Indlela yokuSebenza
(I) I-anesthesia
I-Brachial plexus block isetyenziselwa imilenze ephezulu, i-epidural block okanye i-subarachnoid block isetyenziselwa imilenze ephantsi, kunye ne-anesthesia jikelele okanye i-anesthesia yendawo nayo ingasetyenziswa ngokufanelekileyo.
(II) Isikhundla
Amalungu aphezulu: i-supine, i-elbow flexion, i-forearm phambi kwesifuba.
Izitho ezisezantsi: i-supine, i-hip flexion, i-abduction, i-knee flexion kunye ne-ankle joint kwi-90 degree dorsal extension position.
(III)Ulandelelwano lomsebenzi
Ukulandelelana okuthe ngqo kokusebenza kwe-fixator yangaphandle kukutshintshana kokusetha kwakhona, ukuxutywa kunye nokulungiswa.
[Inkqubo]
Oko kukuthi, i-fracture iqale ibekwe ngokutsha (ukulungisa ukukhubazeka okujikelezayo kunye nokudlulayo), emva koko ihlatywe ngezikhonkwane ezikude kumgca wokuphuka kwaye zilungiswe ekuqaleni, emva koko ziphinde zibekwe ngokutsha kwaye zihlatywe ngezikhonkwane ezisondele kumgca wokuqhekeka, kwaye ekugqibeleni zibekwe kwindawo yokwaneliseka. Ukwaphuka kwaye emva koko kulungiswe ngokupheleleyo. Kwezinye iimeko ezikhethekileyo, ukuphuka kunokulungiswa ngokuphina ngokuthe ngqo, kwaye xa imeko ivumela, ukuphuka kunokutshintshwa, kulungiswe kwaye kulungiswe kwakhona.
[Ukunciphisa Iqhekeza]
Ukunciphisa i-fracture yinxalenye ephambili yonyango lokuphuka. Ingaba i-fracture iyancitshiswa ngokwanelisayo inefuthe elithe ngqo kumgangatho wokuphulukisa ukuphuka. Ukuqhekeka kunokuvalwa okanye phantsi kombono othe ngqo ngokwemeko ethile. Isenokuhlengahlengiswa ngokwefilimu yeX-ray emva kokumakishwa komphezulu womzimba. Iindlela ezikhethekileyo zezi zilandelayo.
1. Ngaphantsi kombono othe ngqo: Kwiziphelo ezivulekileyo kunye neziphelo ezivulekileyo, i-fracture inokubuyiselwa phantsi kombono othe ngqo emva kokuchithwa ngokucokisekileyo. Ukuba i-fracture evaliweyo ihluleka ukunyanzeliswa, i-fracture ingancitshiswa, ihlatywe kwaye ilungiswe phantsi kombono othe ngqo emva kwe-incision encinci ye-3 ~ 5cm.
2. Indlela yokunciphisa evaliweyo: okokuqala yenza i-fracture ngokukhawuleza isetyenziselwe kwaye emva koko isebenze ngokulandelelana, inokusebenzisa ipini yentsimbi kufuphi nomgca wokuphuka, kwaye usebenzise indlela yokuphakamisa kunye nokuqhawula ukuncedisa ukuphuka ukuba kuhlaziywe kwakhona kuze kube kuyaneliseka. kwaye emva koko yalungiswa. Kwakhona kunokwenzeka ukwenza ulungelelwaniso olufanelekileyo lokufuduka okuncinci okanye i-angulation ngokwe-X-ray emva kokunciphisa uqikelelo kunye nokulungiswa ngokusekelwe kumzimba womzimba okanye iimpawu ze-bony. Iimfuno zokunciphisa i-fracture, ngokomgaqo, kukunciphisa i-anatomical, kodwa i-fracture enzulu, kaninzi akulula ukubuyisela ifom ye-anatomical yokuqala, ngeli xesha ukuphuka kufuneka kube ngcono ukudibanisa phakathi kwebhloko ye-fracture, kunye nokugcina iimfuno zomgca wamandla.
[Uphina]
I-Pinning yeyona ndlela iphambili yokusebenza yokulungiswa kwamathambo kwangaphandle, kwaye indlela elungileyo okanye embi yokukhonkotha ayichaphazeli nje kuphela ukuzinza kokulungiswa koqhekeko, kodwa inxulumene nesehlo esiphezulu okanye esisezantsi se-comorbidity. Ngoko ke, iindlela zokusebenza ezilandelayo kufuneka zilandelwe ngokungqongqo xa uthunga inaliti.
