Txoj Kev Ua Haujlwm
(I) Tshuaj loog
Brachial plexus block yog siv rau sab sauv ceg, epidural block lossis subarachnoid block yog siv rau cov ceg qis, thiab kev siv tshuaj loog lossis tshuaj loog hauv zos kuj siv tau raws li qhov tsim nyog.
(II) Position
Upper libs: supine, luj tshib flexion, forearm nyob rau hauv pem hauv ntej ntawm lub hauv siab.
Cov ceg qis: supine, hip flexion, abduction, lub hauv caug flexion thiab pob taws sib koom ua ke hauv 90 degree dorsal extension txoj hauj lwm.
(III) Kev ua haujlwm ua ntu zus
Cov txheej txheem tshwj xeeb ntawm kev ua haujlwm ntawm cov khoom siv sab nraud yog kev hloov pauv ntawm kev rov pib dua, threading thiab fixation.
[Cov txheej txheem]
Ntawd yog, qhov tawg yog thawj zaug repositioned (kho kev sib hloov thiab sib tshooj deformities), ces pierced nrog pins distal rau kab tawg thiab pib kho, ces ntxiv repositioned thiab pierced nrog pins proximal rau txoj kab tawg, thiab thaum kawg repositioned mus rau lub siab ntawm. qhov tawg thiab ces kho nyob rau hauv nws tag nrho. Qee qhov tshwj xeeb, qhov tawg tuaj yeem kho tau los ntawm kev pinning ncaj qha, thiab thaum qhov xwm txheej tso cai, qhov tawg tuaj yeem hloov kho, kho thiab rov kho dua.
[Fracture Reduction]
Kev txo pob txha yog ib feem tseem ceeb ntawm kev kho pob txha. Txawm hais tias qhov tawg puas txaus siab txo qis muaj qhov cuam tshuam ncaj qha rau qhov zoo ntawm kev kho pob txha. Qhov tawg tuaj yeem raug kaw lossis nyob rau hauv qhov muag ncaj qha raws li qhov xwm txheej tshwj xeeb. Nws kuj tuaj yeem hloov kho raws li X-ray zaj duab xis tom qab lub cev kos npe. Cov txheej txheem tshwj xeeb yog raws li hauv qab no.
1. Nyob rau hauv lub zeem muag ncaj qha: Rau cov pob txha qhib nrog cov pob txha tawg, cov pob txha tuaj yeem rov qab tau raws li kev pom ncaj qha tom qab kev sib tsoo tag. Yog tias cov pob txha kaw tsis ua haujlwm, cov pob txha tuaj yeem txo qis, pierced thiab tsau hauv qhov pom kev ncaj qha tom qab qhov kev txiav me me ntawm 3 ~ 5cm.
2. Kaw txoj kev txo qis: ua ntej ua kom cov pob txha tawg roughly rov pib dua thiab tom qab ntawd ua haujlwm raws li qhov sib lawv liag, tuaj yeem siv tus pin steel nyob ze ntawm txoj kab tawg, thiab siv txoj kev nqa thiab wrenching los pab cov pob txha tawg kom rov pib dua ntxiv kom txog thaum nws txaus siab. thiab ces kho. Nws kuj tseem tuaj yeem ua kom haum rau kev hloov pauv me me lossis angulation raws li X-ray tom qab kwv yees txo qis thiab kho raws li lub cev nto lossis cov cim pob txha. Cov kev xav tau rau kev txo cov pob txha, hauv paus ntsiab lus, yog qhov txo qis hauv anatomical, tab sis qhov kev puas tsuaj loj heev, feem ntau tsis yooj yim los kho qhov qub anatomical daim ntawv, nyob rau lub sij hawm no cov pob txha yuav tsum zoo dua kev sib cuag ntawm lub pob txha pob txha, thiab kom muaj ib tug zoo zog kab yuav tsum tau.
[Pinning]
Pinning yog cov txheej txheem tseem ceeb ntawm kev txhim kho cov pob txha sab nraud, thiab cov txheej txheem zoo lossis qhov tsis zoo ntawm pinning tsis tsuas yog cuam tshuam rau kev ruaj ntseg ntawm pob txha fixation, tab sis kuj cuam tshuam rau qhov siab lossis qis ntawm qhov tshwm sim ntawm comorbidity. Yog li ntawd, cov txheej txheem ua haujlwm hauv qab no yuav tsum tau ua raws li nruj me ntsis thaum threading lub koob.
