Nā kuhikuhi no ka amputation limb. Nā'ano o ka hana a me ka ho'oponopono

amputation o ka lala ua manaoia kekahi o ka mea kahiko loa ana i loko o ka mōʻaukala o ka laau lapaau. Ka mua wehewehena i hana ia 4th kenekulia BC. e ka. Naʻe, ka mea hikiʻole ke ana loa kahe ana ke koko, e like me ka pono me ka ike ole e pili ana vascular ligation mea IeAUPIIe, IAa IO ona. Ke kauka paipai truncate mau koʻo ikaika i loko o loli nā'aʻaʻa, ia eliminates ona e kahe ana ke koko, akā, i i hooki i ka laha ana o gangrene.

Ma ka mea mua kenekulia AD, Aulus Korenelio Celsus? Aaei hoʻokahuli aupuni no kona manawa e hoʻokokoke i ka hana ana o ia mau hana, a komo pū koi i:

- e lawe mai i ka truncation o ka nui o viable'aʻaʻa;

- ligation o kaʻawale vascular kumu e pale kahe ana ke koko;

- hoʻopaʻa eiiet okioki'aʻaʻa e uhi i ka iʻa wale me pathological hoʻopilikia.

An nui kūlana i loko o ka hana o ki ina hana like o ka amputation o ka lala hoʻokani ma ka hoike ana o ka iaoia koko ole pae'ōnaehana ka wā Esmarch i hanaʻi hoʻohana hiki i keia manawa laholio koa.

I keia la o ka honua e alakai kulana i waena o nā nāʻikepili no ka amputation noho mimikō a me ka mea'ōnaehana mānowai koko maʻi.

Amputation - truncation o ka lala mea, a he oiaio, ua kona distal hapa, no na iwi, akā, ka mea makemake ia he weliweli kuhihewa, e nānā mea like me ka mea ana o ka loli ana o Hoʻohana. Kēia manawa hoʻohuʻu ea a me ka reconstructiveʻoki kino, nona hou kokololio pono a me ka mea hoʻomanawanui hoʻopulapula.

Aia hoʻi kekahi mau kānaka nāʻikepili no kēia 'ano o keʻoki kino. E noonoo oe e heluhelu ana i kaʻikepili ma hou au mamuli.

Nāʻikepili no ka amputation

- Gangrene.

- ke alo aku o ka pulakaumaka kaumaha o ka maʻiʻaʻai, hoʻoweliweli ma ka hoʻomanawanui ka ola (anaerobic maʻiʻaʻai).

- Irreversible ischemia Muscle contracture.

- maʻi pale e hoea.

- paopao poino Traumatic poino i lala o na moku papa a me nā aʻalolo, alakaʻi no laila, i kapaʻia traumatic amputation.

- occlusive maʻi a me ka hope o ka gangrene.

- tourniquet, kau oi aku mamua o ekolu hora.

- Common,ʻaʻole amenable i ka lapaau neurotrophic ulcers.

- Osteomyelitis me ka make māinoino o na hui, komo.

- ka, he pono ole tubercular lesion o ka iwi'aʻaʻa i loko o ka kūpuna.

- Malignant iwi hikoko me ka manawa kūpono o ka wehe i ka noho kaʻawale keena.

Hoomaopopo ana i ka nui o ka resection

E koho i ka nui o ka amputation hilinaʻi nui ma luna o ka degere o ke koko holo kāna hana i loko o ka hoʻohana wahi, i ke alo o ka gangrene, trophic kāna hana, Hawaii no e pili nā'aʻaʻa a me ka oolea o ka maʻiʻaʻai a me ka eha.

Nā keiki ho'āʻo e pili i ka disarticulation (hoʻokaʻawale o ka loli ana o hapa ma ke ami kiʻekiʻe), 'aʻole i' aʻe ka 'i ka hou iwi ulu.

E like me ka urgency o keʻoki kino kaʻawale lala amputation:

- koke amputation hana i komoʻana mua kōkuaʻoki kino, e wehe ole-viable, poino nā'aʻaʻa;

- pilikia ana me ka truncation ipu ahi intoxication me ka inefficiency makeʻe kulana therapies;

-? Oaony amputation, mālama 'ia i loko o malignant lesions o ka iwi osteomyelitis.

