Neketani arthrodesis: pokuvhiyiwa, mibairo, vapore, kushivirira wongororo

Havasi vose pathologies ose zvetsandanyama nemapfupa ino inogona kubviswa nokuvandudza unhu STRUCTURAL zvinhu. Mune zvimwe zviitiko, ichivharira kushanda mumwe kana kupfuura zvikamu. Arthrodesis of neketani muhudyu - kuvhiya kwakadaro. chinangwa chacho anova achibvisa nonviable okunze kugadzirisa rezasi muzvidimbu akabatana uye mberi Kuda kutamba ose anatomic hurongwa ari vasiri ezvinhu. Under chii ezvinhu rinoitwa arthrodesis pamusoro neketani? Ndezvipi zvakaipira kupindira uye vapore dzemitemo? About ichi - Papera munyaya.

Zvairatidza kunorapwa

Arthrodesis - chipingaidzo, sezvamakaropafadzwa vagari kuita chinhu uye artificially wakaiswa panzvimbo. Kudiwa munhu kuvhiya kuvhiyiwa hakudzivisiki zvinotevera nyaya:

1. Kuvapo dangling rwakashodoka. Izvi ezvinhu rinowanikwa necheseri kunototiomesera interosseous rwakashodoka. Zvinogona kukwana kana zvakakwana. Zvinoguma kutyora deformation kuti vasiri basa mukati vagari (mazhinji kuoma tsandanyama, mapfupa dzakabvaruka, vapfurwa kukuvara, kunyanya kuwedzera majoini).
2. Kugadzirwa deforming chearthritis. Arthrodesis of neketani muhudyu, wongororo izvo unogona kuverenga pazasi, chinodiwa pane imwe purulent, tuberculous uye dzechimwe muchimiro zvokurwara.
3. Chinopedza chearthritis pamwe matambudziko. Pathological ezvinhu kunotoreva kuchinja pfupa epiphysis.
4. Matambudziko poriyo.
5. A kutsemuka anorapa isina kukodzera kana akabatanidza kare.
6. Kana zvakakodzera, muchibereko zvimwe kana yose muhudyu, kana mamwe marudzi kupindira zvinobvira.

Contraindications

Arthrodesis of neketani (nemigumisiro zvakaipa hunhu, uye zvakaoma kunzwisisa zviri mashoma chaizvo pashure pokuvhiyiwa) chinorambidzwa kuita zvinotevera nyaya:

• kusvikira kuyaruka kusvikira zvetsandanyama nemapfupa hurongwa ari padanho kukura;
• Kuvapo fistula tubercular hunhu kunokonzerwa kuitwa kanganisika atypical mycobacteria;
• kuvapo chirwere munzvimbo kupindira;
• chakakomba ezvinhu omurwere, kushaya nokugadzikana pamusoro nguva.

Pashure pemakore 60 nokushanda arthrodesis of neketani kunogonawo kukonzera zvakakomba matambudziko.

mhando kupindira

Kusiyanisa nezvemarudzi shanu chikuru Kuvhiya zvichienderana mberi bata uye kushandiswa michina:

• Intra-articular arthrodesis pamusoro neketani joinhi kuitwa nokubviswa articular shwashwa.
• Extra-articular nzira kunoitwa Bonding mhou zvinhu mifananidzo kubva chete murwere. Zvichida kushandisa nomupi batanidza.
• Combined arthrodesis of neketani muhudyu rinobatanidza zvose mhando remapazi. Bvisai vagari shwashwa uye mapfupa batanidza chokuedza rinoitwa nevanhu kudyara chaiyo edare.
• The ekisitenjeni mhando kushanda inobva nomufambiro chakagadzirwa kutsemuka. Uyezve pfupa zvinhu zviri wakaiswa panzvimbo uye kuita chinhu vasiri rwakatambanudzwa midziyo. Nemamwe mashoko, kwakadai kupindira anonzi "arthrodesis neketani Ilizarov".
• The compression oparesheni rinoitwa nevanhu kugadzira Joint chinhu pamwe spokes, pivots, matanda uye zvimwe mano inoshandiswa traumatology.

