Zvairatidza kuti kudimurwa. Features hwokushanda uye vapore

kugura Mbabvu ichaongororwa remabhuku remapazi munhoroondo zvokurapa. The Rondedzero yokutanga yomusi remakore 4th BC. e. Zvisinei, nekusagona kumisa zvakakomba ropa, uyewo nokushayiwa zivo pamusoro vascular ligation rinowanzova zvinouraya. Chiremba rakarumbidza truncate mutezo mukati sei nyama, izvozvo anobvisa zvinouraya ropa, asi haana kurega kupararira neronda rinonyenga.

Muzana rokutanga remakore AD, Aulus Cornelius Celsus kunoburitsa echimurenga kuti nguva yaro kutaura nomufambiro kwacho, izvo zvaisanganisira kutevedzera kuti:

- kuita truncation pakati pachiyero zvimwe tishu;

- ligation zviri kure vascular chigutsa kudzivirira ropa;

- yokuvevura negadziriro yeparutivi shred zvinyama kufukidza chigutsa pasina pathological makakatanwa.

An basa rinokosha kuvandudzika nzira kugura Mbabvu reDare kutanga nzira ropa anodawo apo Esmarch anosikwa kushandiswa kusvikira ikozvino rekeni.

Munyika yanhasi kutungamirira chinzvimbo pakati zvairatidza kuti kudimurwa kugara chirwere cheshuga uye zvemwoyo chirwere.

Kudimurwa - truncation nhengo dzake ndiko, kana pane ayo distal chikamu, nokuti mapfupa, asi kwaizova kukanganisa zvinotyisa kuona sechinhu chiri nyore kubviswa njodzi chidimbu. Izvi izwi rinoreva mapurasitiki uye reconstructive kuvhiyiwa, zvainanga mamwe nokukurumidza uye inobudirira murwere vapore.

Pane zvimwe zviratidzo hworudzi urwu kuvhiyiwa. Funga kuverenga mashoko zvizere.

Zvairatidza kuti kudimurwa

- neronda rinonyenga.

- The kuvapo inorema muupenyu chirwere, kutyisidzira murwere upenyu (anaerobic chirwere).

- kusingarapiki ischemia tsandanyama contracture.

- apwanye syndrome.

- Tsika Kukuvara Kwokunetseka vaikuvadza dzomuviri huru nenhumbi uye tsinga, inoitwa atumidzwa zvinorwadza kudimurwa.

- occlusive chirwere pamwe migumisiro neronda rinonyenga.

- tourniquet, vakaisa maawa anopfuura matatu.

- Common, kwete amenable kurapwa neurotrophic maronda.

- Osteomyelitis nengozi yomunyika nhego kubatanidzwa.

- The zvakafanana tubercular lesion repfupa rinenge vakwegura.

- akaipa pfupa mapundu pasina mukana nokubvisa yoga kamuri.

Pakusarudza padanho resection

Kusarudza padanho kudimurwa kunoenderana ukuru kweropa zvirwere iri kuvhiyiwa nzvimbo, kuvapo neronda rinonyenga, trophic zvirwere, in pedyo nyama uye kwokuomerwa neutachiona uye kurwadziwa.

Vana edza kushandisa disarticulation (voga pakati njodzi chikamu panguva vadyi pamwero), hakupesani mberi pfupa kukura.

Maererano nokukurumidzira kuvhiyiwa dzoga richiripo kudimurwa:

- pakarepo kudimurwa anoitwa kushandura rubatsiro rwekutanga kuvhiyiwa kubvisa non-musoro, wakaremara munyama;

- chimbichimbi mashandiro pamwe truncation pachoto kudhaka pamwe inefficiency kuchinja kwomuchipatara;

- vakaronga kudimurwa, inoitwa nyanyisa maronda ose mapfupa osteomyelitis.

- reamputatsiya kugadzirisa zvisina kuvimbika chigutsa.

