Mea Maluna myofascial pahu maʻi pale

He nui nā kanaka kahaha: "pahu maʻi pale - He aha ka mea?" Kēia pathology hiki ke malama i loko o nā wahi a pau nā nāʻiʻo i hoopuniia e ka paa fascia - he wahi o na lākou kīkala, puhaka,'ūhā mua, a me ka puhaka hoʻi.

Pahu maʻi pale - he huihui 'ana o ka hoʻololi hoʻonāukiuki ma ka mahuahua ma ka puʻe i loko o ka i kaupalena' ia wahi o ke kino. Ke kaumaha ma muli mea, ua hoʻonāukiuki aku ma ka hoʻoulu i ka puʻe i loko o ka'aʻaʻa, IeAUPIIe, IAa IO hookoaia huʻi paha maʻi maʻi.

Nā kumu o ka maʻi ulu

E like me ka loa e like me ka kumu o ka maʻi i:

• fracture;
• kūāhewa oʻaeʻae'aʻaʻa kāna hana;
• vascular ano hoopono 'aʻe';
• mīkini'opihia o ka lala i ka wa a ka positional'ōpā pū;
• hoolei pono superimposed;
• 'ā;
• lōʻihi traumaticʻoki kino.

I ka lapaau, e haawiia keia i ka hihia i ka hoike ana o ke aa koko a artery puʻe fluids, e like me mea nihoawa la nahesaʻaki.

High kamepiula kūpono a me ka pathology ka wā lawelawe ai ', koko thinners, a me ke ano nui ma ke koko coagulation kāna hana. 'Aʻole i hoʻokoe', a me ka iatrogenic kumu, inattention i ka hoʻomanawanuiʻana, ka poe i unconscious.

Ka maʻi ano o ka maʻi pale

Pahu maʻi pale i ka maʻi ano i loko o ka hihia o ka lōʻihi-makahiki repetitive hoounauna. He ua no hoi me ka loa puʻe i loko o nā nā'aʻaʻa ma ka uha pili. , Pili physical hana e oi aku mamua o na palena o ka oluolu palena, me ka hoonaukiuki aku i hoomahuahua ma ka Muscle buke o 20%, i kumu mīkini'opihia o ka like Hoʻohana. Pahu maʻi pale ua pinepine diagnosed ma ka 'oihana kukini.

pathophysiological kumu

Pathophysiology ka maʻi pale ua kena ae la ia e kūloko'aʻaʻa homeostasis ma lalo o ka aoao o ka hewa, mahuahua puʻe i loko o nā nā'aʻaʻa a me nāʻiʻo o kā lākou mau hoopii, hoemi koko i loko o ka capillaries, hoʻopōʻino venous outflow o ke koko, a laila, i ka lua i pele koko. Ultimately ka mea, ua ulu'aʻaʻa necrosis ku i ka muli o ka oxygen.

symptomatology

Symptoms pahu maʻi pale e kahe ana ma ka huʻi palapala, i olelo ia ma ka hoʻomaka koke ulu nani, a me ka nānā 'ana palpation (' ia paha degere o ka lesion nuʻa). Kekahi e hōʻike 'Oe ia eha iloko o OE neʻe nāʻiʻo (flexion a me ka hoʻolōʻihi' ia 'ana o ka wāwae), i ka pā lonoaʻili ua nalowale.

It E e hoʻomaopopo i ka mea koʻikoʻi loa, hiʻona o ka pathology e like me pahu maʻi pale ka eha, a i ka 'ai ka nui o ke poho pinepine'. Pinepine ia mea e hiki ana ke hooki a hiki ma hope o ka hooponopono ana o analgesic ai '.

Kēia symptom He ano no ka kinoea gangrene.

I ka papa kuhikuhiE ano o ka pahu maʻi pale

Pahu maʻi pale kānāwai i loko o nā 'ano apau loa: abdominal a me ka myofascial (kūloko ischemia maʻi pale kāʻei kua puʻe māhuahua).

Myofascial kinona characterizes ka ka ho'ēmiʻana i loko o perfusion o nāʻiʻo, ischemia, necrosis a me ka contracture ulu. Kumu no ka hooulu ana i na puʻe pidfastsialnogo moe i loko o ka posttraumatic hematoma, hoʻoʻino edema, ka positional mīkini'opihia, e holumua aiʻeho.

Myofascial pahu maʻi pale ua diagnosed ma physical ninaninau.