zvinoshanda yokutindivadza

yokutindivadza Local iyi kuvhiya harishandiswi nekuda chokwadi kuti kuchinja kunoitika zvakadzama shwashwa uye mapfupa ezvirevo. Shandisa zvinotevera mhando yokutindivadza:

• endotracheal yokutindivadza - murwere Kunyudzwa rufimbi hope chaidzo medicaments kubudikidza inhalation, ari akaparadzirwa gaseous chimiro;
• musana yokutindivadza - murwere anoziva, anoona uye anonzwa zvose, asi maoko nemakumbo yakaderera kuita chinhu chose uye kushaya nehanya;
• aibatanidza yokutindivadza - musana analgesia pamwe mumvura vari kutotsimwaira mamiriro, rinoshandiswa varwere zvikuru kugumbuka uye haatani kugumbuka.

Arthrodesis of neketani, murwere uchapupu izvo zvinoratidza kuti oparesheni iri nani refu uye hunogara kubva 2 kusvika 6 maawa. It zvinoenderana zvakaoma sei kwokutanga mamiriro, musanangurwa unyanzvi kupindira uye kudiwa chete murwere wacho batanidza.

murwere gadziriro

Arthrodesis of neketani, murwere uchapupu iyo inoratidza kudiwa preoperative gadziriro, zvinoda kuongororwa rakazara murwere. Sezvo vasati chero kupindira, operable anofanira rasai zvekuchipatara miedzo ropa, weti, nemakemikari omuviri. Kuona mamiriro coagulation, boka ropa uye kusapindirana kweropa chikonzero. Vaiona fanira kuongorora kuti HIV, njovhera, hepatitis, vakabata X-ray.

7 Mazuva asati avhiyiwa zvakakodzera kusiya zvinodhaka kuti chokuita kweropa hurongwa, uye vasiri steroidal Anti-anogumbura zvinodhaka. Zuva rokupedzisira akabvumidza zvokudya safarira chete. The mangwanani kudya nokunwa mvura pamberi kupindira hakubvumidzwi, kuti vadzivise matambudziko panguva yokutindivadza.

Iva nechokwadi, sezvo murwere achava muchipatara, unofanira kugadzirira hwomutambarakede ezvinhu mumba. Kutarisira zvinhu zvakadaro zvinofanira kukura:

• bvisa rugs, izvo zvingazivikanwa kutsvedza;
• sezvo chiine sezvinobvira kuisa tambo, izvo nhema pasi, saka kuti murwere haina akapindwa muropa pavo;
• yokugezera kutenga rukukwe pamwe kubvisa nemikombe, saka kuti arege dzinofamba pamusoro nemadhaka pauriri;
• ronga zvivako zvose zvakafanira kuti kuita utsanana nzira sezvo pedyo sezvinobvira, kuti arege kuva kusvika kwavari.

chidobi pamusoro

Arthrodesis of neketani zvinokuvadza pashure zvisingachashandi kana zvirwere pezvakaitwa zvakakonzera kutyorwa kuri dzichipfekeka mukwaniso, rinoitwa mumatanho akawanda:

1. Nzvimbo kupindira ikarapwa pamwe antiseptics, uye yakafukidzwa chena kuvhiya yomucheka.
2. Vagari fungidziro unotemwa kune masendimita 15 pakureba. Germinativas dissected fascia uye tsandanyama kusvikira articular hukawanika zvisina kuratidzwa mune ronda.
3. Shwashwa rinenge hwaputswa, rakatorwa non-musoro uye akakuvara vadyi okunze.
4. Hukawanika talus uye tibia, izvo zvichaita kukodzera zvakasimba mumwe, vari akaumba zvakakodzera. Izvi zvinoitwa kuti asimbise akarurama akabatana repasi richiripo.
5. The zvichiguma mamiriro iri yakatarwa chinokosha simbi Fittings ngadzirambe nenzira.
6. Kuburikidza nguva, pfupa pachamera pamwe zvinhu nemumwe uye vagari havachazotamburi pakutanga chimiro. mabasa ayo achaitwa zvishoma akagashidzwa nezvimwewo.

