Ukulimala komgogodla (umgogodla) - izimpawu, ukwelashwa, ukubikezela

Ukwephulwa kokuxhumeka komzimba nokwakheka komgogodla womgogodla kanye nomgogodla kubizwa ngokulimala komgogodla. Ukungalingani kwalolu hlobo kufaka ukulahleka kokuhamba, kwezinye izimo kube nemiphumela engalungiseki.

Ukulimala umgogodla nentambo yomgogodla kungumphumela wokuwa, izingozi, ukuwa kwezakhiwo, ukushaywa noma ezinye izenzo ezinolaka.

Abantu abatholakala ngokulimala komgogodla noma abasolwa ngokulimala okunjalo balethwa kwi-neurosurgery noma ku-traumatology, kuya ngobukhulu becala. Uma ukulimala kubhekwa njengokuncane, isiguli sibekwa ngaphansi kokwelashwa kwemizwa.

Ukwahlukaniswa kokulimala komgogodla

Ngo-1997, uMnyango Wezempilo waseRussia wethula uhlelo olusha lokuhlukanisa izifo. Ukufakwa kwekhodi okunembe kakhudlwana, kufaka phakathi izinhlaka zama-alfabhethi nezinombolo, kwenze kwaba nokwenzeka ukukhulisa uhlu nokucacisa izinto eziningi zokwephulwa.

Ngokusho kwe-ICD-10, izifo zomgogodla zihlukaniswa ngaphansi kwencwadi S, imiphumela yokulimala - T.

Ukuxilongwa okulungile kukuvumela ukuthi unikeze ukwelashwa okufanele. Ekulimaleni komgogodla, ijubane lokuthatha izinqumo nokuqokwa kwelashwa kuthonya kakhulu ikhono lesiguli lokuqhubeka nokusebenza kwemoto. Ngakho-ke, esigabeni sokuqala, isimo sokusebenza asihlolwe, kubhekwa ubunzima bokulimala, futhi kunqunywa ukwelashwa okuhlinzekwayo noma okulondolozayo.

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Umonakalo uhlukaniswa ngezinhlobo ezintathu eziyinhloko:

• Ihlukaniswe.
• Kuhlanganiswe - kufaka ukuphazamiseka kwemishini yezitho ezingomakhelwane.
• Kuhlanganiswe - kuyinkimbinkimbi ngemisebe, ubuthi noma ezinye izinto ezithuthukisa isimo sesiguli.

Kukhona ukuhlukaniswa kwe-SCI ngokuya ngezimpawu zokwephula:

• Kuvaliwe - ngaphandle kokulimaza izicubu ezithambile ze-paravertebral.
• Vula - ngaphandle kokungena emgodini womgogodla.
• Amanxeba avulekile angena ngezinhlobo eziningana:
  • Through - ebonakala ngokuthi into elimaze umgogodla idlula.
  • Blind - ngenxa yokubambezeleka kwento emgodini womgogodla.
  • Ama-tangents athinta umgogodla kancane.

Amanxeba avulekile ahlobene nezigaba 2 no-3 ahlukaniswe kwaba ukuqhuma kwesibhamu (i-shrapnel, inhlamvu) kanye non-fire (oqoshiwe, osikiwe, ogwazwe). Okuyingozi kakhulu empilweni inhlamvu.

Ukulimala komgogodla kuhlukaniswa ngezinhlobo ezilandelayo:

• ukudideka (imiphumela inqunywa emavikini amathathu ngemuva kokuqedwa kokushaqeka komgogodla, okuholela ekungalingani kwemisebenzi ye-reflex);
• nyakazisa;
• ukopha noma i-hematoma ye-intracerebral;
• ukuqhekeka kwamathumbu we-capsular ligamentous of the motor motor segment;
• ukuhlukaniswa kwama-vertebrae, kungaba nobukhulu obuhlukahlukene;
• ukuqhekeka kwediski;
• ukuphuka, kanye nokwaphuka kokuhamba;
• kokucindezelwa (ngaphambili, kamuva, acute) ngokuthuthuka okulandelayo kokucindezelwa kwe-myelopathy;
• ukulimala esitsheni esikhulu (ukuhlaselwa yisifo senhliziyo esibuhlungu);
• ukulimala okuhlukahlukene kwezimpande zemizwa yomgogodla;
• ukulimala okuphelele komgogodla kuyingozi kakhulu futhi akunakulungiseka.

