Njira Yogwirira Ntchito
(I) Anesthesia
Brachial plexus block imagwiritsidwa ntchito pamiyendo yakumtunda, epidural block kapena subbarachnoid block imagwiritsidwa ntchito pamiyendo yapansi, ndipo anesthesia wamba kapena anesthesia wamba angagwiritsidwenso ntchito moyenera.
(II) Udindo
Miyendo yam'mwamba: cham'mwamba, kupindika chigongono, mkono kutsogolo kwa chifuwa.
Miyendo yapansi: kumtunda, kupindika kwa m'chiuno, kubera, kupindika mawondo ndi kulumikizana kwa akakolo mu malo owonjezera a 90 degree dorsal.
(III)Kutsata ndondomeko
Mayendedwe enieni a ntchito ya fixator yakunja ndikusintha kwa kukhazikitsanso, ulusi ndi kukonza.
[Njira]
Ndiko kuti, fracture poyamba imayikidwanso (kukonza zopindika zozungulira ndi zowonjezereka), kenaka amapyozedwa ndi zikhomo za distal mpaka pamzere wosweka ndipo poyamba zimakhazikika, kenako zimayikidwanso ndikupyozedwa ndi zikhomo pafupi ndi mzere wothyoka, ndipo pamapeto pake zimayikidwanso kuti zikhutitsidwe. kuthyoka kwake ndiyeno kukhazikika kwathunthu. Muzochitika zina zapadera, kupasukako kungathenso kukhazikitsidwa ndi pinning mwachindunji, ndipo pamene mkhalidwe umalola, fracture ikhoza kukhazikitsidwa, kusinthidwa ndi kukonzanso.
[Kuchepetsa Mphuno]
Kuchepetsa fracture ndi gawo lofunikira la chithandizo cha fracture. Kaya kupasukako kumachepetsedwa mokhutiritsa kumakhudza mwachindunji ubwino wa machiritso a fracture. Kuthyokako kumatha kutsekedwa kapena kuyang'ana mwachindunji malinga ndi momwe zilili. Ikhozanso kusinthidwa molingana ndi filimu ya X-ray pambuyo pa chizindikiro cha thupi. Njira zenizeni ndi izi.
1. Pamaso mwachindunji: Kwa fractures yotseguka yokhala ndi mapeto otseguka, fracture ikhoza kukhazikitsidwa pansi pa masomphenya achindunji pambuyo powonongeka bwino. Ngati fracture yotsekedwa ikulephera kugwiritsira ntchito, kupasukako kungathenso kuchepetsedwa, kuboola ndi kukhazikika pansi pa masomphenya olunjika pambuyo pa kudulidwa pang'ono kwa 3 ~ 5cm.
2. Njira yochepetsera yotsekedwa: choyamba mupangitse kuti fracture ikhazikitsenso pang'onopang'ono ndiyeno igwire ntchito motsatira ndondomekoyi, mungagwiritse ntchito pini yachitsulo pafupi ndi mzere wa fracture, ndikugwiritsanso ntchito njira yokweza ndi kupukuta kuti muthandizidwe kuti fracture ikhale yowonjezereka mpaka itakhutitsidwa. ndiyeno kukonzedwa. Ndikothekanso kupanga zosintha zoyenera pakusamuka pang'ono kapena kung'ung'udza molingana ndi X-ray pambuyo pakuchepetsa pang'onopang'ono ndikukhazikika potengera mawonekedwe a thupi kapena mafupa. Zofunika kuchepetsa fracture, kwenikweni, ndi kuchepetsa anatomical, koma kwambiri comminuted fracture, nthawi zambiri zovuta kubwezeretsa choyambirira anatomical mawonekedwe, pa nthawi yothyoka ayenera kukhala bwino kukhudzana pakati fracture chipika, ndi kukhalabe wabwino mphamvu mzere zofunika.
