I-scaphoid bone. Amathambo ezinyawo: isisu

Umzimba unezinqwaba zamathambo. Ikakhulukazi eziningi zazo ezingxenyeni ezihambayo zomzimba ezinjengezinyawo nezinyawo. Izinqwaba zamathambo, ezixhunywe yi-tendon, zisiza ukwenza umsebenzi ongenakuthola izilwane, ngaphandle, ngaphandle kwezinkawu. Uhlelo oluyinkimbinkimbi yezibhamu nezinyawo, nakuba lunomzimba omkhulu wezicubu ezixhunyiwe, kuncike ekulimaleni nasezifweni ezihlukahlukene. Okuvamile kakhulu ukuhlukana. Umqondo uhlotshaniswa nokuhlukana kwethambo kanye nokukhishwa okungenzeka. Ezandleni nasezinyaweni, njengoba sekushiwo kakade, inamba enkulu yalezi zitho, ezingafani ngosayizi, ngakho-ke kuthatha isikhathi eside ukuziphatha. I-scaphoid bone ithola kakhulu izifo nokulimala.

Misa

Amangqamuzana emilenze ahanjiswa ezinqwaba eziningi. Ezinye zazo zihlangene negama elivamile lonyawo. Ithambo le-scaphoid lingeli qembu. Itholakala phakathi kwe-ramming, cuboid kanye namathambo aphakathi komklamo. Yile ndawo yonyawo, ngaphandle kwezinzwane, okuvame ukutholakala nezinsalela.

Amathambo ezinyawo, ukuma kwawo okumelelwa yizigaba ezintathu, kuningi kakhulu: i-tarsus, i-plyus neminwe. Amathambo ezinyawo ezinyawo ezinamanetha aqukethe namathambo e-navicular emigqeni yawo. Itholakala eduze nendawo yonyawo. Emaphethelweni aso kukhona ukubola kwesifuba se-scaphoid ekhomba phansi. Ezokwelapha, lesi sici sisetshenziselwa ukuchaza indawo yokugqoka ene-stop. Ama-X-ray asiza ukuqonda ukwakheka kwalesi sigaba somzimba.

Ibhulashi

I-bone scaphoid, ngaphezu kwalokho, itholakala ku-cyst. Libhekisela emathanjeni amancane esikhwameni. Nguye obhekene naso sonke isikhathi ekuqhekekeni, ngoba usekugcineni kwesundu. Kuyathakazelisa ukuthi umuntu ophule leli thambo akazwa ubuhlungu futhi angase abe nomuzwa wokulimaza, ngisho noma eqinile. Ngakho-ke, lokhu kuyingozi kakhulu. Uma ungahlanganyeli nodokotela, ungaba nemiphumela emibi kakhulu. Isibonelo, ithambo le-scaphoid lingase lihambisane kahle.

Isikhwebu sinamathambo angu-8. Bakha imigqa emibili, ngayinye lapho kunezingu-4 zazo, eziphakathi kwamathambo e-metacarpal kanye ne-frontarm. Isifuba se-scaphoid kulula ukuphunga ngenxa yendawo yaso. Itholakala emkhatsini wemisipha ye-extensor ende yesithupha nesikhathi sobude besisu.

Izifo zamathambo ezinyawo

Ngaphandle kokwahlukana, ithambo le-scaphoid lomlenze lingahle lenze ezinye izimele nezifo. Isibonelo, izifo zikaKellerra. I-osteochondropathy ingaba ngummemezeli wesifo. Lithinta wonke amathambo enyawo. Kancane kancane ubhubhisa izicubu. Ngesikhathi sokugula, inani elincane legazi lingena emathanjeni, ngakho-ke, akukho okwanele okwanele nezakhi. Ngenxa yalokho, amaseli angazange athole okwanele yale gazi nezinye izingxenye ezidingekayo kancane kancane ziyafa. Nokho, lokhu kwenzeka, esimweni sesifo sikaKeller, ngaphandle kokungenelela kokutheleleka.

