Ukwaphuka le scaphoid: Iimpawu and Treatment

Ukwaphula abantu kwenzeka kaninzi ngokwaneleyo. Ngokuqhelekileyo abalimele lomzimba. Ukophuka enjalo akukho isoyikiso kubomi. Kwiimeko ezininzi, unyango kunye nexesha esalandelayo ayaphumelela.

Enye yeyona ixhaphakileyo yokwenzakala iintlobo na ukwaphuka amathambo navicular. ICD uhlaziyo 10 yabelwe lo S62.0 khowudi umonakalo. I peculiarity yeyokuba oku kunzima kakhulu ukuchonga ezinjengokwaphuka. oogqirha bangenamava kuthatha umonakalo nokwenzakala ezingenamsebenzi, ngoko unyango inikwa ngokufanelekileyo. Kwinqaku namhlanje siya kuchaza ukuba mpawu sikhatshwe ukwaphuka amathambo navicular. Kwakhona, ingqalelo yakho mayinikwe iindlela eziphambili unyango.

reference yokwakheka

Navicular igqalwa omnye weyona milenze ibaluleke ebuhlungu esihlahleni. Kubhaliwe ibekwe kwicala nasesithupheni le. Igama imfundo lakhe navicular luyafuneka ukwenza efana iphenyane. Sosana zimelwe amathambo ezisibhozo encinane, nto leyo yenze imikrozo emibini. Ngamnye kubo phezu izinto ezine. ithambo Navicular kungenziwa iviwe ngokwabo kummandla "snuffbox yokwakheka". Le ngongoma yenzelwe phakathi nemisipha nocikicane abductor kwizihlunu.

Anatomy of the amalungu kunye namathambo esihlahleni yenye kakhulu anzima umzimba uphela. Ezi zithinteli kwenza kube lula ukwenza iintshukumo ezininzi iinqwelomoya ezininzi. Kwelinye icala, nemisipha ukunika amalungu amandla. ithambo Navicular unoxanduva kuququzelelo nokulungiselela ezinye izakhiwo ezikufutshane. Ngoko ke, lo msebenzi yonke, iwotshi yaphukile kwi sayo.

Oonobangela kunye ezisebenza umonakalo

Ukwaphuka wethambo navicular kaninzi kwenzeka ngenxa ekuweni esandleni. Ngenxa yoko kukho hyperextension apha esihlahleni. Ngoko ke, uninzi umthwalo iwela scaphoid. Kwiimeko ezinqabe ukonzakala ibuhlungu kukuba ngenxa yokuba sesichengeni ngqo kwesi sakhiwo.

Uninzi lwezigulane kwafunyaniswa ukuba ngokwaphulwa okuvala amathambo navicular. Ubukho discontinuities eluswini ezinokubangelwa iimpawu trauma. Ngokomzekelo, xa esiwa phezu enamatye.

Ukonakala ithambo navicular zibonakale ngeendlela ezininzi. Phakathi kwazo kwakukho eziphambili ngolu hlobo lulandelayo:

1. split ezinqamlezayo, obuquka ukuyilwa ngamaqhekeza ezimbini twatse ngobukhulu.
2. umsantsa Bone phezu buthelezi.
3. Ngokwaphulwa, sikhatshwe ukuyilwa inani elikhulu ngamaqhekeza kunye nokususwa ithambo. Kungenjalo, ibizwa ngokuba comminuted.

Ukuba sithethe unobangela kulimala, badla zenzeke ngexesha ezemidlalo okanye zisisiphumo kwingozi yemoto.

picture clinical

Ukwaphuka wethambo navicular kakhulu kunzima ukubona. Oku kungenxa komfanekiso clinical mnene. Ngoko ke kubalulekile ngoko nangoko emva kokonzakala, funa uncedo kugqirha kwaye iwise uviwo ebanzi. Oku kuya kunceda siphephe iingxaki kwixesha elizayo.

Ezibonisa ezingundoqo ngokwaphulwa navicular ziquka:

1. Imbonakalo ukudumba kule ndawo ngayo. Ekuhambeni kwexesha, oko utshisa kwiindawo ezininzi.
2. Ubukho intlungu kwi dorsum izihlahla. Ukuqaleka idla kubi xa ulwandiso joint, okanye sikuxinile kummandla ochaphazelekayo.
3. Ukophulwa kwalo msebenzi ngokupheleleyo ngesandla.
4. Ubukho hematoma kunye lokutyunyuzwa ngenxa izitya komsipha.

