Ukuhlukaniswa kwesandla: izimbangela, ukuxilongwa, ukwelashwa

Umqondo wokuhlanganiswa kwesandla ufaka isihlakala, maphakathi ne-carpal, i-intercarpal kanye ne-carpometacarpal joints. Ukwehlukaniswa kwesandla (ngokusho kwekhodi ye-ICD-10 - S63) kusho ukuhlukaniswa kwesihlanganisi sesihlakala, esilimele kaningi kunezinye futhi esiyingozi ngokulimala kwemizwa yangaphakathi kanye ne-tendon jumper. Lokhu uxhumano oluyinkimbinkimbi olwakhiwe yizindawo zamathambo zengalo yesandla nesandla.

Ingxenye esondele kakhulu imelwe yizindawo ezisezingeni eliphezulu ze-radius ne-ulna. Ingxenye ye-distal yakhiwa ngokuvela kwamathambo esihlakaleni womugqa wokuqala: i-scaphoid, i-lunate, i-triangular ne-pisiform. Ukulimala okuvame kakhulu ukuhlukaniswa, lapho kukhona ukuhanjiswa kwezindawo ze-articular ezihlobene komunye nomunye. Isici esidala ukuhlukumezeka ukuhamba kwesandla okuphezulu, okuholela ekungazinzi kwaso nasekuthambekeni okuphezulu kokulimala.

Izizathu

Ku-etiology yokuhlukaniswa, indima ehamba phambili ingeyokuwa nokushaywa:

• Ukuwa:
  • ezandleni ezeluliwe;
  • ngenkathi udlala i-volleyball, ibhola kanye ne-basketball;
  • ngenkathi ukushushuluza (ukushushuluza, ukushushuluza).
• Izifundo:
  • ezemidlalo zokuxhumana (sambo, aikido, isibhakela);
  • Phakamisa izinsimbe ezisindayo.
• Umlando wokulimala kwesihlakala (iphuzu elibuthakathaka).
• Izingozi zomgwaqo.
• Ukulimala emsebenzini (ukuwa komgibeli webhayisikili).

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Izimpawu

Izimpawu eziyinhloko zokuhlukaniswa ngemuva kokulimala zifaka:

• ukwenzeka kobuhlungu obukhali;
• ukuthuthukiswa kwe-edema enzima kungakapheli imizuzu emihlanu;
• umuzwa wokuba ndikindiki noma i-hyperesthesia ngokushaya ngamandla, kanye nokuncinza endaweni yokulondolozwa kwemizwa yangaphakathi;
• ushintsho ekubunjweni kwesandla ngokubonakala kokuphambuka endaweni yezikhwama ezihlangene;
• umkhawulo wobubanzi bokunyakaza kwesandla nobuhlungu lapho uzama ukuzenza;
• ukunciphisa amandla we-flexors yesandla.

Ungakuhlukanisa kanjani ukwahlukana nokulimala noma ukuphuka

Insiza yezimo eziphuthumayo

Uma kusolwa ukuhlukaniswa, kuyadingeka ukukhubaza isandla esilimele ngokusinikeza isikhundla esiphakeme (kunconywa ukuthi unikeze ukwesekwa ngosizo lwe-splint ethuthukisiwe, indima yayo engadlalwa ngumcamelo ojwayelekile) nokusebenzisa isikhwama seqhwa sendawo (iqhwa kufanele lisetshenziswe phakathi kwamahora angama-24 okuqala ngemuva kokulimala, ukufaka isicelo se-15 -20 imizuzu endaweni ethintekile).

Lapho ufaka isigaxa esizenzele, umphetho waso oholayo kufanele uphumele ngaphandle kwendololwane naphambi kwezinzwani. Kungakuhle ukufaka into ethambile (isibani sendwangu, uboya bekotini noma ibhandishi) ebhulashini. Ngokufanelekile, ingalo elimele kufanele ibe ngaphezu kwezinga lenhliziyo. Uma kunesidingo, ukuphathwa kwama-NSAID (Paracetamol, Diclofenac, Ibuprofen, Naproxen) kuyakhonjiswa.

Ngokuzayo, isisulu kufanele siyiswe esibhedlela ukuyobonana nodokotela abahlukumeza ingqondo. Uma kudlule izinsuku ezingaphezu kwezingu-5 selokhu kwalimala, ukususwa kubizwa ngokuthi okungamahlalakhona.

