Indlela yokusebenza
(I) Izinzwa
I-Brachial plexus block isetshenziselwa izitho ezingaphezulu, i-epidural block noma i-subarachnoid block isetshenziselwa izitho ezingezansi, futhi i-anesthesia evamile noma i-anesthesia yendawo nayo ingasetshenziswa ngokufanelekile.
(II) Isikhundla
Izitho ezingaphezulu: i-pine, indololwane igoba, ingalo phambi kwesifuba.
Izitho ezingezansi: i-pine, i-hip flexion, ukuthunjwa, ukugoba kwamadolo kanye ne-ankle joint in 90 degree dorsal extension.
(III)Ukulandelana komsebenzi
Ukulandelana okuqondile kokusebenza kwe-fixator yangaphandle ukushintshanisa ukusetha kabusha, ukuthunga nokulungisa.
[Inqubo]
Okusho ukuthi, ukuphuka kuqala kubekwe kabusha (ukulungisa ukukhubazeka okujikelezayo nokugqagqene), bese kubhobozwa ngezikhonkwane ezikude kuya emugqeni wokuphuka futhi kulungiswe ekuqaleni, bese kuphinde kubekwe kabusha futhi kubhobozwe ngezikhonkwane eziseduze komugqa wokuphuka, futhi ekugcineni zibekwe kabusha ukuze ukwaneliseke. ukuphuka bese ilungiswa ngokuphelele. Kwezinye izimo ezikhethekile, ukuphuka kungabuye kulungiswe ngokuphina okuqondile, futhi lapho isimo sivuma, ukuphuka kungashintshwa, kulungiswe futhi kulungiswe kabusha.
[Ukunciphisa Ukuphuka]
Ukunciphisa ukuphuka kuyingxenye ebalulekile yokwelashwa kokuphuka. Ukuthi ukuphuka kwehliswe ngendlela egculisayo kunomthelela oqondile kwikhwalithi yokuphulukiswa kokuphuka. I-fracture ingavalwa noma ngaphansi kombono oqondile ngokusho kwesimo esithile. Ingase futhi ilungiswe ngokuvumelana nefilimu ye-X-ray ngemva kokumaka ubuso bomzimba. Izindlela eziqondile zimi kanje.
1. Ngaphansi kombono oqondile: Ngokuqhekeka okuvulekile okunomkhawulo oveziwe wokuphuka, ukuphuka kungase kusethwe kabusha ngaphansi kombono oqondile ngemva kokuchithwa ngokuphelele. Uma ukuphuka okuvaliwe kwehluleka ukuguqulwa, ukuphuka kungabuye kuncishiswe, kubhobozwe futhi kulungiswe ngaphansi kombono oqondile ngemva kokusikwa okuncane okungu-3 ~ 5cm.
2. Indlela yokunciphisa evaliwe: qala wenze ukuphuka kucishe kusethwe kabusha bese usebenza ngokulandelana, ungasebenzisa iphinikhodi yensimbi eduze komugqa wokuphuka, futhi usebenzise indlela yokuphakamisa nokusika ukuze usize ukuphuka ukuthi kuphinde kusethwe kabusha kuze kube kwaneliseka. bese ilungiswa. Kungenzeka futhi ukwenza izinguquko ezifanele zokugudluka okuncane noma i-angulation ngokuya nge-X-ray ngemva kokunciphisa cishe nokulungiswa okusekelwe ebusweni bomzimba noma kumaka amathambo. Izidingo zokunciphisa ukuphuka, ngokuyisisekelo, ukuncishiswa kwe-anatomical, kodwa ukuphuka okungathí sina, ngokuvamile akulula ukubuyisela ifomu lokuqala le-anatomical, ngalesi sikhathi ukuphuka kufanele kube ukuxhumana okungcono phakathi kwebhulokhi yokuphuka, nokugcina izidingo zomugqa wamandla omuhle.
[Ukuphina]
Ukuphina kuyindlela yokusebenza eyinhloko yokulungiswa kwamathambo kwangaphandle, futhi indlela enhle noma embi yokuphina ayithinti nje kuphela ukuzinza kokulungiswa kokuphuka, kodwa futhi ihlobene nesigameko esiphezulu noma esiphansi se-commorbidity. Ngakho-ke, amasu okusebenza alandelayo kufanele alandelwe ngokuqinile lapho uhlanganisa inaliti.