Izimbangela zezifo zikaKeller

Isifo sikaKeller asikwazi ukuphakama ngokwaso. Kuye, kunezizathu eziningana ukuthi ngandlela-thile zivimbela igazi ekudluleni amathambo. Ngokuvamile lokhu kulimala kanzima, isibonelo, ukulimala noma ukuphuka okukhulu. Futhi labo abagqoka izicathulo ezingakhululekile zokusayizi ezincane badalulwa kule sifo. I-arthrosis ne-arthritis yizifo eziholela nesifo sikaKeller. Ngaphandle kwezizathu ezingenhla, ukukhubazeka kokubeletha kwamathambo ezinyawo kungabangela nokulimala. Ukufakelwa phansi kungenye yeziphambeko ezinkulu. Kodwa izizathu ezithinta ngokuqondile ukubukeka kwesifo, futhi azitholakalanga nanamuhla.

Amafomu

Amathambo emilenze angena ezinhlotsheni ezimbili zesifo sikaKeller. Konke kuxhomeke kunoma iyiphi ingxenye yonyawo ayitholi izakhi kanye nokomoya okwanele.

Uma isifuba se- scaphoid sithintekile, lesi sifo sisho isifo sikaKeller. Uma igazi lingena emakhanda emathambo wesithathu nese-metatarsal yesibili, okuholela ekuguqulweni kwawo, lokhu kubizwa ngokuthi isifo sikaKeller.

Ngaphezu kwalokho, kunezigaba eziningana:

• I-Necrosis.
• Ukunciphisa ukucindezeleka.
• Ukuhlukaniswa.
• Ukubuyiselwa kwethambo.

Esigabeni sokuqala, izigxobo zamathambo ziyafa, ezisebenza njengezinto ezakhiwe zethambo. Ngaphezu kwalokho, kwakhiwa amathambo amasha amathambo, ngokuvamile aphule ngenxa yamandla ampofu. Khona-ke izinsimbi zethambo ziyoncibilika. Futhi isigaba sokugcina sihambisana ngokuphelele negama.

Ukwelashwa kwezifo zikaKeller

Kubalulekile ukuphatha amathambo ezinyawo. I-anatomy yabo iyinkimbinkimbi kakhulu, ngakho-ke ayitholakali kalula. Ngesifo sikaKeller, 1 kaningi ukuphulwa kwethambo le-scaphoid kwenzeka. Kungaba iphutha ngokulimaza, futhi lesi sifo sinzima kakhulu ukubona. Ngaphandle, ngengozi, lo muntu ogulayo akahlanganyeli nodokotela. Ngemuva kokuthola ukwelashwa. Ithefu elilingana negama elifanayo libuye lishaye, kodwa lokhu kuzothiwa sekuyisifo se-Yreisser, nakuba isimiso sokwelapha sizoba sesinye.

Ukwelapha okulondolozayo kuyinye yezindlela eziphumelela kakhulu zokwelapha. I-bandage ne-plaster ehlanganisiwe. Akukwazelwanga ukuhambisa unyawo ngezinyawo zakho, ngoba kunzima ukulungisa ithambo elincane nelingavamile. Ngemuva kokukhipha i-gypsum, ukuze ulondoloze umphumela, udinga ukuhamba isikhashana emathangeni noma ngomhlanga, izingane zithungwa izinsimbi ezikhethekile. Izidakamizwa zikwazi ukusheshisa ukuhlanganiswa. Izinqubo ze-thermal zisiza okuningi.