Izinhlobo

Ngokuya ngendawo yokulimala, ukuhlukaniswa kuyabonakala:

• ithambo le-scaphoid (elingajwayelekile ukutholakala);
• ithambo lenyanga (elivamile);
• amathambo e-metacarpal (ikakhulukazi isithupha; okungajwayelekile);
• isandla ngokushintshwa kwawo wonke amathambo esihlakaleni ngaphansi kwenyanga, emuva, ngaphandle kokugcina. Ukususwa okunjalo kubizwa ngokuthi yi-perilunar. Kuvamile.

Ukwehlukaniswa kwe-Lunar ne-perilunar kwenzeka kuma-90% wokuhlakazeka kwesandla okutholakele.

I-Transradicular, kanye nokuhlukaniswa kweqiniso - i-dorsal kanye ne-palmar, okubangelwa ukufuduka komugqa ophezulu wamathambo esihlakaleni ohlobene nobuso be-radius - akuvamile kakhulu.

Ngokwezinga lokufuduswa, ukuhlukaniswa kwabantu kuqinisekiswa lokhu:

• gcwalisa ngokuhlukana okuphelele kwamathambo ejoyini;
• ukungapheleli noma ukwehliswa - uma izindawo ezihlanganisiwe ziqhubeka nokuthinta.

Lapho kukhona izifo ezihambisanayo, ukuhlukaniswa kungaba yinto ejwayelekile noma ehlanganisiwe, nesikhumba esiqinile / esonakele - esivaliwe / esivulekile.

Uma ukuhlukaniswa kuvame ukubuyela ngaphezu kwezikhathi ezi-2 ngonyaka, kubizwa ngokuthi kujwayelekile. Ingozi yabo ilele ekuqineni kancane kancane kwezicubu ze-cartilage ngokukhula kwe-arthrosis.

Ukuxilongwa

Ukuxilongwa kwenziwa ngesisekelo sezikhalazo zesiguli, idatha ye-anamnestic (ekhombisa ukulimala), imiphumela yokuhlolwa okulindelekile nokuhlolwa kokuguquguquka kwezimpawu zomtholampilo, kanye nokuhlolwa kwe-X-ray kumaphrojekthi amabili noma amathathu.

Ngokwe-protocol eyamukelwe yi-traumatologists, i-radiography yenziwa kabili: ngaphambi kokuqala kokwelashwa nangemva kwemiphumela yokunciphisa.

Ngokwezibalo, ukuqagela kwe-lateral yikhona okufundisa kakhulu.

Ububi be-X-ray ukukhomba ukuphuka kwethambo noma ukuqhuma kwemisipha. Ukucacisa ukuxilongwa, i-MRI (magnetic resonance imaging) isetshenziselwa ukuthola ukuphuka kwamathambo, amahlule egazi, ukuqhekeka kwe-ligament, i-foci ye-necrosis ne-osteoporosis. Uma i-MRI ingenakusetshenziswa, kusetshenziswa i-CT noma i-ultrasound, enganembi kangako.

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Ukwelashwa

Ngokuya ngohlobo nobukhali, ukwehliswa kungenziwa ngaphansi kwe-local, i-conductive anesthesia noma i-anesthesia (ukukhulula imisipha yengalo). Ezinganeni ezingaphansi kweminyaka emihlanu ubudala, ukunciphisa njalo kwenziwa ngaphansi kwe-anesthesia.

Ukwehliswa okuvaliwe kokuhlukaniswa

Ukuhlukaniswa kwesihlakala esikude kungabekwa kalula ngudokotela ohlinzayo wamathambo. I-algorithm yezenzo imi kanje:

• Ijoyinti lesihlakala selulwa ngokudonsa ingalo nengalo ezinhlangothini eziphambene, bese lisetha.
• Ngemuva kokuncishiswa, uma kunesidingo, kuthathwa isithombe sokulawula i-X-ray, ngemuva kwalokho kufakwa ibhandishi lokulungisa usimende endaweni yokulimala (kusuka eminweni yesandla kuye endololwaneni), isandla sisethwe nge-engela ka-40 °.
• Ngemuva kwezinsuku eziyi-14, ibhandishi liyasuswa ngokuhambisa isandla siye endaweni engathathi hlangothi; uma ukuhlolwa kabusha kuveza ukungazinzi kokujoyina, ukulungiswa okukhethekile ngezintambo zikaKirschner kuyenziwa.
• Ibhulashi liphinde lilungiswe ngosimende amasonto ama-2.

