Indications rau amputation. Nta ntawm lub lag luam thiab kev ncaj ncees

amputation ntawm nqua yog suav tias yog ib tug ntawm cov hiob hauj lwm nyob rau hauv lub keeb kwm ntawm cov tshuaj. Tus thawj piav sau hnub tim 4 xyoo pua BC. e. Txawm li cas los, lub cev tsis txhob mob loj heev los ntshav, raws li zoo raws li tsis muaj kev txawj ntse txog vascular nyuam yog feem ntau neeg tuag taus. Tus kws kho mob pom zoo truncate povtseg hauv cuam tshuam ntaub so ntswg, nws yuav rhuav tshem neeg tuag taus los ntshav, tab sis ho tsis txhob kis ntawm gangrene.

Nyob rau hauv thawj xyoo pua AD, Aulus Cornelius Celsus pom tias revolutionary rau nws lub sij hawm mus kom ze rau tus cwj pwm ntawm tej hauj lwm, uas muaj tswv yim pom zoo mus rau:

- mus nqa tawm lub truncation ntawm cov theem ntawm zaum cov ntaub so ntswg;

- nyuam ntawm cais vascular hauv paus los mus tiv thaiv los ntshav;

- shearing backup shred cov ntaub so ntswg los npog lub hauv paus tsis muaj pathological nro.

Ib qho tseem ceeb luag hauj lwm nyob rau hauv kev txhim kho ntawm txoj kev amputation ntawm nqua ua si los ntawm cov kev taw qhia ntawm txoj bloodless kev khiav hauj lwm thaum Esmarch tsim siv kom txog thaum uas tam sim no roj hmab band.

Nyob rau hauv hnub no lub ntiaj teb no ua txoj hauj lwm ntawm cov indications rau amputation nyob mob ntshav qab zib thiab kab mob plawv.

Amputation - truncation ntawm nqua yog, los yog es nws distal ib feem, rau cov pob txha, tab sis nws yuav ib tug txaus ntshai yuam kev mus saib nws raws li ib tug yooj yim tshem tawm ntawm lub cov ya. Qhov no lub sij hawm no implies yas thiab reconstructive phais, aimed ntawm ntxiv sai thiab zoo neeg mob kev ncaj ncees.

Muaj tej yam indications rau no hom ntawm kev phais. Xav txog kev nyeem ntawv cov ntaub ntawv nyob rau hauv ntau yam.

Indications rau amputation

- gangrene.

- Lub xub ntiag ntawm lub hnyav ua kom pom tseeb ntawm tus kab mob, hem tus neeg mob lub neej (co kab mob).

- irreversible ischemia nqaij contracture.

- crush syndrome.

- Tuav raug mob puas raug mob rau nqua ntawm lub ntsiab hlab ntsha thiab qab haus huv, ua li ntawd, hu ua puas amputation.

- occlusive kab mob nrog rau lub sij hawm ntawm gangrene.

- tourniquet, yuam ntau tshaj peb teev.

- Common, tsis amenable rau kev kho mob neurotrophic ulcers.

- osteomyelitis nrog cov kev hem thawj ntawm Internal hloov khoom nruab nrog kev koom tes.

- Cov hom tubercular lesion ntawm cov pob txha cov ntaub so ntswg nyob rau hauv cov neeg laus.

- phem pob txha hlav tsis tau tshem cov raug rho tawm chamber.

Txiav txim rau theem ntawm kev resection

Xaiv cov theem ntawm amputation nyob ntawm cov neeg kawm ntawv ntawm cov ntshav ncig mob nyob rau hauv lub ua cheeb tsam, lub xub ntiag ntawm gangrene, trophic mob, lub xeev ntawm ib sab ntaub so ntswg thiab cov heev ntawm kab mob thiab kev mob.

Cov me nyuam yuav siv tau cov disarticulation (rho tawm ntawm cov cuam tshuam los ib feem ntawm tus txha theem), tsis txhaum ib tug ntxiv pob txha loj hlob.

