Pona arthrodesis: pokanga, hopearaa, whakanohonoho, arotake manawanui

Ehara i nga pathologies katoa o te pūnaha musculoskeletal taea te whakakorea e te whakapai ake i te kounga o ngā āhuatanga hanganga. I roto i ētahi wā, he mahi ārai o tetahi atu ranei wāhanga. Arthrodesis o te tahi pona - taua pokanga. riro tōna whāinga tango huānga nonviable whakatika te tuaka e alangá raro me te warea atu o ngā hanganga anatomic i roto i te āhuatanga whaiaroaro. I raro i te mea tikanga whakamana te arthrodesis o te pona? He aha e nga hopearaa o te mau parau tumu wawaotanga me te whakanohonoho? Mō tenei - i muri mai i roto i te tuhinga.

Tuhinga mō te pokanga

Arthrodesis - pokanoa, ai ta'e ngāue te tahi, me te āwenewene whakaritea i roto i te tūranga. Ko te hiahia mo te mahi hāparapara he mooni i roto i te wā e whai ake nei:

1. Ko te aroaro o nao tahi. puta tenei huru i roto i te tahi interosseous papamuri riaka. E nehenehe te reira wāhanga oti ranei. Ko te hua ko te takahi o te deformation o mahi whaiaroaro i roto i te tahi (pāpāngia roa o uaua, haea mea tuhonohono e, whara pū, hononga toronga nui).
2. Whanaketanga o deforming rumati. Arthrodesis o te tahi pona, arotake e pā ana ki e taea e koe te pānui i raro, e hiahiatia ana te i te purulent, tuberculous me te ahua pāmamae o te māuiuitanga.
3. rumati degenerative ki pōauautanga. tikanga pathological i uta e huringa i roto i te wheua epiphysis.
4. Fifi o te whakamemeke.
5. He whatinga e whakaora nei tano ore hanumi i roto i te mua ranei.
6. Ki te tika, te implantation o etahi katoa ranei o te tahi, ki te he ka taea atu momo o wawao.

contraindications

araia Arthrodesis o te pona (e tino onge i muri pokanga nga hopearaa o te huru kino, me pōauautanga) te ki te kawe i roto i te wā e whai ake nei:

• tae noa ki te mea te taiohitanga tae noa ki te pūnaha musculoskeletal i roto i te wā o te tupu;
• aroaro fistula pūāhua tubercular meinga e te mahi o te mycobacteria mohiotia rerekē;
• te aroaro o te mate i roto i te rohe o te wawaotanga;
• huru nui o te manawanui, te kore o te pūmautanga i runga i te wā.

I muri i 60 tau o te mahi o arthrodesis o te pona e taea meinga hoki pōauautanga nui.

momo o te wawaotanga

Wehewehe ngā momo matua e rima o te pokanga i runga i te ahunga whakamua o te whawhe me taputapu whakamahia rānei:

• kawea kōtuitui-articular arthrodesis o te tahi pona e i roto i te tango o te wheua ngohe articular.
• mahi anō-articular tukanga e honohono a Ihakara huānga pikitia tangohia i te manawanui kotahi. Pea te whakamahi o te uhi kaituku.
• arthrodesis ngā o te tahi pona fakatahai momo e rua o ngā mahi. Tangohia i te tahi wheua ngohe me te wheua uhi hononga whakamana e tūhāhā peleti ukamea motuhake.
• hāngai ana te momo toronga o te mahi kei te i runga i te whakahaere o te whati horihori. E whakaritea huānga wheua atu i roto i te tūranga, me te ta'e ngāue taputapu totoro whaiaroaro. I roto i te mau parau te tahi atu, ka karanga i tenei momo o te wawaotanga te "arthrodesis pona Ilizarov".
• whakamana ana te mahi kōpeketanga e whakatika i te huānga tahi ki titi, tatau, rakau, me te tahi atu whakaaro motuhake e whakamahia ana i roto i te traumatology.

