Alamomi ga yanki. Features na aiki da kuma fi

yanki na gabar jiki an dauki daya daga cikin tsofaffin ayyukan a cikin tarihi na magani. A farko kwatancin kwanan rana 4th karni BC. e. Duk da haka, da rashin iyawa don dakatar tsanani zub da jini, kazalika da rashin ilmi game da jijiyoyin bugun gini ligation ne yawanci m. The likita da shawarar truncate reshe cikin shafa kyallen takarda, shi gusar m zub da jini, amma bai hana yaduwar gangrene.

A arni na farko AD, Aulus Cornelius Celsus shawarar neman sauyi na da lokaci tsarin kula da hali na irin wadannan ayyuka, da suka hada da shawarwari zuwa:

- a gudanar da wani truncation na matakin na yiwuwa nama.

- ligation na zama ruwan dare jijiyoyin bugun gini dungu su hana zub da jini;

- sausaya madadin fatattaka nama don rufe kututturen ba tare da pathological tashin hankali.

An muhimmiyar rawa a inganta hanyoyin yanki na gabar jiki taka leda da gabatarwar da hanyar zubar da jini aiki a lokacin da Esmarch halitta amfani da har yanzu zaren roba.

A duniya ta yau manyan matsayi a cikin alamomi na yanki zauna ciwon sukari da kuma cututtukan zuciya.

Yanki - truncation na wata gabar jiki ne, ko kuma wajen da distal part, ga ƙasũsuwa, amma zai zama wani mummunan kuskure don duba shi a matsayin mai sauki kau na shafa kashi. Wannan lokaci yakan haifar da roba da kuma reconstructive tiyata, da nufin kara m da tasiri haƙuri fi.

Akwai wasu alamomi na irin wannan tiyata. La'akari da karatun bayanai in more daki-daki.

Alamomi ga yanki

- Gangrene.

- A gaban nauyi mayar da hankali na kamuwa da cuta, barazanar haƙuri da rayuwa (anaerobic kamuwa da cuta).

- komowar ischemia tsoka contracture.

- murkushe ciwo.

- murkushe Rauni Traumatic rauni ga wata gabar jiki na babban tasoshin da jijiyoyi, gudanar don haka ya kira traumatic yanki.

- occlusive cuta da sakamako na gangrene.

- tourniquet, kallafaffen fiye da sa'o'i uku.

- Common, ba amenable don magani neurotrophic ulcers.

- Osteomyelitis tare da barazana da ciki sashin jiki hannu.

- The kowa tubercular rauni na kashi nama a cikin tsofaffi.

- m kashi marurai ba tare da yiwuwar cire ruwan dare jam'iyya.

Tabbatas da matakin na resection

Akwai hanyoyi da matakin na yanki dogara a kan mataki na jini zagayawa cuta a cikin sarrafa yanki, gaban gangrene, trophic cuta, jihohin m tsokoki da kuma mai tsanani kamuwa da cuta da kuma zafi.

The yara kokarin yin amfani da disarticulation (kadaici da abin ya shafa part a hadin gwiwa matakin), ba ya karya wani karin ci gaban kashi.

Bisa ga gaggawa na tiyata ware reshe yanki:

- nan da nan yanki yi a kauda taimakon farko tiyata don cire ba mai yiwuwa, lalace kyallen takarda.

- gaggawa aiki tare da truncation hearth maye da gazawar ra'ayin mazan jiya hanyoyin kwantar da hankali.

- shirya yanki, gudanar a m raunuka na kashi osteomyelitis.

- reamputatsiya to gyara unsound dungu.

Ware wani madauwari, elliptical da patchwork yanki. Ka yi la'akari da wadannan iri a kasa.

madauwari yanki

Babban alamomi ga ablation, wato guillotine (lokaci daya madauwari) amputations ne gas gangrene kuma reshe resection rataye a kan musculocutaneous alamar. A kutse ne da za'ayi na musamman domin gaggawa rai-ceto. A gagarumin drawback wannan dabara ne don samar da wani maras aikin mutu da kuma m nauyin reamputatsiya daidaita reshe prosthesis kara kafa.

A amfani da wannan shi ne rashin yanki na necrotic canje-canje zuwa tãtsuniyõyi, ko a rage jini wadata.

Lokacin da guillotine yanki gan kashe kashi a wannan matakin a matsayin cewa daga cikin taushi da nama.