Iimpawu eziphawula eziintsalu scaphoid kwisihlahla, zahlukene. Xa isifo olululo kunye noviwo efanelekileyo emzimbeni ukuba ukrokrela ingxaki kulula.

lokuqala zoncedo

Emva umonzakalo ixhoba imfuneko engxamisekileyo ukunika uncedo lokuqala. isandla Okokuqala kufuneka bazame ukuba icele. Ulwandiso imisipha reflex ungakhululekanga, okanye nimqumbise ukubana ngamaqhekeza ithambo. Nabo ke, ngakumbi nga kunokwenzakalisa kwizihlunu ezithambileyo. Kufuneka ibe kwindawo simahla yokuxhoma isandla isikhafu okanye kwilaphu. Ngokuzimeleyo lukhuselekile nge brush kwaye wamavili akafanelanga kusetyenziselwa amabhandeji. Naziphi iinketho unyango ngaphandle kokubonisana ugqirha nakanjani contraindicated. Kungenjalo, unako azakulimaza kuphela ixhoba, ngokwaneleyo ukuba nimqumbise uphuhliso iingxaki ezinzulu.

Yintoni enokwenziwa ukuze kuphele iintlungu?

• Qhoboshela urhangqo ice ukuya kummandla ochaphazelekayo. Gcina walisusa okupholisa kufuneka ungabi ngaphezu kwemizuzu eyi-15, ukuze abangele frostbite. Njengoko cutha angasebenzisa iityhubhu umkhenkce, ibhotile abandayo yamanzi okanye iqatha lenyama zibambene. Phakathi kwayo kunye ne phezu ulusu kuyimfuneko ukubeka ngelaphu. Asinako ukuvumela kokungena condensate ezingcolisekileyo ukuba inxeba elivulekileyo.
• Thabatha icwecwe iintlungu ezidakumbisayo. Ngoko kuyimfuneko ukuba ulandele imiyalelo apha kwaye uphephe overdosing. Kungenjalo, iyeza kungadala ityhefu.

Ohambisa ixhoba, njengoko umthetho, oluqhutywa-endlwini. Ungatsalela umnxeba igqiza leengcali zempilo, xa kukho imfuneko. Makungaze naphantsi kwazo naziphi na iimeko ukuba ukho na intshukumo ezimeleyo imoto umntu akrokrela kwi ukwaphuka amathambo navicular. intlungu olomeleleyo ebangela ukwehla ingqalelo.

uxilongo Iimpawu

Xa ubona iimpawu enye okanye ngaphezulu ezintlungwini, abaye kuchazwa nje ngentla, kufuneka ngoko nangoko ufune uncedo abaqeqeshiweyo. Kulungile ukuba umntu onjalo traumatologist okanye kugqirha.

Inyathelo lokuqala diagnostic yi anamnesis. Isigulane kufuneka ukuchaza oko ngaphambi scaphoid eyonakeleyo. Kusenokuba ina, ezemidlalo kakhulu okanye alwe lwasekhaya. Kwakhona, ugqirha wakho kufuneka ukwazi izifo transferred ngaphambili kwinkqubo musculoskeletal, ukwenzakala esihlahleni.

Emva koko, ingcaphephe idla ezinambuzelayo ukuya nokuxilongwa kwemizimba yabo. Ekuqa- kutyhilwa ukudumba kummandla ochaphazelekayo, ubuhlungu iintlungu emva Ngokucofa. Ngamanye amaxesha isigulane ucelwa ukuba Wayitsala joint kwisihlahla, lo gama ukunikela ingqalelo iintshukumo ezithile kule ndawo.

Ukuba ugqirha orhanelwa ukwaphuka i navicular ithambo ngezandla, isigulane sithunyelwa kwi X-ray. Le nkqubo ibithethwa oluqhutywa ineenkalo ezintathu. Ukunqongophala ukungaqheleki ezicaceleyo mfanekiso akuthethi ukuba azikho ngokwenyani. Kulo mzekelo, isigulane isicelo gypsum, nto leyo ayisuseki kwisithuba seeveki ezimbini.

Emva kweli xesha iphindiwe esifubeni. Iintsuku 14 ixesha ithambo zidlule kwinkqubo rarefaction, umsantsa okhoyo phakathi amaqhekeza liza kunyuka ngokuphawulekayo. Loo ukwa nako kuqwalaselwa kwi radiograph. Ngokwesiseko uxilongo ugqirha wenziwe ungenza ukuxilongwa, ukunika iingcebiso unyango.

therapy Conservative

Unyango lwe zaphuka ye brush ithambo navicular kuxhomekeke ebukhulwini ukonzakala kunye nenqanaba lomsebenzi nexhoba. Not indima mncinane kule edlalwa inkanuko isigulane ukululama ngokukhawuleza.

