucwiliswa in a state oseqala ukuzumeka, isetshenziselwa iziguli iyashesha ukuzwela futhi ebucayi kakhulu.

Arthrodesis we iqakala, kobufakazi nesineke ebonisa ukuthi lo msebenzi futhi kunalokho eside ingahlala kusuka amahora 2 kuya ku-6. It kuncike kanzima kanjani isimo sokuqala, okhethiweyo amasu kokungenela kanye nesidingo isiguli esifanayo lo ihlumela.

ukulungiselela isiguli

Arthrodesis we iqakala, kobufakazi nesineke ebonisa isidingo sokulungiselela preoperative, kudinga luhlolo ephelele isiguli. Njengoba ngaphambi kokungenela, operable kumele ovivinyweni olubangelwa basemtholampilo igazi, umchamo, oyisazi samakhemikhali ezinto eziphilayo. Thola isimo coagulation, iqembu igazi RH isici. Kubhekwe ukuhlolwa kuphoqelekile HIV, ugcunsula, isifo sokusha kwesibindi, ebambe x-ray.

izinsuku ezingu-7 ngaphambi ukuhlinzwa kudingekile ukuba ayiyeke le izidakamizwa ezithinta igazi uhlelo ekunqandeni, futhi okungezona steroidal izidakamizwa eqeda ukuvuvukala. Ngosuku lwakhe lokugcina kuvunyelwe ukudla eliphuphile kuphela. Ekuseni ukuba badle futhi baphuze amanzi ngaphambi kokungenela kungavunyelwe, ukugwema izinkinga ezibangwa lapho umuntu ebulawe izinzwa.

Qiniseka, njengoba isiguli kuyoba esibhedlela, kudingeka alungiselele esimweni ntofontofo endlini. Ukuze anakekele izinto ezinjalo kufanele kuthuthukiswe:

• ukususa mata, okungase kube ilele;
• njengoba icwecwe ngangokunokwenzeka ukubeka izintambo, okuyinto abalale phansi, ukuze isiguli akuyona wezithombe kubo;
• endlini yangasese ukuze sithenge umata nge ukuncela izinkomishi, ukuze akusho shift phansi ezimanzi;
• ukuhlela zonke izakhiwo ezidingekayo ukufeza izinqubo inhlanzeko eduze ngangokunokwenzeka, ukuze singathwesi kufanele afinyelele kubo.

su

Arthrodesis wokulinyazwa iqakala ngemva izinqubo akusebenzi noma ezithathelwanayo eziye zaholela ekubeni ubone ukwephulwa amakhono ukusebenza, wenziwa izigaba eziningana:

1. Le ndawo yokungenela ziphathwe antiseptics, futhi wambozwa nelineni oyinyumba kuhlinzwa.
2. Projection ngokuhlanganyela inqanyulwa kuya ku-15 cm ubude. Izinhla dissected fascia futhi imisipha kuze evele articular aziboniswa isilonda.
3. Uqwanga izicubu isuswe, ekhishwe non-iphila futhi abalimala izakhi ngokuhlanganyela.
4. Evele talus kanye tibia, okuzokwenza ukulingana siqinise nomunye, akhiwa ngokufanele. Lokhu kwenziwa ukuze kutholakale eksisi lesifanele esitho engezansi.
5. Isakhiwo okuholela omiswe ekhethekile metal nokufakwa fixed ngendlela.
6. Ngokusebenzisa isikhathi, ithambo luyokhula ndawonye izakhi nomunye kanye ngokuhlanganyela ngeke besakwazi owaqalwa. imisebenzi yayo ngeke kancane wakudlulisela kwabanye izinto.

Yimaphi amanye amalunga omzimba isebenze

Arthrodesis akuyona okuyiyonayona, ke ibalwa iqakala. Ngokufanayo, ukuhlukumezeka odokotela abahlinzayo kungaba kubathene kuzifunda ezilandelayo yokwakheka:

• hip ngokuhlanganyela - ukukhiqiza excision we meniscus uphinde ulungise inhloko kunawo wonke ukuba ukhalo, joint uhlala kungahambi ngokuphelele;
• bony amadolo ngokuhlanganyela - uvunyelwe kuphela ngokungabi bikho pathologies kohlelo zenhliziyo;
• ehlombe ngokuhlanganyela - inqubo ngokuvamile zisebenzisa bone milisa isiguli (hhayi kwenzeke kwenqatshwa) noma donor;
• ukuhambisana metatarsophalangeal - the Umgomo ukuqeda kwaphazamiseka noma valgus ukusonteka isithupha iatrogenic ukuhamba ngokuhlanganyela ukugcina ngemuva kwesikhathi yokutakula.

