Classification myofascial gumbi syndrome

Abantu abaninzi bayazibuza: "gumbi syndrome - ntoni na?" Le ngezifo ibonakala kuzo zonke iindawo apho izihlunu singqongwe yi ifascia isiqina - into yendawo ezimpundwini, iinyonga, igxalaba, esinqeni kunye umva.

Gumbi syndrome - indibanisela utshintsho nomsindo ukwanda koxinzelelo kummandla eliqingqiweyo umzimba. Kuxhomekeke kuye kwavusa ngokwandisa uxinzelelo ngaphakathi izihlunu, ngokuqhelekileyo zizakubalulwa isifo oyingozi okanye esingapheliyo.

Izinto ezibangela Uphuhliso izifo

Njengoko nobangela uqhelekileyo sifo zezi:

• zaphuka;
• nobukhulu ukuphazamiseka zeethishu soft;
• amalungelo ingqibelelo yegazi;
• ucinezelo alo mlenze xa ukucudisa ngokokuma;
• ziphose ngaphezulu ngokuchanekileyo;
• isha;
• utyando elide esibuhlungu.

Xa amayeza, amatyala zidluliselwa Ukuqaliswa emthanjeni okanye uxinzelelo Umthambo ulwelo, kwakunye inobuhlu- iinyoka izinja.

umngcipheko omkhulu likhona kwaye ngezifo xa iziyobisi alawulwa, ithinasi igazi, yaye ngokubanzi kwi coagulation igazi disorder. Hayi ecaleni, kunye oonobangela iatrogenic, inattention ukuba izigulane abazi.

Ifom okondeleyo syndrome

Gumbi syndrome kuthatha uhlobo ezingapheliyo kwimeko umthambo kokuphindaphinda ixesha elide. Kwakhona ezinxulumene noxinzelelo enyuka ancedisana emlenzeni. imisebenzi obukhulu emzimbeni ukuba ingagqithi kwimiqathango imida elamkelekileyo, ukumqumbisa ukwanda izihlunu umthamo we-20%, nto leyo ebangela ucinezelo yabantu abangakwaziyo ohambelana. Gumbi syndrome sivame ukuxilongwa xa iimbaleki zobungcali.

basis pathophysiological

Pathophysiology Esi sifo sibangelwa homeostasis inyama wengingqi phantsi kwempembelelo umdlali olimeleyo, ukwanda koxinzelelo ngaphakathi ancedisana nemisipha amatyala abo, ukunciphisa igazi lokuhamba ke emithanjeni, ukuphuma kakuhle lwemithambo yegazi, kwaye ngoko ke nomthamo igazi. Ekugcineni yokuzenzela izihlunu necrosis ngenxa yokunqongophala kwe-oksijini.

symptomatology

Iimpawu syndrome gumbi aqukuqela ifomu etsolo, ochazwa ukudumba ukwandisa ngokukhawuleza, nto leyo imiselwe Ngokucofa (iseti degree of sisilonda esidumbileyoesingaphakathi mninzi). Kwakhona amaqamza evelayo iphawulwe iintlungu ngexesha izihlunu intshukumo isixando (flexion kunye nokwandiswa unyawo), inovakalelo ilahlekileyo.

Kufuneka kuqatshelwe ukuba inkalo ubalaseleyo ngezifo ezifana gumbi syndrome na ukuba umvandedwa, nto leyo ibonisa inqanaba umonakalo ngamandla. Idla koko akukho akukwazeki ukuba ayeke nasemva nolawulo amachiza iintlungu.

Le uphawu nto luphawu lokuba njengesilonda igesi.

Eyona engundoqo iintlobo gumbi syndrome

Gumbi syndrome kungenzeka ngeendlela ezimbini: esiswini kunye myofascial (ukunyuka koxinzelelo ischemia syndrome imvelaphi yasekuhlaleni).

imilo Myofascial ephawula ukuncipha perfusion izihlunu, ischemia, necrosis kunye nophuhliso contracture. Izizathu zokukhulisa uxinzelelo pidfastsialnogo bubuxoki hematoma posttraumatic, nokudumba kwiintetho ezikralayo, lo ucinezelo ngokokuma, ithumba progressive.