1. Gwema umonakalo wokubambisa: Qonda ngokupheleleyo i-anatomy yendawo yokubhoboza kwaye ugweme ukulimaza imithambo yegazi ephambili kunye nemithambo-luvo.
2. Indlela yokusebenza ye-aseptic engqongqo, inaliti kufuneka ibe yi-2 ~ 3cm ngaphandle kwendawo yesilonda esosulelekileyo.
3. Ubuchule obungqongqo obungena-invasive: xa unxibe isiqingatha-inaliti kunye nobukhulu obukhulu benaliti epheleleyo, i-inlet kunye ne-outlet yenaliti yentsimbi kunye nemela ebukhali ukwenza i-0.5 ~ 1cm yesikhumba sokuqhawula; xa unxibe inaliti enesiqingatha, sebenzisa i-haemostatic forceps ukwahlula isihlunu kwaye emva koko ubeke i-cannula kwaye ugqobhoze imingxuma. Musa ukusebenzisa i-high-speed power drilling xa ubhobhoza okanye udibanisa ngqo inaliti. Emva kokuthunga inaliti, amalungu kufuneka ashukunyiswe ukujonga ukuba kukho ukunyanzeliswa kwesikhumba kwinaliti, kwaye ukuba kukho ukuxhatshazwa, ulusu kufuneka lunqunywe kwaye lufakwe.
4. Khetha ngokuchanekileyo indawo kunye ne-angle yenaliti: inaliti akufanele idlule kwi-muscle kancinane kangangoko kunokwenzeka, okanye inaliti kufuneka ifakwe kwi-gap ye-muscle: xa inaliti ifakwe kwindiza enye, umgama phakathi kwe-gap. iinaliti kwicandelo lokuqhekeka akufanele libe ngaphantsi kwe-6 cm; xa inaliti ifakwe kwiindiza ezininzi, umgama phakathi kweenaliti kwicandelo lokuqhekeka kufuneka ube mkhulu kangangoko. Umgama phakathi kwezikhonkwane kunye nomgca wokuqhekeka okanye umgangatho we-articular akufanele ube ngaphantsi kwe-2cm. I-angle yokuwela izikhonkwane kwi-needling ye-multiplanar kufuneka ibe yi-25 ° ~ 80 ° yezikhonkwane ezipheleleyo kunye ne-60 ° ~ 80 ° yezikhonkwane zesiqingatha kunye nezikhonkwane ezipheleleyo. .
5. Khetha ngokuchanekileyo uhlobo kunye nobubanzi benaliti yensimbi.
6. Gquba umngxuma wenaliti ngokucokisekileyo nge-alcohol gauze kunye ne-sterile gauze.
Indawo ye-distal humeral enaliti yokungena ngokumalunga ne-vascular nerve bundle yengalo engaphezulu (Icandelo eliboniswe kulo mzekeliso yindawo yokhuseleko yokuthunga inaliti.)
[Ukufakwa kunye nokulungiswa]
Kwiimeko ezininzi ukunciphisa ukuphuka, ukukhonkxwa kunye nokulungiswa kuqhutyelwa ngokuhlukileyo, kwaye ukulungiswa kugqitywe njengoko kufunwa xa izikhonkwane zentsimbi ezinqunywe kwangaphambili zihlatywe. Iifractures ezizinzileyo zilungiswe ngokunyanzeliswa (kodwa amandla oxinzelelo akufanele abe mkhulu kakhulu, ngaphandle koko i-angular deformity iya kwenzeka), i-fractures edibeneyo igxininiswe kwindawo engathathi hlangothi, kwaye iziphene zamathambo zigxininiswe kwindawo yokuphazamiseka.
Ifashoni yokulungiswa ngokupheleleyo kufuneka ithathele ingqalelo le miba ilandelayo: 1.
1. Ukuvavanya ukuzinza kokulungiswa: indlela yokulawula i-joint, i-longitudinal umzobo okanye i-lateral pushing isiphelo sokuphuka; isiphelo esizinzileyo sokuqhekeka esizinzile kufuneka singabi namsebenzi okanye inani elincinci lomsebenzi we-elastic. Ukuba ukuzinza akwanelanga, amanyathelo afanelekileyo anokuthathwa ukunyusa ukuqina okupheleleyo.
