Indlela Yokusebenza
(I) I-Anesthesia
I-brachial plexus block isetyenziselwa amalungu angaphezulu, i-epidural block okanye i-subarachnoid block isetyenziselwa amalungu angaphantsi, kwaye i-general anaesthesia okanye i-local anaesthesia nayo ingasetyenziswa njengoko kufanelekile.
(II) Isikhundla
Imilenze ephezulu: ukugoba, ukujika kwengqiniba, ingalo phambi kwesifuba.
Izitho ezisezantsi: ukugoba, ukujika esinqeni, ukuxhwilwa, ukujija idolo kunye nokudibana kweqatha kwindawo yokwandiswa komqolo ngama-degree angama-90.
(III)Ulandelelwano lokusebenza
Ulandelelwano oluthile lokusebenza kwe-fixator yangaphandle kukutshintshana kokuseta kwakhona, ukuthungwa kunye nokulungiswa.
[Inkqubo]
Oko kukuthi, ukwaphuka kuqala kuhlengahlengiswa (kulungiswe ukukhubazeka okujikelezayo nokugqithanayo), emva koko kugxojwe ngeepini ezikude kumgca wokuqhekeka kwaye kulungiswe ekuqaleni, emva koko kuphinde kumiselwe kwaye kugxojwe ngeepini ezikufutshane nomgca wokuqhekeka, kwaye ekugqibeleni kumiselwe ngendlela eyanelisayo ukwaphuka kwaye kulungiswe ngokupheleleyo. Kwezinye iimeko ezikhethekileyo, ukwaphuka kunokulungiswa ngokucinezela ngokuthe ngqo, kwaye xa imeko ivuma, ukwaphuka kunokulungiswa kwakhona, kulungiswe kwaye kulungiswe kwakhona.
[Ukunciphisa ukwaphuka kwamathambo]
Ukunciphisa ukwaphuka kwethambo yinxalenye ebalulekileyo yonyango lokuqhekeka kwethambo. Ukuba ukwaphuka kwethambo kuncitshiswe ngokwaneleyo kunempembelelo ethe ngqo kumgangatho wokuphiliswa kwamathambo. Ukwaphuka kwethambo kunokuvalwa okanye kubonwe ngqo ngokwemeko ethile. Kungalungiswa ngokwefilimu ye-X-ray emva kokuphawula umphezulu womzimba. Iindlela ezithile zezi zilandelayo.
1. Ngaphantsi kokubona ngqo: Kwiingozi ezivulekileyo ezineephelo zokuqhekeka ezibonakalayo, ukwaphuka kunokubuyiselwa kwakhona phantsi kokubona ngqo emva kokucocwa ngokupheleleyo. Ukuba ukwaphuka okuvaliweyo akusebenzi kakuhle, ukwaphuka kunokuncitshiswa, kugqojwe kwaye kulungiswe phantsi kokubona ngqo emva kokusikwa okuncinci kwe-3 ~ 5cm.
2. Indlela yokunciphisa evaliweyo: qala wenze ukwaphuka kuphinde kusetyenziswe kwakhona uze usebenze ngokwendlela olandelelana ngayo, ungasebenzisa iphini yentsimbi kufutshane nomgca wokwaphuka, kwaye usebenzise indlela yokuphakamisa nokukrwela ukunceda ukwaphuka kuphinde kusetyenziswe kwakhona de kwaneliseke kuze kulungiswe. Kukwanokwenzeka ukwenza uhlengahlengiso olufanelekileyo lokuhamba okuncinci okanye ukujijeka ngokwe-X-ray emva kokunciphisa okuqikelelweyo kunye nokulungiswa ngokusekelwe kumphezulu womzimba okanye kwiimpawu zamathambo. Iimfuno zokunciphisa ukwaphuka, ngokomgaqo, kukunciphisa umzimba, kodwa ukwaphuka okunzulu okuncinci, okudla ngokuba nzima ukubuyisela imo yokuqala yomzimba, ngeli xesha ukwaphuka kufuneka kube ngcono ukunxibelelana phakathi kwebhloko yokwaphuka, kunye nokugcina iimfuno ezilungileyo zomgca wamandla.