[Kulemba]
Pinning ndiyo njira yayikulu yopangira mafupa akunja, ndipo njira yabwino kapena yoyipa yokhotakhota sikuti imakhudza kukhazikika kwa fracture fixation, komanso imakhudzana ndi kuchuluka kapena kutsika kwa comorbidity. Chifukwa chake, njira zotsatirazi zogwirira ntchito ziyenera kutsatiridwa mosamalitsa polumikiza singanoyo.
1. Pewani kuwonongeka kwa chikole: Kumvetsetsa bwino momwe thupi limakhalira pamalo oboola ndipo pewani kuvulaza mitsempha yayikulu yamagazi ndi mitsempha.
2. Njira yogwiritsira ntchito kwambiri aseptic, singano iyenera kukhala 2 ~ 3cm kunja kwa malo otupa omwe ali ndi kachilombo.
3. Njira zosagwiritsa ntchito mwamphamvu: povala singano ya theka ndi singano yokhuthala m'mimba mwake, polowera ndi potulukira singano yachitsulo ndi mpeni wakuthwa kuti mupange 0.5 ~ 1cm pakhungu; Mukavala singano ya theka, gwiritsani ntchito mphamvu za haemostatic kuti mulekanitse minofu ndikuyika cannula ndikuboola. Osagwiritsa ntchito kubowola kothamanga kwambiri pobowola kapena pobowola mwachindunji singano. Mukatha kulumikiza singanoyo, mfundozo ziyenera kusunthidwa kuti ziwone ngati pali vuto lililonse pakhungu pa singano, ndipo ngati pali zovuta, khungu liyenera kudulidwa ndi kudulidwa.
4. Sankhani bwino malo ndi ngodya ya singano: singano sayenera kudutsa mu minofu pang'ono momwe mungathere, kapena singano iyenera kulowetsedwa mumpata wa minofu: pamene singano ikulowetsedwa mu ndege imodzi, mtunda pakati pa singano mu gawo losweka sayenera kukhala osachepera 6 cm; pamene singano imalowetsedwa mu ndege zambiri, mtunda pakati pa singano mu gawo losweka uyenera kukhala waukulu momwe mungathere. Mtunda pakati pa zikhomo ndi mzere wothyoka kapena pamwamba pake uyenera kukhala wosachepera 2cm. Kuwoloka kwa zikhomo muzosowa zambiri ziyenera kukhala 25 ° ~ 80 ° pazikhomo zonse ndi 60 ° ~ 80 ° kwa pini theka ndi zikhomo zonse. .
5. Sankhani molondola mtundu ndi m'mimba mwake wa singano yachitsulo.
6. Manga bowo la singano bwinobwino ndi gauze wa mowa ndi wosabala.
Malo a distal humeral lolowera singano mogwirizana ndi minyewa mtolo wa kumtunda kwa mkono (Gawo lomwe lasonyezedwa m'chifanizoli ndi malo otetezedwa okulungira singanoyo.)
[Kuyika ndi kukonza]
Nthawi zambiri kuchepetsa fracture, pinning ndi fixation ikuchitika alternately, ndipo fixation anamaliza monga pakufunika pamene anaikiratu zikhomo zitsulo anaboola. Ma fractures okhazikika amakonzedwa ndi kuponderezedwa (koma mphamvu ya kuponderezedwa sikuyenera kukhala yaikulu kwambiri, mwinamwake kuwonongeka kwa angular kudzachitika), fractures yokhazikika imayikidwa pamalo osalowerera ndale, ndipo zofooka za mafupa zimakhazikika pamalo osokoneza.
Maonekedwe a kukhazikika kwathunthu akuyenera kuyang'ana pazinthu izi: 1.
1. Yesani kukhazikika kwa kukonza: njirayo ndiyo kuyendetsa mgwirizano, kujambula kwautali kapena lateral kukankhira kumapeto kwa fracture; khola lokhazikika lophwanyika liyenera kukhala lopanda ntchito kapena ntchito yochepa chabe ya zotanuka. Ngati kukhazikika sikukwanira, njira zoyenera zingatengedwe kuti muwonjezere kuuma kwathunthu.
