Nemisipha Torn we ngokuhlanganyela ehlombe: Izimpawu kanye Ukwelashwa

Uma sinamathela imfundiso yokuthi umshikashika Yenziwe inkawu indoda, isinyathelo sokuqala kule endleleni ziningi futhi zaba nzima kungokwalabo ngokuhlanganyela ehlombe. Kwaba isakhiwo yakhe eyingqayizivele lengentiwa kumasegmenti esikiselwa esitho elingenhla ukuze uthole ukuphumula ezincelisayo engavamile izici sokusebenza.

Ngakwelinye ihlangothi, kakhulu ekwandiseni imisebenzi yayo kusuka ukwesekwa nje nalapho umuntu eshintshashintsha ukuhamba, umsebenzi wezandla zomuntu ziye zaba enye yezindawo izingxenye ohlukumezekile kakhulu emzimbeni. Kule ndaba, ukulimala of kwebhande ehlombe, obuvame ukuhambisana emisipheni ayebhuqwe joint ehlombe, etholakala kule ndawo ukunakekelwa okukhethekile ka odokotela. Futhi imbangela yalesi - ukulahlekelwa okungenzeka ikhono ukusebenza, futhi yini nakakhulu, umuntu nokukhubazeka kahle noma cha umonakalo ngesikhathi esifanele belashwa.

Mfushane inkomba yokwakheka

Ohlukile joint ehlombe sivezwe njengoba isilinganiso articular evele yayo kweqiniso. Ngo ukwakheka izakhi skeleton abahileleke ngokuqondile amathambo amabili: lomshini bese humerus. Ebusweni articular we humerus umelwe ikhanda eliyindilinga okunzima ukulenza. Ngokuphathelene ebusweni ngilugweda we umgodi glenoid okusaqanda blade endaweni kumayelana kane lincane eduze kwendawo ibhola.

Angekho ikhaba oxhumana naye offset uqwanga indandatho - aminyene isakhiwo zezinzwa, ngokuthi lip articular. Kuyinto lesi sici lunemicu kanye capsule ezizungezile joint, bese imvumela ukuba ibe elungile Ingxenye yokwakheka futhi ngesikhathi esifanayo ukwenza uhla Amazing motion, okuyinto kungenzeka isitokwe kweqa zonke ezinye ngokuhlanganyela.

Ukugcina emisipheni ngokuhlanganyela kanye nemisipha kokunika amandla ukunyakaza

Kuyasiza synovium mncane egobolondweni lelunga ukugcina isakhiwo yokwakheka kwayo okunamandla rostral-humeral umsipha. Kanye ke e ngokuhlanganyela kuyoshaya ukugcina extra-articular capsule bloat biceps umsipha (izikhwepha) nemisipha subscapularis. Lezi ezintathu intambo zezinzwa futhi ahlupheke uma kukhona uqhekeko ka emisipheni ngokuhlanganyela ehlombe.

Subscapularis, deltoid, round above- futhi podkostnaya, abakhulu nabancane, kanye pectoralis ezinkulu latissimus dorsi ukunikeza joint anhlobonhlobo ukunyakaza emhlabeni wonke izimbazo ezintathu. Biceps e nokuhamba kwezindikimba ngokuhlanganyela ehlombe akusho iqhaza.

Sivame ukulimala joint ehlombe izimbangela ukulimala

Phakathi Ukulimala okuvame kakhulu ehlombe ngokuhlanganyela ukukhululwa nemihuzuko. Okungenzeka Ukwenyela ezikanye uqhekeko esinqunyiwe noma ephelele noma ngaphandle kwalo. Dislocation ngokuhlanganyela, naphakathi noma extra-articular avulsion ukwa zezingxenye ezithile (e emisipheni okunamathiselwe) ziphakathi kwezinto eziyishumi ngemuva kokulimala kabi kakhulu.