Lālau aʻela ia i loko o ka mooolelo o kēia nā hoailona:

• ka manawa hala ma hope o ka poino mua komo i ka? aaieou;
• ka manawa, mai kaʻikeaʻana o ka puffiness;
• haanou ana uku o ka mea ulu. (i loko o 6-12 hola ma hope o eha);
• makahiki hoʻohana o ka tourniquet a me ka Kāohiʻana o ka ischemia (ana o ka mea kaua no ka pōkole manawa).

Ka eha i ka hohonu pulsating külana. Ka mea, oko oi pinepine 'ma mua o ka poino o ka maʻamau,ʻaʻole paʻapū ma immobilizing ka iki i wahi, a analgesics iʻike mau nā māhele.

Eha hou i loko o ka OE aku o na nāʻiʻo malalo i ka pōʻino. Ua hoʻololi i ke kulana o ka manamanalima.

A hana o ka puʻe ana i loko o ka'aʻaʻa

E like me ka weheia pahu maʻi pale? Pathologyʻike, ua i ma ke ano o Whiteside (1975), hele 'ana o ke ana interstitial puʻe.

He paipai i ka hoʻohana 'ana o ka:

• 'ōnaehana ec he Hereme manometer;
• ekolu-ala stopcock;
• ka pahu kui kele ma kona anawaena mea ole emi o 1 mm o;
• tubing;
• 'ohe ka leo o ka 20 ml.

Currently, e hooholo i ka Kōmi pidfastsialnogo apparatuses i hana lōʻihi-makahiki ka mālamaʻana. e hoʻohālike nā hualoaʻa me ka 'inideka o cardiac puʻe. Ka puʻe i loko o ka palena myofascial wahi e ole oi aku mamua o 10 mm o Hg. Art. Ke alo aku o ka pahu maʻi pale ua hoʻokūpaʻa, ina ke anakahi pidfastsialnogo puʻe aku i ka pilikia nui o ka 40 mm o Hg. Art. a me ka diastolic ma lalo nei. Kona mea ulu no 4-6 hola e hoʻonāukiuki i nā hanana o ke ischemia.

Mea Maluna myofascial palapala

• Akemāmā maʻi - ka distal lala Hoʻohana me ka pumehana like. Ma ka papa kuhikuhiE arteries o ka palekana memo lāʻau ikiʻai wale. Anakahi podfastsialnogo puʻe ma 40 mm o Hg. Art. lalo diastolic.
• Mean lesion - ili ma pōʻino, ua make lala hapa mai ka haʻahaʻa ana wela ma mua o ola. Na hiohiona hyperesthesia a anesthesia lala manamanalima. Ka lāʻau ikiʻai, ua nawaliwali ia. Podfastsialnoe me diastolic ka puʻuwai o ka ia.
• A kaumaha make - i ka lāʻau ikiʻai wale o na arteries nui mea ole detectable. Ae nānā mau manamana anesthesia. Podfastsialnoe ma luna o diastolic puʻe.

Ke differentiation o kaʻike,

Pahu maʻi pale E e ike okoa mai ka poino ana i na ipu a ka papa, i ke alo o ka arterial thrombosis, pōʻino i ka nā aʻalolo nui ilpko o clostridial a me ka 'ole-clostridial myositis.

Palena pauʻike, e halihaliia oia iwaho ma e like me ka helu o nā ana hoʻohālike.

• alo pulsations;
• haanou ana;
• ka nele o ka waiʻona ma loko o na lala;
• Koko kaʻapu kōheoheo;
• hooulu ana i na leukocytes;
• pidfastsialnogo puʻe anakahi.

I ka make ana o na nāʻiʻo o ka forearm

Nāʻiʻo i loko o ka fascia o ka forearm i kaawale e ekolu iwi fascial wahi: kīloi paʻewa kaola i loko o nāʻiʻo, alo (Muscle kuleana no ka flexing na manamana) a me ka hope (nāʻiʻo kākou i loko o mailaila aku manamanalima).

Inā ka hoʻomanawanui hiki ole straighten i kona mau manamana lima, a laila ia e kuhikuhi i kaʻike,, e like me ke alo o ka forearm kompartament maʻi pale. Inā ka hoʻomanawanui hiki ole kona i kona mau manamana lima, a laila, hahau iho la i ka hope hihia.

