Kupatsanura myofascial mupanda chirwere

Vanhu vazhinji vanofarira: "Compartment syndrome - chii icho?" Izvi zvinogona kuonekwa munharaunda dzose apo misungo yakakomberedzwa ne-fascia yakasimba - ichi ndicho chigamba, chiuno, gumbo, chiuno uye shure.

A compartmental syndrome ndiyo yakagadziriswa inokonzerwa nekuwedzera kumanikidzwa mune imwe nzvimbo shoma yomuviri. Zvichienderana nezvakange zvichikonzerwa nekuwedzera kukamanikidzwa mukati memishonga, itsika yekuparadzanisa chimiro chakaoma kana chisingaperi chechirwere chacho.

Zvinokonzera kukura kwehutano

Sezvo zvikonzero zvinonyanya kukosha zvekukura kwechirwere ndezvekuti:

• Fracture;
• Ukuru hwechirwere chemasvini akaoma;
• Kurwisana kwehutano hwemidziyo yeropa;
• Kugadzikana kwechikwata nekunyoreswa kwepfungwa;
• Izvo zvisina kushandiswa pombi bhenji;
• Burn;
• Kuvhiya kwenguva yakareba.

Muchirapa, inotaura yakagadzirwa nematambudziko ejojeni mumuputi kana ariti yezvinwiwa pasi pekumanikidzwa, pamwe nekurumwa kwehove ine uturu.

Kungozi yakakura yekubudirira kwehutano kunepo nekuiswa kwemishonga inoderedza ropa, uye kazhinji nekuputsa ropa coagulability. Iatrogenic zvinokonzera, kusatarisira kune varwere vasina chavanoziva, havakwanisi.

Chirwere chechirwere chechirwere

The compartmental syndrome inotora chimiro chisingaperi mumamiriro ekutsvaira kwenguva refu. Iyo inobatanidzawo nekuwedzera kwekumanikidzwa mumatumbu mune munharaunda yenharaunda. Zvinhu zvakakura zvepanyama izvo zvinopfuura miganhu yemuganhu unogamuchirwa, zvinoita kuti kuwedzera kwemisumbu yevhesi kusvika ku20%, izvo zvinokonzera kudzvinyirira muchikamu chakafanana. Chirwere chinowanzoongororwa mumakwikiti evashandi.

Pathophysiological basis

Iyo pathophysiology yehutano inokonzerwa nekhaya homeostasis yemasukisi pasi pekuvadzwa kwekukuvadzwa, kuwedzerwa kudzvinyirira mukati memaviri uye musimba maitiro, kuderera kweropa kuderera mumapilisare, kuputsa kwekubuda kweropa, uye zvekubuda kwechirwere. Pakupedzisira, tissue necrosis inokura nekuda kwekushayikwa kweokisijeni.

Symptomatics

Zviratidzo zvemakemikari anokwana, zvichiitika nenzira yakaoma, zvinoratidzwa mukuwedzera kwema edema, iyo inotsanangurwa ne palpation (chiyero chekuwanda kwemahara inotarisana inogadziriswa). Uyewo, kune mabhuruu, kune manzwiro anorwadza nekusava nekufamba kwemuviri (kubhururuka nekuwedzerwa kwetsoka), kunzwisisika kunorasika.

Izvo zvinofanira kuonekwa kuti chinonyanya kukosha chechirwere chakadaro sezvo compartmental syndrome inorwadza, iyo inoratidza iyo kuwanda kwechiremera. Kazhinji, haikwanisi kumiswa kunyange mushure mekunge kuiswa kwepainkillers.

Ichi chiratidzo chinoratidzawo chegesi chinokonzera.

Mhando dzakasiyana dzemakamuri echirwere

Iyo compartmental syndrome inogona kuitika nenzira mbiri: mimba uye myofascial (inogara ischemia syndrome ine kuwedzerwa simba).

Iyo myofascial fomu inoratidzira kuderedzwa kwemisisita inopisa, ischemia, necrosis uye kukura kwechibvumirano. Zvimwe zvikonzero zvekuwedzera kwehuwandu hwemhirizhonga yepasimusi uri mushure mekutambudzika kwehematoma, edema yezvokuvhiringidza muviri, kuwedzera kwepfungwa, kufambira mberi kwechirwere.

Myofascial compartment-syndrome inowanikwa kuburikidza nokuongorora mumuviri.