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Ukuvela kokuphazamiseka ezindaweni eziningana zomgogodla kuhlelwe njengo:

• Ukuphazamiseka okuningi kuma-vertebrae noma kuma-discs we-vertebral aseduze.
• IMultilevel - ukulimala kwama-vertebrae noma ama-disc akude komunye nomunye.
• Multiple multi-level - hlanganisa izici zezinhlobo ezimbili ezedlule.

Izimpawu ezimweni ezahlukene

Izimpawu zokulimala komgogodla ziqala kancane futhi zivame ukushintsha ngokuhamba kwesikhathi. Lokhu kungenxa yokuthi kukhona ukufa okuyingxenye yamaseli ezinzwa esikhathini esibucayi, ukubhujiswa okukhulu kamuva kungenzeka. Zicasulwa yizici ezilandelayo: ukuzilimaza izicubu ezinesici, ukungabi namsoco, ukusuthisa komoya-mpilo, ukudakwa.

Inkambo yalesi sifo ibonakala ngezinguquko ezithile futhi ihlukaniswe ngezikhathi:

• acute - izinsuku ezintathu ngemuva kokulimala;
• ekuseni - kungabi ngaphezu kwezinsuku ezingama-30;
• okuphakathi - izinsuku ezingama-90;
• sekwephuzile - iminyaka engu-2-3 ngemuva kwengozi;
• okusele - imiphumela ngemuva kweminyaka eminingi.

Izigaba zokuqala zibonakala ngezimpawu ezinokubonakaliswa okukhulu kwe-neurological: ukulahlekelwa ukuzwela, ukukhubazeka. Izikhathi zakamuva zivezwa ekushintsheni okuphilayo: i-necrosis, ukonakala.

Isithombe somtholampilo sincike endaweni yokulimala nobukhulu besifo. Kucatshangelwa nezici zokutholakala kokulimala okuthile. Konke lokhu kufanele kubhekwe ngokuhlelekile.

Zonke izinhlobo zokulimala komgogodla zinezimpawu zazo futhi emgogodleni ngamunye ziziveza ngokuhlukile (umlomo wesibeletho, i-thoracic ne-lumbar). Lokhu sizokubheka ematafuleni angezansi.

Ukulimala kwezimpande zomgogodla

Ukulimala komgogodla

Izimpikiswano emgogodleni

Izimpikiswano emgogodleni zigcwele ukubonakaliswa okulandelayo:

Cishe konke ukulimala komgogodla kuhlotshaniswa neqiniso lokuthi ukuzwela kuyanyamalala ngokushesha endaweni yokulimala. Lesi simo siyaphikelela, kuya ngobukhulu bokwephulwa komthetho, kusuka emahoreni ambalwa kuye ezinsukwini ezimbalwa.

Ukuchotshozwa

Lapho ucindezelwe, izimpawu zizofana kungakhathalekile ukuthi ukulimala kukuphi:

• Ukulahleka okuncane kobuzwe.
• Ubuhlungu.
• Umphumela ovuthayo.
• Ubuthakathaka.
• Ukucindezela.
• Ukungasebenzi kwezimoto.

Ukuxubana

Ngokuxubana, isiguli sizwa ukulahleka kwesikhashana kwemisebenzi yemoto, ukungalingani kwe-reflex, ubuthakathaka emisipheni, zonke izimpawu zizibonakalisa ngokushesha, kakade emahoreni okuqala.

Ukuqhekeka komqolo

Ngokuphuka, izimpawu zimi ngale ndlela elandelayo:

Ukwephuka kubonakaliswa ukungalingani okuphelele komsebenzi womzimba, ukuzwela kuyanyamalala, amathuba emoto yamaphethelo aphansi ancipha.

Ukuhlukaniswa

Ukwehlukaniswa kubonakala ngezimpawu ezilandelayo:

Ukuqhuma komgogodla

I-pathology engajwayelekile futhi eyinkimbinkimbi - ukuqhekeka kwentambo yomgogodla, kubonakala ngalezi zimpawu ezilandelayo:

• Ubuhlungu obunzima endaweni yokulimala, okuvame ukungabekezeleleki.
• Ukulahlekelwa umuzwa nokukhubazeka okuphelele njengezinto ezingalungiseki endaweni etholakala ngaphansi kokuqhekeka.