Govera munhu raundi, elliptical uye Pacchiwaku kudimurwa. Ngatimboongororai izvi pazasi.

tenderera kudimurwa

Huru zvairatidza kuti ablation, kureva guillotine (mawa dzeraundi) amputations vari gasi neronda rinonyenga kuzviremadza resection yakarembera musculocutaneous shred. The chipingaidzo rinoitwa chete nechimbichimbi upenyu-okuponesa. A chinokosha drawback kuti unyanzvi iri kupa asiri dzichipfekeka kufa uye nekutambira kunyorerana reamputatsiya kuchinja muzvidimbu prosthesis mberi pakagadzwa.

Kunakisa iri kushaya kugura necrotic kuchinja kuti bvarurwa, kunyange panguva kuderedzwa ropa rive.

Kana guillotine kudimurwa akaona kure pfupa panguva iyoyo pamwero kwakaita nyoro tishu.

Sezvo oparesheni rinoitwa? Kudimurwa wokutanga Danho chinosanganisira paganda incision, subcutaneous mafuta uye fascia. Edge Tsvaira ganda riri mberi aikosha pamupendero. At chechipiri Danho kwetsinga kuti tsandanyama kune pfupa uye zvakare vakatongoparadzwa mapfupa. pfupa magumo pabutiro imhaka ganda uye fascia.

Izvi mhando yakarumbidza nokuda madhipatimendi maoko nemakumbo ane duku kwetsandanyama.

Nokuti madhipatimendi makuru kwetsandanyama trohmomentnaya yakarumbidza kudimurwa (nyore cône, uye raundi ablation kubudikidza Pirogov).

Zvinhanho maviri oparesheni yokutanga zvakafanana dvuhmomentnoy kudimurwa. Uyezve, pashure zvishoma nezvishoma mumatope tsandanyama uye zvachero zvinyama ari proximal kutungamirira, ndizvo kuzodzosera akavezwa tsandanyama wakavhomorwa kumativi kumucheto ganda. Kuburikidza ichi dzinobviswa rakadzika tsandanyama akaturikidzana chinowedzera mberi paumbwe imwe conical chigutsa.

Pacchiwaku nzira kugoverana:

• pamusoro odnoloskutnye (kureba rimwe kurova-rova akaenzana dhayamita chaJese);

• dvuloskutnye (mbiri dhende kuti hukuru-siyana Verengai urefu vanoumba dhayamita amputiruemoy nemakumbo).

In achiumba chigutsa inofanira kurangarirwa kuti vanga irege kuva basa pamusoro. Scraps anofanira kuumbwa kufungisisa kugona kutakura mitoro.

osteoplastic kudimurwa

Sei kudimurwa repasi wamativi? A nevamwe chinhu ndiyo kuvapo pfupa zvimedu akafukidza periosteum ari Zvinoumba makwapa akasvibirika.

osteoplastic kudimurwa repasi gumbo kubudikidza nzira Pirogov yawana vakazivikanwa pasi nokuda anobudirira zvikuru anatomical kuguma rutsigiro kunaya ari vakavhiyiwa gumbo.

Zvakanakira nzira:

- Kuderera soreness chigutsa.

- Kuita kutsigirwa chigutsa magumo.

- Save proprioceptive nehanya kuti tsandanyama nemarunda.

Maitiro matanho

Kana dzichibvisa tibia, cheka miviri vakaitwa pamusoro Pirogov. Nokuti ichi chinangwa, kudimurwa banga. First pave muchinjikwa chekawo pakati dzakapfavirira munyama, achifumura neketani vadyi mberi ishande arcuate chikamu anomuitira achitevedza dorsum norutsoka. Pashure pokuyambuka lateral nemarunda kuti voga pakati talus, tibia mapfupa Kucheka. A muchinjikwa-chikamu yakavharwa makwapa akasvibirika. Kuumba chigutsa.

Mukushanda Sharpe

Pane imwe nzira iyo akaita chinhu kugura ezasi maoko nemakumbo.