Izvi zvinotevera zviratidzo zvinofungidzirwa:

• Nguva yakapera mushure mekukuvadzwa kwakagamuchirwa vasati vabvumirwa kuchipatara;
• Nguva kubva pakuvamba kwekudzimba;
• Mubairo wekudzikurira (mukati maawa matanhatu nemaviri mushure mekukuvara);
• Nguva yekushandiswa kwetamboi uye kudzivirira kweIschemia (kubviswa kwetamboi kwechinguva chiduku).

Marwadzo acho anobva pakadzika, kubuda kwemhepo. Izvo zvakanyanya kudarika pane zvinowanzokonzera, hazvisi kumiswa nekudzivirira kweainge akanganisa uye analgesics mumagetsi.

Marwadzo anowanikwa nekutadza kutarisa kwemisumbu yakave yakanganisa. Izvi zvinoshandura nzvimbo yeminwe.

Nzira yekuyera kuomeswa mukati memishonga

Inhengo yechiprem syndrome inowanikwa sei? Kuongororwa kwehutano kunoitwa kuburikidza nenzira inonzi Whiteside (1975), iyo inobvumira kuyera kupindira kwepakati.

Inosanganisira kushandiswa kwe:

• A system kusanganisira mercury manometer;
• Ivhavha yechitatu nzira;
• Nyeredzi dzejairo, iyo yakareba iyo isiri pasi pe1 mm;
• Tube systems;
• Meshoni 20 ml.

Parizvino, zvigadzirwa zvinotungamirira nguva refu zvinotaridzirwa zvinoshandiswa kugadzirisa kudzvinyirira kwenyika. Zvigumisiro zvinoenzaniswa nehutano hwemwoyo. Izvo zvinoshandiswa mu myofascial space yemuyo hazvifaniri kudarika 10 mm Hg. Art. Kuvapo kwecompartmental syndrome kunosimbiswa kana nhamba yepidfasidhi yepasi inodarika yakakosha chiratidzo ne 40 mm Hg. Art. Uye pasi pe diastolic. Kuwedzera kwaro mukati maawa mana nemaawa matanhatu kunogona kuita kuti kutanga kweIschemia.

Kurongwa kwemyofascial fomu

• Chirwere chakareruka chikamu chemashure chechimiro paunonzwa uchidziya. Pamusoro pemishonga yakakura, kupisa kunochengetedzwa. Nhamba yehurumende yekudzvinyirira ine 40 mm Hg. Art. Pasi pe diastolic.
• Avhareji yesononi - ganda riri panzvimbo yakakanganiswa yechipfuva ine chando chepamusi pane chetano. Ikoko kune hyperesthesia kana anesthesia yemakumbo zvigunwe. Iyo kupisa inogadzikana zvishoma. Shanduro yepasi inenge yakafanana neyodzvinyiriri dambudziko.
• Kukundwa kwakanyanya - kupisa kwemasimba makuru haubvumiri. Anesthesia yeminwe inoonekwa. Kudzvinyirirwa kwepasi kunopfuura kudarika diastolic.

Differential diagnosis

The compartment syndrome inofanira kusiyaniswa nekukuvadza kune midziyo huru, kuvapo kwehutachiona hwehutachiona, kukuvadza kwematombo emagetsi kubva muchestridial uye kwete nonclostridial myositis.

Kusiyana kwekuongororwa kunofanira kuitika maererano nemitemo yakawanda:

• Kuvapo kwekutsvaga;
• Kuzvimba;
• Kusava nekunzwa mukati memukumbo;
• Inxication yeropa;
• Wedzera muhutano hwe leukocyte;
• Indekisi yezvinodzvinyirira pasi.

Chiremera chemisungo yepamberi

Mishonga iri munharaunda yepamberi inoparadzaniswa ne fascia mumatatu e-fascial cases: lateral munharaunda yemasara, mushure mimwe (mitsipa inokonzera ruvara rweminwe) uye posterior (mitsipa inobatanidzwa mukuwedzera kweminwe).

Kana murwere asingakwanisi kusunungura zvigunwe zvake, ipapo chirwere chakadai seanterior compartment-forearm syndrome inotangwa. Kana murwere asingakwanisi kupeta zvigunwe zvake, ipapo bhokisi rekare rinogumburwa.