1. Gwema ukulimala okubanjiswayo: Qonda ngokugcwele i-anatomy yendawo yokubhoboza futhi ugweme ukulimaza imithambo yegazi eyinhloko nezinzwa.
2. Indlela yokusebenza ye-aseptic eqinile, inaliti kufanele ibe ngu-2 ~ 3cm ngaphandle kwendawo yesilonda esinegciwane.
3. Amasu aqinile angahlaseli: lapho ugqoke inaliti enguhhafu kanye nenaliti ewugqinsi yobubanzi obugcwele, indawo yokungena nokuphuma kwenaliti yensimbi ngommese obukhali ukwenza i-0.5 ~ 1cm yesikhumba sokusika; lapho ugqoke inaliti enguhhafu, sebenzisa i-haemostatic forceps ukuze uhlukanise umsipha bese ubeka i-cannula bese ubhoboza izimbobo. Ungasebenzisi amandla okubhola anesivinini esikhulu uma ubhoboza noma uhlanganisa inaliti ngokuqondile. Ngemva kokulubula inaliti, amalunga kufanele anyakaze ukuze kubhekwe ukuthi akukho yini ukushuba esikhumbeni enalitini, futhi uma kunokushuba, isikhumba kufanele sisikwe futhi sithungwe.
4. Khetha kahle indawo kanye ne-angle yenaliti: inaliti akufanele idlule emsipha kancane ngangokunokwenzeka, noma inaliti kufanele ifakwe emgodini wemisipha: lapho inaliti ifakwe endizeni eyodwa, ibanga phakathi izinaliti engxenyeni yokuphuka akufanele ibe ngaphansi kuka-6 cm; lapho inaliti ifakwe ezindizeni eziningi, ibanga phakathi kwezinaliti engxenyeni yokuphuka kufanele libe likhulu ngangokunokwenzeka. Ibanga phakathi kwezikhonkwane kanye nomugqa wokuphuka noma i-articular surface akufanele ibe ngaphansi kuka-2cm.I-angle yokuwela yamaphini kunalidi ye-multiplanar kufanele ibe ngu-25°~80° ngezikhonkwane ezigcwele kanye no-60°~80° ngezikhonkwane eziyisigamu nezikhonkwane ezigcwele. .
5. Khetha kahle uhlobo nobubanzi benaliti yensimbi.
6. Gcoba imbobo yenaliti kahle nge-gauze yotshwala kanye ne-gauze oyinyumba.
Indawo yenalithi yokungena e-distal humeral ngokuhlobene nenqwaba yezinzwa zemithambo yengalo engenhla (Umkhakha oboniswe emfanekisweni uyindawo yokuphepha yokulubula inaliti.)
[Ukukhweza nokulungiswa]
Ezimweni eziningi ukuncishiswa kokuphuka, ukuphina kanye nokulungiswa kwenziwa ngokushintshana, futhi ukulungiswa kuqedwa njengoba kudingekile lapho izikhonkwane zensimbi ezinqunywe kusengaphambili zibhoboziwe. Ama-fractures azinzile alungiswa ngokucindezelwa (kodwa amandla okucindezela akufanele abe mkhulu kakhulu, ngaphandle kwalokho ukukhubazeka kwe-angular kuzokwenzeka), ama-fractures ahlanganisiwe alungiswa endaweni engathathi hlangothi, futhi ukukhubazeka kwamathambo kulungiswe endaweni yokuphazamiseka.
Imfashini yokulungiswa okuphelele kufanele inake lezi zindaba ezilandelayo: 1.
1. Hlola ukuzinza kokulungiswa: indlela yokuqondisa umdwebo ohlangene, ubude noma ukusunduza kwe-lateral ukuphela kokuphuka; ukuphela kwe-fracture okuzinzile okugxilile akufanele kube nomsebenzi noma inani elincane lomsebenzi wokunwebeka. Uma ukuzinza kunganele, izinyathelo ezifanele zingathathwa ukuze kwandiswe ukuqina okuphelele.