Myofascial gumbi syndrome banesifo ngenxa nokuxilongwa kwemizimba yabo.

Thathela ingqalelo ezi zikhombisi zilandelayo:

• ixesha elidlulileyo emva yokwenzakala phambi ukwamkelwa ekliniki;
• ixesha kwathabathela embonakalweni sivakale sidumbile;
• isantya sokukhula ukudumba (kwiiyure 6-12 emva kokonzakala);
• elithi ukusetyenziswa tourniquet kunye nothintelo ischemia (ukususwa awayezinxibile ixesha elifutshane).

Iintlungu nzulu eliguquguqukayo umlinganiswa. Ahluke ngamandla ngaphezu kweyesiqhelo yonakele, hayi isikiwe yi immobilizing endaweni elimele kunye analgesics ngeedosi eziqhelekileyo.

Ubuhlungu kuvela kwisixando yade kwemisipha phantsi umonakalo. Oku lutshintsha indawo neminwe.

A ndlela yokulinganisa xi ngaphakathi esikule

Njengoko kutyhilwa gumbi syndrome? Pathology Uxilongo senziwa indlela Whiteside (1975), ukuvumela ukuba umlinganiselo uxinzelelo Embi.

Uthi ukusetyenziswa:

• inkqubo equka manometer mercury;
• ngendlela ezintathu-isiciko sombhobho omkhulu;
• Inaliti inaliti kabani ubukhulu ayikho ngaphantsi kwe-1 mm;
• zokutyubhisha;
• ngesirinji umthamo ml-20.

Okwangoku, ukujonga uxinzelelo isicelo kwezixhobo pidfastsialnogo ukuba enze uhlolo ixesha elide. Ezi ziphumo kuthelekiswa index xi intliziyo. Uxinzelelo kwindawo myofascial eziphelweni mayingagqithi 10 mm HG. Art. Ubukho gumbi syndrome lusekiwe, ukuba ingcinezelo salathisi pidfastsialnogo ungaphezulu kwinqanaba emandundu 40 mm HG. Art. kwaye iDiastolic ngezantsi. indyebo yalo phezu iiyure 4-6 ukuze bandiqumbise okuvela ischemia.

ifomu Classification myofascial

• isifo kwemiphunga - i distal umlenze kwicandelo kunye yimvakalelo efudumeleyo. Phezu imithambo eziyintloko kumanqaku zokhuseleko ukubetha. Isalathisi xi podfastsialnogo kwi-40 mm HG. Art. ukuzala asezantsi.
• Kuthetha sisilonda - isikhumba lomzimba isabelo eyonakeleyo unalo lobushushu ngaphantsi esempilweni. hyperesthesia okphawliwe okanye lomzimba Ukubulawa iminwe. Pulse ithambile. Podfastsialnoe kunye nengcinezelo ukuzala iyafana.
• A lahluleka heavy - ubume kwemithambo enkulu awubonakali. finger Ukubulawa kuphawula. Podfastsialnoe ngaphezu xi ukuzala.

Le umahluko kwesifo

Gumbi syndrome kufuneka zingahlukaniswa umonakalo ezityeni eziphambili, ubukho esimbaxa thrombosis, umonakalo komboko zemithambo-luvo clostridial kunye myositis non-clostridial.

diagnosis umahluko kufuneka kwenziwe ngokungqinelana kunye nenani criteria:

• pulsations khona;
• ayanda;
• ukungabikho koluvo zamalungu;
• Blood ityhefu;
• ukhulisa leukocytes;
• Isalathisi xi pidfastsialnogo.

Ekubulaleni izihlunu ezi ziyenza

Izihlunu kwi ifascia zengalo ezahlulwa amathambo ezintathu fascial esingxotyeni: umqadi osecaleni nemikhinkqi, phambi (umsipha onoxanduva abhetyebhetye iminwe) nangesemva (izihlunu ababandakanyekayo iminwe ulwandiso).

Ukuba isigulana akakwazi onokolula iminwe yakhe, ngoko ke ubeka sifo, njengoko phambi zengalo kompartament syndrome. Ukuba isigulana akakwazi kugoba iminwe yakhe, ibe ityala angasemva.