[Ukucinezela]
Ukuqhobosha yindlela ephambili yokusebenza yokubopha amathambo angaphandle, kwaye indlela elungileyo okanye embi yokubopha ayichaphazeli nje kuphela ukuzinza kokubopha ukwaphuka, kodwa ikwanxulumene nokwanda okanye ukuhla kweziganeko ezihambisana noko. Ke ngoko, ezi ndlela zilandelayo zokusebenza kufuneka zilandelwe ngokungqongqo xa kuqhoboshwa inaliti.
1. Kuphephe ukwenzakala okubalulekileyo: Yiqonde ngokupheleleyo indlela umzimba ogqobhoze ngayo kwaye uphephe ukwenzakalisa imithambo yegazi ephambili kunye nemithambo-luvo.
2. Indlela yokusebenza engenabungozi ngokupheleleyo, inaliti mayibe yi-2 ~ 3cm ngaphandle kwendawo yesilonda esosulelekileyo.
3. Iindlela ezingangenisi ntsholongwane ngokupheleleyo: xa unxiba inaliti epheleleyo enesiqingatha senaliti kunye nobukhulu obupheleleyo, faka inaliti yentsimbi kunye nendawo ephumayo ngemela ebukhali ukuze wenze ulusu oluyi-0.5 ~ 1cm; xa unxiba inaliti enesiqingatha, sebenzisa i-haemostatic forceps ukuze wahlukanise izihlunu uze ufake i-cannula uze ubhoboze imingxunya. Musa ukusebenzisa ukubhoboza ngamandla ngesantya esiphezulu xa ubhoboza okanye ubopha inaliti ngqo. Emva kokufaka inaliti, amalungu kufuneka ashukunyiswe ukujonga ukuba kukho uxinzelelo eluswini kwinaliti, kwaye ukuba kukho uxinzelelo, ulusu kufuneka lunqunyulwe kwaye luthungwe.
4. Khetha ngokuchanekileyo indawo kunye nekona yenaliti: inaliti akufuneki idlule kwimisipha kancinci kangangoko, okanye inaliti kufuneka ifakwe kwindawo evulekileyo: xa inaliti ifakwe kwindawo enye, umgama phakathi kweenaliti kwindawo eqhekekileyo akufuneki ube ngaphantsi kwe-6 cm; xa inaliti ifakwe kwiindawo ezininzi, umgama phakathi kweenaliti kwindawo eqhekekileyo kufuneka ube mkhulu kangangoko. Umgama phakathi kweepini kunye nomgca wokuqhekeka okanye umphezulu odibeneyo akufuneki ube ngaphantsi kwe-2 cm. I-engile yokunqumla yeepini kwi-needling eneedling eneplanar kufuneka ibe yi-25°~80° kwiipini ezipheleleyo kunye ne-60°~80° kwiipini ezisiqingatha kunye neepini ezipheleleyo.
5. Khetha ngokuchanekileyo uhlobo kunye nobubanzi benaliti yentsimbi.
6. Songa umngxuma wenaliti ngokuthe tye nge-alcohol gauze kunye ne-sterile gauze.
Indawo yenaliti ephumayo ye-humeral ekude ngokunxulumene ne-vascular nerve bundle yengalo engasentla (Icandelo eliboniswe kumfanekiso yindawo yokhuseleko yokufaka inaliti.)
[Ukufakelwa kunye nokulungiswa]
Kwiimeko ezininzi ukunciphisa ukwaphuka, ukuqhobosha kunye nokubopha kwenziwa ngokutshintshana, kwaye ukubopha kugqitywa njengoko kufunekayo xa iiphini zentsimbi ezimiselweyo zigqobhoziwe. Ukwaphuka okuzinzileyo kulungiswa ngokucinezela (kodwa amandla oxinzelelo akufuneki abe makhulu kakhulu, kungenjalo kuya kwenzeka ukukhubazeka kwe-angular), ukwaphuka okuqhekekileyo kulungiswa kwindawo engathathi cala, kwaye iziphene zamathambo zilungiswa kwindawo yokuphazamiseka.
Indlela yokulungisa izinto ngokubanzi kufuneka inike ingqalelo kule miba ilandelayo: 1.
1. Vavanya uzinzo lokuqina: indlela kukuqhuba ijoyinti, umzobo ode okanye ukutyhala icala lesiphelo esaphukileyo; isiphelo sesaphukileyo esizinzileyo akufuneki sibe nomsebenzi okanye sibe nomsebenzi omncinci we-elastic. Ukuba uzinzo alwanelanga, amanyathelo afanelekileyo anokuthathwa ukwandisa ukuqina kwayo yonke into.