rehunga hāngai

e kore te rehunga Local i roto i tenei tikanga hāparapara whakamahia hoki o te meka e e te whawhe wahi i roto i te wheua ngohe me te wheua hanganga hohonu. Hoatu nga momo e whai ake nei o te rehunga:

• rehunga endotracheal - rumakina te manawanui kei roto i te moe faataoto medicaments motuhake i inhalation, tohaina i roto i te puka haurehu waihā;
• rehunga filosilivá - ko te manawanui mohio, kite me rongo katoa, engari rawa ta'e ngāue wahi o raro, me te kore o te tūtohutanga;
• rehunga ngā - analgesia filosilivá ngā ki rumaki i roto i te āhua hawhe-moe, Kei te whakamahia hoki tūroro tino tairongo, me te tairongo rawa.

Arthrodesis o te pona, manawanui mua i tohu e ko kaua roa te mahi, a taea muri i te 2 ki te 6 haora. Tei te reira i runga i te āhua o te pakeke te āhua tuatahi, te wawaotanga tūāhua whiriwhiri me te hiahia mo te taua manawanui te uhi.

faaineineraa manawanui

Arthrodesis o te pona, mua manawanui e tohu i te hiahia mō te faaineineraa te pokanga, titau te whakamātautau oti o te manawanui. Ka rite ki te aroaro o tetahi wawaotanga, me haere operable nga whakamātautau haumanu o toto, mimi, matūora. Te whakatau i te āhua o te coagulation, rōpū toto me te tauwehe rH. Whakaaro whakamātautau whakahauanga mo HIV, pakewakewa, kakā, e pupuri ana x-ray.

7 ra i mua i te pokanga tika ki te whakarere i te raau taero e pā pūnaha upoo- toto, me kore-steroidal taero anti-inflammatory. I tona ra whakamutunga tukua anake kai ngāwari. Ko te ata ki te kai me te inu i te wai i mua i rāhuitia wawaotanga te, ki te karo pōauautanga pea i roto i rehunga.

Kia tino, rite te manawanui ka waiho i roto i te fare ma'i, e hiahia ana koe ki te faaineine i te huru whakamarie i roto i te whare. Ki te tango i tiaki o taua mea e kōkiri:

• tango kaitutei, e te paheke ai;
• rite kiato rite taea ki te waiho i te waea, e takoto ki runga ki te patunga witi, kia e kore te potae te manawanui ki runga ki a ratou;
• te kaukau, ki te hoko i te whāriki ki te kapu momi, kia e kore ia e nuku i runga i te papa mākū;
• whakarite i te whakaurunga e tika ana katoa hoki e mau ana i roto i ngā tukanga akuaku rite tata rite taea, kia rite kore ki te whai ki te tae ratou.

tikanga o

kawea Arthrodesis o te pona whara i muri i ngā tukanga tawhitotia hopuhopu ranei e kua arahina ki maumaui o nga aravihi mahi, kei te roto i te maha ngā wāhanga:

1. tukinotia te rohe o te wawaotanga i te antiseptics, ka hipoki ki te rinena hāparapara horomata.
2. tapahia te ngä tahi te ki te 15 cm te roa. e kore e paparanga dissected fascia me uaua noa nga papa articular whakaaturia i roto i te motu.
3. Kei te nekehia atu ngohe kikokiko, tangohia kore-taea, ka whara huānga tahi.
4. Papa talus me te tibia, e e pai piri ki tetahi ki tetahi, kua hanga e tika. meatia tenei i roto i te tikanga ki te whakatū i te tuaka tika o te e alangá raro.
5. whakaritea te hanganga hua e whare whakarewa motuhake whakaritea tikanga.
6. Na roto i te wā, ka tupu te wheua tahi huānga ki ia atu, me te kore e te tahi i te puka taketake. Ko tōna mahi ka kia wāhanga haere i runga i ki ētahi atu tūemi.

