Tuhinga mō te tapuhia. Āhuatanga o te mahi me te whakanohonoho

whakaaro ia tapuhia o rara, e tetahi o nga ngā mahi matamua i roto i te hītori o te rongoā. Ko te whakaahuatanga tuatahi i tuhia 4 BC rau. e. Heoi, ki te ngoikore mutu te pakaruhanga toto, me te kore o te mea te tikanga mate mōhiotanga e pā ana ki ligation iaia. Te tākuta tūtohutia te popore e alangá mo i roto i te kopa pāngia, faaore te reira toto mate, engari kihai i mutu i te horapa o te kikohangatia.

I roto i te AD senekele matamua, fokotu'u aulus Koroniria Celsus pāhoro mo tona huarahi wa ki te whakahaere o taua ngā mahi, i ngā tūtohutanga ki:

- ki te kawe i te poporetanga o te taumata o te kiko taea;

- ligation o tumu iaia taratahi ki te aukati i te toto;

- kutikuti tārua katokatohia kikokiko ki taupoki ana i te tumu, kahore mānukanuka pathological.

He wāhi nui i roto i te whakapai ake o ngā tikanga o ia tapuhia o wahi takaro e te whakataki o te tikanga whakahaere bloodless ka hanga whakamahia Esmarch mohoa noa nei ropu rapa.

I roto i te ao ārahi tūranga o tenei ra i roto i te tohu mō te tapuhia noho mate huka, me te mate Cardiovascular.

Tapuhia - poporetanga o waewae ko, ranei, kaua ona wahi distal, mo nga wheua, engari e te mea he hape whakamataku ki te tiro i te reira rite te tango ohie o te wāhanga pāngia. fakahu'unga tenei wā kirihou me te pokanga reconstructive, e hāngai ana anō whakanohonoho manawanui tere, me te whai hua.

He etahi tohu mo tenei momo o te pokanga. A feruri pānui i te raraunga i roto i te taipitopito atu.

Tuhinga mō te tapuhia

- kikohangatia.

- Ko te aroaro o te arotahi taimaha o mate, te whakawehi ora (anaerobic mate) o te manawanui.

- tina heke contracture ischemia uaua.

- kuru syndrome.

- Kuru Hiwhiri ngaukino te wharanga ki rara o nga oko matua me raru, whakahaere pera i huaina tapuhia pāmamae.

- mate occlusive ki te putanga o te kikohangatia.

- pāpuni, whakaritea atu atu i te toru haora.

- Common, e kore Nireaha ki keha maimoatanga neurotrophic.

- te tapû ki te riri o te whai wāhitanga o okana ā-.

- Ko te lesion tubercular noa o te wheua kikokiko i roto i te paari.

- te pukupuku wheua mārere waho te taea o te tango i te ruma taratahi.

Whakatau i te taumata o te resection

Te kōwhiri i te taumata o te tapuhia, tei runga i te tohu o disorders toto tohanga i roto i te rohe whakahaeretia, te aroaro o te kaikai, disorders arataukai, āhua o te kopa tata me te pakeke o te mate, me te mamae.

tamata i te tamariki ki te tono i te disarticulation (wehe o te wahi i pangia i te taumata tahi), e kore e ofati i te tupu wheua atu.

E ai ki te ru o te pokanga taratahi tapuhia e alangá:

- tapuhia tonu whakamana i roto i te tāhuahua pokanga āwhina tuatahi ki te tango kore-taea, pakaru te kopa;

- mahi whawhati tata ki te poporetanga kanga haurangi ki koretake tīkina momo;

- whakaritea tapuhia, whakahaeretia i roto i te pāpaka mārere o te wheua te tapû.

- ki te reamputatsiya fakatonutonu tumu a Muldoon.

Tohatoha i te porohita, porotītaha me kanihi tapuhia. A feruri i teie momo i raro.

tapuhia porowhita

Ko te tohu matua mō te ablation, ara pororere (porohita tukutahi) amputations he hau kikohangatia me e alangá mo resection iri ana i runga i paku musculocutaneous. kawea te pokanoa te i roto i anake mo te whawhati tata ora-ora. He drawback nui o tenei tikanga, ko te ki te whakarato i tētahi mate kore-mahi, me te reamputatsiya honohono muri ki te urutau e alangá mo prosthesis whakatū anō.

Ko te painga o tenei ko te kore o te tapuhia o huringa necrotic ki hukahuka, ara i te supply toto iti.

A, no te kitenga o te tapuhia pororere atu te wheua i te taumata kotahi rite taua o te kiko ngohengohe.

