Gawo myofascial chipinda syndrome

Anthu ambiri amadabwa kuti: "syndrome chipinda - ndichiyani?" kudwala Izi zingaoneke m'madera onse kumene minofu amacheza ndi fascia olimba - malo a matako, m'chiuno, phewa, m'chiuno ndi kumbuyo.

Chipinda syndrome - osakaniza kusintha chikwiyire ndi kuwonjezeka mu kuthamanga m'dera zochepa za thupi. Malinga ndi zimene wakhala chikwiyire amayamba kuthamanga mkati minofu, zambiri kusiyana matenda yopweteka kwambiri kapena yokhalitsa.

Zimayambitsa chitukuko matenda

Monga zimakonda matendawa ndi:

• wovulala;
• kukula kwa matenda minofu zofewa;
• mtima wosagawanika kuphwanya;
• psinjika a nthambi pamene Pamalo akamalimbikira;
• adaponyedwa molondola superimposed;
• amayaka;
• yaitali zoopsa opaleshoni.

Mu mankhwala, milandu anatchulidwa kumayambiriro mtsempha kapena mtsempha wamagazi kuthamanga madzi, komanso chiri njoka towuluka.

Mkulu chiopsezo alipo ndi kudwala pamene mankhwala kutumikiridwa, thinners magazi, ndi zambiri pa matenda magazi coagulation. Osati lilibe ndiponso zinthu iatrogenic, inattention kwa odwala amene ali chikomokere.

Mawonekedwe aakulu a matendawa

syndrome chipinda zimatengera chikhalidwe aakulu zinachitikira mobwerezabwereza zolimbitsa yaitali. Iye unakambidwanso mogwirizana ndi kuthamanga mu zimakhala mwendo. ntchito kwambiri thupi kuti olumpha malire a malire yovomerezeka n'zothandiza kuwonjezeka mu minofu buku la 20%, zomwe zimabweretsa psinjika a gawo ofanana. Chipinda syndrome nthawi zambiri anapezeka ku othamanga akatswiri.

maziko pathophysiological

Pathophysiology Matendawa amayamba ndi minofu wamba homeostasis mchikakamizo cha kuvulala, kuthamanga mu zimakhala ndi minofu milandu awo, kuchepetsa magazi mu capillaries ndi, mkhutu venous outflow magazi, ndiyeno utuluke magazi. Potsilizira pake ndi osauka minofu necrosis chifukwa cha kusowa oxygen.

symptomatology

Zizindikiro chipinda syndrome osefukira mawonekedwe pachimake, m'kukoma chikuwonjezereka kutupa, amene anatsimikiza mtima palpation (mnyumba digiri ya chotupa kachulukidwe). Komanso kuwonekera thovu amalembedwa ululu minofu chabe kayendedwe (flexion ndi kutambasuka kwa phazi), tilinazo atayika.

Tikumbukenso kuti chinthu wotchuka kwambiri kudwala monga syndrome chipinda ndi ululu, zimene zikusonyeza mlingo wa kuwonongeka kwambiri. Nthawi zambiri sikutheka kuti asiye ngakhale pambuyo utsogoleli wa mankhwala analgesic.

Chizindikiro chimenechi ndi khalidwe kwa mpweya chilonda.

Mitundu waukulu syndrome chipinda

Chipinda syndrome kumachitika m'njira ziwiri: m'mimba ndi myofascial (m'dera ischemia syndrome maziko kuthamanga kuwonjezeka).

mawonekedwe Myofascial amadziwika kuchepetsa mu perfusion minofu, ischemia, necrosis ndi chitukuko contracture. Zifukwa kulera kuthamanga pidfastsialnogo bodza mu hematoma posttraumatic, yotupa edema, ndi Pamalo psinjika, mwapang'onopang'ono chotupa.

Myofascial chipinda syndrome ndi matenda kudzera Kupenda thupi.