I ka make o ka'ūhā nāʻiʻo

Keiki bipi Muscle fascia puunaueia ka eha iwi-fascial wahī:

• kīloi paʻewa (peroneal nāʻiʻo);
• Front (kuleana no ka palena manawa o ka wāwae);
• Hope (ʻilikai soleus Muscle);
• hope hohonu (kuleana no ka flexion).

Inā ka hoʻomanawanui mea hiki ke flex i ka wāwae a me nā manamana, a me ka ho'āʻo ana i kekahi hana ke kumu no ia loa ka eha, alaila, ua hiki ke kamailio e pili ana i ke alo o ka anterior pahu maʻi pale, a ina ia i hiki ole straighten i kona mau manamana lima, ia mea he hope nānaina.

abdominal

Normal puʻe anakahi i loko o ka abdominal lua hilinaʻi nui ma luna o ke kino kaumaha a me ke kaha like kokekau i ka 'Aʻohe. Ke abdomen mea he? Aieeeua no ka loli, ai ka puʻe ma luna o kaʻili, a ma nā wahi like. Ke kūʻai '-abdominal puʻe hiki ke ana i loko o kekahi opu oihana.

He aha nō i ke kamepiula kumumea no abdominal maʻi pale o ka hypertension? Ke kumu nui i loko o ke aloha intestinal paresis, mau trauma, pilikia laparotomy ma ka hoomanawanui a loaa no ia i ka mālama nui infusion Inc. Kēia maoli i ka buke o ka loli ma ka abdomen.

A ua hoomahuahua ia ka 3-13 mm o Hg ka lehulehu o nā mea maʻi ma hope oʻoki kino i loko o abdominal puʻe anakahi i loko o kona lua. Art. me kekahi lapaʻau hoailona

A hiki i ka puʻe i loko o ka abdomen abdominoplasty i oi aku mamua o 15 mm Hg. ke ala kūpono., i ka hoʻonāukiukiʻana i ka hooulu ana o abdominal pahu maʻi pale.

Me ka awelika 25 mm o Hg. Art. a me ka na hiohiona ole i loko o ka holo ana o na moku nui ma ka peritoneum, e alakai i ka hakuʻala hemahema a me kāna hana ana o na ipu naau a me ke koko.

Ka puʻe i loko o ka abdominal wahi ma luna o 35 mm o Hg. Art. hiki kāhea i ka piha cardiac hopu.

Pehea e holo ai abdominal pahu maʻi pale?

abdominal pahu maʻi pale ua hoikea mai oia, i loko o kaʻilikai pilikia hanu, a emi iho cardiac auaiaea. Kekahi memo i ke alo o ka mimi auaiaea, ke koko ka oxygen saturation.

eha ano o Hypertension ma ka peritoneum ua hookuu ma ka lapaau:

• 1st ka papahelu - he anakahi o ka puʻe o 12-15 mm o Hg. Art.
• 2nd stepen- ana puʻe o 16-20 mm o Hg. Art.
• 3rd ka papahelu - he anakahi o ka'aloʻahiʻa 21-35 mm o Hg. Art.
• 4th ka papahelu - he anakahi o ka puʻe luna 35 mm o Hg. Art.

Nā Papahana no ana i ka puʻe i loko o ka peritoneum

E like me ka rula, i ka puʻe i loko o ka abdominal wahi ua ana ma nā bladder. Good stretchable pā hana like me ka OE alakaʻi mele intraabdominal puʻe inā loli ka leo i loko o ka peritoneum, aole ia i oi aku mamua o 50-100 ml. Me ka buke nui o ka huahelu ua 'ole ma ka puʻe bladder nāʻiʻo.

Inc no abdominal maʻi pale

Like docked pahu maʻi pale? Lapaʻau komo ai? Iaea a hoʻopau o na kumu (wehe 'ia o ka mīkini'opihia hosiery, kiʻekiʻe kū headboard, kiaha dala). Lawe o oxygen Inc, ma i ua hoʻohana 'ia ka nasogastric Tube.

E pale aku hemodynamic decompensation hoihoi hou ia ke koko o oxygen saturation, a hoʻomākaukau leʻa coagulation. Nō hoʻi e hōʻike 'ia o ka manaʻo koikoi i loko o ka peritoneum a me ka mālamaʻana'ē aʻe i hana'.

Pahu maʻi pale o abdominalʻoki kino ua eliminated ma decompression laparostomy. Hana catheterization e hoʻonui i ka peritoneum.