Izizathu ukuthi zidinga arthrodesis amalunga omzimba, zivumelana konke okungenhla.

isikhathi ekululameni

Arthrodesis we ngokuhlanganyela iqakala, isithombe okukuvumela ukuliqonda eningiliziwe ukusebenza, kudinga yokutakula eside. Ngosuku lokuqala awukwazi ukuphuma embhedeni ukuze ligweme izinkinga ezingase zivele kwenzeke indlela yokubulala izinzwa (nesiyezi, ikhanda elibuhlungu, ukuhlanza).

Udokotela sinquma ukusetshenziswa analgesics futhi okungezona steroidal izidakamizwa eqeda ukuvuvukala ngicele impumuzo ubuhlungu. ejenti elwa namagciwane esetshenziswa, uma kunesidingo. Lokhu kuhlobene nengozi eliphezulu suppuration endaweni zemizimba angaphandle (izinaliti, amapuleti, izinduku). Kwamaphilisi kubonelelwa kakhulu ama-okungenani anobuthi ukuba isiguli:

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

Ngemva kwesikhathi esithile ukusebenza kuyadingeka ukugqoka ngebhandeshi usimende, sibekezelele isikhundla emkhawulweni aphansi uhlala eyodwa lapho eqoshiwe onguchwepheshe. Isikhathi Gypsum kungathatha 3-4 izinyanga.

Udokotela eluleke isiguli uma kungenzeka ukuthambisa indawo ukufinyelela ku-intanethi. Wayenalo lokhu akukwazi okungenziwa ukuvimbela ukuba endaweni ukutheleleka. Ngemva kokukhipha ukhonkolo kuyadingeka kabusha-X-ray luhlolo ukuqinisekisa Fusion efanele izakhi bony.

Eyokuqala 2 izinyanga ka ukunyathela umlenze eziqhutshwa asivumelekile, ngakho udinga ukuthenga izinduku behamba nabo. Ngezinye izinyanga 3 emva X-ray ukuze uxazulule ukuhlukumezeka odokotela abahlinzayo usungaqala ancike ngezinyawo bese usebenzisa Physiotherapy ukwelashwa.

Physiotherapy

Ukuvuselelwa ngemva arthrodesis we ngokuhlanganyela iqakala senzelwe ukubandakanya elashwe ngokomzimba, massage, nezinye izakhi esigabeni yokutakula nasezinkingeni ezilandela ngemva kokuhlinzwa. umsebenzi zokwelapha indlela ebaluleke kakhulu ngoba sibonga iziguli zakhe ukuvimbela ukuthuthukiswa contractures ngokuhlanganyela.

Nezinye udokotela ukuze athole ukwelashwa komzimba sinquma:

1. Electrophoresis - endaweni iqakala kuyinto ithonya njalo pulses kagesi. Abakwazi esizosingathwa nge amalungiselelo medicated ihlumela ukuvuvukala, soreness ukuboshwa, ukuqeda ukuvuvukala, normalizing umzimba, umthamo wegazi ogciniwe ukucupha zone ukuhlinzwa.
2. UHF - inqubo lapho kukhona ithonya kagesi emkhakheni UHF ku amaseli nezicubu. UHF ikhuthaza ukusebenza izinqubo okuzivuselela, ukuphulukiswa waphuka namanxeba aqede ukuvuvukala, aqede ubuhlungu, kuvusa wendawo kwegazi.
3. Magnetic - shift Keying, esebenzisa amandla kazibuthe. Kuvela nokuqedwa ubuhlungu futhi edema, uvikelwe ukuphazamiseka esifundeni ukutheleleka, kuyaqina anda imithambo yegazi kanye nokwenza ngcono kwegazi igazi endaweni ethintekile.
4. ukwelashwa Laser - Ukusetshenziswa okungaba khona kwamanzi futhi indlela intraosseous yokuchayeka, okuyizinto ingxenye ukwelashwa nokululama izifo amalunga omzimba.

