Indlela Yokusebenza
(I) Ukubulala izinzwa
I-brachial plexus block isetshenziselwa izitho ezingaphezulu, i-epidural block noma i-subarachnoid block isetshenziselwa izitho ezingezansi, kanti i-general anesthesia noma i-local anesthesia nayo ingasetshenziswa njengoba kufanele.
(II) Isikhundla
Izingalo ezingaphezulu: ukugoba, ukugoba indololwane, ingalo phambi kwesifuba.
Izitho zangaphansi: ukugoba, ukugoba izinqe, ukuthunjwa, ukugoba idolo kanye nokuhlangana kweqakala endaweni yokwelulwa komgogodla ngamadigri angu-90.
(III) Uchungechunge lokusebenza
Ukulandelana okuqondile kokusebenza kwe-fixator yangaphandle kuyindlela yokushintshana kokusetha kabusha, ukufaka intambo kanye nokulungisa.
[Inqubo]
Okusho ukuthi, ukuphuka kuqala kuphinde kubekwe endaweni entsha (kulungisa ukukhubazeka okujikelezayo nokugqagqene), bese kubhobozwa ngezikhonkwane ezikude nomugqa wokuqhekeka bese kuqala kuqiniswe, bese kuphinde kubekwe endaweni entsha futhi kubhobozwe ngezikhonkwane eziseduze nomugqa wokuqhekeka, bese ekugcineni kubekwe endaweni entsha ukuze kwanelise ukuqhekeka bese kuqiniswe ngokuphelele. Kwezinye izimo ezikhethekile, ukuqhekeka kungalungiswa nangokuphina ngqo, futhi uma isimo sivuma, ukuqhekeka kungashintshwa, kulungiswe futhi kulungiswe kabusha.
[Ukunciphisa Ukuphuka Kwamaqhubu]
Ukunciphisa ukwaphuka kwethambo kuyingxenye ebalulekile yokwelashwa kokuphuka kwethambo. Ukuthi ukwaphuka kwethambo kuncishiswe ngokwanele yini kunomthelela oqondile kwikhwalithi yokuphulukiswa kokuphuka kwethambo. Ukuphuka kwethambo kungavalwa noma kubonwe ngqo ngokwesimo esithile. Kungalungiswa futhi ngokwefilimu ye-X-ray ngemva kokumaka ubuso bomzimba. Izindlela ezithile yilezi ezilandelayo.
1. Ngaphansi kokubona ngqo: Uma kuqhekeke amanxeba avulekile aneziphetho zokuqhekeka eziveziwe, ukuqhekeka kungasethwa kabusha ngaphansi kokubona ngqo ngemva kokususwa ngokuphelele. Uma ukuqhekeka okuvaliwe kwehluleka ukuphathwa, ukuqhekeka kungancishiswa, kubhobozwe futhi kulungiswe ngaphansi kokubona ngqo ngemva kokusikwa okuncane okungu-3 ~ 5cm.
2. Indlela yokunciphisa evaliwe: qala wenze ukuphuka kusethwe kabusha bese usebenza ngokulandelana, ungasebenzisa iphini lensimbi eduze komugqa wokuphuka, bese usebenzisa indlela yokuphakamisa nokuklwebha ukusiza ukuphuka ukuthi kusethwe kabusha kuze kube yilapho sekuqediwe bese kulungiswa. Kungenzeka futhi ukwenza ukulungiswa okufanele kokuhamba okuncane noma ukugoba ngokwe-X-ray ngemuva kokunciphisa okulinganiselwe nokuqina okusekelwe ebusweni bomzimba noma izimpawu zamathambo. Izidingo zokunciphisa ukuphuka, ngokomthetho, ukunciphisa umzimba, kodwa ukuphuka okukhulu okuhlanganisiwe, ngokuvamile akulula ukubuyisela isimo sokuqala somzimba, ngalesi sikhathi ukuphuka kufanele kube ukuxhumana okungcono phakathi kwebhulokhi yokuphuka, nokugcina izidingo ezinhle zomugqa wamandla.