I ka papa kuhikuhiE hanana i loko o ka makeʻe kulana lapaʻau

I ka makeʻe kulana lapaʻau, ka i kēia hanana:

• eliminates mīkini'opihia o ka hoʻohuli ai i nā wahi (ana o bandages, puna splints, i mea hoʻonāwaliwali maoli o skeletal traction, i ka wahi o ka loli ana o ka lala i ka hookahi kiʻekiʻe me ka naau i keakea, i ka ulu ana o ka ischemia);
• hoʻomākaukau leʻa holo, e eliminated ma vascular spasm, a mahuahua coagulation;
• hoonui ae i ke koko pele nā hoailona;
• pili analgesics (narcotic analgesics ka nānā 'ona, a me kekahi' o ia hoʻi 'ole-narcoticʻano);
• relieves haanou ana;
• docked acidosis.

Inā makeʻe kulana lapaʻau i ole lawe mai i ka manaʻo i nā hualoaʻa, aia no he pilikia kaʻilikai podfastsialnogo puʻe ma luna o kaʻilikai mālama Muscle leo a me ka edema, ka kahaki ii kaʻoki lāʻau lapaʻau 'uao (noi o ka decompression fasciotomy). Ua hiki ke lawe i ka pākōlea, a kāohi i ka ano.

He aha ka decompressive fasciotomy?

Decompressive fasciotomy - heʻoki lāʻau lapaʻau kaʻina hana nona ma ka Kāohiʻana, a kokua o ka pahu maʻi pale. Ma ka io ana ina poino arteries a me aa koko o ka poohiwi. No hoi, ka mea, ua eliminated ma ka pahu maʻi pale o ka medial ke keʻena o ke kuʻekuʻe aku ami, i ka hopena o nā palapū, a kuʻekuʻe aku fossa arteries a me aa koko ma lalo o ka kuli. Fasciotomy no ka hapanui loa lawe mai i loko o ka laloʻaoʻao.

Nāʻikepili no ka kāohi fasciotomy

I ka papa kuhikuhiE nāʻikepili komo:

• i ke alo o venous insufficiency;
• poino arteries ma lalo o ka kuli;
• 'aʻole i hoʻokō' ia i ka? aeiino? oeoey o na arteries;
• ma hope o ka ho'āla houʻana i nā arteries;
• haʻi pahee'aʻaʻa haanou ana o na lala.

Alakaʻi 'inikua fasciotomy

Ke hana ua hana i loko o nā mea maʻi me ka haʻi subfascial puʻe ia akulla 'i ka mahele. Index luna 30 mm o Hg. Art. pili ana i ka mahele o ka pathological.

Mahuahua subfascial puʻe mea he piha aupuni anakahi no curativeʻoki kino.

ʻO kēia symptoms i ka papa kuhikuhiE nā hoailona no keiaʻoki kino:

• i ke alo o nā paresthesias;
• eha ma OE neʻe o kekahi lala;
• imua o ka lōlō ka wā nā aʻalolo e ho'ōla aku;
• ua hoʻemiʻike ākea ka lāʻau ikiʻai.

aʻoaʻo ma

e ole e lawe mai ia i ka hana i loko o ke ki kala a me ka uha mua. "Mannitol" a me antibiotics mea ma ke kauka o ka manao wale.

Fasciotomy - ana, a hiki i a me complications (maʻiʻaʻai, maʻi ano o kaʻeha, alo aku o ka paresthesia, hoʻokano, osteomyelitis). It E e kaulana ia mea, hōʻike infrequently, akā, i ka pahiki mea nō ma laila. No laila, ma mua o ka piʻiʻana koi akahele ninaninau o ka hoʻomanawanui.

Decompressive fasciotomy i loko o ka forearm

ʻoki kino, e wehe i ka pathology me ka forearm pahu maʻi pale, komo ai i ka waiwai o kūloko anesthesia. Ke incision ua lawe mai ka epicondyle a hiki i ka pulima oʻu wahi. Ke fascia Ua wehe i ka flexor Muscle i loko o ke kuʻekuʻe aku wahi. Ua 'oni iki medially. Superficial nāʻiʻo kuleana no ka flexion, kīloi paʻewa hoʻololi ai. Ke fascia ua oki ma luna o ka hohonu flexor. Kēlā me kēia Muscle fascia hoikeia mai i ka lonikū pauku.

Inā pono volar inā dorsal incision. Live lima koke i pehu. Malama i kona muli o hyperemia.