2. Umgama osuka kwithambo lokulungiswa kwangaphandle ukuya kwesikhumba: 2 ~ 3cm kwinqanaba eliphezulu, i-3 ~ 5cm yecala eliphantsi, ukwenzela ukuthintela ukunyanzeliswa kwesikhumba kunye nokuququzelela unyango lwe-trauma, xa ukuvuvukala kunzulu okanye i-trauma enkulu. , umgama ungashiywa mkhulu kwinqanaba lokuqala, kwaye umgama ungancitshiswa emva kokuba ukuvuvukala kuphelile kwaye ukuxhatshazwa kulungiswe.
3. Xa ihamba kunye nokulimala okunzulu kwezicubu ezithambileyo, ezinye iindawo zingongezwa ukwenza ilungu elimele linqunyanyiswe okanye liphezulu, ukwenzela ukuba kube lula ukuvuvukala kwelungu kunye nokukhusela ukulimala koxinzelelo.
4. I-bone fixator yangaphandle yethambo ye-bone cadre akufanele ichaphazele umsebenzi wokusebenza kwamalungu, umlenze ophantsi kufuneka ube lula ukuhamba phantsi komthwalo, kwaye umlenze ophezulu kufuneka ube lula kwimisebenzi yemihla ngemihla kunye nokuzinyamekela.
5. Ukuphela kwenaliti yensimbi kunokubonakaliswa kwikliphu yokulungisa inaliti yensimbi malunga ne-1cm, kwaye umsila omde ngokugqithisileyo wenaliti kufuneka unqunyulwe. Ukuphela kwenaliti kunye ne-plastic cap seal okanye i-tape ehlanganiswe, ukuze ungagqobhozi ulusu okanye usike ulusu.
[Amanyathelo aza kuthathwa kwiimeko ezizodwa]
Kwizigulane ezinokulimala okuphindaphindiweyo, ngenxa yokulimala kakhulu okanye ukulimala okusongela ubomi ngexesha lokuvuselela, kunye nakwiimeko ezingxamisekileyo ezifana noncedo lokuqala kwintsimi okanye ukulimala kwe-batch, inaliti inokutsalwa kwaye ikhuselwe kuqala, kwaye iphinde ilungiswe, ilungisiwe, kwaye ikhuselwe ngexesha elifanelekileyo.
[Iingxaki eziqhelekileyo]
1. Ukusuleleka komngxuma; kwaye
2. I-necrosis yoxinzelelo lwesikhumba; kwaye
3. Ukulimala kwe-neurovascular
4. Ukulibaziseka ukuphiliswa okanye ukunganyangeki kokwaphuka.
5. Izikhonkwane ezaphukileyo
6. Ukuqhekeka kwephecana le-Pin
7. Ukungasebenzi ngokudibeneyo
(IV) Unyango lwasemva kotyando
Ukunyangwa ngokufanelekileyo emva kokusebenza kuchaphazela ngokuthe ngqo ukusebenza kwonyango, ngaphandle koko iingxaki ezifana nokusuleleka kwi-pinhole kunye nokungadibaniyo kwe-fracture kungenzeka. Ngoko ke, kufuneka kunikwe ingqwalasela eyaneleyo.
[Unyango jikelele]
Emva kotyando, ilungu elenzakeleyo lifanele linyuswe, kwaye ukujikeleza kwegazi kunye nokudumba kwelungu elenzakeleyo kufuneka kubonwe; xa ulusu lunyanzeliswa ngamacandelo e-bone fixator yangaphandle ngenxa yesikhundla okanye ukuvuvukala kwelungu, kufuneka liphathwe ngexesha. Izikrufu ezikhululekileyo kufuneka ziqiniswe ngexesha.
[Ukuthintela kunye nokunyanga usulelo]
Ukulungiswa kwamathambo angaphandle ngokwawo, i-antibiotics ayiyimfuneko ukukhusela ukusuleleka kwi-pinhole. Nangona kunjalo, ukwaphuka kunye nenxeba ngokwalo kusafuneka linyangwe ngamayeza okubulala iintsholongwane ngokufanelekileyo. Ukuqhekeka okuvulekileyo, nokuba isilonda sichithwa ngokupheleleyo, i-antibiotics kufuneka ifakwe kwi-3 kwiintsuku ze-7, kwaye i-fractures echaphazelekayo kufuneka inikwe i-antibiotics ixesha elide njengoko kufanelekile.