Ekubulaleni kwemilenze

Ithole izihlunu ifascia lahlulwe esingxotyeni ezine ithambo-fascial:

• lateral (izihlunu peroneal);
• Front (unoxanduva ukwandiswa yonyawo);
• Yangasemva (surface soleus kwezihlunu);
• diff enzulu (elijongene flexion).

Ukuba isigulane akakwazi ukubonisa unyawo neenzwane, kunye ukuzama lenyathelo elinjalo kubangela intlungu kakhulu, ngoko siyakwazi ukuthetha phambi cipande gumbi syndrome, yaye ukuba akakwazi onokolula iminwe yakhe, ukuba imbono angasemva.

esiswini

Isalathisi xi abaqhelekileyo kwi kwisisu ixhomekeke ubunzima bomzimba kunye nama-ulingana zero. Umnqe ichibi ukuba ulwelo, apho uxinzelelo phezu komhlaba kwaye kuzo zonke iindawo ngokulinganayo. Intra-esiswini xi nga iyakulinganiselwa naliphi na isebe esiswini.

Ziintoni izinto basengozini syndrome esiswini nomfutho? Isizathu ngakwicala emathunjini paresis, umothuko ezininzi, laparotomy olungxamisekileyo xa kukho ogulayo bafumana unyango ukumnika olunzulu. Oku kwandisa umthamo ulwelo esiswini.

Ke kaloku inkitha izigulane emva kotyando xa Isalathisi xi esiswini kwi kwisisu layo linyuke 3-13 mm HG. Art. ngaphandle zimpawu clinical

Xa uxinzelelo ngaphakathi abdominoplasty isisu sibe ngaphezulu kwe-15 mm HG. st., nto leyo evusa uphuhliso esiswini gumbi syndrome.

Nge-avareji 25 mm HG. Art. yaye ukusilela okuphawulekayo Ukubolekisa iimpahla ezinkulu peritoneum, ezikhokelela ukusilela kwezintso kunye disorder iimpahla sentliziyo kunye negazi.

Uxinzelelo kwindawo kwindawo esiswini ngasentla 35 mm HG. Art. akwazi ukuqala wamelwa inhliziyo.

wenza njani esiswini gumbi syndrome?

esiswini gumbi syndrome ibonakalisiwe kwi ukuphefumla umphezulu ubunzima kunye ukunciphisa imveliso intliziyo. Kwakhona uthi phambi imveliso umchamo, ioksijini igazi kufumaneka bantu.

iintlobo ezine lwegazi kwi peritoneum ngesi iyeza:

• degree 1st - sisalathisi yengcinezelo 12-15 mm HG. Art.
• 2 stepen- umlinganiselo xi 16-20 mm HG. Art.
• degree 3 - sisalathisi yengcinezelo 21-35 mm HG. Art.
• degree 4 - sisalathisi yengcinezelo ngasentla 35 mm HG. Art.

Iindlela zokulinganisa uxinzelelo kwi peritoneum

Njengoko umthetho, uxinzelelo kwindawo esiswini lulinganiselwa nge lwesinye. udonga Good stretchable isebenza umqhubi uxinzelelo intraabdominal kwisixando ukuba umthamo fluid kwi peritoneum ayidluli 50-100 ml. Nge umthamo omkhulu lomlinganiselo iphenjelelwa izihlunu xi lwesinye.

Therapy for esiswini syndrome

Njengoko ebekwe gumbi syndrome? Unyango lubandakanya ukulungiswa okanye ukuphelisa izizathu (ukususwa ucinezelo hosiery, ukuma headboard phezulu, nadlamkisayo). unyango oksijini kwayo, apho kusetyenziswa tube nasogastric.

Ukuthintela hemodynamic decompensation wambuyisela ioksijini igazi Ukwanda kunye coagulation eliphezulu. Kwakhona ziboniswa uxinzelelo ngaphakathi peritoneum iliso neminye imisebenzi.

Egumbini syndrome zotyando esiswini iyapheliswa yi decompression laparostomy. catheterization eyenziwa ukwandisa peritoneum.