Akuvumelekile

Akunakwenzeka emva kokususwa kwe-gypsum ukuze bahlanganyele empikiswaneni. Unyawo ludinga ukuthula okuqhubekayo. Kukhona nokuthi kungenzeka ukuhlanganiswa okungalungile nokubunjwa kokuhlanganyela okungamanga, okunzima ukwelapha. Kuzothatha ukusebenza. Ngakho-ke, inqubo yokuvuselelwa kufanele ilashwe ngokucophelela okukhulu. Ngaphezu kwalokho, ungathatha kuphela lezo zidakamizwa udokotela onqunyelwe, ngaphandle kwalokho ungenza umlenze obi kakhulu. Unganaki iseluleko sikadokotela, njengoba umuntu ngamunye enomzimba wakhe siqu. Amanye amathambo ahluleka ukuzalwa, ngakho kufanele aqaphele ngokukhethekile ukwelashwa kwalesi sifo.

Ukuphuka kwethambo engalweni

Njengoba sekushiwo kakade, ithambo le-navicular lezingalo nezinyawo lilungele ukuhlukana kunabanye. Lokhu kungenxa yokuthi kokubili ngezinyawo nangesandla ithambo lisezindaweni ezinjalo okulimala ngaso sonke isikhathi. Uma ubheka izibalo, uma kwenzeka ukuphulwa kwesandla ku-61-88%, kuhlushwa yi-navicular.

Izimbangela zokuphuka

Kodwa kungani leli thambo liphukile? Njengoba umkhuba ubonisa, abaningi balimala, bewela ngezandla zabo. Kulesi simo, lo mthwalo cishe uwela ngokuphelele emthanjeni. Futhi, ama-fractures ngokwawo ahlukile: ama-intraarticular futhi engeziwe-articular.

Izimpawu

Isifuba se-scaphoid sivame ukulimala. Kodwa ngemva kokuphuka, cishe akulimazi. Abaningi bamane bengaqapheli ukuphazamiseka, becabanga ukuthi kuyisihlungu nje. Nokho, udinga ukubona udokotela ngokushesha. Ithefu le-scaphoid ayiphenduli kahle ekwelapheni, futhi uma ungenayo isikhathi sokuthi ifinyelele, kodwa kungaba nemiphumela engenakuqhathaniswa. Ngeshwa, akubona bonke abaya esibhedlela. Ngokuvamile, ukuphuka kutholakala ngokungahleliwe. Ungakwazi ukubona ezinye zezimpawu ezizosiza ukuqaphela ukuhlukumezeka:

• Ubuhlungu esitokisini se-scaphoid.
• Ukunganaki uma amalunga ehambisa izandla.
• Ukwandiswa okubuhlungu kwengqikithi.
• Inqwaba yendawo ethintekile.

Izifo

Njengokuphuka kwethambo esihlakaleni, ukulimala kanzima kuthinta kakhulu unyawo lwesitfuba se-scaphoid. Ama-X-ray asiza ukuthola imbangela yobuhlungu. Ekuqaleni, ukuboniswa kwe-3D kuqhutshwa ku-apparatus, okubhekwa kuzo izindawo zokucubungula ezintathu. Esikhathini sokugcina, ukwehlukana (ukuphuka) kwesitembu se-scaphoid kubonakala ngokucacile. Konke lokhu kwenziwa ngoba ithambo le-scaphoid lilukhuni kakhulu ukuluphatha, lizungezwe ezinye izitho. Ukuze ubeke ibhandishini ye-plaster ngokufanele nangokunembile, udinga ukubonakala kwe-3D kuphela.

Kukhona ubuqili. Isibonelo, iminwe kufanele ifakwe emgqeni. Uma ukuphuka kungabonakali ngokushesha ngosizo lwe-X-ray, futhi kuzo zonke izinkomba, khona-ke isisulu sigqoke amabhandeki ama-plaster cishe amasonto amabili, bese ibhulashi lakhe lihlolwe kaningi. Into yukuthi ukuguqulwa okwenzekayo phakathi nalesi sikhathi futhi ukuphazamiseka kuzobonakala ngokucacile uma, kunjalo, kujwayelekile. Izenzo zisiza ekusunguleni ukuxilongwa nokubeka ukwelashwa.