Ukwehliswa kwesandla okuphumelelayo kuvame ukuhambisana nokuchofoza kwesici. Ukuze uvimbele ukucindezelwa okungenzeka kwe-nerve median, kunconywa ukuthi uhlole ngezikhathi ezithile ukuzwela kweminwe ye-plaster cast.

Olondolozayo

Ngokuncishiswa okuphumelelayo okuvaliwe, kuqala ukwelashwa okulondolozayo, okubandakanya:

• Ukwelashwa kwezidakamizwa:
  • Ama-NSAID;
  • ama-opioid (uma umphumela wama-NSAID unganele):
  • • isenzo esifushane;
    • isenzo eside;
  • ukuphumula kwemisipha kwesenzo esiphakathi (i-Mydocalm, i-Sirdalud; umphumela omkhulu ungatholakala uma uhlanganiswa ne-ERT).
• I-FZT + yelapha ukwelashwa kwesandla esilimele:
  • ukwelashwa kwe-massage kwezicubu ezithambile;
  • micromassage usebenzisa i-ultrasound;
  • ukulungiswa kwamathambo usebenzisa ama-orthoses aqinile, anwebekayo noma ahlanganisiwe;
  • i-thermotherapy (kubanda noma ukushisa, kuya ngesigaba sokulimala);
  • ukuvivinya umzimba okuhlose ukwelula nokwandisa amandla emisipha yesandla.
• Ukwelashwa okungenayo (i-analgesic) (izidakamizwa ze-glucocorticoid kanye ne-anesthetics, isibonelo, iCortisone neLidocaine, kujovwa ejoyintini elithintekile).

Kuhlinzwa

Ukwelashwa kokuhlinzwa kusetshenziswa lapho ukunciphisa okuvaliwe kungenakwenzeka ngenxa yenkimbinkimbi yokulimala nokuba khona kwezinkinga ezihambisanayo:

• ngomonakalo omkhulu wesikhumba;
• ukuqhekeka kwemisipha nemisipha;
• ukulimala emthanjeni we-radial kanye / noma we-ulnar;
• kokucindezelwa kwemizwa ophakathi;
• ukuhlukaniswa okuhlangene nokuqhekeka kwamathambo engalo;
• ukusonteka kwethambo le-scaphoid noma le-lunate;
• ukuhlukaniswa okudala nokujwayelekile.

Isibonelo, uma isiguli sinokuhlukumezeka isikhathi esingaphezu kwamasonto ama-3, noma ukwehliswa kwenziwa ngokungalungile, kukhonjiswa ukwelashwa okuhlinzekwayo. Kwezinye izimo, kufakwa amathuluzi wokuphazamiseka. Ukuncipha kwamalunga amathambo e-distal ngokuvamile akunakwenzeka, okuyisisekelo futhi sokungenelela kokuhlinzwa. Lapho kuvela izimpawu zokucindezelwa kwemizwa yangaphakathi, kuhlinzekwa ukuhlinzwa okuphuthumayo. Kulokhu, isikhathi sokuzilungiselela singaba yizinyanga eziyi-1-3. Njengoba isibuyisile ukwakheka kwesandla, udokotela wamathambo uhambisa isandla ngokufaka ukhonkolo okhethekile kuze kube amasonto ayishumi.

Ukuhlukaniswa kaningi kulungiswa okwesikhashana ngezintambo (izinduku noma izikhonkwane, izikrini nezinsimbi), nazo ezisuswe kungakapheli amasonto ayi-8-10 ngemuva kokuphulukiswa ngokuphelele. Ukusetshenziswa kwalawa madivayisi kubizwa ngokuthi yi-metal synthesis.

Ukuvuselelwa nokuvivinya umzimba

Isikhathi sokutakula sihlanganisa:

• FZT;
• ukubhucungwa umzimba;
• i-gymnastics yezokwelapha.

© Photographee.eu - stock.adobe.com. Ukusebenza ne-physiotherapist.

Izinyathelo ezinjalo zivumela ukujwayeza umsebenzi wezinsimbi zomculo we-musculo-ligamentous. Ukwelapha ukuzivocavoca kuvame ukunikezwa amasonto ayisithupha ngemuva kokulimala.