Raws li cov num ntawm kev phais cais povtseg amputation:

- tam sim ntawd amputation ua nyob rau hauv rendering thawj pab phais kom tshem tawm uas tsis yog-siv tau, puas ntaub so ntswg;

- thaum muaj xwm ceev lag luam nrog truncation hearth intoxication nrog inefficiency conservative kev kho mob;

- npaj amputation, ua nyob rau hauv phem txhab ntawm cov pob txha osteomyelitis.

- reamputatsiya los kho unsound hauv paus.

Faib ib ncig, elliptical thiab patchwork amputation. Xav txog tej yam hauv qab no.

yeej amputation

Lub ntsiab indications rau ablation, namely guillotine (simultaneous yeej) rau raug txiav ceg yog roj gangrene thiab povtseg resection dai rau musculocutaneous dua. Lub cuam yog nqa tawm heev dua lwm yam rau thaum muaj xwm ceev lub neej-saving. Ib tug tseem ceeb drawback ntawm cov txheej txheem no yog muab ib tug uas tsis yog-haumxeeb tuag thiab lub tom ntej losis tswvyim dabtsi reamputatsiya kom pab tau povtseg prosthesis ntxiv lag luam.

Qhov kom zoo dua ntawm qhov no yog qhov tsis muaj amputation ntawm necrotic kev hloov mus rau shreds, txawm nyob rau hauv ib tug txo cov ntshav mov.

Thaum lub guillotine amputation pom tawm tus pob txha nyob rau tib theem li hais tias ntawm lub nqaij mos.

Raws li lub lag luam yog ua? Amputation ntawm tus thawj theem muaj nyob rau hauv daim tawv nqaij incision, subcutaneous rog rog thiab fascia. Ntug Cheb daim tawv nqaij yog ib tug ntxiv landmark rau ntawm ntug. Thaum lub thib ob theem phais ntawm cov leeg mus rau lub pob txha thiab ntxiv txiav pob txha. pob txha kawg cover yog vim cov tawv nqaij thiab fascia.

Qhov no hom pom zoo rau lub tuam ntawm lub nqua nrog ib tus me mob pawg.

Rau departments nrog loj mob pawg trohmomentnaya pom zoo amputation (yooj yim lub khob hliav qab, thiab ib tug yeej ablation los ntawm Pirogov).

Thawj ob theem ntawm lub lag luam no zoo xws li dvuhmomentnoy amputation. Ntxiv mus, tom qab swb rau cov nqaij ntshiv thiab ces dag cov ntaub so ntswg nyob rau hauv lub proximal kev taw qhia, yog rov txiav nqaij twv ib ncig ntawm lub ntug ntawm daim tawv nqaij. Los ntawm no txiav sib sib zog nqus nqaij khaubncaws sab nraud povtseg uas muaj txhawb mus rau lub ntxiv tsim ntawm ib tug conical paus.

Patchwork txoj kev qhia:

• rau odnoloskutnye (ntev ntawm ib nrov plig plawg yog sib npaug zos rau txoj kab uas hla ntawm lub hauv paus ntoo);

• dvuloskutnye (ob daim ntaub ntawm ntau ntau thiab tsawg nyob rau hauv lub sum ntawm cov lengths constituting txoj kab uas hla amputiruemoy nqua).

Nyob rau hauv txoj kev ua rau hauv paus yuav tsum tau borne nyob rau hauv lub siab hais tias qhov caws pliav yuav tsum tsis txhob yuav nyob rau hauv kev ua hauj lwm saum npoo av. Scraps yuav tsum tau tsim nyob rau noj mus rau hauv tus account lub peev xwm los ua tim loads.

osteoplastic amputation

Yuav ua li cas yog lub amputation ntawm lub qis extremities? Ib tug txawv feature yog lub xub ntiag ntawm cov pob txha tawg tsam them nrog periosteum nyob rau hauv nyob tus yeees ntawm thaj ua rau thaj.

osteoplastic amputation ntawm lub qis ceg ntawm cov qauv ntawm cov Pirogov tau thoob ntiaj teb paub vim lub zoo heev anatomical kawg kev pab txhawb nqa kev ncaj ncees ntawm lub ua ceg.

