Kuthamangitsidwa kwa dzanja: zoyambitsa, kuzindikira, chithandizo

Lingaliro lolumikizana ndi dzanja limaphatikizapo dzanja, pakati pa carpal, intercarpal ndi ma carpometacarpal. Kuthamangitsidwa kwa dzanja (malinga ndi ICD-10 code - S63) kumatanthauza kusunthika kwa cholumikizira dzanja, chomwe chimawonongeka nthawi zambiri kuposa ena ndipo ndi chowopsa povulaza mitsempha yapakatikati ndi tendon jumper. Uku ndikulumikizana kovuta komwe kumapangidwa ndimalo ophatikizika am'mafupa a mkono ndi dzanja.

Gawo loyandikana likuyimiriridwa ndi mawonekedwe owonekera a radius ndi ulna. Gawo lotalikilapo limapangidwa ndi mawonekedwe a mafupa amanja a mzere woyamba: scaphoid, lunate, triangular ndi pisiform. Chovulala chofala kwambiri ndikusokonekera, komwe kuli kusunthika kwa malo owonekera pafupi wina ndi mnzake. Zomwe zimayambitsa zoopsa ndizoyenda bwino kwa dzanja, zomwe zimabweretsa kusakhazikika kwake komanso kuvulazidwa kwambiri.

Zifukwa

Pa etiology yosokoneza, gawo lotsogola ndi la kugwa ndi kumenyedwa:

• Kugwa:
  • atambasula manja;
  • pomwe timasewera volleyball, mpira ndi basketball;
  • kwinaku kutsetsereka (kutsetsereka, kutsetsereka).
• Tikuphunzira:
  • kukhudzana masewera (sambo, aikido, nkhonya);
  • kunyamula.
• Mbiri yovulala pamanja (malo ofooka).
• Ngozi zapamsewu.
• Kuvulala pantchito (kugwa kwa wapa njinga).

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Zizindikiro

Zizindikiro zazikulu zakusokonekera pambuyo povulala ndi monga:

• zochitika zopweteka kwambiri;
• chitukuko cha edema kwambiri pasanathe mphindi 5;
• kumva dzanzi kapena hyperesthesia palpation, komanso kumva kulasalasa m'dera la innervation wa mitsempha yapakatikati;
• kusintha mawonekedwe a dzanja ndi mawonekedwe a kutuluka m'dera la zikwama zamagetsi;
• malire a kayendedwe ka dzanja ndikumva kuwawa poyesera kuzipanga;
• kuchepa mphamvu ya kusintha kwa dzanja.

Momwe mungadziwire kutuluka kuchokera pakufinya kapena kuphwanya

Chithandizo choyambira

Ngati mukukayikira kuti kuli kusokonekera, m'pofunika kuti dzanja lovulalalo liwonongeke poyikweza (ndikulimbikitsidwa kupereka chithandizo mothandizidwa ndi chopindika chosavuta, ntchito yake imatha kuseweredwa ndi pilo pafupipafupi) ndikugwiritsa ntchito thumba lachisanu (ayezi liyenera kugwiritsidwa ntchito patadutsa maola 24 mutavulala, kugwiritsa ntchito 15 -20 mphindi kudera lomwe lakhudzidwa).

Mukamagwiritsa ntchito kachipangizo kakapangidwe kake, mbali yake yoyendayo imayenera kupitilira chigongono komanso kutsogolo kwa zala zakuphazi. Ndikofunika kuti muike bulashi chinthu chofewa chochuluka (mtanda wa nsalu, ubweya wa thonje kapena bandeji). Momwemonso, dzanja lovulala liyenera kukhala pamwamba pamtima. Ngati ndi kotheka, kuyang'anira ma NSAID (Paracetamol, Diclofenac, Ibuprofen, Naproxen) kukuwonetsedwa.

M'tsogolomu, wovutitsidwayo ayenera kupita naye kuchipatala kukakambirana ndi a traumatologist. Ngati padutsa masiku opitilira 5 kuchokera povulala, kusunthaku kumatchedwa kuti kosatha.