Mogwirizana ndi zizindikiro zotsatirazi:

• nthawi nthaŵi pambuyo zoipa pamaso chikuonetseratu ku chipatala;
• nthawi maonekedwe a puffiness;
• kutupa mlingo wa kuwonjezeka (pasanathe maola 6-12 pambuyo choipa);
• akuti ntchito tourniquet ndi kupewa ischemia (kuchotsa oyang'anira kwa nthawi yochepa).

zowawa ndi zakuya kugunda khalidwe. Akusiyana mwamphamvu kuposa mu yachibadwa kuonongeka, osati cropped ndi immobilizing m'dera ovulalawo ndi analgesics pa mlingo ochiritsira.

Zowawa kuwonekera chabe kutambasula minofu pansi kuwonongeka. Kumasintha udindo wa zala.

njira ya muyeso kuthamanga mkati minofu

Monga tawerenga syndrome chipinda? Kudwala Matendawa amapangidwa ndi njira Whiteside (1975), kulola kuyeza kuthamanga interstitial.

Iye anaganiza ntchito:

• dongosolo chikukhudza ndi Mercury manometer;
• atatu njira stopcock;
• jekeseni singano amene awiri ndi osachepera 1 mamilimita;
• yamachubu;
• syringe buku la 20 ml.

Panopa kudziwa kuthamanga ntchito pidfastsialnogo apparatuses kuti achite yaitali polojekiti. Zotsatira akuyerekezedwa ndi index a kuthamanga mtima. Kuthamanga ku malekezero myofascial m'dera sayenera upambana 10 mm Hg. Art. Pamaso pa syndrome chipinda unakhazikitsidwa, ngati chizindikiro pidfastsialnogo kuthamanga kuposa mlingo yovuta 40 mamilimita Hg. Art. ndipo diastolic pansipa. Kuchulukitsa kwake pa maola 4-6 imfayo pakutchulidwa wa ischemia.

Gawo myofascial mawonekedwe

• M'mapapo matenda - ndi wapotalikira nthambi gawo ndi kumverera ofunda. Pa mitsempha yaikulu ya chitetezo zolemba zimachitika. Chizindikiro podfastsialnogo kuthamanga pa 40 mamilimita Hg. Art. m'munsi diastolic.
• Zikutanthauza chotupa - khungu pa nthambi gawo zowonongeka ali m'munsi kutentha kuposa wathanzi. Amowabu hyperesthesia kapena mankhwala ochititsa dzanzi nthambi zala. Kugunda ndi ofooka. Podfastsialnoe pampanipani diastolic ali yemweyo.
• A kugonjetsedwa lolemera - zimachitika mitsempha wamkulu si zimadziŵika. Ananena chala ochititsa dzanzi. Podfastsialnoe pamwamba kuthamanga diastolic.

The zosiyanasiyana matenda

Chipinda syndrome ayenera siyanitsa ndi kuwonongeka kwa zipangizo waukulu, pamaso pa wolumikizira thrombosis, kuwonongeka kwa thunthu mitsempha ya clostridial ndipo sanali clostridial myositis.

matenda masiyanidwe ayenera idzachitika mogwirizana ndi chiwerengero cha i:

• pamaso pulsations;
• kutupa;
• kusowa kwa kumverera mu nthambi;
• Magazi poizoni;
• polera leukocytes;
• pidfastsialnogo kuthamanga chizindikiro.

Kugonjetsedwa kwa minofu ya mkono wa

Minofu fascia wa mkono ndi anasiyanitsidwa ndi atatu fupa fascial m'chimake: lateral mtengo m'minofu, kutsogolo (minofu udindo kufewetsa mafupa zala) ndipo kumbuyo (minofu nawo zala kutambasuka).

Ngati wodwala kulungamitsa zala zake, ndiye izo zinaikidwa matenda, monga kutsogolo kwa syndrome mkono kompartament. Ngati wodwala kupinda zala zake, kenako anakantha nkhani kumbuyo.

Kugonjetsedwa kwa minofu mwendo

Ng'ombe minofu fascia akufufuta m'chimake anayi mafupa fascial:

• lateral (peroneal minofu);
• Front (udindo kutambasuka kwa phazi);
• Kumbuyo (padziko soleus minofu);
• kumbuyo kwambiri (udindo flexion).