2. Mtunda wochokera ku fupa lakunja lopangira khungu kupita ku khungu: 2 ~ 3cm kumtunda wapamwamba, 3 ~ 5cm kumtunda wapansi, pofuna kupewa kupanikizika kwa khungu ndikuthandizira chithandizo chamankhwala, pamene kutupa kuli kwakukulu kapena kuvulala kwakukulu. , mtunda ukhoza kusiyidwa wokulirapo kumayambiriro, ndipo mtunda ukhoza kuchepetsedwa kutupa kutha ndipo zoopsazo zakonzedwa.
3. Mukaphatikizidwa ndi kuvulala kwakukulu kwa minofu yofewa, ziwalo zina zimatha kuwonjezeredwa kuti nthiti yovulalayo ikhale yoyimitsidwa kapena pamwamba, kuti athetse kutupa kwa chiwalo ndikupewa kuvulala koopsa.
4. Kukonzekera kwakunja kwa fupa la fupa la cadre kuyenera kusokoneza ntchito yogwira ntchito yamagulu, gawo lapansi liyenera kukhala losavuta kuyenda pansi pa katundu, ndipo chigawo chapamwamba chiyenera kukhala chosavuta pazochitika za tsiku ndi tsiku ndi kudzisamalira.
5. Mapeto a singano yachitsulo akhoza kuwonetsedwa pazitsulo zazitsulo zopangira singano pafupifupi 1cm, ndipo mchira wautali kwambiri wa singano uyenera kudulidwa. Mapeto a singano ndi pulasitiki kapu chisindikizo kapena tepi wokutidwa, kuti puncture khungu kapena kudula khungu.
[Zomwe zichitike pazochitika zapadera]
Kwa odwala omwe avulala kangapo, chifukwa cha kuvulala kwakukulu kapena kuvulala koopsa panthawi yotsitsimula, komanso pazochitika zadzidzidzi monga chithandizo choyamba m'munda kapena kuvulala kwa batch, singano ikhoza kutsekedwa ndi kutetezedwa poyamba, ndiyeno kukonzedwanso; kusinthidwa, ndi kutetezedwa pa nthawi yoyenera.
[Zovuta Zodziwika]
1. Matenda a pachimake; ndi
2. Khungu psinjika necrosis; ndi
3. Kuvulala kwa mitsempha
4. Kuchedwa kuchira kapena kusachira kwa chovulala.
5. Zikhomo zosweka
6. Pini thirakiti fracture
7. Kusokonekera kwa mgwirizano
(IV) Chithandizo cha pambuyo pa opaleshoni
Chithandizo choyenera cha postoperative chimakhudza mwachindunji mphamvu ya chithandizo, mwinamwake mavuto monga matenda a pinhole ndi osagwirizana ndi fracture akhoza kuchitika. Choncho, chisamaliro choyenera chiyenera kuperekedwa.
[Machiritso onse]
Pambuyo pa opaleshoniyo, nthambi yovulalayo iyenera kukwezedwa, ndipo kuyendayenda kwa magazi ndi kutupa kwa nthambi yovulalayo ziyenera kuwonedwa; pamene khungu limapanikizidwa ndi zigawo za fupa lakunja lokonzekera chifukwa cha malo kapena kutupa kwa chiwalo, chiyenera kuchitidwa nthawi. Zomangira zotayirira ziyenera kumangika pakapita nthawi.
[Kupewa ndi kuchiza matenda]
Kwa fupa lakunja lokhazikika, maantibayotiki sali ofunikira kuti ateteze matenda a pinhole. Komabe, kupasukako ndi bala lokha liyenera kuthandizidwabe ndi maantibayotiki ngati kuli koyenera. Kwa fractures yotseguka, ngakhale chilondacho chitayidwa bwino, maantibayotiki ayenera kuikidwa kwa masiku 3 mpaka 7, ndipo fractures yomwe ili ndi kachilombo iyenera kuperekedwa kwa nthawi yaitali ngati kuli koyenera.