Ukunakekelwa Kwezimo Eziphuthumayo Zokulimala Komgogodla

Ukusolwa kokulimala komgogodla kudinga ukubizwa ngokushesha kosizo olufanelekile. Akuvunyelwe neze ukuthatha noma isiphi isenzo ngaphandle kwemfundo yezokwelapha. Noma ikuphi ukukhohlisa ngesisulu kungabulala.

Uma kwenzeka ukulimala komgogodla ngenxa yengozi, kuvumelekile ukunikeza usizo ngaphakathi kohlaka lwezincomo ezilandelayo:

• Ukuze ugweme ukukhubazeka okwandayo, isiguli siyalungiswa. Uma kwenzeka ulimele entanyeni, kufakwa ukhololo oqinile, ubizwa nangokuthi ikhola yasePhiladelphia.
• Uma kwenzeka ukulimala kanzima kubangela ubunzima ekuphefumuleni, donsa umoya-mpilo we-humidified usebenzisa isilinda se-oksijini esinokunamathiselwa kwe-mask okususwayo. Ingathengwa ekhemisi eliseduze. Uma kungenzeka ukuthi ukuphefumula okuzenzakalelayo kukhubazekile, kufakwa ishubhu elikhethekile kudoti kanye nokuphefumula kwamaphaphu okufakelwayo.
• Uma isiguli silahlekelwa igazi ngenxa yokuhlukumezeka, kwenziwa umjovo emthanjeni weRefortan 500 ne-crystalloids. Lezi zinto zokukhohlisa zizobuyisa umfutho wegazi.
• Uma ukulimala kuhambisana nobuhlungu obukhulu, i-analgesic iyajova.

Impumelelo ekwelapheni ukulimala komgogodla incike kakhulu kushesha losizo lokuqala. Uma isisulu sitholakala, siyiswa esibhedlela ngokushesha okukhulu.

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Usizo lokuqala lokushaqeka komgogodla

Ukubonakaliswa kokushaqeka komgogodla kungumphumela wokulimala okungathi sína. Esimweni esinjalo, usizo oluyinhloko kulowo ohlukunyeziwe kuzoba ezokuthutha ezisheshayo nezinekhono esibhedlela.

Ukushaqeka komgogodla kungabonakala ngezindlela ezilandelayo:

• Izinguquko ekushiseni komzimba nasekujulukeni.
• Ukungasebenzi kahle kwezitho zangaphakathi.
• Ingcindezi eyengeziwe.
• I-Arrhythmia.

Ukushaqeka kwenzeka ngenxa yokuphazamiseka emgogodleni futhi kungaholela emiphumeleni eminingi emibi. Isiguli sigxilile endaweni eqinile, simbeka ebheke phezulu noma phansi.

Ukukhethwa kwesikhundla ngqo kuya ngesimo isisulu esitholakale kuso. Lapho behamba, bagcina isikhundla somzimba lapho umuntu abekhona ukuze agweme ukukhubazeka okuqhubekayo kanye nokuwohloka kwesimo.

Uma kunzima ukuphefumula, qinisekisa ukuthambeka kwemikhondo. Ukuphefumula okufakelwayo kuyenziwa.

Izikhathi zokulimala

Ukulimala kwehlukaniswe ngezikhathi:

• Izinsuku zokuqala ezi-2-3 isigaba esibi sihlala. Ngalesi sikhathi, kunzima ukuthola iziphetho mayelana nohlobo lokulimala, ngoba izimpawu zokushaqeka komgogodla zibonakala kakhulu.
• Amasonto amabili kuya kwamathathu ngemuva kokulimala yisikhathi sokuqala. Kubonakala ngokungasebenzi kahle kwe-reflex nokusebenza. Ngasekupheleni kwalesi sigaba, ukwethuka komgogodla kuyancipha.
• Isithombe sangempela sokwephulwa komthetho sikhonjiswa ngesikhathi esiphakathi. Isikhathi saso siyizinyanga ezimbalwa. Ekungabikho kokulimala kwe-motor neuron yesibili ku-lumbar kanye nokuqina kwesibeletho, ukucabanga kuyabuyiselwa, ithoni yemisipha iyanda.
• Isikhathi sokugcina siyaqhubeka kuyo yonke impilo. Kancane kancane umzimba ubuyisela imisebenzi yawo yemvelo, isithombe sezinzwa siyasimama.

