Izinkomba ngoba umlenze. Izici yokusebenza kanye nokuvuselelwa

ukusikwa kwamalungu omzimba ubhekwa imisebenzi endala emlandweni wezokwelapha. Letinchazelo lokuqala sangomhla 4th BC leminyaka. e. Nokho, ukungakwazi ukopha okunzima, kanye ukuntula ulwazi nge-Ligation semithambo ngokuvamile ebulalayo. Udokotela wasikisela QUNTA esitho ngaphakathi izicubu abathintekayo, ke aqede ukopha ebulalayo, kodwa akazange ayeke ukusabalala esibhibhayo.

Ngo ekhulwini lokuqala leminyaka AD, Aulus Cornelius Celsus aphakanyisiwe evula yayo indlela isikhathi ngokuziphatha imisebenzi enjalo, ezazihlanganisa izincomo:

- ukufeza akhronimi ezingeni kwezicubu iphila;

- Ligation ka angawodwa isiqu semithambo ukuvimbela ukopha;

- yokugunda isipele uhlakaze izicubu ukumboza isiqu ngaphandle ukungezwani sokugembula.

Indima ebalulekile ekwenzeni ngcono izindlela ukusikwa kwamalungu omzimba kudlalwa ngokwethula indlela yokusebenza ngaphandle kwegazi lapho Esmarch yasebenzisa kuze kube manje band zenjoloba.

Ezweni isikhundla lanamuhla aholayo phakathi izinkomba for ukunqunywa hlala sikashukela kanye nesifo senhliziyo.

Ukunqunywa - akhronimi nemilenze okungukuthi, noma kunalokho ingxenye yayo distal, ngokuba amathambo, kodwa kuyoba iphutha elibi kakhulu ukulibuka njengoba ukususwa elula ingxenye ethintekile. Leli gama lisikisela plastic nokuhlinzwa reconstructive, okuhloswe ngazo eminye okusheshayo futhi ngempumelelo isiguli nokuvuselelwa.

Kukhona izinkomba ezithile ngoba lolo hlobo lokuhlinza. Cabanga ukufunda idatha ngokuningiliziwe.

Izimpawu ze-ukunqunywa

- esibhibhayo.

- Ukuba khona focus esindayo ukutheleleka, okusongela impilo (anaerobic ukutheleleka) lesiguli.

- awushintsheki ischemia imisipha contracture.

- wayichoboza syndrome.

- Crush Ukulimala Obungapheli ngukulimala nemilenze izitsha main nezinzwa, olwenziwa kangaka okuthiwa ukunqunywa esibuhlungu.

- isifo occlusive ngomphumela esibhibhayo.

- tourniquet, eziphoqelelwe isikhathi esingaphezu kwamahora amathathu.

- Common, hhayi amenable ekwelashweni neurotrophic izilonda.

- osteomyelitis nosongo olukhulu yangaphakathi isitho ukuzibandakanya.

- Okuvame lesion tubercular ithambo izicubu kwasebekhulile.

- Ebulalayo ithambo izimila ngaphandle kokuba nokwenzeka kokukhipha ekamelweni angawodwa.

Icacisa ezingeni resection

Ukukhetha ezingeni ukunqunywa kuncike degree kwegazi iziyaluyalu endaweni eziqhutshwa, khona esibhibhayo, iziyaluyalu trophic, zithi ezicutshini ezincikene nawo nokugasela ukutheleleka futhi ubuhlungu.

Izingane uzame ukusebenzisa disarticulation (kwemihlambi ingxenye abathintekayo ezingeni ngokuhlanganyela), akwephuli eminye bone ukukhula.

Ngokusho ukuphuthuma ukuhlinzwa isehlane ukunqunywa esitho:

- ukunqunywa ngokushesha wenziwa ekunikeleni ukuhlinzwa usizo lokuqala ukususa non-iphila, izicubu ezilimele;

- ukusebenza eziphuthumayo nge akhronimi kwemizi ukudakwa nge nokungasebenzi zokwelapha olandelanayo;

- kuhlelwe umlenze, iqhutshwe izilonda abulalayo ka bone osteomyelitis.

- reamputatsiya ukulungisa isiqu zokungenela.