[Kusamalira pinhole]
Ntchito yowonjezereka pambuyo pa kukhazikika kwa mafupa akunja kumafunika kuti musamalire mapini pafupipafupi. Kusamalidwa bwino kwa pinhole kungayambitse matenda a pinhole.
1. Kawirikawiri kuvala kumasinthidwa kamodzi pa tsiku la 3 pambuyo pa opaleshoni, ndipo chovalacho chiyenera kusinthidwa tsiku ndi tsiku pamene pali kutuluka kuchokera ku pinhole.
2. Masiku 10 kapena kuposerapo, khungu la pinhole ndi fibrous wokutidwa, pamene kusunga khungu laukhondo ndi youma, aliyense 1 ~ 2 masiku mu pinhole khungu madontho a 75% mowa kapena ayodini fluoride njira kungakhale.
3. Pakakhala chipwirikiti pakhungu pabowo la pinyolo, mbali ya nsongayo iyenera kudulidwa mu nthawi kuti muchepetse kupsinjika.
4. Samalani ndi ntchito ya aseptic pamene mukukonzekera fupa lakunja lakunja kapena kusintha kasinthidwe, ndikuthira tizilombo toyambitsa matenda pakhungu lozungulira pinko ndi singano yachitsulo nthawi zonse.
5. Pewani kutenga kachilombo ka HIV panthawi ya chisamaliro cha pinhole.
6. Matenda a pinhole akachitika, chithandizo choyenera cha opaleshoni chiyenera kuchitidwa panthawi yake, ndipo nthambi yovulalayo iyenera kukwezedwa kuti ipumule ndipo mankhwala oyenera ayenera kugwiritsidwa ntchito.
[Zochita zolimbitsa thupi]
Zochita zolimbitsa thupi panthawi yake komanso zolondola sizimangothandizira kuyambiranso ntchito yolumikizana, komanso kukonzanso kwa hemodynamics ndi kukakamiza kupsinjika kuti kulimbikitse kuchiritsa kwa fracture. Nthawi zambiri, kupindika kwa minofu ndi ntchito zolumikizana zimatha kuchitika pabedi pasanathe masiku 7 mutatha opaleshoni. Miyendo yakumtunda imatha kukanikizira ndikugwirana manja ndikuyenda modziyimira pawokha pamikono ndi zigongono, ndipo masewera olimbitsa thupi amatha kuyambika patatha sabata imodzi; miyendo ya m'munsi imatha kuchoka pabedi mothandizidwa ndi ndodo pakatha sabata imodzi kapena chilonda chikachira, kenako pang'onopang'ono amayamba kuyenda ndi kulemera kwathunthu kwa masabata atatu pambuyo pake. Nthawi ndi momwe amachitira masewera olimbitsa thupi amasiyanasiyana munthu ndi munthu, makamaka kutengera momwe zinthu zilili komanso momwe zimakhalira. Pochita masewera olimbitsa thupi, ngati pinhole ikuwoneka yofiira, kutupa, zowawa ndi zizindikiro zina zotupa ziyenera kuyimitsa ntchitoyi, kukweza mwendo wokhudzidwa kuti ukhale wopuma.
[Kuchotsedwa kwa chokonza fupa chakunja]
Chingwe chokhazikika chakunja chiyenera kuchotsedwa pamene fracture yafika pazochitika zachipatala zochiritsira fracture. Pochotsa fupa lakunja lopangira fupa, mphamvu yochiritsira ya fracture iyenera kutsimikiziridwa molondola, ndipo fupa lakunja la fupa siliyenera kuchotsedwa nthawi isanakwane popanda chitsimikizo chotsimikizira mphamvu ya machiritso ya fupa ndi zovuta zoonekeratu za kukonzanso kwa fupa lakunja, makamaka. pochiza matenda monga fracture yakale, comminuted fracture, ndi bone nonunion.
Nthawi yotumiza: Aug-29-2024