Ekuqa- ubuchule angqingqwa exposure zisetyenziswa ngaphandle ukufuduka. Kuba unyango kwi entlanganweni kwisihlahla kunye ngomnwe sokuqala isicelo udaka. Ngebhandishi ezinxitywa ngenjongo malunga ezimbini iinyanga de ezinjengokwaphuka ayikho srastetsya ngokupheleleyo. Ezinye izigulane niqiniseke ukuba utyando ukunciphisa ixesha immobilization kwaye kwakhona ngokukhawuleza uqabe. Le ndlela unyango kusekho ngumbandela imbambano phakathi oogqirha.

Ukwaphuka yesithathu esezantsi uphilisa ithambo scaphoid kwiiveki 4-6. Le yinxalenye brush iphawulwa unikezelo igazi elungileyo, ngoko iingxaki kunye nokubuyiselwa ngokubonakalayo lungenzeki.

Ukwaphulwa kwi wesithathu embindini okanye kwipali proximal kufuna unyango elide. Kwezi nkalo scaphoid abe igazi olihlwempu. ixesha Coalescence ixhomeke yomguli ubudala, ukutya. Ngamaxesha athile, kufuneka ukutyelela ugqirha ukuze uhlole. In ingakumbi iimeko ezinzulu kungafuna-Inqanaba X-reyi kwaye CT scan ukuvavanya ukuziphatha kwakhona amandla.

Kungakhathaliseki kwindawo ethile gypsum trauma ukwaphuka wethambo navicular lisetyenziswa kuzo zonke izigulane. Ngoxa enxibe amabhandeji, oogqirha bathi:

• athintele nokushukumisa izihlahla;
• bashiye lo mdlalo;
• badle ukudla Balanced;
• ukulandela ulawulo lomsebenzi kunye ukuphumla.

ого быстрее. Phantsi iingcebiso ngentla inkqubo ephilisa iza kuhamba th ngokukhawuleza kakhulu.

ukungenelela kuhlinzwa

Xa ukufuduka okuphawulekayo ngamaqhekeza yethambo okanye umngcipheko ophezulu necrosis avascular izigulane kucetyiswa uqhaqho. injongo yayo - ukuze uzinzise mlenze achaphazelekayo. Le ndlela kube lula ukubuyiselwa yokuqala igazi ukuya kummandla ochaphazelekayo, zaphuka ukuphiliswa.

Surgery yenziwa qho kwezigulane nokusetyenziswa zomzimba lommandla okanye yasekuhlaleni. Ngexesha lo msebenzi, ugqirha kususa ukubana amaqhekeza bone oqondela Screw yabo (kweyodwa). Kuphonononga isiphumo ifunyenwe kusetyenziswa X-ray diffraction.

Sika senziwa ngasemva okanye kwicala entendeni ka esihlahleni. ubukhulu kunye eyendawo ethile kuxhomekeke koko yinxalenye ithambo navicular yalulanyiselwa trauma. Ukuyekwa nya lula ngokufanelekileyo. Fresh nokunye scaphoid lithambo esihlahleni ngokuqhelekileyo elibekwa Screw nge imbobo omalunga 3-5 mm.

Ukuba indlela umonakalo sroslos engalunganga kufuna kakhulu ngakumbi. Ugqirha kuqala yenza liqatywe enkulu, nto leyo evumela ukuba enze osteotomy. Emva koko, ukuba uyaqhubeka kutsha komzimba echanekileyo, yaye ke ngoko oqondela izikrufu ithambo.

Xa kukho elimele, ngexesha utyando, a lenkohlakalo okhethekileyo. It is a version zokwenziwa of kwezihlunu ithambo. Ibekwe ehlabathini sisilonda. Le lenkohlakalo isetyenziselwa ukukhuthaza inkqubo ukuphiliswa kwithishyu.

sokubuyisa ixesha ekuphulukenwe

Xa lokufunyaniswa "ziye scaphoid ibhrashi" ngokwemiqathango unyango zixhomekeke kakhulu yesiqhelo kakuhle. iinkqubo lokubuyisa siqale kwikhondo umthambo unyango. Yonke imisebenzi ikhetha ingcali. Eyona njongo yawo engundoqo - ekupheliseni ukuqina kunye contracture. ixesha Rehabilitation lungahlulwa-hlulwa ngezigaba ezithathu kwemiqathango.

