Mgbehu arthrodesis: ịwa ahụ, pụta, ghara ịgbanwe, ndidi reviews

Ọ bụghị ihe niile ndị pathologies nke nweekwa usoro nwere ike na-ewepụ site melite àgwà bughi ọcha. Mgbe ụfọdụ, a igbochi ọrụ nke otu ma ọ bụ karịa agba. Arthrodesis nke ụkwụ nkwonkwo - dị n'ịwa ahụ. Ya ihe mgbaru ọsọ na-aghọ wepụ nonviable ọcha idozi ala N'ịdị axis na n'ihu fixation nke akpụpụta akụkụ na n'ahụ ọnọdụ. N'okpuru ihe ọnọdụ a rụrụ arthrodesis nke ụkwụ? Gịnị ga-eme nke aka na ghara ịgbanwe ụkpụrụ? Banyere nke a - mgbe e mesịrị na isiokwu.

Egosi maka ịwa ahụ

Arthrodesis - nnyonye anya, nke na nkwonkwo megharịa na artificially ofu ke itie. The mkpa a ịwa ahụ na ime bụ apụghị izere ezere na-esonụ mgbe:

1. Ọnụnọ nke dangling nkwonkwo. Nke a ọnọdụ emee ke ndabere nje interosseous nkwonkwo. Ọ nwere ike na mmadụ anya n'ihu ma ọ bụ zuru ezu. N'ihi bụ a mebiri nke deformation nke n'ahụ ọrụ n'ime nkwonkwo (ogologo mkpọnwụ nke mọzụlụ, adọwa ụdọ, gunshot unan, oké ndọtị nkwonkwo).
2. Development of deforming ogbu na nkwonkwo. Arthrodesis nke nkwonkwo ụkwụ na nkwonkwo, reviews banyere nke i nwere ike na-agụ dị n'okpuru, a chọrọ na a purulent, tuberculous na traumatic ụdị daa ọrịa.
3. Degenerative ogbu na nkwonkwo na nsogbu. Enweghị nchịkwa ọnọdụ abuana mgbanwe ọkpụkpụ epiphysis.
4. Nsogbu nke polio.
5. A mgbaji ọkpụkpụ na-agwọ na-ekwesịghị ekwesị ma ọ bụ na merged na n'oge gara aga.
6. Ọ bụrụ na ọ dị mkpa, na nkunye nke ụfọdụ ma ọ bụ niile nke nkwonkwo, ma ọ bụrụ na ndị ọzọ ụdị adọ kwere omume.

contraindications

Arthrodesis nke ụkwụ (ndị na-esi nke a na-adịghị mma agwa, na nsogbu na-nnọọ obere mgbe a wasịrị) a machibidoro iwu na-ebu na-esonụ mgbe:

• ruo mgbe na-eto eto ruo mgbe nweekwa usoro bụ na a na ogbo nke uto;
• ọnụnọ fistula tubercular agwa mere site edinam ịdapụsị gbara gharịị mycobacteria;
• ọnụnọ nke ọrịa na ebe aka;
• oké njọ ọnọdụ onye ọrịa, na enweghị ike karịrị oge.

Mgbe afọ 60 nke ọrụ arthrodesis nke ụkwụ nwekwara ike ime ka oké njọ nsogbu.

ụdị aka

Ịmata Ọdịiche ise isi ụdị nke ịwa ahụ dabere na ọganihu nke aghụghọ na-eji akụrụngwa:

• Intra-articular arthrodesis nke nkwonkwo ụkwụ na nkwonkwo na-rụrụ site na mwepụ nke articular cartilage.
• Extra-articular usoro a na-eme site hụ naanị ọkpụkpụ ọkpụkpụ ọcha foto si na otu ndidi. Ikekwe na ojiji nke na-enye onyinye aka.
• Jikọtara arthrodesis nke nkwonkwo ụkwụ na nkwonkwo na-agwakọta ma ụdị nke arụmọrụ. Wepụ si na nkwonkwo cartilage na ọkpụkpụ aka bonding a rụrụ site n'ịkụnye pụrụ iche metal efere.
• The ndọtị ụdị ọrụ dabeere na omume nke wuru mgbaji ọkpụkpụ. Ọzọkwa ọkpụkpụ ọcha na-ofu ke ọnọdụ na megharịa n'ahụ agbatị ngwa. Ndị ọzọ okwu, nke a na ụdị aka a na-akpọ "arthrodesis ụkwụ Ilizarov".
• The mkpakọ ọrụ a rụrụ site gwara a nkwonkwo mmewere na spokes, azụ, mkpara na ndị ọzọ kpọmkwem ngwaọrụ eji na traumatology.