Qhov zoo ntawm tus qauv:

- Tsawg ce paus.

- Muaj kev pab los ntawm lub hauv paus ntoo kawg.

- Tseg proprioceptive rhiab heev ntawm cov leeg thiab tendons.

Procedural cov kauj ruam

Thaum tshem cov tibia, ob incisions no yog ua los rau cov Pirogov. Rau lub hom phiaj no, amputation riam. Thawj ua ib tug ntoo khaub lig txiav ntawm nqaij mos mos, raug lead lom rau pob luj taws ob leeg ntxiv khiav lag luam arcuate seem txuas nrog lub dorsum ntawm ko taw. Tom qab hla tus sab ligaments ua lub rho tawm ntawm lub talus, tibia pob txha sawing. Ib tug ntoo khaub lig-section kaw thaj ua rau thaj. Tsim ib paus.

Lag luam ntawm Sharpe

Muaj lwm txoj kev uas ua ib tug amputation ntawm sab nqua.

Thaum koj tshem tawm ib tug ko taw ntawm nqaij mos phais yog nqa tawm los ntawm ib tug ob peb centimeters distal phalanges ntawm cov thawj metatarsal pob txha. Tom qab otpreparovyvaniya periosteum yog ua sawing metatarsals thiab smoothing cutters tag nrho cov pom txiav. Hlais cover plantar thaj ua rau thaj.

Xav txog lub ntsiab ua rau amputation.

ntshav qab zib microangiopathy

Kev nqis tes ua kws phais neeg nyob ntawm raws li ntawm kev puas tsuaj. Nyob rau hauv loj heev ntawm purulent necrotic txhab tsib theem:

- ces dag necrosis tsis swb tendons.

- gangrene ntiv tes uas muaj lub thawj Phalanx thiab txog leeg.

- Lub thoob plaws gangrene ntawm cov ntiv tes, ua ke nrog gangrene ntawm ko taw.

- gangrenous lesion tag nrho ko taw.

- Kev Koom Tes nyob rau hauv tus txheej txheem ntawm lub tibia.

Nyob rau kev txais neeg kawm tus neeg mob nrog necrotic ischemia nyob thaum muaj xwm ceev kev ncaj ncees ntawm lub hearth, uas muaj nyob rau hauv qhib lub rwj, kua paug, tsawg heev resection ntawm cov cuam tshuam los yog ib feem ntawm tus pob txha thiab cov kev tshem tawm ntawm tuag cov ntaub so ntswg. Tom qab excision ntawm nonviable cov ntaub so ntswg pom zoo lag luam los txaus ntshav txaus puas nqua.

ischemia:

- tus thawj degree yog ua tau tsuas yog kev ntxuav tu hearth;

- thib ob hwj chim txhais tau tias amputation ntawm lub cov ntiv tes nrog excision txheej txheem muab kev koom tes nyob rau hauv lub tendons;

- thaum peb degree nqa tawm rau raug txiav ceg nyob rau hauv Sharpe siv ib tug tshwj xeeb riam amputation;

- kev kho mob ntawm cov plaub degree yog lub resection ntawm lub tibia;

- nyob rau ntawm tsib degree ntawm lub amputation yog ua nyob rau theem ntawm lub duav.

Frostbite ntawm cov ntiv tes thiab lwm tus lub cev qhov chaw

paub qhov txawv:

• tag nrho khov (lub pathological kev hloov nyob rau hauv nruab nrog cev thiab cov nqaij mos, tsim raws li ib tug tshwm sim ntawm lub plawv mob thiab ntxiv ischemia ntawm lub paj hlwb vim tsis muaj kub ntev-acting);

• perfrigeration (manifested mob inflammatory cov tshuaj tiv thaiv ntawm daim tawv nqaij nyob rau hauv daim ntawv ntawm ib tug blue-ntshav kuj thaj ua rau thaj loj khaus.