- reamputatsiya e paʻipaʻi unsound kumu.

Līkaia no ka hoʻopoepoe, elliptical a me ka patchwork amputation. E hoomanao i kēia mau 'ano ma lalo.

hoʻopoepoe amputation

I ka papa kuhikuhiE nāʻikepili no ablation, o guillotine (i ka wā hoʻokahi hoʻopoepoe) amputations i kinoea gangrene a me ka lala resection e kau ana ma luna o musculocutaneous okioki. Ke 'ākeʻakeʻa ua lawe mai wale nō no ka pilikia ola-olaʻi. A nui drawback o kēiaʻano hana mea e i ka pili-iaea ooieoeiiaeuiiai make, a me ka mahope paa reamputatsiya e ke hakuloli i lala prosthesis hou kukuluia'na.

I ka pono o keia mea i ka nele o ka amputation o necrotic loli i ka okioki, a hiki ma ka hoemi koko lako hou.

I ka wā o ka guillotine amputation ike aku i ka iwi i ka ia kiʻekiʻe me ia o ka pahee'aʻaʻa.

E like me ka hana ua hana? Amputation o ke kahua mua oia ma ka ili incision, subcutaneous momona a me ka fascia. Kaʻe kahili i ili o ka hou hiʻona'āina ma ka lihi. Ma ka lua o ke kahua dissection o nāʻiʻo a hiki i ka iwi a me ka hou oki iwi. iwi hope uhi mea ku pono i kaʻili a me ka fascia.

Kēiaʻano paipai no na Oihana o ka lala me ka kŘpa a uuku Muscle nuipa a.

No ka oihana me ka nui Muscle nuipa trohmomentnaya paipai amputation (alodioʻohana, a me ka hoʻopoepoe ablation e Pirogov).

Ka mua kahua o ka hoʻonaʻauao elua o ka hana e like me dvuhmomentnoy amputation. Eia, ma hope o ka hāʻuleʻana o nā nāʻiʻo a me ka superficial'aʻaʻa i loko o ka proximal kuhikuhi, mea hou-oki nāʻiʻo i unuhiʻia a puni i ka lihi o ka ili. Ma keia, uaʻoki hohonu Muscle papa i ka poʻea pau i ka hou kahua o ka conical kumu.

Patchwork epekema kaʻana like:

• ma odnoloskutnye (lōʻihi o kekahi huʻa mea like me ke anawaena o ka iʻa wale);

• dvuloskutnye (mau Rag o likeʻole nui like 'ole ma o ka huina o ka loa a aha anawaena amputiruemoy lala).

Ma ka ho okumu i ke kumu pono e kaʻikaʻiʻia ma ka manaʻo i ka me ka makaʻu no e ole ia ma luna o ka hanaʻili. Scraps E e hana e lawe i ka mooolelo o ka hana, e lawe i wahie.

osteoplastic amputation

Pehea o ka amputation o ka laloʻaoʻao? A kiʻiona hiʻona o ke alo o ka iwi koena ai uhi ia me periosteum i loko o ka haku mele 'ana o ka loʻi.

osteoplastic amputation o ka lalo wāwae ma ke ano o Pirogov loaa nā hualoaʻa a iaia no a hiki i ka nuiʻana anatomical hopena kākoʻo hoʻopulapula o ka hoʻohana'ūhā.

Pono o ka hana:

- a emi mai soreness kumu.

- Me ke kākoʻo mai o ka iʻa wale hope.

- Mālama i proprioceptive pā lonoaʻili o nāʻiʻo a me tendons.

Hoʻolaha me ke kapuai hookahi

I ka wehe i ka tibia, elua incisions i i ma luna o ka Pirogov. No keia mea, amputation pahi. Mua paka i kekahi kea e oki ai o ka pahee nā'aʻaʻa,ʻilikai i ke kuʻekuʻe wāwae hui hou aku hana arcuate pauku holo ana o ka dorsum o ka wāwae. Hope e holo i ke kīloi paʻewa ligaments e ka hoʻokaʻawale o ka talus, tibia iwi i oloʻia. A keʻa-pauku paa loʻi. Hana i ke kumu.

Hana o Sharpe

Aia o kekahi papa hana ma ka i hana i ka amputation o lalo lala.