na ọdabara ná Nkụnwụ

Obodo ná Nkụnwụ na a usoro ịwa ahụ na-adịghị mee ihe n'ihi na nke eziokwu ahụ bụ na aghụghọ na-ewe ebe miri cartilage na ọkpụkpụ owuwu. Tee ndị na-esonụ ụdị nke ná Nkụnwụ:

• endotracheal ná Nkụnwụ - ọrịa na-mikpuru na anestetiiki ụra pụrụ iche ọgwụgwọ site inhalation, a na-ekesa na gaseous ụdị;
• spinal ná Nkụnwụ - ndidi adịghị, na-ahụ ma na-anụ ihe niile, ma ala ụkwụ kpamkpam megharịa na enweghị uche;
• jikọtara ná Nkụnwụ - spinal analgesia jikọtara na nmikpu nime a ọkara n'ụra ala, na-eji maka ukwuu mwute na oke mwute ọrịa.

Arthrodesis nke ụkwụ, ndidi testimonials nke na-egosi na ọrụ bụ kama ogologo ike-adịru site 2 to 6 awa. Ọ na-adabere otú ike na mbụ ala, a họọrọ Usoro aka na mkpa maka otu ndidi na aka.

ndidi nkwadebe

Arthrodesis nke ụkwụ, ndidi testimonials nke na-egosi mkpa ọ dị ka preoperative nkwadebe, na-achọ a zuru nnyocha nke onye ọrịa. Dị ka tupu ọ bụla aka, operable ga-agabiga na-adakarị ule nke ọbara, mmamịrị, n'ihi mmiri ọgwụ. Kpebisie ike na ala nke coagulation, ọbara ìgwè na RH-akpata. Weere amanyere bụ iwu ule HIV, syphilis, ịba ọcha n'anya, na-ejide x-ray.

7 ụbọchị tupu ịwa ahụ dị mkpa ịhapụ ọgwụ ọjọọ na-emetụta nke ọbara clotting usoro, na ndị na-abụghị steroidal mgbochi mkpali ọgwụ ọjọọ. Ke akpatre usen kwere na bland nri. The ụtụtụ iri ihe na ịṅụ mmiri tupu aka na-aju, zere nwere nsogbu n'oge ná Nkụnwụ.

-N'aka, dị ka onye ọrịa ga-a ụlọ ọgwụ, mkpa ka i kwadebe a ala ikuku ke ufọk. Na-elekọta ndị dị otú ahụ ihe ga-enwe ọganihu:

• wepu rugs, nke nwere ike ukwu;
• dị ka kọmpat dị ka o kwere ebe wires, nke na-edina n'ala, nke mere na onye ọrịa na-adịghị na-ekirikarị na ha;
• na-asa ahụ ịzụta a ute na mmiri iko, nke mere na ọ dịghị ịgbanwee na mmiri n'ala;
• ndokwa niile dị mkpa ụlọ ọrụ ka e si ọcha na usoro dị ka nso ka o kwere omume, ka ha wee ghara nwere iru ha.

Usoro nke

Arthrodesis nke ụkwụ mmerụ mgbe gharazie ịba uru ma ọ bụ na-efe efe Filiks na emewo ka imebi nke ọtọ akọ, a rụrụ ọtụtụ nkebi:

1. The ebe nke aka-emeso ya na antiseptics, na kpuchie akpali mmasị ịwa linen.
2. The nkwonkwo ntule na-ebipụ ka 15 cm n'ogologo. N'ígwé dissected fascia na muscle ruo articular ebupụta na-adịghị egosipụta na ọnya.
3. Cartilage anụ ahụ na-ewepụ, na amịpụtara na-abụghị viable na merụrụ nkwonkwo ọcha.
4. Ebupụta n'akpụ ụkwụ na adị ka okporo ụkwụ, nke ga-dabara tightly ka ọ bụla ọzọ, na-guzobere n'ụzọ kwesịrị ekwesị. Nke a na-eme, iji gosi ezi axis nke ala N'ịdị.
5. Ihe owuwu bụ ofu site pụrụ iche metal oyiyi akwa ofu n'ụzọ.
6. Site oge, ọkpụkpụ ga-eto ọnụ ọcha ọ bụla ọzọ na nkwonkwo-agakwaghị nwere mbụ ụdị. Ya ọrụ ga-ikpe gabiga ihe ndị ọzọ.