Ukuzivocavoca okuyinhloko okunconyiwe yile:

• i-flexion-extension (ukuzivocavoca kufana nokunyakaza okubushelelezi (imivimbo ehamba kancane) ngebhulashi lapho kuhlukaniswa);

• ukuthunjwa (ukuqala isikhundla) umile ubhekise udonga, izandla ezinhlangothini, izintende ohlangothini lweminwe encane zisondele emathangeni; kuyadingeka ukwenza ukunyakaza ngebhulashi endizeni engaphambili (lapho udonga lungemuva emuva) kungaba ngasemunweni omncane noma ngasesithupheni sesandla );

• ukuphakanyiswa-ukuphakanyiswa (ukunyakaza kubonisa ukujika kwesandla ngokuya ngomgomo wokuthi "isobho liphethwe", "isobho elichithekile");

• ukuhlanganiswa kokunwebeka kweminwe;

• ukukhama isihlakala sesihlakala;

• izivivinyo ze-isometric.

Uma kunesidingo, izivivinyo zingenziwa ngezisindo.

Izindlu

I-ERT kanye nokwelashwa kokuzivocavoca kuqala kwenziwa ngokwelashwa kweziguli futhi kulawulwa nguchwepheshe. Ngemuva kokuthi isiguli sijwayele uhla olugcwele lokuzivocavoca kanye nendlela efanele yokwenza lokho, udokotela usinika imvume yokuzijwayeza ekhaya.

Emithini esetshenziswayo kukhona ama-NSAID, amafutha anomphumela ocasulayo (i-Fastum-gel), amavithamini B12, B6, C.

Isikhathi sokutakula

Isikhathi sokuvuselelwa sincike ohlotsheni lokuhlukaniswa. Ngemuva kwenani elithile lamasonto:

• inhlendla - 10-14;
• ingozi - 16-20;
• i-scaphoid - 10-14.

Ukubuyiselwa ezinganeni kuyashesha kunabantu abadala. Ukuba khona kwesifo sikashukela kwandisa isikhathi sokuvuselelwa.

Izinkinga

Ngokwesikhathi sokwenzeka, izinkinga zihlukaniswe zaba:

• Ekuqaleni (kwenzeka emahoreni angama-72 okuqala ngemuva kokulimala):
  • ukulinganiselwa kokuhamba kwamalunga we-articular;
  • ukulimala kwezinzwa noma imithambo yegazi (ukulimala kwesisindo esiphakathi kuyinkinga enkulu);
  • izicubu ezithambile ezidumbile;
  • hematomas;
  • ukusonteka kwesandla;
  • ukuzwa isikhumba sibe ndikindiki;
  • i-hyperthermia.
• Late (thuthukisa izinsuku ezintathu ngemuva kokulimala):
  • ukungena kwesifo sesibili (amathumba kanye ne-phlegmon yendawo ehlukile, i-lymphadenitis);
  • i-tunnel syndrome (ukucasuka okuqhubekayo kwemizwa yangaphakathi ngomthambo noma i-hypertrophied tendon);
  • i-arthritis ne-arthrosis;
  • ukubalwa kwemisipha;
  • izicubu zangaphambili zengalo;
  • ukwephulwa kokuhamba kwesandla.

Izinkinga zokwehlukaniswa kwenyanga imvamisa isifo samathambo, isifo esingamahlalakhona sobuhlungu, nokungazinzi kwesihlakala.

Yini ingozi yokuhlukaniswa ezinganeni

Ingozi ilele ekutheni izingane azithambekele ekuzinakekeleni ukuphepha kwazo, okwenza ukunyakaza okuningi, ngakho-ke ukususwa kwazo kungahle kwenzeke. Imvamisa kuhambisana nokwaphuka kwamathambo, okuthi uma sekonakele futhi, kuphenduke ukuhlukana. Abazali kudingeka bakunake lokhu.

Ukuvimbela

Ukuze uvimbele ukuhlukaniswa okuphindaphindiwe, ukwelashwa kokuzivocavoca kukhonjisiwe, okuhloswe ngakho ukuqinisa imisipha yesandla nethambo lezicubu. Ngalokhu, kubekiwe nokudla okunothe ku-Ca no-vitamin D. Kuyadingeka ukuthi kuthathwe izinyathelo zokunciphisa ubungozi bokuwa, kanye nokukhipha ngaphandle ukuzijwayeza imidlalo engaba yingozi (ibhola, i-roller skating). I-Electrophoresis ene-lidase ne-magnetotherapy yizinyathelo ezisebenzayo zokuvimbela ukuthuthukiswa kwe-tunnel syndrome.

Bukela ividiyo: Meaning of Pretend. Hindi To English Translation Exercise. Improve Your English Vocabulary (Novemba 2024).