Kana ukabvisa Rutsoka dzakapfavirira zvinyama kwetsinga rinoitwa neboka masendimita mashomanana distal phalanges wokutanga metatarsal mafupa. Pashure otpreparovyvaniya periosteum rinoitwa sawing metatarsals uye rimire vematombo zvose zvakaonwa wakatemwa. Cut pabutiro plantar makwapa akasvibirika.

Funga huru zvinokonzera kudimurwa.

shuga microangiopathy

Zviito chiremba kunobva pakuti kukuvara. On kuwanda purulent necrotic maronda vari muzvikamu shanu:

- zvachero necrosis pasina kukundwa nemarunda.

- neronda rinonyenga munwe chokuita phalanx wokutanga uye mudzira.

- The kwakapararira neronda rinonyenga reminwe, pamwe neronda rinonyenga norutsoka.

- gangrenous lesion rutsoka yose.

- Kuita mubishi pamusoro tibia.

On kubvuma murwere necrotic ischemia akabata kwechimbichimbi kunaya pachoto randinogara mune kuzarura pute, abudise kuti abscesses, usingashandi resection pakati njodzi chikamu pfupa uye kubviswa akafa tishu. Pashure excision pamusoro nonviable zvinyama yakarumbidza oparesheni rokudzorera yakakwana ropa chokubuda wakaremara maoko nemakumbo.

Ischemia:

- wokutanga dhigirii rinoitwa chete kutsvinda pachoto;

- simba chechipiri kunoreva kugura njodzi minwe pamwe excision kwacho munyaya nemarunda;

- kana dhigirii wechitatu pavaiita amputations musi Sharpe akashandisa rinokosha banga kudimurwa;

- pakurapa dhigirii rwechina resection panguva tibia;

- panguva rechishanu mwero iri kudimurwa rinoitwa nenhanho muhudyu.

Frostbite of nemimwe uye dzimwe nhengo dzomuviri

kusiyanisa:

• zvachose nechando (the Kumwe kuchinja kunotanga vari nhengo uye munyama, kukura somugumisiro kweropa zvirwere uye mberi ischemia uropi nokuda yakaderera tembiricha refu-nokuita);

• perfrigeration (kwakaratidzwa chisingaperi anogumbura maitiro ganda iri muchimiro rinokwanisa kucheneruka-dzepepuru scaly makwapa akasvibirika zvakaoma. kuvaviwa.

Kune madhigirii zvina:

The dhigirii yokutanga pamwe reversible rokuchinja paganda erythema, kuzvimba, kuvaviwa, marwadzo uye aikanganiswa kuderera unexpressed. Pashure pemazuva mashoma njodzi nzvimbo dziri exfoliated.

Nokuti rechipiri dhigirii dzinoratidzwa chimiro matema nechiedza kugutsikana, akaratidza sezvo kuderera nehanya, zvichida nokuda chirwere kubatana trophic zvirwere.

Wechitatu Danho kunoratidzwa necrotic kuchinja nyoro zvinyama somugumisiro Vanofa, pova dzinza demarcation (delimitation akafa zvinyama kubva utano granulation ubvise), nzvimbo muzvidimbu zvakakuvadza mummified, pamwe accession microbial kasvisto zvingamuka kunyorova neronda rinonyenga.

Kana chechina mwero zvinyama necrosis kunosvika kune pfupa, iyo mvura iri matema iri paganda anova turbid dema, rinokwanisa kucheneruka ganda, marwadzo utetsa nokupera zvachose, uye blackens njodzi richiripo mummified.