He aha ētahi atu hononga mahi

e kore te mea he wawaotanga motuhake Arthrodesis, kua tatau ai ki runga ki te pona. Waihoki, ka taea e tākuta whētuki immobilize te rohe kikokiko e whai ake nei:

• tahi hip - hua excision o te tīhaetia me te whakatika i te matenga o te pūkaka ki te papatoiake, tonu tino whakaroau te tahi;
• tahi turi Ihakara - whakaaetia te anake i roto i te ngaro o pathologies o te pūnaha Cardiovascular;
• tahi pokohiwi - tukanga e maha te whakamahi i wheua uhi o te manawanui (kore ki te tupu te pato'iraa) kaituku ranei;
• wahapū metatarsophalangeal - te whāinga, ko te ki te whakakore pokanoa ranei valgus deformation koromatua iatrogenic nekeneke tahi pupuri i muri i te wā whakaora.

Ko te take e rapua e arthrodesis o nga hononga, hāngai ki te katoa o te runga ake.

wā whakaora

Arthrodesis o te tahi nga pona, he whakaahua o e tukua te māramatanga taipitopito o te mahi, titau te ora roa. Ko te ra tuatahi e kore koutou e taea te tiki i roto i o te moenga i roto i te tikanga ki te karo pōauautanga taea i rehunga (whanoke, ānini, ruaki).

whakatakoto te tākuta te whakamahi o Pë me kore-steroidal taero anti-inflammatory mō te mamae te tauturu. whakamahia āpiha antibacterial, ki te tika. e pā ana tēnei ki te mōrea tiketike o suppuration i te wāhi o tinana ke (ngira, paraharaha, rakau). O paturopi hoatu hiahia te ki te iti rawa paitini ki te manawanui:

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

Etahi wa i muri te mahi he e tika ana ki te kakahu i te takai raima, ki te hoatu ake te tūranga o te pito o raro tonu tetahi i roto i i tuhia reira he mātanga. Roa o te gypsum taea muri ake ki te 3-4 marama.

Ka tohutohu te tākuta te manawanui ka taea wahi taurite uru ipurangi. Ake tenei e kore e taea te mahi ki te aukati i te rohe mate. I muri i te tango i te maka raima he tika ki te anō-X-ray whakamātautau ki te whakaū i hononga tika o ngā huānga a Ihakara.

Kei te riria te 2 marama tuatahi o takahi i runga i te huha whakahaeretia, kia hiahia koe ki te hoko tootoo, ka haere anake ki a ratou. I 3 marama i muri i te X-ray ki te whakatau i tākuta whētuki taea timata ki te whakawhirinaki i runga i waewae, me te whakamahi i maimoatanga i tua.

i tua

tikanga Rehabilitation muri arthrodesis o te tahi pona te ki ngā therapy tinana, te mirimiri, me ētahi atu āhuatanga i roto i te wāhanga whakaora postoperative. mahi haumanu Ko te tikanga tino nui no te mea te reira te whakawhetai ki a ia tūroro ki te ārai i te whanaketanga o contractures tahi.

O ta te tahi atu tākuta tinana therapy:

1. Electrophoresis - i roto i te rohe pona ko te mana o ngātere hiko tonu. Ka taea te whakahaere ratou mā taka whāngai manga mumura, tetahi raru hopu, faaore ngawhatanga, Whakapūnoa pākia, supply toto ki te whakahohe i te rohe pokanga.
2. UHF - he tukanga i roto i nei i reira ko te mana o te UHF parae hiko i runga i ngā pūtau me te kiko. whakatairanga UHF faaitoitoraa o tukanga whakaora, whakaora o piere me patunga, relieves puku, relieves mamae, whakaongaonga tohanga toto rohe.
3. hiki neke, e whakamahi ana i te papa autō - autō. Puta whakakorenga o te mamae me te edema, araia i whakararu rohe o mate, nui haere elasticity o oko toto, me te whakapai ake i te tohanga toto i roto i te wāhi kua pā.
4. therapy Taiaho - te whakamahi taea o te mata, me te tikanga intraosseous o te rongo, i he wahi o te maimoatanga me te whakaora o nga mate o te hononga iho.