Kamar yadda aiki aka yi? Yanki na mataki na farko ya kunshi a cikin fata incision, subcutaneous mai da fascia. Edge shafa fata ne a kara alama a gefen. A mataki na biyu dissection na tsokoki zuwa kashi da kuma kara da yanke kashi. kashi karshen cover ne saboda da fata da kuma fascia.

Wannan irin shawarar da sassan na wata gabar jiki da gwada da kananan tsoka taro.

Domin sassan da manyan tsoka taro trohmomentnaya shawarar yanki (sauki mazugi, da kuma wani madauwari ablation da Pirogov).

A farko matakai biyu na aiki ne kama da dvuhmomentnoy yanki. Bugu da ari, bayan da zamiya da tsokoki da kuma na waje nama a cikin proximal shugabanci, shi ne sake yanke tsokoki kõma a kusa da gefen da fata. Ta hanyar wannan suna yanka zurfin tsoka yadudduka cewa taimaka wa m samuwar wani conical dungu.

Patchwork hanyoyin raba:

• a kan odnoloskutnye (tsawon na daya m ne, sunã daidaita da diamita daga cikin kututture).

• dvuloskutnye (biyu rag na daban-daban masu girma dabam a kan Naira Miliyan Xari da tsawo constituting diamita amputiruemoy wata gabar jiki).

A kafa kututturen dole ne a haifa tuna cewa tabo kada ta kasance a kan aikin surface. Scraps ya kamata a kafa shan la'akari da ikon kai lodi.

osteoplastic yanki

Ta yaya ne yanki na ƙananan extremities? A rarrabe ne gaban kashi, niƙaƙƙun gaɓãɓuwa rufe da periosteum a cikin abun da ke ciki na faci.

osteoplastic yanki na ƙananan kafa ta Hanyar Pirogov tsiwirwirinsu karbuwa a kasashen duniya saboda da sosai daga ilimin Halittar Jiki nasara karshen support fi na sarrafa kafa.

Abũbuwan amfãni daga cikin Hanyar:

- Kadan soreness dungu.

- Samun da goyon bayan da kututturen karshen.

- Ajiye proprioceptive ji na ƙwarai daga tsokoki da kuma tendons.

Procedural matakai

Lokacin da cire tibia, biyu incisions aka sanya a kan Pirogov. A saboda wannan dalili, yanki da wuka. Da farko a samar da giciye yanke taushi tsokoki, fallasa da mahadin idon sawun karin aiki arcuate sashe mikawa tare da dorsum na ƙafa. Bayan tsallaka a kaikaice jijiyoyin sa kadaici da talus, kashi tibia sawing. A gicciye-sashe rufe faci. Samar da wata dungu.

Operation of Sharpe

Akwai wani Hanyar da wanda ya yi wani yanki na ƙananan wata gabar jiki.

A lokacin da ka cire a gindin taushi nama dissection ne da za'ayi da 'yan santimita distal phalanges na farko yatsun kafa kashi. Bayan otpreparovyvaniya periosteum aka yi sawing metatarsals da smoothing masu saro duk ya ga yanke. Cut cover tafin faci.

Ka yi la'akari da babban Sanadin yanki.

m microangiopathy

Actions likita dogara a kan irin nisan da lalacewa. A cikin ruwan dare na surkin jini necrotic raunuka ne biyar, saukarwa:

- na waje necrosis ba tare da shan kashi tendons.

- Gangrene yatsa shafe na farko phalanx da jijiya.

- The tartsatsi gangrene na yatsunsu, a hade tare da gangrene na ƙafa.

- gangrenous rauni dukan sawun.

- hannu a cikin tsari na tibia.

A m da haƙuri da necrotic ischemia gudanar gaggawa fi na hearth, wadda ta ƙunshi a bude da ƙurji, magudanun ruwa na abscesses, kadan resection abin ya shafa na daga cikin kashi da kuma kau da matattu nama. Bayan excision na nonviable nama shawarar aiki don mayar da isasshen jini ya kwarara lalace wata gabar jiki.

Ischemia:

- na farko digiri aka yi kawai tsaftar hearth.

- biyu ikon nufin yanki na shafa yatsunsu tare da excision aiwatar da hannu a cikin tendons.

- a lokacin da na uku mataki za'ayi amputations a kan Sharpe amfani na musamman wuka yanki.

- magani na hudu mataki ne resection a tibia.