2. Ibanga ukusuka ku-fixator yangaphandle yethambo ukuya esikhumbeni: 2 ~ 3cm engxenyeni engenhla, 3 ~ 5cm yesitho esingaphansi, ukuze kuvinjwe ukucindezelwa kwesikhumba futhi kube lula ukwelashwa kokuhlukumezeka, lapho ukuvuvukala kubi kakhulu noma ukuhlukumezeka kukhulu. , ibanga lingashiywa likhudlwana esigabeni sokuqala, futhi ibanga lingancishiswa ngemva kokuncipha kokuvuvukala futhi ukuhlukumezeka kulungiswa.
3. Uma kuhambisana nokulimala okukhulu kwezicubu ezithambile, ezinye izingxenye zingangezwa ukwenza isitho esilimele silengiswa noma ngaphezulu, ukuze kube lula ukuvuvukala kwesitho futhi kuvimbele ukulimala komfutho.
4. I-bone fixator yangaphandle yethambo ye-bone cadre akufanele ithinte umsebenzi wokusebenza kwamalungu, umlenze ophansi kufanele ube lula ukuhamba ngaphansi komthwalo, futhi umlenze ongaphezulu kufanele ube lula emisebenzini yansuku zonke nokuzinakekela.
5. Ukuphela kwenaliti yensimbi kungavezwa kusiqeshana sokulungisa inaliti yensimbi cishe ngo-1cm, futhi umsila omude kakhulu wenaliti kufanele unqunywe. Ukuphela kwenaliti nge-plastic cap seal noma tape ehlanganiswe, ukuze ungabhobozi isikhumba noma usike isikhumba.
[Izinyathelo okufanele zithathwe ezimweni ezikhethekile]
Ezigulini ezinokulimala okuningi, ngenxa yokulimala okunzima noma ukulimala okusongela ukuphila ngesikhathi sokuvuselela, kanye nezimo eziphuthumayo njengosizo lokuqala ensimini noma ukulimala kwe-batch, inaliti ingafakwa futhi ivikeleke kuqala, bese ilungiswa kabusha, kulungiswe, futhi kuvikelwe ngesikhathi esifanele.
[Izinkinga Ezivamile]
1. I-Pinhole infection; futhi
2. I-skin compression necrosis; futhi
3. Ukulimala kwemithambo yegazi
4. Ukwephuza ukuphulukiswa noma ukungapholi kokuphuka.
5. Izikhonkwane eziphukile
6. Phina ukuphuka kwepheshana
7. Ukungasebenzi kwamalunga
(IV) Ukwelashwa ngemva kokuhlinzwa
Ukwelashwa okufanele kwangemva kokuhlinzwa kuthinta ngokuqondile ukusebenza kokwelashwa, ngaphandle kwalokho izinkinga ezifana nokutheleleka kwe-pinhole kanye nokungahlangani kokuphuka kungase kwenzeke. Ngakho-ke, ukunakwa okwanele kufanele kukhokhwe.
[Ukwelashwa okuvamile]
Ngemva kokuhlinzwa, isitho esilimele kufanele siphakanyiswe, futhi kubhekwe ukujikeleza kwegazi nokuvuvukala kwesitho esilimele; lapho isikhumba sicindezelwa izingxenye ze-bone fixator yangaphandle ngenxa yesikhundla noma ukuvuvukala kwesitho, kufanele kuphathwe ngesikhathi. Izikulufu ezixegayo kufanele ziqiniswe ngesikhathi.
[Ukuvikela nokwelapha izifo]
Ukuze kulungiswe amathambo angaphandle ngokwawo, ama-antibiotic akudingekile ukuvimbela ukutheleleka kwe-pinhole. Kodwa-ke, ukuphuka kanye nesilonda ngokwaso kusafanele kuphathwe ngama-antibiotics ngendlela efanele. Ukuphuka okuvulekile, ngisho noma isilonda sikhishwe ngokuphelele, ama-antibiotics kufanele asetshenziswe izinsuku ezingu-3 kuya kwezingu-7, futhi ukuphuka okuthelelekile kufanele kunikezwe ama-antibiotics isikhathi eside ngokufanele.