Ngati wodwala akulephera idzakungana phazi ndi zala, ndi kuyesa za zimenezi amamchititsa ululu, ndiye ife tikhoza kulankhula za kukhalapo kwa syndrome zapambuyo chipinda, ndipo ngati sakhoza limbitsani zala zake, ndi view kumbuyo.

m'mimba

Normal kuthamanga chizindikiro mu zinthu zonse m'mimba zimadalira thupi ndi pafupifupi wofanana ndi ziro. Pamimba ndi mgodi kwa madzimadzi, mmene kuthamanga padziko ndi m'madera onse mofanana. Kwapakati pa-m'mimba kuthamanga angathe kuyeza mu dipatimenti aliyense mimba.

ndi mfundo zoopsa zomwe syndrome m'mimba ya matenda oopsa? Chifukwa chachikulu mu mtima matumbo paresis, zoopsa angapo, laparotomy pangozi wodwala amene analandira tima kulowetsedwa mankhwala. Izi kumawonjezera voliyumu ya madzimadzi m'mimba.

Ndipo unyinji wa odwala pambuyo opaleshoni ku kuthamanga chizindikiro m'mimba mwa M'mimbamo yake chinawonjezeka ndi 3-13 mamilimita Hg. Art. popanda zizindikiro matenda

Pamene kuthamanga mkati abdominoplasty pamimba amakhala kuposa 15 mamilimita Hg. St., amene amakwiya chitukuko cha m'mimba syndrome chipinda.

Ndi pafupifupi 25 mamilimita Hg. Art. ndi kulephera zikusintha kufalitsa ziwiya zikuluzikulu peritoneum, ndikumutsogolera bwino impso ndi matenda ziwiya mtima ndi magazi.

Kuthamanga mu malo m'mimba pamwamba 35 mamilimita Hg. Art. zingakubweretsereni zonse mtima kumangidwa.

Kodi m'mimba chipinda syndrome?

m'mimba chipinda matenda akuwonetseredwa mu vuto pamwamba kupuma ndi kuchepa linanena bungwe mtima. Ananenanso pamaso pa mkodzo linanena bungwe, magazi mpweya machulukitsidwe.

mitundu inayi ya BP mu peritoneum limasuka mankhwala:

• 1 digiri - chizindikiro cha mavuto 12-15 mamilimita Hg. Art.
• 2 stepen- muyeso mavuto 16-20 mamilimita Hg. Art.
• 3 digiri - chizindikiro cha kuthamanga 21-35 mamilimita Hg. Art.
• 4 digiri - chizindikiro cha kuthamanga pamwamba 35 mamilimita Hg. Art.

Njira kuyeza kuthamanga mu peritoneum ndi

Monga ulamuliro, kuthamanga m'dera m'mimba chimaonekera kudzera chikhodzodzo. Good stretchable khoma amachita ngati kungokhala chete wochititsa intraabdominal kuthamanga ngati madzimadzi buku mu peritoneum si upambana 50-100 ml. Ndi buku lalikulu la muyeso wa zimakhudza minofu kuthamanga chikhodzodzo.

Therapy kwa syndrome m'mimba

Monga atazikocheza syndrome chipinda? Chithandizo kumafuna kudzudzulidwa kapena Kupha zifukwa (kuchotsa psinjika hosiery, mkulu ubwenzi headboard, mitsempha). Ananyamula mpweya mankhwala amene ntchito chubu nasogastric.

Pofuna kupewa hemodynamic decompensation kubwezeretsedwa magazi mpweya machulukitsidwe ndi wokometsedwa coagulation. Amasonyezanso ndi kuthamanga mkati peritoneum ndi polojekiti ntchito zina.

Chipinda syndrome opaleshoni m'mimba likuchotsedwa ndi decompression laparostomy. Anachita catheterization kuonjezera peritoneum.