Ukwaba isiyingi, okweqanda futhi zezindwangu ukunqunywa. Cabangela lezi zinhlobo ngezansi.

ukunqunywa isiyingi

I izinkomba esiyinhloko ablation, okungukuthi guillotine (isiyingi kanyekanye) amputations kukhona igesi esibhibhayo nezitho zomzimba resection elenga kungasali nelincane musculocutaneous. I ukuphazamiseka Kwenziwa kuphela eziphuthumayo ukuphila-bonge. A ethile ebalulekile yaleli su ukunikeza die-non-functional futhi okwalandela reamputatsiya esibophezelayo ukuzivumelanisa esitho sokwenziwa ukusungulwa olwengeziwe.

Buhle lokhu ukuntuleka ukunqunywa izinguquko necrotic bube manikiniki, ngisho nalapho encishisiwe liningi igazi.

Lapho ukunqunywa guillotine wabona off ithambo ezingeni efanayo ukuthi we izicubu zomzimba ezithambile.

Njengoba ukusebenza wenziwa? Ukusikwa kwamalungu esigabeni sokuqala esakhiwa ngo imbobo isikhumba, amafutha ongama bese fascia. Edge Shanela isikhumba kuyinto eyingqopha okwengeziwe ngasonqenqemeni. Ngesikhathi yesibili asike izidumbu zabantu esiteji imisipha ukuba amathambo futhi eminye cut ithambo. ikhava ithambo ekupheleni kungenxa isikhumba futhi fascia.

Lolu hlobo Kunconywa yiminyango nasemilenzeni nge yemisipha elincane.

Ukuze iminyango emikhulu yemisipha trohmomentnaya ukunqunywa Kunconywa (Isigaxa elula, futhi ablation isiyingi nge Pirogov).

Laba bobabili izigaba lokuqala ukusebenza zifana dvuhmomentnoy ukunqunywa. Ngaphezu kwalokho, ngemva ngokuhambisa kwemisipha izicubu olukha phezulu ohlangothini proximal, kuyinto imisipha kabusha Imi ungenisa emaphethelweni isikhumba. Ngalesi bafa imisipha izingqimba ezijulile ukuthi kunomthelela kwetinhlavu obengeziwe isiphunzi oyindilinga.

izindlela Awokuchibiyela ukwabelana:

• ku odnoloskutnye (ubude eyodwa ichopho uyalingana ubukhulu esiphunzini);

• dvuloskutnye (ezimbili amanikiniki ezinobukhulu obuhlukahlukene ku isamba ubude akha ububanzi amputiruemoy nemilenze).

Ngo obumba isiqu kumele kukhunjulwe ukuthi yesibazi akufanele kube phezu umsebenzi. Izinsalela kufanele abunjwe ikhumbula ikhono athwale imithwalo.

ukunqunywa osteoplastic

Injani ukunqunywa wemikhawulo aphansi? Isici ehlukile kuba phambi izinsalela embozwe periosteum lichaza ekwakheni nezimagqabhagqabha.

ukunqunywa osteoplastic we umlenze ephansi-indlela Pirogov baqashelwa emhlabeni wonke ngenxa obe yimpumelelo yokwakheka ekupheleni ukwesekwa nokuvuselelwa umlenze eziqhutshwa.

Izinzuzo indlela:

- Ngaphansi soreness isiqu.

- Ukuba ukusekelwa sokuphela isiqu.

- Gcina ukuzwela proprioceptive ka ezicubwini.

izinyathelo zenqubo

Lapho kukhishwa i-tibia, sebeziqhumbuza ezimbili zenziwa kwi Pirogov. Ngenxa yale njongo, ukunqunywa ummese. Okokuqala ukukhiqiza Imi engu- kwezicubu ezithambile, eneka joint iqakala okwengeziwe usebenze kwesigaba arcuate kuyoshaya eduze dorsum senyawo. Ngemva kokuwela nemisipha lateral ukwenza ngabodwa we talus, tibia ithambo sawing. A cross-section ivaliwe nezimagqabhagqabha. Ifomu isiphunzi.

Ukusebenza Sharpe

Kukhona enye indlela ngawo wenza ukusikwa kwamalungu omzimba aphansi.

Uma ukhipha unyawo athambile izicubu asike izidumbu zabantu Kwenziwa ngamasentimitha ambalwa phalanges distal we metatarsal ithambo kuqala. Ngemva periosteum otpreparovyvaniya is ezenziwe sawing metatarsals futhi ahlelembe bezihlahla zonke wabona ukusika. Sika ikhava plantar nezimagqabhagqabha.