Mitundu

Kutengera ndi komwe kuwonongeka, kusunthika kumasiyanitsidwa:

• fupa la scaphoid (lomwe silimapezeka kawirikawiri);
• mafupa amvula (wamba);
• mafupa a metacarpal (makamaka chala chachikulu; chosowa);
• dzanja losunthira mafupa onse a dzanja pansi pamwezi, kumbuyo, kupatula komaliza. Kusokonezeka koteroko kumatchedwa ngozi. Ndi wamba.

Mitsempha yama lunar ndi yoopsa imachitika mu 90% ya omwe amapezeka kuti ali ndi manja.

Transradicular, komanso kusunthika koona - kupindika ndi kanjedza, komwe kumachitika chifukwa cha kusunthidwa kwa mzere wakumtunda kwa mafupa amanja pafupi ndi mawonekedwe a utali wozungulira - ndizosowa kwambiri.

Momwe amasamukira, kusamutsidwa kumatsimikiziridwa kuti:

• kumaliza kwathunthu ndi mafupa olumikizana;
• osakwanira kapena kugonjetsedwa - ngati mawonekedwe ake akupitilizabe kukhudza.

Pakupezeka kwa matenda ophatikizana, kusunthika kumatha kukhala kwachilendo kapena kophatikizana, khungu lokhazikika / lowonongeka - lotsekedwa / lotseguka.

Ngati zosokoneza zimabwereza kawiri pachaka, zimatchedwa chizolowezi. Kuopsa kwawo kumakhala pakulimbalimba kwa minofu ya cartilage ndikukula kwa arthrosis.

Kuzindikira

Matendawa amapangidwa pamaziko a madandaulo a wodwalayo, mbiri ya anamnestic (yosonyeza kuvulala), zotsatira za kuwunika koyenera ndikuwunika kwamphamvu kwakusintha kwa zizindikiritso zamatenda, komanso kuwunika kwa X-ray m'magawo awiri kapena atatu.

Malinga ndi protocol yovomerezedwa ndi a traumatologists, radiography imachitika kawiri: mankhwala asanayambe komanso pambuyo pochepetsa.

Malinga ndi ziwerengero, kuyerekezera kwapambuyo ndiye kothandiza kwambiri.

Kuipa kwa X-ray ndiko kuzindikira kuphulika kwa fupa kapena kutuluka kwa minyewa. Pofuna kufotokoza bwino za matendawa, MRI (magnetic resonance imaging) imagwiritsidwa ntchito pozindikira mafupa, mafupa a magazi, minyewa yamitsempha, necrosis ndi kufooka kwa mafupa. Ngati MRI singagwiritsidwe ntchito, CT kapena ultrasound imagwiritsidwa ntchito, yomwe siyolondola kwenikweni.

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Chithandizo

Kutengera mtundu ndi kuuma kwake, kutsitsako kumatha kuchitika pansi pamankhwala am'deralo, ochititsa dzanzi kapena ochititsa dzanzi (kupumula minofu yam'manja). Kwa ana ochepera zaka 5, kuchepa kumachitika nthawi zonse pansi pa mankhwala ochititsa dzanzi.

Kutsekedwa kotsekedwa kwachangu

Kuchotsedwa kwa dzanja kumayikidwa mosavuta ndi dokotala wa mafupa. Zomwe machitidwe akuchita ndi izi:

• Cholumikizira dzanja chimatambasulidwa pokoka mkono ndi mkono mbali ina, kenako nkukhazikika.
• Pambuyo pochepetsa, ngati kuli kotheka, amatenga X-ray yowongolera, pambuyo pake amamangirira bandeji kumalo opweteka (kuyambira zala za dzanja mpaka chigongono), dzanja limayikidwa pakona la 40 °.
• Pambuyo masiku 14, bandejiyo imachotsedwa ndikusunthira dzanja kumalo osalowerera ndale; ngati kuyang'ananso ndikuwonetsa kusakhazikika palimodzi, kukonza kwapadera ndi mawaya a Kirschner kumachitika.
• Burashi imakonzedwanso ndi pulasitala kwa milungu iwiri.