Ziyini izimbangela eziyinhloko zalokhu lomonakalo ngokuhlanganyela ehlombe kuba nomphumela ngokuqondile noma ngokungaqondile ku oyiyo lokukhanda. Lokhu kungaba hit ngqo futhi ewa eyeluliweyo ingalo phambili. Cijela ngokweqile imisipha ukungezwani, ukuhambisa ngokuhlanganyela, noma kuvevezela lemiqulu emikhulu kungadala njengoba enyelisa noma dislocation we ngokuhlanganyela. Ngokuvamile ephelezelwa nemisipha zabo ziklebhukile we ngokuhlanganyela ehlombe (isithombe kukhonjisiwe ngezansi), ke akudingi nje kuphela aphathe ukulimala kakhulu, kodwa futhi ubuyisele ubuqotho apharathasi umsipha.

Izimpawu umsipha ukudabuka

Ukulimala kungenzeka uma kukhona kuwa in bayiphethe enwetshiwe phambili noma ingalo eceleni. Kungenzeka futhi umsipha ukudabuka ngenxa ukunyakaza elibukhali esiphezulu ngokwezinga kuvunyelwe noma ulenga noma engalweni, isibonelo uma kwehla kusuka ukuphakama.

umonakalo esingezansi bese ukudabuka we capsule izimpawu ehlombe nemisipha ngokuhlanganyela zinezikhathi ubuhlungu obuhlabayo ngesikhathi yokulimala, futhi lokho ikakhulukazi lebalulekile discontinuity, iminyakazo ngokuphinda indlela yokulimala. Ngaphezu kwalokho ekuthuthukiseni edema endaweni ukulimala okushintsha ukucushwa yangaphandle ngokuhlanganyela. Ngaphezu edema, nokuvuvuka kumiswa bangahlanganyela asakazwayo kusuka imithambo yegazi obonakele eduze imisipha, nemisipha noma igazi.

izindlela engeziwe ahlukahlukeneko wokuhlola.Ngokusetjenziswa kobukhulu ukulimala

Phakathi izindlela ucwaningo lwezempilo, okuvumela traumatologist ukunquma ukuthi kukhona uqhekeko olungaphelele emisipheni ngokuhlanganyela ehlombe noma umonakalo Imininingwane, imele uphethwe ultrasonic futhi magnetic resonance imaging. Bobabili izindlela yini izithelo umthwalo osabalalayo, kodwa abe esikhulu kakhulu isinqumo. Ikakhulukazi, i-MRI ivumela nokwethenjelwa esiphezulu ukucacisa uphethwe kanye nokuzikhethela yokwelashwa.

Radiography noma computed tomography abazenzi ukuze ugweme ithambo izilonda: waphuka (kuhlanganise amavawusha), dislocations, conjugated nge ukwa futhi dislocation we ngokuhlanganyela ehlombe. Ngokuvamile esetshenziswa arthrocentesis. Arthroscopy lwenziwa izinguquko esolwa esiwohlozayo zezinzwa izicubu izakhiwo we ehlanganyelwe noma zokugwema ukuphuka we capsule. Kwezinye izimo, wasebenzisa arthrography.

I degree of kobukhulu ukulimala

I classical ukwehlukana elula, ngokulinganisela ukulimala kabi, futhi senziwe maqondana nemisipha zidabukile. Ngu ukulimala okuncane joint ehlombe, kuqhathaniswa nemisipha, zibandakanya esisuka nge umonakalo ngokwengxenye emisipheni endwangwini, ngenkathi sigcina ubuqotho imithambo yegazi, izinzwa nemisipha. Elinesimo degree ngokwengxenye isilinganiso fibre izinyembezi we imisipha, yimisipha ezungezile ingxenye abalimala abahilelekile, egobolondweni lelunga angase lilimele. Eyokuqala siphathelene enyelisa degree, kwesibili - stretchability discontinuity esinqunyiwe.

umonakalo Sinzima ephelezelwa ephelele ukwephulwa umsipha ubuqotho isakhiwo (umsipha) - discontinuity ehlombe nemisipha ngokuhlanganyela umonakalo semithambo zendawo, futhi izinzwa ukubandakanywa yokulimala egobolondweni lelunga. Ngalesi ongakwazi ngayo futhi avulsion intraarticular waphuka, ukopha ngokuhlanganyela (hemarthrosis).