Cabanga kwezimbangela eziyinhloko ukunqunywa.

microangiopathy sikashukela

Izenzo udokotela ohlinzayo kuxhomeke ezingeni esiphakamisa umonakalo. On nokudlanga izilonda ubovu necrotic izigaba ezinhlanu:

- necrosis okukha phezulu ngaphandle kokunqotshwa imisipha.

- esibhibhayo umunwe ezihilela ndlela yokuhlasela yokuhlanganisa izihlangu kuqala futhi umsipha.

- I esibhibhayo okwandile iminwe, kuhlangene esibhibhayo senyawo.

- lesion gangrenous lonke unyawo.

- Ukuzibandakanya inqubo tibia.

On yokuvuma isiguli nge ischemia necrotic labetibambile eziphuthumayo nokuvuselelwa eziko, esakhiwa ngo kokuvula ukusika ithumba, amanzi ka abscesses, resection sakugcina ingxenye ethintekile esihlasela amathambo futhi ukususwa izicubu efile. Ngemva excision kwezicubu nonviable Kunconywa ukusebenza ukubuyisela ezanele ukugeleza kwegazi nemilenze ezilimele.

Ischemia:

- ngezinga lokuqala wenziwa ukuthuthwa kwendle kwemizi kuphela;

- amandla wesibili kusho ukunqunywa neminwe eshile inqubo excision ezihilelekile kule imisipha;

- lapho degree lwesithathu eyenziwa amputations ku Sharpe wasebenzisa ummese ukunqunywa ekhethekile;

- ekwelapheni ngezinga wesine resection ngesikhathi tibia;

- ngesikhathi degree okwesihlanu ukunqunywa wenziwa ezingeni okhalweni.

Frostbite neminwe nezinye izitho zomzimba

ukuhlukanisa:

• Imininingwane okokuqandisa (izinguquko sokugembula e kwezitho nezicubu zomzimba, ukuthuthukisa ngenxa iziyaluyalu kwegazi futhi ischemia okwengeziwe zobuchopho ngenxa lokushisa ongaphakeme eside oyibamba);

• perfrigeration (wabonakaliswa ezingamahlalakhona ukusabela ukuvuvukala isikhumba ngesimo bluish-purple zibe maholoholo nezimagqabhagqabha nge ukulunywa ezinzima.

Kukhona ama-degree amane:

Izinga lokuqala kuhambisana izinguquko esethola kwesikhumba: erythema, ukuvuvukala, ukulunywa, ubuhlungu kanye nokuzwela ukwehla engavezwanga ngamazwi. Ngemva kwezinsuku ezimbalwa le ndawo ethintekile kuthiwa exfoliated.

Ukuze besigaba sesibili libhekene ukubukeka Bubbles nge okuqukethwe ukukhanya, wezwakalisa njengoba ukwehla ukuzwela, kungenxa ukutheleleka ngokujoyina iziyaluyalu trophic.

Isigaba sesithathu kuboniswa izinguquko necrotic e izicubu zomzimba ezithambile ngenxa befa, ukwakha umugqa ukutjheja imikhawulo (ukurhunyezwa izicubu abafileyo granulation strip enempilo), izindawo ezilimele esitho mummified, ne ukubusa microbial flora angagcina esibhibhayo ezimanzi.

Lapho degree wesine kwezicubu necrosis kudlulela ithambo, oketshezini Bubbles isikhumba kuba black turbid, isikhumba bluish, ubuhlungu ukuzwela ubalekela ngokuphelele, futhi blackens esitho ethintekile mummified.

ukwelashwa

• degree 1st. Rewarming isiguli, UHF-therapy, darsonval, esitho yiqhwa zaqina iphawundi boric utshwala.
• degree 2nd. Ukucubungula Kwenziwa Bubbles. Ngemva kokuvula isikhumba sabo ezilimele lisusiwe, sigqoka isilonda sisetshenziswa utshwala. Lefundo yokwelapha ngemithi elwa namagciwane Kunconywa.
• degree Okwesithathu. Ikhipha Bubbles excised necrotic izicubu ngebhandeshi nge nosawoti hypertonic. Imithi elwa namagciwane zisetshenziselwa ukuvimbela ukutheleleka yesibili.
• degree angu-4 th. Necrectomy (ukususwa izicubu devitalized) Kwenziwa-1 cm ngenhla umugqa necrosis. Ukunqunywa wenziwa emva kumiswa uqweqwe.

esibhibhayo

esibhibhayo Dry kuwumphumela kancane disorder okuqhubekayo kwegazi ezicutshini sici iziguli isifo sokuqina kwemithambo yegazi kanye endarteritis nya.