Eyona eziphambili iziganeko unyango elondoloza

Xa unyango ngendeb 'endala, ziganeko zilandelayo:

• ishenxisa ucinezelo ye kummandla ochaphazelekayo (ukususwa amabhandeji, tinsimbi ukutyabeka, buthathaka imoto skeletal, indawo kwesebe ochaphazelekayo kwinqanaba elifanayo ngentliziyo umthwalo uphuhliso ischemia);
• kwegazi eliphezulu, ukuba ziphelisiwe spasm nemithambo kunye nokwanda coagulation;
• uphucula Iimpawu flow igazi;
• analgesics efakiwe (analgesics ezidakumbisayo izinto ezisekelwe, kananjalo kuthetha nendalo non-ezidakumbisayo);
• kuwukhulula ukudumba;
• asidi ebekwe.

Ukuba unyango elondoloza azizange iziphumo ezilindelekileyo, kukho kakhulu xi kwinqanaba podfastsialnogo ngaphezu kwenqanaba waphawula kwezihlunu kunye nokudumba, nongenelelo ezinemifanekiso zotyando (isicelo fasciotomy decompression). Inokuba ukuthwala zonyango kunye zifo endalweni.

Yintoni fasciotomy decompressive?

fasciotomy Decompressive - etyandwa ejoliswe ekuthinteleni nesiqabu of gumbi syndrome. Asebenzisa ukusebenza xa kwemithambo ezonakeleyo ngemithambo ze emagxeni. Kwakhona, oko kuphele egumbini syndrome yecandelo medial welungu engqinibeni, imiphumo zokonzakala engqinibeni fossa imithambo ngemithambo ezantsi kwedolo. Fasciotomy kuba becala kwenziwa eziphelweni asezantsi.

Ubungqina obubonakalayo buxela ukuba fasciotomy othintelo

Yayibubungqina eziphambili ziquka:

• phambi insufficiency lwemithambo;
• umonakalo imithambo ezantsi kwedolo;
• akakwazi ukusenza ngokutsha kwemithambo;
• emva kuvuselelwa kwemithambo;
• libizwa inyama ithambile iindumbisa imilenze.

Ndiqhuba fasciotomy medical

Olu tyando lwenziwa kwizigulane kunye noxinzelelo ngokukhawuleza subfascial zafunyanwa ngethuba lophando. Index ngaphezu 30 mm HG. Art. fanele ukuba kudidi yezifo.

Ukunyuka koxinzelelo subfascial sisalathisi ngokupheleleyo ukuba utyando kuliyeza.

Ezi mpawu zilandelayo izalathisi eziphambili kulo utyando:

• phambi paresthesias;
• ubuhlungu xa intshukumo angenzi konyawo;
• phambi ukukhubazeka xa luvo preservation;
• yehle ukubetha zomzimba.

isilumkiso

akufuneki enze ukusebenza kwi ephangweni okanye emagxeni. "Mannitol" elwa kuphela ngokokubona kagqirha.

Fasciotomy - msebenzi, oko kunokubangela kunye nezigulo (usuleleko, uhlobo ezondeleyo intlungu, phambi paresthesia, ukudumba, osteomyelitis). Kufuneka kuqatshelwe ukuba zivela kungafane, kodwa amathuba lisekhona. Ngoko ke, ngaphambi kokuba ungenelelo lufuna uviwo ngenyameko isigulane.

fasciotomy Decompressive kule ngesa-

Surgery ukususa ngezifo ezifana ngesa- gumbi syndrome, kubandakanya ukusetyenziswa Ukubulawa lendawo. Le liqatywe singahlala ukusuka epicondyle ukuya kwindawo esihlahleni. Le ifascia elivulekayo kwi flexor kwezihlunu kwindawo ingqiniba. Yena Bayeka medially. imisipha ezibalulekileyo elijongene flexion, shifts lateral. Le ifascia lisikwa ngaphezu flexor enzonzobila. ifascia kwemisipha nganye kutyhilwa icandelo longitudinal.

Ukuba kuyimfuneko volar yongeza amaphiko liqatywe. ingalo Live nangoko zanda. Waphawula impendulo hyperemia yakhe.

umsipha Devitalized (idla ephuza, ibekwe ubunzulu) elinombala in yellow, apho Zinjalo necrosis. Le ifascia akukho sutured. inxeba Cutaneous sutured ngaphandle kwempixano. Ukuba ukuphunyezwa yokuntlokothiswa loo akwenzeki, inxeba ulusu esilushiye luvuliwe kwi ngokohlobo ibotshwe.