Inqubo ukwelashwa

Kuye ezingeni kobukhulu ukulimala ehlombe umsipha ngokuhlanganyela apharathasi, ukwelashwa ngoludala noma op ingasetshenziswa. Uma kukhona uqhekeko olungaphelele emisipheni ngokuhlanganyela ehlombe, impatho kukhawulwe izindlela olandelanayo. analgesia osetshenziswayo futhi immobilization (immobilization). Mhlawumbe ephoqelela bintovoy noma ukhonkolo, kuye ngobucayi, ubunjalo ukulimala kanye ivolumu izakhiwo abathintekayo. Bintovuyu noma kakhonkolo immobilisation orthesis Ungashintshanisa (bands) ehlombe ehlanganyelwe noma eqinile nenkanuko edlulele ophansi.

A ikhefu ephelele, ikakhulukazi nge ukulimala kwemisipha amaphilisi ngokuhlanganyela, wasebenzisa ukuhlinzwa. Isisulu idinga iphrofayela esibhedlela ukubheduka eminye nokuvuselelwa eside emva osenyameni evela esibhedlela.

iphutha Operational Umhlahlandlela yokutakula

Ukushesha igebe yokulungiswa ukusebenza ehlombe nemisipha ngokuhlanganyela kuzosetshenziswa, ngcono amathuba ukuze umuntu alulame ngokugcwele umsebenzi ngokuhlanganyela bese wehlise iphesenti yezinkinga ukulimala. ukulungisa Steel we umsipha obonakele (umsipha) imisipha eduze, nokuqeda ezilimele semithambo isici capsule kunciphisa ukuba crosslinking yabo.

Ngaphansi ukubulawa kwezinzwa okuvamile (narcosis) ukufinyelela ngqo senziwa phezu obonakele Locus layerwise asike izidumbu zabantu nokuhlukaniswa izicubu. Ukuphazamiseka kwekhono atholakele sutured. Isilonda uvaliwe izingqimba. Ekuqaleni kwenkathi nasezinkingeni ezilandela ngemva kokuhlinzwa usebenzisa usimende waphonsa immobilization nge ifasitela suture nasezinkingeni ezilandela ngemva kokuhlinzwa.

Izinsuku usimende immobilization kanye nokwelashwa esibhedlela zinqunywa ivolumu izakhiwo ethintekile. Isici esibalulekile ngoba isibalo embhedeni-izinsuku kuyinto engu-isiguli, uhlobo lomsebenzi wakhe, nokubambisana morbidities.

Ukulimala emisipheni indololwane

Akuvamile kakhulu ezimweni yasendlini, ukulimala kuyinto ejwayelekile ngaphezulu abadlali professional, uma usebenzisa asebenzayo futhi abukhali wave uhlangothi, izimisele endololwaneni. iqembu Ubungozi kuhlanganisa, okokuqala kunakho konke, ithenisi abadlali, abadlali, handball, i-baseball, namanzi polo.

Ngokuvamile abalimala umsipha annular we engaba, ulna eseduze umsipha noma osabalalayo. Liluphawu lomonakalo ubuhlungu, okwandisa ngesikhathi ukunyakaza. Libhekene edema, ukopha phakathi nezicubu eziseduze. Ithuba hemarthrosis. Uma kukhona uqhekeko ephelele nemisipha, kungenzeka kancane offset amathambo ibhodi lemisindo emalungeni.