Libhekene ukungabi lokudakwa umzimba, khona ukutjheja imikhawulo ecacile kushaft. Ekwelapheni Ukusetshenziswa okungaba khona ukuphathwa okhulelwe.

Sebenzisa: izidakamizwa ukuthi ngcono izicubu trophism, letindzala yokwelapha ngemithi elwa namagciwane. Ukusebenza Kwenziwa emva ukwakha umugqa esicacile ukutjheja imikhawulo.

esibhibhayo Wet kwenzeka ngenxa ukumisa okukhulu kwegazi (iminwe frostbite, thrombosis, semithambo kokucindezelwa). It libhekene ukudakwa ezinzima, akukho umugqa ukutjheja imikhawulo kanye edema libizwa. Ukunqunywa nge esibhibhayo labetibambile ngokushesha, ukuphathwa okhulelwe akwamukeleki. msebenzi wenziwa emva kokwelashwa ngokukhishwa kobuthi egazini. ukunqunywa umugqa kumele kube esibhibhayo kakhulu ephakeme (nge izilonda Kunconywa ukusikwa kwamalungu hold unyawo ngesikhathi hip ezingeni).

Negesi esibhibhayo kuyinkomba ngokuphelele ukunqunywa guillotine. izimpawu Isici: evelele, ukuvuvukala ngokushesha lesichubekako, khona igesi emisipheni nemisipha, necrosis futhi ithumba ne encibilika izicubu zomzimba ezithambile. Yesilinganiso imisipha lemicu empunga elinamathela othini, zomile, kulula crumple ku palpation. Skin onsomi-bluish, lapho sicindezelwe wezwa crunching futhi creaking. Isiguli ekhononda ka babulawa, Echichima ubuhlungu.

Indlela solvency esiphunzini kanye ukulungela yayo emkhakheni wezitho zokwenziwa okwengeziwe

Ukuze ukusebenza evamile sokwenziwa nobude bokungasetshenziswa joint kufanele sibe ngaphezu ubukhulu bayo. Begodu kuqakathekile ezakheke bokuphila (kancane tapered kusukela phezulu kuya phansi) futhi ngaphandle kobuhlungu. Alondoloziwe Kulinganiselwa ukuhamba ngisho namalungu isikhumba isibanda (ukuhamba kwakhe kanye nokuntuleka nokubumbana nge ithambo isisekelo).

Izimpawu isiqu ngonya

- Distribution yesibazi phezu umsebenzi.

- izicubu zomzimba ezithambile okweqile.

- Ukungabonakali tapering isiqu.

- Fusion ne isibanda izicubu, obucwathile yayo.

- ilungiselelo Too eliphezulu imisipha.

- ukungezwani ngokweqile kwesikhumba ithambo sawdust.

- Ukwenqabela ithambo izingxenye ne ukunqunywa abhanqiwe amathambo.

- ukuma kakhulu oyindilinga esiphunzini.

Ukwenza ukukhubazeka

Ukusikwa kwamalungu omzimba kuyinto isici yokwakheka ezibangele iqembu ukukhubazeka babelwe unomphela. Uma kwakuba khona ukunqunywa umlenze, iqembu ukukhubazeka babelwe ngokushesha.

Ukulinganisa degree of nokulahlekelwa umsebenzi ukusebenza, ukukhubazeka kanye Ukukhubazeka, kanye esinye isabelo yokukhubazeka waziphatha ekomidini uchwepheshe wezokwelapha-ukuvuselelwa.

Ekusunguleni degree of ukukhubazeka uhlolwa:

- Ikhono self-service.

- The kungenzeka ukunyakaza ezimele.

- Ukwanela kwezinto orientation emkhathini nesikhathi ngokungabi bikho zokugula umsebenzi engqondo (kulinganiswa kokuzwa futhi umbono).