Arthrodesis we ngokuhlanganyela iqakala, ngemva kwalokho nokuvuselelwa kungathatha izinyanga 8, isiguli kudinga umsebenzi njalo wedwa. Kuphela kulesi simo kungenzeka ukugwema ukuthuthukiswa ngenxa yezinkinga ukubuyisela umsebenzi endaweni eziqhutshwa.

yezinkinga kungenzeka

Njenganoma iyiphi ukuhlinzwa, arthrodesis we ngokuhlanganyela iqakala ungaba inombolo yezinkinga:

• ukutheleleka ezikanye ukuqhubeka osteomyelitis;
• ukopha, hematoma kumiswa;
• paresthesia - kokunikezwa kwe-ukuzwela ngenxa asike izidumbu zabantu ezincane emsipheni plexus;
• yokuntula ithuba silungise ngokuhlanganyela;
• izinyonga nezinye Gait sokugembula;
• isidingo nezinqubo ezengeziwe kuhlinzwa;
• thrombosing emithanjeni ezijulile esitho engezansi;
• thromboembolism imithambo main.

Qiniseka ukutshela uchwepheshe we zimpawu ezilandelayo:

• umkhuhlane;
• ubuhlungu obukhulu endaweni ukufinyelela kuhlinzwa;
• nokuqinisa ukuvuvukala;
• khona ukuba ndikindiki noma ukushoshozela;
• umlenze noma ukubukeka blueness izindawo ensundu;
• ukubukeka iphika, isicanucanu, ukuhlanza.

ukukhubazeka

Arthrodesis we ngokuhlanganyela iqakala, okuyinto babonwa bekhubazekile emva isimo ezingavamile kudinga sithuthukiswe ukuqeqeshwa umlenze kubi kusukela isiguli. Ukuze isikhathi esincane ngemva kokungenela yokukhubazeka kungenzeka, kodwa kuphela kuze kube ukubuyiselwa isimo nemisebenzi yokusetshenziswa ngokuhlanganyela.

Ngokusho imithetho, evunywe Order of the Ministry of Labour, aphethwe msebenzi ngokuvumela immobilization ngempoqo iqakala izakhi ngokuhlanganyela ezimweni eziningi kuholela yokuphula ezincane izici static-ashukumisayo obusebenzayo, okusho ukuthi ukukhubazeka is hhayi kusungulwa.

Ngu oda ukukhubazeka waqinisekisa amaphesenti yesimo isifo kanye isilinganiso zokugula ethize ohlwini ngenhla izifo. Lapho izinga zokugula-30% (kulinganiselwa ngochwepheshe MSEC Commission) ukukhubazeka kungasethiwe, 40-60% - neqembu lesithathu 70-80% - iqembu lesibili, 90-100% - iqembu lokuqala. Ingane ithola ukukhubazeka ngamazinga kusuka 40 kuya ku-100%.

Izinguquko ezincane ekubonakaleni kwe-okuyinto umuntu uyakwazi ukukhonza ngokwabo, ezakho lezi zigaba. Endabeni contractures futhi izinkinga zemisipha imisebenzi static abizwa ngokuthi arthrodesis we ngokuhlanganyela iqakala, nemiphumela - ukukhubazeka, ukungakwazi ngokuzimela ukuzinakekela futhi ukuhlangabezana nezidingo zentuthuko kule zangokwasemuva zezinhlelo izinkinga ezingokwengqondo.

nobufakazi

Ngokusho kwalabo abasinda ekusebenzeni immobilization ngokuhlanganyela, kuba phakathi nenqubo yokuhlinzwa eside nzima ukuthi kudinga ikhono eliphezulu nodokotela ohlinzayo. Isikhathi isimilo iphuzu elibalulekile ukuthi iziguli uqale ukuzidabukela futhi egculisayo ngokuya ukukhishwa umsebenzi nsuku zonke. Kuyinto lezi amaphutha abe eyamsiza ukuthuthukiswa contractures ngokuhlanganyela futhi kahle motor imisebenzi.

Ngeke bube khona ubuhlungu, ngisho esimweni imithwalo esindayo, ukululama ngokugcwele Gait, ukungabi ukungakhululeki endaweni kokungenela, ukubukeka ezinhle yezimonyo - izinkomba a umsebenzi kuphumelele.