Ukwelashwa kwethambo

I-bone scaphoid esikhwameni ivame ukuphulwa, okuyinto enzima kakhulu ukubona. Ukuthola ukuphuka, umuntu kumele asebenzise ukubonakala kwe-3D. Kodwa ukwelashwa kwephunga kude isikhathi eside futhi kunzima kakhulu. Ukuhlanganiswa kwethambo kubangelwa ikakhulukazi ngenxa ye-endosteal callus, eyakhiwa kancane kakhulu, futhi idinga inani elikhulu lezakhi (igazi). Mhlawumbe ukufuduka kwendima ye-distal. Konke lokhu okungenhla kuholela ekusungulweni kokuhlanganyela kwamanga, futhi ngaleyo ndlela kuphazamisa ukwelashwa kakade okunzima.

Indlela engu-1. Ukwelashwa kokulimala okusha

Indlela elula yokuhlanganisa ithambo lesandla le-navicular ngokusebenzisa i-bandage ye-plaster. Okuvamile kakhulu, lisetshenziselwa amacala angu-90-95%. I-superposition ivela ezihlokweni zamathambo e-metacarpal kuya emhlangothini wesigqoko, kanti ukuthunjwa kwe-phalanx yomunwe omncane kuthathwa njengesibopho. Ibhulashi lihlala lihleliwe, kodwa ukuze kube lula isisulu isikhundla sayo sinendlela yokwandiswa okuncane. Ukumiswa kwebhayisikili kuqhubeka cishe amasonto angu-11. Uma ukuphuka kwenzeka nge-tubercle, kungamaviki amane kuphela. Ngemuva kokususwa kwe-bandage ye-plaster, i-X-ray iyadingeka, okuzokhombisa ukuthi ngabe ukuhlanganiswa kwenzekile ngendlela efanele. Uma kuvezwe igebe, i-bandage ye-plaster iphinda isetshenziswe futhi, kodwa izinyanga ezingu-1-2, ngokulawulwa kwe-fusion eyenzeka njalo ngenyanga. Emva kokuphela kokwelashwa kukhona inkambo yokubuyiselwa.

I-cons yokuphathwa ngendlela efanele ingabizwa ngokuthi:

• Isikhathi sifinyelela.
• Ukuqapha okuqhubekayo odokotela.

Ezinye izindlela. Ukwelashwa kokulimala isikhathi eside

Uma ukuphuka kutholakala kuphela ngemva kwezinyanga ezingu-3, kubhekwa njengesikhathi eside. Ngalesi sikhathi, ukuhlanganyela kwamanga kunesikhathi sokukhula. Lokhu kuyinkimbinkimbi yokwelapha. Ngosizo lwe-X-ray, kutholakala indawo yokuqhekeka, futhi ukutholakala kwemikhumbi ye-cystic kanye ne-diastase emkhatsini we-debris nayo inqunywe. Kulesi simo, ukufakwa kwe-bandage ye-plaster akunakusiza. Enye yezindlela eziningi ezisetshenziswayo, ezidume kakhulu:

1. Ukuhlinza nge-bone plastic nge- gratical corft.
2. I-Bony i-plasty ngokusho kukaMatti-Russe.

Ukuhlinza nge-bone plastic nge- cortical graft

Le ndlela yasungulwa emuva ngo-1928. It isetshenziswa nge nesroshshimisya fractures kanye amalunga amanga bone scaphoid. Ukufinyelela kwe-front-beam isetshenziselwa i-anesthesia ngesikhathi sokuhlinzwa. Ngaphandle kokulimala, ngaphandle kokuthinta izinzwa zomsakazo, kukhona ukujoyina isikhonkwane sekhanda. Ukusatshalaliswa kwe-capsule yakhe kusiza ukuthola ukuhlangana kwamanga. Ngemuva kokuphela kokusebenza, ibhande lokugqoka lisetshenziswa ngendlela efanayo njengoba kuchaziwe ngenhla. Kufanele kuthathe cishe izinsuku ezingu-14. Bese ususe izingxenyeni bese usebenzisa i-bandage yendilinga. Indima yesikhwama samathambo ngokuvamile iqhutshwa ngokufakelwa kwesiponti.