Olee ihe ndị ọzọ na nkwonkwo na-arụ ọrụ

Arthrodesis bụghị a kpọmkwem aka, ọ na-gbakọọ na ụkwụ. N'otu aka ahụ, trauma dọkịta nwere ike ịtụ ndị na-esonụ anatomical mpaghara:

• hip nkwonkwo - emepụta excision nke meniscus na idozi isi nke femur na pelvis, nkwonkwo-anọgide kpamkpam edere duu;
• bụrụ naanị ọkpụkpụ ọkpụkpụ ikpere nkwonkwo - na-ekwe naanị na enweghị pathologies nke obi usoro;
• ubu nkwonkwo - usoro nke na-eji ọkpụkpụ aka nke onye ọrịa (bụghị ime jụrụ) ma ọ bụ na-enye onyinye;
• metatarsophalangeal articulation - ihe mgbaru ọsọ bụ iji kpochapụ iwetara ma ọ bụ valgus deformation iatrogenic mkpịsị aka nkwonkwo agagharị ejigide mgbe mgbake oge.

Ihe mere na-achọ arthrodesis nke nkwonkwo,-ederịta akwụkwọ ozi niile dị n'elu.

mgbake oge

Arthrodesis nke nkwonkwo ụkwụ na nkwonkwo, a foto nke nke ka a zuru ezu na nghọta nke ime ihe, na-achọ a ogologo mgbake. Ụbọchị mbụ i nwere ike ibili ụra iji zere nsogbu si ná Nkụnwụ (dizziness, isi ọwụwa, vomiting).

The dọkịta edepụta ojiji nke analgesics na-abụghị steroidal mgbochi mkpali ọgwụ ọjọọ maka ihe mgbu enyemaka. antibacterial mmadụ na-eji, ma ọ bụrụ na ọ dị mkpa. Nke a na-ejikọta ya na a elu n'ihe ize ndụ nke suppuration na ọnọdụ nke mba ozu (ndudu, efere, mkpara). Of ọgwụ nje mmasị e nyere ndị kasị nta na-egbu egbu onye ọrịa:

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

Mgbe oge ụfọdụ gasịrị ọrụ dị mkpa ka na-eyi a plaster bandeeji, na-etinye elu ọnọdụ nke ala nsọtụ-anọgide na otu nke ọ na e dere a ọkachamara. Duration nke gypsum nwere ike ịdịru ruo 3-4 ọnwa.

The dọkịta ga-nye ndụmọdụ ndidi mgbe o kwere omume atọ ebe online ohere. Up a na-apụghị ime iji gbochie ibute ọrịa ebe. Ke ama okodorode nkedo dị mkpa re-X-ray ule iji gosi ezi anọ na nke naanị ọkpụkpụ ọkpụkpụ ọcha.

The mbụ 2 ọnwa nke n'itinyekwu na ejikwara ụkwụ a machibidoro iwu, otú ị chọrọ ịzụta mkpara na-eje ije na ha. Na 3 ọnwa mgbe X-ray dozie trauma dọkịta na-awa nwere ike na-amalite na-adabere na ụkwụ na-eji physiotherapy agwọ ọrịa.

physiotherapy

Ghara ịgbanwe mgbe arthrodesis nke nkwonkwo ụkwụ na nkwonkwo na-aduak na-agụnye ọgwụgwọ anụ ahụ, ịhịa aka n'ahụ, na ihe ndị ọzọ dị n'eluigwe na ụwa na postoperative mgbake na-adọ. Therapeutic mmega bụ ihe kasị mkpa usoro n'ihi na ọ bụ n'ihi ya ọrịa iji gbochie mmepe nke nkwonkwo contractures.

Nke ndị ọzọ ọgwụgwọ anụ ahụ dọkịta edepụta:

1. Electrophoresis - na nkwonkwo ụkwụ ebe bụ mmetụta nke mgbe nile na-electric pulses. Ha nwere ike ga-ndinọ via medicated preparations ịse mbufụt, soreness njide, iwepu ọzịza, normalizing metabolism, inweta ọbara rụọ ọrụ ịwa mpaghara.
2. UHF - a usoro bụ nke mmetụta nke akpa ubi UHF na mkpụrụ ndụ na anụ ahụ. UHF akwalite ebighị nke regenerative Filiks, na-agwọ ọrịa nke fractures na ọnyá, aka ọzịza, aka mgbu, akpali obodo ọbara ekesa.
3. Magnetik - mgbanwe keying, nke na-eji a ndọta. Emee mkpochapu mgbu na edema, gbochiri nnyonye region nke ibute ọrịa, mụbara ekwedo nke ọbara arịa na rụọ ọrụ ndị ọbara na-otụk ebe.
4. Laser ọgwụ - ekwe omume ojiji nke elu ma intraosseous usoro nke ikpughe, nke bụ akụkụ nke ọgwụgwọ na mgbake nke ọrịa nke nkwonkwo.