Muaj plaub degrees:

Tus thawj degree yog nrog los ntawm reversible hloov ntawm daim tawv nqaij: erythema, o, khaus, mob thiab rhiab heev txo unexpressed. Tom qab ib tug ob peb hnub lub cheeb tsam cov yog exfoliated.

Rau qhov thib ob degree tsiag ntawv los ntawm cov tsos ntawm bubbles nrog ib lub teeb cov ntsiab lus, qhia raws li txo nyob rau hauv rhiab heev, tejzaum nws vim kab mob pub ntxiv tshaj trophic ntshawv siab.

Qhov thib peb theem qhia necrotic hloov nyob rau hauv tej nqaij mos raws li ib tug tshwm sim lawv tuag, txoj kev ua ib kab ntawm demarcation (delimitation tuag cov ntaub so ntswg los ntawm kev noj qab nyob Granulation sawb), puas qhov chaw ntawm lub povtseg mummified, nrog accession microbial muaj tej zaum yuav tsim ntub gangrene.

Thaum lub plaub degree ntawm cov ntaub so ntswg necrosis ncua mus rau cov pob txha, cov kua nyob rau hauv lub bubbles ntawm daim tawv nqaij yuav turbid dub, blue daim tawv nqaij, mob rhiab heev disappears nkaus, thiab blackens cuam tshuam povtseg mummified.

kev kho mob

• 1 degree. Rewarming ib tug neeg mob, UHF-txoj kev kho, darsonval, frostbitten povtseg phaus boric haus dej cawv.
• 2nd degree. Ua yog nqa tawm npuas. Tom qab lawv qhib lub puas daim tawv nqaij yog muab tshem tawm, lub qhov txhab hnav khaub ncaws yog thov haus dej cawv. Mauj tshuaj tua kab mob yog pom zoo.
• Peb degree. Tuskheej npuas excised necrotic cov ntaub so ntswg ntaub qhwv nrog hypertonic saline. Tshuaj tua kab mob uas yog siv los mus tiv thaiv theem nrab kab mob.
• 4-th degree. Necrectomy (tshem tawm ntawm devitalized ntaub so ntswg) yog nqa tawm ntawm 1 cm saum toj no lub necrosis kab. Amputation yog ua tom qab tsim ntawm ib tug qhuav ua kaub puab.

gangrene

Qhuav gangrene yog ib tug ntawm qeeb hnyav teeb meem ntawm cov ntshav mov rau ntaub so ntswg yog cov yam ntxwv ntawm cov neeg mob nrog atherosclerosis thiab obliterating endarteritis.

Tsiag ntawv los ntawm kev qhaj ntawv ntawm intoxication ntawm tus kab mob, lub xub ntiag ntawm ib tug ntshiab demarcation ntawm tus ncej. Nyob rau hauv cov kev kho mob ntawm kev siv expectant tswj.

Thov tshuaj uas txhim kho cov ntaub so ntswg trophism, mauj tshuaj tua kab mob. Lub lag luam yog nqa tawm tom qab txoj kev ua ib ntshiab kab ntawm demarcation.

Ntub gangrene tshwm sim raws li ib tug rau txim ntawm lub mob cessation ntawm kev (frostbite ntiv tes, thrombosis, vascular compression). Nws yog yus muaj los ntawm yam mob loj heev intoxication, tsis muaj demarcation kab thiab cov lus hais rau edema. Amputation nrog gangrene nyob urgently, expectant tswj yog tsis tsim nyog. lag luam yog ua tom qab detoxification txoj kev kho. amputation kab yuav tsum muaj nuj nqis dua gangrene (nrog txhab pom zoo amputation ntawm ko taw tuav ntawm hip theem).