[Ukunakekelwa kwephinifa]
Umsebenzi owengeziwe ngemva kokulungiswa kwamathambo kwangaphandle uyadingeka ukuze unakekele izimbobo zokubopha njalo. Ukunakekelwa kwe-pinhole okungalungile kuzoholela ekuthelelekeni kwe-pinhole.
1. Ngokuvamile ukugqoka kuguqulwa kanye ngosuku lwe-3 ngemva kokuhlinzwa, futhi ingubo idinga ukushintshwa nsuku zonke lapho kuphuma emgodini wokuphina.
2. Izinsuku ezingu-10 noma ngaphezulu, isikhumba somgodi wephini sisongwe, kuyilapho sigcina isikhumba sihlanzekile futhi somile, njalo ezinsukwini ezingu-1 ~ 2 esikhumbeni se-pinhole amaconsi e-75% utshwala noma i-iodine fluoride solution ingaba.
3. Uma kune-tension esikhunjeni embotsheni yephini, uhlangothi olushubile kufanele lunqunywe ngesikhathi ukuze kuncishiswe ukushuba.
4. Naka ukusebenza kwe-aseptic lapho ulungisa isilungisi sangaphandle sethambo noma ushintsha ukumisa, futhi ukhiphe amagciwane esikhumbeni esizungeze imbobo yokukhonkotha kanye nenaliti yensimbi njalo.
5. Gwema ukuthelelana ngezifo ngesikhathi sokunakekelwa kwemigodi.
6. Uma ukutheleleka kwe-pinhole kwenzeka, ukwelashwa okufanele kufanele kwenziwe ngesikhathi, futhi isitho esilimele kufanele siphakanyiswe ukuze siphumule futhi kufanele kusetshenziswe ama-antimicrobial afanelekile.
[Ukuzivocavoca okusebenzayo]
Ukuzivocavoca okusebenzayo okufika ngesikhathi futhi okulungile akusizi nje kuphela ukubuyisela ukusebenza okuhlangene, kodwa futhi nokwakhiwa kabusha kwe-haemodynamics kanye nokugqugquzela ukucindezeleka ukukhuthaza inqubo yokuphulukiswa kokuphuka. Ngokuvamile, ukufinyela kwemisipha nemisebenzi ehlangene kungenziwa embhedeni phakathi kwezinsuku ezingu-7 ngemva kokuhlinzwa. Izitho ezingenhla zingakwazi ukwenza ukumpintsha nokubamba izandla kanye nokunyakaza okuzimele kwesihlakala nendololwane, futhi ukuzivocavoca okujikelezayo kungaqala isonto elingu-1 kamuva; izitho ezingezansi zingashiya kancane umbhede ngosizo lwezinduku emva kweviki elingu-1 noma ngemva kokuba isilonda sesipholile, bese kancane kancane siqala ukuhamba ngesisindo esigcwele amasonto amathathu kamuva. Isikhathi nendlela yokuzivocavoca okusebenzayo kuyahlukahluka kumuntu nomuntu, ikakhulukazi kuye ngezimo zendawo kanye nesistimu. Enkambweni yokuzivocavoca, uma i-pinhole ibonakala ibomvu, ivuvukala, ibuhlungu kanye nezinye izibonakaliso ezivuthayo kufanele zimise umsebenzi, ziphakamise isitho esithintekile ekuphumuleni kombhede.
[Ukususwa kwesilungisi samathambo sangaphandle]
I-brace yokulungisa yangaphandle kufanele isuswe lapho ukuphuka sekufinyelele indlela yomtholampilo yokuphulukiswa kokuphuka. Lapho ususa i-bracket yokulungiswa kwamathambo yangaphandle, amandla okuphulukisa okuphuka kufanele anqunywe ngokunembile, futhi ukulungiswa kwamathambo angaphandle akufanele kususwe ngaphambi kwesikhathi ngaphandle kwesiqiniseko sokunquma amandla okuphulukisa amathambo kanye nezinkinga ezicacile zokulungiswa kwamathambo angaphandle, ikakhulukazi. lapho welapha izimo ezinjengokuphuka okudala, ukuphuka okungapheli, nokungaguquki kwethambo.
Isikhathi sokuthumela: Aug-29-2024