Kuchepetsa dzanja bwino nthawi zambiri kumatsagana ndi kudina. Pofuna kupewa kupsinjika kwa mitsempha yapakatikati, tikulimbikitsidwa kuti nthawi ndi nthawi tizindikire kukhudzidwa kwa zala za pulasitala.

Wosamala

Ndikuchepetsa bwino kotsekedwa, chithandizo choyambirira chimayambitsidwa, chomwe chimaphatikizapo:

• Mankhwala:
  • NSAID;
  • ma opioid (ngati zotsatira za ma NSAID sizokwanira):
  • • kanthu kochepa;
    • kanthu yaitali;
  • zopumulira za minofu yapakati (Mydocalm, Sirdalud; zotsatira zake zabwino zimatheka mukaphatikizidwa ndi ERT).
• FZT + imathandizira anthu ovulala:
  • achire kutikita minofu ya zofewa zimakhala;
  • micromassage ntchito ultrasound;
  • mafupa amadzimadzi ogwiritsa ntchito okhwima, otanuka kapena ophatikizana;
  • thermotherapy (kuzizira kapena kutentha, kutengera gawo lakuvulala);
  • zolimbitsa thupi umalimbana anatambasula ndi kuonjezera mphamvu ya minofu ya dzanja.
• Njira zothandizira (analgesic) (mankhwala a glucocorticoid ndi anesthetics, mwachitsanzo, Cortisone ndi Lidocaine, amalowetsedwa mgulu lomwe lakhudzidwa).

Opaleshoni

Chithandizo cha opaleshoni chimagwiritsidwa ntchito ngati kutsekedwa kotsekedwa sikutheka chifukwa cha kuvulala kwazovuta komanso kupezeka kwa zovuta zomwe zimafanana:

• ndi kuwonongeka kwakukulu kwa khungu;
• Mitsempha ndi minyewa;
• kuwonongeka kwa mtsempha wamagazi ndi / kapena ulnar;
• kupanikizika kwa mitsempha yapakatikati;
• ophatikizana osakanikirana ndi mafupa a mkono;
• kupindika fupa la scaphoid kapena lunate;
• zosokoneza zakale komanso zachizolowezi.

Mwachitsanzo, ngati wodwala wavulala kwamasabata opitilira 3, kapena kuchepetsedwa kumachitika molakwika, chithandizo cha opaleshoni chimasonyezedwa. Nthawi zina, zida zosokoneza zimayikidwa. Kuchepetsa mafupa a distal nthawi zambiri kumakhala kosatheka, komwe kumakhalanso maziko opangira opaleshoni. Pamene zizindikiro za kuponderezedwa kwa mitsempha yamkati zikuwonekera, opaleshoni yadzidzidzi imawonetsedwa. Poterepa, nthawi yokonzekera ikhoza kukhala miyezi 1-3. Atabwezeretsa mawonekedwe am'manja, dotoloyu amalepheretsa dzanja mwa kupaka pulasitala wapadera kwa milungu 10.

Zosunthika nthawi zambiri zimakonzedwa kwakanthawi ndi mawaya (ndodo kapena zikhomo, zomangira ndi zofunikira), zomwe zimachotsedwanso mkati mwa masabata 8-10 mutachira kwathunthu. Kugwiritsa ntchito zida izi kumatchedwa kaphatikizidwe kazitsulo.

Kukonzanso ndikuchita masewera olimbitsa thupi

Nthawi yobwezeretsa imaphatikizapo:

• FZT;
• kutikita;
• masewera olimbitsa thupi.

© Photographee.eu - stock.adobe.com. Kugwira ntchito ndi physiotherapist.

Njira zoterezi zimathandizira kukhazikitsa ntchito ya musculo-ligamentous dzanja. Kuchita masewera olimbitsa thupi nthawi zambiri kumaperekedwa masabata 6 mutavulala.