The zochitika zazikulu mankhwalawa ndiwofatsa

Pamene ndiwofatsa chithandizo, zochitika izi:

• kumatha psinjika za zinkakhala m'dera (kuchotsa nsalu, pulasitala splints, chifooke samatha chigoba, malo a nthambi zinkakhala pa mlingo ofanana ndi mtima kuti kumalepheretsa chitukuko cha ischemia);
• wokometsedwa kufalitsidwa, zidzachotsedwa mu kuphipha mtima ndi kuchuluka coagulation;
• bwino magazi zizindikiro;
• Ntchito analgesics (chomwa mankhwalawa analgesics zinthu za m'Baibulo, ndipo amatanthauzanso sanali chomwa mankhwalawa authunthu)
• relieves kutupa;
• atazikocheza acidosis.

Ngati mankhwala ndiwofatsa sanapereke zotsatira kuyembekezera, pali yovuta mlingo podfastsialnogo kuthamanga pamwamba mlingo anati minofu kamvekedwe ndi edema, ndi zithunzi alowererepo opaleshoni (ntchito ya decompression fasciotomy). Iwo akhoza kunyamula achire ndi njira m'chilengedwe.

Kodi decompressive fasciotomy?

Decompressive fasciotomy - ndi opaleshoni umalimbana kapewedwe ndi chithandizo cha matenda chipinda. Pogwiritsa ntchito ngati mitsempha kuonongeka ndi mitsempha ya paphewa. Komanso likuchotsedwa mwa chipinda syndrome wa medial zikuluzikulu za chigongono limodzi zotsatira za kuvulala ndi mawondo fossa mitsempha ndi mitsempha bondo. Fasciotomy kwakukulukulu ikuchitika malekezero m'munsi.

Zikuonetsa kuti fasciotomy zodzitetezera

The zizindikiro zazikulu ndi monga:

• pamaso pa insufficiency venous;
• kuwononga mitsempha bondo;
• ukulephera amalize kumanganso mitsempha ya;
• pambuyo kumanganso mitsempha ya;
• kutchulidwa zofewa minofu kutupa nthambi.

Kuchititsa fasciotomy zachipatala

opaleshoni imagwiridwa odwala ndi kutchulidwa subfascial kuthamanga wapezeka pa phunzirolo. Index pamwamba 30 mamilimita Hg. Art. limabweretsa gulu la pathological.

Amayamba kuthamanga subfascial ndi chizindikiro mtheradi kwa opaleshoni umathandizanso.

Zizindikiro zotsatirazi zowonetsera kwa opaleshoni izi:

• pamaso pa paresthesias;
• ululu kayendedwe chabe chiwalo;
• pamaso pa ziwalo pamene mitsempha kuteteza;
• utachepa zimachitika zotumphukira.

chenjezo

sayenera kugwira opareshoni zoterozo mu ntchafu kapena paphewa. "Mannitol" ndi mankhwala okha pa mobisa dokotala.

Fasciotomy - opareshoni, zomwe zingachititse ndi mavuto (matenda aakulu chikhalidwe cha ululu, pamaso pa paresthesia, kutupa, osteomyelitis). Tikumbukenso kuti iwo amaoneka infrequently, koma Mwina ukadali kumeneko. Choncho, pamaso alowererepo amafuna kuunika bwinobwino wodwalayo.

Decompressive fasciotomy mu forearm ndi

Opaleshoni kuti achotse kudwala monga syndrome mkono chipinda, zimaphatikizapo kugwiritsa ntchito mankhwala oletsa ululu pamalopo. ang'ambe thupilo The ikuchitika ku epicondyle m'dera dzanja. fascia tidutse pa flexor minofu m'dera chigongono. Iye ankatembenukira medially. minofu chongodziwa udindo flexion, mosinthana lateral. fascia The Kadulidwa pamwamba pa flexor kwambiri. Aliyense fascia minofu anavumbula gawo kotenga.

Ngati ndi kotheka volar wodzilemekeza dorsal ang'ambe thupilo. dzanja Live yomweyo yapitirira. Kuona mmene hyperemia ake.

Devitalized minofu (kawirikawiri bender ili kuya) ndi akuda mwa chikasu, amene Ndi mmene necrosis. The fascia si sutured. bala Cutaneous sutured popanda mavuto. Ngati kukhazikitsa mpheto ngati sizingatheke khungu bala ndi zosatseka mu mawonekedwe a bandeji.