Ka wā e wehe i ka wāwae o ka pahee'aʻaʻa dissection ua lawe mai ma kekahi mau kenimika distal phalanges o ka mua metatarsal iwi. Ma hope o otpreparovyvaniya periosteum ua hana i oloʻia metatarsals a smoothing kālai a pau ike oki. Mai hooki aku uhi plantar loʻi.

E noonoo oe i ka papa kuhikuhiE kumu o ka amputation.

diabetic microangiopathy

Hana surgeon hilinaʻi nui ma luna o ka loa o ka poino. Ma ka prevalence o purulent necrotic lesions i elima kahua o ka hoʻonaʻauao.

- Superficial necrosis me pio tendons.

- Gangrene manamana lima o kekahi kanaka phalanx ka mua a me ka tendon.

- Ka laha gangrene o ka manamana lima, hui me gangrene o ka wāwae.

- gangrenous lesion holoʻokoʻa wawae.

- komo i loko o ke kaʻina hana o ka tibia.

Ma ka noi komo 'o ka hoʻomanawanui me ka necrotic ischemia e paa ana ia pilikia hoʻopulapula o ka ipu ahi, a he i ka weheʻana o ka abscess, nōkahea o abscesses, ka palena haʻahaʻa resection o ka loli ana o kekahi hapa o ka iwi, a me ka wehe' ia o ka make'aʻaʻa. Ma hope o excision o nonviable'aʻaʻa paipai ana e hoihoi kūpono koko ke kahe lala.

Ischemia:

- i ke degere mua ua hana wale sanitation ipu ahi;

- lua o ka mana o ia hoʻi, amputation o ka hoʻohuli ai i nā manamana lima a me excision kaʻina hana 'ole i loko o ka tendons;

- ka wā i ke kolu o ka degere lawe mai amputations ma Sharpe hoʻohana i ka kūikawā pahi amputation;

- lapaau ana o ka ha o ke degere o ka resection ma ka tibia;

- ma ka lima o ka degere o ka amputation ua hana ma luna o ka iliwai o ka puhaka.

Frostbite o na manamana a me nā kino wahi

hoomaopopo:

• huina ke kūpaleʻana (ka pathological loli ma nā loko, a nā'aʻaʻa, ulu like me ka hopena o circulatory kāna hana, a hou ischemia o ka lolo ma muli o ke ana wela haʻahaʻa loa-hanaʻiʻo akula nō);

• perfrigeration (hoikeia maʻi hoʻoʻino naoh o ka ili, ma ke ano o ka bluish-ulaula scaly loʻi me ka loa maneo.

Aia mau eha degere:

Ke degere mua ua pu ma reversible loli o kaʻili: erythema, nani, ka ohane ame, ka eha, a me ka pā lonoaʻili emi unexpressed. Ma hope o kekahi mau lā o ka hoʻohuli ai i nā 'āpana i exfoliated.

No ka mea lua o ke degere wehewehe aku ma keʻano o nā Oe me ka malamalama ka maʻiʻo, kaheaia like emi ma ka pā lonoaʻili, o hiki mai ma muli o ka maʻiʻaʻai hui trophic kāna hana.

Ke kolu o ke kahua me ua hōʻike necrotic loli maʻaeʻae'aʻaʻa like me ka hopena e make, ho okumu i ka laina o ke demarcation (delimitation make'aʻaʻa mai ola granulation loloa), poino wahi o ka lala mummified, a me ka piʻiʻana microbial flora e hoʻomōhala pulu gangrene.

A hiki i ka ha o ka degere o ka'aʻaʻa necrosis kŰlń ao i ka iwi, ka loli i loko o nā Oe ma ka ili i turbidʻeleʻele, bluishʻili, eha pā lonoaʻili nalo loa, a blackens i ka loli ana o ka lala mummified.