Ndezvipi zvimwe majoini ushande

Arthrodesis haisi chairo kupindira kuti rinowanikwa pamusoro neketani. Saizvozvowo, kunotevera vanovhiya anogona kuvakanganise zvinotevera anatomical nharaunda:

• hudyu vagari - kubereka excision of meniscus uye kugadzira musoro femur kusvikira chiuno, vagari anoramba zvachose mira;
• mhou ibvi vagari - anobvumirwa chete pasina pathologies pakati kumwoyo;
• fudzi vagari - nzira iyo kazhinji kushandisa mapfupa batanidza murwere (kwete kuitika kuramba) kana anyatsoronga;
• metatarsophalangeal nekunyatsotsanangura - chinangwa kubvisa vachipindira kana valgus deformation iatrogenic thumbs kwemajoini mufambo ngaunyatsobata mushure pakupora nguva.

Zvikonzero kuti zvinoda arthrodesis pakati mapfundo, anoenderana ose pamusoro.

kupora nguva

Arthrodesis of neketani muhudyu, mufananidzo hunoita tsanangudzo kunzwisisa oparesheni, zvinoda menguva yakareba. zuva rokutanga hamugoni kumuka kuitira kuti tidzivise matambudziko kubva yokutindivadza (dzungu, nomusoro, kurutsa).

Chiremba prescribes kushandiswa analgesics uye vasiri steroidal Anti-anogumbura zvinodhaka kuti kurwadziwa. antibacterial vamiririri akashandiswa, kana zvichidikanwa. Izvi chokuita yakakwirira mukana suppuration panguva nzvimbo kwemiviri vatorwa (tsono, ndiro, tsvimbo). Inorwisa mabhakitiriya zvatinofarira anopiwa kuvaduku chepfu kumurwere:

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

Vamwe nguva avhiyiwa zvakafanira kupfeka varinamire bhandeji, kuti muvake nzvimbo rezasi kumugumo inoramba imwe pacho akanyorwa nyanzvi. Duration kuti gypsum hunogara kusvika 3-4 mwedzi.

The chiremba vakuudzeyi zvekuita murwere pazvinokwanisika achidiridzira nzvimbo paIndaneti kuwana. Pachako izvi hazvigoni kuitwa kudzivirira chirwere nzvimbo. Mushure nokubvisa varinamire chakakandirwa zvinokosha kuzodzosera X-ray aongororwa kuzosimbisa kwakarurama Fusion kuti pave nemapfupa anobudira zvinhu.

The 2 mwedzi achisiya pamusoro vakavhiyiwa gumbo wokutanga chinorambidzwa, saka unofanira kutenga madondoro uye kufamba chete navo. Pana 3 months pashure X-ray kugadzirisa kunotevera vanovhiya angatanga kuvimba netsoka uye kushandisa physiotherapy kurapa.

physiotherapy

Rehabilitation pashure arthrodesis pamusoro neketani muhudyu zvichiitirwa zvinosanganisira kurapa, masaja, uye zvimwe zvinhu zviri postoperative kupora danho. Kuchirapa muviri nzira inokosha nokuti achionga varwere vake kudzivirira kukura pamwe contractures.

Nemamwe chiremba wenyama kurapa prescribes:

1. Electrophoresis - ari neketani nzvimbo ane simba tinyanye yemagetsi pulses. Vanogona kupiwa Via medicated kugadzirira nhungirwa kuzvimba, soreness kusungwa, kubvisa kuzvimba, normalizing muviri, ropa wedzerai Activate kuvhiyiwa wongoramba.
2. UHF - imwe nzira umo pane simba pamusoro remagetsi munda UHF pamusoro masero uye tishu. UHF anokurudzira activation pamusoro rokuzvivandudza rakaita kuti irambe urongwa, kuporesa mitswe uye maronda, anobatsira kuzvimba, anobatsira marwadzo, kunomutsa zveko kweropa.
3. Magnetic - kusuduruka keying, iyo anoshandisa simba remagineti. Kunoitika kubviswa marwadzo uye edema, kutadziswa kukanganiswa kumiganhu chirwere, vakawedzera elasticity midziyo ropa uye kuvandudza ropa kuparadzirwa Munzvimbo.
4. Laser mushonga - zvinoita kushandisa nomumativi intraosseous nzira yokuwana, inova chikamu kurapwa uye kuzoita zvirwere mapfundo.