1. Tsis txhob muaj kev puas tsuaj rau lub cev: Ua kom nkag siab txog lub cev ntawm qhov chaw tho thiab tsis txhob raug mob rau cov hlab ntsha loj thiab cov hlab ntsha.
2. Cov txheej txheem ua haujlwm aseptic nruj me ntsis, lub koob yuav tsum yog 2 ~ 3cm sab nraum qhov chaw mob.
3. nruj me ntsis cov txheej txheem tsis-invasive: thaum hnav ib nrab-koob thiab tuab txoj kab uas hla tag nrho cov koob, lub inlet thiab qhov hluav taws xob ntawm lub steel koob nrog ib tug ntse riam los ua ib tug 0.5 ~ 1cm daim tawv nqaij incision; Thaum hnav ib nrab koob, siv haemostatic forceps cais cov leeg thiab muab cov cannula thiab tho qhov. Tsis txhob siv high-ceev fais fab drilling thaum drilling los yog ncaj qha threading lub koob. Tom qab threading koob, cov pob qij txha yuav tsum tau txav mus los xyuas seb puas muaj qhov nro ntawm daim tawv nqaij ntawm rab koob, thiab yog tias muaj qhov nro, daim tawv nqaij yuav tsum tau txiav thiab sutured.
4. Xaiv qhov chaw thiab lub kaum sab xis ntawm rab koob kom raug: rab koob yuav tsum tsis txhob hla cov leeg nqaij tsawg li sai tau, lossis rab koob yuav tsum tau muab tso rau hauv cov leeg nqaij sib txawv: thaum rab koob muab tso rau hauv ib lub dav hlau, qhov deb ntawm qhov koob nyob rau hauv ib tug tawg ntu yuav tsum tsis txhob tsawg tshaj li 6 cm; Thaum cov koob tau muab tso rau hauv ntau lub dav hlau, qhov kev ncua deb ntawm cov koob nyob rau hauv ib qho kev tawg yuav tsum loj npaum li qhov ua tau. Qhov kev ncua deb ntawm cov pins thiab cov kab tawg los yog cov pob txha pob txha yuav tsum tsis pub tsawg tshaj 2cm.Lub hla lub kaum sab xis ntawm cov pins nyob rau hauv multiplanar needling yuav tsum yog 25 ° ~ 80 ° rau tag nrho cov pins thiab 60 ° ~ 80 ° rau ib nrab pins thiab puv pins. .
5. Xaiv cov hom thiab txoj kab uas hla ntawm lub koob steel.
6. Qhwv lub koob lub qhov tiaj tiaj nrog cawv cawv thiab cov ntaub qhwv tsis muaj menyuam.
Txoj hauj lwm ntawm lub distal humeral penetrating koob nyob rau hauv kev sib raug zoo rau vascular paj ntaub pob ntawm sab caj npab (Lub sector qhia nyob rau hauv daim duab yog lub cheeb tsam kev nyab xeeb rau threading lub koob.)
[Mounting thiab fixation]
Feem ntau cov pob txha txo qis, pinning thiab fixation yog ua los ntawm kev sib hloov, thiab fixation tiav raws li qhov yuav tsum tau muaj thaum lub predetermined steel pins tau pierced. Cov pob txha ruaj khov yog kho nrog compression (tab sis lub zog ntawm compression yuav tsum tsis txhob loj dhau, txwv tsis pub angular deformity yuav tshwm sim), comminuted fractures yog tsau nyob rau hauv nruab nrab txoj hauj lwm, thiab cov pob txha tsis xws luag yog tsau nyob rau hauv lub distraction txoj hauj lwm.
Kev zam ntawm tag nrho fixation yuav tsum tau xyuam xim rau cov teeb meem hauv qab no: 1.
1. Ntsuas qhov ruaj khov ntawm kev txhim kho: txoj hauv kev yog los ua kom muaj kev sib koom ua ke, kos duab longitudinal lossis lateral thawb qhov kawg ntawm pob txha; qhov ruaj khov ruaj khov kawg yuav tsum tsis muaj kev ua si lossis tsuas yog ib qho me me ntawm kev ua haujlwm elastic. Yog tias qhov kev ruaj ntseg tsis txaus, kev ntsuas tsim nyog tuaj yeem ua kom muaj zog tag nrho.