Gas gangrene yog ib txog kev hais rau guillotine amputation. Yam ntxwv cov tsos mob: pronounced, sai hnyav o, lub xub ntiag ntawm roj nyob rau hauv cov ntaub so ntswg thiab cov nqaij, necrosis thiab rwj nrog melting nqaij mos. Dig muag, cov nqaij ntshiv grayish, npub, ib qho yooj yim mus zuaj rau palpation. Daim tawv nqaij ntshav-blue, thaum nias hnov crunching thiab creaking. Tus neeg mob yws ntawm unbearable, bursting nrog mob.

Cov kev solvency ntawm lub hauv paus ntoo thiab nws cov ntawv rau ntxiv cov khoom cuav

Rau ib txwm hauj lwm ntawm lub prosthesis mus rau lub residual ntev ntawm lub ob leeg yuav tsum muaj ntau tshaj nws txoj kab uas hla. Tsis tas li ntawd ib qho tseem ceeb yog nws physiological zoo (me ntsis tapered los ntawm sab saum toj mus rau nram qab) thiab tsis mob. Rua yog kwv yees li muaj ntawm cov pob qij txha thiab tej tawv nqaij caws pliav (nws muaj thiab cov tsis muaj cohesion nrog cov pob txha hauv paus).

Tej yam tshwm sim vicious hauv paus

- Faib qhov caws pliav nyob rau hauv lub chaw ua hauj lwm saum npoo av.

- tshaj nqaij mos.

- Qhov uas tsis muaj tapering hauv paus.

- Fusion nrog caws pliav nqaij, nws stillness.

- dhau siab kev kho ntawm cov leeg.

- Ntev nro ntawm daim tawv nqaij pob txha sawdust.

- Rejection ntawm cov pob txha feem nrog amputation paired cov pob txha.

- Tsis tshua muaj neeg conical zoo ntawm lub hauv paus ntoo.

ua tsis taus

Amputation ntawm nqua yog ib qho anatomical defect uas tshwm sim los ntawm kev tsis taus pab pawg neeg raug indefinitely. Yog hais tias muaj yog ib tug ceg amputation, kev tsis taus pab pawg neeg raug tam sim ntawd.

Kwv yees ntawm cov neeg kawm ntawv poob ntawm tej qhov kev ua si, kev tsis taus thiab Disability, raws li zoo raws li ib tug ntxiv txoj hauj lwm ntawm kev xiam oob khab yog koom nyob rau hauv kev kho mob-kev ncaj ncees cov kws muaj txuj pawg neeg.

Nyob rau hauv kev tsim kom muaj cov neeg kawm ntawv tsis taus yog soj ntsuam:

- Cov muaj peev xwm rau nws tus kheej-kev pab cuam.

- Cov tau ywj siab zog.

- Lub adequacy ntawm lub orientation rau hauv qhov chaw thiab lub sij hawm nyob rau hauv lub qhaj ntawv ntawm pathology puas siab puas ntsws kev ua si (ntsuas lub rooj sib hais thiab pom kev zoo).

- Kev sib txuas zog, muaj peev xwm piav tes piav taw, sau ntawv, nyeem ntawv, thiab lwm yam ...

- Cov theem ntawm kev tswj lawv tus kheej tus cwj pwm (ua raws li kev cai lij choj, kev ncaj ncees thiab raug cai cai ntawm cov haiv neeg).

- kev kawm muaj peev xwm, lub sijhawm los kawm cov txuj ci tshiab, txoj kev loj hlob ntawm lwm yam hauj lwm.

- Muaj peev xwm mus koom nyob rau hauv kev ua hauj lwm.

- Muaj peev xwm mus txuas ntxiv mus ua hauj lwm tsis pub dhau lub moj khaum ntawm lawv cov kev ua ub no tom qab kev ncaj ncees thiab lub creation ntawm tshwj xeeb tej yam kev mob.