Ka rite ki whakamana te mahi te? Tapuhia o te atamira tuatahi ngā i roto i te kokoti kiri, ngako subcutaneous me te fascia. Edge Tahitahia kiri ko te atu rohe i runga i te mata. I te rua o te tuakitanga wā o uaua ki te wheua, me te atu wheua tapahia. wheua mutunga cover he tika ki te kiri, me te fascia.

Tenei momo tūtohutia mo nga tari o nga wahi ki te puranga uaua āhua iti.

Hoki tari ki nui te uaua papatipu trohmomentnaya tapuhia tūtohu (tihi ohie, me te ablation porohita e Pirogov).

He rite ki te dvuhmomentnoy tapuhia te wāhanga tuatahi e rua o te mahi. I tua atu, i muri i retireti i te uaua, me te kiko ausia i roto i te aronga proximal, he uaua anō-tapahia unu huri noa te mata o te kiri. Na roto i tenei e tapahia paparanga uaua hohonu e whai wāhi ki te hanganga anō o te tumu koeke.

tikanga kanihi faaite:

• i runga i odnoloskutnye (he rite ki te diameter o te tumu roa o tetahi paki);

• dvuloskutnye (e rua rag o ngā rahi i runga i te moni o te roa e whakatu diameter amputiruemoy wahi).

I roto i te hanga i te tumu me whanau i roto i te ngakau e kore e waiho te nawe i runga i te mata mahi. kia hanga e kohi tango ki pūkete te kaha ki te mau kawenga.

tapuhia osteoplastic

Kia pehea te Ko te tapuhia o nga topito o raro? He āhuatanga motuhake ko te aroaro o whatiwhatinga wheua hipoki ki te kiriuhi wheua i roto i te hanganga o pāti.

tapuhia osteoplastic o te waewae o raro e te tikanga o Pirogov riro āhukahuka ao e tika ana ki te tino angitu kikokiko whakanohonoho tautoko mutunga o te waewae whakahaeretia.

Painga o te tikanga:

- Iti tetahi raru tumu.

- He te tautoko o te mutunga tumu.

- Tiaki tūtohutanga proprioceptive o uaua me tendons.

kaupae ngā

A, no te tango i te tibia, kua hanga e rua vahi i runga i te Pirogov. Hoki tenei whakaaro, maripi tapuhia. Tuatahi hua i te tapahia ripeka o te kopa ngohengohe, e tuu i te tahi pona mahi atu wāhanga arcuate whakawhānui haere te dorsum o te waewae. I muri whiti nga mea tuhonohono lateral hanga te wehe o te talus, tibia wheua Toka. katia te-wāhanga ripeka pāti. Puka te tumu.

Operation o Sharpe

Tera atu ano tetahi tikanga i ai whakamana te tapuhia o wahi o raro.

A, no te tango koe i kawea he waewae o tuaki kiko ngohengohe i roto i te torutoru henimita phalanges distal o te wheua metatarsal tuatahi. I muri kiriuhi wheua otpreparovyvaniya te meatia e te räkau metatarsals me whakaene kaitarai kite tapahia katoa. Cut pāti cover plantar.

A feruri i te take matua o te tapuhia.

microangiopathy mate huka

Tei taote Hohenga i runga i te whānuitanga o te kino. I runga i te nuinga o pāpaka necrotic purulent e rima ngā wāhanga:

- necrosis ausia kahore tendons hinga.

- kikohangatia maihao whai wāhi mai i te phalanx tuatahi, me te iohere.

- Ko te kikohangatia whānui o maihao, ngā ki kikohangatia o te waewae.

- lesion olotou waewae katoa.

- whai wāhi i roto i te tukanga o te tibia.

I whakauru te manawanui ki ischemia necrotic tū whakanohonoho whawhati tata o te kanga, i ngā roto whakatuwhera i te whēwhē, waikeri o abscesses, resection iti o te wahi i pangia o te wheua, me te tango o te kiko mate. I muri i excision o kiko nonviable mahi tūtohu ki te whakahoki rere toto rawaka pakaru wahi.

Ischemia:

- whakamana te tohu tuatahi te rerenga parukore anake kanga;

- tuarua mana te tikanga tapuhia o te maihao pāngia ki tukanga excision wāhi i roto i te tendons;

- ka kawea te toru o nga tohu i roto i amputations i runga i Sharpe whakamahia te tapuhia maripi motuhake;

- maimoatanga o te wha o nga tohu, ko te resection i te tibia;

- i te rima o nga tohu o te tapuhia whakamana i runga i te taumata o te hope.