Isikhathi sokuqala ngemuva kokwelashwa, izindlela zokuvuselela, ezibalulekile kwezokwelapha nezenhlalo, zibalulekile. Ikakhulukazi kulabo abahlukumezekile abathole isimo sokukhubazeka.

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Izindlela zokuxilonga

Ukuxilongwa kuqala ngokuxoxisana nesisulu noma ofakazi bengozi. Izindlela zokuhlola zamathuluzi nezinsimbi zihlangene nezinzwa. Udokotela uhlola futhi ahlasele.

Ngenqubo yokuqoqa idatha nokwenza ukuxilongwa, udokotela unesithakazelo esikhathini sokulimala kanye nemishini yesigameko. Kubalulekile lapho isiguli sizwa khona ukulahleka kobuzwe nemisebenzi yezimoto. Ngesikhathi sokuhlolwa, bathola ukuthi yikuphi ukunyakaza izinzwa eziqinisa noma ezenza buthakathaka.

Uma isisulu siyiswe emtholampilo, ofakazi bokuzibonela kumele babike ukuthi ngabe isisulu sithuthe ngemuva kokulimala.

Ukuphazamiseka kwemizwa okuvela ngokushesha ngemuva kokulimala kukhombisa ukulimala komgogodla. Uma, ngokungabikho kokushaqeka komgogodla, isiguli siba nezimpawu zemizwa, ukucindezelwa kokuqala noma sekwephuzile komgogodla nezimpande zawo yi-hematoma noma ithambo elonakele noma izakhiwo ze-cartilaginous eziwela emgodini womgogodla.

Ukulahleka kwememori okugcwele noma okuyingxenye kudinga ukuhlolwa kobuchopho. Ezimweni ezinjalo, ukuxilongwa, kufaka phakathi i-X-ray kanye nokuhlolwa kwe-palpation, kubalulekile. Ukulahlekelwa ukuzwela ezindaweni ezithile kunzima kakhulu ukuxilonga, ngakho-ke, zonke izindlela ezitholakalayo zocwaningo lwezinsimbi ziyasetshenziswa. Kuze kube manje, i-radiography ibhekwa njengendlela esheshayo nenembile kunazo zonke yokuxilonga; I-CT neMRI nakho kunqunyiwe.

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Ngenxa yokuhlolwa okuyisisekelo okuyisisekelo, ukukhubazeka komzimba kuyabonakala futhi nezindawo zokulimala ziyabonakala. Ngokuya ngalokhu, kunikezwa izifundo zokulandelela. Ama-hematomas nokudangala esifundeni se-thoracic kukhombisa ukuphuka kwezimbambo, ukuqhuma kwamaphaphu nokunye ukulimala. Ukukhubazeka okubonakalayo esifundeni se-thoracolumbar kungahambisana nokulimala ezinso, isibindi nobende.

Lapho uhlola ukulimala komgogodla, akunakwenzeka ukucacisa ukuhamba kwe-pathological of the vertebrae ngokushaya, ukukhohlisa okunjalo kuholela ekulimaleni okwengeziwe ezitsheni nasezitho zangaphakathi.

Ukuhlolwa kwamathuluzi kwenziwa ukuze kucaciswe okwasendaweni, imvelo nezimbangela zokucindezelwa, izici zokulimala komgogodla.

Ukwelashwa

Uma kusolwa ukulimala komgogodla, ukukhubazeka kwenziwa kuqala. Uma umuntu olimele etholakala equlekile, lapho kwenzeka khona izingozi noma ngemuva kokushaywa, indawo yomgogodla nayo ayinamandla ngaphambi kokuhlolwa nokushiywa kwamanxeba omgogodla.

Kunezimo lapho ukungenelela okuphuthumayo kuhlinzekwa khona:

• ukwanda okuqhubekayo kwezimpawu ze-neuralgic, uma ukulimala kungahambisani nokushaqeka komgogodla;
• ukuvinjelwa kweziteshi lapho kuhamba khona i-cerebrospinal fluid;
• uma kwenzeka ukwephulwa komsele womgogodla ngokukhama izinto;
• ukopha emgogodleni, kukhuliswe ukuvinjelwa kokusakazwa kuketshezi lwe-cerebrospinal;
• kutholakala ukuthi kunokucindezelwa kwesitsha esiyinhloko somgogodla;
• ukwephulwa kwezigaba zezimoto zomgogodla ezinomlingiswa ongazinzile, okubeka ingozi yokucindezelwa okuphindaphindekayo noma ngezikhathi ezithile komgogodla.