- a karo na biyar digiri na yanki da aka yi a kan matakin da kwatangwalo.

Frostbite na yatsunsu da sauran sassan jiki

rarrabe:

• total daskarewa (da pathological canje-canje a cikin gabobin da kyallen takarda, masu tasowa, a sakamakon Sistem sakulasan cuta da kuma kara ischemia na kwakwalwa saboda low zazzabi dogon-addashin).

• perfrigeration (bayyana kullum kumburi dauki na fata a cikin wani nau'i na bluish-purple scaly faci da tsanani itching.

Akwai hudu digiri:

A farko mataki ne tare da reversible canje-canje na fata: erythema, kumburi, itching, zafi da ýan rage unexpressed. Bayan 'yan kwanaki da shafa yankin suna exfoliated.

Domin na biyu digiri halin da bayyanar kumfa tare da wani haske abun ciki, kamar yadda ya bayyana karu a ji na ƙwarai, yiwu saboda kamuwa da cuta shiga trophic cuta.

The uku mataki ne da aka nuna necrotic canje-canje a cikin m nama a sakamakon da suka mutu, forming wani layin na gindaya (delimitation matattu nama daga lafiya granulation tsiri), lalace yankunan da reshe mummified, tare da Accession da ake dasu Flora iya ci gaba da rigar gangrene.

Lokacin da na hudu mataki na nama necrosis kara zuwa kashi, da ruwa a cikin kumfa a kan fata ya zama turbid baki, bluish fata, zafi ƙwarai vuya gaba ɗaya, da kuma blackens shafa reshe mummified.

magani

• 1st digiri. Rewarming wani haƙuri, UHF-far, darsonval, frostbitten reshe laba boric barasa.
• 2nd digiri. Processing ne da za'ayi kumfa. Bayan su bude lalace fata an cire, da rauni miya aka yi amfani da barasa. Tsari kwayoyin far bada shawarar.
• Uku mataki. Kawar da kumfa excised necrotic nama bandeji da hypertonic Saline. Maganin rigakafi ake amfani da su hana sakandare kamuwa da cuta.
• 4-th digiri. Necrectomy (kau na devitalized nama) ne da za'ayi a 1 cm sama da necrosis line. Yanki ne ya yi, bayan da samuwar wani bushe ɓawon burodi.

gangrene

Dry gangrene ne a sakamakon jinkirin da m cuta na jinin samar wa kyallen takarda ne halayyar da marasa lafiya da atherosclerosis da obliterating endarteritis.

Halin da babu maye da kwayoyin, gaban bayyananne gindaya na shaft. A lura da yiwu amfani da expectant management.

Aiwatar: kwayoyi da inganta nama trophism, tsari kwayoyin far. The aiki ne da za'ayi bayan kafa wata hujja layi na gindaya.

Rigar gangrene auku a matsayin sakamako na m lõkacin fatara daga wurare dabam dabam (frostbite yatsunsu, thrombosis, jijiyoyin bugun gini matsawa). An halin tsanani maye, babu gindaya line kuma furta edema. Yanki da gangrene gudanar gaggawa, expectant management ne unacceptable. aiki da aka yi, bayan detoxification far. yanki line dole ne da yawa mafi girma gangrene (tare da raunuka da shawarar yanki na kafar riƙe a hip matakin).

Gas gangrene ne mai cikakkar nuni ga guillotine yanki. Halayyar bayyanar cututtuka: pronounced, hanzari m kumburi, gaban gas a cikin tsokoki da kuma tsokoki, necrosis da ƙurji da dab taushi nama. Gani tsokoki grayish, maras ban sha'awa, da sauki crumple a kan palpation. Skin m-bluish, a lokacin da guga man ji crunching da creaking. A haƙuri tanã kai ƙãra na numfashi ba, yadda nake alfaharin da zafi.

A sharudda ga solvency na dungu da shiri domin kara prosthetics

Ga al'ada aiki na prosthesis ga saura tsawon na hadin gwiwa dole ne mafi girma daga diamita. Har ila yau muhimmanci shi ne ta physiological siffar (dan kadan Tapered daga sama zuwa kasa), kuma m. Sami Ceto kiyasta motsi na gidajen abinci da kuma fata tabo (ya motsi da kuma rashin cohesion da kashi-akai).

ÃyõyinSa mugun dungu

- Rarraba da tabo a kan aikin surface.

- rarar taushi nama.

- The rashin tapering dungu.