UBony ugwazwe nguMat-Russe

Omunye wemisebenzi ephumelela kakhulu. Kodwa kuhle kakhulu. Kuye, insimu ixoshiwe, noma kunjalo, ukuhlinzeka ngegazi cishe akusho ukuwohloka. Qinisekisa ithambo le-scaphoid ngosizo lwabakhulumeli. Ukuhlanganiswa kuhlanganiswa emthanjeni. Ukubekwa kokuqala kwezinaliti ezingavumelani akuvumeli ukuxuba izingcezu. Immobilization ithatha amasonto angaba ngu-10. Ukukhishwa kwamazwi kwenzeka ngemuva kwamasonto angu-8 kuphela.

Ukuphuka kwezinyawo

Njengoba sekushiwo kakade, amathambo e-tarsal ahlaselwa kakhulu ezinhlobonhlobo zokuhlukunyezwa. Ngokuvamile, ikhefu livela ngemva kokuwa kwezinto ezinzima ezinyaweni. Ngezinye izikhathi akukho thambo elilodwa elihluphayo, kodwa limbalwa, ngoba liseduze kakhulu futhi linamanani amancane. Njengomuthi we-carpal wesihenqo, ungasheshi ukwelashwa. Noma kunjalo, unyawo lulula kakhulu ukuluphatha. Ukuphulwa ngokuqondile kwethambo le-scaphoid kwenzeka ngenxa yokuwa kwezinto, ezinesisindo esikhulu, noma ngenxa yokucindezela phakathi kwabanye. Amathambo ezinyawo ahlukene kakhulu, i-anatomy yawo ibheka izinhlobo eziningi zezinhlobo.

Izimpawu

Thola ukuhlukana kwesitembu se-scaphoid ezinyaweni kulula kakhulu kunokushayela. Ngenxa yokukhathazeka kwalolu hlobo, cishe akunakwenzeka ukuhamba ngendlela evamile, kukhona ubuhlungu obuqhubekayo. Ngaphezu kwalokho, ukunyakaza kwesigungu sonyawo kubonisa ukuqhuma ekugcineni, ithambo lizizwa lizwakala. Kodwa cishe njalo, ukuhlukumezeka kwesithambo se-scaphoid kuhlangene nokulimala kwamanye amathambo ezinyawo futhi, ikakhulukazi, i-tarsely.

Ukwelashwa kwethambo lonyawo

Ukuze ukwazi ubukhulu nendawo ye-crack, kwanele ukwenza i-ray ray ku-2, futhi hhayi ku-3, njengoba kwakunjalo ngethambo le-scaphoid le-shayela. Uma kungekho ukufuduka, khona-ke i-plaster ejwayelekile iphonswa isetshenziswa. Kodwa uma kwenzeka, kufakwe i-reposition. Ezimweni ezimbi kunazo zonke, ukuvulelwa kabusha kuvuliwe. I-cast isetshenziswa ngokulinganisa amasonto angu-4.

Ekuphetheni, kungashiwo ukuthi i-scaphoid ngaphezu kwamanye amathambo wesigqoko nonyawo ayengakwazi ukulimala. Kuthatha isikhathi eside ukuwuphatha, ngokuvamile kufanele usebenzise ukuhlinzwa. Kodwa-ke, ukugawula ithambo enyaweni kuhamba ngokushesha futhi kulula. Thola ukuhlukana kwi-cyst kunzima kakhulu, futhi kaningi kwenzeka ngeengozi. I-boneaphos yezinyawo ezinyaweni uma kwenzeka kuphahlazeka kakhulu.