Ukusebenza kuyaphikiswa ezimweni ezilandelayo:

• ukushaqeka isimo nge Dynamics engazinzile (hemorrhagic noma traumatic);
• ukulimala ngokuphulwa okuhambisanayo kwezitho zangaphakathi;
• ukulimala okubuhlungu kobuchopho obukhulu, okusolakala ukuthi i-hematoma engasebenzi;
• izifo ezihambisanayo ezihambisana ne-anemia.

Ukungenelela kokuhlinzwa kokucindezelwa kwentambo yomgogodla kwenziwa ngokushesha. Izinguquko zomzimba ezingalungiseki zenzeka kungakapheli amahora ayisishiyagalombili ngemuva kokulimala. Ngakho-ke, isiguli ngokushesha siya egumbini labagula kakhulu noma egumbini labagula kakhulu, lapho konke ukuphikisana nokuhlinzwa kususwa ngokushesha.

Isikhathi sokuvuselela ngemuva kokulimala komgogodla sinde. Isisulu singaphansi kokulawulwa odokotela, odokotela bezinzwa, izazi zomgogodla kanye nabelapha ngokwelashwa. Kukholakala ukuthi inhlanganisela yokwelashwa ngokomzimba nokwelashwa komzimba kusebenza kakhulu ngesikhathi sokululama.

Isibikezelo

Cishe ama-50% abantu abanokulimala komgogodla bafa esikhathini sokuhlinzwa, iningi labo alifinyeleli ngisho nasezikhungweni zezokwelapha. Ngemuva kokuhlinzwa, izinga lokufa lehla laya ku-4-5%, kepha lingakhuphukela kuma-75% ngokuya ngobunzima bokulimala, ikhwalithi yokunakekelwa kwezokwelapha nezinye izinto ezihlobene.

Ukululama okugcwele noma okuyingxenye kweziguli ezine-SCI kwenzeka cishe kumaphesenti ayi-10%, kucatshangelwa ukuthi ukulimala kugwazwe. Ngamanxeba okudutshulwa, umphumela omuhle kungenzeka kuma-3% wamacala. Izinkinga ezivela ngesikhathi sokuhlala esibhedlela azikhishwa.

Ukuxilongwa okusezingeni eliphakeme, imisebenzi yokuzinzisa umgogodla nokuqeda izinto zokucindezelwa kunciphisa ubungozi bomphumela omubi. Izinhlelo zesimanje ezifakwayo zisiza ukuphakamisa isiguli ngokushesha, kususe imiphumela emibi yesikhathi eside sokungakwazi ukuhamba.

Imiphumela

Noma yikuphi ukulimala komgogodla kuhambisana nokukhubazeka. Lokhu kwenzeka ngenxa yokuphazamiseka komsebenzi wamaseli ezinzwa. Isikhathi kanye nokubuyiselwa emuva kokunganyakazi kuncike ebucayi bokulimala nekhwalithi yokunakekelwa.

Ungakhuluma ngemiphumela yokulimala ngemuva kwamasonto e-8, kwesinye isikhathi kuncane. Ngalesi sikhathi, ukushaqeka komgogodla kuyashelela futhi isithombe esicacile somonakalo siyabonakala. Imvamisa ngalesi sikhathi ukuxilongwa kokuqala kuyaqinisekiswa.

Imiphumela engalungiseki ivele lapho umgogodla uchotshoziwe, okuholela ekhefini eliphelele lokwakheka komzimba.

Imiphumela kanye nezinkinga zokulimala komgogodla zihlukaniswe zaba:

• Ukutheleleka nokuvuvukala - kwenzeka ngezikhathi ezahlukahlukene, kuhlotshaniswa nomonakalo ezinhlelweni zokuchama nokuphefumula.
• Ukuphazamiseka kwe-Neurotrophic ne-vascular - kuvela njengomphumela we-muscle atrophy. Ngesikhathi sokuqala, ingozi ye-vein thrombosis ejulile iphezulu.
• Ukungasebenzi kahle kwezitho ze-pelvic.
• Izinkinga zamathambo - i-scaliosis, i-kyphosis, ukungazinzi kwezindawo ezilimele zomgogodla.

Bukela ividiyo: Sekushelwa Kanje Manje (May 2025).