Arthrodesis o te tahi pona, i muri nei e taea whakanohonoho muri ake ki te 8 marama, titau te manawanui mahi tamau runga kita. Anake i roto i tenei take, ko te reira taea ki te karo i te whanaketanga o pōauautanga, me te whakahoki i te mahi o te rohe whakahaeretia.

pōauautanga taea

Ka rite ki ki tetahi pokanga, arthrodesis o te tahi nga pona e taea whai i te maha o pōauautanga:

• mate tahi ki te whanaketanga atu o te tapû-;
• toto, kanokanototo hanganga;
• paresthesia - he takahi o te tūtohutanga rite ki te hua o te tuakitanga o te plexus karere iti;
• kore o te whai wāhitanga ki te whakatika i te tahi;
• totitoti, me ētahi atu kiwi e pathological;
• te hiahia hoki atu ngā tukanga hāparapara;
• thrombosing uaua hohonu o te e alangá raro;
• thromboembolism pera matua.

Kia tino ki te korero i te tohunga o te tohu e whai ake nei:

• kirika;
• mamae nui i te pae o te whai wāhi hāparapara;
• whakapakari o ngawhatanga;
• aroaro o te kōpā mania ranei;
• alangá ranei ahua karawarawa o parauri;
• te ahua o te hāhā o te manawa, whakapairuaki, ruaki.

hauātanga

Arthrodesis o te tahi pona, whakaaro nei ki te kia mono i muri i whakarite te huru onge whakarei whakangungu waewae kino i te manawanui. Hoki wā iti i muri i te mea e taea te wawaotanga o te hauātanga, engari anake ki runga ki te faaho'iraa mai o te huru mahi o te tahi.

E ai ki nga ture, whakaaetia e Order o te Tāhuhu o Reipa, puritia mahi i immobilization takoha o te pona āhuatanga tahi i roto i nuinga o te wā arata'i ki maumaui iti o ngā āhuatanga mahi pateko-hihiri, e te tikanga e kore e whakapumautia te hauātanga.

Na roto i te tikanga o te hauātanga whakapumautia ōrau o te huru mate me te ōwehenga o te māuiuitanga motuhake ki te rārangi i runga ake o mate. A, no te kore e te taumata o te māuiuitanga ki te 30% (whakatau tata e tohunga MSEC Commission) hauātanga whakaturia, 40-60% - he rōpū tuatoru o 70-80% - he rōpū tuarua, 90-100% - te rōpū tuatahi. E tango ana te tamaiti i te hauātanga i reiti i 40 ki te 100%.

e kore e huringa iti i roto i nei e taea ki te mahi ki a ratou ano he tangata he, no ki enei kāwai. I roto i te take o contractures me disorders musculoskeletal o ngā mahi pateko e kua huaina arthrodesis o te tahi pona, te mau hopearaa - hauātanga, te aravihi ki te tango takitahi tiaki o ratou, a ki te whakatau i nga hiahia o te whanaketanga i roto i tenei papamuri o raruraru hinengaro.

mua

E ai ki te hunga e ora te mahi o te immobilization tahi, he mea he tukanga hāparapara faingataa roa e titau te pūkenga tiketike o te tākuta. Ko te wā whakanohonoho ko te wāhi nui kei e tīmata tūroro ongo'i pouri hoki koe me te underperforming i roto i ngā o te mahi o te mahi o ia rā. Ko enei mau hapa hei te huānga matua i roto i te whanaketanga o contractures tahi me mahi nekeneke waimaero.

No mamae, ara i roto i te āhua o pikaunga taimaha, he ora tonu o kiwi e, te kore o te hūhi i roto i te rohe wawaotanga, he ahua Paku pai - tohu o te mahi angitu.