mabatiro

• 1st dhigirii. Rewarming murwere, UHF-kurapa, darsonval, frostbitten muzvidimbu paundi boric doro.
• 2nd dhigirii. Processing rinoitwa matema. Mushure kuvhura ukama ganda ravo yabviswa, vanga kupfeka rikashandiswa doro. Systemic inorwisa mabhakitiriya kurapa inokurudzirwa.
• Third dhigirii. Anobvisa matema excised necrotic zvinyama bhandeji pamwe hypertonic sesaline. Mishonga inoshandiswa hutachiwana yechipiri.
• 4-fung dhigirii. Necrectomy (Kubviswa devitalized zvinyama) rinoitwa pana 1 masendimita pamusoro necrosis mutsetse. Kudimurwa rinoitwa mushure paumbwe yakaoma goko.

neronda rinonyenga

Dry neronda rinonyenga imhaka anononoka mberi kukanganisika ropa wedzerai munyama maitire varwere atherosclerosis uye vatsvaire endarteritis.

Dzinoratidzwa kusavapo kudhaka pamusoro muviri, kuvapo demarcation pachena nomubato. In pakurapa zvichibvira kushandisa pamuviri utariri.

Shandisa: zvinodhaka kuti kuvandudza zvinyama trophism, systemic asingaurayiwi kurapa. The oparesheni rinoitwa pashure wezvamatongerwe mutsetse pachena demarcation.

Wet neronda rinonyenga kunoitika Somugumisiro rikwanise kumbomira wokufambisa (frostbite minwe, thrombosis, vascular compression). It kunoratidzwa zvikuru kudhaka, hapana demarcation mutsetse uye kutaurwa edema. Kudimurwa pamwe neronda rinonyenga wakaitwa zvikurusa, pamuviri utariri nezvisingabvumwi. mashandiro rinoitwa mushure detoxification mishonga. kudimurwa mutsetse zvinofanira dzinokwanisa yepamusoro neronda rinonyenga (pamwe maronda yakarumbidza kugura tsoka vakabata pa hudyu pamwero).

Gas neronda rinonyenga iMhedziso_ chiratidzo nokuda guillotine kudimurwa. Mamirire zviratidzo: raidudzwa, nokukurumidza mberi kuzvimba, kuvapo gasi munyama uye tsandanyama, necrosis uye pute pamwe kubvunda nyoro tishu. Nemaziso tsandanyama grayish, mikukutu, nyore crumple pamusoro palpation. Skin yepepuru-rinokwanisa kucheneruka, kana achingomutambudza anzwa crunching uye creaking. Murwere anonyunyuta kuti sokusingatsungiririki, anobuda marwadzo.

Nzira dzekuziva nadzo solvency chaJese wayo akagadzirira mamwe prosthetics

For dzose kushanda prosthesis kusvika residual Kureba muhudyu anofanira kuva mukuru kwayo dhayamita. Uyewo chinokosha zvayo vasiri chimiro (zvishoma tapered kubva kumusoro kusvikira pasi) uye nyarara. Kuponeswa zvinofungidzirwa mufambo pamusoro mapfundo ganda vanga (ake mufambo uye kushaya cohesion pamwe pfupa hwaro).

Signs utsinye Chigutsa

- Distribution of vanga pabasa pamusoro.

- Dzimwe nyoro tishu.

- The kushayikwa tapering chigutsa.

- Fusion pamwe vanga rinenge kwayo Kuchakati zii.

- Too yakakwirira urongwa netsandanyama.

- Kunwisa Makakatanwa ganda mapfupa sawdust.

- Kuramba pfupa zvikamu vane kudimurwa aiwanzopiwa wokushanda mapfupa.

- Aiva conical Maumbirwe chigutsa.

Kugadzira urema

Kugura Mbabvu chiri anatomical kuremara chakaparira boka urema akagoverwa nokusingaperi. Kana paiva gumbo kudimurwa, boka urema akagoverwa pakarepo.

Uchimutarira of mwero kurasikirwa dzichipfekeka basa, vakaremara Disability, uyewo mamwe basa yokuremara iri vaiita zvokurapa-vapore nyanzvi inoona.

In pave ukuru vakaremara ari kuongororwa:

- The Kukwanisa nokuzvidzora basa.