2. Umgama ukusuka kwi-bone external fixator ukuya kulusu: 2~3cm kwilungu eliphezulu, 3~5cm kwilungu elisezantsi, ukuze kuthintelwe ukucinezelwa kolusu kwaye kube lula unyango lwe-trauma, xa ukudumba kukhulu okanye i-trauma inkulu, umgama ungashiywa mkhulu kwinqanaba lokuqala, kwaye umgama ungancitshiswa emva kokuba ukudumba kuphelile kwaye i-trauma ilungisiwe.
3. Xa kukhatshwa kukwenzakala okukhulu kwezicubu ezithambileyo, ezinye iindawo zingongezwa ukuze ilungu elonzakeleyo lixhonywe okanye libekwe phezu kwentloko, ukuze kube lula ukudumba kwelungu kunye nokuthintela ukwenzakala koxinzelelo.
4. I-bone external fixator ye-bone cadre akufuneki ichaphazele umthambo osebenzayo wamalungu, umlenze ongezantsi kufuneka kube lula ukuwuhamba phantsi komthwalo, kwaye umlenze ongasentla kufuneka ube lula kwimisebenzi yemihla ngemihla kunye nokuzinyamekela.
5. Isiphelo senaliti yentsimbi singabonakaliswa kwisiqhoboshi senaliti yentsimbi malunga ne-1cm, kwaye umsila omde kakhulu wenaliti kufuneka unqunyulwe. Isiphelo senaliti sigqunywe ngesivalo seplastiki okanye iteyiphu, ukuze singagqobhozi ulusu okanye ulusu.
[Amanyathelo ekufuneka athathwe kwiimeko ezikhethekileyo]
Kwizigulane ezineengozi ezininzi, ngenxa yokwenzakala okukhulu okanye ukwenzakala okusongela ubomi ngexesha lokuvuselelwa, kunye nakwiimeko ezingxamisekileyo ezifana noncedo lokuqala ebaleni okanye ukwenzakala kweqela, inaliti ingafakwa imisonto kwaye iqiniswe kuqala, ize ilungiswe kwakhona, ilungiswe, kwaye iqiniswe ngexesha elifanelekileyo.
[Iingxaki Eziqhelekileyo]
1. Usulelo lwe-pinhole; kunye
2. I-necrosis yoxinzelelo lwesikhumba; kunye
3. Ukulimala kwemithambo-luvo
4. Ukuphola okanye ukungapholi kwenxeba eliqhekekileyo.
5. Iiphini eziphukileyo
6. Ukuqhekeka kwendlela yepini
7. Ukungasebenzi kakuhle kwamalungu
(IV) Unyango emva kotyando
Unyango olufanelekileyo emva kotyando luchaphazela ngqo ukusebenza kakuhle konyango, kungenjalo iingxaki ezinje ngosulelo lwemingxuma kunye nokungadibani kokwaphuka zinokwenzeka. Ke ngoko, kufuneka kunikwe ingqwalasela eyaneleyo.
[Unyango ngokubanzi]
Emva kotyando, ilungu elonzakeleyo kufuneka liphakanyiswe, kwaye ukujikeleza kwegazi kunye nokudumba kwelungu elonzakeleyo kufuneka kujongwe; xa ulusu lucinezelwe zizinto ze-bone external fixator ngenxa yendawo okanye ukudumba kwelungu, kufuneka luphathwe ngexesha. Izikrufu ezikhululekileyo kufuneka ziqiniswe ngexesha.
[Ukuthintela nokunyanga izifo]
Ukuze kuqiniswe ithambo langaphandle, ii-antibiotics azifuneki ukuthintela usulelo lwemingxuma. Nangona kunjalo, ukwaphuka kunye nenxeba ngokwalo kufuneka kunyangwe ngee-antibiotics njengoko kufanelekile. Kwizaphuko ezivulekileyo, nokuba inxeba lisuswe ngokupheleleyo, ii-antibiotics kufuneka zisetyenziswe iintsuku ezi-3 ukuya kwezi-7, kwaye izaphuko ezinentsholongwane kufuneka zinikwe ii-antibiotics ixesha elide njengoko kufanelekile.
