Ubungqina obubonakalayo buxela ukuba umlenze. Iimpawu ze ukusebenza kunye nokuvuselelwa

ukusikwa kwamalungu omzimba igqalwa omnye imisebenzi ezindala kwimbali yezonyango. Iinkcazelo lokuqala yomhla BC kwekhulu 4. e. Noko ke, kukungakwazi ukuyeka ukopha kakhulu, kwakunye yokuswela ulwazi malunga tubal nemithambo kudla ebulalayo. Ugqirha Kucetyiswa Ungalinciphisa libe ngamalungu asibhozo nomzuzwana kwinyama bachaphazelekayo, akubikho ukopha esibulalayo, kodwa zange ayeke ukwanda ukubola.

Xa AD Ngenkulungwane yokuqala, Aulus Cornelius uCelsus wacebisa revolution ukuba indlela ngexesha layo ekuqhutyweni imisebenzi enjalo, eziquka iingcebiso:

- ukuze baphumeze akhronimi yenqanaba yethishyu namahlelo;

- tubal of isiphunzi semithambo ezisemagqagaleni ukunqanda ukopha;

- bezimvu backup wawaxabelela zomzimba yokugubungela isiphunzi ngaphandle kwesimo yezifo.

Indima ebalulekileyo ekuphuculeni iindlela ukusikwa kwamalungu omzimba edlalwa ukuqaliswa indlela yokusebenza kwegazi xa Esmarch yasebenzisa kude kube ngoku rubber band.

Kwindawo hlabathi ephambili lanamhlanje phakathi okukhomba ukuba okwalandelwa nokuhlala seswekile kunye nesifo sentliziyo.

Ukusikwa - akhronimi kwamalungu omzimba, okanye mandithi inxalenye yayo distal, kuba amathambo, kodwa kuya kuba yimpazamo eyoyikekayo ukujonga njengokuba ukususwa elula ingxenye achaphazelekayo. Eli gama libonisa zeplastiki kunye Ukuhlinza, ezijolise ngakumbi kwimo nomonde ngokukhawuleza nangempumelelo.

Kukho imiqondiso ethile olu hlobo lotyando. Cinga ngokufunda data zolwimi ngokunzulu.

Ubungqina obubonakalayo buxela ukuba umlenze

- ukubola.

- Ubukho ugxininiso enzima zosulelo, ezisongela ubomi (usulelo anaerobic) yesigulana.

- ayibuyiseki umva ischemia kwezihlunu contracture.

- eyo syndrome.

- Crush Injury traumatic umonzakalo amalungu iimpahla eziphambili kunye luvo, kwenziwa ngokuba okwalandelwa esibuhlungu.

- isifo occlusive ngesiphumo ukubola.

- tourniquet, wabeka iiyure ezingaphezu kwezintathu.

- Eliqhelekileyo, hayi efanele nezilonda neurotrophic unyango.

- Osteomyelitis kunye nokoyikiswa inxaxheba omzimba lwangaphakathi.

- I sisilonda esidumbileyoesingaphakathi eziqhelekileyo tubercular esiqwini kwamathambo abadala.

- yamathumba bone ebulalayo ngaphandle ithuba kokususa egumbini ekwanti.

Ukumisela izinga resection

Ukukhetha inqanaba okwalandelwa kuxhomekeke iqondo ukuphazamiseka kwegazi kwindawo esisebenza, ubukho ekuboleni, ukuphazamiseka trophic, uthi izicwili ezikufuphi nobukhali yosulelo neentlungu.

Abantwana bazama ukusebenzisa disarticulation (Ukuqhela inxalenye ochaphazelekayo kwinqanaba joint), aluluchaphazeli kakubi ukukhula ithambo ngakumbi.

Ngokutsho ukungxamiseka kotyando ekude umlenze kwemilenze:

- umlenze ngoko nangoko lwenziwa ekunikeleni utyando zoncedo lokuqala ukususa, iithishu ezonakeleyo non-athembisayo;

- operation ezingxamisekileyo akhronimi Iziko ukunxila kunye nokungasebenzi nokusebenzisa endala;

- ezicwangcisiweyo umlenze, olwenziwa izilonda amabi of osteomyelitis ithambo.