- The mukana akazvimirira kufamba.

- The adequacy of dzidziso iri nzvimbo uye nguva pasina zvokurwara kwepfungwa basa (akayera kunzwa uye zvakaratidzwa).

- Kukurukurirana mabasa, kugona wevaFiripi, kunyora, verenga, etc ...

- The pamwero rokudzora yavo maitiro (zvaidiwa nomutemo, tsika uye zvetsika zvine dzemunharaunda yacho vanhu).

- kudzidza unyanzvi, mukana wokudzidza unyanzvi hutsva, pave nemamwe ounyanzvi hwokugadzira.

- The Kukwanisa kuita basa.

- Mano kuramba kushanda mukati yechinangwa zvavo nyanzvi mabasa pashure vapore uye pakusika Mamiriro ezvinhu.

- The functionality uye mwero Kugadzirwa prosthesis.

Boka rokutanga

Zvairatidza kuti mubayiro boka rokutanga:

- kudimurwa zvose makumbo ari muhudyu pamwero.

- The kusavapo minwe mina (kusanganisira wokutanga phalanx) maoko maviri.

- kudimurwa maoko.

The rechipiri boka

- kudimurwa munwe nhatu (yokutanga phalanges) ake maviri.

- Kubviswa 1 uye 2 minwe.

- No 4 minwe apo tiine phalanges vokutanga.

- kudimurwa munwe paruoko rumwe rurefu chomuti ruoko wechipiri.

- Operation kuti Chopart uye Pirogov.

- High resection mumwe gumbo, pamwe chete pasina minwe ruoko mumwe kana ziso.

- kugura ruoko mumwe uye ziso.

- disarticulation hudyu kana pamapfudzi.

The boka rechitatu

- yaitsigira divi kudimurwa reminwe pasina nokubvisa phalanx wokutanga.

- Double-mativi kudimurwa wemimwe.

- High kudimurwa ane gumbo kana ruoko.

- Bvisai zvose tsoka pamusoro Sharpe.

- The musiyano gumbo kureba masendimita 10.

Rehabilitation pashure kudimurwa

Kuwedzera anatomical kuremara muzvidimbu kudimurwa kunotungamirira dzakakomba mupfungwa kunotevera murwere. Murwere rwunopera pamusoro pfungwa vasingakoshi mumaziso vanhu, anotenda kuti upenyu hwake huri pamusoro.

Kubudirira mune ramangwana prosthetic vakatsunga kwete chete nokuda timeliness remapazi, padanho kudimurwa kwaizotevera hanya chairo chigutsa.

Mazuva 3-4 mushure Kudzivirira kudimurwa kunotanga flexion contractures, achiita chigutsa masangano. Pashure Kubviswa sutures vanoshingaira muviri tsandanyama chigutsa inokurudzirwa. Kwapera mwedzi, kutanga kuedza prosthesis wokutanga.

Anokosha Chinangwa vapore ndiko kudzikamisa murwere mupfungwa ehurumende uye paumbwe ake zvakakwana pakurapa prosthetics.

Uyezve zvinhu zvinosanganisira:

- dzidzo pakushandisa pamusoro prosthesis;

- kuva kurovedza kuti Activate zviri prosthesis wayo unyorwe zvinonyatsorehwa motokari kufanana nevechiduku;

- normalization kuti kufambisa, kushandisa kurovedza zvokurapa uye prosthetic.

- socio-vapore mabasa, kuchinjira kumamiriro murwere upenyu ane prosthesis;

- kuderedza kukura wacho zvirongwa kudzidzisazve uye mberi basa (nokuti 2nd uye 3rd mapoka).

Kana kuona phantom marwadzo ari kudimburwa gumbo dzinokurudzira kuti novocaine blockade, hypnosis uye psychotherapy. Kana pasina kuvandudzika zvinobvira kuita kuvhiyiwa pamwe resection pakati njodzi etsinga.