[Ukuphina]
Ukuphotha kuyindlela eyinhloko yokusebenza yokubopha amathambo angaphandle, futhi indlela enhle noma embi yokubopha ayithinti nje kuphela ukuzinza kokubopha amanxeba, kodwa futhi ihlobene nokwanda noma ukwehla kwezifo ezihambisana nalokhu. Ngakho-ke, amasu okusebenza alandelayo kufanele alandelwe ngokuqinile lapho kufakwa intambo enalitini.
1. Gwema umonakalo ohambisanayo: Qonda ngokugcwele ukwakheka kwendawo yokubhoboza futhi ugweme ukulimaza imithambo yegazi eyinhloko kanye nemizwa.
2. Indlela yokusebenza engaphephile ngokuphelele, inaliti kufanele ibe yi-2 ~ 3cm ngaphandle kwendawo yesilonda esinegciwane.
3. Amasu angangenisi magciwane ngokuphelele: uma ufaka inaliti enesigamu kanye nobubanzi obukhulu, faka i-inlet kanye ne-outlet yenaliti yensimbi ngommese obukhali ukuze wenze i-incision yesikhumba engu-0.5 ~ 1cm; uma ufaka inaliti enesigamu, sebenzisa i-haemostatic forceps ukuze uhlukanise imisipha bese ubeka i-cannula bese ubhoboza imigodi. Ungasebenzisi ukubhoboza ngamandla asheshayo lapho ubhoboza noma ubopha inaliti ngqo. Ngemva kokufaka intambo enalitini, amalunga kufanele ahanjiswe ukuze kuhlolwe ukuthi kukhona yini ukucindezeleka esikhumbeni enalitini, futhi uma kukhona ukucindezeleka, isikhumba kufanele sinqunywe futhi sithungwe.
4. Khetha indawo kanye ne-engeli yenaliti ngendlela efanele: inaliti akufanele idlule emisipheni kancane ngangokunokwenzeka, noma inaliti kufanele ifakwe esikhaleni semisipha: lapho inaliti ifakwa endaweni eyodwa, ibanga eliphakathi kwezinaliti engxenyeni yokuqhekeka akufanele libe ngaphansi kuka-6 cm; lapho inaliti ifakwa ezindaweni eziningi, ibanga eliphakathi kwezinaliti engxenyeni yokuqhekeka kufanele libe likhulu ngangokunokwenzeka. Ibanga eliphakathi kwezikhonkwane nomugqa wokuqhekeka noma ubuso obuhlangene akufanele libe ngaphansi kuka-2 cm. I-engeli yokuwela yezikhonkwane ku-needling eneplanar kufanele ibe ngu-25°~80° wezikhonkwane ezigcwele kanye no-60°~80° wezikhonkwane eziyingxenye nezikhonkwane ezigcwele.
5. Khetha kahle uhlobo nobubanzi benaliti yensimbi.
6. Songa imbobo yenaliti kahle nge-alcohol gauze kanye ne-sterile gauze.
Indawo yenaliti ephumayo ye-humeral ekude maqondana ne-vascular nerve bundle yengalo engenhla (Umkhakha oboniswe emfanekisweni yindawo yokuphepha yokufaka inaliti.)
[Ukufaka nokulungisa]
Ezimweni eziningi ukunciphisa ukwaphuka, ukuchoboza kanye nokubopha kwenziwa ngokushintshana, futhi ukubopha kuqedwa njengoba kudingeka lapho izikhonkwane zensimbi ezinqunyiwe sezibhoboziwe. Ukuqhekeka okuzinzile kulungiswa ngokucindezela (kodwa amandla okucindezela akufanele abe makhulu kakhulu, kungenjalo kuzokwenzeka ukukhubazeka kwe-angular), ukuqhekeka okuhlanganisiwe kulungiswa endaweni engathathi hlangothi, kanti amaphutha ethambo alungiswa endaweni yokuphazamiseka.
Indlela yokulungisa yonke into kufanele inake lezi zinkinga ezilandelayo: 1.
1. Hlola ukuqina kokuqina: indlela iwukuqondisa ijoyinti, ukudweba okude noma ukusunduza uhlangothi lokwaphuka; uhlangothi lokwaphuka oluqinile oluqinile akufanele lube nomsebenzi noma lube nomsebenzi omncane wokunwebeka. Uma ukuqina kunganele, kungathathwa izinyathelo ezifanele zokwandisa ukuqina okuphelele.