Zochita zoyeserera zazikulu ndi izi:

• kutambasula (kulimbitsa thupi kumafanana ndi kuyenda kosalala (zikwapu zochepa) ndi burashi mukamasiyana);

• kubedwa-kutengeka (poyambira poyimirira - kuyimirira kumbuyo kwako kukhoma, manja mmbali, mitengo ya kanjedza kumbali ya zala zazing'ono zili pafupi ndi ntchafu; ndikofunikira kupanga kusuntha ndi burashi kutsogolo (komwe khoma limakhala kumbuyo) mwina chala chaching'ono kapena chala chachikulu cha dzanja );

• kutchulidwa-kutchulidwa (kusuntha kumaimira kutembenuka kwa dzanja molingana ndi "msuzi wonyamula", "msuzi wotayika");

• kukulitsa-kuphatikiza zala;

• kufinya chotulutsa dzanja;

• masewera olimbitsa thupi.

Ngati ndi kotheka, masewero olimbitsa thupi amatha kuchitidwa ndi zolemera.

Nyumba

FZT ndi masewera olimbitsa thupi amayamba kuchitira odwala kunja ndikuwongolera akatswiri. Wodwalayo atadziwa bwino zolimbitsa thupi zosiyanasiyana komanso njira yoyenera yochitira izi, adokotala amamulola kuchita kunyumba.

Mwa mankhwala omwe amagwiritsidwa ntchito ndi ma NSAID, mafuta odzola (Fastum-gel), mavitamini B12, B6, C.

Nthawi yobwezeretsa

Nthawi yokonzanso imadalira mtundu wa kusunthika. Pambuyo pa masabata angapo:

• kachigawo - 10-14;
• zoopsa - 16-20;
• scaphoid - 10-14.

Kuchira mwa ana kumathamanga kuposa achikulire. Kupezeka kwa matenda a shuga kumawonjezera nthawi yokonzanso.

Zovuta

Malinga ndi nthawi yakhalidwe, zovuta zidagawika mu:

• Oyambirira (amapezeka m'maola 72 oyamba atavulala):
  • malire a malo olumikizirana mafupa;
  • kuwonongeka kwa mitsempha kapena mitsempha yamagazi (kuwonongeka kwa mitsempha yapakatikati ndi vuto lalikulu);
  • congestive edema zimakhala zofewa;
  • hematomas;
  • kupindika kwa dzanja;
  • kumva dzanzi la khungu;
  • matenda oopsa.
• Chakumapeto (pangani masiku atatu mutavulala):
  • kupezeka kwa matenda achiwiri (abscesses ndi phlegmon of localization, lymphadenitis);
  • tunnel syndrome (kukwiya kosalekeza kwa mitsempha yapakatikati yokhala ndi mtsempha wamagetsi kapena hypertrophied tendon);
  • nyamakazi ndi nyamakazi;
  • kuwerengera kwa mitsempha;
  • minofu yamanja;
  • kuphwanya motility yamanja.

Zovuta zakusokonekera kwa mwezi nthawi zambiri zimakhala nyamakazi, matenda opweteka, komanso kusakhazikika kwa dzanja.

Kodi kuopsa kochotsedwa kwa ana ndi kotani?

Kuopsa kwake ndikuti ana samakonda kusamalira chitetezo chawo, ndikupita kosunthika, kuti kusunthika kwawo kungabwererenso. Nthawi zambiri limodzi ndi mafupa osweka, omwe akawonongeka, amatha kusintha. Makolo ayenera kuganizira izi.

Kupewa

Pofuna kupewa kusokonezeka mobwerezabwereza, kugwiritsa ntchito mankhwalawa kumawonetsedwa, cholinga chake ndikulimbitsa minofu ya dzanja ndi mafupa. Pachifukwa ichi, zakudya zomwe zili ndi Ca komanso vitamini D. Zimaperekedwanso. Ndikofunikira kuchitapo kanthu kuti muchepetse kugwa, komanso kupewa masewera olimbitsa thupi (mpira, ma skating roller). Electrophoresis yokhala ndi lidase ndi magnetotherapy ndi njira zothandiza popewa chitukuko cha matenda a mumphangayo.