Simba remhuru dzenzombe

Mhuru dzenzombe dzakaparadzana neFascia muzvinyorwa zvina-osteo-fascial:

• Gare gare (mushure mutsvuku);
• Pamberi (inotarisirwa kuwedzerwa kwetsoka);
• Posterior (pasina chimiro chemasisipo);
• Posterior yakadzika (inosungirirwa pakufamba).

Kana murwere asingagoni kukotama tsoka uye neminwe, uye kuedza kwechiito chakadaro kunomutambura kurwadziwa kwakanyanya, saka tinogona kutaura pamusoro pekuvapo kwe anterior compartmental syndrome, uye kana asingakwanisi kusunungura minwe yake, zvino iyi iite shure.

Nhengo dzepamuviri

Izvo zvinowanzoonekwa zvekumanikidzwa mumudumbu remuviri zvinoenderana nehutatu hwemuviri uye inenge zero. Dumbu iri gadzi rine mvura, iyo inomanikidza pamusoro uye munzvimbo dzose zvakafanana. Mumakumbo ekumanikidzwa kunogona kuyerwa mune chero chikamu chemuviri.

Ndezvipi zvinokonzera kukanganisa kwehutano hwehutano hwepamuviri? Chinonyanya kukonzera chirwere chepachiviri paresis, kukuvadzwa kwakakura, kurapwa kwekukurumidzira mumurwere anogamuchira mushonga wekodzero yakawanda. Izvi zvinoita kuti kuwedzere kwehuwandu hwemvura inenge iri mudumbu.

Mune varwere vanoverengeka mushure mekuvhiyiwa mudumbu, kushungurudzika mumakona kunowedzera ne3-13 mm Hg. Art. Pasina chero kliniki zviratidzo

Nebdominoplasty, kupikisa mukati mamuviri kunowedzera ne 15 mm Hg. Icho chinokonzera kukura kwemuviri kumakumbo syndrome.

Nechiratidzo chema 25 mm Hg. Art. Uyezve kune kushaya kushanda mukati meropa riri pedyo nemidziyo mikuru munharaunda ye peritoneal, iyo inotungamirira kusviko kusina uye kugumbura mwoyo nemidziyo.

Izvo zvinodzvinyirira mumudumbu remuviri zvinopfuura 35 mm Hg. Art. Inogona kutsamwisa kupedza kusungwa kwemwoyo.

Madzimai emukati memubhedha anoratidza sei ?

Dumbu remubhedha syndrome rinozviratidza mukudzivirirwa kwepamusoro kunopesana nekufema uye kuderera kwechibereko chemoyo. Diuresis uye kuisa ropa kunowanikwawo.

Muchirapa, kune marudzi mana eupfemta mukati me peritoneum:

• Chikoro chekutanga - kupikisa index 12-15 mm Hg. Art.
• Dhigirii yechipiri inomiririri wei 16-20 mm Hg. Art.
• Dhigirii yechitatu ipikisi yezvinokonzera 21-35 mm Hg. Art.
• Dhigirii 4-yei-chiratidzo chekumanikidza pamusoro pe 35 mm Hg. Art.

Nzira dzekuyera peritoneal pressure

Sezvo mutemo, kushungurudzwa mukati mamuviri kunotaridzwa kuburikidza nemukaka. Rusvingo rwakatambanudzwa runoita semutungamiri wepachiviri chemukati wepamuviri kana simba remvura mukati me peritoneum risingapfuuri 50-100 ml. Nezwi guru, kuyerwa kwemisumbu yechipfuva kunokonzera chiyero.

Therapy for mimba syndrome

Iko inonzi compartmental syndrome yakamira sei? Kurapa kunosanganisira kugadziriswa kana kubviswa kwezvinokonzera (kubviswa kwekambani yakashandurwa, nzvimbo yakakwirira yemusoro wemubhedha, zvigadzirwa). Oxygen therapy inoshandiswa, iyo inonzi nasogastric tube inoshandiswa.

Kuchengetedza kupererwa kwemahymicamine, ropa rinoputika neokisijeni rinodzoserwa uye kubatana kunogadziridzwa. Kudzvinyirira kuongorora mukati me peritoneum nemamwe mabasa kunoratidzwawo.

The compartmental syndrome in chirwere chemuviri inobviswa nenzira yekuderedza maparostomy. Iyo catheterization yechipfuva inoitwa kuti iwedzere izwi re peritoneum.