2. Ibanga elisuka ku-fixator yangaphandle yethambo liye esikhumbeni: 2 ~ 3cm engxenyeni engenhla, 3 ~ 5cm engxenyeni engezansi, ukuze kuvinjelwe ukucindezelwa kwesikhumba futhi kube lula ukwelashwa kokuhlukumezeka, lapho ukuvuvukala kukubi kakhulu noma ukulimala kukhulu, ibanga lingashiywa likhulu esigabeni sokuqala, futhi ibanga lingancishiswa ngemva kokuphela kokuvuvukala futhi ukulimala kulungisiwe.
3. Uma kuhambisana nokulimala okukhulu kwezicubu ezithambile, ezinye izingxenye zingangezwa ukuze umlenze olimele ulengiswe noma ubekwe phezu kwekhanda, ukuze kube lula ukuvuvukala komlenze nokuvimbela ukulimala kwengcindezi.
4. I-fixator yangaphandle yethambo le-bone cadre akufanele ithinte ukuzivocavoca okusebenzayo kwamalunga, isitho esingezansi kufanele kube lula ukuhamba ngaphansi komthwalo, kanti isitho esingaphezulu kufanele sibe lula emisebenzini yansuku zonke kanye nokuzinakekela.
5. Isiphelo senalithi yensimbi singavezwa kusiqeshana sokuqinisa isinali yensimbi cishe u-1cm, kanti umsila omude kakhulu wenalithi kufanele unqunywe. Isiphelo senalithi siboshwe ngesivalo sepulasitiki noma ngeteyipu, ukuze singabhobozi isikhumba noma sinqume isikhumba.
[Izinyathelo okufanele zithathwe ezimweni ezikhethekile]
Ezigulini ezinezimo eziningi zokulimala, ngenxa yokulimala okukhulu noma ukulimala okusongela ukuphila ngesikhathi sokuvuselelwa, kanye nasezimweni eziphuthumayo njengosizo lokuqala ensimini noma ukulimala kweqembu, inaliti ingafakwa intambo futhi iboshwe kuqala, bese ilungiswa kabusha, ilungiswe, futhi iboshwe ngesikhathi esifanele.
[Izinkinga Ezivamile]
1. Ukutheleleka kwe-pinhole; kanye
2. I-necrosis yokucindezeleka kwesikhumba; kanye
3. Ukulimala kwemithambo yegazi
4. Ukuphola okulibazisekile noma ukungapholi kokuphuka.
5. Amaphini aphukile
6. Ukuphuka komgudu wephini
7. Ukungasebenzi kahle kwamalunga
(IV) Ukwelashwa ngemva kokuhlinzwa
Ukwelashwa okufanele ngemva kokuhlinzwa kuthinta ngqo ukusebenza kahle kokwelashwa, ngaphandle kwalokho izinkinga ezifana nokutheleleka kwe-pinhole kanye nokungahlangani kokuphuka kwethambo kungase kwenzeke. Ngakho-ke, kufanele kunakwe ngokwanele.
[Ukwelashwa okuvamile]
Ngemva kokuhlinzwa, isitho esilimele kufanele siphakanyiswe, futhi ukujikeleza kwegazi nokuvuvukala kwesitho esilimele kufanele kubhekwe; lapho isikhumba sicindezelwa yizingxenye ze-fixator yangaphandle yethambo ngenxa yesikhundla noma ukuvuvukala kwesitho, kufanele siphathwe ngesikhathi. Izikulufo ezikhululekile kufanele ziqiniswe ngesikhathi.
[Ukuvimbela nokwelapha izifo]
Ukuze kuqiniswe ithambo langaphandle, ama-antibiotic awadingeki ukuvimbela ukutheleleka kwe-pinhole. Kodwa-ke, ukwaphuka kanye nenxeba ngokwalo kumele kusaphathwa ngama-antibiotic njengoba kufanele. Uma kwaphuka okuvulekile, noma ngabe inxeba lihlanzwe kahle, ama-antibiotic kufanele asetshenziswe izinsuku ezi-3 kuya kweziyi-7, kanti ama-fracture athelelekile kufanele anikezwe ama-antibiotic isikhathi eside njengoba kufanele.