- imisebenzi Ukuxhumana, ikhono isenzo, ukubhala, ukufunda, njll ...

- Izinga ukulawula ukuziphatha kwabo siqu (ukuhambisana namazinga zomthetho, kuyisiphazamiso esimisweni sokuhle nokubi umphakathi).

- yokufunda ikhono, ithuba lokufunda amakhono amasha, ukuthuthukiswa kwamanye ubuchwepheshe.

- Ikhono bahlanganyele umsebenzi.

- Amandla bayaqhubeka besebenza ngaphansi kohlaka nemisebenzi yabo professional ngemva ukuvuselelwa kanye ukudalwa izimo ezikhethekile.

- Ukusebenza kanye degree yentuthuko sokwenziwa.

Iqembu lokuqala

Izinkomba ukuba umklomelo we iqembu lokuqala:

- ukusikwa kwamalungu imilenze yomibili ezingeni hip.

- Ukungabi bikho iminwe ezine (kuhlanganise ndlela yokuhlasela yokuhlanganisa izihlangu lokuqala) izandla zombili.

- ukunqunywa yezandla.

Iqembu lesibili

- ukusikwa kwamalungu iminwe emithathu (ne phalanges lokuqala) yezandla kokubili.

- Ukususwa 1 no-2 iminwe.

- Cha iminwe 4 ebe egcina phalanges kuqala.

- ukusikwa kwamalungu tingalo esandleni sinye nge isiphunzi okusezingeni eliphezulu esandleni wesibili.

- Ukusebenza Chopart futhi Pirogov.

- resection Ephakeme umlenze owodwa, ngokuhlanganiswa ukungabi khona iminwe yesandla esisodwa noma iso.

- unqunywe esinye isandla esisodwa bese iso.

- disarticulation hip noma ehlombe.

Iqembu lesithathu

- ukunqunywa unilateral iminwe ngaphandle kokukhipha ndlela yokuhlasela yokuhlanganisa izihlangu kuqala.

- ukunqunywa kabili emaceleni yeminwe.

- ukunqunywa Ephakeme umlenze noma ingalo.

- Susa totimbili Sharpe.

- Umehluko emlenzeni ubude 10 cm.

Ukuvuselelwa ngemva ukunqunywa

Ngaphezu yokwakheka isici esitho ukunqunywa kuholela sina ukuhlukumezeka ngokwengqondo nesineke. Isiguli uvala phezu imicabango bebancane emehlweni umphakathi, akholelwa ukuthi ukuphila kwakhe iphelile.

Ukuphumelela wokufakelwa esizayo kunqunywa hhayi nje ngenxa yezinkulumo Ukwenza imisebenzi, izinga ukunqunywa nokunakekela okwalandela efanele isiqu.

3-4 izinsuku emva ukunqunywa zokuvimbela iqala flexion contractures, enza isiqu ukunyakaza. Ngemva ukususwa sutures asebenzayo umsebenzi imisipha isiqu Kunconywa. Ngemva kwenyanga, baqale ukuzama sokwenziwa kuqala.

Umgomo obaluleke kunayo yonke nokuvuselelwa ukuletha uzinzo esimweni lesiguli ngokwengqondo kanye kumiswa ayokwelashwa ezanele emkhakheni wezitho zokwenziwa.

Imisetjenzana iragela phambili zihlanganisa:

- ukuqeqeshwa e ukusetshenziswa sokwenziwa;

- iqoqo umzimba ukuze kusebenze sokwenziwa kanye ukufakwa yayo kule jikelele motor ngemibono;

- ukuzinza kokuxhumana, ukusetshenziswa nokwelapha kanye nomlenze wokufakelwa.

- imisebenzi zenhlalo-mpilo wokusiza imilutha, lithathelwe ekuphileni lesiguli nge sokwenziwa;

- ukunciphisa ukuthuthukiswa izinhlelo ngazinye, kabusha futhi umsebenzi olwengeziwe (amaqembu 2 kanye 3rd).

Uma uhlangabezana ubuhlungu phantom i esitho unqanyulwe ukuncoma ukuthi novocaine ukuvinjelwa, ukuluthwa ingqondo futhi ukwelashwa kwengqondo. Uma kukhona intuthuko kungenzeka ukuba afeze ukuhlinzwa nge resection we emsipheni ethintekile.