Maitiro makuru ekuchengetedza kurapwa

Nekuchengetedzwa kwakachengetedza zviyero zvinotevera zvinoitwa:

• Inoita kuti kudzvinyirirwa kwenharaunda inobviswa (kubviswa kwebhanji, kuvepa mavara, kushaya simba kwechikwata chemafupa, nzvimbo yechipfuva chakabatwa pane imwe nhamba nemwoyo, iyo inodzivisa kukura kweIschemia);
• Inogadzirisa kupararira kweropa, inopedza mararamiro munzvimbo yevascular uye yakawedzera coagulation;
• Kuvandudza rheological zviratidzo zveropa;
• Anesthetics inoshandiswa (analgesics inobva kune zvinodhaka, pamwe chete kwete zvinhu zvinodhaka);
• Kufuridzira kwakabviswa;
• Acidosis yakamira.

Kana kurapwa kwakachengetedza hakuunza zviitiko zvinotarisirwa, huwandu hwekudzvinyirirwa kwepasi pasi pehutano hunotaridzika hunoonekwa, hutema hutema uye kuvhara kunoonekwa, zvino kushandiswa kupindira (kushandiswa kwekucheka kwechisimba fasciotomy) kunoratidzwa. Zvinogona kuva zvekudzivirira uye kudzivirira.

Chii chinonzi décompression fasciotomy?

Kusagadziriswa fasciotomy inopindira yokuvhiya inobatsira kudzivirira uye kumira compartmental syndrome. Kuvhiya kwakashandura kukanganisa kune arteri uye mitsipa yepafudzi. Uyewo, inobvisa chikamu-chirwere chemukati wemukati wejoka rehuta, zvinokonzerwa nekukuvadza matanda etare uye arteri uye mitsipa pasi pemabvi. Fasciotomy inowanzoitwa pamakumbo ezasi.

Zviratidzo zvekuchengetedza fasciotomy

Zviratidzo zvikuru ndezvi:

• Kuvapo kwekushaya simba;
• Kukuvadza kune ariti pasi pemabvi;
• Kusagadzirisa kugadziriswazve kuvakazve arteri;
• Gare gare kuvakwa kwemaseroti;
• Kuratidza kuzvimba kwezvinyama zvishoma zvemuviri.

Kutakura chirongwa chechiremba fasciotomy

Kuvhiya kunoitwa nevarwere vane chirevo chekudengenyeka kwepasi kwakaratidzwa panguva yekudzidza. Nhamba yacho yakakwirira kupfuura 30 mm Hg. Art. Inotsanangurwa sechirwere.

Kuwedzerwa kwepasi pasi kudzvinyirira ndiyo chiratidzo chakakwana chekutungamirira kurapwa.

Zviratidzo zvikuru zvekupindira kwakadaro ndizvo zvinotevera:

• Kuvapo kweparesthesias;
• Zvinorwadza zvinorwadza nekufamba kwechimiro chemuviri;
• Kuvapo kwekuoma mutezo pakuchengetedzwa kwemutsipa;
• Kupera kweropa kunopera.

Chenjerera

Usaita chirwere chakadaro munzvimbo yehudyu kana papfudzi. "Mannitol" nemishonga inorwisa mabhakitiriya inorayirwa chete pakucherechedza kwachiremba.

Fascotomy is opera iyo inogona kukonzera matambudziko (utachiona, kurwadziwa kusingaperi, paresthesia, kurira, osteomyelitis). Izvo zvinofanira kuonekwa kuti vanoita sevasingaiti, asi zvingave zvichiripo. Saka, vasati vapindira, kunyatsoongorora murwere kunodiwa.

Kudzvinyirira Fasciotomy Munharaunda Yakafanirwa

Kupindira kwekuvhiya kuti kubvisa chirwere chakadaro sekamuri-syndrome ye forearm, inosanganisira kushandiswa kwe Local anesthesia. The incision inobva epicondyle kusvika munharaunda. Inofadza inovhurwa pamusoro pemasikiramu musimba munharaunda. Iyo inoparadzaniswa mukati mega. Iyo musungo wepamusoro inokonzerwa nekuyerera inodzingwa pakarepo. The fascia dissects pamusoro pemvura yakadzika. Iko kunofadza kwemushuga mumwe nomumwe kunovhurwa neketitudinal incision.