[Ukunakekelwa kwembobo yephini]
Kudingeka umsebenzi owengeziwe ngemva kokulungiswa kwamathambo angaphandle ukuze kunakekelwe imigodi yama-pin njalo. Ukunakekelwa okungalungile kwemigodi yama-pin kuzoholela ekuthelelekeni kwemigodi yama-pin.
1. Ngokuvamile i-dressing ishintshwa kanye ngosuku lwesithathu ngemva kokuhlinzwa, futhi i-dressing idinga ukushintshwa nsuku zonke uma kuphuma amanzi emgodini.
2. Ezinsukwini eziyi-10 noma ngaphezulu, isikhumba se-pinhole sigoqwe nge-fiber, kuyilapho sigcina isikhumba sihlanzekile futhi somile, njalo ezinsukwini eziyi-1-2 esikhumbeni se-pinhole amaconsi e-75% alcohol noma i-iodine fluoride angaba khona.
3. Uma kukhona ukucindezeleka esikhumbeni emgodini wephini, uhlangothi lokucindezeleka kufanele lunqunywe ngesikhathi ukuze kuncishiswe ukucindezeleka.
4. Naka ukusebenza kwe-aseptic lapho ulungisa i-bone external fixator noma ushintsha ukucushwa, bese uhlanza isikhumba esizungeze imbobo yephini kanye nenaliti yensimbi njalo.
5. Gwema ukutheleleka okuthelelanayo ngesikhathi sokunakekelwa kwembobo encane.
6. Uma kwenzeka ukutheleleka ngembobo ye-pinhole, ukwelashwa okufanele kufanele kwenziwe ngesikhathi, futhi umlenze olimele kufanele uphakanyiswe ukuze uphumule futhi kusetshenziswe imithi yokulwa namagciwane efanele.
[Ukuzivocavoca okusebenzayo]
Ukuzivocavoca okusebenza ngesikhathi esifanele akugcini nje ngokusiza ekubuyiseleni ukusebenza kwamalunga, kodwa futhi nokwakha kabusha i-haemodynamics kanye nokukhuthaza ukucindezeleka ukuze kukhuthazwe inqubo yokuphulukiswa kokuphuka. Ngokuvamile, ukufinyela kwemisipha kanye nemisebenzi yamalunga kungenziwa embhedeni zingakapheli izinsuku eziyi-7 ngemuva kokuhlinzwa. Izitho zamalunga ezingaphezulu zingenza ukuncinza nokubamba izandla kanye nokunyakaza okuzenzakalelayo kwezitho zamalunga esihlakaleni nasendololwaneni, futhi ukuzivocavoca okujikelezayo kungaqalwa ngesonto eli-1 kamuva; izitho zamalunga ezingezansi zingashiya umbhede kancane ngosizo lwezinduku zokusibekela ngemva kwesonto eli-1 noma ngemva kokuba inxeba selipholile, bese kancane kancane ziqala ukuhamba zithwele isisindo esiphelele emavikini ama-3 kamuva. Isikhathi nendlela yokuzivocavoca okusebenza iyahlukahluka kumuntu nomuntu, ikakhulukazi kuye ngezimo zendawo nezesimiso. Enkambisweni yokuzivocavoca, uma imbobo yephini ibonakala ibomvu, ivuvukile, ibuhlungu kanye nezinye izimpawu zokuvuvukala kufanele kumiswe umsebenzi, kuphakanyiswe isitho esithintekile siye ekuphumuleni kombhede.
[Ukususwa kwe-fixator yangaphandle yethambo]
I-brace yokuqinisa yangaphandle kufanele isuswe lapho ukwaphuka sekufinyelele ezindinganisweni zezokwelapha zokuphulukiswa kokuphuka. Lapho kususwa i-bracket yokuqinisa ithambo yangaphandle, amandla okuphulukisa okwaphuka kufanele anqunywe ngokunembile, futhi ukuqina kwethambo langaphandle akufanele kususwe ngaphambi kwesikhathi ngaphandle kokuqiniseka kokunquma amandla okuphulukisa ethambo kanye nezinkinga ezisobala zokuqina kwethambo langaphandle, ikakhulukazi lapho kwelashwa izimo ezifana nokuphuka okudala, ukwaphuka okuhlanganisiwe, kanye nokungahlangani kwethambo.
Isikhathi sokuthunyelwe: Agasti-29-2024