Ngebhandishi isicelo ebulala okanye sorbents. Kamva sasisebenzisa namafutha aqholiweyo emulsion zolwelo.

amalungu Secondary superimpose iintsuku ezintlanu emva kotyando. Ngamanye amaxesha inxeba ihlala ivulekile inyanga. Kwezinye iimeko, ukuze uvale inxeba isicelo ukucinywa isisu kwenza ezongezelelweyo okanye iintlobo ezahlukeneyo uqhaqho zeplastiki.

Su fasciotomy kwi brush

Umsebenzi ubandakanya le ikhomishini icandelo longitudinal kwingingqi Ngokwentetho ithambo lokuqala metacarpal. Loo imbobo oluqhutywa ithambo enxuseneyo yesihlanu carpal. Kwangaxeshanye oko akuthethi phambana le ezayo i-luvo ulnar. Decompression intercostals nemisipha ezenziwe amacandelo eyahlukileyo Ezomva brush.

Oqhuba umlenze fasciotomy asezantsi

asezantsi umlenze gumbi syndrome iyapheliswa yi utyando kunye Ukubulawa zasekuhlaleni.

Ukuba isigulana kunzima agobe unyawo neenzwane ngenxa yentlungu ahlekise, kunokwenzeka ukuba kugweba ubukho cipande gumbi syndrome. Ukuba ke akakwazi onokolula umlenze asezantsi, oko ke angasemva gumbi syndrome shin.

Ukuze atyhile zonke iimeko, baye babhenela amacandelo amabini okanye amathathu longitudinal emlenzeni, ubude yayo-15 cm. Ukuba kuyimfuneko ifascia liqatywe usenokuba ifom Z-ezimile.

Ukuba kwegazi kwi unyawo ayilungiswanga kwimizuzu embalwa, le liqatywe medial nzulu waza wavula ityala phezu ngasemva ngokusebenzisa isikere. Imbobo ye ifascia akuthethi ubambe incakuba, njengoko kungonakalisa kwemithambo ngomva tibial nemithambo tibial.

Le ifascia liqatywe kukuba sikarhulumente evulekileyo. Ukuba kunokwenzeka, inxeba eluswini sutured ngaphandle kwempixano. Ukuba uthunge akwenzeki, isilonda uvuliwe phantsi walisusa. welds Secondary bakholisa elibhalwe ngokuqhelekileyo emva kweentsuku ezi-5.

Technique bokusebenza ngeenyawo

Loo msebenzi ufuna i ubukho iindlela ezine. liqatywe ezimbini amaphiko senziwe ecaleni we2 4 amathambo amadeo, apho ukuvula izikhewu ezine phakathi amathambo kunye kwisingxobo central kule mfumba. Esinye isibini emanxebani kwenziwa yokuxazulula kwaye medially. Bona uvula amatyala.

Operation olwenziwe ukuba izihlunu zomzimba necrosis, unezinga eliphezulu ngobuchule. Ngosuku lwesithathu emva kokuba decompression liyancipha ukudumba, kwaye kusenokwenzeka esilondeni ukuvalwa. Ukuba decompression necrosis ye inwebu yesihlunu ichongiwe, ngoko kususa inxenye kwabafileyo. ucinezelo lokugqibela kule meko luhlehliswe iveki.

abantu abane

Abantu abane kwesifo ixhomekeke ngqo kwi ukufaneleka unyango kunye ukuphunyezwa ngokupheleleyo uqhaqho. Ukuba iintlungu ebekwe, kukho ukuphazamiseka luvo, sukube sibonisa iinguqu ongenakulungiseka zophendlo lwezifo. Engaphezulu kuphunyezo necrectomy kunye nezinye iinkqubo abakwazi ukusindisa yomlenze ukusikwa kubonisa zakhe. Ukuze ukuba zazise le meko ngokugqithileyo, kucetyiswa ngendlela ngexesha ukwenza yonke imisebenzi ezijoliswe ekuthinteleni uphuhliso komparment syndrome.