- Fusion tare da tabo nama, ta rarrabe.

- Too high tsari na tsokoki.

- fiye da kima tashin hankali da fata kashi sawdust.

- kin amincewa da kashi segments da yanki guda biyu ƙasũsuwa.

- Musamman conical siffar da kututture.

yin tawaya

Yanki na gabar jiki ne daga ilimin Halittar Jiki lahani da ya sa aka tawaya kungiyar sanya illa ma sha Allahu. Idan akwai wani yanki kafa, tawaya kungiyar sanya nan da nan.

Hakkin da digiri na asarar aikin aiki, tawaya da kuma tawaya, kazalika da ci gaba da aiki na tawaya ke tsunduma a cikin likita-fi gwani kwamitin.

A kafa mataki na tawaya da aka kiyasta:

- The ikon kai-da sabis.

- The yiwuwar m motsi.

- The adequacy na fuskantarwa a sarari da kuma lokaci da in babu Pathology shafi tunanin mutum da aiki (auna ji da gani).

- Sadarwa ayyuka, da ikon wa karimcin, rubuta, karanta, da dai sauransu ...

- The matakin na iko da nasu hali (yarda da doka, da halin kirki da kuma da'a norms na al'umma).

- koyo ikon, da damar su koyi sababbin dabarun, ci gaban sauran harkokin rayuwa.

- The ikon tafiyar da aikin yi.

- Ability don ci gaba da aiki a cikin tsarin na su masu sana'a da ayyukan bayan gyaran fuska da kuma halittar yanayi na musamman.

- A ayyuka da kuma mataki na ci gaba da prosthesis.

Na farko da kungiyar

Alamomi da lambar yabo na farko rukuni:

- yanki na kafafuwansa biyu a hip matakin.

- The rashi na hudu yatsunsu (ciki har da farko phalanx) a kan hannayensa biyu.

- yanki na hannuwanku.

Na biyu kungiyar

- yanki na uku yatsunsu (tare da na farko phalanges) na hannayensa biyu.

- Removal of 1 da 2 yatsunsu.

- Babu 4 yatsunsu yayin da rike farko phalanges.

- yanki na yatsunsu a hannu daya da wani babban kututture na biyu hannun.

- Operation of Chopart da Pirogov.

- High resection na daya kafa, a hade tare da rashi na yatsun wannan hannu ko ido.

- yanki na hannu daya kuma da ido.

- disarticulation hip ko kafada.

Na uku kungiyar

- unilateral yanki na yatsunsu ba tare da cire farko phalanx.

- Biyu-gefe yanki na yatsunsu.

- High yanki na kafa ko hannu.

- Cire biyu ƙafãfunku a Sharpe.

- The bambanci a kafa tsawon na 10 cm.

Fi bayan yanki

Bugu da kari ga ilimin Halittar Jiki aibi reshe yanki take kaiwa zuwa tsanani m rauni haƙuri. A haƙuri rufe a kan tunani da kasawarmu, a cikin idanu na jama'a, ya yi imanin cewa rayuwarsa ne a kan.

Nasarar da nan gaba afar roba m ba kawai ta timeliness na ayyukan, matakin yanki da kuma m dace kula ga dungu.

3-4 kwanaki bayan yanki rigakafin fara lankwashewa contractures, yin dungu ƙungiyoyi. Bayan kau na sutures aiki motsa jiki tsoka dungu shawarar. A watan daga baya, za a fara gwada na farko prosthesis.

A mafi muhimmanci burin na fi shi ne don daidaita haƙuri ta m jihar da kuma samuwar ya isasshen magani ga prosthetics.

Bugu da ari ayyuka sun hada da:

- horo a cikin yin amfani da prosthesis.

- wani sa na bada don kunna prosthesis da ta hada a cikin sauran motor stereotype.

- daidaita daidaituwa, da yin amfani da likitanci da} afar roba horo.

- socio-fi ayyukan, karbuwa ga haƙuri da rayuwa tare da wani prosthesis.

- rage cin gaban mutum shirye-shirye, maimatawar horaswa da kuma kara da aikin yi (ga 2nd da 3rd kungiyoyin).

Idan ka fuskanci fatalwa zafi a gurguwar reshe bayar da shawarar cewa novocaine kawancen, hypnosis da psychotherapy. Idan babu kyautata yiwu a gudanar da wani aikin tiyata da resection na shafa jijiya.