- reamputatsiya ukulungisa isiphunzi esibi.

Anikezele setyhula, ukusikwa okweqanda kunye ombaxa. Khawuqwalasele ezi ntlobo ngezantsi.

umlenze setyhula

Yayibubungqina esingundoqo ablation, ezizezi ukufa (setyhula ngaxeshanye) abanqanyulwe ezi njengesilonda igesi kunye nomlenze resection zonekwe kabukho musculocutaneous. Le uphazamiseko yenziwa kuphela olungxamisekileyo ubomi ukugcina. A ethile ebalulekileyo kule ndlela kukubonelela swa non-esebenza kunye reamputatsiya kukubophelela emva ukuziqhelanisa lomzimba afakelweyo ngakumbi ziko.

Abaxhamla kule kukunqongophala ukusikwa utshintsho necrotic manikiniki, maxa wambi igazi lifinyele.

Xa okwalandelwa ukufa wabona off ithambo kwinqanaba efanayo naleyo inyama ithambile.

Njengoko umsebenzi yenzelwa? Okwalandelwa kwinqanaba lokuqala iqulathe kwi liqatywe eluswini, amafutha ongama kunye ifascia. Edge kome isikhumba esinye eyimbali buthelezi. Ngelo isigaba asike lesibini izihlunu amathambo kunye ithambo cut. cover ekupheleni ithambo kungenxa nesikhumba ifascia.

Olu hlobo Kucetyiswa ukuba amasebe imilenze esinobunzima kwezihlunu encinci.

Kuba kumasebe izihlunu mass trohmomentnaya umlenze enkulu kucetyiswa (cone elula, kunye ablation setyhula yi Pirogov).

Izigaba ezibini zokuqala yokusebenza ezifana dvuhmomentnoy okwalandelwa. Ngaphezu koko, emva kokuba beya kwizihlunu zomzimba phezulu kwicala proximal, ukuba izihlunu re-cut azotywe ngeenxa ngohlangothi esikhumbeni. Ngale bayakube maleko kwezihlunu enzulu into enegalelo ekwenzeni kusekwe ngakumbi isiphunzi etsobhileyo.

Iindlela Ukuxokonyezelelwa wabelane:

• kwi odnoloskutnye (ubude caba omnye ulingana ubukhulu be isiphunzi);

• dvuloskutnye (ezimbini bemthandele zobungakanani ezahlukeneyo kwi sum of ubude ekulelona ubukhulu amputiruemoy omzimba).

Xa uyila isiphunzi kufuneka kukhunjulwe ukuba kukuqulungana akufuneki ibe phezu wobuso. Imvuthuluka kufuneka abunjwe kuthathelwa ingqalelo ubuchule ukuthwala imithwalo.

umlenze osteoplastic

Njani na okwalandelwa kweqondo eliphantsi? Uphawu lisahlulayo ubukho ngamaqhekeza bone alekwe periosteum kuhlanganiselo namabala.

ukusikwa osteoplastic yomlenze ngenombolo indlela Pirogov wazuza ingqalelo ehlabathini lonke ngenxa yokuba i kakhulu yimpumelelo kwimo ekupheleni inkxaso yokwakheka yomlenze owawusebenza.

Izinto eziluncedo le ndlela:

- Ngaphantsi bomzimba isiphunzi.

- Ukuba inkxaso lesiphelo isiphunzi.

- Gcina ubuntununtunu proprioceptive izihlunu kunye nemisipha.

amanyathelo enkqubo

Xa ukususa lesiquluba, ukusikwa ezimbini zenziwa Pirogov. Ukulungiselela le njongo, ukusikwa imela. Okokuqala ukuvelisa cut cross izicwili ethambileyo, exwebula buvele edibeneyo amaqatha ngakumbi isebenze icandelo arcuate ngokwandisa ecaleni dorsum yonyawo. Emva kokuwela nemisipha osisi ukwenza kwaleli talus, sawing ithambo lesiquluba. A cross-icandelo ivaliwe ngamabala. Yakha isiphunzi.

Ukusebenza Sharpe

Kukho nenye indlela apho wenza i ukusikwa nemilenze.