2. Qhov kev ncua deb ntawm cov pob txha sab nraud fixator rau ntawm daim tawv nqaij: 2 ~ 3cm rau sab sauv ceg, 3 ~ 5cm rau sab caj npab, txhawm rau tiv thaiv daim tawv nqaij compression thiab pab txhawb kev raug mob, thaum qhov mob hnyav lossis kev raug mob loj. , qhov kev ncua deb tuaj yeem sab laug loj dua nyob rau theem pib, thiab qhov kev ncua deb tuaj yeem txo qis tom qab qhov o thiab kev puas tsuaj raug kho.
3. Thaum nrog cov ntaub so ntswg raug mob hnyav, qee qhov tuaj yeem muab ntxiv los ua kom cov leeg nqaij raug mob raug tshem tawm lossis nyiaj siv ua haujlwm, txhawm rau pab txhawb qhov o ntawm ceg ceg thiab tiv thaiv kev raug mob siab.
4. Cov pob txha sab nrauv fixator ntawm cov pob txha cadre yuav tsum tsis txhob cuam tshuam rau kev ua haujlwm ntawm cov pob qij txha, cov ceg qis yuav tsum yooj yim rau kev taug kev hauv qab, thiab sab sauv qaum yuav tsum yooj yim rau kev ua haujlwm txhua hnub thiab kev saib xyuas tus kheej.
5. Qhov kawg ntawm rab koob steel tuaj yeem raug rau lub koob steel hlau fixation clip rau li 1cm, thiab tus Tsov tus tw ntev ntev ntawm rab koob yuav tsum raug txiav tawm. Qhov kawg ntawm rab koob nrog lub hau yas los yog daim kab xev qhwv, thiaj li tsis mus rau puncture ntawm daim tawv nqaij los yog txiav daim tawv nqaij.
[Cov kauj ruam yuav tsum tau ua thaum tshwj xeeb]
Rau cov neeg mob uas muaj ntau yam kev raug mob, vim yog raug mob hnyav los yog kev raug mob rau lub neej thaum lub sij hawm resuscitation, nrog rau thaum muaj xwm txheej ceev xws li kev pab thawj zaug hauv lub tshav pob lossis kev raug mob batch, rab koob tuaj yeem raug threaded thiab ruaj ntseg ua ntej, thiab rov kho dua, kho, thiab ruaj ntseg ntawm lub sijhawm tsim nyog.
[Common Complications]
1. Pinhole kab mob; thiab
2. daim tawv nqaij compression necrosis; thiab
3. Kev raug mob Neurovascular
4. Kev kho mob qeeb lossis tsis kho ntawm pob txha.
5. Cov pins tawg
6. Pin kev puas tsuaj
7. Kev ua haujlwm tsis zoo
(IV) Kev kho mob tom qab phais
Kev kho mob tom qab phais kom raug ncaj qha cuam tshuam rau kev kho mob, txwv tsis pub muaj teeb meem xws li tus kab mob pinhole thiab tsis sib koom ua ke ntawm pob txha yuav tshwm sim. Yog li ntawd, yuav tsum tau them nyiaj txaus.
[Kev kho mob dav dav]
Tom qab kev ua haujlwm, cov ceg raug mob yuav tsum tau nce siab, thiab cov ntshav ncig thiab o ntawm cov ceg raug mob yuav tsum tau saib xyuas; thaum daim tawv nqaij yog compressed los ntawm cov khoom ntawm cov pob txha sab nraud fixator vim yog txoj hauj lwm los yog o ntawm cov ceg, nws yuav tsum tau ua raws sij hawm. Loose screws yuav tsum tau nruj me ntsis raws sijhawm.
[Kev tiv thaiv thiab kho kab mob]
Rau kev kho pob txha sab nraud nws tus kheej, cov tshuaj tua kab mob tsis tsim nyog los tiv thaiv tus kab mob pinhole. Txawm li cas los xij, pob txha thiab qhov txhab nws tus kheej tseem yuav tsum tau kho nrog tshuaj tua kab mob raws li qhov tsim nyog. Rau cov pob txha qhib, txawm tias lub qhov txhab raug tshem tawm kom huv si, yuav tsum tau siv tshuaj tua kab mob rau 3 mus rau 7 hnub, thiab cov kab mob pob txha yuav tsum tau muab tshuaj tua kab mob ntev dua raws li qhov tsim nyog.