Kana zvichidikanwa, mutumbi wekuvharidzirwa unowedzererwa nekwenya dorsal incision. Mushonga unorarama unobva wanyura. Ikoko kune mhinduro yake hypermiaia.

Mutsipa usingagoneki (kazhinji unoshanduka mumhepo yakadzika uri mukati) wakaita ruvara rwezuva, iyo inofanirwa necrosis. Izvozvo hazvivhari. Donda rakagurwa rakakanganiswa risina simba. Kana kushandiswa kwekugadzirisa kwakadaro hakugoneki, ipapo ronda rakatemwa rinosara panze pasi pebhanji.

Nokupfekedza, antiseptic agents kana mashebhe anoshandiswa. Zvimwe mvura-emulsion mafuta anoshandiswa.

Secondary sutures anoshandiswa mazuva mashanu mushure mekuvhiyiwa. Dzimwe nguva chironda chinoramba chakazaruka kwemwedzi. Mune zvimwe zviitiko zvimwe zvinokonzerwa nemakumbo kana zvimwe zvakasiyana-siyana zvepurasitiki zvinoshandiswa kuvhara ronda.

Tsika ye fasciotomy paruoko

Kuvhiya kunosanganisira kuita nekudzivirira kwemazuva akawanda munzvimbo yekutanga yekutanga metacarpal bone. Iyi incision inofanana nechechishanu pfupa bone. Izvo zvinoratidzika zvehutachiona hwemagetsi hazvipindi. Kusagadzikana kwemisungo inopesana inobviswa kubva kune zvaunofungidzirwa pamusana pechanza.

Kufambisa fasciotomy pamakumbo ezasi

Compound-shin syndrome inobviswa nekupindira kwekuvhiya nemunharaunda yeanesthesia.

Kana murwere akaoma kugadzika rutsoka neminwe nekuda kwekutambudzika kukuru, saka tinogona kutonga kuvapo kwe anterior compartment syndrome. Kana asingakwanisi kusunungura gumbo rezasi, zvino iyi ndiyo yekare compartment-shin syndrome.

Kuti uzarure matanho ose, shandisa maitiro maviri kana matatu ekureba kwemazuva, iyo yakareba masendimita 15. Kana zvichidikanwa, kudheka kunogona kuva neZ-shape.

Kana ropa kuparadzirwa rutsoka haina mumaminitsi mashoma, kune medial incision kunowedzera uye akazarura nyaya iri necheshure achishandisa chigero. Incision of fascia asinganyimi munhu scalpel, sezvo unogona kuparadza posterior tibial tsinga uye tibial tsinga.

The incision fascia iri rakashama mamiriro. Kana zvichibvira, vanga iri paganda sutured pasina makakatanwa. Kana stitching zvisingaiti, vanga anoramba rakavhurwa mucheka. Secondary welds kazhinji zvinobva zvarongwa pashure 5 mazuva.

Chidobi hwokushanda netsoka

Kwakadaro kuvhiyiwa zvinoda kuvapo pedyo mana. Two dorsal incision chinoitwa achitevedza 2nd uye 4th metatarsal mafupa, kuburikidza icho zarurai Makwanza mana pakati mapfupa uye nechepakati homwe iri wemagazini. Chimwe vaviri maronda zvakaitwa laterally uye medially. Dzinondishamisira zviitiko.

Operation inoitwa kuti tsandanyama rinenge necrosis, ane yakakwirira mwero kunyatsoshanda. Pazuva rechitatu pashure decompression zvinoderedza kuzvimba, uye zvinokwanisika kuti muchikuvadza kuvhara. Kana decompression necrosis pamusoro tsandanyama rinenge rakazivikanwa, ipapo anobvisa vakafa mugove. Final compression mune iyi iri kumbosiyiwa kwevhiki.

fungidziro

Fungidziro chirwere chiri zvakananga novimba timeliness ari mishonga uye zvizere Implementation wokuvhiya. Kana marwadzo ari yacho, pane chetsinga nyonganyonga, zvinowanzoda inoratidza kusingarapiki Kumwe kuchinja kunotanga. Uyezve Implementation necrectomy uye dzimwe nzira havagoni kuponesa pabazi kudimurwa wake zvinoratidzwa. Kuti varege kuuya mamiriro zvikuru, Zvinokurudzirwa mu nenguva nenzira kuita zvinhu zvose kuti chinangwa kutadzisa budiriro komparment syndrome.