Xa ususa unyawo soft esiqwini asike ikhutshwa phandle besentimitha ezimbalwa phalanges distal wethambo amadeo yokuqala. Emva periosteum otpreparovyvaniya luyenziwa namarhela metatarsals kunye smoothing abaqingqi abo bonke abakubonayo kunqunyulwa. Sika amabala cover plantar.

Cinga Iimbangi ezingundoqo okwalandelwa.

microangiopathy seswekile

Iintshukumo ugqirha kuxhomekeke kubungakanani umonakalo. Ngedlela esi sifo esigqugqisa izilonda ubovu necrotic amabakala ezintlanu:

- necrosis phezulu ngaphandle imisipha amoyise.

- njengesilonda umnwe ebandakanya le ndlela yokuhlasela yokuqala kunye imicu.

- The bandile njengesilonda yeminwe, zidibene njengesilonda senyawo.

- sisilonda esidumbileyoesingaphakathi xuki unyawo yonke.

- Ukubandakanyeka inkqubo lesiquluba.

Kwi yokwamkelwa ngomonde ischemia necrotic zabanjwa kwimo olungxamisekileyo le eziko, ekukho ekuvuleni ithumba, kutsalwe amathumba, resection incinane inxalenye uchaphazelekayo womGaqo amathambo kunye nokususwa nyama. Emva Ukusikwa izihlunu nonviable Kucetyiswa ukusebenza ukubuyisela ukuhamba kwegazi eyaneleyo nemilenze ezonakeleyo.

Ischemia:

- isidanga sokuqala lwenziwa kuphela Iziko ucoceko;

- amandla yesibini kuthetha okwalandelwa iminwe achaphazelekayo kunye nenkqubo Ukusikwa ababandakanyekayo imisipha;

- xa isidanga wesithathu wenziwe abanqanyulwe kwi Sharpe wasebenzisa imela okwalandelwa okhethekileyo;

- unyango weqondo lwesine resection kwi lesiquluba;

- e iqondo yesihlanu okwalandelwa lwenziwa kwinqanaba esinqeni.

Frostbite neminwe kunye namanye amalungu omzimba

ahluke:

• ukuqanda (utshintsho zophendlo lwezifo kwi Amalungu nezihlunu, nokuphuhlisa ngenxa yokuba ukuphazamiseka yegazi kunye ischemia ngakumbi ingqondo ngenxa lobushushu eliphantsi elide-Acting) iyonke;

• perfrigeration (ebonakalisa indlela ezingapheliyo yokukrala ulusu ngohlobo a amabala enamaxolo oluhlaza-purple kunye ukurhawuzelela kakhulu.

Kukho degrees ezine:

Le isidanga sokuqala lukhatshwa utshintsho ingathityazwa ulusu: erythema, ukudumba, ukurhawuzelela, iintlungu kunye novakalelo nciphisa engavezwanga. Emva kweentsuku nje ezimbalwa indawo nababandakanyekayo exfoliated.

Kuba ngokuzalana luphawulwa ukuvela amaqamza ezinomthamo ukukhanya, wavakalisa njengoko ukuhla uvakalelo, mhlawumbi ngenxa yokuba kusulelo wokujoyina ukuphazamiseka trophic.

Isigaba sesithathu kuboniswe utshintsho necrotic kwi kwizihlunu ezithambileyo ngenxa ukuba uyafa, wakha umgca kwemida (kwemida nyama ukusuka okunempilo granulation strip), iindawo ezonakeleyo alo mlenze zidumbu, kunye flora eqale ngeentsholongwane lisenokuba ekuboleni emanzi.

Xa iqondo yesine esiqwini necrosis kudlulela wethambo, kulwelo amadlu kwi ulusu uba omnyama turbid, isikhumba oluhlaza, ubuntununtunu iintlungu shwaka ngokupheleleyo, kwaye blackens mlenze achaphazelekayo zidumbu.

unyango

• degree 1. Rewarming umguli, UHF-unyango, darsonval, yalityatya ngokwamathambo zaqina iponti boric utywala.
• degree 2. Iqhubekekisa ke amaqamza yenziwe. Emva kokuvula i-ulusu lwabo yonakele isusiwe, yokunxiba inxeba sifakwa utywala. unyango systemic zintsholongwane kuyacetyiswa.
• degree wesithathu. Ususa amaqamza excised necrotic izihlunu iqhiya saline hypertonic. Amachiza asetyenziswa ukuthintela usulelo eziziisekondari.
• degree 4-th. Necrectomy (ukususwa izihlunu devitalized) oluqhutywa phaya 1 cm ngaphezu umgca necrosis le. Umlenze lwenziwa emva kokuba ukuyilwa kwento uqweqwe.

nezilonda

njengesilonda Dry usisiphumo disorder olucothayo phambili ubonelelo yegazi kwinyama na uphawu izigulana yegazi kunye endarteritis nya.