Hukapuri o nga maihao, me te tahi atu wahi tinana

wehewehe:

• katoa mīti (te huringa pathological i roto i whekau me te kopa, te whakawhanake rite ki te hua o disorders circulatory me ischemia atu o te roro e tika ana ki iti pāmahana roa-mahi);

• perfrigeration (whakakitea tauhohenga inflammatory ma'i o te kiri i roto i te puka o te pāti kawe kikorangi-papura ki minamina nui.

E wha nekehanga:

haere tahi ana te tohu tuatahi e huringa reversible o te kiri: erythema, puku, minamina, te mamae me te tūtohutanga heke parau- ore-. I muri i te torutoru nga ra e exfoliated te wāhi kua pā.

Hoki te tohu tuarua āhuatanga e te ahua o mirumiru ki te ihirangi marama, faaite rite hekenga i roto i te tūtohutanga, pea e tika ana ki te mate hono disorders arataukai.

whakaaturia te toru o te atamira e huringa necrotic i roto i te kiko ngohengohe rite ki te hua mate ratou, hanga o te fakangatangata he aho (whakawhāititanga mate kikokiko i Unuhia granulation hauora), pakaru wāhanga o te e alangá kua pakoko, me otaota rironga koiora kia whakawhanake kikohangatia mākū.

A, no te toro te wha o nga tohu o te kiko necrosis ki te wheua, te wai i roto i te mirumiru i runga i te kiri riro mangu i takatakahia, kiri he kikorangi, riro katoa mamae tūtohutanga, ka blackens te alangá kua pā kua pakoko.

maimoatanga

• tohu 1. Rewarming he manawanui, UHF-therapy, darsonval, alangá frostbitten pauna boric waipiro.
• tohu 2. kawea tukatuka i roto mirumiru. I muri nekehia ratou te whakatuwhera i te kiri pakaru te, tono te tauiraa marutanga te waipiro. tūtohutia pūnahanaha therapy paturopi te.
• tohu Tuatoru. He tango motuhia mirumiru takai kiko necrotic ki saline hypertonic. E whakamahia paturopi ki te ārai i te mate tuarua.
• tohu 4-th. kawea Necrectomy (tango o kiko devitalized) i roto i te 1 cm ki runga ake i te rārangi necrosis. whakamana ia tapuhia te i muri i te hanganga o te kirinuku maroke.

kikohangatia

kikohangatia maroke ko te hua o puhoi whakararuraru, ahu whakamua o te supply toto ki te kopa he āhuatanga o tūroro ki atherosclerosis me endarteritis obliterating.

Āhuatanga e te ngaro o te haurangi o te rauropi, i te aroaro o te mārama fakangatangata o te take. I roto i te maimoatanga o te whakamahi taea o te whakahaere expectant.

Hoatu: taero e whakapai ake kiko trophism, pūnahanaha therapy paturopi. kawea te mahi i roto i muri i hanga i te aho mārama o fakangatangata.

puta kikohangatia Wet rite te putanga o te mutunga whakapeka o tohanga (maihao hukapuri, Thrombosis, iaia kōpeketanga). Kei te āhuatanga i te reira i te haurangi kino, kahore aho fakangatangata me edema korerotia. Tapuhia ki kaikai tū wawe, he Kāore whakahaere expectant. whakamana mahi te i muri i detoxification therapy. Me kia raina tapuhia kikohangatia tino teitei (ki pāpaka tapuhia o te mau waewae tūtohutia i te taumata hip).

Gas kikohangatia Ko te tohu tino mō te tapuhia pororere. tohu āhuatanga: korerotia, puku tere ahu whakamua, te aroaro o te hau i roto i te kopa, me uaua, necrosis me te whēwhē ki rewa kiko ngohengohe. E ngā uaua grayish, puhoi, ngāwari ki te kōpenupenu i palpation. Kiri papura-kikorangi, ka rongo crunching me creaking aki. amuamu te manawanui o fuu, pakaru ki te mamae.

Ko te paearu mō te whakaea o te take, me tona hihiko hoki atu prosthetics

Hoki te mahi noa o te prosthesis ki te roa wäriu o te tahi me kia nui atu i tona diameter. nui hoki ko tona āhua whaiaroaro (paku maaro i runga ki raro), me te mamae kore. tata Tiakina te nekeneke o te hononga me te nawe kiri (tona nekeneke me te kore o te piringatahi me te pūtake wheua).

Signs tumu nanakia

- Te tuari o te nawe i runga i te mata mahi.

- te taikaha kiko ngohengohe.

- Ko te kore o kiore tumu.

- Fusion ki nawe kiko, tona lōngonoa.

- whakaritenga tiketike rawa o uaua.