[Ukhathalelo lwemingxuma]
Kufuneka umsebenzi omninzi emva kokulungiswa kwamathambo angaphandle ukuze kunyanyekelwe imingxuma rhoqo. Ukunganyanyekelwa kakuhle kwemingxuma yemingxuma kuya kubangela usulelo lwemingxuma yemingxuma.
1. Ngokwesiqhelo i-dressing itshintshwa kube kanye ngosuku lwesithathu emva kotyando, kwaye i-dressing kufuneka itshintshwe yonke imihla xa kukho ukuvuza okuvela kwi-pinhole.
2. Emva kweentsuku ezili-10 okanye ngaphezulu, ulusu lomngxuma lugqunywe ngemicu, ngelixa lugcina ulusu lucocekile kwaye lomile, rhoqo emva kweentsuku ezi-1 ukuya kwezi-2 kwimngxuma ulusu lunamaconsi e-75% yotywala okanye isisombululo se-iodine fluoride.
3. Xa kukho uxinzelelo eluswini kwindawo enomngxuma, icala loxinzelelo kufuneka linqunyulwe ngexesha ukuze kuncitshiswe uxinzelelo.
4. Nika ingqalelo kwindlela esebenza ngayo i-aseptic xa ulungisa i-bone external fixator okanye utshintsha indlela ebekwe ngayo, kwaye ucoce ulusu olujikeleze umngxuma we-pinhole kunye nenaliti yentsimbi rhoqo.
5. Kuphephe ukosuleleka ngaxeshanye ngexesha lokunyamekela imingxunya yemingxuma.
6. Xa usulelo lwemingxuma luqalile, kufuneka kwenziwe unyango oluchanekileyo lotyando ngexesha, kwaye ilungu elonzakeleyo lifanele liphakanyiswe ukuze liphumle kwaye kusetyenziswe amayeza afanelekileyo okubulala iintsholongwane.
[Umthambo osebenzayo]
Ukuzilolonga ngexesha elifanelekileyo nokusebenzayo akuncedi nje ekubuyiseleni ukusebenza kwamalungu, kodwa kukwanceda ekwakheni kwakhona i-haemodynamics kunye nokukhuthaza uxinzelelo ukukhuthaza inkqubo yokuphiliswa kwamalungu aqhekekileyo. Ngokubanzi, ukuxinana kwemisipha kunye nemisebenzi yamalungu inokwenziwa ebhedini kwiintsuku ezisi-7 emva kotyando. Amalungu angaphezulu anokwenza ukucinezela nokubamba izandla kunye neentshukumo ezizimeleyo zamalungu esihlathi kunye nengqiniba, kwaye ukuzilolonga okujikelezayo kunokuqaliswa emva kweveki e-1; amalungu asezantsi anokuphuma kancinci ebhedini ngoncedo lweenduku emva kweveki e-1 okanye emva kokuba inxeba lipholile, aze aqale ukuhamba kancinci kancinci emva kweeveki ezi-3. Ixesha kunye nendlela yokuzilolonga okusebenzayo kuyahluka kumntu nomntu, ikakhulu kuxhomekeke kwiimeko zasekuhlaleni nezenkqubo. Ngexesha lokuzilolonga, ukuba umngxuma wepin ubonakala ubomvu, uvuvukile, ubuhlungu kunye nezinye iimpawu zokudumba kufuneka uyeke umsebenzi, uphakamise ilungu elichaphazelekayo liye kwindawo yokuphumla ebhedini.
[Ukususwa kwe-external bone fixator]
I-external fixation brace kufuneka isuswe xa ukwaphuka kufikelele kwimigangatho yeklinikhi yokuphiliswa kwamathambo. Xa kususwa i-external bone fixation bracket, amandla okuphiliswa kwamathambo aqhekekileyo kufuneka amiselwe ngokuchanekileyo, kwaye i-external bone fixation mayingasuswa ngaphambi kwexesha ngaphandle kokuqinisekiswa kwamandla okuphiliswa kwamathambo kunye neengxaki ezicacileyo ze-external bone fixation, ingakumbi xa kunyangwa iimeko ezifana nokuqhekeka okudala, ukwaphuka okuncinci, kunye nokungadibani kwamathambo.
Ixesha lokuthumela: Agasti-29-2024