- Cov functionality thiab degree ntawm kev loj hlob ntawm lub prosthesis.

Cov thawj pab pawg neeg

Indications rau cov puav pheej ntawm thawj pab pawg neeg:

- amputation ntawm ob txhais ceg nyob rau hip theem.

- Cov kev qhaj ntawv ntawm cov plaub ntiv tes (xws li tus thawj Phalanx) nyob rau ob qho tag nrho ob txhais tes.

- amputation ntawm ob txhais tes.

Qhov thib ob pab pawg neeg

- amputation ntawm peb tug ntiv tes (nrog rau cov thawj phalanges) ntawm ob txhais tes.

- Tshem Tawm ntawm 1 thiab 2 tug ntiv tes.

- Tsis muaj 4 tug ntiv tes thaum tswj cov thawj phalanges.

- amputation ntawm ntiv tes rau ntawm ib tug tes nrog rau lub siab paus ntawm lub thib ob txhais tes.

- lag luam ntawm Chopart thiab Pirogov.

- High resection ntawm ib ceg, ua ke nrog rau cov tuaj kawm ntawv ntawm cov ntiv tes ntawm ib sab tes los sis qhov muag.

- amputation ntawm ib txhais tes thiab lub qhov muag.

- disarticulation hip los yog lub xub pwg.

Qhov thib peb pab pawg neeg

- unilateral amputation ntawm cov ntiv tes tsis tshem cov thawj Phalanx.

- Muab ob npaug rau mog amputation ntawm cov ntiv tes.

- High amputation ntawm ib tug ceg los yog caj npab.

- Tshem ob txhais ko taw rau Sharpe.

- Qhov txawv nyob rau hauv cov ceg ntev ntawm 10 cm.

Rehabilitation tom qab amputation

Nyob rau hauv tas li ntawd mus anatomical defect povtseg amputation ua rau loj puas hawv kev poob plig mob. Tus neeg mob kaw rau cov kev xav ntawm inferiority nyob rau hauv lub qhov muag ntawm lub neej, nws ntseeg hais tias nws lub neej lawm.

Cov kev vam meej ntawm lub neej yav tom ntej prosthetic txiav txim tsis tsuas yog lub timeliness ntawm kev ua hauj lwm, cov theem ntawm amputation thiab tom ntej kom zoo saib xyuas rau cov hauv paus.

3-4 hnub tom qab amputation kev tiv thaiv pib flexion contractures, ua hauv paus taw. Tom qab tshem tawm ntawm sutures active ce nqaij hauv paus pom zoo. Ib lub hlis tom qab, pib rau sim cov thawj prosthesis.

Qhov tseem ceeb tshaj lub hom phiaj ntawm kev ncaj ncees yog los tswj tus neeg mob lub hlwb lub xeev thiab lub tsim ntawm nws txaus kho mob rau cov khoom cuav.

Ntxiv cov kev ua ub no muaj xws li:

- kev kawm nyob rau hauv kev siv ntawm cov prosthesis;

- ib tug txheej ntawm ce mus qhib lub prosthesis thiab nws cov menyuamuas nyob rau hauv lub zuag qhia tag nrho lub cev muaj zog stereotype;

- normalization ntawm kev sib koom tes, kev siv cov kev kho mob thiab prosthetic kev kawm.

- socio-kev ncaj ncees kev ua ub no, adaptation rau tus neeg mob lub neej nrog ib tug prosthesis;

- txo txoj kev loj hlob ntawm tus neeg cov kev pab cuam, kev rov qhia dua thiab ntxiv ua hauj lwm (rau cov 2nd thiab 3rd pawg).

Yog hais tias koj muaj kev phantom mob nyob rau hauv ib tug amputated povtseg xav kom lub novocaine blockade, hypnosis thiab hlwb. Yog hais tias muaj yog tsis muaj txoj kev txhim kho tau mus nqa tawm kev phais nrog resection ntawm cov cov paj.