Radiography ivumela ukwehlukanisa ukwa ka dislocation. MRI sizobonisa lapho yenziwe yaba yasendaweni ukudabuka of emisipheni indololwane. Ukwelashwa nokuvikelwa ukudabuka ngokwengxenye futhi akuphelele we olandelanayo. Kusebenza immobilization amasonto amaningana. A ikhefu ephelele eyenziwe ngepulasitiki kuhlinzwa nemisipha lilimele.

anatomy ezimfushane ngokuhlanganyela esihlakaleni

Inxanxathela e isakhiwo kwakhiwa ngokuhlanganyela articular uqwanga kobuso ipuleti ngemisebe ulna yi ibhodi lemisindo kanye scaphoid, lunate futhi esingunxantathu ohlangothini ibhulashi. Pisiform ithambo itholakala ingaphakathi umsipha iqhaza ngqo kwetinhlavu joint alamukeli.

Qinisa ngokuhlanganyela nemisipha ezinhlanu. Entendeni iyona indololwane kanye esihlakaleni umsipha ebusweni emuva - emuva kweqembu ibhulashi. Ezinhlangothini kukhona Palmar lateral (ohlangothini isithupha) kanye ulnar (kancane side umunwe) nemisipha.

Ukulimala emisipheni esihlakaleni lingandile kangako kuka emisipheni ayebhuqwe joint ehlombe. Kodwa ngaphezu emisipheni indololwane.

Phula emisipheni esihlakaleni

Mshini nesenzakalo yokulimala okuhlobene ne-ukuwa ku phambili wadalula ingalo noma buhlungu shayela izimisele noma waqonda. Isikhundla isandla ngesikhathi kokulimala ngqo olufanele ukuze kunqunywe ukuthi yiziphi we umsipha kungenzeka lilimele. Ngaphezu kwakho konke abalimala okuphambene zezinzwa isakhiwo emphethweni umshanelo.

izici Phezulu umonakalo umsipha: ubuhlungu, edema, ukuphazamiseka kwengqondo umsebenzi ngokuhlanganyela kanye ezithambile izicubu hematoma. Uma kukhona ubuhlungu ku movement in the iminwe noma isandla ke kwandisa ngokucijile ekuqa- emalungeni, ingase esolwa nemisipha ayebhuqwe joint esihlakaleni. Izimpawu kuthiwa kwahambisana ucwaningo sitholakele hardware:-X-ray - ukubekela eceleni kwamathambo waphuka, ultrasound kanye / noma i-MRI. Ziyakwazi okudingekile ukunquma uhlobo umonakalo ka nemisipha nezinye izicubu ezithambile ezungeze ngokuhlanganyela.

Njengoba kunoma yiliphi elinye icala, uma kukhona nemisipha igebe joint esihlakaleni, ukuphathwa kuzoncika kobukhulu ukulimala. Ngo kobukhulu okuncane noma okusesilinganisweni osebenza olandelanayo ngaphansi ezisindayo - isu tekusebenta.

Kungakhathaliseki lokho okwenzeka uhlobo ukulimala, lokho uhlobo yokwephula ubuqotho izakhiwo ohlanganyelwayo, ngokuhlanganyela elimele, isihlakala, indololwane, noma kukhona uqhekeko esinqunyiwe noma ephelele emisipheni ngokuhlanganyela ehlombe, ukwelashwa kufanele ngaso sonke isikhathi iphathwe nguchwepheshe. kokubonisana ephoqelekile iphrofayli gumbi (ukwa umtholampilo kufanele ukuhlukumezeka emtholampilo noma emnyangweni ukuthola kukaJesu traumatological esibhedlela). Lokhu kuyiqiniso ikakhulukazi ebuntwaneni ukuhlukumezeka, njengoba iziguli abasebasha, kukhona inombolo yezici ezihlobene nokukhula ezingaba fihla kokulimala kakhulu. Futhi yokwephuza ukuthola usizo olunikezwa izisebenzi kungaholela eside nemiphumela emibi.