Arthrodesis nke nkwonkwo ụkwụ na nkwonkwo, mgbe nke ghara ịgbanwe nwere ike ịdịru ruo 8 ọnwa, onye ọrịa na-achọ mgbe nile na-arụ ọrụ na onwe. Naanị na nke a ọ bụ ike igbochi mmepe nke nsogbu ma weghachi ọrụ nke ejikwara ebe.

kwere omume nsogbu

Dịka ọ dị na ịwa ahụ, arthrodesis nke nkwonkwo ụkwụ na nkwonkwo nwere ike a ọnụ ọgụgụ nke nsogbu:

• nkwonkwo ọrịa na n'ihu mmepe nke osteomyelitis;
• agba ọbara, hematoma guzobere;
• paresthesia - a mebiri nke uche dị ka a n'ihi nke dissection nke obere akwara plexus;
• enweghị ohere idozi nkwonkwo;
• lameness na ndị ọzọ na-enweghị nchịkwa na gait;
• mkpa ọzọ usoro ịwa ahụ;
• thrombosing miri veins nke ala N'ịdị;
• thromboembolism isi akwara.

Jide n'aka na-agwa ndị ọkachamara ndị na-esonụ mgbaàmà:

• fever;
• n'oké ihe mgbu na saịtị nke ịwa ahụ ohere;
• ike nke ọkọ;
• ọnụnọ nke nkụnwụ ma ọ bụ tingling;
• N'ịdị ma ọ bụ blueness ọdịdị aja aja tụrụ;
• ọdịdị nke mkpụmkpụ nke ume, ọgbụgbọ, vomiting.

nkwarụ

Arthrodesis nke nkwonkwo ụkwụ na nkwonkwo, nke a na-atụle-nkwarụ mgbe a obere ọnọdụ na-achọ enwekwukwa ọzụzụ ọjọọ ụkwụ si ndidi. N'ihi obere oge mgbe aka nke nkwarụ bụ ekwe omume, ma naanị ruo mweghachi nke a ọtọ ọnọdụ nke nkwonkwo.

Dị ka iwu si, mma site Order nke Ministry of Labor, ẹkenịmde n'olu site na-amanye Immobilization nke ụkwụ nkwonkwo ọcha na ọtụtụ mgbe na-eduga ná obere imebi nke static-ike ọtọ àgwà, nke pụtara na a nkwarụ na-adịghị ike.

Site na iji nke nkwarụ enen percentages nke ọrịa ọnọdụ na ruru nke kpọmkwem daa ọrịa na n'elu ndepụta ọrịa. Mgbe larịị nke daa ọrịa na 30% (atụmatụ site ọkachamara MSEC Commission) nkwarụ na-agaghị, 40-60% - a atọ ìgwè nke 70-80% - a abụọ otu, 90-100% - ìgwè nke mbụ. A na nwa na-enweta a nkwarụ na udu site na 40 ruo 100%.

Minor mgbanwe nke mmadụ bụ onye na-eje ozi ha, na-abụghị nke ndị a na edemede. N'ihe banyere contractures na nweekwa ọrịa nke static ọrụ na-akpọ arthrodesis nke nkwonkwo ụkwụ na nkwonkwo, ndị na-esi - nkwarụ, enweghi ike onwe-elekọta onwe ha na-egbo mkpa nke mmepe na a ndabere nke psychological nsogbu.

nleba

Dị ka ndị na-anwụghị na-arụ ọrụ nke nkwonkwo Immobilization, ọ bụ ogologo gbagwojuru anya usoro ịwa ahụ na-achọ a elu nkà nke dọkịta na-awa. The ghara ịgbanwe oge bụ ihe dị mkpa na-ekwu bụ na ọrịa na-amalite imere onwe gị ebere na underperforming na okwu nke ogbugbu nke kwa ụbọchị mmega. Ọ bụ ndị a adịghị na-a-eme ihe na mmepe nke nkwonkwo contractures na isi moto ọrụ.

Ọ dịghị ihe mgbu, ọbụna a steeti ibu, a zuru mgbake nke gait, enweghị erughị ala na aka ebe, a mma ịchọ mma n'ile - egosi nke a nke ọma ọrụ.