[Kev saib xyuas Pinhole]
Kev ua haujlwm ntau dua tom qab kho pob txha sab nraud yuav tsum tau saib xyuas cov pinholes tsis tu ncua. Kev tu tus pinhole tsis raug yuav ua rau tus kab mob pinhole.
1. Feem ntau cov hnav khaub ncaws raug hloov ib zaug rau hnub 3 tom qab kev phais, thiab hnav khaub ncaws yuav tsum tau hloov txhua hnub thaum muaj oozing los ntawm lub pinhole.
2. 10 hnub los yog li ntawd, daim tawv nqaij ntawm lub pinhole yog fibrous qhwv, thaum ua kom cov tawv nqaij huv si thiab qhuav, txhua 1 ~ 2 hnub nyob rau hauv lub pinhole daim tawv nqaij tee ntawm 75% cawv los yog iodine fluoride tov yuav ua tau.
3. Thaum muaj qhov nro ntawm daim tawv nqaij ntawm lub pinhole, sab nro yuav tsum tau txiav rau lub sij hawm kom txo tau qhov nro.
4. Ua tib zoo saib xyuas cov kev ua haujlwm aseptic thaum kho cov pob txha sab nraud fixator lossis hloov cov kev teeb tsa, thiab tshuaj tua kab mob ntawm daim tawv nqaij nyob ib ncig ntawm lub pinhole thiab rab koob steel tsis tu ncua.
5. Tsis txhob kis kab mob thaum lub sij hawm tu tus pinhole.
6. Thaum tus kab mob pinhole tshwm sim, kev kho phais kom raug yuav tsum tau ua raws sij hawm, thiab cov ceg ceg raug mob yuav tsum tau nce siab kom so thiab siv cov tshuaj tua kab mob tsim nyog.
[Kev ua haujlwm ua haujlwm]
Kev ua haujlwm raws sij hawm thiab raug tsis yog tsuas yog ua rau kev rov ua haujlwm ntawm kev sib koom ua ke, tab sis kuj tseem ua rau kev tsim kho ntawm hemodynamics thiab kev ntxhov siab stimulation los txhawb cov txheej txheem ntawm pob txha kho. Feem ntau hais lus, cov leeg nqaij thiab kev sib koom ua ke tuaj yeem nqa tawm hauv txaj hauv 7 hnub tom qab ua haujlwm. Cov ceg tawv sab saud tuaj yeem nqa tawm pinching thiab tuav ntawm ob txhais tes thiab autonomous txav ntawm lub dab teg thiab lub luj tshib pob qij txha, thiab kev sib hloov ua haujlwm tuaj yeem pib 1 lub lis piam tom qab; cov ceg qis tuaj yeem tawm ntawm lub txaj nrog kev pab ntawm cov ntoo khaub lig tom qab 1 lub lis piam lossis tom qab lub qhov txhab tau zoo lawm, thiab maj mam pib taug kev nrog qhov hnyav tag nrho 3 lub lis piam tom qab. Lub sijhawm thiab hom kev ua haujlwm ntawm kev ua haujlwm txawv ntawm ib tus neeg mus rau ib tus neeg, feem ntau nyob ntawm lub zos thiab lub cev. Nyob rau hauv tus txheej txheem ntawm ce, yog hais tias tus pinhole tshwm liab, o, mob thiab lwm yam inflammatory manifestations yuav tsum nres qhov kev ua si, elevate tus cuam tshuam ceg mus pw so.
[Kev tshem tawm cov pob txha sab nraud fixator]
Sab nraud fixation brace yuav tsum tau muab tshem tawm thaum lub pob txha tawg tau mus txog cov txheej txheem kho mob pob txha. Thaum tshem tawm cov pob txha sab nraud fixation bracket, kho lub zog ntawm cov pob txha yuav tsum raug txiav txim siab, thiab cov pob txha sab nraud yuav tsum tsis txhob raug tshem tawm ntxov yam tsis muaj qhov tseeb ntawm kev txiav txim siab kho lub zog ntawm cov pob txha thiab pom tseeb cov teeb meem ntawm cov pob txha sab nrauv kho, tshwj xeeb tshaj yog. thaum kho tej yam mob xws li qub pob txha, comminuted fracture, thiab pob txha nonunion.
Post lub sij hawm: Aug-29-2024