Bandeji ntchito antiseptics kapena sorbents. Kawiri kawiri tidzakhala ntchito amadzimadzi emulsion mafuta.

zimfundo Secondary superimpose masiku asanu pambuyo opaleshoni. Nthawi zina bala wotseguka kwa mwezi umodzi. Nthawi zina, kutseka chilonda ntchito mabala zina mankhwala ofewetsa tuvi tolimba kapena mitundu yosiyanasiyana ya opaleshoni pulasitiki.

Njira ya fasciotomy pa burashi ndi

opaleshoni ikukhudza ntchito gawo kotenga m'dera la ndondomeko ya woyamba metacarpal fupa. Chotero ang'ambe thupilo ndi ikuchitika mu kufanana chachisanu carpal fupa. Pa nthawi yomweyo zilibe intersect ndi ziyerekezo kwa mitsempha ulnar. Decompression intercostals minofu anapanga zigawo zosiyana pa kumbuyo kwa burashi lapansi.

Kunyamula pa mwendo fasciotomy m'munsi

m'munsi mwendo chipinda syndrome likuchotsedwa ndi opaleshoni ndi mankhwala oletsa ululu pamalopo.

Ngati wodwala kovuta kukhotetsa phazi ndi zala chifukwa cha ululu waukulu, n'zotheka kuweruza pamaso pa syndrome zapambuyo chipinda. Ngati sangathe kuwongola mwendo m'munsi, ndi kumbuyo chipinda syndrome atavalanso zoteteza.

Kuvumbulutsa zachisinsi milandu onse, ayamba zigawo ziwiri kapena zitatu kotenga mwendo, utali umene ndi 15 cm. Ngati ndi kotheka fascia ang'ambe thupilo akhoza kukhala Z woboola mtundu.

Ngati magazi aziyenda bwino mu phazi n'zopanda mu maminiti pang'ono, ang'ambe thupilo medial chimakula ndipo anatsegula mlandu pa kumbuyo mwa lumo. Ang'ambe thupilo la fascia si kusungira scalpel, monga mukhoza kuwononga zapambuyo tibial mtsempha wamagazi ndi mitsempha tibial.

Ang'ambe thupilo fascia ndi mu chikhalidwe poyera. Ngati n'kotheka, bala pa khungu sutured popanda mavuto. Ngati stitching sizingatheke bala wotseguka pansi bandeji lapansi. welds Secondary zambiri zakhala zikuzunza m'miyoyo patapita masiku 5.

Njira ya opaleshoni pa phazi

Chotero opareshoni amafuna pamaso pa njira zinayi. Awiri dorsal ang'ambe thupilo wapangidwa pamodzi 2 ndi 4. mafupa metatarsal, kupyolera mwa amene kutsegula mipata anayi pakati pa mafupa ndi thumba lalikulu mulu wa. Banja lina la mabala mwachita laterally ndi medially. Amatsegula milandu.

Opaleshoni imachitika kwa minofu minofu necrosis, ali ndi digiri yapamwamba ya dzuwa. Pa tsiku lachitatu pambuyo decompression amachepetsa kutupa, ndipo n'zotheka kuti chilonda kutsekedwa. Ngati decompression necrosis a minofu minofu wakhala kuzindikiridwa, ndiye amachotsa gawo akufa. psinjika Final mu nkhani iyi ndi kulephereka kwa sabata.

madokotala ananena zawo

Kulosera tsogolo la matenda a matenda ndi mwachindunji amadalira Timeliness mankhwala ndi kukhazikitsa zonse opaleshoni. Ngati ululu ndi atazikocheza, pali ubongo matenda, izo kawirikawiri limasonyeza sizingasinthe kusintha pathological. Komanso kukhazikitsa necrectomy ndi njira zina sangathe kupulumutsa nthambi amputation wa mapulogalamu ake. Pofuna kubweretsa zinthu koopsa, izo tikulimbikitsidwa m'njira yake kuchita zinthu zonse umalimbana yopewera matenda chitukuko komparment.