lapaʻau

• 1st degere. Rewarming ka hoomanawanui, UHF-Inc, darsonval, frostbitten lālā paona boric ka waiʻona.
• 2nd degere. Aaioee ua lawe mai Oe. Ma hope o kā lākou mau wehe i ka poino ili ua weheʻia, i kaʻeha ua kahikoia a nani ua noi ia ka waiʻona. Systemic antibiotic Inc ua paipai.
• Ekolu degere. E lawe aku oe Oe excised necrotic'aʻaʻa lole wili me hypertonic Saline. Antibiotics i hoʻohana 'ia e ole haumāna maʻiʻaʻai.
• 4-la loa. Necrectomy (wehe 'o devitalized'aʻaʻa) ua lawe mai i 1 knm ma luna o ka necrosis laina. Amputation ua hana ma hope o ke kahua o ka pńpa maloʻo.

gangrene

Maloo gangrene mea he hopena o na mea e holumua ai kāna hana o ke koko lako hou i nā'aʻaʻa Ua ano o nā mea maʻi me ka atherosclerosis a me ka obliterating endarteritis.

Wehewehe aku ma ka wa e kaawale aku o intoxication o ka meaola, ke alo aku o kekahi akaka demarcation o kona kumu. Ma ka iapaau ana o ka hiki pono o ka expectant'ōnaehana.

Pili: ai 'i ka hoʻoikaika' ana'aʻaʻa trophism, systemic antibiotic Inc. Ke hana ua lawe mai ma hope o ho okumu i ka laina akaka o ka demarcation.

Pulu gangrene ia lŘlŘ like me kaʻilihune o ka huʻi cessation o ka holo (frostbite manamana lima, thrombosis, vascular mīkini'opihia). Ua Ua wehewehe aku ma ka loa intoxication,ʻaʻohe demarcation laina, a hai edema. Amputation me ka gangrene paʻa urgently, expectant'ōnaehana mea unacceptable. hana ua hana ma hope o detoxification Inc. amputation laina pono e nunui oi gangrene (me lesions paipai amputation o ka wāwae paʻa ma ka Hip pae).

Kinoea gangrene mea he piha aupuni PAaIEN no guillotine amputation. Ano symptoms: haʻi, hoʻomaka koke e holumua ai nani, i ke alo o ke kinoea i loko o nā nā'aʻaʻa a me nāʻiʻo, a me ka necrosis abscess me ka hauneneʻe pahee'aʻaʻa. Visually nāʻiʻo grayish, hoopaa hoi, oluolu e crumple ma palpation. Skin poni-bluish, ka wā kaomi lohe kamumu a creaking. Ke hoomanawanui complains o unbearable, hikiʻana mai me kaʻeha.

Nā ana hoʻohālike no ka solvency o ke kumu a me kona mākaukau no ka hou prosthetics

No ka maʻamau functioning o ka prosthesis a hiki i ke koena loa o ke ami pono kela aku kona nui ma mua o kona anawaena. I nui o kona physiological shape (iki tapered, mai luna a lalo) a me ka painless. Haʻakiu Nā ua oaeuiinoe ka hoʻoneʻe o na ami a me ka ili me ka makaʻu no (kona ka hoʻoneʻe, a me ka nele o ke kū pūʻuoʻuo me ka iwi kulanui i).

Hoailona vicious kumu

- hoi o ka makana o ka me ka makaʻu no ma ka hanaʻili.

- oi pahee'aʻaʻa.

- Ka nele o tapering kumu.

- kuʻi nukeliu me ka me ka makaʻu no'aʻaʻa, kona stillness.

- Po kiʻekiʻe hoʻoponoponoʻana o Kamehameha o nāʻiʻo.

- Excessive hoʻopilikia o ka ili iwi sawdust.

- Rejection o ka iwi Hoʻohana me ka amputation hui kaulua iwi.

- loa conical kinona o ka iʻa wale.

E hoolilo ana i kīnā o ke kino

Amputation o ka lala o ka anatomical kina i kena ae la i ka ke kīnā pae ia loa. Inā he ua he uha amputation, kīnā o ke kino pae ia koke.

Manaʻo o ke degere o ka poho o ooieoeiiaeuiiai haʻawina, kīnā o ke kino a me ke kīnā, e like me ka hou paha o ke kīnā o ke kino ua hana ma ka 'inikua-hoʻopulapula akamai komite.

I e kukulu i ka degere o ke kīnā o ke kino ua auhau:

- ka hiki ana i ka hoʻoponopono-hana.

- ka manawa kūpono o ka kuokoa neʻeʻana.