Esibonakala ngokungabikho kunxilwe yento ephilayo, ubukho kwahlukanisa ocacileyo kwizikhondo. Xa unyango lokusetyenziswa yolawulo okhulelwe kunokwenzeka.

Faka: iziyobisi ukuphucula izihlunu trophism, unyango systemic isibulala-zintsholongwane. Olu tyando lwenziwa emva kokusekwa umgca ngokucacileyo kwemida.

njengesilonda emanzi kwenzeka ngenxa engasayi nokoyika ejikeleza (iminwe frostbite, thrombosis, imithambo ucinezelo). Lubonakala yi ukunxila kakhulu, akukho umgca kwemida kunye nokudumba libizwe. Umlenze ne njengesilonda zabanjwa ngokukhawuleza, ulawulo okhulelweyo ayamkelekanga. operation lwenziwa emva konyango ubuthi. umgca umlenze kufuneka njengesilonda kakhulu ngaphezulu (kunye nezilonda kucetyiswa okwalandelwa emboniselweni unyawo kwinqanaba hip).

Gas njengesilonda kubonisa ngokupheleleyo ukuba okwalandelwa ukufa. Iimpawu uphawu: ngokukhawuleza, ukudumba ngokukhawuleza ngcembe, ubukho berhasi kwi ancedisana izihlunu, necrosis kunye ithumba kunye ukunyibilikisa inyama ithambile. Ngokweliso imisipha nombala, buthuntu, kulula ukuba kwidayrektri kwi Ngokucofa. Ulusu purple-bamantshontsho xa icinezelwe weva egramza kwaye ezize,. Isigulane ikhalazela olungaphezu, ugcwele ziintlungu.

Iikhrayitheriya yokuhlawula amatyala esiphunzini kunye nokulungela kwayo zokwenziwa olunye

Kuba eqhelekileyo yokusebenza afakelweyo nobude intsalela welungu kufuneka ibe ngaphezulu kuno ubukhulu bayo. Enye into ebalulekileyo imilo wayo komzimba (tapered kancinane ukusuka phezulu ukuya ezantsi) kunye elula. Onge kuqikelelwa nokushukumisa amalungu kukuqulungana ulusu (ukushukumiseka yakhe kunye nokungabikho umanyano kunye isiseko ithambo).

Iimpawu isiphunzi ukhohlakeleyo

- Ukusasazwa kukuqulungana phezu wobuso.

- Uchatha inyama ithambile.

- Ukungabikho tapering isiphunzi.

- Fusion ne kukuqulungana izihlunu, ukuthula yayo.

- ilungiselelo eliphezulu kakhulu izihlunu.

- kwesimo kakhulu le esisesweni ithambo esikhumbeni.

- engafunwa uziziqwempu bone nge umlenze ngezibini amathambo.

- imilo kakhulu etsobhileyo esiphunzini.

Ukwenza ukukhubazeka

Ukusikwa kwamalungu omzimba yi siphene yokwakheka awabangela iqela sokukhubazeka eyabelwe ngokungenammiselo. Ukuba kukho okwalandelwa umlenze, iqela abakhubazekileyo owabelwe ngoko nangoko.

Uqikelelo weqondo zokulahleka umsebenzi ezisebenzayo, ukukhubazeka kunye Ukukhubazeka, kwakunye esinye isabelo ukukhubazeka libandakanywe kwikomiti ingcali kwezonyango-kwimeko yesiqhelo.

Xa ekusekeni iqondo lokukhubazeka ihlolwe:

- Ukukwazi self-nkonzo.

- Ukuba nokwenzeka intshukumo elizimeleyo.