- mānukanuka nui o te otaota wheua kiri.

- taliteke'í o wāhanga wheua ki tapuhia takirua wheua.

- āhua Tino koeko o te tumu.

Making hauātanga

Tapuhia o rara ko te koha kikokiko e meinga te rōpū hauātanga whakaritea ake. Ki te reira ko tetahi tapuhia waewae, whakaritea tonu rōpū hauātanga.

whai wāhi i whakaritea e o te tohu o te mate o mahi mahi, hauātanga me te Hauātanga, me te he taumahi anō o te hauātanga i roto i te komiti hauora-whakanohonoho tohunga.

I roto i te haamauraa i te tohu o te hauātanga aromatawaitia te:

- Ko te kaha ki te mahi-whaiaro.

- Ko te taea o te kaupapa motuhake.

- Ko te hāngaitanga o te takotoranga i roto i te wāhi me te wā i roto i te ngaro o te māuiuitanga mahi hinengaro (whanganga rongo me te kite).

- mahi Communication, te kaha ki te tohu, ki te tuhituhi, te pānui i, etc ...

- Ko te taumata o te mana o to ratou ake whanonga (tautukunga ki tikanga ture, morare, me te matatika o te hapori).

- kaha te ako, te whai wāhi ki te ako i ngā pūkenga hou, te whanaketanga o ētahi atu ngaio.

- ki te kaha whai wāhi i roto i te mahi.

- ki te Te āhei tonu ki te mahi i roto i te anga o ratou mahi ngaio i muri whakaaurakitanga me te hanga o te tikanga motuhake.

- Ko te taumahinga me te tohu o te whanaketanga o te prosthesis.

Ko te rōpū tuatahi

Tuhinga ki te tohu o te rōpū tuatahi:

- tapuhia o waewae e rua i te taumata huha.

- Ko te ngaro o te maihao wha (tae atu i te phalanx tuatahi) i runga i nga ringa e rua.

- tapuhia o ringa.

Ko te rōpū tuarua

- tapuhia o maihao toru (ki te phalanges tuatahi) o ringa e rua.

- Tangohanga o 1 me te 2 maihao.

- No 4 maihao i te tiaki i te phalanges tuatahi.

- tapuhia o maihao i tetahi ringa ki te tumu nui o te ringa tuarua.

- Operation o Chopart me Pirogov.

- resection High o tetahi waewae, ngā ki te ngaro o te maihao o tetahi ringa kanohi ranei.

- tapuhia o tetahi ringa, me te kanohi.

- disarticulation hip pokohiwi ranei.

Ko te toru o te rōpū

- tapuhia unilateral o maihao kore tango i te phalanx tuatahi.

- tapuhia Double-iu o maihao.

- tapuhia High o te waewae ringa ranei.

- Tangohia waewae e rua i runga i Sharpe.

- Ko te rerekētanga i roto i te roa waewae o te 10 cm.

Rehabilitation i muri ia tapuhia

I tua atu ki kikokiko tapuhia e alangá mo koha arata'i ki nui manawanui whētuki hinengaro. kati te manawanui i runga i te whakaaro o mā'ulalo i nga kanohi o te hapori, whakapono ia e tona ora ko runga.

Ko te angitu o te prosthetic heke mai whakaritea kore anake e te arotau o ngā mahi, te taumata o te tapuhia, me te tiaki tika muri mo te tumu.

3-4 ra i muri i te ārai ia tapuhia tīmata contractures flexion, e mahi ana nekehanga tumu. I muri i tango o sutures kaha tumu mahi uaua tūtohutia. He marama i muri mai, timata ki te tamata i te prosthesis tuatahi.

Ko te whāinga tino nui o te whakanohonoho he ki te ū āhua hinengaro o te manawanui, me te hanganga o tona maimoatanga tika mō prosthetics.

Ētahi atu mahi ngā:

- whakangungu i roto i te whakamahi o te prosthesis;

- ki te huinga o mahi whakahohe te prosthesis me tona whakaurua i roto i te stereotype nekeneke whānui;

- māori o ruruku, te whakamahi o te whakangungu rata, me te prosthetic.

- ngā mahi pāpori-whakanohonoho, urutaunga ki te ora o te manawanui ki te prosthesis;

- te whakaiti i te whanaketanga o te hōtaka takitahi, ngä tünga me te mahi atu (mo nga rōpū 2, me te 3).

Ki te wheako koe mamae mariko i roto i te e alangá mo avae tūtohu e te novocaine pā, rotu me te hinengaro. Ki te reira he taea kahore whakapai ake ki te kawe i roto i pokanga ki resection o te karere pāngia.