- Ka adequacy o ke kohoʻia ma ka makahiki a me ka manawa i loko o ka wa e kaawale aku o ka pathology noʻonoʻo hana (ana me ka hoolohe, a me ka hihiʻo).

- palapala oihana, ke hiki i ka lima kolohe 'ana, e kākau, heluhelu, a pela aku ...

- Ka nui o ka hooponopono ana o kā lākou mau hana (kaʻaeʻana me ka loio, pono a me ka pono kūmau o ke kaiāulu).

- aʻo waiwai, i ka manawa e aʻo hou nā mākau, ka hooulu ana o nāʻoihana kahuna, ai.

- ka hana, e komo ma ka hana.

- hana e hoʻomau i ka hana i loko o ka? Aieao o ko lākou mau 'oihana hana ma hope o hoʻopulapula, a me ka hanaia'na hoi o kūikawā ana.

- ka functionality a me ka degere o? Acaeoey o ka prosthesis.

Ka mua pūʻulu

Nāʻikepili a hiki i ka hoʻolilo 'ana o ka pae mua:

- Amputation o nā wāwae ma ka hip-pae.

- ka hele ana o na manamana eha (me ka phalanx mua) ma luna o nā lima.

- Amputation o nā lima.

Ka lua o ka pūʻulu

- Amputation o ka manamana lima ekolu (me na phalanges mua) o nā lima.

- Removal o 1 a me 2 manamanalima.

- No 4 manamana oiai ka malama ana i ka phalanges mua.

- Amputation o ka manamana lima ma kekahi lima a me ke kumu kiʻekiʻe o ka lima lua.

- hana o Chopart a me Pirogov.

- High resection o kekahi wāwae, hui me ke kaawale ana o na manamana o kekahi lima, a me ka maka.

- amputation o kekahi lima, a me ka maka.

- disarticulation Hip paha poʻohiwi.

Ke kolu o ka pūʻulu

- Unilateral amputation o ka manamana lima me ka wehe phalanx mua i ka.

- menina-kapakahi amputation o ka manamanalima.

- High amputation o ka'ūhā a lima.

- Wehe i nā wāwae ma luna o Sharpe.

- Ke koena unuhi ma ka wāwae lōʻihi o 10 knm.

Hoʻopulapula ma hope o amputation

Ma waho aʻeo ia anatomical kina lala amputation hiki aku ai i ka mea manaʻoʻike trauma ahonui. Ke hoomanawanui pani ma luna o nā manaʻo o ka inferiority i loko o ka maka o ke kaiāulu, ka mea i manaoio i kona ola nei no.

I ka pomaikai o ka wā e hiki mai prosthetic hoʻoholo ole wale ma ke kaʻina o nā hana, i ka nui o ka amputation, a mahope kupono malama no ke kumu.

3-4 lā ma hope o amputation Kāohi hoʻomaka flexion contractures, hana kumu ka neʻe 'ana. Ma hope o kona wehe 'ia o nā suturesʻeleu hoounauna Muscle kumu paipai. A mahina ma hope, hoʻomaka e ho'āʻo i ka prosthesis mua.

Ka mea nui wale pahuhopu o ka hoʻopulapula mea e stabilize i ka hoʻomanawanui i ka manaʻoʻike moku'āina, a me ka ho okumu ana o kona poe e pono lapaʻau no prosthetics.

Hou hana nā:

- aʻo i loko o ka hana o ka prosthesis;

- he lākou o ka hoʻokō 'ana e haʻalele i ka prosthesis a me kona inclusion i loko o ka nohona ma Hawaii stereotype;

- normalization o ōhumu, ka pono o ka 'inikua, a prosthetic aʻo.

- kaiapili-hoʻopulapula hana, ka hoʻololiʻana i ka hoʻomanawanui i ka ola me ka prosthesis;

- hoemi i ke kūpono 'ana o ke kanaka polokalamu, retraining a me ka hoi hana (no ka mea 2nd a me ka 3rd pūʻulu).

Inā e 'ike phantom eha i loko o ka amputated lala waiho aku i ka novocaine blockade, hypnosis a me ka psychotherapy. Inā he mea i hana hou i hiki ke lawe maiʻoki kino me ka resection o ka maikaʻiʻole ia ma nā aʻalolo.