[Ukhathalelo lomngxuma]
Umsebenzi omninzi emva kokulungiswa kwamathambo angaphandle kuyadingeka ukunyamekela iipinhole rhoqo. Ukhathalelo lwepinhole olungafanelekanga luya kubangela usulelo lwepinhole.
1. Ngokuqhelekileyo ukugqoka kutshintshwa kanye ngosuku lwe-3 emva kokuhlinzwa, kwaye ukugqoka kufuneka kutshintshwe yonke imihla xa kukho ukukhupha kwi-pinhole.
2. Iintsuku ezili-10 okanye kunjalo, ulusu lwe-pinhole lusongelwe nge-fibrous, ngelixa ugcina ulusu lucocekile kwaye lomile, zonke iintsuku ze-1 ~ 2 kwi-pinhole yesikhumba sehla ye-75% yotywala okanye isisombululo se-iodine fluoride ingaba.
3. Xa kukho ukunyanzeliswa kwesikhumba kwi-pinhole, icala loxinzelelo kufuneka linqunywe ngexesha lokunciphisa ukuxhatshazwa.
4. Nika ingqalelo kwi-aseptic operation xa ulungisa i-bone fixator yangaphandle okanye ukuguqula ukucwangciswa, kunye ne-disinfected isikhumba esijikeleze i-pinhole kunye nenaliti yensimbi ngokuqhelekileyo.
5. Gwema ukusuleleka kwi-cross-infection ngexesha lokunakekelwa kwe-pinhole.
6. Emva kokuba usulelo lwe-pinhole lwenzekile, unyango oluchanekileyo lotyando kufuneka lwenziwe ngexesha, kwaye ilungu elenzakeleyo kufuneka liphakanyiswe ukuze liphumle kwaye i-antimicrobial efanelekileyo kufuneka isetyenziswe.
[Umthambo osebenzayo]
Ukusebenza ngexesha elifanelekileyo kunye nokuchanekileyo akuncedi kuphela ekubuyiseleni umsebenzi odibeneyo, kodwa kunye nokwakhiwa kwakhona kwe-haemodynamics kunye nokuvuselela uxinzelelo ukukhuthaza inkqubo yokuphulukisa ukuphuka. Ngokuqhelekileyo, ukuchithwa kwemisipha kunye nemisebenzi edibeneyo inokuqhutyelwa ebhedini phakathi kweentsuku ze-7 emva kokusebenza. Amalungu angaphezulu angakwazi ukwenza i-pinching kunye nokubamba izandla kunye nokunyakaza okuzimeleyo kwesandla kunye ne-elbow joints, kunye nokuzivocavoca okujikelezayo kunokuqaliswa kwiveki eyi-1 kamva; imilenze engezantsi inokushiya ngokuyinxenye ibhedi ngoncedo lweentonga emva kweveki e-1 okanye emva kokuba isilonda sipholisiwe, kwaye ngokuthe ngcembe uqale ukuhamba kunye nobunzima obupheleleyo kwiiveki ezi-3 kamva. Ixesha kunye nendlela yokwenza umthambo osebenzayo iyahluka ukusuka kumntu ukuya kumntu, ngakumbi ngokuxhomekeke kwiimeko zendawo kunye nenkqubo. Kwinkqubo yokuzilolonga, ukuba i-pinhole ibonakala ibomvu, idumbile, ibuhlungu kunye nezinye izibonakaliso ezivuthayo kufuneka ziyeke umsebenzi, ziphakamise umlenze ochaphazelekayo ekuphumleni kwebhedi.
[Ukususwa kwesilungisi samathambo sangaphandle]
I-brace yokulungiswa kwangaphandle kufuneka isuswe xa i-fracture ifikelele kwiikhrayitheriya zeklinikhi zokuphulukisa ukuphuka. Xa ususa i-bracket yokulungiswa kwamathambo yangaphandle, amandla okuphulukisa ukuphuka kufuneka agqitywe ngokuchanekileyo, kwaye ukulungiswa kwamathambo angaphandle akufanele kususwe ngaphambi kwexesha ngaphandle kokuqinisekiswa kokumisela amandla okuphilisa amathambo kunye neengxaki ezicacileyo zokulungiswa kwamathambo angaphandle, ngakumbi. xa kunyangwa iimeko ezifana nokwaphuka kwakudala, ukwaphuka kwethambo, kunye nokungabikho kwethambo.
Ixesha lokuposa: Aug-29-2024