- Lokufaneleka kuqhelaniswa isithuba kunye nexesha kungekho kwezimilo msebenzi yengqondo (kulinganiswa ukuva kunye nombono).

- imisebenzi lezoNxibelelwano, ukukwazi isenzo, ukubhala, ukufunda, njl ...

- Inqanaba ukulawula ukuziphatha zabo (ukuhambelana nezithethe ezisemthethweni, kwindlela yokuziphatha ngentsulungeko uluntu).

- ukukwazi ukufunda, ithuba lokufunda izakhono ezintsha, uphuhliso neminye imisebenzi.

- Ukukwazi ukungena emsebenzini.

- Amandla ukuqhubeka ukusebenza ngaphakathi sikhokelo yemisebenzi wabo emva kokuba kwimeko yesiqhelo kunye nokudalwa iimeko ezizodwa.

- I ukusebenza kunye neqondo uphuhliso sokwenziwa.

Iqela lokuqala

Izinto ezibonisa ukuba ukunikezelwa iqela lokuqala:

- ukusikwa zombini imilenze kwinqanaba hip.

- Ukungabikho iminwe emine (kuquka yokuhlasela lokuqala) kwizandla zombini.

- ukusikwa izandla.

Iqela lesibini

- ukusikwa yiminwe emithathu (kunye phalanges lokuqala) ye ngezandla zozibini.

- Ukususwa iminwe-1 no-2.

- Akukho iminwe 4 lo gama kugcinwe lo phalanges kuqala.

- ukusikwa leminwe esandleni enye isiphunzi eliphezulu esandleni yesibini.

- Nokusebenza Chopart kunye Pirogov.

- resection eliphezulu ngomlenze omnye, idityaniswe kunye nokungabikho iminwe yesandla omnye okanye amehlo.

- okwalandelwa icala iliso.

- disarticulation ihleza okanye negxalaba.

I Iqela lesithathu

- umlenze unilateral iminwe ngaphandle kokususa yokuhlasela yokuqala.

- umlenze kabini-kabini weminwe.

- umlenze High ka umlenze okanye ingalo.

- Susa zombini iinyawo kwi Sharpe.

- Umahluko ubude umlenze we-10 cm.

Rehabilitation emva kotyando

Ukongeza yokwakheka siphene lomzimba umlenze kukhokelela kakhulu umothuko engqondweni nomonde. Isigulane luvalwa phezu iingcinga bephantsi emehlweni oluntu, ikholelwa ukuba ubomi bakhe liphelile.

Impumelelo zokufakelwa elizayo ndagqiba kuphela ukufaneleka imisebenzi, inqanaba okwalandelwa kunye nokhathalelo efanelekileyo yenye isiphunzi.

iintsuku ezi-3-4 emva nothintelo umlenze luqala contractures flexion, ukwenza iintshukumo isiphunzi. Emva ukususwa sutures esebenzayo isiphunzi umthambo kwezihlunu kucetyiswa. Kwinyanga kamva, baqale uzame sokwenziwa yokuqala.

Eyona njongo ibalulekileyo itiphu kukuzinzisa imeko yomguli zengqondo kunye nokusekwa unyango lwakhe eyaneleyo zokwenziwa.

Imisebenzi Eminye ziquka:

- uqeqesho ekusetyenzisweni kwale ngengqondo;

- iseti olulandelenayo ukuvula afakelweyo nokuqukwa yayo motor bazibandakanye ngokubanzi;

- kuqheleke ulungelelwaniso, ukusetyenziswa uqeqesho zonyango kunye angoozenzele.

- imisebenzi zentlalo-yesiqhelo, ukuziqhelanisa ebomini yomguli kunye sokwenziwa;

- ukunciphisa ukuphuhliswa kweenkqubo zomntu ngamnye, ukuba baphinde baqeqeshwe ngokutsha kwaye nengqesho phambili (ukuba amaqela we2 3rd).

Ukuba iintlungu phantom kwi lomzimba inqunyulwe bacebisa ukuba novocaine yaye kuvalwe, ngomlingo kunye nonyango lwengqondo. Ukuba akukho ukuphucuka kungenzeka ukuba afeze utyando kunye resection le-luvo achaphazelekayo.