Devitalized Muscle (IeAUPIIe, IAa IO he bender, Aia i loko o ka hohonu) ua 'ia nā pōpō i loko o melemele, i mea typical o necrosis. Ke fascia ua ole sutured. Cutaneous eha sutured me ka hoʻopilikia. Inā i ka manaʻo o ia manipulation mea i hiki, ka iliʻeha ua waiho hamama ma ke ano o ka lole wili.

Lole wili pili antiseptics paha sorbents. A laila mākou hoʻohana koʻana koko emulsion me ka hinu.

Secondary ami superimpose elima mau lā ma hope oʻoki kino. I kekahi manawa, i kaʻeha koe hamama no ka mahina. I kekahi manawa, e pani i kaʻeha pili hou laxativeʻoki a me kekahi mauʻano o ka eaʻoki kino.

'Ana i kūpono o ka fasciotomy ma ka palaki

Ke hana komo ai i ke Komisina o ka pauku lonikū i loko o ka wahi o ka ano o ka mua metacarpal iwi. Oia ka incision ua lawe mai i ka laua lima carpal iwi. I ka Ia manawa ka mea, aole i intersect i ka wānana o ka ulnar nā aʻalolo. Decompression intercostals nāʻiʻo i ka hookaawale na pauku ma ka hope o ka palaki.

Lawe ma ka lalo wāwae fasciotomy

haʻahaʻa wāwae pahu maʻi pale ua eliminated eʻoki kino me ka kūloko anesthesia.

Inā ka hoʻomanawanui mea paakiki e lena i ka wāwae a me nā manamana wāwae no ka huʻi eha, he mea hiki, e hoʻoponopono i ke alo o ka anterior pahu maʻi pale. Inā ia i hiki ole straighten i ka lalo wāwae, ka mea, o ka hope pahu maʻi pale mau pale.

E wehe i na hihia a pau, ua io i elua a ekolu lonikū na pauku ma ka uha mua, ka lōʻihi o ka i mea 15 knm. Inā e pono ai fascia incision hiki i ka Z-hoʻokino palapala.

Inā i ke koko holo i loko o ka wāwae ua i like i loko o kekahi mau minuke, ai ka medial incision deepens a wehe i ka hihia ma ka hope ma ka mea o nā'ūpā. Incision o ka fascia, aole ia i paa i ka scalpel, e like me oe e hanaʻino i ka posterior tibial artery a me tibial nā aʻalolo.

Ke incision fascia mea i loko o ka hamama moku'āina. Inā hiki, i kaʻeha ma luna o kaʻili sutured me ka hoʻopilikia. Inā ka stitching mea i hiki, kaʻeha koe hamama ana ma lalo o ka wili. Secondary welds i ana noae ma hope o 5 mau lā.

'Ana i kūpono o ka hana ma ka wawae

Oia ka hana pono i ke alo o ka eha hoʻokokoke mai. Elua dorsal incision ua i ma ka 2nd a me ka 4th metatarsal iwi, ma i hoʻokaʻakaʻa aʻeʻoe iʻehā wahi i wāhiʻia ma waena o nā iwi, a me nā kikowaena kieke i loko o ka noae. Kekahi mau oʻoki hana laterally a medially. Ka mea, wehe hihia.

Ana i mālama 'ia i ka Muscle'aʻaʻa necrosis, i ke kiʻekiʻe loa o ka hoʻokōʻana. Ma ke kolu o ka lā ma hope decompression emi nani, a me ia mea hiki e ke hooeha panina. Inā decompression necrosis o ka Muscle'aʻaʻa i ua hōʻike, a laila, e lawe aku oe i ka hapa make. Hope mīkini'opihia ma keia hihia uaʻula a no ka pule.

prognosis

Prognosis o ka maʻi mea pololei e kaukaʻi ma o ka Alemanaka o ka Inc, a me ka piha manaʻo o keʻoki kino. Inā ka eha ua docked, eia neurological kāna hana, ia i hookuu Hōʻike ka irreversible pathological hoʻololi. E möakäka hou manaʻo necrectomy a me nā kaʻina hana i ole hiki ke hoola i ka lala amputation o kona mau E hoike mai. I mea ole, e lawe mai i ke kahua i ka lōʻihi, ka mea, ua pono i loko o ka 'eleu kūpono, e lawe mai i nā hana a pau i nona i pale no ka hooulu ana komparment maʻi pale.