Arthrodesis of neketani muhudyu, pashure vapore hunogara kusvika 8 months, murwere Zvinoda kuramba basa ega. Chete muchiitiko ichi zvinokwanisika kudzivisa kukura yematambudziko uye adzorere kushanda pakuvhiya nzvimbo.

zvinogoneka yematambudziko

Kungofanana kuvhiyiwa, arthrodesis pamusoro neketani muhudyu anogona kuva nhamba yematambudziko:

• vagari chirwere pamwe pakuzadzisa osteomyelitis;
• ropa, hematoma inotungamirwa;
• paresthesia - kutyora nehanya somugumisiro kwetsinga zviduku tsinga plexus;
• kushaya mukana kugadzirisa pamwe;
• lameness nezvimwe pathological gait;
• kudiwa mamwe maoparesheni;
• thrombosing mutsinga repasi richiripo yakadzika;
• thromboembolism chikuru arteries.

Iva nechokwadi kuti kuudza nyanzvi anotevera zviratidzo:

• fivhiri;
• kurwadziwa panguva nzvimbo kuvhiya kuwana;
• nokusimbaradza kuzvimba;
• Kuvapo chiveve kana tingling;
• muzvidimbu kana blueness chimiro shava makwapa;
• kuonekwa kupfupika mweya, kuda kurutsa, kurutsa.

urema

Arthrodesis of neketani muhudyu, izvo vaiona kuti akaremara pashure isingawanzowanikwi mamiriro zvinoda kunowedzerwa nokudzidziswa gumbo zvakaipa kubva murwere. Nokuti nguva duku pashure kupindira urema kunobvira, asi chete kusvika kudzorerwa kushanda nemamiriro pejoinhi.

Maererano nemitemo, aifarirwa Order of Bazi Labor, vakabata kushanda kubudikidza kumanikidzwa immobilization pamusoro neketani pamwe zvinhu kakawanda kunoita kuti zviduku kutyorwa kunofambira mberi-guru dzichipfekeka maitiro, izvo zvinoreva kuti vakaremara haangasimbiswi.

By hurongwa yokuremara akasimbisa pauwandu hweavo ezvinhu chirwere uye nhamba chaiyo zvokurwara kusvika apa mazita zvirwere. Kana padanho zvokurwara kusvika 30% (zvinofungidzirwa nenyanzvi MSEC Commission) urema haina kuisa, 40-60% - chetatu boka 70-80% - kechipiri boka, 90-100% - boka rokutanga. A mwana anogamuchira urema dzimwe prices kubva 40 kusvika 100%.

kuchinja kuduku umo munhu anogona kushandira pachavo, hamuzi mhando izvi. Kana contractures uye zvirwere zvetsandanyama nemapfupa kuti dzinonzi arthrodesis pamusoro neketani muhudyu, zvakaipira kunofambira mberi mashandiro - urema, nekusagona vakazvimirira kuzvitarisira uye kuti zvinodiwa kukura iyi yaitwa nezvinetso zvepfungwa.

Testimonials

Maererano nevaya vakapona mukushanda pamwe immobilization, ndiko refu kuoma kuvhiya rinoda refu unyanzvi chiremba. The vapore nguva chinhu chinokosha ndechokuti varwere kutanga kuzvinzwira tsitsi uye underperforming panyaya achiurayiwa zuva muviri. Zviri kutadza izvi kuva chinhu chinokosha kukura pamwe contractures uye vasingadzoreki motokari mabasa.

No kurwadziwa, kunyange mumamiriro ezvinhu inorema, yakazara kuzoita gait, kushayikwa kusagadzikana mune kupindira nzvimbo, yakanaka zvizorwa nechitarisiko - zviratidzi rakabudirira kuvhiyiwa.