Ngelo isanda LFK ulandela misebenzi ilandelayo:

• ukuthanjiswa izihlunu kummandla ochaphazelekayo;
• kubulawe buhlungu;
• kubulawe yokopha;
• normalizing lokuhamba ulwelo emithanjeni;
• zokubuyiselwa iinkqubo metabolic.

Ezi njongo ukuvumela ukuba ukhethe i imithambo kakhulu ngempumelelo. Njengomgaqo, esetyenziswa umnwe flexion nokwandiswa, setyhula kunye pendulum nentshukumo brush. Esi sigaba recovery ithatha malunga neentsuku ezili-14.

Ukususela kwiveki yesithathu umthambo ezininzi iguqulwe kancinane. Ngoku imithambo ijolise lomzimba ukuchacha ezisebenzayo kunye noluhlu ngokubambisana motion. Ngenxa yoku, bubulumko izakhiwo ezahlukeneyo ibhola zemithambo kwaye umatshini.

Kwisigaba sesithathu lweenjongo umzimba bamele bakhulisele nethoni yelo yonke ephilayo, ukuphucula isimo abachaphazelekayo. Izigulane zivumelekile imithambo enzima: atyhale-ups, ukutsalwa-ups, njalo njalo.

Emva zaphuka ithambo scaphoid kunye nokususa uphosa physiotherapy elimisiweyo compulsorily (UHF, zokuthambisa, ezibhateni zeparafini). A iindlela kakuhle anyuliweyo yesiqhelo unako ukubuyisela ngokupheleleyo ukuhamba kunye nocikizeko mlenze owenzakeleyo.

engaba khona

kwesifo okuchanekileyo wokwenzakala kubaluleke kakhulu kuba kuvumela ukuba iyaluthintela uphuhliso emibi. Ukongeza, awukwazi ukushiya ngaphandle therapy ukwaphuka amathambo navicular. Unyango owenziwa emva kwexesha, ukusongela ukuvela iingxaki. Phakathi kwabo zithathwa kuyingozi kakhulu zezi:

1. Ukudleka welungu esihlahleni. Le ngezifo ihamba kabuhlungu intlungu ukushukumiseka lunqongophele imilenze. Kwiimeko ingakumbi kakhulu, oko kukhokelela nokukhubazeka.
2. ukuphiliswa bone engafanelekanga. Kwiimeko ezinqabe kakhulu, amaqhekeza ezonakeleyo edidekile kwindawo engile okungephi. Isigulana kule meko luhlangabezana nobunzima kakhulu intlungu. A ngxaki ingasombululwa kuphela ngoncedo umsebenzi omtsha. Ngexesha utyando eyenziwa re Kucinywe ulungelelwaniso lithambo beengxenye zonke. Emva koko, dlulela lokususa ithambo.
3. Necrosis. Ngokuchasene imvelaphi kwegazi engentlanga ithambo kancane ziyafa. Ngenxa yokuba zokuphuhlisa inkqubo kwiintetho ezikralayo, yaye kwiimeko oluphezulu zingavela ukubola. Ukuphelisa esi sifo isoloko ifuna okwalandelwa ngokupheleleyo esandleni. ifomu necrosis Aseptic uvela kancinane. Kumanqanaba okuqala akunakwenzeka ukubona, nkqu phezu radiograph. iinyanga 2-3 emva kokonzakala wabonisa iimpawu iqapheleka ukuphazamiseka. Amaxesha amaninzi, ukugcina ithambo ayisendim kunokwenzeka.

Ngamafuphi

Ngokutsho manani, ukwaphuka le scaphoid idla kakhulu ngqalelo. Ngoko ke, esi sifo inkangeleko semvelo yeengxaki ezahlukeneyo. isifo ngexesha unyango ofanelekileyo kungundoqo kuzo nokuchacha. Kulo mzekelo, ngokusebenzisa inkqubo echanekileyo yesiqhelo akakwazi ukubuyisela ngokupheleleyo ukusebenza kwesebe.

Oogqirha zilumkisa ngelithi ezinjengokwaphuka wethambo navicular (ICD-10 - S62.0) sisifo esibi kakhulu. Ukungananzi unganaki obubonakala kufuneka kungabi. Ukonakala ithambo encinane kudla ngokuphumela ukuphazamiseka yonke esihlahleni.